Experiences from conception to age six have the most important influence of any time in the life

Action Team on Triadic Attachment and Child Health (ATTACH)

Action Team on Triadic Attachment and Child Health (ATTACH): Developing & Testing a Reflective Function Intervention

Summary of the Project

Parents suffering toxic stress (depression, addiction, violence) are unable to respond sensitively to their infants which interferes with forming secure parent-infant attachments necessary for healthy child development. Secure attachment is influenced by parental Reflective Function (RF); parents’ capacity to understand and thus regulate their own feelings/behaviour toward their child. Few RF interventions exist and focus only on mothers’ understanding of their own psychological caregiving representations but do not promote learning RF skills via practice, and ignore co-parents. Building on this research ATTACH has developed and pilot tested a RF intervention designed for mothers and co-parents; intended as an add-on program to existing parenting programs (Nurturing Parenting, Thera-play). We are currrently working to report our progress from the ATTACH pilot studies. 

Methods. The ATTACH project is community-based, employing integrated knowledge transfer via partnering with Calgary Urban Project Society (CUPS), an inner city agency serving  vulnerable families. The sample drawn from CUPS Nurturing Parenting program did not cover RF. ATTACH completed two 12 week intervention pilot studies with 20 families

Results. Results to be shared soon; developing strong therapeutic alliances between mothers and ATTACH facilitators was key to participant engagement, CUPS support, very low attrition and sustaining a nurturing environment. 

Conclusion. Over 25% of Canadian children are vulnerable to cognitive and behavioral problems. Not surprising the World Health Organization has called for programs like ATTACH to address persistent discrepancies in child development to “close the gap”. Understanding associations between parental RF and (1) maternal sensitivity/responsiveness, attachment, and (2) child development fills an empirical gap and informs the effectiveness of community programs for at risk parents/children. ATTACH enhances ISPCAN’s vision of accelerating innovation to improve environments that support healthy child development.

Goals and Objectives

Short Term Goals

  • Engage mothers in safe, supportive RF-focused sessions
  • Engage mothers in practicing RF
  • Engage mother’s co-parenting support (e.g. child’s father, mother’s partner, mother’s friend or family member) in supporting mothers’ practice of RF

Long-Term Goals

  • Grow the mothers’ capacity for RF
  • Support mothers’ ability to be sensitive and responsive in interactions with child (and others)
  • Support secure mother-infant attachment
  • Support healthy development of infant

Funded by: 

  • Palix Foundation
  • Alberta Centre for Child, Family & Community Research (ACCFCR)
  • Anonymous Donor
  • Harvard Frontiers of Innovation
  • Calgary Foundation

Members of the Team


Name and Title: Dr. Nicole Letourneau (PI), Professor and Norlien/ACHF Research Chair in Parent-Infant Mental Health (AllerGen Investigator)

Email Address: Nicole.Letourneau@ucalgary.ca

Name and Title: Dr. Martha Hart (Co-PI), Project Manager, Faculty of Nursing, University of Calgary

Email Address: mhart@ucalgary.ca

Co-Investigators / Collaborators:

Name and Title: Dr. Karen Benzies, Professor and Associate Dean (Research)

Email Address: benzies@ucalgary.ca

Name and Title: Dr. Deborah Dewey, Professor, Departments of Paediatrics,Community Health Sciences; Adjunct Professor, Faculty of Kinesiology; Director, Behavioural Research Unit, Alberta Children's Hospital

Email Address: dmdewey@ucalgary.ca

Name and Title: Dr. Gerald Giesbrecht (PI), Postdoctoral Fellow, Dept. of Pediatrics, Univ. of Calgary

Email Address: GGiesbre@ucalgary.ca

Name and Title: Dr. Carol Ewashen, Associate Professor, Faculty of Nursing, University of Calgary 

Email Address: ewashen@ucalgary.ca

Name and Title: Dr. Yvonne Hayne, Senior Instructor, Faculty of Nursing, University of Calgary 

Email Address: ymhayne@ucalgary.ca

Name and Title: Glenda MacQueen, Professor, University of Calgary; Adjunct Clinical Professor, University of Toronto 

Email Address: gmmacque@ucalgary.ca


Name and Title: Chaya Kulkarni,  Director of Infant Mental Health Promotion (IMHP), The Hospital for Sick Children, Toronto

Email Address: chaya.kulkarni@sickkids.ca

Name and Title: Marsha Kline-Pruett, Maconda Brown O’Connor Professor at Smith College School for Social Work

Email Address: mpruett@email.smith.edu

Name and Title: Kyle Pruett, Clinical Professor, Yale University 

Email Address: kyle.pruett@yale.edu


Name and Title: Carlene Donnelly, Executive Director, Calgary Urban Project Society 

Email Address: carlened@cupscalgary.com


Name and Title: Dean Schroeder, Senior Director – Developmental Strategy, Calgary Urban Project Society 

Email Address: deans@cupscalgary.com