University of Turku, Finland; Turku University Hospital, Finland.
IWK Health Centre, Halifax, Nova Scotia, Dalhousie University, Halifax, Nova Scotia, and the Strongest Families Institute, Halifax, Nova Scotia, Canada.
J Am Acad Child Adolesc Psychiatry. 2018 Sep;57(9):658-668.e1. doi: 10.1016/j.jaac.2018.07.001. Epub 2018 Aug 3.
To determine whether an internet-based and telephone-assisted parent training intervention, which used whole population screening and which comprehensively targeted symptomatic 4-year-old children, was effective 24 months after the start of treatment. No long-term follow-up studies using a randomized controlled trial (RCT) existed on this subject.
Of the 4,656 children 4 years old who were screened in Southwest Finland, 730 met the criteria for high-level disruptive behavioral problems, and 464 parents agreed to be randomized to the 11-week Strongest Families Smart Website (SFSW) intervention (n = 232) or an educational control (EC) (n = 232). After 24 months, 163 SFSW parents (70%) and 165 EC parents (71%) were still participating.
When we compared the results at baseline and 24 months, the primary outcome of the Child Behavior Checklist (CBCL) externalizing score showed significantly higher improvements in the SFSW group (effect size 0.22; p < 0.001). This group also showed greater improvements in the secondary outcomes: the CBCL total and internalizing scales, 5 of the 7 CBCL symptom domains, 3 of the 5 DSM subscores, and self-reported parenting skills. Fewer SFSW children (17.5%) than EC children (28.0%) had been referred to child mental health services between baseline and 24 months (odds ratio = 1.8; 95% confidence interval = 1.1-3.1).
The SFSW internet-based and telephone-assisted parental training program was effective 24 months after initiation, underlining the value of identifying children at risk in the community early and providing evidence-based parent training for a large number of families.
STRONGEST FAMILIES FINLAND CANADA: Family-based Prevention and Treatment Program of Early Childhood Disruptive Behavior (Fin-Can). http://www.clinicaltrials.gov; NCT01750996.
确定基于互联网和电话辅助的家长培训干预措施是否有效，该措施使用了全人群筛查，并全面针对有症状的 4 岁儿童。在此主题上，没有使用随机对照试验（RCT）进行的长期随访研究。
在芬兰西南部，对 4656 名 4 岁儿童进行了筛查，其中 730 名儿童符合高水平破坏性行为问题的标准，464 名家长同意随机分配到 11 周的 Strongest Families Smart Website（SFSW）干预组（n=232）或教育对照组（EC）（n=232）。24 个月后，163 名 SFSW 家长（70%）和 165 名 EC 家长（71%）仍在参与。
当我们比较基线和 24 个月时的结果时，SFSW 组的儿童行为检查表（CBCL）外部问题评分的主要结果显示出显著的改善（效果量 0.22；p<0.001）。该组在次要结果方面也显示出更大的改善：CBCL 总分和内部问题量表、CBCL 的 7 个症状领域中的 5 个、DSM 5 个亚量表中的 3 个以及自我报告的育儿技能。与 EC 儿童（28.0%）相比，SFSW 儿童（17.5%）在基线和 24 个月之间转介到儿童心理健康服务的人数较少（比值比=1.8；95%置信区间=1.1-3.1）。
SFSW 基于互联网和电话辅助的家长培训计划在启动后 24 个月仍然有效，强调了在社区早期识别有风险的儿童并为大量家庭提供循证育儿培训的价值。
STRONGEST FAMILIES FINLAND CANADA：儿童早期破坏性行为的基于家庭的预防和治疗计划（Fin-Can）。http://www.clinicaltrials.gov；NCT01750996。
