Research In Action
Research In Action
Author’s Note: As a pediatric psychologist, I have the privilege of partnering with families as they make their way through their medical journeys. I recently co-authored a book with Melissa J. Hogan, JD, Afraid of the Doctor: Every Parent’s Guide to Preventing and Managing Medical Trauma, to help support families during these difficult times. An adapted excerpt from the book is shared here.
Early in my career I had the opportunity to work with a bold and brave 7-year-old boy, Joey, who was battling a disease that resulted in recurrent tumors. Joey’s medical team asked me to help with his difficult behaviors in clinic, including his refusal to have his port-a-cath (a device under the skin used for blood draws and medication infusions) accessed.
The first time I watched his port access, both of his parents were yelling in frustration, Joey was thrashing around screaming and crying, and it took four nurses to hold him to give him his life-saving medication through his port. By the time his port access was finished, everyone in the room was exhausted and tense.
The family told me that this was getting worse every week. At every appointment, Joey was becoming angrier, and the family felt ready to give up. Joey’s port access had become traumatic to him, even though according to his medical team, “it wasn’t supposed to hurt.”
Applying the C.O.A.C.H. Framework
Together with Joey and his family, we came up with a new plan, adding one or two new strategies for the next three weeks. We applied the C.O.A.C.H. framework by:
- Collecting Information (Why was port access difficult? What has worked in the past to help Joey overcome fears?)
- Observing (Watching Joey's progress as we added new strategies)
- Asking Questions (Asking the medical team how often port access was required and asking to have the same nurse access Joey each week)
- Choosing Strategies (Using music as a distractor; creating a reward chart)
- Helping (Getting help from multiple medical team members, including the child life specialist, nurses, doctors, and psychologist)
After four weeks of working together, I watched Joey climb up on the exam table by himself and prepare himself for his port access. He put on his headphones to rock out to “Highway to Hell” (parent-approved). Joey laid down calmly and got ready for his nurse (only one) to access his port. And he did it! He continued to bravely face his port access for the next year of treatment.
Since becoming a parent, I can more fully understand everything that we as healthcare providers ask parents to do to support their child’s health. I have been blessed with two amazing, energetic boys, each of whom have had some run-ins with the medical world.
I live the daily parenting juggle…the overwhelming love, joy, exhaustion, and general circus. And I must confess, I have looked at my own kids’ doctors and thought, “You want me to do what? How can I possibly get my child to actually swallow that disgusting medicine? Have you tasted it?” My children have brought me opportunities to try out many of the strategies in this book, not only as a professional, but as a parent.
A lot of love and a little (okay, a lot of) patience are often the best tools to start with. You got this. You can do more than survive. You can thrive.
Click here for more information on Afraid of the Doctor: Every Parent’s Guide to Preventing and Managing Medical Trauma.