Many pediatricians have already developed a way to talk to families about healthy active living. This typically includes a discussion of plotting weight for length or BMI, and counseling on nutrition and physical activity. These are very standard and appropriate ways to approach a health supervision interaction with limited time. By integrating the strength based approach into this encounter with families, pediatricians can forge an alliance with families that allows them to work together to tackle any needed behavior changes.
What is the Strength Based Approach?
Building on the asset model, the strength based approach gives a broad perspective on development more so than the traditional deficit approach. While the more traditional deficit approach focuses on problems, the asset model encourages health promoting interactions. It specifies what families should be implementing or saying “yes" to for a healthier life.
Comparison of Asset and Deficit Models:
- Positive family environment
- Relationships with caring adults
- Religious and spiritual anchors
- Involvement in school, faith-based organization
- Abuse or neglect
- Witness to domestic violence
- Family discord and disruption
- Unsafe schools
The strength based approach at the core gives parents and children the ability to continue their development by encouraging a family’s growth and competency building across time. This approach acknowledges that parents are experts on their family and want to do right by their child. The clinician takes an active role in building parents’ knowledge and encouraging mastery while providing good ideas on how to integrate new opportunities for competency into a family’s daily life. In addition, the strength based approach encourages and is complementary to shared-decision making where clinicians and families can problem solve with the clinician to become more efficacious in their health decision-making.
How do I implement the strength based approach in a busy clinical encounter?
First, identify the parent's and child 's strengths. In our work with clinical practice teams implementing the strength based approach, clinicians have found they can always start with a discussion of how the family cares about their child’s health as evidenced by their coming to the pediatric office.
Second, once the strengths are identified, give the feedback to the family. Some clinicians prefer to provide families feedback based on their observations taken during the history and encounter such as focusing on mastery, belonging, generosity, and independent decision making. Many clinicians have found a framework to prompt themselves to identify families' strengths and provide strength based feedback. (See Resources below for a list of frameworks).
Third, if a behavior change is needed, utilize a shared decision-making strategy to encourage the change. Shared decision-making encourages a family to be an active participant in the final decision—which motivates their own implementation of the behavior change. Many clinicians use motivational interviewing a very effective shared-decision making strategy. A brief approach to beginning a shared decision-making encounter would be: 1) Discuss the problem. 2) Ask the family what they would like to change first? 3) Ask when you can follow-up with them.
Strength Based Approach: A Healthy Active Living Case
Meet Rikki and Cruz
- Cruz is 90% for weight, 50% for height at 18 months.
- Cruz started cereal at 3 months – loves food! Great eater! Cereal in bottle at night, cereal for breakfast, favorite meals include chicken nuggets for lunch & tacos/beans for dinner, eats some vegetables, eats fruit, drinks juice, milk and orange soda at grandparents.
- Easygoing temperament, enjoys playing in park with mother, grandparents keep Cruz in apartment as grandmother has some mobility issues
- TV watching minimal.
- Rikki struggles with her weight.
- Rikki lives with her husband and in the same apartment building as both sets of Cruz’s grandparents.
During your encounter with Rikki and Cruz the following is found:
- Mastery: Rikki is a loving attentive mother that has recently read a book about child development.
- Belonging: Rikki and Cruz have a great sense of community within their immediate and extended family and at church.
- Generosity: Rikki helps with childcare at church on a weekly basis.
- Independent decision-making: Rikki’s family, including grandmothers and aunts that help with child care, help Rikki make major decisions around feeding.
Using the strength-based approach Rikki is given encouragement to continue everything she is doing to increase the well being and development of her family including reading about child development and fostering a sense of community with family and church. This sets the groundwork to talk about the concern around independent decision-making around feeding decisions for Cruz. This discussion with Rikki can start asking what do the relatives want Rikki to do, followed by what Rikki wants to do and finally what is best for Cruz.
How is the strength based approach related to the Bright Futures Guidelines?
The Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition is based on the belief that effective health supervision involves an ongoing partnership between health care professionals and families. You can implement the strength based approach within Bright Futures by:
- Using the age related examples of questions to elicit strengths, as well as phrases and anticipatory guidance concepts in each chapter.
- Using the Bright Futures Tool and Resource Kit forms including: pre-visit questionnaires, documentation forms, and anticipatory guidance handouts. These forms are designed to collect information from families to document strengths.
- Strength Based Approach Frameworks:
American Academy of Pediatrics