Family Check-up for Children
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.
A component of Family Check-up for Children seeks to improve children's outcomes by improving the quality of interparental relationships (IPR).
EIF Programme Assessment
Child outcomes
This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.
According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:
Supporting children's mental health and wellbeing
Reduced internalising behaviours
based on study 2
- Statement: 0.58-point improvement on the Child Behaviour Checklist (Internalising Scale)
- Score: 8
- Timeframe: Between post-test and 2-year follow-up
- Long term: 1
Decreased emotional and behaviour problems
based on study 3
Preventing crime, violence and antisocial behaviour
Reduced disruptive behaviour (boys only)
based on study 1
Improved behaviour
based on study 1
Reduced externalising behaviours
based on study 2
- Statement: 0.82-point improvement on the Child Behaviour Checklist (Externalising Scale)
- Score: 9
- Timeframe: Between post-test and 2-year follow-up
- Long term: 1
Reduced problem behaviour
based on study 2
- Statement: 0.71-point improvement on the Eyberg Child Behaviour Inventory
- Score: 9
- Timeframe: Between post-test and 2-year follow-up
- Long term: 1
Reduced defiant behaviour
based on study 2
- Statement: 0.15-point improvement on the Child Behaviour Checklist (Problem Behaviour Scale)
- Score: 12
- Timeframe: Between post-test and 5-year follow-up
- Long term: 1
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.
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
- Netherlands
- Spain
- Sweden
- United Kingdom
- United States
Ireland provision
Ireland evaluation
About the programme
What happens during the 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 NFQ-9/10 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 NFQ-9/10 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 NFQ-9/10.
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.
Intended outcomes
Contact details
For training-related inquiries, contact chris@nwpreventionscience.org or visit https://www.nwpreventionscience.org
For the main Family Check-up website, visit https://fcu.uoregon.edu/
About the evidence
Family Check-up Children’s most rigorous evidence comes from an RCT which was conducted in the United States.
This study identified statistically significant positive impact on a number of child and parent outcomes.
This programme has evidence from at least one rigorously conducted RCT along with evidence from two additional comparison group studies. Consequently, the programme receives a 3+ rating overall.
Study 1
| Citation: | Shaw et al (2006) |
| Design: | RCT |
| Country: | United States |
| Sample: | 120 mother-son dyads in Pittsburgh, Pennsylvania |
| Timing: | 12-month follow-up; 24-month follow-up |
| Child outcomes: |
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| Other outcomes: |
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| Study rating: | 2+ |
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.
Study design and sample
The first study is an RCT.
This study involved random assignment of children to an FCU treatment group and a standard care control group.
This study was conducted in the US, with a sample of 120 mothers and their two-year old sons. Almost half (48.3%) of the mothers identified as African American. The average family income was $15,374 per year.
Measures
Maternal involvement was measured using the Involvement subscale of the Home Observation for Measurement of the Environment (HOME) (direct assessment).
Child aggression and destructive behaviour were measured using the Destructive and Aggression scales of the Child Behavior Check List (CBCL) (parent report)
Findings
This study identified statistically significant positive impact on one child and parent outcome, respectively.
Child outcome includes reductions in disruptive behaviour (boys only)
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: | One-year follow-up; two-year follow-up; three-year follow-up; five and a half-year follow-up |
| Child outcomes: |
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| Other outcomes: |
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| Study rating: | 3 |
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/
Study design and sample
The second study is a rigorously conducted RCT.
This study involved random assignment of children to an FCU treatment group and a treatment-as-usual control group.
This study was conducted in the US, with a sample of 731 disadvantaged families with a two-year old child (mean age 29.9 months). Half (50.1%) of the children were of European American ethnic background. More than two-thirds of the families had an annual income of less than $20,000.
Measures
Child problem behaviour was measured using the Eyberg problem behaviour scale (parent report). Child internalising and externalising behaviour were measured using the Child Behavior Check List (CBCL) (parent report). Child oppositional defiant behaviour was measured using the CBCL (parent report) and the DSM-oriented Oppositional Defiant Problems scale from the Teacher Report Form (teacher report). Child behavioural self-regulation was measured using the Inhibitory Control subscale of the Children’s Behavior Questionnaire (CBQ) (parent report).
Maternal depression was measured using the Center for Epidemiological Studies on Depression Scale (CES-D) (parent report). Parent-child interaction was measured using family assessment videotapes (expert observation of behaviour).
Findings
This study identified statistically significant positive impact on a number of child and parent outcomes.
Child outcomes include:
- Reduced externalising behaviours
- Reduced internalising behaviours
- Reduced problem behaviour
- Reduced defiant behaviour
Study 3
| Citation: | Garbacz et al., 2018 |
| Design: | Cluster RCT |
| Country: | United States |
| Sample: | 365 families, with children between 4 and 6 years old with a mean age of 5.45 years, where families have children enrolled in schools receiving federal funds for having a higher-than-average percentage of low-income students. |
| Timing: | Interim measurement (1 year before end of intervention); Post-test |
| Child outcomes: |
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| Other outcomes: | |
| Study rating: | 2+ |
Garbacz, S. A., McIntyre, L. L., Stormshak, E. A., & Kosty, D. B. (2020). The Efficacy of the Family Check-Up on Children’s Emotional and Behavior Problems in Early Elementary School. Journal of Emotional and Behavioral Disorders, 28(2), 67-79.
Available at:
https://journals.sagepub.com/doi/abs/10.1177/1063426618806258
Study design and sample
The third study is an RCT.
This study involved random assignment of children to an FCU treatment group and a business-as-usual group.
The study was conducted in the USA, with a sample of children between the age of 4 and 6. 65% of children were eligible for free or reduced-price school lunches.
Measures
Emotional and behavioural problems was measured using the Strengths and Needs Survey (teacher report)
Findings
This study identified statistically significant positive impact on a number of child outcomes:
- This includes reduced emotional and behavioural problems.
The conclusions that can be drawn from this study are limited by methodological issues pertaining to non-blind data collection and a lack of clarity in terms of attrition, hence why a higher rating is not achieved.