Compare
Click the checkbox below to add an intervention for comparison
Clicking this button will open the self-assessment tool in a new window.
Key overview details
- Universal
- Targeted
- Antisocial Behaviour
- Conduct Problems
- Prosocial behaviour
- Emotion Regulation / Emotional literacy
- Parenting
- Parent-child relationship / Attachment
- Infants and Toddlers: 0-36 months
- Preschool: 3 to 5 years
- Primary school: 6 to 12 years
- Adolescents: 13 to 18 years
Family Check-up
Summary
The Family Check-Up (FCU) is empirically validated for families of children age 2-17, with components for children ages 1 month to 24 months under development with an ongoing RCT since 2017. Although it is a universal programme, applicable for all those who care for or work with children, outcomes are most robust when delivered to families with children at risk of maltreatment or adversity. The Family Check-Up is delivered directly to individual families in 3 key stages, composed of an Initial Interview, followed by Assessments and concluding with Feedback to Parents about strengths and challenges. The programme’s strengths-based, collaborative approach threads through each of these meetings, usually conducted once a week over three consecutive weeks. This comprehensive assessment process then informs the nature of recommended intervention to follow. Although Everyday Parenting (EDP) is the parenting programme developed within the FCU suite, evaluated in the FCU studies and has the advantage of being intrinsically linked with key aspects of the FCU assessment process, it is possible to follow the FCU assessment with any appropriate, tailored parenting intervention.
The FCU is currently delivered across the US as well as in Sweden and Canada. There has not yet been UK implementation, however the first group of practitioners have recently been trained in the UK.
Website: https://reachinstitute.asu.edu/programs/family-check-up
® Family Check-Up is a federally registered trademark owned by the University of Oregon.
Core Components
The core target population is any family with children 1 month -17 years old. There are no eligibility criteria but evidence suggests that the intervention effects are more robust among families/children that demonstrate risk factors such as: maternal and paternal depression, lack of social support, poverty and poor or compromised caregiving.
The programme is delivered in two phases, with all content and modes of delivery clearly outlined and operationalised. The first phase is the Family Check-up, with 3 key steps of:
i) Initial Interview (grounded in Motivational Interviewing techniques and takes approximately 45 to 60 minutes)
ii) Assessment (includes questionnaires and videotaping clips of parent-child interaction tasks; questionnaires take approximately 30 to 45 minutes and Family Interaction Tasks take approximately 30 minutes)
iii) Feedback to Parents (which includes shared review of videotaped clips and takes approximately 60 to 90 minutes)
The second phase is based on the outcomes of this assessment which determine the nature of the intervention to follow, which generally includes parenting support. Although practitioners can employ any evidence-based parenting intervention, the programme within the FCU suite is Everyday Parenting (EDP). One of the advantages of engaging this approach is that it can be tailored specifically to target those areas identified in FCU, avoiding the need to employ the entire EDP curriculum. Follow-up services may also include interventions other than parenting support, such as health service support for the parent or child.
Fidelity
The programme has an integral, mandatory, empirically based fidelity assessment tool, COACH. Practitioners submit videotaped sessions of FCU (Feedback session) or EDP delivery for review by FCU Consultant. Fidelity is assessed across 6 dimensions, including client engagement, accurate adherence to programme content and responsiveness to families’ needs and context.
In order to become a Certified FCU or EDP practitioner, practitioners need to pass COACH criteria on 2 taped delivery sessions of FCU or EDP.
Modifiable Components
Adaptations are encouraged to effectively fit the programme with intended recipients. The assessment process, for example parent-child interaction task, varies dependent on child age, as do some of the intervention options. Practitioners can also draw on the range of programme tools to greater or lesser extent, depending on recipient need and capacities, with the strengths-based ethos underpinning delivery throughout. All potential modifications are included in the core training.
FCU has been adapted for virtual delivery. Since March 2020 training and consultation has focused on supporting the delivery of the model remotely. Resources are now available for remote delivery they include: 1) individual specific links generated for parents to complete intervention questionnaires that can be e-mailed or texted to parents, 2) transition to using a Video platform for implementation and videotaping parent-child interaction tasks which are a component of the Family Check-Up assessment, 3) video resources and handouts for parents that demonstrate how to successfully implement positive parenting skills, and 4) a web-based application, the Family Check-Up Online, which is designed for families to engage with the program asynchronously and for their case manager to monitor engagement and progress within the programme.
The programme is currently being adapted for use with populations such as kinship and foster carers, native tribal populations, mothers who used opioids during pregnancy and parents of deaf children. In addition, a version of the programme for infants and toddlers 6-23 months old, with a core focus on responsive parenting and early parent-child interactions, is currently being implemented in community and clinic settings and is undergoing evaluation.
As well as being an effective intervention in its own right, FCU highlights its adaptability as a model to enhance other interventions, adding a layer of additional assessment and tailored intervention for those more complex families who require it.
Training is provided by US-based FCU, with different options available regarding the extent of face-to-face and Webinar components.
Support for Organisation/Practice
Implementation Support
The programme provides a suite of services to support set up and implementation, with the goal being that sites ultimately feel empowered to take on training and consultation for themselves. The programme provides clear criteria of characteristics for successful implementation and incorporates these in to optional monthly consultation between the FCU Consultant and the site. FCU Implementation Coordinator can offer implementation support during the preparation, implementation and sustainability of FCU with services accessing those aspects which necessity and budget allow.
Data management is coordinated and supported by the programme, with data-informed feedback being a core aspect of their implementation strategy. The range of forms used to facilitate delivery are available online, and questionnaire data are submitted online for automated scoring. Technological support is available through the REACH Institute (who hosts the FCU programme).
Start-up Costs
Training costs vary depending on which version is selected by sites, with costs ranging from $6,100 for up to 6 trainees (plus trainer travel) for the Hybrid E-learning and 1-day workshop to $8,000 for up to 6 trainees (+ trainer travel) for the 2-day in person workshop.
The Train the Trainer model costs $4,800 per provider per intervention. In order to become a Supervisor/Trainer for FCU and EDP, the total cost per provider is $9,500.
Certification costs $1,700 per provider for submission of either two FCU Feedback Sessions or any two EDP Sessions and is valid for 2 years. If certification criteria are not met, additional video reviews are available at $475 per video reviewed. Re-certification requires Consultant review of one session and costs $475 per video reviewed. Re-certification occurs every 2 years.
Monthly group clinical consultation, provided by a REACH Consultant, costs $250 per hour.
FCU implementation support consultation is $250/hour.
Building Staff Competency
Qualifications Required
Although it is recommended that FCU providers have a professional qualification and experience of delivering parent-child interventions, paraprofessionals and individuals with bachelors or associates degrees can become providers, with appropriate support and supervision. Programme can provide support in selection of appropriate providers.
Training Requirements
There are 3 training options to become FCU “Qualified Provider” which all include resources, supplemental training and support needed to implement the FCU model, including 1-year access to FCU Resource Website. Training can take place over a two-day in-person workshop, through e-learning and webinar sessions (although less accessible outside of the US) or as a hybrid of the e-learning course and a 1-day in-person workshop. The remote access training includes three 5-hour asynchronous interactive webinars. A component of the webinars includes training and practice on adaptation of the intervention for telehealth delivery.
Further training, following the same 3 options of training delivery, is required to becomes an EDP Qualified Provider.
The programme encourages site sustainability through a ‘Train-the-Trainer’ model, where Certified Providers can be certified to become trainers and supervisors on their own sites.
Supervision Requirements
FCU recommends that providers engage in monthly group consultation with a REACH Consultant for the first year of implementation. All post-training consultation is now delivered via webinar.
It has been demonstrated across two Randomised Control Trials that Family Check-up leads to significant reduction in child behaviour difficulties and significant improvement in caregiver positive behaviour support.
Theory of Change
The FCU is grounded in Social Learning, Family Systems and Motivational Interviewing approaches, focusing on the strengths of the parent and child to develop a comprehensive assessment and case conceptualisation, which drives the tailored intervention to follow. Exploration of mechanisms of change have highlighted improvements in positive parenting and family relationships as well as reductions in maternal depression as key mediators. The tenets of the paired parenting intervention, Everyday Parenting, are based on Social Learning Theory principles for behavioural change.
Infants and Toddlers: 0-36 months - Rating: 4
Number of Research Studies & Research Design
Relevant to this 0-36 month period of interest, there have been 2 large internal Randomised Control Trials (RCTs) of FCU, with a number of further analyses of the data over the subsequent years.
Outcomes Achieved
In comparison to controls, families who received FCU when their child was 2 years old, and followed annual top-up, elicited the outcomes below. Research pertaining to FCU with an infant 6-23-month population is underway.
Child Outcomes
- Significant reduction in child behaviour difficulties (Dishion et al., 2008)
- FCU at 2 & 3 years old positively associated with academic achievement at 5 & 7.5 years old (Brennan et al., 2013)
- Longitudinal analysis identified that continued FCU intervention (i.e. engagement in annual ‘top-ups’) led to improvements in teacher reports of behaviour at age 7.5 – these improvements increase as a function of the number of yearly FCUs parents participated in (Dishion et al., 2014)
Parent Outcomes
- Increased caregiver positive behaviour support (Dishion et al., 2008)
Key References
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., Dishion, T. J., Supplee, L., Gardner, F., & Arnds, K. (2006). Randomized trial of a family-centered approach to prevention of early conduct problems: 2-year effects of the Family Check-Up in early childhood. Journal of Consulting & Clinical Psychology, 74(1), 1-9.
Preschool: 3 to 5 years - Rating: 1+
Research Design & Number of Studies
There is no evidence for Family Check Up specifically relevant to intervention with caregivers of the 3-5 year old population.
Primary school: 6 to 12 years - Rating: 4
Research Design & Number of Studies
Relevant to this 6-12 year old period of interest, there have been 2 large internal Randomised Control Trials (RCTs) of FCU delivered during US middle school (11-15 years old), with long term follow-up and a number of further analyses of the data over the subsequent years. (It should be noted that families within intervention groups of both RCTs had access to a family resource centre with books, pamphlets and further parenting information in addition to opting in to FCU participation.)
There has also been an internal community effectiveness-implementation trial of FCU implementation with 71 families of children 5-17 years old (mean age 11.6 years).
Outcomes achieved
Compared to a control group, parental engagement with FCU was found to have the following outcomes:
Child outcomes
- FCU intervention during middle school:
- Significant preventative impact on depressive symptoms for youths with low initial symptoms (Connell et al., 2018) and a longer-term impact in reducing diagnoses of depression in adulthood (Connell & Dishion, 2017).
- Significant reduction in suicide risk in adolescence and early adulthood in long-term follow-up (Connell et al., 2016).
- Significantly reduced youth alcohol, tobacco and marijuana use from ages 11-17 years (Connell et al., 2007) and predicted reduced tobacco and marijuana use at age 23 years (Veronneau et al., 2016)
- FCU intervention when child 5-17 years old:
- Significant reduction in youth (11+ years) self-reported conduct problems (Smith et al., 2015).
Key references
Connell AM, Dishion TJ, Yasui M, Kavanagh K. An adaptive approach to family intervention: Linking engagement in family-centered intervention to reductions in adolescent problem behavior. Journal of Consulting and Clinical Psychology 2007;75:568–579.
Smith, J., Stormshak, E. & Kavanagh, K. (2015). Results of a Pragmatic Effectiveness–Implementation Hybrid Trial of the Family Check-Up in Community Mental Health Agencies. Administration and Policy in Mental Health, 42:265–278.
Van Ryzin, M. J., Stormshak, E. A., & Dishion, T. J. (2012). Engaging parents in the Family Check-Up in middle school: Longitudinal effects on family conflict and problem behavior through the transition to high school. Journal of Adolescent Health, 50(6), 627-633
Adolescents: 13 to 18 years - Rating: 4
Research Design & Number of Studies
The best evidence for Family Check Up for adolescents aged 13-17 years old comes from the two large-scale internal RCTs and internal community effectiveness-implementation trial described in the 6-12 year old section above. These studies included children 13 years and older and so evidence outcomes for the age range 13-17 years is the same as for the 6-12 years evidence above.
Values
Family Check-Up is grounded in Social Learning, Family Systems and Motivational Interviewing approaches to deliver an assessment driven approach to tailoring parent-child intervention. One of the core elements of programme delivery involves video recording interactions between parent and child within their home.
- Is this assessment-driven approach aligned with the core values and priorities of your organisation?
- As a service, do you accept the essential role of capturing and reviewing video footage of parent-child interactions?
Priorities
FCU is applicable for all families, however outcomes are most robust for those children and families at high risk of adverse experiences and living in areas of high deprivation.
- Is working with parents of young children in an early intervention approach a key priority for your organisation?
Existing Initiatives
Family Check-Up can be applied to link in any intervention programmes already existing within your service, or through the introduction of their tandem programme, Everyday Parenting.
- Does your service already provide early intervention programmes aiming to improve child development and mental health outcomes?
- Do you already deliver parent-child intervention programmes which might be augmented by the addition of a comprehensive FCU assessment?
- Do you have strong links with a range of parent-child intervention providers, to be able to make onward referrals for appropriate, tailored interventions as indicated by the FCU assessment?
Workforce
Family Check-Up implementation requires at least 2 practitioners who would be available to deliver the programme for at least 10 hours per week, with an additional 60 minutes of indirect service time allotted for preparation of the 3rd Session of FCU for each family, the Feedback Session. In addition, practitioners must engage in up to two hours of consultation per month.
- Do you have practitioners within your service who could be released to attend the relevant training and be given protected time to deliver FCU as described?
- Do these practitioners have prior experience in working with vulnerable families and delivering parent-child interventions?
Certification as an FCU practitioner requires passing COACH (fidelity measure) criteria on two taped sessions. This can take up to 6-9 months after practitioners finish training and begin working with FCU with families. Certified FCU practitioners can then go on to become a Supervisor and Trainer, which involves a commitment of at least 35 hours of Certification Activities and can extend up to 1 year after Certification as a practitioner.
- Will your practitioners, and your agency supporting them, be committed to striving for certification as an FCU practitioner?
- Will at least one practitioner in your agency be motivated and supported to pursue certification as an FCU Supervisor and Trainer to allow sustainability of FCU in your agency?
Technology Support
FCU fidelity monitoring and certification process require practitioners to videotape and review sessions.
- Do you have the technology to support practitioners to videotape and review sessions, to be able to deliver the programme with fidelity?
- As an agency, do you have high-speed internet access to be able to upload securely and within compliance recorded video for use in certification consultation with the programme?
- As an agency, do you have the technological knowledge/support to be able to upload securely and within compliance recorded video for use in certification consultation with the programme?
Administrative Support
FCU will require some administrative support; in managing referrals, data input and ensuring appropriate service policies are in place to ensure the programme can be delivered as manualised.
- Do you have administrative procedures in place to support your practitioners to implement a programme like this?
Financial Support
Initial training costs range from $6,100 for up to 6 trainees (plus trainer travel) for the Hybrid E-learning and 1-day workshop to $8,000 for up to 6 trainees (+ trainer travel) for the 2-day in person workshop.
The Train the Trainer model costs $4,800 per provider per intervention. In order to become a Supervisor/Trainer for FCU and EDP, the total cost per provider is $9,500.
Certification costs $1,700 per provider for submission of either two FCU Feedback Sessions or any two EDP Sessions and is valid for 2 years. If certification criteria are not met, additional video reviews are available at $475 per video reviewed.
Re-certification requires Consultant review of one session and costs $475 per video reviewed. Re-certification occurs every 2 years.
Monthly group clinical consultation, provided by a REACH Consultant, costs $250 per hour.
FCU implementation support consultation is $250/hour.
- Do you have the finances to support practitioners to access training and consultation for certification (and recertification every 2 years)?
- Do you have the finances to secure the technological equipment necessary for videotaping and reviewing sessions?
- Do you have the finances to pay for ongoing programme implementation consultation to facilitate implementation with success?
Comparable Population
FCU is particularly effective for families at high risk of child maltreatment and multiple adverse experiences, as well as for those with high levels of reported child behaviour difficulties at baseline.
- Are families with children with significant parent-reported behaviour difficulties and/or at risk of adverse experiences an identified population of particular concern to your organisation?
Desired Outcome
FCU input at 2 years of age has been demonstrated to improve child behaviour, academic performance and positive parenting practices. FCU input during early adolescence has been shown to improve adolescent depressive symptoms and substance misuse behaviours through until early adulthood.
- Are the improvements of children and adolescents’ development, learning and mental health priority outcomes for your organisation?
- Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?
Dr. Anne Mauricio: amariem@uoregon.edu
Anne Gill, FCU Clinical Supervisor and implementer of the 6-24-month programme: anne.gill@pitt.edu