7/27/19

1

Sheri MadiganUniversity of Calgary

Beyond the Academic Silo: Collaboration &

Community Partnerships in

Attachment Research

Knowing is not enough; we must APPLY.

Willing is not enough; we must DO.

-Goethe

”

Presentation ObjectivesDiscuss the Research to

Practice GapHow long is it anyway?!?

An Attempt to Shrink the Gap: The AMBIANCE-Brief Project

How can we Move beyond the Academic Silo?

How long does it take to get

evidence into practice?

Morris, Wooding, & Grant, 2011

17 YEARS

Why is there a research-to-practice

gap?

Stepping Sideways to Move Forward Together

“The research process often unfolds in less timely and tidy ways in the real world than in the controlled laboratory, but sparks fly at the interface of science and practice that ignite new questions, new methods, new interpretations, and new directions. “

- Debra Pepler (2016), Canadian Psychology

7/27/19

2

Translational Attachment Research

The lack of validated tools for use in community practice have been highlighted as one of the major challenges facing the research-to practice gap (Cicchetti & Toth, 2006)

AMBIANCE: Atypical Maternal BehaviorInstrument for Assessment &

Classification (Bronfman, Madigan, & Lyons-Ruth, 2014)

A Coding System for Identifying Disrupted Maternal Affective Communication

Bridge the information regarding disrupted caregiving behavior to a high risk population with hope of offering more opportunity for reunification, relational repair and altering intergeneration issues.

Community-Identified Need

Translational Attachment Research

• Validated tools for use in clinical practice are in demand• The most validated marker of disorganized attachment to

date, is frightened, frightening, and disrupted forms of caregiving.

• However, assessing disrupted caregiving in clinical settings is an extremely challenging task, as observational tools are exceedingly time consuming for service providers to learn and administer.

An Opportunity To Narrow the Gap Emerged!

• SSHRC Partnership Development Grants:

• Provides support over one to three years to teams/partnerships, to:• design and test new partnership approaches for

research and/or related activities that may result in best practices or models that either can be adapted by others or have the potential to be scaled up to a regional, national or international level.

• Heidi Bailey• Catherine Borland-Kerr• Yvonne Bohr• Chantal Cyr• J.D. Haltigan• Karlen Lyons-Ruth• André Plamondon• Nicole Racine• George Tarabulsy

AMBIANCE-Brief Project - Collaborators

7/27/19

3

The AMBIANCE-Brief Project

The Language of Affect

• Infants are born speaking a language, this is the language of affect

• Affective cues have intrinsic meaning to the infant and these meanings are shared in dialogues with caregivers.

Disrupted maternal behaviors are associated with disorganized attachment.

The AMBIANCE taps into the errors & absence of this bi-directional language of affect.

• ”Fright without solution”: caregiver is simultaneously source of safety and source of fear.

• Infant displays incoherent, contradictory behaviors as a result of having no reliable means of regulating themselves.

Disorganized Attachment

(Hesse & Main, 1999; Main & Hesse, 1990)

AMBIANCE DisorganizedAttachment

r = .35***

***p < .001

Disrupted Maternal Behaviors Predict Disorganized Attachment

Madigan, Bakermans-Kranenburg, van IJzendoorn, Moran, Pederson & Benoit, 2006

Prevalence of Disorganized Attachment

Middle class, low-risk~20%

Adolescent mothers23-60%

Low SES18-34%

Mothers with Bipolar disorder

23-50%

Mothers who perpetrate

maltreatment48-82%

Mothers with drug/alcohol

abuse35-53%

van IJzendoorn, Schuengel, & Bakermans-Kranenburg, 1999; Fearon & Belsky, 2018; Carlson et al., 1989; DeMulder & Radke-Yarrow, 1991; Lyons-Ruth et al., 1990; Madigan, Moran et al., 2006; Main & Weston, 1981; O’Connor et al., 1987; Osbuth et al., 2014; Teti et al., 1995. Photo: San Piazza

7/27/19

4

Clinical Concern• Stress, emotion dysregulation, and

negative affect• Dissociation• Borderline symptoms• Suicidality• Externalizing behavior problems• Reduced social functioning

(Bernard et al., 2010; Carlson et al., 1989; Cooke et al., 2018; Cyr et al., 2010; DeMulder & Radke-Yarrow, 1991; Fearon et al., 2010; Lyons-Ruth et al., 1990; Lyons-Ruth et al., 2013; Madigan, Moran et al., 2006; Madigan et al., 2016; Main & Weston, 1981; O’Connor et al., 1987; Osbuth et al., 2014; Pallini et al., 2014 Teti et al., 1995; van IJzendoorn et al., 1999)

AMBIANCE

Affective Communication Errors

Role/Boundary Confusion

Fear or Disorientation

Negative or Intrusive Behavior

Withdrawal

(Bronfman, Madigan, & Lyons-Ruth, 2014)Into childhood, adolescence, and early adulthood, disrupted caregiving behaviors coded for by the AMBIANCE are predictive of: • Disorganized attachment• Other maladaptive outcomes:

• Substance use• Borderline features• Antisocial features• Suicidality• Dissociation

The AMBIANCE

(Dutra et al., 2009; Lyons-Ruth et al., 2013; Lyons-Ruth et al., 2016; Moran et al., 2006; Madigan, Bakermans-Kranenburg et al., 2006; Madigan, Voci, & Benoit, 2011)

The AMBIANCE: Ages for use

4 months 12 months 24 months 7 years

Stabilityr = .56**

Madigan, Bakermans-Kranenburg, van IJzendoorn, Moran, Pederson & Benoit, 2006 **p < .01

Pros & Cons of using AMBIANCE in a Child Welfare Setting

• AMBIANCE identifies parenting behaviors that are observed frequently in a Child Welfare setting in access (visits) between parents and children

• Provides clear areas for therapeutic

interventions

• Provides an evidence based attachment informed assessment tool

Pros• Video taping in a child welfare setting is a

problem!

• Coding too extensive and clinical training capacity of a large organization is limited

• Child Welfare workers are on timelines,

court process and resources are limited

Cons

7/27/19

5

How do we bridge the research to practice gap for the AMBIANCE measure?

Create a brief measure that aims to maintain it’s psychometric properties

The conduct of translational research involves a process with various steps taken along the way. There must be a recognition and agreement that

basic research needs to be conceived within a conceptual framework that understands the goal

of informing future application.

“-Cicchetti & Toth from “Building Bridges and Crossing them”, 2006 ”

AMBIANCE-Brief Project

Step 1 Address feasibility issues by creating an AMBIANCE-Brief

Step 2 Assess the validity of the AMBIANCE-Brief

Step 3S p r i n g : Pilot using the AMBIANCE-Brief with community partners. Use feedback to make any necessary changes to improve

feasibility.

F a l l : Roll out of two-day training with

community partners

Step 4 Build delivery platform for ease of integration in community settings

Address Feasibility Issues• The AMBIANCE lacks feasibility for clinical use

• 150 behavioral codes

• Narrative written for each dyad, taking at least one hour to code

• 3-day training + 20 training tapes + 20 reliability tapes = 80 hours

• Not coded in real-time

STEP 1:

Address Feasibility IssuesSTEP 1:

Full AMBIANCE (19 behavioral codes) AMBIANCE-briefElicits reassurance from infant xDefers to infant xAsks infant’s permission to do something xDemands show of affection from infant xSeeks physical attention from infant while infant is engaged in activity ✓Prioritizes own needs over infant’s needs xRepeats self-references ✓Behaves as a child rather than a parent xSpeaks in baby talk (not in response to infant) xUses “we” to describe self or infant xEncourages infant to engage in negative behaviors xFake cries in response to infant xDirects infant to self xPleads with infant xAsks for infant reassurance around separation xThreatens to cry ✓Speaks for infant in baby voice xEscalates infant’s distress xDoes not share toys with infant x

Full AMBIANCE150 Items

AMBIANCE-Brief45 Items

7/27/19

6

The AMBIANCE-Brief

Dr. Sheri Madigan Dr. Elisa Bronfman

Dr. Karlen Lyons-Ruth Dr. J.D. Haltigan

Validate the AMBIANCE-BriefSTEP 2:

Sample§ 76 adolescent mother-infant dyads§ Recruited from London, ON§Mothers:§ Mean age = 18.43 years§ 81% Caucasian, 19% minority§ Majority single and low income§ Infants:§ 50.5 % female

76 adolescent mother-infant dyads from London, ON

Strange Situation Procedure at 12 months

• Code for attachment patterns• Code AMBIANCE• Code AMBIANCE-Brief

Validate the AMBIANCE-BriefSTEP 2: AMBIANCE-Brief Validation

ObjectivesAssess the feasibility of the AMBIANCE-Brief in terms of

time-to-code in real-timeA.Examine the reliability of the AMBIANCE-BriefB.

Establish the convergent validity of the AMBIANCE-Brief with the full AMBIANCEC.

Assess the concurrent validity of the AMBIANCE-Brief in relation to infant disorganized attachmentD.

6MINUTES

On average, it takes approximately 6 minutes to code the AMBIANCE-Brief in play contexts in real-time.

This demonstrates its feasibility for use in applied clinical settings.

Under Inter-Rater Reliability of the AMBIANCE-Brief

ICC= .86**

**p < .01,

7/27/19

7

Full AMBIANCE AMBIANCE-Briefr = .65***

Convergent Validity

***p < .001

AMBIANCE-BriefDisorganizedAttachment

r = .30***

Concurrent Validity

***p < .001

Concurrent Validity

AMBIANCE-Full DisorganizedAttachment

Concurrent Validity

***p < .001

Concurrent Validity

r = .50***

Madigan, Moran, & Pederson (2006)

Summary of FindingsThe AMBIANCE-brief demonstrates…

ü Initial feasibility for use in practiceo Takes less than 6 minutes per 3-min observation

üCoder reliability

üConvergent validity with the full AMBIANCE

üPredictive validity for infant disorganized attachment at 12 months

How should the AMBIANCE-Brief be used? What should it be used for?

• Screening for disrupted caregiving in settings with limited resources

• Intended to be used in conjunction with other assessments or interventions

• Using multiple methods & informants

• Not diagnostic in nature & not for assessing parenting capacity

The AMBIANCE-Brief

Dimension 1

Tally behaviors coded for in each dimension

Dimension 2Dimension 3Dimension 4Dimension 5Global Level of Disrupted Caregiving

Rate from 1-7 based on behaviors tallied

7/27/19

8

Results from pilot training thus far…

of trainees have become reliable

Results from pilot training thus far…

of trainees have become reliableMean ICC = .77

What did we learn?

•Feedback from partnering agencies:• 2 day training rather than 1 is

needed• Reliability should take place on the

second half of the second day to expedite reliability process

DAY 1

8:30 – 9am Overview the AMBIANCE and development of AMBIANCE-Brief.

9 – 10am Dimension 1 & 2 - Behavior ExemplarsGroup practice tape/guided rating.

10 – 10:15am - BREAK -

10:15 –12:15pm

Dimension 4 – Behavioral ExemplarsGroup practice rating and discussion

12:15 – 1:15pm - LUNCH -

1:15 – 2:30pm Dimension 3 – Behavioral ExemplarsGroup practice rating and discussion

2:30 – 2:45pm - BREAK -

2:45 – 4:15pm Dimension 5 – Behavioral ExemplarsGroup practice rating and discussion

4:15 – 4:30pm Questions and discussion.

DAY 2

8:30am – 9:00am Refresher on scale of AMBIANCE-Brief and 5 Dimensions

9:00 – 10:00am 2 group practice tapes & discussion of coding

10:00 – 10:15am - BREAK -

10:15 – 12:15pm 2 group practice tapes & discussion of coding

12:15 – 1:15pm - LUNCH -

1:15 – 2:45pm Reliability coding

2:45 – 3:00pm - BREAK -

3:00 – 4:15 pm Reliability coding & submission

4:15 – 4:30pm Evaluation and implementation questions; feedback survey.

How long to shrink the

AMBIANCE research to

practice gap?

18 YEARS!

7/27/19

9

Keep up-to-date with the AMBIANCE-Brief

www.madiganlab.com

Ongoing Translation Attachment Research

Also see:Parent-Child Interaction

Assessment Project•Forrer, Schuengel, & Oosterman(2018). The effect of video exemplars on interrater reliability in assessment of parental behavior. WAIMH, Rome, Italy. IMHJ, 39 (Suppl), 56-57.•Forrer, Schuengel, Oosterman, & Fearon (2018). The Effect of Decision Trees on Rater Accuracy in Assessment of Parental Behavior. EUSARF, Porto, Portugal.

How can we Move Beyond the Academic Silo?

Do you want to

move beyond the silo?

A new requirement for research!

Policy & Decision Makers

CommunityPartners

PatientEngagement

Industry Partners

ParticipantStakeholders

Is there a blueprint for moving beyond the academic silo?

Partnering with One Another: Attachment Consortiums

• Conducting larger, multisite studies rather than small single site studies would narrow the gap by enrolling required subjects more quickly and reducing the time required to complete research.

• Individual Participant Data Meta-Analyses collate raw data to enable “mega-analyses” of existing data and resolving fundamental questions in attachment, which can then be translated to policy and practice.

• These consortiums would provide more generalizable data, speeding translation to practice.

7/27/19

10

Community Science!

• Partner with community agencies from the outset.• What are their burning

research questions? Are they the same as yours?

• Seek out community identified needs and questions• Co-construct research projects

designed to address their needs

Disseminating Research to Community Partners

Disseminating Research to Community Partners

https://perspectives.waimh.org/

Extending Research Findings to the Public

7/27/19

11

5 Steps of “serve and return”

• Notice the serve and share the child’s focus of attention

• Return the serve by supporting and encouraging

• Give it a name!

• Take turns….and wait. Keep the interaction going back and forth

• Practice endings and beginning

12345

Building Bridges & Crossing Them

To bridge the gap between basic and applied research,

researchers who are receptive to

approaches that may go beyond the boundaries and

“comfort zones” of their areas of

expertise, are needed.

-Cicchetti and Toth, 2006

“

”

Dr. Sheri Madigan Dr. Nicole Racine Dr. Rochelle Hentges Jessy Cooke (BSc) Camille Mori (BA)

Anh Ly (MA) Brae McArthur (PhD) Rachel Eirich (BA) Chloe Devereux Whitney Ereyi-Osas