Effektevaluering av International Child Development Programme (ICDP). En randomisert kontrollert studie
English Summary Introduction Children's development transpires in a complex interplay between genetic, biological, and environmental factors. The relationship between the child and their close caregivers, the interaction between parents and children, the parents' mental health, their parenting style, and conflicts within the family are all important elements in children's development. Thus, parental guidance is a widespread measure – used both by parents who experience major challenges related to having children, and by parents who do not experience such difficulties. The International Child Development Program (ICDP) is a universal preventive parental guidance program, aimed at parents of children aged 0-18 years. The program has Norwegian origins but is currently used in more than 45 countries worldwide. In Norway, The Norwegian Directorate for Children, Youth and Family Affairs (Bufdir), is responsible for the organisation and implementation of the program, targeting to offer ICDP in all the Norwegian municipalities. The measure is provided in the form of group sessions led by certified ICDP supervisors, and the program is based on developmental and cultural psychology, as well as pedagogical theory. The focus of the program is on the interaction and relationship between the caregivers and their children, and the program is intended to suit various settings and cultural contexts. Previous studies indicate that parental guidance can contribute to the strengthening of caregivers in their parental role, improve the interaction between the parents and their children, and promote positive health and development in children. However, there is a need for more research on the effectiveness of these programs, both short- and long-term. This study is the first randomized controlled trial (RCT) of ICDP conducted in Norway, and the largest RCT study of ICDP internationally. This study was conducted by the Norwegian Institute of Public Health on behalf of Bufdir. The aim of the study is to investigate the effect of the universal, standard version of the parental guidance program ICDP in Norway by using parent-reported outcome measures. This is done by examining changes in 1) the parents, 2) the parent-child relationship, and 3) the child. We investigate the effect of ICDP on three different levels, by examining the study's three research questions: 1. Does ICDP lead to a positive change in the parental role? 2. Can ICDP strengthen the relationship between the parents and their children? 3. Can ICDP help improve children's quality of life, emotional difficulties, and social functioning? Methods The study sample consists of parents in Norway who signed up for ICDP (standard version), in the period between 1 January 2017 to 5 October 2020. In order to be able to decide whether an intervention is effective or not, it is imperative that the effect can be attributed to the intervention and not to systematic differences between the interventionor control groups. Thus, we conducted a randomized controlled trial to investigate the effectiveness of ICDP. The study participants were randomly allocated to one of the two groups: 1) The study’s intervention group, n = 327 parents who had signed up to receive ICDP guidance, and their group was selected to receive the ICDP guidance. 2) The study control group (waiting list groups), n = 339 parents who had also signed up to participate in an ICDP group, but the group was selected to not receive the ICDP measure (until after the study was completed). All participants received the electronic questionnaires prior to randomisation and the start of the intervention (t1), immediately after the intervention was completed (ten weeks after t1 for the control group) (t2), and six months after the first questionnaire was sent (t3). The group supervisors also handed in questionnaires, first when joining the study, and then they filled in one form after each of the eight group meetings. Data were analysed by intention-to-treat (ITT). In total, 590 parents with 494 children were included in the ITT analysis (292 parents in the intervention group, 298 parents in the control group). Since we had multiple measurement time points, and all outcome measures were continuous, we used a linear mixed model regression analysis to estimate the effect of ICDP on the selected outcome measures. Results Overall, the study results showed that ICDP had a positive effect on parents and on the relationship between them and their children, even though the effects were small. After completing the ICDP course, the parents from the intervention group had become more confident in the parental role and practiced a more supportive parenting style compared to the control group, according to self-report. The positive change applied to both shortand long-term follow-up. Furthermore, the parents from the intervention group stated that they felt closer to their child immediately after the intervention ended, and at the last measure point they reported fewer conflicts with the partner regarding child rearing. We found no difference in change between the intervention group and the control group when it comes to positive involvement with the child and level of conflict between parents and children at any of the measurement times. Our results further show that the ICDP intervention appears to have little or no effect on changes in the child. However, we do find that the parents in the intervention group, compared with the control group, report reduced internalizing difficulties and improved prosocial behaviour immediately after ICDP. At the same time, we found no differences in change between the two groups when it comes to externalizing difficulties or quality of life in the child at any measure points. Conclusion This effect evaluation of the universal parental guidance program ICDP in Norway showed that the program had a positive effect on the parents in the intervention group. They reported more confidence in the parenting role, that they felt closer to their child, experienced less conflicts related to child rearing, and practiced a more supportive parenting style after completing ICDP compared to the control group. Although the reported effects were small, they may still be important for practice, as the program is available for all parents and may thus reach many parents and their children. Our study found a limited effect on the children. It is however important to note that these effects are not inconsiderable when understood in context: One cannot expect finding large effects from a universal program, and the intended change from the ICDP is primarily on the parents. The intention is that the positive impact on the parents will be of importance to the child – in short or long term. We found some positive changes in favour of the intervention group in terms of internalizing difficulties and prosocial behaviour, but these effects are very small, and should therefore be interpreted with caution. ICDP is a universal preventive measure and is offered regardless of the level of risk; many of the children who receive ICDP will already have good psychosocial health before entering the study. The results of this study are based on a strong evaluation design and include validated instruments and scales. The results from the study therefore provide scientific support for the standard version of the ICDP being an appropriate tool in the work of strengthening caregivers in their parental role, and in improving the interaction between parents and their children.
Publisert i 2021
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