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Intensive home visiting program for multiproblem families: Effectiveness, mediators and moderators of effects


- candidate number3604
- NTR NumberNTR1375
- ISRCTNISRCTN wordt niet meer aangevraagd
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR9-jul-2008
- Secondary IDs82000004 ZonMw
- Public TitleIntensive home visiting program for multiproblem families: Effectiveness, mediators and moderators of effects
- Scientific TitleIntensive home visiting program for multiproblem families: Effectiveness, mediators and moderators of effects
- ACRONYMN/A
- hypothesisThe aims of this project are the following:
1. To examine short and long term effects of Intensieve Pedagogische Thuishulp (IPT) on parents (changes in parenting behavior and parent-child relationship) and children (changes in problem behavior, social and academic competence) compared to 'care as usual' (CAU)
2. To understand the processes through which the IPT works by testing the hypothesized mediators of beneficial treatment
3. To understand differential pathways to change by determining circumstances in which IPT yield or does not yield beneficial outcomes
- Healt Condition(s) or Problem(s) studiedIntensive home visiting program, Multi-problem families
- Inclusion criteria1. Child age between 4 and 18 years
2. Multiple problems in the family (based on diagnostic information from clinicians)
3. Parents (or care givers ) are sufficiently motivated to start treatment.
- Exclusion criteria1. Child age under the age of 4 and above 18 years
2. The physical and/or psychological integrity of the child is in danger.
- mec approval receivedyes
- multicenter trialyes
- randomisedyes
- masking/blindingSingle
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-dec-2006
- planned closingdate1-aug-2010
- Target number of participants200
- InterventionsIntensive home-based treatment (IHT) is a systematic and structured method (see for manual Hermanns et al., 2000).
IHT is based on bio/social ecological and family systems theories, and on research on the causes and correlates of parenting and child problems. The goal of the IPT is to help children by helping the parents of those children. In other words, IPT operates under assumption that parents mediate changes for their children.
Therefore the therapist coordinates care around the family, supplies practical, informational, instrumental and emotional support and, together with the parents, plans the specification of changes in the family needed to promote child development and family wellness and prevent out of home placement in the long run. Although the basic principles of IHT are applied in all families, it is not a 'one size fits all' approach. Rather, the treatment is individualized to address specific needs of clients. It can contain treatment of parents with substance dependency or relational problems, supporting the use of effective parent management training, assistance with financial or housing problems, contacts with school etc. Despite the different ingredients, the therapist forms the centre from which families needs are assessed and matched, and assistance to families is arranged and implemented. With regard to parenting, parents learn skills for age-appropriate parenting style and expectations for their child behavior, building positive relationship with the child and improving communication, promoting and rewarding desirable behavior, giving effective instruction and setting rules, applying effective consequences to negative behavior, monitoring child behavior outside the home.

To summarize, IPT differs from CAU on three main points:
(1) the coordination of care by one therapist (the IPT therapist coordinates all care around the family, supplies practical, informational, instrumental and emotional support) vs no coordination of care in CAU;
(2) family-focused and bottom-up apporoach (the IPT therapist, together with the parents, plans the specification of changes in the family) vs child-centered and top-down approach in CAU; and
(3) organization of care within the everyday, family environment vs more institutionally oriented care in CAU.

Care as usual (CAU)
The families in the control group will receive 'care as usual', including ambulant care, semi-residential and residential care. Most of these treatments focus on child problem behavior. Although family and school-related issues are not excluded, these issues are not the first priority, and they are therefore given less attention.

To summarize, IHT differs from CAU on three main points:
(1) the coordination of care by one therapist (the IHT therapist coordinates all care around the family, supplies practical, informational, instrumental and emotional support) vs almost no coordination of care in CAU;
(2) family-focused and bottom-up apporoach (the IHT therapist, together with the parents, plans the specification of changes in the family) vs child-centered and top-down approach in CAU; and
(3) organization of care within the everyday, family environment vs more institutionally oriented care in CAU.
- Primary outcomePrimary outcome measures include:
- Parental behavior (consistency, responsiveness, positive parenting, harsh parenting, psychological control, and behavioural Control)
- Quality of the parent-child relationship (communication, conflicts, and attachment)
- Family Functioning (Cohesion, External locus of control and Family organisation).
- Secondary outcomeSecondary outcome measures are:
- Child problem behavior
- Quality of life
- Child academic competence.

Evenmore, parental competence and child cogntions are investigated as possible mediators and family and treatmnet characteristics as moderators.
- TimepointsAll measures are conducted at:
- Pretest assessment (T1; immediately prior to the beginning of treatment)
- Posttest assessment (T2; immediately after treatment, on average 12 months)
- Follow up (T3; 6 months after the end of treatment).
An observation task will conducted at pre-treatment and post-treatment for a selected group of participants.
- Trial web siteN/A
- statusopen: patient inclusion
- CONTACT FOR PUBLIC QUERIESDr. Denise Bodden
- CONTACT for SCIENTIFIC QUERIESDr. Denise Bodden
- Sponsor/Initiator Utrecht University (UU)
- Funding
(Source(s) of Monetary or Material Support)
ZON-MW, The Netherlands Organization for Health Research and Development
- PublicationsN/A
- Brief summaryMany of the treatments available for multiproblem families have never been properly evaluated in the Netherlands, and thus non-evaluated treatments continue to dominate the field.
The present study focuses on an intensive home-based treatment for multiproblem families with children aged 4 to 18.
Intensive home based treatment (IHT) can be labelled as promising because it incorporates several characteristics that have been shown to increase the effectiveness: it is multi-faceted, intensive, strength-based treatment and the services are delivered to families in their own homes.
Indeed, recent meta-analysis of home visiting programs in the USA showed that parents received benefit from home visits in terms of their parenting attitudes and behaviour and children in families who were enrolled in home visiting programs fared better than did control group children. It must be pointed out, however, that there are many differences between the USA and The Netherlands in organization of mental health services, availability of different treatments, type of clients etc., so the question remains whether these positive results will be obtained.
The current project aims first to examine whether IHT produces outcomes that are superior to the comprehensive treatments already available ('care as usual'). Primary outcomes include parenting behavior and the quality of the parent-child relationship. Secondary outcomes include child problem behavior, social and academic competence. A large body of treatment-effectiveness studies has focused solely on pragmatic goals (i.e. whether the treatment is effective), devoting little attention to how and for whom interventions yield beneficial outcomes. The present study aims to go beyond the simple effectiveness question. Second aim therefore is to examine the processes through which the IHT works by testing the hypothesized mediators of beneficial treatment. These treatment mediators are suggested by theoretical models that provide a conceptual basis of IHT. For parenting (primary) outcomes mediators include changes in parental competence, whereas for the child (secondary) outcomes, mediators are improvements in parenting behavior and the parent-child relations.
Third aim is to determine circumstances in which IHT yield or does not yield beneficial outcomes by examining possible treatment moderators: characteristics of participants and characteristics of treatment.
A randomized clinical trial will be conducted, including pretest-posttest control group design, randomized assignment to conditions (IHT vs. control group - care as usual,CAU) and a long term follow up. Each treatment condition (IHT and CAU) will include 100 multiproblem families. Pre-test assessment (T1) will take place immediately prior to the beginning of treatment, post-test assessment (T2) will take place immediately after treatment (on average 12 months), and follow up (T3) will be conducted 6 months after the end of treatment. The identical assessment battery will be administered to both groups at T1, T2, and T3. The assessment will include multi methods (interviews, questionnaire, observation) and multi sources of information (parent, child, therapist, observer). In addition, to examine the processes of change (see Aims 2) a three-monthly assessment will take place in the IHT group only.
- Main changes (audit trail)
- RECORD9-jul-2008 - 25-jul-2008


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