O3207: The Iowa CARE Project: Cultivating Attachment Through Relationship Education

Background: Early Relational Health (ERH) is a framework for exploring and understanding the impact of early relationships and experiences on a child's growth, learning, and health over their lifespan. ERH develops over time within safe, secure, nurturing caregiver/child relationships (SSNRs). SSNRs are biological necessities for all children that buffer toxic stress, build resilience, and promote wellness. Pediatric primary care providers are ideally positioned to support families in promoting SSNRs by building 2-generational skills. However, pediatric providers have varied levels of knowledge and skill in ERH promotion. Our objective with the Iowa CARE (Cultivating Attachment through Relationship Education) project was to identify and train pediatric champions to promote ERH to other pediatric providers across the state in order to reach more patients and families. Our secondary objective was to increase our AAP Chapter’s capacity for future ERH advocacy by continued connection with Iowa’s ERH champions.

Project Description: We convened a statewide, cross-sector CARE team steering committee who created the following tools: a "train-the-trainer" ERH webinar, a digital ERH resource toolkit, and a hands-on toolkit for providers. The committee then recruited 4 pediatric champions from underserved regions to be trained in the CARE project ERH model. CARE champions and steering committee members were surveyed before and after the training session to evaluate their knowledge and practice of ERH promotion practices. CARE Champions then trained pediatric providers at a rural clinic in their region on the CARE model. These providers also participated in the surveys.

Discussion: CARE champions increased their knowledge and practices of ERH after completing the webinar. Rural clinicians also increased their knowledge and practices after the webinar. The addition of the hands-on toolkit and digital toolkit were effective in increasing knowledge and practices at rural clinics. We were also able to complete a 1-page user's guide to how this project can be translated into a Quality Improvement project for providers across our state or in other states. Recruitment of rural Champions was challenging due to the 2022 “Tri-demic” which limited participation of several CARE Champions.

Conclusion: When pediatric providers are trained on promotion of ERH, they improve their knowledge, attitudes, and communication of ERH to their patients. Working with both statewide early childhood stakeholders and pediatricians from across 4 regions allowed us to diversify and amplify messaging in order to reach more of Iowa’s children at risk. We also created useful tools for pediatricians to continue to use which are on our Iowa AAP Website. Further research into how these discussions improve caregiver/child relationships and other child health outcomes is needed.