Providing Evidence-Based Parenting Supports within Pediatric Primary Care: Implementation Outcomes and Pediatricians’ and Parents’ Perspectives

Background

Pediatric primary care is a promising setting for dissemination of evidence-based parenting interventions. Pediatricians are in a position to detect child behavior and parenting problems, and are a trusted point of contact for families with these challenges. This potential remains largely untapped, however. Many pediatricians report feeling unequipped to provide effective guidance for children’s behavior problems or parenting dysfunction.

Methods

The Parenting Help Online study tested the delivery of the Triple P Online System (TPOS; online version of Triple P – Positive Parenting Program) through pediatric clinics. Pediatric clinics (N = 31) were randomized to receive Primary Care Triple P training for pediatricians and TPOS for parents of 3-8 year-old patients with behavior problems (INT), or access to a community referral website (UCC)(N pediatricians=119; N families=351). INT pediatricians were trained to consult with families on behavior issues, refer them to TPOS, and support parents’ use of TPOS. This hybrid effectiveness-implementation study simultaneously evaluated TPOS’ effects on child/family outcomes and the pediatrician training’s effects on physicians’ protocols and self-efficacy for assisting parents of children with behavior problems. Data on implementation, feasibility, and clinic support were also obtained from INT pediatricians, as well as parents’ perceptions of their pediatricians’ skill in addressing their parenting concerns. Analytic method was mixed-model ANCOVA, with pediatricians and parents nested within clinics.

Findings

At baseline, pediatricians reported low confidence in helping parents with children’s behavior problems. At one year post-training, INT pediatricians showed improved self-efficacy and self-perceived proficiency in helping parents with behavior problems and increased use of targeted parent consultation strategies, compared to UCC. Large variability was found among pediatricians in the extent of support provided to parents on TPOS usage and direct consultation on behavior issues, and in ratings of feasibility and clinic support for doing so. A range of predictors moderated these findings. Physicians who perceived more clinic support were more likely to implement the parenting supports. These findings will be presented along with parents’ reports of pediatricians’ skill in providing parenting supports, as well as data from follow-up interviews with pediatricians on their perceptions of implementation barriers and facilitators, and sustainable implementation models for delivery of parenting supports in pediatric primary care.

Conclusion

This study has important implications for the development of sustainable delivery models for evidence-based parenting programs in pediatric primary care.