The goal of this clinical trial is to evaluate the feasibility, acceptability, and initial effectiveness of using the Adaptive Behavioral Counseling Decision Framework to provide behavioral counseling for common preschool behavior problems in pediatric primary care. The interventions will be provided by integrated behavioral health clinicians and provided to primary caregivers of children aged 18-65 months who screen positive on the Preschool Pediatric Symptom Checklist (PPSC) or otherwise identify a child behavior concern. Participants will receive behavioral guidance based on the Adaptive Behavioral Counseling Decision Framework during their child's medical visit or a single behavioral health visit. The main question[s] it aims to answer are:

• What is the feasibility and acceptability of using a decision framework to guide selection and delivery of a single-session intervention for early childhood behavior concerns in pediatric primary care?
• What is the initial effectiveness of framework-guided brief interventions in reducing parent-reported behavior concerns based on caregiver report?

The hypotheses are that the intervention will be delivered with fidelity in the time allotted, and that caregivers will rate the intervention as feasible and acceptable.

Inclusion Criteria:

• Caregivers of children ages 18-65 months who screen positive on the Preschool Pediatric Symptom Checklist (PPSC) or otherwise identify a child behavior concern.
• Caregivers must be at least 18 years old.
• Caregivers must speak English or Spanish sufficiently to complete study procedures. Study procedures in other languages are not feasible.

Exclusion Criteria:

• Children with moderate to severe intellectual disabilities.
• Child and caregiver are already receiving more intensive behavioral parent training intervention (either at OHSU or in the community).

Data will be available from the PI upon request .

5 years from the end of the study.

Anonymized data will be available from the PI upon request.