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Best Practices to Integrate Early Relational Health Interventions in Pediatric Primary Care

Thursday, November 13, 10:15 to 11:45am, Property: Hyatt Regency Seattle, Floor: 5th Floor, Room: 509 - Tolt

Abstract

Background: Early relational health (ERH) – safe, stable, nurturing relationships in early life between children and their caregivers – is considered critical for optimal child development. Pediatric primary care (PPC) has been identified as a key platform for effective promotion of ERH given its broad reach (>90% of families), ability to capitalize on existing infrastructure, and family trust in their PPC provider. However, little is known about how PPC clinics employ ERH programs, or barriers to their implementation, particularly when multiple ERH programs are present.


Purpose: This study aims to describe ERH program implementation and integration in PPC clinics nationwide and to develop a best practices toolkit to provide guidance and useful tools that clinicians and staff can use in the clinic setting.


Method: An iterative process to identify best practices was conducted using a modified Delphi process. In phase one, 131 respondents across 42 PPC clinics nationwide were recruited through Academic Pediatric Association’s Continuity Research Network, HealthySteps Connect, Reach Out and Read, and American Academy of Pediatrics Council on Early Childhood. Respondents participated in an anonymous online survey, which assessed evidence-based ERH programs (subscale of Evidence-Based Practices in Pediatric Care) and clinic needs, resources, and climate (Organizational Social Context Scale).


In phase two, five focus groups were conducted with 18 participants (mean participants/group = 3.6) using purposeful sampling with regard to their clinic role and clinic characteristics including, urbanicity, Medicaid eligibility, number of children served, and current ERH programs. Questions probed for understanding how PPC clinics chose ERH programs, funded and received reimbursement for programs, managed clinic workflow, targeted and referred families to programs, and integrated multiple programs in their clinics.   


Results: Survey results indicated diverse pediatric care roles (35% pediatricians, 58% nurses/staff, 14% ERH program staff) and geographic areas (30% Northeast, 22% Midwest, 31% South, 12% West). Most respondents worked in urban clinics (60%) and those serving primarily Medicaid-eligible patients (83%). 93% of respondents reported having at least 1 ERH program at their clinic; 58% reported 2+. Respondents with multiple programs reported implementation issues related to: 1) evaluating and tracking patient needs; 2) training staff; 3) promoting patient participation in ERH programs; and 4) sustaining program funding.


Emerging focus group themes expanded upon the implementation issues reported in the survey and included: 1) cultural humility promotes trust and acceptance of programs; 2) importance of shared goals to learn about programs; 3) internal and external funding sources promote sustainability, and uncertainty/volatility in funding; 4) program participation supports sustainability; and 5) importance of removing barriers to program implementation.


Based on these findings, a best practice toolkit was developed focusing on: 1) planning; 2) piloting; 3) monitoring and evaluation; and 4) sustainability of integrated programs. The initial toolkit was sent to focus group participants for feedback and re-assessment. Clinicians reported the toolkit was clear, concise, and accurately reflected strategies for implementing and addressing barriers for ERH programs.


Conclusions: To successfully integrate multiple ERH programs in PPC clinics, this study offers a useful toolkit about processes for integration and implementation. 

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