A Letter from Leslie Barker, RN, BScN

October, 2008

As mentioned in the introduction, several members of the National Parenting Education Network agreed to comment on the training efforts of CEHL. The first remarks came in the form of a letter from Leslie Barker, RN, BScN, Parenting Educator and Coordinator of a project for  supporting parents of young children in Calgary, Alberta.  The contents of her letter follow. ~Dr. Howard King, MD, MPH, CEHL Founder

Dear Howard,

I am a nurse and parenting educator working in Calgary, Alberta, Canada. I have been involved in parenting education for over 20 years. In my current position, I coordinate a project supporting the healthy parenting of young children in our community.  parents of young children for our Health Region. I am responsible for helping our organization "speak with a common voice" in supporting healthy parenting of young children through our many points of contact with young families, as well as contributing to the ongoing development of healthy parenting in our community through collaboration with our community’s family-serving agencies.

Your project seems to me to be a great way to support physicians in helping parents and children deal with emotional/behavioral concerns. Several Canadian surveys have indicated that physicians are an important source for parents seeking information on child development and how to cope, so it is very important for physicians to have a strong understanding of child emotional/social development and the skills to assess. Your project takes pediatric practice one step further by enhancing capacity of pediatricians for working with families as a team to find solutions to children’s problems.

I think your proposal is very well thought out and the model, I would assume, is very acceptable for the physicians. A monthly, 2 hour meeting (with the presentation/case review format), CME credits, resources, training, plus online support would seem to give participants ample opportunity to develop knowledge and skills. The skills you have outlined (including interviewing skills, empathic listening, boundary setting, in-depth family histories, and identifying whose problem it is) are critical to effective professional/client interactions, and in fact, when employed, model to parents many of the skills that are integral to effective parenting. 
The piece I think is most unique about your project is the strength-based approach that you have taken which is modeled in the personal attention (individual interviews with you) you give to both the physicians and the parents and children. At both levels, your training helps people identify their areas of challenge but also their strengths. Too often, we overlook these strengths, focusing primarily on the deficit and problems. Your model helps professionals recognize and build their personal strengths so they can better help families identify and build their own.

Your project has also captured the importance of taking time to build trust - something we seem to have lost in this 'hurry-up' world!  The extended interviews for families - along with the in-depth family histories – will surely help pediatricians understand the nature and root of the real problem.

One other component of your project that I really appreciate is that families are seen as an integral part of the team. I believe that this is crucial to success in working with families. Your approach really communicates to parents and child that you feel they are just as important as any other member of the 'team' and the undivided attention gives families time to explore their issues to find a joint solution.

The only aspect I would suggest adding is awareness of community resources. Physicians can be such a valuable link for families to get to resources in their community (e.g. parenting programs, support groups, agencies that deal with specific conditions) as their word carries a lot of weight with families.  Parents are more likely to seek out resources recommended by their doctor. This awareness also helps doctors recognize that there is help for them in the community as well.  They don't have to do it all for families.

In terms of partnering with parenting educators, parents would truly benefit if we were able to work in a more integrated fashion. For instance, physicians could help advance parenting educators’ knowledge about when a child’s behavior is normal and developmentally appropriate, and when it is a concern. Parenting educators, on the other hand, could help physicians better understand parenting strategies that support behavior that, while typical for the developing child, may be of concern to the parent. It is important for both disciplines to recognize that different strategies may need to be employed in each situation. Behavior modification approaches that are commonly used to help families bring order to chaos when there are severe behavioral issues may not be the most appropriate strategies for dealing with developmentally normal behavior challenges and promoting pro-social behavior. 

For example, for typical parenting concerns such as crying, not sleeping through the night, exploratory and/or autonomous behaviors, not sharing, temper tantrums, etc., parents need to know that this is normal development and appropriate for the age (if it is). They need to know how to cope with these behaviors in a way that helps their child learn and fosters their child's development – not just make the behavior stop (while at the same time keeping the parent sane!)

The other advantage of working together would be an awareness of the supports that are available to both parents and professionals. While parents rely on their physician as a key resource for information on parenting and development, many physicians, nurses and researchers are unaware that there is a whole body of knowledge around parenting education/support with a field of professionals who have been practicing this craft for many years. Too often, other disciplines feel alone in trying to help families cope, believing they have to do it all. Rather than "reinventing the wheel", it would be fabulous if we could tap into this strength of knowledge in our communities. Working together to ensure we are all giving parents consistent information and support can only help to build a family’s resilience.

I am interested to read the results of your evaluation of the original study and will check out your website. I would find it very helpful to have more information on your evaluation strategies and tools used. Follow-up evaluation with the participants (both parents and physicians) would be very beneficial to see how this experience changed things for them. I think people will be really interested in what you have found. I would also like to share the information about your project as one of the strategies we might want to consider in our work. I think this looks like a great way to increase the capacity of physicians for determining when a child's issues are 'normal' and when it is a concern to the child's development, while providing them with strategies for assessing those larger concerns and working out action plans with the families.
In summary, I think you have created a very worthwhile project. Thank you for letting me review your proposal and good luck with your work. It is time well spent.

Leslie A. S. Barker

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I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center,  and the families of my medical practice. 

I hope you find this site useful and encourage any comments.

- Dr. Howard King, M.D.