Prevention of Problem Behavior Through Annual Family Check-Ups in Early Childhood

The Family Check-up (FCU) is a brief, three-session intervention to motivate parental family management practices, is made available through a community setting, and is intended to motivate parent engagement with a wide range of family-centered interventions ranging from brief interventions to more intensive family management treatment guided by a structured curriculum (Dishion, Stormshak, & Kavanagh, 2011). The Early Steps project was designed to examine the effectiveness of the FCU in reducing the progression of risk towards problem behavior in early childhood, including families that were recruited and screened from WIC programs. Two studies found that randomization to the FCU resulted in improved parenting practices and problem behavior from age 2 through 4 (Shaw, Dishion et al, 2006; Dishion, Shaw et al, 2008).

In the presented study, we examine two hypotheses: (a) random assignment of high-risk WIC families with a 2-year-old to the FCU model would result in reductions in parent-reported oppositional and defiant behavior from age 2 through 5, and teacher report of oppositional behavior at age 7.5, and (b) successful engagement of families in successive FCU interventions at age 2,3, 4 and 5 and would increase the effects of the FCU on parent and teacher report of oppositional defiant behaviors, as defined above. A multiethnic risk sample of 731 families in 3 distinct geographical settings who were receiving assistance from the Women, Infants, and Children (WIC) program were randomly assigned to the yearly FCU. Intention to treat (ITT) analyses and complier average causal effect (CACE) modeling were used to examine the effects of intervention engagement when the child was ages 2 through 7.5 per parent and teacher report of child oppositional behavior.

Overall, ITT intervention effects were found on both parent report (age 2 through 5) and teacher report at age 7.5 of oppositional child behavior, favoring less growth in problem behavior for children in the intervention group, compared to those in the control group.  CACE modeling of intervention engagement revealed that the effect sizes on both parent and teacher reported oppositional behavior increased as a function of the number of the number of sessions in which caregivers participated in the FCU (see Figure 1 below). These findings suggest that embedding parenting support in health and social services can potentially prevent early onset trajectories of antisocial behavior. The key to successful family-centered interventions is engaging families in need of support.