Clinician Cameo: A Siblings Expert Who Knows Her Way Around Capitol Hill
The Clinician Cameo is a monthly interview series with a clinician in the Brown Department of Psychiatry & Human Behavior (DPHB).
Wendy Plante, Ph.D., is a pediatric psychologist at Hasbro Children’s Hospital, where she directs SibLink, a clinical service for siblings of children with illnesses. She also co-chairs the Social Justice and Public Policy Committee at the Rhode Island Psychological Association (RIPA), where she served as federal advocacy coordinator for nearly a decade. She is a clinical professor of pediatrics and of psychiatry and human behavior.
In this interview, Plante talks about the uniqueness of the sibling relationship, the curious invisibility of siblings in Western medicine, and the trick to bending a legislator’s ear.
What drew your interest to sibling relationships?
I was initially interested in how a child’s illness or disability affects the whole family. But when I came to Brown as a postdoc, I focused more on siblings – they're often the forgotten part of the family.
Most children in the United States have at least one sibling. In fact, kids in the U.S. are more likely to live with a sibling than with a father. Yet oftentimes in our care systems, when we talk about family-centered care, we're really thinking about parents and children.
Take hospitals. Many of them no longer allow siblings to visit hospitalized children. So siblings are not getting information about the diagnosis or what the treatment is like. And when they're not allowed to visit, that means they don't have access to their mom or dad during that period, either.
Kids in the U.S. are more likely to live with a sibling than with a father. Yet oftentimes in our care systems, when we talk about family-centered care, we're really thinking about parents and children.
Dr. Wendy Plante
Why do you think that siblings are so often overlooked?
Some of it is logistical. If we think about hospitals again, bringing another person into the equation often requires more coordination.
The other thing is that in psychology and psychiatry, so much focus has been on parent-child relationships, particularly in Western, industrialized cultures. Even though, in most cases, the sibling relationship is going to be the longest lasting family relationship. There will be more overlap of your timeline with your sibling than with your parents.
What are some other cultural views of the role of siblings?
Some of our research has tried to bring in more of a cultural perspective. In Latino families, for example, the sibling relationship is often described as more positive. There’s more caretaking from the sibling that is expected and valued, especially when one of the children has a disability or illness. Those siblings are sometimes more involved in helping their parents navigate the healthcare system because of language barriers, and so may be more likely to miss school when the family has a medical appointment.
Dr. Plante received the Federal Advocacy Coordinator of the Year Award from the American Psychological Association in 2019 for her federal advocacy work.
Generally speaking, what might a child experience when their sibling is facing health challenges?
Some siblings worry more or feel sadder. It’s also common, if you’re a sibling, to feel left out. The mom and dad and sibling may always be going off to these appointments, and you're left behind with grandma. You may also feel left out at school if everyone is asking about your sibling. It can seem that it’s always about the other kid.
More recently, though, we've seen that there are ways in which siblings can develop positive qualities from the experience. As adults, especially, they may say that because of what they went through, they appreciate their own health or abilities more. Or that it brought them closer as a family. Or that they were more mature because they had to be responsible at a younger age.
We often hear from parents that these siblings are very welcoming and tolerant of differences in their peers. We also hear anecdotally that they may develop an early interest in the healthcare field because they're exposed to speech pathologists, doctors, nurses. We often hear about siblings going into those fields.
How is SibLink addressing the needs of these siblings?
Our goal is to get information about how to support siblings out to the community and healthcare providers. Things like: What books can you have in your waiting room for siblings? How can you check in with parents on how their other kids are doing? Do they have questions about how to explain the diagnosis to them?
We also do evaluations of siblings to see how they're doing. We work with siblings and parents on communication about what's going on in their family, and we provide groups where siblings get to meet each other and know that they're not the only ones going through these unique experiences.
We try to help parents understand that it's not all doom and gloom. There are a lot of ways in which they can help the sibling understand what's going on, adapt, and thrive.
Apart from SibLink, you also served as the federal advocacy coordinator at RIPA for many years. What does that mean, exactly?
I was involved in helping to advocate for mental health and health care access at the state legislature and at the federal level. I also helped educate psychologists in Rhode Island, and some of our Brown trainees, about how to become an advocate.
Dr. Plante and a delegation of mental health advocates visit Washington, D.C., to speak with lawmakers.
What would you say to mental health professionals who may be hesitant to get involved in politics?
Historically, we've been trained to keep politics out of our work. But that’s begun to shift. There’s more of a recognition of the ways in which the law affects our students, ourselves, and our patients. I used to present on this topic and people would be hesitant. Now, our students and trainees are coming to us with experience being advocates.
It’s important to remember the people making laws are not experts in everything. They're looking for people with our background to help them understand how they can pass laws that can help people live better lives. That might include policy around areas we’re experts in, whether that’s children’s mental health, social determinants of health, or the education system, for example. We can be helpful by bringing the science to policymakers.
In your experience, what’s the most effective approach to persuading lawmakers?
As scientists, we’re always thinking about the data, which can be helpful. But we often don’t realize how much a story can help, too. Bring the background behavioral evidence, but also put a face to it. Sometimes we have people in our setting who want to be advocates, and we help them present their story. Other times, we give examples of how a particular issue impacted someone’s life, being careful with confidentiality, of course.
The other important thing, I’d say, is to play the long game. There was a bill [the federal Mental Health Parity and Addiction Equity Act] that basically said you can't discriminate against people for behavioral health conditions in their insurance coverage. That bill was presented every year for something like 10 years before it finally passed. Now it’s a really influential law.
Because Rhode Island is so small, you get to know your senators and representatives here. They might be coaching your kid’s little league game, they might be your next-door neighbor, you might see them pumping gas. I hear those stories all the time. So you do want to play nice and you do want to play the long game. You might be going to your state house year after year for several years just to get a small law passed. But altogether, these laws actually can build momentum on a particular issue.
