This article about how Kidpower can help health care providers protect patients from bullying, abuse, and violence is thanks to Healthful Life MD Abby Bleistein, who teaches these skills in her practice. Dr. Bleisten is a board certified physician in Internal Medicine, pediatrics, and obesity medicine. She is also a Kidpower International Board member.
Safety is a predominant health concern for children through young adulthood. Health care providers have a great opportunity to increase the physical and emotional well being of their patients by providing education and skills for them to practice and use.
Kidpower provides practical, hands-on, safe, age-appropriate, and abilities-appropriate programs, which are easily incorporated into a medical office visit.
While time is very limited during an office visit or well-child check, Kidpower skills are simple to learn, teach, and incorporate in increments during these visits, providing excellent tools and resources for common problems and issues that arise that can be communicated in just a couple of minutes.
Safety Skills for Well-Child Check Visits
Well-child check visits provide a regular opportunity to incorporate safety education into the health care structure.
As soon as children are able to understand, at age 3 or 4, I ask them if they know their safety plan at home and for being out in public. I review with parents making a safety plan wherever they go, but more importantly, I encourage them to role-play the plan at home and “on location” before getting started on their outings.
Role-playing, or practicing skills, is a major component of the Kidpower safety program. By role-playing safety skills in a safe way, the skill becomes part of the young child’s muscle memory. As a result, they are far more likely to remember and use the skill in a time of need or stress.
Reviewing with parents how to formulate a safety plan and then practicing takes 1-2 minutes of the visit, but this is a valuable safety skill for families to use regularly for many years.
When I examine younger children, I help them develop an understanding of healthy boundaries on touch by incorporating Kidpower language. For example, before a genital exam, I explain to children, “ I am touching your bottom and vagina right now to make sure everything is okay. This is safe because your mother is right here, and because I am doing it for your health. Touch should NEVER be a secret, so you can tell everybody we did this.”
At other well-child visits, I introduce the concept of “Checking First” before a plan is changed. Knowing what is safe, how to get help, and to check first are skills that can prevent a host of problems.
Safety Skills for Bullying
Screening during the well-child check with older children often brings up issues of bullying. If patients complain about being bullied, we practice skills such as:
- using the Kidpower Trash Can to throw away hurting words
- using Walk Away Power or Closed Mouth Power to avoid getting into a fight
- being persistent in Getting Help from busy adults
Bullying is viewed by many as a matter of course in school, and it is often difficult for children to get the help they need. Role-playing the skill of persistence, actually practicing ways of requesting help, as well as identifying a safe adult who may be helpful, empowers children. I have also worked with parents to build advocacy skills so that they can intervene on behalf of their children and persist until issues are addressed.
Bullying can have a dramatic negative impact on a student’s success in school and can ultimately lead to high risk behaviors in the victim. For example, during a well-visit with a high school student, I discovered that her grades had gone from straight A’s to C’s and D’s over the course of several months. The patient went from being seen as a “good student” to one who constantly got into trouble.
In further discussion of what made the change, the student revealed that her teacher was embarrassing her in front of the class by making unkind jokes. I explained the concept that you can FEEL one way and ACT another and that you aren’t always going to like everyone. We practiced using Mouth Closed Power to avoid making things worse in the moment, and we practiced the words to say later to tell the teacher in a clear and respectful way that what she was saying was upsetting. We also practiced how to find and approach an adult who was likely to be of help at school and how to get help at home.
I reviewed with this girl’s parents how to practice the skills at home, because role-playing the skills in a safe environment will help their daughter to use the skills at school. I talked with the parents about how they could advocate for their daughter as well. While my time is tight during these visits, a significant problem was identified, and in a relatively short period, I could use Kidpower skills to teach the family tools that might put an end to this problem.
Many children come in with complaints that may be caused by anxiety, such as abdominal pain, trouble sleeping, behavior problems, or headaches. During the screening for the problem, I ask children if there is anything they are worrying about. Children may reveal that other kids are picking on them at school or home.
I find that parents are grateful to have ideas about how to deal with bullying and the opportunity to see how to practice skills with their children. For a child who is feeling upset because kids are making fun of her name, for example, we might practice setting boundaries by finding out what other kids are saying, pretending to be a kid doing this—making it very clear that we are pretending, that we in fact love her name—and coaching the girl to say, “I don’t like it when people make fun of my name. Please stop.”
By practicing in a safe environment and using the words the child has heard before, the impact on her in the actual situation is lessened, and she can build confidence in her ability to respond clearly. We practice getting help, discussing how to find helpful adults at school, and what to do if an adult says, “Solve it yourself.” By addressing the trigger of the symptoms and practicing skills to resolve the problem, the symptoms are more likely to resolve as well.
Safety Skills to Heal After a Violent Injury
Health care providers are often involved in evaluating patients after violent injury. In addition to the immediate health of the patient and caring for any injuries, the long-term healing of the patient is an important consideration. Kidpower skills can help patients regain a sense of their personal power.
After violent injury, people often blame themselves, feel powerless, and worry about what else might happen to them. For example, a date-rape survivor I saw in clinic felt that she was responsible for the incident that occurred. Other kids at school heard about the episode and were teasing her, making her feel embarrassed and uncertain.
I practiced the Kidpower Trash Can with this patient, not only to throw away hurting words from others, but also to help her throw away the hurting words she was telling herself. We role-played being persistent in getting help and setting boundaries, and we identified safe adults she could go to at school to get help and support. I also encouraged her to take a safety skills workshop through Kidpower to help build her own confidence and belief that she does indeed have the power and tools to keep herself safe.
Safety Skills to Prevent Accidents
Accidental ingestions are unfortunately not uncommon in pediatrics. Checking First is a skill that can help prevent these and other types of injuries. While I teach this valuable skill during well-child checks, I have found it useful to practice after a situation arises.
The Check First Rule of Kidpower is: “Check first before you change your plan about what you are doing, where you are going, and whom you are with.” The rule includes not eating food from people you know or people you don’t know until you have checked with your adult in charge.
One little boy I saw in the office was brought in because he ingested pepper spray he found in a closet. He thought it was mouth spray and sprayed it in his mouth. His father, who had bought the spray for protection, was understandably distraught. The pepper spray itself did not cause any lasting injury, but the father was shaken.
We practiced Checking First for a few situations. If you see something interesting you want to play with, if a friend offers you a cookie, or if a gate is opened to a swimming pool, the Kidpower Rule is to Check First. We reviewed role-playing situations frequently to help this young child remember the rule. The father felt much better that he could actively work on a skill to prevent future problems.
Safety Skills for Children With Special Needs
Health care providers often work with children with special needs, from kids who are impulsive or exhibit aggressive behaviors, to children with developmental delay.
For children with aggressive behavior, Kidpower skills can help a child learn to control their impulses and aggressive behavior. For example, I have a patient who gets angry with other children at school when she feels her boundaries have been crossed. She will act out by pushing or hitting other children, or even throwing chairs.
We have practiced skills with this child such as setting boundaries with voice and saying, “Stop!” in a calm, firm way; using Calm Down Power and Walk Away Power to avoid fights; and how to get help from the adult in charge. She has learned to identify her feelings, “I am feeling angry/frustrated and I need help,” and to persist to get the help she needs.
Children with developmental delay are at a greater risk of abuse and violence, and parents are often worried about how to protect their children. Kidpower skills are broken down into very basic skills. By practicing the skills regularly, children are much more likely to integrate the skills into their behaviors.
A child with autism, for example, had anxiety about going to the mall with his mother. We reviewed coming up with a safety plan, getting help, and role-playing these skills at home and before each outing. Over time, the child was able to gain confidence in these situations and go out with less anxiety.
By incorporating Kidpower skills into their daily lives, children with special needs can start to learn to protect themselves as well. Skills such as setting boundaries, getting help because Problems Should Not Be Secrets, and persistence in getting help from busy adults are all important tools that will help these children be safer and will serve them as they transition to adulthood and greater independence.
A Framework of Skills for Improving Children’s Health and Safety
As a busy primary care provider, I have a limited amount of time with each of my patients. I am faced daily with safety concerns from parents that all impact children’s health. Kidpower gives me a framework of skills that I can readily teach to families with confidence that they are practical, simple, and accessible enough for adults to practice with their children at home. I believe these skills will ultimately make my patients safer and lead more confident, healthy, and fulfilling lives.
Here is a typical example of how this framework can make a great difference during a regular visit.
A five-year-old boy was in for his well-child check. He felt very concerned about me examining his private parts. He had been told that no one should look at private parts and felt strongly that this was “inappropriate.”
After confirming that he has not been touched inappropriately in the past, I discussed with him the Kidpower rules regarding our bodies. We talked about how our bodies are our own and we can set boundaries around our bodies. I explained to him that, if he and his brother wanted to play tag in a safe place and it was okay with the adults in charge, they could do that. If he changed his mind, he could tell his brother to stop and that would be okay too. I told him, however, when it comes to health and safety, we don’t always have a choice.
I explained that this was a medical exam to be certain that he was healthy. I explained that we know it’s okay because his mother was right there to let us know that this is safe. I explained that I understood that he did not want to have this exam done, but because it is about his health it is important that we complete the exam. I also told him that problems should not be secrets. He could tell anyone that he wanted that the doctor had to examine his entire body including listening to his heart and looking at his private parts. He could tell everyone that his mother was there and said the doctor could do this.
This boy said he planned to explain to his dad that he had to have a physical exam today. While he was still not happy about his exam, it was a good teaching moment about safety with our bodies, and problems should not be secrets.
I referred his mom to the Kidpower.org website for more information. It was also good to give the mother language and a routine to practice that is a far better perspective then “stay away from strangers.” I discussed with the mom how these practices clarify what could otherwise be confusing rules for kids.
Supporting Adult Leadership in Keeping Kids Safe
Kidpower also provides resources for parents in how to protect their children and teens. For example, after an upsetting story about an abduction attempt gets into the news, many parents give their kids fearful messages that just make them anxious without making them safer. If this is an issue, I show parents how to practice skills like Staying Aware, Moving Away, and Checking and Thinking First, which can keep kids safe most of the time.
In our waiting room, we have seasonal articles and information about emotional and physical safety during holidays, when starting school, and other times of the year– as well as coloring book pages for kids. We also have a copy of the Kidpower Safety Comics for children to read- and of the The Kidpower Book for Caring Adults for their parents.
During International Child Protection Month in September, we have posters with actions adults can take to protect their young people from harm and empower them to take charge of their own well-being – such as discussing the Kidpower Protection Promise with their children and making our Put Safety First Commitment.
I think that all health care providers can greatly benefit their patients by incorporating these skills and by making these resources easily available.