Discussing Their Futures with Kids in Primary Care 8/3/2021

Erik Erikson, Ph.D., a lay psychoanalyst, was a great thinker, skilled clinician, and compelling writer who viewed human psychology in a developmental context.  His schema describes nine major psychosocial developmental stages and the associated psychological challenges, from infancy to the end of life.

Today’s newsletter discusses how a primary care provider, working within the time constraints of their office workflow might assess a youngster’s progress along these developmental stages by asking some simple questions about their future goals.   Doing so can create opportunities to provide encouragement and guidance to enhance healthy development.   Integrating simple Motivational Interviewing techniques into the dialogue is an element in this process.

While certainly not rocket science, nor a panacea for improving the lives of all young persons, the suggested interventions do leverage the influence and authority of the PCP by demonstrating their interest in the development tasks facing the child/adolescent patient(s).  This may help orient them (and their parents) toward their futures and encourage healthier social and emotional attitudes and behaviors.  Equally importantly, the effort may help to identify youth facing serious challenges or who are in deeper trouble— those who might then benefit from appropriate mental health referrals.

The following chart gives some examples of dialogue that could be used in the primary care clinic setting.

PSYCHOSOCIAL STAGES

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DIALOGUE 1:    Youth’s View of their Future:  Work

Question(s):                 “Boy you are surely growing each time I see you!  So I’m wondering…

                                       what do you think you want to do when you grow up?”

Follow Up:                  If youth’s response is idealized (e.g., I want to be in the NFL or be like  Angelina Jolie), ….

                                    “Sounds great, and that would be pretty cool.  What would be your backup plan if that didn’t work out?” 

——

[YOUTH RESPONSE]

——

As appropriate, discuss future steps that might be appropriate:

“Hmm, being a ________ means {getting training/going to college/etc.}, so I hope you continue {learning that skill/working hard at school} to get  ahead with that.  That’d be a real good thing to do.”

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DIALOGUE 2:           Youth’s View of their Future:   Family—Children & Marriage 

Question(s):  “It’s still real early in your life, but I think a lot about the future, so I am wondering… What do you think about your future?,… like, will you want to have a family of your own when you grow up– or will you want to live independently?”

                                                ——

                                    [YOUTH RESPONSE]

——

Follow Up:                 If “Yes”, “Hey, that’s neat. It is a big step to {have kids/get married}.” 

                                    If “No”, “Hey that’s good, being independent can be a big step.”                                                 

“You’ve got plenty of time to prepare for that part of your life.  In the  meantime, and, whatever you decide, I know that it is important for  a young person to take good care of themselves and to build friendships and to be involved with your family at home, your teachers at school and good people in your neighborhood.  Maybe next time we meet, you can tell me how those parts of your life                                    are going.”

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 DIALOGUE 3:           Risks & Vulnerabilities 

Question(s):                “Can you think of any risky things that you’d have to be careful about as

                                      you are growing up?” 

——

[YOUTH RESPONSE]

——

Affirm youth’s positive safety comments—e.g., drugs, sex, etc.

“That is real good thinking.  It can sometimes be hard to do what’s best, but it can make a real big difference. As you get older, it will be        important to think for yourself about what is safe and to ask for help if and when you feel you need it.” 

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In the above examples, the PCP aims to be conversational, future-focused, and encouraging, with efforts made to clarify and support the patient’s positive responses affirmatively.

It should never be a heavy lift for the interviewer, but rather, it works best when the locus of control remains in the youth’s hands.

As with all Motivational Interviewing, the interviewer’s job is to create an opportunity to identify their personal goals and wishes, and then offer encouragement and support.

 References:

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