# Effectiveness of group-based indicated prevention in children identified with disruptive behavior problems: results of an implementation study in the German health care system

## TL;DR

A group-based prevention program for children with disruptive behavior problems showed improvements in behavior and prosocial skills over six months.

## Contribution

This study evaluates the effectiveness of the 'Baghira' program within Germany's healthcare system using real-world implementation.

## Key findings

- Children in the 'Baghira' program showed significant decreases in disruptive behavior and increases in prosocial behavior.
- Improvements were maintained six months after the intervention ended.
- The NO BA group also showed some behavioral improvements, though less consistent.

## Abstract

Subclinical disruptive behavior problems often occur during childhood and are a risk factor for developing a mental disorder later in life. To prevent a manifestation of dysfunctional disruptive behavior, early intervention is critical. This study aimed to examine the effectiveness of an indicated prevention program in children with disruptive behavior problems.

Screening for disruptive behavior problems was conducted using the Strength and Difficulties Questionnaire during routine pediatric health check-ups. Depending on their risk status (normal vs. borderline vs. abnormal), children received a recommendation for no intervention, an indicated prevention program (i.a. “Baghira”) or further diagnostics. Questionnaires such as the Child Behavior Checklist and the Parent Rating Scale for Conduct Disorder (DISYPS Competence scale) were administered at three time points (T0: pre-intervention, T1: 6 months after screening/ post-intervention, T2: 6 months after T1). Children who participated in “Baghira” (BA n = 171), a cognitive-behavioral group program for children with disruptive behaviors, were compared to children screened as normal (NOR n = 881) or received a recommendation for “Baghira” but refused participation (NO BA n = 46).

Disruptive behavior problems decreased (BA: β = − 3.61, p <.001) and prosocial behavior increased (BA: β = 1.67, p <.001) in the BA compared to the NOR group from T0 to T1. These effects were maintained at T2 follow-up (BA: β = − 1.60; p =.035; β = 1.12; p =.019). However, the NO BA group also improved in prosocial behavior and from T0 to T1.

Although an improvement in disruptive behavior symptoms as well as an increase in prosocial behavior were observed, controlled studies using matched or stratified designs are needed to replicate the effectiveness of “Baghira” in a prevention context, apart from the Covid-19 pandemic, to improve children’s mental health.

The online version contains supplementary material available at 10.1186/s13034-025-00902-8.