NR606 Midterm Exam

NR606 Midterm Exam Steps for Obtaining Informed Consent - -Assess pt ability to understand medical info, tx options, to make a voluntary decision. -Present relevant info with accuracy and sensitivity: • diagnosis • nature & purpose of tx options • benefits, risks, burdens of all tx options, including forgoing tx -Document informed consent conversation in the medical record, including all consent forms. Underlying assumptions for child and adolescent psychotherapy - Developmental considerations Family involvement Systems involvement Resiliency Underlying assumptions for child and adolescent psychotherapy: Developmental considerations - -developmental level will impact how they: • reason • approach relationships • regulate emotion and behavior • communicate -Developmental considerations • inform the diagnostic process • guide tx planning Underlying assumptions for child and adolescent psychotherapy: Family involvement - -Family involvement in tx & decision-making • a norm in child and adolescent psychotherapy -invite parents to share the hx of the child or adolescent's chief complaint & prior tx, medical & developmental hx, & behavioral info privately with the therapist ahead of the session • avoid feelings of criticism or discouragement -collaborate with parent or caregiver as a tx partner Underlying assumptions for child and adolescent psychotherapy: Systems involvement - -Therapists must consider the systems that surround children & adolescents & promote their development • family • school • peers • the community -Therapy can help promote the child/adolescent's socioemotional competence -help develop a community support system Underlying assumptions for child and adolescent psychotherapy: Resiliency - -therapist work to promote resiliency in children & adolescents • using strength-based orientation -supports: • functioning • self-regulation • deal with challenges they faces Piaget's Stages of Cognitive Development - -Sensorimotor stage: Birth-2 yrs • cognitive abilities based on reflexes • object permanence & causality -Preoperational stage: 2-7yrs • can use mental representations, symbolic thought, & language • thinking is egocentric -Concrete operational stage: 7-11yrs • logical operations when thinking/solving problems • thinking is concrete -Formal operational stage: 12yrs+ • Adolescent can use abstract reasoning in addition to logical operations • Child can understand theories, hypothesize, comprehend abstract ideas (love & justice) Screening, Brief Intervention, Referral to Treatment (SBIRT) - -Screening • Quickly assesses severity of substance use & ID the appropriate level of tx -Brief intervention • Focuses on increasing insight & awareness regarding substance use & motivation toward behavioral change -Referral • Guidance to tx provides those identified as needing more extensive tx with access to specialty care Medication-Assisted Treatment (MAT) - Treatment for opioid use disorder combining the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies. Mental health and youth - -13% of children ages 8-15 experience a mental health condition -50% of children ages 8-15 experiencing a mental health condition do not receive tx -13-20% of children living in the U.S. (1 out of 5 children) experience a mental health condition in a given year -17% of high school students seriously consider suicide -1/2 of all lifetime cases of mental illness begin by age 14 Barriers to Mental Health Treatment in Children and Adolescents - -lack of sufficient information or access to services -stigmas or negative perceptions towards mental health services -many drop out before receiving effective treatment, often due to: • poverty • language barriers • living in communities with scarce resources • stressors such as problems in the family violence in the community unstable housing unemployment food insecurity -Cost -scheduling conflicts -long waitlists for services -high staff turnover Prescribing Considerations for Children and Adolescents - -physiologic factors impact pediatric med selection & dosing -Children, more rapid metabolism than adults, may require larger dose of med per unit of body weight -Around puberty, pharmacokinetic properties reach adult parameters • dosing after puberty may need to be decreased -Developmental considerations • attuned to signs of adverse effects, younger children may not be able to communicate complaints Kassia, a 5-year-old, is prescribed a stimulant medication for ADHD (Attention Deficit Hyperactivity Disorders) for the first time. Consider Piaget's stages, match the developmentally-appropriate education statements with the correct client: "It's kind of like you've got a great bike. The brakes just need some fixing. The medication is like fixing the brakes." "This medication can help you ignore distractions so you can complete tasks. They can also help with self-control, which ma - "Do you know how it's sometimes hard for you to sit still and pay attention at school? This medicine will help you." Rationale: Kassia is in the Preoperational Stage. This stage usually lasts from ages 2-7. Children think symbolically. They learn to use words or pictures to represent objects. They are egocentric and have difficulty seeing things from others' perspectives. Preoperational thinking is very concrete. Oliver, a 10-year-old, is prescribed a stimulant medication for ADHD for the first time. Consider Piaget's stages, match the developmentally-appropriate education statements with the correct client: "It's kind of like you've got a great bike. The brakes just need some fixing. The medication is like fixing the brakes." "This medication can help you ignore distractions so you can complete tasks. They can also help with self-control, which may help you get along better with your frien - "It's kind of like you've got a great bike. The brakes just need some fixing. The medication is like fixing the brakes." Rationale: Oliver is in the Concrete Operational Stage. This stage usually lasts from age 7-11. Thinking becomes more logical and organized about concrete events. Children begin to reason inductively, from specific information to general principles. The use of simile is a helpful instructional strategy for children in this stage. Tamika, a 15-year-old, is prescribed a stimulant medication for ADHD for the first time. Consider Piaget's stages, match the developmentally-appropriate education statements with the correct client: "It's kind of like you've got a great bike. The brakes just need some fixing. The medication is like fixing the brakes." "This medication can help you ignore distractions so you can complete tasks. They can also help with self-control, which may help you get along better with your frien - "This medication can help you ignore distractions so you can complete tasks. They can also help with self-control, which may help you get along better with your friends and parents. Do you have any concerns about taking the medication?" Rationale: Tamika is in the Formal Operational stage. This stage typically occurs at age 12 and up. Adolescents and young adults begin to reason abstractly and can consider hypothetical problems. They begin to think more about moral, philosophical, ethical, social, and political issues. Addressing Parental Concerns: Collaborative Treatment Plans - -tx plans for children typically made in collaboration with parents or guardians -Collaboration between the PMHNP, clients, and families when creating the treatment plan is key to ensuring the plan meets the client's needs and is comfortable and manageable for the family Ethical Considerations in the Treatment of Children and Adolescents - Privacy and HIPAA Informed Consent Mandatory Reporting Ethical Considerations in the Treatment of Children and Adolescents: Privacy and HIPAA - -parents have right to req access to a minor's mental health record, including symptoms, diagnosis, tx plan • circumstances may limit that right see HIPAA fact sheet Ethical Considerations in the Treatment of Children and Adolescents: Informed Consent - -Parents may decide whether to allow tx child is unable to provide true informed consent -children may not be able to give legal consent, should be included in discussions about med & tx whenever possible • encourage tx adherence Ethical Considerations in the Treatment of Children and Adolescents: Mandatory Reporting - -PMHNPs mandated reporters in most states • required to report suspicions about abuse or neglect to the appropriate authorities -federal & state statutes include stipulations related to mandatory reporting