Discussion: Treating Childhood Abuse

In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.

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In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.

Learning Objectives

To Prepare for this Discussion:

• Read the Learning Resources concerning treating childhood abuse.
• Read the Child Abuse Case Study in the Learning Resources.

Post:

• What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
• How might exposure to the media and/or social media affect the patient?
• What type of mandatory reporting (if any) is required in this case? Why?

Child Abuse Case Study

NURS 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent

Morgan, a 19-year-old male comes to your office to discuss his current mood and symptoms. This is his first visit to a mental health clinic. “I’ve had 26 jobs in the last 2 years; I finally have a job that I like and I want to make it work.” As you begin to get to know him, he tells you that his mood is down and that he also has times where he has “more energy and motivation”: “That’s when I am able to get a new job.” He says that he has difficulty interacting with coworkers. “I feel like I can’t talk to them.” If it wasn’t for his supportive girlfriend, he wouldn’t be able to function. “She understands me and accepts me; she knows what I have been through.” As the PMHNP listens to the client and explores what he means by some of his statements, you try to put together his story. He mentions that he has been having nightmares and is not sleeping well. He says he startles easily. He becomes withdrawn when he begins to talk about the reason for the nightmares. “This all started a few weeks ago when a cousin of mine got out of jail.” He haltingly tells the story of his parents’ mental illness and how he had to live with various relatives. “One cousin who I stayed with a lot took advantage of me. He molested me.” They found out he also molested other children and he went to jail. “It gives me the creeps that he is out of jail. I have to face what he did to me.” Morgan asks about his diagnosis. The PMHNP tells him that he has some symptoms that sound like depression and anxiety, and that when a child has a traumatic experience, it can reoccur and stay with a person for many years. He acknowledges that he thought about PTSD but wasn’t sure what the symptoms look like. As you think about Morgan’s story, consider the following questions: Where did he fall between the cracks? Are there agencies who advocate for children like him? There are thousands of children like Morgan. They were in a vulnerable family situation and the “responsible” adult was not able to care for the child. Sometimes it takes years for clients to remember and disclose the abuse.