Digitally Assisted Parent Training Intervention for Disruptive Behavior in 4-Year Old Children (Voimaperheet – Huomaa hyvä lapsessasi)

Current status: Ongoing implementation

Outcomes include: Implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, sustainability, satisfaction), long-term follow-up data

Oppositional and conduct problems are developmental precursors to a wide range of negative outcomes that indicate a later risk of marginalization, including peer rejection, school failure, psychopathology, substance abuse, criminality and suicidality. Approximately half of the preschool children who are identified as aggressive and have externalizing behavior develop persistent problems. Untreated disruptive behavior disorders are some of the most costly early childhood psychiatric disorders.

Parental training is the most effective approach to the psychosocial treatment of disruptive behavior and one of the best‐validated therapeutic techniques. Parents who take part in training interventions typically learn to identify, define and observe problem behaviors in new ways and acquire strategies to prevent and respond to oppositional behavior.

Voimaperheet intervention is based on telephone coaching, evidence-based digitalized psychoeducation and parent training. The length of the intervention is eleven weeks.

Main results

The intervention

  • resulted in significant improvement in child externalizing symptoms at 6 and 12 and 24 months after randomization compared with the control group
  • improved most psychiatric symptom domains, including parent-reported aggression, affective, anxiety, and sleep problems compared with the control group
  • reduced callousness scores,which are associated with poorer treatment outcomes
  • improved parenting skills
  • reduced significantly the use of child mental health services compared to control group in 24 month follow-up
  • was successfully implemented widely in primary health care covering one third of Finnish child health clinics
  • promotes preventive framework and increases identification of psychosocial risk factors of children and their families according to the health nurses using the Voimaperheet intervention at child health clinics.

The Voimaperheet model has been integrated as a part of the extended health check-up covering the age cohort. The implementation resulted in good feasibility, fidelity, accessibility when compared with intervention in RCT study setting. The discontinuation of treatment in the implementation group was exceptionally low (12,4%).

Voimaperheet-ohjelman levinneisyys.

Population: Families with 4 -year old children through population-based screening for conduct problems.  Over 100,000 families have been screened and over 5000 families have received the intervention.



  • Ristkari T, Mishina K, Lehtola MM, Sourander A, Kurki M. Public health nurses’ experiences of assessing disruptive behaviour in children and supporting the use of an Internet‐based parent training programme. Scand J Caring Sci 2019 Sep 5. doi: 10.1111/scs.12744. [Epub ahead of print]
  • Ristkari T, Kurki M, Suominen A, Gilbert S, Sinokki A, Kinnunen M, Huttunen J, McGrath P, Sourander A. Web-Based Parent Training Intervention With Telephone Coaching for Disruptive Behavior in 4-Year-Old Children in Real-World Practice: Implementation Study. J Med Internet Res 2019 Apr 11;21(4):e11446.
  • Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Hinkka-Yli-Salomäki S, Kurki M, Lingley-Pottie P. Two-Year Follow-Up of Internet and Telephone Assisted Parent Training for Disruptive Behavior at Age 4. J Am Acad Child Adolesc Psychiatry 2018 Sep;57(9):658-668.e1.
  • Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Lingley-Pottie P, Hinkka-Yli-Salomäki S, Kinnunen M, Vuorio J, Sinokki A, Fossum S, Unruh A. Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial. JAMA Psychiatry 2016 Apr;73(4):378-87.
  • Fossum S, Cunningham C, Ristkari T, McGrath PJ, Hinkka-Yli-Salomäki S, Sourander A. Does parental mental health moderate the effect of telephone and internet-assisted remote parent training for disruptive 4-year-old children? Scand J Psychol. 2018 Jun;59(3):273-280.
  • Fossum S, Ristkari T, Cunningham C, McGrath PJ, Suominen A, Huttunen J, Lingley-Pottie P, Sourander A. Parental and child factors associated with participation in a randomised control trial of an Internet-assisted parent training programme. CAMH, 2016 Nov 10.
  • McGrath PJ, Sourander A, Lingley-Pottie P, Ristkari T, Cunningham C, Huttunen J, Filbert K, Aromaa M, Corkum P, Hinkka-Yli-Salomäki S, Kinnunen M, Lampi K, Penttinen A, Sinokki A, Unruh A, Vuorio J, Watters C. Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada). BMC Public Health 2013 Oct 21;13:985.