Abstract of Distinction: International Implementation of the Family Check-up to Prevent Conduct Problems Early in Life

Introduction Children’s conduct problems comprise an international public health issue. Conduct problems show stability from preschool age, increasing risk for later interpersonal problems, drug abuse and crime. Following the success of two randomised controlled trials (RCT) in the United States using the Family Check-Up (FCU) with low-income families of toddlers, the current research combined the FCU with a universal intervention. This explored combined universal/targeted versus targeted prevention alone using existing community services in a large Australian metropolitan area to prevent conduct problems in early childhood.

Methods Parents of 1,353 infants were recruited across nine socioeconomically diverse government areas at well-child nursing centres. Measures completed at baseline were sociodemographic characteristics, infant temperament, maternal mental health (DASS), a public health screen for parent substance misuse, social isolation, home violence and partner relationship, and parenting (PBC). Child Behavior Checklist (CBCL/1.5-5), PBC and DASS were also completed at ages 3 and 4.5 years.

Results Of families attending well-child clinics, 63% took part in the implementation trial. Retention was 76% at age 3 years and 77% at 4.5 years. Analyses were intention-to-treat using imputed data (adjusted mean difference (95% CI; p-value)). At age 3 and 4.5, there were no significant differences between trial arms for mothers’ report of child conduct problems (targeted prevention vs. usual-care control -0.2 (-1.7 to 1.2, p=0.76); combined prevention vs. usual-care control 0.4 (-1.1 to 1.9, p=0.60). However, a complete case analysis indicated a positive effect for the targeted and combined prevention groups on child conduct problems based on father reports of child behaviour. There was also an intervention effect on mothers’ reports of child internalising symptoms when fathers were involved.

Conclusions: Population approaches that effectively prevent child conduct problems in early life are needed. While practitioners in Australia delivering the targeted parenting program completed the initial FCU workshop, only 29% (2 of 7) achieved fidelity certification by its United States trainers. In implementation science and practice across countries, for fidelity it is important that therapist professional qualifications align with original effectiveness trials. For ongoing therapist supervision, detailed advance planning for practical considerations is required (videoconferencing technology, practitioner release-time and travel).