1 / 28

What Will Our Child Actually Do ? Factors Affecting Compliance

What Will Our Child Actually Do ? Factors Affecting Compliance. K. Verdolini Abbott, Ph.D., CCC-SLP September 2010. http://www.babble.com/CS/blogs/strollerderby/2008/11/16-22/children-playing.jpg. Caveat: Terminology. Some people don’t like the term “compliance” (hierarchical model)

pillan
Download Presentation

What Will Our Child Actually Do ? Factors Affecting Compliance

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. What Will Our Child Actually Do?Factors Affecting Compliance K. Verdolini Abbott, Ph.D., CCC-SLP September 2010

  2. http://www.babble.com/CS/blogs/strollerderby/2008/11/16-22/children-playing.jpghttp://www.babble.com/CS/blogs/strollerderby/2008/11/16-22/children-playing.jpg

  3. Caveat: Terminology • Some people don’t like the term “compliance” (hierarchical model) • http://www.ark-of-salvation.org/pyramid.gif • Alternate terms • Adherence • Concordance (e.g., Bissell et al., 1997) • http://integressblog.files.wordpress.com/2009/09/handshake.jpg

  4. Caveat: Measuring compliance • Problematic • http://ruler.magsinet.com/ruler_10_20.jpg

  5. Adult literatureFactors increasing compliance (cites in Titze & Verdolini, 2010) • Findings • Perceived severity of health problem • Short duration of illness • High income • Unemployed • Urban setting • Transportation • Implications for kids • Many not be sharply aware of problem • Many referred with chronic problem • (Insurance issues?) • Child with time • ??? • Important

  6. Adult literature, cont’d • Findings • Remembering • Positive attitude about disease • Confidence in treatment • Internal locus of control • Self-efficacy • Minimal side effects • Implications for kids • Help them to remember • Pump them up about the process • Give them confidence • You can do it! • You can do it! • Minimize side effects

  7. Adult literature, cont’d • Findings • Family/social support • Information about disease and treatment (sometimes) • Clinician/patient match in information • Infrequent doses • Simple program • Written instructions • Follow-up • Implications for kids • Parent support critical • Education about disease and treatment process may help • Adapt level of information to child • Minimize exercises • Make it simple • Write out instructions • Follow-up therapy

  8. Adult literature, cont’d • Findings • Clinician/patient interaction • Implications for kids • How we interact matters

  9. Children proper • Distilling key points • Motivation • Remembering • Instilling confidence • Adapting info level • Minimize cosmetic s.e. • Keep the load simple • Write out instructions • Parental support • Clinical presence • (Next pages)

  10. Motivation • Most children referred by an adult (parent, physician) • Motivation may not be inherent • Child may only be dimly aware of the problem, although it is troublesome to him/her • http://www.ineedmotivation.com/blog/wp-content/uploads/2008/07/pp30580motivation-posters.jpg

  11. Motivation • Important to “set the stage” for the child • Need child “buy-in” • Speak directly to the child (even if parent is involved) • AIV (check) http://jimvining.files.wordpress.com/2009/05/empty-stage.jpg • AIV (check) • AIV (check)

  12. Motivation • Maintenance of “buy-in” may be enhanced by extrinsic rewards for doing the tasks • Caution about extrinsic rewards for how the task is done (potential extinction; Skinner; see motor learning lecture) • AIV (check) http://unusuario.com/wp-content/uploads/2009/12/free-vector-graphics-stickers1.jpg • AIV (check)

  13. Motivation • Specific moderately-difficult goals may be better than “do your best” • e.g. Kyllo & Landers, 1995 http://img.dailymail.co.uk/i/pix/2008/04_04/GarciaGhostGoal_468x358.jpg • AIV (check)

  14. Remembering • Key for compliance is remembering an instruction in the first place http://www.durgana.com/webquest/remember.gif

  15. Remembering • Conscious remembering is facilitated by so-called associational or elaborative processing (information presented in broader context) • E.g. Craik & Lockhart, 1972 • AIV (check) • Creation of stories about voice and voice care should help make therapy instructions memorable to the child http://mypetjawa.mu.nu/archives/toy_story_ver1.jpg

  16. Instilling confidence • Self-efficacy also applicable to compliance in children • (e.g. Heitzler et al., 2010) • AIV (check) • Deal/talk directly with child • Give child opportunity for success • Make exercises “do-able” http://ag.udel.edu/extension/fam/gb/36month/reading.jpg

  17. Adapting information level • Obvious • AIV (check) • Single program • But adapt tone, language, and some specifics according to age http://www.communicationsintheworkplace.com/Adapt_Win_Workplace_Communications.gif

  18. Cosmetics • Child literature • Negative cosmetic side effects of cyclosporine (hirsutism, gum hyperplasia) with renal transplantation may affect compliance with treatment (Willetts & Trompeter, 2004) • Lack of confidence with headgear in orthodontic treatment affected compliance (Sergl et al., 2000) • AIV (check) • Pay attention to child’s comments and concerns about “sounding different”

  19. Keep the load simple • Child literature • Complexity: Single doses of antibiotics have better compliance with children than multiple doses • Duration: Two-hr eye patch use gets higher compliance than 6-hr eye patch use • Arguedas et al., 2004; Gottlob et al., 2004 • AIV (check) • Keep the home program short, sweet (and fun!) http://corditecountryshownotes.files.wordpress.com/2009/10/gold-pills.jpg

  20. Write out instructions • Definitely. • Audio CDs too! • AIV(check) http://www.mamismachicago.com/blog/assets/content//perscription.jpg

  21. Parental support • Child literature • Critical mothers had more difficulty getting child (6-13 yr) to comply with asthma treatments, as compared to less critical moms • Critical parents had adolescents with greater improvement in asthma severity, greater reduction in steroid dose, shorter hospital stays; however those adolescents had poorer compliance with meds • Schobinger et al., 1993; Wamboldt et al., 1995 http://img.thesun.co.uk/multimedia/archive/00854/ControllingParents-_854169a.jpg

  22. Parental support • AIV (check) • Encourage parental support rather than criticism or nagging http://www.lssi.org/Service/Images/BHSCounselingParentSupport.jpg

  23. Parental support • Child literature • Parents and behavioral home programs • Home activity programs (HAP) for kids with global developmental delay (N=41; OT, PT, SLP) http://myportfolio.usc.edu/ecamin/pediatric_occupational_therapy.jpg • Compliance increased with • Support by therapist • Fewer secondary health problems • Smaller family • Older child receiving program (4.3 vs 3.8 yr) • Marital stability (longer marriage) • Father with university degree • Positive feelings about the program • Tetreault et al., 2003

  24. Parental support • HAPs, cont’d • Many parents with high stress maintained the program • Important: When prescribing HAPs, be aware of demands placed on (Moms) http://www.couchavenue.com/wp-content/uploads/2008/04/exhausted.jpg

  25. Parental support • HAPs, cont’d: Implications? • Important suggestions to help compliance • 1. Check to see if other HAPs are already in place; do not overburden family • 2. Ask parents if they agree to HAP • 3. Choose goals/activities with parents, for easier use in daily life • 4. No more than two goals per therapist, 6 goals total • 5. Take time to teach parents how to use the HAP • 6. Schedule follow-ups (e.g. phone calls) • 7. Revise HAP every 3-6 months http://www.atlanticstreet.org/images/momdtr2.gif

  26. Frank behavior problems(no extra charge) • Autism • Noncontingent positive reinforcement decreased self-injury behavior • I.e. escape from learning activities on fixed time schedule • Vollmer et al., 1995 http://www.topnews.in/health/files/autism2.jpg

  27. Frank behavior problems • Autism and possibly some other conditions, implications? • Consider noncontingent reinforcement? • AIV (check) • The whole therapy is a game • “Escape” not particularly needed http://www.filetransit.com/images/screen/6a96d4695b18e7d7b570b02ff4aadcab_Memonix.jpg

  28. Clinician presence • Importance of rapport, patient-clinician relationship, emphasized • E.g. Johnson et el., 1998 (orthodontia) • AIV (check) http://www.sacredheartenergyhealing.com/Warm_Light.jpg

More Related