Training for Addiction Counsellors and Pilot Implementation
This fall members of our Healthy Mothers Health Families Research team won Ryerson’s Innovation Circle Discovery prize. We received $70,000 to train counsellors in maternal substance use treatment programs in a parenting intervention called Attachment and Biobehavioral Catch-up (ABC) and complete a pilot implementation and evaluation.
Why parenting intervention?
While motherhood is central to the design of Ontario’s Early Childhood Development Addiction Initiative (ECD) programs, “evidence-based” parenting interventions tailored to the needs of the population are rare. In speaking with ECD programs, we learned that many create their own parenting interventions, adapt existing interventions, or refer to the community. With 34 ECD programs in Ontario (the most by far in Canada), ECD programs are unique position to pilot ABC in their programs and if it is found to be effective, be provincial and national leaders in scaling up its delivery.
ABC is 10-week evidence-based parenting intervention for parents who live in the context of complex risk, including mental health, addictions, child welfare involvement and poverty. A lesson (e.g., providing nurturance, following the child’s lead with delight, reducing overwhelming or frightening behaviors, recognizing how the caregiver’s early relational experiences impact current parenting) is embedded into naturalistic play between mother and child. The counsellor observes the interaction and provides frequent strength focused “in the moment” feedback, at a frequency rate of at least once per minute to really build parenting confidence and reinforce skill.
Based on a comprehensive review of the literature (click here)* and consultation with stakeholders, ABC was seen as a good fit because:
- Developed for and valuated with
- Strength-based and designed to empower mothers to see their strengths and impact on their child
- Individually delivered allowing for accommodations based on mother’s learning strengths/needs
- Option of involving others in family/care flexibly in the treatment
- Demonstrated positive impact on “three clients” – mother, child and mother-child relationship.
- Brief intervention (10 weeks) with flexible delivery location (home/clinic/virtual/hybrid)
- Strong training and supervision model, with attention to sustainable implementation and development of a community of practice.
*If you don’t have access, contact us
What will training look like?
There will be two types of training offered:
- One-day virtual conference led by the developers of ABC (Dr. Mary Dozier, renowned attachment expert, and her team). They will provide an introduction to ABC, including the theory underlying the intervention, components of the intervention, resources needed and practice-based tips on building effective and sustainable implementation.
- Intensive ABC training and supervision program leading to ABC certification for 4-6 counsellors
*Note. Counsellors will not be able to implement ABC after just this introductory training. The content may however provide theory, general strategies, and discussion that we believe will be helpful in the context of their current programming. It will also provide the opportunity to consider if this intervention may be a fit for the ECD program in the future.
What is required of Agencies and Counsellors who engage in the Intensive ABC Training?
- Two-day initial training. Counsellors who complete the intensive training will attend a two-day virtual training (introduction to ABC conference + hands-on training) led by ABC developers. Two days and access to a computer with a microphone, video and internet is required.
- Counsellors need to work with mothers who are parenting children 6 to 24 months of age. Counsellors will complete the intervention with about 5-6 families over a one-year period. At this time, mothers need to have access to their children at least 50% of time.
- Choice of in person or virtual implementation. We will come up with an implementation model that works for the agency and family, including in-person or virtual care. While visits can be completed in clinic at least a couple of in home sessions is desired as it helps promote the transfer of the skills learned to the home setting and facilitates understanding of strengths and challenges in the home setting.
- Comfort with an intervention that uses videorecording. Videorecording mother-child interactions is a key part of the intervention and is used to play back for mothers the very specific ways in which they are parenting in sensitive and nurturing ways. Supporting mothers and understanding/ addressing discomfort with video will be explicitly discussed as part of the training and supervision process. Videos of sessions are required for the supervision process and to assess outcomes. We will work with you to develop a clear way of explaining to women what is videotaped, why it is needed, what happens to the video, and video security to ensure comfort of all involved. We recognize that this may be a requirement that is a barrier for some women. We will be working with you to better understand this and other barriers to engaging (and enjoying) ABC so that we can support the longer-term development of a menu of parenting interventions to support diverse needs. This is just a first step!
- Access to or ability to share information on a secure HIPAA secure video platform. We will determine with your program the best way to share videos with the supervision team. A secure server in the Child and Family WISE lab at Ryerson, led by Dr. Karen Milligan who is leading this project, can be used if a secure server that can be accessed only by the ABC supervisor and counsellor, is not available. All supervision sessions will also be completed on a secure HIPAA platform (e.g., Zoom Healthcare). Videos will have no identifying information on them and will be deleted after their use by the counsellor and team within two weeks.
- Equipment Needed. We will provide counsellors with required toys and a tablet required for the intervention. If access to internet and a tablet are required for families to participate (in the case of virtual intervention), we will work with programs to develop a plan to support this.
- Time Intensive. Counsellors will need to commit approximately 7 hours/week for one year, inclusive of completing sessions with their clients and supervision.
What are the potential benefits for mothers, children and families based on the exiting US-based research?
- Increased parenting confidence
- Increased sensitivity in mother-infant interactions
- Better child developmental outcomes (language and social emotional well-being
- Gains seen up to 9 years follow-up
What are the some of the potential benefits for ECD programs?
- Counsellors will have access to expert training with no conference/workshop fee
- Counsellors in intensive training will have expert supervision for a year and a community of practice with other ECD programs
- Ongoing feedback on the delivery of ABC will be provided, including ongoing support in flexibly thinking through implementation issues specific to the ECD program and to the broader system
- Program-level evaluation data on outcomes of ABC (e.g., mother-child interaction) with the option of including measures of interest to the ECD program.
- Offering an evidence-based program (and evidence from ECD programs) may help ECD programs to advocate for:
- women/families around goals/needs/timing relating to child welfare, the legal system, and other involved systems
- the program having the time and funding needed to effectively implement a sustainable and effective parenting intervention