P2.076: Implementation and Caregivers' Perspectives of Anticipatory Guidance on Play at Well Child Visits

Purpose/Objectives: Play is essential for healthy child development. Yet, as highlighted in AAP's 2018 Clinical Report, The Power of Play, children are playing less. Pediatric clinicians have an opportunity to guide caregivers on playful learning during well-child visits (WCVs). To improve anticipatory guidance about play we engaged community primary care clinicians in a quality improvement (QI) effort. Our objectives are: educate clinicians on beneficial developmental aspects of play, identify barriers to implementing anticipatory guidance on play through Prescription for Play and understand caregivers’ attitudes about play.

Design/Methods: 47 clinicians from four university-affiliated community primary care practices participated in a 9-month QI effort. Interventions included: clinicians and staff receiving educational training on the value of play and QI specialist worked with teams to implement anticipatory guidance using Prescription for Play. QI specialists guided the teams on selecting a population between 18-36 months of age, redesigning workflows to utilize grant funded LEGO® kits as prompts for discussions, implementing documentation in electronic health records (EHR) with a goal of 80% capture, reviewing data and feedback to track progress for iterative Plan-Do-Study-Act cycles and formalizing a plan to sustain implementation. Surveys were conducted at six additional sites to examine caregiver understanding of the benefits of play and their attitudes regarding recommendations about play from their clinicians.

Results: Over 9 months, there was an increase in discussion of play from baseline of 0% to mean aggregate of 61%. No individual clinic showed a statistically significant improvement over time due to random-cause variation. Among caregivers who had completed the survey (n=53), 26% (n=14) had received guidance regarding important of play. 98% (n=52) knew that it was beneficial for caregivers to play with their children. 87% (n=46) knew that playing with their children helps build resilience. 51% (n=27) stated that it was difficult to play with their children due to other factors. 55% (n=29) did not want their clinician to discuss play in a way that feels more connected to their culture.

Conclusion/Discussion: Despite existing knowledge and QI support highlighting the importance of play in early childhood development, documentation of anticipatory guidance continues to show variability in how play is prescribed. To support effective adoption of Prescription for Play in primary care settings, several key barriers must be addressed: the behavioral adaptations required to integrate new clinical workflows, the tendency to deprioritize play during well-child visits in favor of addressing more immediate health concerns, and challenges related to staff turnover and training. While caregivers acknowledge the significant role of play in the development of their children, the following barriers hinders a caregiver’s capacity to engage in playtime with their child: work commitments, fatigue and household responsibilities. Therefore, anticipatory guidance should be reframed to support more constructive and meaningful guidance about play.