TABLE 2

Facilitating Parent-Provider Collaboration and Defining the “Teachable Moment”

1. Nonverbal behavior. Nonverbal factors are vital for creating a working relationship. One of the first elements is comfortable eye contact at the same physical level as parents/patients, that is, clinicians should sit down. This conveys genuine interest in listening to and helping families. Other nonverbal behaviors include a forward, attentive, but relaxed body posture. Although providers must write down pertinent information during the visit, note-taking and looking at the patient record should be minimized during conversations.32
2. Opening channels of communication. Warm greetings, “small talk,” questions about well-being, and a search for shared interests help families feel comfortable raising troubling issues. Parents can be asked, “How have you and your family been since our last visit?” Children and adolescents can be asked, “Tell me some of the fun things you’ve been doing.” Such questions enable providers to proffer appropriate and well-timed self-disclosure (eg, “Very exciting. I’m also interested in …”).29,30,33,34
3. Identifying the parent/patient agenda. The value of communicating well with families is enormous and known to increase visit uptake/patient retention and positive parenting practices.21,30,31,3336 Open-ended statements such as “Tell me any questions you have today” convey an interest in families’ issues and perspectives. Active listening skills (eg, summarizing, restating, questioning, and seeking further clarification) are needed to ensure mutual understanding. Incorporating parents’ own words and phrases in subsequent questions is useful (eg, if a parent says, “I think she is hyper,” clinicians can restate and request details [eg, “Please tell me more about why you think she is hyper”]).
 It takes time and encouragement for families to fully state their worries and describe relevant symptoms (which are rarely listed in order of diagnostic importance).3337 Yet, families are often redirected before they can list their worries, resulting in “late-arising/door-knob” issues and extended visit length. Particularly effective is to use accurate measures eliciting parents/patients concerns before the encounter (eg, paper/pencil in waiting rooms, self-administration via parent portals from home or public school/library computers). Such tools are known to help families identify their main concerns, decrease disruptive “oh by the way” concerns that often occur at the end of encounters when there is little time to address them, and contain visit length to expected intervals.3338 Additional methods for focusing visits include posters in waiting rooms listing topics that may be of interest, and checklists of topics/previsit questionnaires, which families can use to identify their specific information needs (and which topics were covered at previous visits).20,33,34,39 A distinct advantage of previsit questionnaires and screening tools eliciting parent/patient concerns is that clinicians can prepare materials (eg, information handouts, brochures about referral sources, etc) before entering the examination room.
4. Further defining the teachable moment. To a carefully elicited list of families’ concerns, clinicians should observe and then comment on parents’ and/or children’s behavior (eg, “He sure is a busy little boy. Tell me how he is at home.” or “She looks very tired today. Please tell me about her sleep habits.” or “You seem down. How are you doing?”).21,30 Synthesizing professionals’ observations with parents’ concerns leads to a family-centered agenda known to improve parents’ willingness to follow through with suggestions and recommendations. As a consequence, clinicians’ own agenda list (eg, routine health and safety tips) have a greater chance of efficacy.3339