P3.D066: Prescription for Play: A Process and Outcome Evaluation of a Play Promotion Intervention in Federally Qualified Health Centers

Background: Despite the importance of play for early development, not all children have equal access to or opportunities for play. Children from lower-income families are especially likely to face social and structural barriers to play. Although several play-based initiatives targeting under-resourced children exist, such programs have been narrowly implemented. To reach a wider population of children, Prescription for Play (P4P), a social impact program of The LEGO® Group, leverages attendance at well-child checks (WCCs) to discuss and promote play. P4P specifically provides training and support to pediatric care providers seeing 18-to-36-month-old patients for WCCs to increase play through caregiver education. Importantly, limited work has investigated the process and outcomes of P4P to understand the feasibility and effectiveness of its implementation, particularly within under-resourced communities. As such, this research aimed to evaluate the implementation outcomes of P4P within multiple federally qualified health centers (FQHCs), which serve as important safety-net medical homes for under-resourced families.

Methods: Data were collected from six geographically diverse FQHCs between July 2022 and December 2023. To understand whether P4P impacts caregiver outcomes, an interrupted time series design was used in which two separate samples of caregivers completed a researcher-designed survey before (n=180) and after (n=262) implementation of P4P. Caregivers reported on several play-related constructs, including attitudes, subjective norms, perceived behavioral control, and behavioral intentions towards play. A mixed-methods approach was further undertaken to evaluate the process of delivering P4P in FQHC settings using a conceptual framework for implementation fidelity. For this purpose, staff surveys (n=27) and interviews (n=25) as well as clinic observations (n=44) were completed.

Results: Among the full caregiver sample, most respondents were Spanish-speaking (70%), reported their race to be Hispanic/Latinx (85%), and identified as women (96%). Caregivers reported positive views towards play and a strong desire to play with their children both before and after implementation of P4P, with independent samples t-tests showing no differences between groups on any survey construct (ps>.06). Triangulation of the qualitative and quantitative process data showed that P4P can be implemented as designed within varied FQHC settings and is acceptable among clinic staff, with additional themes emerging related to implementation barriers and facilitators.

Conclusion: Even before exposure to P4P, caregivers report positive views of and a strong investment in playing with their children, and these factors remain high following program participation. Future work is needed to evaluate whether P4P influences additional caregiver and child outcomes, such as actual play behavior. Nevertheless, this study offers important evidence that P4P can be implemented to fidelity during WCCs within FQHCs, making it a feasible program to deliver in safety-net settings.