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Mary Kay Stranik: Observations by a Pediatric Nurse Practitioner

October, 2008

Several members of the National Parenting Education Network were kind enough to comment on our project.  One of them is Mary Kay Stranik, a pediatric nurse practitioner with Family Program Consultants in Minneapolis, Minnesota.  Here are some of her thoughts as well as a brief professional history.  ~Dr. Howard King, MD, MPH, CEHL Founder

My background

I was trained as a pediatric nurse practitioner at Massachusetts General in 1968 and worked as a public health nurse in a Johnson administration “war on poverty” center in Connecticut.  I used that training and experience and subsequent information from the Pediatric Nurse Associate Program at the University of Minnesota School of Public Health, which I finished in 1970, as the baseline for my career. 

I practiced as a Nurse Practitioner in Minnesota and taught at the University of Minnesota until 1977.  Beginning in 1973, I consulted for MELD, a national model of parenting education started in Minnesota, and in 1977 I began working for MELD, full time, until 2000.  Subsequently, I have consulted for many different organizations, both in parenting education and in child care.

My thoughts on the mental health field

With increased defined mental illnesses in our current society and in our children in particular, it is vital to move from a mental illness paradigm to a mental health paradigm. Supporting mental health in young families must be the focus of front line contacts with families, e.g. pediatricians, family practitioners, nurse practitioners, and parenting educators.  

Understanding appropriate physical and social emotional child development, helpful parenting practices. and maintenance of good physical health are all components of care that support maintenance of good mental health. Practitioners need that understanding and they need educational methods that will assist families to incorporate those areas into their family life.

In addition, early identification of short-term unhealthy practices or long term mental illness is crucial.  Here solid assessment of family systems and intergenerational dynamics is critical. Sometimes this early identification can be managed in the office but depending on many factors, it may need to be referred to other providers, e.g. social workers and psychologists.

Because of the above, training of front line workers around mental health and illness is absolutely critical!!  There are 2 levels of practice that should be impacted by the training:  the part that should be worked into every well child visit and the part that should be in a follow up visit for an expressed problem.  Either the parent or the practitioner should be able to identify problems or issues.

My perspectives on pediatric outpatient practice

I feel the well child visit in an outpatient public or private practice is an ideal setting for psychosocial assessment of children and families. The only system that young families come to on a regular basis in the first 5 years of a child’s life is the health care system.  Child care is one other “outside the family” system where children are seen but the expertise in the child care system varies enormously.  Perhaps churches, family and friends are other places but again there is huge variation in expertise.

None of the previously mentioned systems have as much training as the pediatric health care system. In addition, families accept the health care system as normal, and even required, and a place to get good help and advice.  There isn’t a stigma in taking your child to a doctor.  In fact, there is even a negative stigma if you don’t take your child for appropriate care.

However, the pediatric health care system does have some barriers to accomplish a more in-depth assessment of children.  MDs, whose training tends to be more specialized around disease frequently practice in outpatient settings where the demands are more in the prevention or minor illness arena.  In training, mental illness is seen in the area of disease.  So when confronted in the office with mental health issues, practitioners become fearful and move away from the topic.  There is little training about how to handle these issues when they occur in families.

One other problem is the perception of the role of the practitioner.  Parents usually see pediatricians giving advice only about children, not about family or marriage. If one is going to propose more in-depth assessment, the provider needs to frame that second visit in a very careful way.   This is especially true in some groups, such as teen moms, who don’t understand the need for a routine family history.  Distrust can be intensified in these groups if there are cultural differences between patient and provider.

Communication about many of the things providers do in office visits is critical.  But if providers have not been trained adequately in medical or nursing schools, parents should rightly be wary, as the processes used and the information given out is not always based on substantiated knowledge.

My thoughts on CEHL

Overall, it is a wonderful program and badly needed.

You have chosen a wonderful title, especially that part of your program, which relates to the idea of “difficult conversations.”  Everyone can connect to it immediately and will want good training to cope with the challenge of “difficult conversations”.  It also will decrease fear in providers as “conversations” in a very neutral word…something one can handle.

Your goal of increasing the competence and confidence is well founded, based on my comments above.  You give good information as well as acknowledging the fear factor in providers.  The format is excellent and uses many forms of learning – content, case studies, group discussion, and consultation about practitioners’ own issues.

Information on the multigenerational history is excellent and much needed as parents begin to understand their own issues and the family patterns that create those issues.  Until those are “on the surface,” parents can’t begin to change their relationship with their child.

The only comment that might need some thought on your end is there does seem to be a lot of emphasis on depression when there are several other areas of psychosocial stress in families, e.g. poverty, unemployment, anxiety, etc.  Are those also included and just not obvious in your program description?

This brings a question to mind. Who in a busy practice would actually do these interviews? Would the nurses and physicians do it on their own patients or would it be a nurse or physician who was most interested and skilled who would do it for the whole practice?  I would definitely think nurse practitioners would be interested in this training, but that is somewhat dependent on the ingredients of their basic training. They may feel they already know how to do this work. However, there are advantages to be trained together with physicians so that the skills are respected in the practice setting.
Insights into parenting education

Our field varies enormously in the preparation of practitioners, so almost anything I say will not fit for part of the group.  For many, the key words in their title are “educator” and “provider of support.”  This is in contrast to the health field where assessment, treatment, and management are key components of the role.  Also, parenting education programs vary from a few hours of contact to several years of relationships with parents.  Methodology includes groups, home visits and centers where parents and their children gather.  Parenting educators are really a primary source of information for families and are a resource for pediatricians.  Please visit our website to learn more about us, www.npen.org.

Mary Kay Stranik, MS
NPEN Chairperson
Family Program Consultants
4711 Cedarwood Road
Minneapolis, MN 55416

Updated: October 29, 2008

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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.