Family STEPS: Family Check-Up+

Description: As part of the reach assessment of the RE-AIM domain, We will assess the extent to which the target population is reached in FCU. Recruitment will be assessed as the proportion of eligible families who consent and enroll in the study following screening for FCU+ eligibility.

Unit of Measure: Proportion (%) of eligible families enrolled. Recruitment will be interpreted using a traffic-light approach (green = feasible; amber = feasible with modification; red = not feasible without substantial redesign), which is commonly used in pilot trials to support transparent decision-making regarding progression.

Recruitment feasibility will be assessed based on the proportion of eligible families who consent and enroll:

• Green: ≥60% of eligible families approached enroll
• Amber: 40-59% enroll
• Red: <40% enroll

Data Source: Study screening logs and REDCap enrollment records

Description: Fidelity to FCU delivery within routine services will be assessed for the core FCU components (initial interview, assessment, and feedback) using the COACH observational rating system. Sessions will be securely video-recorded and coded by trained raters.

Unit of Measure: Mean COACH fidelity score and proportion (%) of sessions meeting predefined fidelity thresholds. The COACH assesses five dimensions of observable in-session coordinator skills: conceptual accuracy; responsiveness to family context and needs; active session structuring; effective teaching and corrective feedback; and generation of hope and motivation. Each dimension includes exemplars and non-exemplars and is rated on a 9-point scale reflecting competent adherence to the program (1-3 = needs work; 4-6 = competent work; 7-9 = excellent work), with higher scores indicating stronger mastery of FCU principles

Data Source: Coded video-recorded sessions and fidelity rating forms

Description: Retention will be assessed as the proportion of randomized participants who complete follow-up assessments at each scheduled time point.

Retention performance will be interpreted using a traffic-light approach (green = feasible; amber = feasible with modification; red = not feasible without substantial redesign). Retention feasibility will be assessed based on completion of follow-up assessments:

• Main follow-ups (6 and 12 months):

• Green: ≥80% retained at 6 months and ≥75% retained at 12 months
• Amber: 70-79% retained at 6 months and/or 65-74% retained at 12 months
• Red: <70% retained at 6 months or <65% retained at 12 months
• Short follow-ups (3 and 9 months):

• Green: ≥75% completion
• Amber: 65-74% completion
• Red: <65% completion retained at 12 months:
• Green: ≥75% provide complete parenting and child outcome measures
• Amber: 65-74% complete data
• Red: <65% complete data

Data Source: REDCap follow-up records

Description: Within the intervention arm, uptake of core FCU components will be assessed by completion of the assessment and feedback sessions.

Unit of Measure: Proportion (%) of intervention participants completing core FCU components using means, medians, and relevant quantiles.

Data Source: Structured intervention delivery logs

Description: Among participants for whom parenting support is indicated, engagement will be assessed by participation in at least one EDP session.

Unit of Measure: Proportion (%) of indicated participants attending EDP sessions using means, medians, and relevant quantiles.

Data Source: Intervention delivery logs

Description: Among participants for whom service navigation is indicated, uptake will be assessed by receipt of navigation and linkage activities.

Unit of Measure: Proportion (%) of indicated participants receiving navigation services

Data Source: Intervention delivery logs

Description: Dose of FCU delivery within routine services will be assessed using routine service records documenting completion of FCU components, parenting support sessions, and navigation and linkage activities, when indicated.

Unit of Measure: Number and proportion (%) of completed FCU-related service components

Data Source: Routine service records and de-identified monthly provider logs

Description: Timeliness of FCU delivery within routine services will be assessed as the elapsed time from randomization to completion of the FCU assessment and feedback.

Unit of Measure: Time (days) in intervention using means, medians, and relevant quantiles.

Data Source: REDCap enrollment records and intervention delivery logs

The investigators will measure change in child emotional and behavioural problems across time points using the Strengths and Difficulties Questionnaire (SDQ). The questionnaire consists of 25 questions divided into five scales. The prosocial behaviour scale showcases strengths, while the remaining four evaluate negative behaviours such as emotional symptoms, conduct problems, hyperactivity and inattention, and peer relationship problem.

Add the scores of all the items in the first four subscales (Emotional Symptoms + Conduct Problems + Hyperactivity/Inattention + Peer Relationship Problems). The Total Difficulties Score represents the overall level of emotional and behavioral difficulties.

Scoring: total score can range from 0-50 cut offs: 0 to 12: Close to Average 13 to 15: Slightly Raised 16 to 18: High 19 and above: Very High

Discipline style measured using the Parenting Scale. The 25-item questionnaire has each item rated on a 7-point scale, measures three stable factors of dysfunctional discipline. Scores for each question range from 1-7 with a total score ranging from 25-175. Higher scores indicate dysfunctional parenting.