Working with Difficult Parents: Achieving Successful Partnerships

1. Working with Difficult Parents: Achieving Successful Partnerships Sarah Hamill Skoch, PhD and Mary McGuire, MSW University Medical Center June 9th 2012

2. Overview of today’s talk • Characteristics of parents today • What are the challenges • Communication strategies • Effectively dealing with your own stress • Q & A

3. Why are we here? • Increase children’s success! • Many variables that affect a child’s trajectory • Most important variable = parents • Research shows parent involvement = increased child success (Williams et al., 1989, Epstein, 1992)

5. Today’s parents – Who are they? • Family configurations • Working parents • Single parent families • Economic factors for families/parents • 1 out of 5 AZ parents earning below the poverty level • 60% of AZ’s mothers are working moms • (US Census Bureau, 2002)

6. Today’s parents • Family Stress • Time a valuable and precious resource for parents • Mental health issues among parents • Anxiety, depression, chronic stress • Decreased coping skills

7. Why do parents act that way? • Parents perception – perception is reality • Negative school experiences • Parents unsure how to be involved

8. Situations you are up against • Parents who deny child has mental health problems • Dealing with parents who call about their child, but then want to spend time talking about their own issues • Parents who come to you under the influence • Parents who become hostile with you

9. Situations you are up against • Difficulty getting a hold of parents • Difficulty getting a parent to come pick up a sick child • Feeling bullied as the school nurse • Misunderstandings about what happened to a child in a given day • Role reversals (child as the parent)

10. Situations you are up against

11. Building Rapport • Trust • Listening to the parents concerns • Goal is a collaborative relationship

12. Building rapport and Increasing communication • Making parents feel welcome • Finding common ground • Communicating in good times • Hearing good news from you

13. Making praise with parents effective • Be Authentic • Be Specific • Make Praise Immediate • Keep it “Clean”

14. The power of active listening • We want to solve problems • An ear, not an answer • “I am sorry that happened” • Active listening, validation and empathy first

15. Keeping your cool • Honest assessment of yourself • How am I contributing to the situation ? • How am I perceiving this parent? • What else might be going on?

16. Keeping your cool assessment • How you are feeling with the parent • Monitor defensiveness • What does it mean? • How to notice your own signs of feeling defensive?

17. Techniques to Keep your cool • Voice – turn the volume down • Non-verbal behaviors • Eye contact • Body movements • Neutral stance with families

18. When the parent is right • Get to them first • Using the “S” word – I am sorry • Thanking the parent • Validation and building rapport

19. Boundaries and structure of conversations with parents • Time and a place for all conversations • Set an Agenda • Social media • Policies of your employer/professional ethics code

20. Logistical Tools • Providing parents with resources/handouts/written information • A digital file of resources for parents • Keeping notes for yourself – what did you discuss

21. Clinical vignette • Parents of an 8 year old with chronic asthma, presented at a pulmonary hospital • Objective - parenting help and couples work • Parents were initially scheduled with an attending psychologist • Parents rescheduled and double booked

22. Clinical vignette • Tools I used: • Listened to their concerns • Apologized  validated their experience • Provided them with options • Let them make the final decision

23. Parents of children with chronic illness • Families with a child with chronic illness • How these parents may differ • 504 plans and additional support for these families

24. Angry versus aggressive parents • Aggressive and abusive behavior • Let the parent know  this is not okay • Mrs. Jones please don’t talk to me like that. I would never speak to you like that, and I will never speak to your son/daughter like that • Knowing when to end a conversation

25. When to refer a parent/family for services • Suspect mental health issues • Child suffering • When you find yourself out of options • Aggression • Need additional assistance with a parent/family

26. Role play

27. Role play

28. Discussion • What did you notice about the two scenes?

29. Focusing on the future • Agree to disagree • We can agree we don’t want this to happen again! • What can we do differently next time?

30. Increasing parent involvement • “The more involved parents get in education – their own children’s and the nation’s – the better our school become.” • Hirshberg, 1999 • Understanding why parents are not involved • Finding ways to increase parents presence

31. Summary • Stressors for parents • Tools • Building rapport • Increasing communication • Active listening • Keeping your cool • Setting boundaries

32. Summary • Logistical considerations • Ways to save time with parents • Focusing on the future • How can we apply this to the next situation

34. Stress • A physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation • A state of bodily or mental tension resulting from factors that tend to alter an existent equilibrium (www.merriam-webster.com/medical/stress)

35. Some physical indicators of stress • Shortness of breath • Headaches • Muscle tension • Heartburn • Upset stomach • High blood pressure • Sleep disturbance • Too much/little sleep • Fatigue • Chest pain • Suppressed immune system

36. Some emotional indicators of stress • Nervousness • Anxiety • Irritability • Anger • Impatience • Crying easily • Sensitivity

37. Some behavioral indicators of stress • Eating patterns • Substance use • Grinding teeth • Nail biting • Neglecting appearance • Procrastination

38. Some cognitive indicators of stress • Poor concentration • Memory lapse • Negative attitude • Forgetfulness • Confusion • Worrying

39. Stress Test

40. Stress Test Question #1 • Rate your stress on a scale of 1-5 where 1 is the lowest and 5 is the highest

41. Stress Test Question #2 • In the last month, how often have you felt you were unable to control the important things in your work life? (never, almost never, sometimes, fairly often, very often)

42. Stress Test Question #3 • In the last month, how often have you felt confident in your ability to handle your personal problems? (never, almost never, sometimes, fairly often, very often)

43. Stress Test Question #4 • In the last month, how often have you felt things were going your way? (never, almost never, sometimes, fairly often, very often)

44. Stress Test Question #5 • In the last month, how often have you felt that difficulties in your workplace were piling up so high you could not overcome them? (never, almost never, sometimes, fairly often, very often)

45. Stress Assessment • Low Stress Level: • Associated with a healthier life, being less fatigued and having more peace. Try to maintain at this level. Continue your stress management strategies. Monitor for any signs/symptoms of increasing stress such as headaches, anger, indigestion and/or mood swings. Evaluate your life for any internal/external stressors. (http://www.mayoclinic.com/health/stress-assessment/SR00029)

46. Stress Assessment • Moderate Stress Level: • Moderate levels of stress can have serious health consequences over time so you should address your stress now. Stress is experienced when your ability to cope with stressors is exceeded by the stress (http://www.mayoclinic.com/health/stress-assessment/SR00029)

47. Stress Assessment • High Stress Level: • You are at increased risk of serious health issues, including obesity, heart disease and depression. Steps should be taken now to lower your stress level in order to help manage your health (http://www.mayoclinic.com/health/stress-assessment/SR00029)

48. Other indicators of stress • Neglecting your diet • Trying to do everything yourself • Easily agitated • Setting unrealistic goals • Failing to find humor in other situations people find funny • Complaining of your disorganization • Keeping your feelings bottled up • Neglecting exercise • Having minimally supportive relationships • Getting minimal sleep

49. Other indicators of stress • Frequently racing through the day • Feeling there is only one right way to do something • Not incorporating relaxation into daily life • Feeling unable to cope with everything you have to do • Getting angry when kept waiting • Procrastination • Easily intimidated • Making a big deal of everything

50. Sources of stress • Death of a loved one • Separation/Divorce • Child leaves the home • Personal illness/injury • Change in a loved one’s health • Put in jail or an institution • Loss of employment • Change in employment hours/conditions • Marriage • Marital Reconciliation • Gain of a new family member • Pregnancy • Retirement • Change in employment • Change in responsibilities • Partner starts or stops employment