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A Mixed-Method Investigation of Parent Perspectives on Early Childhood Behavioral Services in Primary Care

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Abstract

Primary care is a key setting for the delivery of parent-focused behavioral interventions. Various methods of intervention show promising efficacy but fail to engage adequate parental participation. This study used a sequential-explanatory mixed-method design to understand factors underlying parents’ attitudes toward the content, sources, and delivery methods of behavioral guidance in primary care. Fifteen parents who previously participated in a larger survey study participated in interviews about their experiences and attitudes toward integrated primary care. Qualitative data were analyzed and sorted by quantitative data of interest to identify demographic, child, and parental factors that shape attitudes toward integrated care. Parents emphasized a need for tailored behavioral guidance, and multiple interconnected factors (e.g., trust of providers, perceived convenience of delivery modalities, stigma associated with behavioral health services) drove parents’ attitudes toward behavioral primary care. These attitudes varied based on socioeconomic status, child behavior symptoms, and reported use of corporal punishment.

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References

  1. Perrin EC, Leslie LK, Boat T. Parenting as primary prevention. JAMA Pediatrics. 2016;170(7):637-638.

    Article  Google Scholar 

  2. American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine, Bright Futures Periodicity Schedule Workgroup. Recommendations for pediatric preventive health care. Pediatrics. 2014;133(3):568-570.

    Article  Google Scholar 

  3. Leslie LK, Mehus CJ, Hawkins JD, et al. Primary health care: Potential home for family-focused preventive interventions. American Journal of Preventative Medicine. 2016;51(4 Suppl 2):S106-118.

    Article  Google Scholar 

  4. O'Connell ME, Boat T, Warner KE. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington D.C.: National Academies Press; 2009.

    Google Scholar 

  5. Yogman MW, Betjemann S, Sagaser A, et al. Integrated behavioral health care in pediatric primary care: A quality improvement project. Clinical Pediatrics (Phila). 2018;57(4):461-470.

    Article  Google Scholar 

  6. Nasir A, Watanabe-Galloway S, DiRenzo-Coffey G. Health services for behavioral problems in pediatric primary care. Journal of Behavioral Health Services & Research. 2016;43(3):396-401.

    Article  Google Scholar 

  7. Pidano AE, Kimmelblatt CA, Neace WP. Behavioral health in the pediatric primary care setting: Needs, barriers, and implications for psychologists. Psychological Services. 2011;8(3):151.

    Article  Google Scholar 

  8. Combs-Orme T, Holden Nixon B, Herrod HG. Anticipatory guidance and early child development: pediatrician advice, parent behaviors, and unmet needs as reported by parents from different backgrounds. Clinical Pediatrics (Phila). 2011;50(8):729-737.

    Article  Google Scholar 

  9. Shah R, Kennedy S, Clark MD, et al. Primary care-based interventions to promote positive parenting behaviors: A meta-analysis. Pediatrics. 2016;137(5):e20153393.

    Article  Google Scholar 

  10. Brown CM, Raglin Bignall WJ, Ammerman RT. Preventive behavioral health programs in primary care: a systematic review. Pediatrics. 2018;141(5):e20170611.

    Article  Google Scholar 

  11. Blount A. Integrated primary care: Organizing the evidence. Families, Systems, & Health. 2003;21(2):121.

    Article  Google Scholar 

  12. Sanders MR, Kirby JN. Consumer engagement and the development, evaluation, and dissemination of evidence-based parenting programs. Behavior Therapy. 2012;43(2):236-250.

    Article  Google Scholar 

  13. Riley AR, Walker BL, Wilson AC, et al. Parents' consumer preferences for early childhood behavioral intervention in primary care. Journal of Developmental & Behavioral Pediatrics. 2019;40(9):669-678.

    Article  Google Scholar 

  14. Gershoff ET, Goodman GS, Miller-Perrin CL, et al. The strength of the causal evidence against physical punishment of children and its implications for parents, psychologists, and policymakers. American Psychologist. 2018;73(5):626-638.

    Article  Google Scholar 

  15. Fehr KK, Leraas BC, Littles MMD. Behavioral health needs, barriers, and parent preferences in rural pediatric primary care. Journal of Pediatric Psychology. 2020;45(8):910-920.

    Article  Google Scholar 

  16. Mehus CJ, Kazlauskaite V, Colianni S, et al. Parents' interest in resources to address their child's behavioral health through primary care. Families, Systems, & Health. 2019;37(3):244-248.

    Article  Google Scholar 

  17. Pidano AE, Segool NK, Delgado N, et al. Parent perceptions of pediatric primary care providers' mental health-related communication and practices. Journal of Pediatric Health Care. 2020;34(5):e49-e58.

    Article  Google Scholar 

  18. Wu YP, Deatrick JA, McQuaid EL, et al. A primer on mixed methods for pediatric researchers. Journal of Pediatric Psychology. 2019;44(8):905-913.

    Article  Google Scholar 

  19. Ivankova NV, Creswell JW, Stick SL. Using mixed-methods sequential explanatory design: From theory to practice. Field Methods. 2006;18(1):3-20.

    Article  Google Scholar 

  20. Palinkas LA, Horwitz SM, Green CA, et al. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health. 2015;42(5):533-544.

    Article  Google Scholar 

  21. Eyberg SM, Pincus D. Eyberg Child Behavior Inventory and Sutter-Eyberg Student Behavior Inventory - Revised: Professional Manual. Odessa, FL: Psychological Assessment Resources; 1999.

    Google Scholar 

  22. Riley AR, Walker BL, Hall TA. Development and initial validation of a measure of parents' preferences for behavioral counseling in primary care. Familes, Systems, & Health. 2020;38(2):139-150.

    Article  Google Scholar 

  23. Parent J, Forehand R. The Multidimensional Assessment of Parenting Scale (MAPS): Development and psychometric properties. Journal of Child and Family Studies. 2017;26(8):2136-2151.

    Article  Google Scholar 

  24. Borkan J. Immersion/Crystallization. Doing Qualitative Research. In: Crabtree BF, Miller WL, eds. Doing Qualitative Research. 2nd ed. Thousand Oaks, CA: Sage Publications; 1999:179-194.

    Google Scholar 

  25. Committee On Hospital Care and Institute For Patient and Family-Centered Care. Patient- and family-centered care and the pediatrician's role. Pediatrics. 2012;129(2):394-404.

    Article  Google Scholar 

  26. Bauchner H. Shared decision making in pediatrics. Archives of Disease in Childhood. 2001;84(3):246-246.

    Article  CAS  Google Scholar 

  27. Mimila NA, Chung PJ, Elliott MN, et al. Well-child care redesign: A mixed methods analysis of parent experiences in the PARENT trial. Academic Pediatrics. 2017;17(7):747-754.

    Article  Google Scholar 

  28. Riley AR, Wagner DV, Tudor ME, et al. A survey of parents' perceptions and use of time-out compared to empirical evidence. Academic Pediatrics. 2017;17(2):168-175.

    Article  Google Scholar 

  29. Gurney BA, German M, Keller K, et al. Increasing behavioral health appointment attendance using warm handoffs in an integrated primary care setting. The Behavior Therapist. 2020;43(1):14-19.

    Google Scholar 

  30. Piotrowski CC, Talavera GA, Mayer JA. Healthy Steps: A systematic review of a preventive practice-based model of pediatric care. Journal of Developmental & Behavioral Pediatrics. 2009;30(1):91-103.

    Article  Google Scholar 

  31. Erickson SJ, Gerstle M, Feldstein SW. Brief interventions and motivational interviewing with children, adolescents, and their parents in pediatric health care settings: A review. Archives of Pediatrics & Adolescent Medicine. 2005;159(12):1173-1180.

    Article  Google Scholar 

  32. Schleider JL, Dobias ML, Sung JY, et al. Future directions in single-session youth mental health interventions. Journal of Clinical Child & Adolescent Psychology. 2020;49(2):264-278.

    Article  Google Scholar 

  33. Miller BF, Ross KM, Davis MM, et al. Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care. American Psychologist. 2017;72(1):55.

    Article  Google Scholar 

  34. Radey M, Randolph KA. Parenting sources: How do parents differ in their efforts to learn about parenting? Family Relations. 2009;58(5):536-548.

    Article  Google Scholar 

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Correspondence to Andrew R. Riley PhD.

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This work was supported by the Agency for Healthcare Research and Quality [K12HS022981] and the Health Resources and Services Administration [D40HP26865]. The authors report no other competing interests.

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Riley, A.R., Walker, B.L., Ramanujam, K. et al. A Mixed-Method Investigation of Parent Perspectives on Early Childhood Behavioral Services in Primary Care. J Behav Health Serv Res 49, 134–148 (2022). https://doi.org/10.1007/s11414-021-09772-2

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  • DOI: https://doi.org/10.1007/s11414-021-09772-2

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