Despite the concerns they cited about discussing social needs with pediatricians, particularly their more sensitive needs, most parents in these groups responded enthusiastically when the moderators asked for their ideas about how pediatricians should approach discussing social determinants of health. Parents’ recommendations for pediatricians included:
Build trust. Parents in the groups emphasized that talking openly about social determinants of health with pediatricians is a matter of building trusting relationships. While some parents said they would prefer discussing social determinants of health with pediatricians face to face and others said they would prefer a questionnaire, their overriding message was that they could only share information about sensitive topics in the context of a trusting relationship with their children’s pediatricians.
Choose the right moment for parents. With long waits for short appointments, parents felt pediatricians should choose the right moment to start conversations about social needs. They emphasized that if they come to an office visit with a child who has a cold or other immediate concern, the pediatrician should address that concern and wait for another visit, when they might have the time and energy for the conversation, to bring up more sensitive, complex topics.
Not in front of the children. Parents said that if they were to discuss social determinants of health with their children’s pediatricians, they would prefer to do so in private, not in front of their children. They said pediatric offices should create dedicated spaces where children can play, giving adults time and space to discuss sensitive, complex topics, as well as easing the burden of long waits for appointments with sick children or siblings.
Let parents choose to learn about helpful resources at their own initiation. Parents often said they wanted posters on waiting room or exam room walls and pamphlets they could take themselves. They said posters and pamphlets would let them choose to learn about social needs—particularly more sensitive ones—and about helpful resources on their own time, discreetly and at their initiation.
Signal confidentiality and be transparent about what triggers reporting to child welfare. Parents in these groups understood that when a child is truly in danger, a pediatrician must share that information with the appropriate authorities. But they also wanted pediatricians to be transparent about what triggers reporting and what does not, so they would know which issues they could talk about openly. They also felt strongly that when they share sensitive information, it must be kept confidential.
Do not ask just for the sake of asking. These parents were very firm in their conviction that if pediatricians ask about sensitive issues, they should be willing and able to provide or suggest helpful resources. Parents wanted to avoid the double loss of disclosing sensitive information without receiving help. They said referrals to other organizations should come with an offer of guidance and a warm handoff.
Make clear that screening is standard protocol. It was very important to parents in these groups to be assured that everyone gets screened—whether face to face or with questionnaires—not just those who appear to be struggling, are enrolled in Medicaid or are low-income. Otherwise, parents said, they would feel judged or profiled.
Consider “letters of support” and other ways to be parents’ allies. Parents in these groups indicated that the doctors have a unique authority and can be their allies in difficult situations. Parents specifically said it could be helpful for pediatricians to provide what they called “letters of support,” for instance, when they face problems with the public housing authority or private landlords regarding peeling paint, pests or other environmental hazards. Some parents said pediatricians could vouch for them when they face legal difficulties or child welfare investigations.