The TREE Program: Promoting Positive Early Childhood Experiences During Well-Child Visits

Access: Institutional Access

Publication year

2024

study description

quasi-experimental, wait-list control group feasibility study trial

core topic(s)

Early Relational Health , Pediatric Primary Care

Population Characteristics

Infant/Newborn , Toddler/Preschool

Exposures, Outcomes, Other

Clinic-Based Programs and Interventions

metric(s)

StimQ Cognitive Home Environment Questionnaire (StimQ)

objectives

1) Evaluate the developmental coaching TREE (Talk Read Engage Encourage) program for historically marginalized children ages 0 to 2 years, embedded within pediatric visits 2) Examine if TREE could enhance caregiver-child interactions and increase pediatric resident report of competency and self-efficacy in coaching caregivers

exposure

TREE program

outcomes evaluated

Parents' self-reported Parent Verbal Responsivity; residents' promotion of positive caregiver-child interactions, and residents' confidence in conveying child development

setting

outpatient primary care practices associated with 2 pediatric training programs in 1 mid-sized city (One site served as the intervention site and the other as the control site)

methods

Authors provided TREE program training to residents. Questionnaires assessed the experiences of residents and parents.

sample size

A convenience sample of 167 families (79 intervention; 88 control)

measures

STIMQ2

• • Relevant STIMQ2 subdivisions
    • Reading (subdimensions Quantity, Diversity, Quality)
    • Parental Involvement in Developmental Advance (PIDA)
    • Parental Verbal Responsivity (PVR; subdimensions Everyday Routines, and Play and Pretend)
    • Availability of Learning Materials (ALM).

Impact of Training and Technical Assistance (IOTTA).

TREE Provider Questionnaire.

TREE implementation fidelity tracked via EMR documentation.

results

The study demonstrated significant increases in self-reported Parent Verbal Responsivity by intervention group caregivers. Intervention pediatric residents reported significant increases in promoting positive caregiver-child interactions and confidence in conveying child development.

conclusions

The TREE program is a promising practice that operationalizes promotion of relational health and positive early childhood experiences within pediatric primary care. Further research will be conducted.

limitations

Impact of COVID-19 (fewer families completed follow-up appointments; caregiver self-report may have been impacted). Intervention residents may have reported more positive perceptions knowing they were part of a study. There was also a larger drop out of pediatric residents in the control group who did not complete follow-up questionnaires which may have introduced uncertain sampling bias. Unclear why baseline scores were different between control and intervention groups. TREE questionnaire not validated tool. Some increase of parental language and cognitive developmental stimulation over time is likely a naturalistic function of kids getting older.