Tue, April 8, 2025

Teach-back Technique for Close Communication

By Kelly Fradin, Pediatrician and Author

As parents know, most children have a team of people involved in their care: teachers during and after school, therapists, babysitters, and family who aren’t always involved day to day. Even when children aren’t facing challenges, keeping everyone informed can be a time-consuming task — what does your child want to eat, what’s the routine for sleep, what do they wear are all essential pieces of information constantly changing. When a child is facing a challenge, the quantity of information and the essential nature of the information multiplies: medications, therapies, appointments, doctors’ phone numbers, emergency plans, and supplies. If there were a time when you could fully train everyone and just be done with it, that would be one thing, but a child is always changing and so is their plan.

Informing family of the plan to give medication or pick a child up from a certain address on a certain day can seem straightforward, but many challenges involve care plans that bring up individual opinions, values, and beliefs. Diet, discipline, use of medication, making a big deal out of something, or maintaining vigilance about a safety plan are the types of issues I see frequently cause drama between parents and other members of the care team. Fear of judgment and stigma can become barriers to communication. Communication about other conditions such as mental health, disabilities, or genetic conditions can similarly be more complicated to discuss openly, especially with many stakeholders.

As a caregiving parent, you’ll find that you know more about your child than anyone else, sometimes even more than your medical or educational teams. But there will be times when others are caring for, teaching, coaching, or supervising your children. To effectively quarterback your child’s care, you have to share your knowledge with others productively and keep them updated over time. An essential part of this is to build in time and opportunity for communication. When you leave a meeting with a teacher at the school or a physician in a clinic, it’s a good practice to consider not just what you need to do, but who you need to inform about the conversation. You can also consider regular meeting times to solicit feedback from other caregivers on how things are going. When you listen to these other important people in your child’s life, you can learn important information to improve your child’s care plan. You can also share important updates and priorities for their time with your child.

It’s essential for parents to be thoughtful about minimizing errors and maximizing understanding. The Agency for Healthcare Research and Quality (AHRQ) has developed a “Health Literacy Universal Precautions Toolkit,” designed to help medical providers communicate more effectively with patients. Their data show that only 12 percent of individuals receiving instructions from their provider understand them. The education level of the individual is only one of many barriers here; often, health professionals use jargon and convey complex topics quickly, particularly when emotions are high or an individual is not feeling well or focused. Similarly, when you communicate between a caregiving parent and another family member or paid caregiver, there may be a misunderstanding.

To tackle this problem, one of the tools the AHRQ promotes is called “teach-back.” Teach-back was designed for health-care providers to use with their patients, but this tool can be used by caregiving parents when they are communicating their child’s care plan with others. You are now the expert in your child and you are instructing others, so using similar techniques makes sense. Teach-back involves asking the receiver of information to explain what they’ve just been told. The goal isn’t to test their verbatim recall. If they repeat your words back to you, that doesn’t mean what you said was understood. The goal is to see how they have interpreted what you’ve said.

Say a parent brings their child into the emergency room after their child has had a seizure. After a workup, my team concludes it is a febrile seizure and I explain what that means. Next, I’d say, “I have just given you a lot of information about your child’s febrile seizures. It’s important for you to understand, and I know you’ve been through a lot today. Because this is important, I want you to pretend that I’m a friend or family member who you’ll be sharing this information with, so I can be certain what I’ve told you is clear and accurate.”

Though many parents are shy to begin this exercise, once they do, I congratulate them and validate what they do understand well and correct whatever they misunderstand. Even the most conscientious, educated parent misses things sometimes, either because I was unclear, their attention wandered, or they were tripped up by jargon.

You can also practice this at home. If you’re just starting out with a new diagnosis, you might say to your co‑parent, teacher, or babysitter, “I’ve been learning so much about this new challenge, and I can’t recall exactly how much I’ve shared. Would you mind just summarizing your understanding of what my child’s diagnosis and plan are so I can be certain we’re on the same page?” This big check‑in might feel overwhelming, especially at first, so you can start slowly or with a more specific topic. “I really want to ensure we don’t make a mistake with this medicine so can you show me how you’ll pull up the dose?” While it can feel awkward at first, incorporating teach-back is a very effective tool for making sure your child is getting the best care.

Teach-back can also help with assessing the big-picture understanding of those on your team. In my work with children with type 1 diabetes, I frequently encounter families with personal experience with type 2 diabetes. This may appear to be an advantage — a family member with diabetes might be more adept at monitoring blood sugars, identifying the symptoms of high blood sugar, and understanding why it’s important to control the sugars. Unfortunately, this is not always the case.

Type 2 diabetes responds to lifestyle modifications in a way that type 1 diabetes does not. An individual with type 2 diabetes is less sensitive to the effects of insulin and has some ability to control elevated blood sugar by changing behavior — exercise, diet, sleep, and maintaining a healthy weight. That said, medication is often an important component of care for people with type 2 diabetes. In type 1 diabetes, the pancreas is essentially burned out and produces no insulin. This means that, for these kids, life with diabetes will be different — their blood sugars will never be normal without insulin. They will always be fully dependent on insulin.

But if you have a family member, nurse, or babysitter who has experience managing type 2 diabetes, they might not fully understand that the child’s blood sugar spikes are not due to their behaviors or dietary habits. They may be inclined to blame the child, which is fundamentally unfair. The goal should be to help these children live and enjoy their best lives while providing the insulin they need.

If these parents use teach-back to communicate with their caregivers to assess their understanding, they can be sure that the caregivers truly understand the condition so they can provide the best care. If the people involved in your child’s life don’t understand the foundations of your child’s condition, they may make errors or mismanage your child’s care. To refer back to the example above, the “why” of the high blood sugar makes all the difference in how you form your plan and the tone of your day‑to‑day communications with the child. Checking for understanding of the details and the big picture is an important piece of your work.

Working with early intervention services and school-based support teams

My complex-care practice at an academic medical institution involved working fifty hours or more a week and taking patient phone calls one out of every three nights. Though I loved my patients and my team, and I loved doing research and educating future pediatricians, I needed more time and energy to focus on my own growing family. I was not willing to abandon my professional goals, but I decided that moving my practice to a public school setting would allow me to have better boundaries.

Something that helped me make this transition was knowing that school is where most children spend most of their time. The potential impact of appropriate school services on improving a child’s quality of life is substantial. Working within the New York City public school system meant I could have summers off and do shift work. No one would call me in the middle of the night or on weekends. Even so, in many ways going from a hospital setting to a school setting was a more difficult shift than I anticipated. I went from knowing everything about my one hundred patients to knowing next to nothing about the 120,000 children served by my district’s schools. I learned a lot during that time, but one essential takeaway was that every school, even in the same district, in the same neighborhood, had a different way of doing things.

The school offices had the same paperwork, the same job titles filled, and supposedly the same processes, but the stakeholders — the people you really need to talk to when a child needs a specific type of support — were different in each scenario. Some principals took a more hands-on role and some secretaries took on leadership roles in delegating services. Each school had a cohesive process, but I found that parents need to learn how their child’s school works in order to understand what is required to get your child the services they need.

Complexity of the system aside, sending a child to school while they face a challenge is often emotional. In her book, Raising a Rare Girl, author Heather Lanier summarizes how she attempted to navigate entrusting her special needs child to the local school. Her child was smaller than the other children and needed more support. She says, “You do three things. You prepare the school professionals as best you can. You tune your instincts keenly to their responses, sussing out whether they seem competent and respectful of your kid. And then if your instincts approve, you let go.”

While I haven’t navigated the process of sending a child with challenges to school as a parent, I can affirm that sending any child to school is stressful. There’s separation anxiety at drop-off, fatigue and pent‑up emotions that get dumped on the parent at pickup, and the new uncertainty of not knowing exactly what happened at school. Did your child drink enough water, eat enough food, or use the bathroom? Were your child’s peers kind and inclusive? Did your child have meaningful engagement with the education provided? When your child is facing challenges, there is even more to worry about.

That said, school can be invaluable to both parent and child. The separation of your life from your child’s life can help both of you grow. Your child will grow and learn and have a space of their own. You will have more room in your life for your own concerns. And if your child has faced challenges, in some way the school community can offer even more benefits: special education services and occupational, speech, and physical therapy not provided through health insurance. Schools can offer teaching plans customized to your child and access to skilled professionals who often care for your child and provide you as a parent with coaching and daily support.

But it’s not an easy transition, and when your children have challenges, the stakes feel higher. In practice, it can be very difficult to sort out “I’m stressed about this transition” from “I don’t trust my children’s school.” Teachers, similar to medical professionals, often pursue their career through a passion for helping children. This means that most of the time they share your goals and strive to work in the best interest of your child.

Teachers, therapists, and educational professionals are still only human, with their own strengths and weaknesses. Sometimes we don’t know what we don’t know. Just as in medicine, educational best practices evolve over time and some schools will be more up to speed and willing to try new things, while other schools may have a more traditional approach. The range of the quality of care schools can offer can be broad. The only way to know is to do the research.

As you approach decisions about school, be honest and upfront about your child’s needs. You’d much rather the school be the right fit than have your child struggle without appropriate support. As part of your research, ask other parents about their experiences with the school. Seek out community resources through social media or educational advocates and consultants.

It’s important for parents to be organized in order to navigate the complexities of school services. While some conversations may seem friendly about your child’s school day, it’s wise to remember that, on the other side, whether public, private, or parochial, the school is bound to rules and protocols. Make requests in writing, ensure all communication is marked with dates, keep records, and ask for written responses. If the school says no to an intervention you’ve requested, remember it may not be a decision based on your child but one based on the capacity to offer necessary support.

Lastly, as you have conversations with educators about interventions in educational considerations, I urge you to ask for the recommended interval for reevaluation. Most schools recommend reevaluation every two to three years, and it can take at least three months for educators to develop an educational plan. If you are used to thinking of medical interventions where you see improvements in a few weeks, it can be disappointing, but not unexpected, to have to wait longer to know if educational interventions are effective. Be sure to have realistic expectations from the beginning.

As you think through the support your child is getting at school, think of the following questions:

Do you think your child is getting the support they need to thrive? If not, what changes could you make to support them?

Do you understand how the system works at your child’s school to adjust the plan and communicate effectively?

Would you benefit from more organization in your communications with school?

I hope reviewing the systems where your child will receive care has been helpful. When you are helping your child through a challenge, sometimes the devil is in the details. If you don’t take the medication, see the right specialist, understand your follow‑up plan, or find the right behavioral and educational support, you may have more difficulty addressing your child’s challenge. But another key component of your plan is understanding the big picture. Here we focused on the specifics, but remember as your child develops, you will continue to zoom out to understand common patterns faced by your family and others.

Dr. Kelly Fradin is a New York City pediatrician and author sharing information and advice in fields of health, wellness, and education.