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About this paper symposium
| Panel information |
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| Panel 16. Prevention and Interventions |
| Paper #1 | |||
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| A Pilot Feasibility and Acceptability Trial for a Social-Emotional Learning Intervention in Pediatric Primary Care | |||
| Author information | Role | ||
| Michael T. Sanders, Ph.D., Dartmouth Health, United States | Presenting author | ||
| Susanne E. Tanski, M.D., Dartmouth Health Children's, United States | Non-presenting author | ||
| Mary K. Jankowski, Ph.D., Dartmouth Health, United States | Non-presenting author | ||
| Abstract | |||
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Childhood mental health concerns are rising at an alarming rate (Samji et al., 2022), which is further exacerbated by the COVID-19 pandemic and the focus of the health system to respond after mental health problems arise. Research suggests that early investment in social-emotional learning (SEL) skills as the target of universal prevention has the potential to improve population-level wellbeing and promote positive adjustment across multiple important domains (Greenberg et al., 2017). Because it serves ~95% of children under age 5, and because of its central role to promote healthy development and prevent health problems, pediatric primary care has the potential to expand access to SEL content to children and families who may otherwise have limited access to services (Buka et al., 2022). However, there remains a need to develop low-cost, low-burden, SEL-focused content for delivery in pediatrics. To begin to address this gap with simple and scalable prevention programming, we created “Project Bloom,” a program that curated, synthesized, and delivered novel SEL educational materials based on emerging research highlighting core components identified across evidence-based, exemplar SEL programs (see Jones et al., 2017). The current study reports on the initial non-randomized, pre-post, mixed methods pilot trial that evaluated the feasibility and acceptability of delivering two (of five total) kernel strategies for parent-child use through pediatric primary care: belly breathing and interactive reading. Parents of all children ages 3–6 attending a well-child check were eligible to participate in the study. We recruited 50 of 80 (63%) eligible parent-child dyads over the course of a 4-week recruitment period from a primary care clinic in a rural academic medical center in Northern New England, illustrating the high demand for SEL content among parents of young children. Thirty-three (66%) parents of 3-6-year-old children (Mage = 4.39; 45% female; 76% White, 9% Asian, 3% Black, 12% Multiracial; 91% not Hispanic/Latinx) completed the baseline measures and engaged with study materials; 28 of 33 (85%) completed follow-up measures after using the materials at home for two weeks. Parent acceptability was measured using a 20-question survey designed for this study. Overall, 82% (n=23) of participants agreed or strongly agreed that the materials and content were excellent. Themes that emerged from follow-up interviews with parents (n=10) included appeal of the materials, effectiveness of the kernel strategies, and need for and preference to receive SEL content in primary care. Themes from pediatric providers (n=13) indicated a belief that Project Bloom fills a gap in pediatric primary care as an important resource that can promote positive adjustment for young children and families. Initial provider professional development trainings and providers introducing Project Bloom to families also served to support its implementation. These findings illustrate the potential for high-quality, low-burden, SEL-focused content to be feasibly delivered in the pediatric primary care setting and suggest the possibility of increasing access to primary prevention for many families. Results of future efficacy trials will inform the utility of Project Bloom as a universal prevention program with implications for its use in pediatric and community systems to promote mental health equity. |
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| Paper #2 | |
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| Integrating Brief Telehealth Parent Trainings into Medical Clinics: Acceptability, Feasibility, and Preliminary Efficacy | |
| Author information | Role |
| James T. Craig, Ph.D., Dartmouth Health, United States | Presenting author |
| Michael T. Sanders, Ph.D., Dartmouth Health, United States | Non-presenting author |
| Christina C. Moore, Ph.D., Dartmouth Health, United States | Non-presenting author |
| Erin R. Barnett, Ph.D., Dartmouth Health, United States | Non-presenting author |
| Kady F. Sternberg, B.A., Dartmouth Health, United States | Non-presenting author |
| Nina Sand-Loud, M.D., Dartmouth Health Children's, United States | Non-presenting author |
| Mary K. Jankowski, Ph.D., Dartmouth Health, United States | Non-presenting author |
| Abstract | |
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Disruptive behavior disorders, including Attention Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), are the most common mental health concerns that present in medical clinics during early childhood (ages 0-8; Briggs-Gowan et al., 2003; Georgiades et al., 2019). Evidence-based behavioral parent trainings (BPTs) are effective treatments for young children with disruptive behavior disorders and the first line treatment for children diagnosed with ADHD in early childhood. Participation in BPTs leads to reduced disruptive behaviors, ADHD symptoms, and parenting stress (see Phillips et al., 2024). Despite their effectiveness, systematic barriers to care (inadequate and unevenly distributed workforce, cost, stigma) make BPTs remarkably difficult to access and engage with for most families, especially for those in rural communities. To address these needs, this paper reports on two recent studies examining the acceptability, feasibility, and preliminary efficacy of a brief, made-for-telehealth parent training delivered through medical clinics in a rural area. Study 1 was a mixed-methods analysis of a 4-session telehealth BPT program in primary care and examined multiple stakeholders’ perceptions of acceptability and feasibility. This study included 27 families with children between ages 2-7 (Mage = 5.3; 62% male; 89% White, non-Hispanic/Latinx), three clinicians, and 13 staff. Participants provided quantitative and qualitative data describing the feasibility and acceptability of the program that were integrated using a mixed design. Study 2 was a pilot RCT that recruited families of children diagnosed with ADHD from a developmental pediatrics clinic serving a large, rural area. Caregivers received an expanded 7-session version of the original program with content specifically focused on the needs of children with ADHD. Forty-four children (ages 3-7; Mage = 4.8; 62% male; 96% White; 89% non-Hispanic/Latinx) were randomized into either the brief telehealth program or treatment as usual and followed for 24 weeks. We collected data on feasibility, treatment acceptability, parenting practices, caregiver empowerment, disruptive behaviors, ADHD symptoms, and levels of impairment. Results across both studies indicated that the brief telehealth program was acceptable and feasible to deliver. All families across the two studies found the program to be at least Moderately Acceptable based on our criteria. Study 1 revealed unique insights from caregivers on barriers and facilitators related to brief telehealth. Narratives from clinic staff revealed both promise for the approach and important caveats to consider when integrating programs into medical clinics. In Study 2, repeated measures ANOVAs found significant group*time interaction effects in favor of the treatment group vs. control for family empowerment scores, inattention, total behavior problems, and symptom-related impairment. These two studies help articulate the promise as well as the challenges associated with providing brief telehealth programs to rural families. We concluded that brief telehealth BPTs represent feasible, acceptable, and likely beneficial alternatives to traditional care for families with limited access to traditional mental health services. Future studies confirming the cost-benefit advantages of these treatments over traditional care speaks to the potential of these programs to increase the capacity to provide efficacious and equitable care to rural and low-resource communities. |
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| Paper #3 | |||
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| The Pittsburgh Study: A Community-Partnered, Tiered Approach to Promote Early Relational Health and Child Development | |||
| Author information | Role | ||
| Daniel S. Shaw, Ph.D., University of Pittsburgh, United States | Presenting author | ||
| Chelsea Weaver Krug, Ph.D., University of Pittsburgh, United States | Non-presenting author | ||
| Alan L. Mendelsohn, M.D., New York University, United States | Non-presenting author | ||
| Abstract | |||
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To address the heterogeneity of strengths and risks for parents of children 0-4 years, especially those families facing economic and racial/ethnic discrimination, the Early Childhood Collaborative of The Pittsburgh Study (TPS) was designed to be a community-partnered, population-level strategy for supporting early child development via early relational health (ERH) programs. Key innovations include: 1) Utilization of health care and community settings for engagement and services; 2) Parent choice of ERH programs across a menu of options aligned with family strengths and risks; and 3) a centralized system for supporting family receipt of services. The current paper presents results from the first 1,045 families enrolled in TPS followed for at least one year following initial enrollment. TPS uses a tiered approach to provide ERH programs for children 0-4 years old presenting to health care and community agencies serving young children in Allegheny County, PA (Pittsburgh metropolitan area). After enrollment and semi-annual/annual screens through age 4, parents completed 25-to-30-minute screens to assess strengths/risks. Parents were then placed into one of four risk/resource groups that dictated offerings of programs. ERH programs ranged in intensity from text- or play-based parent education (Groups 1 and 2) to weekly home visiting (Groups 3 and 4) at locations to optimize accessibility (e.g., primary care, WIC, home/virtual). The first 878 primary parents (P1) and 190 second parents (P2) enrolled were screened to provide a risk-stratified, tiered-based choice in ERH programs. Families were racially/ethnically diverse (45% Black and 17% multi-racial or other races than white), 47% single or divorced, and 52% having an annual income <$30,000. About 25% of P1s were placed into each of the four risk/resource groups. >78% of P1s and P2s chose to participate in at least one supportive parenting program, a rate that increased to 82.7% after 6- and 12-month follow-up screens. Importantly, P1s in the moderate risk Group 3 were significantly more likely to select a program compared to parents in Group 2 (moderately low risk). P1s in the highest risk group 4 (e.g., facing homelessness, substance abuse/mental health challenges, and/or child welfare contact) were more likely to choose a program than the two lower risk Groups 1 and 2. For those with clinical levels of parental depression, the cumulative engagement rate was 88.9%. Additional analyses will examine engagement in specific programs within and across risk/resource groups as well as parent and child outcomes one to two years following enrollment for those who engaged in interventions versus those who did not. The latter group will include subgroups of families who did not select programs and those who selected programs but did not attend intervention program sessions. Initial findings support TPS’ strategies to engage and support families by offering choices in programs and optimizing accessibility to services. TPS was successful in engaging ~83% of families in ERH programs, and especially successful in engaging families at greatest risk, who are often the most difficult to engage. Findings support establishing collaborations between health care and community settings serving young children. |
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Increasing Access to Prevention and Intervention for Children and Families Through Innovative Public Health Approaches
Submission Type
Paper Symposium
Description
| Session Title | Increasing Access to Prevention and Intervention for Children and Families Through Innovative Public Health Approaches |