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As a psychiatric nurse for the past 20 years in a variety of settings and treating a diverse age population of clients, I have witnessed first-hand the high recidivism rate primarily related to medication and treatment non-adherence.  This finding has been consistently supported in the research as well.  Mental health problems in children and adolescents are frequent, with a high risk of persistence into adulthood.  The possible consequences of untreated psychiatric problems with this population include longer duration of the illness, increased severity of symptoms, higher relapse rates, greater risk of suicidal behavior, academic difficulties, and increased peer and family conflict.

I am currently a family psychiatric nurse practitioner student.  Planning on initially working with children and adolescents upon graduation, I realize another variable is added to the equation; i.e. the inclusion of parents/guardians and the need to obtain informed consent prior to initiating any psychotropic medication.  The process of obtaining informed parental consent in this vulnerable population can lead to both ethical and practical dilemmas which are further exacerbated if the parent/guardian is not in agreement with the use of medication.  The level of psychiatric prescribing in children and adolescents is increasing; however, rates of adherence in this group of patients range from only 34-54% (Waterman, Hales, and Glackin, 2015).  As a result, I am creating this blog to tap into your expertise to help improve this disappointing rate.

Medication education can be a valuable tool to help promote adherence to psychotropic medication.  Eisenmann (2012), discussed utilizing various strategies to educate children, adolescents, and their families on an inpatient unit such as a medication education game, educational handouts, and conducting group and individual educational sessions.  On an out-patient basis, providing patients with time to address their questions and concerns during the consultation process impacts positively on patient outcomes and develops a philosophy of concordance between the patient and prescriber (Drennan, et. al., 2011).  Similarly, Brown and Gray (2015) found it may first be necessary for prescribers to challenge their clients’ pre-existing beliefs about adherence before addressing specific medication education.  Nonetheless, according to the Cochrane Review (2014), there is not enough evidence in terms of clinically meaningful and sustainable effects to support a shared decision-making approach to promote and maintain medication adherence rates.

Therefore my inquiries include:

• What strategies do you implement to address medication education, obtaining informed consent, and promoting medication adherence?

• How do you address when there is disagreement/consent among parents with shared custody and/or when one parent consents and the other disagrees

• How do you proceed when the child/adolescent wants to take the medication because of improvement experienced while on it yet parent refusing to continue med (get it refilled/give to child)?

Thank you in advance for your responses, pearls of wisdom that I will hopefully be able to utilize as I embark on this new role. 

References

Barbui, C., Girlanda, F., Ay, E., Cipriani, A., Becker, T., & Koesters, M. (2014). Implementation of treatment guidelines for specialist mental health care. Cochrane Database of Systematic Reviews, (1), N.PAG.

Brown, E., & Gray, R. (2015). Tackling medication non-adherence in severe mental illness: where are we going wrong? Journal of Psychiatric & Mental Health Nursing, 22(3), 192-198. doi:10.1111/jpm.12186

Drennan, J., Naughton, C., Allen, D., Hyde, A., O’Boyle, K., Felle, P., & ... Butler, M. (2011). Patients’ level of satisfaction and self-reports of intention to comply following consultation with nurses and midwives with prescriptive authority: A cross-sectional survey. International Journal of Nursing Studies, 48(7), 808-817. doi:10.1016/j.ijnurstu.2011.01.001

Eisenmann, C. (2012). Revising a medication education program on an inpatient child and adolescent psychiatric unit. Journal of Psychosocial Nursing & Mental Health Services, 50(1), 41-47. Doi: 10.3928/02793695-20111206-01

Waterman, Y., Hales, L., & Glackin, M. (2015). Prescribing for children and adolescents in mental health. Nurse Prescribing, 13(6), 296-300.