Depression Screening in Adolescents Case Study You are a nurse

Depression Screening in Adolescents Case Study You are a nurse practitioner student working with a family nurse practitioner (FNP) at a rural community health center. Today you are seeing a 14-year-old Caucasian male, Jake, for his well child check-up, and he is brought in by his father. In reviewing his chart, you note that he plays football, has no concerning health history, but that at his appointment last year he screened positive for mild depression on the PHQ-A with a score of 8. At that time, he denied any suicidal thoughts. Anxiety was not screened for at his last visit. You could find no note of depression being discussed at his last checkup. Additionally, you note that Jake’s mother has called the nurse a few times in the last two months saying that Jake is complaining of headaches and stomachaches frequently, which are causing him to miss school and football practice. Today, you note that his PHQ-A score has increased to 14. Additionally, while he remains at the 75th percentile for height as he has throughout his life, his weight has dropped from the 70th percentile to the 50th percentile in the last year. Today, as Jake and his father walk in, his father is complaining about his long hair and asking him why he just doesn’t cut it already. Jake appears uncomfortable in the room with his father,as if he is trying to get away from him. Jake is fidgety, making minimal eye contact and mostly looking at the floor. He initially answers questions monosyllabically or with grunts. The father reports that his only concerns regarding Jake’s health are that he seems to be eating less and is trying to quit football, which he has played since he was six. He also reports that Jake seems more withdrawn and irritable. When the FNP asks Jake why he no longer wants to play football, he shrugs, looks at the floor, and says he’s just not interested in it anymore. His dad interjects and says he just needs to man up and try harder. After Jake’s father leaves the exam room, the FNP proceeds with the exam. The only abnormal findings are Jake’s weight and his depression screening score. When the FNP discusses the PHQ- A score, Jake initially says he’s fine, then he begins crying and states he’s so tired of “holding everything in and faking it all the time.” After talking about what he means, he discloses that he thinks he’s trans. He says he wants to quit football because he doesn’t feel comfortable on the team anymore. He has told one of his close friends and his older sister who are accepting, but he is terrified to tell his parents, especially his dad. Jake says that both his parents are very religious and conservative and frequently make negative comments about LGBTQ people. Hefears that if he comes out as trans to them, they will kick him out and he will be homeless. Jake acknowledges that he did complain to his mom about headaches and stomachaches because it would get him out of football and school. He hoped that if he had enough absences, he’d get kicked out of his Catholic school and have to go to public school. The FNP discusses with Jake what he would like her to call him and which pronoun to use. He asks her to use male pronouns in his record and around his parents, so they do not find out. He also asks her not to tell his parents, especially his father, anything they discuss. The FNP agrees to not tell his parents about being trans, however she does tell him that she will have to discuss his depression and treatment options with him and his father. Jake agrees with this approach. With Jake, she discusses counseling options, and Jake is amenable to this. When his father returns to the room, the FNP lets him know that Jake’s exam was normal except for his diminished weight and his depression. She recommends counseling for the depression and attributes his weight loss to his depression as well. The father asks if she can just give Jake a pill for the depression because they can’t afford that counseling “nonsense” to talk about feelings. He also states that he’ll work to push Jake to eat more. The FNP agrees to start Jake on Prozac 10mg daily. She counsels Jake and his father on side effects and instructs them to come back in three months to see how he is responding to the medication. After Jake and his father leave, you ask the FNP why she didn’t give Jake information on counseling services because as a 14-year-old in Oregon he is able to consent on his own for mental health treatment (Oregon Health Authority, 2016). She says that she wasn’t going to recommend something that the parents weren’t going to go along with. You state that you are also concerned that even though his depression was addressed, he wasn’t screened for suicidal thoughts or an eating disorder. You know that transgender kids are at an elevated risk of not only depression, but anxiety, eating disorders, and suicide as well (Connolly et al., 2016; Olson et al., 2016). The FNP says she didn’t ask about suicide because she doesn’t know what to do if people say they are suicidal,because “the clinic doesn’thave a policy about that.” Identify the ethicalconcerns with this situation. What information will you need before a responsible decision can be made? (Consider what the information is and where it will come from.) Who are stakeholders involved in the decision, and what is the process in which those involved could come to a decision? (e.g., what tools are/could be used to create an informeddecision) What are the values relevant to this problem? (Values are the things that you believe are important in makingthe decision. They [should] determine priorities.) What are the options for the decision? Think in terms of values and feasibility (e.g., financial, political, organizational, religious constraints). Considering all these ethical concerns, write a short narrative of how you believe to best managethis situation.

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