Showing papers in "Journal of Child and Adolescent Psychiatric Nursing in 2009"

Protective effects of self-esteem and family support on suicide risk behaviors among at-risk adolescents.

Abstract: PROBLEM: If and how family support and self-esteem might interact to protect against adolescent suicide risk is not well understood METHODS: Hierarchical multiple regression was used to examine the moderating effect of family support on the relationship between self-esteem and suicide risk behaviors among potential high school dropouts (N = 849), using questionnaires and in-depth assessment interviews FINDINGS: Family support moderated the impact of self-esteem on suicide risk; the ameliorating effect of self-esteem was stronger among adolescents with low versus high family support CONCLUSIONS: Self-esteem influences adolescent suicide risk behaviors for youth with low as well as high family support Interventions designed to strengthen both self-esteem and support resources are appropriate Language: en

Poverty and adolescent mental health.

Abstract: PROBLEM: Poverty and accelerations of inequality, manifested by the increasing difference between the richest and poorest populations, have significant effects on the mental health of vulnerable groups. Adolescents are vulnerable to the effects of poverty. As a time of change and transition for youth and their families, adolescence creates both challenges and opportunities to intervene in the effects of poverty. PURPOSE: The purpose of this article is to discuss the significance of poverty and its impact on adolescent mental health and mental health services. SOURCES: An interdisciplinary literature search was conducted on the topic of poverty and adolescent mental health. CONCLUSIONS: Results indicated that nurses need to remain active participants in the provision of mental health services to adolescents in poverty and increase their advocacy for the creation of policy changes that address mental health needs of this population.

Depression Among a Sample of First‐Time Adolescent and Adult Mothers

Abstract: Research has shown that about 1 out of every 10 people in the United States suffer from depression, with women being affected at about twice the rate as men (National Institutes of Mental Health, 2008; Blehar & Oren, 1997). Of particular concern is the negative impact that depression has on parenting practices and behavior causing impairments in both the mother’s and children’s health and development. A lack of social support and elevated rates of stress increase the risk of depression among new mothers and likely contribute to negative parenting practices such as neglect (Lesser, Anderson, & Koniak-Griffin, 1998; East & Felice, 1990). Depressive symptomatology rates among indigent mothers of young children are in the range of 40 – 50 percent (Lanzi, Pascoe, Keltner, & Ramey, 1999; Orr, James, Burns, & Thompson, 1989), with a 2- to 3-fold increased risk for depression in their children (Weissman et al., 2006). In about 80% of the cases, treatment can help alleviate symptoms of depression; however, about 2/3 of people do not seek help (Robins & Regier, 1990), and for many their symptoms go unnoticed by health practitioners due to a variety of reasons, including lack of recognition (Gjerdingen & Yawn, 2007). In general, adolescent mothers, ranging in ages from 15 – 18 years, have been shown to be more depressed than first-time adult mothers ages 22–35 years (Whitman, Borkowski, Keogh, & Weed, 2001). The etiology of depression and how early and unplanned onset of parenthood may impact the course of depression and child neglect, however, are not well-documented (Zuckerman, Amaro, & Beardslee, 1987). It is often thought that situational depression is due to lack of knowledge, experience, and resources and that depression may impede individuals from “acting.” The role of depression in adolescent mothers (including the onset, severity, and duration) has yet to be fully explored. It is clear that maternal depression is endemic in low-income families, and that within poverty, there are many stressors that potentially increase depression (Lanzi, Pascoe, Keltner, & Ramey, 1999). The current study explores the variation of adolescents’ moods and parenting behavior through multiple measures of depression and parenting behaviors at multiple time periods. The parenting behaviors and mood fluctuations of adolescent mothers is compared to that of a matched adult sample of mothers. These comparisons are necessary to assess whether potentially neglectful parenting behavior is a function of age, stage, or experience. Becoming an adolescent mother often takes the teen off society’s normative life trajectory. The adolescent is no longer able (or as able) to participate in age-typical social events and sports, nor is she able to date as easily. The early onset of parenthood often inhibits the development of stable relationships and in many cases, the adolescent mother often faces the daunting responsibility of being a parent with minimal or no support from a partner (Brooks-Gunn & Furstenberg, 1986; Lesser, Anderson, & Koniak-Griffin, 1998). Whitman, Borkowski, Keogh, and Weed (2001) found that only 6% of infants born to adolescent parents received support from a father or male figure. The support provided by the adolescent mother’s own mother is key as well (Lesser, Anderson, & Koniak-Griffin, 1998). Even though adolescent mothers assume a great deal of adult responsibility by becoming a mother, they are still children themselves and the grandparents continue to have an obligation to meet their daughters’ needs. Further, it is often the case that adolescent mothers are the children of adolescent mothers themselves, who may not have adequate time, energy, and resources to provide support to their daughters. These combined factors often place the adolescent mother in an environment where there is little support for her needs, which in many cases, may translate into the adolescent mother becoming depressed and not being able to, or wanting to, provide for the needs of her newborn child. In this paper, we explore the underlying factors associated with the prevalence of depression among a sample of first time adolescent and adult mothers. Using a diverse sample of mothers, we aim to document: (1) the rates of positive depression screens and their fluctuations and stability from the prenatal period through 6 months postpartum; (2) the most salient individual and family ecological factors associated with positive maternal depression screens; and (3) how maternal depression affects mother’s parenting and children’s development. This paper is one of several reports that utilize data from the Parenting for the First Time Project (Centers for the Prevention of Child Neglect, year), a landmark 4-site NICHD prospective longitudinal study of early predictors and precursors of parenting among first children born to adolescent and adult mothers. The study includes multiple measures including direct observation, interviews, self-report, and developmental assessments. Conclusions and recommendations for addressing depression among first-time mothers in terms of research and clinical practice are presented.

Health risk behavior of youth in foster care.

Abstract: Problem Adolescent health problems are predominantly caused by risk behavior. Foster adolescents have disproportionately poor health; therefore identification of risk behavior is critical.

The Triad of Impairment in Autism Revisited

Abstract: TOPIC: The triad of impairment referred to at present in the autism-related literature is a behavioral triad. This paper extends this thinking of the triad of impairment to the triad that underlies the behavioral manifestation. The real triad of impairment. PURPOSE: This paper considers the thinking and information processing style of autism and takes the next transitional step in understanding the triad of impairment. SOURCES USED: Contemporary literature on autism and information processing. CONCLUSIONS: Exceptional pioneering work in the late 1970s gave rise to the concept of the triad of impairments as the central plank of the construct of autism: impaired communication; impaired social skills; and a restricted and repetitive way of being-in-the-world. This clear articulation of the structures of the phenomena allowed a new way for professionals and families to see and understand autism, and to relate to those with autism. Like the evolution of many concepts, this was a transitional idea. The original triad of impairments described the behavioral manifestation; the actual triad of impairments is at the level of cognitive processing. The actual triad of impairment is static and ubiquitous unlike the variable and fluctuating behavioral manifestation. The actual triad of impairment in autism is visual as opposed to linguistic processing, impaired abstraction, and lack of theory of mind. The actual triad is central to all diagnosis that together makes up the autism spectrum.

Improving Recruitment and Retention Rates in Preventive Longitudinal Research with Adolescent Mothers

Abstract: PROBLEM: In order to understand the risks and protective factors associated with poor health outcomes in adolescent mothers and their children, nurses need to design rigorous longitudinal research. Attrition of subjects can contribute to sampling error. Recruitment and retention efforts need to be optimized. METHODS: In a 4-year longitudinal study with adolescent mothers and their babies, the design for tracking included frequent phone calls, progressive monetary incentives, gifts, and one phone number of an alternative contact. FINDINGS: Of the 97 mother–infant dyads recruited, retention was 54% at 6 months and 38% at final data collection. Successful strategies included persistence in making contacts and utilizing alternative contact numbers. CONCLUSIONS: Retention rates for this study were low. With today's technology, many additional strategies need to be employed to improve retention rates with adolescent mothers.

Factors associated with parental distress.

Abstract: PROBLEM: Associations of perceptions of social support, personal control, and child behavioral problems to distress in parents of children with mental health problems were examined. METHODS: One hundred and fifty-five parents of children 2–19 years old receiving community mental health services participated. FINDINGS: Stepwise regression analysis identified internalizing and externalizing child behaviors, perceived personal control, and tangible social support as independent predictors of parental distress. Independent predictors of objective distress included internalizing child behaviors, perceived personal control, and intangible social support. CONCLUSIONS: Internalizing and externalizing child behaviors were significantly associated with parental distress. Perceived personal control moderated the relationship between internalizing child behaviors and parental subjective distress.

Korean American adolescents' and their parents' perceptions of acculturative stress.

Abstract: According to the limited data on Korean American adolescents’ (KAAs’) mental health, compared with Chinese- and Japanese-American adolescents, KAAs reported considerably higher scores on the Symptoms Checklist-90-Revised (SCL-90-R), a measure of a wide range of mental health symptoms such as depression, anxiety, hostility, and somatization (Yeh, 2003). Also, KAAs demonstrated significantly higher levels of depression and lower levels of selfesteem, coping, and mastery than whites (Choi, Stafford, Meininger, Roberts, & Smith, 2002). Acculturative stress is known to be a significant predictor for these mental health problems (Choi, Meininger, & Roberts, 2006; Kang, 1996; Yeh, 2003). According to the Model of Acculturative Stress, Depression, and Suicidal Ideation (Hovey & King, 1997), accumulated and unresolved acculturative stress may lead to depression and even suicide. In previous studies, acculturative stress was found to be closely related to undesirable mental health outcomes such as substance abuse, depression, and suicidal ideation (Choi, et al., 2006; Gil, Wagner, & Vega, 2000; Noh & Kaspar, 2003; Yearwood, Crawford, Kelly, & Moreno, 2007). People can experience acculturative stress when adjusting to new or dominant culture as well as when they perceive discrimination (Chavez, Moran, Reid, & Lopez, 1997). Thus, acculturative stress can reflect “one kind of stress, that in which the stressors are identified as having their source in the process of acculturation, often resulting in a particular set of stress behaviors that include anxiety, depression, feelings of marginality and alienation, heightened psychosomatic symptoms, and identity confusion” (William & Berry, 1991, p. 634) or a more chronic long-term stressor related to perceived discrimination. Acculturative stress is thus relevant to the U.S.-born immigrants as well as recent immigrants. For KAAs, acculturative stress was positively associated with anxiety, anger, depression, obsessive-compulsiveness, and suicidal ideation (Kang, 1996; Yeh, 2003). Despite the identified mental health problems among KAAs and known correlations between acculturative stress and mental health problems, only a limited number of studies have explored their perceptions of acculturative stress. Among a limited number of qualitative studies that explored KAAs’ perceptions of acculturative stress, none interviewed both KAAs and their parents. Current qualitative studies interviewed only parents (Yang & Rettig, 2003), adolescents (Yeh, et al., in press), or young adults using the retrospective method (Kim, 2004). The traditional Korean family structure requires Korean children to be obedient to their parents and to conform to the family rules. However, as Korean children adjust to new societal and cultural expectations in the U.S., this traditional family structure and the relationships within the family structure tend to be modified (Kim, 2004; Um & Dancy, 1999). Children, who acquire new language and culture faster than their parents, become independent and begin to take on more responsibilities as translators and cultural brokers for their parents (Choi, 2001). In contrast, parents feel powerless due to language and cultural barriers and their limited access to mainstream society. These changes in family structure and the relationships often create conflicts between parents and children (Kim, 2004; Um & Dancy, 1999). Family conflict was significantly related to increases in internalizing problems among KAAs, such as somatic complaints, withdrawal, and anxious/depressed mood (Cho & Bae, 2005). In order to provide culturally and developmentally relevant mental health assessment and care for KAAs, it is necessary to understand both KAAs’ and their parents’ perceptions of acculturative stress experienced by KAAs (National Institute of Mental Health [NIMH], 2001; Smedley, Stith, & Nelson, 2001). Qualitative studies using in-depth interviews would allow a more dynamic and multidimensional understanding regarding KAAs’ experiences with acculturative stress (Berry, Poortinga, Segall, & Dasen, 1992; Oetting & Beauvais, 1990–91).

A comparison of two types of social support for mothers of mentally ill children.

Abstract: In the United States, approximately 20% of children have mental health problems, of which only 20% are receiving mental health services (National Institute of Mental Health, 2002; U.S. Public Health Service, 2000) and only about half are receiving appropriate services (Junek & Thompson, 1999; Knitzer, 1993; President’s New Freedom Commission on Mental Health, 2003). As with other areas of health care, more and more responsibility for mental health care is being placed on the parents or other primary caregivers (Grey, Knafl, & McCorkle, 2006). Being the mother of a child with mental illness is associated with high levels of distress and depression (Elgar, McGrath, Waschbusch, Stewart, & Curtis, 2004). Efforts to reduce parents’ depression and/or distress have been significantly associated with improvement in child mental health problems (Weissman et al., 2006). However, the main focus of care is typically the treatment of the child, and as a result, the parents’ needs are rarely addressed (Downey & Coyne, 1990; Elgar et al.). According to the National Mental Health Association and the Federation of Families for Children’s Mental Health (NMHA & FOF, 1993), parents who are caring for children with mental illness find it extremely difficult to get their own mental health needs met while trying to meet the mental health needs of their children. The Surgeon General’s Conference on Children’s Mental Health (U.S. Public Health Service) noted that these children and their families face a healthcare crisis because of a lack of available services. A randomized controlled investigation is being conducted to test two types of social support interventions—TSS and Web-based social support—for mothers of seriously mentally ill children. Mothers recruited for the study have children ranging from 5 to 12 years of age who have been recently discharged from an inpatient psychiatry unit. The ongoing study uses an experimental design with randomization to three groups: a usual care group, a TSS group, and a Web-based social support group. This paper reports the findings from a qualitative portion of the investigation examining the interactions between mothers with the TSS nurses and the chat room nurse facilitator. The purpose of this analysis was to compare the amount and types of support offered via these two different types of telehealth interventions.

Descriptions of help by Finnish adolescents who self-mutilate.

Abstract: PURPOSE: The purpose of this study is to describe help from the viewpoint of self-mutilating Finnish adolescents. METHODS: Methodological triangulation was used in data collection. Written descriptions were provided by 62 self-mutilating adolescents (aged 12–21 years) of the help they received and wished to receive, and individual interviews were conducted with 10 self-mutilating adolescents (aged 15–22 years). Qualitative content analysis was applied. FINDINGS: Three groups of people that can be of help were identified by the self-mutilating adolescents: age-mates, including peers and fellow self-mutilating adolescents; loved ones; and adults, including unknown adults, health and social care professionals, teachers and school counsellors, and parents. Factors contributing and hindering to help were identified. CONCLUSIONS: Self-mutilating adolescents want to be helped and, in their opinion, adults are duty-bound to help and care for them.

Correlation of the Experience of Peer Relational Aggression Victimization and Depression among African American Adolescent Females

Abstract: Violence is a large and growing problem in contemporary America. In 2001, an excess of 50,000 deaths were attributed to violence. Perhaps surprisingly, 31,000 of these violent deaths were suicides, and 21,000 were actual homicides (U.S. Department of Health and Human Services, 2006). According to the World Report on Violence and Health (Krug, 2002), action has been taken to bring attention to the myriad of detrimental consequences of violence on individuals, families, and communities. A major new field of public health has emerged, and consensus is building for a more expansive and inclusive approach to violence research. Moreover, violence through the lens of gender has gained increasing interest and awareness. Expanding knowledge of those violent acts most typically committed by females has shed new light on the phenomenon of violence. Now, acts of relational aggression – which were not previously regarded as acts of violence – are recognized as critical and legitimate aspects of the violence phenomenon (Werner & Crick, 1999). This exploration of relational aggression has aided in understanding the detrimental consequences of acts that were previously thought of as just a normal part of growth and development. Consequently, acts such as rumor-spreading, gossiping, and socially isolating others are now considered violent acts and have been linked to related poor health outcomes(Crick & Grotpeter, 1995). The task of discovering methods to treat relational aggression has begun. However, more research is needed within various ethnic groups in order to fully understand from a global perspective the problem of this type of violence.

Prevention of mental, emotional, and behavioral disorders in youth: the Institute of Medicine report and implications for nursing.

Abstract: TOPIC: Preventing Mental, Emotional, and Behavioral Disorders among Young People: The Institute of Medicine (IOM) Report and Implications for Nursing. PURPOSE: The purpose of this manuscript is to review the recently released IOM report on preventing mental, emotional, and behavioral disorders among young people and to identify some implications of this report for nursing. SOURCES: The primary source of this information is the recently released IOM report. CONCLUSIONS: Mental, emotional, and behavioral disorders are common among young people, and a growing research base supports preventive interventions. Nurses can play an important role in supporting the implementation and evaluation of these interventions in a variety of practice and community settings.

The Effects of Exposure to Community Violence on Aspects of Adolescent Identity Development

Abstract: PROBLEM: A gap exists in our understanding of the impact of exposure to community violence on identity development. The purpose of this study was to explore how exposure to community violence affects adolescents' identity development. Data were collected to describe the perceptions, interpretations, and meanings adolescents ascribe to their experiences with community violence. METHODS: Male and female inner-city adolescents (13-18 years) were invited to share their personal stories about exposure to community violence. A constant comparative approach was employed to analyze data from personal narratives. RESULTS: All adolescents in this study reported exposure to violence and shared stories about living and coping with the prevalence of violence. Aspects of identity development that emerged in the data included self-perceptions, coping patterns, efficacy, and a moral self. Some stories revealed psychological distress that had potential for long-term developmental consequences. Personal strengths and positive attributes of the participants were also evident in the data. CONCLUSIONS: Exposure to community violence affected the identity development of these adolescents. When working with adolescents, it is important for nurses to assess for community violence exposure and promote coping strategies that reduce distress and foster healthy intimacy. Language: en

Parenting style and the vulnerable child syndrome.

Abstract: TOPIC: Vulnerable child syndrome (VCS) refers to the combination of the parental view that their child is at increased risk for death despite the child's objective health and the resulting behavior problems in the child. Although risk factors for the development of the syndrome have been outlined, the variability in the development of VCS has not been explained. PURPOSE: A theoretical explanation for the variability in the development of VCS utilizing Susan Calkins' model is explored. By considering the development of VCS in light of Calkins' model, variability may be explained and preventative interventions may be instituted. SOURCES USED: Relevant literature pertaining to child development and VCS was reviewed. CONCLUSIONS: By recognizing the risk of the role that parenting sensitivity plays in the development of VCS, team-based interventions involving a developmental approach may be employed, and the long-term behavioral sequelae of the disorder may be prevented or alleviated.

Reducing Reactive Aggression by Lowering Coping Demands and Boosting Regulation: Five Key Staff Behaviors

Abstract: TOPIC: Lowering the incidence of reactive aggression on inpatient child/adolescent psychiatric units by creating a milieu that reduces coping demands and augments children's self- regulation capabilities. PURPOSE: This article elaborates on specific staff approaches that have the potential to reduce occurrences of reactive aggression and behavioral eruptions frequently displayed by children and adolescents during inpatient psychiatric treatment. Identified are key staff behaviors along with explanations on how they dampen the kindling of reactive aggression and create an enhanced milieu. Accompanying each staff behavior is an explanation of the neuroscience and theory that supports the intervention. SOURCES: Published literature and clinical examples. CONCLUSIONS: Children hospitalized on inpatient psychiatric units frequently have poor self-regulation skills and diffuse the negative affects they experience via behaviors such as tantrums, venting, and aggression. Staff can reduce this reactive aggression by tempering the way they set expectations, by providing structure, and by decreasing threat via sensible rules that encourage choice. Staff must also create and maintain relationships with the patients that set a particular tone, thereby creating an enhanced milieu populated with adults who are positive and able to attune to a child's changing affect level.

Nursing children and adolescents with bipolar disorder: assessment, diagnosis, treatment, and management.

Abstract: TOPIC: The role of the mental health nurse in the assessment, diagnosis, treatment, and management of children and adolescents with bipolar disorder in community and hospital settings. PURPOSE: In many areas of clinical practice, mental health nurses have more contact with service users than any other professional group. They are therefore well placed to support children and adolescents with bipolar disorder during first contact with primary care services, through engagement with specialist mental health services, and in accessing early intervention and crisis services. This paper summarizes the contribution that child and adolescent mental health nurses make to the care of children and adolescents with bipolar disorder. SOURCES: This paper is based on evidence from systematic reviews; meta-analyses and best practice evidence from CINAHL; EMBASE; MEDLINE, PsychINFO; Cochrane Collaboration; National Institute for Health and Clinical Excellence; National Collaborating Centre for Mental Health; NHS Centre for Reviews and Dissemination; Oxford Centre for Evidence Based Medicine; United States Agency for Healthcare Research and Quality. CONCLUSIONS: Child and adolescent mental health nurses work with children and adolescents who have bipolar disorder in a range of settings. These include community mental health services, hospitals, and schools. Due to the multidisciplinary nature of the treatment and management of bipolar disorder during childhood and adolescence, nurses have a major role to play in providing frontline assessment services, monitoring treatment, and delivering psychosocial interventions.

Exploring patient and provider level variables that may impact depression outcomes among African American adolescents.

Abstract: TOPIC: Optimizing development outcomes among African American adolescents with depression. PURPOSE: This paper aims to explore patient and/or provider level variables that may impact the assessment, detection, and diagnosis of depression among African American adolescents. SOURCES: Multidisciplinary literature specific to depression among African American adolescents and clinical experience. CONCLUSION: Nurses are in a position to advocate for the appropriate detection of depression among African American adolescents. Both patient- and provider-level variables (i.e., potential attitudes toward mental health care, ethnocultural variations in the manifestation of depression, and individual provider biases) must be sensitively addressed to affect much needed change and minimize disparate health outcomes.

Biopsychosocial approach to treating self-injurious behaviors: an adolescent case study.

Abstract: TOPIC: Self-injurious behaviors (SIBs) are a common coping mechanism in the adolescent population. A marked increase in SIB has been seen in recent years, yet effective treatment remains elusive. PURPOSE: This study aims to review current theoretical perspectives and treatment options that reflect a biopsychosocial framework. SOURCES: Selected multidisciplinary literature related to SIB. CONCLUSIONS: A 6-month multidisciplinary approach targeting the unique physical, emotional, and social needs of a 14-year-old girl in residential treatment led to the complete cessation of SIB.

Treatment of trauma- and abuse-related dissociative symptom disorders in children and adolescents.

Abstract: TOPIC: Dissociated cognition is defined as thinking and feeling that have not become successfully integrated into the usual sense of self; this results in discontinuities in conscious awareness and disruptions in the ongoing “link-making” in the development of identity. PURPOSE: Illness identification methods for the specific components of the disorder that most often affect children and adolescents (amnesia and depersonalization) will be described. SOURCES USED: Current research and practice scholarly articles on diagnosis and assessment of children and adolescents for dissociation and dissociative symptom disorders were accessed and critically reviewed. CONCLUSIONS: Nurses identify early symptoms of dissociation in children and adolescents; those who practice in psychiatric settings, emergency departments, and community health should be especially cognizant of the clinical features of dissociation in pediatric patients.

Almost Invisible: Rural Youth in Foster Care

Abstract: A couple of times a year and usually around the holiday season, the plight of a child in foster care will capture the attention of the media. Unfortunately, the report typically focuses on a sensational case of abuse or major failure of child welfare systems. For example, the case of an adolescent who was starved to death (weighing 48 pounds) was recently in the headlines (Wilson, 2008, para. 1); another story described a case of a homicide of a toddler who was tortured to death by his parents (Wilson, para. 3). Clearly, these highly publicized cases are horrendous. As terrible as these examples are, they do not come close to portraying the day-to-day work of caring for youth in foster care. Editorial writers and public officials offer lip service and note that many bad things happen beneath the radar of the media, but they occur nevertheless. What they miss, however, is the least visible of these low visibility children: children in rural foster care.

Treatment of major depression in adolescents: weighing the evidence of risk and benefit in light of black box warnings.

Abstract: TOPIC: This article is a review of the risks and benefits associated with selective serotonin reuptake inhibitors (SSRIs) in light of recent advisory guidelines issued by the U.S. Food and Drug Administration and the Medicines and Healthcare Products Regulatory Agency of the United Kingdom. This article also makes recommendations for integrating SSRIs into a treatment plan for adolescents with major depressive disorder. PURPOSE: This study aims to provide an overview of the evidence in the literature to inform clinicians who are concerned by reports linking SSRI use with increased incidence of suicidal ideation in adolescents with major depressive disorder. SOURCES: Salient literature from 2004 to 2006, as well as case study based on the author's clinical experience. CONCLUSIONS: Practitioners need to be aware of cautionary guidelines issued by the U.S. and U.K. authorities; however, this awareness does not preclude continued use of SSRIs. There are risks and benefits associated with SSRIs, but they remain an effective tool for use in the treatment of adolescents with depressive symptomatology. SSRI use should be part of a comprehensive treatment plan, which includes patient and family education regarding side effects of these drugs.

Assessing behavior and social competence of severely emotionally disturbed youth admitted to psychiatric residential treatment.

Abstract: PROBLEM: Youth admitted to psychiatric residential treatment centers demonstrate behavioral problems and social competence deficits. Little systematic inquiry has quantified these issues or their impact on therapeutic care. METHOD: Secondary data from Child Behavioral Checklists and Relationship Questionnaires were collected through retrospective chart reviews and were statistically analyzed. FINDINGS: Seventy-one percent of the 113 subjects met clinical behavioral problem levels. Youth who were older than 15 years at admission lagged significantly behind 12th-grade norms in social competence, having scores congruent with 8th-grade students. CONCLUSION: Youth in this study had significant behavioral problems, and deficits in social competence were identified among older youth.

THIS ARTICLE HAS BEEN RETRACTED Results of Psychometric Testing of the RADS-2 With School-Based Adolescents Seeking Assistance for Sexual Orientation and Gender Identity Concerns. Part 2: Research Brief

Abstract: PROBLEM: First-stage measures of depressive symptoms need to demonstrate high levels of accuracy in capturing all the facets of depressive illness in order to be maximally useful for nurses performing psychosocial assessments and for nurse researchers. METHODS: Reliability, validity, and factor analysis testing were conducted on the Reynolds Adolescent Depression Scale (RADS-2). Factor analysis testing examined each item of the instrument to identify the clinical characteristic it measures as well as the broad profiles of symptoms the instrument reveals. FINDINGS: Four factors were identified and all appear to demonstrate adequate internal consistency reliability. CONCLUSIONS: Psychometric results demonstrate a firm foundation for nursing clinical and research uses for the RADS-2.

Adolescents in acute mental distress on inpatient pediatric settings: reflections from a pediatric liaison practitioner.

Abstract: Topic: Exploration of the impact of adolescents in acute mental distress admitted onto in-patient pediatric settings: on the staff group caring for them and the adolescent’s consequent experience of the service provided, from a descriptive and psychodynamic theoretical point of view. Purpose: To examine the impact this client group can have on the staff, environment and multi-disciplinary systems caring for them, with the aim of identifying practical strategies for providing effective child and adolescent mental health service consultation and liaison for this complex and high risk group. Sources: This paper draws on psychoanalytic theories of adolescent development, trauma, organizational dynamics and reflections on personal experiences in the field of pediatric liaison. The challenges of providing effective support in this context are illustrated with clinical examples from the authors own practice. Conclusions: The importance of attending to the very primitive anxieties and subsequent defense mechanisms aroused in staff having to care this client group within this context is highlighted. A case is made for the provision of mental health consultation and support that provides emotional containment for the young people and staff and that incorporates understanding of the organizational issues that can contribute to the complexity of this work.

Social issues among children with high or intermediate imperforate anus : a proxy perspective.

Abstract: PROBLEM: Children with imperforate anus (IA) may be psychosocially affected. METHODS: Parents of children with IA and parents in two comparison groups rated their children using a study-specific qu ...

Youth-, family-, and professional-rated utility of a narrative discharge letter written to older adolescent psychiatric inpatients.

Abstract: PROBLEM: Little has been written on the value of composing narrative letters to adolescent psychiatric inpatients as rated by those who receive them. METHODS: Survey of youth, family members, and professionals given copies of a narrative discharge letter written as an alternative to a copy of an initial discharge letter written to the referrer. FINDINGS: Narrative letters conceptualized and validated youth experience, progress, and future directions in a language easily understood by the youth and family members, enabling reflection and empowerment. CONCLUSION: Narrative letter writing is a valuable therapeutic tool to facilitate reflective, empowering partnerships among professionals, youth, and family members.