Child-Adult Relationship Enhancements in Primary Care (PriCARE)

About the program

Child-Adult Relationship Enhancements in Primary (PriCARE) is a trauma-informed group training program to teach caregivers techniques to support the social and emotional growth of children. The theoretical foundation is derived from attachment and social learning theory. The program is designed as a prevention model for children with behavioural concerns who might be at risk for maltreatment.

Who does it work for?

The program is designed for children with behavioural concerns who might be at risk for maltreatment. One RCT was conducted in the USA with an initial sample size of 410, and a final sample size of 120 (Schilling et al. 2017). Parents were recruited from an urban primary care clinic, and 15% were Hispanic, 43% Black, and 26% White. Children were aged between 2 and 6 years. 54% ofparents were aged between 18 and 29 years, 26% between 30 and 39 years, and 20% were over the age of 40. Income levels were as follows: under US$22,000 (51% of the sample); US$22-33,000 (30%); and over US$33,000 (19%). For education levels, 15% of participants had not finished high school, 34% had a high school diploma; 51% had attended some college. Family violence was reported by 11% of the sample.

The review did not identify any evidence that the program has been evaluated in Australia or with First Nations communities.

What outcomes does it contribute to?

Positive outcomes:

Parent empathy, Corporal punishment attitudes, Acceptance of child’s autonomy: As measured by the AAPI Inventory, there were a slight but significant increase in empathy in the intervention group, compared to control; corporal punishment attitudes and acceptance of child’s autonomy improved slightly in the intervention group.

No effect:

None.

Negative outcomes:

None.

Is the program effective?   

Overall, the program had a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

There are 6 weekly one and a half hour sessions. Caregivers attend sessions without their children. This program is delivered in a clinical setting.

How much does it cost?

Information not available

What else should I consider?

Generalisability is limited by 172 families not enrolling, and lack of blinding of caregivers to the study aim.

Where does the evidence come from?

An RCT was conducted in the USA with an initial sample size of 410 families and a final sample size of 120 families (Schilling et al. 2017).

Further resources

• Schilling, S., et al. (2017). “Child-Adult Relationship Enhancement in Primary Care (PriCARE): A Randomized Trial of a Parent Training for Child Behavior Problems.” Academic Pediatrics 17(1): 53-60.