Early Initiatives for Children at Risk: A Comprehensive Program for the Prevention and Treatment of Conduct Problems in Primary Care Settings

Introduction: To scale up the use of evidence-based interventions for the prevention and treatment of child conduct problems in primary care settings, the program Early Initiatives for Children at Risk (Norwegian acronym; TIBIR) was developed. The program was designed to identify and reach children (3-12 years) with conduct problems as early as possible. TIBIR is influenced by Parent Management Training, the Oregon Model (PMTO) and consists of 5 interventions (3 parent training interventions, 1 teacher intervention, and 1 child intervention) targeting important social arenas for children (i.e., home, kindergarten, or school). The use of multiple interventions in multiple settings offers a flexible approach, tailoring intervention to level of problem severity in children and families. Currently, 73 of 430 (17%) municipalities in Norway are implementing TIBIR. Because all interventions in TIBIR should be evidence-based, four randomized effectiveness trials have been conducted, while one is currently being conducted. The main findings from the four trials will be presented.

Method: This study was based on four randomized controlled trials: 1) The PMTO trial consisted of 112 children (4-12 years) and their families who were randomized to PMTO or regular services. 2) The PMTO parent group (PMTO PG) trial consisted of 137 families randomized to PMTO PG or regular services. 3) The Brief Parent Training (BPT) trial consisted of 216 families randomized to BPT or regular services. 4) The Individual Social Skills Training (ISST) trial consisted of 198 children randomized to ISST or practice as usual. All studies examined the immediate and long-term (6 to12 months after termination) effectiveness of the interventions.

Results: Overall, the effectiveness trials revealed the parent training interventions in TIBIR had significant and positive (immediate and long-term) effects on parenting and child outcomes, with moderate to large effect sizes. The findings from the ISST trial, however, suggest limited effects in ameliorating child conduct problems.

Conclusions: The findings indicate that parent training can be disseminated with positive outcomes in real-world settings. As TIBIR is largely based on PMTO-principles, findings suggest that these principles can be successfully transported across cultures, i.e., from the US to Norway, both when delivered as full-scale treatment (PMTO) and as short-term intervention (BPT).