Adaptation of the Family Check-up for Delivery in Primary Care and Enhancement to Promote Healthy Behaviors to Prevent Obesity and Sequelae

One of the most promising service delivery systems for implementation of prevention programs for children is primary care. It is in many ways ideal for the delivery of evidence-based parenting programs that prevent common problems in childhood (Leslie et al., 2016): it offers a wide net for identifying children at risk early on; pediatric clinics routinely deliver preventive services; and parents are accustomed to receiving advice about parenting practices when they attend their child’s visits to primary care. Even if they are appropriate for primary care, it has not yet been clearly established that evidence-based family interventions can be feasibly embedded in this context. The majority of existing programs were not designed to meet the demands of primary care. They are lengthy (both in session time and number of sessions), often delivered in group format, and lack a focus on ways to address common health issues that pediatricians routinely encounter.

In this paper, we describe a multi-step process for adapting and enhancing the Family Check-Up (FCU) program for primary care. The Dynamic Adaptation Process (Aarons et al., 2012) is used to illustrate the ways multiple factors shaped the intervention’s adaptation over time. We began by assessing the needs and capacity of a primary care organization and the families they serve. The results indicated that the goals of the FCU aligned well with problems commonly encountered during primary care visits, with the exception of directly addressing obesity-related concerns. The FCU was then pilot tested in a general pediatrics clinic and a clinic for children with advanced obesity to determine feasible delivery modifications as well as enhanced content for obesity management and prevention. During and at the end of the pilot trial, feedback was systematically solicited from stakeholders and families. A draft of the adapted version was then developed, additional feedback was sought from experts and stakeholders and a second pilot-testing phase was completed. Feedback was again collected from families who received the intervention and from stakeholders who participated in the pilot. The intervention protocol and content were further refined. Finally, a large-scale study of the adapted and enhanced version of the FCU, called the FCU4Health (FCU4H) began and is currently underway.

This paper illustrates how the Dynamic Adaptation Process can be applied to an existing evidence-based family intervention for delivery in primary care. There is tremendous potential benefit to public health if wide scale implementation of family-centered prevention in this context is achieved. This study demonstrates that a careful adaptation and enhancement process is necessary for this to be realized.