Parent Connext: Parent Coaching in Pediatric Practices

Parent Connext is a collaborative parent coaching process that helps parents and other caregivers navigate everyday parenting challenges. The coaching process supports parents in reducing and/or preventing toxic stress within their family, as well as helping their children develop critical life skills and coping skills needed for them to thrive. Parent Connext is rooted within the Natural Strength Parenting framework, which draws on ideas from social cognitive theory (e.g., goal-setting and monitoring and self-efficacy) and positive psychology (e.g., mindfulness and strengths) to develop a coaching model within which parents are active collaborators in their goal-setting and behavior change process. Parent Connext parent coaches are embedded within pediatric practices, which enables enhanced communication among pediatricians, medical office staff, and parent coaches, thereby enabling the program to intervene quickly and mitigate the potential for negative long-term health and social concerns.

Population-wide screenings at identified well-child visits (1 month, 15 months, 3 years, etc.) assess risk factors such as adverse childhood events (ACEs), food/financial insecurity, harsh discipline and parental stress. Families screened as “at risk” are identified for parent coaching, as are families who report parenting concerns at other pediatric appointments. Coaches repeatedly outreach to parents to engage them in coaching. The goal of coaching is to educate, empower and guide parents in creating their own solutions to parenting concerns, addressing risk factors and improving family functioning in order to support their children’s development and positive health outcomes. Coaching engagements with parents typically range between two and six sessions; current program average is 2.86 sessions. The initial session is approximately 90 minutes, while follow-up sessions typically last 45 minutes to one hour. The primary reasons parents seek and/or are referred to coaching are for child behavioral issues, child emotion regulation, anxiety, school concerns, sleep issues, sibling rivalry and parental stress.

The coaching process is focused on collaborative identification and attainment of the goals identified by parents at intake and throughout the coaching process. Specific steps in the process include: 1) identify desired outcomes, 2) establish specific parenting vision/goals, 3) provide information/education key to obtaining desired change, 4) co-create an action plan for achieving parenting goals, 5) monitor and evaluate progress, and 6) modify action plans as needed. The monitor-evaluate-modification steps of this process constitute a simple cycle of self-regulated behavior that is key in creating intentional behavior change4 and resulting in sustained improvements in parent-child interactions.

The goal of Parent Connext is to support parents in reducing and/or preventing toxic stress in the family and help children develop critical life skills and coping skills. Recent studies have found that up to 50% of health outcomes are attributable to social and economic factors and that lifetime costs associated with child maltreatment are comparable to other costly healthcare conditions such as stroke or type 2 diabetes. Moreover, 4 in 5 physicians report lacking confidence in their ability to meet patients’ social needs, which can impede their ability to provide high quality medical care. As a result, interventions that target parents’ social needs may have important implications for reducing healthcare costs and have the added benefit of enabling physicians to provide high-quality care to their patients.

Parent Connext was evaluated using pre-test and post-test measures of parental and family functioning from 10 pediatric clinics in southwestern Ohio and northern Kentucky.
Four subscales of The Healthy Family Parenting Inventory (HFPI) were administered to parents at intake (n = 246). The HFPI subscales used to evaluate the program assess change in four domains of healthy parenting: parenting efficacy, parent-child behavior, role satisfaction, and personal/self-care. Comparison of the HFPI domain scores at the beginning of the program and after three program sessions used a paired-samples analysis showed statistically significant improvements in role satisfaction (t=-5.68, p<.001, 95% CI [-1.54, -0.75]), parent-child behavior (t=-8.86, p<.001, 95% CI [-2.46, -1.36]), parenting efficacy (t=-7.67, p<.001, 95% CI [-2.42, -1.43]), as well as the combined overall parenting score (t=-7.53, p<.001, 95% CI [-6.75, -3.95]). Moreover, an additional paired samples analysis (n=81) revealed that improvements in domain scores persisted at three months following case closure: role satisfaction (t=-3.70, p<.001, 95% CI [-2.00, -0.60]), parent-child behavior (t=-4.90, p<.001, 95% CI [-3.45, -1.45]), parenting efficacy (t=-2.57, p=.012, 95% CI [-2.08, -.26]), and overall parenting (t=-4.06, p<.001, 95% CI [-7.64, -2.60]). Personal/self-care domain scores after three program sessions and three months-post case closure were elevated compared to pre-program scores, but did not reach statistical significance (p=.11 and p=.64, respectively).