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Child Abuse Negl. 2015 Apr;42:163-73. doi: 10.1016/j.chiabu.2014.07.007. Epub 2014 Jul 25.

Pilot study of a program delivered within the regular service system in Germany: effect of a short-term attachment-based intervention on maternal sensitivity in mothers at risk for child abuse and neglect.

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Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany.
Friedrich-Alexander-University Erlangen-Nuremberg, Institute of Psychology, Nägelsbachstraße 49a, 91052 Erlangen, Germany.
University of Toronto, 563 Spadina Crescent, Toronto, Ontario M5S 2J7, Canada.


This pilot study examined the effectiveness of a short-term attachment-based intervention, the Ulm Model, in a German population at risk for child abuse and neglect. The intervention used home visits and video feedback to promote maternal sensitivity, and was implemented by trained staff within the health care and youth welfare systems. Mothers in the control group (n=33) received standard services only, while those in the intervention group (n=63) additionally the Ulm Model intervention. The outcomes measured were maternal sensitivity, as assessed by the CARE-Index at pre-intervention, after the last session, and at about 6 and 12 months of age; and infant socio-emotional development, as assessed by the ET6-6 development test at about 6 and 12 months of age. The moderating effects on treatment outcomes of two variables were examined: risk for child abuse (moderate vs. high) and type of maternal attachment representation (secure vs. insecure). Among participants at moderate risk for child abuse, no differences were found between the intervention group and control group in either maternal sensitivity or infant development. Among those considered high risk, mothers in the intervention group showed a significant increase in maternal sensitivity from pre- to post-intervention; however, no group differences were seen at follow-up. There were some indications that infants of mothers in the intervention group showed better emotional development. The variable of maternal attachment representation was not a significant moderator for the intervention effect, but post hoc analysis indicated that the mean sensitivity of secure mothers was significant higher at the 6-month follow-up.


Attachment representation; Attachment-based early intervention; Child abuse and neglect; Regular service system; Risk status

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