Abstract
BackgroundPsychosocial problems in children have adverse effects on the children, their families, and society, thus early intervention is important. Community pediatric services offer an ideal setting to detect problem behaviour in children and provide support to parents. The objective of this study was to assess the effectiveness of a Primary Care Triple P (PCTP) program compared with care as usual (UC) for parents of children with mild psychosocial problems after an initial, evidence-based screening in routine community pediatric care.MethodsWe conducted a multicenter, randomized, controlled trial in community pediatric services in the Netherlands, enrolling parents of children with mild psychosocial problems. The population was identified by screening using the Strengths and Difficulties Questionnaire (SDQ) with a cut-off point of 11 or higher (that is, a subclinical score). We compared PCTP with UC, and measured the effects immediately after treatment and after 6 and 12 months. PCTP comprised four individual counseling sessions with the parent of 20 to 30 minutes each. The primary outcome measures were the child psychosocial problems as measured by the SDQ and the Eyberg Child Behaviour Inventory (ECBI).ResultsIn total, 81 families were recruited and randomized, and 67 provided post-intervention data. Both treatment groups improved after treatment, with the PCTP group improving only slightly more than the UC group on most measures. The maximum difference on the SDQ was 1.94 (95% CI = −0.30 to 4.19, P = 0.09) and 5.81 (95% CI = −3.37 to 14.99, P = 0.21) on the ECBI (n = 67). None of the differences between PCTP and UC was significant. In the subsidiary analyses, only one of the twenty outcomes (that is, SDQ conduct problems) was significant.ConclusionsPCTP did produce a reduction in psychosocial problems in children but had no statistically significant advantage over UC. In general, a few outcomes improved in both groups. Based on this admittedly underpowered study, we cannot conclude that PCTP is more effective than UC in preventive child healthcare.Trial registrationNederlands Trial Register (Dutch Trial Register): NTR1338.
Highlights
Psychosocial problems in children have adverse effects on the children, their families, and society, early intervention is important
Eight parents dropped out immediately after randomization, reconsidering their need for parenting support or their decision to participate in the research, and did not provide a baseline measurement
Main reason for drop out (n=4): reconsidering the need for parenting support or their decision to participate in the research
Summary
Psychosocial problems in children have adverse effects on the children, their families, and society, early intervention is important. Community pediatric services offer an ideal setting to detect problem behaviour in children and provide support to parents. The objective of this study was to assess the effectiveness of a Primary Care Triple P (PCTP) program compared with care as usual (UC) for parents of children with mild psychosocial problems after an initial, evidence-based screening in routine community pediatric care. Psychosocial problems, such as aggressive behaviour, fear, and anxiety, are common in children and may lead to restrictions in daily functioning. There is a need for standardized parenting support interventions that are short term and suit the competences of child healthcare professionals (CHPs)
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