Bridging access and impact: primary care parenting intervention reduces early behavior problems in both virtual and
Fithi Andom1, Joanne N Wood2, Li Jiang3
1The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Insights
Virtual Child-Adult Relationship Enhancement in primary care (PriCARE) significantly improves early childhood behavior problems and increases program completion rates. This virtual delivery method shows comparable effectiveness to in-person programs, expanding access to crucial behavioral interventions.
Area of Science:
- Pediatric behavioral health
- Evidence-based interventions
- Digital health
Background:
- Early childhood behavior problems are common and linked to adverse outcomes, including maltreatment risk.
- Child-Adult Relationship Enhancement in primary care (PriCARE) is an evidence-based group parenting program proven effective in in-person trials.
- Barriers to in-person PriCARE include workforce shortages and limited infrastructure, necessitating exploration of virtual delivery.
Purpose of the Study:
- To evaluate the effectiveness of virtual PriCARE in improving child behavioral outcomes.
- To compare the outcomes of virtual PriCARE with those from prior in-person trials.
Main Methods:
- A multi-center randomized controlled trial (RCT) involving caregivers of children aged 18 months to 6 years.
- Child behavior assessed using the Eyberg Child Behavior Inventory (ECBI) at baseline and 6-8 month follow-up.
- Interim analysis compared ECBI score changes between virtual and prior in-person trials using linear regression and ANCOVA.
Main Results:
- Virtual PriCARE demonstrated significant reductions in child behavior problems (ECBI Intensity and Problem scores) compared to usual care.
- Higher attendance rates were observed in the virtual group (23.8% completion) compared to the in-person group (18.9% completion).
- No significant differential effects were found based on delivery mode (virtual vs. in-person).
Conclusions:
- Virtual PriCARE is an effective intervention for early childhood behavior problems, comparable to in-person delivery.
- Higher completion rates and comparable effectiveness suggest virtual delivery can expand access to behavioral interventions.
- This approach offers scalable prevention strategies to promote child well-being and mitigate maltreatment risk.
Background:
Early childhood behavior problems are common and linked to adverse outcomes, including risk of maltreatment. Child-Adult Relationship Enhancement in primary care (PriCARE) is an evidence-based group parenting program delivered in pediatric primary care to reduce disruptive behaviors and strengthen caregiver-child relationships. In-person RCTs have demonstrated the efficacy of PriCARE, but barriers such as workforce shortages, transportation issues, and limited behavioral health infrastructure restrict access. Virtual delivery offers a potential solution, yet its effectiveness relative to in-person delivery is not well established.
Objective:
To evaluate the effectiveness of virtual PriCARE in improving child behavioral outcomes and compare these outcomes with those from prior in-person trials.
Study Design:
A multi-center RCT of virtual PriCARE is underway with caregivers of children aged 18 months to 6 years. Child behavior was assessed using the Eyberg Child Behavior Inventory (ECBI) at baseline and at 6-8 month follow-up. An interim analysis was conducted to examine changes in ECBI scores from baseline to follow-up among virtual participants and to compare mean ECBI change trajectories between virtual delivery and prior in-person trials. Attendance patterns were compared using the Cochran-Armitage trend test. Effectiveness was evaluated using linear regression models with ANCOVA adjustment for baseline ECBI scores and caregiver/child demographics.
Results:
Subjects included 698 virtual PriCARE participants and 417 in-person PriCARE participants. Attendance was higher virtually, with 23.8% of participants completing all sessions, compared to 18.9% in-person (p < .001). Children in the virtual intervention group showed significant reductions in ECBI Intensity (-7.81 vs. 1.45, p < 0.001) and Problem scores (-3.80 vs. -1.91, p < .001) compared with usual care. The delivery mode×intervention interaction was not significant for either ECBI Intensity (p = 0.833) or Problem scores (p = 0.744), suggesting no evidence of differential effects by delivery mode.
Conclusions:
Virtual PriCARE was associated with significant improvements in early childhood behavior problems and higher completion rates, with no evidence of differential effects by delivery mode. These findings highlight the potential of virtual behavioral interventions in pediatric primary care to expand reach, reduce access barriers, and provide scalable prevention strategies to promote child well-being and prevent maltreatment.
Trial Registration:
ClinicalTrials.gov, NCT05233150. Registered 10 February 2022 https://clinicaltrials.gov/study/NCT05233150.
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