Learning, Enjoying, Growing, Support model: an innovative collaborative approach to the prevention of conduct disorder in preschoolers in hard to reach rural families

Objective:  To develop, implement and evaluate a pilot program targeting rural families with preschool aged children at risk of conduct disorder.Design:  A prospective single group repeated measures design.Setting:  Communities in four local government areas in the Mid Western Area Health Service, New South Wales.Subjects:  A total of 33 families were referred to the program through community services where they were established clients.Interventions:  The Learning, Enjoying, Growing, Support model comprised a parenting program (Incredible Years; Kids Challenge and Change); a children's social skills program (Playing and learning to Socialise) and a transition to school component. Group programs were run simultaneously over 5–10 weeks.Main outcome measures:  Measures of positive parenting and child problem behaviour and social skills were conducted on referral, and at completion of the program.Results:  There was a self‐reported increase in utilisation of all positive parenting skills with significant increases in rewarding (median score on referral: 4 (range: 4–6); at completion of program 6 (4–6); ( P =  0.02)) and ignoring (2 (0–6) to 3 (1–8); ( P =  0.02)). Children increased their levels of social skills. Significant improvement was reported in cooperation: (median score: 24 (18–33) to 27 (19–33); ( P =  0.02)); interaction (24 (6–9) to 26 (11–32); ( P =  0.03)) and independence(25 (16–33) to 28 (20–33); ( P =  0.008)). There was a downward trend in problem behaviour exhibited with a significant reduction in internalising behaviour (median score 19 (3–30) to 12 (0–32); ( P =  0.04)). Conclusions:  The positive impact of the model on parenting skills and child behaviour is promising and communities are continuing to run the programs. We recommend a broader adoption through rural communities.What this paper adds:  Children with conduct disorder and their families utilise a range of services such as health, education, welfare and juvenile justice, costing the community 3 to 10 times as much as a child with no problems. Conduct disorder is most prevalent in socially and educationally disadvantaged children. Rural areas have higher rates of social and educational disadvantage, indicating the potential for a number of families to be a risk. Programs that are most effective in preventing long‐term behavioural problems in children are those that simultaneously address parenting, children and community support. There was a need to develop and evaluate a preventative strategy specific to rural communities that accessed the most vulnerable families. We describe a collaborative approach to the prevention of conduct disorder not previously reported in the published literature, which addressed positive parenting and children's social skills. The program accessed vulnerable families through referrals from agencies such as the Department of Community Services and Family Support Services. There was an increase in positive parenting skills and a reduction in child problem behaviour at completion of the group programs. Communities have continued to run programs.