Effects of Pediatrician Training on Implementation of Parenting Supports in Pediatric Primary Care for Families Challenged By Children’s Behavior Problems

Introduction: Primary care clinics are an ideal setting for early detection of child behavior and parenting problems and for disseminating evidence-based parenting interventions. Pediatricians are a trusted first point of contact for families with behavioral or parenting challenges. Most pediatricians, however, are not well trained in how to treat behavior problems and remain largely unequipped to provide effective guidance for children’s behavior problems or parenting dysfunction.

Methods: The Parenting Help Online study is testing the viability of delivering the Triple P Online System (TPOS; an online version of the Triple P – Positive Parenting Program) through pediatric settings to improve pediatricians’ ability to meet families’ needs. Pediatric clinics (N = 31) were randomized to receive Primary Care Triple P training for pediatricians and TPOS for parents of their 3- to 8-year-old patients with behavior problems, or to receive access to a community referral website (N pediatricians = 119; N families = 366). Pediatricians in the intervention condition were trained to consult with families on behavior issues, refer families to TPOS, and support parents’ use of TPOS. This hybrid effectiveness-implementation study is simultaneously evaluating TPOS’ effects on child/family outcomes and the pediatrician training’s effects on physicians’ protocols for assisting parents of children with behavior problems, self-efficacy for doing so, and attitudes toward evidence-based parenting interventions. Analytic method used is mixed-model ANCOVA, with pediatricians nested within clinics.

Results: Preliminary results at one year post-training show large variability among pediatricians in the extent of support provided to parents on TPOS usage and direct consultation on behavior issues. Large variance was also seen in perceptions of feasibility of behavioral consultation and supporting parents’ use of an online parenting program; these ratings were moderated by pediatrician age. Final results will be presented on one-year post-training effects of the pediatrician training on protocols for handling children’s behavior problems, self-efficacy for working with parents on these issues, and attitudes toward evidence-based parenting interventions, as well as moderators of these outcomes. Final results will also be presented on pediatricians’ uptake of skills targeted in the training, predictors of uptake, and perceptions of feasibility of implementation in a primary care setting.

Conclusion: Primary care settings present a viable home for providing parenting supports to families struggling with children’s behavior problems, and pediatricians can be successfully trained to do so. Feasibility concerns regarding time, workflow, and costs remain challenges to be solved.