The Family Check-Up Online Program for Parents of Middle School Students: Protocol for a Randomized Controlled Trial

Digital Health Delivery of Parenting Skills to Improve Conduct Problems in Middle School Youth Across Two Distinct Randomized Trials

This study evaluated direct and indirect effects of the Family Check-Up Online (FCU-O) across two distinct randomized trials with middle school youth and families. The FCU-O is a digital health adaptation of the Family Check-Up that is delivered in a brief, online format with supportive coaching. The FCU-O was delivered to parents of middle school youth with a focus on targeting both proximal and distal outcomes that impact the development of conduct problems, including a range of parenting skills, effortful control, and youth emotional problems. Participants were primary caregivers of children aged 10 to 14 years. Eligibility varied across the trials and included endorsing depression or significant stress, or having a child enrolled in a school with limited resources. A total of 374 participants across trials were included in the analysis and were randomly assigned to receive the intervention or control. Using Integrative Data Analytic techniques, we examined the effects of random assignment on a range of outcomes, including emotional and behavior problems, parenting skills, parenting confidence, and effortful control. We examined the indirect effects of the FCU-O on changes in conduct problems from baseline to 6 months via changes in mediator variables at the first follow-up assessment (2-3 months). The FCU-O improved emotional problems, effortful control, parenting confidence, and parent sense of importance at the first follow-up. Mediation analyses suggested indirect effects on conduct problems at 6-month follow-up via improvements in effortful control and emotional problems, but not via improvements in parenting confidence or sense of parenting importance. Results indicate the FCU-O has potential as a public health intervention for families with middle school youth to reduce behavioral risk. ClinicalTrials.gov Identifier: NCT03060291; NCT05117099.

Family Check-Up Online: Effects of a Virtual Randomized Trial on Parent Stress, Parenting, and Child Outcomes in Early Adolescence

We adapted the Family Check-Up Online (FCU-O) (1) to support families coping with pandemic-related stressors to prevent behavioral and emotional problems among middle school youth and (2) for smartphone delivery to increase access and reach during the COVID-19 pandemic. This study evaluated the direct and indirect effects of the adapted FCU-O at 4-months post-baseline. The FCU-O combines online parenting support with telephone coaching. Participants were primary caregivers of children ages 10 to 14 years. Eligibility included endorsing depression on the PHQ-2 or significant stress on a 4-item version of the Perceived Stress Scale. We randomly assigned participants to the adapted FCU-O (N = 74) or a waitlist control condition (N = 87). Participants predominantly self-identified as female (95%), 42.77 years old on average, and White (84.6%). Outcomes included caregiver reports of perceived stress and parenting, and youth conduct problems and depressive symptoms. Using a multilevel modeling approach, we tested intent-to-treat intervention effects at 4-months, with time points nested within participants. The FCU-O reduced caregiver stress and improved proactive parenting and limit setting but had no effects on youth outcomes. Effect sizes were small to moderate (Cohen's d ranged from .37 to .57). We examined indirect effects on youth outcomes at 4-months via changes in caregiver stress and parenting at 2-months. Mediation analyses suggested indirect effects on youth depressive symptoms via reductions in caregiver stress and increases in proactive parenting. Results indicate the FCU-O has potential as a public health intervention for families facing extreme stressors such as those during the COVID-19 pandemic. ClinicalTrials.gov Identifier: NCT05117099.

A review of mental health disparities during COVID-19: Evidence, mechanisms, and policy recommendations for promoting societal resilience

Social and economic inequality are chronic stressors that continually erode the mental and physical health of marginalized groups, undermining overall societal resilience. In this comprehensive review, we synthesize evidence of greater increases in mental health symptoms during the COVID-19 pandemic among socially or economically marginalized groups in the United States, including (a) people who are low income or experiencing homelessness, (b) racial and ethnic minorities, (c) women and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) communities, (d) immigrants and migrants, (e) children and people with a history of childhood adversity, and (f) the socially isolated and lonely. Based on this evidence, we propose that reducing social and economic inequality would promote population mental health and societal resilience to future crises. Specifically, we propose concrete, actionable recommendations for policy, intervention, and practice that would bolster five "pillars" of societal resilience: (1) economic safety and equity, (2) accessible healthcare, including mental health services, (3) combating racial injustice and promoting respect for diversity, equity, and inclusion, (4) child and family protection services, and (5) social cohesion. Although the recent pandemic exposed and accentuated steep inequalities within our society, efforts to rebuild offer the opportunity to re-envision societal resilience and policy to reduce multiple forms of inequality for our collective benefit.

Evaluating the Efficacy of the Family Check-Up Online to Improve Parent Mental Health and Family Functioning in Response to the COVID-19 Pandemic: A Randomized Clinical Trial

This study evaluated the effects of an enhanced version of the Family Check-Up Online (FCU-O), adapted to address parent and family functioning in response to the COVID-19 pandemic. In order to increase accessibility, the FCU-O was delivered as a web-based application coupled with online coaching support, a service delivery model that is consistent with pandemic-related limitations for in-person intervention, as well as the limited staffing and resources available in many schools and health care settings despite the increased need for mental health services driven by the pandemic. This registered clinical trial (blinded) tested the effects of the intervention on parental mental health, parenting behaviors, and family functioning from pre-treatment to 2-month follow-up. Families were randomly assigned to receive the FCU-O (N = 74) or to a wait-list control condition (N = 87). Random assignment to the FCU-O was associated with significant improvements in parental well-being, including reduced anxiety, depression, and perceived stress. Further, the FCU-O predicted significant improvements in adaptive parenting skills (e.g. less negative/coercive parenting, greater proactive parenting), and enhancements in family-relational functioning (e.g. improved coparenting). Effect sizes were small to moderate in magnitude (partial eta squared values between 0.03 and 0.11). The results indicate that online delivery of a family-centered intervention may represent a promising approach for addressing pandemic-related impacts on parent and family functioning.

The Family Check-Up Online: A Telehealth Model for Delivery of Parenting Skills to High-Risk Families With Opioid Use Histories

Growing opioid misuse in the United States has resulted in more children living with an adult with an opioid use history. Although an abundance of research has demonstrated a link between opioid misuse and negative parenting behaviors, few intervention efforts have been made to target this underserved population. The Family Check-Up (FCU) has been tested in more than 25 years of research, across multiple settings, and is an evidence-based program for reducing risk behavior, enhancing parenting skills, and preventing the onset of substance use. It is designed to motivate parents to engage in positive parenting practices and to change problematic parenting and has been tested across a variety of ages including early childhood and adolescence. It is highlighted in NIDA’s Principles of Substance Use Prevention for Early Childhood: A research-based guide as one of only three effective selective prevention programs for substance abuse among families with young children. Recently, we developed an online version of the FCU that has now been adapted for early childhood and families with opioid use histories. The online platform and telehealth model allow for wide-scale dissemination, ease of training with community providers, and increased public health reach for families in remote, rural areas. This is particularly important when targeting families with opioid misuse and addiction because there are high rates of addiction in remote areas, yet few services available. In this article, we describe the FCU Online and review new content in the model that targets a population of young adult parents with substance abuse histories, including opioid use. New modules include content focused on harm reduction for this high-risk population of parents, such as safety in the home, substance use while parenting, and managing conflict with partners and friends.

Therapeutic alliance as a predictor of behavioral outcomes in a relationally focused, family-centered telehealth intervention

This study evaluates therapeutic alliance as a mediator of the relationship between dosage and clinical outcomes for the Family Check-Up (FCU) Online, a telehealth adaptation of an evidence-based parenting intervention for parents of middle school youth. The sample consisted of N = 111 parents with children in middle school who received the FCU Online as part of an ongoing clinical trial. They were randomly assigned to receive telehealth coaching and participated in the intervention and follow-up assessment 12 months later. Data was collected using parent and child questionnaires as well as engagement data collected as part of the online intervention, using both parents and children as reporters of parent behavioral change. Using parent report measures, there was clear support for a mediation model, with parent report of alliance predicting parent self-report ratings of clinical progress (parent behavior change) at 12-month follow-up. However, for the child-report data, there was no clear relationship between dosage or therapeutic alliance with child reports of parenting. Clinical implications and future research directions are discussed.