Grant: Operating Grant: SPOR Innovative Clinical Trial Multi-Year Grant

Addressing the impact of toxic stressors (e.g. family violence, parental depression, low-income) on children can give children the best start in life and reduce entrenched societal health inequities. Toxic stress undermines parent-child relationship quality (including attachment) and puts children at risk for cognitive and motor developmental challenges, and health problems including alterations in immune function. Parents' reflective function (RF), i.e. capacity to understand their own and their child's mental states, can strengthen parent-child relationships, and buffer the impacts of toxic stress on children. We have developed and tested an intervention program called ATTACH for parents exposed to toxic stress and their vulnerable preschool-aged children, focusing on improving parents' RF. In extensive pilot work, we found the intervention not only improved RF, but also parent-child relationship quality and attachment, as well as children's cognitive and motor development. We recently adapted the program based on community partner feedback and developed a prototype e-learning platform to more rapidly train health care professionals to implement ATTACH. Using integrated knowledge transfer approaches, we will conduct an effectiveness-implementation hybrid study of ATTACH to evaluate real-world implementation: 1a) impacts on parent-child relationship quality (primary outcome), parental RF, and child development (cognitive and motor), 1b) for whom it works best/worst, 1c) impacts on immune biomarkers of inflammatory disease risk, 1d) health professionals' adherence to ATTACH program and (1e) longer-term impacts. We will also evaluate patients', health care professionals' and administrators' perspectives of 2a) intervention uptake and fidelity, 2b) implementation benefits, facilitators, barriers and challenges, and 2c) utility of the ATTACH e-learning platform.