Parent Engagement in an Integrated Care Parenting Intervention to Prevent Toxic Stress

Objective: This study assessed parent engagement and satisfaction with an evidence-based parenting intervention delivered within a pediatric primary care clinic serving families at-risk for toxic stress. Method: Ten pilot study parent participants (all female; 80% African American; mean age = 26.1 years) completed sociodemographic, adverse childhood experiences (ACEs) history, depression, social support, and session satisfaction measures to assess parent characteristics and intervention satisfaction. Parent attendance was assessed and thematic analysis of session notes was conducted to assess parent engagement in intervention sessions. Results: Sixty percent of respondents had elevated ACE scores (Total Score ≥4), and 27% of respondents had elevated Edinburgh (Total Score ≥10). Attendance in intervention sessions was inconsistent. Thematic analysis indicated that parents demonstrated several engagement behaviors during sessions they attended, including sharing opinions/disclosing information and providing one's point of view. Follow-through with activities recommended during intervention sessions was more likely when linked to parents' personal strengths or concerns. Parents reported all session content as "helpful or "very helpful" and would recommend the program to others. Conclusions: Parents experiencing risk factors for toxic stress may face challenges in consistently attending integrated care parenting intervention sessions but engage in sessions they attend. Strategies for engaging parents at risk for toxic stress in a primary care-based parenting program include building from parent strengths, addressing identified parent concerns, offering proactive support including parent mental health promotion, and building trusting relationships. Implications for Impact Statement This is a small pilot study that assessed parent engagement in a parenting program connected to infant well-child visits. The intervention was designed to promote responsive caregiving by strengthening parents' understanding of their infant's behavior and supporting parents in responding to their child's emotional and physical needs. The study found that building from parent strengths, responding to identified parent concerns, offering proactive support (including parent mental health referrals), and building trusting relationships may promote parent engagement.