Religious and spiritual assessment of the child and adolescent

Integrating Spirituality and Religious Beliefs in a Mindfulness Based Cognitive Behavioral Therapy for PTSD with Latinx Unaccompanied Immigrant Children

Purpose: Unaccompanied immigrant children (UIC) experience significant mental health concerns, particularly posttraumatic stress. This is a vulnerable population, yet little systematic research has examined the effectiveness of evidence-based models such as cognitive behavioral therapy (CBT) to meet their needs. Integrating religious beliefs and spirituality into therapy could elucidate better understandings of traumatic stress, and posttraumatic cognitions when working with UIC with strong faith traditions/beliefs. Methods: We report on modifications made to a pre-existing treatment, consisting of integrating religious and spiritual themes, to engage and work with UIC participants in a pilot study of Mindfulness-Based CBT. Thematic analysis of therapy notes evaluated the implementation process for integrating religious and spiritual themes. Three composite vignettes illustrate how religiosity and spirituality were salient for UIC participants in this pilot study, and how these were integrated into therapy to address posttraumatic cognitions and symptoms. We assessed changes in PTSD symptom severity and posttraumatic cognitions for UIC and in comparison, to non-UIC participants using the Child PTSD Symptom Scale and the Posttraumatic Cognitions Inventory. Results: Religiosity and spirituality were important for coping and conceptualizations of trauma, served as facilitators for engaging UIC in therapy, and related to improving posttraumatic cognitions and symptoms. Conclusion: Religious identity and spirituality can be important for meaning making, trauma cognitions and symptoms, and can be important to explore in therapy with unaccompanied immigrant children and adolescents. Clinical Trial Registration: Not applicable.

Spiritual Care: Minimizing the Vulnerability of Parents Whose Children With Cancer Face the End of Life

There is a distinct lack of literature related to the spiritual care of parents whose children with cancer are at the end of life. This has led to a dearth in evidence about how nurses may intervene with spiritual care interventions to best support these vulnerable parents. The purpose of this scoping review was to examine the evidence regarding the value of spirituality/spiritual care in minimizing the vulnerability of parents whose children were diagnosed with cancer and who faced the end of life. The Arksey and O'Malley methodological framework guided the analysis of the reviewed quantitative and qualitative literature. Spirituality and spiritual care provided bereaved parents and parents of children with cancer with necessary support and enhanced coping to allow them to better deal with this devastating experience. Spirituality and spiritual care instilled hope, assisted in the search for meaning and purpose, and guided parents to develop continuing bonds with their child. Through skillful communication, pediatric oncology nurses may guide parents of children who face the end of life to strengthen relationships that offer support, plan activities that provide opportunities for hope and connection, and identify sources of meaning in their experiences.

From phenomenology to neurophysiological understanding of hallucinations in children and adolescents

Typically reported as vivid, multisensory experiences which may spontaneously resolve, hallucinations are present at high rates during childhood. The risk of associated psychopathology is a major cause of concern. On the one hand, the risk of developing further delusional ideation has been shown to be reduced by better theory of mind skills. On the other hand, ideas of reference, passivity phenomena, and misidentification syndrome have been shown to increase the risk of self-injury or heteroaggressive behaviors. Cognitive psychology and brain-imaging studies have advanced our knowledge of the mechanisms underlying these early-onset hallucinations. Notably, specific functional impairments have been associated with certain phenomenological characteristics of hallucinations in youths, including intrusiveness and the sense of reality. In this review, we provide an update of associated epidemiological and phenomenological factors (including sociocultural context, social adversity, and genetics, considered in relation to the psychosis continuum hypothesis), cognitive models, and neurophysiological findings concerning hallucinations in children and adolescents. Key issues that have interfered with progress are considered and recommendations for future studies are provided.

Addressing children's beliefs through Fowler's stages of faith

Knowledge of child development, including faith development, is important in providing holistic care to the child. Pediatric nurses and nurse practitioners may be inadequately prepared to meet the spiritual needs of children in developmentally appropriate ways. This article demonstrates why it is necessary to asses a child's or an adolescent's religious and spiritual beliefs and when and how a nurse intervenes. Modeled here is one way in which pediatric nurses can effectively combine their knowledge of child development and Fowler's theory of faith development to address the child and adolescent's spiritual needs.

Longing: the lived experience of spirituality in adolescents with Duchenne muscular dystrophy

Although much has been written regarding ill adolescents, research has not described their spiritual response. The purpose of this descriptive phenomenological study was to describe the lived experiences of spirituality in adolescents with Duchenne muscular dystrophy using van Manen's phenomenological method. Findings from nine teens showed that the essential theme of spirituality was "longing," the strong desire for something unattainable. Consistent with Reed's (1992) paradigm for understanding spirituality, participants mediated their longing through "Connecting with others, self, and beyond self." These findings support the need for nursing to assess spirituality in teens and determine developmentally appropriate interventions to ameliorate longing.

Practice parameter for the psychiatric assessment and management of physically ill children and adolescents

This practice parameter describes the psychiatric assessment and management of physically ill children and adolescents. It reviews the epidemiology, clinical presentation, assessment, and treatment of psychiatric symptoms in children and adolescents with physical illnesses and the environmental and social influences that can affect patient outcome.

Ethics and the prescription pad

This article reviews the considerations that inform ethical psychotropic medication prescription processes at the clinical level with child and adolescent patients and their families or guardians. Physician attributes, cultural and religious factors, and the psychodynamic aspects of psychopharmacology are reviewed, in addition to the applications of basic ethical principles and concepts to the act of dispensing psychotropic medications. Attention is given to the processes of informed consent, assent, and challenges encountered to ethical prescribing for special populations such as children in foster care and juvenile justice systems. Ramifications of black box warnings and off label prescribing are discussed. Finally, the authors offer practical tips to guide clinicians in ethical psychopharmacologic management of their child and adolescent patients.

Talking with patients about spirituality and worldview: practical interviewing techniques and strategies

Psychiatrists now recognize that religion and spirituality are important to much of the populace and that attending to them probably will improve clinical psychiatric practice. This article presents a practical guide for addressing some of the key interviewing skills needed to explore a patient's framework for meaning-the patient's religion, spirituality, and worldview. It offers guidelines on the process of the interview, including ways to initiate conversation in this area, with suggestions and specific questions for a more thorough exploration of the patient's religious and spiritual life.

Illness: an opportunity for spiritual growth

Spirituality is an innate aspect of being human, and every patient has the potential for spiritual growth through suffering from an illness. However, spirituality and spiritual care are rarely mentioned in the field of medicine, either because their definition can be ambiguous or because their nature can be highly personal. In a departure from the traditional biomedical view of health care, the author in this paper explores another aspect of the patient, hoping to inspire caregivers to be more attentive to the growth of a patient's spirituality. Furthermore, citing several clinical examples and by extrapolating the trajectory of human adaptation to illness, the author also delineates the proper compass of spiritual care and uncovers the distinction between spirituality, religion, and psyche.

Multidisciplinary care of the dying adolescent

The adolescent at the end of life poses a unique combination of challenges resulting from the collision of failing health with a developmental trajectory meant to lead to attainment of personal independence. Because virtually all spheres of the dying adolescent's life are affected, optimal palliative care for these young persons requires a multidisciplinary team whose members have a good understanding of their complementary roles and a shared commitment to providing well-coordinated care. Members of the team include the physician (to initiate and coordinate palliative care management); the nurse (to work collaboratively with the physician and adolescent, especially through effective patient advocacy); the psychologist (to assess and manage the patient's neurocognitive and emotional status); the social worker (to assess and optimize support networks); the chaplain (to support the adolescent's search for spiritual meaning); and the child life specialist (to facilitate effective communication in preparing for death). A crucial area for dying adolescents is medical decision making, where the full range of combined support is needed. By helping the young person continue to develop personal autonomy, the multidisciplinary team will enable even the dying adolescent to experience dignity and personal fulfillment.