Adaptation and Implementation of the Family Check-up for the Treatment of Pediatric Obesity within a Primary Care Setting

Introduction: Parenting practices play a significant role in the development and maintenance of obesity, yet treatment and prevention strategies often focus primarily on children’s behavior. Therefore, there is a pressing need to develop and study family-centered interventions that specifically address parenting practices as part of prevention or treatment of pediatric obesity involving diverse populations. An especially promising venue for the design and implementation of family-centered interventions is primary pediatric care, in that this service setting is uniquely poised to provide an array of medical and behavioral health services to reduce and prevent pediatric obesity. In the present study, The Family Check-Up (FCU), an evidence-based family intervention originally designed to treat and prevent youth behavior problems through family management that also has demonstrated effects on preventing weight gain in young children, was adapted for delivery in a primary care clinic in a children’s hospital to more explicitly target childhood obesity. We sought to demonstrate successful implementation by assessing the following outcomes: acceptability, adoption, feasibility, and fidelity.

Methods:  We used a community-based participatory research approach when adapting the FCU, beginning with interviews of stakeholders in the Department of Gastroenterology at Phoenix Children’s Hospital and the families served. Discussions focused on the content of the FCU, feasibility of integrating the FCU within this medical setting, and barriers to adequate fidelity of implementation. Based on the information we obtained, we (1) wrote a manual detailing the adapted version of the FCU and (2) developed an implementation strategy to effectively deliver the intervention in this setting. After six months of delivering the intervention, we will assess the acceptability, adoption, feasibility, and fidelity, as these are critical outcomes of initial efforts at implementation. Acceptability will be measured using the Evidence-Based Practice Attitudes Scale for stakeholders and a Client Satisfaction Questionnaire for participating families. Adoption and feasibility will be assessed through observation and administrative data. Last, fidelity will be measured with the FCU's implementation rating system, called the COACH, which assesses five dimensions of therapist skill in delivering the model.

Conclusions: These findings will provide information regarding the success of our adaptations to the FCU and the implementation strategy in a primary care setting. Augmenting typical care for obesity with the FCU may increase effects by improving family practices that support children’s behavior change related to weight management, such as eating behaviors and physical activity.