Abstract
This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3–15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents’ health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.

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Glied S, Sacarny A (2018) Is the US health care system wasteful and inefficient? Review of the evidence. J Health Polit Policy Law 43(5):739–765. https://doi.org/10.1215/03616878-6951103
Herrmann JA (2018) Complex problems, progressive policy solutions, and one health. Beyond one health: from recognition to results, 1st edn. Wiley, Hoboken, pp 293–306
Ivanova MY, Dewey L, Swift P, Weinberger S, Hudziak J (2019) Health promotion in primary care pediatrics: initial results of a randomized clinical trial of the Vermont family based approach. Child Adolesc Psychiatr Clin N Am 28(2):237–246. https://doi.org/10.1016/j.chc.2018.11.005
Hudziak J, Ivanova MY (2016) The Vermont Family Based Approach: family based health promotion, illness prevention, and intervention. Child Adolesc Psychiatr Clin N Am 25(2):167–178. https://doi.org/10.1016/j.chc.2015.11.002
Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR et al (2007) No health without mental health. Lancet 370(9590):859–877. https://doi.org/10.1016/S0140-6736(07)61238-0
Kolappa K, Henderson DC, Kishore SP (2013) No physical health without mental health: lessons unlearned? Bull World Health Organ 91(1):3-3A. https://doi.org/10.2471/BLT.12.115063
DuBois CM, Lopez OV, Beale EE, Healy BC, Boehm JK, Huffman JC (2015) Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: a systematic review. Int J Cardiol 195:265–280. https://doi.org/10.1016/j.ijcard.2015.05.121
Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, Kim ES, Koga HK et al (2018) Positive psychological well-being and cardiovascular disease: JACC health promotion series. J Am Coll Cardiol 72(12):1382–1396. https://doi.org/10.1016/j.jacc.2018.07.042
Celano CM, Beale EE, Moore SV, Wexler DJ, Huffman JC (2013) Positive psychological characteristics in diabetes: a review. Curr Diab Rep 13(6):917–929
Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry 60(7):709–717. https://doi.org/10.1001/archpsyc.60.7.709
Copeland W, Shanahan L, Costello EJ, Angold A (2011) Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. J Am Acad Child Adolesc Psychiatry 50(3):252–261. https://doi.org/10.1016/j.jaac.2010.12.014
Roehrig C (2016) Mental disorders top the list of the most costly conditions in the United States: $201 billion. Health Aff 35(6):1130–1135. https://doi.org/10.1377/hlthaff.2015.1659
Erskine H, Moffitt TE, Copeland W, Costello EJ, Ferrari AJ, Patton G et al (2015) A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 45(7):1551–1563. https://doi.org/10.1017/S0033291714002888
Baranne ML, Falissard B (2018) Global burden of mental disorders among children aged 5–14 years. Child Adolesc Psychiatry Ment Health 12(1):19. https://doi.org/10.1186/s13034-018-0225-4
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE et al (2013) Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet 382(9904):1575–1586. https://doi.org/10.1016/S0140-6736(13)61611-6
Vigo D, Thornicroft G, Atun R (2016) Estimating the true global burden of mental illness. Lancet Psychiatry 3(2):171–178. https://doi.org/10.1016/S2215-0366(15)00505-2
You D, Gu D, Yi Z (2010) Familial transmission of human longevity among the oldest-old in China. J Appl Gerontol 29(3):308–332. https://doi.org/10.1177/0733464809340154
An P, Perusse L, Rankinen T, Borecki IB, Gagnon J, Leon AS et al (2003) Familial aggregation of exercise heart rate and blood pressure in response to 20 weeks of endurance training: the HERITAGE family study. Int J Sports Med 24(01):57–62. https://doi.org/10.1055/s-2003-37200
Schwenk RW, Vogel H, Schürmann A (2013) Genetic and epigenetic control of metabolic health. Mol Metab 2(4):337–347. https://doi.org/10.1016/j.molmet.2013.09.002
Cárdenas-Roldán J, Rojas-Villarraga A, Anaya J-M (2013) How do autoimmune diseases cluster in families? A systematic review and meta-analysis. BMC Med 11(1):73. https://doi.org/10.1186/1741-7015-11-73
Wassel CL, Loomba R, Ix JH, Allison MA, Denenberg JO, Criqui MH (2011) Family history of peripheral artery disease is associated with prevalence and severity of peripheral artery disease: the San Diego population study. J Am Coll Cardiol 58(13):1386–1392. https://doi.org/10.1016/j.jacc.2011.06.023
Albright F, Teerlink C, Werner TL, Cannon-Albright LA (2012) Significant evidence for a heritable contribution to cancer predisposition: a review of cancer familiality by site. BMC Cancer 12(1):138. https://doi.org/10.1186/1471-2407-12-138
Niermann CY, Spengler S, Gubbels JS (2018) Physical activity, screen time, and dietary intake in families: a cluster-analysis with mother-father-child triads. Front Public Health 6:276. https://doi.org/10.3389/fpubh.2018.00276
Watanabe E, Lee JS, Mori K, Kawakubo K (2016) Clustering patterns of obesity-related multiple lifestyle behaviours and their associations with overweight and family environments: a cross-sectional study in Japanese preschool children. BMJ Open 6(11):e012773. https://doi.org/10.1136/bmjopen-2016-012773
Swaminathan S, Thomas T, Yusuf S, Vaz M (2013) Clustering of diet, physical activity and overweight in parents and offspring in South India. Eur J Clin Nutr 67(2):128–134
McLaughlin KA, Gadermann AM, Hwang I, Sampson NA, Al-Hamzawi A, Andrade LH et al (2012) Parent psychopathology and offspring mental disorders: results from the WHO world mental health surveys. Br J Psychiatry 200(4):290–299. https://doi.org/10.1192/bjp.bp.111.101253
McAdams TA, Rijsdijk FV, Neiderhiser JM, Narusyte J, Shaw DS, Natsuaki MN et al (2015) The relationship between parental depressive symptoms and offspring psychopathology: evidence from a children-of-twins study and an adoption study. Psychol Med 45(12):2583–2594. https://doi.org/10.1017/S0033291715000501
Shaw DS, Sitnick SL, Reuben J, Dishion TJ, Wilson MN (2016) Transactional effects among maternal depression, neighborhood deprivation, and child conduct problems from early childhood through adolescence: a tale of two low-income samples. Dev Psychopathol 28(3):819–836. https://doi.org/10.1017/S095457941600033X
Nicholson JS, Deboeck PR, Farris JR, Boker SM, Borkowski JG (2011) Maternal depressive symptomatology and child behavior: transactional relationship with simultaneous bidirectional coupling. Dev Psychol 47(5):1312. https://doi.org/10.1037/a0023912
Pilowsky DJ, Wickramaratne P, Talati A, Tang M, Hughes CW, Garber J et al (2008) Children of depressed mothers 1 year after the initiation of maternal treatment: findings from the STAR* D-child Study. Am J Psychiatry 165(9):1136–1147. https://doi.org/10.1176/appi.ajp.2008.07081286
Wickramaratne P, Gameroff MJ, Pilowsky DJ, Hughes CW, Garber J, Malloy E et al (2011) Children of depressed mothers 1 year after remission of maternal depression: findings from the STAR* D-child study. Am J Psychiatry 168(6):593–602. https://doi.org/10.1176/appi.ajp.2010.10010032
Seifer R (2011) Parental psychopathology and children’s sleep. In: El-Sheikh M (ed) Sleep and development: familial and socio-cultural considerations. Oxford University Press, Oxford, pp 79–98
Zajicek-Farber ML, Mayer LM, Daughtery LG (2012) Connections among parental mental health, stress, child routines, and early emotional behavioral regulation of preschool children in low-income families. J Soc Social Work Res 3(1):31–50. https://doi.org/10.5243/jsswr.2012.3
Manczak EM, Williams D, Chen E (2017) The role of family routines in the intergenerational transmission of depressive symptoms between parents and their adolescent children. J Abnorm Child Psychol 45(4):643–656. https://doi.org/10.1007/s10802-016-0187-z
Demarzo MM, Montero-Marin J, Cuijpers P, Zabaleta-del-Olmo E, Mahtani KR, Vellinga A et al (2015) The efficacy of mindfulness-based interventions in primary care: a meta-analytic review. Ann Fam Med 13(6):573–582. https://doi.org/10.1370/afm.1863
Fjorback LO, Arendt M, Ørnbøl E, Fink P, Walach H (2011) Mindfulness-based stress reduction and mindfulness-based cognitive therapy–a systematic review of randomized controlled trials. Acta Psychiatr Scand 124(2):102–119. https://doi.org/10.1111/j.1600-0447.2011.01704.x
Kamioka H, Tsutani K, Yamada M, Park H, Okuizumi H, Tsuruoka K et al (2014) Effectiveness of music therapy: a summary of systematic reviews based on randomized controlled trials of music interventions. Patient Prefer Adherence 8:727. https://doi.org/10.2147/PPA.S61340
Fancourt D, Ockelford A, Belai A (2014) The psychoneuroimmunological effects of music: a systematic review and a new model. Brain Behav Immun 36:15–26. https://doi.org/10.1016/j.bbi.2013.10.014
Biddle SJ, Asare M (2011) Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med 45(11):886–895. https://doi.org/10.1136/bjsports-2011-090185
Ross A, Thomas S (2010) The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med 16(1):3–12. https://doi.org/10.1089/acm.2009.0044
Itani O, Jike M, Watanabe N, Kaneita Y (2017) Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med 32:246–256. https://doi.org/10.1016/j.sleep.2016.08.006
Shochat T, Cohen-Zion M, Tzischinsky O (2014) Functional consequences of inadequate sleep in adolescents: a systematic review. Sleep Med Rev 18(1):75–87. https://doi.org/10.1016/j.smrv.2013.03.005
Slawson DL, Fitzgerald N, Morgan KT (2013) Position of the academy of nutrition and dietetics: the role of nutrition in health promotion and chronic disease prevention. J Acad Nutr Diet 113(7):972–979. https://doi.org/10.1016/j.jand.2013.05.005
Grosso G, Bella F, Godos J, Sciacca S, Del Rio D, Ray S et al (2017) Possible role of diet in cancer: systematic review and multiple meta-analyses of dietary patterns, lifestyle factors, and cancer risk. Nutr Rev 75(6):405–419. https://doi.org/10.1093/nutrit/nux012
Gariepy G, Honkaniemi H, Quesnel-Vallee A (2016) Social support and protection from depression: systematic review of current findings in Western countries. Br J Psychiatry 209(4):284–293. https://doi.org/10.1192/bjp.bp.115.169094
Barth J, Schneider S, Von Känel R (2010) Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis. Psychosom Med 72(3):229–238. https://doi.org/10.1097/PSY.0b013e3181d01611
Barry MM, Clarke AM, Jenkins R, Patel V (2013) A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health 13(1):835. https://doi.org/10.1186/1471-2458-13-835
Pennant M, Davenport C, Bayliss S, Greenheld W, Marshall T, Hyde C (2010) Community programs for the prevention of cardiovascular disease: a systematic review. Am J Epidemiol 172(5):501–516. https://doi.org/10.1093/aje/kwq171
Gonzalez-Campoy J, St. Jeor S, Castorino K, Ebrahim A, Hurley D, Jovanovic L et al (2013) Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults. Endocr Pract 19(5):875–887. https://doi.org/10.4158/EP13155.ESGL
Solomon A, Mangialasche F, Richard E, Andrieu S, Bennett DA, Breteler M et al (2014) Advances in the prevention of Alzheimer’s disease and dementia. J Intern Med 275(3):229–250. https://doi.org/10.1111/joim.12178
Pak CCY (ed) (2012) Renal stone disease: pathogenesis, prevention, and treatment, vol 5. Springer, Cham
Feldman AS, He Y, Moore ML, Hershenson MB, Hartert TV (2015) Toward primary prevention of asthma. Reviewing the evidence for early-life respiratory viral infections as modifiable risk factors to prevent childhood asthma. Am J Respir Crit Care Med 191(1):34–44. https://doi.org/10.1164/rccm.201405-0901PP
Swift PJ, Dewey L, Ivanova MY, Foret D, Flanders E, Plasha L et al (2018) Incorporating family-based care into outpatient child/adolescent psychiatry: initial findings implementing the Vermont Family Based Approach. J Am Acad Child Adolesc Psychiatry 57(10S):S265. https://doi.org/10.1016/j.jaac.2018.09.413
Sung SC, Tng HY, Wong ZJ, Tan YL, Tan YR, Choong SF et al (2019) Assessing for mood and anxiety disorders in parents of clinically-referred children: laying the foundation for a family-based approach to mental health in Singapore. Ann Acad Med Singap 48:55–62
McGinnis JM, Williams-Russo P, Knickman JR (2002) The case for more active policy attention to health promotion. Health Aff 21(2):78–93. https://doi.org/10.1377/hlthaff.21.2.78
Frieden TR (2010) A framework for public health action: the health impact pyramid. Am J Public Health 100(4):590–595. https://doi.org/10.2105/AJPH.2009.185652
van de Vijver S, Oti S, Addo J, de Graft-Atkins A, Agyemang C (2012) Review of community-based interventions for prevention of cardiovascular diseases in low-and middle-income countries. Ethn Health 17(6):651–676. https://doi.org/10.1080/13557858.2012.754409
Miller WR, Rollnick S (2012) Motivational interviewing: helping people change. Guilford, New York
Stanger SB, Ivanova MY, Hall AY, Shaw JS, Slunecka F, Kapaska D et al. (2016) School-based family wellness: a gateway to service utilization. Vermont Center for Children, Youth, and Families; Technical Report
Buckingham S, Paiva-Salisbury M, Ivanova M, McGinnis E, Hall A, Shaw JS, et al. (2017) Feasibility, acceptability, and efficacy of the Vermont Family Based Approach in a school setting: the Addison Central Supervisory Union family wellness program. Vermont Center for Children, Youth, and Families; 2017. Technical Report
Achenbach TM, Rescorla L (2000) Manual for the ASEBA Preschool Forms & Profiles. Research Center for Children, Youth, and Families, Burlington
Campo JV, Geist R, Kolko DJ (2018) Integration of pediatric behavioral health services in primary care: improving access and outcomes with collaborative care. Can J Psychiatry 63(7):432–438. https://doi.org/10.1177/0706743717751668
Asarnow JR, Rozenman M, Wiblin J, Zeltzer L (2015) Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: a meta-analysis. JAMA Pediatr 169(10):929–937. https://doi.org/10.1001/jamapediatrics.2015.1141
Ivanova MY, Hall A, Weinberger S, Crockett P, Foret D, McGinnis E et al (2019) RCT of the Vermont Family Based Approach (VFBA) in primary care pediatrics: engagement with health and support services. J Am Acad Child Adolesc Psychiatry 58(10S):S220. https://doi.org/10.1016/j.jaac.2019.08.242
United States Census Bureau (2019) QuickFacts: Burlington city, Vermont. United States Census Bureau, Suitland
Moos BS, Moos RH (2009) Family Environment Scale manual: development, applications, research, 3rd edn. Mind Garden, Palo Alto
Dunst CJ, Leet HE (1987) Measuring the adequacy of resources in households with young children. Child Care Health Dev 13:111–125
Israel AC, Roderick HA, Ivanova MY (2002) A measure of the Stability of Activities in a Family Environment. J Psychopathol Behav Assess 24:85–95
McMahon RJ, Forehand RL (2005) Helping the noncompliant child: family-based treatment for oppositional behavior, 2nd edn. Guilford, New York
ACT.md. Version 1.0. (2012). Accessed from https://www.activatecare.com.
Achenbach TM (2002) General description of 1975 Hollingshead occupational categories updated to 2001. Research Center for Children, Youth, and Families, Burlington
Campbell I (2007) Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Stat Med 26(19):3661–3675. https://doi.org/10.1002/sim.2832
Achenbach TM, Rescorla L (2001) Manual for the ASEBA school-age forms & profiles. Research Center for Children, Youth, and Families, Burlington
Ivanova MY, Achenbach TM, Rescorla LA, Guo J, Althoff RR, Kan K et al (2019) Testing syndromes of psychopathology in parent and youth ratings across societies. J Clin Child Adolesc Psychol 48(4):596–609. https://doi.org/10.1080/15374416.2017.1405352
Ivanova MY, Achenbach TM, Rescorla LA, Harder VS, Ang RP, Bilenberg N et al (2010) Preschool psychopathology reported by parents in 23 societies: testing the seven-syndrome model of the child behavior checklist for ages 1.5–5. J Am Acad Child Adolesc Psychiatry 49(12):1215–1224. https://doi.org/10.1016/j.jaac.2010.08.019
Franz L, Angold A, Copeland W, Costello EJ, Towe-Goodman N, Egger H (2013) Preschool anxiety disorders in pediatric primary care: prevalence and comorbidity. J Am Acad Child Adolesc Psychiatry 52(12):1294–1303. https://doi.org/10.1016/j.jaac.2013.09.008
Flynn AB, Fothergill KE, Wilcox HC, Coleclough E, Horwitz R, Ruble A et al (2015) Primary care interventions to prevent or treat traumatic stress in childhood: a systematic review. Acad Pediatr 15(5):480–492. https://doi.org/10.1016/j.acap.2015.06.012
Achenbach TM, Rescorla L (2003) Manual for the ASEBA adult forms & profiles. Research Center for Children, Youth, and Families, Burlington
Ivanova MY, Achenbach TM, Rescorla LA, Tumer LV, Ahmeti-Pronaj A, Au A et al (2015) Syndromes of self-reported psychopathology for ages 18–59 in 29 societies. J Psychopathol Behav Assess 37(2):171–183. https://doi.org/10.1007/s10862-014-9448-8
Ware JE Jr, Sherbourne CD (1992) The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care 30(6):473–483. https://doi.org/10.1097/00005650-199206000-00002
McHorney CA, Ware JE Jr, Lu JR, Sherbourne CD (1994) The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32(1):40–66. https://doi.org/10.1097/00005650-199401000-00004
McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31(3):247–263. https://doi.org/10.1097/00005650-199303000-00006
Hardin JW (2005) Generalized estimating equations (GEE). In: Everitt BS, Howell DC (eds) Encyclopedia of statistics in behavioral science. Wiley, Hoboken
Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N et al (2010) To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology 21(4):467–474. https://doi.org/10.1097/EDE.0b013e3181caeb90
Zhang H, Yu Q, Feng C, Gunzler DD, Wu P, Tu XM (2012) A new look at the difference between the GEE and the GLMM when modeling longitudinal count responses. J Appl Stat 39(9):2067–2079. https://doi.org/10.1080/02664763.2012.700452
Nolen-Hoeksema S (2012) Emotion regulation and psychopathology: the role of gender. Annu Rev Clin Psychol 8:161–187. https://doi.org/10.1146/annurev-clinpsy-032511-143109
Kessler RC, Birnbaum HG, Shahly V, Bromet E, Hwang I, McLaughlin KA et al (2010) Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: results from the WHO world mental health survey initiative. Depress Anxiety 27(4):351–364. https://doi.org/10.1002/da.20634
Costello EJ, Copeland W, Angold A (2011) Trends in psychopathology across the adolescent years: what changes when children become adolescents, and when adolescents become adults? J Child Psychol Psychiatry 52(10):1015–1025. https://doi.org/10.1111/j.1469-7610.2011.02446.x
Kroenke K, Unutzer J (2017) Closing the false divide: sustainable approaches to integrating mental health services into primary care. J Gen Intern Med 32(4):404–410. https://doi.org/10.1007/s11606-016-3967-926
Macchi CR, Kessler R, Auxier A et al (2016) The practice integration profile: rationale, development, method, and research. Fam Syst Health 34(4):334–341. https://doi.org/10.1037/fsh0000235
Morris S (2008) Estimating effect sizes from pretest-posttest-control group designs. Organ Res Methods 11(2):364–386. https://doi.org/10.1177/1094428106291059
Colon-Rentas O, Gordon L, Montejo LD, Reitsma P, Sánchez FA, Song B (2006) The impact of the sleeper effect and relapse on the dynamics of cigarette smoking among adolescents. Mathematical and Theoretical Biology Institute; Technical Report. MTBI-03-04M
Sklad M, Diekstra R, Ritter MD, Ben J, Gravesteijn C (2012) Effectiveness of school-based universal social, emotional, and behavioral programs: do they enhance students’ development in the area of skill, behavior, and adjustment? Psychol Sch 49(9):892–909. https://doi.org/10.1002/pits.21641
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Ivanova, M.Y., Hall, A., Weinberger, S. et al. The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children’s and Parents’ Emotional and Behavioral Problems and Parents’ Health-Related Quality of Life. Child Psychiatry Hum Dev 54, 1297–1308 (2023). https://doi.org/10.1007/s10578-022-01329-4
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DOI: https://doi.org/10.1007/s10578-022-01329-4