| Summary: | <strong>Importance:</strong> Behaviour problems are the most common mental health disorder in childhood and can undermine children’s health, education, and employment outcomes into adulthood. There are few effective interventions for early childhood.
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<strong>Objective:</strong> To test the clinical effectiveness of a brief parenting intervention, Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), in reducing behaviour problems in young children aged 12-36 months.
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<strong>Design:</strong> The Healthy Start, Happy Start study was a two-arm, parallel group, researcher-blind, multisite, randomised controlled trial. Baseline and 5-month follow-up data were collected between July 30, 2015, and April 27, 2018.
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<strong>Setting:</strong> Health visiting services in six National Health Service (NHS) trusts in England.
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<strong>Participants:</strong> Of the 1,430 eligible families, 227 declined to participate, and 300 were randomised into the trial. Target participants were caregivers of children who scored in the top 20% for behaviour problems on the Strengths and Difficulties Questionnaire. Participants were randomly allocated (1:1) to either VIPP-SD (n=151) or usual care (UC) (n=149), stratified by site and number of participating caregivers.
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<strong>Intervention:</strong> All families continued to access usual care. Families allocated to VIPP-SD were offered six home-based, fortnightly video-feedback sessions of 1-2 hours duration.
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<strong>Main outcome(s):</strong> The primary outcome was an early childhood version of the Preschool Parental Account of Children’s Symptoms (PPACS), a structured interview of behaviour symptoms, at 5-months post-randomisation. Secondary outcomes included caregiver-reported behaviour problems on the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ).
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<strong>Results:</strong> Among 300 participating children (mean age, 23 months; male, 163 [54%]), primary outcome data were available for 140 (93%) VIPP-SD and 146 (98%) UC participants. Using intention-to-treat analysis, there was a mean difference in total PPACS score of 2.03 (95% CI 0.06 to 4.01; p=0.04; Cohen’s d=0.20) between trial arms with fewer behaviour problems in the VIPP-SD group, particularly conduct symptoms (d=0.30, 0.08 to 0.51). Other child behaviour outcomes showed similar evidence favouring VIPP-SD. No treatment or trial-related adverse events were reported.
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<strong>Conclusions and relevance:</strong> VIPP-SD was effective in reducing symptoms of early behaviour problems in young children when delivered in a routine health service context.
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<strong>Trial registration:</strong> ISRCTN (isrctn.org); number: 58327365.
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