Engaging parents in a discussion about psychological and social factors provides the clinician with the opportunity to identify and provide feedback on specific parenting or family strengths. The conversation may reveal the existence of a very supportive extended family, a bedtime routine that includes reading, or a move that requires "baby proofing all over again." Reflective listening leads to an easy transition to positive acknowledgement and encouragement.
Often the visit structure allows for observation of a parent encouraging independent exploration or comforting their child. Comments that reflect observations of positive parent-child behavior during the visit are especially powerful positive reinforcers. Other family issues, such as parental substance abuse, domestic violence, and maternal depression, dramatically affect the child's developmental trajectory but might not come up in the course of the usual pediatric history taking. There are strategies, questions, and tools that can help child health professionals initiate discussion of these important issues.
Included in this module are examples of tools with questions that your practice can use or adapt when assessing parental well-being in the home environment and safety within the family. A 2000 study of U.S. children ages 4–35 months found that the majority of parents feel that these are appropriate question for providers to ask. Structured screening for psychosocial issues can be oriented toward a wide variety of conditions that are known to affect children's health. Maternal depression, childhood depression and mental health status, domestic abuse, family substance abuse, family social capital, family socioeconomic distress, school problems, temperament, behavioral difficulties, and community connectedness have all been the focus of psychosocial screening efforts. All of these concerns can affect a child's developmental outcome.
A few psychosocial screens have been tested for reliability and validity and can be used for assessment as well as screening. Others have less testing in a practice environment, but are still useful for beginning a dialogue with the family. Some of the best-studied screens are copyrighted, and require purchase. However, many are available at no cost, in journal articles, on the Internet, or in the Bright Futures Mental Health Tool Kit; a number of these resources are listed in this module's bibliography.
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