Referral to Digital Parent Training in Primary Care: Facilitators and Barriers

Overview

Journal Clin Pract Pediatr Psychol

Date 2022 Jul 13

PMID 35821979

Authors

Caitlin Fehrenbacher

Michael E Schoeny

Monique Reed

Mona Shattell

Susan M Breitenstein

Affiliations

Soon will be listed here.

Abstract

Objective: Parent training (PT) programs for parents of preschool-aged children promote effective parenting practices and reduce the risk for the development of child behavior problems. Digital platforms and self-administered formats can expand access to preventive PT and complement traditional behavioral services. Primary care provides an ideal environment to refer patients to prevention-focused PT; however, effective integration of a referral process requires an understanding of implementation facilitators and barriers. The current study is a secondary analysis of facilitators and barriers to the implementation of a referral to Parent, a self-administered, digital PT program, in four primary care clinics from the perspective of clinic personnel.

Method: Personnel from participating clinics took part in semi-structured group interviews to share their experiences of referral to Parent. Researchers extracted themes using the Consolidated Framework for Implementation Research.

Results: Clinic personnel support preventive PT, but time, workflow, and organizational barriers impede consistent referral implementation.

Conclusions: The authors discuss recommendations for harnessing facilitators for referring primary care patients to digital PT using the strengths of multidisciplinary clinical teams and organizational structures.

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References

Asarnow J, Kolko D, Miranda J, Kazak A . The Pediatric Patient-Centered Medical Home: Innovative models for improving behavioral health. Am Psychol. 2017; 72(1):13-27. DOI: 10.1037/a0040411. View

Stancin T, Perrin E . Psychologists and pediatricians: Opportunities for collaboration in primary care. Am Psychol. 2014; 69(4):332-43. DOI: 10.1037/a0036046. View

Raney L, Bergman D, Torous J, Hasselberg M . Digitally Driven Integrated Primary Care and Behavioral Health: How Technology Can Expand Access to Effective Treatment. Curr Psychiatry Rep. 2017; 19(11):86. DOI: 10.1007/s11920-017-0838-y. View

Ghandour R, Sherman L, Vladutiu C, Ali M, Lynch S, Bitsko R . Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. J Pediatr. 2018; 206:256-267.e3. PMC: 6673640. DOI: 10.1016/j.jpeds.2018.09.021. View

Coma E, Medina M, Mendez L, Hermosilla E, Iglesias M, Olmos C . Effectiveness of electronic point-of-care reminders versus monthly feedback to improve adherence to 10 clinical recommendations in primary care: a cluster randomized clinical trial. BMC Med Inform Decis Mak. 2019; 19(1):245. PMC: 6884876. DOI: 10.1186/s12911-019-0976-8. View

Dill J, Morgan J, Chuang E, Mingo C . Redesigning the Role of Medical Assistants in Primary Care: Challenges and Strategies During Implementation. Med Care Res Rev. 2019; 78(3):240-250. DOI: 10.1177/1077558719869143. View

Breitenstein S, Laurent S, Pabalan L, Risser H, Roper P, Saba M . Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care. Fam Syst Health. 2019; 37(4):282-290. PMC: 6901710. DOI: 10.1037/fsh0000447. View

Kozlowska O, Lumb A, Tan G, Rea R . Barriers and facilitators to integrating primary and specialist healthcare in the United Kingdom: a narrative literature review. Future Healthc J. 2019; 5(1):64-80. PMC: 6510038. DOI: 10.7861/futurehosp.5-1-64. View

Kazak A, Nash J, Hiroto K, Kaslow N . Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges. Am Psychol. 2017; 72(1):1-12. DOI: 10.1037/a0040382. View

10.

Sandler I, Wolchik S, Cruden G, Mahrer N, Ahn S, Brincks A . Overview of meta-analyses of the prevention of mental health, substance use, and conduct problems. Annu Rev Clin Psychol. 2014; 10:243-73. PMC: 3984908. DOI: 10.1146/annurev-clinpsy-050212-185524. View

11.

Crowley R, Kirschner N . The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: executive summary of an American College of Physicians position paper. Ann Intern Med. 2015; 163(4):298-9. DOI: 10.7326/M15-0510. View

12.

Wood E, Ohlsen S, Ricketts T . What are the barriers and facilitators to implementing Collaborative Care for depression? A systematic review. J Affect Disord. 2017; 214:26-43. DOI: 10.1016/j.jad.2017.02.028. View

13.

Harrison M, Grantham S . Learning from implementation setbacks: Identifying and responding to contextual challenges. Learn Health Syst. 2019; 2(4):e10068. PMC: 6508762. DOI: 10.1002/lrh2.10068. View

14.

Grace S, Rich J, Chin W, Rodriguez H . Flexible implementation and integration of new team members to support patient-centered care. Healthc (Amst). 2015; 2(2):145-51. DOI: 10.1016/j.hjdsi.2014.02.003. View

15.

Barlow J, Bergman H, Kornor H, Wei Y, Bennett C . Group-based parent training programmes for improving emotional and behavioural adjustment in young children. Cochrane Database Syst Rev. 2016; (8):CD003680. PMC: 6797064. DOI: 10.1002/14651858.CD003680.pub3. View

16.

Fryers T, Brugha T . Childhood determinants of adult psychiatric disorder. Clin Pract Epidemiol Ment Health. 2013; 9:1-50. PMC: 3606947. DOI: 10.2174/1745017901309010001. View

17.

Landes S, McBain S, Curran G . An introduction to effectiveness-implementation hybrid designs. Psychiatry Res. 2019; 280:112513. PMC: 6779135. DOI: 10.1016/j.psychres.2019.112513. View

18.

Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009; 4:50. PMC: 2736161. DOI: 10.1186/1748-5908-4-50. View

19.

Brown-Johnson C, Shaw J, Safaeinili N, Chan G, Mahoney M, Asch S . Role definition is key-Rapid qualitative ethnography findings from a team-based primary care transformation. Learn Health Syst. 2019; 3(3):e10188. PMC: 6628978. DOI: 10.1002/lrh2.10188. View

20.

Chapman S, Blash L . New Roles for Medical Assistants in Innovative Primary Care Practices. Health Serv Res. 2016; 52 Suppl 1:383-406. PMC: 5269548. DOI: 10.1111/1475-6773.12602. View