Post-Jenny

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