Examining Implementation Outcomes of Sit Down and Play, a Primary Care-Based Intervention, in a Large Urban Primary Care Clinic.

Abstract

Economical, operational, and employment strains present challenges for widespread implementation of parent-directed interventions. We designed Sit Down and Play (SDP) with the aim of creating a brief primary care-based program that encourages positive parenting practices through take-home play activities. To develop a sustainable model of implementation in real-world settings, we explored the use of university student volunteers as a potential solution for employment strains. Guided by Proctor and colleagues' implementation outcome framework, this study focused on understanding the following implementation outcomes: acceptability, feasibility, fidelity, and service penetration. Exploratory analysis on the limited-efficacy of the program on parental behavior was also assessed. Student facilitators were trained utilizing a train-the-trainer model. During the study period, facilitators delivered SDP to caregivers attending theirwell-child visits(WCVs) in a primary care clinic serving predominantly low-income families. Implementation data was gathered from clinic records, student facilitator surveys, and caregiver surveys. Student facilitators delivered SDP interventions to 99/146 (67.8%) eligible families. Caregivers overwhelmingly found the program helpful (M = 4.70, SD = 0.82), enjoyable (M = 4.88, SD = 0.32), and were highly satisfied with individuals who delivered it (M = 4.97, SD = 0.16).Student facilitators successfully delivered the program with high fidelity. Implementation findings suggest that delivery of SDP by student volunteers combined with the use of a train-the-trainer model is a feasible model to integrate strategies that support positive parenting behaviors into existing systems, such as the primary care setting. This study yields promising results that suggest the benefit of utilizing university partnerships with healthcare settings for wider dissemination and adaptations for other subgroups and contexts.