A pilot study to evaluate the efficacy of adding a structured home visiting intervention to improve outcomes for high-risk families attending the Incredible Years® parent programme

Abstract

Background: Child conduct problems are increasing and left untreated, they have the potential to develop into adult criminality. Evidence-based treatments such as the Incredible Years® Parent Programme are effective but high-risk families often have poor response to such treatment. Adding a home visiting programmes has the potential to improve outcomes. Aim: To evaluate the acceptability and efficacy of adding a structured Home Parent Support intervention to improve outcomes for high-risk families attending the Incredible Years® Parent Programme. The primary hypothesis was that Home Parent Support would improve child behaviour scores at post-treatment on the Eyberg Total Problem Scale. Results would inform the design of a larger prospective study. Method: A single blind, parallel, superiority, randomised controlled trial was conducted. Parents of children aged 3-7 years with conduct problems (N = 126) were randomly allocated in a computer-generated 1:1 ratio in permuted blocks to receive the addition of Home Parent Support (n = 63) or to the control group of Incredible Years® Parent Programme alone (n = 63). Data on standard child behaviour measures were collected at pre- and post-treatment and six-month follow-up and were analysed using an intention-to-treat design. Qualitative data were collected at each time point and were coded to identify themes and relationships between themes by randomised group. Intervention: Home Parent Support is a 10 session home visiting enhancement developed by the author to provide personalised coaching to address individual and systemic barriers for implementing effective parenting strategies. Setting: The trial was carried out in a clinical service in Tauranga, New Zealand. Results: Complete data were collected at post-treatment for N = 123 (97.6%, treatment n = 62, control n = 61) and at follow-up n = 115 (91.3% treatment n = 62, control n = 53). Results show no additional benefit of Home Parent Support at post-treatment (F(1,124,) = 0.2, p = .624). While the primary hypothesis was not supported, the maintenance of change at sixmonth follow-up showed some benefit on ECBI-P (F(2,248) = 3.5, p = .032). Secondary outcomes also showed benefits in terms attendance, retention, per protocol analysis and percentage of participants in the clinical range at post-treatment. Māori responded equally to treatment and satisfaction was high in both groups. Power calculations represent a realistic sample size to replicate this trial. Qualitative analysis showed parents valued the additional support. Their narratives demonstrated an understanding of principles for behaviour change, including their capacity to reflect on their own interactions with their children. This insight may contribute to maintainance of change over time. Conclusion: The additional benefit of Home Parent Support was not evident at posttreatment, however the maintenance of change at six-month follow-up was promising suggesting longer term benefits. The addition of Home Parent Support could be a realistic and clinically practical intervention to improve outcomes for vulnerable families while they attend the Incredible Years® group programme. Recommendations for future development include a larger prospective study with a larger sample of Māori partipants, follow-up at one or two years to assess maintentance of change, and a study of mediators and moderators. Trial Registration Australian New Zealand Clinical Trial. ACTRN12612000878875