What Doesn’t Work for Whom? Exploring Heterogeneity in Responsiveness to the Family Check-Up in Early Childhood Using a Mixture Model Approach

Abstract

This study applied latent class analysis to a family-centered prevention trial in early childhood to identify subgroups of families with differential responsiveness to the Family Check-Up (FCU) intervention. The sample included 731 families with 2-year-olds randomized to the FCU or control condition and followed through age 5 with yearly follow-up assessments. A two-step mixture model was used to examine whether specific constellations of family characteristics at age 2 (baseline) were related to intervention response across ages 3, 4, and 5. The first step empirically identified latent classes of families based on several family risk and adjustment variables selected on the basis of previous research. The second step modeled the effect of the FCU on longitudinal change in children’s problem behavior in each of the empirically derived latent classes. Results suggested a five-class solution, where a significant intervention effect of moderate-to-large size was observed in one of the five classes—the class characterized by child neglect, legal problems, and parental mental health issues. Pairwise comparisons revealed that the intervention effect was significantly greater in this class of families than in two other classes that were generally less at risk for the development of child disruptive behavior problems, albeit still low-income. Thus findings suggest (a) the FCU is most successful in reducing child problem behavior in more highly distressed, low-income families, and (b) the FCU may have little impact for relatively low-risk, low-income families. Future directions include the development of brief screening process that can triage low-income families into groups that should be targeted for intervention, redirected to other services, monitored prospectively, or left alone.

Evaluating the efficacy of the Family Check-Up Online: A school-based, eHealth model for the prevention of problem behavior during the middle school years

“…The FCU Online has the potential to exert a sizable public health impact if it can reach a large percentage of the population, is accessible to families through schools, and is shown to be associated with behavioral change. Furthermore, our research suggests that the FCU benefits high-risk families more than low-risk families, consistent with prior research (Pelham et al, 2017; Shelleby, Shaw, Dishion, Wilson, & Gardner, 2018). Screening families for risk and implementing the intervention as a selective or indicated approach to prevention may reduce the cost of implementation and increase outcomes across various community settings (e.g., Moore et al, 2016).…”

Latent Impulsivity Subtypes in Substance Use Disorders and Interactions with Internalizing and Externalizing Co-Occurring Disorders

“…Second-order interaction terms, class × externalizing CODs and class × internalizing CODs, were included in both models. This analytical approach is an analogous procedure applied to cross-sectional studies derived from the test of heterogeneity of effects in longitudinal research ( 32 ).…”

The ADHD teen integrative data analysis longitudinal (TIDAL) dataset: background, methodology, and aims

“…As the field of child and adolescent mental health moves toward precision medicine [24], personal-level analyses are essential to ensuring maximally effective care. Precision medicine studies have led to important advances in the treatment of childhood conduct problems [25] and adult depression [19], among other disorders. These analyses require large sample sizes that have not yet been available in the treatment of adolescent ADHD.…”