Pediatric Primary Care Case Studies by Catherine E. Burns, Beth Richardson, Cpnp Rn Dns Beth Richardson, Margaret Brady
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visit. The decision was made that Ms. Murphy and the school psychologist will meet with Katie the next morning to discuss the plan. You plan to call the family and meet with Katie after that discussion to see if she will agree to counseling and the plan as arranged.
When do you want to see this patient back again?
The primary care provider may initiate follow-up with the student’s parent via telephone or written communication within a week to inquire about the effectiveness of the reintroduction plan and with an office visit scheduled in the next few weeks to confirm that the child has returned to school and to follow up on the family’s needs for counseling services. Children who are treated with medications will need to be monitored.
Katie returned for a follow-up visit in one month. She had returned to school, although she still reported stomachaches periodically. Ms. Murphy reported that she did not see any other physical symptoms so encouraged Katie to go to school. She had met with the school psychologist and had learned how to recognize the signs that she was becoming increasingly anxious and how to use some relaxation techniques in response to her anxiety. All of her missed schoolwork had been completed, and her grades seemed to be good. She was interacting more with her close friends, and Ms. Murphy felt that overall Katie seemed happy. Katie spoke more with you and said that she still worried at times, but that school was “OK” and that she was doing more things with her two best friends, including a sleepover planned for the next weekend.
Key Points from the Case
1. School refusal is a common problem that must be addressed immediately using a variety of assessment strategies.
2. School refusal may arise for a variety of reasons; the assessment needs to identify the appropriate causes for the individual child.
3. Management of school refusal requires a team effort, including the child, parents, healthcare provider, and school educators and counselors.
4. The primary care provider needs to be a part of the team, including visiting with the school personnel, attending a team meeting, and following up both with the healthcare and the total management plan to get the child back into school and functioning in a happy and healthy way.
REFERENCES
Achenbach, T. M., & Ruffle, T. M. (2000). The Child Behavior Checklist and related forms for assessing behavior/emotional problems and competencies. Pediatrics in Review, 21 , 265–271.
Bernstein, G. A., & Borchardt, C. M. (1996). School refusal: Family constellation and family functioning. Journal of Anxiety Disorders, 10 (1), 1–19.
Bernstein, G. A., Warren, S. L., Massie, E. D., & Thuras, P. D. (1999). Family dimensions in anxious-depressed school refusers. Journal of Anxiety Disorders, 13 (5), 513–528.
Bloom, B., & Cohen, R. A. (2007). Summary health statistics for U.S. children: National Health Interview Survey, 2006. National Center for Health Statistics. Vital and Health Statistics 10 (234). Retrieved July 25, 2008, from http://www.cdc.gov/nchs/data/series/sr_10/sr10_234.pdf
Cohen, E., Mackenzie, R. G., & Yates, G. L. (1991). HEADSS, a psychosocial risk assessment instrument: Implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health, 12 (7), 539–544.
Egger, H. L., Costello, E. J., & Angold, A. (2003). School refusal and psychiatric disorders: A community study. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (7), 797–807.
Elliot, J. G. (1999). School refusal: Issues of conceptualization, assessment, and treatment. Journal of Child Psychology and Psychiatry, 40 , 1001–1012.
Fremont, W. (2003). School refusal in children and adolescents. American Family Physician, 68 , 1555–1560.
Glascoe, F. P. (2000). Detecting and addressing developmental and behavioral problems in primary care. Pediatric Nursing, 26 (3), 251–258.
Heyne, D., King, N. J., Tonge, B. J., & Cooper, H. (2001).
When do you want to see this patient back again?
The primary care provider may initiate follow-up with the student’s parent via telephone or written communication within a week to inquire about the effectiveness of the reintroduction plan and with an office visit scheduled in the next few weeks to confirm that the child has returned to school and to follow up on the family’s needs for counseling services. Children who are treated with medications will need to be monitored.
Katie returned for a follow-up visit in one month. She had returned to school, although she still reported stomachaches periodically. Ms. Murphy reported that she did not see any other physical symptoms so encouraged Katie to go to school. She had met with the school psychologist and had learned how to recognize the signs that she was becoming increasingly anxious and how to use some relaxation techniques in response to her anxiety. All of her missed schoolwork had been completed, and her grades seemed to be good. She was interacting more with her close friends, and Ms. Murphy felt that overall Katie seemed happy. Katie spoke more with you and said that she still worried at times, but that school was “OK” and that she was doing more things with her two best friends, including a sleepover planned for the next weekend.
Key Points from the Case
1. School refusal is a common problem that must be addressed immediately using a variety of assessment strategies.
2. School refusal may arise for a variety of reasons; the assessment needs to identify the appropriate causes for the individual child.
3. Management of school refusal requires a team effort, including the child, parents, healthcare provider, and school educators and counselors.
4. The primary care provider needs to be a part of the team, including visiting with the school personnel, attending a team meeting, and following up both with the healthcare and the total management plan to get the child back into school and functioning in a happy and healthy way.
REFERENCES
Achenbach, T. M., & Ruffle, T. M. (2000). The Child Behavior Checklist and related forms for assessing behavior/emotional problems and competencies. Pediatrics in Review, 21 , 265–271.
Bernstein, G. A., & Borchardt, C. M. (1996). School refusal: Family constellation and family functioning. Journal of Anxiety Disorders, 10 (1), 1–19.
Bernstein, G. A., Warren, S. L., Massie, E. D., & Thuras, P. D. (1999). Family dimensions in anxious-depressed school refusers. Journal of Anxiety Disorders, 13 (5), 513–528.
Bloom, B., & Cohen, R. A. (2007). Summary health statistics for U.S. children: National Health Interview Survey, 2006. National Center for Health Statistics. Vital and Health Statistics 10 (234). Retrieved July 25, 2008, from http://www.cdc.gov/nchs/data/series/sr_10/sr10_234.pdf
Cohen, E., Mackenzie, R. G., & Yates, G. L. (1991). HEADSS, a psychosocial risk assessment instrument: Implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health, 12 (7), 539–544.
Egger, H. L., Costello, E. J., & Angold, A. (2003). School refusal and psychiatric disorders: A community study. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (7), 797–807.
Elliot, J. G. (1999). School refusal: Issues of conceptualization, assessment, and treatment. Journal of Child Psychology and Psychiatry, 40 , 1001–1012.
Fremont, W. (2003). School refusal in children and adolescents. American Family Physician, 68 , 1555–1560.
Glascoe, F. P. (2000). Detecting and addressing developmental and behavioral problems in primary care. Pediatric Nursing, 26 (3), 251–258.
Heyne, D., King, N. J., Tonge, B. J., & Cooper, H. (2001).
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