Skip to main content

Advertisement

SpringerLink
Log in

Behavior Checker® Staff Training for Positive Parenting in Primary Care: Changes in the Knowledge, Attitudes, and Confidence

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

Adverse Childhood Experiences have been associated with an increased risk for various health and mental health challenges in adulthood, which shed new light on positive parenting as important preventive healthcare. Although behavioral parenting interventions have been shown to be effective in promoting positive parenting and reducing harsh discipline, beneficiaries have been limited to parents with identified needs. Lately, primary care has been increasingly recognized as an ideal platform to disseminate evidence-based positive discipline strategies at the population level. Behavior Checker® is a multi-component primary care-based parenting intervention, seeking to maximize the utility of primary care in population-based positive parenting promotion. The purpose of this study was to examine the effects of Behavior Checker® training on pediatric staff’s perceived knowledge, attitude, and confidence in educating parents about positive discipline strategies. Pre- and post-training surveys were administered to staff who participated in the Behavior Checker® training in a university-affiliated pediatric clinic located in a Midwestern metropolitan region. A paired t-test and Wilcoxon signed-rank tests were conducted to compare pre- and post-training scores in the perceived knowledge and confidence in educating parents about positive discipline strategies to manage common behavioral issues of children. The level of perceived knowledge and confidence significantly increased following staff’s participation in the training. A larger study is warranted.

Highlights

  • Primary healthcare can be a potential dissemination channel for evidence-based positive discipline strategies.

  • Behavior Checker®, a multi-component positive parenting intervention, may be effective in increasing primary healthcare staff’s knowledge and confidence in parenting education.

  • Educating and training primary care healthcare staff in positive discipline can maximize the utility of primary care in population-based positive parenting promotion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T.

    Article  Google Scholar 

  • Aragon, N. J., Hudnut-Beumler, J., White Webb, M., Chavis, A., Dietrich, M. S., Bickman, L., & Scholer, S. J. (2013). The effect of primary care interventions on children’s media viewing habits and exposure to violence. Academic Pediatrics, 13(6), 531–539. http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/086/CN-00915086/frame.html.

  • Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037//0033-295x.84.2.191.

    Article  PubMed  Google Scholar 

  • Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122–147.

    Article  Google Scholar 

  • Barth, R. P., & Liggett-Creel, K. (2014). Common components of parenting programs for children birth to eight years of age involved with child welfare services. Children and Youth Services Review, 40, 6–12.

    Article  Google Scholar 

  • Bender, H. L., Allen, J. P., McElhaney, K. B., Antonishak, J., Moore, C. M., Kelly, H. O. B., & Davis, S. M. (2007). Use of harsh physical discipline and developmental outcomes in adolescence. Development and Psychopathology, 19(01), 227–242.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berkel, C., Rudo‐Stern, J., Abraczinskas, M., Wilson, C., Lokey, F., Flanigan, E., Villamar, J. A., Dishion, T. J., & Smith, J. D. (2020). Translating evidence‐based parenting programs for primary care: stakeholder recommendations for sustainable implementation. Journal of Community Psychology, 48(4), 1178–1193. https://doi.org/10.1002/jcop.22317.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berkovits, M. D., O’Brien, K. A., Carter, C. G., & Eyberg, S. M. (2010). Early identification and intervention for behavior problems in primary care: a comparison of two abbreviated versions of parent-child interaction therapy. Behavior Therapy, 41(3 Sep), 375–387. https://doi.org/10.1016/j.beth.2009.11.002.

    Article  PubMed  Google Scholar 

  • Berkule, S. B. P., Cates, C. B. P., Dreyer, B. P. M. D., Huberman, H. S. M. D. M. P. H., Arevalo, J. B. A., Burtchen, N. M. D., Weisleder, A. P., & Mendelsohn, A. L. M. D. (2014). Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care. Clinical Pediatrics, 53(5), 460–469.

    Article  PubMed  PubMed Central  Google Scholar 

  • Breitenstein, S. M., Fogg, L., Ocampo, E. V., Acosta, D. I., & Gross, D. (2016). Parent use and efficacy of a self-administered, tablet-based parent training intervention: a randomized controlled trial. JMIR mHealth and uHealth, 4(2), e36–e36. https://doi.org/10.2196/mhealth.5202.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, J., Cohen, P., Johnson, J. G., & Salzinger, S. (1998). A longitudinal analysis of risk factors for child maltreatment: findings of a 17-year prospective study of officially recorded and self-reported child abuse and neglect. Child Abuse & Neglect, 22(11), 1065–1078.

    Article  Google Scholar 

  • Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 35(6), 408–413. https://doi.org/10.1016/j.chiabu.2011.02.006.

    Article  Google Scholar 

  • Canfield, C. F., Weisleder, A., Cates, C. B., Huberman, H. S., Dreyer, B. P., Legano, L. A., Johnson, S. B., Seery, A., & Mendelsohn, A. L. (2015). Primary care parenting intervention and its effects on the use of physical punishment among low-income parents of toddlers. Journal of Developmental and Behavioral Pediatrics, 36(8), 586–593. https://doi.org/10.1097/dbp.0000000000000206.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cates, C. B., Weisleder, A., Dreyer, B. P., Johnson, S. B., Vlahovicova, K., Ledesma, J., & Mendelsohn, A. L. (2016). Leveraging healthcare to promote responsive parenting: impacts of the Video Interaction Project on parenting stress. Journal of Child and Family Studies, 25(3), 827–835. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=27134514&site=ehost-live.

  • Centers for Disease Control and Prevention. (2017). Strategic direction for child maltreatment prevention: Preventing child maltreatment through the promotion of safe, stable, and nurturing relationships between children and caregivers. https://www.cdc.gov/violenceprevention/pdf/CM_Strategic_Direction-Long-a.

  • Centers for Disease Control and Prevention. (2018). The social-ecological model: a framework for prevention. Retrieved April 20 from https://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html.

  • Cohen, M. L., Heaton, S. C., Ginn, N., & Eyberg, S. M. (2012). Parent-child interaction therapy as a family-oriented approach to behavioral management following pediatric traumatic brain injury: a case report. Journal of Pediatric Psychology, 37(3), 251–261. https://doi.org/10.1093/jpepsy/jsr086.

    Article  PubMed  Google Scholar 

  • Combs-Orme, T. P., Nixon, B. H. L., & Herrod, H. G. M. D. (2011). Anticipatory guidance and early child development: pediatrician advice, parent behaviors, and unmet needs as reported by parents from different backgrounds. Clinical Pediatrics, 50(8), 729–737.

    Article  PubMed  Google Scholar 

  • Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Science, 4, 50 https://doi.org/10.1186/1748-5908-4-50.

    Article  Google Scholar 

  • Dubowitz, H., Lane, W. G., Semiatin, J. N., Magder, L. S., Venepally, M., & Jans, M. (2011). The safe environment for every kid model: Impact on pediatric primary care professionals. Pediatrics, 127(4), e962–e970.

    Article  PubMed  PubMed Central  Google Scholar 

  • Feigelman, S., Dubowitz, H., Lane, W., Grube, L., & Kim, J. (2011). Training pediatric residents in a primary care clinic to help address psychosocial problems and prevent child maltreatment. Academic Pediatrics, 11(6), 474–480. https://doi.org/10.1016/j.acap.2011.07.005.

    Article  PubMed  PubMed Central  Google Scholar 

  • Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8.

    Article  PubMed  Google Scholar 

  • Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2013). Improving the adverse childhood experiences study scale. JAMA Pediatrics, 167(1), 70–75. https://doi.org/10.1001/jamapediatrics.2013.420.

    Article  PubMed  Google Scholar 

  • Fixsen, D. L., Blase, K. A., Naoom, S. F., & Wallace, F. (2009). Core iplementation components. Research on Social Work Practice, 19(5), 531–540. https://doi.org/10.1177/1049731509335549.

    Article  Google Scholar 

  • Grazier, K. L., Smiley, M. L., & Bondalapati, K. S. (2016). Overcoming barriers to integrating behavioral health and primary care services. Journal of Primary Care & Community Health, 7(4), 242–248.

    Article  Google Scholar 

  • Grazier, K. L., Smith, J. E., Song, J., & Smiley, M. L. (2014). Integration of depression and primary care: Barriers to adoption. Journal of Primary care & Community Health, 5(1), 67–73.

    Article  Google Scholar 

  • Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. American Psychological Association.

  • Grol, R. P. T. M., Bosch, M. C., Hulscher, M. E. J. L., Eccles, M. P., & Wensing, M. (2007). Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Quarterly, 85(1), 93–138. https://doi.org/10.1111/j.1468-0009.2007.00478.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lang, T., & Rayner, G. (2012). Ecological public health: the 21st century’s big idea? An essay by Tim Lang and Geof Rayner. BMJ, 345, e5466.

    Article  PubMed  Google Scholar 

  • Leeman, J., Baernholdt, M., & Sandelowski, M. (2007). Developing a theory‐based taxonomy of methods for implementing change in practice. Journal of Advanced Nursing, 58(2), 191–200. https://doi.org/10.1111/j.1365-2648.2006.04207.x.

    Article  PubMed  Google Scholar 

  • Leslie, L. K., Mehus, C. J., Hawkins, J. D., Boat, T., McCabe, M. A., Barkin, S., Perrin, E. C., Metzler, C. W., Prado, G., Tait, V. F., Brown, R., & Beardslee, W. (2016). Primary health care: potential home for family-focused preventive interventions. American Journal of Preventive Medicine, 51(4), S106–S118. https://doi.org/10.1016/j.amepre.2016.05.014.

    Article  PubMed  PubMed Central  Google Scholar 

  • Loeb, D. F., Leister, E., Ludman, E., Binswanger, I. A., Crane, L., Dickinson, M., Kline, D. M., deGruy, F. V., Nease, D., & Bayliss, E. A. (2018). Factors associated with physician self-efficacy in mental illness management and team-based care. General Hospital Psychiatry, 50, 111–118. https://doi.org/10.1016/j.genhosppsych.2017.11.003.

    Article  PubMed  Google Scholar 

  • McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351–377.

    Google Scholar 

  • Moon, D. J., Damman, J. L., & Romero, A. (2020). The effects of primary care–based parenting interventions on parenting and child behavioral outcomes: a systematic review. Trauma, Violence, & Abuse, 21(4), 706–724. https://doi.org/10.1177/1524838018774424.

    Article  Google Scholar 

  • Moon, J., Unell, B., & Johnson-Motoyama, M. (2016). A Feasibility study of behavior checker: enhancing the capacity of pediatric staff to deliver evidence-based strategies to manage children’s common behavioral issues for parents society for prevention research 25th ANNUAL MEETING, Washington D.C. https://spr.confex.com/spr/spr2017/webpr.

  • Perrin, E. C., Leslie, L. K., & Boat, T. (2016). Parenting as primary prevention. JAMA Pediatrics, 170(7), 637–638. https://doi.org/10.1001/jamapediatrics.2016.0225.

    Article  PubMed  Google Scholar 

  • Perrin, E. C. M. D., Sheldrick, R. C. P., McMenamy, J. M. P., Henson, B. S. P., & Carter, A. S. P. (2014). Improving parenting skills for families of young children in pediatric settings: a randomized clinical trial. JAMA Pediatrics, 168(1), 16–24. https://doi.org/10.1001/jamapediatrics.2013.2919.

    Article  PubMed  Google Scholar 

  • Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health, 36, 24–34.

    Article  PubMed  Google Scholar 

  • Raised with Love and Limits Foundation. (n.d.). Behavior checker: parenting is healthcare. Retrieved October 26 from https://childrens.behaviorchecker.org/.

  • Sanders, M. (1999). Triple P-Positive Parenting Program: Towards an empirically validated multilevel parenting and family support strategy for the prevention of behavior and emotional problems in children. Clinical Child and Family Psychology Review, 2(2), 71–90. https://doi.org/10.1023/A:1021843613840.

    Article  PubMed  Google Scholar 

  • Schilling, S., French, B., Berkowitz, S. J., Dougherty, S. L., Scribano, P. V., & Wood, J. N. (2016). Child-Adult Relationship Enhancement in Primary Care (PriCARE): a randomized trial of a parent training for child behavior problems. Academic Pediatrics, 17(1 Jan-Feb), 53–60. https://doi.org/10.1016/j.acap.2016.06.009.

    Article  PubMed  Google Scholar 

  • Scholer, S. J., Hudnut-Beumler, J., & Dietrich, M. S. (2011). The effect of physician–parent discussions and a brief intervention on caregivers’ plan to discipline: is it time for a new approach? Clinical Pediatrics, 50(8), 712–719. https://doi.org/10.1177/0009922811400730.

    Article  PubMed  Google Scholar 

  • Sege, R. D., Siegel, B. S., ABUSE, C. O. C., CHILD, C. O. P. A. O., & HEALTH, F. (2018). Effective discipline to raise healthy children. Pediatrics, 142(6), e20183112.

  • Shah, R., Kennedy, S., Clark, M. D., Bauer, S. C., & Schwartz, A. (2016). Primary care-based interventions to promote positive parenting behaviors: a meta-analysis. Pediatrics, 137(5), e20153393. https://doi.org/10.1542/peds.2015-3393.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shonkoff, J. P. (2012). Leveraging the biology of adversity to address the roots of disparities in health and development. Proceedings of the National Academy of Sciences, 109 (Supplement 2), 17302–17307.

  • Turner, K. M. T., & Sanders, M. R. (2006). Help when it’s needed first: a controlled evaluation of brief, preventive behavioral family intervention in a primary care setting. Behavior Therapy, 37(2), 131–142. https://doi.org/10.1016/j.beth.2005.05.004.

    Article  PubMed  Google Scholar 

  • Turner, K. M., Nicholson, J. M., & Sanders, M. R. (2011). The role of practitioner self-efficacy, training, program and workplace factors on the implementation of an evidence-based parenting intervention in primary care. The Journal of Primary Prevention, 32(2), 95–112.

    Article  PubMed  Google Scholar 

  • Unell, B., & Wyckoff, J. (2016). Behavior checker: pediatric telephone and office prescriptions for managing common behavioral issues (1st ed.). Raised with Love and Limits Foundation.

  • Violence Prevention Alliance in World Health Organization. (2018). The ecological framework. http://www.who.int/violenceprevention/approach/ecology/en/.

  • Webster‐Stratton, C. (2010). Adapting the incredible years, an evidence‐based parenting programme, for families involved in the child welfare system. Journal of children’s Services, 5(1), 25–42. https://doi.org/10.5042/jcs.2010.0115.

  • Weiss, B., Dodge, K. A., Bates, J. E., & Pettit, G. S. (1992). Some consequences of early harsh discipline: Child aggression and a maladaptive social information processing style. Child Development, 63(6), 1321–1335.

    Article  PubMed  Google Scholar 

  • Woods-Jaeger, B., Thompson, J. E., Foye-Fletcher, A., Siedlik, E., Chakawa, A., Dalbey, K., & Gupta, R. C. (2020). Parent engagement in an integrated care parenting intervention to prevent toxic stress. Clinical Practice in Pediatric Psychology, 8(3), 298–303.

    Article  Google Scholar 

  • Zero to Three. (2016). National parent survey report. Retrieved November 17 from https://www.zerotothree.org/resources/1425-national-parent-survey-report.

Download references

Funding

This study was funded by the University of Kansas.

Author information

Authors and Affiliations

  1. School of Social Work, University of Pittsburgh, 2217A Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA

    Deborah J. Moon

  2. Pediatrics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA

    Stephen J. Lauer

  3. Raised with Love and Limits Foundation, 3004W 118th St, Leawood, KS, 66211-3056, USA

    Barbara Unell

Authors
  1. Deborah J. Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen J. Lauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barbara Unell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah J. Moon.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moon, D.J., Lauer, S.J. & Unell, B. Behavior Checker® Staff Training for Positive Parenting in Primary Care: Changes in the Knowledge, Attitudes, and Confidence. J Child Fam Stud 30, 932–940 (2021). https://doi.org/10.1007/s10826-021-01917-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-021-01917-3

Keywords

Search

Navigation