A Systematic Review of Attachment-Based Interventions for Caregivers and Young Children Living in Poverty

Abstract

Almost half of the 11 million children under the age of three in the United States live in low-income families. Early childhood may be the developmental period most sensitive to the conditions affected by income and living in poverty places children at greater risk for low quality attachment. The purpose of this systematic review was to summarize common themes, differences and shortcomings of interventions that aim to improve child-caregiver attachment and caregiver behaviors with children under the age of three who have been identified as living in poverty or a low socioeconomic background. Eighteen studies met the inclusion criteria. Data extraction identified specific intervention characteristics and the quality of intervention reporting using the TIDieR checklist. Characteristics of the caregivers, children, and interventionists involved in the studies, intervention delivery method, group or individual intervention, location of intervention implementation, the duration, and dose of the intervention were coded from each article. Studies were also analyzed to identify cultural aspects of the participants involved in the interventions, and how those characteristics may have modified or changed the interventions. TIDieR intervention guidelines clearly revealed that more detail was needed in all aspects of intervention reporting. Identification and description of the procedures and materials were most often missing, making it difficult to compare and contrast intervention procedures, and replication of interventions. However, common characteristics of interventions were noted. Mothers were the primary caregivers involved in the intervention, most of were delivered face-to-face (n=18) and in the home (n=17). The majority of interventions (n=14) were provided in individual family/dyad settings as opposed to group settings. Eight studies addressed cultural characteristics regarding the participants involved or how attachment definitions may change regarding participants’ culture; most addressed language (n=6). Based on the results of this systematic review, it is recommended that interventions to enhance child-caregiver attachment and caregiver behaviors for those living in poverty should incorporate a multidimensional and culturally relevant approach, and be reported in a detailed way to allow for deep understanding and replication of the interventions.