Adapting a preschool disruptive behavior group for the underserved in pediatric primary care practice.

INTRODUCTION: While behavioral parent training (BPT) is the first line treatment for preschool aged children with disruptive behavior, only a fraction of families receive these therapies. The integration of BPT within the pediatric primary care (PPC) setting is a promising way to address this need, as the PPC setting is the first and only point of contact for most children diagnosed with mental health disorders. We piloted a clinical innovation by implementing an adapted BPT group in an urban, academic, PPC practice, serving a low-income, predominantly Black population. METHOD: Using a formative program development approach and a cultural adaptation framework, structural and cultural adaptations to the program were implemented to increase engagement and adaptability of the group to meet the needs of our PPC population. RESULTS: Learnings indicated that these adaptations were feasible and acceptable to families. Specifically, they were effective in engaging families and transforming the practice of primary care providers. DISCUSSION: Our work offers a case example to guide efforts to thoughtfully and effectively adapt evidence-based interventions for disruptive behavior in primary care settings. These processes provide one strategy to ameliorate behavioral health disparities in diverse, racial/ethnic minority populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interpersonal Violence and Psychological Well-Being: Perspectives of Low-Income Patients, Social Workers, and Medical Doctors in Mexico City, Mexico.

The violence epidemic in Mexico is becoming more widespread. Using a social-ecological framework, the current study sought to understand interpersonal violence among those impoverished communities in Mexico City, Mexico. Participants were recruited from Community Health Centers located within districts that were densely populated, had high rates of poverty and marginalization, and where people experience complex social needs. Semi-structured interviews were conducted with patients, social workers, and medical doctors (N = 15) who were either receiving or providing services in these centers. Data were analyzed using an inductive, thematic approach. Analysis resulted in three themes: (a) interpersonal violence permeates all settings in which people live and interact; (b) social and cultural factors increase the risk of becoming a perpetrator or victim of interpersonal violence; and (c) interpersonal violence is closely intertwined with mental health. Rapid changes within gender roles and expectations in Mexico, combined with widening income inequality, are shifting dynamics within families that may be inherently linked to interpersonal violence. Our findings support the conceptualization of interpersonal violence at the four levels of the social-ecological framework: individual, relationship, community, and societal. Prevention and interventions for violence reduction must be applied across the four levels simultaneously. Community-level efforts should go toward strengthening existing community health centers and equipping primary care providers with training and resources on the screening and triaging of patients encountering interpersonal violence.

Parents' Preferences for Behavioral Services in Primary Care During the COVID-19 Pandemic.

OBJECTIVE: Pediatric primary care is an ideal setting to provide behavioral health services to young children and their families during the COVID-19 pandemic. However, it is unclear how the pandemic altered parents' priorities and preferences to obtain behavioral services in this setting. METHOD: Between July 2020 and January 2021, 301 parents of young children in 5 pediatric sites across the United States completed survey measures on their preferences for behavioral topics and service delivery methods in primary care. The current sample was compared with a previous sample of parents (n = 396) who completed the same measures in 2018. RESULTS: Child self-calming was the only behavioral topic that was rated as significantly more important in the pandemic cohort in comparison with the prepandemic cohort. The pandemic cohort also reported significantly more interest in using certain media resources (e.g., mobile apps and videos) as a delivery method and less interest in group classes/seminars. After controlling for demographic differences between the samples, there was an increased preference for multimedia resources overall in the pandemic cohort, as well as a decreased preference for usual care. CONCLUSION: Parents generally endorse similar priorities for behavioral topics in primary care during the pandemic as they did before the pandemic. However, there is a clear preference for more remote and media-based services during the pandemic. Pediatric practices may consider augmenting behavioral health services with multimedia resources during and after the COVID-19 pandemic to meet parents' needs.

Preventive Behavioral Health Programs in Primary Care: A Systematic Review.

CONTEXT: Early childhood is a critical period for socioemotional development. Primary care is a promising setting for behavioral health programs. OBJECTIVES: To identify gaps in the literature on effectiveness and readiness for scale-up of behavioral health programs in primary care. DATA SOURCES: PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Embase, Evidence-Based Medicine Reviews, and Scopus databases were searched for articles published in English in the past 15 years. Search terms included terms to describe intervention content, setting, target population, and names of specific programs known to fit inclusion criteria. STUDY SELECTION: Inclusion criteria were: (1) enrolled children 0 to 5 years old, (2) primary care setting, (3) measured parenting or child behavior outcomes, and (4) clinical trial, quasi-experimental trial, pilot study, or pre-post design. DATA EXTRACTION: Data were abstracted from 44 studies. The rigor of individual studies and evidence base as a whole were compared with the Society of Prevention Research's standards for efficacy, effectiveness, and scale-up research. RESULTS: Gaps in the literature include: study findings do not always support hypotheses about interventions' mechanisms, trust in primary care as a mediator has not been sufficiently studied, it is unclear to which target populations study findings can be applied, parent participation remains an important challenge, and the long-term impact requires further evaluation. LIMITATIONS: Potential limitations include publication bias, selective reporting within studies, and an incomplete search. CONCLUSIONS: Targeting gaps in the literature could enhance understanding of the efficacy, effectiveness, and readiness for scale-up of these programs.

Fathers Know Best: Inner-City African American Fathers' Perceptions Regarding Their Involvement in the Pediatric Medical Home.

OBJECTIVE: Despite nearly three in four African American (AA) children being born to unwed mothers, AA fathers maintain relatively high levels of parenting engagement, whether or not they live with their children. While father involvement correlates with decreased adverse child health outcomes, the nature of AA father involvement in child health-including engagement in the pediatric medical home-remains largely unexplored. Our study aimed to assess perceptions of pediatric medical home participation among a cohort of urban, AA fathers. METHODS: Group level assessments (GLA; N = 17) were conducted among AA fathers in an urban, Midwestern neighborhood to examine perceptions regarding pediatric medical home involvement. Study participants generated themes based on GLA responses, and study staff used grounded theory as a framework for qualitative analysis of thematic data. RESULTS: Fathers desired to have their parental role acknowledged by mothers and pediatricians. They perceived unrecognized parenting strengths, including being role models, teachers, and providers for their children. Respondents endorsed uncertainty navigating the pediatric health care system, unawareness of their children's pediatric appointments, and feeling excluded from health care decision-making by their children's mothers and pediatric providers. CONCLUSIONS: In our cohort, AA fathers have a strong desire to be involved in their children's healthy development, but feel marginalized in their parenting role. AA fathers want improved communication with physicians and their children's mothers and to be actively included in health care decision-making. Enhanced efforts to engage fathers in the pediatric medical home may lead to improved health outcomes and reduced disparities for minority children.