Evaluation of the Implementation of Delivering the ezParent Program in Primary Care

Introduction: Behavioral parent training (PT) is an evidence-based approach to improve parenting practices and prevent behavioral problems in young children. Unfortunately, the positive effects of PT programs are often compromised by lack of program availability in usual care settings and low rates of parent attendance in face-to-face delivery models. Pediatric primary care practices are ideal settings for PT delivery because they are trusted sources of information and are regularly accessed by families. The purpose of this study was to evaluate the implementation processes in a pediatric primary care setting of an RCT testing a tablet-based parent training program (ezParent) for parents of children age 2-5. We will report on evaluation of two primary care practices serving as implementation sites for the project over a 6-month period.

Methods: Training and implementation was designed with input from MD champions and administration to create a process that fit into practice workflow. Parents were introduced to the study by their primary care provider during a well child visit. The purpose of introducing the study during the well child visit was to approximate the process that would occur for providers if they were to offer the ezParent program as a matter of course. A descriptive design using the “R”, “A”, and “I” components of the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework guided the evaluation of ezParent implementation.

Results: Training included a brief face-to-face training, written materials, and emails. Practice sites received monthly reports benchmarking their progress. Specific implementation processes and training will be articulated in the poster. Preliminary results indicated 17% of eligible parents (n = 1,196) from the practices were introduced to the study. Of those introduced (n=205), 80% returned interest forms; however, only 20% of those who returned interest forms were enrolled in the study over the 6-month period. We will present changes over time of recruitment and enrollment rates aligned with systematic changes to implementation processes. The most significant obstacle related to implementation is practitioner and staff behavior change. Specific challenges included an inability to amend the EHR, staff remembering to give information to patients, and physicians remembering to introduce the study.

Conclusions: These findings have implications for developing best practices and creating implementation toolkits for embedding evidence based prevention programs in usual care settings. In addition, a feasible reimbursement structure for providing parenting services in primary care could facilitate the implementation of parenting programs in primary care.