Abstract
BACKGROUND: Behaviour problems are common in childhood and are associated with higher rates of mental health problems, educational and relationship difficulties throughout life. This study assessed whether a Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) has sustained benefit 6 years after delivery. It had previously been shown to reduce behavioural problems in children aged 2 and 4 years old. METHODS: The Healthy Start, Happy Start study was a 2-arm, multisite randomised clinical trial conducted in 6 NHS trusts in England. Participants (N = 300) were parents/caregivers of children (aged 12-36 months) at risk of behaviour problems. Participants were randomised to receive either VIPP-SD (n = 151) or usual care (n = 149). Those allocated to VIPP-SD were offered 6 home-based video-feedback sessions. Six-year follow-up data were collected from May 2022 to July 2023. The primary outcome was the total score on Parental Account of Children's Symptoms (PACS). The analysis used prespecified longitudinal Bayesian models to handle missing data, and findings are reported as posterior probabilities of superiority alongside treatment effect estimates with 95% credible interval. RESULTS: Analysis included 294 of the 300 participants, with 6-year primary outcome data available for 244/300 (81%) (106 girls [43%]; mean age, 8.2 years). The probability of superiority for VIPP-SD on PACS was 86%. The mean difference in the total PACS score was -1.23 (95% Cred.I [-3.34, 0.90]); d = -0.11 (95% Cred.I [-0.032, 0.09]), with fewer behavioural problems in children in the VIPP-SD group (mean [SD] score of 25.30 [9.63] vs. 26.36 [11.05]). CONCLUSIONS: This trial found a probability of 86% that VIPP-SD was superior for reducing behaviour problems in children up to 6 years later. Taken together with the earlier positive trial findings, this suggests a small enduring positive impact of a brief early intervention with potential for scaling.