Expanding the pediatrician's black bag: a psychosocial care improvement model to address the "new morbidities".
BACKGROUND
Behavioral, developmental, and psychosocial problems ("new morbidities") significantly affect the well-being of children ages 0-3 years. Practices generally fail to deliver consistent anticipatory guidance or counseling to parents. A multifaceted intervention was designed to increase the capacity of three very different practice types to adopt and implement Practicing Safety, a child abuse and neglect prevention program.


METHODS
Using a feasibility intervention study, a combination of organizational change approaches, including complexity science principles--self-organization, emergence, and co-evolution--were tested. The multimethod assessment process (MAP) was employed to understand the unique characteristics of each practice that could impede or promote innovation. Findings guided a facilitated, team-based change intervention, the Reflective Adaptive Process (RAP) to restructure psychosocial care.


RESULTS
Each practice demonstrated fundamental changes in decision making, developmental assessment, and parent education processes. Practicing Safety tools were adopted and incorporated into daily routines. RAP team members exhibited new patterns of communication and relationships that supported organizationwide preventive service innovations.


CONCLUSIONS
The MAP and RAP interventions enabled study practices to integrate novel methods for prevention of child abuse and neglect into daily routines.
Abatemarco
Diane J
DJ
Graduate School of Public Health, University of Pittsburgh, USA. dja17@pitt.edu
Kairys
Steven W
SW
Gubernick
Ruth S
RS
Kairys
Jo Ann
JA
D002648:Child; D002649:Child Abuse / Q000517:prevention & control / Q000523:psychology; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017146:Models, Organizational; D010287:Parent-Child Relations; D010372:Pediatrics; D010824:Physicians' Offices / Q000458:organization & administration*; D011320:Primary Health Care; D011584:Psychology