This longitudinal study of low-income families tested neighborhood-, family-, and child-centered promotive factors in early childhood, responses to an early family intervention, and their interactions as predictors of school-entry levels of and early school-age gains in academic skills. Using a racially-diverse, low-income sample (n = 527) from a randomized controlled trial of the Family Check-Up (FCU) intervention and Bayesian multilevel regression modeling, we tested whether neighborhood cohesion, positive mother-child engagement, and child self-regulation in early childhood (ages 2-5 years) and their interactions with FCU group assignment predicted the intercept and slope of academic skills across child age 5, 7.5, and 8.5 years. Higher positive mother-child engagement and child self-regulation predicted higher academic skills at school entry. An interaction between the FCU intervention and positive mother-child engagement predicted gains in academic skills compared to national norms. The findings suggest the FCU intervention leveraged positive mother-child engagement in early childhood to promote academic skills, offering a potential avenue from which to prevent income achievement gaps before school entry.

SummaryBackgroundPaediatric obesity is a multifaceted public health problem. Family based behavioural interventions are the recommended approach for the prevention of excess weight gain in children and adolescents, yet few have been tested under “real‐world” conditions.ObjectivesTo evaluate the effectiveness of a family based intervention, delivered in coordination with paediatric primary care, on child and family health outcomes.MethodsA sample of 240 families with racially and ethnically diverse (86% non‐White) and predominantly low‐income children (49% female) ages 6 to 12 years (M = 9.5 years) with body mass index (BMI) ≥85th percentile for age and gender were identified in paediatric primary care. Participants were randomized to either the Family Check‐Up 4 Health (FCU4Health) program (N = 141) or usual care plus information (N = 99). FCU4Health, an assessment‐driven individually tailored intervention designed to preempt excess weight gain by improving parenting skills was delivered for 6 months in clinic, at home and in the community. Child BMI and body fat were assessed using a bioelectrical impedance scale and caregiver‐reported health behaviours (eg, diet, physical activity and family health routines) were obtained at baseline, 3, 6 and 12 months.ResultsChange in child BMI and percent body fat did not differ by group assignment. Path analysis indicated significant group differences in child health behaviours at 12 months, mediated by improved family health routines at 6 months.ConclusionThe FCU4Health, delivered in coordination with paediatric primary care, significantly impacted child and family health behaviours that are associated with the development and maintenance of paediatric obesity. BMI did not significantly differ.

Hundreds of studies have documented an association between depression in mothers and behavior problems in children. Theory and empirical findings suggest this association may be confounded by other factors, but little attention has been paid to this issue. We used propensity score methods in a sample of 731 low-income families assessed repeatedly from child age 2 through 14 years to produce a weighted sample of families that were similar at child age 3 years except for mothers' depression. Depressive symptomatology was measured via self-report rating scale. Mothers were categorized as having clinically-elevated versus non-clinically-elevated scores based on an established threshold. Mothers with elevated versus nonelevated scores were equated on 89 other relevant characteristics (e.g., SES, child behavior, marital conflict). We then compared the equated groups on mother, secondary caregiver, and teacher ratings of child externalizing and internalizing behavior from child ages 4 to 14 years. Prior to equating, the mean prima facie effect of exposure to clinically-elevated mothers' depression scores at child age 3 years was d = 0.45 per mothers, d = 0.26 per secondary caregivers, and d = 0.13 per teachers. After equating, the mean adjusted effect was d = 0.07 per mothers, d = 0.01 per secondary caregivers, and d = 0.03 per teachers. Findings suggest that a substantial portion of the prima facie association between mothers' depression and later child behavior problems is accounted for by confounding variables rather than a causal effect of depressive symptoms per se. To fully understand why children of depressed mothers exhibit more behavior problems, a multicausal theory is needed that jointly considers the cluster of co-occurring clinical features that often accompany maternal depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Family Check-Up 4 Health (FCU4Health) is an adaptation of the Family Check-Up (FCU) for delivery in primary care settings. While maintaining the original FCU’s focus on parenting and child behavioral health, we added content targeting health behaviors. This study evaluated whether the adapted FCU maintained positive effects on parenting (positive behavior support, limit setting, parental warmth) and child behavioral health (self-regulation, conduct problems, emotional problems). Pediatric (6–12 years) primary care patients with a BMI ≥ 85th%ile (n = 240) were recruited from primary care clinics in Phoenix. Children were 75% Latino, 49% female, and 73% Medicaid recipients. This type 2 effectiveness-implementation hybrid trial compared families randomized to FCU4Health (n = 141) or usual care (n = 99). FCU4Health was delivered over a period of 6 months. This study focuses on a priori secondary outcomes included parenting and child behavioral health targets of the original FCU, assessed at baseline and 3, 6, and 12 months. Significant improvements were found for the FCU4Health condition, compared to usual care, in parenting from baseline to the 3-month assessment [β = .17 (.01; .32)]. Parenting predicted improvements in child self-regulation at 6-months [β = .17 (.03; .30)], which in turn predicted reductions in conduct problems [β = − .38 (− .51; − .23)] and emotional problems [β = − .24 (− .38; − .09)] at 12 months. Ethnicity and language of delivery (English or Spanish) did not moderate these effects. The FCU4Health can improve parenting and child behavioral health outcomes when delivered in primary care. Trial Registration Trial registration number: NCT03013309 ClinicalTrials.gov

Although cognitive-behavioral interventions have reduced the risk of substance use, little is known about moderating factors in children with disruptive behaviors. This study examined whether aggressive preadolescents' inhibitory control and intervention engagement moderates the effect of group versus individual delivery on their substance use. Following screening for aggression in 4th grade, 360 children were randomly assigned to receive the Coping Power intervention in either group or individual formats. The sample was primarily African American (78%) and male (65%). Assessments were made of children's self-reported substance use from preintervention through a six-year follow-up after intervention, parent-reported inhibitory control at preintervention, and observed behavioral engagement in the group intervention. Multilevel growth modeling found lower increases in substance use slopes for children with low inhibitory control receiving individual intervention, and for children with higher inhibitory control receiving group intervention. Children with low inhibitory control but who displayed more positive behavioral engagement in the group sessions had slower increases in their substance use than did similar children without positive engagement. Aggressive children's level of inhibitory control can lead to tailoring of group versus individual delivery of intervention. Children's positive behavioral engagement in group sessions is a protective factor for children with low inhibitory control.

Background: Parenting interventions like the Family Check-Up have demonstrated effects on child physical and behavioral health outcomes. However, access to these programs is limited, particularly for populations experiencing health disparities. Primary care settings have become recognized as a potential delivery system in which these programs may be implemented at scale. The purpose of this trial is to test the effectiveness of the Family Check-Up 4 Health (FCU4Health) program, an adaptation of the FCU for primary care, and assess program implementation in an integrated primary care setting. Methods: We will conduct a hybrid type 2 effectiveness-implementation trial in partnership with a primary care clinic in a low-income, majority Latino community. Families with 2to 5-year-old children will be eligible to participate. Families will be randomized to receive the intervention (n = 130) or services as usual (n = 70) and will be assessed annually over three years. Outcomes are informed by the RE-AIM framework (i.e., reach, effectiveness, adoption, implementation, and maintenance). Effectiveness outcomes include child health behaviors (e.g., Dietary Screener Questionnaire), behavioral health (e.g., Strengths and Difficulties Questionnaire), and parenting (e.g., Proactive Parenting). Early stage implementation outcomes are also included (e.g., cost, acceptability, appropriateness, and feasibility). Effectiveness outcomes will be assessed via intent-to-treat (ITT) analyses. Implementation outcomes will be primarily descriptive with comparisons to prior trials of FCU4Health and the original FCU. Projected outcomes: This trial will provide evidence related to the potential of integrated primary care settings to deliver evidence-based preventive interventions with a dual focus on behavioral and physical health.

This study examined the long-term effects of a randomized controlled trial of the Family Check-Up (FCU) intervention initiated at age 2 on inhibitory control in middle childhood and adolescent internalizing and externalizing problems. We hypothesized that the FCU would promote higher inhibitory control in middle childhood relative to the control group, which in turn would be associated with lower internalizing and externalizing symptomology at age 14. Participants were 731 families, with half (n = 367) of the families assigned to the FCU intervention. Using an intent-to-treat design, results indicate that the FCU intervention was indirectly associated with both lower internalizing and externalizing symptoms at age 14 via its effect on increased inhibitory control in middle childhood (i.e., ages 8.5-10.5). Findings highlight the potential for interventions initiated in toddlerhood to have long-term impacts on self-regulation processes, which can further reduce the risk for behavioral and emotional difficulties in adolescence.

The present study tested the moderating role of interparental relationship quality and child inhibitory control on the stability of paternal depression over time and associations between paternal depression and child internalizing problems in early childhood. Participants were a subsample (n = 166) of families from the Early Steps Multisite study, a longitudinal study of low-income parents and children. Interparental relationship quality (age 2) attenuated the association between paternal depressive symptoms at age 2 and paternal depressive symptoms at age 3. Both interparental relationship quality (age 3) and child inhibitory control (age 3) attenuated the association between paternal depressive symptoms (age 3) and age 4 child internalizing problems. Results suggest that high interparental relationship quality may be a protective factor in terms of lessening the stability of paternal depressive symptoms over time, as well as the association between paternal depression and later child internalizing problems. Similarly, high levels of inhibitory control may buffer children from the negative effects of paternal depression on the development of internalizing problems.

Aims To translate evidence-based programs (EBP) for a new setting, attention must be given to the characteristics of the intervention and the local setting, as well as evidence that is compelling to decision-makers. This paper describes the history of a partnership and stakeholder recommendations to inform the adaptation of an EBP for primary care. Methods We established a community advisory board (CAB) consisting of stakeholders with expertize in primary care delivery. A thematic analysis was conducted with fieldnotes and transcriptions from CAB meetings and regular meetings with participating clinics. Results We found that (a) parenting programs with a focus on behavioral and physical health are appropriate for this setting, (b) variability in the structure of primary care means implementation must be tailorable, and (c) financial and organizational outcomes are compelling for decision-makers. Conclusion Factors related to the content and structure of evidence-based programs are uniquely related to distinct implementation outcomes of interest to key stakeholders.

Child birth order (CBO) in the family has received little attention in the field of prevention science. CBO is relevant to early interventionists from a public health perspective, as the most widely disseminated home-visiting program has traditionally targeted mothers and their first-born children. The current paper revisits a previous publication by Shaw et al. (2009) on the effectiveness of the Family Check-Up (FCU) to evaluate CBO (firstborn vs. middle vs. youngest) as a moderator of treatment effects of the FCU in relation to improvements in parenting, maternal depressive symptoms, and child outcomes from ages 2 to 4 in a sample of low-income, ethnically diverse families (N = 709) with multiple children. Results suggest that the FCU elicited improvements in observed parenting from ages 2 to 3 primarily for target children who were the youngest or middle children, but not for firstborns. Findings are discussed in the context of implications for prevention science research, dissemination, and public policy.

High-quality evidence about the costs of effective interventions for children can provide a foundation for fiscally responsible policy capable of achieving impact. This study estimated the costs to society of the Family Check-up, an evidence-based brief home-visiting intervention for high-risk families implemented in the Early Steps multisite efficacy trial. Intervention arm families in three sites were offered 4 consecutive years of intervention, when target children were ages 2 through 5. Data for estimating total, average, and marginal costs and family burden (means and standard deviations, 2015 USD, discounted at 3% per year) came from a detailed database that prospectively documented resource use at the family level and a supplemental interview with trial leaders. Secondary analyses evaluated differences in costs among higher and lower risk families using repeated measures analysis of variance. Results indicated annual average costs of $1066 per family (SD = $400), with time spent by families valued at an additional $84 (SD = $99) on average. Costs declined significantly from ages 2 through 5. Once training and oversight patterns were established, additional families could be served at half the cost, $501 (SD = $404). On the margin, higher risk families cost more, $583 (SD = $444) compared to $463 (SD = $380) for lower risk families, but prior analyses showed they also benefited more. Sensitivity analyses indicated potential for wage-related cost savings in real-world implementation compared to the university-based trial. This study illustrates the dynamics of Family Check-up resource use over time and across families differing in risk.

Motivational interviewing (MI) is a therapeutic style in which a provider elicits client motivation and helps strengthen commitment to change (Miller and Rollnick 2002). The original Family Check-Up (FCU; Dishion and Stormshak 2007)—and the adapted version for improving health behaviors in primary care, the Family Check-Up 4 Health (FCU4Health; Smith et al. 2018a)—are brief, assessment-driven, and family-centered preventive interventions that use MI to improve parent engagement in services to improve parenting and prevent negative child outcomes. This study examines the role of MI in the Raising Healthy Children project, a randomized trial to test the effectiveness of the FCU4Health for the prevention of obesity in pediatric primary care, with data from the 141 families assigned to receive the FCU4Health. Families were eligible for the study if the child was between 5.5 and 12 years of age at the time of identification and had a BMI ≥ 85th percentile for age and gender at the most recent visit to their primary care provider. MI skills at the first session predicted caregiver in-session active engagement, attendance at follow-up parenting sessions, and improvements in motivation to address child health and behavior goals. Baseline characteristics of the family (i.e., child health diagnosis, caregiver baseline depression, motivation, and Spanish language preference) had differential associations with responsiveness and MI skills. This study has implications for program development, provider training, and fidelity monitoring.

The confluence model theorizes that dynamic transactions between peer rejection and deviant peer clustering amplify antisocial behavior (AB) within the school context during adolescence. Little is known about the links between peer rejection and AB as embedded in changing networks. Using longitudinal social network analysis, we investigated the interplay between rejection, deviant peer clustering, and AB in an ethnically diverse sample of students attending public middle schools (N = 997; 52.7% boys). Adolescents completed peer nomination reports of rejection and antisocial behavior in Grades 6-8. Results revealed that rejection status was associated with friendship selection, and adolescents became rejected if they were friends with others who were rejected. Youth befriended others with similar levels of AB. Significant patterns of peer influence were documented for AB and rejection. As hypothesized, rejected youth with low AB were more likely to affiliate with others with high AB instead of similarly low AB. In contrast, nonrejected youth preferred to befriend others with similarly high or low AB. Results support an updated confluence model of a joint interplay between rejection and AB as ecological conditions that lead to self-organization into deviant clusters in which peer contagion on problem behaviors operates.

We used provider (n=112) data that staff at the agency disseminating the Family Check-Up (FCU; REACH Institute) collected to profile provider diversity in community settings and to examine whether provider profiles are related to implementation fidelity. Prior to FCU training, REACH Institute staff administered the FCU Provider Readiness Assessment (PRA), a provider self-report measure that assesses provider characteristics previously linked with provider uptake of evidence-based interventions. We conducted a latent class analysis using PRA subscale scores as latent class indicators. Results supported four profiles: experienced high readiness (ExHR), experienced low readiness (ExLR), moderate experience (ME), and novice. The ExHR class was higher than all other classes on: (1) personality variables (i.e., agreeableness, conscientiousness, openness, extraversion); (2) evidence-based practice attitudes; (3) work-related enthusiasm and engagement; and (4) their own well-being. The ExHR class was also higher than ExLR and ME classes on clinical flexibility. The ME class was lowest of all classes on conscientiousness, supervision, clinical flexibility, work-related enthusiasm and engagement, and well-being. During the FCU certification process, FCU Consultants rated providers' fidelity to the model. Twenty-three of the 112 providers that completed the PRA also participated in certification. We conducted follow-up regression analyses using fidelity data for these 23 providers to explore associations between probability of class membership and fidelity. The likelihood of being in the ExHR class was related to higher FCU fidelity, whereas the likelihood of being in the ExLR class was related to lower fidelity. We discuss how provider readiness assessment data can be used to guide the adaptation of provider selection, training, and consultation in community settings.

This study investigates suicide risk in late childhood and early adolescence in relation to a family-centered intervention, the Family Check-Up, for problem behavior delivered in early childhood. At age 2, 731 low-income families receiving nutritional services from Women, Infants, and Children programs were randomized to the Family Check-Up intervention or to a control group. Trend-level main effects were observed on endorsement of suicide risk by parents or teachers from ages 7.5 to 14, with higher rates of suicide risk endorsement in youth in the control versus intervention condition. A significant indirect effect of intervention was also observed, with treatment-related improvements in inhibitory control across childhood predicting reductions in suicide-related risk both at age 10.5, assessed via diagnostic interviews with parents and youth, and at age 14, assessed via parent and teacher reports. Results add to the emerging body of work demonstrating long-term reductions in suicide risk related to family-focused preventive interventions, and highlight improvements in youth self-regulatory skills as an important mechanism of such reductions in risk.

This study originated in collaboration with Thomas Dishion because of concerns that a group format for aggressive children might dampen the effects of cognitive-behavioral intervention. Three hundred sixty aggressive preadolescent children were screened through teacher and parent ratings. Schools were randomized to receive either an individual or a group format of the child component of the same evidence-based program. The results indicate that there is variability in how group-based cognitive-behavioral intervention can affect aggressive children through a long 4-year follow-up after the end of the intervention. Aggressive children who have higher skin conductance reactivity (potentially an indicator of poorer emotion regulation) and who have a variant of the oxytocin receptor gene that may be associated with being hyperinvolved in social bonding have better outcomes in their teacher-rated externalizing behavior outcomes over time if they were seen individually rather than in groups. Analyses also indicated that higher levels of the group leaders' clinical skills predicted reduced externalizing behavior problems. Implications for group versus individual format of cognitive-behavioral interventions for aggressive children, and for intensive training for group therapists, informed by these results, are discussed.

Assessment of fidelity that is effective, efficient, and differentiates from usual practices is critical for effectively implementing evidence-based programs for families. This quasi-experiemntal study sought to determine whether observational ratings of fidelity to the Family Check-Up (FCU) could differentiate between levels of clinician training in the model, and from services as usual, and whether rating segments of sessions could be equivalent to rating complete sessions. Coders rated 75 videotaped sessions—complete and 20-min segments—for fidelity, using a valid and reliable rating system across three groups: (a) highly trained in FCU with universal, routine monitoring; (b) minimally trained in FCU with optional, variable monitoring; and (c) services as usual with no training in the FCU. We hypothesized that certain dimensions of fidelity would differ by training, whereas others would not. The results indicated that, as expected, one dimension of fidelity to the FCU, Conceptually accurate to the FCU, was reliably different between the groups (χ2 = 44.63, p < .001). The differences observed were in the expected direction, showing higher scores for therapists with more training. The rating magnitude of session segments largely did not differ from those of complete session ratings; however, interrater reliabilities were low for the segments. Although observational ratings were shown to be sensitive to the degree of training in the FCU on a unique and theoretically critical dimension, observational coding of complete sessions is resource intensive and limits scalability. Additional work is needed to reduce the burden of assessing fidelity to family-centered programs.

This chapter reviews a 25-year program of research on the benefits and optimal strategies for embedding evidence-based parenting supports into the public-school system. Specifically, translational research is described that led to the development of a systemic approach referred to as Positive Family Support (PFS). Implementation findings from a randomized hybrid effectiveness trial across 41 public middle schools facilitated the identification of three key needs related to enhancing implementation fidelity: (a) trained professional staff working within schools to provide parenting supports, (b) centralized training to minimize disruptions in family support secondary to staff turnover, and (c) district support to principals for monitoring and engaging parents of high-risk students in an effort to prevent school failure and expulsion.

This study examined the mediating effect of friends' characteristics (problem behavior and academic achievement) in the association between students' background (family and individual factors) and later academic adjustment, as operationalized by problem behavior and academic achievement. We recruited 998 participants in three public middle schools and used three annual waves of data collection (Grades 6, 7, and 8). We found that students' own academic achievement and problem bahvior are predictors of later adjustment. Friendship choices are identified as a mediation mechanism that contributes to consistent adjustment from the beginning to the end of middle school. Specifically, high-achieving students in Grade 6 tend to associate with high-achieving friends and are unlikely to associate with friends who exhibit problem behavior in Grade 7, which results in continued achievement in Grade 8. Associating with high-achieving friends in Grade 7 also mediated the link between adolescent problem behavior in Grade 6 and academic achievement by Grade 8. Friends' characteristics in Grade 7 did not mediate the effect of any family factor measured in Grade 6. In general, our results suggest friendship selection is central to sustained success throughout the middle school years.