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Distressed Parents and Family Issues

  • Laura Judd-GlossyEmail author
  • Eileen Twohy
Chapter
  • 25 Downloads
Part of the Issues in Clinical Child Psychology book series (ICCP)

Abstract

This chapter provides an overview of disruptive family behaviors that may occur in pediatric medical settings and discusses strategies to address and prevent these behaviors. Risk factors that may contribute to these problematic behaviors, including those related to patient and family functioning, provider characteristics, and broader systematic factors, are described. The SAFTeam (Strengthening Alliances with Families Team) is introduced as a model for how to address these disruptive behaviors within a pediatric medical setting, with detailed review of a case example. General recommendations are also provided, including strategies to effectively address concerning behavior (e.g., the importance of multidisciplinary teams, safety and accountability, and using a strength-based approach). Suggestions are shared for how to take a proactive approach in developing a hospital culture that promotes healthy family involvement in pediatric care. Finally, aspects of diversity and healthcare disparities are reviewed in the context of patient and family experiences within pediatric medical settings.

Keywords

Disruptive behavior Multidisciplinary team Safety Pediatric psychology Psychological consultation Family coping Family stress 

Notes

Acknowledgments

We would like to acknowledge Jenny Reese, MD, and Harrison Levine, MD, who first developed the SAFTeam model at Children’s Hospital Colorado in 2009.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Barrier, P. A., Li, J. T. C., & Jensen, N. M. (2003). Two words to improve physician-patient communication: What else? Mayo Clinic Proceedings, 78(2), 211–214.CrossRefGoogle Scholar
  3. Beach, M. C., Inui, T., & Relationship-Centered Care Research Network. (2006). Relationship-centered care: A constructive reframing. Journal of General Internal Medicine, 21(1), S3–S8.CrossRefGoogle Scholar
  4. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and healthcare. Public Health Reports, 118(4), 293–302.CrossRefGoogle Scholar
  5. Blackall, G. F., & Green, M. J. (2012). “Difficult” patients or difficult relationships? The American Journal of Bioethics, 12(5), 8–9.CrossRefGoogle Scholar
  6. Breuner, C. C., & Moreno, M. A. (2011). Approaches to the difficult patient/parent encounter. Pediatrics, 127(1), 163–169.Google Scholar
  7. Center for Practical Bioethics Ethics Committee Consortium. (2000). Guidelines for providing ethical care in difficult provider-patient relationships. Kansas City: Kansas City Area Ethics Committee Consortium.Google Scholar
  8. Coker, T. R., Rodriquez, M. A., & Flores, G. (2010). Family-centered care for US children with special health care needs: Who gets it and why? Pediatrics, 125(6), 1159–1167.Google Scholar
  9. Cousino, M. K., & Hazen, R. A. (2013). Parenting stress among caregivers of children with chronic illness: A systematic review. Journal of Pediatric Psychology, 38(8), 809–828.CrossRefGoogle Scholar
  10. Dudzinski, D. M., & Alvarez, C. (2017). Repairing “difficult” patient-clinician relationships. AMA Journal of Ethics, 19(4), 364–368.CrossRefGoogle Scholar
  11. Fiester, A. (2012). The “difficult” patient reconceived: An expanded moral mandate for clinical ethics. The American Journal of Bioethics, 12(5), 2–7.CrossRefGoogle Scholar
  12. Flores, G. (2000). Culture and the patient-physician relationship: Achieving cultural competency in health care. Pediatrics, 136(1), 14–23.CrossRefGoogle Scholar
  13. Frosch, D. L., May, S. G., Rendle, K. A., Tietbohl, C., & Elwyn, G. (2012). Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Affairs, 31(5), 1030–1038.CrossRefGoogle Scholar
  14. Hinchey, S. A., & Jackson, J. L. (2011). A cohort study assessing difficult patient encounters in a walk-in primary care clinic, predictors and outcomes. Journal of General Internal Medicine, 26(6), 588–594.CrossRefGoogle Scholar
  15. Jackson, J. L., & Kroenke, K. (1999). Difficult patient encounters in the ambulatory clinic: Clinical predictors and outcomes. Archives of Internal Medicine, 159(10), 1069–1075.CrossRefGoogle Scholar
  16. Judd-Glossy, L., Twohy, E., Penner, A., & Carubia, B. (2017, April). SAFTeam: An innovative consultation model to support family-centered care in challenging patient/provider relationships. Poster presented at the annual conference of the Society of Pediatric Psychology.Google Scholar
  17. Kazak, A. E. (2006). Pediatric Psychosocial Preventative Health Model (PPPHM): Research, practice, and collaboration in pediatric family systems medicine. Families, Systems & Health, 24(4), 381.CrossRefGoogle Scholar
  18. Kazak, A. E., Schneider, S., Didonato, S., & Pai, A. L. H. (2015). Family psychosocial risk screening guided by the Pediatric Psychosocial Preventative Health Model (PPPHM) using the Psychosocial Assessment Tool (PAT). Acta Oncologica, 54(5), 574–580.CrossRefGoogle Scholar
  19. Kazak, A. E., Simms, S., & Rourke, M. T. (2002). Family systems practice in pediatric psychology. Journal of Pediatric Psychology, 27(2), 133–143.CrossRefGoogle Scholar
  20. Krebs, E. E., Garrett, J. M., & Konrad, T. R. (2006). The difficult doctor? Characteristics of physicians who report frustration with patients: An analysis of survey data. BMC Health Services Research, 6, 128.CrossRefGoogle Scholar
  21. Mack, J. W., Ilowite, M., & Taddei, S. (2017). Difficult relationships between parents and physicians of children with cancer: A qualitative study of parent and physician perspectives. Cancer, 123(4), 675–681.CrossRefGoogle Scholar
  22. Meadow, R. (1992). Difficult and unlikeable parents. Archives of Disease in Childhood, 67(6), 697–702.CrossRefGoogle Scholar
  23. Meltzer, L. J., Steinmiller, E., Simms, S., Grossman, M., Li, Y., & Team, T. C. C. C. (2009). Staff engagement during complex pediatric medical care: The role of patient, family, and treatment variables. Patient Education and Counseling, 74(1), 77–83.CrossRefGoogle Scholar
  24. Nelson, A. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666.PubMedPubMedCentralGoogle Scholar
  25. Ngui, E. M. & Flores, G. (2006). Satisfaction with care and ease of using health care services among parents of children with special health care needs: The roles of race/ethnicity, insurance, language, and adequacy of family-centered care. Pediatrics, 117(4), 1184–1196.Google Scholar
  26. Phillips, J. P. (2016). Workplace violence against health care workers in the United States. The New England Journal of Medicine, 374(17), 1661–1669.CrossRefGoogle Scholar
  27. Riskin, A., Erez, A., Foulk, T. A., Riskin-Geuz, K. S., Ziv, A., Sela, R., … Bamberger, P. A. (2017). Rudeness and medical team performance. Pediatrics, 139(2), 1–11.CrossRefGoogle Scholar
  28. Robiner, W. N., & Petrik, M. L. (2017). Managing difficult patients: Roles of psychologists in the age of interdisciplinary care. Journal of Clinical Psychology in Medical Settings, 24(1), 27–36.CrossRefGoogle Scholar
  29. Rodrigues, N., & Patterson, J. M. (2007). Impact of severity of a child’s chronic condition on the functioning of two-parent families. Journal of Pediatric Psychology, 32(4), 417–426.CrossRefGoogle Scholar
  30. Steinmiller, E. A., & Ely, E. (2015). Patient, family, and provider complex care situations in pediatric acute medical care: Creation of the Red Flags Situation Assessment Tool. Journal for Specialists in Pediatric Nursing, 20(4), 290–297.CrossRefGoogle Scholar
  31. Valenzuela, J. M., & Smith, L. (2016). Topical review: Provider–patient interactions: An important consideration for racial/ethnic health disparities in youth. Journal of Pediatric Psychology, 41(4), 473–480.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Departments of Psychiatry and Pediatric SurgeryUniversity of Colorado School of MedicineAuroraUSA
  2. 2.Children’s Hospital ColoradoAuroraUSA
  3. 3.Department of Psychiatry and Behavioral MedicineUniversity of Washington School of MedicineSeattleUSA
  4. 4.Seattle Children’s HospitalSeattleUSA

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