Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Birth to Three: A Pragmatic clinical trial for child maltreatment prevention

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Project Number: R40 MC 23629
Grantee: Albert Einstein College of Medicine of Yeshiva University
Department/Center: Family and Social Medicine
Project Date: 2/1/2012

Final Report


Principal Investigator

Karen Bonuck, PhD
1300 Morris Park Avenue
Bronx, NY  10461-1975
Phone: 718-430-4085


  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)


Despite the critical importance of the MCHB's primary proposed goal "to reduce fatal and nonfatal child maltreatment" non-empirically supported parenting skills classes remain the treatment consistently recommended by agencies to prevent maltreatment. Fewer than 10% of 20+ centers in the Bronx (location of proposed work) advertised in a city directory under parent skills training were able to identify adherence to a specific curriculum during a recent phone survey. Thus the vast majority of treatment received by at risk families is well-intentioned but unproven. Our overall goal is in line with the MCHB Strategic Research Issue #IV by promoting the healthy development of mothers, fathers and their children. The intervention is designed to enhance coping and resilience by improving the quality of the parent-child relationship. The project addresses major goals of Healthy People 2020 for prevention of child maltreatment and the promotion of a secure parent child relationship. This proposed MCHB R40 project will conduct a pragmatic clinical trial (PCT) testing the effectiveness of two tertiary prevention interventions for families with young children aged 2-36 months at risk for maltreatment. One hundred at risk families, referred from child welfare, family court, primary care, and preventive agencies will be randomly assigned to: 1) Group Attachment Based Intervention: (GABI) a interactive parent-child treatment which has been used to treat over 100 families alongside their young children in NYC or 2) "treatment as usual": parents -only parenting s kills c las s es . Both groups will be assessed at baseline, end of treatment and at 6 months follow up. Aim 1: Test whether a parent-child group attachment intervention is associated with improved child, parent, and parent-child related outcomes. Outcome Hypotheses, GABI will be associated with: 1) Child Outcomes - less exposure to trauma, less incidence of maltreatment, and improved social-emotional and cognitive development. 2) Parent Outcomes - improved social support, mental health, and decreased stress. 3) Parent-child Outcomes - decreases in child-parent disorganized attachment. Aim 2: Translate and disseminate research findings to inform policy makers of effectiveness of practices to prevent child maltreatment. In addition to parent representatives, an Advisory Panel made up of city and state pediatricians, psychologists, lawyers and policy makers will convene to determine a) if results warrant replication, b) if so, how to translate to settings and locales that would provide sufficient evidence for a large-scale adoption of GABI as a treatment modality to prevent maltreatment in babies and toddlers.


Listed is descending order by year published.

Murphy A, Steele H, Bate J, Nikitiades A, et al. (2015). Group attachment based intervention: trauma-informed care for families with adverse childhood experiences. Fam Community Health. 2015 Jul-Sep;38(3):268-79.

Murphy A, Steele M, Dube SR, Bate J, Bonuck K, Meissner P, Goldman H, Steele H. Adverse Childhood Experiences (ACEs) questionnaire and Adult Attachment Interview (AAI): implications for parent child relationships. Child Abuse Negl. 2014 Feb;38(2):224-33. doi: 10.1016/j.chiabu.2013.09.004. Epub 2013 Oct 24. PubMed PMID: 24670331.

Steele M, Steele H, Bate J, Knafo H, Kinsey M, Bonuck K, Meisner P, Murphy A. Looking from the outside in: the use of video in attachment-based interventions. Attach Hum Dev. 2014;16(4):402-15. doi: 10.1080/14616734.2014.912491. Erratum in: Attach Hum Dev. 2014;16(6):656. PubMed PMID: 24972107.


Parent-Child Relationship, Parenting, Mental Health & Wellbeing, Violence & Abuse

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