Throughout the module is a script, designated by the star icon, which can be used to introduce issues, ask reflective questions, prompt discussion, elicit feedback, and summarize important take-home messages. The script can be read or preferably paraphrased by the educator(s) facilitating the teaching sessions.

The World Health Organization has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Bright Futures embraces this broad definition of health — one that includes not only prevention of morbidity and mortality, but also the achievement of a child’s full potential. In the Bright Futures concept of health, providing the capacity for healthy child development is as important as ameliorating illness or injury. Recognizing and acknowledging the strengths and resources of the child, family, and community are essential to promoting healthy growth and development.

To build that capacity, the Pediatrics in Practice curriculum focuses on six core concepts: Partnership, Communication, Health Promotion, Time Management, Education, and Advocacy. The curriculum also includes a companion module (Health) and videotape that present an overview of Pediatrics in Practice and the Bright Futures approach.

Today’s session is the first of three that comprise the Pediatrics in Practice Communication module.

This session focuses on active listening skills. Family satisfaction with health care is closely related to the child health professional's ability to listen to and communicate with the child and family.

Skills in communication, particularly active listening, increase the pediatric provider's ability to hear and address the needs and concerns of children and their families. Active listening involves listening for content and meaning, responding to the feelings expressed, and carefully noting verbal and nonverbal cues.

Effective communication is especially important in our current practice environment where time is at a premium. By facilitating communications, child health professionals can help ensure that the needs and concerns of the child and family are met and that relevant information is provided.

In today’s session, our objectives will be to:

• Focus on and discuss the key elements of active listening
• complete a reflective exercise on the use of active listening to build a trusting partnership with children and families

When we have completed the session, you should be able to answer the following questions:

• What can I do to promote an atmosphere of trust so that children and families will share their true concerns?
• How can I incorporate the context of the family (community, school, cultural background) while providing comprehensive health care?
• How do I demonstrate that I am actively listening to my patients?

I would like each of you to spend 3 minutes considering the many health encounters you have observed or experienced personally over the last year. Think of the various settings in which you interact with children and families or observe interactions among pediatrics providers and families.Slowly narrow your focus and concentrate on recreating one specific experience that stands out as particularly powerful. For example, do you remember a time when the real concerns of the family were missed, or when effective listening led to a meaningful discussion or disclosure?

• What were the positive and the negative aspects of the child health professionals's or your listening skills?
• What worked well? What did not work as well?

Now turn to the person sitting beside you and describe our experience as fully as possible in the next 2 minutes.

Try to address the following questions directly or indirectly as your story unfolds:

• In what context did this experience occur?
• What words, behaviors, questions, or mannerisms were used?
• What aspects of the interview or encounter contributed to or could have contributed to improved communication?
• Was the communication centered on the child and family or on the provider?
• What active listening skills were demonstrated in the encounter?
• Were important family needs or concerns missed? Or were they identified?
• What do you feel made your example powerful and illustrative?
• How have you changed personally and professionally as a result of the experience?
• What will you do differently or improve upon in your future practice as a result of the experience?

Who would like to describe and discuss their experience?

What elements of active listening contribute to improved communication and interactions among child health professionals, children and families?

What observations have you made about the use of active listening skills in establishing rapport and building trust with children and families?

The nuances of the health interview are complex. However child health professionals who use active listening as a regular part of their communication with children and families are more likely to make important observations about how well they are establishing rapport and building trust.

How do active listening skills help to focus a health interview?

Child health professionals who are both effective and time-efficient use active listening skills to promote partnership, improve family satisfaction, and build trust with children and their families. Active listening requires the pediatric provider to listen for content and meaning.

This handout highlights both verbal and non-verbal behaviors that promote active listening during a health visit. It identifies behaviors that create a welcoming environment for open communication and help to elicit the needs and concerns of children and their families. Please take some time before our next session to review this information and reflect on it.

Before we conclude, what questions remain about what we addressed today?

Now that we have completed this session on Communication, you should be able to answer the following questions:

What can I do to promote an atmosphere of trust so that children and families will share their true concerns?

• Listen for content and meaning
• Ask about child and family's feelings and respond to the feelings they express
• Offer supportive comments
• Note all verbal and nonverbal cues carefully

How can I incorporate the context of the family (community, school, cultural background) while providing comprehensive health care?

• Use family-centered communication skills
• Discuss family life, community, and school

How do I demonstrate that I am actively listening to my patients?

• Allow children and their families to state concerns without interruption
• Address the important issues that children and families bring to the health visit
• clarify statements with follow-up questions

In the next session, which focuses on eliciting the concerns of children and families, we will continue our discussion of effective communication methods.

Please take some time before the next session to reflect on how you would encourage children and families to verbalize or otherwise indicate their expectations for the health visit.