TABLE 3

Development of Therapeutic Relationships in Well-Child Care: Clinician Statements Regarding Key Elements of Relationships

Know the family
    “To know the family and for the family to trust you”
    “I learn about each family's philosophy of child rearing”
    “Having knowledge about and giving attention to cultural issues or concerns”
Individualized family care
    “I always try to validate the parent's success—pointing out what they are doing well.”
    “I find it helpful to pay close attention to the mother's state of health. I might say, ‘You look tired, Julie' and wait for a response. This works best when trust has developed.”
    “I discover what a child is good at—especially with isolated kids and those with a chronic condition.”
    “Giving increased attention to family support systems”
Continuity of care
    “Well-child visits begin when I first see them checking in or in the waiting room. What are the interactions between people … the emotional tone. I'll check my notes regarding past concerns. Because it's well-child care we have a track record … ‘What's been going on since last visit? Any new problems? Have you had a good summer?,' all part of the ongoing narrative.”
    “I'm more convinced now than I have ever been … that the relationship with the family is what allows us to not have an hour with them and still have an impact on them.”
Source of information
    “I think that families trust pediatricians as a source of information and also as a source of nurturing. I'm struck so often by how families relate to us as sort of being parents in loco… . This is an important relational issue, a psychoeducational process—that I can help nurture the families so they can nurture their children.”