Question

Emma is a 12-year-old girl enrolled in year 7 at a local state high school. Since commencing high school this year, Emma’s academic results have dropped significantly over the past 9 months from an A to a C level student. She has lost interest in completing schoolwork and participates little in class. She regularly misses days from school and when she is there, frequently isolates herself at break times and asks to go home as she is feeling ill. Teachers have spoken to you as the School Based Youth Health Nurse regarding Emma’s wellbeing. They are concerned as to whether there may be any physical or mental health issues impacting Emma’s presentation at school. After speaking with Emma’s mother to obtain the background case history information detailed below, you consult the School Guidance Officer who refers Emma to the local Child and Youth Mental Health Service (CYMHS), requesting COPMI support and investigation of potential anxiety disorder.

Demographic information
Emma lives with her mother Julie, aged 29 and younger sister Ariella, aged 9. Julie’s husband Paul is aged 32 and works as a Fly in Fly out (FIFO) miner who spends 2 weeks away then 2 weeks back in town. Paul lives separately, about 15 minutes’ drive away, after acrimoniously separating from Julie for a second time, 9 months ago. Despite Paul being in town for 2 full weeks at a time, he has been unpredictable in his contact with both Emma and Ariella. Julie reports that Paul will often turn up to her house at odd hours before school or in the evening, demanding to see the girls. He will yell and argue loudly with Julie about child support payments and contact with the girls whilst his daughters remain inside the house. To cope with this stressful contact, lack of nearby family support and financial worries caused by unemployment, Julie self-medicates with a combination of alcohol and medications. On one occasion after school, Emma found her mother unconscious as a result of overdose. Emma later overheard paramedics say that if she hadn’t called 000 when she did, her mother would have died.

In your discussion with Julie, she describes spending her childhood in a regional town however she left home at 15 years of age as a result of her own parent’s separation and divorce following paternal alcohol problems. Julie has had limited contact with her parents and younger sister since that time. She described feeling highly anxious during her teenage years whilst living on the streets. To cope with her anxiety, she engaged in substance misuse for 18 months before falling pregnant with Emma. Whilst pregnant with Emma, she met Paul and soon married him. For a short time, Julie and Paul lived with Paul’s parents in the regional town however Paul’s father was frequently verbally and physically aggressive towards them so they moved to the city in the hope that Paul could have improved employment opportunities. Two years later, Julie fell pregnant with Ariella who is Paul’s only biological child. Paul has made it clear to Emma from a young age that she is not his child and that he prefers to spend time with Ariella. Emma has never met her biological father as Julie has had no contact with him since informing him of her pregnancy with Emma. Emma is described by her mother as mature for her age, with a shy, sensitive and caring nature. She has a small group of close friends who she has maintained regular contact with up until the last 6 months. Since then, Emma has preferred to come home and spend time in her room despite regular invitations to visit friends after school and stay for sleepovers. From the age of 8 years onwards, Emma has had a love of netball, regularly attending all weekly practice sessions and weekend games. However, at the start of this netball season Emma has only attended sporadic practices and games, preferring to stay at home with her mother and sister. Julie reported that Emma has more recently complained of feelingsick before school and frequently asks to stay home. Julie explains that she has allowed this to occur on several occasions, particularly when she is stressed knowing Paul is home from his FIFO work.

1. Emma is aged 12. Identify the developmental (biological and psychological) issuesto be considered by the nurse when caring for Emma;
2. Relate information in Emma’s history to known factors associated with risk of mental illness in adolescents;
3. List the potential impacts for Emma related to her schooling and social interactionsif she and her mother are not engaged with mental health services? Summarise strategies mental health nurses can implement to engage with the family;
4. Outline methods the mental health nurse, aware of the potential for re-traumatisationand the reality that ongoing trauma may still be present in their life experience, will use to build trustwith Emma and her mother;
5. Review the HEEADSSS assessment tooland the MSE for children: Write two questionsyou would pose to Emma about school and netball(education, activities: alone and with peers)– to engage Emma in conversation(speech, concept of self/others, positive attributes).
6. Complete a risk assessment(see table on the last page of this document);
7. Emma has a provisional diagnosis of anxiety. In the context of child and youth mental health services, outline the aim of early intervention.  Summarise the pharmacologic and non-pharmacologic approachesto care and identify referral and support pathways to other health care professionals and services.

Answer 1

Every person expects a happy life in this whole world, Anyway Emma is a 12 year old child, in this small age she should deserve a happy life.

1.She has lost interest in studies and schoolwork. Her results Dropped from A to C. She missess her classes by taking leave telling that she is not feeling well, she isolates herself from other students, participates less in recreational activities.so the nurse must consider this issue.

• Emma father quarrel with her mother julie infront of the children, which develops a bad impact on emma. She has not seen her father and she missess the love of her father as he loves Ariella infront of Emma.
• On another occasdion Emma found her mother unconscious resulting overdosages of alcohol due to the stress in the family. All these things should be considered by the nurse.

2.Isolating self from the school freinds, not going to school regularly, Drop in school propgress reports, losing interest in studies These all things shows that she is not getting proper attention by the parents. The care, love and affection which should be given to the child is lacking. That 's so why is going into the state depression.

She has not seen her biological father but the present father is also not taking care of her.

Her father is not at home most of the time due to his official work but when he comes home from FIFO for leave then also he makes a big issue with his wife julie.He tells that Emma is not her child. Though she is a small child but now she is stepping into the adoloscene stage and she understands everything. So anxiety develops in this condition and turns as a disorder.

3. Teachers have spoken to you as the School Based Youth Health Nurse regarding Emma’s wellbeing. They are concerned as to whether there may be any physical or mental health issues impacting Emma’s presentation at school. After speaking with Emma’s mother to obtain the background case history information detailed below, you consult the School Guidance Officer who refers Emma to the local Child and Youth Mental Health Service (CYMHS), requesting COPMI support and investigation of potential anxiety disorder.

• Encourage the mother and child to participate in the yogas, behavioural classes, spiritual gatherings and to participate in recreational programmes+

4. HEEADSSS

H- home environment

E- education and employment,

E- eating, peer related

A- activities

D- drug

S - sexuality,

S- suicide

S- safety from injury