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Improving Interactions with Teens Stephani Stancil, APRN, FNP-BC Children’s Mercy Teen Clinic.

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Presentation on theme: "Improving Interactions with Teens Stephani Stancil, APRN, FNP-BC Children’s Mercy Teen Clinic."— Presentation transcript:

1 Improving Interactions with Teens Stephani Stancil, APRN, FNP-BC Children’s Mercy Teen Clinic

2 Objectives Describe ways to improve communication with teens in the clinical setting By the end of this presentation, participants will be able to: – Describe 3 barriers to effective communication with teens – Identify 3 key techniques to improve communication with adolescents – Utilize motivational interviewing to influence behavior change

3 Communication Short video clip: Teen Slang Watch for how mom in the video reacts to teens’ use of common slang words HUH??!?!!? WHAT??!?!?!


5 Adolescence Transition between childhood and adulthood Generally physically healthy period Needs vary by development and personal circumstances Experience shaped by race, ethnicity, religion, socioeconomic status, family/peers, etc. PRCH © 2006 5

6 Normal Stages and Tasks of Teens PubertyAutonomyIdentityThinking Early10-14 Onset and tempo variable Ambivalence Am I Normal? Concrete operational Middle15-16 Girls earlier than boys Limit-testing, experimental behavior Who am I? Transitional Late>17 Adult appearance Ambivalence Who am I in relation to others? Formal operational (75%)

7 Adolescent Thinking Piaget: Concrete to Formal operations Concrete: Here and now (5 senses) Formal: Abstraction (algebra, metaphors, symbols, etc); Hypothesizing and Considering the future

8 Cognitive Piaget: Concrete to Formal operations Egocentrism: normal narcissism and self- centeredness Personal fable: invulnerability, invincibility, “nothing bad will happen to me…” Imaginary audience – “Everybody is looking at ME and thinking about ME…”

9 Case 1 15 year old Type 1 DM – no longer wanting to check BG What would you do? As HCP, our desire is to: – Parent: tell them what to do, make them fully informed Discussing long term effects like kidney and eye disease may be ineffective. INSTEAD try: – To emphasis current benefits – Mutual goal setting – Short term-follow up (even 1 month may be too long) – To normalize experience – Identify other areas of control

10 Adolescent Thinking and Health Care Concrete operations – Focus on immediate benefits of change – Do not emphasize long term complications Egocentrism – Form therapeutic alliance – Autonomy alignment and readiness to change Personal fable – Provide information of personal relevance Imaginary audience – Reassure about normalcy

11 Adolescent Autonomy Limit-testing (challenging rules) Experimental behavior (smoking, alcohol) Risk-taking (D.U.I., Ø contraception) Need for control (resisting authority) Being listened to is more important than getting one’s way

12 Autonomy and Health Care Legal rights of minors Confidentiality Treatment non-adherence (forget or refuse) Passive-aggressive behavior Determine what is essential (no compromise) Negotiate what is optional Authoritative, not authoritarian, approach

13 Internal Barriers to Care for Adolescents Reliance on peers or family members for health information Perceived/actual negative past experience with health and/or social system Sense of invincibility/vulnerability Low self-esteem Cultural and linguistic barriers PRCH © 2006 13

14 External Barriers to Care Perceived lack of confidentiality and restrictions (parental consent/notification) Poor communication by providers Insensitive attitudes of care providers Lack of provider knowledge and skills Lack of money, insurance and transportation Inaccessible locations and/or limited services Limited office hours PRCH © 2006 14.

15 Teenagers are… Risk takers Reactive Rebellious Confused Prone to making errors Experimenting Exploring Believers in a personal fable

16 Most health care providers are... Adults Too busy and overworked Not very tolerant of teen behavior Wanting to help people achieve health Used to completing a task to get something done Feeling a sense of obligation to give a plan for improvement for problem patient behaviors

17 Elements of Effective Communication Effective Communication Involves:  Verbal cues (adolescent appropriate)  Non-verbal cues (tone, gestures, proximity)  Listening, responding (active listening, convey empathy, elicit and validate emotions) Poor Communication Examples:  Judgmental statements  Ignoring emotions  Eye contact not consistent with adolescent’s culture  Culturally inappropriate language  Perceived gender stereotypes PRCH © 2006 17

18 Effective communication Don’t Use “pet” names (honey, sweetie, hun…) Use judgmental language (“why would you do that?”) Use slang unless offered first Do Assure confidentiality Explain why you are asking sensitive questions Practice active listening (“I heard you say …”) Validate feelings (“Many teens your age feel this way…” or “It’s normal to feel like…”)

19 Toddlers and Teens With toddlers, we: Give choices Encourage independence within safe boundaries Allow teachable moments With teens, we need to: Give choices, encourage independence and allow teachable moments by: – Involving teen in development of care plan, give “leader” or “co- leader” role with adequate support and encouragement – Not expecting perfection! This is still a vital period of learning for the teen (Problem-solving skills, self-confidence, etc.)

20 What about motivation?

21 What is Motivation? Motivation is key to change Motivation is multidimensional Motivation is a dynamic and fluctuating state Motivation is interactive Motivation is a state of readiness or eagerness to change, which may fluctuate Motivation can be influenced

22 What influences motivation? Trait Example Money Shift differential Authority Legal system Pain “I give up” Fear “Am I pregnant?” Empathy “You really understand” State of readiness “I’ll do it now” to change

23 Motivational Interviewing A technique and clinical strategy designed to enhance the patient’s motivation or willingness to change A therapeutic style intended to help providers work with patients to address ambivalence, with resultant change of behavior which improves health outcomes This is a way of interacting with patients

24 Transtheoretical Stages of Change Model by Prochaska and DiClemente Precontemplation—not considering change Contemplation—considering, but ambivalent Determination—preparing to change Action—involved in change Maintenance—sustaining change Relapse—may be undecided again

25 Techniques for Successful Motivational Interviewing Ask open-ended questions Express empathy through reflective listening – Use as a method of clarifying communication – This approach allows for patient and provider to understand each other and explore common ground or compromise – Characterized by brief statements and reiterations of what the patient has said

26 Techniques for Successful Motivational Interviewing Three types of reflective comments: – Simple repetition – Using a synonym – Paraphrasing the statement Affirm and support Summarize Elicit self-motivational statements

27 Techniques for Successful Motivational Interviewing Establish a nonjudgmental, collaborative and accepting relationship Compliment rather than denigrate Listen rather than tell Gently persuade, with the understanding that change is up to the patient Develop discrepancy or doubt between incongruent behavior and stated goals

28 Helpful provider characteristics Focusing on a person’s strengths rather than weaknesses Respecting other’s autonomy and decisions Using empathy, not authority or power Celebrating interim goals (“baby steps”), incremental or even temporary steps toward a goal

29 Helpful provider characteristics Become an advocate FOR the patient; a cheerleader or mentor role Let the patient be the expert Active listening and reflection cannot be over emphasized

30 Putting it into Practice

31 Before the Visit Self-assessment Personal biases, judgments, stereotypes Don’t try to be too cool Cool Dad


33 Introduction Shake hand with teen Ask what they prefer to be called Michael, Mike, Mickey Ask teen to introduce others in room “Who did you bring with you today? “ Explain what to expect during visit Disclose the need for private discussion at the beginning so parents know what to expect

34 Interview Ask about unique features – Bright hair color, body jewelry, tattoos… Open-ended questions – Tell me about…. Carve out time for private discussion – Ask parent to leave the room Use non-judgmental statements – “Some teens your age use cigarettes, have you ever tried those before?”

35 Summary Points for effective communication Active listening Demonstrate empathy Access readiness to change Engage in motivational interviewing Accentuate positives Mutual goal setting Short team follow up

36 Reality 16 year old male presents for a routine physical – Smokes ½-1 pack of cigarettes a day – Smokes marijuana every other weekend – Tried drinking alcohol but doesn’t really like it because it made him get sick – He is an A and B student in high school – He is not interested in being in your office—Mom made him come to this appointment!

37 The Dilemma “Wow, there’s so much I need to do for this young man.” “He should stop smoking and using marijuana. Doesn’t he know how bad it is for him?” “He needs to listen to me because I used to be a smoker and I know how hard it is to quit.” “Just wait ‘til I give him a piece of my mind about smoking. I’ll tell him how bad it is.”

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