Centre for Community Child Health, Royal Children's Hospital, Parkville, Australia.
BMC Public Health. 2012 Jun 8;12:420. doi: 10.1186/1471-2458-12-420.
Externalising and internalising problems affect one in seven school-aged children and are the single strongest predictor of mental health problems into early adolescence. As the burden of mental health problems persists globally, childhood prevention of mental health problems is paramount. Prevention can be offered to all children (universal) or to children at risk of developing mental health problems (targeted). The relative effectiveness and costs of a targeted only versus combined universal and targeted approach are unknown. This study aims to determine the effectiveness, costs and uptake of two approaches to early childhood prevention of mental health problems ie: a Combined universal-targeted approach, versus a Targeted only approach, in comparison to current primary care services (Usual care).
METHODS/DESIGN: Three armed, population-level cluster randomised trial (2010-2014) within the universal, well child Maternal Child Health system, attended by more than 80% of families in Victoria, Australia at infant age eight months.Participants were families of eight month old children from nine participating local government areas. Randomised to one of three groups: Combined, Targeted or Usual care.The interventions comprises (a) the Combined universal and targeted program where all families are offered the universal Toddlers Without Tears group parenting program followed by the targeted Family Check-Up one-on-one program or (b) the Targeted Family Check-Up program. The Family Check-Up program is only offered to children at risk of behavioural problems.Participants will be analysed according to the trial arm to which they were randomised, using logistic and linear regression models to compare primary and secondary outcomes. An economic evaluation (cost consequences analysis) will compare incremental costs to all incremental outcomes from a societal perspective.
This trial will inform public health policy by making recommendations about the effectiveness and cost-effectiveness of these early prevention programs. If effective prevention programs can be implemented at the population level, the growing burden of mental health problems could be curbed.
ISRCTN61137690.
外化问题和内化问题影响了七分之一的学龄儿童，是心理健康问题进入青春期早期的单一最强预测因素。由于精神健康问题在全球范围内持续存在，儿童精神健康问题的预防至关重要。预防可以针对所有儿童（普遍性）或有发展心理健康问题风险的儿童（针对性）。针对特定人群的方法（目标性）与仅针对普遍性和目标性相结合的方法的相对有效性和成本尚不清楚。本研究旨在确定针对儿童心理健康问题的早期预防的两种方法的有效性、成本和接受程度，即：一种是普遍性与目标性相结合的方法，另一种是仅针对目标性的方法，与当前的初级保健服务（常规护理）相比。
方法/设计：在澳大利亚维多利亚州的全民性、良好儿童母婴保健系统内进行了一项为期三年的、以人群为基础的、集群随机试验（2010-2014 年），该系统由超过 80%的家庭参加。参与者为来自九个参与地方政府区域的 8 个月大婴儿的家庭。随机分为三组：普遍性-目标性组、目标性组或常规护理组。干预措施包括：（a）普遍性与目标性相结合的方案，所有家庭都接受普遍性的 Toddlers Without Tears 育儿小组方案，然后接受有针对性的一对一家庭检查方案；（b）仅针对目标性的家庭检查方案。家庭检查方案仅提供给有行为问题风险的儿童。将根据他们被随机分配的试验臂对参与者进行分析，使用逻辑回归和线性回归模型比较主要和次要结果。从社会角度出发，进行成本后果分析，比较增量成本和所有增量结果。
这项试验将通过对这些早期预防方案的有效性和成本效益提出建议，为公共卫生政策提供信息。如果能够在人群层面实施有效的预防方案，那么日益增长的精神健康问题负担可能会得到遏制。
ISRCTN61137690。
