Early Literacy Research Library (ELRL) - Article

The Welch Emotional Connection Screen: Adapting Observational Methods to Pediatric Primary Care via Resident Training

O’Banion, D.D., Hane, A.A., Litsas, D., Austin, J., Welch, M.G. (2021) The Welch Emotional Connection Screen: Adapting Observational Methods to Pediatric Primary Care via Resident Training. Infant Behavior and Development, 65, 101629.,

Access: Institutional Access

Publication year


study description

Single group, preclinical pilot study.

core topic(s)

Early Relational Health , Pediatric Primary Care

Population Characteristics

Medical Trainees , Urban

Exposures, Outcomes, Other

Medical Training/Education , Parent-Child Relationships/Interactions , Provider Behaviors and Skills , Provider Knowledge, Attitudes, and Beliefs , Screening and Tools , Validity, Reliability, Feasibility, and Acceptability


The aims of this study were to evaluate the efficacy of WECS pediatric resident training: 1) to improve residents’ accuracy in recognizing the dyadic behaviors of emotional connection (EC) via WECS training and 2) to improve residents’ attitudes, self-efficacy, and perceived professional norms (ASPPN) pertaining to Early Relational Health in Pediatrics.


Welch Emotional Connection Screen (WECS).

outcomes evaluated

WECS accuracy and attitudes, self-efficacy, and ERH related ASPPN.


Pediatric residents in their first year of post graduate training were recruited from the two schools of medicine in a major metropolitan area. The two residency programs complete their primary care experiences in the same clinic: the children’s hospital associated with the safety-net adult hospital in an urban, underserved area.


The Welch Emotional Connection Screen (WECS) is a novel instrument that is a brief, practicable, evidenced-based observational screening tool for assessing relationship health between parent and child. The WECS requires observing 2-3 min of face-to-face interactions between parent and child, without toys, prompts, paradigms or technology. Here, we describe a translational project from the coding lab to the primary care provider via a residency training program conducted with 50 residents during a 30-day developmental and behavioral pediatrics medical resident education rotation.

sample size

n=50 (residents)


Measure of WECS Accuracy: we developed 14 Likert items to cover the nuances embedded within the 4 domains of the original WECS (i.e., mutual attraction, vocal communication, facial communication, and sensitivity/ reciprocity, See Supplemental Table A). The expanded rating scales were designed to train residents to specifically hone in on the key elements of EC that are embedded within the more global screening decisions involved in the WECS’ 4 dimensions.


Measure of Attitudes, Efficacy, ASPPN: Likert-style survey adapted from a resident education project and underwent expert review with resident educators. The Attitudes section comprised 9 items on resident attitudes towards relational health and training, Self-Efficacy contained 5 items on self-rated abilities in relational health, and PPN’s 8 items queried resident beliefs about relational health’s importance to peers, supervisors, and institutions.


Results indicate that using a rapid prototyping approach to training, residents improved in their identification of dyads showing low to midrange levels of emotional connection. As well, resident attitudes about the importance of relationship health in pediatrics and their self-efficacy in identifying emotional connection improved significantly after this brief resident training.


Findings reported herein suggest that the WECS is practicable for broad dissemination in pediatric training programs, therefore expanding the physician’s capacity to help numbers of mothers and children who need support for establishing or maintaining EC.


The first is that this was a convenience sample of pediatricians-in training without childcare experience. Though we were not able to compare our trainees to a control group, we feel that the post training rating on video set B immediately following the education better explains the improvement in accuracy than chance or incidental experience. The consistently low accuracy on video set A, which reflects residents beginning their DBP rotation throughout the academic medical year, suggests that relational health education is missing from other experiences in their first year of residency. Another limitation is that the effect of our training program was measured on videos of dyads and not in the clinical setting. Prior to translating this observation skill to the clinic, we must consider the implications and intimate nature of discussing the findings with families, the cultural transference possible, and the treatment options available to the families in our setting.