Problem
Emerging evidence around the Life Course Health Development Framework emphasises that supporting children’s social emotional (SE) development may promote positive mental and physical health outcomes later in life.1 2 Optimal SE development is defined as a child’s ability to have and maintain positive relationships and manage their emotions in a healthy and appropriate manner.3 SE development is demonstrated by the ability to understand both one’s own emotions and the emotional states of others, constructively manage strong emotions, regulate one’s own behaviour, display empathy and maintain relationships.4–6 Positive caregiver–child relationships support children feeling safe and secure, especially when they receive consistent, reliable responses from primary adult caregivers.7 These early childhood relationships assist with the full development of neural synapses, brain architecture, empathy, resilience and other cognitive capabilities.8
The paediatric well-child visit presents a unique opportunity to promote SE development and provide parents with important resources and support. The 12 recommended well-child visits between birth and age 3 years provide a unique and frequent opportunity to interact with and support families.8 However, paediatric practices primarily focus on cognitive development and the prevention and treatment of physical illness. While there are a variety of promising programmes already functioning that support SE development in paediatric primary care, such as HealthySteps9 and Reach Out and Read,10 these are not universal. Additionally, paediatricians and their staff lack familiarity and confidence with many established SE screens and thus miss opportunities to promote both SE development and the primary caregiver–child relationship. In addition, limitations in the current well-child visit such as visit length, number and length of other screening, and family education all challenge the adoption of universal promotion of SE health.11
In 2017, a group of early childhood private funders collaborated to launch the Pediatrics Supporting Parents initiative to optimise the SE development of children from birth to age 3 years by redesigning processes that improve support to parents during well-child visits. A year-long learning community of 18 paediatric practices from across the USA was launched in March 2019. The aim from March 2019 to March 2020 was to support 18 practices in creating more reliable systems for screening and providing SE development support to children and parents during well-child visits. The ultimate goal was for parents to leave the well-child visits in a better position to provide SE support to their children. Teams were provided a change package of evidence-informed strategies (see table 1—Core practices) and used improvement science to test and learn how to best incorporate them into their workflow. The 11 core practices used were identified and informed by a programme analysis conducted from 2017 to 2019 by the Center for the Study of Social Policy.
Paediatric practices were recruited through an online marketing campaign that used the networks of the National Institute for Children’s Health Quality (NICHQ) and early childhood community partners across the USA. Twenty-two practices completed applications and 18 were selected representing 12 states and a total patient population of 78 000 children/year (see table 2). Selection criteria included demonstrated alignment with the learning community’s guiding principles, existing community partnerships to enhance care coordination for families, existing infrastructure for collecting and analysing improvement data, and previous experience with a major improvement or transformative change activity. NICHQ sought diversity of geography, patient demographics and paediatric practice size to inform learning.