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 two that comprise the Partnership module. For some of you, the concept of a clinical partnership is relatively new; for others, the concept is familiar, but a method for developing partnerships in your practice may be new. The principles of partnering can be applied at the individual or community level. This module focuses on fostering individual partnerships between child health professionals and the children and families they serve. However, similar concepts may be applied to community partnerships. (The Advocacy module explores important concepts in partnering with communities.)

Today’s module introduces a conceptual framework for clinical partnerships: six steps that help build and maintain successful partnerships in your practice.In today’s session, our objectives will be to:

• Explore key attitudes or qualities that are prerequisites for building effective partnerships.
• Introduce a six-step framework for developing clinical partnerships.

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

• What specific attitudes do child health professionals need in order to adopt the Bright Futures approach?
• What are some of the major benefits of building a successful partnership with a child and family?

For working purposes, let us define a clinical partnership as the delivery of health care in a way that recognizes the critical roles and contributions of each participant (child, family, health professional, and community) in promoting health and preventing or treating illness.

What characteristics of the child health professional might facilitate a clinical partnership?

What patient or family characteristics might help foster the partnership?

Developing partnerships begins with attitudes, but sometimes attitudes present potential barriers. Some families, for example, are reluctant to partner and prefer to follow the health professional’s recommendations. Sometimes, either the health professional or the family believes that an equal partnership is not possible because professionals have the medical knowledge that families lack; others may think the health visit is more “efficient” when the professional decides on a plan of action and clearly explains it to the family. Time constraints, too, can be persuasive in convincing some health professionals that attempting to partner with every family is unrealistic and takes too much time.

As we conclude this session, I want to move beyond key attitudes and introduce a practical set of steps that form the framework for building partnerships with children and their families. In the next session, we will develop some skill-building tools to put these steps into practice in the health visit.

Partnership development is a continuum, from sharing information to partnering around certain issues to building a full partnership in health. The key to building a partnership is to recognize that all children and families possess information and skills critical to optimal health care delivery.

Families who partner with their health professional participate more fully in health care delivery. They feel more comfortable sharing information with the professional and are more committed to following through with an identified health care plan.

Creating or sustaining full partnerships with individual patients and families is not always easy or even possible. Family dynamics, personalities, and other issues may prevent providers and families from participating as equal partners. However, it is important to consistently nurture the elements of trust, respect, and empathy in every relationship. These qualities — some of which will be addressed in Session 2 of this module — ultimately foster an effective partnership. They help prevent the frustration and conflict that can ultimately lead to poor time management and ineffective health care delivery.

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

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

What specific attitudes do child health professionals need in order to adopt the Bright Futures approach?

• Health professionals need to develop attitudes that foster trusting, empathic, respectful relationships between the professional and the children and families they serve. Openness, a willingness to actively listen, and the capacity to learn from and affirm the child’s and family’s strengths are critical.

What are some of the major benefits of building a successful partnership with a child and family?

• Improved quality of care for the child is one of the best outcomes of forming true partnerships with families. This quality of care is reflected in prompt and accurate identification of family concerns, appropriate management and follow-up of identified problems, efficient use of the family’s and the professional’s time, and family satisfaction with care.

What are the six essential steps for building effective partnerships?

• Model and encourage open, supportive communication with the child and family.
• Identify issues through active listening and “fact finding.”
• Affirm the strengths of the child and family.
• Identify shared goals.
• Develop a joint plan of action based on stated goals.
• Follow up: Sustain the partnership.

In the next session, we will use the six-step framework in a case discussion in order to develop practical skills in building partnerships in the health encounter.