P3B367: Promoting First Relationships and the Parallel Process - Supporting Residents to Support Early Child-caregiver Relationships

Background: “The best way for a doctor to promote Early Relational Health (ERH) is by living it and demonstrating the importance of building emotional connection in the way you listen and talk to the families you serve. Do you want to encourage parents and caregivers to find everyday moments to emotionally connect with their babies? Role Model it for the families. Never underestimate the power of your actions when you are a trusted partner with the families you serve.” — ERH Family Network Collaborative Parent Leader

To support strong, positive, and nurturing early child-caregiver relationships within primary care, medical trainees require training and support. Promoting First Relationships (PFR) in Pediatrics, adapted from an evidenced-based home visiting program, provides foundational training in ERH including specific connecting strategies (Table 1) and a way of being with families to ensure they feel valued and supported. The training transforms traditional wellness care using a relationship-based framework to observe responsive caregiving in the moment and provide positive, reflective feedback helping caregivers support their child’s social-emotional development. Feeding, sleep and challenging behaviors are approached through a developmental, relationship-focused lens (Figure 1). The training operationalizes the ideals of cultural humility and strengths-based care.

Methods: Pediatric and family medicine residents take a half day, small-group PFR training facilitated by 2 primary care pediatricians with early childhood expertise. The training includes infant mental health foundations, wellness visit specific strategies and anticipatory guidance, videos to practice observational skills and space for self-reflection. Participants voluntarily complete a post then pre-format survey.

Results: 46 pediatric and 11 family medicine residents completed the PFR training in the 2021 academic year. On a scale of 0 (strongly disagree) to 5 (strongly agree), residents reported improved confidence after the training in establishing trusting relationships with caregivers (mean-4.4) and helping families support their child’s development (mean-4.4). Residents noted being more comfortable observing parent-child interactions and understanding strengths and vulnerabilities in the relationship (mean-4.5) and working with caregivers reporting behavioral difficulties (mean-4.0).

Examples changes residents intended to make after the training (selected illustrative quotes):
- “I want to do less talking and more listening”
- “Focus more on the parent and child dynamic rather than my own questions”
- “Vocalize my observations of the child more, so the family can hear the positives about their child and their parent-child relationship”
- “I intend to take my time with each patient, resetting my mind prior to entering each patient room. Now I will look for more patient cues and point these out to parents.”

Conclusion: PFR training helps residents understand how to foster early child-caregiver relationships within primary care. This foundational training early in residency supports trainees’ implementation of this vital approach in caring for families and children.