Group-based Parenting Program to Reduce Child Conduct Disorder Symptoms in Finland
Condition: Conduct Disorders in Children
MeSH terms: Conduct Disorder
Study type: Interventional

Summary: 
      According to studies, approximately 20% of children having contact with child protection
      services have conduct disorder. Negative parenting can make this problem even worse. Research
      has shown Incredible Years Program to be one of the most effective programs to prevent and
      reduce child conduct problems. This study is an randomized controlled trial, which evaluates
      the suitability and effectiveness of group-based Incredible Years program in child protection
      and family support services. The aim of this study is to find out whether this intervention
      reduces children's psychiatric symptoms, especially conduct symptoms, increases positive
      parenting and positive interaction between parents and children, and reduces children's and
      parent's stress and increase well-being. The study will be carried out in 2015-2018. Overall
      101 children and 120 parents participate in the study.
    

Detailed description: 
      1. Introduction Parenting skills and home environment play a major role in children's
           development and safety, especially in early childhood. Studies have shown that
           maltreating parents have poor child management techniques, high levels of hostile
           feelings, reduced emotional responsiveness and escalated verbal aggression. It is
           apparent that large number of parents receiving child protection services are engaged in
           parental behaviors that do not decrease child's problems, but instead may be harmful to
           their children. Since over 80 000 of the children receiving support from child
           protection services in Finland remain in their homes, the need of effective methods to
           support parenting is evident.

           Several randomized trials have shown that parent management training programs, which are
           based primarily on social learning theory, cognitive-behavioral theory, and attachment
           theory, effectively improve parenting skills, parents' mental health and child conduct
           problems. These programs build on social learning theory according to which parents
           model the appropriate behavior to their children. Behavioristic principles, however,
           include methods of prompting children's positive behavior. Ideas based on cognitive
           theory help parents change their conceptions of the child and his/her problematic
           behavior and coaches them to use problem solving and anger management skills. The basis
           of attachment theory is that when a sensitive and safe attachment has developed between
           the child and the caretaker, it helps a child feel safe and builds his/her positive
           perception of different situations.

           Incredible Years Parent Training Program(IY) is one of the most researched programs and
           has been found to be effective in different countries and contexts, for example among
           high-risk, disadvantaged, and maltreating families and also among foster carers .
           However, only a few studies have been made in the context of child protection services
           or with maltreated children.

           The IY program is group-based, focuses on building support networks and decreasing
           isolation, and has a format designed to reduce stigma, and increase parental
           participation and engagement. It emphasizes individual goal-setting and a
           self-reflective learning style, as well as intensive behavior practice and rehearsal
           methods with other parents and a positive, collaborative relationship between group
           leaders and parents. For the previous reasons it may be particularly relevant to
           families with child protection services contact and should be thoroughly researched.

        2. Aims

           The main study question is:

           Does the group based, intensive Incredible Years Parent Management Training reduce
           children's (age 3-7) (sub)clinically significant behavioral problems?

           The other study questions are:

           Does Incredible Years Parent Management Training

             -  increase positive parenting?

             -  increase positive interaction between parents and children?

             -  reduce children's (age 3-7) other psychiatric symptoms?

             -  reduce children's and parent's stress?

             -  increase parent's well-being?

        3. Study Design Randomized controlled trial design will be used (RCT). Participants are 3-7
           year old children (index children, n=101) with behavioral problems and their parents who
           are currently clients of child protection services, other special support services for
           families or families who are clients of family centers or need support just for their
           parenting. Parents and children were randomized before the baseline measurements to the
           intervention group or treatment as usual / waiting list condition. The intervention
           program is Incredible Years Parent Training (Preschool Basic), with 20 parent group
           meetings, including 4 home visits. Children themselves do not participate in any
           intervention. Based on earlier studies the intervention effects of parent management
           training is mediated by changed parenting practices towards children. The measuring
           points are pre, post and 1 year. The study will be carried out in 2015-2018.

           Intervention Participants will attend the Incredible Years Parent Training Program,
           Preschool Basic version, with 18-20 group meetings. The program is based mainly on
           cognitive-behavioral and social learning theories.

           The goal of the group is to enhance and support parenting skills, increase knowledge of
           child development, improve child's positive behavior and parent-child interaction.
           Parents are taught to use more positive and consistent strategies in reducing child
           misbehavior by watching dvd's, rehearsing and group discussions. Groups consist of 10-12
           parents and they get together weekly for app. 2-2,5 hours at a time. Four home visits
           are added to the program to support parents in practicing new skills and to provide
           individual practical consultation. Also weekly phone calls are being made to the
           parents, as part of normal procedure of the program.

           Parents will be interviewed before starting the intervention to explain it fully.

           The intervention groups will start in fall 2016 or beginning of 2017. In each group
           there will be three trained group leaders, of which two are from family counselling
           services and one a family worker from child protection services, who also conducts
           family visits.

           Program fidelity The group leaders will receive supervision from certified peer coach
           every three weeks and once from a mentor during the duration of the groups. Group
           leaders will fill out check lists and self-evaluations after every group meeting. Also
           evaluations from parents after every group meeting will be gathered.

        4. Ethics

      Parents and children are participating voluntarily in the research. Participants of the
      intervention group are given concrete information and training about positive parenting
      methods in a supportive and positive peer group by trained leaders. The participants of the
      control group can access all the other services and support they are entitled to, other than
      the intervention program being researched. The restrain and discomfort caused to participants
      can be considered minor.

      Families participating the study have been interviewed and their willingness to participate
      have been asked beforehand. The group leaders of the intervention will interview the
      participants of the intervention group and tell about the intervention. The participants of
      the control group have a possibility access the next available parent group in the community.

      Parents participating the research have at any time a right to withdraw from the research.
      Confidentiality will be taken care of.
    

Intervention name(s): Incredible Years, Parent group supported by home visiting
Intervention type(s): Behavioral
Intervention description(s): Parents are taught to use positive and consistent strategies in reducing child misbehavior
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomize Controlled Trial with intervention and control groups (TAU)
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Children's mental health; Conduct disorders; Conduct problems; Externalizing problems; Parental Intervention; Groups based intervention; Finland; Social learning theory; Cognitive-behavioral theory