The following 4-year-old biracial male living with his grandmother in a high-density public housing complex

Building a health history

The client is a 4 -year old biracial boy who is accompanied by his grandmother whom he lives with in a high- density public housing complex.  This is the first time you are meeting them both and therefore a complex health history is to be collected through interviewing both the child and his grandmother. Familiarizing oneself with the patient is also a goal for today’s assessment.  Ball et al. (2019) remind us that, the policies, procedures, and consent of treating a minor must be considered.    Due to the client being only 4 years, the questions will be directed towards the grandmother with some participation of the child to foster compliance with the plan of care.    Interaction with the child is important as this allows him to engage in the conversation and not feel left out.  I will be at eye level with the client when engaging him in conversation.  Inquiring as to why the child is in the care of his grandmother would be an important history to know.

Communication Techniques

Proper communication is key in gathering pertinent information from both the child and grandmother as well as forming a positive and trusting relationship.  Different ethnicity, gender, and age groups will have different communication skills and therefore language that is easily and clearly understood should be used.  As a clinician, I must also consider that clients may speak a different language and therefore must be able to accommodate an interpreter in the interview process.  The questions presented should be simple and easy to understand with no medical jargon per Ball et al. (2019)

As part of information gathering, the patient and his grandmother must be assured that the information is important as part of the treatment plan.  An important technique when asking the child questions would be to start with something that he likes.  l can ask what cartoons he likes to watch or what games are his favorite.  The clinician must always be at the child’s level when engaging them in conversation while maintaining eye contact as Bell and Condrell (2016) explain.  This allows the child to be at ease. Questions to the grandmother should be short, and straight forward.  Allowing the patient and the grandmother an opportunity to ask questions greatly minimizes assumptions while confirming that the questions were well understood as Ball et al. (2019) explains.   The health history should cover the chief concern, history of present illness, past medical history of any illnesses, family history, and a review of systems (ROS).

Risk Assessment Instrument

The client and his grandmother live in public housing and therefore a risk factor to consider would be insufficient resources and the ability of the grandmother to care for the child. Lower socioeconomic factors can impact a child’s health due to the inability of the grandmother to access healthcare or financial constraints.  Potential health risks like mold, lead (in older buildings) can cause health conditions for not only the patient but also the grandmother. The child could end up having a diagnosis of asthma or recurring respiratory problems.  A risk assessment to consider is the lack of adequate and proper resources.  With public housing, there can be a lack of proper resources, overcrowding, poor maintenance of the building or infrastructure.

WHO (2020) explains social determinants of health (SDOH) as the conditions which depict where a person is born, grows up, lives, works, and gets older.  Poverty, however, limits people from having access to proper amenities like education, safety, transportation to name a few.  I would use the screening tool called Survey of the Well-Being of Young Children (SWYC).  This assessment instrument looks at a child’s developmental milestones, behavioral and/or emotional development, as well as family psychosocial risk factors according to Parts of the SWYC (n.d.).   This instrument can guide a practitioner if the child is falling behind in achieving milestones as compared to his peers.   At 4 years of age, the child should have acquired motor skills, language as well as cognition.  These instruments assess for autism and inquire from caregivers whether they have any concerns regarding the development of the child.   Asking questions as a practitioner removes assumptions.

Questions to ask the patient

1.  Can you tell me how old you are?
2. What is your name?
3. Are you able to kick a ball, stand on 1 foot, or jump rope?

Questions to ask the grandmother

1. The child’s parents and if they are a part of his life
2. Any allergies that the child has
3. Any cancer in the family
4. The overall health of the child
5. Any past hospitalizations of the child

Questions to the child can relay more information to a physician if the patient is developing normally or not, has delayed speech or any other problems.

Reference

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier.

Bell, J., & Condren, M. (2016). Communication strategies for empowering and protecting children. The Journal of Pediatric Pharmacology and Therapeutics, 21(2), 176-184. doi: 10.5863/1551-6776-21.2.176

Parts of the SWYC. (n.d.). Retrieved June 03, 2020, from https://www.floatinghospital.org/The-Survey-of-Wellbeing-of-Young-Children/Parts-of-the-SWYC

World Health Organization (WHO, 2020).  About social determinants of health.  Retrieved from             https://www.who.int/social_determinants/sdh_definition/en/

response

4-year-old biracial male living with his grandmother in a high-density public housing complex

Thank you for your informative and well-organized post. I agree with you, as it is important to sit at the eye level of the child. Doing this gives the child the sense of participation and moreover being the focal point of the visit. Also conversing with the Grandmother and targeting most of the questions to The grandmother is The screening assessment tool that I would use is the Survey of Wellbeing of Young Children (SWYC) This type of screening addresses the developmental milestones, behavioral /emotional development, and family risk factors like substance abuse (Sheldrick & Perrin, 2-13). Another tool I would use is Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education Survey Instrument (WE CARE). This screening tool helps identify needs in the following areas: psychosocial problems of the family to include education, employment, childcare, housing, food, and utilities (Garg, 2015). I believe that utilizing either of these screening tools will be beneficial in gathering enough information to identify any barriers for the child and Grandmother.

References

Garg A, Toy S Tripodis Y, et al: Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT. Pediatrics Feb 2015; 135(2): 296-304.

Sheldrick, R.C. & Perrin, E.C. Evidence-based milestones for surveillance of cognitive language and motor development. (2013) Academic Pediatrics. 13(6):577-86

Discussion: Building a Health History

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

By Day 3 of Week 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research.

 Interview Summary and Communication Techniques

     For this week’s discussion regarding risk assessments and building a health history, I was assigned profile number two which reads: A 4-year-old biracial male living with his grandmother in a high-density public housing complex. There are specific interview and communication techniques for pediatric patients that should be utilized in order to effectively communicate with this patient and his grandmother.

     Effective communication in pediatric patients increases diagnostic accuracy, patient and family understanding of treatment, and improves patient outcomes (Damm, Leiss, Habeler, & Ehrich, 2015). One technique I would use with this four-year-old child is to let him talk if he chooses to. Damm, Leiss, Habeler, and Ehrich (2015) write that regardless of the child’s age, their parent or caretaker tends to interfere with the provider-patient relationship by dominating the conversation but it is important for children to understand that they have a voice and should be a part of the conversation. It is obviously important to collect thorough health history from his grandmother, but I would also focus on the young boy as well and let him express any concerns so that he understands his role as the patient as he continues to develop and achieve milestones.

Risk Assessment Instrument

       I decided to utilize the CHEOPS (children’s hospital of eastern Ontario pain scale) as a risk assessment instrument for this child. This tool is designed to assess pain in children ages 1-5 by observing and rating cry, facial expression, verbal ques, torso movement, touch response, and leg movement (“CHEOPS,” n.d.). Although there may not be any reason to believe that this child is in pain, at the age of four it is still important to assess this as children can easily mask their pain.

Targeted Questions

One immediate concern that sticks out to me is that this child lives in a high-density public housing complex. This tells me to assess this child for possible lead exposure as it is very possible that the public housing where he lives may have traces of lead-based paint in it. Lead poisoning in children can lead to severe cognitive defects (Shannon et al., 2005). I would ask this child’s grandmother how old her living complex is and if she knows of any lead-based paint issues within the complex. Those who live in older housing are especially at risk for lead poisoning (Shannon et al., 2005).

I would ask the patient and his grandmother if there are ever any issues breathing or if the grandmother notices any wheezing. Asthma is common in children and respiratory function is appropriate to assess in early childhood. I would ask this patient and his grandmother if there is any known food or drug allergies. This is always important when establishing care and potentially prescribing medication. If there are any environmental allergy concerns the child may need to be referred to a specialist. I would ask this child his favorite food and discuss eating habits with his grandmother. Nutrition is key for proper development and it is important that his grandmother understands what type of meals he should be eating. Lastly, I would ask this child’s grandmother if she has any concerns regarding his vision. I should also conduct a vision test. This child will be starting school soon and it is important that his vision is tested for possible abnormalities.

                                                                                                        References

Children’s hospital of eastern Ontario pain scale (CHEOPS) in young children. (n.d.). Retrieved from https://com-jax-emergency-pami.sites.medinfo.ufl.edu/files/2015/02/Childrens-Hospital-of-Eastern-Ontario-Pain-Scale-CHEOPS.pdf

Damm, L., Leiss, U., Habeler, U., & Ehrich, J. (2015). Improving care through better communication: Continuing the debate. EUROPEAN PAEDIATRIC ASSOCIATION, 167(2), 501-502. Retrieved from https://www.jpeds.com/article/S0022-3476(15)00547-8/pdf

Shannon, M., Best, D., Binns, H., Kim, J., Mazur, L., Weil, W., … Spire, P. (2005). Lead exposure in children: Prevention, detection, and management. AMERICAN ACADEMY OF PEDIATRICS, 116(4), 1036-1046. http://dx.doi.org/10.1542/peds.2005-1947

sample response

Good post! The following are clear from the interview summary and communication techniques used on a 4-year-old biracial male living with his grandmother. First, your discussion shows that effective communication in pediatric patients enhances the accuracy of the diagnostic, makes both the patient and family understand the treatment, and improves patient results (Damm, et al. 2015). Second, the discussion points out that it is vital to interview patients independently regardless of their ages to avoid interferences from either the parent or the caretaker; doing this will help the child understand that he has a voice and should be part of the conversation. Other than that, what comes out from this post is that it is vital to use health risk assessment by collecting health history from the child’s grandmother to be able to understand the root cause of the patient’s problems (Ball, et al, 2019).

Moreover, additional interview and communication techniques that health care provider may apply is the use of structured assessment tools (Srinath, Jacob, Sharma & Gautam, 2019). Lastly, it is correct to say that the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) is a good risk assessment for this scenario (CHEOPS, n.d.).

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Children’s hospital of eastern Ontario pain scale (CHEOPS) in young children. (n.d.). Retrieved from https://com-jax-emergency-pami.sites.medinfo.ufl.edu/files/2015/02/Childrens-Hospital-of-Eastern-Ontario-Pain-Scale-CHEOPS.pdf

Damm, L., Leiss, U., Habeler, U., & Ehrich, J. (2015). Improving care through better communication: Continuing the debate. EUROPEAN PAEDIATRIC ASSOCIATION, 167(2), 501-502. Retrieved from https://www.jpeds.com/article/S0022-3476(15)00547-8/pdf

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019, January). Clinical Practice Guidelines for Assessment of Children and Adolescents. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345125/