. 2023 Jul 29;27(Suppl 1):75–86. doi: 10.1007/s10995-023-03762-w

Table 2.

Barrier themes and representative quotes

	Theme	Representative quote
Barrier	Intervention complexity: Resource intensiveness 6% of Mothers 85% of Clinicians	• “I personally would not want to be taking a lot of notes because I'd want to dedicate the visit to really addressing the family's concerns and being with the patient. I think then, documenting after the fact and remembering the different interactions with each different family and provider, our patient and parent, and doing thorough documentation would be difficult.” (Clinician) • “I think that space is always limited, so it would be needing a room and then needing little pop-off areas to do the individual care. So, sort of, coordinating that. I think we would need to have the appropriate ancillary staff. Say they needed to have shots. We would need to have a medical assistant, and it would be nice if the case manager and social worker could be there. So just organizing the players that would need to do this.” (Clinician)
Loss of privacy as a negative outcome 42% of Mothers 31% of Clinicians	• “Her special things like her club foot. I don’t know how open I am about that, because not everyone has knowledge about it. So I don’t know if I would talk about that there.” (Mother) • “Downsides, I think would be if moms are hesitant to speak up because they are in a group setting or if there was something more confidential, personal. I don’t know if there’s time built into the group well visit to have one-on-one time with each parent, or is the entire visit conducted as a group. I think if there are more private or personal issues that need to be addressed, I don’t know exactly how that would go…” (Clinician)
Intervention difficulty: addressing comprehensive medical and psychosocial care needs 6% of Mothers 69% of Clinicians	• “It would just feel almost like a class, not an appointment. So I like to be able to ask questions or just anything, I wouldn’t be able to ask because there’s so many other moms and kids and they have a lot at one time, so maybe it wouldn’t feel like all your needs can be met.” (Mother) • “I think that it would work best for a healthy population, that if there’s a child who has specific medical needs, those I again, would worry, it would be tough to devote enough time to that in a group model.” (Clinician)
Intervention complexity: Intricacies of scheduling 19% of Mothers 46% of Clinicians	• “Say it’s my baby’s appointment, but I had my daughter, would she be allowed to come too? Or would she be a distraction? That’s other stuff that I would consider, if they’re going to have childcare, or with other kids what I would do during that setting if that applied.” (Mother) • “Again, it’s mostly logistics. So like having the appointment slot be at a time that would work best both for the patients and for my own schedule. So sometimes carving out time for an appointment takes more time… if it was first thing in the morning, fine, that's relatively easy. But if it was some point carved into the day, making sure that I'm done with the previous patients before it, getting to the place that it was at, those types of challenges for sure” (Clinician)
Intervention difficulty: Managing group dynamics 19% of Mothers 69% of Clinicians	• “Everyone's at different stages when you come to the [treatment center] and that’s not necessarily a bad thing, but it can be a difficult thing.” (Mother) • “I think you can sometimes have people that dominate the small groups. You have to learn how to make it a safe space for everyone to be able to participate, so have sort of rules of engagement established.” (Clinician)
	Increased exposure to COVID-19 as a negative outcome 87% of Mothers 92% of Clinicians	• “Just I really think everybody should wear a mask and keep their distance and nobody should be touching other people’s children. Because both my kids got chronic asthma and me and my husband are both HIV positive, so we’re very at-risk. If we get it we’ll get really sick.” (Mother) • “I don’t know how feasible it is to have all the children in one room together, which then obviously creates a little bit of an issue. But parent-wise, masks, making sure they're all sitting a decent amount apart, and then keeping the groups small enough that we can keep social distancing.” (Clinician)

Theme

Representative quote

Barrier

Intervention complexity: Resource intensiveness

6% of Mothers

85% of Clinicians

• “I personally would not want to be taking a lot of notes because I'd want to dedicate the visit to really addressing the family's concerns and being with the patient. I think then, documenting after the fact and remembering the different interactions with each different family and provider, our patient and parent, and doing thorough documentation would be difficult.” (Clinician)

• “I think that space is always limited, so it would be needing a room and then needing little pop-off areas to do the individual care. So, sort of, coordinating that. I think we would need to have the appropriate ancillary staff. Say they needed to have shots. We would need to have a medical assistant, and it would be nice if the case manager and social worker could be there. So just organizing the players that would need to do this.” (Clinician)

Loss of privacy as a negative outcome

42% of Mothers

31% of Clinicians

• “Her special things like her club foot. I don’t know how open I am about that, because not everyone has knowledge about it. So I don’t know if I would talk about that there.” (Mother)

• “Downsides, I think would be if moms are hesitant to speak up because they are in a group setting or if there was something more confidential, personal. I don’t know if there’s time built into the group well visit to have one-on-one time with each parent, or is the entire visit conducted as a group. I think if there are more private or personal issues that need to be addressed, I don’t know exactly how that would go…” (Clinician)

Intervention difficulty: addressing comprehensive medical and psychosocial care needs

6% of Mothers

69% of Clinicians

• “It would just feel almost like a class, not an appointment. So I like to be able to ask questions or just anything, I wouldn’t be able to ask because there’s so many other moms and kids and they have a lot at one time, so maybe it wouldn’t feel like all your needs can be met.” (Mother)

• “I think that it would work best for a healthy population, that if there’s a child who has specific medical needs, those I again, would worry, it would be tough to devote enough time to that in a group model.” (Clinician)

Intervention complexity: Intricacies of scheduling

19% of Mothers

46% of Clinicians

• “Say it’s my baby’s appointment, but I had my daughter, would she be allowed to come too? Or would she be a distraction? That’s other stuff that I would consider, if they’re going to have childcare, or with other kids what I would do during that setting if that applied.” (Mother)

• “Again, it’s mostly logistics. So like having the appointment slot be at a time that would work best both for the patients and for my own schedule. So sometimes carving out time for an appointment takes more time… if it was first thing in the morning, fine, that's relatively easy. But if it was some point carved into the day, making sure that I'm done with the previous patients before it, getting to the place that it was at, those types of challenges for sure” (Clinician)

Intervention difficulty: Managing group dynamics

19% of Mothers

69% of Clinicians

• “Everyone's at different stages when you come to the [treatment center] and that’s not necessarily a bad thing, but it can be a difficult thing.” (Mother)

• “I think you can sometimes have people that dominate the small groups. You have to learn how to make it a safe space for everyone to be able to participate, so have sort of rules of engagement established.” (Clinician)

Increased exposure to COVID-19 as a negative outcome

87% of Mothers

92% of Clinicians

• “Just I really think everybody should wear a mask and keep their distance and nobody should be touching other people’s children. Because both my kids got chronic asthma and me and my husband are both HIV positive, so we’re very at-risk. If we get it we’ll get really sick.” (Mother)

• “I don’t know how feasible it is to have all the children in one room together, which then obviously creates a little bit of an issue. But parent-wise, masks, making sure they're all sitting a decent amount apart, and then keeping the groups small enough that we can keep social distancing.” (Clinician)