Refereed journal article or data article (A1)

The Effectiveness of an Internet and Telephone Assisted Parent Training for Disruptive Behavior at Four Years of age: Implementation Study

List of Authors: Sourander Andre, Ristkari Terja, Kurki Marjo, Gilbert Sonja, Hinkka-Yli-Salomäki Susanna, Kinnunen Malin, Pulkki-Råback Laura, McGrath Patrick J

Publisher: JMIR Publications

Publication year: 2021

Journal: Journal of Medical Internet Research

eISSN: 1438-8871



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Parent training is one of the most effective treatment to child disruptive behaviour. Due to barriers related to conventional techniques, research has shifted to examining digital delivery of parent training. However, there are no previous effectiveness studies on digital parent training programs when they are implemented in real life practice.


The objectives of this study were to investigate the changes in the children’s psychopathology and functioning level, and in the families’ parenting skills after receiving the digital parent training program in child health clinic implementation, and to compare the treatment characteristics and effectiveness between the 600 families who received the Strongest Families Smart Website (SFSW) intervention in these real-life setting (Implementation group) and the 232 families who received the intervention during the randomized controlled trial (RCT intervention group).


The evidence-based Strongest Families Website (SFSW) parent training intervention was provided for 600 families who visited child health clinics between years 2015 and 2018 in Finland. Their demographics, child and parent outcomes were compared with 232 families that received the SFSW intervention during the randomized controlled trial to examine whether the positive effects are maintained when the program was implemented in real life.


The Implementation group was more likely to complete the intervention compared to the RCT intervention group (85.7% versus 75.9%; p<0.001). There were significant improvements from baseline to 6-months follow-up in the Implementation group in externalizing (6.2; 95% CI 5.5 – 7.0, P<.001), total (15.2; 95% CI 13.3 – 17.2, P<.001) and internalizing scores (3.6; 95% CI 2.9 – 4.3, P<.001). We observed also significant improvements in the Inventory of Callous-Unemotional Traits (ICU) total score, the Parenting Scale and the Depression Anxiety Stress Scale 21 (P<.001). Further, the Implementation group reported significant improvements in children’s social and transitional situations. There were no significant differences between the Implementation and RCT intervention in CBCL externalizing (-0.2; 95% CI -1.3 – 1.6, P=.83), total (-0.7; 95% CI -3.0 – 4.5, P=.70) or internalizing scores (-0.3; 95% CI -1.0 – 1.6, P=.64). In addition, no significant differences were detected in Parenting Scale nor ICU.


The internet and telephone assisted parent training based on population-based screening was effectively implemented to real-life settings. These findings have implications for addressing the unmet needs of children with disruptive behavior problems in different sociocultural contexts. Our initiative could also provide a fast, socially distanced solution for the considerable mental health impact of the COVID-19 pandemic. Clinical Trial: NCT01750996;

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Last updated on 2022-13-07 at 09:47