A Feasibility Study of Behavior Checker: Enhancing the Capacity of Pediatric Staff to Deliver Evidence-Based Strategies to Manage Children's Common Behavioral Issues for Parents

Introduction

Positive parenting has a significant influence on mitigating toxic stress resulting from adverse experiences for children while harsh and ineffective discipline is associated with maltreatment and poor developmental outcomes. Pediatric practice is an underutilized platform to deliver evidence-based strategies to manage children’s common behavioral issues for parents. Behavior Checker is a pediatric telephone and office prescription for managing common behavioral issues. The Behavior Checker training educates pediatric staff about the core skills in managing behavioral issues and teaches them to use a manual during a phone triage with parents. The purpose of this study was to explore the feasibility of implementing Behavior Checker in a pediatric hospital and examine its preliminary effects on increasing pediatric staff’s knowledge and the level of confidence to engage parents in discussions related to managing children’s behaviors, and thereby, increasing their capacity to act as gatekeepers in preventing maltreatment.

Methods

A one group pre-post study was conducted in the pediatric department of a university medical center in a Midwestern state, following the IRB approval. A survey instrument was developed to assess pediatric staff’s knowledge, attitudes, and the level of confidence in engaging parents in discussions related to children’s common behavioral issues. An anonymous survey was distributed to pediatric staff before and after the two-hour Behavior Checker training. In total, 41 pre-training and 35 post-training surveys were completed. Descriptive analyses were conducted using SPSS. Post training changes in staff’s level of confidence (Wilcoxon) and knowledge (Paired t-test) in educating parents about the strategies to manage children’s common behavioral issues were examined. Narrative questions were also asked to explore staff’s experience in participating in the training, which was analyzed using the event code method.

Results

A majority of participants reported that they are likely to encounter parents expressing concerns, asking questions, and seeking their advice in managing children’s common behavioral issues and expressed the need for further training. A significant post training increase in the level of knowledge [t(14) = -5.656, p < .001] and the confidence [Z = -3.188, P = .001] in engaging parents in discussions related to managing children’s common behavioral issues were found.

Conclusions

Behavior Checker is a feasible intervention that can be implemented in a pediatric setting to increase staff’s capacity to deliver evidence-based strategies to manage children’s common behavioral issues for parents, and thereby, preventing children’s exposure to adverse experiences and toxic stress. A larger study is warranted.