How can GPs help children and parents get through challenging periods?

The Emerging Minds course, ‘Supporting Children’s Resilience in General Practice,’ is specifically designed to assist GPs use a preventive and early intervention framework to help parents and children through difficult periods – and to pick up on warning signs of childhood mental illness.
 
The course – supported by the RACGP - is aimed at helping GPs begin conversations on difficult topics in situations such as when a parent has an issue which will impact the child, when a parent is concerned about a child’s behaviour, or if a GP is concerned about the wellbeing of a child after seeing their parent.
 
Dr James Best, Chair of the RACGP Child and Young Person’s Health Specific Interest Network, told newsGP that the significant early demand for the course showed that many GPs were grappling with these issues.
 
‘This is the hard stuff – but I think it’s up to us to meet the challenge,’ he told newsGP.
 
‘It can be very challenging for a doctor to raise these topics. It can be confronting. I know personally, it can be almost overwhelming to deal with a family in crisis, especially when a child is involved.’
 
‘It’s important that we do raise these issues, because they can often go under the radar. A good doctor’s role is to go on the front foot here and ask – how are you going? How is your child going at school? In their lives?’
 
‘For GPs, it can be a confronting presentation when a child comes in with a mental illness.’
 
Some childhood mental illnesses are becoming more common, according to the Australian Institute of Family Studies, with rates of major depressive episodes rising from 2.1% to 3.2% in 6–17 year olds between 1998 and 2013, while attention deficit hyperactivity disorder (ADHD) prevalence decreased from 9.8% to 7.8%.
 
Dr Best said this type of work was hard, but could lead to significant benefits for the family involved.
 
‘It can be a really rewarding area to deal with – if a child is struggling with anxiety, being bullied, or even abused – the effect on their lives is profound. So the benefit you can give a family can be profound as well.’
 
‘You have to develop your own skills. It is bordering on social work at times. You can deal with things like parenting style, smacking, communication, building a child’s self-esteem and resilience through effective parenting. Addressing these can help reduce what may lead to a diagnosable illness.
 
‘These issues can be societally and culturally entrenched, but they can be addressed and changed. Parents, almost universally, are very motivated to be the best parent they can be. Sometimes they just need a bit of help in getting there.
 
‘Parents are increasingly under pressure. Expectations of what we can do as parents and what our children should be doing has transformed. We’re pushing kids pretty hard these days.
 
‘Then there’s the impact of the internet and social media on children. There’s bullying, cyberbullying. So there are many factors that go into this.’
 
Another factor was that mental illness was being diagnosed more across the population, Dr Best said.
 
‘Children are totally dependent on their parents and will often reflect their parents’ behaviour. There’s certainly an enormous amount of anxiety, especially amongst mothers, and issues like postnatal depression have often gone under the radar or being underdiagnosed. That can mean a parent’s ability to nurture their child is under stress.’
 
Dr Best said a key challenge for GPs was picking up on cues, or recognising that a parent’s condition could potentially affect their children.
 
‘A parent can present under stress, and if you’re familiar with the family, it may occur to you to ask how their children are coping.
 
‘Or a child may be brought in by parents, with concerns about behaviour, school refusal, bullying or anxiety.’
 
Dr Best also said using the model of asking broad open questions around quality of life was a good way to begin.
 
In his own practice, the Sydney GP has had patients come to him asking how to help communicate with a child who was struggling and how to build their confidence.
 
‘When I talk to them, you see the parents light up. Because when they’re struggling with parenting – say a kid has behavioural issues – often they simply don’t know what to do.
 
‘So when I raise this, nearly always I find the parent is really relieved that someone is trying to help them. Because they are lost – especially if they are isolated or don’t have extended family to help, or financially stressed, or with a partner working long hours. People may not know where to turn to.’
 
Dr Penny Burns, GP and lecturer at Western Sydney University, will also be presenting part of the course.
 

Dr Penny Burns believes it is important for GPs to think preventively in terms of children's mental health.

She told newsGP the course was evidence-based and relied on preventive frameworks to help parents and children get through difficult times.
 
‘With younger children, if there are ongoing difficult conditions, they show rather than tell [what’s going on]. So the changes in behaviour are really important,’ she said.
 
‘[It might be] changes at school, academic levels, poor sleep or concentration, more irritable or withdrawn, more dependent or clingy.
 
‘GPs often see kids for their vaccinations or if they have an accident, but we don’t see them so much any more for preventive issues.
 
‘So we’re thinking of ways to engage parents around how their family is going, around the importance of resilience and mitigating immediate risk. Parents play a crucial role in their children’s health development.’
 
Dr Burns offered some tips for GPs on how to start a conversation with parents that could help lead into discussions of mental health concerns.
 
‘Asking parents how they’re going, how their children are going and how they’re coping with being a parent – that creates a focus on the child, instead of just the acute issue they’ve come in for,’ she said. ‘It’s a lot easier if you know the family well.
 
‘It’s about being curious, being respectful of the fact that they’re the main carers, being sensitive to how they’re feeling – and bringing in hope. Parents know if there’s been a change in their child – so if there’s a change, find out why.
 
‘It’s about supporting parents to be really active partners in their child’s development, health and wellbeing.’
 
The online course is now open.

Child health Family health Mental illness resilience