Transferring an evidence-based treatment to practice is not self-evident but requires extensive work. The study published in the open access Journal of Medical Internet Research (JMIR) examined how evidence-based digital parent training intervention with telephone coaching can be put into practice in primary health care.

The study compared families that participated in parent training during the randomised controlled trial with families that participated in the programme during the implementation study. The families were identified as part of the risk group during their fourth-year visit to a child health clinic. The Finnish child health clinics provide regular check-ups that offer universal health care and are attended by 99.6% of the children.

– During the study, the parents were offered research-based support for parenting by teaching daily parenting and problem solving skills. The training took place on the internet and by telephone.

Throughout the study, the parents’ satisfaction with the programme and working with their coaches remained excellent as did their experience of the development of their parenting skills, says the main author of the study, Researcher Terja Ristkari from the Research Centre for Child Psychiatry of the University of Turku, Finland.

Parents in both groups completed the programme in approximately the same amount of time. The families spent around 1.5 hours each week studying the programme online and on the phone with their coach.

Low discontinuation rate when intervention offered as a service

A significant change was that the discontinuation rate of the parent training intervention decreased by nearly a half in the implementation group when compared with the controlled trial group. Only 12.4 percent of the participants discontinued the 11-week programme when it was used as a service in the implementation study.

–The discontinuation rate was substantially lower than in traditional parent training interventions which are usually carried out in groups, says Ristkari.

Moving interventions outside traditional clinics and into people’s daily environments, like the internet, can facilitate better access to mental health services. Web-based interventions can also remove the barriers associated with the face-to-face interventions and enable people to seek help for mental health problems without the fear of being stigmatised. From the families’ point of view, digitally delivered programmes can offer faster and more flexible services without the need for transport, juggling work schedules, arranging childcare, or the practical cost of accessing services.

As disruptive behaviour was more severe in the implementation group, the findings may also suggest that the parents of the children with more severe disruptive behaviour are highly motivated to receive help and complete the programme.

Implementation phase is critical for successful treatment

The identification of the risk groups was done during the annual check-ups at child health clinics both in the randomised controlled trial and in the implementation study. The intervention offered to the risk groups had the same contents in both groups and was centrally implemented through a specialised unit.

However, offering the programme as a service in the implementation study required careful planning and close collaboration with decision-makers and healthcare professionals.

–Repeating evidence-based treatment in the real world is not always successful. So that the intervention remains faithful to the original model and the participants receive equal treatment, the implementation requires careful quality control,” emphasises Research Director, Professor Andre Sourander.

232 families participated in the controlled trial and 882 families in the implementation study. During the controlled trial, altogether 4,656 families from Southwest Finland participated in the screening at the annual check-up, and 12,780 families from all over Finland during the implementation study.

This study is part of the APEX consortium (Transferring child and adolescent mental health treatment to awareness, prevention and early intervention) and INVEST (Inequalities, Interventions, and New Welfare State) Research Flagship. The consortium receives funding from the Strategic Research Council (SRC) at the Academy of Finland and the Academy of Finland Flagship Programme. The study is part of a project that develops digital treatments for preventing mental health problems significant for public health at the transition phases that are important for development.

Original publication: Ristkari T, Kurki M, Suominen A, Gilbert S, Sinokki A, Kinnunen M, Huttunen J, McGrath P, Sourander A. Web-Based Parent Training Intervention With Telephone Coaching for Disruptive Behavior in 4-Year-Old Children in Real-World Practice: Implementation Study. J Med Internet Res 2019;21(3):e11446

More information: Research Coordinator Terja Ristkari, University of Turku, terja.ristkari@utu.fi

