COMMUNICATING WITH CHILDREN ABOUT HEALTH AND ILLNESS

Question 1

Children need information to understand & manage their health condition:

Answer 1

and should be included in decision making at developmentally appropriate levels

Question 2

Take Home Messages

Answer 2

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

Question 3

Health Belief Model(How do people conceptualize illness?)

Answer 3

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?

Question 4

Chronic Illness

Answer 4

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

Question 5

3 Categories of Stress

Answer 5

Daily role stressors

Stressors related to treatment

Uncertainty

Question 6

Daily role stressors

Answer 6

Missing or falling behind in school

not being able to do things (participation)

having to go to the hospital/appts

concerns about family & friends

Question 7

Stressors related to treatment

Answer 7

Pain/soreness

nausea

changes in appearance

Question 8

Uncertainty stressors

Answer 8

Not understanding what doctors say

confused about illness and causes

concerns about the future

Question 9

Coping

Answer 9

”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)

Question 10

Coping Frameworks

Answer 10

Active Coping

Accommodative Coping

Disengaged Coping (Passive, Avoidant)

Question 11

Active Coping

Answer 11

Change a stressor (i.e. problem solve)

Question 12

Accommodative Coping

Answer 12

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

Question 13

Disengaged Coping (Passive, Avoidant)

Answer 13

Orient away from the stressor or one’s reaction to the stressor (i.e. denial)

positive thinking, distraction, acceptance

Question 14

Families and Health: A Child’s Voice

Answer 14

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?

Question 15

UN CONVENTION ON THE RIGHTS OF THE CHILD (CRC)

Answer 15

An international treaty that recognizes the human rights of children

(people up to 18 years old)

Question 16

CRC
Article 12 (Respect for the views of the child):

Answer 16

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

Question 17

CRC
Article 13 (Freedom of expression):

Answer 17

Children have the right to get and share information, as long as the information is not damaging to them or others

Question 18

CRC
Article 23 (Children with disabilities):

Answer 18

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

Question 19

CRC
Article 24 (Health and health services):

Answer 19

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

Question 20

INFORMED CONSENT:

Answer 20

Legal Approval of the legal representative of the child and/or competent child for medical interventions following appropriate information

Question 21

INFORMED ASSENT:

Answer 21

Child Approval to medical procedures in circumstances where he/she is not legally authorized or lacks sufficient understanding for giving consent completely

Question 22

4 Elements of Assent

Answer 22

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

Question 23

Parent-Child-Therapist Communication

Answer 23

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.

Question 24

Cultural Considerations

Answer 24

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

Question 25

Minority Americans more likely to __

Answer 25

forgo asking questions to their doctor

Question 26

Minority Americans face ___ during doctor’s visits

Answer 26

greater difficulty communicating

Question 27

Minority Americans find it harder to ___ from a doctor’s office.

Answer 27

understand instructions

Question 28

Minority Americans less involved in their health decision making than __

Answer 28

they would like to be

Question 29

Children need info to understand & manage their conditions

Answer 29

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

Question 30

WHAT’S HARD FOR PARENTS?

Answer 30

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

Question 31

Misconceptions

Answer 31

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

Question 32

Moral & ethical obligation to discuss health & illness with children

Answer 32

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

Question 33

Include the Child!

Answer 33

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