An online randomised controlled trial to evaluate the effectiveness of an online intervention for parents/guardians of children aged 4-7 years old who are concerned about their children’s emotional and behavioural development: EMERGENT study.

Background: Many young children experience emotional and behavioural difficulties, yet access to early support is restricted by long waiting times and financial and logistical barriers. Digital mental health interventions (DMHIs) offer scalable support, but few are designed to engage both parents and children collaboratively. Embers the Dragon is a self-guided parent–child programme designed to help support the emotional wellbeing of parents/guardians and children aged 4–7. Aims: This study evaluated the effectiveness, acceptability, and health economic impact of Embers the Dragon compared with treatment as usual (TAU). Methods: A two arm online randomised controlled trial allocated 456 parents/guardians to Embers (n=235) or control (n=221). Assessments were completed at baseline, 8, 16, and 24 weeks. Primary outcomes were the Strengths and Difficulties Questionnaire (SDQ) and Parents Sense of Competence (PSOC). Secondary outcomes included the Parenting Scale (measuring parental discipline) and EuroQol Five Dimensions of health (EQ-5D-3L). Analyses followed an intention to treat mixed effects model. Results: Participants in the Embers condition reported significant reductions in SDQ scores from baseline to 24 weeks; the control group showed no improvement. Parental confidence increased in both conditions, with greater improvements shown in the Embers condition at 16 weeks, although differences were not maintained at 24 weeks. Parenting discipline improved across conditions, with more pronounced improvements for the Embers condition by 24 weeks. EQ5D3L scores showed no meaningful change over time and did not differ between conditions. Health economic analysis indicated that Embers was less costly and more effective than TAU, producing net savings per unit improvement in both SDQ and self-efficacy outcomes. Conclusions: Embers the Dragon delivered meaningful improvements in children’s emotional wellbeing, as well as parenting confidence and discipline responses. As a low intensity, self-guided programme, it shows promise as a scalable early intervention option. Trial registration: https://osf.io/ybxzu/ and ISRCTN (ISRCTN58327872).