Improving Child Behaviors and Parental Stress: A Randomized Trial of Child Adult Relationship Enhancement in Primary Care.

Abstract

Prior single-site evaluations of Child Adult Relationship Enhancement in Primary Care (PriCARE), a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes. To measure the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study. Caregivers of children 2- to 6-year-old with behavior concerns recruited from 4 pediatric primary care practices were randomized 2:1 to PriCARE intervention (n=119) or waitlist control (n=55). Seventy-nine percent of caregivers identified as Black and 59% had annual household incomes under $22,000. Child behavior, parenting stress, and parenting attitudes were measured at baseline and 2 to 3 months after intervention using the Eyberg Child Behavior Inventory, Parenting Stress Index, and Adult-Adolescent Parenting Inventory-2. Marginal standardization implemented in a linear regression compared mean change scores from baseline to follow-up by treatment arm while accounting for clustering by site. Mean change scores from baseline to follow-up demonstrated greater improvements (decreases) in Eyberg Child Behavior Inventory problem scores but not intensity scores in the PriCARE arm compared to control, (problem: -4.4 [-7.5, -1.2] vs -1.8 [-4.1, 0.4], P= .004; intensity: -17.6 [-28.3, -6.9] vs -10.4 [-18.1, -2.6], P= .255). Decreases in parenting stress were greater in the PriCARE arm compared to control (-3.3 [-4.3, -2.3] vs 0 [-2.5, 2.5], P= .025). Parenting attitudes showed no significant changes (all P> .10). PriCARE showed promise in improving parental perceptions of the severity of child behaviors and decreasing parenting stress but did not have an observed impact on parenting attitudes.