Barriers and facilitators to social-emotional health screening in pediatrics: Results from a qualitative study of practitioner perspectives

Abstract

Social-emotional health (SEH) affects well-being and outcomes across the lifespan and is most malleable when addressed before age five. Despite the importance of early screening, SEH screening does not occur at most well-child visits. This study aimed to evaluate the barriers and facilitators to implementing SEH screening across individual, community, and statewide levels and to develop implementation strategies for SEH screening among children ages 0–5 years at each level. We employed a qualitative descriptive design using semi-structured interviews with SEH experts across the United States (N = 38). Our final sample included pediatric clinicians, educators, and policymakers. We identified three themes to encompass relevant considerations for implementing SEH screening: (1) Prioritizing SEH, (2) Selecting a SEH measure, and (3) Accountability. All informants stressed the criticality of universal SEH screening, although our findings underscore the complex nature of implementing such strategies. Within each theme, informants emphasized the need for actions to prioritize equity and prevent harm that can be inflicted by tools and strategies lacking intentional health equity focus. Our results identified significant gaps preventing universal SEH screening from being implemented. Existing efforts and other potential solutions could be leveraged to address this. Improved infrastructure is necessary to make universal SEH screening achievable. When implementing SEH screening and selecting measures, both feasibility and equity should be considered. Such investments could facilitate the implementation of SEH screening and ultimately bolster children's mental health and well-being.