The interview process when meeting a new patient sets the tone, as Ball et al., (2019) would say, for a successful partnership. This first encounter allows providers to establish a rapport with their patient to allow for effective and trusting communication for future visits. Infants and children are considered minors; therefore, they will be accompanied by a legal guardian. It’s important as providers to confirm that the adult has the right to consent to the care of the child. In the interview process, a lot of children are uncomfortable and rather scared going to the doctors. Having a playful approach such as, getting down to their level with asking questions, letting them touch your stethoscope or tools before using them, and using language they understand are all ways to gain their trust.
My patient is a pre-school aged white female living in a rural community. Therefore, I will be using the same techniques discussed previously when interviewing her. It’s important to obtain an extensive family history from the legal guardian, any developmental concerns, their feeding habits, any past or present illnesses, their school information, personal and social history, and a complete comprehensive review of all systems. During the interview process, the parent/legal guardian will also be involved in assessments. Ball et al. (2019) discuss that family dynamics become evident during history taking and may even lead to clues that a parent is in need of help. Knowing that the child comes from a rural area is important and will alter my interview questions.
Marcin, Shaikh, & Steinhorn (2016) state that rural areas of the United States are home to nearly 20% of the population. As a result, children face significant access barriers to important pediatric health services. These barriers include geographic challenges for families living in rural communities, a relative shortage and maldistribution of general pediatricians and pediatric subspecialists, as well as social and economic barriers that make it difficult to travel to locations where pediatric health services are providers. In addition, Vinopal & Morrissey (2020) state that within a few months of entering Kindergarten, children from high-poverty neighborhoods have poorer health behaviors, lower cognitive scores, and higher rates of food insecurity.
Risk Assessment Tool
With that being said, the risk assessment tool I would select for this patient would be an ASQ-3 60-month Questionnaire to provide me with reliable, accurate developmental and social-emotional milestones so that I could identify any risks for delays or disorders. This tool is a nine-page packet that allows the parents to answer questions targeted at the child’s milestones appropriate for their age. This tool allows providers to assess any delays the child may be having and focus on what milestones need attention. Hirai, Kogan & Kandasamy (2018) state that early identification and intervention are critical to optimize language, cognitive, motor, and socioemotional development as well as educational success, yet only an estimated 10% of children with delays are identified and receive intervention. Zablotsky & Black (2020) conducted a study and found that there was a higher prevalence of children with developmental disabilities in rural areas compared with urban areas. Furthermore, among children with developmental disabilities, those living in rural areas were less likely to use a range of health care and educational services compared with their urban peers. Therefore, it is imperative as a provider, to provide developmental screening tools from birth to five during the most critical time of a child’s life.
During an interview, questions need to be open-ended or indirect questions, especially when working with children. Questions I would ask during my interview to begin building the health history would be, “Tell me about your home life: Who do you live with? What does our house look like? What do you usually have for breakfast, lunch, and dinner? What do you like to do at home?” I would ask the personal-social questions, “Does your child undress herself, tie her own shoes, and use the toilet on her own?” Another question I would ask is about the child’s eating habits and schedule. “How are your child’s eating habits? Does she eat her fruits and vegetables? Does she finish her plate? What are typical meals in your household? How many snacks a day does she have?” I would ask the parent, “What is our family history like? Have any relatives suffered from substance abuse, cancers, behavioral conditions, or any other illnesses? Does your child suffer from any illnesses either past or present?” To end my interview, I would ask the parent if there are any concerns that they might have regarding their child. This question is important and opens the floor to any concerns the parent has been having that you may have not covered in the interview.
Interviewing a new patient is a critical period in the patient-provider relationship. Knowing who the patient is and where they come from is an importance piece in developing an interview approach. When working with children from rural areas, providers must keep in mind that their developmental stages may be different than those of urban areas and providing the parent with developmental screen tools in imperative. Singh, Jung Yeh, Blanchard (2017) state that early childhood is a critical period because the first five years of life are fundamentally important, and early experiences provide the base for brain development and functioning throughout life. Early identification of developmental disabilities is essential for timely remedial intervention and leads to early treatment and ultimately improved long-term outcomes.
Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). The History and Interviewing Process. In Seidel’s guide to physical examination: An interprofessional approach (9th ed., pp. 1-21). St. Louis, MO: Mosby.
Marcin, J., Shaikh, U., & Steinhorn, R. (2016) Addressing health disparities in rural communities using telehealth. Pediatric Research. 79, 169-176. https://doi.org/10.1038/pr.2015.192
Singh, A., Jung Yeh, C., & Blanchard, S. (2017). Ages and Stages Questionnaire: a global screening scale. Boletín médico del Hospital Infantil de México. 74(1), 1665-1146. https://doi.org/10.1016/j.bmhimx.2016.07.008
Vinopal, K & Morrissey, T. (2020). Neighborhood disadvtange and children’s cognitive skill trajectories. Child Youth Serv Rev. https://doi.org/10.1016/j.childyouth.2020.105231
Zablotsky, B & Black, L. (2020). Prevalence of children aged 3-17 years with developmental disabilities, by Urbanicity: United States, 2015-2018. National Health Statistics Reports. 139, 1-7.