Handouts

Tips on How to Talk with Kids about Guns

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After talking with a few parents & colleagues about my last post: “Kids and Guns: It’s about Child Safety” it became clear that a follow up post was needed.  While playdate cards help parents talk to other parents, what resources are there to help non-gun owning families talk to children about guns?

S0, how do you start the conversation with your child if you live in a gun-free home?  When should you bring it up?  Will talking make a child curious? Yes.

Children are curious about EVERYTHING.

RELATED: How I Talk to My Children About Guns

As parents, we talk to children about looking both ways before they cross the street. We talk to them about buckling up whenever in the car. We talk to them about not talking to strangers.

Talking to children about what to do if they ever find a gun or weapon in a friend’s home is just as important. Guns in US homes are common. Reasons vary for keeping guns & weapons:  work, recreation or personal protection.

It is important to help your child be prepared to know what to do.

RELATED: How to End Gun Violence in the US

LISTEN TO THIS: How guns can affect families forever–StoryCorp: Gone with a Gunshot, His Little Sister Remains, Eternally 8

This handout*summarizes some key things for parents to think about before and during talking with children about guns and other weapons. It gives some suggestions on how and when to start the conversation. It also gives parents a reminder to use a matter of fact tone.

Review this handout. Share with your partner, spouse, family, friend. Then talk to your children about guns/weapons. It can help keep yet another child safe from gun violence.

And remember, talk to other parents about guns/weapons in their homes before sending your child over to play.  They will not be offended.

RELATED: Blood on our Hands

*A special thank you to Dr. Mandy Harris and Rebecca Cisneros for talking through this important topic and providing suggestions for the handout!

Guns & Kids: It’s about Child Safety

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One of the first issues I became passionate about was keeping kids safe from guns. Why? While I was a pediatric resident in San Diego, the school shootings at Santee, California occurred. This was just two years after the horrific events at Columbine. I saw kids coming to clinic, with non-specific complaints and in the end, not wanting to go to school. Parents had questions about how to best handle their kids’ (and their own) fears.

Why did this happen? How could it happen here? Should kids be allowed to stay home from school? What can we do from preventing this horrible thing from happening again?

This experience set me on the path towards advocating for children’s health within the context of public health. I saw just how this type of violence affects individual families but also its effects on the larger community. I started a project to simplify the screening for the presence of guns and other risks for childhood injury during clinic visits; passed out free gun locks to families who told me there were guns in the home; and distributed play date safety cards to families.

Over 75% of gun injuries and death are the result of children with easy access to guns that are improperly stored. When these types of events happen, it is usually at a friend’s house or their own. Now we see these headlines daily: a toddler who finds his mother’s handgun in her purse and accidentally shoots himself; school aged boys who come across a loaded gun during play and it accidentally discharges; a teenager with depression or is bullied who has easy access to a gun and commits suicide or decides to bring it to school as an act of revenge for perceived wrongdoings. The one thing that comes out of these events is that  they are brought to our attention.  The endless stories can cast no doubt that guns and kids are a public health epidemic. On the other hand, hearing these headlines daily can leave us feeling no longer shocked that these events happen. That somehow it is part of our daily fabric living in this country. Too many children’s lives lost, too many senseless events that could have been prevented. Too many families torn apart and affected by guns.

BUT DO NOT GET NUMB. Sometimes it can feel like there is nothing we can do as a society to change things because too many of these events happen EVERY DAY. However, we have a responsibility to do what we can for our own children, for those in our care, for those in our global community. No one is immune to these events.

We must remain vigilant and continue to do what we can as responsible adults, providers, parents, and community members. We can join organized groups that advocate for action  at the federal level to pass sensible gun safety laws and ensuring access to comprehensive mental health services. There are things we can do each day by knowing what safety risks might be present in the places our children are allowed to play. We cannot assume that children will know the right thing to do when they stumble upon a gun.

Playdate safety cards are meant to help parents ask each other about potential safety hazards in the environment in which children play. It is hard to ask someone if they have guns in the home, and even more so of friends or acquaintances you have known for a while but may have never thought to ask. These playdates cards can help start the conversation.

While this is a small measure and will not “cure” this epidemic, it can be a step towards prevention of another event.

When parents arrange a playdate for their children, they usually share information about their children including any food allergies and any fears of pets. Parents exchange phone numbers or emails in the process.  This is the ideal time to ask whether there are guns in the home. It is up to the individual parent what to do with that information if the answer is yes. However, if you don’t ask, you won’t know–and I would argue it is always better to know.

The cards can be printed on cardstock.  You can stick it on the refrigerator with a magnet or in an address book once completed. You can trade them when you meet another parent. The crucial part is that it has statistics and a section with questions to ask the other parent. If you cannot bring yourself to ask spontaneously, having these cards can give you ideas for how to start the conversation. The first few times may feel awkward, but after that it becomes easier.

Download the playdate card file here.*

*A special thanks to Heather Hunt Dugdale, Esq. for working with me in those early days in San Diego on this tool. Another heartfelt thanks to one of my first mentors, Dr. Bronwen Anders, whose clinic I worked at during residency, who supported and helped me gain the confidence to move this cause forward.
Educate yourself about this issue & what you can do to help this cause.

More more information:

  1. American Academy of Pediatrics, HealthyChildren.org website has great parent friendly resources including: Gun Safety: Keeping Children Safe
  2. http://momsdemandaction.org
  3. http://everytown.org

 

Helping kids with ADHD talk about “My Today”

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MyToday-EnglishWhen families face chronic diseases, it is especially important to encourage their active participation with the medical team. This is the hallmark of the “chronic care model,” which encourages medical providers and the patient/family to work together. Chronic diseases often require lifestyle and behavior change to maximize outcomes. This is especially true in pediatrics and behavioral conditions. Published clinical care guidelines for all pediatric behavioral/mental health conditions (such as ADHD) highlight parent training and behavioral interventions as “first line” treatments.

Part of what we do in the ADHD group visit model is to help pediatric providers empower parents and children with knowledge and skills that encourage active monitoring of symptoms and behaviors. It is important to involve children in their own self-care as soon as they are able to understand basic concepts of health and illness, can participate in some aspects of self-care and show self-awareness.

We developed an ADHD group visit curriculum for parents to begin to breakdown elements of ADHD chronic care over 5 sessions–knowledge about ADHD and developmental considerations and treatment options (behavioral considerations and positive parenting, educational supports, and medications).  We have a separate child curriculum that includes complementary topics, such as teaching children what ADHD is, along with specific skills to promote self-care and problem solving skills to use in home and school.

One of the things we noticed that happened organically after the group visits was that parents and children were eager to talk to each other about what they had learned or talked about in groups. This is because parents and children participate in group separately. Groups are run at the same time but in different rooms.

One of the tools that has come out of this work is a worksheet designed to help children monitor their feelings and how their bodies feel. This is especially important if a child is on medications for ADHD since potential side effects include headaches, stomachaches and decreased appetite. Helping children learn how to “tune in” to their bodies and thoughts and also how to talk with their parents about it is a important skill.

Together with our Patient Advisory Board and the team of health communication designers, we developed a way for children to track these feelings and thoughts. We printed these as memo pads and distributed them after session 2.

Children can be encouraged to complete these sheets for the first few days after starting or increasing medication as a way to “jump start” self-awareness and conversation. It can also be shared with the child’s doctor.

Click here to download “My Today” in English.

Click here to download “My Today” in Spanish.

*A special thanks to Dustin Lynch, Courtney Moore, Helen Senamatsu and Dr. Sarah Wiehe, as well as the families of our patient advisory board for their assistance in co-developing this tool.

 

Helping families understand the educational system alphabet soup

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FINAL S3 educational narrative_Page_1It is important to help families become advocates for their children. For children with behavioral conditions, this is even more important because children’s behaviors often can lead to stress and strain on peer relationships and functioning in school. However, there are terms or abbreviations that need to be explained in clear language so families can be prepared.

Parents often rely upon their child’s pediatrician when faced with stress around their child’s behavior. However, I have learned that many pediatricians often do not feel comfortable with coaching families about educational advocacy because it is not something that is taught during training. Aside from opportunities to learn what this is all about with individual families, this is by and large a skill that is missing and thus leaves many pediatric providers uncomfortable with these questions.

Helping families become comfortable engaging with the school and being involved in their child’s education increases the likelihood of the child’s educational success at any age. Some of the positive outcomes, regardless of the family background, include:

  1. Higher grades and test scores
  2. High quality work habits and task attendance
  3. Regular school attendance
  4. Better social skills and behavior
  5. Graduate and go on to post-secondary education

The first step is to ensure parents are viewed and feel like an equal partner at the table when working with schools. However, if parents have not had positive experiences with the school system either as a child or with their child, it makes it less likely that the parent will know where to start.

That is where pediatric providers come in and can help coach families on the importance of educational advocacy.  As part of our ongoing work with ADHD group visits, one session is dedicated just to this topic because we have structured sessions to focus on the various treatment modalities for ADHD (Note: we work hard to make sure families understand that even though medications are often the first thing they think about when ADHD comes up, it is just one part of treatment. Positive parenting and educational support are equally as important!)

It also became clear that pediatric providers really crave tools to help explain the “alphabet soup” tied to understanding educational advocacy.  So we engaged our patient advisory board and patient engagement core to help us translate these complex topics into something that can be used by the pediatric provider when talking with parents about interfacing with school.

We learned that parents want to hear about others’ stories about school experiences, even if it does not entirely relate to their own child. Stories are powerful ways to understand concepts or scenarios and that ‘first-hand’ experience is valuable to other parents. Moreover seeing different approaches can help families adapt to their own situation. As a result of this process, our design team came up with a “choose your own adventure.”  Every aspect of this colorful brochure has been carefully thought out–right to the “pauses” rather than hard stops at each part of the story.

During our studies using this in our ADHD group visits, these tools were welcomed by parents and providers since it helped simplify the conversation and served as a nice road map for helping both parties to talk about the process.

Download a copy of the English version here.*

Download a copy of the Spanish version here.*

*Special thank you to our patient advisory board and Dr. Sarah Wiehe, Dustin Lynch, Courtney Moore  (IU Patient Engagement Core) & to Helen Sanematsu.

As always, please share your experiences using these tools, whether as a parent or provider.

 

 

Praise: the undervalued positive parenting tool

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PraiseWe have all heard the advice to praise kids more. However, that requires some clarification. We need to communicate clearly to our children what it is we like about what they are doing when they are doing it. This helps to “connect the dots” between the desired behavior and what our expectations are. As busy as we all are, we can forget that feedback is helpful, especially when you want someone to repeat a behavior again.

It is easier to focus on what has not been done, what has been done wrong or what needs to be done quicker. Notice also how when we focus on the negative, it often is done with  raised voices because we are frustrated, angry, or disappointed.

Yet, these are exactly the times when we can make use of a teachable moment. We can instead turn it around to help our children understand what it is we want them to do by using praise.

What do I mean by praise? Not simply issuing a generic or vague statement, such as “good job!” or “wow!”To be as effective as possible, make sure praise is SPECIFIC and IMMEDIATE. This is especially helpful when giving praise to a younger child or a child with ADHD. By communicating exactly what it is you liked when your child completes a task or behavior, you are letting children know that you notice them and their actions. This, in turn, will help children feel good about themselves, about the choice they made or the way in which they acted. When children feel especially proud or receive positive attention, they are more likely to have a repeat performance.

This is how praise can be so powerful. Yet, it is woefully underutilized and overlooked as a way to help shape behavior.

This, however, doesn’t mean to praise everything and go over the top. In order for praise to be effective, you need to use it appropriately and with genuine feeling. Kids can often see through praise that is given just because or praise that may even end up not being true, “You are the smartest kid I know!” Praise when delivered right can be a powerful motivator to help give kids the extra boost they need to keep going with challenging or multi-step tasks. Praise can help them see that they are capable and competent, help them see we value their contributions.

Sometimes parents may feel praise is phony or should not be used for tasks or chores that just should be done. However, children often need guidance to understand what is expected of them. When parents use praise for making an effort or for compliance with a request right when we ask or without argument, it helps children keep going and to try to be the best they can be.

We all like to be recognized for efforts in our work, in our homes and in our relationships. It reminds us that someone else values us for who we are and what we do. Who doesn’t thrive on little reminders?

Below are a set of handouts (in English and in Spanish) on the basic principles of PRAISE that can be used when counseling families about the importance of this tool.

Click here for the English handout.*

Click here for the Spanish handout.*

*Please retain copyright in the lower right hand corner.

Note: I always welcome comments on the handouts in general, its utility and any feedback you receive from parents.

Time-In: The Foundation of Parent-Child Relationships

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The concept of “time-in” seems so simple but it is often overlooked once children grow older. We get busy. We are tired. There are a million things to do. However, everyone needs ‘special time’ with their partner, spouse, parent, friend. Somehow, as we grow older and our lives become even busier, it is easy to forget the small things.

I first learned about “time in” when I sat in on a 22-week parenting group. This was before I had kids of my own. I had been running a foster care clinic in Seattle and was seeing well intentioned foster parents struggling to care for children entrusted in their care. Children who were acting out because of the stress and scariness of losing their parent, their home. Sometimes they acted out because they were angry and tired of all the change, all the uncertainty. Some children were placed with strangers. But sometimes children were placed with family friends or relatives.. but for that moment, it was not with their parent. All this translated into a difficult time for all.

I learned a tremendous deal during that parenting group led by Dr. Carolyn Webster-Stratton, the developer of the Incredible Years parenting series. I also learned that pediatrics residency had not prepared me for the tough questions that these foster parents had and the even tougher behaviors the children were having. It didn’t feel right to medicate these children just to “calm them down” or “make their anger or aggression more bearable.” These children needed security, routine, structure and the repeated knowledge that a nurturing and caring adult was in their corner.

In that group, I learned Dr. Webster-Stratton’s approach was to teach the skill of “time in” no matter if the parenting group was for prevention of behavior problems or for treatment of them. She ALWAYS started with building that foundation. I learned if parents do not make an effort to do “time-in”, “time outs” won’t work. This is because time outs are essentially an extended ignore and if parents are not  giving children positive attention in the first place, time outs won’t make a difference.

Time-In simply refers to spending one-on-one time with another person without life distractions. For young children, the word “time-in” often conjures up images of parents on the floor playing with their children. However, even as we grow older, time-in is just as important. It can be that ‘check-in’ with your high schooler after practice while driving home or the family conversations over dinner.  Time-in means going back to the basics of just focusing on your child and being sensitive to their cues, their need for attention. We can forget that even with all the material things we can buy our children, our time and presence is what matters the most.

Educating parents that children thrive on attention is important and should start early. Attention can be positive (hugs, kisses, praise) or negative (yelling, reprimanding); in the end, children just want our attention. If parents give positive attention freely, kids won’t have to act out to get attention. This concept applies to all relationships. Water and tend to your friendships and they blossom and thrive; neglect them and friendships wither and slowly lose touch over time.

Always go back to the basics.

Below are a set of handouts focused on “Time In” to be used with families to discuss the importance of this essential positive parenting skill.

Time In English (English).*

Time In Spanish (Spanish).*

Parent-child Time-In Love Note Activity (It’s Challenge Time).*

*Please retain copyright in lower right hand corner.

For more information about The Incredible Years, go to www.incredibleyears.com

A new handout for ADHD

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ADHD JIT Revised FINAL

My passion & ongoing research examines innovative ways (e.g. group visit models, health information technology) to engage pediatric providers and families around common developmental-behavioral and psychosocial topics in primary care.  I am a firm believer in improving communication at the point of care.

Carefully designed handouts can be used for clear information exchange, can be shared with other family members and improve parental understanding.  This is one of my newest handouts that focuses on pediatric attention-deficit hyperactivity disorder (ADHD).  It can be used after completing the work-up for ADHD to help families understand what ADHD is, introduce the idea that treatment actually is not just medicine (which is what I find parents are most worried/concerned about), help families understand who is on their team moving forward and includes simple parenting strategies for helping their child. There is also a message that the medical home should be viewed as a resource for the parents for ongoing support and encourages parents to ask questions.

Download a copy of the English version here*: ADHD Informational Handout

Download a copy of the Spanish version here*: ADHD Informational Handout-Spanish

*Please keep the copyright in the lower right hand corner intact.