Distance-Delivered Parent Training for Childhood Disruptive Behavior (Strongest Families™): a Randomized Controlled Trial and Economic Analysis
Disruptive behavior disorders are prevalent in youth, yet most children with disruptive behavior do not have access to timely, effective treatment. Distance-delivered service (e.g., via telephone, Internet) can overcome several barriers to care. This study tested the effectiveness of a 12-week parent training program, Strongest Families™ Parenting the Active Child, delivered via written material, skill-based videos, and telephone coaching sessions, as compared to usual care in reducing child externalizing behavior. Participants were 172 primary caregivers of a 6- to 12-year-old (29% girls; M age = 8.5 years) recruited from community children’s mental health clinics. Participants were randomized to either Strongest Families™ or usual care and completed measures of child externalizing behavior, parenting practices, parent distress, and intervention services consumed at baseline and 5-, 10-, 16-, and 22-months post-baseline. Growth curve analysis showed significant reductions in externalizing behavior in both conditions over time. Improvements were significantly greater at 10 months in the Strongest Families™ condition (d = 0.43). At 22 months, however, the differences were not significant and small in magnitude (d = −0.05). The intervention decreased inconsistent discipline significantly more than usual care. Parents in both conditions showed significant reductions in distress. We also conducted a cost-effectiveness analysis to assess the value for money of the Strongest Families™ program versus usual care. Distance parent training is a promising way to increase access to, and reduce costs associated with, mental health care for families with a child with disruptive behavior.
KeywordsCost-effectiveness Disruptive behavior Distance delivery Parent training Treatment access Usual care
The authors would like to thank the members of our Data Safety Monitoring Board – Drs. Walter Ambrosius, Christine Arlett, and John Hunsley – for their time and contribution.
This study was funded by Operating Grant 91030 from the Canadian Institutes of Health Research to Drs. McGrath and Cunningham.
Compliance with Ethical Standards
Conflict of Interest
Dr. McGrath is the volunteer Chair of the Board of the Strongest Families Institute (SFI) and owns intellectual property rights for the Strongest Families™ Parenting the Active Child program, but has assigned rights to SFI. Dr. Cunningham receives salary support and holds shares in BCFPI.inc and receives compensation for workshops and materials for large group COPE parent training programs. Dr. Lingley-Pottie is a full-time paid employee, President, and CEO of SFI and the IRIS platform. The remaining authors have no conflicts of interest.
The present trial was approved by Research Ethics Boards at the IWK Health Centre and McMaster University.
All participants (parents) provided informed consent.
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