How Co-Created Goals Support Social Emotional Development 

And ideas for integrating them into a pediatric practice workflow

pediatrician and parentParents are children’s first and most important teachers. However, depending on daily stressors and their own life and childhood experiences, parents may need support from professionals in strengthening the parent-child bond and promoting their children’s social and emotional development. This is where positive, trusting, strength-based relationships among parents and healthcare providers can be helpful.  

Social emotional development, which begins in infancy, helps children learn to understand their emotions and sustain positive relationships with others. When pediatric providers partner with families to co-create goals to support their children’s social emotional development, in the same way they do to promote children’s overall health and wellness, children thrive.

“Working with families to identify specific and achievable goals around social emotional development is one of the best things we can do to help parents engage in positive interactions with their children,” says Dipesh Navsaria, MPH, MSLIS, MD, associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health, founding medical director of Reach Out and Read Wisconsin and president of the Wisconsin Chapter of the American Academy of Pediatrics.

By engaging parents in goal-setting conversations, pediatric health professionals empower families as advocates for their children’s health and as partners in promoting it. That’s why co-created goals are a core strategy for the 18 pediatric practices working on Pediatrics Supporting Parents, an initiative seeking to leverage the well-child visit to encourage positive parent-child interactions that foster healthy social emotional development. Over the past 10 months, practices have begun to integrate goal-setting conversations with families into their well-child visits with promising early results.

“Having families choose a goal is much more powerful than telling them what to do; it really empowers families to become more involved with their children’s social emotional development,” explains Alexandra Zamora, program coordinator for the Northeast Valley Health Corporation, a Pediatrics Supporting Parents practice team. “Parents have told us, ‘this visit was different than my other visits; my provider talked with me more and really helped me feel confident in my ability to help my child.’”

Time can be a major barrier to co-creating goals with families, particularly in busy pediatric practices with limited resources. Moreover, if providers are new to developing co-created goals, they may struggle to know how to engage families as partners. Here, we share valuable ideas from Northeast Valley and Navsaria, who is an expert faculty on the project.

Talk to families about social emotional development

The first step towards supporting co-created goals is having a conversation with each family. Explain what social emotional development means and why it matters to their child’s health, well-being and future. Talk to parents about developmental milestones, such as smiling, being able to calm down, and making eye contact, and then, give families an opportunity to ask questions or share concerns. This first conversation inspires a trusting and strength-based relationship from which you’ll work together to co-create goals.  

Streamline social emotional screening

Screening for a child’s social emotional development helps families develop relevant and achievable co-created goals. After reviewing the results of the screening, providers can talk with families about setting goals that are consistent with their child’s age, family culture and routine, and screening results. Given the time-constraints facing many pediatric providers, Northeast Valley streamlines the screening process: they mail the ASQ:SE-2 (a reliable social emotional screening tool) to families in advance of their visit, call families to ensure receipt of the questionnaire and remind them to complete and bring it to their appointment. Once in the office, medical assistants score the screening before giving it to the providers. This process helps ensure that providers and parents can focus their visit on understanding their screening results and planning next steps.  

Set realistic and relevant goals

Goals need to be achievable, which means they need to account for families’ individual circumstances, explains Navsaria. “Families might set a goal during a visit and then realize they won’t actually have time to do it, or that they don’t know where to begin because the goal is too big. For example, the goal, ‘I want my child to be happy’, is just too broad; families won’t know where to start. Instead, focus on engaging in activities that are simple, specific, achievable and measurable.”

Interested in creating your own goal sheet? Use a Plan-Do-Study-Act cycle to test what works, says NICHQ Improvement Advisor Sue Butts-Dion. Design a sheet that you think will work for your population. Test the sheet by sharing it with one family.  At the end of the visit, ask them what they liked about it and what they might change. Ask staff involved about its value. You may find that they would like more images, simpler language, etc. Adapt the sheet based on feedback and test again with the very next family. Keep adapting and testing under different conditions (e.g., increased number of patients, increased number of providers, during busy times) until the sheet becomes part of the normal work flow. 

Pediatric providers can help guide goal-setting conversations by asking parents for their ideas and giving parents a list of age-appropriate activities to choose from. For example, the ASQ:SE-2 includes a sheet of more than 15 learning activities that support social emotional development. Pediatric providers can print the sheet, review the activities with families, and then help them choose a goal. If choosing from 15 activities seem overwhelming, consider developing your own streamlined goal sheet. Northeast Valley asked pediatric providers to choose the five most popular and impactful activities and are developing a visually appealing, simple chart showing the five options. This makes it easier for families to select an activity that fits their daily or weekly routines.

Develop a script

Providers and families should have several important conversations before they start goal setting: Families need to understand why social emotional development is important, the purpose of the screening, their child’s results, and, depending on their child’s score, any referrals to additional providers or community supports. To keep goal setting from getting lost in the shuffle, Northeast Valley has developed a script that captures these different conversations and ensures a smooth transition between each.

“The script helps with the overall flow of the visit, and it makes it simpler for providers to smoothly transition from talking about screening to partnering with families to co-create goals,” says Zamora. “Because of this, families can more easily understand why setting goals that support social emotional development is really important.” 

When developing their script, Northeast Valley edited samples found in the ASQ:SE-2; check out what they came up with here.

Document the process

Following-up with families about co-created goals at their next pediatric visit sends a clear message: we want to work with you to track your progress because you have identified this goal as a priority for your child and family’s overall health. Conversely, if providers don’t follow-up, families may assume that the goal was not a priority.

Documenting co-created goals in each child’s medical chart will help pediatric providers remember to follow-up with the family. And importantly, it can help pediatric practices monitor how often they partner with families to co-create goals and track how many goals each family chooses to set. Ultimately, this will help them track the success of their efforts to partner with parents to improve social emotional development of young children.

Interested in learning more about how pediatric practices can support children’s social emotional development? Find five promising strategies here