The Assignment Respond to at least two of your colleagues by recommending at least one additional way you would treat a child or adolescent client differently than you would an adult and at least one additional way you would address the legal and ethical issues involved. Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. Colleagues Response # 1 Wk 6- Adult vs. Pediatric Emergencies             Adults presenting for psychiatric emergencies are often handled quite different than children.  The decision-making rights of an adult is one of the most basic human rights that must be respected whenever possible (Mental Health America [MHA], 2015).  However, children and adolescents presenting for psychiatric emergencies also have rights, but these rights are sometimes different because of their inability to make some independent decisions as a result of them not being of age to grant legal consent.  Take for example, Sara, a 41-year-old female presenting to the emergency department after a domestic violence dispute with her husband.  Sara’s husband has been physically and emotionally abusive for years.  The most recent physical assault resulted in her needing stitches in her forehead and multiple bruises are visible on her face and body.  Sara was treated for her injuries, a police report was filed, and she was provided information of shelters for victims of domestic violence.  However, Sara declined all offers and asked to be released from the hospital so that she could go bail her husband out of jail.  This case is unfortunate, but not uncommon, with many women choosing to return to their abusive partners.              In contrast, consider a child presenting to the emergency department with similar injuries inflicted by the parents.  However, this case is less obvious with the parents saying the injuries were “an accident”.  When the nurse attempts to evaluate the child, without the parent in the room, the parent refuses to leave, thereby making the nurse suspicious of child abuse.  This situation is quite different in that the child’s physical injuries and suspected abuse must be reported.  The provider that suspects or discovers child abuse is considered a mandatory reporter and are required, by law, to report suspected child abuse (Child Welfare Information Getaway, 2019).  Mandatory reporting of suspected child abuse is both a legal and moral requirement for psychiatric providers.  We must advocate for our young clients and psychiatric providers have a legal and ethical duty to continually evaluate their safety in the home environment (Sadock et al., 2014).  Based on this concern, I would call the police and Child Protective Service (CPS) to assist with evaluating the safety of this child’s home environment.           The child’s safety at home and mandatory reporting is quite different from that of Sara, the adult victim of domestic .

1. The Assignment
Respond
to at least
two
of your colleagues by recommending at least one additional
way you would treat a child or adolescent client differently than
you would an adult and at least one additional way you would
address the legal and ethical issues involved.
Support your responses with evidence-based literature with at
least two references in each colleague’s response with proper
citation in APA Format.
Colleagues Response # 1
Wk 6- Adult vs. Pediatric Emergencies
Adults presenting for psychiatric emergencies are often
handled quite different than children. The decision-making
rights of an adult is one of the most basic human rights that
must be respected whenever possible (Mental Health America
[MHA], 2015). However, children and adolescents presenting
for psychiatric emergencies also have rights, but these rights are
sometimes different because of their inability to make some
independent decisions as a result of them not being of age to
grant legal consent. Take for example, Sara, a 41-year-old
female presenting to the emergency department after a domestic
violence dispute with her husband. Sara’s husband has been
physically and emotionally abusive for years. The most recent

2. physical assault resulted in her needing stitches in her forehead
and multiple bruises are visible on her face and body. Sara was
treated for her injuries, a police report was filed, and she was
provided information of shelters for victims of domestic
violence. However, Sara declined all offers and asked to be
released from the hospital so that she could go bail her husband
out of jail. This case is unfortunate, but not uncommon, with
many women choosing to return to their abusive partners.
In contrast, consider a child presenting to the
emergency department with similar injuries inflicted by the
parents. However, this case is less obvious with the parents
saying the injuries were “an accident”. When the nurse
attempts to evaluate the child, without the parent in the room,
the parent refuses to leave, thereby making the nurse suspicious
of child abuse. This situation is quite different in that the
child’s physical injuries and suspected abuse must be reported.
The provider that suspects or discovers child abuse is
considered a mandatory reporter and are required, by law, to
report suspected child abuse (Child Welfare Information
Getaway, 2019). Mandatory reporting of suspected child abuse
is both a legal and moral requirement for psychiatric providers.
We must advocate for our young clients and psychiatric
providers have a legal and ethical duty to continually evaluate
their safety in the home environment (Sadock et al., 2014).
Based on this concern, I would call the police and Child
Protective Service (CPS) to assist with evaluating the safety of
this child’s home environment.
The child’s safety at home and mandatory reporting is
quite different from that of Sara, the adult victim of domestic
violence. Despite the blatant lack of safety within Sara’s home,
she can return to her abuser regardless of risk for her safety.
This is quite different when it comes to child abuse.
Regardless of a child’s wishes to return to an abusive
household, providers determine safety first, with the child’s

3. requests often being ignored if safety is a problem. The big
difference between Sara and a child being that I cannot prevent
Sara’s return to her abuser, but for a child, law enforcement and
CPS can step in and assume custody of a child that is in an
unsafe home environment.
Legal and Ethical Issues
Legal and ethical issues surround the reporting of abuse
for adults and children. Although I am required to report Sara’s
abuse to law enforcement, she may refuse to press charges and
elect to return to her abuser. For a child victim of abuse, this
outcome is often quite different. Providers are mandated by law
to report the abuse and removal from the home may occur
regardless of the child’s wishes (Sadock et al., 2014).
References
Child Welfare Information Getaway. (2019).
Mandatory reporters of child abuse and neglect - child welfare
information gateway
. Retrieved October 5, 2020, from
https://www.childwelfare.gov/topics/systemwide/laws-
policies/statutes/manda/
Mental Health America. (2015, March 7).
Position statement 22: Involuntary mental health treatment
. Retrieved October 5, 2020, from
https://www.mhanational.org/issues/position-statement-22-
involuntary-mental-health-treatment
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.

4. Colleagues Response # 2
Treatment of psychiatric emergencies in children versus adults
A previous case I experienced involved a 22-year-old
female. She was being seen by a therapist for weekly
psychotherapy due to generalized anxiety disorder and major
depressive disorder. She had difficulty with transitioning from
home to college and felt hopeless. She began to isolate from her
family and friends and developed worsening anxiety, isolation,
and depressive symptoms. During a weekly therapy session, she
disclosed that she had suicidal thoughts, a plan to overdose on
her medication, and intention to do so. She could not contract
for safety with the therapist. The therapist talked to her about
going to an inpatient psychiatric facility because of these
thoughts and the client was receptive to this information. The
therapist called the facility to set up an evaluation and the client
stated that she would drive there and voluntarily admit herself
to the hospital. We saw the client after she was released from
the hospital and she thanked the therapist for helping her
through a “dark period in her life.” She denied any ongoing
suicidal thoughts and felt safe in her living environment.
Differences with Children
Children are treated differently than adults during psychiatric
emergencies. Children are minors and cannot admit themselves
to a hospital. A parent or guardian needs to sign them in for
them to be admitted, in most cases. Technically, children are
voluntarily admitted because their parents have taken them to
the hospital and signed them in. However, many children do not
want to go to the hospital so are personally involuntary. I often
see this in my work as a pediatric psychiatric nurse in an
inpatient unit. Kids are often upset and angry about coming to
the hospital despite being ‘voluntary’ admissions.

5. The practitioner must assess the minor and determine if suicidal
thoughts or other emergencies require hospitalization.
Psychiatric admission is required if the client is ambivalent
about suicidal thoughts and is a harm to themselves or others
(Sadock et al., 2014). This practice is similar to adults but with
children and adolescents, parents or guardians are also involved
in the decision and treatment.
Legal and Ethical Issues
One major ethical and legal consideration with children and
adolescents is involuntary commitment. This issue is complex
because the child may disagree with the decision of the parents
and the practitioner (American Academy, 2020). The
practitioner must consider the best interest of the child and their
developmental level when making the decision for them to be
treated in an inpatient facility (American Academy, 2020). In
addition to this, a parent may want to have their child
discharged after they have been admitted to an inpatient
facility. Under the involuntary treatment act, the minor can be
held for 72 hours and then the court will need to petition for the
minor to be involuntarily committed for an additional 14 days
(American Academy, 2020). In my experience, this becomes
especially upsetting and disruptive. An example of this occurred
when an adolescent’s parents were strongly encouraged to have
their child admitted to the facility. After three days they wanted
the child to be discharged but the psychiatrist did not think the
child was safe to go home. The parents signed a 3-day document
and the legal system became involved. Ultimately, the court
sided with the psychiatrist and the patient was held against his
and his parent’s will. The parents and patient were very upset
and were especially angry with the nursing staff and hospital for
the events. These situations must be carefully considered and
ultimately the patient’s safety and best interest must be the
center of decision making.

6. Another ethical and legal consideration when working
with minors in emergency cases is physical and chemical
restraints. Restraints affect the child’s safety and autonomy and
must be carefully considered. Restraints should be used as a
very last resort for a child who is an immediate danger to
themselves or others (Carubia et al., 2016). It is especially
important that the practitioner examines the state of the child
and thoroughly determines if the child will be a threat to
themselves or others before restraint is applied.
References
American Academy of Child & Adolescent Psychiatry. (2020).
Ethical issues in clinical practice.
Retrieved from
https://www.aacap.org/AACAP/Member_Resources/
Ethics/Ethics_Committee/Ethical_Issues_in_Clinical_Practice.a
spx
Carubia, B., Becker, A., & Levine, B. H. (2016). Child
psychiatric emergencies: Updates on
trends, clinical care, and practice changes.
Current Psychiatry Reports
,
18
(41). https://doi.org/10.1007/s11920-016-0670-9
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.

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