The following is a summary of “Opening Pandora’s box – key facilitators of practice change in detecting and responding to childhood adversity – a practitioner perspective,” published in the July 2024 issue of Pediatrics by Loveday et al.

Childhood adversities have long-term detrimental effects on physical and mental health. Health and social care practitioners are crucial in identifying and addressing these adversities but often face reluctance due to perceived service shortages, time constraints, and a lack of training and confidence. 

This study aimed to measure changes in practitioners’ comfort and confidence in identifying and responding to childhood adversity after a multimodal intervention within an integrated child and family health and social care hub, and to identify the barriers and facilitators of practice change.

Hub practitioners were surveyed on the competence and comfort in directly addressing adversity at baseline, and at 6 and 12 months post-training. Additionally, interviews were conducted to explore the barriers and enablers of practice change. The interviews were recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. The theoretical domains framework was employed to pinpoint the key drivers of practice change.

Of 18 practitioners, 15 completed all 3 surveys, with 70% reporting increased competence and comfort in directly addressing, and confidence in responding to, a range of adversities over the 12-month intervention. Interviews were conducted with 21 practitioners, 6 themes emerged as either facilitators or barriers to the practice change. Facilitator themes included the importance of connection,  the assurance provided by knowledge, confidence in one’s abilities, and the willingness to change. Barrier themes were perpetual time constraints and the apprehension of uncovering complex issues, likened to ‘opening Pandora’s box.’ Key drivers of practice change identified were ‘social influence’, ‘belief in capability’, ‘knowledge’, and ‘behaviour regulation’, whereas barriers included ‘environmental context and resources’ and ‘emotion’.

The findings indicated that practitioners experienced increased confidence in identifying and responding to childhood adversity through a multimodal intervention in an integrated Child and Family Hub. However, successful practice change required more than education and training alone. Opportunities for social connection and coaching were essential to bolster self-confidence and perceived competence, helping practitioners overcome the fear associated with addressing complex issues.

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04918-5