Mental health illness is a reality in many children’s lives, especially those in foster care. There are several ways of treating mental illness, with one of them being the administration of psychotropic medications. When appropriately used, medication can relieve the debilitating symptoms. In this case, Tasha is unresponsive to the psychotherapy as it did not only have a limited impact on alleviating her aggressive behavior and anxiety, but she also suffered from their side effects. The case manager must advocate for Tasha, and this is achieved by getting answers to the following questions:
- Which diagnostic tool was used to evaluate Tasha’s symptoms for Bipolar I Disorder, Oppositional Defiant Disorder, and Post Traumatic Stress Disorder? The diagnostic criteria were designed for adults; hence applying them to children might sometimes be challenging (Ingersol & Rak, 2016). Consequently, most professionals end up confusing the acting out of foster children as a bipolar symptom.
- Was the recommended pediatric dosage given to Tasha? It is recommended that if children are going to be placed on benzodiazepines, such as Xanax, prescribers should “start low and go slow” (Ingersol & Rak, 2016, p. 253). This is because this class of drugs has an inhibitory impact on the CNS thus can cause cognitive impairment. Hence, many new guidelines recommend the use of benzodiazepines for not more than 30 days (Ingersol & Rak, 2016).
- Since Tasha is not responding to the stand-alone psychotropic medication, do you think she would benefit from having behavior therapy alone or concurrently with her medication? Behavior therapy is regarded as the first-line of treatment.
- Little research has been carried on evaluating the efficacy of Xanax in treating anxiety among children, and if so, the results showed a null effect. Is it possible for Tasha to be placed on an anxiety medication that is more suitable for her age group?
- Xanax is often used on an “as needed basis” or for a short period. Is it possible that she is being overdosed with the 0.25mg twice daily treatment plan for the two months?
- Might the side effects that Tasha is suffering from be a consequence of polypharmacy? Tasha is taking sertraline (an antidepressant), Trileptal/oxcarbazepine (a mood stabilizer), and Xanax (an anxiolytic).
- Is Tasha receiving adequate supportive care at home from both her foster parents and siblings?
- Was Tasha adherent and compliant to her psychotropic medication prescription?
The above questions should be asked to the mental health agency psychiatrist, court-related social worker, Tasha, and her foster parents. This is because, based on the lack of improvement and emergence of side effects, it is probable that she was misdiagnosed, non-compliant and non-adherent, or maybe the situation in her new home environment exacerbates her poor mental health condition. Therefore, the advocacy needs to address every possible sphere associated with the outcome.
It is crucial to approach the topic resourcefully and tactically with the significant others in Tasha’s life. A good first impression should be presented and maintained to avoid the presentation of false information. The psychiatrist and social worker can be contacted for a consultation. They should be asked questions regarding the tool(s) used for Tasha’s mental health assessment and their results. Furthermore, the psychiatrist would be asked questions revolving around what they are treating Tasha for and her response to treatment in the past two months. Conversely, Tasha should be asked the questions delicately as she is only 9-years-old. It is appropriate at the beginning to tell her that there are a lot of questions, and some will be easy and others harder. However, she does not have to answer the more challenging questions. Additionally, if she does not understand or does not remember, she can say so.
Considerable attention should be placed when approaching Tasha’s foster parents as they are the primary guardian. It is necessary to avoid using the word “drugs” and instead use “medication”. Moreover, they should be asked open-ended questions to enable the case manager to get comprehensive feedback on Tasha’s welfare at home and treatment. If the foster parents become angry during questioning, they should be assured that Tasha is a pediatric patient who has developed mental issues resulting from a previous harmful environment; therefore, whichever questions are asked aim to ensure a better health outcome for her.
Ingersol, R. E., & Rak, C. F. (2016). Psychopharmacology for mental health professionals (2nd ed.). Cengage Publishing. Web.