Working with Difficult Parents: Achieving Successful Partnerships Sarah Hamill Skoch, PhD and Mary...

Working with Difficult Parents: Achieving Successful Partnerships Sarah Hamill Skoch, PhD and Mary McGuire, MSW University Medical Center

June 9th 2012

OVERVIEW OF TODAY’S TALK

• Characteristics of parents today

• What are the challenges • Communication strategies

• Effectively dealing with your own stress

• Q & A

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)

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 thepoverty level• 60% of AZ’s mothers are working moms

(US Census Bureau, 2002)

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

WHY DO PARENTS ACT THAT WAY?

• Parents perception – perception is reality

• Negative school experiences

• Parents unsure how to be involved

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

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)

SITUATIONS YOU ARE UP AGAINST

BUILDING RAPPORT

• Trust

• Listening to the parents concerns

• Goal is a collaborative relationship

BUILDING RAPPORT AND INCREASING COMMUNICATION• Making parents feel welcome

• Finding common ground

• Communicating in good times• Hearing good news from you

MAKING PRAISE WITH PARENTS EFFECTIVE• Be Authentic

• Be Specific

• Make Praise Immediate

• Keep it “Clean”

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

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?

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?

TECHNIQUES TO KEEP YOUR COOL

• Voice – turn the volume down

• Non-verbal behaviors• Eye contact• Body movements

• Neutral stance with families

WHEN THE PARENT IS RIGHT

• Get to them first

• Using the “S” word – I am sorry

• Thanking the parent • Validation and building rapport

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

LOGISTICAL TOOLS

• Providing parents with resources/handouts/written information

• A digital file of resources for parents

• Keeping notes for yourself – what did you discuss

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

CLINICAL VIGNETTE

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

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

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

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

ROLE PLAY

ROLE PLAY

DISCUSSION

• What did you notice about the two scenes?

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?

INCREASING PARENT INVOLVEMENT

SUMMARY

• Stressors for parents

• Tools• Building rapport• Increasing communication• Active listening • Keeping your cool• Setting boundaries

SUMMARY

• Logistical considerations • Ways to save time with parents

• Focusing on the future • How can we apply this to the next situation

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)

Shortness of breath

Headaches

Muscle tension

Heartburn

Upset stomach

High blood pressure

Sleep disturbance

Too much/little sleep

Fatigue

Chest pain

Suppressed immune system

Nervousness Anxiety Irritability Anger Impatience Crying easily Sensitivity

Eating patterns Substance use Grinding teeth Nail biting Neglecting

appearance Procrastination

Poor concentration Memory lapse Negative attitude Forgetfulness Confusion Worrying

Rate your stress on a scale of 1-5 where 1 is the lowest and 5 is the highest

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)

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)

In the last month, how often have you felt things were going your way? (never, almost never, sometimes, fairly often, very often)

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)

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)

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)

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)

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

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

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

Trouble with boss Changes in finances Foreclosure on a

mortgage or loan Violations of the law Change in

arguments with a partner or child

Conflicts with relatives/in-laws

Buying a house A new large

purchase, such as a new car

Starting or finishing school

Change in living environment or school

Holidays Vacation Change in sleep

POSITIVES: Helps us get things

done Can be manageable

NEGATIVES: Can wear us out

mentally and physically over a period of time

Can negatively affect our relationships and interactions

When we are not managing our stress, we are less likely to: Listen attentively Control our emotions and reactions Make time Show empathy Focus on strengths Look at the bigger picture Attain our desired goal from our

communications

• Not taking on too much • Not worrying about the

“small stuff”• Self relaxation• Mood management

(avoiding extreme reactions to situations)

• Get enough sleep• Eat healthy • Exercise

Positive attitude Be realistic Spirituality Take breaks and use

your vacation time Proactive planning

and organization Seek professional

help if needed (EAP option)

• Asking for and obtaining assistance from your supervisors, school counselors and/or staff

Be realistic of your job expectations Preventative planning (create an action

plan for how you will deal in difficult situations)

Inform of any safety concerns with parents

• Importance of understanding your school policies

Dealing with Difficult Parents by Whitaker and Fiore

http://teachers.net/gazette/MAR08/gruber/

http://www.helpguide.org/mental/stress_management_relief_coping.htm

Community Resources Handout

Mary McGuire, MSW(520) 626-1569mmcguire@peds.arizona.edu

Sarah Hamill Skoch, Ph.D.(520) 626-7739shamill@email.arizona.edu