Module II: Communicating with Caretakers, Children, and Adolescents

Key Questions:• What is communication?

• How can I communicate effectively with caretakers?

• What factors facilitate or hinder communication with children and adolescents?

• What are useful strategies and techniques to communicate with children and adolescents?

So…… What is…

COMMUNICATION ???COMMUNICATION ???

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Communication Is....

– Process of sending and receiving messages from one person to another so that both understand the messages

– Sending and receiving of information from one person to another with a feedback.

– Interchange of thoughts, opinions , information

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Types of Communication

1. Verbal (speaking and listening)

2. Non-verbal (body language) Facial expressions Posture Touch Gestures/ expressions

3. Writing and Reading (digital)

Activity: Identifying ‘Good’ & ‘Bad’ techniques in

Communicating with Caretakers

1. Get into your four host team groups.

2. Work together with your team to quickly arrange the communication cards into two groups.

Good Communication Bad Communication

Are you communicating effectively with caretakers?

Share your good practices!

How are you an active listener? (what specifically do you do?)

How do you show interest in the caretaker? (what specifically do you do or say?

How do you build confidence in the caretaker to continue to engage with you?

How do you recognize or praise the caregiver? (specific examples)

How do you give practical suggestions?

How do you address the caretakers questions and concerns?

Key Communication Skills: Communicating with Children or Caretakers

1. Be an active listener- involves paying active attention, shows you care - helps client think more clearly about the problem

Techniques: repeating, clarifying, paraphrasing, reflecting feelings, summarising

2. Check for understanding- helps clients explore and visualize their problems- helps counselor get required information

3. Ask and answer questions - helps clarify client’s understanding

Remember to always:

• Give accurate answers

• Give information not advice

• Answer appropriately and relevantly

• Use simple clear language

Are you a ‘child friendly health worker’?

What works?- get down to child’s eye level - speak softly - smile- be honest - identify and respect normalexpressions of emotion (e.g. crying or anger is okay) - give the child choices - talk about things that interest

the child - respect their privacy!

What doesn’t work?DON’Tdon’t say ‘be a big boy’ don’t make the child feel like a ‘baby’

don’t pity the child

don’t compare the child to others

Useful Techniques forCommunicating with Children

Empathy- Ability to reflect on what is said, suspending judgement and see the world through others’ eyes.

Empty chair- virtual bringing an absent person into the session

- helps child prepare to enact solutions in difficult situations

»symbolic and powerful techniques

Techniques for communicating with children (cont’d)

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Enactment- Understanding child/family interaction in problem solving.-Child is asked to show/act what happens if the problem arises-Observe the communication process and interaction and identify where the problem lies.

Commenting- Sensing child’s mood/ reaction to issues.

- Process feelings and action or reactions seen

- A way of clarifying and making a child aware of his/her environment.

» Ability to make child aware of ,talk about, clarify and understanding child’s and actions

Techniques for communicating with children (cont’d)

Questioninga) Closed questions

- usually accompanied by responses; ‘yes’ or ‘no’ - are interrogative, judgemental,.

e.g. do you live on your own????do you take your medicines everyday???

b) Open questions- usually provide explanatory, expression responses- are seeking more information and clarification.

e.g. how has HIV/AIDS affected your life at school?

» 5Ws and 1H questions

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Techniques for communicating with children (cont’d)

Externalising- Separating the problem/issue at hand from the child.

For example: always call the child by his/her namedo not label them in relation to bad behaviour

»Used to normalise situations which the child thinks are abnormal

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Modes of Communicating with Children

1. Drawing- A powerful activity for opening hidden cupboards in a child’s life.- Children communicate their emotional state without having to put it into words.- Most children enjoy drawing.

»A practical tool for counselling

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Modes of Communication… (cont’d)

2. Story telling- Children don’t like lots of direct questions and long lectures.

- A story serves as a useful tool for problem solving.

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Modes of Communication… (cont’d)

3. Play/ Drama- Expression of their feelings about events and how they make sense of their world.

- Children act out or imitate things occupying

their brain.

»helps in understanding the type of emotions they are experiencing

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Barriers to effective communication

LanguageLack of confidencePoor attitudeLack of sufficient informationPoor listeningLack of creation of rapport (discussion)Environment

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Strategies for overcoming barriers

• Use local language

• Understand your emotions

• Refer situations where you get emotionally involved

• Know your limits and strengths

• Develop good listening skills and attending behaviour

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Strategies… (cont’d)

• RRelax

• OOpen

• LLean forward

• EEye contact

• SSit at the same level with the child

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Communicating with Adolescents

• Adult medicine consists of adult clinicians communicating with other adults, who share largely similar social values and norms about health, even taking account of cultural differences.

• In Paediatrics, health professionals negotiate treatment decisions with the parents, with children's participation obtained by explanation and parental authority.

Communicating with Adolescents (continued)

• In contrast, in consultations with adolescents, health professionals are faced with the challenge of communicating with a personality undergoing rapid physical, psychological and social changes.

• The adolescent may not share an adult's understanding of society or adult cognitive abilities to decide between treatment alternatives.

To effectively communicate with adolescents, we need to consider the adolescent’s:

• physical concerns• psychosocial concerns • cognitive abilities and capacity for

understanding choices, and making decisions

Issues around the management of chronic illness, for example, can be quite different with a 13 year old boy in very early puberty who has poorly developed abstract thinking compared with a 16 year old girl who is sexually mature, at final height, and has well developed adult cognitive skills.

Activity: Improving Communication with Adolescents

Group 1: Suggest a few helpful concepts during the first visit with an adolescent and their family.

Group 2: What changes could you make to a clinical setting to make it more "adolescent friendly?”

Group 3: What items are critical to ask in the psychosocial history of a 16-year-old adolescent?

Helpful concepts during the first visit with an adolescent and their family

• Assuring confidentiality

• Involving the family unless there are particular contraindications

• Using good listening techniques

• Being aware of the hidden agenda

• Interviewing the adolescent with a developmentally oriented approach

• Including a psychosocial history in the history taking

• Making sure the adolescent understands the diagnosis and treatment plan.

• Liking the Adolescent

Making the clinical setting more adolescent friendly…

• Having appropriate materials in the waiting room and offices for teens

• Setting up special times for teens to come to the clinic

• Making sure the exam table does not face the door and have privacy curtains available

• Allowing more time for the first visit

• Discussing with the adolescent his/her preference for involving parents/caretakers.

Getting the psychosocial history of a 16-year-old adolescent…

• Home situation

• Educational/school issues

• Activities and hobbies the teen is involved in

• Drug use including alcohol, cigarettes and other drug use

• Sexuality issues including relationships, types of sexual activity,

sexual orientation, contraception, STIs.

• Mental health assessment • Sexual or physical abuse particularly in teens with higher risk profile

or problems

As health professionals communicating with all clients we need to be:

• Open

• Flexibile

• Trustworthy

• Patient

• Approachable

• Respectful

• Caring

• Accepting

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And we should NOT:

• Be judgemental • Use a commanding tongue• Impose adult values on children• Compare children• Make empty promises to children• Talk too much• Interrupt the child/adolescent• Blame the child/adolescent

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Key Messages

Children and adolescents may not

remember exactly what you did or what you

said, but they will always remember how you

made them feel.

Treat each child/adolescent as an individual

Involve caretakers/parentsApril 19, 2023 29