Presentation on theme: "I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME."— Presentation transcript:
I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation. Strength Based Approach Barbara Frankowski MD, MPH, FAAP University of Vermont College of Medicine April 21& 27 2011
2 Case Study - Samantha 21 year old mother with an 18 month old daughter. They have just begun living in a homeless shelter Refusing to put her daughter in child care so she can’t get a job now Doesn’t have a place to live and doesn’t want to live with her mom anymore no matter what
3 Parental Strengths: PreSIP Parental Strengths were discussed at last health supervision visit (9, 24 month visit) Answer ‘yes’ if there is documentation that parental strengths were discussed at the last health supervision visit (ie, 9, 24 month visit), can include: Documentation of a discussion of Parental Support Use of Connected Kids People who care about me worksheet
Parental Strengths (cont) Documentation about helping parents identify their own/family’s strengths: has a friend or family member to turn to when they need help (connections, belonging), able to make independent decisions, helps out family members or others, participates in community activities has self-confidence, can get things done (mastery) copes with stress,
5 Strength-based approach Strength-based approach outlined in Bright Futures Giving parents and children the ability to continue their development by providing opportunities to grow and build competency Building parents knowledge and encouraging mastery but also providing good ideas on how to integrate into their daily life Independent decision-making and problem-solving Giving people a chance to problem solve and become efficacious in making own decisions Honoring the idea that they are an expert on their family Parents want to do well by their children Messages should align with the fact that parents want to do well by their children (Brazelton)
6 Strength-Based Approach Identify parent/child strengths Give feedback to the parents Use a framework Utilize shared decision-making
7 Touchpoints Principles of Practice (Brazelton) Value and understand the relationship between you and the parent. Use the behavior of the child as your language. Value passion wherever you find it. Look for opportunities to support mastery. Be willing to discuss matters that go beyond your traditional role.
8 The parent is the expert on his or her child. All parents want to do well by their child. All parents have strengths. All parents have something critical to share at each developmental stage. All parents have ambivalent feelings. Parenting is a process built on trial and error. Touchpoints Parent Assumptions (Brazelton)
9 Let’s get back to Samantha Filled out all the Bright Futures forms Found out that her concerns were Boyfriend's mother had a child with autism, so concerned about imms Risk factor identified – new immigrants at homeless shelter – had contact with people from Laos for three weeks
10 Search for Some Strengths Risks need to be identified BUT: Strengths are an essential part of health Look for Resiliency and Strengths: ask about strengths at every encounter! Promoting strengths will enhance interactions with parents Search for strengths Connection/Belonging Competence/ Mastery Independent decision-making Helping out (family and/or community) Copyright University of Vermont
11 Identified her strengths Helps out at the shelter with reading – went to the library to get the books (Helps out) Wants to have her daughter grow up always feeling safe and smoke-free, so she moved out of her mother’s house because she smoked and was “always yelling” (independent decision- making Finished her GED, worked as a waitress, never needed help from agency before (Mastery) Has a partner who has been with her and Samantha for 6 months – he lives with his parents (Belonging)
12 19 yo dad of 12 month old Jared Lives with baby’s mother & MGM Comes to most visits with mother, but seems unengaged, lets her do all the talking Shows up alone with Jared for this check up (mother is in court today)
13 What about Warren? Texting while Jared is playing alone Answers your questions as briefly as possible, not much eye contact When Jared falls and bumps his head, he immediately goes to Warren, who picks him up and comforts him easily “It’s ok, little man!” Jared smiles & hugs his dad What could you do with this opportunity?
14 What are Warren’s Strengths? Mastery/Competence – he knows more about child care than you thought! What other questions can you ask about his involvement as a father? How about other areas of competency in his life? (school, job) Belonging/Connections How does he see his role as a father and partner?
15 What are Warren’s strengths? Independent decision making What does Warren feel he has control over in his life now? Helping family or others What does he do for his son or partner that he feels most proud of?
16 Maria and Jorge: Grandmas’ Helping! Maria has a large, loving family here and in PR Lives with husband in same apt building as both sets of GP Maria struggles with weight Jorge is at 90% for wt, 50% for ht Started cereal at 3 months – loves food! Great Eater! Cereal in bottle at night
17 What is Maria doing well? Mastery/competence: loving, attentive mother, has read a book about child development Belonging/Connection: Husband, extended family, church Independent decision making: Grandmothers & Aunties help with child care, Maria turns to them for major decisions Helping others: helps with childcare at church
18 How can you help Maria exercise independence? Work around feeding decisions: What do your relatives tell you? What do YOU want to do? What is best for your baby?
19 Mary & Maryanne: Food = Love 21 yo single mom of 3 yo Socially isolated – Mary was raised by her disabled GM, who passed away shortly after Maryanne was born “I know you said her BMI is high, but she looks healthy to me!” “I would never deny her food because I love her too much!”
20 Mary’s Strengths Independent decision making: raising a beautiful, smart daughter by herself! Maryanne knows her colors, numbers, letters Mastery/Competence: see above! Helping out: would do anything for her daughter, gave up her job to raise her Belonging: bonded with daughter, but socially isolated
21 Reframing “Love” What is most important to you? Wants daughter to be happy and healthy Maryanne craves your attention How else can you do that besides food? Go out and play! Exercise together, make new friends for Mary AND Maryanne!