Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial

Abstract

Objective To determine whether a parenting programme, offered universally in primary care, can prevent behavioural problems in children and improve parenting and maternal mental health. Design Cluster randomised trial. Setting 40 primary care nursing centres (clusters) in Victoria, Australia. Participants 733 English speaking mothers of 8 month old children sequentially recruited from well child appointments; 656 retained at 24 months. Intervention Structured three session programme at age 8-15 months, co-led by well child providers and a parenting expert. The programme covered normal development and behaviour, strategies to increase desired behaviour, and strategies to reduce unwanted behaviour. Main outcome measures Maternal report of child externalising behaviour (child behavior checklist 1½-5 year old), parenting (parent behavior checklist), and maternal mental health (depression anxiety stress scales) at 18 and 24 months. Results At 18 months, child behaviour and parenting scores were similar in the two groups. At 24 months, externalising scores in the intervention and control groups were similar (mean 11.9 (SD 7.2) v 12.9 (7.4)); however, on the parent behavior checklist subscale scores, intervention group parents were less likely to report harsh/abusive parenting (mean 38.9 (SD 7.7) v 40.5 (8.8); adjusted mean difference −1.83, 95% confidence interval −3.12 to −0.55) and unreasonable expectations of child development (40.9 (9.9) v 42.7 (9.6); −2.18, −3.74 to −0.62). Mean scores for nurturing parenting and maternal mental health were similar in the two groups at both times. Conclusions A universal parenting programme resulted in modest improvement in parenting factors that predict behavioural problems in children but did not reduce externalising behavioural problems or affect maternal mental health at 2 years. Trial registration ISRCTN 77531789.