Perspectives Online

Extension helps fill information void between physicians and patients

Cooperative Extension agents in rural counties extend the reach of pediatricians by offering parents information about children's development.
Photo courtesy of Karen DeBord

Young children spend a good deal of time in the pediatrician's office for immunizations, well checkups and illnesses, so parents naturally turn to their pediatricians for information about children's development and parenting issues. But in a short office visit, pediatricians don't always have time to adequately address parents' concerns.

Moreover, while pediatricians in urban areas can often refer patients to other agencies for assistance, resources are limited in rural areas. North Carolina Cooperative Extension is partnering with pediatric practices in rural counties to provide Extension agents to fill these voids.

"Doctors get training in addressing the physical aspects of children," said Dr. Karen DeBord, child development and parenting specialist with Cooperative Extension. "They're seeing 40 to 60 patients a day, and they don't have time to probe an issue with parents, like children's sleep patterns."

Cooperative Extension is partnering with the N.C. Pediatric Society and Community Care of North Carolina, a division of the Office of Rural Health, in a pilot program to explore different ways to getting information to parents. In the three pilot counties, Extension has formed a partnership with local pediatricians and is targeting parents with children between the ages of 12 and 24 months.

"Children in that age group start to toddle and touch things," said DeBord, who is based in the Department of 4-H Youth Development and Family and Consumer Sciences in the College of Agriculture and Life Sciences. "Parents are dealing with children's toileting and sleeping through the night. That's why people call these wonderful years the 'terrible twos.'"

Since last fall, three agents in the pilot counties have contacted parents with children in the target age group and prepared three models of parent education programs, based on the needs and preferences of the parents in their counties.

Glennie Daniels, family and consumer sciences agent in Catawba County, planned to develop some type of Web-based education program for parents. Daniels worked with Catawba's Parenting Network to develop a partnership with pediatrician Dr. David Millsaps of Hickory, whose practice includes 200 parents with children in the 12- to 24-month age range.

Daniels communicates with parents largely through electronic channels, seeking a system that younger parents will respond to. Daniels provides publications in the pediatrician's check-in center for all patients. In addition to articles about child development and parenting, there is information about how to access additional electronic information, how to subscribe to the electronic version of "Parents' Page," Daniels' bi-monthly newsletter, and contact information for Daniels.

Millsaps says that he spends 50 to 75 percent of a well-child visit dealing with parents' nonclinical issues. "This doctor acknowledges the high quality of education that Extension provides in this area," Daniels said.

In Dare County, FCS agent Amanda McDaniel is partnering with Dr. Christian Lige of Health East Family Care in Nags Head. Her original plan was to conduct one-hour evening workshops for parents for four weeks, providing on-site childcare. But when she contacted parents, she learned that all were part-time or full-time students who had no time for evening meetings.

Instead, she has agreed to meet parents at the doctor's office for 15 to 20 minutes when they come for well-baby checkups. She also plans to help parents by providing fact sheets, parenting literature and newsletters so they receive contacts in multiple ways.

"I envision this model of educational delivery to be a new direction for Cooperative Extension in Dare County," McDaniel said. "By meeting with parents on their schedule, delivering research-based information, modeling positive interactions with children and following up with educational resources, Cooperative Extension is becoming more user friendly for busy families with hectic schedules."

Lige helped identify non-medical topics that parents in his practice ask about. Those include children's bedtime, napping, emotions, television viewing, sleeping habits and transitioning from bottle to cup. The parents enrolled in the program will receive resources related to these topics and others that may concern them.

To boost interest in this new initiative, McDaniel planned to visit children's story hour at the local library.

"There really aren't many resources here," she said. "This is a good opportunity for Extension to make ourselves more visible within the community."

-Natalie Hampton