Diversity and Health Assessments: Case #1
Considering the cultural factors of the case study patient, a 16 yo WF, will require assessing the lifestyle, background, and socioeconomic factors to adequately provide patient-centered holistic care for the patient. Important cultural factors for consideration that were presented in the case study include a family history of substance abuse, the mother being currently incarcerated, and the patient withdrawing from activities she previously enjoyed. Adolescents who lack parental monitoring are at higher risk for substance use, depression, and risky sexual behavior (Ball et al., 2019). The presenting factors put the patient at high risk for multiple health concerns that must be addressed in a sensitive manner to provide adequate treatment for the patient. One in 14 children in America have experienced the incarceration of a parent (Arditti & Johnson, 2020). At this alarming rate, it is imperative for healthcare providers to be aware of the ramifications of parental incarceration on the patient population and have strategies for addressing the sensitive cultural challenges that parental incarceration presents to treatment.
Challenges and Strategies
Patients with an incarcerated parent present with significant challenges that compromise the mental, emotional, and physical well-being of the patient. Incarceration of a parent causes stress for children through the witnessing of unlawful activities, separation from the parent, loss of income, and shame from the stigma associated with incarceration (Davis & Shlafer, 2017). These issues require sensitive treatment on behalf of the provider to be able to build trust and provide hope for the patient. A particular challenge for this patient will be developing trust since she has already lost reason to trust in her parents, which can lead to significant barriers to trusting others. One particular strategy that can be useful is the RESPECT model from the U.S. Department of Health and Human Services, a tool that assists healthcare providers with effective, patient-centered communication by addressing areas of rapport, empathy, support, partnership, explanations, cultural competence, and trust. This tool is comprehensive and considers many aspects, including suspension of judgement, understanding, overcoming barriers, the importance of flexibility, and recognizing that self-disclosure is often difficult for patients (Ball et al., 2019). The case study patient has become withdrawn and does not make eye contact. Using this evidence-based tool will help the provider overcome barriers to self-disclosure that is so critical for the patient to begin to heal.
It is important for the provider to include the family in supporting the patient’s recovery and treatment plan. This will help build a support system around the patient that will enhance the efficacy of treatment. Resilience researchers emphasize the importance of assessing for age-appropriate developmental tasks of being able to control impulses, form relationships, and complete schoolwork (Arditti & Johnson, 2020). Following the evidence-based research of a family resilience model for understanding and treating patients living with parental incarceration, these targeted questions will be helpful in building a health history for the case study patient:
- Who can you rely on for support; who do you trust?
- What improvements would you like to see as result of treatment?
- What obstacles can we help you overcome?
- Can you tell me about school: strengths, challenges, grades, peers?
- What are your favorite activities?
- Have there been any recent changes to your appetite or sleep pattern?
- Do you have any thoughts of harming yourself?
- What helps you to cope when you have feelings of depression or anxiety?
Studies show that adolescents are capable of coping with the challenges of parental incarceration in diverse, positive, and resourceful ways after accessing social support networks and participating in various activities (Arditti & Johnson, 2020). Being a culturally competent healthcare provider means adapting to the unique needs of the patient by considering the patient’s culture and background and adopting curiosity about the patient’s values and belief systems to develop a trusting patient-provider rapport (Ball et al., 2019). The APRN plays a key role in empowering this patient, leading the patient from the consequences of emotional turmoil to resiliency through effective behavioral health treatment that begins with a culturally competent health assessment and building patient trust.
Arditti, J. A., & Johnson, E. I. (2020). A family resilience agenda for understanding and responding to parental incarceration. American Psychologist. https://doi.org/10.1037/amp0000687
Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Cultural competency. In Seidel’s guide to physical examination: an interprofessional approach (9th ed., pp. 22–31). Mosby.
Davis, L., & Shlafer, R. J. (2017). Mental health of adolescents with currently and formerly incarcerated parents. Journal of Adolescence, 54, 120–134. https://doi.org/10.1016/j.adolescence.2016.10.006