Possible Unintended Consequences of Pediatric Clinician Strategies for Communicating About Social-Emotional and Developmental Concerns in Diverse Young Children

Introduction: Screening to promote social-emotional well-being in toddlers has positive effects on long-term health and functioning. Communication about social-emotional wellbeing can be challenging for primary care clinicians for various reasons including lack of time, training and expertise, resource constraints, and cognitive burden. Therefore, we explored clinicians’ perspectives on identifying and communicating with caregivers about social-emotional risk in toddlers. Method: In 2021, semistructured interviews were conducted with pediatric clinicians (N = 20) practicing in Federally Qualified Health Centers in a single metropolitan area. Most participants identified as female (n= 15; 75%), white non-Hispanic/Latino (n = 14; 70%), and were Doctors of Medicine or Osteopathic Medicine (n = 14; 70%). Thematic analysis was conducted on audiorecorded interview transcripts. Results: Clinicians used various approaches to identify social-emotional concerns which were sometimes difficult to distinguish from other developmental concerns. The clinician–caregiver relationship guided identification and communication practices and cut-across themes. Themes include: starting with caregivers’ concerns, communicating concerns with data and sensitivity, navigating labels, culture, and stigma, and limiting communication based on family capacity and interest. Discussion: Prioritizing the clinician–caregiver relationship is consistent with best practice and family-centered care. Yet, the dearth of standardized decision support may undermine clinician confidence and impede timely conversations about social-emotional concerns. An evidence-based approach with developmentally based culturally informed quantitative tools and standardized decision supports could help ensure equitable management and decision making about young children’s social and emotional well-being and development.