The "Family Check Up" in Early Childhood: A Public Health Intervention to Prevent Long-term Behavioral and Emotional Disorders.

Young children with significant disruptive or oppositional behavior may account for a majority of adolescents who develop severe conduct problems (e.g., Dishion and Patterson, 2006; Shaw & Gross, 2008). Moreover, research has shown that it now makes sense in public policy to target high risk families of infants and toddlers with interventions that can facilitate their movement from higher risk trajectories towards more positive developmental pathways. The Family Check Up (FCU) was developed as a home visiting intervention for early childhood (Dishion & Stormshak, 2007; Shaw, Dishion et al., 2006) for this purpose. One of the key principles of a public health focus is to design interventions that reach as many individuals as possible on the continuum of risk within a community (Kellam, 1990). Intervening during developmental transition points optimizes cascading long-term benefits and reduces risks for children as they grow older. With such an approach, even relatively small effects, over rime, can have large and significant outcomes (Biglan, 1995). One of the most effective strategies for a public health focus is to embed empirically supported interventions in services contexts that reach a large number of children and families (Hoagwood & Koretz, 1996). The FCU in early childhood was designed to fit within the service delivery system of Women, Infants and Children Nutritional Supplement programs (WIC), but could also be adapted into Early Head Start or other community-based programs that promote home visiting and support for parenting, such as the child welfare system. The FCU in early childhood is a brief, three-session intervention to motivate family management practices using a menu-driven, family-choice model, designed to enhance the impetus to change during a key developmental transition point in the development of conduct problems. The early childhood FCU is designed to motivate caretaker engagement with an individually selected array of interventions, based on an empirically validated family management curriculum called Everyday Parenting (Dishion, Stormshak & Kavanagh, 2011). The services that are linked with the FCU range in intensity from brief sessions on positive behavior support, limit setting and relationship building; to frequent sessions over time covering all family management skills, based on parent training procedures (e.g., Forgatch & Patterson, 2010; Kazdin, 2010; Ziller & Eyberg, 2010). The FCU is designed to be provided in family homes using a home visiting model, but it can be delivered in other community-based settings, such as pediatric offices, schools, community mental health or Head Start centers, or the child welfare system. A fuller description of the intervention methods, components and procedures is contained in previously published work (Dishion & Stormshak, 2007; Dishion, Stormshak and Kavanagh, 2011). The first randomized control trial was a pilot study with 120 mother-son dyads screened to be at risk for early starting conduct problems (Shaw, Dishion, Supplee, Gardner & Arnds, 2006; Gardner, Shaw, Dishion, Burton, & Supplee, 2007). The results demonstrated that FCU was effective in increasing positive maternal involvement and in reducing the disruptive behavior in the boys. These significant outcomes were accomplished with a mean number of 3.26 sessions. Following this pilot study, the Early Steps Multisite intervention trial was begun. This was a randomized study of 731 economically disadvantaged families and their 2- to 3-year-old toddlers, who were also screened based on the presence of socioeconomic, family, and child risk. The families were again recruited through WIC. Initial results found improvements in observations of caregiver positive parenting, which promoted decreased CP as reported by mothers at ages 3 and 4 (Dishion, et al., 2008). This increase in positive behavior support was also related to improvements in children's school readiness (Lunkenheimer, Dishion, Shaw, Connell, Gardner, Wilson, & Skuban, 2008). Moreover, the intervention effects were highest among families reporting the most severe levels of problem behavior at age 2. Additional findings have shown that families with different types of sociodemographic risk are no more or less likely to be responsive to the intervention, with the exception that caregivers with less education are more responsive to the FCU than more educated parents (Gardner, Connell, Trentacosta, Shaw, Dishion, & Wilson, 2009; Shaw, Dishion, Connell, Wilson, & Gardner, 2009). Overall, findings on the Early Steps FCU suggest that this brief, family-centered intervention can be equally effective in reaching the most distressed and most disadvantaged families, compared to those who are more advantaged. A brief, theory-driven intervention that pays particular attention to parent motivation and provides family-centered assessment and feedback while giving families choices in the type of intervention can increase positive parenting, reduce maternal depression and child problem behavior, and increase school-readiness in at risk populations of toddlers. Results from two randomized trials suggest that the FCU has the potential to disrupt the early emergence of both emotional and behavioral problems.