Use of the Family Check-up in Health Care Settings Serving at-Risk Children

Even though several evidence-based interventions have been developed to address problem behavior of at-risk youth, identifying real-world delivery contexts for offering and engaging at-risk youth such interventions presents a challenge. The current paper discusses how Dishion’s Family Check-Up (FCU), a preventive intervention to address child problem during points of developmental transition, has been used in health care settings with toddlers and young adolescents (10-13 years old), and plans for continuing this approach with infants and young adolescents in pediatric settings. In the first part of the talk, findings from two randomized controlled trials with at-risk children and families will be reviewed. The first study was carried out with 731 toddlers and parents utilizing WIC services, recruited on the basis of sociodemographic, family, and child risk factors. Carried out in three distinct communities (i.e., suburban, rural, urban) with the goal of preventing early conduct problems, engagement rates were found to be moderately high (73% at age 2 and by age 5, > 90%), as were intervention effects on child conduct problems, parenting, maternal depression, and other child outcomes (e.g., child emotional problems, inhibitory control, school achievement). In the second study, conducted in two pediatric clinics serving predominantly low-income families, we tested an adaptation of the FCU to promote sleep, emotion regulation skills, and physical activity among a sample of ethnically diverse (84% African American) 10 to 13 year olds. Again, engagement rates in the FCU were moderately high across the two years of intervention (Year 1:65%, Year 2:79%), and two-year effects were found on children’s sleep waking, emotion regulation skills, and for girls, physical activity.

The second part of the talk will discuss two other ongoing studies extending the use of the FCU to pediatric clinics. First, using the well-child brief screen discussed by Speaker 2, those youth and families meeting eligibility requirements for substance use risk will be randomly assigned to the FCU or treatment as usual, and followed up for 2-3 years. This version of the FCU will focus primarily on parent management strategies (e.g., monitoring of youth, setting limits, open communication) and factors that compromise parenting effectiveness rather than promoting individual youth skills.  Second, an RCT using the FCU as a selective intervention in conjunction with a universal intervention to improve parenting skills among at-risk infants (Mendelsohn et al., 2005) will be described, extending use of the FCU to children’s first year.