Engaging primary care clinicians in the selection of implementation strategies for toddler social-emotional health promotion in community health centers.

Abstract

Background: Social-emotional risk for subsequent behavioral health problems can be identified at toddler age, a period where prevention has a heightened impact. This study aimed to meaningfully engage pediatric clinicians, given the emphasis on health promotion and broad reach of primary care, to prepare an Implementation Research Logic Model to guide the implementation of a screening and referral process for toddlers with elevated social-emotional risk. Method: Using an adaptation of a previously published community partner engagement method, six pediatricians from community health centers (CHCs) comprised a Clinical Partner Work Group. The group was engaged in identifying determinants (barriers/facilitators), selecting and specifying strategies, strategy-determinant matching, a modified Delphi approach for strategy prioritization, and user-centered design methods. The data gathered from individual interviews, two group sessions, and a follow-up survey resulted in a completed Implementation Research Logic Model. Results: The Clinical Partner Work Group identified 16 determinants, including barriers (e.g., patient access to electronic devices) and facilitators (e.g., clinician buy-in). They then selected and specified 14 strategies, which were prioritized based on ratings of feasibility, effectiveness, and priority. The highest-rated strategies (e.g., integration of the screener into the electronic health record) provided coverage of all identified barriers and comprised the primary implementation strategy “package” to be used and tested. Conclusions: Clinical partners provided important context and insights for implementation strategy selection and specification to support the implementation of social-emotional risk screening and referral in pediatric primary care. The methodology described herein can improve partner engagement in implementation efforts and increase the likelihood of success.

A vision for implementing equitable early mental health and resilience support in pediatric primary care: A transdiagnostic, developmental approach.

“…As described in Carroll et al (2023), successful implementation of pediatric screening tools and intervention plan/referral processes is aided by meaningfully engaging diverse community partners in implementation planning. Clinical partners in the health system, as well as recipient families, can codesign the implementation with researchers and implementation experts.…”

Addressing mental health, earlier in pediatric primary care: Introduction to the special section.

“…Barriers included inequitable access to technology and inequities in health literacy among families. Carroll et al (2024) argue that for the systematic mental health screening of young children to be effectively implemented into real-world care, buy-in from implementers (i.e., pediatric primary care clinicians) is critical. They describe the process of engaging pediatric clinicians in the preparation of an implementation research logic model (IRLM) to guide the implementation of screening and referral for toddlers with elevated social-emotional risk.…”