MANAGING THE PATIENT, PARENT AND PRACTICE III

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MANAGING THE PATIENT, PARENT AND PRACTICE III

• THE DENTIST-CHILD RELATIONSHIP

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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

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MULTISENSORY PERSPECTIVE

• Transmitter Dentist
• Medium Office Environment
• Receiver Child Patient

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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.

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TELL

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

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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.

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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!

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GINOTT PRINCIPLES

• Acknowledge the childs experience.
• Grant in fantasy what you cannot grant in
  reality.
• Children are equal in dignity.
• Praise
• Give children choices-offer options
• Acknowledge correctness
• Children need to be liked.

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GORDON MODEL FOR COMMUNICATING WITH CHILDREN

• Parent Effectiveness Training
• by Thomas Gordon

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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

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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.

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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.

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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
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WHEN THE CHILD OWNS THE PROBLEM
When are you going to be finished?
Dentist
Child
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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..
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WHEN THE CHILD OWNS THE PROBLEM
When are yougoing to be finished?
Dentist
Child
Youre getting tired.
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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.

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ACTIVE LISTENING...

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

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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.

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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.

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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.

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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.

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

• I messages are more effective in influencing a
  child to modify behavior.
• I messages must 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.

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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.

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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.

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SELECTING AND USING APPROPRIATE TERMINOLOGY
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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.