Distal Outcomes Research Articles

Enhancing systematic review efficiency in hand surgery using artificial intelligence (natural language processing) for abstract screening.

The aim of the present study was to train a natural language processing model to recognize key text elements from research abstracts related to hand surgery, enhancing the efficiency of systematic review screening. A sample of 1600 abstracts from a systematic review of distal radial fracture treatment outcomes was annotated to train the natural language processing model. To assess time-saving potential, 200 abstracts were processed by the trained models in two experiments, where reviewers accessed natural language processing predictions to include or exclude articles. The natural language processing model achieved an overall accuracy of 0.91 in recognizing key text elements, excelling in identifying study interventions. Use of the natural language processing reduced mean screening time by 31% without compromising accuracy. Precision varied, improving in the second experiment, indicating context-dependent performance. These findings suggest that natural language processing models can streamline abstract screening in systematic reviews by effectively identifying original research and extracting relevant text elements.Level of evidence: IV.

Examining Immediate and Sustained Effects of Check-In/Check-Out in Finnish Elementary Schools

Check-in/Check-out (CICO) behavioral support has been implemented in Finnish School-Wide Positive Behavior Interventions and Support (SWPBIS) schools to cater to students who require personalized behavior support beyond the universal level. Previous studies have demonstrated the effectiveness of CICO as a behavioral support method. However, further research is needed to investigate its effectiveness in a larger sample and to analyze the timeline for behavioral change. This study focused on 51 elementary school students, assessing their behavior at baseline and during the CICO intervention phase using two data collection methods: the Daily Report Card (DRC) and the School Situation Questionnaire (SSQ). Nonlinear growth modeling was employed to examine the effects of the intervention. The results indicated that CICO yielded significant positive effects on behavior within 1 week of initiating support. After the outcomes stabilized, the behavior change remained stable beyond the first week of the intervention. These effects were detected in both the target behavior measured with DRC and the problem behavior measured with SSQ. These findings suggest that CICO interventions produce rapid and sustained changes in behavior. Further, the effects of CICO were observed in various settings within the school environment, indicating distal outcomes.

Longitudinal validation of the PROMIS-16 in a sample of adults in the United States with back pain.

This longitudinal study evaluates whether the Patient-Reported Outcomes Measurement and Information System (PROMIS)-16 domains capture average change over time comparable to the PROMIS-29 + 2 and have similar associations with change in overall health rating and two disability indices. Data were collected using Amazon's Mechanical Turk at baseline, 3 months, and 6 months among individuals reporting chronic low back pain. The analytic sample includes respondents who completed baseline and at least one follow-up assessment (N = 1137). We estimated latent growth models for eight PROMIS domains and compared growth parameters between the PROMIS-16 and PROMIS 29 + 2 with a z-test. Additionally, for each domain, random intercept and slope scores for individuals were computed for the PROMIS-29 + 2 and PROMIS-16 and correlated to estimate concordance. Using growth parameters for physical function and pain interference, we predicted average change in the Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), the overall health rating, and compared regression coefficients between the PROMIS-16 and PROMIS 29 + 2. All growth models fit the data well. Intercept and slope parameters were statistically comparable (p's > 0.05) in magnitude across all domains between the PROMIS-16 and PROMIS-29 + 2. Correlations between random intercept and slope scores for individuals across domains were high. Additionally, the regression coefficients between slopes for pain interference and physical function and ODI, RMDQ, and overall health rating were statistically comparable (p's > 0.05) between the PROMIS-16 and PROMIS 29 + 2. Results provide between-level support for the longitudinal and predictive validity of the PROMIS-16. Similar average baseline scores and changes over time were observed between PROMIS-16 and PROMIS-29 + 2. Further, average change estimates comparably predicted average change in distal outcomes. This work provides evidence supporting the utility of the PROMIS-16 as a viable, short-profile option for use in clinical and research settings.

It Matters How You Got There and Who Else Is Doing It: Examining the Effects of Two Social‐Contextual Characteristics of Working From Home

ABSTRACTDrawing on self‐determination theory, this study advances our understanding of employees' experiences working from home (WFH). Specifically, we examine the effects of two social‐contextual characteristics of WFH arrangements: whether employees voluntarily initiate their arrangement (WFH initiation) and the proportion of WFH employees in a unit (WFH density). We conducted multilevel analyses on a multisource dataset drawn from organizational HR records and two surveys of 2115 WFH employees in a Fortune 500 organization. Employees who voluntarily initiated WFH, rather than at their employer's direction, experienced higher job autonomy and lower isolation. WFH employees in units with a lower proportion of other WFH employees experienced higher job autonomy. WFH initiation and WFH density also had effects on several distal employee outcomes, including job satisfaction, organizational knowledge, and turnover intentions, through their effects on job autonomy and isolation. Our findings provide valuable insight into the experiences of WFH employees and call attention to two important, yet understudied, factors that shape these experiences.

The Effects of Functional Reading Activities to Motivate and Empower for Autistic Young Adults: A Single-Case Design Study.

The purpose of this study was to examine the effects of Functional Reading Activities to Motivate and Empower (FRAME) on use of reading comprehension strategies in intellectually and/or developmentally disabled young adults. A single-case, multiple-probe design across functional literacy stimuli (e.g., text messages, e-mails) was replicated across three intellectually or developmentally disabled 23- to 26-year-old young adults, all of whom had a primary diagnosis of autism. Within FRAME, reading comprehension strategies were taught and practiced within the context of functional texts or activities of daily living that involve written language (e.g., text messages, e-mails). Each session followed the teach-model-coach-review approach and was conducted via telepractice. Participants' use of reading comprehension strategies was measured in baseline, intervention, maintenance, and with generalization probes. Visual analysis of the data indicated a functional relation between FRAME and the use of reading comprehension strategies for two of the three autistic young adults. All participants maintained increased use of reading comprehension strategies post-intervention. This study provides preliminary evidence that FRAME is associated with improved use of reading comprehension strategies that maintains over time. Thus, FRAME has the potential to support continued improvement of functional reading skills throughout the lifespan, which is critical as autistic individuals make the transition from adolescence to adult life. Further research is needed to evaluate the effects of the intervention on more distal outcomes of written language and to examine how to best tailor the intervention to individual differences to optimize outcomes. https://doi.org/10.23641/asha.26882422.

Diagnosing leadership – construction and validation of the leadership impact inventory

PurposeThe purpose is to examine the connection between leadership and its proximal and distal outcomes on employee, team and organization-level outcomes. As a more practical endeavor, a leadership measurement is constructed and validated.Design/methodology/approachThe study takes a quantitative approach, statistically analyzing 301 online survey responses to a survey of leader attributes and their organizational impacts.FindingsThis study shows that the impact of leadership is associated more with actionable behaviors than personality traits. More specifically, leader success leans on leader dependability, management mode, emotive skills and coaching style, which relate to organizational outcomes. Additionally, preventative conflict management belongs to immediate supervisory foci, whereas already escalated conflicts ought to be outsourced to e.g. HR. Further, the findings verify that management is even more about communication than previously understood. Interestingly, employee satisfaction does not predict willingness to stay and is therefore irrelevant as a predictor of employee retention. This verifies the role of satisfaction as a proximal outcome and a post-goal state. Finally, the role of psychological safety is incoherent and equivocal in relation to organizational outcomes.Practical implicationsAs a practical ramification, we devise an instrument, the Leadership Impact Inventory, for (1) diagnosing the quality and effect of organizational leadership in an easy-to-adopt, cost-effective and quick manner and (2) analyzing the influence of various leadership dimensions on satisfaction and goals on individual, team and organizational levels.Originality/valueThis study expands the earlier body of research on leader influence to factors promoting not only proximal outcomes that are typically post-goal states but also distal outcomes. Further, it examines outcomes on all organizational levels, as an extension to prior studies which are typically limited to the entire organization. Finally, the study does not explore leadership as a force or process separate from culture but rather appreciates their synergy through the inclusion of cultural features. This is achieved by monitoring leader success with such subjective aspects describing employee experience and organizational culture that are associated with follower performance.

Outcomes of integrated knowledge translation: A comparative, multi-country case study

Abstract Background Integrated knowledge translation (IKT) seeks to establish continuous relationships between researchers and knowledge users, in particular decision-makers, to enhance evidence-informed decision-making in public health and healthcare. IKT is, however, difficult to evaluate and outcome evaluations remain scarce. The German-African Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) undertook research on IKT and non-communicable diseases in Ethiopia, Malawi, Rwanda, South Africa, and Uganda. Over six years, we implemented an IKT approach and evaluated it according to a pre-defined programme theory. Methods We conducted qualitative interviews and surveys with CEBHA+ researchers and their decision-making partners at two stages (3/2020-2/2021; 9/2022-5/2023) and collected IKT-related documents (see protocol: https://rdcu.be/dyfBP). Transcripts and documents were analysed using qualitative content analysis and surveys were analysed descriptively, with subsequent integration, cross-case analysis, and revision of the programme theory. Results We collected 92 IKT-related documents; and 55 researchers and decision-makers participated in surveys, focus groups or interviews. Proximal outcomes were collaborative research; capacity-building related to research skills and evidence use; and relationship-building, establishing trust and partnerships. Intermediate outcomes were changes in attitudes and knowledge; decision-makers became attuned to research and researchers increased their understanding of the decision-making context, and developed a vision for research impact. Distal outcomes were the production of applicable research and the consideration of evidence by decision-makers. High opportunity costs associated with IKT implementation constituted unintended effects. Conclusions Our study presents rich, theory-informed insights into IKT outcomes, based in particular on the experience of researchers implementing the CEBHA+ IKT approach. Key messages • A multi-country research collaboration offered an opportunity to examine IKT implementation and investigate proximal, intermediate, and distal IKT outcomes based on a pre-defined programme theory. • Beyond our initial conceptualisation, the IKT approach was linked to researchers developing a vision for ‘research impact’ and gaining a better understanding of the decision-making context.

The only constant is change: Stable vs. variable aspects of food approach bias relate differently to food craving and intake

The tendency to approach food faster than to avoid it (i.e., approach bias) is thought to facilitate food intake, particularly foods that conflict with one's dietary goals. However, this relationship has been difficult to demonstrate, which ties into an ongoing debate about whether such cognitive-behavioral biases represent stable traits or fluctuating states. We thus investigated the temporal fluctuations of food approach bias (1), its within-participant association with food craving (2) and intake (3), and the role of top-down control in this bias-intake association (4). The 76 participants completed an impulsivity questionnaire and performed a smartphone-based approach-avoidance task on nine days. Every day, they also reported their daily craving, intake, and dietary intentions for 12 personalized foods they wanted to eat less or more often over the study period. Approach bias varied considerably within individuals (1), and correlated in unexpected ways with food craving (2) and intake (3); this association of approach bias with intake was moderated by inter-individual differences (rather than day-to-day fluctuations) in dietary intentions and impulsivity (4). Results emphasize the need to re-conceptualize approach bias as comprising both state and trait components, and indicate that the more trait-like aspects of top-down control gate the relationship of approach bias with intake. The large day-to-day variation in approach bias may explain why single-session bias measures often do not predict distal outcomes like body weight. Furthermore, our results suggest that interventions targeting approach bias may be most effective for certain timepoints (high-risk situations) and individuals (those with weak dietary intentions).

Cascading Effects of the Family Context in Adolescence: Implications for Young Adult Antisocial Behavior and Intergenerational Transmission of Risk.

Inspired by the tremendous impact of Robert McMahon's career, this study evaluated an intergenerational cascade model in which young adult conduct problems may serve as a risk pathway linking generation 1 (G1) parenting and family climate in adolescence with generation 2 parenting quality and family climate with their children (G2-G3). Our sample included 396 parents (Mage = 28.3; 70% women; child Mage = 3.96, 48% girls) who have participated in the PROSPER study since they were in 6th grade. Our developmental model included a random intercept cross-lagged panel model assessing bidirectional relations between family climate and effective discipline, assessed over six measurement occasions from 6th through 10th grade (G1). In turn, random intercepts for family climate and effective discipline in adolescence predicted distal outcomes: young adult antisocial behavior (assessed at ages 20, 23, and 25) and G2-G3 parenting quality (warm, lax, harsh, and abusive parenting) and family-level (cohesion, conflict, routines) functioning. Cross-lagged analyses revealed a bidirectional relation between G1 family processes: in early adolescence, higher levels of a positive family climate were associated with increases in effective discipline; in middle adolescence, the direction of effects reversed, with effective discipline predicting increases in positive family climate. In terms of cascading effects, a more positive G1 family climate was associated with reduced risk for young adult antisocial behavior, but no effect was evident for G1 effective discipline. Antisocial behavior was linked with all three aspects of G2-G3 family climate and with lower levels of parental warmth. Direct, domain-specific intergenerational links were found for G1 family climate with G2-G3 family-level functioning and G1 effective discipline with more effective G2-G3 parenting.

The Problems (and possible solutions) of assessing risk, race and recidivism in long operating drug treatment courts

Formal criminogenic risk tools can be an important control in assessing racial inequities in access to treatment courts and in evaluating both proximal and distal outcomes from those programs. To achieve this potential, however, it is important that risk tools themselves operate in a racially neutral fashion and that they operate consistently over the period assessed. Tools that are not properly calibrated by race and changes in the tools used over the life of a program are therefore significant evaluation concerns. Our paper is the first to assess the adequacy of an important risk-needs instrument, the LSI-R, across racial groups in a drug treatment court setting. The main contribution of the current study is not as a test of that instrument, which has been widely studied in other settings. Rather, because two different criminogenic risk tools were used over the study time period, we took this opportunity to explore the use of a readily constructible “proxy” measure of risk to support analysis of risk and race interactions over the life of the program.

A cluster randomized controlled trial to assess the impact of the ‘Caring for Providers to Improve Patient Experience’ (CPIPE) intervention in Kenya and Ghana: study protocol

BackgroundPoor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interventions to address PCMC. We describe the protocol for a trial to test the effectiveness of the “Caring for Providers to Improve Patient Experience” (CPIPE) intervention, which includes five strategies, targeting provider stress and bias as intermediate factors to improve PCMC and address inequities.MethodsThe trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will be assessed among healthcare workers in the study health facilities and among women who give birth in the study health facilities. The primary outcome is PCMC measured with the PCMC scale, via multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to the intervention), midline (6 months after intervention start), and endline (12 months post-baseline) (N = 2000 across both countries at each time point). Additionally, 400 providers in the study facilities across both countries will be followed longitudinally at baseline, midline, and endline, to assess intermediate outcomes. The trial incorporates a mixed-methods design; survey data alongside in-depth interviews (IDIs) with healthcare facility leaders, providers, and mothers to qualitatively explore factors influencing the outcomes. Finally, we will collect process and cost data to assess intervention fidelity and cost-effectiveness.DiscussionThis trial will be the first to rigorously assess an intervention to improve PCMC that addresses both provider stress and bias and will advance the evidence base for interventions to improve PCMC and contribute to equity in maternal and neonatal health.Trial registrationClinicalTrials.gov: NCT06085105. Protocol version and date: v2-11-07-23

Effects of performance appraisal on employees’ extra-role behaviors and turnover intentions – A parallel mediation model

PurposeResearch on the underlying mechanisms that transfer the effects of performance appraisal (PA) on employees’ behaviors and intentions remains scarce. The social exchange view of performance appraisal can be a source of deeper understanding about these underlying mechanisms. This study aims to investigate how psychological empowerment (PE) and organizational commitment (OC) explain the link between performance appraisal and three important distal outcomes: voice behavior (VB), organizational citizenship behavior (OCB), and turnover intentions (TOI).Design/methodology/approachThe current study utilizes two wave – two source data from a sample of 250 employees and their supervisors from private organizations in Pakistan and tested the mediation model using SMART-PLS.FindingsResults demonstrated that organizational commitment mediated the effects of performance appraisal on VB, OCB, and TOI, whereas psychological empowerment mediated the effects of performance appraisal on VB and OCB. These results have significant implications for theory and practice.Originality/valueThis study adopts the social exchange perspective to examine the mediation mechanisms linking PA with the three distal outcomes: VB, OCB and TOI. The paper identifies two novel mediators of PA – outcome relationship, i.e., psychological empowerment and organizational commitment.

Academic Readiness among Young Children Treated for Brain Tumors: A Multisite, Prospective, Longitudinal Trial.

Young children treated for central nervous system (CNS) malignancies are at high risk for difficulties with academic functioning due to increased vulnerability of the developing brain and missed early developmental opportunities. Extant literature examining academics in this population is limited. We investigated academic readiness, its clinical and demographic predictors, and its relationship with distal academic outcomes among patients treated for CNS tumors during early childhood. Seventy patients with newly diagnosed CNS tumors were treated on a prospective, longitudinal, multisite study with chemotherapy, with or without photon or proton irradiation. Patients underwent assessments of academic skills at baseline, six months, one year, and then annually for five years. Assessments measured academic readiness and academic achievement in reading and math. Mixed linear models revealed slowed development of academic readiness skills over time. Socioeconomic status (SES) was predictive of academic readiness at all time points. Other demographic (eg, age at treatment) and clinical (eg, shunt status, treatment exposure) variables were not predictive of academic readiness. Distal reading difficulties were proportionally greater than normative expectations while math difficulties did not differ. Academic readiness was predictive of distal academic outcomes in reading and math. Treatment for CNS malignancies in early childhood appears to slow development of academic readiness skills, with SES predictive of risk. Academic readiness skills were predictive of subsequent academic achievement. A disproportionate number of long-term survivors performed below age-based expectations in reading. These findings suggest the need for monitoring and interventions targeting early academic skills in this population.

Organisational identification and workers' well‐being: The mediating role of trust, meaning of work and self‐objectification

AbstractGiven the recognised benefits of organisational identification (OI) on workers' well‐being, we investigated the underlying mechanisms of this association in this work. We conducted a cross‐sectional study (N = 192) to examine the possible mediating role of three factors related to individuals' workplace experiences (organisational trust, the meaning of work and self‐objectification) in the relationship between OI and well‐being. Specifically, the research aims to examine the relationship between identification in the workplace and favourable well‐being outcomes. The study results demonstrated the significant indirect effects of the hypothesised model. In particular, OI was positively related to well‐being via increased trust and meaning of work and through a reduced self‐objectification experience. The findings highlight the significance of OI in relation to distal outcomes despite the potential presence of negative perceptual experiences within the relationship. This study seeks to offer innovative perspectives through which we can observe the relationship between less‐examined variables within the workplace, thus providing guidance for practitioners and researchers in this field.

Sink or Swim? Empowering Trainees for Informal Learning to Improve Transfer and Distal Outcomes

Sink or Swim? Empowering Trainees for Informal Learning to Improve Transfer and Distal Outcomes

Associations Between Components of Self-Management Theory and Falls Among Older Adults.

To examine the relationship of key individual and family self-management theory (IFSMT) components, including self-management process variables on proximal (self-management behaviors) and distal (falls) outcomes in older adults. A secondary data analysis was conducted using data of 99 older adults living in continuing care retirement communities in the U.S. Midwest. Descriptive statistics, multiple regression, and logistic regression were performed to analyze the data. The multiple regression model demonstrated a positive association between self-efficacy for physical activity and steps per day. The logistic regression model showed that high expectations regarding aging are associated with reduced likelihood of meeting daily protein intake. Key components of the IFSMT, such as self-efficacy, steps per day, and expectations regarding aging, are important when designing self-management interventions to prevent falls. [Journal of Gerontological Nursing, 50(8), 19-28.].

Promoting home safety with older adults: a systematic review of occupational therapy interventions

PurposeDue to the projected increase in the older adult population, occupational therapy providers will have an increasing role in supporting health outcomes for older adults in the coming years. The purpose of this systematic review was to determine the effectiveness of occupational interventions to promote home safety in older adults.Design/methodology/approachThis systematic review followed the Preferred Reporting Items of Systematic reviews (PRISMA) guidelines. Articles were double screened by separate researchers, then exported and managed in EndNote. The Risk of Bias Table determined certainty of evidence for themes.FindingsThree main preliminary themes were identified from the 17 included articles. Themes include multimodal interventions (n= 6), exercise interventions (n= 9) and home modifications (n = 2). None of the articles explicitly defined home safety, but distal outcomes related to safety included: increased strength, balance improvement and functional mobility.Research limitations/implicationsImportantly, an absent consensus for a definition of home safety limits the results of this systematic review while at the same time providing opportunity for future research.Practical implicationsExercise combined with nutrition provided the strongest intervention evidence for physical functionality. Additionally, home modifications alone may be insufficient to result in improved home safety.Social implicationsAn occupational therapy’s (OT) holistic approach benefits older adults through evidenced-based interventions improving home safety, independence in functional tasks and overall quality of life.Originality/valueFindings provide clinicians with information on the effectiveness of interventions within the scope of OT that can be implemented within the home to promote home safety.

Do Mathematics and Reading Skills Impact Student Science Outcomes?

Establishing validated science programs for students with or at risk for learning disabilities requires testing treatment effects and exploring differential response patterns. This study explored whether students' initial mathematics and reading skills influenced their treatment response to a whole-class, second-grade science program called Scientific Explorers (Sci2). The original Sci2 study employed a cluster randomized controlled design and included 294 students from 18 second-grade classrooms. Differential effects of the program by initial mathematics and reading skill levels were not observed for an interactive science assessment and a distal science outcome measure. However, based on initial reading skill levels, moderation results were found on a science vocabulary measure, suggesting the effects of Sci2 were greatest for students with higher initial reading skills. Similar results were found using initial mathematics skill levels as a predictor of differential response such that students with higher mathematics skills reaped stronger treatment effects on the vocabulary measure. Further, we found initial mathematics skills also influenced outcomes on the proximal science content assessment, where students with higher initial mathematics skills led to higher outcomes. Overall, findings suggest Sci2 produced robust effects for all students (g = 0.24-1.23), regardless of initial skill proficiencies. Implications for exploring differential response in science intervention research are discussed.

A comparison of distal triceps tendon repair outcomes by surgical technique

Distal triceps tendon ruptures are an uncommon injury with several reported repair techniques. Outcomes research between the repair techniques is complicated by the rarity of the injury as most published materials are based on small sample sizes and specific surgical techniques. This study compared surgical complications, reoperations, and range of motion between all suture transosseous tunnel only (TT), suture anchor only (SA), and transosseous tunnel plus suture anchor (TTSA) repair techniques. We retrospectively identified patients who underwent a distal triceps repair at our tertiary-care institution from 2011 to 2021. The electronic medical record was reviewed for patient demographics, triceps rupture characteristics, repair technique, and postoperative complications. This study includes 199 patients who underwent a repair by TT (82), SA (69), or TTSA (48) techniques. No differences were identified between groups with regards to demographics and medical comorbidities. Patients treated by SA technique were more likely to have a loss of elbow extension (SA: 14 [26.4%], TT: 6 [8.57%], TTSA: 4 [10.0%], P= .014) postoperatively with an average loss of 9° for the patients in all groups. However, no differences were identified between the groups with regards to postoperative complications (TT: 15.9%, SA: 17.4%, TTSA: 18.8%, P= .911), including triceps rerupture (TT: 6.10%, SA: 4.35%, TTSA: 12.5%, P= .260), and reoperation (TT: 11.0%, SA: 11.6%, TTSA: 14.6%, P= .822) rates. Regardless of repair technique, distal triceps tendon repair surgery has a relatively high complication and reoperation rate. However, given the similarities between the various methods of repair, surgeons can be confident in repairing this type of injury by whichever modality they deem appropriate.

Child Welfare Outcomes After Attachment and Biobehavioral Catch-Up Intervention Participation: A Quasi-Experimental Study.

Limited research is available examining distal child welfare outcomes after participation in evidence-based parenting interventions. To address this gap, this study employed a multi-tiered analytic approach to examine child welfare outcomes after participation in Attachment and Biobehavioral Catch-up (ABC). Using propensity score analytic techniques to establish a matched comparison group, logistic regressions examined subsequent maltreatment reports and substantiation, and survival analyses observed time to and likelihood of reunification for children who received one of three ABC curriculums compared to comparison group children (child welfare services as usual). In total, 205 children were included in the impact analysis (n = 66 treatment; n = 139 comparison); the majority of the children were White (53.7%), non-Hispanic (84.4%), males (59.5%) with an average age of 6 months (M [SD] = .50 [1.0]). Over half (56.1%) of the study sample was in out-of-home placement; 23.5% of the removed children experienced reunification. No statistically significant group differences were observed on the likelihood of subsequent or substantiated maltreatment reports. All three ABC curriculums were associated with a statistically significant increased likelihood of reunification, when compared to their matched counterpart. Additional research is warranted, though results indicate ABC may be a promising intervention to help enhance the likelihood of reunification.