On a muggy day in July 2015, I spent the afternoon in St. Albans, a working-class neighborhood in Queens, New York, at the home of Stephanie King, the foster mother to Julianna, a sweet-natured girl just a few weeks shy of her second birthday, and her baby sister, Isabella. I was at Stephanie’s house to observe a visit from Margarita Prensa, a parent coach with a home-visiting program called Attachment and Biobehavioral Catch-up, or ABC. The intervention, which is now used in the child-protection and foster-care systems at four sites in New York City, is the creation of Mary Dozier, a researcher in psychology at the University of Delaware, and it draws heavily on the principles of attachment psychology.
Like most children in foster care, Julianna was born into difficult circumstances. Her mother, a woman in her early twenties named Valerie, was living in New York City’s shelter system when Julianna was born. About a month after Julianna’s birth, Valerie sent Julianna to stay for the weekend with Stephanie and her partner, Canei, who were friends of Valerie’s. When the weekend was over, Valerie announced that she couldn’t take Julianna back. Instead of coming to pick her daughter up, she sent over a small bag containing all of Julianna’s worldly possessions—some clothes and a couple of toys. Julianna has been in the custody of Stephanie and Canei ever since, though she still sees Valerie regularly, and Valerie is trying, eventually, to regain custody. A few months before my visit, Valerie gave birth to Isabella, her second child, and it wasn’t long before Isabella was living with Stephanie and Canei, too.
These patterns of instability and uncertainty are exactly what make the foster-care process so damaging developmentally for so many children. And yet Julianna, during the time I spent with her, appeared to be doing just fine. And that, it seemed, had a lot to do with her relationship with Stephanie, an African-American woman in her early thirties with dyed red hair, an easy laugh, and a wry manner.
ABC uses home visits from coaches like Margarita to encourage parents and foster parents to connect more, and more sensitively, with the young children in their care. While we were visiting Stephanie and Julianna, Margarita kept up a steady stream of commentary as she watched the two of them interact: “You followed her lead nicely there.” “Good delighting and smiling!” “She started crying, and you started rubbing her forehead. That’s good; that’s good nurturance.” The goal of this narration is to make parents like Stephanie more conscious of the small interactions they are having with the children in their care. By drawing attention to and praising the moments that promote connection and attachment between parent and child, Margarita helped steer Stephanie toward better parenting approaches. And by accentuating the positive, rather than criticizing missteps, she underscored that good parenting is not rocket science—that Stephanie was, in fact, already performing many of these positive behaviors.
During much of our visit, Julianna was playing with a set of plastic stacking cups that Margarita had brought with her, the kind that come in a range of sizes so that each cup nests neatly inside the next-largest cup. At one point, as Stephanie and Margarita were talking about Isabella, Julianna started crumbling a cookie she was eating into one of the cups—and then suddenly threw a handful of cookie at Stephanie and her baby sister.
“No, Bobo,” said Stephanie calmly, looking at Julianna. “We are not throwing cookies all over the place.”
“Yes!” said Julianna. She stood a few feet away from Stephanie, staring at her, defiant in her white cotton pants and pink shirt.
Stephanie rose to her feet, still holding the baby. “Perhaps we’re done with the cookies.”
“No!” replied Julianna, her voice rising in pitch and volume.
“No, we’re totally done with the cookies, because the cookie came over here to my part of the room.” Stephanie reached down to retrieve the remaining cookie crumbs from Julianna’s fist. “Give me that, please. Thank you very much.”
Julianna started to wail. “Nooooo!”
Stephanie walked over to the garbage can in the kitchen to deposit the crumbs. “Can you sit down?”
“No!” But then Julianna did go and sit down. She said, sadly, “Oh no! No more cookies!” She looked down at her hands. “Cookies all gone.”
“That’s right, the cookies are all gone,” Stephanie said.
Julianna stood up and started to cry. By this point, Stephanie was back in the living room. She kneeled down and handed Julianna one of the plastic stacking cups. “Have a seat,” she said. “You can even have this. But we’re done with the cookies.”
Julianna sniffled a bit and then went back to playing with the cups.
“Are you OK?” Stephanie asked.
Julianna nodded her head.
They both looked at the big cup that Julianna was trying to fit into a smaller cup, with no success. “Can you get it in there?” Stephanie asked. “Here, let me show you.”
Margarita, who had sat silently observing this whole interaction, now praised Stephanie’s measured approach. “Good job,” she said. “You stayed calm, and then you started following her lead right away.” Stephanie smiled.
It was a small moment, but it was easy to see how the few minor choices Stephanie had made—keeping her voice low, redirecting Julianna’s attention, being firm about rules but expressing sympathy for Julianna’s feelings—had helped Julianna remain stable and relatively stress-free. And it was easy to see how different choices, the kind that might come more naturally to a beleaguered mom—taking Julianna’s misbehavior personally, raising her voice, dwelling on punishment and retribution rather than moving on to a new moment—would have elevated Julianna’s stress level, not only that afternoon, but over the long term.
When Dozier and other researchers have studied the impact of ABC on parents (including foster parents) and children, they have found consistently positive effects according to a number of indicators. One study found that after ten ABC home visits with foster parents, the children in their care showed significantly higher rates of secure attachment and were better able to regulate their behavior. Children’s stress rates improved, too: Their daily patterns of rising and falling levels of cortisol, a key stress hormone, were no longer abnormal, as is often the case with children in the high-stress situation that is foster care. In fact, the cortisol patterns of the foster children of ABC-treated mothers are indistinguishable from those of typical, well-functioning, non-foster-care children.
A few weeks after my trip to Queens, I visited the Stress Neurobiology and Prevention lab at the University of Oregon in Eugene, where a team of researchers led by Phil Fisher, a psychologist, has developed a series of interventions with parents that in many ways parallel the ABC program, though with one major difference: They use digital video as a teaching tool to help steer parents away from behaviors that cause fear and stress in children and toward patterns that promote attachment and self-regulation.
The video-coaching program, which Fisher introduced in 2010, is called Filming Interactions to Nurture Development, or FIND. The basic strategy is similar to what Margarita Prensa was doing with the play-by-play narration she offered to Stephanie King—trying to draw a parent’s attention to the small moments in parent-child interactions that are most beneficial for children. With FIND, though, there is no coach narrating those moments in the present tense, the way Margarita did; instead, the videos help isolate such moments and, through careful review later on, render them especially vivid for parents.
Social-service agencies that use FIND usually employ teams of parent coaches who visit several at-risk parents or foster parents each day. When a FIND-trained coach arrives at a family’s home, she sets up a video camera to record every interaction between parent and child during the visit, which usually lasts just half an hour. In the evening, the day’s videos are edited to highlight three brief moments that illustrate positive serve-and-return-style interactions. During the coach’s next visit with that parent, she plays the video on a laptop or tablet, stopping it frequently to discuss with the parent why that particular interaction was meaningful and positive for the child.
The core idea behind FIND, Fisher explained to me, is that “serve-and-return is going on even in the most adverse home circumstances. Rather than get preoccupied in these homes with what parents are doing wrong, we just zero in on this one positive moment, and then we make the moment salient to parents by slowing things way down. The message to parents is: You don’t need to learn something new. We just want to show you what you’re already doing, because if you do more of that, it’s going to be transformative for your baby.”