A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT
Background: Behaviour problems emerge early in childhood and place children at risk for later psychopathology. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of a parenting intervention to prevent enduring behaviour problems in young children. Design: A pragmatic, assessor...
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NIHR Journals Library
2021-05-01
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Online Access: | https://doi.org/10.3310/hta25290 |
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doaj-335286cb8efe4bb38c9e67c1e02c6966 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Christine O’Farrelly Beth Barker Hilary Watt Daphne Babalis Marian Bakermans-Kranenburg Sarah Byford Poushali Ganguli Ellen Grimås Jane Iles Holly Mattock Julia McGinley Charlotte Phillips Rachael Ryan Stephen Scott Jessica Smith Alan Stein Eloise Stevens Marinus van IJzendoorn Jane Warwick Paul Ramchandani |
spellingShingle |
Christine O’Farrelly Beth Barker Hilary Watt Daphne Babalis Marian Bakermans-Kranenburg Sarah Byford Poushali Ganguli Ellen Grimås Jane Iles Holly Mattock Julia McGinley Charlotte Phillips Rachael Ryan Stephen Scott Jessica Smith Alan Stein Eloise Stevens Marinus van IJzendoorn Jane Warwick Paul Ramchandani A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT Health Technology Assessment behaviour problems early intervention health visiting parenting |
author_facet |
Christine O’Farrelly Beth Barker Hilary Watt Daphne Babalis Marian Bakermans-Kranenburg Sarah Byford Poushali Ganguli Ellen Grimås Jane Iles Holly Mattock Julia McGinley Charlotte Phillips Rachael Ryan Stephen Scott Jessica Smith Alan Stein Eloise Stevens Marinus van IJzendoorn Jane Warwick Paul Ramchandani |
author_sort |
Christine O’Farrelly |
title |
A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT |
title_short |
A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT |
title_full |
A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT |
title_fullStr |
A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT |
title_full_unstemmed |
A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT |
title_sort |
video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the healthy start, happy start rct |
publisher |
NIHR Journals Library |
series |
Health Technology Assessment |
issn |
1366-5278 2046-4924 |
publishDate |
2021-05-01 |
description |
Background: Behaviour problems emerge early in childhood and place children at risk for later psychopathology. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of a parenting intervention to prevent enduring behaviour problems in young children. Design: A pragmatic, assessor-blinded, multisite, two-arm, parallel-group randomised controlled trial. Setting: Health visiting services in six NHS trusts in England. Participants: A total of 300 at-risk children aged 12–36 months and their parents/caregivers. Interventions: Families were allocated in a 1 : 1 ratio to six sessions of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) plus usual care or usual care alone. Main outcome measures: The primary outcome was the Preschool Parental Account of Children’s Symptoms, which is a structured interview of behaviour symptoms. Secondary outcomes included caregiver-reported total problems on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The intervention effect was estimated using linear regression. Health and social care service use was recorded using the Child and Adolescent Service Use Schedule and cost-effectiveness was explored using the Preschool Parental Account of Children’s Symptoms. Results: In total, 300 families were randomised: 151 to VIPP-SD plus usual care and 149 to usual care alone. Follow-up data were available for 286 (VIPP-SD, n = 140; usual care, n = 146) participants and 282 (VIPP-SD, n = 140; usual care, n = 142) participants at 5 and 24 months, respectively. At the post-treatment (primary outcome) follow-up, a group difference of 2.03 on Preschool Parental Account of Children’s Symptoms (95% confidence interval 0.06 to 4.01; p = 0.04) indicated a positive treatment effect on behaviour problems (Cohen’s d = 0.20, 95% confidence interval 0.01 to 0.40). The effect was strongest for children’s conduct [1.61, 95% confidence interval 0.44 to 2.78; p = 0.007 (d = 0.30, 95% confidence interval 0.08 to 0.51)] versus attention deficit hyperactivity disorder symptoms [0.29, 95% confidence interval –1.06 to 1.65; p = 0.67 (d = 0.05, 95% confidence interval –0.17 to 0.27)]. The Child Behaviour Checklist [3.24, 95% confidence interval –0.06 to 6.54; p = 0.05 (d = 0.15, 95% confidence interval 0.00 to 0.31)] and the Strengths and Difficulties Questionnaire [0.93, 95% confidence interval –0.03 to 1.9; p = 0.06 (d = 0.18, 95% confidence interval –0.01 to 0.36)] demonstrated similar positive treatment effects to those found for the Preschool Parental Account of Children’s Symptoms. At 24 months, the group difference on the Preschool Parental Account of Children’s Symptoms was 1.73 [95% confidence interval –0.24 to 3.71; p = 0.08 (d = 0.17, 95% confidence interval –0.02 to 0.37)]; the effect remained strongest for conduct [1.07, 95% confidence interval –0.06 to 2.20; p = 0.06 (d = 0.20, 95% confidence interval –0.01 to 0.42)] versus attention deficit hyperactivity disorder symptoms [0.62, 95% confidence interval –0.60 to 1.84; p = 0.32 (d = 0.10, 95% confidence interval –0.10 to 0.30)], with little evidence of an effect on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The primary economic analysis showed better outcomes in the VIPP-SD group at 24 months, but also higher costs than the usual-care group (adjusted mean difference £1450, 95% confidence interval £619 to £2281). No treatment- or trial-related adverse events were reported. The probability of VIPP-SD being cost-effective compared with usual care at the 24-month follow-up increased as willingness to pay for improvements on the Preschool Parental Account of Children’s Symptoms increased, with VIPP-SD having the higher probability of being cost-effective at willingness-to-pay values above £800 per 1-point improvement on the Preschool Parental Account of Children’s Symptoms. Limitations: The proportion of participants with graduate-level qualifications was higher than among the general public. Conclusions: VIPP-SD is effective in reducing behaviour problems in young children when delivered by health visiting teams. Most of the effect of VIPP-SD appears to be retained over 24 months. However, we can be less certain about its value for money. Trial registration: Current Controlled Trials ISRCTN58327365. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 29. See the NIHR Journals Library website for further project information. |
topic |
behaviour problems early intervention health visiting parenting |
url |
https://doi.org/10.3310/hta25290 |
work_keys_str_mv |
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doaj-335286cb8efe4bb38c9e67c1e02c69662021-05-21T10:58:14ZengNIHR Journals LibraryHealth Technology Assessment1366-52782046-49242021-05-01252910.3310/hta2529013/04/33A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCTChristine O’Farrelly0Beth Barker1Hilary Watt2Daphne Babalis3Marian Bakermans-Kranenburg4Sarah Byford5Poushali Ganguli6Ellen Grimås7Jane Iles8Holly Mattock9Julia McGinley10Charlotte Phillips11Rachael Ryan12Stephen Scott13Jessica Smith14Alan Stein15Eloise Stevens16Marinus van IJzendoorn17Jane Warwick18Paul Ramchandani19Division of Psychiatry, Imperial College London, London, UKDivision of Psychiatry, Imperial College London, London, UKSchool of Public Health, Imperial College London, London, UKImperial Clinical Trials Unit, Imperial College London, London, UKClinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the NetherlandsInstitute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, UKInstitute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, UKDivision of Psychiatry, Imperial College London, London, UKDivision of Psychiatry, Imperial College London, London, UKDivision of Psychiatry, Imperial College London, London, UKNetmums, London, UKDivision of Psychiatry, Imperial College London, London, UKDivision of Psychiatry, Imperial College London, London, UKInstitute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, UKDivision of Psychiatry, Imperial College London, London, UKDepartment of Psychiatry, University of Oxford, Oxford, UKDivision of Psychiatry, Imperial College London, London, UKDepartment of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, the NetherlandsWarwick Clinical Trials Unit, University of Warwick, Coventry, UKDivision of Psychiatry, Imperial College London, London, UKBackground: Behaviour problems emerge early in childhood and place children at risk for later psychopathology. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of a parenting intervention to prevent enduring behaviour problems in young children. Design: A pragmatic, assessor-blinded, multisite, two-arm, parallel-group randomised controlled trial. Setting: Health visiting services in six NHS trusts in England. Participants: A total of 300 at-risk children aged 12–36 months and their parents/caregivers. Interventions: Families were allocated in a 1 : 1 ratio to six sessions of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) plus usual care or usual care alone. Main outcome measures: The primary outcome was the Preschool Parental Account of Children’s Symptoms, which is a structured interview of behaviour symptoms. Secondary outcomes included caregiver-reported total problems on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The intervention effect was estimated using linear regression. Health and social care service use was recorded using the Child and Adolescent Service Use Schedule and cost-effectiveness was explored using the Preschool Parental Account of Children’s Symptoms. Results: In total, 300 families were randomised: 151 to VIPP-SD plus usual care and 149 to usual care alone. Follow-up data were available for 286 (VIPP-SD, n = 140; usual care, n = 146) participants and 282 (VIPP-SD, n = 140; usual care, n = 142) participants at 5 and 24 months, respectively. At the post-treatment (primary outcome) follow-up, a group difference of 2.03 on Preschool Parental Account of Children’s Symptoms (95% confidence interval 0.06 to 4.01; p = 0.04) indicated a positive treatment effect on behaviour problems (Cohen’s d = 0.20, 95% confidence interval 0.01 to 0.40). The effect was strongest for children’s conduct [1.61, 95% confidence interval 0.44 to 2.78; p = 0.007 (d = 0.30, 95% confidence interval 0.08 to 0.51)] versus attention deficit hyperactivity disorder symptoms [0.29, 95% confidence interval –1.06 to 1.65; p = 0.67 (d = 0.05, 95% confidence interval –0.17 to 0.27)]. The Child Behaviour Checklist [3.24, 95% confidence interval –0.06 to 6.54; p = 0.05 (d = 0.15, 95% confidence interval 0.00 to 0.31)] and the Strengths and Difficulties Questionnaire [0.93, 95% confidence interval –0.03 to 1.9; p = 0.06 (d = 0.18, 95% confidence interval –0.01 to 0.36)] demonstrated similar positive treatment effects to those found for the Preschool Parental Account of Children’s Symptoms. At 24 months, the group difference on the Preschool Parental Account of Children’s Symptoms was 1.73 [95% confidence interval –0.24 to 3.71; p = 0.08 (d = 0.17, 95% confidence interval –0.02 to 0.37)]; the effect remained strongest for conduct [1.07, 95% confidence interval –0.06 to 2.20; p = 0.06 (d = 0.20, 95% confidence interval –0.01 to 0.42)] versus attention deficit hyperactivity disorder symptoms [0.62, 95% confidence interval –0.60 to 1.84; p = 0.32 (d = 0.10, 95% confidence interval –0.10 to 0.30)], with little evidence of an effect on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The primary economic analysis showed better outcomes in the VIPP-SD group at 24 months, but also higher costs than the usual-care group (adjusted mean difference £1450, 95% confidence interval £619 to £2281). No treatment- or trial-related adverse events were reported. The probability of VIPP-SD being cost-effective compared with usual care at the 24-month follow-up increased as willingness to pay for improvements on the Preschool Parental Account of Children’s Symptoms increased, with VIPP-SD having the higher probability of being cost-effective at willingness-to-pay values above £800 per 1-point improvement on the Preschool Parental Account of Children’s Symptoms. Limitations: The proportion of participants with graduate-level qualifications was higher than among the general public. Conclusions: VIPP-SD is effective in reducing behaviour problems in young children when delivered by health visiting teams. Most of the effect of VIPP-SD appears to be retained over 24 months. However, we can be less certain about its value for money. Trial registration: Current Controlled Trials ISRCTN58327365. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 29. See the NIHR Journals Library website for further project information.https://doi.org/10.3310/hta25290behaviour problemsearly interventionhealth visitingparenting |