Following the Affect: Learning to Observe Emotional Regulation

On inpatient psychiatric units, staff deal with children and adolescents whose affect escalates quickly and intensely. These same children experience strong emotions that they can neither understand nor explain. To intervene effectively, inpatient staff must understand the regulation issues underneath the escalated behaviors. Emotion Regulation theory and the developmental line of emotional understanding are useful concepts in assessing and intervening with these children and adolescents. Presented here are criteria to guide inpatient staff's assessment of children and adolescents with emotion regulation difficulties. The assessment cues are based in concepts of Emotion Regulation and emotional understanding and are accompanied by suggested intervention strategies.     

Learning to Observe in Context: Child and Adolescent Inpatient Mental Health Assessment

On child and adolescent inpatient psychiatric units, nursing staff have 24-hour exposure to patients, an excellent vantage point for observing behavior in a variety of situations and interpersonal contexts. How staff members respond to milieu behaviors depends in part on their judgment of what prompted a youngster's response and his/her ability to process the event and control the attendant emotions. To assess such aspects of a child or adolescent's presentation requires that staff appraise not just the presenting behavior but the patient's information-processing and affect-regulation abilities. One way this developmental knowledge can be embedded in practice is through assessment guides that contain observation cues for key issues related to how children/adolescents think, feel, and behave. This article sets down the rationale for the content and organization of such inpatient nursing assessment guides and suggestions for their dissemination to the unit staff.     

Learning to Observe Cognition, Mastery, and Control

On inpatient psychiatric units, intervening with children and adolescents' behaviors demands an understanding of how they take in and process information. The third paper focuses on assessment cues that will help inpatient staff decipher patients' deficits and strengths in information processing, self-efficacy, and inhibitory control. Each assessment area is explained in the context of the supporting cognitive, neurobiologic, and social-learning theory. Inpatient interventions consistent with the assessment are explained and illustrated with clinical applications.     

Top 10 Milieu Interventions for Inpatient Child/Adolescent Treatment

Presented in this article are 10 interventions to deal with children and adolescents on inpatient psychiatric units. The 10 are divided into three categories: behavioral, cognitive, and affective. The interventions discussed are particularly relevant to staff in their efforts to help children and adolescents achieve control over their thoughts, feelings, and behaviors. Each intervention includes a summary of the theory that supports its efficacy, a brief explanation of the intervention, and methods for applying the technique in clinical situations.     

Reducing Reactive Aggression by Lowering Coping Demands and Boosting Regulation: Five Key Staff Behaviors

TOPIC:  Lowering the incidence of reactive aggression on inpatient child/adolescent psychiatric units by creating a milieu that reduces coping demands and augments children's self- regulation capabilities.
PURPOSE:  This article elaborates on specific staff approaches that have the potential to reduce occurrences of reactive aggression and behavioral eruptions frequently displayed by children and adolescents during inpatient psychiatric treatment. Identified are key staff behaviors along with explanations on how they dampen the kindling of reactive aggression and create an enhanced milieu. Accompanying each staff behavior is an explanation of the neuroscience and theory that supports the intervention.
SOURCES:  Published literature and clinical examples.
CONCLUSIONS:  Children hospitalized on inpatient psychiatric units frequently have poor self-regulation skills and diffuse the negative affects they experience via behaviors such as tantrums, venting, and aggression. Staff can reduce this reactive aggression by tempering the way they set expectations, by providing structure, and by decreasing threat via sensible rules that encourage choice. Staff must also create and maintain relationships with the patients that set a particular tone, thereby creating an enhanced milieu populated with adults who are positive and able to attune to a child's changing affect level.     

Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit

Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20‐item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery‐oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm.     

Transitioning Adolescents with Emotional and Behavioral Disorders from Most-to-Least Possible Restrictive Environments: Views of Transition Service Providers

This study examined the transition from most-to-least possible restrictive environments for youth with emotional and behavioral disorders. Components of positive transition experiences were identified from the literature as planning for transition at intake in such a way as to promote continuity of care, family involvement, academic and employment success, and assistance in navigating the adult mental health system and services. In this phenomenological study, transition service providers were interviewed to explore the transition practices currently utilized, and results were compared to recommended practices in the literature. Transition professionals were able to identify consistency, gradual change, individualization, communication between providers, opportunities for community experiences, and youth involvement in the transition as necessary to successful transition.     

Relationships of Positive and Negative Affect to Coping and Functional Outcomes in Systemic Sclerosis

This study examined the role of two distinct factors of emotion, positive (PA) and negative affect (NA), in adjustment to a chronic rheumatic disease, systemic sclerosis (SSc). Ninety-two patients with a confirmed diagnosis of SSc completed self-report measures assessing PA and NA (Positive and Negative Affect Schedule), coping (Revised Ways of Coping Checklist), and functional outcomes (pain and disability measured with the Health Assessment Questionnaire). Confirmatory factor analysis indicated that PA and NA constituted separate, negatively correlated factors. PA and NA showed differential relationships to coping and functional outcomes. Affect mediated the association between coping and functional outcomes after controlling for disease severity. The results suggest the importance of both PA and NA as factors influencing adjustment to chronic illness.     

‘I don't want to be here but I feel safe’: Referral and admission to a child and adolescent psychiatric inpatient unit: The young person's perspective

Early and appropriate intervention can assist children and young people manage their mental illness and prevent it becoming a long‐term condition. However, satisfaction with mental health services can influence the level of engagement individuals are willing to participate in beyond the time of the initial contact or hospitalization. A qualitative design was used to identify and understand the experiences of the admission process for young people referred to the sole psychiatric inpatient unit in one Australian state for children up to the age of 18 years. Eleven young people participated in semistructured interviews that were audiotaped, transcribed, and coded. Interview data were examined through thematic analysis. Satisfaction with the inpatient experience was influenced by whether or not young people experienced a sense of connection with staff or other patients on the ward. The ability of nursing staff in identifying and catering to the individual needs of young people in their care facilitated feelings of safety, security, and acceptance, and contributed to the young person's desire to remain engaged in treatment post‐discharge. This research supports the shift towards perceiving patient satisfaction as a separate entity from service delivery and quality, with some participants able to voice dissatisfaction about the lack of services, while reporting overall satisfaction with the inpatient experience.     

Mental Health Needs of Children and Adolescents at Camp: Are They Being Assessed and Treated Appropriately by the Camp Nurse?

TOPIC: Increasingly, more children and adolescents are attending camps with mental health concerns. This can pose a challenge for camp nurses who may lack experience in assessment and treatment of mental health issues. PURPOSE: To focus on the importance of addressing and treating mental health needs of children and adolescents at camp utilizing the Scope and Standards of Psychiatric Mental Health Nursing Practice. SOURCES: Personal observations, camp nursing experience, and scholarly published literature. CONCLUSIONS: It is paramount that mental health needs of children and adolescents at camp are addressed and managed appropriately by the camp nurse. Education of camp nurses and camp administrators is also a vital part of providing care.     

Study protocol to investigate the correlation between Tourette syndrome and allergy in children and adolescents

ObjectiveNoting that the usefulness of cases diagnosed in administrative registers is dependent on diagnostic validity, in this study, we aim to elucidate the correlation between Tourette syndrome and allergy in children and adolescents, specifically with regard to incidence of asthma, allergic rhinitis, allergic conjunctivitis, and atopic dermatitis.MethodsBased on a set of inclusion and exclusion criteria, we intend to enroll 200 children and adolescents aged 18 years and younger, accompanied by their parents, for a duration of 2 years. We will administer an anonymous questionnaire in a case–control study. We will use the chi-squared test to evaluate differences between cases and controls.ResultsAccording to the European Review for Medical and Pharmacological Sciences, the proportion of allergic diseases expected in patients with Tourette syndrome is 53.1% (17/32) and 22.9% (8/35) in the controls. Setting the type 1 error to 0.05 and the power to 0.8, we will ensure a 1:2 case-to-control ratio.ConclusionsThis study protocol describes our analysis of anonymous questionnaire responses. Comorbidity rates, environmental factors, and genetic factors for various allergens, allergies, and other neuropsychiatric disorders will be studied.     

A practice guideline for treatment of eating disorders in children and adolescents

Eating disorders are diseases of both the body and the psyche. Early treatment focuses on restoration of nutritional status and somatic health, including psycho‐educational counselling and support offered to the patient and his/her family. Diagnosis and treatment require a multidisciplinary approach. Psychological factors related to the condition should be assessed. The most severe weight loss should be reversed before psychotherapeutic treatment. Nutritional counselling is recommended, and the benefits of individual and/or family therapy are considered in accordance with the patient's age, development, symptomatology and comorbid psychiatric disorders. Medication is useful in the treatment of bulimia nervosa and certain comorbid symptoms of anorexia nervosa. Early admission to treatment and active therapy are associated with a more favourable prognosis.     

Best practice from admission to discharge in acute inpatient care: considerations and standards from a whole system perspective

Best practice from admission to discharge in acute inpatient care: considerations and standards from a whole system perspective Effective mental health care and promotion involves numerous agencies and individuals. Hence, practice development for people with acute mental health needs requires a systemic (or whole system) perspective. Whilst a policy imperative, this is unfamiliar practice for many health and social care workers. In a previous paper published within this journal, the authors argued that admission to acute inpatient care may sometimes be occasioned by the need to contain worker anxiety within the whole system, rather than being clinically justified or necessary. In this paper the authors seek to follow up this premise with proposals for purposeful admission and standards to assure the quality throughout the patient journey, into and out of acute inpatient wards.     

Treatment of Trauma- and Abuse-Related Dissociative Symptom Disorders in Children and Adolescents

TOPIC:  Dissociation is believed to be one of the most common underlying psychological processes among children and adolescents receiving mental health treatment, but most of the dissemination of information about dissociation has occurred among psychiatrists and psychologists.
PURPOSE:  Modes of treatment for dissociation as it affects children and adolescents are described.
SOURCES USED:  Current research and practice scholarly articles on treatment of children and adolescents for dissociation and dissociative symptom disorders were accessed and critically reviewed.
CONCLUSIONS:  Prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however, expert clinicians and researchers agree that early, intense treatment offers the greatest possibility of full recovery.     

12~17岁儿童青少年健康相关久坐行为研究

目的 观察12~17岁儿童青少年健康相关久坐行为特征。方法 2020年5月至7月,采用wGT3X-BT三轴加速度计和《儿童青少年久坐行为调查问卷》分别对300例儿童青少年久坐行为、久坐间断次数和低强度身体活动进行测量。结果 客观测量显示,儿童青少年久坐时间普遍偏高(上学日占80.28%,休息日占81.38%);女生上学日和休息日久坐时间占比均高于男生(F > 5.322, P < 0.05);不同年级儿童青少年在上学日和休息日久坐时间占比、久坐间断次数和低强度身体活动占比方面均有非常高度显著性差异( F > 11.355, P < 0.001)。主观测量显示,分别有86.67%和63.67%的儿童青少年上学日和休息日日均久坐时间超过8 h。教育类久坐、社交类久坐、视频类久坐是当前儿童青少年久坐行为的主要类型,并随学段的增长,教育类久坐时间逐渐增加,社交类、视频类久坐时间相对减少。交通类久坐、文化类久坐时间在儿童青少年总久坐时间中的占比不大。不同年级儿童青少年在上学日社交类久坐、休息日文化类久坐、上学日/休息日视频类久坐、上学日/休息日教育类久坐和上学日/休息日交通类久坐时间方面有显著性差异( F > 2.934, P < 0.05)。 结论 儿童青少年久坐时间普遍偏高,以教育类久坐为主,久坐时间随学段变化而变化。     

医教结合提高学习障碍儿童综合素质的研究

目的 :研究尝试将医疗与教育相结合 ,总结一套实用、有效的可行性措施 ,改善学习障碍儿童的不良表现 ,提高综合素质。方法 :采用问卷调查法 (家长、教师 )及标准测验法调查有学习障碍儿童 2 4例 ,通过全面了解其神经心理机能、行为表现、学习能力及智力水平 ,实施感觉统合功能训练、心理咨询与改善学校、家庭教育方法相结合干预学习障碍儿童。结果 :干预后儿童的感觉统合能力和学习成绩均得到显著提高 (P <0 .0 0 1) ;焦虑问题得到明显改善 (P <0 .0 5) ;冲动 多动问题、多动指数、心身问题、学习问题及智商前后对照差异无显著性 (P >0 .0 5)。结论 :医疗与教育 (学校、家庭 )的有机结合 ,可以在短时间内同步改善学习障碍儿童的神经心理功能 ,增强其自信心和环境适应能力 ,提高学习成绩 ,减轻或消除其不良行为 ,不失为提高学习障碍儿童综合素质的有效方法     

Coping and psychosocial adaptation to Type 2 diabetes in older Blacks born in the Southern US and the Caribbean

Older Black men and women (n = 212) with Type 2 diabetes completed questionnaires. Spearman's rho correlation indicated that confrontive coping strategies supported effective psychosocial adaptation for persons originally from Haiti and Jamaica, while emotive coping strategies were related to ineffective psychosocial adaptation for persons originally from Barbados and to increased psychological distress for all participants. Women used more palliative coping; no gender differences were observed for psychosocial adaptation. Health care orientation, extended family relationships, and psychological distress domains distinguished Blacks born in Haiti from Blacks born in Barbados and Jamaica, the Southern US and Jamaica, and the Southern US, Barbados, and Jamaica. Findings from this study may aid in the development of interventions focused on improving diabetes self-management for older Blacks.