Delivery of the intervention: Individual-/family-based
Aim of the intervention: The intervention aims to identify and prevent children’s behavioral problems at an early stage in the primary health care. The Strongest Families -intervention supports and guides parents, who perceive challenges in bringing up a child with behavioral problems.
Description of the intervention: The Strongest Families is a digital intervention for the families with a pre-school child demonstrating behavioral problems. The intervention is based on epidemiological research knowledge about childhood behavioral problems, which are associated with mental health problems in adulthood (Sourander et al. 2007) and the efficacy of parent training as a preventive intervention for childhood behavioral problems. The Strongest families also lies on research-based knowledge about formation of the therapeutic alliance through remote methods (Lingely-Pottie & McGrath 2006; 2008). In the municipalities, which have implemented the intervention, the Strongest Families –questionnaire is delivered to the families who attend the child health clinic checkup for children at the age 4. The questionnaire is the basis for evaluating the need for support. Family coach who has received a special Strongest Families training guides the family through the program websites. In the beginning of the intervention, the coach and the parent(s) set contents and goals according to the specific needs of the child and family. Duration of the Strongest Families -intervention is from three to four months, during which the family coach contacts the family via telephone on a weekly basis. After the intervention the family coaches conduct follow-up phone call.
Availability of the intervention in Finland: Strongest Families family coach –training is provided for the healthcare professionals. The training is based on a structured curriculum and ongoing work supervision is provided for the coaches to ensure fidelity and method skills. The participating municipalities provide training for the implementation of the Strongest Families –intervention. The Research Center for Child Psychiatry at the University of Turku, in co-operation with the Canadian Strongest Families research group, has developed the intervention, and is responsible for the training. Research on the development and follow-up of the Strongest Families has been conducted for over a decade. The implementation of the intervention extends currently across one third of the child health clinics in Finland. The Strongest Families is a digital intervention and is thus suitable also in regions where conventional face-to-face services are not available.
Research- and evidence-based efficacy of the intervention: The Strongest Families has been tested in Canadian study, which comprised three separate RCT- studies (McGrath et al. 2011) as well as in a Finnish RCT (Sourander et al. 2016). In the Canadian study, a psychiatric diagnosis was set for less children in the intervention group than in the control group who received treatment as usual (McGrath et al. 2011). In turn, the Finnish study found that the children in the intervention group (n=232) had significantly less behavioural problems compared to the control group (n=232) (McGrath et al. 2013; Sourander et al. 2016). A two-year follow-up study indicated that, in the intervention group, parenting skills improved, behavioural problems were significantly reduced, and sought help in the mental health services significantly less than in the control group (Sourander et al. 2018). There is strong research-based evidence for effectiveness of the Strongest Families in reducing behavioural problems in preschool children, and it is classified as a strong intervention.
- Lingely-Pottie P. & McGrath, P. J. (2006). A therapeutic alliance can exist without face-to-face contact. Journal of Telemedicine and Telecare 1, 396–399.
- Lingley-Pottie P & McGrath P.J. (2008). A pediatric therapeutic alliance occurs with distance intervention. Journal of Telemedicine and Telecare 14, 236–240.
- McGrath P., Lingley-Pottie P., Thurston C., MacLean, C., Cunningham, C., Waschbusch, DA., Watters, C. Stewart, S., Bagnell, A., Santor, D. & Chaplin, W. (2011). Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: Randomized trials and overall analysis. Journal of the American Academy of Child Adolescent Psychiatry, 50, 1162–1172.
- McGrath P.J., Sourander A., Lingley-Pottie P., Ristkari T., Cunningham C., Huttunen J., Filbert K., Aromaa M., Corkum P., Hinkka-Yli-Salomäki S., Kinnunen M., Lampi K., Penttinen A., Sinokki A., Unruh A., Vuorio J. & Watters C. (2013). Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada). BMC Public Health 13, 985.
- Sourander A., Jensen P., Davies M., Niemelä, S., Elonheimo, H., Ristkari, T., Helenius, H., Sillanmäki, L., Piha, J., Kumpulainen, K., Tamminen, T., Moilanen, I. & Almqvist, F. (2007). Who is at greatest risk of adverse long-term out-comes? The Finnish from a boy to a man study. Journal of American Academy of Child and Adolescent Psychiatry, 46, 1148–1161.
- Sourander, A., McGrath, P.J., Ristkari, T., Cunningham, C., Huttunen, J., Lingley-Pottie, P., Hinkka-Yli-Salomäki, S., Kinnunen, M., Vuorio, J., Sinokki, A., Fossum, S. & Unruh, A. (2016). Internet-assisted parent training intervention for disruptive behavior in 4-year old children. A randomized clinical trial. JAMA Psychiatry 73, 378–87.
- Sourander, A., McGrath, P., Ristkari, T., Cunningham, C., Huttunen, J., Hinkka-Yli-Salomäki, S., Kurki, M. & Lingley-Pottie, P. (2018). Two-year follow-up of internet and telephone assisted parent training for disruptive behavior at age 4. J Am Acad Child Adolesc Psychiatry, 57, 658–668.