Positive Parenting and the Importance of Interdisciplinary Collaboration
By Kayla Reed
Sarah Kate Bearman, PhD, and Abby Bailin, a doctoral student in the department of psychology, are two examples of true collaboration here at UT Austin. In previous years, Bailin has worked with Bearman as both a doctoral student and full-time research assistant. The two reinstated their partnership in the summer of 2016 for a project centered around their shared goal of advancing access and use of research supported mental health treatments proven to be effective, specifically for children in traditionally underserved communities.
Though there are large number of treatments developed in academic settings, there is an equally large research to practice gap. Many of the populations studied in academic research trials don’t reflect the characteristics of children needing services in the real world. Trials often exclude “complicated” cases in favor of children with singular diagnoses. This simplicity is not at all mirrored by the diversity in mental health service settings which leaves many providers unsure of how to apply evidence-based treatment to cases. There is also a large percentage of children who simply won’t find their way to places where specialty services, like mental health support, are offered. With this in mind, Bearman and Bailin have developed a program of research that emphasizes making research-supported treatments fit real children, training people from a variety of backgrounds in these treatments, and then increasing access to these services.
The pair previously worked with mental health clinics, child welfare agencies, and schools, which can provide a percentage of mental health services for young children. They shifted their interest to primary care after realizing that it offered a chance to reach younger children, who often don’t begin school until age five or six.
Bailin: “We don’t have required pre-k here, so you could have children in need of mental health services that won’t show up on a school’s radar until six or seven. However, many children go see their pediatrician. By the time a kid is five they may have had up to 30 well-child visits. This means they have a relationship with the office. It’s a place they can trust, so how can we move mental health services into those settings?”
Bailin originally shadowed providers at partner clinics in the Austin area during well-child visits and had planned to provide training on how to incorporate mental health interventions during visits. After observing just two families, she realized time and task restraints made this approach impossible.
A lack of time with physicians is just one pitfall of the movement to manage emotional as well as physical stress in primary care settings. Many existing models integrating mental health into primary care involve increasing training for staff which can be expensive and taxing on already busy providers. Other approaches involve mental health professionals being co-located, as both separate offices down a hall and in-office consultants, but bringing new people into the fold can cause pragmatic challenges of its own.
In her clinic visits, Bailin noticed how much time families spent waiting to see providers or accessing clinic info. The team recognized this window of opportunity and steered development toward a video intervention centered around Behavioral Parent Training, a scientifically supported treatment that improves parent-child relationships and improves children’s emotional and physical well-being. While a full BPT intervention could take as long as 20 weeks with multiple moving parts, Bearman wanted to focus on one piece that she felt could be an important protective factor for children: having a warm and responsive caregiver.
“Promoting Positive Parenting for High-Risk Families in Primary Care Settings” was formed and presented to a grant competition funded by the Seton-CHASP Research Collaborative. At a potential grantee meeting, Bearman says the mission for the 2017 cycle was described as “focused on value-based care,” or how to add value to what is already being provided without increasing cost. As this project planned to take advantage of well-child visits already covered by Medicaid and 3rd party payers, it was selected as one of just three winning proposals.
In order to further the development phase, the pair reached out to Dr. Mike Mackert, Director of the Center for Health Communication.
Bearman: “We really knew nothing about the technology options available to us, but we were interested in how much of what [Mackert] and the Center does is really at the heart of our own mission. We thought ‘This guy is the Director, he’s never going to do it… but let’s send him an email anyway and see what happens!’ Of course Dr. Mackert being Dr. Mackert, he replied incredibly promptly and was like ‘Let’s set up a meeting!”
Bearman and Bailin were the content drivers for the project, including what the treatment evidence base deems the most important for mental health interventions. Mackert drove the methodology backed by his experience communicating health to people in similar higher risk environments. His advice has been very influential on the design of this project and both women say they’ve learned a lot.
Bailin: “I don’t understand how we ever functioned before! I remember one time leaving a meeting with Mike thinking ‘How are we ever going to make change happen if we don’t partner with people like this?’”
Bearman: “Right! Some of [Mackert’s approaches] were so radically different from what our own methodologies. It’s really different when you’re developing a product with a certain marketing aspect. There’s a real problem in the field of implementation science for mental health, which is that we sometimes all just talk to each other. We need to be partnering more with stakeholders more and understanding how that social messaging works. To move research based practices into real world service you have to be communicating with the users. Clinicians and other end users like parents will require different methods of appeal. It’s great to find people who view problems through this lens.”
Mackert is helping to facilitate a mindful consumer codesign of this project by bringing in the right questions. How do families access technology? What is their previous experience with mental health education? Where or when would they feel most comfortable receiving advice? Both Bearman and Bailin highlight the benefits they’ve experienced by including this communication expertise and plan on utilizing the Center’s resources for future projects.
In the coming months, 10 caregivers of children aged 2-8 will be interviewed at routine well-child visits to inform a prototype of the video training platform. The beta phase will have 30 families providing feedback to fine-tune the interface. For the final phase of randomized trials, the team hopes to secure close to 500 families in Austin and surrounding areas.
Bearman has a strong personal mission to increase access to research supported, effective services. In addition to the study, she will be providing behavioral training to any staff or providers at the partner clinics.