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Gardner, F., Connell, A., Trentacosta, C. J., Shaw, D. S., Dishion, T. J., & Wilson, M. N. (2009). Moderators of outcome in a brief family-centered intervention for preventing early problem behavior. Journal of Consulting and Clinical Psychology, 77(3), 543–553.

Model(s) Reviewed: Family Check-Up® For Children
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Randomized controlled trial Low Not established on race/ethnicity, SES, or baseline measures of the outcomes. None None
Notes:

footnote265

Submitted by user on Fri, 03/15/2019 - 14:29

This study is part of a large RCT described by Dishion et al. (2008).

Earlier, this study was listed as an additional source for Dishion et al. 2008. In the course of the 2017 annual review, HomVEE identified outcomes within this study that were eligible for review beyond those that were reported within Dishion et al. 2008, so it is eligible for review on its own and is not solely an additional source of information published in another study. Based upon a review of these additional outcomes, the study receives a moderate rating.

Study characteristics
Study participants The study included 731 families that met two criteria. First, they participated in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) when their son or daughter was between 2 years 0 months old and 2 years 11 months old. Second, they met the study’s criteria for being at risk for behavior problems—defined as one standard deviation or more above normative averages in at least two of three domains: (1) child behavior problems (such as conduct problems or high-conflict relationships with adults); (2) primary caregiver problems (such as maternal depression, daily parenting challenges, self-reported substance or mental health diagnosis, or status as a teen parent at first birth); and (3) socioeconomic status (a caregiver with low educational achievement or low family income based on WIC criteria). Screening was conducted in 2002 and 2003. Of the 731 primary caregivers who agreed to participate, 41 percent had a high school diploma or GED, 32 percent had one or two years of post-high school training, and 24 percent had less than a high school diploma or GED. More than two-thirds of the randomized sample had an annual income below $20,000. Of the 731 children in the study, 50 percent were European American, 28 percent were African American, 13 percent were biracial, and 9 percent were from another racial group. Thirteen percent were Hispanic. The children were 29.9 months old on average at the time of the age 2 assessments. Forty-nine percent of the children were female, and 58 percent lived in two-parent households.
Setting Families were recruited from WIC program sites in and around Pittsburgh, Pennsylvania (37 percent of sample); Eugene, Oregon (37 percent of sample); and Charlottesville, Virginia (26 percent of sample).
Intervention services The Family Check-Up program typically involves three meetings: an initial contact meeting (a “get to know you” meeting); an assessment meeting, during which families participate in a comprehensive assessment of child and family functioning; and a feedback meeting to discuss the results of the assessment. After the feedback meeting, families can choose to participate in additional follow-up meetings. For this study, the order of the meetings was changed. All families participating in the study were given the comprehensive assessment. The researchers then randomized families into intervention and comparison groups. Following randomization, families in the intervention group participated in the initial contact and feedback meetings, which were led by parent consultants. These consultants discussed family issues and family functioning during the initial contact meeting and, during the feedback meeting, used motivational interviewing techniques to discuss the results of the assessment, areas of strength, areas for improvement, and recommended services that might help the family. After the feedback meetings, families could choose to participate in additional follow-up meetings. Families assigned to the intervention group received the intervention once yearly when their children were 2, 3, and 4 years old.
Comparison conditions Families in the comparison group received the Family Check-Up's comprehensive assessment but did not receive any other interventions or services.
Staff characteristics and training Parent consultants for this study had either a master’s or doctorate degree; had previous experience conducting family-based interventions; and were of diverse ethnicities, including Latino, African American, European American, and mixed ethnicity. Consultants were trained for two-and-a-half to three months in strategies that included didactic instruction and role-playing as well as ongoing videotaped supervision of intervention activity. Consultants were certified by lead parent consultants at each site; the lead consultants were certified by a member of the research team. Certification was repeated annually and was established by reviewing videotapes of feedback and follow-up sessions. Weekly conference calls were held to discuss cases, and annual consultant meetings were held to update training, discuss possible changes in the intervention, and address issues related to families’ needs.
Funding sources National Institutes of Health grant R01 DA16110 to Gardner, Shaw, Dishion, and Wilson.
Author affiliation The authors are associated with Oxford University, Case Western Reserve University, Wayne State University, the University of Pittsburgh, the University of Oregon, and the University of Virginia. In addition, Thomas Dishion, a study author, is a developer of this model.
Study Registration:
Clinicaltrials.gov Identifier: None found. Study registration was assessed by HomVEE beginning with the 2014 review.

Findings details

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Child Behavior Checklist (CBCL) Externalizing, Age 3, Mean and SD
FavorableUnfavorable or ambiguousNo Effect
WIC sites in Pittsburgh, PA, Eugene, OR, and Charlottesville, VA Age 3 651 children Unadjusted mean = 55.83 Unadjusted mean = 56.11 Mean difference = -0.28 HomeVEE calculated = -0.03 Not statistically significant, p=0.70

footnote162

Submitted by user on Fri, 03/15/2019 - 14:29

Negative value is favorable to the intervention.

Moderate Child Behavior Checklist (CBCL) Externalizing, Age 4, Mean and SD
FavorableUnfavorable or ambiguousNo Effect
WIC sites in Pittsburgh, PA, Eugene, OR, and Charlottesville, VA Age 4 619 children Unadjusted mean = 52.68 Unadjusted mean = 54.67 Mean difference = -1.99 HomeVEE calculated = -0.19 Statistically significant, p=0.02

footnote162

Submitted by user on Fri, 03/15/2019 - 14:29

Negative value is favorable to the intervention.

Moderate Child Behavior Checklist (CBCL) Externalizing, Ages 3 and 4, Latent growth model
FavorableUnfavorable or ambiguousNo Effect
WIC sites in Pittsburgh, PA, Eugene, OR, and Charlottesville, VA Ages 3 and 4 723 children Not reported Not reported Not Reported Not available Statistically significant, p<0.052

footnote266

Submitted by user on Fri, 03/15/2019 - 14:29

Authors used a latent growth model to estimate the impact.

Moderate Eyeberg Child Behavior Inventory Problem Score, Age 3, Mean and SD
FavorableUnfavorable or ambiguousNo Effect
WIC sites in Pittsburgh, PA, Eugene, OR, and Charlottesville, VA Age 3 642 children Unadjusted mean = 59.18 Unadjusted mean = 60.06 Mean difference = -0.88 HomeVEE calculated = -0.08 Not statistically significant, p=0.28

footnote162

Submitted by user on Fri, 03/15/2019 - 14:29

Negative value is favorable to the intervention.

Moderate Eyeberg Child Behavior Inventory Problem Score, Age 4, Mean and SD
FavorableUnfavorable or ambiguousNo Effect
WIC sites in Pittsburgh, PA, Eugene, OR, and Charlottesville, VA Age 4 616 children Unadjusted mean = 58.64 Unadjusted mean = 60.63 Mean difference = -1.99 HomeVEE calculated = -0.18 Statistically significant, p=0.03

footnote162

Submitted by user on Fri, 03/15/2019 - 14:29

Negative value is favorable to the intervention.

Moderate Eyeberg Child Behavior Inventory Problem Score, Ages 3 and 4, Latent growth model
FavorableUnfavorable or ambiguousNo Effect
WIC sites in Pittsburgh, PA, Eugene, OR, and Charlottesville, VA Ages 3 and 4 723 children Not reported Not reported Not Reported Not available Statistically significant, p<0.052

footnote266

Submitted by user on Fri, 03/15/2019 - 14:29

Authors used a latent growth model to estimate the impact.

Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Maternal Depression (Center for Epidemiological Studies Depression Scale), Age 3, Mean and SD
FavorableUnfavorable or ambiguousNo Effect
WIC sites in Pittsburgh, PA, Eugene, OR, and Charlottesville, VA Age 3 651 mothers Unadjusted mean = 14.62 Unadjusted mean = 16.26 Mean difference = -1.64 HomeVEE calculated = -0.15 Not statistically significant, p=0.06

footnote162

Submitted by user on Fri, 03/15/2019 - 14:29

Negative value is favorable to the intervention.

Outcome measure summary

Child development and school readiness
Outcome measure Description of measure Data collection method Properties of measure

Child Behavior Checklist (CBCL) Externalizing, Age 3, Mean and SD

The Eyeberg Child Behavior Inventory is a 36-item behavior checklist that assesses two factors: (1) the perceived intensity, and (2) degree a behavior is a problem for caregivers. The researchers focused on the problem factor, which asks caregivers to report on the extent the behavior is a problem for the parent using a 7-point scale. Parent/caregiver report

Internal consistencies were 0.84 at age 2, 0.90 at age 3, and 0.94 at age 4.

Child Behavior Checklist (CBCL) Externalizing, Age 4, Mean and SD

The CBCL for ages 1.5–5 is a 99-item assessment of behavioral problems in young children. The CBCL includes two broadband factors—internalizing and externalizing—that were used to evaluate the frequency of problem behavior during the study period. Parent/caregiver report

Internal consistencies were 0.86 at age 2, 0.89 at age 3, and 0.86 at age 4.

Child Behavior Checklist (CBCL) Externalizing, Ages 3 and 4, Latent growth model

The CBCL for ages 1.5–5 is a 99-item assessment of behavioral problems in young children. The CBCL includes two broadband factors—internalizing and externalizing—that were used to evaluate the frequency of problem behavior during the study period. Parent/caregiver report

Internal consistencies were 0.86 at age 2, 0.89 at age 3, and 0.86 at age 4.

Eyeberg Child Behavior Inventory Problem Score, Age 3, Mean and SD

The Eyeberg Child Behavior Inventory is a 36-item behavior checklist that assesses two factors: (1) the perceived intensity, and (2) degree a behavior is a problem for caregivers. The researchers focused on the problem factor, which asks caregivers to report on the extent the behavior is a problem for the parent using a 7-point scale. Parent/caregiver report

Internal consistencies were 0.84 at age 2, 0.90 at age 3, and 0.94 at age 4.

Eyeberg Child Behavior Inventory Problem Score, Age 4, Mean and SD

The Eyeberg Child Behavior Inventory is a 36-item behavior checklist that assesses two factors: (1) the perceived intensity, and (2) degree a behavior is a problem for caregivers. The researchers focused on the problem factor, which asks caregivers to report on the extent the behavior is a problem for the parent using a 7-point scale. Parent/caregiver report

Internal consistencies were 0.84 at age 2, 0.90 at age 3, and 0.94 at age 4.

Eyeberg Child Behavior Inventory Problem Score, Ages 3 and 4, Latent growth model

The Eyeberg Child Behavior Inventory is a 36-item behavior checklist that assesses two factors: (1) the perceived intensity, and (2) degree a behavior is a problem for caregivers. The researchers focused on the problem factor, which asks caregivers to report on the extent the behavior is a problem for the parent using a 7-point scale. Parent/caregiver report

Internal consistencies were 0.84 at age 2, 0.90 at age 3, and 0.94 at age 4.

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

Maternal Depression (Center for Epidemiological Studies Depression Scale), Age 3, Mean and SD

The Center for Epidemiological Studies-Depression Scale is a 20-item assessment of depressive symptoms. Parent/caregiver report

Internal consistencies were 0.76 at age 2 and 0.75 at age 3.