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