79 - Kinder Ready Clinics: A roadmap to the implementation of school readiness interventions across two distinct pediatric clinics

Poster Number: 79
Publication Number: 79.210

Janine Bruce, Stanford University School of Medicine, Stanford, CA, United States; Kendra Fehrer, Stanford University School of Medicine, Santa Clara, CA, United States; Soung Bae, Stanford University, Stanford, CA, United States; Amy Gerstein, Stanford University, Stanford, CA, United States; Lisa J. Chamberlain, Stanford University School of Medicine, Stanford, CA, United States

Background: School-readiness (SR) at kindergarten is associated with future educational, professional, and psychological success. Low-income children demonstrate less SR compared to their high-income peers. Pediatric clinics with near universal access to children 0-5 years, provide a unique opportunity to implement SR interventions (e.g., texting, coaching, Reach out and Read).

Objective: To examine the experiences of two pediatric clinics developing Kinder Ready Clinics (KRC) through an array of SR interventions and strategies.

Design/Methods: Two contrasting clinic sites included an academic-affiliated FQHC and a County Health System clinic, both serving low-income, predominantly immigrant populations. The qualitative study utilized interviews with clinic staff and administrators, ethnographic observations, and document analysis to create a KRC roadmap that depicts the distinct experiences of the participating clinics. Areas of focused exploration included implementation design and decision-making, facilitating factors and barriers, and provider perceptions.

Results: From Sept. 2019-Dec. 2020, 27 participants across both clinics (administrators, SR champions, SR coaches, nurses/managers, IT fellows, health coordinators, primary care providers) participated in >1 interviews (41 interviews total). One hundred fifty ethnographic touchpoints were reviewed (e.g., informal conversations, meeting observations, digital communications), and 35+ SR documents and protocols were reviewed. Personnel involved in the core KRC team varied by intervention, clinic, and context (Figure 1). Participating clinics created two distinct implementation approaches: 1) a “concentrated” intervention with tailored personnel, resources, time, and materials dedicated to promotes SR, and 2) SR messaging and resources “embedded” in a brief follow-up exchange with parents by phone (Figure 2). Comprehensive planning to ensure staffing, SR materials, implementation procedures, and buy-in from key stakeholders was required. The analysis revealed the selection of interventions was driven by the champion’s assessment of feasibility, potential impact, and sustainability, resulting in distinct opportunities and challenges (Figure 3). Conclusion(s): KRC implementation roadmaps revealed there is no one-size-fits all approach. Strategies for implementation included some similarities, with mostly distinct approaches that were uniquely tailored to meet the needs of the KRC team and parents, are better positioned to promote KRC feasibility, impact, and sustainability. Next steps involve examining the impact of KRC interventions on parent and child outcomes.
Figure 1. Establishing the core KRC team
Figure 2. Selecting SR interventions best suited to clinic needs, context, and capacity