HS Dialog, 26(2), Copyright © 2023, ISSN: 1930-9325 Bridging the Gap: Feasibility, Appropriateness, and Acceptability of an Integrated Attachment-Based Training for Teachers and Parents in Early Head Start Carla Caringi Barron1 Claire Vallotton3 Ann Stacks1 Olivia Oates2 Anike Adekoya3 Maria Muzik2 Katherine Rosenblum2 Holly Brophy-Herb3 1Wayne State University 2University of Michigan 3Michigan State University Early care and education (ECE) programs often struggle to consistently engage parents in programming that supports caregiving at home. As part of an Early Head Start (EHS) University Partnership, we adapted an attachment-based, reflective training program centered on supporting teachers to share information with parents; and investigated its appropriateness, acceptability, and feasibility in the context of EHS. Qualitative data from university-based facilitators (n = 8), infant/toddler teachers (n = 20), and parents (n =13), suggest that a small group format and a facilitator stance of openness, curiosity, and cultural humility promoted teachers’ and parents’ positive perspectives of HMB concepts. Participants in this study helped us to understand challenges to HMB’s feasibility, including logistical challenges that need to be considered for successful implementation in other EHS sites. This study tapped the perspectives of stakeholders and provides insights that will support the implementation of ongoing, reflective training models across the ECE system. Keywords: Early Childhood Education, Early Head Start, Infants, Parent-Teacher Relationships, Parent Engagement, Qualitative Study, Reflective Learning RESEARCH ARTICLE INTEGRATED ATTACHMENT-BASED TRAINING 49 INTRODUCTION “HMB+P bridges the gap between the parents and the teachers and the children so that we’re working together as a team to better the development for the child” – Early Head Start Teacher Sensitive and responsive caregiver-child interactions for infants and toddlers across home and early care and education (ECE) contexts support optimal development and school readiness (e.g., Halle et al., 2011; NICHD Early Child Care Research Network, 2002; Tamis-LeMonda et al., 2014). High quality experiences cannot be fully achieved for infants and toddlers without cooperation and communication among the caregivers across these care settings (Elicker et al., 1997): parents or other family members at home (referred to here as “parents”) and educators (referred to here as “teachers”). Importantly, for families in Early Head Start (EHS), the parent- teacher relationship is associated with positive program outcomes (Elicker et al., 2013), which may be in part because the quality of this relationship predicts families’ duration of involvement (Jeon et al., 2018). Thus, family engagement in childcare is considered a standard of ECE program practices (NAEYC, 2019; U.S. DHHS, 2018a), and educator professional competencies (Vallotton et al., 2021). National efforts have been made to provide resources and support to define and assess effective parent-teacher relationships (Porter, et al., 2012), and the competencies needed by ECE practitioners to develop, maintain, and utilize effective partnerships with families (U.S. DHHS, 2018b; 2018c). While ECE programs understand the importance of and prioritize relationships, the focus of interventions is on dyadic relationships in the home or in the classroom, rather than the integration of these relationship systems. To address this, the US Department of Health and Human Services Administration for Children and Families funded four EHS University partnerships, the Parent-Teacher Intervention Consortium, to develop and test integrated interventions for EHS center-based programs that could be delivered as part of their professional development and parent engagement requirements (see Sheridan et al., 2020 and Stacks et al., 2022). As part of this consortium, our team worked with EHS partners to develop and evaluate an integrated program. Hearts and Minds on Babies (HMB) is an attachment- and mindfulness-based multilevel training curriculum that incorporates shared training components for teachers and parents. The program aims to reduce caregiver (i.e., teacher and parent) stress through mindfulness practice and to improve reflective functioning and responsive caregiving through understanding of and reflection upon infants’ and toddlers’ attachment needs. Moreover, through engagement in the integrated parent-teacher components of the HMB program (named Hearts and Minds on Babies + Parents; HMB+P), these two crucial caregiver groups build shared language for effective communication and promotion of social- emotional development. In this paper, we present qualitative data on the shared parent-teacher component. Specifically, we present data on the appropriateness, acceptability, and feasibility of the HMB+P program in the context of EHS. CARINGI BARRON ET AL. 50 Addressing Parent-Teacher Relationship Quality Through Coordinated Interventions Despite national standards for family engagement, available assessments for the parent-teacher relationship, and the known value of this relationship for children’s development, there have been minimal training efforts or interventions specific to improving the quality of this relationship or aligning caregiver-child interactions across home and ECE settings. Most efforts to enhance the quality of infant and toddler interactions with caregivers focus either on the professional development of teachers or on parent-child interactions at home, rather than on a coordinated approach that could influence the same qualities of interactions in both of these important relationships (Landry et al., 2017). Rarer still are any approaches that specifically address the quality of the parent-teacher relationship in ECE. Coordinated training for these caregivers capitalizes on training across school and home contexts and show promising child development outcomes (e.g. Biringen et al., 2012; Yoshikawa et al., 2015); yet evidence for these interventions in the context of infant/toddler care are insufficient (Sheridan et al., 2020). Hearts and Minds on Babies As part of the Parent-Teacher Intervention Consortium, our team worked in partnership with EHS Programs to develop HMB. The HMB program was adapted from an existing, evidence-based, multifamily parenting and mental health intervention, named Mom Power (Muzik et al., 2015; Rosenblum et al., 2018); a clinical intervention rooted in attachment theory, trauma-informed practice, and infant mental health. Mom Power aims to improve parents’ responsive caregiving by increasing their reflective functioning, relational empathy, and coping with parenting stress (Ho et al., 2020, Swain et al., 2017). HMB promotes responsive caregiving by increasing reflective functioning, which enables caregivers to effectively read and respond to attachment needs. It also supports caregivers’ ability to cope with stress by introducing mindfulness-based exercises. A primary goal of our collaboration was to ensure that HMB could be implemented by EHS programs within the context of their professional development and parent programming. Over a five-year period, we conducted a series of Plan-Do-Study-Act cycles with our EHS partner sites to adapt HMB into a three-arm integrated training program that targets multiple levels of the child-caregiving ecosystem: administrators and center leaders (HMB+A); teachers (HMB+T); and parents (HMB+P). In all three HMB program variants, HMB concepts are shared through manualized content and relationship-based interactions. HMB+P: An Integrated Intervention to Bridge the Gap between Teachers and Parents In our initial design of a parent component to the HMB program, we trial tested the use of the original Mom Power parent intervention (Muzik et al., 2015; Rosenblum et al., 2018). While the attachment-based content was appropriate and acceptable to EHS parents, its clinical focus and time requirement (10 weekly two-hour groups and three 90-minute individual sessions) was not INTEGRATED ATTACHMENT-BASED TRAINING 51 feasible for EHS programs or families. Thus, we redesigned the HMB parent component to include three 90-minute parent trainings that were co-facilitated by an HMB-trained EHS teacher and a university facilitator. In collaboration with EHS partners, it was decided that parent trainings would be held during the school day. We also developed a parallel 8-hour teacher training that prepared teachers to present HMB concepts and materials to parents. A cornerstone of the HMB+P training is promotion of shared reflection which is foundational for building trusting and responsive relationships. Its format supports this relationship building as university facilitators and teachers relate to each other in a reflective, relationship-based, and culturally responsive way during the teacher training. This is then carried forward to interactions between parents and teachers in the parent training. The goal is the cultivation of a shared language between parents and teachers to respond to children’s behaviors in an empathic and developmentally appropriate way, and to establish a deeper and more trusting communication between the caregiving partners. Figure 1 describes the HMB+P training and highlights the parallel content for teacher and parent sessions. Figure 1 The Integrated Hearts and Minds on Babies + Parents Training Note: This figure displays the integrated nature of the HMB+P training. The teacher curriculum begins with discussion and activities to support the teachers use of The Tree with parents. The parent curriculum follows by presenting this concept (The Tree) to the parents during their first group. Other core concepts – the Wondering and Response Wheel, Balanced Caregiving, and Sunshine Time – are reviewed during the teacher groups with a particular focus on sharing these concepts with parents in the upcoming parent group and during CARINGI BARRON ET AL. 52 daily interactions, as well as applying the concepts in their relationships with parents. In addition to these foundational HMB concepts, mindful self-care concepts and time to practice strategies are included in both sets of trainings. Parent and teacher groups include time for reflection and opportunities to discuss how HMB concepts fit within their cultural parenting/caregiving practices and cultural understanding. This integrated training model is unique in that it (a) addresses each critical relationship in the ECE system; (b) invites and encourages teachers to turn their reflective lens toward parents; (c) builds foundational competencies with the teacher, then engages teachers as trusted sources of information for parents; and (d) builds teachers’ own competencies for communicating the concepts to parents and in the classroom. See Stacks et al., (2023) for a detailed description of HMB concepts. Implementation Science Strategies to Ensure Feasibility, Appropriateness, and Acceptability An important aspect of the Parent-Teacher Intervention Consortium was to promote consistent, high-quality caregiving across home and ECE settings through the development of useful content that fits within EHS philosophies and can be delivered without ongoing support from the university team. Implementation science involves the use of scientific methods and strategies to investigate feasibility of interventions when they are moved from more controlled settings (i.e. a university- based research study) to the community setting (Durlak, 2015). Defined by Proctor and colleagues (2011), appropriateness of the HMB+P training refers to the perceived fit of the content of the curriculum within EHS, the relevance of the topics for EHS parents and teachers, and whether it is useful and practical within their lived experiences. Acceptability calls attention to whether participants are satisfied with the content, format, and delivery of HMB+P in an EHS context. Lastly. feasibility is assessed by asking providers or organizational settings whether the intervention can be delivered as intended, that is, whether programs can adhere to the recommended facilitator training and supervision, HMB delivery format, schedule, and ongoing use of the concepts. Current Study This qualitative study aimed to explore participant experiences of the HMB+P training to determine whether it was feasible to have teachers deliver HMB+P; and whether and how the training program was acceptable and appropriate. The study research questions were as follows: 1) What is the appropriateness of HMB+P for EHS? 2) How do stakeholders describe the acceptability of the HMB+P format and content? 3) Is it feasible for teachers to deliver HMB+P? INTEGRATED ATTACHMENT-BASED TRAINING 53 METHODS Research Design The current study employed qualitative phenomenological methodology, the goal of which is to document and understand participants’ experiences with a particular phenomenon (Bhattacharya, 2017). HMB+P participant voices and experiences are critical to its ongoing and future use as they promote the implementation of relevant and useful training. Thus, focus groups captured the experiences and perspectives of the EHS teachers, EHS parents, and university based HMB trainers who were involved in HMB+P. Procedure This study was approved by the Institutional Review Board (IRB) at both lead institutions, Wayne State University and Michigan State University. Parents and teachers who participated in HMB+P were recruited via flyers distributed to four EHS programs. Additionally, university-based HMB trainers were recruited via email to add their perspectives. Written consent was obtained prior to focus group implementation. Focus groups varied in length but averaged 90 minutes. Participants were given a meal and $40 cash for their time. A total of ten focus groups across four EHS sites were held in person and led by members of the research team: four teacher groups; four parent groups; and two university-based trainer groups. Focus groups were led by experienced research team members who had knowledge of the HMB training program. Focus groups were audio recorded, transcribed, and personal identifiers were removed. Transcripts were checked for accuracy against the audio recordings. Participants A total of eight HMB university-based trainers; 20 EHS teachers; and 13 EHS parents participated in the study. Study findings and participant demographics are reported in aggregate to maintain a level of confidentiality. Participants were predominantly Black (83%) and female (93%). The distribution of race and education varied in each group (see Table 1). Table 1 Participant Demographics Facilitators (n = 5) Teachers (n = 14) Parents (n = 11) Total (n = 30) n % n % n % n % Gender Male 0 0 1 7.1 1 9.0 2 6.7 Female 5 100.0 13 92.8 10 90.9 28 93.3 Race a CARINGI BARRON ET AL. 54 American Indian or Alaska Native 0 0 1 7.1 0 0 1 3.3 Asian 0 0 0 0 1 9.1 1 3.3 Black or African American 1 20.0 13 92.8 11 100.0 25 83.3 White 3 60.0 2 14.3 0 0 5 16.7 Other 1 20.0 0 0 0 0 1 3.3 Ethnicity Hispanic/Latino/a 0 0 2 14.2 1 9.1 3 10.0 Highest Level of Schooling b High School/GED 0 0 2 14.2 4 36.3 6 20.0 Some College Credit 0 0 1 7.1 2 18.1 3 10.0 Associate degree 0 0 5 35.7 2 18.1 7 23.3 Bachelor’s degree 0 0 6 42.8 2 18.1 8 26.6 Graduate degree 5 100.0 0 0 0 0 5 16.6 a Percentage larger than 100 due to multiple races chosen b Missing Data: One parent participant did not answer Measures Semi-Structured Interview Guide. Qualitative data were gathered using a semi-structured interview process. Guided by implementation science (Durlak & DuPre, 2008), the focus group interview protocol was developed to prompt study participants to think deeply about their experience participating in HMB+P and probe for their thoughts related to its feasibility, appropriateness, and acceptability. Following recommended protocol for qualitative interviewing (Padgett, 2017), focus groups began with overarching questions about the HMB training experience such as, What general feedback do you have about Hearts and Minds on Babies for EHS parents. Teacher groups then continued with more specific questions such as: How is HMB+P relevant to the mission and goals of Early Head Start and How does the workplace climate at your agency or center impact your ability to engage in training and use HMB concepts. Additional questions for parents included: How was it to have an EHS teacher share information with you and What are you doing differently as a result of the HMB+P training. Questions for university-based trainers included: What did you see as the advantages of having teachers share concepts with parents and What barriers did you observe or experience when planning and facilitating the parent groups. Demographic Information. A demographic form was used to gather information related to each participant’s race, ethnicity, gender identity, and level of schooling. Teachers and facilitators were also asked about years working in the field. Data Analysis Thematic analysis as described by Braun & Clarke (2006) was used to discern and capture the experiences of study participants. Thematic analysis is deemed appropriate when the research INTEGRATED ATTACHMENT-BASED TRAINING 55 questions focus on the lived experiences and perspectives related to a particular phenomenon (Saldaña, 2021). Data analysis was completed by a three-person university-based coding team lead by the first author. The team comprised of three cisgender women, one who identifies as Black and two who identify as white. Two of the members of the team hold masters-level training in social work and one was an undergraduate student at the time of the analysis. In addition, each held additional roles in the HMB implementation project: one team member was involved in HMB’s initial development, implemented HMB teacher groups, and co-facilitated three of the study focus groups; another member implemented parent groups and co-facilitated two of the study focus groups; the third member was involved in data collection and management. Data analysis involved the use of qualitative software (Dedoose, 2021). First, initial coding was completed by assigning in vivo codes within the transcripts (i.e., codes using the language and terminology used by the research participants). Initial codes from each participant group were collated into themes and renamed to align with the content of the theme. Initial themes from all transcripts were then collected, combined, and collated together (see Figure 2). Themes across participant groups were then grouped by relationship to each other and collapsed when deemed connected and similar in meaning. Final theme groupings were then sorted into related categories. At the final level of this iterative analysis, clear definitions and names were generated for each of the categories relevant to the study questions (Braun & Clarke, 2006). Figure 2 Process of Analyzing and Categorizing Data from Three Participant Groups CARINGI BARRON ET AL. 56 Considerations of Trustworthiness Strategies attending to rigor and trustworthiness were used throughout this study to ensure that data collection and analysis remain grounded in the participant perspective. While qualitative research captures the depth of an experience and the researcher's perspective can add to its richness (Bhattacharya, 2017), it is important that the researcher's perspective is used to understand and interpret the participants’ views, not override the participants’ experiences with the researcher’s assumptions, expectations, and ideas (Saldaña, 2021). This is especially important to consider in the HMB implementation, as members of the coding team had other roles in this study. Therefore, it was critical to use bracketing, qualitative memoing, and peer debriefing throughout the data collection, analysis, and dissemination (Padgett, 2017; Saldaña, 2021). Importantly, any researcher assumptions that were identified were discussed and challenged among the coding team to ensure that the identification of themes remained grounded in the data. Throughout the data analysis period, coding team members met weekly and engaged in open discussions to challenge each other and discuss any differences in perspective. Disagreements related to codes and themes were resolved by returning to the data and engaging in discussion until coming to a consensus (Saldaña, 2021). FINDINGS This study’s purpose was to understand participant experiences of HMB+P. Descriptions of participants and their data use the singular ‘they’ pronouns and the forms their and them. Question 1: What is the appropriateness of HMB+P for EHS? Three main categories emerged from the parents, teachers and university-based facilitators related to the appropriateness of the HMB+P training (table 2 lists final categories and themes): (a) cultural relevance of concepts; (b) promotion of parenting skills; and (c) promotion of parent-teacher relationships. Table 2 Final Appropriateness Categories and Themes from Teachers, Parents, and University-based Facilitators Primary Category Theme Cultural relevance of concepts Theoretical foundations can be cross-culturally applicable Some concepts challenged parental values and cultural/racial experiences Promotion of parenting skills Provided developmental knowledge Promoted parenting efficacy Promotion of parent-teacher relationships Shared language Shared experience New perspectives of each other INTEGRATED ATTACHMENT-BASED TRAINING 57 Cultural Relevance of Concepts Data from this study suggest that the theoretical foundations and content of the HMB training can be applicable across cultures, particularly the importance of caregiver-child relationships and acknowledging children’s emotions. However, data also suggest that some of the HMB concepts challenged cultural and racial experiences, values, and beliefs related to raising young children. Theoretical Foundations can be Cross-Culturally Applicable Participants in this study agree that the theoretical foundations of HMB are applicable across cultures. This teacher believes that acknowledging one’s own feelings, children’s feelings, and co-regulation crosses all cultural beliefs: “I feel like it doesn’t depend on, it doesn’t, um, matter what culture, you still be able to acknowledge a child’s feelings. You still be able to balance yourself, you know, when, uh, approaching a child like I said before, you have to calm yourself before, you know, approaching.” Some Concepts Challenged Parental Values and Cultural/Racial Experiences Data from this study suggest that some of the concepts promoted behavioral responses that challenged values and beliefs about parenting and the needs of young children that were learned through early relationships and family culture. This parent helps us to understand the dissonance that can be evoked when their childhood experiences were different from HMB concepts and ways they want to respond to their own children: “...when my eight-year-old decided to push the two-year-old off the porch...I need[ed] to take a breathe moment. ‘Cause my first instinct because how I was raised, was like whack her on her butt send her to her room. And it’s, it’s hard to break what we grew up with. Especially like with the new studies that come out ‘cause I look back and…it gives me, personally, it gives me that kind of confusion on like I saw that worked with my brother and I, but not wanting to do it with my kids.” Promotion of Parenting Skills Study participants identified ways that HMB+P was appropriate for parents of very young children. Data suggest that HMB+P: (a) provided parents with developmental knowledge; and (b) promoted parenting efficacy and confidence. Provided Parents with Developmental Knowledge. Data from this study suggest that HMB+P showed parents the dyadic and collaborative nature of communication and encouraged parents to consider the emotional needs behind their child’s behaviors, including wondering about and labeling their child’s emotions. This parent described how they were better able to respond to their child’s needs at separation after attending HMB+P: CARINGI BARRON ET AL. 58 “I tell him like it’s okay, I love you. He might cry a little bit but you know when I see him I tap him on the back and I be like, I be back. And I notice a difference not only taking him away from me all the time, but I noticed a difference in school. Like his behavior, um, got a little better with him going away because it let him know like it’s okay for me to be apart from mom because she’s gonna always come back, so I’m happy that I did do that. It took a while but, but it, it really helped.” Promoted Parenting Efficacy and Confidence. In addition to developmental knowledge, data from this study suggest that HMB+P content and being in group with other parents, helped participants increase confidence in their parenting role and choices. This parent describes how HMB+P helped them to understand that they were not alone in struggling with parenting: “And we live in a world where everybody’s outputs this perfect life, that kids are perfect, they never sass, and they never talk back. So, then you sit back and you’re like, what am I doing wrong? So, the class helped...me understand these are the phases they go through. This is how you can help them through it. And that it’s normal. Everybody goes through it not just me. ‘Cause that can be hard.” Promotion of Parent-Teacher Relationships Data from this study suggest that HMB+P promoted positive teacher-parent relationships through the following three themes: (a) shared language and shared experience; (b) new perspectives of each other; and (c) increased trust in the teacher. Shared language and experience. Teachers, parents, and university-based trainers noted that HMB’s unique way of presenting social emotional development, such as the Tree metaphor, allowed for the development of a shared language that can be used among participants to talk about the importance of social-emotional development and early relationships for children. This teacher identifies how the shared language and shared experience of HMB+P promoted collaboration between parents and teachers: “I think that, um…once the teachers go through it [HMB+T] and then they’re able to use, utilize the concepts in their classrooms and then…we were able to go into the parent group and share what we’ve learned, and how we, um…facilitated in our classroom, and helped them to be able to…use the same concepts with their children at home. I think that it gives the parents, um…kind of a sight into the classroom without being in the classroom. Like, okay. This is working for them in the classroom, I can do this at home. So it kinda bridges the gap, um, between the parents and the teachers and the children so that we’re working together as a team to better…the development for the child.” New Perspectives of Each Other. This teacher talks about how HMB+P helped them to understand the importance of the parent’s perspective to their working relationship: INTEGRATED ATTACHMENT-BASED TRAINING 59 “I would say that we have to have partnerships with the parents. So it [HMB+P] kind of helps, it helps like give us ideas how to talk to the parents or like ways to kind of understand maybe what they are bringing to the, to the, that side of, you know, for their child and kind of where they’re at and how we can meet in the middle.” Increased Trust. Study participants noted that the integrated training approach allowed them to form more trusting relationships. This parent described how having the teacher as a facilitator of the parent group enhanced their confidence in the teacher, supported buy-in and connection to the material, and supported the parent-teacher relationship: “They went through the class [HMB+T], you know, before us. That alone boosts my confidence because at that point I know they know what they doing. You know, I have that confidence that, you know, they’re following the, you know, the training. I mean, they’re following the, the resources, what they learned in doing the training, everything.” Question 2: How Do Stakeholders Describe The Acceptability Of The HMB+P Format And Content? Two main categories emerged from teachers, parents, and university-based trainers about the acceptability of HMB+P (table 3 lists final categories and themes): (a) cultural and racial experiences need to be considered; and (b) structure of training. While participants in this study noted that HMB was beneficial and relevant, dissonance between cultural beliefs and the HMB concepts was identified, and participants stressed the importance of time for teachers and parents to process these feelings and consider how HMB concepts might fit their lived experience. Table 3 Final Acceptability Categories and Themes from Teachers, Parents, and University-based Facilitators Primary Category Theme Cultural and racial experiences need to be considered Content needs to be presented with stance of cultural humility and curiosity Consider current and historical sociocultural contexts Structure of ongoing training Promoted reflection Motivation to participate Understanding of HMB concepts takes time Cultural And Racial Experiences Need to Be Considered Themes from this study suggest that within the content of the training and its delivery, cultural and racial experiences of the participants must be considered. Content should be presented with a CARINGI BARRON ET AL. 60 stance of cultural humility and curiosity that includes consideration of current and historical sociocultural contexts of families and staff. Content Needs to Be Presented with A Stance of Cultural Humility and Curiosity. Data from this study underscored the importance of having time to discuss cultural and family norms and values related to young children’s development and parental responses. Following is a quote from a university-based facilitator who is attempting to hold in mind the cultural and racial realities of some parents and teachers that can get in the way of embracing and putting into practice HMB concepts. This facilitator advocates for time to think deeply about cultural fit: I think that [the concepts] fit, but there isn’t time in the curriculum to, to fully unpack them. I think the Wondering and Response Wheel [reference to a specific tool used in curriculum to enhance reflection], well, it’s hard, uh, for parents who...uh and teachers, who are in these very complex situations where they’re, they feel like there just isn’t time to stop and think. Um, and also the belief where, just the thinking about you know, cultural and historical perspectives, how, you know, historical narratives where, like you, if you’re acting out, you just need to stop.” Consider Current and Historical Sociocultural Contexts. Focus group participants described the need for HMB facilitators to consider the current and historical sociocultural contexts of EHS families and staff, such as gender and racial identity experiences and the neighborhoods and communities within which they live. These parents offer reflections on the contexts within which they are raising their children and how racism and levels of safety impact disciplinary strategies used by their caregivers and themselves: “When I was growing up we were spanked if we was bad. And I tried not to do that. But sometimes it happens. If someone is in danger, someone is getting wacked on the booty. But trying to find that balance is kind of difficult because this is how I was taught. This is how we do it. It’s totally un-okay in other areas. So, trying to find what meets being okay around and being okay in your household has been kind of difficult.” “I believe it trickled down from slavery and how we was treated and how our parents was raised. Because even the other day I saw a big long branch and told my son to come here...but I didn’t do it, you know. I talked to him and went and played by him with the rest of the kids. He said ‘no mommy I don’t want a whooping.’ I said, ‘good, because I don't want to beat you with this branch.’ Structure of Ongoing Training A theme emerged from this study that suggests the way in which HMB+P is structured (ongoing, group-based, reflection, practice) helps parents think about and reflect on the changes they made in their parenting, which in turn helped parents to see how HMB the concepts fit with their lived experience. However, intrinsic motivation to attend benefitted participants, due to the ongoing nature of the group as well as the need for time to integrate HMB concepts. INTEGRATED ATTACHMENT-BASED TRAINING 61 Promoted Reflection. This parent helps us to understand that HMB+P helped them gain insight about their own emotional and behavioral response, and now they are better able to respond to their child’s feelings: “For me, it just help me, you know, take time to assess their feelings before I react in a situation. I realize I react too quickly to situations. Not just with [the three- year-old], with my teenagers as well, so I’ve been caring about they feelings and it’s helpful.” Motivation to Participate. Intrinsic motivational factors were important to acknowledge. Some parents and teachers were intrinsically motivated to attend groups as they valued ongoing learning and wanted to support children in new ways. These parents identify intrinsic motivation to try the training and continue to attend HMB+P groups when they say that the concepts were relevant and useful: “Anything where I can learn about what’s going on with my child, I put myself involved.” “After the first class, I was more excited to go to the next ones because…I tried those things. They worked, and I’m like “Okay, I want to know more. What else can I do?” Understanding of HMB Concepts Takes Time to Develop. Participants in this study identified that understanding promoted use of the concepts. This university-based trainer states that a teacher has to “get it” in order to be able to integrate and use the information with parents: “You have to, like, you have to like, I don’t know how to...you have to get it, you have to be able to relate it to how it’s going to make you a better teacher and how it’s gonna make, you know, give the skills to parents to make them happier.” However, data also suggest that understanding of the concepts takes time. Another university- based trainer identified how HMB allows time to develop the understanding that is important to ongoing use of the concepts: “The HMB+P group was a nice way [for teachers] to stay connected to the material that I think just needs a lot of time to become an ingrained part of your...being. For Head Start, I think they need the...revisiting of it...to keep everyone connected to it all.” Question 3: Is It Feasible For Teachers To Deliver HMB+P? Data from the university-based trainers and teachers who participated in HMB+P teacher groups and co-led parent groups suggest two main categories to consider related to feasibility (table 4 CARINGI BARRON ET AL. 62 lists the final categories and themes): (a) the reality of the classroom and (b) elements needed to use and share HMB concepts. Table 4 Final Feasibility Categories and Themes from Teachers and University-based Facilitators Primary Category Theme The reality of the early childhood setting Classroom responsibilities Parent availability Elements needed to use and share HMB concepts Supportive learning environment Dispositions Professional Knowledge and skills The Reality of The Early Childhood Setting Teachers and university-based trainers expressed concern over classroom responsibilities that took precedence over the teacher’s facilitation of the three HMB+P groups. Even though sites planned for consistent substitute teachers, teacher facilitators in this study described that it was difficult to leave the children and their co-teachers to facilitate HMB+P parent groups due to a lack of consistent staffing support in their classroom. Additionally, some parents’ work schedules did not permit them to attend HMB+P sessions during the day, so teachers were prompted to share information at drop-off and pick up where parents’ time was limited. This teacher described the challenge to engage parents in conversation when the parents could not participate in HMB+P: “I think just for the parents who were part of the group, they benefited from it the most. Parents who were not, it just a foreign language. They’re dropping their kids off, they going home, going to work. So it’s kind of hard to be like, “Let me tell you about this tree [concept]!” When you’re on your way out the door.” This university-based trainer expressed concern about teachers facilitating parent groups due to their classroom responsibilities, which limited their time for debriefing and supervision: “For most of them [teachers], this was their first time doing something like this. They were [facilitating] the same group that we were in, and to assume that they didn’t need some debriefing time afterwards, it just seemed odd to me and then, and they, my teacher, too, had to go immediately into her classroom after group.” Elements Needed To Use And Share HMB Information The second category related to feasibility includes the elements necessary for sharing HMB information with parents and facilitating HMB+P groups. Data suggest three themes in this category: (a) supportive learning environment; (b) dispositions; and (c) professional knowledge and skills. INTEGRATED ATTACHMENT-BASED TRAINING 63 Supportive learning environment. Participants in this study underscored the importance of their EHS program’s organizational and leadership supports to share HMB concepts with parents. When teachers did not have the logistical and emotional support from the administration, they experienced more challenges. This teacher who facilitated an HMB+P parent group describes what support from their administration was necessary to successfully implement the concepts as well as the HMB+P groups: “...there was support in terms of like, acknowledging the concepts and kind of encouraging us to use them...but I would say that we did probably need more support in terms of, like, they knew we were facilitating the meetings and doing these things, but we didn’t always have, like, [class]room coverage. So we didn’t, I feel like in that way, we didn’t always have support.” Dispositions. Teachers and university-based trainers identified intrinsic dispositions that were important for teachers to share and for parents to be ready to learn HMB concepts. These dispositions include being open-minded, a capacity for reflection, patience, and curiosity. This university-based trainer describes the importance of maintaining an open and curious stance when learning the concepts and sharing them with others: “I would say curiosity is, curiosity, um, for, some of our teachers, we saw reflective capacity really evolve, where they came in really struggling with it. Uh, so I would say curiosity and some degree of readiness to, not, not even ready readiness in “Ooh, I want to be more reflective. I want to increase my reflective capacity,” but “I wonder what this is all about?” Professional Knowledge and Skills. Teachers and university-based trainers acknowledged that successfully engaging teachers and parents requires HMB facilitators to have the following professional knowledge and skills: knowledge of early childhood and the HMB concepts, skills in group facilitation, and skills to engage parents. Data from this study suggest that the required knowledge and skills for facilitation were best achieved by participating in an HMB group as a teacher or administrator before attending a training to facilitate an HMB+P group. This university- based trainer highlights the importance of teachers having confidence in their professional knowledge when sharing HMB information with parents: “You have the tools, you have the...being able to go with your gut and do what you need to do, so I think they have to have some confidence that they can do this...it’s just a tool to be able to have that relationship and conversation with a parent.” DISCUSSION This study aimed to investigate the appropriateness, acceptability, and feasibility of an attachment- and mindfulness-based intervention for EHS parents - HMB+P. Findings suggest that HMB+P was beneficial to teachers and parents who were able to participate in the group sessions and that teachers had the knowledge and skill to facilitate HMB+P, yet feasibility remained a problem due CARINGI BARRON ET AL. 64 in part to organizational capacity. Overall, the parent group training sessions were acceptable for parents who were able to attend during the day, and parents were able to use the HMB concepts within their daily lives, suggesting the content was appropriate. Importantly, findings from this study offer insights into the significance of supporting cultural humility in group facilitators and ways to integrate parent training and engagement in ECE settings that enhances the parent-teacher relationship and caregiving quality. Appropriateness and Acceptability of HMB+P Participants in this study helped us to understand the integrated nature of appropriateness and acceptability. We found that while the HMB concepts were culturally relevant, promoted caregiving skills and developmental knowledge, and that both the content and format promoted parent-teacher relationships, these benefits could be impacted by the format and delivery of HMB+P. For example, we found that it was important to consider the delivery of the HMB concepts (acceptability) as this may impact how the participants were able to integrate the concepts into their lived experience (appropriateness). We were particularly interested in whether the concepts and practices would be seen as culturally relevant, given variation in cultural views of young children’s emotions and behavior, and practices in responding to these (e.g., Burchinal et al., 2010; Dodge et al., 2005; Dunbar et al., 2017; Jambunathan et al., 2000). Data from this study suggest that while the concepts are relevant to multicultural perspectives, this finding may not generalize to parents and teachers with cultural backgrounds different from the current study participants. We found that some HMB concepts challenged cultural views and required HMB facilitators to maintain a stance of cultural curiosity and cultural humility. Participants stressed the importance of HMB facilitators providing time for teachers and parents to process these feelings and to consider how the concepts might fit their lived experience despite the dissonance they might first identify between HMB concepts and their beliefs about children. Thus, findings underscore the need for more thought and training related to how the concepts were presented and discussed in the group. Key concepts in HMB+P related to reflection, relationships, and responsiveness required facilitators to be flexible in the ways they delivered the content. For example, taking time to respond to participants’ differing perspectives that arose out of their cultural contexts, meeting these differences with curiosity, and encouraging exploration of the ideas through reflection. In this way, the participants could explore the ideas and perhaps their discomfort with them through reflection, without fear of risking a rupture within the group or with facilitators. Principles of culturally responsive teaching and learning (Gay, 2018) support these findings. Connecting the material to the cultural values, language, and beliefs of participants, and using examples and perspectives of diverse participants, increases the acceptability of the training, and can promote integration and use of the HMB material (Gay, 2018). Participants in this study noted that the HMB material provided developmental knowledge and promoted feelings of efficacy and confidence among parents. The sharing of knowledge within a cultural framework paired with the HMB relationship-based and reflective structure, has the potential to bolster these outcomes. Participants can learn material in ways that connect to their INTEGRATED ATTACHMENT-BASED TRAINING 65 cultural experiences and have time to think about and practice new strategies, with opportunities for continued reflection and feedback from the group. Teachers as Facilitators: Parallel Content and Format Next, training teachers to run parent groups was an attempt to engage parents in a new way. This unique way of implementing parent groups allowed for the development of a shared language and shared experience between the teachers and parents, which furthered the use of the HMB concepts with the children. Thus, HMB+P built a bridge between the classroom and the home environment and strengthened relationships between parents and teachers, which is particularly important to the lives of children and caregivers. Improved teacher-parent relationships can increase parents’ access to information about their child’s classroom, learning, and development. In turn, this can promote parental self-efficacy and parental motivation to remain involved in the program and continue to invest in trusting relationships with teachers and staff (Powell et al., 2010; Rosenblatt & Peled, 2002). In addition to these parental outcomes, improved teacher-parent relationships can also promote teacher efficacy and confidence in their educator role (Karakus & Savas, 2012). While the benefits of parent and family engagement are well documented, it can be challenging for educational programs to develop meaningful partnerships with parents that support continued engagement in services. Indeed, we found that the ongoing nature of the HMB+P groups was a continued challenge to both teacher and parent attendance; which could impact the development and strengthening of parent-teacher relationships. In addition, there are multiple perspectives on what parent engagement entails. This research points to the importance of involving stakeholders to define and determine best practices to support parent engagement in ways that are unique to particular ECE sites and teacher and parent populations. HMB+P used a unique training delivery format to engage and support families. Although the use of teachers as facilitators presented additional challenges to the feasibility of implementation, the unique structure and format of HMB+P (with teachers as both participants in groups and facilitators of parent groups) was important to the benefits we found in this study. Teachers and parents reported that HMB+P strengthened their abilities to communicate with one another about children’s behaviors and needs. When parents were able to attend the groups, parents and teachers developed a shared language for talking about children’s behaviors and needs and built a mutual understanding. Teachers’ abilities to practice effective bidirectional communication with families, and their subsequent knowledge about the child and family is an important relationship skill in family engagement. Communication between parents and teachers about children’s behavior and what it means provides a link between the home and ECE contexts, and provides each caregiver with greater insights, enabling them to become more sensitive to children (Elicker & Fortner- Wood, 1995; Lang et al., 2016; Owen, et al., 2000). Feasibility of the HMB+P Training Daily realities of the ECE setting. Even the most effective intervention cannot be effectively implemented if it is not feasible in that setting. Data from this study suggest things to consider that CARINGI BARRON ET AL. 66 could impact the implementation of HMB+P in EHS and childcare partners. First, the reality of the ECE setting was identified as important to consider when implementing an ongoing, integrated training. As we were adapting Mom Power into HMB+P, parents noted that they wanted their child’s teacher to facilitate the HMB+P groups, that they enjoyed time to reflect with other parents, and that they needed childcare to attend parenting groups (Stacks et al., 2023). EHS administration was very supportive of this idea but pointed to the Head Start Performance Standards as limiting in this context as they tried to juggle providing enough educational hours to children, professional development to teachers, and not going beyond a 40-hour work week for teachers or site leaders. This meant finding a way for teachers to be out of the classroom to prepare for and offer the group, de-brief, and attend reflective supervision, approximately 4 hours/month for 3 months. Our EHS partners tried to be creative so that when teachers were out of the classroom a consistent, familiar substitute was available. This is important from an attachment perspective; it ensures that the co- teacher does not endure additional stress and allows the teacher facilitator to be fully present in group and provide parents with a felt sense of security. However, teachers in this study reported challenges when they were scheduled to leave the classroom to co-facilitate the parent groups and we found that they were often unable to plan and debrief effectively due to time and staffing constraints. They also found it difficult to leave the children when they were unable to help the children understand and plan for who was going to come into the classroom to take their place. In addition, scheduling the teacher groups was challenging due to limitations on paid time for professional development. We found that agency trainings that satisfied requirements for licensure, for example CPR, would take precedence over HMB+P, and would contribute to inconsistent attendance. This element of feasibility connects with the participants’ views of the acceptability of HMB; that is, the ongoing nature of the group and the time and opportunity for reflection was important to the use and integration of the concepts; yet having sufficient time for reflection came into conflict with the daily realities of scheduling, staffing, licensing standards and children’s needs in the ECE setting. Reflective practices and supportive learning environments. Next, individual- and organizational-level implementation drivers were identified to effectively use and share HMB concepts and information. Implementation science stresses the importance of identifying skills and attributes of staff, named competency drivers, that support the learning, use, and sharing of training concepts (Durlak & DuPre, 2008; Fixsen et al., 2018). Participants in this study identified several qualities, or dispositions that would support the learning and teaching of the HMB concepts. Important to HMB were being open-minded and having a capacity for reflection, patience, and curiosity, which are key dispositions for learning and using reflective practices in early child education (Vallotton et al., 2021). Additionally, for participants in this study, a supportive learning environment included a level of organizational support that allowed teachers to engage in training, integrate the concepts with parents, and reflect. Thus, the feasibility of implementing the HMB+P concepts in the context of EHS relied not only on overcoming logistical challenges related to staff time that inhibited full participation, but also on the psychosocial characteristics of individual teachers and their relationships in the ECE setting that enabled them to engage fully in the content of the trainings. INTEGRATED ATTACHMENT-BASED TRAINING 67 Feasibility Meets Appropriateness and Acceptability. There were challenges to consistent participation for both teachers and parents that are important to consider and understand in future iterations of HMB+P and other multi-session professional development trainings within the ECE setting. An ongoing or multi-session group that relies on the relationships and reflective stance developed among group members over time, and presents content that builds from week to week, is challenging to implement within the ECE setting and within the busy lives of teachers and parents. While parents stressed their own intrinsic motivations to participate in groups that will benefit their parenting skills and the children’s development, they also noted how hard it can be to add another commitment into their daily routines. In addition, considering the importance of culturally relevant teaching and the time it may take to integrate HMB concepts into interactions with young children, the concepts and strategies learned may not show immediate results. That is, for some parents, the implementation of HMB concepts may challenge some existing beliefs and experiences about behaviors which parents may need to consider and discuss among the group. These ideas take time to understand as it is often not until a parent (or teacher) has practiced it, gained skills, and experienced the benefits that they may see how it is relevant to them. Strengths and Limitations Sampling within each stakeholder group – university-based trainers, teachers, and parents - allowed for multiple perspectives on the HMB+P training. Because the ECE setting involves levels of important relationships, it was critical to understand the perspectives of all those involved. Additionally, the use of an implementation science framework throughout the development and implementation of this study (community partnership-building, methodology, data collection, and dissemination) is a strength that can promote the implementation of HMB as well as other professional and parent training within the ECE setting. Further, research study staff who facilitated the focus groups and completed the data analysis were familiar with HMB content and its approach to training. This knowledge and experience allowed for rich discussion within the focus groups and probing questions that provided in-depth reflections about the HMB+P training. However, there are limitations that should be taken into consideration when interpreting the findings. First, the researchers did not return to the study sample to review the qualitative findings. Member checking is an important trustworthiness strategy within qualitative research to ensure that the themes extracted from the data in fact do reflect the perspectives of the participants (Padgett, 2017); and would also provide clarification of ideas and additional perspectives on the identified themes (Saldana, 2021). The focus group data were collected just prior to the outbreak of COVID-19. Due to restrictions imposed during the height of the pandemic, we did not have access to our hard-copy forms that contained the participants’ contact information. Further, while this study illuminates important considerations for the HMB+P program and posits that these could benefit other multi-session training programs within the ECE setting, the findings are unique to this intervention within the context of our ECE partner programs, and not generalizable beyond. However, the fact that these data come from participants across four different sites and in two different communities add robustness to the heuristic value of the findings. CARINGI BARRON ET AL. 68 Future Directions Importantly, future HMB work must continue to cultivate a deeper understanding of how the challenges to an ongoing group format can be minimized to promote the relationships and time necessary to teach the concepts within a stance of cultural humility and curiosity. The use of culturally relevant teaching strategies is important to consider within professional development and family engagement, and important to future iterations of HMB+P. CONCLUSION HMB+P is a unique integrated training model in which the format and delivery supports the learning and integration of relationship- and attachment-based content. 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