Children - Key Activity 7

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.