Practicing safety: a quality improvement intervention to test tools to enhance pediatric psychosocial care for children 0–3 years

Abstract

BackgroundChild maltreatment is a significant public health issue in the United States. Yet, fewer than half of pediatricians discuss behavioral, developmental, or parenting issues with parents.ObjectiveThis paper describes the testing of bundles of tools and processes, part of a larger intervention, Practicing Safety, targeted at changing physician and staff behavior to identify families at risk for child maltreatment, provide anticipatory guidance, refer to community resources, and follow-up and track at-risk families. The intervention was implemented with 14 pediatric primary care practices throughout the United States; the study was completed in 2011.MethodsA within-subjects repeated measures pre-post follow-up design was used to evaluate the intervention. Baseline and repeated measurements of pediatric practices’ processes were collected using qualitative and quantitative methods. In total, 14 core improvement teams from across the country tested three bundles of tools (maternal, infant, toddler) within a quality improvement framework over seven months.ResultsQuantitative results showed statistically significant adoption of tools and processes and enhancement of practice behaviors and office environmental supports. The increase in tool use was immediate and was sustained for six months after implementation. Qualitative data provided insight as to how meaningful the intervention was to the core improvement teams, especially with more complicated behaviors (eg, engaging social workers or community agencies for referrals). Barriers included lack of community resources. Findings showed unanticipated outcomes such as helping practices to become medical homes.ConclusionLessons learned included that practices appreciate and can adopt brief interventions that have meaningful and useful tools and process to enhance psychosocial care for children 0–3 and that do not place a burden on pediatric practice. An innovative, quality improvement strategy, intuitive to pediatricians, with a brief intervention may help prevent child maltreatment.

Follow-Up Care After Maltreatment: Sociodemographic Associations With Timeliness in a Southern State

“…Child maltreatment prevention programs (e.g., Safe Environment for Every Kid [SEEK] and Practicing Safety) designed for primary care may also increase caregiver medical adherence after maltreatment (Abatemarco et al, 2018; Dubowitz et al, 2009). These programs screen for and address maltreatment risk factors as well as provide anticipatory guidance about normative child development.…”

“…These programs screen for and address maltreatment risk factors as well as provide anticipatory guidance about normative child development. These programs appear to reduce maltreatment, CPS reports, medical non-adherence, and increase provider knowledge of community resources (Abatemarco et al, 2018; Dubowitz et al, 2009). Additionally, although motivational interviewing (MI) is not a specific intervention package, a recent narrative review showed that provider’s use of MI strategies with maltreating parents may increase positive parenting and parental service engagement (Shah et al, 2019).…”

What aspects of their child's primary care do mothers value? A qualitative analysis of perspectives of women in treatment for opioid use disorder

“…Providing education on addiction to all clincial and support staff as well as training on how to improve interaction and communication with families affected by maternal OUD may be warranted. Previous research within the context of paediatric primary care has shown that accessible resources placed within a framework of quality improvement may enable physicians and staff to modify their practice‐based systems to improve communication with and support and care for patients (Abatemarco et al, 2018). This type of resource, tailored towards the needs of mothers with OUD and their children, may also be beneficial for clinics providing care to this population.…”

“…Such stigma may lead to feelings of guilt and shame, which could deter mothers to share honestly about the health of their child or to engage in health promotion programmes and interventions. A previous study of mothers in treatment for OUD found that stigma directly impacted the extent to which mothers engaged in early intervention child development services (Peacock-Chambers et al, 2020 (Abatemarco et al, 2018). This type of resource, tailored towards the needs of mothers with OUD and their children, may also be beneficial for clinics providing care to this population.…”

“…Preventive paediatric healthcare provides a critical opportunity for clinicians to diagnose and prevent illness and injury, evaluate child growth and development and provide anticipatory guidance to reduce risk factors and optimize child outcomes (Abatemarco et al, 2018; American Academy of Pediatrics, 2019). Current research, however, suggests that the delivery of routine well child care (WCC) for children affected by maternal opioid use disorder (OUD) could be improved.…”