Parents' Perspectives on Early Relational Health: A Qualitative Study.

OBJECTIVE: The American Academy of Pediatrics endorses a paradigm shift toward promoting early relational health (ERH) in pediatrics. Pediatric clinicians have a unique opportunity to promote ERH, yet little work has sought parents' perspectives on how clinicians can do so effectively. We sought to understand diverse parents' perspectives on ERH and the role of pediatric clinicians in supporting it. METHODS: We conducted virtual focus groups using a guide prepared with input from community partners and parent advisors. We purposively sampled a diverse group of parents of children aged ≤7 years. Focus groups were recorded and transcribed verbatim. We analyzed data as it was collected and identified themes using an inductive and iterative process. RESULTS: Thirty-seven parents participated in 8 focus groups (median parent age: 36.0 years; 43.2% Asian, 18.9% Black/African-American; 32.4% Hispanic/Latino; 78.4% mothers). We identified 3 organizing themes: (1) Time, attention, and open communication with children lay a foundation for ERH; (2) Pediatric clinicians have an opportunity to promote ERH, but disconnected parent-clinician relationships are a major barrier; and (3) Enhanced communication and careful attention to child development and family well-being represent key opportunities to strengthen parent-clinician relationships. CONCLUSION: Parents identified time, attention, and open communication as essential to ERH. Although participants expressed openness to clinicians addressing ERH, such work is contingent on strong parent-clinician relationships. Policymakers and clinicians seeking to address ERH in pediatric settings must also be prepared to address potential barriers through strategies like providing adequate time to facilitate relationship-building and careful attention to address this critical topic.

The Effect of Exposure to Reach Out and Read on Shared Reading Behaviors.

BACKGROUND: Caregiver-child shared reading improves literacy skills, school readiness, familial relationships, and social-emotional development. This multiyear study seeks to evaluate the effect of exposure to Reach Out and Read (ROR) on caregiver reading frequency and behaviors. METHODS: Caregivers of children 6 months to 5 years in 427 primary care clinics in North and South Carolina were asked to complete the Reach Out and Read Parent Feedback Survey. Caregivers not previously exposed to ROR were categorized as "new," and those who had previously been exposed to ROR as "returning" to compare reading behaviors between groups. RESULTS: From 2014 to 2019, caregivers completed 100,656 surveys. Returning caregivers were more likely to report reading or looking at books every day (adjusted odds ratio [AOR] = 1.27; 95% confidence interval [95% CI], 1.22-1.33). Returning caregivers were more likely to perform behaviors like letting the child turn pages (AOR = 1.71; 95% CI, 1.62-1.79), making up stories about the pictures (AOR = 1.46; 95% CI, 1.39-1.53), asking what is happening in the pictures (AOR = 1.39; 95% CI, 1.32-1.47), helping identify things in the pictures (AOR = 1.57; 95% CI, 1.50-1.65), reading to the child 30 minutes every day (AOR = 1.39; 95% CI, 1.33-1.46), and taking the child to the library (AOR = 1.26; 95% CI, 1.20-1.34). CONCLUSIONS: This study shows a significant association between caregivers' exposure to ROR, high-frequency reading, and positive reading behaviors, and is consistent for all 6 years studied.retain-->.

Advancing early relational health: a collaborative exploration of a research agenda.

Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection-a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.

Clinician Perceptions on Literacy Promotion in Pediatric Continuity Clinics.

OBJECTIVE: We describe LP perceptions of pediatric and internal medicine/pediatrics residents and faculty and determine the relationship between LP training and perceptions of LP. Reach Out and Read (ROR) is a widely implemented evidence-based literacy promotion (LP) intervention. Recent data have shown that there is variability in both LP training for pediatric residents and implementation of ROR. However, little is known about the perceptions regarding LP and the relationship with training. METHODS: Faculty and residents at participating sites completed an anonymous online survey on LP perceptions and training. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression modeling. RESULTS: A total of 473 faculty and 1216 residents at 42 pediatric training programs participated. Faculty versus resident status was a significant predictor of almost all perception questions. Most faculty (65.3%) and residents (44.3%) completely agreed that it is the job of pediatricians to assess and encourage reading (P < .0001). Most faculty (69.6%) and residents (51.5%) completely agreed that LP is as important as advice about car seats, bike helmets, and "back-to-sleep" (P < .0001). More faculty (65.8%) than residents (46.6%) completely agreed with the statement "discussing sharing books with children at health supervision visits can be an effective early intervention strategy" (P < .0001). More faculty (34%) compared to residents (18.2%) completely agreed they felt confident modeling reading for parents during the visit (P < .0001). CONCLUSIONS: Faculty status predicted most favorable LP perceptions, while continuity clinic training and learning in-clinic from others predicted some favorable LP perceptions.

Clinician Experiences With Reach Out and Read: An Exploratory Qualitative Analysis.

BACKGROUND: Enhanced literacy and increased vocabulary related to Reach Out and Read (ROR) are well described. Less is known about clinicians' experience with the program. OBJECTIVE: Understand clinician experiences of implementing ROR. DESIGN/METHODS: This study was a collaboration between ROR and the Academic Pediatric Association's Continuity Research Network. Participants completed an anonymous online survey to evaluate Literacy Promotion activities and training, and were asked "What has been the most meaningful experience you have encountered with using ROR?" and "Is there anything else you would like to add?" Responses were evaluated by researchers and 4 themes were generated through discussion. All responses were divided and coded by researchers working in pairs and subsequently by all researchers until consensus was reached. Data were organized into themes. FINDINGS: Responses were provided by 592 (35%) participants. Qualitative analysis revealed benefits to participation in ROR within 4 themes: 1) Child/Family Impact (60%): "Seeing a child read for the first time" 2) Physician Impact (16%): "I... use the books... to connect with patients." 3) Impact on clinic practice (25%): "I... enjoy modeling for parents and use the books to assess... development" 4) Social Determinants of Health (2%): "The books... are an invaluable resource to our under-served population." CONCLUSION: Clinicians who implement ROR report positive impact on patients, families, and their own satisfaction and methods in practice. Clinicians value that the program addresses social determinants of health and facilitates developmental surveillance. Further study is needed to understand how clinician's perspectives affect and are affected by their experiences.

Literacy Promotion Training and Implementation in Pediatric Continuity Clinics.

BACKGROUND: Despite endorsement by the American Academy of Pediatrics, there are no national data on literacy promotion (LP) training and behaviors. OBJECTIVE: To describe LP training experiences and behaviors of pediatric and internal medicine/pediatrics residents and faculty nationally, and the association between LP training and behaviors. METHODS: The Academic Pediatric Association's Continuity Research Network and Reach Out and Read National Center sent an online survey to faculty and residents at participating Continuity Research Network clinics. Respondents were asked about LP training experiences and behaviors. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression modeling. RESULTS: 473 faculty and 1216 residents at 42 institutions participated. More faculty than residents reported completing online Reach Out and Read training (63% vs 45%, P < .0001). More residents reported learning in clinic from others (92% vs 89%, P = .04). Training experiences did not differ otherwise. More faculty reported providing anticipatory guidance (87% vs 77%, P < .0001); modeling shared reading (69% vs 45%, P < .0001); and using books for developmental assessment (80% vs 62%, P < .0001). Both groups (97%) reported distributing books. The training modality most often endorsed as "very/extremely influential" was learning in clinic from others. Some LP behaviors were associated more strongly with online training while others were associated more strongly with in-person training. CONCLUSIONS: Online training and in-person training are both associated with high quality delivery of LP. Faculty members are more likely to have completed online training and to report engaging in the full range of recommended LP behaviors. These data have implications for LP training.