INTERVENTIONS AND “WELL-BEING” INITIATIVES

Kathleen A Kapp-Simon, Ph.D.Northwestern University and

Cleft-Craniofacial ClinicShriners Hospitals for Children

Chicago, IL

“Well-Being”

How well a person’s life is going: What’s good for them or makes them happy.• Family relationships• Social relationships• Intellectual pursuits• Relaxation• Health related quality of life

Goals of Treatment

Medical/Surgical Management• Optimal Physical Functioning • Best Possible Facial Appearance

Psychological Outcomes• Optimal Behavioral/Emotional Adjustment• Social Competence• Maximal Cognitive/Academic Development

CHALLENGES: Managing Differing Priorities

Family Issues• Siblings• Economic Resources• Social Support

Child Needs• Emotional Needs• Social • Educational

Surgery• Timing/frequency• Expectations vs Outcomes

Therapies• Time Commitment• Child/Parent Effort

Social Problems

Social Inhibition Withdrawal Anxiety Peer Teasing

Factors Associated with Social Competence in CFC Literature

Parent Interaction Style Parenting Stress

Child Friendliness Emotional Self-Awareness Self-Concept

Factors Associated with Social Competence in Child Literature

Social Anxiety Aggression Inhibition Friendliness Self-Perception Child’s Perception of Peers

Variability of Child Characteristics

Temperament Social Skills Self-Perception

Temperament

Emotionality• The way a child responds to distress, fear, or

anger Activity Level

• A child’s ability to attend to a situation• Cognitive distractibility/persistence

Sociability• A child’s tendency to approach or avoid new

people or situations

Personality Types Resilient child

• Socially competent• Exhibits positive emotions

Over controlled child• Extremely shy• Variable Compliance• Dependent

Under controlled child• Uncooperative• Noncompliant• Negative emotions

Impact on Treatment

The Resilient Child• Cooperative• Participate in Assessments• Emotion proportionate to situation

Impact on Treatment

Over controlled child• Sociability: Shy, slow to warm up• Emotionality: Distressed/fearful• Activity level: Good attention skills/ “hyper-

aware”

Impact on Treatment

Under-controlled Child• Sociability: Often outgoing, but inappropriate

approaches. May intrude into spaces or conversations

• Emotionality: Unpredictable responses to stressful situations; emotional outbursts, aggression

• Activity level: Difficulty sustaining behavior through long clinic exam; runs around exam room, destroys equipment, toys etc.

Parent-Professional Responses

Parent• Calm• Expectant

Professional• Provide adequate time for child to ‘warm up’• Exude warmth and understanding• Provide direct but simple explanations of what

is expected of the child • Allow the child to ‘save face’

Encouragement*

Focus on what child ‘can do’• Communicate to the child that you believe she

is capable of the task before her Expect cooperation

• But accept a valiant effort Provide specific feedback

• “You put your tongue exactly where we talked about and you made a great ‘t’ sound.

*Nelsen, Erwin & Duffy, 1998

Anxiety Management

Relaxing Breathing Muscle Relaxation Visualization Positive Self-Talk Distraction

Fostering Emotional Development*

Emotional Awareness• Teach the child words that express emotions:

Happy, sad, excited, worried, disappointed, angry

• Be aware of child’s perspective on situation• Recognize your own emotions in situation

*Gottman & DeClaire, 1997

Fostering Emotional Development

Emotions Provide Opportunities for Teaching• Recognize and acknowledge emotions early• Responding to strong emotions with empathy

and patience increases child’s ability to solve problems

Fostering Emotional Development

Use Active Listening to Validate Child’s Feelings• Take children’s feelings seriously• Use words to communicate understanding

and acceptance: “You’ve been very quiet since we left the clinic, I’m wondering if you’re disappointed about having to wait another year for the lip revision?”Specific identification of a feeling and the situation

that generated the feeling.

Fostering EmotionalDevelopment

Recognize Difference between Feelings and Behavior• Feelings are neither good nor bad; Actions

are choices and can be for better or worseChild has a right to feel angry about having an IV

that limits his mobility; choosing to pull the IV is not a good option

Parents/professionals can help child by accepting his feelings while simultaneously guiding him to identify an adaptive solution

Fostering Emotional Development

Self-confidenceSchool achievementComplianceSocial competenceHealth

Social Skills

Behaviors that enhance social interaction• Positive peer relationships protect a child from

being teased or bullied• Positive peer relationships help develop self-

esteem• Friendships enhance confidence and

minimize feelings of depression and isolation

Social Skills

Pragmatic skills• Eye contact• Tone of voice• Social distance• Rhythm of communication

Social Skills

Skills for joining a group• Smile at one or more of the children in the

group as you walk toward them• Observe what group is doing or talking about• Join in by participating in conversation or

group activity

Social Skills

Making Friends• Pay attention to peers interests/conversation• Have ideas about activities • Give compliments• Use Active Listening

Self-Talk

Learn to listen to internal voice Consciously reframe message

• “I can sit with Jonathon at lunch”• “I know how to play soccer. I can join that

group” Use anxiety-management techniques

• Take a deep breath• Imagine a successful approach

Parent-Professional Collaboration to Promote Child

Well-Being

Thank You!