The Family Check-Up 4 Health (FCU4Health): Applying Implementation Science Frameworks to the Process of Adapting an Evidence-Based Parenting Program for Prevention of Pediatric Obesity and Excess Weight Gain in Primary Care.

Justin D Smith,Sara M St George,Cady Berkel,Anne M Mauricio,Thomas J Dishion,Jenna Rudo-Stern,Meg M Bruening,Zorash Montaño,Guillermo Prado,Amanda Chiapa

doi:10.3389/fpubh.2018.00293

Abstract

Implementation experts have recently argued for a process of “scaling out” evidence-based interventions, programs, and practices (EBPs) to improve reach to new populations and new service delivery systems. A process of planned adaptation is typically required to integrate EBPs into new service delivery systems and address the needs of targeted populations while simultaneously maintaining fidelity to core components. This process-oriented paper describes the application of an implementation science framework and coding system to the adaptation of the Family Check-Up (FCU), for a new clinical target and service delivery system—prevention of obesity and excess weight game in primary care. The original FCU has demonstrated both short- and long-term effects on obesity with underserved families across a wide age range. The advantage of adapting such a program is the existing empirical evidence that the intervention improves the primary mediator of effects on the new target outcome. We offer a guide for determining the levels of evidence to undertake the adaptation of an existing EBP for a new clinical target. In this paper, adaptation included shifting the frame of the intervention from one of risk reduction to health promotion; adding health-specific assessments in the areas of nutrition, physical activity, sleep, and media parenting behaviors; family interaction tasks related to goals for health and health behaviors; and coordinating with community resources for physical health. We discuss the multi-year process of adaptation that began by engaging the FCU developer, community stakeholders, and families, which was then followed by a pilot feasibility study, and continues in an ongoing randomized effectiveness-implementation hybrid trial. The adapted program is called the Family Check-Up 4 Health (FCU4Health). We apply a comprehensive coding system for the adaptation of EBPs to our process and also provide a side-by-side comparison of behavior change techniques for obesity prevention and management used in the original FCU and in the FCU4Health. These provide a rigorous means of classification as well as a common language that can be used when adapting other EBPs for context, content, population, or clinical target. Limitations of such an approach to adaptation and future directions of this work are discussed.

Highlights

Translation of evidence-based interventions, programs, and practices (EBPs) for children and adolescents to the real-world service systems that can support them is a challenging endeavor and the lack of wide scale dissemination and implementation is well documented [1, 2]
This paper attempts to accomplish three aims: First, we propose four levels of evidence as a framework to guide decision-making around the adaptation of an EBP for a new clinical target—this is not represented in the adaptation literature
This section of the paper describes the FCU4Health program and classifies in what ways the original Family Check-Up (FCU) was adapted for primary care or enhanced for the prevention of obesity and excess weight gain

Summary

Introduction

Translation of evidence-based interventions, programs, and practices (EBPs) for children and adolescents to the real-world service systems that can support them is a challenging endeavor and the lack of wide scale dissemination and implementation is well documented [1, 2]. Parenting programs are slowly making their way into the service delivery systems where youth and families are served. These include social services, schools, and home visitation. A relevant setting where such interventions have not largely been adopted is pediatric primary care. This setting is relevant for preventive parenting interventions as the majority of children in the U.S receive annual primary care services [5]; low-income children have high rates of access [6]; parents expect to receive parenting advice from physicians and view them as respected experts; there are potentially stable mechanisms to fund these EBPs, whereas in other settings, these are lacking; and this setting does not hold the stigma that others, such as schools, do [7]. One of the barriers to doing so, is the need to adapt parenting programs for the primary care context and the populations that would receive these interventions

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