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Mishina K, Kinnunen M, Heikkinen A, Saarinen S, Hinkka-Yli-Salomäki S, Sinokki A, Imberg T, Sourander A. Digital universal parent training program to promote positive parenting skills – A randomized waiting-list study. Eur Psychiatry 2022. [PMCID: PMC9567941 DOI: 10.1192/j.eurpsy.2022.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Parent training programs have high potential to promote positive parent-child relationships as well as reach and engage parents to participate. Digitally delivered programs may overcome the barriers associated with face-to-face interventions, such as stigma, logistic challenges and limited resources. Objectives To assess the effectiveness and feasibility of digital universal parent training program for families with 3 years-old children, focusing on parenting skills and child´s behavior. Methods A non-blinded randomized controlled trial (RCT) with two groups: (I) the intervention group, in which participants receive the parent training and (II) the waiting list group, in which participants are placed on a waiting list to receive the parent training intervention after the first follow-up measurement have been completed. Participants must meet the following inclusion criteria: a) guardians having a child age 3 years, b) participating to annual health checkup in child health clinic, c) at least one of the guardian is able to understand the languages that intervention is provided. Results Pilot study with feasibility assessment finished at early 2021. Recruitment of the wider RCT study is currently ongoing. The results from the pilot study and more detailed description about the intervention will be presented. Conclusions This study with good national geographical coverage is a unique possibility to evaluate universal parenting program on promoting parenting behaviors associated with the promotion of optimal child emotional development. This study also provides population level information about parenting skills and child´s behavior. Disclosure No significant relationships.
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Korpilahti-Leino T, Luntamo T, Ristkari T, Hinkka-Yli-Salomäki S, Pulkki-Råback L, Waris O, Matinolli HM, Sinokki A, Mori Y, Fukaya M, Yamada Y, Sourander A. Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study. J Med Internet Res 2022; 24:e26438. [PMID: 35138265 PMCID: PMC9009379 DOI: 10.2196/26438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/19/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has had a major impact on families’ daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children’s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods The Let’s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program’s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children’s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. Conclusions The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery.
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Affiliation(s)
- Tarja Korpilahti-Leino
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Terhi Luntamo
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Laura Pulkki-Råback
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Otto Waris
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Hanna-Maria Matinolli
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Atte Sinokki
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Yuko Mori
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Mami Fukaya
- Department of Psychology and Human Developmental Sciences, Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Yuko Yamada
- Section of Medical Care and Consultation, Nagoya City Central Care Center for Disabled Children, Nagoya, Japan
| | - Andre Sourander
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Kurki M, Gilbert S, Mishina K, Lempinen L, Luntamo T, Hinkka-Yli-Salomäki S, Sinokki A, Upadhyaya S, Wei Y, Sourander A. Correction to: Digital mental health literacy -program for the first-year medical students' wellbeing: a one group quasi-experimental study. BMC Med Educ 2021; 21:602. [PMID: 34872544 PMCID: PMC8650248 DOI: 10.1186/s12909-021-03031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Marjo Kurki
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland.
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland.
- ITLA Children's Foundation, Porkkalankatu 24, 00180, Helsinki, Finland.
| | - Sonja Gilbert
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Kaisa Mishina
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Department of Nursing Science, University of Turku, Joukahaisenkatu 3-5, FI-20014, Turku, Finland
| | - Lotta Lempinen
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Terhi Luntamo
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Subina Upadhyaya
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Yifeng Wei
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Lemminkaisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Turku University Hospital, PO Box 52, 20521, Turku, Finland
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Kurki M, Gilbert S, Mishina K, Lempinen L, Luntamo T, Hinkka-Yli-Salomäki S, Sinokki A, Upadhyaya S, Wei Y, Sourander A. Digital mental health literacy -program for the first-year medical students' wellbeing: a one group quasi-experimental study. BMC Med Educ 2021; 21:563. [PMID: 34742258 PMCID: PMC8571980 DOI: 10.1186/s12909-021-02990-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical students are prone to mental disorders, such as depression and anxiety, and their psychological burden is mainly related to their highly demanding studies. Interventions are needed to improve medical students' mental health literacy (MHL) and wellbeing. This study assessed the digital Transitions, a MHL program for medical students that covered blended life skills and mindfulness activities. METHODOLOGY This was a one group, quasi-experimental pretest-posttest study. The study population was 374 first-year students who started attending the medical faculty at the University of Turku, Finland, in 2018-2019. Transitions was provided as an elective course and 220 students chose to attend and 182 agreed to participate in our research. Transitions included two 60-minute lectures, four weeks apart, with online self-learning material in between. The content focused on life and academic skills, stress management, positive mental health, mental health problems and disorders. It included mindfulness audiotapes. Mental health knowledge, stigma and help-seeking questionnaires were used to measure MHL. The Perceived Stress Scale and General Health Questionnaire measured the students' stress and health, respectively. A single group design, with repeated measurements of analysis of variance, was used to analyze the differences in the mean outcome scores for the 158 students who completed all three stages: the pre-test (before the first lecture), the post-test (after the second lecture) and the two-month follow-up evaluation. RESULTS The students' mean scores for mental health knowledge improved (-1.6, 95% Cl -1.9 to -1.3, P<.001) and their emotional symptoms were alleviated immediately after the program (0.5, 95% Cl 0.0 to 1.1, P=.040). The changes were maintained at the two-month follow up (-1.7, 95% Cl -2.0 to -1.4, P<.001 and 1.0, 95% Cl 0.2 to 1.8, P=.019, respectively). The students' stress levels reduced (P=.022) and their attitudes towards help-seeking improved after the program (P<.001), but these changes were not maintained at the two-month follow up. The stigma of mental illness did not change during the study (P=.13). CONCLUSIONS The digital Transitions program was easily integrated into the university curriculum and it improved the students' mental health literacy and wellbeing. The program may respond to the increasing global need for universal digital services, especially during the lockdowns due to the COVID-19 pandemic. TRIAL REGISTRATION The trial was registered at the ISRCTN registry (26 May 2021), registration number 10.1186/ ISRCTN10565335 ).
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Affiliation(s)
- Marjo Kurki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland.
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland.
- ITLA Children's Foundation, Porkkalankatu 24, 00180, Helsinki, Finland.
| | - Sonja Gilbert
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Kaisa Mishina
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Department of Nursing Science, University of Turku, Joukahaisenkatu 3-5, FI-20014, Turku, Finland
| | - Lotta Lempinen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Terhi Luntamo
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Subina Upadhyaya
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
| | - Yifeng Wei
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, FI-20014, Turku, Finland
- Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, Finland
- Turku University Hospital, PO Box 52, 20521, Turku, Finland
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Luntamo T, Korpilahti-Leino T, Ristkari T, Hinkka-Yli-Salomäki S, Kurki M, Sinokki A, Lamminen K, Saanakorpi K, Saarinen S, Maunuksela M, Sourander S, Toivonen K, Zadkova A, Suilamo M, Casagrande L, Palmroth J, Sourander A. Internet-assisted cognitive behavioural therapy with telephone coaching for anxious Finnish children aged 10-13 years: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e045474. [PMID: 34162641 PMCID: PMC8230974 DOI: 10.1136/bmjopen-2020-045474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Childhood anxiety is common, causes significant functional impairment and may lead to psychosocial problems by adulthood. Although cognitive behavioural therapy (CBT) is effective for treating anxiety, its availability is limited by the lack of trained CBT therapists and easily accessible local services. To address the challenges in both recognition and treatment, this study combines systematic anxiety screening in the general population with a randomised controlled trial (RCT) on internet-assisted CBT (ICBT) with telephone coaching. Child, family and intervention-related factors are studied as possible predictors or moderators, together with the COVID-19 pandemic. METHODS AND ANALYSIS The study is an open two-parallel group RCT, stratified by sex, that compares ICBT with telephone coaching to an education control. Children aged 10-13 are screened at yearly school healthcare check-ups using five items from the Screen for Child Anxiety Related Disorders (SCARED) Questionnaire. The families of children who screen positive for anxiety are contacted to assess the family's eligibility for the RCT. The inclusion criteria include scoring at least 22 points in the 41-item SCARED Questionnaire. The primary outcome is the SCARED child and parent reports. The secondary outcomes include the impact of anxiety, quality of life, comorbidity, peer relationships, perceptions of school, parental well-being and service use. Additional measures include demographics and life events, anxiety disorder diagnoses, as well as therapeutic partnerships, the use of the programme and general satisfaction among the intervention group. ETHICS AND DISSEMINATION The study has been approved by the research ethics board of the Hospital District of South West Finland and local authorities. Participation is voluntary and based on informed consent. The anonymity of the participants will be protected and the results will be published in a scientific journal and disseminated to healthcare professionals and the general public. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03310489, pre-results, initially released on 30 September 2017.
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Affiliation(s)
- Terhi Luntamo
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Tarja Korpilahti-Leino
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Sanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Kaisa Lamminen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Kristiina Saanakorpi
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Susanna Saarinen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Marjukka Maunuksela
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Saana Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Katja Toivonen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Anna Zadkova
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Miia Suilamo
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Linda Casagrande
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Johanna Palmroth
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - A Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
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Ristkari T, Kurki M, Suominen A, Gilbert S, Sinokki A, Kinnunen M, Huttunen J, McGrath P, Sourander A. Web-Based Parent Training Intervention With Telephone Coaching for Disruptive Behavior in 4-Year-Old Children in Real-World Practice: Implementation Study. J Med Internet Res 2019; 21:e11446. [PMID: 30973337 PMCID: PMC6482405 DOI: 10.2196/11446] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/09/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022] Open
Abstract
Background Parent training is the most effective approach to the psychosocial treatment of disruptive behavioral problems in childhood. However, no studies exist on how well Web-based training programs work when they make the transition from the research setting to implementation in primary health care. Objective The study aimed to examine how the randomized controlled trial (RCT) and implementation study groups of the Strongest Families Smart Website (SFSW) intervention differed in child psychopathology, family demographics and treatment-related factors, such as therapeutic alliance and parents’ satisfaction rates. The intervention was conducted in the pediatric primary health care in Finland. Methods The study focused on 232 parents who had taken part in the SFSW intervention, which formed part of a 2-arm RCT study, and 882 families that would participate in the subsequent SFSW implementation study group. Both groups comprised parents whose children displayed high levels of parent-reported disruptive behavioral problems when they were screened in child health clinics at 4 years of age. Parents in both groups were provided with the SFSW intervention, which consisted of a Web-based training program with 11 weekly themes and associated telephone sessions. Results Demographic factors or duration of behavioral problems did not differ statistically or clinically between the RCT and implementation groups. Overall, 42.0% (362/862) of children in the implementation group and 35.4% (80/226) in the RCT intervention group had suffered from behavioral difficulties more than 1 year before the screening phase (χ12=3.2; P=.07). The mean duration of telephone coaching calls was very similar in the implementation and RCT intervention groups, that is, 38 and 37 min per call, respectively (t279.5=0.26; P=.79). The total time spent on the website of the program was 451 min in the implementation group and 431 min in the RCT intervention group (t318.8=1.38; P=.17). In the RCT intervention group, 52 of the 232 participants (22.4%) discontinued the program before the tenth week, whereas in the implementation group, 109 of the 882 participants (12.4%; odds ratio 2.05, 95% CI 1.4-3.0; P<.001) discontinued. Parents in both the implementation (77.1% to 98.5%, 498/742 to 731/742, respectively) and the RCT (64.8% to 98.2%, N=105/162- to 159/162, respectively) groups reported qualitatively similar and high level of posttreatment satisfaction rates in improved parenting skills, expectations, and stress relief. Parents in both groups reported a high level of satisfaction in skills and professionalism of the telephone coaches. Conclusions The implementation of population-based screening of Web-based parent training intervention with telephone coaching resulted in good feasibility, fidelity, accessibility, and similar satisfaction level post treatment when compared with intervention in RCT research setting. The discontinuation of treatment in the implementation group was exceptionally low.
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Affiliation(s)
- Terja Ristkari
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Auli Suominen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Sonja Gilbert
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
| | - Patrick McGrath
- Centre for Research in Family Health, Izaak Walton Killam Health Centre, Halifax, NS, Canada.,Strongest Families Institute, Halifax, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Central Hospital, University of Turku, Turku, Finland
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Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Lingley-Pottie P, Hinkka-Yli-Salomäki S, Kinnunen M, Vuorio J, Sinokki A, Fossum S, Unruh A. Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial. JAMA Psychiatry 2016; 73:378-87. [PMID: 26913614 DOI: 10.1001/jamapsychiatry.2015.3411] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems. OBJECTIVE To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment. DESIGN, SETTING, AND PARTICIPANTS This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n = 232) or an education control (EC) group (n = 232). INTERVENTIONS The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching. MAIN OUTCOMES AND MEASURES Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization. RESULTS Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.5-5 externalizing scale (effect size, 0.34; P < .001), internalizing scale (effect size, 0.35; P < .001), and total scores (effect size, 0.37; P < .001); 5 of 7 syndrome scales, including aggression (effect size, 0.36; P < .001), sleep (effect size, 0.24; P = .002), withdrawal (effect size, 0.25; P = .005), anxiety (effect size, 0.26; P = .003), and emotional problems (effect size, 0.31; P = .001); Inventory of Callous-Unemotional Traits callousness scores (effect size, 0.19; P = .03); and self-reported parenting skills (effect size, 0.53; P < .001). CONCLUSIONS AND RELEVANCE The study reveals the effectiveness and feasibility of an Internet-assisted parent training intervention offered for parents of preschool children with disruptive behavioral problems screened from the whole population. The strategy of population-based screening of children at an early age to offering parent training using digital technology and telephone coaching is a promising public health strategy for providing early intervention for a variety of child mental health problems. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01750996.
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Affiliation(s)
- Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland2Turku University Hospital, Turku, Finland
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada4Faculty of Science, Dalhousie University, Halifax, Nova Scotia, Canada5Strongest Families Institute, Halifax, Nova Scotia, Canada6Department of Psychiatry, Dalhousie Uni
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jukka Huttunen
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Patricia Lingley-Pottie
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada5Strongest Families Institute, Halifax, Nova Scotia, Canada6Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Malin Kinnunen
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Jenni Vuorio
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Sturla Fossum
- Center for Child and Adolescent Mental Health, North Norway, University of Tromsø, Breivika, Norway
| | - Anita Unruh
- Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
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McGrath PJ, Sourander A, Lingley-Pottie P, Ristkari T, Cunningham C, Huttunen J, Filbert K, Aromaa M, Corkum P, Hinkka-Yli-Salomäki S, Kinnunen M, Lampi K, Penttinen A, Sinokki A, Unruh A, Vuorio J, Watters C. Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada). BMC Public Health 2013; 13:985. [PMID: 24139323 PMCID: PMC4015286 DOI: 10.1186/1471-2458-13-985] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/08/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. METHODS/DESIGN This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. DISCUSSION The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. TRIAL REGISTRATION ClinicalTrials.gov # NCT01750996.
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Affiliation(s)
- Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
| | - Andre Sourander
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
- Center for Child and Adolescent Mental Health, North Norway (RBUP), University of Tromsø, 9037, Breivika, Norway
| | - Patricia Lingley-Pottie
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
- Strongest Families Institute, 7105 Chebucto Road, Suite 355, Halifax, Nova Scotia B3L 4W8, Canada
| | - Terja Ristkari
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Charles Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Science, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Jukka Huttunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katharine Filbert
- Centre for Research in Family Health, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Minna Aromaa
- Outpatient Clinic for Children and Adolescents, Itäinen Pitkäkatu 30, 20700, Turku, Finland
- Department of Public Health, University on Turku, FI-20014, Turun Yliopisto, Finland
| | - Penny Corkum
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Malin Kinnunen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Katja Lampi
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anne Penttinen
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Anita Unruh
- Dalhousie University, Faculty of Health Professions, Burbidge Building, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Jenni Vuorio
- Department of Child Psychiatry, Clinical Sciences, Medical Faculty, Turku University and Turku University Hospital, 20520, Turku, Finland
| | - Carolyn Watters
- Dalhousie University, Faculty of Computer Science, 6050 University Avenue, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
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