Showing papers in "Journal of Child and Adolescent Psychiatric Nursing in 2010"

Family Acceptance in Adolescence and the Health of LGBT Young Adults

Abstract: ISSUE: The role of family acceptance as a protective factor for lesbian, gay, bisexual, and transgender (LGBT) adolescents and young adults has not been established. METHODS: A quantitative measure with items derived from prior qualitative work retrospectively assessed family accepting behaviors in response to LGBT adolescents' sexual orientation and gender expression and their relationship to mental health, substance abuse, and sexual risk in young adults (N= 245). FINDINGS: Family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors. CONCLUSIONS: Family acceptance of LGBT adolescents is associated with positive young adult mental and physical health. Interventions that promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities.

The Role of Electronic Communication Technology in Adolescent Dating Violence

Abstract: PROBLEM: Adolescent dating violence and electronic aggression are significant public health problems. The purpose of this study was to (a) identify ways in which technology is used in dating violence and (b) present examples of dating violence in which electronic aggression played a salient role. METHODS: The data set included the transcribed narratives of 56 young adults who had described their adolescent dating violence experiences for an on going study. FINDINGS: Eight ways in which technology is used in dating violence were identified using qualitative descriptive methods. CONCLUSIONS: The findings indicate that electronic communication technology influences dating violence by redefining boundaries between dating partners. Language: en

The impact of maternal childhood abuse on parenting and infant temperament.

Abstract: The impact of maternal history of maltreatment and psychopathology on mother-child relationship, parenting, and infant temperament was evaluated. Women completed self-report measures addressing childhood trauma, psychopathology, infant-parent relationship, parenting, and infant temperament. Maternal physical abuse was associated with poorer mother-child interactions, increased vigilance, and difficulty recovering from distress among infants, whereas a history of emotional abuse was linked with less interactional dysfunction, lower levels of infant frustration, and more pleasure. Maternal depression was associated with infant temperament and attitudes about parenting. These findings suggest that maternal history of childhood abuse and psychopathology are important determinants of parenting and infant temperament.

Siblings and family environments of persons with autism spectrum disorder: a review of the literature.

Abstract: OBJECTIVES: The purpose of this literature review is to summarize studies on siblings of individuals with autism spectrum disorders (ASD) in four major areas, to identify gaps in the literature, and to propose future directions for research of siblings of persons with ASD. DESIGN AND METHODS: A systematic review of research published within the past 10 years in peer review journals includes investigations on siblings' and parental characteristics, as well as sibling behaviors, relationships, and adaptation. Twelve studies are synthesized to include purpose, findings, and discussion relating it to previous work. RESULTS: Siblings are influenced by the context of their families that are impacted by biological, psychological, sociological, and ecological factors. Research studies are primarily exploratory and no intervention studies are identified. CONCLUSION: The literature review of parental and sibling characteristics, relationships, and adaptation support intervention measures for siblings and family members of persons with autism. Assessment of siblings is necessary to identify those who may be at risk for future adjustment problems and maladaptive behaviors.

Raising an autistic child: perspectives from Turkish mothers

Abstract: PROBLEM: Autism is an illness with severe deficits in reciprocal social interactions, imagination, communication, and restricted or unusual behavioral repertories that affect all areas of a child's life such as daily living activities, home/school life, and relationships with family members and others. Yet, there is much to be learned about the impact of this disorder on parents' experiences, and ways in which their lives are altered and ways that they can be assisted to better manage the home environment. METHODS: The purpose of this study was to explore and categorize the experiences of mothers having an autistic child using a phenomenological design in the qualitative tradition. Semistructured interviews were conducted with 43 mothers regarding their experiences with their autistic children. Data were analyzed with deductive content analysis based on coding, and were grouped into categories based on common themes. The distributions of common responses in categories were presented as percentages. FINDINGS: Based on this qualitative study, mothers expressed feelings of burden and stress because of their child's behaviors associated with autism, as well as their own role and future expectations, and the complexity of care needed by their children at home. CONCLUSIONS: This study provided new knowledge about the difficulties and experiences of mothers of autistic children in Turkey. The results underscored the needs of mothers who require support from family members, healthcare organizations, and society. The findings support the need for training programs for mothers and parents conducted by nurses and other healthcare professionals who have special knowledge and skill to provide education and modeling of therapeutic interventions.

Social justice and social determinants of health: Lesbian, gay, bisexual, transgendered, intersexed, and queer youth in Canada.

Abstract: TOPIC: While nurses address lesbian, gay, bisexual, transgendered, intersexed, and queer (henceforth LGBTIQ) patients' health needs, the professional nursing practice value of social justice provides a larger role for nurses in identifying and minimizing social barriers faced by LGBTIQ patients. PURPOSE: This paper examines the social and health-related experiences of LGBTIQ youth in Canada, a country which has removed many of the social and legal barriers faced by LGBTIQ in countries such as the United States. An awareness of the Canadian LGBTIQ experience is instructive for nurses in different countries, as it reveals both the possibilities and limitations of social legislation that is more inclusive of LGBTIQ youth. SOURCES: Review of literature in PubMed, Academic Search Premier, government documents. CONCLUSION: The literature reveals that exclusion, isolation, and fear remain realities for Canadian LGBTIQ adolescents. The Canadian experience suggests that negative social attitudes toward LGBTIQ persist despite progressive legislation. The value of social justice positions nurses to constructively intervene in promoting the health and well-being of LGBTIQ youth in the face of social homophobia.

Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory.

Abstract: TOPIC: Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications. PURPOSE: Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated. SOURCES: International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources. CONCLUSIONS: Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence. Psychosocial treatment alternatives are preferred. With maturation, adolescents have more influence on decisions related to adherence.

GLB Adolescent's “Coming out”

Abstract: TOPIC: A greater number of gay males, lesbians, and bisexual females or males (GLB) are “coming out” during adolescence. Discussion includes nursing implications. PURPOSE: The purpose of this paper is to review the process of GLB disclosure, highlight the trend toward earlier outing, and discuss its implications for nursing practice. SOURCES: Sources include scholarly published literature, professional organization documents, and GLB advocacy publications. CONCLUSIONS: Nurses need to update their knowledge of coming-out issues, as well as nondisclosing sexual behavior, to assess youth and family needs and direct care appropriately.

Correlates of Substance Use Severity Among Homeless Youth

Abstract: The transition to adulthood is, in general, a difficult phase—one riddled with physical, mental, and social changes (Park, Kim, Kim & Sung, 2007; Votta & Manion, 2004). Among homeless youth, this transition is made more difficult due to circumstances of poverty, lack of support, exposure to violence and crime, and resulting mental health issues. For many, substance use is perceived as “self medication” as a support to deal with mental illness, as a social connection to peers and as a coping strategy when living on the streets (Christiani, Hudson, Nyamathi, Mutere, & Sweat, 2008). Compared to their non-homeless counterparts, homeless youth use substances earlier and with greater frequency (Barczyk & Thompson, 2008; Meade, Slesnick & Tonigan, 2001; Nyamathi et al., 2007; Park et al., 2007). While knowledge about correlates of heightened substance use is crucial for understanding homeless youth’s substance use and associated risk behaviors for HIV (Human Immunodeficiency Virus) and hepatitis B (HBV) and C (HCV) virus, the literature contains little information about such correlates among homeless youth. The purpose of this study is to assess correlates of substance use among homeless youth. Understanding these factors can lead to the development of targeted intervention programs that assist youth in areas that facilitate or discourage ongoing substance use. Although the literature on correlates of substance use among homeless youth is limited, sociodemographic information, peer and family influence, and childhood abuse have been identified as predictors of substance use among the general youth population (Martijn & Sharpe, 2006; Rew, Taylor-Seehafer, & Fitzgerald, 2001). Immutable factors, like race and gender, can forecast the frequency of substance use. For example, findings on ethnic and racial group differences in substance use among youth have been fairly consistent since the 1970s (Galanter, 2005). Native American youth reportedly have the highest use of alcohol (Galanter, 2005), followed by the Caucasian majority (Adams & Berzonsky, 2005; Miller & Carroll, 2006; Thompson, Kost & Pollio, 2003; Tyler & Torres-Stone, 2003). Hispanic youth consume alcohol the next most frequently, followed by African Americans (Adams & Berzonsky, 2005; Galanter, 2005; Tyler & Torres-Stone, 2003); Asian American youth have the lowest rate of alcohol use (Adams & Berzonsky, 2005; Miller & Carroll, 2006). Furthermore, African Americans have the highest rates of illicit substance use (Miller & Carroll, 2006). While racial/ethnic differentiation can sometimes predict future substance use among housed youth (Adams & Berzonsky, 2005; Miller & Carroll, 2006), few studies elaborate on whether such differences are found when comparing various ethnic groups of homeless youth (Rew et al., 2001). In terms of gender, regardless of race or other determinants, males are more likely than females to use alcohol and other drugs (Adams & Berzonsky, 2005; Galea, Nandi, & Vlahov, 2004; Park et al., 2007). Peer substance use and peer pressure often increase a youth’s substance use (Kim, Zane & Hong, 2002; von Sydow, Lieb, Pfister, Hofler & Wittchen, 2002). Prevalent drug and alcohol use within the youth’s social network strongly predicts self-reported substance use (Bousman et al., 2005; Galanter, 2005; Shaw, 2002). In fact, in a study of more than 2,000 high school students, social network characteristics were more responsible for explaining youth’s alcohol use than familial situations (Galea et al., 2004). At the opposite end of the social spectrum, youth without any social network also report heavy illicit substance use (Galanter, 2005), as substance use can serve as a coping mechanism for issues related to loneliness and resulting depression (Torres & Gore-Felton, 2007). Abuse within the family plays a significant role in predicting drug and alcohol use among youth. Families where relationships between parents and children are poor, where there is a sudden disruption in structure, or where other adverse conditions are present, often produce children with excessive alcohol and substance use (Adams & Berzonsky, 2005; Galea et al., 2004). Childhood abuse is one of the most serious risk factors for substance-using youth (Galanter, 2005; Park et al., 2007; Slesnick, Bartle-Haring, & Rashmi, 2006). In a recent study, the physical abuse rate of substance-using youth was six to 12 times higher than that of non-substance users (Park et al., 2007). Additionally, youth with alcohol abuse or dependence were 18–21 times more likely to have a history of sexual abuse than their counterparts without these alcohol problems (Park et al., 2007), underscoring the important link between victimization and substance use. Among homeless males, when these gender-dictated obligations of being self-sufficient and employed are not met, their self-esteem is lowered (LaGory et al., 2001), frequently leading to risky behaviors (Christiani et al., 2008). In addition, social networks and peers also play a large role in determining a homeless youth’s drug and alcohol use (Adams & Berzonsky, 2005; Galea et al., 2004; Shaw, 2002). Criminal involvement and academic failure have also been cited as predictors of homeless youth’s substance use (Barczyk & Thompson, 2008). However, the literature is inconsistent since schooling and the education domain have also been found to have only an indirect linkage to substance use (Kim et al., 2002). Such findings point to pain, trauma, and an inability to cope as predictors of drug and alcohol use (Slesnick, 2004). The difficult situations inherent in a homeless existence, including exposure to crime, victimization, a fluctuating family life, and impaired social networking, can have a great effect on a youth’s drug and alcohol use (Slesnick, 2004).

The psychological consequences to adolescents of exposure to gang violence in the community: an integrated review of the literature.

Abstract: PROBLEM: Gang violence affects many adolescents in the United States, and there has been an increase in violent crimes against adolescents in recent years. METHOD: A literature review examined studies related to gang violence. FINDINGS: Little research has focused on adolescents' exposure to gang violence and its effects on adolescents' mental health. Adolescents develop internalizing symptoms and externalizing behaviors after exposure to violence; but other factors influence adolescents' exposure and reaction to violence. CONCLUSION: With the increase in gang violence over the years, more research is needed on gang violence and its effects on adolescents and their mental health. Language: en

Emotion regulation related to children's future externalizing and internalizing behaviors.

Abstract: PROBLEM: Emotion regulation in children is a construct with important theoretical and clinical implications for healthcare providers, yet currently there is not a reliable and valid instrument that can be easily administered to young children. METHODS: The study was based on interviews with 126 children ages 5.5–12 years from a longitudinal study conducted over 4 years. Reliability, internal construct, and discriminant and predictive validity were examined. FINDINGS: The study was able to distinguish between two types of emotions, sadness and anger, and provided evidence that outcomes may be different for each of these emotion dysregulations. CONCLUSIONS: This study provides empirical evidence that an interview with children as young as 5.5 years can provide researchers with a reliable and valid measure of emotion

The Mediating Effects of Stress and Coping on Depression Among Adolescents in China

Abstract: AIMS: To explore gender differences in Chinese adolescent depression related to the mediating effects of stress and coping. METHODS: The data were collected using a cross-sectional design from a multisite follow-up investigation of adolescent physical and psychological study carried out in China. The study population consisted of 17,622 students aged from 11 to 22 years of age in junior high, senior high schools, and colleges/universities from eight large cities in China. RESULTS: Overall, 44.3% of the sample reported depression during the past week. Male adolescents were more likely to have depression than female counterparts (46.8% versus 41.7%), especially those aged 17 years of age. Overall, stress in boys was statistically higher than that of girls. Boys experienced high levels of stress from school, family, health, and romantic domains, while girls suffered a higher level of peer stress. A multivariate logistic regression model showed that a high level of total stress was significantly associated with increased risk for depression, while peer stress and positive coping style were protective factors for depression in both boys and girls in China. CONCLUSIONS: Unlike their Western counterparts, Chinese boys suffered more depression than girls, which is partly due to more stressful life events and less positive coping style. Our study has important implications for health officers and public health professionals to pay much attention to the relationship between stress and coping style in prevention on adolescent depression.

The impact of the acculturation process on Asian American youth's psychological well-being.

Abstract: TOPIC: Acculturation process and Asian American youth's psychological well-being. PURPOSE: This paper provides an overview of acculturation, its correlates, and psychological well-being of Asian American youth. SOURCES USED: Interdisciplinary research related to acculturation, ethnic socialization, and minority youth's psychological outcomes. CONCLUSIONS: Familial ethnic socialization is mediated by demographic variables, parents' attitudes, and parent–child relationships. Parent–child relationships during acculturation predicts Asian American youth's psychological outcomes. The key components of culturally sensitive health care for Asian American youth include evaluation of family relationships, congruence in parents' and youth's acculturation patterns, and sensitivity to implications of the model minority image.

Developmental Health of Infants and Children Subsequent to Foster Care

Abstract: BACKGROUND: Every day, the United States child welfare system is entrusted with the care of over 400,000 children through foster care. The majority of children entering this social setting are infants, the most developmentally vulnerable. METHODS: Bronfenbrenner's human health ecology model and Bowlby's attachment theory are used to delineate the social setting of foster care and its impact on developmental health, and elucidates the relationship between childhood experiences and the overall continuum of health. Additionally, the notion of inherited genes and environmental influences or epigenetics toward gene expression will be explored. RESULTS: Research points out that what happens in childhood matters; the consequences of not addressing childhood adversity and the associated risk factors of foster care increase a child's risk for poor developmental health and other major illnesses noted later in life such as cardiac disease, depression, and even premature death. Healthcare providers and others charged with caring for this vulnerable population who understand the social setting of foster care and its impact on developmental health may help identify and treat developmental problems earlier, thus potentially reducing long-term effects of abuse and neglect. CONCLUSION: Improvement plans that promote best practice for child welfare must include those that directly address the unique developmental needs of all infants and children in foster care itself. Such plans will ensure that foster care as an intervention to protect vulnerable children at risk does not create more harm by reducing the associated risks and maximizing benefits while in foster care, and ensures that those born genetically vulnerable and disproportionately susceptible to poor outcomes in adversity are also protected and provided opportunities that promote optimal developmental health.

Associations between the coping self in adolescence and mental health in early adulthood.

Abstract: PROBLEM: We have insufficient knowledge of the factors that should be considered when attempting to promote the mental health of adolescents, and whether the coping self during adolescence is indicative of mental health in later life. METHODS: Coping self data were collected in 1996 from 14-year-old pupils (N= 249) using part of the Offer Self-Image Questionnaire. Mental health data were collected in 2006 from the same persons at the age of 24 years, using the Symptom Checklist-90 instrument, with a response rate of 64.0% (n= 159). FINDINGS: Feelings of adolescents related to poor emotional health including fear, shame, guilt, and low trust were associated with depression in women and interpersonal symptoms in men in early adulthood. In addition, feelings of a lack of mastery in adolescence were associated with psychotic symptoms in women and interpersonal symptoms in men in early adulthood. CONCLUSION: Adolescents' perceptions of their emotional health and mastery are important factors to consider in attempts to promote mental health.

. . . on Foster Care International Society of Psychiatric-Mental Health Nurses

Abstract: PROBLEM: Mental health problems are particularly widespread for foster children. There are approximately 700,000 youth in foster care and nonfamily settings in the United States. The mean entry age is 3 years. The average stay is 2 years. Experts estimate that between 30% and 85% of youngsters in out-of-home care have significant emotional disturbances. Foster care children represent 5% of Medicaid enrollees but use approximately 40% of Medicaid funds. A substantial number of these children have psychological problems so serious that they require residential placement. Adolescents living with foster parents or in group homes have about four times the rate of serious psychiatric disorders than those living with their own families (2009a). Despite this level of need, less than one-third of children in the child protective system are receiving mental health services (2009a). SOURCES: Child psychiatric nurse advocates from the Association of Child and Adolescent Psychiatric Nurses Division of the International Society of Psychiatric-Mental Health Nurses compiled this position statement for adoption by the Board of Directors as the Association's formal statement on the plight of children and adolescents in foster care. CONCLUSIONS: Areas that need to be addressed include (a) lack of consistent and comprehensive service planning; (b) communications across agencies and with the youth, their foster parents, and key stakeholders; (c) use of evidence-based interventions to prevent and reduce the incidence of disability; (d) education of child welfare case workers about mental and emotional therapeutic management; and (e) education of foster parents and youth about mental health issues and appropriate treatments.

Exploring relationships among maternal BMI, family factors, and concern for child's weight.

Abstract: PROBLEM: In an effort to better understand child obesity, this study examined the association between family living location, family function, mother's body mass index (BMI), and mothers' attitudes and behaviors concerning child feeding. Recent research on obesity has shown there is limited information on family influence and parental perceptions and attitudes. METHODS: A cross-sectional analysis was performed on data from 47 mothers of school-aged children. FINDINGS: Urban African-American mothers had higher BMIs and were significantly more concerned about their child's weight status than rural white mothers. Additionally, maternal BMI was associated with the total number of individuals in the household. CONCLUSION: Results suggest the importance in understanding the family and community and its influence on childhood obesity. Armed with knowledge about family factors and parents' beliefs and perceptions, nurses can develop interventions that can assist families and communities to focus on healthy children feeding and weight management.

Psychometric Testing of the Children's Resourcefulness Scale

Abstract: PROBLEM: Resourcefulness is known to reduce depression in adults, but its effects on children are less well known, possibly for lack of a psychometrically sound measure. METHODS: This study examined the reliability and validity of the 32-item Children's Self-Control Scale (C-SCS), which measures resourcefulness, in 122 school-aged children. FINDINGS: Standard scale refinement methods produced a 10-item scale with α= .72 and correlations with the C-SCS (r = .86), positive thoughts (r = .38), and depressive symptoms (r =–.32). Factor analysis revealed two factors: problem-solving and delay of gratification. CONCLUSIONS: The 10-item scale may be useful for identifying children who are not resourceful and are at risk for depression.

Healing patterns revealed in middle school boys' experiences of being bullied using Roger's Science of Unitary Human Beings (SUHB).

Abstract: PROBLEM: Although two of the primary risk factors for being bullied include “male” and “middle school” status, a gap in knowledge exists of middle school boys’ personal accounts and meanings of being bullied and their healing. METHODS: Giorgi’s descriptive phenomenological approach using open-ended semi-structured individual interviews was used to collect and analyze evidence related to middle school boys’ lived experiences of being bullied and healing. Roger’s Science of Unitary Human Beings (SUHB) guided interpretation of the healing patterns. FINDINGS: Three patterns of healing were identified in boys’ experiences: meaning-making, self-transcendence, and nonviolently claiming personal power. CONCLUSIONS: Evidence of healing patterns exists in middle school boys’ experiences of being bullied, offering a foundation for further research and practice focused on healing. When working with middle school boys who have been bullied, nurses need to ask about their experiences and promote their healing. Search terms: Bullying, self-healing patterns of middle school boys’ coping

The Concept of Patient Satisfaction in Adolescent Psychiatric Care: A Qualitative Study: The Concept of Patient Satisfaction in Adolescent Psychiatric Care: A Qualitative Study

Abstract: PROBLEM Few studies have asked how adolescents perceive the quality of psychiatric care. Therefore, the aim of the study was to explore adolescents' perception of quality of care and of satisfying treatment outcomes. METHODS Fourteen adolescents participated in this hermeneutic study. FINDINGS Several concepts describing adolescents' perspective of quality of care were found: secure place, tough love, peer solidarity, self-expression, and person not patient. Concepts describing satisfying treatment outcomes fell into four categories: improved mental health, personal development, strengthening of the self, and improved family relations. CONCLUSIONS By casting light on users' perspectives, the study offers guidance for improvement of quality of care and for the development of patient satisfaction instruments.

IOM Releases Report on Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities

Abstract: • Negative self-image • Apathy • Anxiety • Dysthymia • Insecure attachment • Poor social skills: impulsive, aggressive, passive, and withdrawn • Poor social problem-solving skills • Shyness • Poor impulse control • Sensation-seeking • Lack of behavioral self-control • Impulsivity • Early persistent behavior problems • Attention deficit/hyperactivity disorder • Anxiety • Depression • Antisocial behavior • Head injury • Self-reported psychotic symptoms

Nursing care of families with parents who are lesbian, gay, bisexual, or transgender.

Abstract: TOPIC: Families in which parents are lesbian, gay, bisexual, or transgender are more diverse than they are similar. The numbers of parents and children in these families appear to be increasing with implications for nurses and other clinicians. PURPOSE: This paper reviews the current literature to determine the fundamental issues facing alternate families that include sexual minority parents and their children. It also explores the unique nursing needs of families with gay, lesbian, transgender, or bisexual parents in the field, which are critically examined for direct relevance to psychiatric nursing practice. SOURCES USED: Current theoretical and research literature in nursing, child development, family law, and healthcare professional journals. CONCLUSIONS: Despite a relative lack of pathology noted in the literature related to families with sexual minority parents, nurses, and other healthcare professionals can incorporate current knowledge of unique child developmental, parenting, and legal issues into their work with these families. Assessments and interventions that address the unique needs of these families may help parents and children to deal with social stress from being perceived as “different” by other children, or as “problematic and threatening” by other parents.

Reparative Therapy: The Adolescent, the Psych Nurse, and the Issues

Abstract: TOPIC: Reparative therapy aims to modify the sexual orientation of lesbian, gay, and bisexual (LGB) people into that of heterosexuals. Although denounced as harmful by most professional organizations, these treatments continue—youth may be particularly vulnerable to the negative consequences. PURPOSE: The purpose of this article is to discuss reparative therapies, the potential harm LGB youth may experience, clinical and practice issues for psychiatric nurses, and the ethical issues surrounding nurse involvement in reparative therapy. CONCLUSIONS: Reparative therapy for adolescents raises important clinical and ethical issues for psychiatric nursing. Further discussion of nurse involvement in these treatments is needed.

Helping Young People Who Self-Harm: Perspectives From England

Abstract: TOPIC: Interventions for young people who self-harm. PURPOSE: To inform the international community of concerns that have arisen in England in relation to self-harm in young people, the therapies available to young people, and the evidence base for these therapies. SOURCE(S) USED: Published literature on the topic, together with the clinical and academic expertise of the paper's authors. CONCLUSIONS: A variety of treatment modalities (categorized according to whether they were individual, family, group, or psychopharmacological therapies) used in England with young people who self-harm are discussed. The overall picture regarding these interventions is unclear: a few have no research evidence; some, however, do show promise though limitations in study design, and a lack of replication means no definitive conclusions can be drawn. There needs to be further research and development in this area, especially evaluative research of interventions. Nurses should play a lead role here as they are often in the most unique position to help young people who self-harm. Language: en

Promoting Positive Developmental Outcomes in Sexual Minority Youth Through Best Practices in Clinic-School Consultation

Abstract: TOPIC: Educational and healthcare service delivery systems play an important role within the lives of sexual minority youth. PURPOSE: To provide justification and recommendations for improving the coordination and collaboration of school-based mental health professionals and child and adolescent psychiatric nurses via presentation of a set of consultation best practices. SOURCES: Multidisciplinary literature specific to sexual minority youth, school climate, clinical experience, and consultation practices. CONCLUSION: Nurses are in a position to advocate for and provide education about sexual minority youth in schools and to provide direct support to this population. By creating collaborative relationships across clinics and schools, information and expertise can be shared and applied to affect change and lead to positive outcomes for all students. Search terms: Sexual minority youth, school climate, consultation, mental health

Educating the workforce who cares for the pediatric population.

Abstract: A recurring belief in modern society is that children are the earth’s most important resource. Indeed, I saw those sentiments on a poster hanging on the wall of the elementary school where I went to vote. Yet, budgets in all educational venues ranging from elementary to higher education are being slashed throughout the country. For years we have advocated for early identification and intervention of mental health disorders of children. Yet, when those children become college students universities lament the number of students needing campus mental health services. In nursing schools across the country, clinical hours in pediatric settings, generally and child and adolescent mental health settings, specifically are declining at alarming rates. Who will take care of the children? How will they do it? And how will they be prepared? We want to discuss three opportunities before us now that provide a proactive mechanism: the Patient Protection and Affordable Care Act (PPACA) Public Law 111-148, the Pediatric Nursing Alliance, and the ISPN White Paper on the educational preparation of advanced practice nurses who provide mental healthcare to children and adolescents. The PPACA contains language that covers many aspects of health care. Much of the components address care being provided in community, home, and school settings— environments well known to nurses and ones where the nursing workforce is well poised to practice. For this discussion, however, we will mention just four aspects of PPACA: primary care workforce; nurse managed health centers; nurse education, practice, and retention; and nursing workforce diversity grants. Funding would be increased for the primary care workforce in that a variety of entities would develop programs that teach provision of primary care. This aspect parallels nicely with the nurse managed health centers component that would provide funding for establishing comprehensive primary care and wellness services for people with limited financial abilities. Providing primary physical and mental health care for underserved populations while affiliated with an academic department of nursing is ideal for the patients served and for increasing opportunities for faculty practice, clinical settings for students, and research. The nurse education, practice and retention component would provide funding for nursing schools or health facilities who demonstrate enhanced collaboration and communication. As child and adolescent psychiatric nurses, we excel at collaboration and communication. Designing a formal operation could be the very next challenge for someone who is reading this right now. Finally, the nursing workforce diversity grants would provide funding for registered nurses to enter bridge or accelerated nursing degree programs. In turn, more nurses would be prepared for graduate education as well as being able to provide care in the complex contexts mentioned above. The Pediatric Nursing Alliance (PNA) is a coalition of organizations formed to strengthen and secure the well being and welfare of children and their families. PNA wants to address five areas that impact quality care of children and families: access, advocacy, care coordination, education for pediatric nurses, and safe evidence-based nursing practice. International Psychiatric Nurses Association (ISPN) was one of the 17 pediatric nursing organizations that met in November 2009 to begin the collaborative dialog. In that meeting, representatives from the nursing groups mapped out the dilemmas they face in supporting the health and mental health of children. The group developed a White Paper, Securing the Future of Children’s Health, which can be accessed at http://www.pedsalliance.org. On the web site you can also view videos of the topic groups that crafted strategies to address education, policy, access and quality. Maintaining ISPN representation with the PNA is one way that the pediatric agenda, in general and pediatric mental health, specifically remains on the national radar. Together we can move towards creating prevention-oriented mental health system as well as one geared to early recognition and intervention. Finally, an ISPN/American Psychiatric Nurses Association (APNA) Task Force recently completed a white paper: The Educational Preparation of Advanced Practice Nurses to Address the Mental Health Needs of Children and Adolescents. The task force, ably led by Dr. Margaret Brackley, presented the paper at the April 2010 ISPN Annual Business Meeting in St. Louis, Missouri. The paper alludes to the significance of collaboration and supports increasing primary care practice knowledge of children’s mental health as well as increasing the knowledge that the psychiatric mental health (PMH) workforce has about life span development. Recommendations include competencies for graduates of primary care practitioner programs and competencies for the preparation of PMH Advanced Registered Nurse Practitioners. This differentiation between mental health competencies for primary doi: 10.1111/j.1744-6171.2010.00241.x © 2010 Wiley Periodicals, Inc.

The intersection of CBPR, health disparities, and child and adolescent mental health.

Abstract: For more than a decade, communities and their academic partners have used community-based participatory action research (CBPR) to build knowledge and support social justice. CBPR has been referred to as a transformative approach to both qualitative and quantitative research that emphasizes co-learning (through which community and academic partners exchange knowledge and expertise), capacity building (in which partners commit to training community members in research processes and other skills), mutual benefit (through which knowledge produced by the research process benefits all partners), and a long-term commitment to eliminating health disparities. By exposing and addressing systemic factors influencing health behavior and tackling issues of concern to stakeholders in the community, CBPR is well suited for bridging gaps in health disparities research and addressing questions of interest to readers of the Journal of Child and Adolescent Psychiatric Nursing.