Respond to your colleague by providing at least two ways that their strategies may be expanded or improved.   NOTE: Positive comment                                                          Main Post Treating Childhood Abuse Psychiatric  Nurse Practitioners who work with children are mandatory reporters  (Child Welfare Information Gateway, 2019). Each state enacts specific  statutes that will clarify the guidelines/requirements about reporting  suspected child abuse, and it is the obligation of the PMH-NP to know  the law in his/her praciting state (Child Welfare Information Gateway,  2019). Assessing for Abuse Sadock,  Sadock & Ruiz (2014) identify certain vulnerability factors for  PTSD, including the presence of childhood trauma, inadequate support,  genetic predisposition to psychiatric illnesses, and recent stressful  life changes, all of which the patient in the case study displays. I  would keep those facts in mind as I assess any patient for the  possibility of abuse/trauma. First  and foremost, establishing a therapeutic alliance is paramount; there  can be no self-disclosure without trust (Wheeler, 2014). I’m not sure if  this is a “strategy,” per se, but it is the foundation of any  relationship between the PMH-NP and her clients.  As  I researched this topic, and I researched for hours because of the  gravitas of this topic, I found little conclusive evidence for specific  strategies. What I did find was a study from the WHO’s Mental Health Gap  Action Programme (2015) that concluded with,  “Evidence  supporting the efficacy of strategies for detecting maltreatment of  children and youth within the context of mental health and developmental  assessment is sparse and inconclusive. No studies have evaluated the  performance of measures in predicting referrals and health outcomes.  However, it is generally agreed that it is important for health care  providers to detect child maltreatment. It is recognised that assessment  of child maltreatment requires a clinician who is competent enough to  ask the right questions and to respond appropriately’ (p. 17).  While  this is disheartening, it is also a call to action. Not only do we need  to be attentive and alert with our younger patients, it is also clear  that we can and should be doing more to establish evidence-based  protocols for these situations.  With  this particular case, considering this is a nineteen year old adult  presenting with a history of abuse versus current abuse (at least that  has been disclosed thus far), establishing trust and normalizing the  feelings of the client will be my priority. Also, I think it’s  imperative that we know our limits as clinicians and, while I might feel  competent to prescribe medications for this client, I am well aware  that bad therapy can worsen trauma for those with PTSD. I used to work  closely with our Trauma Stress Center at work and they consistently  drove home the importance of shoring up coping skills for these p.

1. Respond
to your colleague by providing at least two ways that their
strategies may be expanded or improved.
NOTE: Positive comment
Main Post
Treating Childhood Abuse
Psychiatric Nurse Practitioners who work with children are
mandatory reporters (Child Welfare Information Gateway,
2019). Each state enacts specific statutes that will clarify the
guidelines/requirements about reporting suspected child abuse,
and it is the obligation of the PMH-NP to know the law in
his/her praciting state (Child Welfare Information Gateway,
2019).
Assessing for Abuse
Sadock, Sadock & Ruiz (2014) identify certain vulnerability
factors for PTSD, including the presence of childhood trauma,
inadequate support, genetic predisposition to psychiatric
illnesses, and recent stressful life changes, all of which the
patient in the case study displays. I would keep those facts in
mind as I assess any patient for the possibility of abuse/trauma.
First and foremost, establishing a therapeutic alliance is
paramount; there can be no self-disclosure without trust
(Wheeler, 2014). I’m not sure if this is a “strategy,” per se, but

2. it is the foundation of any relationship between the PMH-NP
and her clients.
As I researched this topic, and I researched for hours because
of the gravitas of this topic, I found little conclusive evidence
for specific strategies. What I did find was a study from the
WHO’s Mental Health Gap Action Programme (2015) that
concluded with,
“Evidence supporting the efficacy of strategies for detecting
maltreatment of children and youth within the context of
mental health and developmental assessment is sparse and
inconclusive. No studies have evaluated the performance of
measures in predicting referrals and health outcomes. However,
it is generally agreed that it is important for health care
providers to detect child maltreatment. It is recognised that
assessment of child maltreatment requires a clinician who is
competent enough to ask the right questions and to respond
appropriately’ (p. 17).
While this is disheartening, it is also a call to action. Not only
do we need to be attentive and alert with our younger patients,
it is also clear that we can and should be doing more to
establish evidence-based protocols for these situations.
With this particular case, considering this is a nineteen year old
adult presenting with a history of abuse versus current abuse
(at least that has been disclosed thus far), establishing trust and
normalizing the feelings of the client will be my priority. Also,
I think it’s imperative that we know our limits as clinicians
and, while I might feel competent to prescribe medications for
this client, I am well aware that bad therapy can worsen trauma
for those with PTSD. I used to work closely with our Trauma
Stress Center at work and they consistently drove home the
importance of shoring up coping skills for these patients before
ever delving into the trauma, itself. I think too often some

3. clinicians overestimate their ability to help without taking into
consideration the possibility of doing harm.
Exposure to Social Media
As with most things in life, exposure to social media has both
pros and cons, particularly when it comes to mental
health/awareness/illness. On the one hand, good information
and resources are readily available; however, there is also a
glut of bad information. While there does seem to be some
evidence that social media can increase depression and/or
loneliness (Healthline, 2018) due to the tendency to compare
oneself to others, there are other studies which have not
reached that same conclusion. Instead, a study by Berryman,
Ferguson & Negy (2018) seem to suggest that the way social
media is utilized is more important than the mere use of social
media. Certainly, at times social media can increase connection
with others.
Mandatory Reporting
As previously referenced, the mandatory reporting
requirements vary from state to state (Child Welfare
Information Gateway, 2019); however, in the particular case,
the client is nineteen years old. In the case of adults, unless
this is a elderly adult or adult with disabilities (National Adult
Protective Services Association, 2020). If Morgan is not being
currently abused and does not have a disability, mandatory
reporting is not required.
As a side note, per the ANCC IQ practice questions for
certification (American Nurses Association, 2020), even if you
suspect that an elderly patient is being abused, if that patient is
competent, you must respect his/her wishes if they explicitly
forbid you from reporting the abuse to anyone. That surprised
me but the rationale states, “The patient is an adult. He has the

4. right to make decisions for himself. Not all states have
mandatory elder abuse statutes or mandatory domestic abuse
statutes” (https://learning.ana-nursingknowledge.org/
d2l/le/content/8482/viewContent/40740/View, 2020). I would
obviously double-check with state statutes to clarify state law.
References
American Nurses Association. (2020). Psychiatric Mental
Health Nurse Practitioner
Certification Practice IQ. Retrieved from https://learning.ana-
nursingknowledge.org/d2l
home/8482
Berryman, C., Ferguson, C.J. & Negy, C. (2018). Social Media
Use and Mental Health
Among Young Adults.
The Psychiatric Quarterly
89
(2), 307–14. doi:10.1007/s11126-017-9535-6.
Child Welfare Information Gateway. (2019).
Mandatory reporters of child abuse and
neglect.
Washington, DC: U.S. Department of Health and Human
Services, Children's Bureau.
Healthline. (2018). The FOMO is Real: How Social Media
Increases Depression and Loneliness.

5. Retrieved from https://www.healthline.com/health-news/social-
media-use-increases-
depression-and-loneliness
National Adult Protective Services Association. (2020). What is
Adult Protective Services?
Retrieved from https://www.napsa-now.org/get-help/how-aps-
helps/#:~:text=In%20most%20states%20in%20the,professionals
%20to%20report%20their%20concerns.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of
psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.
Wheeler, M. (Ed.) (2014).
Psychotherapy for the advanced practice psychiatric nurse: A
how-to
guide for evidence-based practice.
New York, NY: Springer.
World Health Organization (WHO). (2015). Effective strategies
for detecting maltreatment of
Children and youth within the context of mental health and
developmental assessment.
Retrieved from
https://www.who.int/mental_health/mhgap/evidence/resource/ch
ild_q15.pdf