Children - Key Activity 7


Attend to Social and Emotional Development in WCVs


This key activity involves all seven elements of person-centered population-based care: operationalize clinical guidelines; behavioral health integration; address social needs.


This activity outlines how practices can support social and emotional development of their patient population, as well as screen for and respond to children with social and emotional development needs.

Social and emotional development creates the foundation for building self-esteem and self-confidence, self-efficacy, self-regulation, and executive functioning, as well as social and communication skills.[1]

Educating and supporting parents and families on how to nurture social and emotional development is an important activity for a pediatric clinic, as is screening for and responding to children and youth with social and emotional development needs. Per the American Academy of Pediatrics (AAP), an understanding of how a child grows and develops can establish realistic expectations for child behavior at all ages. Parents who experienced harsh discipline or other negative childhood experiences may need extra help to change the parenting patterns they learned as children. All caregivers can benefit from increasing their knowledge and understanding of child development including: physical, cognitive, language, and social-emotional development; signs of developmental delays and where to turn for help; and healthy discipline and strategies to impact child behavior.[2]

Universal early childhood developmental screening offers a strong opportunity to discuss childhood development with parents. This discussion can help to promote healthy childhood development and prevent risks that may impact the social and emotional growth of children. Importantly, screening tools for social and emotional development are better than broader developmental screening tools at identifying young children at risk for behavioral and social and emotional issues. The Department of Health Care Services (DHCS) Comprehensive Quality Strategy and Medi-Cal Accountability Set (MCAS) For Health Care Delivery Systems include developmental screening in the first three years of life among their measures.

As trusted authority figures, clinicians play a role in helping parents cope with variability and delays in social and emotional development. This means helping patients and families understand what is normal, when there is a need for watchful waiting, and when there is need for additional follow-up.

Even before the pandemic, one in six children ages two to eight had an unidentified mental health concern.[3] Children of color and children with a social and emotional developmental need or concern from families with lower socioeconomic status are less likely to be identified and supported than white children.[4] Including universal education and screening with response can mitigate this unjust inequity.

For multiple reasons, unmet social needs increase risk for suboptimal social and emotional development. Tending to the social needs of patients and families in service to optimal social and emotional development is an essential strategy. Additionally, bringing a strengths-based, trauma-informed frame to these discussions and interventions can support families and the relationships between the clinic and families. See Key Activity 10: Implement Trauma-Informed Care Approach Across the Patient Journey.

Alongside efforts to support social and emotional development, Bright Futures recommends integrating social drivers of health into primary care to assess family connections and access to resources necessary for optimal child development. Bright Futures has developed age-specific pre-visit questionnaires for ready adoption; they are freely, readily accessible online. These efforts should include:

  • Tending to families’ support structure, including extended family, friends and community support. These resources can be valuable for fostering resilience.
  • Supporting parents’ resilience, as resilient families are more likely to achieve healthy outcomes and maintain healthy relationships.

EHRs can be utilized to prompt and structure history taking and assessments in well-child visits. Appendix D: Guidance on Technological Interventions lists screening tools that are available in digital format assessments or results-only and can be captured in the EHR as well. These screeners can also be delivered directly to patients on tablets in the office or remotely through patient-facing outreach and engagement applications. Expanded care teams can also utilize care management applications to conduct assessments and to manage referrals required for follow-up. It is important to consider how results and the need for follow-up of any assessments carried out in these other applications are also available in the primary record, as well as used for quality reporting.

Other relevant HIT capabilities to support this activity include care guidelines, registries, clinical decision support, and care dashboards and reports.

Action steps and roles

1. Review current practices to identify key opportunities for improvement.

Suggested team member(s) responsible: QI lead and staff.

Catalog and map the clinic and healthcare team’s current practices and processes related to social and emotional development support, screening and referrals.

Also examine staff’s current comfort with knowledge, tools and communication about social and emotional development.

2. Identify materials and resources for educating about and supporting healthy social-emotional development in childhood.

Suggested team member(s) responsible: Staff.

Review existing materials and explore new sources for educating families about social and emotional development. Select and test materials and resources with a small number of families.

3. Identify social and emotional development screening tools and processes.

Suggested team member(s) responsible: QI lead with staff and families.

Review currently used tools and consider exploring new or other tools for screening social and emotional development during well-child visits (WCVs). Select and test tools with a small number of families. Bright Futures provides a list of links to tools for use at specific Bright Futures visits, as well as screening and assessment tools for use at the discretion of the health care professional: Bright Futures Developmental, Behavioral, Psychosocial, Screening and Assessment Forms.

Please note that some of the tools provided in the link above are free to use. Others, such as the Ages and Stage Questionnaire: Social-Emotional (ASQ:SE-2), require a nominal fee. Again, as mentioned above, Bright Futures has also developed age-specific pre-visit questionnaires for ready adoption, freely, readily accessible online.

4. Develop standard processes for incorporating social and emotional development education, screening and referrals during WCVs.

Suggested team member(s) responsible: Care team.

Test adaptations to current practices and processes to work towards high-quality social and emotional development education, screening and referrals during every WCV. Depending on the need, referral sources range from behavioral health clinicians, development pediatricians, speech and language therapists, early intervention, and the local school system. Having an accessible list of contact information for these resources is an important first step for developing a closed loop referral process. Consider testing different versions of who does what, where, when and how. Create and adapt a process map to standardize and optimize workflow.

5. Focus on the medical care team.

Suggested team member(s) responsible: Director.

Ensure that the medical care team is comfortable addressing socioemotional development education, screening and referrals. Support the care team with education, training and practice delivering sensitive information and supporting parents. Engage behavioral health colleagues who are trained in pediatric care to aid in this work.


Parental Resilience: Protective and Promotive Action Sheet

The action sheet provides specific advice for clinicians on how to work with parents around each of the five protective factors: parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and social and emotional competence of children. Infographics that can be shared with parents for each of these protective factors are available on the Alliance National Parent Partnership Council website.


  2. Assessment of Social Emotional Development and Protective Factors [Internet]. Available from: 
  3. Cree RA, Bitsko RH, Robinson LR, Holbrook JR, Danielson ML, Smith DS, Kaminski JW, Kenney MK, Peacock G. Health care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2–8 years — United States, 2016. MMWR, 2018;67(5):1377-1383.  
  4. Cree RA, Bitsko RH, Robinson LR, Holbrook JR, Danielson ML, Smith DS, Kaminski JW, Kenney MK, Peacock G. Health care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2–8 years — United States, 2016. MMWR, 2018;67(5):1377-1383.