Advancing implementation of relational health interventions in pediatric primary care

The National Institute of Child Health and Human Development awarded the University of Kansas Medical Center Research Institute $169,110 on December 1, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to examine implementation mechanisms for Talk with Me Baby for Well-Child Care (TWMB-WCC), a provider-delivered intervention promoting responsive caregiver-child language interactions during pediatric visits.

The study, led by Dr. Behrens, extends a parallel NIH-funded hybrid effectiveness-implementation trial (R01HD112446) by investigating how organizational factors such as implementation climate and leadership support, and individual factors such as provider self-efficacy and perceived value, predict adoption and reach of TWMB-WCC across eight pediatric clinics. Aim 1 uses clinician surveys, electronic health records, and structured fidelity checklists to measure provider uptake and the proportion and representativeness of families served. Aim 2 employs stratified post-implementation focus groups with providers in the highest and lowest fidelity quartiles to identify contextual and behavioral determinants of adherence to the intervention's core components. Analyses are guided by the Theoretical Domains Framework and Consolidated Framework for Implementation Research.

Performance occurs in Kansas City, Kansas with an ultimate completion date of August 12, 2028. The assistance type is a Project Grant, which supports individual research training fellowships at the postdoctoral level under the National Research Service Award mechanism.

Abstract

Relational health, the quality of interactions between young children and their caregivers, is foundational to early cognitive, language, and social-emotional development. Yet over 40% of children under age 3, particularly in under-resourced communities, are at elevated risk for compromised relational health. Pediatric primary care, which reaches 98% of young children, offers a universal platform for scalable relational health promotion. However, persistent barriers including time constraints, workforce shortages, and under- reimbursement limit the implementation of preventive strategies in this setting. This study led by DR. Behrens will identify multilevel contextual and behavioral factors influencing implementation of talk with me baby for well-child care (TWMB-WCC), a provider-delivered intervention that promotes responsive caregiver-child language interactions during well-child visits. TWMB-WCC has demonstrated feasibility and acceptability and is currently being evaluated in an NIH-funded hybrid effectiveness-implementation trial (R01HD112446) across 16 pediatric clinics. This F32 project will extend that trial by examining implementation mechanisms in eight clinics. Aim 1 will use clinician surveys, electronic health records, and structured fidelity checklists to examine how organizational (e.g., implementation climate, leadership support) and individual (e.g., self-efficacy, perceived value) factors predict TWMB-WCC adoption (provider uptake) and reach (proportion and representativeness of families served). Aim 2 will use stratified post-implementation focus groups with providers in the highest and lowest fidelity quartiles to explore contextual and behavioral determinants of adherence to TWMB-WCC's core components. Analyses will be guided by the theoretical domains framework (TDF), consolidated framework for implementation research (CFIR), and a causal pathway model. Findings will advance implementation science by identifying modifiable factors that support sustainable delivery of relational health interventions in pediatric care. The project will also support DR. Behrens' training in implementation science, mixed-methods analysis, and pediatric health services research, preparing her for an independent research career focused on scalable, systems-level approaches to promoting early relational health. .