Child and Adolescent Management A Collaborative Approach to Care June 30, 2018 * Tex-CHIP Training Series

Medical Management of Disruptive Behaviors in Children and Adolescents

Understanding Provider Role in Treating Children and Adolescents Primary Care Providers Provide: Immunization follow-up & School/Activity Physicals Care for minor injuries and illnesses (sometimes not so minor) Regular “well checks” to insure MILESTONES are being met at every age. Examples of what is included: Physical Growth/Motor Skills (especially in early years) Cognitive Functioning Language Psycho-Social-Emotional Address Parental Concerns A lot of ground to cover in one brief appointment!

Considerations when Interacting with Clients In general with children and adolescents: Interactions and examinations are within the context of developmental age and expectations Concerns for reason for the appointment AND: Trauma – all types Signs & Symptoms of Behavioral Health (Mental Health & Substance Abuse) Issues Sexual activity (depending on age) Assessing without parental presence Opportunity to assess multiple concerns within a very short time span and needing to have continuity over time for trust.

Our Treatment Plan Healthcare Domain: Primary Care Clarification: Client (patient) is Marta Provider: Nurse Practitioner Objective: Provide alleviation of presenting problems as indicated by client’s report: (a) Feels “well” as evidenced by resolved “cold” symptoms and headaches. (b) Improved sleep patterns (c) Feels supported - able to cope better with the demands of (functionally) being a single parent.   Goals: a)  Improvement or resolution in overall generalized malaise b)Marta’s sleep will be (7 – 8 hours nightly) (c)  PHQ-4 Scores will improve (quantify) Interventions:  Address “cold symptoms” and general complaints of malaise with “forcing fluids” and possibly prescription, depending on the specified “cold” symptoms. Provide non-pharm sleep hygiene suggestions to be followed with the team. (See below) c)  Per the Case study, refer Marta to the Interdisciplinary Team (IT) for further assessment and assistance for Marta and Sam. “Normalizing” what is common for young children when parental figures are deployed and leverage lack of behavior issues in school.  d) Encourage Marta to explore ways to get respite periods when working with the IT through family/friends. Explore whether the Navy have a family support program especially with the deployments

Measuring Outcomes/ Success Priority focus on Marta’s wellbeing. “Cold Symptoms” improved or resolved based on specific symptoms such as cough or sore throat. WBC return to normal ranges. Report of more “restful” consistent sleep (7 – 8 hours/night). Eating more regular/nutritious meals Identify/use social support for herself (Marta) Improved PHQ-4 Scores After the interdisciplinary team has had the opportunity to follow-up with a more comprehensive assessment of Marta and Sam, then PCP can determine the best way to participate with the team. It is feasible, as the team works with Marta and Sam and Marta’s presenting symptoms resolve, Sam’s disruptive behaviors may subside – think “parallel process.”

Communication from Counselors Since the Primary Care Provider (PCP) referred on the basis of Mother’s report, the communication of the assessment findings from the counselors is essential – both findings from further assessment of Marta and Sam. Additionally, how are Marta and Sam responding to interventions and recommendations? Should the PCP also see the child in reference to Mother’s report? SBAR communication.