PMHNP: Working with Pediatric Patients

00:01 Hi, I'm Jack. I'm a psychiatric mental health nurse practitioner.

00:06 Today we're going to talk about working with pediatrics in a mental health outpatient clinic. Depending on their program and certification, most advanced psychiatric nurse practitioners working with pediatrics have the training and authority to do one of these four things or really, all of these four things: conduct comprehensive psychiatric evaluations, diagnose mental health conditions, prescribed medications, and provide psychotherapy.

00:32 This role is not specific to inpatient or outpatient providers, and you can find providers either collaborating with pediatricians, schools, families, and other health care providers to ensure coordinated care.

00:45 They're particularly valuable in underserved areas where child psychiatrists may be scarce. Psychiatric mental health nurse practitioners must maintain a deep understanding of normal childhood development stages to differentiate between typical behaviors and concerning symptoms.

01:01 For instance, separation anxiety might be normal for a toddler, but concerning for a teenager.

01:08 We use a lot of these screening tools.

01:10 All of those need to be tailored to the age we are using them with.

01:15 You really shouldn't use a tool designed for toddlers when you're trying to treat a teenager or vice versa.

01:21 It won't give you the reliable data that we need.

01:23 Another aspect of this is thinking about physical and social development.

01:27 Hormonal changes during puberty can significantly impact mental health presentations. Asking questions about the timing of symptoms is really crucial. Every child's social development can be different, but there are general stages that affect how children interact with peers and handle their emotions. Really understanding how they should progress helps you see where they are on the continuum.

01:52 Common conditions seen by psychiatric mental health nurse practitioners.

01:55 Number wise, the most frequent conditions we see are attention deficit hyperactivity disorder or ADHD, anxiety disorders, depression, autism spectrum disorders, and behavioral problems.

02:11 Eating and substance disorders often emerge later on in adolescence.

02:17 We also see trauma-related conditions and school-related issues like learning disabilities, anytime there are mental health concerns.

02:25 For example, I see a lot of PTSD in divorced parents.

02:30 This really puts the kids through a lot of stress, anxiety, and that's really a big issue with these kids.

02:37 Complex family dynamics psychiatric mental health nurse practitioners often encounter complex family dynamics that can complicate treatment.

02:45 They may need to navigate custody disputes affecting treatment consent.

02:51 I actually had one of these yesterday in my outpatient clinic towards the end of the day.

02:55 A father brought in his 15-year-old daughter, who was in a crisis that had just done some self-harm at school.

03:02 The father brought her in, signed the consent treatments and during the course of the assessment, the mother of the daughter called who the parents were divorced and said she did not consent to their daughter being treated.

03:14 We just kind of held off on the treatment and asked them to provide some documentation today so that we could see who was actually in charge of consent for that treatment.

03:26 Another thing that can affect treatment is cultural and religious beliefs.

03:29 That's a big thing. It can significantly impact how families view mental health treatment. Some families may seek treatment due to unusual behaviors that turn out to be normal, while others might minimize serious symptoms as it's just a phase. Social media and cyberbullying create modern challenges that affect mental health presentation.

03:50 Parents may look to you for advice on how to talk to their kids and the school about handling these situations.

03:55 In summary, working with pediatrics struggling with mental health issues can be complex, but for me, it's the most rewarding part of my job.

04:04 I see about a third of my patients are pediatrics, and to me it's the most rewarding.

04:10 I love that the kids are honest and open most of the time during the assessment.

04:15 Sometimes you find that adults don't seem to be as honest and open.

04:19 That's why I think working with Peds is my favorite patient population.