Background: A public health approach to child maltreatment prevention relies on programs that impact the underlying drivers of maltreatment and that can easily be implemented. Stress in the family, mental illness, unrealistic expectations, and lack of knowledge have all been shown to be preceding factors in maltreatment risk. To help address some of these risks, an education program consisting of the Period of PURPLE crying, a social and economic stressor questionnaire, and the Parenting Action Plan was designed for maternal caregivers of newborns at pediatric clinics. This paper explores implementation challenges and successes of the education program, and describes strategies to implement such a program for maternal caregivers of newborns in pediatric clinics.
Methods: The education program was delivered at 4 pediatric clinics serving low-income families in Houston, Texas. Each clinic received a program orientation, topic specific training for implementing staff, and technical assistance as needed. The implementation evaluation of the education program focused on responses from key informant interviews with 18 staff members from the 4 pediatric clinics. Interview data was recorded through note taking then transcribed and coded relying on the grounded theory approach using inductive reasoning for analysis.
Results: A majority of the 18 study staff interviewed across all four clinics expressed the need for and benefits of providing an education program to maternal caregivers of newborn during well-child visits. Key themes that emerged were (1) maternal caregivers were receptive to an education program for support during well-child visits and staff saw its benefits, (2) motivational interviewing was helpful in engaging caregivers in conversations, and (3) it is important to establish a workflow that can accommodate the maternal caregivers and clinic needs alike.
Conclusions: An education program in pediatric clinics is a valuable resource to support maternal caregivers and their families. This type of program can be achievable when key factors are in place including: leadership and staff buy-in by having program transparency, efficient workflow that carefully considers maternal caregivers and staff time, and willingness of the organization is invest into the program. However, there is no one-size fits-all approach to successfully implement an education program into a routine part of pediatric care. It is vital to understand the organizational and structural strengths of each implementing clinic and leverage personnel in order to implement the program components with the highest fidelity
