Psychiatric nurses offer a critical point of view that often is missing in treating adolescents who have mental health issues and are in foster care, according to a recent study.
Adding a mental health nurse to the treatment team would be ideal, Julie Bertram, RN, MSN, PMHCNS-BC, lead author and an instructor at Saint Louis University School of Nursing, said in a news release. He or she could bring a much-needed medical perspective to caring for teens in foster care who have psychiatric disorders. Child welfare workers and social workers dont have the specific training they need to track health problems.
Mental health RNs also would be able to mitigate the national shortage of child psychiatrists, according to Bertram, by helping social workers, case managers, foster families and teens navigate the medical system.
Bertrams work, published in the December issue of the Archives of Psychiatric Nursing, described her role on a treatment team that studied foster youth and chronicled case workers and teens reactions to her involvement. J. Curtis McMillen, PhD, professor at the University of Chicago School of Social Service Administration, was the principal investigator of the study.
Three-quarters of children in foster care have suffered serious traumas such as sexual abuse or mistreatment, according to the release. Typically one or both parents have histories of mental illness and substance abuse.
Not surprisingly, teens in foster care receive mental health services at a very high rate, according to the article abstract. Their use of medications for psychiatric problems is as much as five times the rate of young people who are not in foster care, and many take multiple different drugs.
They frequently change psychiatrists as they move between homes, some accumulating conflicting diagnoses and medicines. They leave foster care without fully understanding their mental health issues and treatment options, according to Bertram.
High rates of psychotropic medication use, polypharmacy and problems in continuity of care have raised alarms about whether youth in the foster care system may be receiving inappropriate treatments for the symptoms they present, Bertram said in the release. The strikingly high rate of medication use may be just the tip of the iceberg when it comes to concerns about quality of care within the child welfare system.
For the study, Bertram served on the care team for eight adolescents with histories of hospitalization for psychiatric problems. These teens took multiple psychotropic medications and lived and attended school in residential care foster facilities essentially locked group homes when the study began. They were transitioned out of the residential settings to live with specially trained foster families.
Bertram served as the teams nurse consultant synthesizing medical information, sharing pertinent details at weekly team meetings and intervening in times of crisis and when routine medical questions arose. She also met with teens and their foster parents, establishing a rapport and trust while teaching them how to have a voice in decisions about their medical care.
Bertram started by reviewing past medical records and charts and interviewing case managers, foster parents, psychiatrists and teens to clarify mental health issues, such as diagnoses and what medications were prescribed. She then organized each teens medical profile to create a comprehensive mental health summary.
Bertram found the teens each had taken an average of 13 psychotropic medications some as many as 21 and had an average of eight different diagnoses for psychiatric problems.
I was able to purge old, outdated or inaccurate diagnoses across cases, which typically reduced the number of diagnoses to an average of two problems, Bertram said in the release. I also reviewed the medication profiles and recommended changes for two teens one based on side effects and another because the teen was taking greater than maximum recommended doses of medications and multiple medicines without clear benefits.
Case workers described managing medical information as ridiculously difficult and said the newly reorganized report was very helpful. The teens said the reports answered questions they had about their diagnoses and gave them information to advocate for their own health needs.
The research was funded by the National Institute of Mental Health.
Study abstract: www.psychiatricnursing.org/article/S0883-9417%2813%2900113-1/abstract