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 Health Promotion module.

As child health professionals, you are in a unique position to promote health and prevent illness. You have frequent interactions with children and families, particularly in the early years. These encounters give you ample opportunities to observe, listen to, and recognize issues in promoting health and preventing illness. Families may have questions about the seriousness of an illness; concerns about expenses; anxiety about child care issues; family issues such as divorce or separation; work-related issues; or even concerns about their own fitness as parents. Because families often hesitate to initiate discussions on these topics with child health professionals, it is essential that you identify and focus on the needs and concerns of each child and family.

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

• Focus on the importance of asking openended interview and directed follow-up questions in order to elicit a family’s concerns during a health visit.
• Examine a specific case to demonstrate the use of interview and follow-up questions to promote health and prevent illness.

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

• How can I effectively identify relevant health promotion and illness prevention topics?
• How can I ensure that I give personalized guidance?

This case about Manuel will demonstrate how asking open-ended questions, followed by asking focused questions, can help to identify problems specific to each child.

What are your impressions and reactions to this case?

What might you want to address and explore further?

What questions would you ask and how would you ask them?

What are some nonjudgmental interview questions you would want to ask the mother?

Which questions do you think were the most effective interview questions? Which were less effective?

Effective questions are open ended and nonjudgmental.

Good questions allow the child health professional to ask follow-up questions.

Ineffective questions are those that invite yes or no answers and may imply judgment of behaviors.

Beatrice’s husband left her 6 months ago.

Beatrice and Manuel moved in with Beatrice’s sister and her children.

The living conditions in the apartment are not good. There is often no heat, and the paint is peeling.

Beatrice is quite concerned about the effects of this situation on Manuel.

Your initial questions have disclosed the family’s concerns. The next step is to ask directed follow-up questions that will elicit more information from the family.

Beatrice has noticed that Manuel and her sister’s children have eaten some of the paint chips.

Beatrice has been concerned about Manuel’s development.

Manuel has never been anemic or had lead poisoning.

Beatrice must support herself since Manuel’s father is no longer in the picture.

When Manuel’s lab results return the next day, they show that his hemoglobin is low at 10.8 gms%, and his venous lead level is quite elevated at 45 mcg/dl.

In this example, we see that the initial openended interview questions, combined with the more-specific, directed follow-up questions, uncovered the needed diagnosis of lead poisoning.

When the family returns to get Manuel’s laboratory results, you will want to help them understand the information and to provide personalized guidance.

How would you share this information with the family?

While it’s important that you explain the medical aspects of the case (such as interventions), you also want to involve the family in the discussion about how to deal with the problem.

At the end of the visit, you want to be sure that the family understands what is being done and what has been decided.

What would be a good way to end the health visit?

Answers to these questions might identify barriers to the guidance you have given and the care you have prescribed.

The case vignette in this session demonstrates the importance of good interview questions, careful listening, and specific follow-up questions in identifying relevant health promotion topics.

Without the right interview questions, a child health professional might not have been aware that Beatrice had recently moved in with her sister and that Manuel was at risk for lead poisoning. This case also illustrates techniques that you, as a child health professional, can use to involve the family and community in handling a health promotion or illness prevention issue.

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

This handout illustrates sample interview and follow-up questions (adaptable for use with parents). Please review the handout, and if you have any questions, we can answer them during clinic today or at another time.

How can I effectively identify relevant health promotion and illness prevention topics?

• Ask effective open-ended and nonjudgmental interview questions to obtain information.
• Ask directed follow-up questions to focus the discussion and communicate understanding.
• Listen to and recognize nonverbal cues during encounters with patients and families.

How can I ensure that I give personalized guidance?

• Introduce new information and reinforce healthy practices based on responses to your questions and facts obtained in the medical, social, and family history.
• Identify and address any barriers to care.

The child health professional, the family, or the community might present a barrier to optimal health care. The following are some examples:

The child health professional may:

• Encounter lack of trust by the family.
• Lack confidence in the role of child health professional.
• Experience scheduling difficulties.
• Lack adequate time with patients.

The family may:

• Be afraid or anxious.
• Lack information or be in denial.
• Have inadequate resources.
• Experience spousal, grandparent, or sibling problems.

The community may:

• Not have pediatric and family-centered hospitals.
• Lack responsive social services.
  

In our next session, we will look at another case and review the importance of asking open-ended and follow-up questions. We will also discuss the use of family and community resources. As you prepare for the next session, please consider the following question:

How can I identify and use family and community resources to promote health and prevent illness?