522 - Perceptions of Cultural Humility and Collaborative Models Enhancing Family Engagement in Pediatric Primary Care Programs

Publication Number: 4510.522

Janae Kuttamperoor, George Washington University School of Medicine and Health Sciences, New York, NY, United States; Victoria Guevara, NYU Langone Grossman School of Medicine, Sunnyside, NY, United States; Elizabeth B.. Miller, New York University Grossman School of Medicine, New York, NY, United States; Irish Joy Bicasan, Hunter College, White Plains, NY, United States; Yu Chen, New York University Grossman School of Medicine, New York, NY, United States; Kristin A. Ratliff, State University of New York Upstate Medical University, Syracuse, NY, United States; Diana Walther, NYU Grossman School of Medicine, New York, NY, United States; Caitlin F. Canfield, NYU Grossman School of Medicine, New York, NY, United States

Background: Implementing evidence-based programs (EBPs) in pediatric primary care (PPC) has proven benefits in promoting early relational health (ERH; stable, nurturing, positive caregiver-child relationships) and buffering children's adverse childhood experiences (e.g., family violence, neighborhood safety, family mental health symptoms). However, structural barriers and family challenges may inhibit families' capacity to participate in EBPs.

Objective: To explore clinic personnel's perceptions of barriers preventing families from accessing services in PPC, as well as their recommendations for promoting trust and acceptance of programs to increase family engagement.

Design/Methods: Eighteen physicians, nurses, and ERH program staff participated in five focus group discussions (FGD; mean participants/group = 3.6) based on results from a national survey of pediatric clinic personnel (n=126). FGDs were conducted via Zoom and explored barriers, strategies, and processes of integrating EBPs in PPC clinics. After transcription, two coders created a codebook, coded the transcripts in Dedoose, and searched for emergent themes and subthemes using thematic analysis.

Results: Focus groups largely consisted of urban and academic clinics that serve a high population of Medicaid eligible families (Table 1). Additionally, most participants identified as female (94%), White (89%), and non-Hispanic (78%).

Emergent themes revealed that 1) Families hesitate to participate in programs; 2) Patients fall through the cracks due to structural barriers (Table 2). Clinic personnel described language and socioeconomic and legal status as obstacles preventing trust in EBPs. Time and location constraints, in addition to lack of policies supporting ERH, decreased access to services. To mitigate these barriers, clinic staff suggested: 3) Cultural humility promotes trust and acceptance of programs; 4) Collaborative models and flexible scheduling enhance family engagement (Table 3). Clinic staff expressed that diversity and longevity within their team builds the rapport necessary to address families' complex care needs. Additionally, introducing programs as a continuation of care within their pediatric visits or via telehealth increases program accessibility.

Conclusion(s): Clinic personnel's ongoing commitment to building relationships with families fosters an optimal environment for offering EBPs in PPC clinics. Additionally, clinic staff's willingness to tailor EBPs to patients' needs is vital in engaging more families in programs and promoting ERH.

Table 1. Demographics and clinic characteristics (n= 18 participants across 5 focus groups)


Table 2. Barriers preventing families from accessing services


Table 3. Recommendations for building patient rapport