Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care.

Abstract

The use of mobile delivery to deliver parent training can address barriers to access and improve the translation of interventions in existing settings like pediatric primary care. Studying implementation provides critical information to identify and address barriers and facilitators and inform sustainability efforts. Method: This study was a descriptive evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework as part of a Hybrid Type I Effectiveness-Implementation trial of the ezParent Program within 4 pediatric primary care clinics. We collected data before, during, and after implementation to evaluate provider implementation and their perspectives on program benefits and barriers to implementation. Results: On average, 14% of eligible parents were introduced to the study. Of these parents, 78% expressed interest in participating and 37% enrolled in the study. Seventy-eight percent of staff providers (n ϭ 36) implemented the procedures at least once, and among those who implemented 3 or more times (n ϭ 24), 79% maintained implementation for 6 months. Barriers to implementation include limited time, lack of information, and full practice buy-in and engagement. Discussion: Implementation fidelity may improve with additional education and training of the interdisciplinary team, clear messaging regarding the purpose and content of the ezParent program, defining roles within the care team, identifying practice champions, and use of the electronic health record. Findings from this evaluation, including data from the randomized controlled trial and literature to support intervention effectiveness and implementation, will be used to develop an implementation toolkit to include specific strategies for implementation and ideas for local adaptations.

Socioeconomic factors and parents' preferences for internet- and mobile-based parenting interventions to prevent youth mental health problems: A discrete choice experiment

“…Meta-analyses indicate parenting internet- and mobile-based interventions (IMIs) can successfully reduce externalizing and internalizing difficulties in young people ( Nieuwboer et al, 2013 ; Spencer et al, 2020 ), with no significant difference in intervention effects found between online and face-to-face parenting programs ( Florean et al, 2020 ). Examples of preventive parenting IMIs targeting youth mental health include Cool Little Kids Online ( Morgan et al, 2016 ; Morgan et al, 2017 ), ez Parent ( Breitenstein et al, 2016 ; Breitenstein et al, 2019 ), Triple P Online ( Baker et al, 2017 ; Sanders, 1999 ; Sanders et al, 2003 ), Parenting Resilient Kids ( Fernando et al, 2018 ; Sim et al, 2020 ), ParentWorks ( Piotrowska et al, 2020 ), and Partners in Parenting ( Cardamone-Breen et al, 2018 ; Yap et al, 2018 ; Yap et al, 2019 ).…”

Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study

“…One notable line of research has been conducted on the ez Parent Program, which is a tablet-based preventive behavioral parent training intervention adapted from the Chicago Parent Program [ 43 ] tailored for youth aged 2 to 5 years in primary care settings. An advantage of the development strategy for ez Parent is that many of its aspects, including implementation factors, adherence, and parental perceptions of engaging with the program, have been studied [ 44 - 46 ]. Nevertheless, when tested in a randomized controlled trial, ez Parent was not more effective on child outcomes than enhanced usual care [ 47 ].…”

Referral to digital parent training in primary care: Facilitators and barriers.

“…We conducted a Type I effectiveness-implementation trial of ez Parent at four primary care clinics (Breitenstein et al, 2019). The primary focus of a Type I effectiveness-implementation trial is intervention testing with a secondary focus on implementation factors (Landes, McBain, & Curran, 2019).…”

“…We defined successful referrals as completion of three standardized steps: (1) provision of an information packet about the study, (2) a verbal conversation/referral from a PCP, and (3) documentation of the referral. After clinic personnel completed the ez Parent referral process, study personnel provided parents with information about the study and, if consented and enrolled, a tablet to access either ez Parent or the active control intervention (general child development resources; Breitenstein et al, 2019). Implementation outcomes from this study showed substantial variation among clinics in implementing referral protocols: average referral rates (the percentage of eligible parents who received referrals) were 14% (range = 7%–52%; Breitenstein et al, 2019).…”

“…After clinic personnel completed the ez Parent referral process, study personnel provided parents with information about the study and, if consented and enrolled, a tablet to access either ez Parent or the active control intervention (general child development resources; Breitenstein et al, 2019). Implementation outcomes from this study showed substantial variation among clinics in implementing referral protocols: average referral rates (the percentage of eligible parents who received referrals) were 14% (range = 7%–52%; Breitenstein et al, 2019). These heterogenous results indicate the need to explore referral facilitators and barriers.…”