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Program Profile: Family Check-Up (FCU) for Children

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on March 16, 2015

Program Summary

The program is a preventative, family-based intervention targeting families with young children who possess risk factors for child behavioral misconduct. The program is rated Promising. Evaluation results suggest that the intervention indirectly reduced child problem behavior via parental positive behavior support. More specifically, the intervention appeared to significantly increase levels of parents’ positive behavior support, which in turn significantly reduced children’s problem behavior.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals
Family Check-Up (FCU) is a preventative, family-based intervention targeting families with young children who possess risk factors for child behavioral misconduct. The FCU program is a family assessment intervention that emphasizes motivation to change, and involves three sessions implemented in the home with optional follow-up parental training sessions. Primary goals include reductions in child problem behavior and prevention of delinquency later in life. Secondary goals include increased maternal involvement and improvements in positive behavior support and other family management practices. Specifically, the program targets disrupted and unskilled family management practices in early childhood to reduce and prevent future child problem behavior.
 
Target Population
The FCU intervention targets families with socioeconomic, family, and/or child risk factors for future behavioral problems. Two risk factors specifically examined include low child inhibition and maternal depression. Families with children between the ages of 2 and 11 years are eligible for FCU.

Program Activities
The FCU is a brief, three session intervention based on motivational interviewing. The three meetings are conducted by a professional therapist in the home. The sessions consist of a one-hour assessment session, an interview session, and a feedback session.
  • The first session involves a staff member who reviews and discusses concerns with the caregiver, focusing on family issues that are most critical to the child’s well-being. Specifically, the interview covers the parent’s goals and concerns within the family.
  • The assessment engages family in a variety of in-home videotaped tasks of parent-child interactions, while caregivers complete questionnaires about their own, their child’s, and their family’s functioning. During this session, staff completes ratings of parent involvement and supervision.
  • The third meeting is a feedback session where the parent consultant can summarize results of the assessment and work with the parent to assess his/her motivation and willingness to change problematic behavior. This final session also includes an overview of the behaviors and/or practices that need additional attention. At that time, parents are offered a maximum of six follow-up sessions to continue improving their parenting practices and family management skills. Two annual follow-ups are conducted to assess progress over the long-term.
Key Personnel
Key personnel include the consultants and the Quality Assurance Implementation Team at Arizona State University (ASU) REACH Institute. Trainees are typically psychologists, family therapists, social workers, program developers, community mental health workers, and/or intervention scientists.
 
Program Theory
The FCU intervention is grounded on vulnerability theory, claiming that children who have a greater genetic risk for problem behavior are more susceptible to environmental influences, including punitive or neglectful parenting practices (Caspi et al., 2002). With this in mind, intervention strategies should strengthen parental use of positive behavior support strategies (Horner & Carr, 1997; Sugai, Horner, & Sprague, 1999). Thus, FCU includes motivation-to-change strategies based on the ecological approach to family intervention and treatment, otherwise known as the EcoFIT model. The EcoFIT approach was originally designed to improve children’s adjustment to various environments, seeking to motivate positive behavior support practices in these settings. FCU and EcoFIT interventions are tailored to the individualized needs of youth and families as revealed by assessments and other family observations. It stands to reason that preventing behavioral problems in early childhood will decrease one’s risk for substance abuse and criminal activity during adolescence. 

Evaluation Outcomes

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Study 1
The study by Dishion and colleagues (2008) examined the effects of the Family Check-Up (FCU) intervention program and found moderate impacts. Results suggest that the intervention indirectly reduced child problem behavior via parental positive behavior support. More specifically, the intervention appeared to significantly increase levels of positive behavior support, which in turn significantly reduced problem behavior in early childhood for children in the treatment group. 

Eyberg Problem Behavior
FCU participation significantly reduced problem behavior in early childhood as measured by the Eyberg Child Behavior Inventory.

Child Behavior Checklist (CBCL) Externalizing Behavior
FCU participation significantly reduced problem behavior for children in the treatment group, but the effect sizes were small in magnitude. Reduced child problem behavior may be attributed to improved positive behavior support, as FCU participation also significantly improved levels of this construct within families.
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Evaluation Methodology

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Study 1
Dishion and colleagues (2008) evaluated the effects of a Family Check-Up (FCU) program based on the previously developed ecological approach to family intervention and treatment known as the EcoFIT model. An experimental longitudinal design was used to evaluate the extent to which participants of the FCU program differed from nonparticipants on variables associated with problem behavior among children, levels of caregiver involvement, and familial positive behavior support.

The program was implemented in the homes of high-risk families residing in three geographical regions, including metropolitan Pittsburgh, PA; suburban Eugene, OR; and rural Charlottesville, VA. The study included high-risk families with a child between the ages of 2 and 3 years with socioeconomic, family, and/or child risk factors for future behavior problems. Families were recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites and were screened to determine eligibility for the study. Participation in the program was voluntary, with 731 families agreeing to be involved. Thus, all 731 families received an initial 2.5-hour baseline assessment, where the family’s interaction and engagement in a variety of assessments were videotaped and coded. After the assessment, participants were randomly assigned to the FCU treatment (N=367) and control (N=364) groups. The treatment group received the two remaining components of the FCU/EcoFIT intervention, which included an interview session and a feedback session. The control group received an initial baseline assessment, followed by WIC services as usual. Follow-ups were conducted to assess outcomes at child age 3 and child age 4.

A total of 659 families (90 percent) participated in the 1-year follow-up when children were approximately 3 years old, and 619 families (85 percent) were retained for the 2-year follow-up when children were about 4 years old. There were no significant differences between groups at baseline, and attrition levels between the two groups over time were statistically similar. The children in the sample during the first assessment had a mean age of 29.9 months and about half (49 percent) of those children were female. The majority of caregivers self-identified as European American (50 percent), African American (28 percent), or biracial (13 percent), while 9 percent remained in the “other race” category. More than two-thirds of families had an annual income less than $20,000 with an average household size of 4.5 persons.

Study instruments included socio-demographic questions related to family structure, parental education and income, parental criminal history, and areas of familial stress. A measure known as the Center for Epidemiological Studies on Depression Scale (CES-D) was used to assess maternal depression at the child ages 2 and 3 home assessments. Early childhood problem behavior was also measured during all three stages of the intervention using two previously developed questionnaires, the Child Behavior Checklist (CBCL) and the Eyberg Child Behavior Inventory. Data collection took place during all sessions of the intervention as well as during both 1- and 2-year follow-ups. Latent growth mixture modeling (LGMM) was used to analyze trajectories related to child problem behavior and positive parenting. A mediation model was used to assess the indirect effect of intervention on child behavior, mediated by levels of maternal positive behavior support. 
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Cost

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New staff members need initial training, consisting of two workshops at approximately $400 each. The average cost for training is about $800 per trainee. Other implementation costs can vary, and may include staff salaries and miscellaneous supplies. On-site training for up to 20 trainees is available. Costs may vary depending on the site’s individualized training needs. For additional information visit http://reachinstitute.asu.edu.
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Implementation Information

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Therapists should be trained to develop collaborative relationships with parents and help them work through their motivation issues and provide support through the course of developmental transition. The Arizona State University REACH Institute has developed online support systems for clinical outcome and implementation monitoring and uses an empirically-validated tool to assess fidelity of the model. For additional information visit http://reachinstitute.asu.edu.
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Other Information

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The FCU program examined in the study by Dishion and colleagues (2008) was implemented differently than the traditional FCU model. Normally, the FCU would consist of three ordinal sessions, consisting of an initial interview, comprehensive assessment, and a feedback session. However, in order to reduce differential attrition between groups, the researchers implemented the assessment prior to random assignment. Thus, the assessment was administered to all study participants (i.e. both groups), followed by the initial interview and feedback sessions for the intervention group only. The control group received the assessment followed by WIC services as usual. All participants received follow-up assessments at child age 3 and 4. It should be noted that the actual FCU assessment protocol was also modified when applied to families of toddlers. Specifically, the assessment was expanded to focus on key development processes for families of toddlers, including those challenges that affect parenting and early child adjustment.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Dishion, Thomas J., Arin Connell, Chelsea Weaver, Daniel Shaw, Frances Gardner, and Melvin Wilson. 2008. “The Family Check-Up With High-Risk Indigent Families: Preventing Problem Behavior by Increasing Parents’ Positive Behavior Support in Early Childhood.” Child Development 79(5): 1395-1414. doi: 10.1111/j.1467-8624.2008.01195.x
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683384/
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Additional References

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These sources were used in the development of the program profile:

Caspi, Avshalom, Joseph McClay, Terrie E. Moffitt, Jonathan Mill, Judy Martin, Ian W. Craig, Alan Taylor, and Richie Poulton. 2002. “Role of Genotype in the Cycle of Violence in Maltreated Children.” Science 297(5582): 851-854. doi: 10.1126/science.1072290

Child and Family Center . “Education, Training, and Conferences: Family Check-Up and Everyday Parenting Institute,” Eugene, Oregon: Child and Family Center, University of Oregon, accessed November 20, 2014
http://pages.uoregon.edu/cfc/index.htm

Horner, Robert H., and Edward G. Carr. 1997. "Behavioral Support for Students with Severe Disabilities: Functional Assessment and Comprehensive Intervention." The Journal of Special Education 31(1): 84-104. doi: 10.1177/002246699703100108

Shaw, Daniel S., Lauren Supplee, Thomas J. Dishion, Frances Gardner, and Karin Arnds. 2006. “Randomized Trial of a Family-Centered Approach to the Prevention of Early Conduct Problems: 2-Year Effects of the Family Check-Up in Early Childhood.” Journal of Consulting and Clinical Psychology 74(1): 1-9. (This study was reviewed but did not meet Crime Solutions’ criteria for inclusion in the overall program rating.)
http://www.pitt.edu/~ppcl/Publication/early%20steps/JCCP%20paper%20feb%202006%20ES%202%20to%204%20intervention%20effects%20pdf.pdf

Sugai, George, Jeffrey R. Sprague, and Robert H. Horner. 1999. “Functional-Assessment-Based Behavior Support Planning: Research to Practice to Research.” Behavioral Disorders 24(3): 253-257. 
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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Early Self-Control Improvement Programs for Children
This practice consists of programs designed to increase self-control and reduce child behavior problems (e.g., conduct problems, antisocial behavior, and delinquency) with children up to age 10. Program types include social skills development, cognitive coping strategies, training/role playing, and relaxation training. This practice is rated Effective for improving self-control and reducing delinquency.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Juvenile Problem & At-Risk Behaviors - Self-Control
Effective - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
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Program Snapshot

Age: 1 - 11

Gender: Both

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Rural, Suburban, Urban

Setting (Delivery): Home

Program Type: Family Therapy, Parent Training, Motivational Interviewing

Targeted Population: Families

Current Program Status: Active

Listed by Other Directories: Model Programs Guide, Blueprints for Healthy Youth Development (formerly Blueprints for Violence Prevention)

Program Developer:
Thomas Dishion
ASU REACH Institute Director, Arizona State University
Arizona State University, REACH Institute
PO Box 876005
Temple AZ 85287
Phone: 480-965-5405
Fax: 480-965-5430
Website
Email