By Perri Klass and Dipesh Navsaria, JAMA Pediatrics, January 11, 2021
Young children learn and develop primarily through contingent interactions and strong foundational relationships; this is true of language and, more generally, cognitive and socioemotional development. Separate domains have great utility for screening, assessment, and referral, since isolated delays can point to specific diagnoses and therapies. In other respects it is difficult (and sometimes artificial) to separate cognitive from socioemotional, given the complex overlays of cause and effect and the essential role that interactions and language play throughout. Healthy mental, emotional, and behavioral development in young children reflects—and requires—secure attachment and stable foundational relationships with adult caregivers, including the emotional responsiveness and positive parenting behaviors that also result in the kinds of positive language-rich interactions that stimulate language and cognitive development. Now, with the coronavirus disease 2019 pandemic stressing families, strategies to strengthen and support those relationships and behaviors on a population scale are critical.
Boat and Kelleher argue eloquently for the unique advantages of pediatric primary care for promoting healthy mental, emotional, and behavioral development by providing anticipatory guidance, screening for social determinants, and coordinating care across 2 generations, given the vital importance of family and parental well-being. They cite Reach Out and Read (ROR) for successful promotion of school readiness and widespread successful implementation, with fidelity to an evidence base as “an example of population-based efforts.” We are honored and write to expand on the existing and future potential of this already-established network of pediatric primary care clinicians and on shared reading as an intervention to promote positive parenting and healthy mental, emotional, and behavioral development.
In the coronavirus disease 2019 pandemic, families are facing extraordinarily high levels of economic and emotional stress, bringing even more urgency to work already the focus of much thought and attention, including the report from the National Academies of Sciences, Engineering, and Medicine. The Pediatrics Supporting Parents initiative is a “big bet” initiative aimed at realizing the extraordinary promise of children’s primary care as a near-universal, nonstigmatized, highly skilled, and well-respected point of contact for parents to receive reassurance, modeling, coaching, and guidance, specifically around supporting socioemotional development, incorporated into health supervision visits. The Center for the Study of Social Policy surveyed parenting support programs and deeply analyzed 13 exemplar programs (including ROR), identifying 3 categories of actions: nurturing parents’ competence and confidence, connecting families to additional supports to promote healthy development and address stressors, and enhancing the care team and the clinic. While primary care operates in these domains, more can be done, so via a multipronged approach, Pediatrics Supporting Parents aims to articulate what drives evidence-based, successful, scalable programs while—critically—also considering what can be done through health care financing to allow these initiatives to be well implemented. The Center for the Study of Social Policy has developed a strategy for funding change through Medicaid and the Children’s Health Insurance Program, while the National Institute for Children’s Health Quality has developed strategies for practice improvement—with further work to come from Pediatrics Supporting Parents.
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