Recommendations for Promoting Young Children’s Socioemotional Development in Primary Care

Posted April 14, 2016 by Cindy Hutter

Mother And Infant With Pediatrician At Office
Promoting optimal child development focuses on how PCPs can reinforce positive socioemotional behaviors in caregivers of young children.
Early childhood is a critical window of opportunity for promoting early socioemotional health. When children's socioemotional health (defined as a child’s capacity to form secure relationships, experience and regulate emotions and explore and learn) is compromised, it can have significant implications on long-term wellness including failure in school, inability to make or sustain friendships, and poor self-image.

Through a project called Promoting Optimal Child Development, NICHQ, along with Ariadne Labs and the Einhorn Family Charitable Trust (EFCT), worked together to develop recommendations for using pediatric primary care practices to reinforce positive socioemotional behaviors in primary caregivers of children ages 0 to 3.

“Promoting optimal socioemotional development requires a comprehensive, system-wide approach, including ways to support all children and their families across multiple settings,” says NICHQ President and CEO Scott D. Berns, MD, MPH, FAAP. “Key to driving impactful socioemotional health interventions for children is engagement of pediatric primary care clinicians across the U.S.”

After a six month discovery process involving an in-depth environmental scan of related initiatives, peer-reviewed literature, interviews with leaders in the early childhood mental health field, as well as an expert meeting with medical providers and parents, 11 recommendations/interventions emerged.


Promoting Young Children's (Ages 0-3) Socioemotional Development in Primary Care

This report, developed as part of the Promoting Optimal Child Development project, presents an overview of principles, recommendations and interventions designed to address early childhood socioemotional development within the pediatric primary care setting. View the report or listen to a webinar about the report and its findings (starts at 00:07:50), and video remarks by Atul Gawande. 

  1. Use well visits to assess bond between caregiver and child.
  2. Model behaviors that promote socioemotional development during well visits.
  3. Educate families about socioemotional development and age-appropriate expectations during visit.
  4. Modify visit structure and timing to allow for meaningful interactions.
  5. Provide access to extended care team members (i.e., in addition to the physician) during and between visits to continue family support and identify families requiring extra resources; build team unity so all care team members feel they are part of team (including parent supports and community supports).
  6. Improve the quality of interaction between care team and caregivers.
  7. Create an office culture that promotes openness and nurturing and fosters the bond between care team and caregiver, as well as caregiver and child.
  8. Use the waiting room to foster and model pro-social interactions.
  9. Provide all families with resources to promote socioemotional development and age-appropriate expectations between visits.
  10. Connect families to tailored resources they can access during and between visits. Tier resources based on level of need. Use extended care team to help families navigate systems.
  11. Use time between visits to strengthen bond between care team and caregivers.
“When children are very young, pediatricians’ offices are among the few near-universal points of contact for assuring their health and well-being,” said Atul Gawande, executive director of Ariadne Labs. “Studies have shown that it is feasible to use pediatric visits to assess and improve socioemotional health at this exceedingly important time of development. Pediatricians and their teams have a tough, often undervalued job as it is. We nonetheless have a major opportunity to create approaches that make it possible, and easier, for them to improve the capacity of vulnerable children to form close bonds with others and learn.”

The 11 recommendations, along with themes around measurement, barriers to scale and other considerations for scale that were identified through the environmental scan, led the team to identify five target areas of focus for moving forward into the next phase of work. The focus areas include:
  1. Identify and implement standardized socioemotional outcome measurement within primary care assessments
  2. Define the path for scaling interventions in the pediatric setting
  3. Validate the recommendations recommended for pediatric well-child visits
  4. Investigate impact, scalability and collaboration between pediatric care and other settings
  5. Establish a learning community to enhance existing interventions’ efforts to scale
“This has been a great partnership with NICHQ and Ariadne Labs, one that has already sharpened our approach to parenting and early childhood. There’s no doubt that the development of high-quality relationships—between parents and their children, between families and their doctors—is at the center of socioemotional health,” says EFCT’s Executive Director, Jennifer Hoos Rothberg. “We are also encouraged by the many stakeholders who have expressed interest in this work. We’re dedicated to creating ways to work collaboratively to explore the report’s recommended next steps.”

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