Abstract
BACKGROUND: The prevention of internalizing and externalizing behavioral problems in children is a critical scientific and public health priority. Research highlights maternal sensitivity-defined as a caregiver's ability to perceive, interpret, and respond appropriately to their child's cues-and consistent but non-coercive discipline as key factors in reducing these behavioral issues. The Video-feedback Intervention to Promote Positive Parenting and Sensitive Discipline (VIPP-SD) aims to enhance maternal sensitivity and promote non-coercive discipline strategies. Meta-analyses have demonstrated its effectiveness in improving parental sensitivity, limit-setting practices, and child attachment security, particularly among socioeconomically disadvantaged families. However, evidence on its impact on externalizing behaviors remains mixed, with some studies suggesting delayed or context-specific effects. This project aims to evaluate VIPP-SD's impact on parental sensitivity, discipline, child behavioral problems, and parental mental health in Portugal. Additionally, it seeks to assess the intervention's cost-effectiveness by analyzing health outcomes, resource utilization, and associated costs. METHODS: The program consists of a baseline visit, four intervention sessions, and optional booster sessions, focusing on themes such as sensitive responsiveness, positive reinforcement, and empathetic boundary-setting. 120 families from vulnerable populations in Portugal will be recruited and randomly assigned to the VIPP-SD intervention or the same number of contacts without feedback on parenting. Trained interveners will deliver the intervention. Pre- and posttest assessments include observed and self-reported parenting behaviors, parental mental health, quality of life, and resource use. Follow-up assessments include questionnaires on parent and child variables. DISCUSSION: The study aims to provide robust evidence to inform health policy decisions and prioritize cost-effective early interventions that improve developmental outcomes, reduce societal costs, and support family well-being. TRIAL REGISTRATION: NCT07153198, 02/09/2025.