Using Pediatric Group Visits to Promote Social Emotional Development

In the earliest years of life, children’s brains are developing rapidly, producing more than a million neural connections every second. During this period of rapid brain development, children gain the social and emotional skills they need to make friends and succeed at school and later in life. Pediatric primary care is a vital opportunity to help ensure that parents—children’s first and most important teachers—have the necessary supports and resources to promote their children’s social emotional development.

We recognize that pediatric group visits currently may not be possible due to the COVID-19 pandemic and your local safety recommendations. We hope that the strategies outlined in this article will inspire change in your approach to group visits in the future.

Recently, Boston Children’s Hospital launched an innovative pilot program focused on using group pediatric visits for 2 ½ year old children to provide parents with enhanced guidance around supporting children’s social emotional development.

“In one-on-one visits, we usually don’t have the luxury of extra time,” explains Joanna Perdomo, MD, who is leading the pilot program. “Group visits give us an opportunity to provide an added layer of parental support—something we know is so key for promoting social emotional development and helping parents address concerns.”

Four to six families attend each group visit along with Perdomo; pediatricians Corinna Rea, MD, MPH, or Nicole de Paz, MD; and Boston Children’s Early Intervention specialist Marissa Speranza, MSW, LICSW. During the visit, families learn about social emotional development and ask questions while watching their children play together.

This structure encourages open conversation and shared learning, explains Perdomo. It’s easier for parents to ask questions or raise concerns after hearing other parents say they’re facing similar challenges. And it’s easier for providers to explain potential developmental concerns while parents are watching their children play with kids who are the same age.   

Boston Children’s Hospital launched its pilot program as part of the NICHQ-led Pediatrics Supporting Parents learning community, an initiative seeking to leverage the well-child visit to encourage positive parent-child interactions that foster healthy social emotional development. The Boston Children’s Hospital Team was fortunate to have Melanie Griffin, director of Boston Children’s Early Intervention, as a part of their Pediatrics Supporting Parents team. Griffin helped facilitate the partnership between the clinic sites and a co-located early intervention site for the group visit. The Boston Children’s Hospital Team initiated the pilot program for patients across their two clinic sites and are partnering with NICHQ to continue to improve the program.

Initial feedback from families has been really encouraging, says Perdomo. “Families have reported feeling like they’ve received real time and attention, and like they’ve walked away with resources and concrete tips for supporting their children.”

Approaches for a successful group visit

Optimize the visit’s structurehealthy children playing

Perdomo’s team has implemented a few specific strategies to optimize their group visit structure. First, they begin group visits with brief individual check-ins with families where they update the child’s medical chart and ask the family if they have any individual concerns they would like to discuss. “For us in particular, starting off with the one-on-one medical portion and then moving on to the group setting has been really helpful,” says Perdomo. “Families appreciate having time to speak with us behind closed doors where we check-in about their comfort with the group setting and give them time to raise any individual concerns before going into the larger group.”

After the individual check-ins, everyone comes together for a brief introduction with some short group activities. Then, the pediatric providers engage children in developmentally appropriate play (e.g., coloring stations, pretend play, and listening to a story being read), observe how they interact with one another, and check their observations against a developmental milestone checklist. Parents are watching the whole time from an observational room and can easily step in if their children get all nervous. In the meantime, Speranza engaged parents in conversation about social emotional development, touching on everything from picky eating to managing caregiver stress and self-care. Speranza also provides families with early development resources and tip sheets. This extended and uninterrupted time with an early childhood expert creates needed space for conversation and resource-sharing. 

Engage an interdisciplinary team

Having Speranza, who is an early intervention specialist and a social worker, co-lead each group visit has been enormously beneficial, says Perdomo. “The group visit allows for this great interplay between what we can do as pediatricians and what she [Speranza] does with her many years of experience running groups with kids and doing parenting classes. Together, we make sure parents get all the support they need in an integrated way.”

Along with providing advice on social emotional development, Speranza can guide families through important processes, such as registering for pre-school and for Head Start. And when families share resource needs and challenges they might be facing, such as housing or food insecurity, Speranza can connect them with Boston Children’s Hospital’s primary care social work team who can provide greater support outside the group visit. With this, group visits become a one-stop-shop for medical care, social emotional guidance, and connecting families to social supports and services.

Work with the right age group

The Boston Children’s Hospital group visits focus on children who are 2 ½ years old. They chose this age-range purposefully because it’s when a lot of common developmental questions come up, such as about toilet training and working towards’ kindergarten readiness. It’s also when developmental challenges often emerge, including speech delays and autism.

“Focusing on social emotional development is so key at this age, whereas other routine health care medical maintenance, like labs or vaccines, are really at a minimum,” says Perdomo. “Because of this, we have the freedom to bring people together in a group setting for a longer period of time and really hone in on the social emotional piece.”

Seek feedback from families

Before launching a pilot program, connect with families and ask what will make group visits successful, says Perdomo. From brainstorming ways to increase attendance to learning what social emotional resources families like best, family partner input is invaluable during the pilot planning stage. Once the program has started, continue to prioritize family’s feedback: create surveys for participating families asking what they enjoyed and what could make their experience better, and then make adjustments based on their input. Centering the visit around family needs is the best way to maximize its impact.

Interested in learning about additional strategies for supporting social emotional development during pediatric visits? Find five promising strategies here.