eConnect: Interactive online delivery of an attachment-based group intervention

Mental health problems are prevalent among adolescents and have significant consequences. Yet there continues to be a significant gap in mental health services for families in Canada, especially in rural and small communities. The COVID-19 pandemic increased the need for such services but created additional barriers for families across communities to access mental health services, particularly group-based interventions. Connect, an attachment-based, trauma-informed parenting group intervention, has been shown to be effective in improving the mental health and functioning of adolescents and parents and has been widely implemented in an in-person format in British Columbia (BC), Canada. The present study reports on the adaptation of Connect for a virtual delivery format (eConnect), as well as the implementation and evaluation of eConnect across communities in BC during the pandemic through a Theory of Change approach. Results supported the effectiveness of the implementation model. Facilitators and the implementation team successfully developed competency in eConnect delivery and reported positive views about their own and their agencies' readiness to continue to deliver the program. Their reports also supported the program's feasibility, acceptability, and sustainability in BC, Canada. Parents' pre- versus post-treatment reports showed significant reductions in internalizing and externalizing problems among their children, their children's attachment anxiety and avoidance, and the use of aggression in parent-child relationships. Improvements in caregiver strain and parental sense of competence were also observed but were smaller than anticipated from prior research, and the reduction in parental depressed mood was not significant. The attenuated and non-significant improvements in parental functioning may be due to the pandemic-related parental stress. While further research, particularly randomized controlled trials, is needed to further investigate the treatment effectiveness of eConnect, the present study provides encouraging evidence to support the continued implementation of eConnect. The implementation-science-informed approach to adaptation and implementation adopted in the present study also informs future efforts to introduce innovations into complex healthcare systems. Implications of the research findings and future research directions are discussed.