|
Indian Pediatr 2016;53: 961-963 |
|
Concept of Health Care Counseling for
Pediatricians
|
MKC Nair, ML Leena and K Ajithkumar
From Kerala University of Health Sciences, Thrissur,
Kerala, India.
Correspondence to: Dr MKC Nair, Kerala University of
Health Sciences, Thrissur, Kerala, India.
Email: [email protected]
|
The term ‘Health Care Counseling’ denotes
introduction of the science and practice of counseling at all healthcare
delivery points, apart from the existing mental health settings.
Introduction of healthcare counseling is expected to bring about
palpable changes in the existing communication gap between health care
professionals and their clients, particularly the parents of the young
ones. There is ample opportunities for introducing health care
counseling in the life-cycle approach to child care and development, a
philosophy that encompasses all actions essential for preparing for
future motherhood, joyful pregnancy, safe delivery, and optimal growth
and development till 18 years of age [1]. Establishing health care
counseling services in the healthcare sector would involve: (i) a
formal need assessment, (ii) identification of research
priorities, (iii) development of human resources, (iv)
identification of services for all specialized healthcare situations
across the entire pediatric age group – birth to 18 years, (v)
development of service models, (vi) formal evaluation, and (vii)
seeking policy support. This article intends to highlight the relatively
new concept of Health Care Counseling (HCC), particularly relevant to
practicing pediatricians, in terms of; (i) system approach to
counseling, (ii) the conceptualization of HCC, (iii) the
need for HCC, (iv) capacity building for HCC, (v)
description of HCC, and (vi) plan of action.
System Approach to Counseling
In India, one of the major problems that healthcare
services face is related to demand and supply. Every day the number of
persons seeking services of healthcare institutions is increasing, but
there is no proportionate increase in the personnel and infrastructure
facilities due to financial constraints. There is a wide variety of
health systems around the world, with varying histories and
organizational structures [2]. Healthcare delivery system is like any
other system and is governed by some basic principles of system
operation. The basic principles of system approach to counseling have
been originally developed in physical sciences and later social
sciences, where an individual is taken as part of the system, and an
intervention for betterment of individual would be effective only if it
can bring about change at a systemic level [3]. Many biological and
non-biological phenomena share the attributes of a system: (i)
all systems are based on a set of rules, for example in the context of
healthcare system, all major activities are to follow a ‘standard
operating procedure’, (ii) there is a lifecycle for a system –
stages of formation, growth, retraction and disintegration, e.g.,
lifecycle approach to child care and development, (ii) every
system has a predictable and unpredictable style of operation, for
example a routine children’s hospital casualty activities versus
response to an unpredictable calamity like food poisoning in the
neighbourhood school or school van accident that may upset the
efficiency of the system, (iii) a unified whole can be identified
from the sum of its parts and any change in one part affects the system,
e.g., poor front-office management would affect reputation of an
otherwise competent hospital, (iv) functioning systems tend to be
homeostatic in operation, meaning once a system is established, it
maintains a stable state by regulating the system through feedback
information, e.g., monitoring routine immunization service in the
community, and (v) finally, report of a lacuna in one part of the
system may need changes at the systemic level, for example complaint of
poor communication skill of a child health nurse, need system correction
not only at the supervisory level, but also at the primary training
level.
Conceptualization of HCC
Traditionally body and mind were considered separate,
and this had led to lot of scientific advances both in biological
science and human psychology [4]. For example, psychotherapy that may be
categorized into five fuzzy-bordered groups: (i) psychoanalysis,
(ii) behavioral therapy, (iii) cognitive therapy, (iv)
mindfulness-based therapy, and (v) body psychotherapy, with each
one having many branches and extensive literature [5]. All these in turn
have resulted in professional partnership in the mental health domain
between medicine and clinical psychology, later supported by psychiatric
social work professionals. The same may be true in case of childhood
disability management – a fruitful partnership between pediatrician,
child psychologist, physiotherapist, speech therapist and community
health worker, as envisaged in the Rashtriya Bal Swasthya Karyakram
(RBSK) of Government of India.
HCC is an integral part of medical care.
Traditionally, counseling was the forte of Psychology postgraduates and
later Masters in Social Work, both lacking adequate exposure to human
biology. Psychological/mental health problems occur in the backdrop of
biological and sociological processes. For example, ‘premenstrual
syndrome’ among adolescent girls; a condition with recurrent moderate
physical and psychological symptoms that resolve with onset of
menstruation [6]. Although menstruation is a normal biological process,
the premenstrual syndrome is more related to the psychological makeup of
the girl and the comfort with which the family members handle this
simple biological process. Again the bio-psycho-social model of
depression [7] necessitates deeper understanding of biological and
psychological backdrop and the social context of the adolescent. This
then necessitate that HCC should integrate basic knowledge in human
biology, human behavior and social milieu of the adolescent, amply
supported by elements from communication, philosophy, and spirituality.
Need for HCC
Before the onset of the 19th century, the medical
practitioner was a learned person, philosopher, counselor, spiritual
leader, and faith-healer; all in one. In the first half of the 20 th
century, medicine was practiced more as an art and less of a science.
But the second half of 20th
century has witnessed unimaginable progress in science of medicine and
large scale incorporation of technology into medical science. Major
medical schools have become centers of excellence in medical technology
and healthcare management. The personal communi-cation between the
physician and the patient has been compromised and the same is often
reflected in the training of new medical graduates. Avoiding
communi-cation pitfalls and sharpening the basic communication skills
can help strengthen the patient-physician bond that many patients and
physicians believe is lacking [8].
Capacity-building for HCC
In India, with inadequate trained mental health
professionals, there is an acute need for capacity-building of existing
health care professionals in the art and science of counseling,
especially for the young. Healthcare needs in each setting can differ
greatly in different healthcare settings – primary, secondary and
tertiary, and hence we need to create health care professionals with
basic training in counseling principles in general and guided counseling
training on specific issues related to their field of work. Newcomers
require to become familiar not only with new practices and procedures
but also the art of communicating with the children and their parents.
Qualified practitioners who have learned by experience need to be
sensitized to the diverse situations they might face in a variety of
healthcare settings – busy out-patient, crowded inpatient and suboptimal
intensive care units, both neonatal and pediatric. There is practically
no healthcare facility or service without a professional nurse in
station. The nurses have an advantage as they already have exposure and
training in human biology, human psychology, and medical sociology, even
during their graduate training, further reinforced in post-graduate
training.
Description of HCC
HCC should be viewed as an add-on service by existing
specially trained healthcare professionals in their areas of service
delivery and as appropriate to the needs of their pediatric patients and
their parents. This should not be considered a stand-alone or referral
service and should in no way interfere with the existing mental health
services locally available. In fact, it is a fruitful amalgamation of
expertise of consultant subspecialists in pediatric medicine and surgery
and the counseling and communication skills of other supportive staff
for the optimal benefit of the child population. Hence, it is a
percolation of counseling services to all nodal areas of healthcare
delivery without additional financial burden for the provider. The areas
to be included are still evolving, yet would involve the following
priority areas needing counseling services namely: (i)
neonatal/pediatric intensive care, (ii) lactation management (iii)
young child feeding/nutrition, (iv) childhood disability
management, (v) genetic counseling, (vi) problems of
preschool child, (vii) scholastic backwardness, (viii)
child rearing/parenting, (ix) adolescent reproductive health
education, (x) psycho-social/mental health supportive care, (xi)
substance abuse management, (xii) premarital and relationship education,
(xiii) sexual abuse counseling, (xiv) disfigurement and
cosmetic dentistry, (xv) lifestyle related diseases prevention, (xvi)
wellness counseling, (xvii) childhood cancer care, (xviii)
crisis management, and (xix) bereavement counseling.
Plan of Action
With the introduction of the Reproductive, Maternal,
Neonatal, Child Health + Adolescent (RMNCH+A) program in India [9], and
a strategic approach developed to provide an understanding of ‘continuum
of care’ to ensure equal focus on various life stages, there is a huge
demand for counseling services at every stage, especially during
adolescence [10]. In the Kerala context, the proposed strategy, based on
the concept of having a trained healthcare counselor at every point of
delivery of child health service and using existing healthcare personnel
would involve the following steps: (i) Kerala University of
Health Sciences (KUHS) take the lead position through development of the
Centre for Health Care Counselling Studies at KUHS, (ii) further
development of the child HCC areas mentioned earlier including
conceptualization, research and clinic models through advanced
masters/research program, (iii) preparation of modules on each of
the suggested HCC areas, (iv) training of trainers program for
faculty of KUHS with masters degree in any discipline of health
sciences, (v) training programs for all healthcare service
personnel in Kerala both public and private sector, and (vi)
simultaneous process evaluation. Subsequently, other Health Science
Universities may emulate the same for both the pediatric and adult
population.
Conclusion
In India, with limited availability of clinical
psychologists/psychiatrists, their expertise should be optimally used
for mental health services. We need to create a pool of qualified
trained and certified healthcare counselors as resource persons for
training existing health care staff at every point of health care
service delivery and for every medical specialty. The suggested HCC
approach by trained healthcare staff could be a solution for the
existing vacuum in the area of supportive care and effective
communication between health care providers and patients. This is
especially important for the child population, as the pediatricians and
pediatric nurses need to partner the parenting responsibilities in
different illness-care settings, covering newborn to adolescence period.
Once developed and evaluated, the same could be replicated in other
states of the country.
References
1. Nair MKC, Mehta V. Life cycle approach to child
development. Indian Pediatr. 2009;46:S7-S11.
2. White F. Primary health care and public health:
foundations of universal health systems. Med Princ Pract.
2015;24:103-16.
3. McLeod J. An Introduction to Counselling. 3rd ed.
2003. Open University Press, Great Britain. P. 191-204.
4. Stolorow R, Atwood G, Orange D. Worlds of
Experience: Interweaving Philosophical and Clinical Dimensions in
Psychoanalysis. New York: Basic Books; 2002.
5. Leitan ND, Murray G. The mind-body relationship in
psychotherapy: grounded cognition as an explanatory framework. Front
Psychol. 2014;5:472.
6. Biggs WS, Demuth RH. Premenstrual syndrome and
premenstrual dysphoric disorder. Am Fam Physician. 2011;84:918-24.
7. Schotte CK, Van Den Bossche B, De Doncker D, Claes
S, Cosyns P. A biopsychosocial model as a guide for psychoeducation and
treatment of depression. Depress Anxiety. 2006;23:312-24.
8. Travaline JM, Ruchinskas R, D’Alonzo GE.
Patient-Physician communication: Why and how. J Am Osteopath Assoc.
2005;105:13-8.
9. National Health Portal. Reproductive, Maternal,
Newborn, Child and Adolescent Health. Available from: http://www.nhp.gov.in/health-programmes/national-health-programmes/
reproductive-maternal-newborn-child-and-adolescent. Accessed October
17, 2015.
10. Nair MKC, George B, Indira MS, Sumaraj L. Adolescent Counselling.
First Edition, 2016. New Delhi: Jaypee Brothers.
|
|
|
|