P0077 - Measuring and Addressing Social-Emotional Well-Being in Early Childhood

Background: Early childhood social-emotional health (SEH) from birth to 5 years predicts multiple positive long-term health and economic outcomes. As healthcare shifts towards root-cause care delivery and value-based payment models, there are opportunities to incorporate early childhood SEH into routine clinical care and healthcare transformation models, including coordinating screening and promotion programs for early childhood SEH across sectors (e.g., healthcare, childcare settings). However, we know little about best practices for evaluating and addressing SEH in young children.

Objective: To describe recommendations and challenges for the design and implementation of early childhood SEH screening and promotion programs

Methods: We conducted semi-structured key informant interviews with 37 geographically diverse stakeholders across sectors (pediatricians, policymakers, child health program leaders, and academic thought leaders). Qualitative content analysis was utilized to identify themes and synthesize recommendations, policy levers, and barriers.

Results: Cross-cutting program design recommendations included establishing routine SEH screening in healthcare starting in infancy and prioritizing integrated data sharing systems across healthcare, early education, and social welfare sectors that allow for both real-time SEH case management and aggregation of population-level data for policy making (e.g. through Early Childhood Integrated Data Systems (ECIDS)). Investment in universal consent policies that allow families to consent once to data sharing across multiple sectors can assuage privacy concerns and avoid repeated screening in multiple sectors. A second program design recommendation was to assess caregiver well-being and familial social drivers of health in tandem with child SEH (e.g., maternal mental health documentation in children’s health care records or behavioral healthcare payments for child-parent dyads). Key informants also recommended prioritizing the validation of SEH measures and interventions across language, culture, and social context differences. Informants universally described the critical need for clear community-based intervention resources and follow-up accountability via a closed feedback loop when a child has a concerning SEH screen. Policy levers to support early childhood SEH measurement programs include mandating SEH screening in primary care with specific reimbursement for SEH screening and linking screening or performance on SEH metrics to value-based payment models. Implementation challenges cited included the lack of measures and outcome data for ages 0-3, the scarcity of culturally and racially sensitive screening tools, and distinct considerations for SEH measurement and data aggregation at the individual versus population-level.

Conclusions: To better coordinate across the currently fragmented early childhood SEH measurement landscape, universal screening policies, reimbursement within healthcare, and data sharing infrastructure are key needs. The broad themes and examples identified from key informant interviews provide important insights for developing equitable population-level programs to promote SEH screening, follow up, intervention, and data sharing—to promote the longstanding well-being of children and their families.