PC1148: Improvements in Tailored Assessment and Counseling on the Parenting/home Lifestyle Environment and Social Determinants of Health During Two Rounds of a Collaborative to Support Comprehensive Early Obesity Prevention

Purpose/Objectives: Studies support the importance of the first 1000 days (conception to age two) to obesity prevention and overall health. Other studies suggest that providers do not routinely address aspects of a child’s physical and social environment related to healthy weight during well visits with children < 2 years. The Optimize Infant and Toddler Feeding for Obesity Prevention project is a 19-week, virtual, team-based quality improvement collaborative, designed to address these gaps in care. To support comprehensive early obesity prevention, in addition to covering diet/nutrition, key drivers, clinical measures, and provided resources include a focus on the parenting/home lifestyle environment and social determinants of health (SDOH). To support tailored care, measures and resources encompass many possible subtopics. Subtopics for the parenting/home environment include responsive feeding, other parenting strategies (e.g., authoritative parenting), food environment, sleep, active play, and media exposure. Subtopics for SDOH include food security, economic security, family health, and family strengths. This analysis aimed to assess improvements for assessment/counseling of subtopics for the parenting/home environment and SDOH during project Rounds 1 and 2 (R 1 & R2), to inform provided education/resources during future rounds.

Design/Methods: R1 began in January 2020, was delayed in March for 10 weeks due to the pandemic but was completed by 16 of 19 teams. R2 began in January 2021 and was completed by 11 of 12 teams. Teams completed required trainings and conducted Plan-Do-Study-Act cycles, using a suite of provided resources/tools. During the collaborative, teams submitted 20 randomly selected charts from well visits with children < 2 years at 3 time points (T1-T3). Teams submitted an additional “monitoring” data cycle (T4) at week 42. Improvements in subtopics at T3 and T4, relative to T1 values, were assessed using Fisher’s exact test (Bonferroni p<.025). T3 and T4 values were also compared (p <.05) to assess sustainability.

Results: Subtopic values at T4 were nearly always ≥T3 values. Between T1 and T4, for the parenting/home environment, assessment and counseling on sleep and assessment of responsive feeding increased during both rounds. Assessment/counseling for other subtopics increased during 1 round, except counseling on responsive feeding and other parenting strategies, which were unchanged (Table). For SDOH, assessment of all subtopics increased during ≥1 round and economic security and family health increased during both. For SDOH counseling, family health and strengths subtopics improved during R2, but food and economic security were unimproved. With the exception of R1 SDOH counseling, participants increased the number of subtopics assessed and counseled per visit for the parenting/home environment and SDOH (Figure).

Conclusion/Discussion: A collaborative to facilitate comprehensive early obesity prevention showed improved assessment/counseling for subtopics concerning the parenting/home environment and SDOH. Additional training/resources could be considered for counseling on responsive feeding/parenting practices and, particularly, food/economic security.