Overview
As a healthcare practitioner, you will be required to work with people at various stages of development, including children and adolescents. Adolescence can be particularly challenging as the individual negotiates new social roles, contends with sometimes difficult family and extra-familial contexts, experiences rapid physiological and neurological development and sexual maturation and develops a personal narrative separate from the family. Healthcare practitioners need to consider these issues when interacting with young people and their families.
Learning outcomes
1. Connect developmental theories to mental health and ill health, social roles and personal narratives of a meaningful life.
2. Visualise the young person within family constellations, emerging identities and physiological changes.
3. Design, in partnership with consumers, helpful interventions to common mental health conditions for young people.
Task
You have been asked to provide a treatment report on a client (a child or adolescent) that can be used in referral or handover. The report can either be based on a previous or current child or adolescent client with whom you have worked. Alternatively, you can utilise the case study in Appendix A. The report must contain the following sections (an example of a template is included in Appendix B):
1. Background
2. Formulation
3. Treatment plan
4. Letter to GP (Note the letter should clearly and briefly outline 1,2 & 3)
Note that this is a report. However, your formulation should cite appropriate literature to support your formulation.
Appendix A: Provided case study (optional)
Name: Talaihla Smith
Date of Birth: 12.07.2006
Talaihla was brought to a local emergency department on an emergency examination authority (Queensland) after consuming a quantity of pills from the bathroom cabinet.
She lives with her mother, Karen, and younger brother, Zane, who is nine years old, has behavioural problems and is probably on the autistic spectrum. Talaihlas parents separated when she was nine years old. Her father re-partnered and moved interstate with his new family. Talaihla doesnt hear from him often but does spend holidays with him.
The night of the overdose was unexceptional. Karen finished up at 5pm from her disability support job and picked up Zane from after school care. Talaihla was in her room when Karen and Zane got home, which was not unusual. She refused to come out for dinner. Talaihla was still angry that her mother had refused to allow her to go a party on a school night earlier in the week. She did come out of her room at 9pm and had a snack. Talaihla posted a picture of a handful of pills and a goodbye message on Instagram around 10pm, and a concerned school friend rang Karen. Talaihla acknowledged she had taken an overdose, and Karen rang the ambulance. Talaihla refused to talk to the ambulance crew.
Whilst Talaihla was medically cleared by toxicology, she was not cooperative with the triage nurse. She was more forthcoming with you, the acute care team worker. She disclosed that she had started cutting herself on the thighs some six months ago after an incident at a party, which she didnt want to discuss. She said that life really sucked since she started high school. She volunteered that she really hated her body and that everyone thought she was fat and ugly. She wont eat lunch at school and frequently skips dinner. She has recently started making herself vomit after she sneaks out to the refrigerator late at night and eats too much.
She said that a boy had asked her to a party earlier in the week, and she wasnt allowed to go. She saw a picture of him kissing another girl on social media, and then, she decided to kill herself. She occasionally thinks about suicide as everyone talks about it, and a girl who used to be her best friend earlier in the year told her she should go and do it. She hadnt, however, formulated any clear plan.
Karen was aware that Talaihla had fallen out with her best friend from primary school. She was surprised by the overdose. She said that Talaihla used to be her best friend and was warm and affectionate, but since starting high school and hitting puberty, Talaihla didnt want to talk to her. Talaihla does, however, have a warm relationship with a grandfather and has a small network of girlfriends whom she hangs out with. She is academically OK, and she continues to go to piano lessons every week. She used to play netball but stopped that this year as she said she is too busy with school. This year, she wants to go out to parties, but Karen says she will only let her go out on weekends with a strict curfew. She says Talaihla doesnt ask very often. Lately, says Karen, Talaihla has been -a bit of a drama queen- but will laugh and giggle when they all watch a movie together.
Talaihla says that it was all a silly mistake, and she thinks she should go home soon. You need to write up your plan for discharge, discuss your formulation with the Consultant and write a letter recommending follow-up.
Appendix B: Report sections
Background
Succinctly describe the key mental health issues and relevant background information in this case.
Outline what additional information you would like to obtain and from whom.
Formulation
Construct a succinct psychosocial formulation that will explain and guide treatment and follow-up in language that both the individual and family will understand.
Outline the salient and important issues that you have considered in arriving at this formulation with reference to developmental theory.
Describe how you would assess and mitigate risk of self-harm, suicide or other risks.
Treatment plan
• Outline a plan that will enable the individual to be safely discharged and include recommendations for follow-up and support.
• Outline a prescription for lifestyle advice to enhance the young persons wellbeing.
Letter
• Write a letter to the individuals general practitioner (cc appropriate agencies), provide a discharge summary and summarise your follow-up plan.
Southern Cross University
Mental health across the lifespan
Assessment 2: Rubric
Criteria High Distinction Distinction Credit Pass Fail
Background (10%) I —a- Patient background is extremely comprehensive. An excellent, thorough and accurate consideration of all relevant constellations. Patient background is very comprehensive. Thoroughly and accurately considers relevant constellations. Patient background is quite comprehensive. Accurately considers relevant constellations. Patient background is addressed. Considers mostly accurate and relevant constellations. Patient background is poorly considered. Does not accurately address relevant constellations.
Formulation (35%) Provides an excellent interpretation of the presenting problem, including excellent consideration of background, diagnosis, theory and research Provides a good interpretation of the presenting problem, including good consideration of background, diagnosis and theory. Provides an interpretation of the presenting problem, including consideration of background and diagnosis. Provides limited interpretation of presenting problem, with some consideration of background and/or diagnosis. Provides inaccurate or incomplete interpretation of presenting problem, with limited to no consideration of background and/or diagnosis.
Treatment plan (35%) Treatment plan is extremely extensive and utilises a very comprehensive patient-centred approach, accurately interpreting the most current evidence-based literature and is congruent with formulation The treatment plan is very extensive and utilises a comprehensive patient-centred approach, accurately interpreting the most current evidence-based literature. Treatment plan is extensive and utilises a patient-centred approach, mostly accurately interpreting current evidence-based literature and has some relationship with the formulation Treatment plan is provided and mostly considers a patient-centred approach. Interpretation of some, OR inaccurate interpretation of, evidence-based literature. Treatment plan is limited and has some OR no consideration of a patient-centred approach. Limited OR inaccurate interpretation of evidence-based literature.
1” Letter/ Communication (20%) Clear, succinct and insightful outline of the background, formulation, recommended treatment plan, referrals and anticipated outcomes Flawless writing. A clear and succinct summary is provided with sound recommendations to address problems, Almost flawless writing. Very good writing style, and each section is addressed competently with a brief and adequate plan for followup. A good enough summary of key issues outlined but perhaps some errors, simplistic formulation or unremarkable recommendations Poorly articulated letter. Errors in grammar, spelling or factual inconsistencies.
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