Since Dishion’s original use of the Family Check-Up (FCU) in school systems, there has been a desire to extend the reach to other settings frequented by children across developmental stages in their daily lives. This is especially challenging in early childhood when many children are not attending preschool and the size of individual programs tend to be modest. Following trials co-directed by Dr. Dishion that utilized WIC for delivering the FCU, the current paper discusses the use of pediatrics for delivering the FCU to both very young children at birth in combination with a universal intervention, Video Interaction Project (VIP), and during early adolescence, after screening for risk of substance use.
In the early childhood trial (Smart Beginnings (SB)), families having public insurance in two large urban areas were enrolled in the study shortly after the birth of their child. 403 families were randomly assigned to control or intervention conditions with those in the intervention condition receiving VIP during well child check-up visits at primary care. In addition, those meeting criteria based on parent or child risk, also received the FCU. In the adolescent trial (SafeKeeping Youth (SKY)), 361 children ages 10-13 and parents attending routine pediatric care visits were screened for substance use risk using a brief screen completed by parents and children, with those meeting eligibility criteria randomly assigned to the FCU or pediatric care as usual conditions.
Preliminary results from both trials are encouraging in terms of engaging families and showing improvements in both parenting and child behavior. For SB, through 12 months, nearly 80% of families received 5 out of a possible 6 VIP sessions across sites, with approximately 70% engaging in the FCU. For SKY, 93% of families offered the FCU engaged in the intervention (i.e., had at least assessment, initial interview, and feedback sessions). For SB, intervention effects on observed parenting are evident at 6 months, with statistically reliable impacts on both parenting and child problem behaviors (i.e., CBCL) at 24 months. Similarly, impacts on SKY at the one-year follow-up indicate intervention effects on substance use initiation, conduct problems and youth reported depression, as well as parental monitoring. Implications for social policy will be discussed.