COMMUNICATING WITH CHILDREN ABOUT HEALTH AND ILLNESS Flashcards
Children need information to understand & manage their health condition:
and should be included in decision making at developmentally appropriate levels
Take Home Messages
It is our responsibility to obtain legal consent & child assent prior to any physical therapy services
Communicating health information to children requires a different skill set than communicating health info to adults
Supporting children and families to use selective coping mechanism can positively impact outcomes and child/family wellness
Health Belief Model(How do people conceptualize illness?)
LABEL/DIAGNOSIS = What do I have?
CAUSE = How did I get this illness/condition?
CONSEQUENCE = How will it affect me?
TREATMENT = How can I get better? What can be done?
TIMELINE = How long will this illness/condition last?
Chronic Illness
A health problem that last 3+ months
Affects a child’s normal activities
Requires frequent hospitalizations, home health care, and/or extensive medical care
1 out of 4 children in US have a chronic illness
3 Categories of Stress
Daily role stressors
Stressors related to treatment
Uncertainty
Daily role stressors
Missing or falling behind in school
not being able to do things (participation)
having to go to the hospital/appts
concerns about family & friends
Stressors related to treatment
Pain/soreness
nausea
changes in appearance
Uncertainty stressors
Not understanding what doctors say
confused about illness and causes
concerns about the future
Coping
”conscious and volitional efforts to regulate emotion, cognition, behavior, physiology, & the environment in response to stressful events or circumstances”
(not a specific behavior - rather a broad organizational construct to try to manage stressful experiences)
Coping Frameworks
Active Coping
Accommodative Coping
Disengaged Coping (Passive, Avoidant)
Active Coping
Change a stressor (i.e. problem solve)
Accommodative Coping
Adapt oneself to a stressor (i.e. cognitive reappraisal, positive thinking, acceptance, distraction)
Good fit with the often uncontrollable aspects of childhood illnesses
positive thinking, distraction, acceptance
Disengaged Coping (Passive, Avoidant)
Orient away from the stressor or one’s reaction to the stressor (i.e. denial)
positive thinking, distraction, acceptance
Families and Health: A Child’s Voice
Identify health beliefs & potential misconceptions
Identify major sources of stress for these children
Identify examples of active, accommodating or disengagement coping. What appear to be effective?
UN CONVENTION ON THE RIGHTS OF THE CHILD (CRC)
An international treaty that recognizes the human rights of children
(people up to 18 years old)
CRC
Article 12 (Respect for the views of the child):
When adults are making decisions that affect children, children have the right to say what they think should happen and have their opinions taken into account
CRC
Article 13 (Freedom of expression):
Children have the right to get and share information, as long as the information is not damaging to them or others
CRC
Article 23 (Children with disabilities):
Children who have any kind of disability have the right to special care and support, as well as all the rights in the Convention, so that they can live full and independent lives
CRC
Article 24 (Health and health services):
Children have the right to good quality health care – the best health care possible, to safe drinking water, nutritious food, a clean and safe environment, and information to help them stay healthy
Rich countries should help poorer countries achieve this
INFORMED CONSENT:
Legal Approval of the legal representative of the child and/or competent child for medical interventions following appropriate information
INFORMED ASSENT:
Child Approval to medical procedures in circumstances where he/she is not legally authorized or lacks sufficient understanding for giving consent completely
4 Elements of Assent
1) Explain condition in developmentally appropriate words
2) Tell child what to expect with tests/treatment
3) Assess child’s understand of the situation & factors influencing how (s)he is responding
4) Determine child’s willingness to accept proposed care
Parent-Child-Therapist Communication
Informative – Quantity and quality information
Sensitive – Therapist attentive to and interested in the parent/child’s feelings/concerns
Partnership – Therapist invites parents/child to share concerns, perspective, cultural beliefs, suggestions, etc.
Cultural Considerations
Consider the need for interpreter or cultural brokerage services
Be aware of the general cultural norms and taboos of the dominant subcultures
Who gets information
Who makes decisions
Amount of eye contact
Forthrightness
Need for indirect discussion
Appropriateness of children questioning adults
Primary language spoken
Minority Americans more likely to __
forgo asking questions to their doctor
Minority Americans face ___ during doctor’s visits
greater difficulty communicating
Minority Americans find it harder to ___ from a doctor’s office.
understand instructions
Minority Americans less involved in their health decision making than __
they would like to be
Children need info to understand & manage their conditions
Children should assume greater decision making roles as they get older
Professionals often defer to parents to have this conversation. Parents find it hard.
Many children do not receive age-appropriate information
WHAT’S HARD FOR PARENTS?
Content Considerations = WHAT to say (complex multi-dimensional conditions)
Developmental Considerations = HOW to say it (match the child’s cognitive level)
Affective/Emotional Considerations = FEAR that talking about it will make it worse
Misconceptions
Non disclosure is protective
Don’t discuss/tell if a child doesn’t ask
Avoid providing info for a young child or one who doesn’t understand completely
Moral & ethical obligation to discuss health & illness with children
Parent involvement with WHAT and HOW info will be shared
Seeking child input should be routine practice
Children as young as 7 are more accurate than parents in providing health data that predicts future health outcomes (i.e. self report) but poorer at giving accurate medical history
Outcomes are better when children are involved
Include the Child!
Talk directly with the child at his/her eye level
Physically arrange yourself to be attentive to the child.
Listen actively (Listen closely to your child for misinformation, misconceptions and underlying fears. Provide accurate information.)
Determine who the child wants to be present
