Preventing Family Violence through Healthy Parenting in Primary Care:

Background and Purpose

Primary care has been increasingly recognized as an underutilized platform to widely disseminate evidence-based behavioral parenting interventions to prevent family violence at the population level. Although studies have shown that these interventions hold promise, limited research has been done to explore the implementation aspect of integrating such interventions into the complex healthcare system.

This study is a mixed study, which involved surveys and a focus group with pediatric staff to explore their perspectives regarding the process of integrating an evidence-informed behavioral parenting intervention, Behavior Checker, into the routine care practice of a pediatric services unit within a university-affiliated hospital system located in a Midwestern metropolitan region.

Methods

Surveys were administered to pediatric staff before and Behavior Checker staff training following the IRB approval. The survey included items related to staff’s perceptions regarding the need to integrate behavioral parenting interventions, their exposure to previous training in relevant topics, and the knowledge and level of confidence in educating parents about positive parenting strategies. Descriptive analyses were conducted to assess participants’ perceptions of need and previous training exposure. A paired t-test and a Wilcoxon Signed Rank test were conducted using SPSS to examine changes in staff’s level of knowledge and confidence in educating parents about positive parenting strategies after participation in the Behavior Checker training. Additionally, a focus group was conducted approximately 3 months after the implementation of Behavior Checker to explore staff’s perspectives regarding facilitators and barriers in implementing Behavior Checker.

Results

Total 41 pre-training and 35 post-training surveys were completed. A majority of participants reported that they are likely to encounter parents expressing concerns, asking questions, and seeking their advice in managing children’s common behavioral issues and expressed the need for further training. A significant post training increase in the level of knowledge [t(14) = -5.656, p < .001] and the confidence [Z = -3.188, P = .001] in educating parents about positive parenting strategies were found. A focus group revealed the following facilitator themes: 1) staff education; 2) content that is relevant to pediatric care needs; 3) practical skills; and 4) use of electronic health record for documentation. Barrier themes included 1) parents’ preference to discuss issues with physicians only; 2) parents’ tendency to prioritize medical issues; 3) space and time issues; 4) limited endorsement from physicians in charge); 5) staff’s tendency to rely on their experiences; 6) a lack of departmental-wide education and leadership involvement; and 7) no incentives for the delivery of Behavior Checker.

Conclusions and Implications

Primary care is a viable platform to disseminate behavioral parenting interventions to prevent family violence at the population level. Although pediatric staff perceive Behavior Checker as valuable resources, leadership and organizational policy support may be necessary to maximize its use in the healthcare system. Implementation science can add important insights in further advancing the effort to integrate behavioral parenting interventions into primary care. The role of social work in the multidisciplinary effort to promote positive parenting through primary care will be discussed.