Child and Adolescent Behavioral Health E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1871

Veröffentlichungsjahr: 2012

Beschreibung

As an increasing number of children and adolescents with psychiatric symptoms go unrecognized in our current healthcare system, the ability to identify and treat these issues in multiple healthcare settings has become vitally important. With access to primary care providers increasing and a shortage of child psychiatric providers, collaboration between psychiatric, pediatric and family advanced practice nurses is essential to improving care for this vulnerable population. Child and Adolescent Behavioral Health provides a practical reference to aid in this endeavour. Written and reviewed by over 70 nurse experts, it is a must-have reference for all practitioners caring for children and adolescents.

Leseprobe

Contents

About the Editors

Contributors

Foreword by Janet A. Deatrick

Foreword by Judith Haber

Preface

Peer Reviewers

SECTION 1 Assessment

1 Child, Adolescent, and Family Development

Introduction

Early Brain Development

Social and Emotional Development

Self-Esteem

Cognitive Development

Development and Information Processing Theory

Development of Coping in Children

Language Development

Bronfenbrenner’s Bioecological Theory of Human Development

Family Life Cycle Development

Assessment Tools

Case Exemplar

Summary

2 Temperament and Self-Regulation

Introduction/Overview

Description of the Issue

Assessment

Observations in Context: Children with Serious Emotional or Behavioral Problems

Linkages with Behavioral/Psychiatric Profile

Goodness of Fit

Evidence-based Implications for Practice

Models of Treatment

Case Exemplar

Summary

Recommended Resources

3 Neurobiology and Neurophysiology of Behavioral/Psychiatric Disorders

Introduction

Anatomy of the Central Nervous System

Synaptic Organization of the Brain

Development of the Central Nervous System

Neurotransmission

Conclusions and Implications for Primary Care and Mental Health Nursing Practices

4 Integration of Physical and Psychiatric Assessment

Overview of Chapter

Integrating Psychiatric and Physical Assessment Approaches

Who Initially Assesses the Child?

Elements of an Assessment

Observation of the Child, Adolescent, and Family

Impact of the Problem or Disorder

Eliciting Information

Areas of Psychiatric Assessment of Children and Adolescents

Use of Assessment Tools

Ethnic Differences Using Behavioral Rating Scales

Review of Specific Evaluation Tools for Use in Primary Care

Identifying Risk and Protective Factors

Teaching Needs

Communicating Findings to Children, Adolescents, and Families

Establishing Trust with the Child or Adolescent and Family

Implications for Nursing Practice, Research, and Education

Case Exemplar

Resources for Primary Care Providers and Families

Appendix 4.A

Appendix 4.B

Appendix 4.C

Appendix 4.D

5 Child and Adolescent Sexual Development and Sexual Identity Issues

Introduction

Sexuality in Childhood

Sexual Development

Clinical Implications

Sexual Behaviors

Consequences of Abnormal Sexual Development

SEXUALITY

Sexual and Gender Identity

Conclusion

Resources on Adolescent Sexual Development

Resources for Precocious Puberty

Resources on Homosexuality and Adolescents

Resources for Lesbian and Gay Adolescents and Families

Other Resources

SECTION 2 Treatment

6 Issues in Prescribing Psychiatric Medication to Children and Adolescents

Introduction

Challenges in Prescribing Psychotropic Medications

Assessment

Performing the Psychiatric Interview

Physical Exam

Formulation of a Diagnosis and Plan

Need for Consultation

Patient Family Education

Review of Common Psychiatric Medications

Anxiolytics

Antipsychotics

Summary

7 Attention Deficit Hyperactivity Disorder (ADHD)

Introduction

Historical Perspective

Epidemiology and Prevalence of ADHD

Etiology

Implications for Adulthood

Presenting Signs and Symptoms of ADHD

Common Comorbid Conditions and Treatment

Effects of ADHD on Peer Relationships

Evidence-Based Interventions

Approach to Management

Case Exemplars

Role Differentiation Between Primary Care and Child Psychiatric Advanced Practice Nurses

Implications for Nursing Practice, Research, and Education

8 Anxiety Disorders

Introduction

Normative Anxiety as Part of Development

Epidemiology and Prevalence of Anxiety Disorders

Genetics and Environmental Risk Factors

Role of Trauma in the Development of Anxiety

Types and Symptoms of Anxiety Disorders

Assessment of Anxiety

Comorbidities of Anxiety Disorder with Other Psychiatric Disorders

Models of Treatment

Case Exemplar

Integration with Primary Care and Referral

Management of Anxiety Disorders and Implications for Practice, Research, and Education

Summary

Resources for Practitioners and Families

9 Mood Dysregulation Disorders

Introduction

Symptom Recognition in Children and Adolescents

Depression

Bipolar Disorder

Etiology

Internalizing and Externalizing Symptoms in the Context of Mood Dysregulation

Risk Factors for Mood Dysregulation

Protective Factors

Assessing Mood Dysregulation in Primary Care

Physical Examination

Importance of Differentials

Surveillance and Screening

Role of APNs

Evidence-Based Treatment

Implications for Practice and Nursing Research

Case Exemplar

Conclusion

Resources

10 Deliberate Self-Harm: Nonsuicidal Self-Injury and Suicide in Children and Adolescents

Introduction

Nonsuicidal Self-Injury

Diagnostic and Behavioral Presentations

Assessment of Self-Injury in Primary Care

Suicide

Case Exemplar

Summary

Resources

11 Perceptual Alterations Disorders

Introduction

Clinical Picture

Presenting Symptoms

DSM-IV-TR Diagnostic Criteria

Differential Diagnosis

Evidence-based Data and Assessment Tools

Epidemiology

Etiology

Neurobiological/Neurophysiological Factors

Genetic and Genomic Factors

Family History

Psychosocial Factors

Evidence-Based Nursing Intervention

Integration with Primary Care

Implications for Practice, Research, and Education

Case Exemplar 1: Case Study of an Adolescent with Schizophrenia

Case Exemplar 2: Case Study of a Seven-year-old Child with Schizophrenia

Summary

Resources on Perceptual Alterations Disorders (Community Groups, Websites, Advocacy, and Treatment Resources)

12 Eating Disorders in Children and Adolescents

Introduction

Historical and Cultural Perspective

Onset and Prevalence

Course of Illness, Remission, and Recovery

Etiology

Clinical Picture

Medical Complications

Psychiatric Comorbidities

Continuum of Care and Treatment

The Primary Care Practitioner Role in the Diagnosis and Management of Eating Disorders

The Role of the PMH-APN in the Diagnosis and Management of Eating Disorders

Evidence-Based Treatment for Eating Disorders

Exemplary Models of Interdisciplinary Collaboration

Case Exemplar

Conclusion

13 Autism Spectrum Disorder

Introduction

Etiology

The Clinical Picture: Screening and Assessment

Physical Assessment and Examination

Referral

Laboratory and Diagnostic Investigations

Interventions and Plan

Implications for Practice, Research, and Education

Case Exemplar

Summary

Resources

14 Learning and Intellectual Disabilities

Introduction

Intellectual Disabilities

Intellectual Disabilities Associated with Learning

Etiology of Learning Disorders

Types of Learning Disabilities

Intellectual Disabilities: Clinical Picture

Specific Federal Acts Protecting Those with Disabilities

Assisting with Family Coping

Resiliency Model

Conclusion

Case Exemplar

15 Nonpharmacological Treatment Modalities:

Introduction

Play Therapy

Group Therapy

Practice, Education, and Research Implications

Summary

Case Exemplar

Resources

16 Individual and Family Therapies

Introduction

Individual Therapy

Cognitive-Behavioral Therapy

Psychodynamic Psychotherapy

Interpersonal Psychotherapy

Multisystemic Therapy

Eye Movement Desensitization and Reprocessing

Family Therapy

Parent and Teacher Training

Triple P-Positive Parenting Program

Case Exemplar

The Incredible Years

Parent Management Training—the Oregon Model

Parent-Child Interaction Therapy

Summary

17 Cognitive and Behavioral Approaches in Child and Adolescent Mental Health Treatment

Introduction

Cognitive Techniques

Other Child/Adolescent Disorders Addressed with CBT Interventions

Behavioral Interventions

Preventive Mental Health

Overview of Behavioral Techniques Used in Both Specialty and Primary Care

Parent Training

Case Exemplar

Conclusion

Resources

SECTION 3 Special Populations

18 Disorders Specific to Infants and Young Children

Introduction

Prevalence of Mental Health Problems

The Nature of Mental Health Problems in Early Childhood

Posttraumatic Stress Disorder

Disorders of Affect

Prolonged Bereavement/Grief Reactions

Anxiety Disorders of Infancy and Early Childhood

Depression of Infancy and Early Childhood

Mixed Disorder of Emotional Expressiveness

Adjustment Disorder

Regulation Disorders of Sensory Processing

Sleep Behavior Disorder

Feeding and Eating Disorders

Disorders of Relating and Communicating

Mental Health Assessment of Infants and Young Children

Behavioral Therapies

Psychopharmacology

Environmental Intervention

Collaboration between Primary Care and Child Psychiatry

Case Exemplar

Implications for Research and Education

Resources

19 Juvenile Justice Populations

Introduction

A Developmental Perspective

The Community Context

Medical and Mental Health Needs of Incarcerated Youth

Mental Illness and Juvenile Offending

Substance Abusing Youth and Juvenile Offending

Assessing Risk and Amenability to Treatment

Disproportionate Minority Confinement/Contact

Individualized Treatment Programming

Case Exemplar

Evidence-Based Practice

Nursing’s Contributions to the Field

Conclusion

Websites/Resources

20 Substance Use

Introduction

Terminology

Trends in Substance Use During Childhood and Adolescence

Statistics Related to Substances of Abuse by Youth

Neurobiology

Etiology

Clinical Presentation

Screening, Brief Intervention, Referral, and Treatment (SBIRT)

Evidence-Based Assessment Tools

Collaborative Nursing Care

Implications for Advanced Practice Nurses

Case Exemplar

Summary

Resources

21 Child and Adolescent Victims of Trauma

Introduction

Description of the Issue

Epidemiology

Profile of the Traumatized Child and Adolescent

Recognition of the Behavioral Patterns of Abused Children

Implications for Clinical Practice

Prevention

Intervention

Providing Specialized Care

Forensic Implications

Implications for Research and Education

Case Exemplar

Summary

Recommended Resources

22 Children in Out-of-Home Placement

Introduction

The Current State of the U.S. Child Welfare System

Types of Out-of-Home Placements

The Complex Needs of Children in Out-of-Home Placements

Intensive Family Preservation

Intensive Case Management by an Interdisciplinary Health Care Team

The Interdisciplinary Health Care Team

Intensive Case Management

Case Exemplar

23 Chronic and Palliative Care Pediatric Populations

Introduction

History and Evolution of Pediatric Palliative Care in the United States

How Does Need for Palliative Care Place Children and Families at Risk?

Ethical Foundations and Legal Issues

Basic Concepts and Quality Indicators

Settings for Provision of Pediatric Palliative Care

Assessment of Child and Family

Barriers to Pediatric Palliative Care

Facilitators of Pediatric Palliative Care

Communication

Goals of Care

Education and Advocacy

Case Management

End-of-life Care

Grief and Bereavement

Compassion Fatigue

Case Exemplar

Future Directions

Summary

Resources

SECTION 4 Special Issues

24 Collaborative Treatment with Primary Care

Introduction

Traditional Health Care

Defining Integrated Health Care

Patient-Centered Health Home

Examples of Different Models of Care

Challenges and Barriers

Implications for Practice, Research, and Education

Conclusion

Case Exemplar

Resources

25 Legal and Ethical Issues

Introduction

Description of the Issue

Legal and Ethical Issues: Risks to Children

Who Is the Client?

Who Is the Guardian?

Obligations of Children and Their Guardians

Foundations for Practice: Legal

Potential Liabilities for the Nurse

Importance of Documentation

Foundations for Practice: Ethical

Moral Distress

Basic Professional Ethics Obligations

Complex Ethical Risks in Health Care

Patient’s Rights and Basic Obligations of Providers

Sovereignty vs. Abandonment

Implications for Practice

Confidentiality and the Right to Information

Problem Solving and Decision Making

Capacity and Competence

Informed Consent

Right to Refuse Treatment

Involuntary Patients

Chemical or Physical Restraint

Reproductive Issues

Implications for Research

Implications for Education and Continuing Education

Accreditation of Educational Programs

Implications for Primary Care—Ethical Situations

Summary

26 Evidence-Based Nursing Practice

Introduction

Significance of Implementing Evidence-Based Practice

Comparison of Evidence-Based Practice to Traditional Clinical Practice

The Evidence-Based Process

Formulating Relevant Clinical (PICO) Questions

Searching for the Best Available Evidence

Searching for an Answer to Our PICO Question

Understanding the Evidence

Evaluating the Evidence through Critical Appraisals

Practice Guidelines

Implementation and Evaluation of Practice Guidelines

Barriers to Implementing Evidence-Based Practice

Implications for Future Directions

Summary

27 Influence of Culture/Needs of Immigrant Children

Introduction

Changing U.S. Demographics

Stages of Migration

Why Knowledge of Culture Matters

Social Determinants of Health

Poverty

Potential Protective Factors

Behavioral and Psychiatric Presentations of Immigrant Youth

Assessment and Screening Tools

Collaborative Care Delivery

Research, Education, and Practice Implications

Conclusion

Case Exemplar

Resources

28 Conducting Research with At-Risk and High-Risk Children and Adolescents

Introduction

Advanced Practice Nurses as Research Consumers, Contributors, and Collaborators or Investigators

Building a Research Team

Sources of Research Funding for Nurses

Conducting Health Behavior Research with At-Risk Children, Adolescents, and Families

Using Health Behavior Theories and Models to Guide Behavioral Health Research and Interventions

Applying Behavioral Health Models in Nursing Research

Case Exemplar

The Jamaican Mother-Daughter HIV Risk Reduction Intervention Curricula

Issues of Informed Consent with At-Risk Children and Adolescents Involved in Behavioral Health Research

Summary

29 Advanced Practice Nurses Interfacing with the School System

Introduction

Mental Health in the Education System

Description of the Issue

Etiology of Behavioral Health in Schools

The School Team

APN Collaboration

Linkage With Behavioral/Psychiatric Profile of the Child and Adolescent

The APN Role in School Collaboration

Evidence-Based Implications for Practice, Research, and Education in Child and Adolescent Behavioral Health in Primary Care

Case Exemplar

Summary

Resources

30 Child and Adolescent Mental Health Policy

Introduction

Children’s Rights

Policy Formation

Why Is Policy Important?

Timeline of Existing Policy Development

Child and Adolescent Mental Health Promotion

Collaborative Advocacy

Summary

Index

This edition first published 2012 © 2012 by John Wiley & Sons, Inc

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Library of Congress Cataloging-in-Publication Data

Child and adolescent behavioral health : a resource for advanced practice psychiatric and primary care practitioners in nursing / editors, Edilma L. Yearwood, Geraldine S. Pearson, Jamesetta A. Newland.p. ; cm.Includes bibliographical references and index.

ISBN 978-0-8138-0786-7 (pbk. : alk. paper)I. Yearwood, Edilma Lynch. II. Pearson, Geraldine S. III. Newland, Jamesetta A.[DNLM: 1. Child. 2. Mental Disorders. 3. Adolescent. 4. Advanced Practice Nursing.5. Nursing Assessment–methods. 6. Primary Care Nursing. 7. Psychiatric Nursing. WS 350]618.92–dc23

2011036443

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print maynot be available in electronic books.

Dedication

To my children, Arayna and Matthew, and my parents, Edmund and Dorothy Lynch, for their love, support, understanding, and patience. Our special thanks to all the children, adolescents, and families who over the years served as the inspiration for this book.

Edilma

To Lloyd, Elizabeth, Neal, and David Pearson for their loving support throughout this project. And to my dear mother, Doris M. Sanner, R.N., for inspiring me to become a nurse.

Geri

To my husband and children, Lloyd, Kristina, Michael, Sonya, and Maya; my mother, Kather Lene Alexander; my sisters Sharon, Brenda, Sheila, and Michele; and my mother-in-law, Gloria Chang, for a lifetime of encouragement and support.

Jamie

About the Editors

Left to right: Edilma Yearwood, Geraldine Pearson, and Jamesetta Newland

Edilma L. Yearwood, PhD, PMHCNS, BC, FAAN, is associate professor at the School of Nursing & Health Studies at Georgetown University, where she teaches psychiatric nursing. She is on the editorial board and is the column editor on cultural issues for the Journal of Child and Adolescent Psychiatric Nursing. She is a content expert reviewer for numerous nursing and psychology journals. Dr. Yearwood is ANCC certified as a clinical nurse specialist in child/adolescent psychiatric-mental health nursing and is a member of the International Society of Psychiatric Nurses.Geraldine S. Pearson, PhD, PMHCNS, BC, FAAN, is past president of the International Society of Psychiatric Nurses and editor-in-chief of the journal Perspectives in Psychiatric Care. She is an associate professor in the Department of Psychiatry at the University of Connecticut School of Medicine and director of the Home Care Program, a community intervention for juvenile justice youth. Dr. Pearson is ANCC certified as a clinical nurse specialist in child/adolescent psychiatric-mental health nursing.Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, is clinical associate professor and director of the Doctor of Nursing Practice Program at New York University College of Nursing. She is the editor-in-chief of The Nurse Practitioner: The American Journal of Primary Healthcare. Dr. Newland, an ANCC certified family nurse practitioner, maintains practice at the NYU College of Nursing Faculty Practice, a primary care clinic serving a diverse inner city population.

Contributors

Angela Amar, PhD, RN, FAANAssociate ProfessorRobert Wood Johnson Nurse Faculty ScholarDirector, Forensic Nursing ProgramWilliam F. Connell School of NursingBoston CollegeBoston, MARobin Bartlett, PhD, RNAssociate ProfessorSchool of NursingUniversity of North Carolina at GreensboroGreensboro, NCCecily L. Betz, PhD, RN, FAANEditor-in-Chief, Journal of Pediatric NursingClinical Associate ProfessorKeck School of MedicineUniversity of Southern CaliforniaLos Angeles, CAElizabeth Bonham, PhD, RN, PMHCNS, BCCollege of Nursing and Health ProfessionsUniversity of Southern IndianaEvansville, INSusan Boorin, MSN, PMHNP-BCPredoctoral FellowSchool of NursingYale UniversityNew Haven, CTEve Bosnick, MSN, APRN, PNP-BCDirectorAdolescent Health and Wellness CenterAdvocare Mainline PediatricsNarberth, PAClinical FacultyPrimary Care Pediatric Nurse Practitioner ProgramDivision of Family and Community HealthSchool of NursingUniversity of PennsylvaniaPhiladelphia, PAPenelope R. Buschman-Gemma, MS, RN, PMHCNS-BC, FAANAssistant Professor of Clinical NursingDirector of the Psychiatric Nurse Practitioner ProgramSchool of NursingColumbia UniversityNew York, NYEllen Carroll, RN, CPNP, DNS(c)Health Services DirectorAbilisGreenwich, CTDiane M. Caruso, DNP, FNP-BCAssistant ProfessorSchool of NursingUniversity of North Carolina CharlotteCharlotte, North CarolinaNurse PractitionerCleveland PediatricsCleveland, NCJudith Coucouvanis, MA, APRN, PMHCNS-BCClinical Nurse Consultant and Nurse PractitionerDepartment of Psychiatry: Child and Adolescent SectionUniversity of Michigan Health SystemAnn Arbor, MIAngela A. Crowley, PhD, APRN, PNP-BC, FAANAssociate ProfessorYale University School of NursingYale UniversityNew Haven, CTTammi Damas, PhD, MBA, WHNP-BC, RNChair, Graduate ProgramsDivision of NursingCollege of Nursing & Allied Health SciencesHoward UniversityWashington, DCJanet A. Deatrick, PhD, FAAN, RNProfessorSchool of NursingUniversity of PennsylvaniaPhiladelphia, PAKathleen R. Delaney, PhD, PMH-NP, FAANProfessor and Specialty Coordinator – Psychiatric Mental Health—FNP ProgramDepartment of Community Systems and Mental Health NursingCollege of NursingRush UniversityChicago, ILJaniece DeSocio, PhD, RN, PMHNP-BCAssociate Dean for Graduate EducationAssociate Professor of NursingSeattle University College of NursingSeattle, WAElizabeth Burgess Dowdell, PhD, CRNP, RNAssociate ProfessorCollege of NursingVillanova UniversityVillanova, PAEdith (Emma) Dundon, PhD, RN, CPNPClinical Assistant ProfessorSchool of NursingUniversity of Massachusetts AmherstAmherst, MAKathryn K. Ellis, DNP, APRN, FNP-BC, ANP-BCAssistant Professor and FNP Program DirectorDepartment of NursingSchool of Nursing & Health StudiesGeorgetown UniversityWashington, DCJean Nelson Farley, MSN, RN, PNP-BC,CRRNInstructorDepartment of NursingSchool of Nursing & Health StudiesGeorgetown UniversityWashington, DCLinda M. Finke, RN, PhDProfessorCollege of Health and Human ServicesIndiana University–Purdue University Fort WayneFort Wayne, INMarie Foley, PhD, RNAssociate ProfessorCollege of NursingSeton Hall UniversitySouth Orange, NJPamela Galehouse, PhD, PMHCNS, BCAssociate ProfessorBehavioral Science, Community and Health SystemsCollege of NursingSeton Hall UniversitySouth Orange, NJJudith Haber, PhD, APRN, BC, FAANInterim Dean, New York University College of NursingThe Ursula Springer Leadership Professor in NursingCollege of NursingNew York UniversityNew York, NYDonna Hallas, PhD, PNP-BC, CPNPClinical Associate ProfessorCoordinator PNP ProgramCollege of NursingNew York UniversityNew York, NYMargaret Hardy, RN, MBA, JDAttorneySands Anderson PCRichmond, VAElizabeth Hawkins-Walsh, PhD, CPNPAssistant Dean for Clinical Affairs and Community PartnershipsClinical Associate ProfessorDirector of Pediatric Nurse Practitioner ProgramsThe Catholic University of AmericaWashington, DCLaura C. Hein, PhD, RN, NP-CAssistant ProfessorCollege of NursingUniversity of South CarolinaColumbia, SCCharlotte A. Herrick, PhD, RNProfessor EmeritusSchool of NursingUniversity of North Carolina at GreensboroGreensboro, NCJudith Hirsh, NP-P, PMHCNS-BC, RPT-SPsychiatric Nurse PractitionerRegistered Play Therapist and SupervisorPrivate PracticeRye, NYM. Katherine Hutchinson, PhD, RN, FAANAssociate ProfessorCollege of NursingNew York UniversityNew York, NYBarbara Schoen Johnson, PhD, RN, PMHNPPsychiatric Mental Health Nurse PractitionerCook Children’s Health Care SystemFort Worth, TXKathleen Kenney-Riley, APRN, PNP, EdDPediatric Nurse Practitioner & Clinical Coordinator of Pediatric Rheumatology Fellowship ProgramChildren’s Hospital at MontefioreBronx, NYAllison W. Kilcoyne, MS, RN, C-FNPFamily Nurse Practitioner and Site ManagerTeen Health Center at Lynn English High SchoolLynn, MAMaureen Reed Killeen, PhD, PMHCNS, BC, FAANProfessorDepartment of Biobehavioral NursingCollege of Nursing at AthensGeorgia Health Sciences UniversityAthens, GAEunjung Kim, PhD, RN, CPNPAssociate ProfessorDepartment of Family and Child NursingSchool of NursingUniversity of WashingtonSeattle, WACarol Anne Marchetti, PhD, RN, PMHCNS-BC, SANESoutheast Regional CoordinatorMA Sexual Assault Nurse Examiner ProgramMassachusetts Office for Victim AssistanceBoston, MANatalie McClain, PhD, RN, CPNPAssistant ProfessorWilliam F. Connell School of NursingBoston CollegeBoston, MACaroline R. McKinnon, PhD(c), PMHCNS, BCPhD Candidate in NursingCollege of Graduate StudiesGeorgia Health Sciences UniversityAugusta, GAMikki Meadows-Oliver, PhD, RNAssistant ProfessorSchool of NursingYale UniversityNew Haven, CTBeth Muller, APRNNurse ClinicianUniversity of Connecticut Health CenterFarmington, CTLois C. Powell, NP-P, PMHCNSNurse Practitioner in Psychiatry/ConsultantPrivate PracticeNew York, NYCathy Quides, MSNPediatric Nurse PractitionerChild Development CenterDivision of Mental Health and Child DevelopmentChildren’s Hospital & Research Center OaklandOakland, CASally Raphel, MS, APRN/PMH, FAANUniversity of MarylandJohns Hopkins UniversitySchool of NursingBaltimore, MDAmanda Reilly, MEd, MSNNurse ClinicianUCONN Health CenterFarmington, CTJoan B. Riley, MS, MSN, FNP-BC, FAANAssistant ProfessorDepartments of Human Science and NursingSchool of Nursing & Health StudiesNurse PractitionerStudent Health CenterGeorgetown UniversityWashington, DCCynda H. Rushton, PhD, RN, FAANAssociate ProfessorSchool of NursingJohns Hopkins UniversityBaltimore, MDPatricia Ryan-Krause, MS, RN, MSN, CPNPAssociate ProfessorPediatric Nurse Practitioner SpecialtyDirector of Clinical EducationCenter for International Nursing Scholarship and EducationSchool of NursingYale UniversityNew Haven, CTLawrence D. Scahill, MSN, PhD, FAANProfessorPsychiatric-Mental Health SpecialtyProfessorYale Child Study CenterSchool of NursingYale UniversityNew Haven, CTKathleen Scharer, PhD, RN, PMHCNS-BC, FAANAssociate ProfessorCollege of NursingUniversity of South CarolinaColumbia, SCKaren G. Schepp, PhD, RN, PMHCNS, BC, FAANAssociate Professor and Interim ChairDepartment of Psychosocial & Community HealthSchool of NursingUniversity of WashingtonSeattle, WACarolyn Schmidt, BSN, RNCommunity Health Nurse-RetiredGuilford County Department of Public HealthGreensboro, NCKathy Ann Sheehy, APRN, PCNS-BCAdvanced Practice NurseDivision of Anesthesia and Pain MedicineChildren’s National Medical CenterWashington, DCDeborah Shelton, PhD, RN, NE-BC, CCHP, FAANE. Jane Martin Professor and Associate Dean for Research West Virginia University School of NursingRobert C. Byrd Health Sciences Center Morgantown, WVSarah B. Vittone, RN, MSN, MAAssistant ProfessorSchool of Nursing & Health StudiesEthics Consultant, Center for Clinical BioethicsGeorgetown UniversityWashington, DCSandra J. Weiss, PhD, DNSc, RN, FAANProfessor and Eschbach Endowed Chair in Mental HealthDepartment of Community Health SystemsSchool of NursingUniversity of California, San FranciscoSan Francisco, CAStephanie Wright, PhD, FNP-BC, PNP-BCAssociate ProfessorSchool of NursingThe George Washington UniversityWashington, DC

Foreword by Janet A. Deatrick

We are often lectured as professionals about the importance of collaborating with individuals in other professions in order to optimize child and family outcomes. In addition, we are now being told to start those collaborative efforts during the educational process and to make interprofessional education a priority. While these efforts are most important, this book reminds us about the importance of collaboration within our own profession.

This book was written to enable the collaboration of nurses with each other. More specifically, the vision of the editors of this book is to provide a state-of-the-science guide regarding behavioral health that will be helpful not only for advanced practice psychiatric nurses but also for primary care nurse practitioners and to facilitate their communication with each other. Edilma Yearwood, Geraldine Pearson, and Jamesetta Newland are to be congratulated for this vision and for the grand success of this enormous undertaking.

My own journey within the profession of child psychiatric nursing has been rather circuitous. My education at the master’s level in the early 1970s was avant-garde in the sense that I had the fortune of being educated by young, forward-looking clinicians who valued the importance of family and community in the lives of children. Throughout our classroom and clinical experiences, we were immersed in those phenomena. To this day, I use those understandings to frame my scholarship, as well as my own philosophy, values, and passion. During that time and throughout my career, I worked with many of the individuals who have contributed to this book. They have been a source of continued inspiration to me as I took a different road for my career outside of psychiatry into the world of pediatric nursing practice for my research regarding families and children with chronic conditions and cancer. During my travels, I have had the opportunity to work with individuals from many professions and have been able to build upon my strong nursing identity and what I have learned about the purpose for our work from other child psychiatric nurses. Thus, I feel very strongly about the message of this book; that is, about the importance of collaboration within our profession.

We as nurses have a unique opportunity to become intimately involved in the lives of children, adolescents, and their families and therefore have a concomitant obligation to advocate for them. As outlined in this book, that advocacy may take many forms but all leads back to our desire for optimal functioning for everyone in the family system. I have always found that pediatric nursing gives me the best avenue for that advocacy. Thus, being given this opportunity to introduce this book also gives me the opportunity to go full circle, back to my roots, and allows me to lavish in the wisdom of my colleagues contained in these pages.

The book is organized according to issues of assessment, treatment, special populations, and special issues. Each section of text is written or reviewed collaboratively by a child and adolescent psychiatric advanced practice nurse and a pediatric or family nurse practitioner. Use it to build your wisdom, and may your travels be as rich as those whose work is reflected in this volume.

Best,Janet A. Deatrick, PhD, RN, FAAN

Foreword by Judith Haber

Nursing historically has been in the forefront in training health care professionals using a holistic framework that acknowledges a responsibility to address the needs of the whole person; individuals are not composed of parts that function independently of each other, to be separated for convenience or by virtue of the health care provider’s educational preparation and training. Physical health and psychological well-being are intricately linked and, as such, the state of one influences the state of the other, and optimal health cannot be achieved if either one is overlooked or attended to without consideration for the other. In our nation’s health care system, physical health and behavioral health have been traditionally rendered by different providers and in separate settings. Communication between the two groups often is either restricted or nonexistent. People are treated as two detachable and disconnected halves. This approach to patient care results in outcomes such as fragmented care; limited or no access to appropriate and timely care; the “falling through the cracks” phenomenon; disparate reimbursements between medical and mental health professionals; entrenched “silo” education, training, and practice; and patients with unmet needs, especially related to behavioral health. A paradox is reflected in the high demand for mental health services but a low supply of mental health professionals. There is an urgent need to prepare primary care nurses to be cognizant about and competent in assessing, treating, and managing mental health problems, and psychiatric mental health nurses to be knowledgeable about physical health problems of children and adolescents so they are prepared to address these through appropriate collaboration and referral.

The time is right, and the editors of this book—Edilma, Geri, and Jamie—had a vision to create a text that would be useful to primary care and psychiatric mental health advanced practice nurses in integrating primary care and behavioral health for children and adolescents. Children and adolescents represent one of the most vulnerable populations in our society, and to ensure a healthy future for the nation, we must address the needs of the young from a holistic as well as developmental perspective and initiate treatment in primary care settings. Many mental health problems and psychiatric disorders that begin in childhood are likely to persist and possibly worsen as the child reaches adulthood. The number of mental health professionals is not adequate to keep up with the demands of steadily increasing numbers of children with behavioral health needs. Thus, primary care professionals must take a more active and continuous role in identifying these children and facilitating access to appropriate interventions.

Putting together a text of this magnitude is a daunting task, but the editors, all highly accomplished experts who are recognized in their fields, selected authors from both primary and psychiatric mental health care to work together in writing the chapters. The intent was to make sure that both perspectives were represented and integrated in the discussions. This text will enhance the knowledge, assessment, and management skills of advanced practice nurses who care for children from infancy through adolescence. Because there is an emphasis on collaboration and integration of care throughout the book, readers will become acutely aware of the need to change systems of care to reduce barriers to the assessment and management of the behavioral health needs of this population. The advanced practice nursing role affords opportunities to continue moving nurses into positions of leadership on interprofessional teams and as innovators in developing new models to deliver primary care services to this special population of children and adolescents.

Warm regards,Judith Haber, PhD, APRN, BC, FAAN

Preface

This book was conceptualized to help advanced practice nurses (APNs) working directly with children and adolescents in multiple care systems address the growing problem of unmet mental health needs of this population. The research on health disparities shows that early identification, access to care, and early treatment are lacking for vulnerable populations including children and adolescents. Children access primary medical care more frequently because of school requirements for regular immunizations, physical exams, and common childhood illnesses. There is no such requirement for mental health assessment. The result is a growing number of children and adolescents whose psychiatric symptoms largely go unrecognized and untreated. Research shows that many adult psychiatric disorders originate in childhood and adolescence and that these individuals have a poorer prognosis if not treated early. Physical health is a recognized public health issue; mental health, which is often not as visible or tangible, is often neglected. Another powerful barrier that cannot be overestimated is the powerful negative force of individual, group, and societal stigma toward mental illness and its effect on knowledge, understanding, treatment, inclusion/exclusion, and quality of life of those with a mental or behavioral disorder.

Early on in the process of developing this book, the commitment was to produce a body of work that was collaborative and reflected the work experience of child psychiatric, pediatric, and family APNs. Most chapters have been written through the joint efforts of both child psychiatric and primary care practitioners. All peer reviewers have reflected both psychiatric and primary care knowledge. Each chapter presents state-of-the-art, evidence-based knowledge about specific psychiatric and behavioral health issues presented by children and adolescents across health care settings.

It is our hope that any APN can use this book to understand behavioral disorders and their etiology, assessment guidelines, strategies for treatment in primary care settings, and indications for consultation, collaboration, and referral. The book is developmentally based and proposes strategies for working in partnership with children, adolescents, families, and other health care providers to improve mental health status of the vulnerable child population. The sections include assessment, treatment, special populations, and special issues. Chapters in each section focus on disorder and behavioral presentations. Chapters focused on disorders review clinical manifestation, etiology, nursing interventions, integration with primary care and implications for practice, research, and education. Chapters focused on issues describe the issue and the linkages with a behavioral/psychiatric profile of the child and associated risk and management issues.

The reality is that there are not enough child psychiatric providers to meet the burgeoning needs of the pediatric population for mental health services both in the United States and worldwide. Primary care is at the forefront of service provision and, as such, can play a significant role in mental health early case finding and supportive linkages to treatment. It is not the intent of this book to suggest that primary care providers treat complex mental health presentations. However, APNs in primary care can be instrumental in initial assessment and can and should continue to treat simple behavioral presentations, such as ADHD, affective disorders, and anxiety. As screening, collaboration, and referral are integral parts of the primary care practitioner’s role, this book is intended to raise the awareness in primary care practitioners to consider behavioral health presentations in their assessment, then screen for severity, and work collaboratively with colleagues like APN child and adolescent psychiatric-mental health nurses, to ensure all children and adolescents receive treatment.

We endorse the view that nursing care is built on trust. Primary care nurses are in the unique position to have long-term relationships with children, adolescents, and their family. They can be the supportive bridge and catalyst to ensure that mental health treatment is both destigmatized and accessed.

Health care reform and development of innovative care delivery afford us an opportunity to forge new models of care including the integration of behavioral health into primary care treatment for children and adolescents. The ultimate goal is ensuring that children and adolescents presenting with mental health issues have access to timely care with the most appropriate health care provider. Healthy People 2020 goals advocate for all levels of prevention in pediatric care including early case finding, access to treatment, and increased awareness of mental health needs. It is our goal that this book facilitates the work of all APNs who interact with children, adolescents, and families.

Edilma YearwoodGeraldine PearsonJamesetta Newland

Peer Reviewers

Michelle Beauchesne, DNSc, RN, CPNPAssociate Professor Coordinator, Pediatric Nurse Practitioner SpecializationSchool of NursingBouvé College of Health SciencesNortheastern UniversityBoston, MAEve Bosnick, MSN, APRN PNP-BCDirectorAdolescent Health and Wellness CenterAdvocare Mainline PediatricsNarberth, PAClinical FacultyPrimary Care Pediatric Nurse Practitioner ProgramDivision of Family and Community HealthSchool of NursingUniversity of PennsylvaniaPhiladelphia, PAAngela A. Crowley, PhD, APRN, PNP-BC, FAANAssociate ProfessorYale University School of NursingYale UniversityNew Haven, CTKathleen R. Delaney, PhD, PMH-NP, FAANProfessor and Specialty Coordinator – Psychiatric Mental Health-FNP ProgramDepartment of Community Systems and Mental Health NursingCollege of NursingRush UniversityChicago, ILClinical Assistant ProfessorSchool of NursingUniversity of Massachusetts AmherstAmherst, MAAssociate ProfessorBehavioral Science, Community and Health SystemsCollege of NursingSeton Hall UniversitySouth Orange, NJClinical Associate ProfessorCoordinator PNP ProgramCollege of NursingNew York UniversityNew York, NYAssociate ProfessorVanderbilt School of NursingVanderbilt UniversityNashville, TNAssistant ProfessorCollege of NursingUniversity of South CarolinaColumbia, SCPsychiatric Nurse PractitionerRegistered Play Therapist and SupervisorPrivate PracticeRye, NYAdjunct Nursing InstructorPediatric Urology Nurse PractitionerDysfunctional EliminationDepartment of SurgerySection of UrologySt Christopher’s Hospital for ChildrenPresident Healthlinx, LtdMedical Legal ConsultantsPhiladelphia, PAPsychiatric Mental Health Nurse PractitionerCook Children’s Health Care SystemFort Worth, TXProfessorSchool of NursingUniversity of Alabama – BirminghamBirmingham, ALPediatric Nurse Practitioner & Clinical Coordinator of Pediatric Rheumatology Fellowship ProgramChildren’s Hospital at MontefioreBronx, NYFamily Nurse Practitioner and Site ManagerTeen Health Center at Lynn English High SchoolLynn, MAAssistant Clinical ProfessorDivision of Undergraduate Nursing, R.N.-B.S.N. Completion DepartmentCollege of Nursing and Health ProfessionsDrexel UniversityPhiladelphia, PAAssociate ProfessorTrack Leader Advanced Child HealthCollege of Nursing and Health SciencesFlorida International UniversityMiami, FLProfessor and Advanced Practice Psychiatric Nursing Specialty CoordinatorSchool of NursingUniversity of Alabama at BirminghamBirmingham, ALAssociate ProfessorPediatric Nurse Practitioner SpecialtyMaster’s ProgramYale University School of NursingNew Haven, CTNurse ClinicianUniversity of Connecticut Health CenterFarmington, CTClinical Associate ProfessorCollege of NursingNew York UniversityNew York, NYAssociate ProfessorDirector, HomeCare ProgramDepartment of PsychiatrySchool of MedicineUniversity of ConnecticutFarmington, CTDean and ProfessorCollege of Health SciencesWilliam and Kathryn Shields Endowed ChairIndiana University – South BendSouth Bend, INAssistant ProfessorDepartments of Human Science and NursingSchool of Nursing & Health StudiesNurse PractitionerStudent Health CenterGeorgetown UniversityWashington, DCAssociate ProfessorCollege of NursingUniversity of South CarolinaColumbia, SCSeattle Children’s HospitalSeattle, WAAssociate Professor and Assistant Dean of Academic Integration and Evaluation of Community ProgramsDivision of Graduate NursingDoctor of Nursing Practice DepartmentCollege of Nursing and Health ProfessionsDrexel UniversityPhiladelphia, PAFamily Nurse PractitionerDepartment of NursingSchool of Nursing & Health StudiesGeorgetown UniversityWashington, DCAssociate ProfessorDepartment of NursingSchool of Nursing & Health StudiesGeorgetown UniversityWashington, DCDeanCollege of Health and Human ServicesCalifornia State University, Los AngelesLos Angeles, CAO’Neill Institute for National and Global Health LawGeorgetown UniversityWashington, DC