Respond to your colleague by providing at least two ways that their strategies may be expanded or improved.
NOTE: Positive comment
Main Post
Treating Childhood Abuse
Psychiatric Nurse Practitioners who work with children are mandatory reporters (Child Welfare Information Gateway, 2019). Each state enacts specific statutes that will clarify the guidelines/requirements about reporting suspected child abuse, and it is the obligation of the PMH-NP to know the law in his/her praciting state (Child Welfare Information Gateway, 2019).
Assessing for Abuse
Sadock, Sadock & Ruiz (2014) identify certain vulnerability factors for PTSD, including the presence of childhood trauma, inadequate support, genetic predisposition to psychiatric illnesses, and recent stressful life changes, all of which the patient in the case study displays. I would keep those facts in mind as I assess any patient for the possibility of abuse/trauma.
First and foremost, establishing a therapeutic alliance is paramount; there can be no self-disclosure without trust (Wheeler, 2014). I’m not sure if this is a “strategy,” per se, but it is the foundation of any relationship between the PMH-NP and her clients.
As I researched this topic, and I researched for hours because of the gravitas of this topic, I found little conclusive evidence for specific strategies. What I did find was a study from the WHO’s Mental Health Gap Action Programme (2015) that concluded with,
“Evidence supporting the efficacy of strategies for detecting maltreatment of children and youth within the context of mental health and developmental assessment is sparse and inconclusive. No studies have evaluated the performance of measures in predicting referrals and health outcomes. However, it is generally agreed that it is important for health care providers to detect child maltreatment. It is recognised that assessment of child maltreatment requires a clinician who is competent enough to ask the right questions and to respond appropriately’ (p. 17).
While this is disheartening, it is also a call to action. Not only do we need to be attentive and alert with our younger patients, it is also clear that we can and should be doing more to establish evidence-based protocols for these situations.
With this particular case, considering this is a nineteen year old adult presenting with a history of abuse versus current abuse (at least that has been disclosed thus far), establishing trust and normalizing the feelings of the client will be my priority. Also, I think it’s imperative that we know our limits as clinicians and, while I might feel competent to prescribe medications for this client, I am well aware that bad therapy can worsen trauma for those with PTSD. I used to work closely with our Trauma Stress Center at work and they consistently drove home the importance of shoring up coping skills for these patients before ever delving into the trauma, itself. I think too often some clinicians overestimate their ability to help without taking into consideration the possibility of doing harm.
Exposure to Social Media
As with most things in life, exposure to social media has both pros and cons, particularly when it comes to mental health/awareness/illness. On the one hand, good information and resources are readily available; however, there is also a glut of bad information. While there does seem to be some evidence that social media can increase depression and/or loneliness (Healthline, 2018) due to the tendency to compare oneself to others, there are other studies which have not reached that same conclusion. Instead, a study by Berryman, Ferguson & Negy (2018) seem to suggest that the way social media is utilized is more important than the mere use of social media. Certainly, at times social media can increase connection with others.
Mandatory Reporting
As previously referenced, the mandatory reporting requirements vary from state to state (Child Welfare Information Gateway, 2019); however, in the particular case, the client is nineteen years old. In the case of adults, unless this is a elderly adult or adult with disabilities (National Adult Protective Services Association, 2020). If Morgan is not being currently abused and does not have a disability, mandatory reporting is not required.
As a side note, per the ANCC IQ practice questions for certification (American Nurses Association, 2020), even if you suspect that an elderly patient is being abused, if that patient is competent, you must respect his/her wishes if they explicitly forbid you from reporting the abuse to anyone. That surprised me but the rationale states, “The patient is an adult. He has the right to make decisions for himself. Not all states have mandatory elder abuse statutes or mandatory domestic abuse statutes” (https://learning.ana-nursingknowledge.org/
d2l/le/content/8482/viewContent/40740/View, 2020). I would obviously double-check with state statutes to clarify state law.
References
American Nurses Association. (2020). Psychiatric Mental Health Nurse Practitioner
Certification Practice IQ. Retrieved from https://learning.ana-nursingknowledge.org/d2l
home/8482
Berryman, C., Ferguson, C.J. & Negy, C. (2018). Social Media Use and Mental Health
Among Young Adults. The Psychiatric Quarterly 89(2), 307–14. doi:10.1007/s11126-017-9535-6.
Child Welfare Information Gateway. (2019). Mandatory reporters of child abuse and
neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.
Healthline. (2018). The FOMO is Real: How Social Media Increases Depression and Loneliness.
Retrieved from https://www.healthline.com/health-news/social-media-use-increases-
depression-and-loneliness
National Adult Protective Services Association. (2020). What is Adult Protective Services?
Retrieved from https://www.napsa-now.org/get-help/how-aps-
helps/#:~:text=In%20most%20states%20in%20the,professionals%20to%20report%20their%20concerns.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of
psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Wheeler, M. (Ed.) (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to
guide for evidence-based practice. New York, NY: Springer.
World Health Organization (WHO). (2015). Effective strategies for detecting maltreatment of
Children and youth within the context of mental health and developmental assessment.
Retrieved from https://www.who.int/mental_health/mhgap/evidence/resource/child_q15.pdf
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