A Brief Home-Based Parenting Intervention to Reduce Behavior Problems in Young Children

Abstract

Behavior problems are one of the most common mental health disorders in childhood and can undermine children's health, education, and employment outcomes into adulthood. There are few effective interventions for early childhood. OBJECTIVE To test the clinical effectiveness of a brief parenting intervention, the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), in reducing behavior problems in children aged 12 to 36 months. DESIGN, SETTING, AND PARTICIPANTS The Healthy Start, Happy Start study was a 2-group, parallel-group, researcher-blind, multisite randomized clinical trial conducted via health visiting services in 6 National Health Service trusts in England. Baseline and 5-month follow-up data were collected between July 30, 2015, and April 27, 2018. Of 818 eligible families, 227 declined to participate, and 300 were randomized into the trial. Target participants were caregivers of children who scored in the top 20% for behavior problems on the Strengths and Difficulties Questionnaire. Participants were randomly allocated on a 1:1 basis to receive either VIPP-SD (n = 151) or usual care (n = 149), stratified by site and number of participating caregivers. Analysis was performed on an intention-to-treat basis. Statistical analysis was performed from September 5, 2019, to January 17, 2020. INTERVENTIONS All families continued to access usual care. Families allocated to VIPP-SD were offered 6 home-based video-feedback sessions of 1 to 2 hours' duration every 2 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the score on an early childhood version of the Preschool Parental Account of Children's Symptoms, a semistructured interview of behavior symptoms, at 5 months after randomization. Secondary outcomes included caregiver-reported behavior problems on the Child Behavior Checklist and the Strengths and Difficulties Questionnaire. RESULTS Among 300 participating children (163 boys [54%]; mean [SD] age, 23.0 [6.7] months), primary outcome data were available for 140 of 151 VIPP-SD participants (93%) and 146 of 149 usual care participants (98%). There was a mean difference in the total Preschool Parental Account of Children's Symptoms score of 2.03 (95% CI, 0.06-4.01; P = .04; Cohen d = 0.20 [95% CI, 0.01-0.40]) between trial groups, with fewer behavior problems in the VIPP-SD group, particularly conduct symptoms (mean difference, 1.61 [95% CI, 0.44-2.78]; P = .007; d = 0.30 [95% CI, 0.08-0.51]). Other child behavior outcomes showed similar evidence favoring VIPP-SD. No treatment or trial-related adverse events were reported. CONCLUSIONS AND RELEVANCE This study found that VIPP-SD was effective in reducing symptoms of early behavior problems in young children when delivered in a routine health service context.

Longitudinal associations between prosocial behavior and behavioral problems across childhood: A robust random-intercept cross-lagged panel model.

“…The VIPP-SD has been related to decreases in problem behavior (e.g. O'Farrelly et al, 2021) and might be related to increases in social competence, such as prosocial behavior (see Euser et al, 2016). Because the VIPP-SD intervention was not the emphasis of the current study, but could potentially influence the results, we controlled all analyses for intervention group by adding a dummy variable (0 = intervention group, 1 = control group).…”

Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline

“…In a pilot study focusing only on fathers the feasibility was rated high, but the pilot was too small (N = 5) for effectiveness evaluation (Lawrence et al, 2013). In the large Healthy Start, Happy Start trial the involvement of fathers seemed not to add to the effectiveness of the intervention (O'Farrelly et al, 2021). Another study showed the feasibility of prenatal video-feedback using ultrasound (VIPP-PRE) with fathers (Alyousefi-van Dijk et al, 2021).…”

Video feedback parent‐infant intervention for mothers experiencing enduring difficulties in managing emotions and relationships: A randomised controlled feasibility trial

“…Clinicians delivering the intervention attended a 5-day accredited training in the VIPP-SD programme and the VIPP-PMH adaptations, with supervision by an accredited supervisor prior to each delivered session. Sessions were audio-recorded with parental consent, and a randomly selected 10% of audio recordings were coded for fidelity by an independent researcher using a VIPP-SD adherence scale adapted for VIPP-PMH (O'Farrelly et al, 2018(O'Farrelly et al, , 2021. Scores range from 1 (did not follow the manual at all) to 5 (followed the manual very closely), with all coded sessions rated at least 3 ("acceptable fidelity").…”