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Preventing Preschool Mental Health Problems: Population-Based Cluster Randomized Controlled Trial
Harriet Hiscock1,2,3, Alisha Gulenc2,3, Obioha C Ukoumunne4
1Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
Insights
Implementing parenting programs did not improve child behavior at the population level. However, these interventions did lead to better parenting practices, suggesting a potential indirect benefit.
Area of Science:
- Child psychology and developmental interventions.
- Public health and preventive mental health.
- Parenting and family studies.
Background:
- Early prevention of child behavior problems is crucial for reducing later mental health issues.
- Evaluating population-level effectiveness of targeted versus universal parenting programs is essential.
Purpose of the Study:
- To compare the population-level effectiveness of a targeted prevention program, alone or combined with a universal parenting program, in reducing child behavior problems.
- To assess the impact on parenting behaviors and associated costs.
Main Methods:
- A three-arm, cluster randomized controlled trial involving 1353 primary caregivers and 8-month-old infants.
- Child behavior was assessed using the Child Behavior Checklist (CBCL) at ages 3 and 4.5 years.
- Parenting behaviors were measured via caregiver reports, including over-involved/protective parenting and harsh discipline.
Main Results:
- No statistically significant differences in child externalizing or internalizing behavior problems were found at ages 3 or 4.5 years between intervention and usual care groups.
- Both targeted and combined programs led to reduced over-involved/protective parenting and, for secondary caregivers, less harsh discipline.
- Program costs per family were A$218 for the targeted arm and A$682 for the combined arm.
Conclusions:
- When implemented by existing staff at the population level, these pre-existing parenting programs were ineffective in improving child behavior.
- The interventions demonstrated effectiveness in improving parenting practices, indicating a potential indirect pathway for future mental health benefits.
- Further research may be needed to optimize program delivery for enhanced child behavior outcomes.
Objective:
Prevention of child behavior problems may reduce later mental health problems. We compared the effectiveness, at the population level, of an efficacious targeted prevention program alone or following a universal parenting program.
Methods:
Three-arm, cluster randomized controlled trial. One thousand three hundred fifty-three primary caregivers and healthy 8-month-old babies recruited from July 2010 to January 2011 from well-child centers (randomization unit).
Primary Outcome:
Child Behavior Checklist (CBCL) externalizing and internalizing scales* at child ages 3 and 4.5 years.
Secondary Outcomes:
Parenting Behavior Checklist* and over-involved/protective parenting (primary caregiver report). Secondary caregivers completed starred measures at age 3.
Results:
Retention was 76% and 77% at ages 3 and 4.5 years, respectively. At 3 years, intention-to-treat analyses found no statistically significant differences (adjusted mean difference [95% confidence interval (CI); p-value]) for externalizing (targeted vs usual care -0.2 [-1.7 to 1.2; p = .76]; combined vs usual care 0.4 [-1.1 to 1.9; p = .60]) or internalizing behavior problems (targeted vs usual care 0.2 [-1.2 to 1.6; p = .76]; combined vs usual care 0.4 [-1.1 to 2.0; p = .58]). Primary outcomes were similar at 4.5 years. At 3 years, primary and secondary caregivers reported less over-involved/protective parenting in both the combined and targeted versus usual care arm; secondary caregivers also reported less harsh discipline in the combined and targeted versus usual care arm. Mean program costs per family were A$218 (targeted arm) and A$682 (combined arm).
Conclusion:
When translated to the population level by existing staff, pre-existing programs seemed ineffective in improving child behavior, alone or in combination, but improved parenting.
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