Effectiveness of the ATTACH™ program on Indigenous parents and their children exposed to intergenerational stress: pilot findings

11/02/2026

Can J Public Health. 2026 Feb 10. doi: 10.17269/s41997-026-01157-2. Online ahead of print.

ABSTRACT

INTERVENTION: The Attachment and Child Health (ATTACH™) program is a 10-12-week mentalization-based parenting intervention designed to increase parental reflective function (PRF), promote secure attachment, increase parent/child interaction quality, and improve child development outcomes in families at risk of poor health outcomes due to intergenerational stressors such as poverty, domestic violence, substance use and depression.

RESEARCH QUESTION: What is the effect of the ATTACH™ program on PRF, parent-child interaction quality, and child development in Indigenous participants who have experienced intergenerational stressors?

METHODS: Secondary analysis was performed on data collected from participating Indigenous dyads (n = 17) who provided complete data on the primary outcome in one of seven pilot trials which consisted of both randomized controlled trial (RCT) and quasi-experimental (QE) studies. This study utilised two-tailed paired t-tests (alpha = 0.05) to compare baseline and post-assessment scores on the Reflective Function Scale (RFS) obtained from transcribed and coded Parent Development Interviews (PDI), Parent-Child Interaction Teaching Scale (PCITS), Ages and Stages Questionnaire (ASQ-3), and Ages and Stages Questionnaire – Social Emotional (ASQ-SE) for all Indigenous participants who received the ATTACH™ program in both the RCT and QE pilots.

RESULTS: We found significant improvements in Parental-, Child-, and Total RF scores (p = 0.023, p = 0.024, p = 0.015 respectively). There was also significant improvement in the PCITS clarity of cues (p = 0.040).

CONCLUSION: The ATTACH™ program is a promising intervention that stands to counter the effect of intergenerational stressors on high-risk Indigenous parents’ abilities to reflect on their own and their children’s thoughts and feelings and may improve parent-child interaction quality.

PMID:41667754 | DOI:10.17269/s41997-026-01157-2

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