TABLE 2

Common-Factors Approach: HELP Build a Therapeutic Alliance

H = Hope
 Hope facilitates coping. Increase the family’s hopefulness by describing your realistic expectations for improvement and reinforcing the strengths and assets you see in the child and family. Encourage concrete steps toward whatever is achievable.
E = Empathy
 Communicate empathy by listening attentively, acknowledging struggles and distress, and sharing happiness experienced by the child and family.
L2 = Language, Loyalty
 Use the child or family’s own language (not a clinical label) to reflect your understanding of the problem as they see it and to give the child and family an opportunity to correct any misperceptions.
 Communicate loyalty to the family by expressing your support and your commitment to help now and in the future.
P3 = Permission, Partnership, Plan
 Ask the family’s permission for you to ask more in-depth and potentially sensitive questions or make suggestions for further evaluation or management.
 Partner with the child and family to identify any barriers or resistance to addressing the problem, find strategies to bypass or overcome barriers, and find agreement on achievable steps (or simply an achievable first step) aligned with the family’s motivation. The more difficult the problem, the more important is the promise of partnership.
 On the basis of the child’s and family’s preferences and sense of urgency, establish a plan (or incremental first step) through which the child and family will take some action(s), work toward greater readiness to take action, or monitor the problem and follow-up with you. (The plan might include, eg, keeping a diary of symptoms and triggers, gathering information from other sources such as the child’s school, making lifestyle changes, applying parenting strategies or self-management techniques, reviewing educational resources about the problem or condition, initiating specific treatment, seeking referral for further assessment or treatment, or returning for further family discussion.)
  • Adapted from Foy JM; American Academy of Pediatrics, Task Force on Mental Health. Enhancing pediatric mental health care: algorithms for primary care. Pediatrics. 2010;125(suppl 3):S110.