NRNP 6831 Week 8 Behavioral Health Case Study Example

Behavioral Health Case Study: Bringing Trauma-Related Symptoms Into the Asthma Plan of a 9-Year-Old in Her Third Foster Placement

Student Name

College of Nursing, Walden University

NRNP 6831: Management of Specialized and Complex Populations

Instructor Name

Month Day, Year

Behavioral Health Case Study: Bringing Trauma-Related Symptoms Into the Asthma Plan of a 9-Year-Old in Her Third Foster Placement

Harper is a composite 9-year-old girl who entered foster care at 7. She has moderate persistent asthma and, since entering care, sleep disruption, aggression at school, and a strong startle response. She is in her third placement in 2 years, and her health records are split across two counties and three clinics. This case study records what moved with her and what did not, describes her medical and behavioral needs apart and then together, sets out who may consent to what, applies a trauma-informed approach to clinic practice, and proposes a single health summary that moves with her.

Placements as a Timeline

Placement 1, age 7, kinship care with an aunt in her home county, 9 months. Her asthma was managed by her long-time pediatric clinic. Her records stayed in that clinic.

Placement 2, age 8, a licensed foster home in a neighboring county, 11 months. She was seen at a new clinic for her initial health screening. Her controller inhaler prescription did not transfer; the new clinic learned of it only from the inhaler in her bag, which ran out 3 weeks later. Her asthma action plan did not move.

Placement 3, age 9, a second foster home in the same neighboring county, now 4 months. She is seen at a third clinic, ours. We have the second clinic's records but only a summary from the first, and no record of her behavioral health screening from either.

The AAP recommends that children entering foster care have a health screening within 72 hours of placement, a comprehensive assessment within 30 days, and a medical home that keeps their history across placements (Szilagyi et al., 2015). Harper had screenings at each move, but no single place kept her history.

Two Sets of Needs, Then Their Overlap

Medical needs. Harper has moderate persistent asthma treated with a daily inhaled corticosteroid and a rescue inhaler. She had two emergency visits for exacerbations this year, each within a month of a placement change. Her current foster mother reports night cough 2 or 3 times a week.

Behavioral needs. She has trouble falling asleep and wakes most nights. Her teacher reports hitting other children twice this month, both times after unexpected changes in the classroom routine. She startles at loud noises and at being touched from behind. A trauma screen at our clinic was positive, and she is waiting for an assessment with a child therapist.

The overlap. Each set of needs makes the other worse in specific ways. Night cough breaks her sleep, and poor sleep makes her more irritable and reactive at school the next day. Each placement move interrupted her controller medicine, and each gap was followed by an emergency visit. Emergency visits, with masks, restraint, and strangers, are themselves frightening for a child who startles at touch, which makes the next visit harder. An asthma plan that ignores her trauma, or a behavioral plan that ignores her nights, will fail.

Who May Consent to What

Consent rules for children in foster care vary by state. Table 1 sets out the rules this case assumes, which follow a common pattern: the child welfare agency holds legal custody, the foster parent may consent to routine care, the court must approve psychotropic medication, and parental rights have not been terminated.

Table 1

Consent Map for Harper Under the Rules This Case Assumes

The practical result is that the therapy referral needs the caseworker's signature, while the asthma plan can be changed with the foster mother at a visit. The plan is built so that neither waits for the other.

Trauma-Informed Practice in the Clinic

SAMHSA describes six principles of a trauma-informed approach: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and attention to cultural, historical, and gender issues (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). The AAP describes trauma-informed pediatric care in similar terms, as care that recognizes the effects of trauma and builds resilience while avoiding retraumatization (Forkey et al., 2021). Applied to Harper's visits, the principles become routines rather than values.

Safety. Her visits are scheduled first in the day, so she does not wait in a crowded room, and she is seen by the same clinician each time.

Trustworthiness and transparency. Each step of the examination is explained before it happens, and she is never touched from behind. She is told at the start how long the visit will take and what will happen.

Collaboration and choice. She chooses which side is examined first and whether her foster mother stays in the room. She practices her inhaler technique by teaching it to a stuffed animal, which gives her the role of expert.

Peer and cultural considerations. Her foster mother is connected to a support group for foster parents of children with trauma histories, and her plan uses the words she uses for her feelings (SAMHSA, 2014).

Communication in Writing

For Harper: "Your lungs sometimes get tight at night. Your orange inhaler helps keep them calm every day, even when you feel fine. If it's hard to sleep or you feel scared at night, you can tell your foster mom, and she will help. Your doctor will always tell you before she touches you."

For her foster mother: "Harper's night cough and her sleep problems are connected, and both get worse after changes. Give her controller inhaler every morning and evening, even on good days. If she wakes coughing more than twice a week, call us. When routines change at home or school, telling her ahead of time helps. Her therapy referral is waiting for the caseworker's signature, and we will call you when it is scheduled."

One Summary That Travels

The final part of the plan is a one-page health summary that moves with Harper at every placement change. It lists her diagnoses, current medicines and doses, her asthma action plan, allergies, immunizations, the dates and reasons for her last two emergency visits, her trauma screening result and therapy status, the consent map, and the name and number of her medical home. Our clinic's care coordinator is its keeper, updating it after every visit and sending it to the caseworker, who is responsible for handing it to the next caregiver on the day of any move. A summary of this kind is what the AAP asks for when it recommends a medical home that holds a child's health history across placements (Szilagyi et al., 2015).

References

Forkey, H., Szilagyi, M., Kelly, E. T., Duffee, J., Council on Foster Care, Adoption, and Kinship Care, Council on Community Pediatrics, Council on Child Abuse and Neglect, & Committee on Psychosocial Aspects of Child and Family Health. (2021). Trauma-informed care. Pediatrics, 148(2), Article e2021052580. https://doi.org/10.1542/peds.2021-052580

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884).

Szilagyi, M. A., Rosen, D. S., Rubin, D., Zlotnik, S., Council on Foster Care, Adoption, and Kinship Care, Committee on Adolescence, & Council on Early Childhood. (2015). Health care issues for children and adolescents in foster care and kinship care. Pediatrics, 136(4), e1142-e1166. https://doi.org/10.1542/peds.2015-2656