1. I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation. Strength Based Approach Barbara Frankowski MD, MPH, FAAP University of Vermont College of Medicine April 21& 27 2011

2. 2 Case Study - Samantha  21 year old mother with an 18 month old daughter. They have just begun living in a homeless shelter  Refusing to put her daughter in child care so she can’t get a job now  Doesn’t have a place to live and doesn’t want to live with her mom anymore no matter what

3. 3 Parental Strengths: PreSIP  Parental Strengths were discussed at last health supervision visit (9, 24 month visit)  Answer ‘yes’ if there is documentation that parental strengths were discussed at the last health supervision visit (ie, 9, 24 month visit), can include: Documentation of a discussion of Parental Support Use of Connected Kids People who care about me worksheet

4. Parental Strengths (cont)  Documentation about helping parents identify their own/family’s strengths: has a friend or family member to turn to when they need help (connections, belonging), able to make independent decisions, helps out family members or others, participates in community activities has self-confidence, can get things done (mastery) copes with stress,

5. 5 Strength-based approach  Strength-based approach outlined in Bright Futures Giving parents and children the ability to continue their development by providing opportunities to grow and build competency  Building parents knowledge and encouraging mastery but also providing good ideas on how to integrate into their daily life Independent decision-making and problem-solving  Giving people a chance to problem solve and become efficacious in making own decisions  Honoring the idea that they are an expert on their family Parents want to do well by their children  Messages should align with the fact that parents want to do well by their children (Brazelton)

6. 6 Strength-Based Approach  Identify parent/child strengths  Give feedback to the parents Use a framework  Utilize shared decision-making

7. 7 Touchpoints Principles of Practice (Brazelton)  Value and understand the relationship between you and the parent.  Use the behavior of the child as your language.  Value passion wherever you find it.  Look for opportunities to support mastery.  Be willing to discuss matters that go beyond your traditional role.

8. 8  The parent is the expert on his or her child.  All parents want to do well by their child.  All parents have strengths.  All parents have something critical to share at each developmental stage.  All parents have ambivalent feelings.  Parenting is a process built on trial and error. Touchpoints Parent Assumptions (Brazelton)

9. 9 Let’s get back to Samantha  Filled out all the Bright Futures forms  Found out that her concerns were  Boyfriend's mother had a child with autism, so concerned about imms  Risk factor identified – new immigrants at homeless shelter – had contact with people from Laos for three weeks

10. 10 Search for Some Strengths Risks need to be identified BUT:  Strengths are an essential part of health  Look for Resiliency and Strengths: ask about strengths at every encounter!   Promoting strengths will enhance interactions with parents  Search for strengths  Connection/Belonging  Competence/ Mastery  Independent decision-making  Helping out (family and/or community) Copyright University of Vermont

11. 11 Identified her strengths  Helps out at the shelter with reading – went to the library to get the books (Helps out)  Wants to have her daughter grow up always feeling safe and smoke-free, so she moved out of her mother’s house because she smoked and was “always yelling” (independent decision- making  Finished her GED, worked as a waitress, never needed help from agency before (Mastery)  Has a partner who has been with her and Samantha for 6 months – he lives with his parents (Belonging)

12. 12  19 yo dad of 12 month old Jared  Lives with baby’s mother & MGM  Comes to most visits with mother, but seems unengaged, lets her do all the talking  Shows up alone with Jared for this check up (mother is in court today)

13. 13 What about Warren?  Texting while Jared is playing alone  Answers your questions as briefly as possible, not much eye contact  When Jared falls and bumps his head, he immediately goes to Warren, who picks him up and comforts him easily “It’s ok, little man!” Jared smiles & hugs his dad  What could you do with this opportunity?

14. 14 What are Warren’s Strengths?  Mastery/Competence – he knows more about child care than you thought! What other questions can you ask about his involvement as a father? How about other areas of competency in his life? (school, job)  Belonging/Connections How does he see his role as a father and partner?

15. 15 What are Warren’s strengths?  Independent decision making What does Warren feel he has control over in his life now?  Helping family or others What does he do for his son or partner that he feels most proud of?

16. 16 Maria and Jorge: Grandmas’ Helping!  Maria has a large, loving family here and in PR  Lives with husband in same apt building as both sets of GP  Maria struggles with weight  Jorge is at 90% for wt, 50% for ht  Started cereal at 3 months – loves food! Great Eater! Cereal in bottle at night

17. 17 What is Maria doing well?  Mastery/competence: loving, attentive mother, has read a book about child development  Belonging/Connection: Husband, extended family, church  Independent decision making: Grandmothers & Aunties help with child care, Maria turns to them for major decisions  Helping others: helps with childcare at church

18. 18 How can you help Maria exercise independence?  Work around feeding decisions: What do your relatives tell you? What do YOU want to do? What is best for your baby?

19. 19 Mary & Maryanne: Food = Love  21 yo single mom of 3 yo  Socially isolated – Mary was raised by her disabled GM, who passed away shortly after Maryanne was born  “I know you said her BMI is high, but she looks healthy to me!”  “I would never deny her food because I love her too much!”

20. 20 Mary’s Strengths  Independent decision making: raising a beautiful, smart daughter by herself! Maryanne knows her colors, numbers, letters  Mastery/Competence: see above!  Helping out: would do anything for her daughter, gave up her job to raise her  Belonging: bonded with daughter, but socially isolated

21. 21 Reframing “Love”  What is most important to you? Wants daughter to be happy and healthy  Maryanne craves your attention How else can you do that besides food?  Go out and play! Exercise together, make new friends for Mary AND Maryanne!