Positive Parenting Program to Improve Problem Behaviors in Preschool-Age Children (PriCARE)

Statement of Problem

Behavioral problems are common in young children. Approximately 11 percent to 20 percent of children in the United States meet diagnostic criteria for a behavioral health disorder at any given time. Children with behavioral problems enter kindergarten disadvantaged in language, motor, social and school readiness skills, and are at increased risk of poor long-term academic outcomes. Behavioral problems are also associated with increased risk of substance abuse, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD) and suicide. Furthermore, children with behavioral problems are at increased risk of harsh parenting and physical abuse.

Problem behaviors from young children can provoke negative and reactive parenting responses, which, in turn, increases the child’s behavior problems. Parenting interventions that promote positive, authoritative parenting (characterized as reliable, dependable and nurturing) can reduce the severity and frequency of behavioral problems, decrease parental stress and reduce the risk of child maltreatment. While the pediatric primary care setting is an ideal venue to provide parent training and support, pediatricians have made little progress toward addressing the long-term behavioral, learning and mental health of children. Between 25 percent to 50 percent of pediatric office visits involve behavioral or emotional concerns. While some patients may require referral to a behavioral health specialist, many children may not require intensive, ongoing behavioral health treatment, especially in the early, formative years when these problem behaviors first develop. Providing a family-centered positive parenting program in the setting of the child’s primary care pediatrician could support parents and prevent future severe behavioral health problems in their children. 


Recognizing the untapped potential of the pediatric primary care setting for addressing children’s behavioral problems, Dr. Joanne Wood and colleagues from Safe Place: Center for Child Protection and Health and the Child and Adolescent Psychiatry and Behavioral Sciences at CHOP modified an existing intervention called Child–Adult Relationship Enhancement (CARE). Together, they developed PriCARE, a trauma-informed group-training program to teach caregivers techniques to support the social and emotional growth of children for the primary care setting. As a group training program for parents, PriCARE is designed to improve child behavior, strengthen parent-child relationships and decrease stress for parents. 

In the first study of its kind, Dr. Wood and colleagues tested the effectiveness of PriCARE through a randomized controlled trial at CHOP’s primary care facility in South Philadelphia. The study team enrolled 120 families and found that children whose parents participated in PriCARE had significant short-term improvements in behavioral symptoms. Additionally, after attending the PriCARE intervention parents reported improvements in several common parenting behaviors that are felt to influence child behavior. These include decreased belief in use of corporal punishment and increased empathy toward their children.  Academic Pediatrics, one of the premier medical journals, published the findings of this research trial.  

Next Steps

Encouraged by the positive findings from the initial PriCARE evaluation, the team has now expanded the capacity of PriCARE to reach more families. Currently, PriCARE is being offered to caregivers of children ages two to six at two CHOP Primary Care Network sites (Karabots and South Philadelphia).

Although PriCARE has shown promise as an effective parent training program in strengthening the child-caregiver relationship and providing caregivers the skills to nurture positive child behavior, further implementation and evaluation of PriCARE is warranted to establish if these improvements are generalizable to other populations. Additionally, given the lessons learned by this research team, evaluating barriers and facilitators to engagement and retention in PriCARE will be important. Dr. Wood plans to build on PriCARE’s preliminary evidence by continuing to rigorously evaluate and refine this model. Over the next three years, Dr. Wood and her team expect to enroll 180 parent/child pairs in the expanded phase II of PriCARE. Utilizing direct observation methods, the team will conduct video observations of children’s behaviors on a subset of participants. They will also conduct qualitative interviews with parents in order to inform efforts to improve the program. Given the current evidence of parent and child benefit from PriCARE, parents are welcome to participate in PriCARE without enrollement into the study. 

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Positive Parenting Program to Improve Problem Behaviors in Preschool-Age Children (PriCARE) [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here]. 

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