Implementation of Emotional Connection Training in Pediatric Primary Care: Mixed Methods Study

In 2021, the American Academy of Pediatrics released a policy statement spotlighting the health-promoting and stress-buffering effects of early relational health (ERH) and calling for universal ERH promotion in pediatric primary care. However, little educational content for the observation and promotion of ERH is available, highlighting the need for scalable ERH training modules.

This study aims to investigate the acceptability, feasibility, and impact of the "Lens of Emotional Connection," a self-paced, asynchronous, ~45-minute ERH training module codeveloped by Reach Out and Read and the Center for Early Relational Health at Columbia University. The module introduces practitioners to emotional connection, an observable component of ERH, through written and video didactic content and experiential rating of emotional connection in videos of parent-child dyads interacting face-to-face.

The evaluation was conducted by the Carolinas Collaborative. Pediatric providers across 8 clinical sites were invited to participate and responded to embedded pre-post surveys. Focus groups conducted with participants further examined the educational experience.

Of 653 invited clinicians, 207 (31.7%) participated in the module. Individual survey responses were available for 44-75 participants, depending on the question. Of responders, 64 out of 69 (93%) reported the module was a good way to learn about emotional connection, and 63 out of 69 (91%) felt the module provided valuable knowledge. Overall, 60 out of 69 respondents (87%) reported satisfaction with the module length, and 36 out of 44 respondents (82%) reported they would recommend this training to other clinicians. Focus groups echoed these findings. Comparison of pre-post data showed the greatest changes were in familiarity with emotional connection (n=75, pre mean 54.20, SD 18.59; post mean 73.99, SD 14.73; Cohen d=1.14; P<.001) and confidence in observing the quality of the parent- or caregiver-infant relationship during well-child visits (n=75, pre mean 55.36, SD 18.49; post mean 74.20, SD 14.07; Cohen d=1.28; P<.001). Suggested areas for improvement included more thorough explanations of specific components of emotional connection identified in parent-child interaction videos, a desire for synchronous live training, and additional content addressing what to do if low emotional connection is identified.

In this evaluation of a training module designed to introduce pediatric practitioners to ERH and emotional connection, acceptability among participants was found to be high, with most responders reporting it as valuable and reporting they would recommend it. Statistically significant impact was noted in both perceptions of the importance of information about emotional connection and perceived knowledge acquisition. Feasibility of widespread implementation with voluntary participation, as here, was relatively low, with only a minority completing the module. Critically, Reach Out and Read's commitment to iterative creation, validation, and eventual delivery of ERH training creates a scalable avenue for wide-scale implementation, given the organization's presence in >6500 clinics across the 50 states.