Moderators of outcome in a brief family-centered intervention for preventing early problem behavior.

Abstract

This study investigated moderators of change in an empirically supported family-centered intervention (the Family Check-Up) for problem behavior in early childhood. Participants were 731 2-to 3-year-olds (49% girls; 28% African American, 50% European American, 13% biracial) from low-income families and had been screened for risk of family stress and early-onset problem behavior. They were randomized to the Family Check-Up intervention or to a no-intervention control group. Latent growth models examined sociodemographic and parent psychological risk factors as potential moderators of change in problem behavior between ages 2, 3, and 4. Results revealed 2 moderators of intervention effectiveness. Caregivers with the lowest educational levels were more responsive to the family-centered intervention, and 2-parent families were more responsive to the intervention. Other risk factors showed no predictive effects. Overall, findings suggest that this brief family-centered intervention can be equally effective in reaching the most distressed and most disadvantaged families, compared to those who are more advantaged. However, results suggest that more attention may be needed to address the intervention needs of single parent families in reducing problem behavior in early childhood. Keywordschild problem behavior; early prevention; moderators; parenting; conduct problems Numerous randomized trials show that parenting interventions are effective in preventing child problem behavior (Kazdin, 2002). These include "efficacy" trials, conducted in relatively specialist settings, as well as more recent adaptations of these interventions into "effectiveness" trials, which have the potential for widespread dissemination into real-world, communityCorrespondence concerning this article should be addressed to Frances Gardner, Department of Social Policy and Social Work, Barnett House, 32 Wellington Square, Oxford OX1 2ER, United Kingdom. frances.gardner@socres.ox.ac.uk. (Dishion & Stormshak, 2007;Gardner, Burton & Klimes, 2006;Webster-Stratton, 1998a, 1998b. To take such interventions to scale, investigators have developed modified interventions that are brief and low cost (Turner & Sanders, 2006) and that are adapted to engage the most marginalized families (Dishion, Nelson, & Kavanagh, 2003;Shaw, Dishion, Supplee, Gardner, & Arnds, 2006). It is generally accepted that such low-cost interventions, even those with quite modest effect sizes, could potentially be useful and could translate into large public health benefits (Biglan & Taylor, 2000). NIH Public AccessA key issue underlying the potential for public health impact is whether such brief interventions are effective for the most high-risk families in society, or whether they confer greater benefit on more advantaged families, as reported in recent meta-analyses of predictors of outcome in parent training (Lundahl, Risser, & Lovejoy, 2006;Reyno & McGrath, 2006). This is an important concern, given that high-risk families are also those most likely to have children showin...

Could scale-up of parenting programmes improve child disruptive behaviour and reduce social inequalities? Using individual participant data meta-analysis to establish for whom programmes are effective and cost-effective

“…45,46 Even when trials are much larger, findings can be hard to interpret or replicate; for example, one US trial found no moderator effects of low income or teenage parenthood on outcome but found stronger effects for low educated parents along with diminished effects for lone parents. 47 Given a prominent body of literature concluding that socially disadvantaged families fare less well in parenting interventions, but which is based on less than ideal methods, our findings are of particular significance. Our study overcomes these three major limitations and points to a clear and more optimistic conclusion, namely that families disadvantaged by low income and low educational level, or by lone parenthood, are just as likely to benefit.…”

“…43,44 On the other hand, other reviews draw more uncertain conclusions. 12,45 Some of the few individual trials testing moderator effects [46][47][48] find that these parenting interventions are equally or sometimes more effective for the most disadvantaged families, which, without intervention, tend to do worse, suggesting the potential for reversing some of the poorer child outcomes associated with family poverty. It is worth noting that most trials have not used their data to ask these questions.…”

Childhood Psychosocial Determinants of Cardiovascular Health

“…Metaanalyses of various parent-training interventions aimed at modifying parenting and child problem behavior have identified specific psychosocial risk factors, including parental depression, low income, and single parent status, associated with poorer outcomes [41,42]. However, more promising results have been found for programs that specifically target common barriers to intervention engagement and retention among socioeconomically disadvantaged families (i.e., delivering interventions in the home; incorporating goals and support related to family economic self-sufficiency; incorporating financial or material incentives) [43,44]. In a trial of 731 lowincome toddlers randomly allocated to the in-home FCU intervention versus no intervention, effects on child problem behavior were not moderated by parental depression, parental marital or drug problems, or having a mother who had given birth as a teenager, suggesting that children with these disadvantages were just as likely to do well following intervention [43].…”

“…However, more promising results have been found for programs that specifically target common barriers to intervention engagement and retention among socioeconomically disadvantaged families (i.e., delivering interventions in the home; incorporating goals and support related to family economic self-sufficiency; incorporating financial or material incentives) [43,44]. In a trial of 731 lowincome toddlers randomly allocated to the in-home FCU intervention versus no intervention, effects on child problem behavior were not moderated by parental depression, parental marital or drug problems, or having a mother who had given birth as a teenager, suggesting that children with these disadvantages were just as likely to do well following intervention [43]. The only identified psychosocial risk factor associated with poorer intervention response was single parent status, whereas lower maternal education was actually associated with greater improvement in child problem behavior.…”

“…Even in the case of a brief, three-session intervention delivered in the home for which families were given a financial incentive for participation, 17% of at-risk families chose not to enroll [43]. Families who decline interventions despite psychosocial risk factors may unfortunately be those in greatest need of assistance, such as first-time parents lacking knowledge regarding the challenges of child rearing or those uncomfortable with the model of in-home visitation (possibly due to unsuitable or unstable living conditions) [45].…”