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Family Check-up for Children

Evidence rating
3
Cost rating
2
Review: Foundations for Life, July 2016

The Family Check-up (FCU) for Children is a strengths-based, family-centred intervention that motivates parents to use parenting practices to support child competence, mental health and risk reduction.

The intervention has two phases. The first is a brief, three-session programme that involves three one-hour sessions: interview, assessment and feedback.

The second phase is ‘Everyday Parenting’, a family-management training programme that builds parents’ skills in positive behaviour support, healthy limit-setting and relationship-building. As a health-promotion and prevention strategy, phase two of the FCU can be limited to one to three Everyday Parenting sessions. As a treatment approach, phase two can range from three to 15 Everyday Parenting sessions. The first phase may be followed by additional community referral services as indicated.

The intervention model is tailored to address the specific needs of each family and can be integrated into a variety of service settings, including schools, primary care and community clinics. Although providers implementing the intervention are typically Masters-level therapists or social workers, bachelor and paraprofessional/non-bachelor-level providers, with the appropriate consultation and supervisory support, may also implement the FCU.

EIF Programme Assessment

Evidence rating
3

Family Check-up for Children has evidence of a short-term positive impact on child outcomes from at least one rigorous evaluation.

What does the evidence rating mean?

Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.

This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants. 

What does the plus mean?

The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.

Cost rating
2

A rating of 2 indicates that a programme has a medium-low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of £100–£499.

Child outcomes

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Preventing crime, violence and antisocial behaviour

Reduced disruptive behaviour (boys only) - based on study 1

Improved behaviour - based on study 1, study 2

Reduced defiant behaviour - based on study 2

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Family Check-up for Children

Key programme characteristics

Who is it for?

The best available evidence for this programme relates to the following age-groups:

  • Toddlers

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Individual

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Home
  • Secondary school
  • Community centre
  • In-patient health setting
  • Out-patient health setting

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Targeted selective

Where has it been implemented?

Canada, Spain, Sweden, United States

UK provision

This programme has not been implemented in the UK.

UK evaluation

This programme’s best evidence does not include evaluation conducted in the UK.

Family Check-up for Children

About the programme

What happens during delivery?

How is it delivered?
  • FCU is delivered over nine sessions of 50-60 minutes' duration each by one FCU provider (often a therapist or social worker).
What happens during the intervention?

The FCU is delivered in two phases. The first 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 practitioner who reviews and discusses concerns with the caregiver, focusing on family issues that are most critical to the child’s wellbeing. 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, the practitioner completes ratings of parent involvement and supervision.
  • The third meeting is a feedback session where the parent consultant can summarise results of the assessment and work with the parent to assess his/her motivation and willingness to change problematic behaviour. This final session also includes an overview of the behaviours 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.
  • The second phase involves the delivery of Everyday Parenting, a family management training program that builds parents’ skills in positive behaviour support, healthy limit-setting and relationship-building. As a health-promotion and prevention strategy, phase two of the FCU can be limited to one to three Everyday Parenting sessions. As a treatment approach, phase two can range from 3 to 15 Everyday Parenting sessions. The first phase may be followed by additional community referral services as indicated.

What are the implementation requirements?

Who can deliver it?
  • It is delivered by one therapist or social worker who is qualified to QCF-7/8 level and has received 35 hours of programme training. With the appropriate consultation and supervisory support, a paraprofessional/non-bachelor-level practitioner also may implement the programme.
What are the training requirements?
  • The practitioners have 35 hours of training. Booster training of practitioners is recommended.
How are the practitioners supervised?
  • It is recommended that programme practitioners are supervised by one host-agency supervisor with QCF-7/8 level qualifications (who receives standard practitioner programme training, with an additional 28 to 45 hours of additional training support) and one programme developer supervisor also qualified to QCF.
What are the systems for maintaining fidelity?
  • Training manual
  • Other printed material          
  • Other online material
  • Video or DVD training
  • Face-to-face training
  • Supervision
  • Accreditation or certification process
  • Booster training
  • Fidelity monitoring
Is there a licensing requirement?

There is no licence required to run this programme.

How does it work? (Theory of Change)

How does it work?
  • Family Check-up is based on social learning principles that assume that some parenting behaviours inadvertently encourage non-compliant behaviours in toddlerhood.
  • Parents learn positive behaviour support strategies to help parents proactively structure family situations to promote children’s self-regulatory development and minimise problem behaviour.
  • In the short term, parents learn positive strategies for engaging with their child.
  • In the longer term, children are less likely to engage in antisocial and risky behaviour.
Family Check-up for Children

About the evidence

  • FCU’s most rigorous evidence comes from two RCTs, both of which were conducted in the USA.

Study 1

Citation: Shaw et al (2006)
Design: RCT
Country: United States
Sample: 120 mother-son dyads in Pittsburgh, Pennsylvania
Timing: -
Child outcomes: Reduced disruptive behaviour (boys only)
Improved behaviour
Other outcomes: Increased maternal involvement

Shaw, D.S., Dishion, T.J., Supplee, L., Gardner, F. & Arnds, K. (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, 1-9.

Available at
https://www.ncbi.nlm.nih.gov/pubmed/16551138

Study 2

Citation: Dishion et al (2008), Shaw et al (2009), Lunkenheimer et al (2008), Dishion et al (2014)
Design: RCT
Country: United States
Sample: 731 mother-child dyads
Timing: -
Child outcomes: Improved behaviour
Reduced defiant behaviour
Other outcomes: Improved parent-child interaction
Reduced maternal depression
Improved parent-child interaction

Dishion, T.J., Shaw, D., Connell, A., Gardner, F., Weaver, C., & Wilson, M. (2008). The Family Check-up with high-risk indigent families:  Preventing problem behaviour by increasing parents’ positive behaviour support in early childhood. Child Development, 7, 1395-1414.

Shaw, D.S., Connell, A., Dishion, T.J., Wilson, M.N. & Gardner, F. (2009). Improvements in maternal depression as a mediator of intervention effects on early childhood problem behaviour. Developmental Psychopathology, 21, 417-439.

Lukenheimer, E.S. (2008). Collateral benefits for the family check-up on early childhood school readiness:  Indirect effects of parents’ positive behaviour support. Developmental Psychopathology, 44, 1737-1752.

Dishion, T.J, Brennan, L.M., Shaw, D.S., McEachern, A.D., Wilson, MN., & Booil, J. (2014).  Prevention of problem behaviour through annual family check-up in early childhood:  Intervention effects from home to early elementary school. Journal of Abnormal Child Psychology, 42, 343-354.

Available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683384/
https://www.ncbi.nlm.nih.gov/pubmed/19338691
https://www.ncbi.nlm.nih.gov/pubmed/18999335
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952033/

Published March 2017   |   Last updated April 2017