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Premarital sex

Traditional family roles

Alcohol and substance abuse

Alcohol and substance misuse and its impact on children who witness it.

Use of harsh disciplinary methods

Marital conflicts and their impact on children who witness them.

Possible abuse within the household requiring escalation; families to be informed of the rationale and potential impact on the children

The caregiver has been observed using a vape in the presence of the child and has also allowed the child to handle or play with the device.

Use of harsh disciplinary methods has been observed in the caregiver’s interactions with the child and getting parents to understand such approaches may negatively impact the child’s emotional and psychological development

Home environment safety - e.g. window grilles, sleep safety

Harsh physical punishment

Marital conflict / intimate partner violence where child is exposed

Caregiver's mental health

Family planning

Appropriate family boundaries (e.g. showering child of opposite gender, changing in front of child/changing child in front of older siblings etc) - Have not personally discussed this yet but came up during a joint HV with FSC

I think the challenge for me is not so much in broaching the topic/gathering info/finding out family's perceptions and beliefs, but how to continue after knowing the above points.

Bearing in mind that there could be differences in beliefs and values that stem from personal experiences/culture etc.

Some internal dilemmas or considerations could be: To what extent is this something that we can respect client's autonomy about or something that we have to take a firm stance on? How much do we want to 'push' for/encourage a certain action or way of doing things, and also how do we follow up in a way that still respects that parents are the experts of their children, and that doesn't seem to undermine our trust in the family.

Just a simple example to illustrate: say even for issue of home environment safety - parent may say oh they have taught child to stay away from the window and child understands, so there's no need for window grilles/ or parent says they are sensitive to baby's movements during sleep and will always wake up when baby moves around or wakes up, so baby won't fall off the bed. Then how do we encourage certain actions/change without letting family feel that we are doubting their words and their ability

In general, adopting a stance of care and curiosity, instead of immediately making a judgment/giving own opinions on what parents should or should not do is helpful.

Also, trying to observe cues and check-in (e.g. noticing that parent suddenly becomes quiet/noticing that parent is looking around the house, seem to be worried that family member will hear them/spouse will come back etc) Can check in with parent if parent wants to stop the conversation/continue the conversation another time

In terms of broaching sensitive topics, sometimes I will set the stage by talking about other people (e.g. For some couples, when things get heated, they may get physical... I'm wondering if this happens for you and your spouse when y'all have quarrels?) or empathising/explaining the rationale for asking (e.g. for a parent who seems more wary about sharing about themselves, may introduce PHQ-9 or ask more about mental health by saying cause taking care of children can be really tiring and stressful etc etc or this is something we hope to check in with all our families). May sometimes help to 'normalise' things for the family and lead in to the topic

As shared in previous learning circle from Prof Lori's talks: also helpful to ask for permission to share about something

Addressing this issue with the caregiver is difficult, especially if they do not perceive vaping as harmful or feel judged. I need to be tactful and have non-confrontational approach to raise awareness of the potential dangers and encourage safer behavior.

Harsh disciplinary methods observed in the caregiver’s interactions with the child. This is challenging because such methods may be deeply rooted in cultural beliefs or personal upbringing.

Example: This caregiver is 2 children with special needs and the middle child observes parents giving attention to his siblings, therefore child acts out in order to get parents attention resulting to parents getting overwhelmed.

Caregivers may not be aware of the negative impacts these approaches can have on a child’s emotional and psychological development.

Its hard to bring this to their attention as they are really overwelled. I have to be also mindful of it.