P3A161: Quality Improvement for Resiliency Parenting Education: "Resilience University" as an Intervention to Integrate Healthy Coping Skills and Trauma-informed Guidance into Pediatric Primary Care

Background: The depth and breadth of primary care advice in response to symptoms arising from trauma remains limited. Pediatricians routinely provide anticipatory guidance and parenting advice however an understanding of trauma-informed, resilience fostering advice has not been routinely integrated into pediatric training or practice. During COVID, mental and behavioral health issues increased creating an opportunity to improve the quality and quantity of resiliency parenting advice provided in the context of existing primary care pediatric relationships, using mental health and behavioral concerns as the point of engagement with families.

Methods: An August 2020 survey consisting of a convenience sample of 40 pediatric providers via Facebook's COVID-19 Pediatrician Group confirmed other providers also felt more resiliency tools would be helpful in responding to behavioral and mental health needs. I developed a step-wise approach to integrating evidence-based resiliency parenting education (“Resilience University" or "RU") which included positive parenting tools and healthy coping strategies in combination with motivational interviewing and Plan-Do-Study-Act (PDSA) cycles. This approach allowed resilience building guidance to be readily available when addressing potential toxic stress or trauma related symptoms. I piloted the approach with four providers in my practice in November 2020 as a small test of change to evaluate if RU was an improvement.

Results: Facebook survey participants agreed they’d like more ways to counsel parents with mental and behavioral health issues (85%) and to offer alternates to time-outs (85%). 80% of respondents also reported not having enough community resources for current mental health needs and 82.5% reported not enough resources for behavioral health needs. The provider intervention included two 1-hour training sessions with four pediatric providers who all reported increased confidence in coaching parents and patients in self-care (breathing exercises, meditation and mindfulness practices), alternates to time-outs as well as discussing suicidal ideation with patients and parents. One parent commented: "The lessons and skills you taught us will be used for a lifetime! We thank you so much for instilling in us a greater understanding of emotional behavior of a young child. We are forever grateful."

Conclusion: "Resilience University" holds promise as a novel approach to bolster pediatric providers depth and breadth of resiliency parenting education. Integrating evidence-based resilience building strategies into routine primary care pediatrics was well received by families and providers in this small test of change. Tailoring the approach to meet the acute mental or behavioral health needs of the family in a strengths-based fashion allows providers to integrate trauma-responsive care making proven protective factors more accessible. RU could be studied to evaluate if it reduces barriers to positive childhood experiences in families where parents have experienced trauma and appears to offer a feasible, quick and cost-effective response to family stress and childhood adversity.