Community–Researh Partnerships to Promote the Implementation of Evidence-Based Parenting Programs in Primary Care

Given its reach and contact throughout childhood, pediatric primary care may be an ideal setting for delivering family centered evidence based programs (EBPs). Based on our longstanding experience with primary care, we also know there are many barriers to sustainable implementation of EBPs. This presentation describes the process of engaging with stakeholders to support the implementation of the Family Check-Up 4 Health, an adapted version of the Family Check-Up to prevent pediatric obesity and sequelae in primary care. Our approach closely mirrors the Kellam (2012) partnership model.

We began with one large primary care clinic with whom the first author has collaborated with for nearly a decade. As we identified potential barriers, we invited partners with relevant expertise to join our advisory board, which contains representatives from multiple groups: clinical and administrative staff from primary care clinics and FQHCs, Medicaid, healthplans, DHS, professional organizations, and experts in pediatric obesity. In preparation for our CDC-funded trial, 30 members of our advisory board and research team met to address three overarching barriers identified by the group: How can the program be integrated with minimal interruptions to clinic flow? How can we keep program content current over time? What types of evidence would encourage sustainable funding? Topics were addressed in three workout groups; each led by an individual chosen from the board. Each breakout group then reported back to the full group with identified solutions. Breakout sessions and the full group meeting were transcribed and thematically analyzed.

The following solutions were identified by the groups:

1. Use the lowest level position that is able to perform and potentially bill
2. Offer services in the clinic or at home and monitor how families engage as there costs and benefits for each
3. Use electronic learning collaboratives to share updated resources
4. Consider and measure benefits at multiple stakeholder levels
   1. Families: better health and quality care. Consider assessing collateral effects on parents as they may have a faster ROI than child health outcomes
   2. Providers: recruiting and retaining both patients and staff
   3. Payors: avoidance of unnecessary healthcare costs
   4. Use mixed method data to engage stakeholders

The results of a qualitative analysis of transcripts from our advisory board meeting are presented for each theme.

With the increasing attention to primary care as a context for expanding the reach of EBPs, eliciting the engagement of primary care stakeholders will increase the feasibility, acceptability, and likelihood of sustained implementation. Engagement processes and specific recommendations are relevant for others interested in implementation in primary care.