The Feasibility of Supporting Caregivers of Young Children With Disruptive Behaviors Through Nurse-Delivered Phone Coaching: Quality Improvement Study.

Background: Although childhood behavior problems are common, and strong evidence-based interventions exist to address these challenges, many families struggle to access care and remain in treatment long enough to see results. The Support and Advocacy through Providing Parents Helpful Interventions, Resources, and Education (SAPPHIRE) program was developed to address barriers to accessing care for disruptive behaviors in young children. Objective: This quality improvement program assessed the feasibility of SAPPHIRE, a primary care-based intervention delivered via telephone by trained nurses to caregivers of young children (n=36, ages 1-6 y) who exhibit disruptive behaviors. Methods: The feasibility and acceptability of the SAPPHIRE program were assessed during a 3-month quality improvement study. Results: Of 36 participants, 25 (69%) completed the SAPPHIRE program. Over the course of 3 months, the number of nurse calls with completers ranged from 1 to 15, with a mean of 5.3 (SD 3.4) calls. Overall, nurses spent an average of 120.9 (SD 99.2, range 15-380) minutes on the phone with each caregiver across the 3-month pilot period. Caregivers and nurses rated the program as acceptable across all metrics. For nurses, strengths of SAPPHIRE included the continuity of care with one family, while barriers included time constraints. Comparison of preintervention and postintervention caregiver ratings on measures of disruptive behaviors showed a moderate to negligible effect on reported behavior problems depending on the age of the child (children <4 y: d=0.55 and children 4-6 y: d=0.18). Caregiver-rated parenting self-competence increased over the course of the SAPPHIRE intervention, approaching a large effect (d=0.75). Conclusions: Findings suggest that SAPPHIRE is a feasible and acceptable treatment for caregivers of young children with disruptive behaviors and shows promise for increasing parenting self-competence, which is a hypothesized moderator of future behavior problems. These preliminary data support the need for more rigorous empirical evaluation of the SAPPHIRE program.