Innovative risk calculator and telehealth delivered parenting program for early childhood mental health promotion in pediatric primary care: A hybrid type 3 effectiveness-implementation study

PROJECT SUMMARY — SIGNATURE PROJECT (SP) Community-based pediatric primary care offers a tight net for identifying children experiencing mental health problems who would benefit from preventive services and support. Parenting-based interventions are effective at reducing risk for common mental health problems in toddlers but have not been translated to primary care. A challenge to widescale prevention efforts in pediatric primary care is the dearth of systematic methods for identifying very young children at risk for mental health problems. Salient barriers limiting implementation of pediatric screening practices and linked parenting interventions are developmentally-grounded decision tools that are clinically feasible, the cost of implementing these practices, caregiver engagement strategies, and accessible delivery solutions along with a well-trained workforce. The MHE Center’s Signature Project, Pediatricians Building Resilience through early Identification for Toddler Well-Being (Peds-BRITE) proposes a mental health risk calculator to identify at-risk toddlers, the Developmental Early Childhood Instrument for Deciding Effectively for Mental Health (DECIDE) Tool linked to a telehealth and digital application-based version of the evidence based Family Check-Up® (FCUOnline). FCUOnline has demonstrated effects on parenting and child self-regulation, which lead to short- and long-term prevention of internalizing and externalizing problems. Peds-BRITE will be the first implementation of FCUOnline in routine community based pediatric primary care for toddlers. The transdiagnostic DECIDE Tool is key to developmentally reliable mental health risk determination feasible in routine care, enabling risk for an array of syndromes to be identified with a single screen that also accounts for assets. Using the MHE Center’s novel cluster randomized Roll-Out Implementation Optimization (ROIO) design, Peds-BRITE aims are: Aim 1: Optimize the implementation of the DECIDE Tool in pediatric primary care linked to FCU-Online®. Aim 1a: Identify and test strategies for DECIDE Tool implementation. Aim 1b. Identify and test strategies for FCUOnline implementation and effectiveness. Peds-BRITE’s implementation optimization process and outcome evaluation are guided by the REAIM framework. Aim 2: Evaluate implementation of the DECIDE Tool and FCUOnline. Assess implementation on key clinic, clinician, and caregiver levels implementation outcomes at multiple points within the ROIO design to optimize strategies. Aim 3: Test the effectiveness of FCUOnline at reducing toddler behavioral vulnerability to preschool-age mental health symptoms. Experimental therapeutic targets are child self-regulation- promoting parenting skills. The primary outcomes for determining FCUOnline effectiveness are parenting skills, internalizing and externalizing symptoms, and irritability related impairment. Assessments will occur at study entry, 6- and 12-months. Improving pediatric decision making about young children’s mental health risk and its prevention in routine care is promising for population level reduction of early starting, chronic mental health trajectories.