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. 2025 Feb;34(2):739-749.
doi: 10.1007/s00787-024-02523-6. Epub 2024 Aug 14.

Enrollment and completion rates of a nationwide guided digital parenting program for children with disruptive behavior before and during COVID-19

Sakari Lintula #  1   2 , Andre Sourander #  3   4   5 , Susanna Hinkka-Yli-Salomäki  1   2 , Terja Ristkari  1   2 , Malin Kinnunen  1   2 , Marjo Kurki  1   2   6 , Altti Marjamäki  1   2 , David Gyllenberg  1   2   7   8 , Hyoun Kim  9 , Amit Baumel  10
Affiliations

Enrollment and completion rates of a nationwide guided digital parenting program for children with disruptive behavior before and during COVID-19

Sakari Lintula et al. Eur Child Adolesc Psychiatry. 2025 Feb.

Abstract

Our aim was to study enrollment and completion levels for the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention, for parents of young children with disruptive behavior before and after the COVID-19 lockdown period. Population-based screening was carried out on 39,251 children during routine check- ups at 4 years of age. The parents of children scoring at least 5 on the Strengths and Difficulties Questionnaire were assessed against inclusion and exclusion criteria. Associations with enrollment or completion were analyzed using logistic regression models. The effects of COVID-19 restrictions on these were estimated using interrupted timeseries analysis. Of 39,251 families, 4894 screened positive and met the eligibility criteria. Of those, 3068 (62.6%) decided to enroll in the SFSW program and 2672 (87.1%) of those families completed it. The highest level of disruptive behavior (OR 1.33, 95% CI 1.12-1.57, p < 0.001) and overall severity of difficulties (OR 2.22, 95% CI 1.91-2.57, p < 0.001) were independently associated with enrollment. Higher parental education was associated with enrollment and completion. Higher paternal age was associated with enrollment, and parent depressive symptoms with non-completion. The SFSW enrollment did not significantly change following the COVID-19 restrictions, while the completion rate increased (COVID-19 completion OR 1.75, 95% CI 1.22-2.50, p = 0.002). Guided digital parenting interventions increase the sustainability of services, by addressing the child mental health treatment gap and ensuring service consistency during crisis situations.

Keywords: COVID-19 pandemic; Internet-based intervention; Mental health; Parenting; Public health.

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Conflict of interest statement

Declarations. Conflict of interest: Dr. Sourander is the founder and director of Digifamilies, which provides evidence-based treatments to Finnish public health services. The authors declare no other conflicts of interest. All authors read and approved the final manuscript.

Figures

Fig. 1
Fig. 1
Flowchart of sampling and study design
Fig. 2
Fig. 2
A Enrollment rate from January 1 2015 to June 30 2021. Solid line shows estimated enrollment rate and the estimated change on March 16 2020. Red dashed lines are 95% CIs. Numbers within brackets are annual enrollment rates. B Completion rate from January 1 2015 to June 30 2021. Shaded grey area indicates time after COVID-19 restrictions. Points are monthly enrollment and completion rates. Numbers below years are annual enrollment and completion proportions
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