3 - (SYM 11) Family-reported Determinants of Engagement in Behavioral Parent Training Based in Primary Care for Children with ADHD

Minoritized families of low socioeconomic status experience significant logistical (e.g., transportation, scheduling, childcare) and perceptual (e.g., mistrust of the system, stigma, provider cultural humility) barriers to engaging in evidence-based care (Hodgkinson et al., 2017). Integration of behavioral health into pediatric primary care is one promising approach to increasing equitable access to behavioral health care (Mautone et al., 2020), yet integration alone is insufficient to address engagement challenges (Hodgkinson et al., 2017). Partnering to Achieve School Success (PASS; Power et al., 2014) is an enhanced behavioral parent training (BPT) intervention for implementation in primary care with integrated behavioral health clinicians serving primarily low-income families of minoritized backgrounds. PASS has an explicit focus on addressing the needs of minoritized families. Intervention features include strategies to address trauma and chronic stress, a focus on clinician cultural humility, involvement of a Community Health Partner (CHP), school collaboration, and team-based care. The CHP, a liaison between providers and families, engages in regular communication to promote attendance and adherence, troubleshoot barriers, and connect families with community resources. The purpose of this presentation is to describe family-reported perceptions of the CHP and the cultural humility of clinicians.
To date, 13 families who participated in PASS have completed post-treatment interviews and preliminary qualitative coding has been conducted. Codes related to the CHP include helpfulness of session reminders, scheduling support, persistent encouragement, facilitated communication with the care team, and engagement-facilitating personality characteristics (reliable, respectful, non-judgmental, supportive, responsive). Areas for improvement include additional support for service navigation (e.g., insurance) and connection (e.g., social work, school) and support for talking with family members about mental health. Preliminary codes related to cultural humility of clinicians highlight openness to family background and being non-judgmental of generationally-learned discipline strategies. Interviews are ongoing and we anticipate data from an additional 20 interviews by the conference. The presentation will include a discussion of implications for developing and adapting BPT programs to support engagement in treatment delivered in primary care practices for minoritized families.