MANAGING THE PATIENT, PARENT AND PRACTICE III

1
MANAGING THE PATIENT, PARENT AND PRACTICE III

• THE DENTIST-CHILD RELATIONSHIP

2
COMMUNICATING WITH CHILDREN

• Effective communication is a primary objective.
• Communicate in two basic ways
• verbally school activities,pets,articles of
  clothing, childrens television programs, books,
  muppets
• non-verbally holding young child in lap
  touching tenderly, smiling approvingly

3
MULTISENSORY PERSPECTIVE

• Transmitter Dentist
• Medium Office Environment
• Receiver Child Patient

4
TELL-SHOW-DO

• Tell-Show-Do is the classical model for
  communicating with children in the dental
  environment.
• Developed (first documented in the literature) by
  Harold Addelston, of New York Universitys School
  of Dentistry.

5
TELL

• TELL
• before
• during
• after
• TELL using euphemisms (substitute
  language)
• Understanding critical
• Be honest in your TELLing!

6
SELECTING AND USING APPROPRIATE TERMINOLOGY
7
VOICE INTONATION

• The tone of the dentists voice can also be a
  very effective way to alter the childs behavior.
• Kind to firm, or soft to stern voice can
  communicate much!
• Im upset! has shock value and can gain the
  childs attention quickly.

8
SHOW

• SHOW (demonstrate) the child what will be
  happening,how it will happen, and with what
  equipment.
• But, it is not wise to SHOW fear- promoting
  instruments.
• Remember the multi-sensory perspective in
  SHOWing children can HEAR, SEE, TOUCH, TASTE,
  and SMELL.

9
DO

• DO what you said you were going to do.
• DO it in the manner you said you were going to do
  it.
• As you DO it, continue to TELL the child what you
  are DOing.
• DO NOT DO until the child has a clear awareness
  and understanding of what you are going to DO.
• DO it expeditiously!

10
Haim Ginott, Ph.DClinical Child Psychologist

• Between Parent and Child
• Between Parent and Teenager
• Teacher and Child
• Ginott Disciples Faber and Mazlish
• How to Talk So Kids Will Listen and Listen So
  Kids Will Talk
• Liberated Parents, Liberated Children

11
GINOTTS APPROACH TO

• Dealing with feelings
• Engaging cooperation
• Using Praise

12
DEALING WITH FEELINGS

• Acknowledge the Childs Feelings
• Children need to have their feelings understood
  and acknowledged. This is empathy.
• Never deny a childs feelings all feelings must
  be acknowledged, even though certain actions must
  be limited.

13
DEALING WITH FEELINGS

• Never deny a childs feelings
• Outright denial you cant possibly feel be
  scared there is nothing to scared about.
• Philosophizing well its too bad you feel that
  way, but this is necessary.
• Offering advice well get along better and
  things will be easier if you just relax.
• Asking questions why do you feel that way?
• Pity I feel sorry for you having to go through
  this.
• Amateur psychoanalysis I think the real reason
  your upset is . . .

14
DEALING WITH FEELINGS

• Ways to acknowledge a childs feelings and thus
  empathize
• You can listen quietly and attentively.
• You can acknowledge their feelings with a word.
  OhMmmI see.
• You can give the feeling a name. It sounds like
  you are really nervous about being here today.
• You can grant the child in fantasy what you
  cannot give in reality. I wish I could make the
  scary feelings you have go away.

15
ENGAGING COOPERATION

• Ineffective/destructive ways to attempt to gain
  cooperation
• Blaming and accusing If we dont finish this
  silver filling today its going to be your
  fault! (So you think I care!)
• Name calling You are being a bad little girl.
  (I hate you.)
• Threats If you dont sit still Ill have to
  have someone hold you down. (Leave me alone.)
• Commands You stop that right now. (Try and
  make me.)
• Lecturing and Moralizing Its not nice to not
  do what I ask you to! (Im dumb. Whose even
  listening.)
• Warnings Dont you touch that! (Whatever I
  do, Im in trouble.)

16
ENGAGING COOPERATION

• Martydom statements Will you stop that
  screaming, youre driving me crazy! (Who even
  cares.)
• Comparisons Why cant you behave like Johnny
  over there? (I feel like a failure.)
• Sarcasm Wow, that sure is helpful. (when a
  child holds hands over mouth.) (Hes mean.)
• Prophecy If you dont behave yourself and let
  me do this youll have ugly teeth. (I give up.
  Im doomed. )

17
ENGAGING COOPERATION

• Describe describe what you see, or describe the
  problem. I have trouble doing my job when the
  mouth keeps closing.
• Give information When you open you mouth
  really wide, I can see to put the rubber raincoat
  ring on the right tooth.
• Say it with a word My finger!
• Talk about your feelings I am really frustrated
  because I cant spray sleepy water on teeth I
  cant see.

18
PRAISE

• All to often in attempting to gain a childs
  cooperation, we praise them with evaluative words
  like great, good, wonderful.
• However, as humans we are taught to shrink or
  retreat from direct praise that is, we dont
  quite know how to handle it.
• Andwhen we praise in global evaluative terms
  like good, the child tacitly understands that
  we are in an evaluative mode relative to our
  relationship with them, and we could easily also
  say, bad.

19
PRAISE

• When wanting to reinforce positive behavior,
  instead of evaluatingDESCRIBE.
• Describe what you see. I see a young man who is
  holding his mouth open really wide and sitting
  really still!
• Describe what you feel. It is really a pleasure
  to be the dentist of a young lady who opens her
  mouth so wide.
• Sum up the childs praiseworthy behavior in a
  word. I see a young man with his hands in his
  lap. Thats what I call cooperation.

20
PRAISE

• In summary
• DO NOT use global terms of evaluation. Avoid
  great, good, wonderful, as in youre being
  good.and certainly negative and perjorative
  judgements such as youre being bad.
• RATHER, think about what is happening with the
  child that makes you want to say, Your are being
  good! and rather than saying that--describe the
  conditions present that make you want to say it.
  In this way, you are defining what good means, a
  much more meaningful way to praise.
• ALLOW the child to form their own evaluations of
  their behavior.
• ALWAYS look for opportunities to acknowledge
  correctness.

21
OTHER Ginott Principles

• Children are Equal in DignityWith adults, please
  and thank you and other forms of kindness and
  courtesy are routine. Children deserve and
  appreciate the same respect. Use please and
  thank you regularly and often.
• Children Need to Be Liked
• Without authenticity and empathy, techniques
  fail. If you do not enjoy treating
  children--dont! If you have enjoy a child--say
  so I really like you a lot! Thanks for letting
  me be your dentist.
• Give Children Choices/Options
• Go out of your way to grant the child some
  autonomy and control. Would you like for me to
  count you top teeth first, or your bottom teeth?

22
GORDON MODEL FOR COMMUNICATING WITH CHILDREN

• Parent Effectiveness Training
• by Thomas Gordon

23
ROADBLOCKS TO COMMUNICATION

• Ordering, Directing, Commanding
• Warning, Admonishing, Threatening
• Exhorting, Moralizing, Preaching
• Advising, Giving Suggestions/Solutions
• Lecturing
• Judging, Criticizing, Blaming
• Praising
• Name Calling, Ridiculing, Shaming
• Interpreting, Analyzing, Diagnosing
• Reassuring, Sympathizing, Consoling
• Probing, Questioning, Interrogating
• Withdrawing, Distracting, Humoring

24
OWNING THE PROBLEM

• In the dental setting (and in every human
  relationship) there are times when
• The dentist owns the problem that is, some
  need the dentist has is not being met.
• The child owns the problem that is, some need
  of the child is not being met.
• There is no problem, as the needs of both the
  child and the dentist are being met.

25
THREE PROBLEM CIRCUMSTANCES IN THE DENTAL
ENVIRONMENT

• Child is whining because doesnt want to be in
  dental chair wants to be finished and with
  parent. But child is being cooperative so dentist
  can complete the treatment. THE CHILD OWNS THE
  PROBLEM.
• Child is comfortable, seeming enjoying the
  experience, and cooperative. THERE IS NO
  PROBLEM.
• Child is satisfying needs, but is being
  uncooperative, tangibly interfering with dentist
  having his/her needs met of completing the
  treatment. THE DENTIST OWNS THE PROBLEM.

26
OWNING THE PROBLEM
Area of Acceptable Behavior for Dentist

• Child Owns the Problem
• There is No Problem

• Dentist Owns the Problem

Area of UnacceptableBehavior for Dentist
27
WHEN THE CHILD OWNS THE PROBLEM
When are you going to be finished?
Dentist
Child
28
WHEN THE CHILD OWNS THE PROBLEM
When are you going to be finished?
Dentist
Child
You want to get back to school.
No, I didnt mean that. I meant I am really
tired of holding my mouth open..
29
WHEN THE CHILD OWNS THE PROBLEM
When are yougoing to be finished?
Dentist
Child
Youre getting tired.
30
ACTIVE LISTENING...

• In active listening, the receiver tries to
  understand what the senders message means.
• S/he then puts his/her understanding of it into
  own words and feeds it back to the sender for
  verification.
• Does not send a message of own--such as an
  evaluation, opinion, advice, analysis or
  question--only understanding of the senders
  message.

31
ACTIVE LISTENING...

• . . . is used when
• the child owns the problem.

32
ACTIVE LISTENING...

• Helps children discover exactly what they are
  feeling.
• Helps children become less afraid of negative
  feelings. When dentist accepts the feelings the
  child learns that feelings are friendly.
• Promotes a relationship of warmth between the
  dentist and the child. Being heard and understood
  is very satisfying.
• Facilitates problem-solving by the child.
• Influences the child to be more willing to listen
  to the dentists thoughts and ideas.

33
WHEN THE DENTISTOWNS THE PROBLEM

• When the dentist is prevented from accomplishing
  what needs to be done, that is, the childs
  behavior is effectively preventing such, the
  dentist, owns the problem.
• At such times, the dentist must confront the
  childs behavior in such a manner as to change
  it.
• This is done most effectively by using I
  messages.

34
YOU MESSAGES ARE NOT HELPFUL

• Our natural tendency in times when the child
  is not behaving in a manner acceptable to us is
  to send a you message
• YOU stop that!
• YOU must not do that!
• Dont YOU ever!
• YOU are being bad!
• YOU are not acting like a big girl!
• Why cant YOU be good?!
• YOU should know better.

35
YOU MESSAGES...

• Are put-downs.
• Impugn the childs character.
• Deprecate the child as a person.
• Shatter the childs sense of self self-esteem.
• Underline the childs inadequacies.
• Cast a judgement on the childs personality
• They point the finger of blame toward the child,
  and are roadblocks to communication.

36
WHEN THE DENTIST OWNS THE PROBLEM
I cannot put the rubber raincoat onwith hands
over the mouth.!
Dentist
37
WHEN THE DENTIST OWNS THE PROBLEM
You sure are no help!
Dentist
Child
38
WHEN THE DENTIST OWNS THE PROBLEM
I cannot put the rubber raincoat on with hands
over the mouth.
Child
Dentist
39
I MESSAGES

• I messages are more effective in influencing a
  child to modify behavior.
• I messages much less apt to provoke resistance
  and rebellion.
• I messages are less threatening to the child.
• I messages are more effective because they
  place responsibility for change within the child.

40
I MESSAGES

• I messages can be sent non-verbally as well
• A stern look says, I am unhappy with you
  behavior.
• A firm positioning of a squirming child in the
  chair says, I need to work on a non-moving
  target.

41
SUMMARY

• When you have a problem with the childs
  behaviorSEND AN I MESSAGE!
• When the child is having a problemACTIVE
  LISTEN!
• When neither of you have a problem, continually
  reinforce the childs behavior, citing tangible
  aspects of that behavior.