Uncategorized
Critique your colleague’s targeted questions, and explain how the patient might interpret these questions
Respond two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why. 3 APA style references/ citations
Post One
BK is a 16-year-old Caucasian female who comes in with her grandmother for an annual exam. The grandmother reports BK has been “acting strange, staying in her room all the time and refusing to do things she used to enjoy like singing in the youth choir.” Grandmother shares that BK’s mother is a drug addict is currently incarcerated, so she is worried BK is using drugs and wants her tested for drugs. BK is not on any medications. She is obese and does not make eye contact when you enter the room.
Haskins et al. (2018) stated that one in every 14 children has had a parent in some form of correctional supervision (approximately eight million children are affected). The authors have found that the outcomes for children of incarcerated parents include disruptive behavior, hyperactivity, aggression, anxiety, inhibition, and depression.
The Pew Research Center (2018) stated that 10% of children living with grandparents live below the poverty line. The majority (15%) of these children are Black or Asian. Thirteen percent of Black children living with a grandparent live below the poverty line, followed by 11% for Asian children. Forty percent of children living with a grandparent live without a parent in the home. Smith and Palmieri (2007) found that children living with grandparents had more behavioral disturbances than children living with parents. The researchers found that more custodial difficulties were related to white children than black children.
Adolescent Drug Screening and Limitations
I would explain the limitation to drug testing to the patient and her grandmother. Levy et al. (2014) stated that the American Academy of Pediatrics (AAP) noted that blood testing for drugs helps detect alcohol and other drug use within the past two to 12 hours. Blood testing is intrusive and requires special equipment and personnel; these limitations make blood testing rare in primary care settings. Urine drug screening (UDS) is less invasive and allows for a more extended detection period for some substances, and is the more prevalent screening method used in primary care. There are two types of UDS available: qualitative testing for screening and quantitative for confirmation. False-positive and false-negative results are common with UDS, and the AAP advises clinicians to seek verification assistance from the testing laboratory with test result interpretations.
Levy et al. (2014) stated that the AAP strongly recommends protecting the dignity of the adolescent in question and attaining a reasonable balance between the teen’s overall health and the necessity of such testing. Forgoing a drug test and basing clinical decisions on the patient’s health history and physical examination will help establish or preserve a provider-patient relationship. If there is a suspicion of illicit drug use, the clinician can refer the patient for further evaluation by a mental health provider. The AAP cautions against involuntary drug testing in adolescents. If the child is competent, drug testing without her consent is impractical, erodes her trust in health care providers, and testing without her knowledge is unethical.
Guidelines for Adolescent Depression in Primary Care (GLAD-PC)
I would use the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) tool, as recommended by the American Academy of Pediatrics (Zuckerbrot et al., 2018). The guidelines distinguish from mild, moderate, and severe forms of major depressive disorder (MDD).
Five Targeted Questions
Before asking the patient health history questions, I would ask the grandmother to leave the room to provide the patient with privacy and answer the questions more candidly. Prior to administering the GLAD-PC questionnaire to the patient, I would first prompt her by asking questions relating to those included on the scale (one through four):
1. Your grandmother mentioned that you had lost interest in singing in the youth choir; why do you think this has happened?
2. What is the most challenging part of your life right now?
3. How do you feel about your mom’s incarceration?
4. What do you like to do for fun in your spare time?
5. Would you consent to a drug screen? (I would not perform the test without the patient’s consent, and only if both the patient and her grandmother now understood the limitations of drug testing)
After asking these targeted questions, I would ask the patient to complete the GLAD-PC questionnaire and continue gathering information for completing the patient’s health history.
References
Gerlach, J. (2020). Teens of incarcerated parents: A group counseling intervention for high school counselors [PDF]. Journal of School Counseling, 18(16). https://files.eric.ed.gov/fulltext/EJ1254173.pdf
Haskins. A. R., Amorim, M., & Mingon, M. (2018, March). Parental incarceration and child outcomes: Those at risk, evidence of impacts, methodological insights, and areas of future work. Sociology Compass, 12(3), 1-14. https://doi.org/10.1111/soc4.12562
Levy, S., Siqueira, L. M., & Committee on Substance Abuse. (2014). Testing for drugs of abuse in children and adolescents. Pediatrics, 133(6), e1798-e1807. https://doi.org/10.1542/peds.2014-0865
Pew Research Center. (2013, September 4). Children living or being cared for by a grandparent. https://www.pewresearch.org/social-trends/2013/09/04/children-living-with-or-being-cared-for-by-a-grandparent/
Smith, G. C., & Palmieri, P. A. (2007, October). Risk of psychological difficulties among children raised by custodial grandparents. Psychiatric Services (Washington D. C.), 58(10), 1303-1310. https://doi.org/10.1076/ps.2007.58.10.1303
Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. E. K., Laraque, D., Levitt, A., Birmaher, B., Campo, J., Clarke, G., Emslie, G., Kaufman, M., Kelleher, K. J., Malus, M., Sacks, D., Waslick, B., & Sarvet, B. (2018, March 1). Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics, 141(3), Article e20174082. https://doi.org/10.1542/peds.2017-4081
Post 2
I have the case study of BK, who is a 16-year-old Caucasian female with a drug addicted mother that lives with her grandmother. This patient is interesting in that building the health history requires a large socioeconomic approach and less of a physical one. BK has quite a few issues regarding her past and present that appear to be having significant effects on her being. Her situation where she is living with her grandmother due to her mother’s incarceration may have profound psychological effects on BK. Children in this situation often feel lost, alone, or abandoned and have security issues regarding their care (Reed & Reed, 1997). Having her grandmother as a primary caregiver is helpful, but this also places the grandmother in a compromising position, since the lost caregiver happens to be her daughter.
There are many significant social issues simultaneously at play in this scenario. Building a health history might be more helpful if information was also gathered from the grandmother. Information based around whether the grandmother is on assistance and able to provide for her granddaughter. Does the grandmother have a job, which would put BK in a latchkey situation? And probably the biggest question which would be an assessment of the grandmother’s ability, is she able to deal with not only the trauma of her own daughter going to jail for drugs, but her granddaughter’s emotional stability of the same issue (Gordon, 2018).
BK’s obesity is of concern, not primarily for the physical aspect, but to determine how it plays a part in her experience. It is not difficult to understand that BK may be going through some very difficult interpersonal issues. Understanding where she is and how to approach her to provide the best treatment is of high importance. The probability that she is experiencing a degree of depression should be considered, and finding out if her obesity is a byproduct of depression, or depression stems from her obesity is an important information to design a therapeutic approach (Boutelle et al., 2010).
BK’s situation is complex and deserves attention and focused treatment based on the information gathered. A careful approach is required to gain the trust of BK, so she feels safe answering the questions. BK lacks security in her life and needs as much support as can be offered, but it is also important to ask BK the questions away from her grandmother to avoid pressure of judgment from anyone else (deKemp et al., 2007).
The questions I would ask BK are:
1. Do you feel safe living with your grandmother?
2. Have you ever tried or thought of hurting yourself?
3. Have you ever taken drugs or drank alcohol? How often/much?
4. Can you tell me some of the activities that you enjoy doing alone and with your friends?
5. On a regular day, can we talk about what you eat for your meals?
I feel the information gathered from these questions would help me build a rudimentary idea of what is happening with BK and what treatment she needs.
Boutelle, K.N., Hannan, P., Fulkerson, J.A., Crow, S.J., & Stice, E. (2010). Obesity as a
predictor of depression in adolescent females. Health Psychology, 29(3), 293.
de Kemp, R.A., Overbeek, G., de Wied, M., Engels, R.C., & Scholte, R.H. (2007). Early
adolescent empathy, parental support, and antisocial behavior. The Journal of Genetic
Psychology, 168(1), 5-18.
Gordon, L. (2018). ‘My daughter is a drug addict’: grandparents caring for the children of
addicted parents. Kotuiti: New Zealand Journal of Social Sciences Online, 13(1), 39-54.
Reed, D.F., & Reed, E.L. (1997). Children of incarcerated parents. Social Justice, 24(3(69),
152-169.