O’Farrelly, C., Watt, H., Babalis, D., Bakermans-Kranenburg, M. J., Barker, B., Byford, S., ... & Ramchandani, P. G. (2021). A brief home-based parenting intervention to reduce behavior problems in young children: a pragmatic randomized clinical trial. JAMA Pediatrics, 175(6), 567-576.
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 2 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Not assessed for randomized controlled trials with low attrition |
No | No |
Yes, details reported below for findings on valid, reliable outcomes that otherwise rate at least moderate |
The PPACS total score from the complete case analysis received a high rating. All other findings received a low rating because they did not satisfy the imputation requirements in HomVEE Version 2 standards or provide reliability information about the outcome measures. Models controlled for baseline measures of outcomes, age of children, and whether one or two caregivers participated in the home visiting intervention. The manuscript also reports complier average causal effects analyses. HomVEE did not review these analyses because intent-to-treat analyses are available for the same findings and HomVEE prefers to review such findings when both types of analyses are presented.
| Study participants | The study invited families whose children scored in the top 20th percentile for behavior problems on the Strengths and Difficulties Questionnaire (SDQ) to participate. Eligible families had a parent or caregiver age 18 or older and a child 12 to 36 months. The study excluded families if the child or parent had a sensory impairment, learning disability, or language limitation that precluded participation; if a sibling participated; or if the family participated in a related trial and/or court proceedings. The study randomly assigned 300 families, with 151 assigned to the Video-feedback Intervention to Promote Positive Parenting Adapted-Sensitive Discipline (VIPP-SD) intervention group and 149 to the comparison group. Children were 23 months old on average at baseline. The majority were White (65 percent of children and 72 percent of primary caregivers); 20 percent of children (and 7 percent of primary caregivers) were of mixed race and ethnicity, 6 percent (and 10 percent of primary caregivers) were Asian, 6 percent (and 6 percent of primary caregivers) were Black, and 3 percent (and 4 percent of primary caregivers) were of another race or ethnicity. Either one or two caregivers could participate in the study with each child. Most participating primary caregivers (96 percent) were women. |
|---|---|
| Setting | The study took place in England at six National Health Service trusts. |
| Intervention services | VIPP-SD participants received six home-based sessions that lasted one to two hours each, delivered every two weeks. The intervention consisted of four core sessions, during which the home visitor videotaped parent–child interactions and provided feedback based on the previous visit. The intervention offered the last two sessions as booster sessions to reinforce material from the first four sessions. |
| Comparison conditions | In both groups participants continued to receive usual care for children with behavior problems. The study authors reported that such care was usually minimal, and may have included support or advice from a general practitioner, home visits through the National Health Service health visitor program, or referrals for behavior interventions or parenting supports. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). • Mother or female caregiver • Father or male caregiver • Race/ethnicity of primary caregiver • Age of child • Number of participating caregivers • Baseline externalizing behavior (on SDQ screening) |
| Funding sources | This research was supported by a National Institute for Health and Care Research (NIHR) Health Technology Assessment programme grant (13/04/33) and the NIHR Biomedical Research Centre based at Imperial College Healthcare National Health Service Trust and Imperial College London. |
| Author affiliation | Drs Bakermans-Kranenburg and van IJzendoorn, two of the authors of the study affiliated with Leiden University, are developers of the VIPP-SD intervention. |
| Peer reviewed | Yes |
Clinicaltrials.gov Identifier: None found. SocialScienceRegistry.org Identifier: None found. Registry of Efficacy and Effectiveness Studies Identifier: None found. Study registration was assessed by HomVEE for Clinicaltrials.gov beginning with the 2014 review, and for other registries beginning with the 2021 review.
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Preschool Parental Account of Childhood Symptoms (PPACS): Total behavior problems score |
FavorableUnfavorable or ambiguousNo Effect |
VIPP-SD vs. usual care, England 2015-2018, full sample |
5-month follow-up |
286 children | Adjusted mean = 28.21 | Adjusted mean = 30.30 | Mean difference = -2.09 | HomVEE calculated = -0.22 | Statistically significant, p <0.05 |
Negative effect is favorable to the intervention. |