Evaluation of Virtual Enhanced Child Adult Relationship Enhancement in Primary Care Intervention.

Only 122 of the 182 randomised families completed the 3-month follow-up, and completion was lower among caregivers in the programme arm, so the comparison rests on whoever came back. Caregivers knew whether they were in the programme or the wait-list, and most of the outcomes are their own ratings of their parenting and their child, so some of the reported improvement may reflect what they hoped or expected to see. Wait-list families may have picked up other parenting resources from their provider or on their own, which would make the programme look less effective than it is. Attendance was uneven: 11% of caregivers randomised to PriCARE attended no sessions and only 33% attended all six. The child abuse risk questionnaire was hit by skipped items and invalid scores, so the study could not properly test whether the programme lowers maltreatment risk; the authors say reports to child protective services would be needed to answer that question. The observation of parenting skills was meant to be standardised but had to move online because of the pandemic, the setting was hard to control and some recordings were too poor to code, leaving only 88 families with usable recordings; the authors describe the sample as small. The trial ran during the pandemic, when family circumstances were unusual, and the authors say the virtual version needs testing outside those conditions.

The authors declare no conflicts of interest relevant to this manuscript. The funding source is not stated in the text supplied.

Do not read this as proof that the online version works as well as the in-person programme. This trial had no in-person comparison group; the authors reached that conclusion by comparing their results with earlier studies of in-person PriCARE, which is not a direct test.