Integrating equifinality and multifinality into the of prevention programs in early childhood: The conceptual case for use of tiered models

Abstract

Introduced in the context of developmental psychopathology by Cicchetti and Rogosh in the Journal, the current paper incorporates the principles of equifinality and multifinality to support the use of tiered models to prevent the development of emerging child psychopathology and promote school readiness in early childhood. We use the principles of equifinality and multifinality to describe the limitations of applying one intervention model to address all children presenting with different types of risk for early problem behavior. We then describe the potential benefits of applying a tiered model for having impacts at the population level and two initial applications of this approach during early childhood. The first of these tiered models, Smart Beginnings, integrates the use of two evidenced-based preventive interventions, Video Interaction Project, a universal parenting program, and Family Check-Up, a selective parenting program. Building on the strengths of Smart Beginnings, the second trial, The Pittsburgh Study includes Video Interaction Project and Family Check-Up, and other more and less-intensive programs to address the spectrum of challenges facing parents of young children. Findings from these two projects are discussed with their implications for developing tiered models to support children’s early development and mental health.

Population mental health science: Guiding principles and initial agenda.

“…Collaborative of The Pittsburgh Study have chosen to engage in at least one program, with higher selection rates for those facing higher levels of economic and psychosocial risk (e.g., previous involvement with child welfare, history of mental health and/or substance use, homelessness, parent incarceration; Shaw et al, 2024).…”

“…Public schools could be funded at higher levels to enable support services such as social workers and nurses. Similarly, locating social workers trained in EBPs in pediatric clinics and WIC centers could make preventive interventions more accessible to parents of young children, particularly those facing economic challenges and individual/structural discrimination based on race (Shaw et al, 2024). High-quality grocery stores could be financially supported and located in food deserts so young children could have improved nutrition.…”

“…Following the results of initial screenings (20–30 min in length with reimbursement for their time) that are repeated every 6–12 months through age 4, families are given the opportunity to engage in EBPs tailored to their economic and psychosocial strengths and challenges to promote early child mental health. By locating screenings at places parents of young children already frequent and delivering programs at convenient locales (e.g., via telehealth, family’s homes, pediatric clinics, WIC, libraries), more than 80% of the more than 1,000 parents enrolled in the Early Childhood Collaborative of The Pittsburgh Study have chosen to engage in at least one program, with higher selection rates for those facing higher levels of economic and psychosocial risk (e.g., previous involvement with child welfare, history of mental health and/or substance use, homelessness, parent incarceration; Shaw et al, 2024).…”