Stepping up to COVID-19: A Clinical Trial of a Telepsychology Positive Parenting Program Targeting Behavior Problems in Children With Neurological Risk

Abstract

Objective: To evaluate the feasibility, acceptability, and preliminary efficacy of a stepped-care parenting program implemented during COVID-19 among families of behaviorally at-risk children with neurological or neurodevelopmental disorders aged 3-9 years.

Methods: Stepped-care I-InTERACT-North increased psychological support across 3 steps, matched to family needs: (1) guided self-help (podcast), (2) brief support, and (3) longer-term parent support. The intervention was provided by clinicians at The Hospital for Sick Children. Recruitment occurred via hospital and research cohort referral. A single-arm trial using a pragmatic prospective pre-post mixed-method design was utilized to assess accrual, engagement, acceptability, and preliminary efficacy.

Results: Over 15 months, 68 families enrolled (83% consent rate) and 56 families completed stepped-care (Step 1 = 56; Step 2 = 39; Step 3 = 28), with high adherence across Steps (100%, 98%, and 93%, respectively). Parents reported high acceptability, reflected in themes surrounding accessibility, comprehension, effectiveness, and targeted care. Positive parenting skill increases were documented, and robust improvement in child behavior problems was apparent upon Step 3 completion (p =.001, d = .390). Stepped-care was as effective as traditional delivery, while improving consent and completion rates within a pandemic context.

Conclusions: This stepped-care telepsychology parenting program provides a compelling intervention model to address significant gaps in accessible mental health intervention while simultaneously balancing the need for efficient service. Findings inform program scalability beyond COVID-19 and emphasize the value of stepped-care intervention in delivering and monitoring mental health treatment.

Keywords: COVID-19; child behavior; early brain injury; mental health; neurodevelopmental; parenting; stepped-care; telepsychology.

Figure 1.

Model of Stepped-Care I-InTERACT-North.

Figure 2.

Recruitment CONSORT diagram demonstrating study enrollment and adherence. Note: BQ = Background Questionnaires; LTF = lost to follow-up; PSQ = post-study questionnaires. ^aReasons for ineligibility: not affiliated with REB approved referral sources—Hospital for Sick Children or POND Network (n = 3); outside of the specified age-range of the study (n = 1); had competed the original version of the program (n = 1). ^bProvided reasons included: lack of time (n = 6), feeling overwhelmed with current commitments or pandemic uncertainties (n = 2), and lack of interest (n = 4). ^cTwo families referred to Step 3 did not complete all sessions due to lack of time/family circumstances, but completed post-study questionnaires. They were classified as exiting after Step 2, although non-adherent to typical stepped-care protocol.

Figure 3.

In-session positive parenting skills across steps of program completion.

Figure 4.

Pre–post intervention analyses on parent-rated child behavior number and intensity according to the highest level of stepped-care completed by families. Note: Reflecting the stepped-care service model, baseline ECBI child behavior problems T-score significantly differed by program step, F(2, 61) = 3.65, p = .032, η² = .107; Step 3 completers (M = 65.19, SD = 10.41, p = .019) reported highest baseline scores compared to completers of Step 2 (M = 56.55, SD = 7.54), and comparisons approached significance for Step 1 (M = 59.68, SD = 10.98, p = .057).