Attachment Based Care for Teams (ABC4T)

Overview of the ABC4T Program

  • A training program for the entire staff of a treatment facility
  • Uses a trauma informed, attachment promoting clinical framework
  • Uses attachment theory as an overall program philosophy
  • Makes the Milieu milieu experience more clinically consistent with the therapy interventions.
  • Builds strong team collaboration across all disciplines
  • Increases the role of parents in the treatment process
  • Helping caregivers and staff members to be a secure base for children and young people (CYP) to support their developing autonomy and competency

Aims of the Program

The ABC4T Program helps the entire staff to take a more psychotherapeutic approach to milieu management, in contrast to the more typical behavioral management models. While managing safety is critical, an attachment-based lens, is grounded in trauma informed care models. This helps staff understand patient behaviors as emerging from unmet interpersonal needs that are poorly expressed. Conflicts and resistance become therapeutic opportunities rather than barriers to treatment.

  • Staff we work with: Administrators, doctors, educators, nurses, therapists, line and support staff
  • Settings we work with: Inpatient, residential, partial hospital, day treatment facilities, and large-scale outpatient organizations.

The program consists of three components:

  • Component 1 – Pre-Training: Evaluation phase to understand the culture and structure of the unit.
  • Component 2 – Traning:
    • Track 1: Family therapist becomes certified in Attachment-Based Family Therapy and serves as the change agent on the unit.
    • Track 2: Training phase where all staff engage in a 3-day training to learn the ABC4T model.
  • Component 3 – Sustainability: The sustainability phase focuses on supervision and consultation to help integrate the model into practice.

Attachment-Based Family Therapy becomes a primary clinical framework in the unit. ABC4T then helps extend the attachment framework to the milieu. The milieu supports work in the family sessions and vice versa. When patients act out on the unit, rather than punish the behavior, staff understand it as a partial reaction to past trauma and current clinical challenges.

As a result of this program:

  • All clinical and milieu staff have a shared understanding, clinical vocabulary, intervention strategies and desired outcome.
  • Patients and caregivers experience the staff as more unified in their approach to clinical challenges.
  • Staff morale and job satisfaction increase when frontline staff and clinical staff feel equally invested in each other and the clinical care. All staff are valued as part of the clinical team.

The ABC4T Program does not impede the use of other treatment components already in place, such as CBT, MBT, DBT, NVR, Signs of Safety, etc. But it helps provide an overarching framework to unify different intervention strategies.

The ABC4T Program is trans-diagnostical, trans-age and trans-framework.

Client Feedback

This program has been implemented and is being evaluated in a young adult inpatient hospital program. Clients and staff have provided feedback on their experiences. Those who have engage in the Attachment Based Care for Teams Program have experienced: 

Increased patient engagement 

  • “I want to come continue treatment for the ABFT sessions. Things are really starting to change at home. My dad listens to me now. And I’m listening to him.” 

Increased parent satisfaction 

  • “After so many hospitalizations for our adoptive son, we’ve now experienced psychiatry can be different, can make a difference.” 

Increased team member resilience 

  • “Every time we discuss a case from the attachment perspective we’re trained in, we see new options for care and treatment. We find hope again in seemingly hopeless cases.” 

Augmented team efficiency 

  • “Our treatments go deeper and target what really matters now. Since we’ve adopted the Attachment Based Treatment Program, we know what we are doing. We share moments of proudness of our work with vulnerable young people.” 

History of ABC4T Program

The ABC4T program was developed by Ilse Devacht, in collaboration with the residential care team at Asster Hospital in the Netherlands, and esteemed researchers Guy Bosmans, Ph.D. (KU-Leuven University), Guy Diamond, Ph.D., and Suzanne Levy, Ph.D. (formerly at the Center for Family Intervention Science at Drexel University). This initiative was designed to address several critical challenges faced by the unit, including:

  1. Lack of an overarching framework for clients with diverse presenting problems.
  2. Emphasis on individual responsibility and behavioral stabilization leading to high conflict between staff and young adults.
  3. Focus on behavioral control leading to conflicts among staff members and between staff and young adults.
  4. Difficulties engaging primary caregivers, resulting in conflicts between staff and parents and subsequent parental disengagement.

For more information about the development of ABC4T: https://onlinelibrary.wiley.com/doi/abs/10.1002/anzf.1383