Bridging access and impact: primary care parenting intervention reduces early behavior problems in both virtual and in-person delivery modes

Background Early childhood behavior problems are common and linked to adverse outcomes, including risk of maltreatment. Child-Adult Relationship Enhancement in primary care (PriCARE) is an evidence-based group parenting program delivered in pediatric primary care to reduce disruptive behaviors and strengthen caregiver-child relationships. In-person RCTs have demonstrated the efficacy of PriCARE, but barriers such as workforce shortages, transportation issues, and limited behavioral health infrastructure restrict access. Virtual delivery offers a potential solution, yet its effectiveness relative to in-person delivery is not well established. Objective To evaluate the effectiveness of virtual PriCARE in improving child behavioral outcomes and compare these outcomes with those from prior in-person trials. Study design A multi-center RCT of virtual PriCARE is underway with caregivers of children aged 18 months to 6 years. Child behavior was assessed using the Eyberg Child Behavior Inventory (ECBI) at baseline and at 6-8 month follow-up. An interim analysis was conducted to examine changes in ECBI scores from baseline to follow-up among virtual participants and to compare mean ECBI change trajectories between virtual delivery and prior in-person trials. Attendance patterns were compared using the Cochran-Armitage trend test. Effectiveness was evaluated using linear regression models with ANCOVA adjustment for baseline ECBI scores and caregiver/child demographics. Results Subjects included 698 virtual PriCARE participants and 417 in-person PriCARE participants. Attendance was higher virtually, with 23.8% of participants completing all sessions, compared to 18.9% in-person ( p < .001). Children in the virtual intervention group showed significant reductions in ECBI Intensity (−7.81 vs. 1.45, p < 0.001) and Problem scores (−3.80 vs. −1.91, p < .001) compared with usual care. The delivery mode×intervention interaction was not significant for either ECBI Intensity ( p = 0.833) or Problem scores ( p = 0.744), suggesting no evidence of differential effects by delivery mode. Conclusions Virtual PriCARE was associated with significant improvements in early childhood behavior problems and higher completion rates, with no evidence of differential effects by delivery mode. These findings highlight the potential of virtual behavioral interventions in pediatric primary care to expand reach, reduce access barriers, and provide scalable prevention strategies to promote child well-being and prevent maltreatment. Trial registration ClinicalTrials.gov , NCT05233150. Registered 10 February 2022 https://clinicaltrials.gov/study/NCT05233150 .