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Journal of Child and Adolescent Psychiatric Nursing
ISSN 1073-6077
Editorial
Why Do We Need A Child Psychiatric Nursing Specialty?
I have a colleague who writes commentary on child mental health and issues of culture, access, and equity. Her recent column concerned the children who were traveling into the country from Central America and the response of the United States citizenry. She stressed the need to react within a frame of equity, a sense of children and respect for their rights. I had been aware of these children and the controversy around the situation but had not put the issue in the context of social justice. I needed a colleague who “sees” situations with that lens to articulate the grounding context. In child psychiatric nursing, we are fortunate to have a cohort of nurses who maintain their practice with children and also eloquently tie their knowledge to the larger issues that affect children’s mental health. Via a long membership in the Association of Child and Adolescent Psychiatric Nurses, first known as Advocates for Child Psychiatric Nurses, I have come to know many of such nurses who see child mental health as a national priority and through that lens isolate issues such as social justice, diversity and equity, policy, how best to support families, and prevention. It is within these dialogs that ideas take root and are then shaped. Such dialogs help us grow as a specialty. One might ask why nursing should be concerned with sustaining and growing a child mental health specialty. What is the need for child psychiatric nurses? Phil Barker (2001) believes that the “need for nursing” grew out of the need for individuals in human crisis to have another person be there for them, supporting them, and providing a relational environment through which the person might grow and eventually grow out of their distress. Over the years, I have come to know many child psychiatric nurses who have embraced that notion. Families raising a child with serious emotional disturbance (SED) need a professional partner to help them through the changes and crises they encounter, including managing the ongoing challenge of creating a healing environment for their child. These child psychiatric nurse specialists marry this commitment to families with an exquisite knowledge of evidence-based interventions and psychopharmacology, knowledge they use to refine and adapt a treatment regime to the child’s changing presentation. The specialty and the families they serve need these nurses.
doi: 10.1111/jcap.12101
Journal of Child and Adolescent Psychiatric Nursing 28 (2015) 1–2 © 2015 Wiley Periodicals, Inc.
The term patient-centered care finds its way into almost every discussion of healthcare reform. But at the most basic level, it begins with a genuine interest in learning what matters to the patient (Epstein, Fiscella, Lesser, & Stange, 2010). That requires understanding how patients’ stories carry meaning and the emotional impact events have over time (Hall & Powell, 2011). To arrive at that place of narrative understanding requires engagement, which in turn demands both intentional presence, a felt sense of the patient, and a cognitive grasp of the individual’s state of mind (Delaney & Ferguson, 2014). These are skills psychiatric nurses cultivate as they focus on developing relationship leverage with individuals in crisis or dispirited by their mental illness. Families tell us that child psychiatric services often do not address the everyday problems they face (Horwitz et al., 2012) Thus, there is a need for child psychiatric nurses who can understand a family’s narrative of their life with their child, how they contextualize his/her behaviors and define the problems they face. The future for child mental health relies on bringing mental health care to children. There is a need for child psychiatric nurses to partner with school nurses and perhaps for school nurses to think of themselves as child psychiatric nurses. School nurses are the second largest group of schoolbased professionals delivering mental health services in schools and these interventions involve one-third of their day (Foster et al., 2005). School nurses are seen as an important bridge with feet in both the educational and medical world, thus important translators to school personnel about illness and to primary care providers about the range of accommodations a school might make in the management of a particular condition (Taras, 2014). These front line providers offer mental health supports in a unique way, often helping children and teens with the everyday stressors of their lives. If we are going to meet the need for mental health services and to prevent stress (including toxic stress) and distress from moving to SED, then we need child psychiatric nurses in schools who can provide a range of mental health services from supportive to targeted evidence-based interventions (Bethell, Newacheck, Hawes, & Halfon, 2014). Thus, the range of need for child psychiatric nurses is as broad as the range of child mental health issues this county confronts. To accommodate this need will require a large workforce as well as focused specialists. And one group has to inform the other. As a specialty, we also need those child 1
Editorial
nurses who remind us of the larger context of equity, justice, and our social contract to promote the mental health of children and their families. So even in this day of life span practitioners and integrated care (both of which are excellent ideas), let us assure that we keep boundaries around the child mental health nursing specialty and their priority of promoting mental health of children. Kathleen R. Delaney, PhD, PMH-NP, FAAN Professor Community and Mental Health Nursing Rush College of Nursing Chicago, IL, USA Author contact: [email protected] References Barker, P. (2001). The Tidal Model: Developing an empowering, person-centered approach to recovery within psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing, 8(3), 233–240. Bethell, C. D., Newacheck, P., Hawes, E., & Halfon, N. (2014). Adverse childhood experiences: Assessing the impact on health
2
and school engagement and the mitigating role of resilience. Health Affairs, 33(12), 2106–2115. Delaney, K. R., & Ferguson, J. (2014). Peplau and the brain: Why interpersonal neuroscience provides a useful language for the engagement process. Journal of Nursing Education and Practice, 4, 145–152. doi:10.5430/jnep.v4n8p145 Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy push on patient-centered health care. Health Affairs, 29(8), 1489–1495. Foster, S., Rollefson, M., Doksum, T., Noonan, D., Robinson, G., & Teich, J. (2005). School mental health services in the United States 2002–2003. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. DHHS Pub. No. (SMA) 05-4068. Hall, J. M., & Powell, J. (2011). Understanding the person through narrative. Nursing Research and Practice, 2011(2011). doi: 10.1155/2011/293837; Article ID 293837, 10 pages. Horwitz, S. M., Demeter, C., Hayden, M., Storfer-Isser, A., Frazier, T. W., Fristad, M. A., & Findling, R. L. (2012). Parents’ perceptions of benefit of children’s mental health treatment and continued use of services. Psychiatric Services, 63, 793–801. Taras, H. L. (2014). School nursing: Beyond medications and procedures. JAMA Pediatrics, 168, 604–606. doi:10.1001/jamapediatrics.2014.45
Journal of Child and Adolescent Psychiatric Nursing 28 (2015) 1–2 © 2015 Wiley Periodicals, Inc.
Journal of Child and Adolescent Psychiatric Nursing
ISSN 1073-6077
Editorial
Why Do We Need A Child Psychiatric Nursing Specialty?
I have a colleague who writes commentary on child mental health and issues of culture, access, and equity. Her recent column concerned the children who were traveling into the country from Central America and the response of the United States citizenry. She stressed the need to react within a frame of equity, a sense of children and respect for their rights. I had been aware of these children and the controversy around the situation but had not put the issue in the context of social justice. I needed a colleague who “sees” situations with that lens to articulate the grounding context. In child psychiatric nursing, we are fortunate to have a cohort of nurses who maintain their practice with children and also eloquently tie their knowledge to the larger issues that affect children’s mental health. Via a long membership in the Association of Child and Adolescent Psychiatric Nurses, first known as Advocates for Child Psychiatric Nurses, I have come to know many of such nurses who see child mental health as a national priority and through that lens isolate issues such as social justice, diversity and equity, policy, how best to support families, and prevention. It is within these dialogs that ideas take root and are then shaped. Such dialogs help us grow as a specialty. One might ask why nursing should be concerned with sustaining and growing a child mental health specialty. What is the need for child psychiatric nurses? Phil Barker (2001) believes that the “need for nursing” grew out of the need for individuals in human crisis to have another person be there for them, supporting them, and providing a relational environment through which the person might grow and eventually grow out of their distress. Over the years, I have come to know many child psychiatric nurses who have embraced that notion. Families raising a child with serious emotional disturbance (SED) need a professional partner to help them through the changes and crises they encounter, including managing the ongoing challenge of creating a healing environment for their child. These child psychiatric nurse specialists marry this commitment to families with an exquisite knowledge of evidence-based interventions and psychopharmacology, knowledge they use to refine and adapt a treatment regime to the child’s changing presentation. The specialty and the families they serve need these nurses.
doi: 10.1111/jcap.12101
Journal of Child and Adolescent Psychiatric Nursing 28 (2015) 1–2 © 2015 Wiley Periodicals, Inc.
The term patient-centered care finds its way into almost every discussion of healthcare reform. But at the most basic level, it begins with a genuine interest in learning what matters to the patient (Epstein, Fiscella, Lesser, & Stange, 2010). That requires understanding how patients’ stories carry meaning and the emotional impact events have over time (Hall & Powell, 2011). To arrive at that place of narrative understanding requires engagement, which in turn demands both intentional presence, a felt sense of the patient, and a cognitive grasp of the individual’s state of mind (Delaney & Ferguson, 2014). These are skills psychiatric nurses cultivate as they focus on developing relationship leverage with individuals in crisis or dispirited by their mental illness. Families tell us that child psychiatric services often do not address the everyday problems they face (Horwitz et al., 2012) Thus, there is a need for child psychiatric nurses who can understand a family’s narrative of their life with their child, how they contextualize his/her behaviors and define the problems they face. The future for child mental health relies on bringing mental health care to children. There is a need for child psychiatric nurses to partner with school nurses and perhaps for school nurses to think of themselves as child psychiatric nurses. School nurses are the second largest group of schoolbased professionals delivering mental health services in schools and these interventions involve one-third of their day (Foster et al., 2005). School nurses are seen as an important bridge with feet in both the educational and medical world, thus important translators to school personnel about illness and to primary care providers about the range of accommodations a school might make in the management of a particular condition (Taras, 2014). These front line providers offer mental health supports in a unique way, often helping children and teens with the everyday stressors of their lives. If we are going to meet the need for mental health services and to prevent stress (including toxic stress) and distress from moving to SED, then we need child psychiatric nurses in schools who can provide a range of mental health services from supportive to targeted evidence-based interventions (Bethell, Newacheck, Hawes, & Halfon, 2014). Thus, the range of need for child psychiatric nurses is as broad as the range of child mental health issues this county confronts. To accommodate this need will require a large workforce as well as focused specialists. And one group has to inform the other. As a specialty, we also need those child 1
Editorial
nurses who remind us of the larger context of equity, justice, and our social contract to promote the mental health of children and their families. So even in this day of life span practitioners and integrated care (both of which are excellent ideas), let us assure that we keep boundaries around the child mental health nursing specialty and their priority of promoting mental health of children. Kathleen R. Delaney, PhD, PMH-NP, FAAN Professor Community and Mental Health Nursing Rush College of Nursing Chicago, IL, USA Author contact: [email protected] References Barker, P. (2001). The Tidal Model: Developing an empowering, person-centered approach to recovery within psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing, 8(3), 233–240. Bethell, C. D., Newacheck, P., Hawes, E., & Halfon, N. (2014). Adverse childhood experiences: Assessing the impact on health
2
and school engagement and the mitigating role of resilience. Health Affairs, 33(12), 2106–2115. Delaney, K. R., & Ferguson, J. (2014). Peplau and the brain: Why interpersonal neuroscience provides a useful language for the engagement process. Journal of Nursing Education and Practice, 4, 145–152. doi:10.5430/jnep.v4n8p145 Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy push on patient-centered health care. Health Affairs, 29(8), 1489–1495. Foster, S., Rollefson, M., Doksum, T., Noonan, D., Robinson, G., & Teich, J. (2005). School mental health services in the United States 2002–2003. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. DHHS Pub. No. (SMA) 05-4068. Hall, J. M., & Powell, J. (2011). Understanding the person through narrative. Nursing Research and Practice, 2011(2011). doi: 10.1155/2011/293837; Article ID 293837, 10 pages. Horwitz, S. M., Demeter, C., Hayden, M., Storfer-Isser, A., Frazier, T. W., Fristad, M. A., & Findling, R. L. (2012). Parents’ perceptions of benefit of children’s mental health treatment and continued use of services. Psychiatric Services, 63, 793–801. Taras, H. L. (2014). School nursing: Beyond medications and procedures. JAMA Pediatrics, 168, 604–606. doi:10.1001/jamapediatrics.2014.45
Journal of Child and Adolescent Psychiatric Nursing 28 (2015) 1–2 © 2015 Wiley Periodicals, Inc.
