A Brief Home-Based Parenting Intervention to Reduce Behavior Problems in Young Children: A Pragmatic Randomized Clinical Trial

Christine O'Farrelly, Hilary Watt, Daphne Babalis, Marian J. Bakermans-Kranenburg, Beth Barker, Sarah Byford, Poushali Ganguli, Ellen Grimas, Jane Iles, Holly Mattock, Julia McGinley, Charlotte Phillips, Rachael Ryan, Stephen Scott, Jessica Smith, Alan Stein, Eloise Stevens, Marinus H. Van Ijzendoorn, Jane Warwick, Paul G. Ramchandani

Research output: Contribution to journalArticlepeer-review

26 Citations (SciVal)


Importance: Behavior problems are one of the most common mental health disorders in childhood and can undermine children's health, education, and employment outcomes into adulthood. There are few effective interventions for early childhood. Objective: To test the clinical effectiveness of a brief parenting intervention, the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), in reducing behavior problems in children aged 12 to 36 months. Design, Setting, and Participants: The Healthy Start, Happy Start study was a 2-group, parallel-group, researcher-blind, multisite randomized clinical trial conducted via health visiting services in 6 National Health Service trusts in England. Baseline and 5-month follow-up data were collected between July 30, 2015, and April 27, 2018. Of 818 eligible families, 227 declined to participate, and 300 were randomized into the trial. Target participants were caregivers of children who scored in the top 20% for behavior problems on the Strengths and Difficulties Questionnaire. Participants were randomly allocated on a 1:1 basis to receive either VIPP-SD (n = 151) or usual care (n = 149), stratified by site and number of participating caregivers. Analysis was performed on an intention-to-treat basis. Statistical analysis was performed from September 5, 2019, to January 17, 2020. Interventions: All families continued to access usual care. Families allocated to VIPP-SD were offered 6 home-based video-feedback sessions of 1 to 2 hours' duration every 2 weeks. Main Outcomes and Measures: The primary outcome was the score on an early childhood version of the Preschool Parental Account of Children's Symptoms, a semistructured interview of behavior symptoms, at 5 months after randomization. Secondary outcomes included caregiver-reported behavior problems on the Child Behavior Checklist and the Strengths and Difficulties Questionnaire. Results: Among 300 participating children (163 boys [54%]; mean [SD] age, 23.0 [6.7] months), primary outcome data were available for 140 of 151 VIPP-SD participants (93%) and 146 of 149 usual care participants (98%). There was a mean difference in the total Preschool Parental Account of Children's Symptoms score of 2.03 (95% CI, 0.06-4.01; P =.04; Cohen d = 0.20 [95% CI, 0.01-0.40]) between trial groups, with fewer behavior problems in the VIPP-SD group, particularly conduct symptoms (mean difference, 1.61 [95% CI, 0.44-2.78]; P =.007; d = 0.30 [95% CI, 0.08-0.51]). Other child behavior outcomes showed similar evidence favoring VIPP-SD. No treatment or trial-related adverse events were reported. Conclusions and Relevance: This study found that VIPP-SD was effective in reducing symptoms of early behavior problems in young children when delivered in a routine health service context. Trial Registration: isrctn.org Identifier: ISRCTN58327365.

Original languageEnglish
Pages (from-to)567-576
Number of pages10
JournalJAMA Pediatrics
Issue number6
Early online date15 Mar 2021
Publication statusPublished - 30 Jun 2021

Bibliographical note

Funding Information:
Conflict of Interest Disclosures: Drs O’Farrelly, Babalis, Byford, Grimas, Iles, Scott, Stein, and Ramchandani and Mss Watt, Barker, Mattock, and Smith reported receiving grants from the National Institute for Health Research (NIHR), Health Technology Assessment (HTA) during the conduct of the study. Drs Bakermans-Kranenburg and van IJzendoorn reported being developers of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) intervention program tested. Dr Iles reported being employed by Imperial College London during the conduct of the study; training clinicians and researchers to deliver VIPP-SD for 2 other research studies; and being employed to work on 1 of these studies (funded by the National Institute for Health Research Research for Patient Benefit) outside the submitted work. Dr Ramchandani reported directing the Play in Education, Development, and Learning (PEDAL) Research Centre at the University of Cambridge, which received a donation for funding from the LEGO Foundation outside the submitted work. No other disclosures were reported.

Data Data available: Yes Data types: Deidentified participant data, Data dictionary How to access data: Data will be available one year after publication from Paul Ramchandani - pr441@cam.ac.uk When available: beginning date: 01-01-2022 Supporting Documents Document types: None Additional Information Who can access the data: researchers whose proposed use of the data has been approved Types of analyses: For a specified purpose Mechanisms of data availability: After approval of a proposal with a signed dat access agreement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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