Pediatric Reflections on Addressing Problem Behaviors in Primary Care

Primary Care: Ideal Spot to Address Problem Behaviors

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Children's Doctor

Grace thought her days of parenting were long behind her, but she found herself raising her grandson. He was a sweet and loving boy, but like many children he could also be challenging. Grace asked her grandson’s pediatrician for advice and was referred to the Child Adult Relationship Enhancement in Pediatric Primary Care (PriCARE) program. Grace went because she wanted to know how to stop his tantrums. She was surprised when the first PriCARE session focused not on discipline, but on the importance of play and praise.

Behavioral problems are a common concern among caregivers of young children in primary care. Challenging behaviors can increase parental stress and in some cases prompt negative and reactive parenting, which can further escalate child behavior problems. Interventions that promote authoritative parenting can improve a child’s behavior, strengthen child-parent attachment, and improve long-term child outcomes. However, despite the benefits of early intervention, many families never receive services. To meet the need for high-quality parent training and support delivered in primary care, providers at CHOP’s PolicyLab and Safe Place partnered with Cincinnati Children’s Hospital to develop PriCARE.

PriCARE, a positive parent training program, teaches caregivers techniques to support the social and emotional growth of children 2 to 6 years of age. PriCARE skills are taught in a group format during 6 weekly 1½ hour sessions. The first phase teaches skills focused on giving attention to children’s positive, pro-social behaviors while ignoring minor misbehaviors. Parents practice these skills at home with their children during one-on-one play. The second phase teaches techniques for giving children effective commands to set age-appropriate limits. Recognizing the adversity and chronic stress experienced by many families in our community, PriCARE also includes a trauma and stress education component.

In a randomized control trial, PriCARE was associated with decreased parental belief in harsh parenting, increased empathy toward child’s needs and decreased child behavioral problems. Based on these promising results, the PriCARE program was expanded with support from The Pew Charitable Trusts Foundation, Oscar G. & Elsa S. Mayer Family Foundation, and a private donor. PriCARE groups are now offered at no cost to caregivers of children 2 to 6 seen in CHOP primary care. Food, transit tokens, and onsite child care are provided.

To refer a family to PriCARE, email or call 267-318-1707.


Schilling S, French B, Berkowitz SJ, Dougherty SL, Scribano PV, Wood JN. Child-adult relationship enhancement in primary care (PriCARE): a randomized trial of a parent training for child behavior problems. Acad Pediatr. 2017;17(1):53-60.