Background Attachment refers to an infant’s instinct to seek close proximity to their caregiver and research has shown it is important in promoting a child’s healthy social and emotional development. Parenting interventions have been developed in order to promote secure attachment and reduce disorganised attachment. Many interventions used in routine practice have a limited evidence base (e.g. no randomised controlled trials [RCTs]) and it is important that they are robustly evaluated to ensure they are safe and effective.

Objectives The research aimed to; conduct a large scale survey to determine what interventions are being used in UK services to improve attachment in infants, conduct a systematic review assessing the evidence base for parenting attachment interventions and to develop recommendations for future research and practice on the use of these interventions.

Methods We used a national survey, focused on relevant UK services, to collect details around the interventions being used to treat attachment problems. These results informed two systematic reviews. One review searched for all RCT evidence for any parenting attachment intervention. The second review searched for all available research focused on the top ten routinely used interventions identified from the survey.

Results The survey collected 625 response from 734 services. This recorded information around which interventions were most commonly used, how they were delivered and the measures of attachment used.

For the first review, 7 studies were included from 2,516 identified records. These results were combined with a previous systematic review conducted by the research team to update two separate meta-analyses, yielding 20 studies measuring disorganised attachment and 26 studies measuring secure attachment. Overall, parenting interventions are effective in reducing disorganised attachment (p<0.001) and increasing secure attachment (p<0.001) in children.

The second review looked at all available literature for the top ten routinely used interventions identified by the survey. Searches returned 1,198 records, with a final inclusion list of 61 studies. These studies identified that the most commonly used interventions in UK services (including Individual Child Psychotherapy and Dyadic Developmental Psychotherapy) have very little or weak evidence base whereas the interventions with the strongest evidence base and highest number of RCTs (including Attachment Bio-behavioural Catch-up and Video Feedback Intervention to Promote Positive Parenting) are not widely used.

Conclusions Parenting interventions are effective in treating attachment problems. However there is a current disconnect between research and practice. The large variation in intervention research may be related to research funding opportunities or practitioner and academic preferences. The variation in practice may be related to training opportunities and costs, intervention complexity, cost and accessibility; and preferences from clinical leaders and commissioners. High quality research evaluating interventions that are used in services is needed, whilst including patient and public involvement to ensure that the research is translatable to practice. Good quality dissemination and training should also inform the public, clinicians and commissioners and shed a light on which interventions practices should use to improve attachment relationships.

Funding Statement This Project was funded by the National Institute for Health Research (NIHR) HTA programme (Project Number NIHR127810).