Introduction
Care plans are essential in healthcare since they provide a road map for patient care and treatment. Melanie is a 15-year-old girl who has made repeated visits to the local emergency department because of three identified issues: self-inflicted lacerations, paracetamol overdose, and suicidal thoughts. The patient has a history of self-harm, suicide ideation, and a suicide attempt, and has had an unstable home growing up.
Melanie is grappling with numerous challenges within her family and social circles, impacting her response to treatment, which underscores the necessity for comprehensive support. A care plan is critical for this patient because she consistently leaves assessments prematurely. This essay outlines a recovery-focused care plan for Melanie that focuses on her treatment goals, treatment recommendations, resources for self-care and community support, and her placement on the stepped care model.
Constructing a Care Plan
Melanie will be referred to the Headspace youth model, Australia’s best practice for reorientating youth mental healthcare. Headspace is a youth-centric model that aims to provide youth and young adults (12-25 years) easy access to a model of care that holistically addresses youth concerns (Rickwood et al., 2019). Headspace provides youth groups, music studios, social clubs, art groups, and young people’s advisory committees (Headspace, 2024).
Headspace has multiple funding streams, including the Australian Government Department of Health (AGDH) access to the Australian Government’s Medical Benefits Scheme, financial contributions from the consortium and local organizations, and fundraising activities (Rickwood et al., 2019). It has a “no-wrong-door “policy and accepts referrals from all sources, including self-referrals. The Headspace services are free or low-cost.
Social Futures (SF) is a non-government organization funded by the AGDH funds with programs for youth aged 12-17. SF provides support such as the Reconnect program, which provides mediation and practical support for young people and their families. SF also works to stabilize the young person’s environment, strengthen relationships within the family, and establish broader connections in the community. Social Futures has a Clubhouse program for 12- to 17-year-olds that provides a safe and fun environment to create projects, including digital storytelling, music/movie production, podcasting, and arts and crafts, as well as living sustainably (Social Futures, n.d.).
Treatment Goals
The goals of the treatment plan are to:
- Ensure Melanie’s safety and stabilize her mental health by eliminating self-harming behaviors by providing individual sessions with qualified psychologists.
- Manage maladaptive distress reduction behaviors while developing alternative coping strategies. Educating the patient on emotional regulation and the window of tolerance in CBT.
- Reduce symptoms of depression, anxiety, and complex post-traumatic distress with an assessment by a psychiatrist and psychoeducation.
- Increase the ability to build interpersonal relationships. Develop communication skills, decision-making, and problem-solving skills. Involve Melanie’s mother in these sessions.
- Support Melanie with her recreational, educational, and lifestyle goals.
The primary objective is to ensure Melanie’s safety and stabilize her psychological condition. To achieve this goal, the provider needs to assist her in building coping mechanisms to help her manage distressing feelings. These strategies will also reduce self-inflicting behaviors while enhancing her ability to handle crises (Gunasiri et al., 2022; Stallman, 2020). The measure of her progress can be gauged by observing her ability to manage and alleviate distressing thoughts and emotions.
Another goal is to help the patient learn to regulate her emotions. For example, the provider can teach her about mindfulness techniques and grounding exercises. Fresco (2022) indicates that cognitive-behavioral strategies are also effective in emotional regulation. The goal will be attained when she can regulate her emotions, as evidenced by fewer, less frequent outbursts. Many issues with her family dynamic affect her well-being (Umberson & Thomeer, 2020; Orben et al., 2020). The goal will be measured by how she communicates with Melanie, her mother, and Skye, and will be attained when she thrives in a supportive family environment.
Another issue is her employment and education situation. She is a gifted student who should have the opportunity to complete school, as this would improve her social determinants of health (Kondirolli & Sunder, 2022). Her performance in school will be measured against the goals, and she will attain them when she completes the semester and finds employment. This goal will help her in the long run and will potentially break the cycle that keeps bringing her back to the hospital.
Recommended Treatments
The recommended treatments are therapy, psychiatric evaluation and treatment, community support, and school-based interventions. Melanie should attend individual therapy to address her mental health needs and trauma history. She can choose between cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and trauma-focused therapy (Syros et al., 2022).
She should also attend family therapy sessions to help improve communication and resolve conflicts within her family. A therapist will provide this treatment. She should see a family therapist because they would best suit her needs (Minuchin et al., 2021). The therapist will determine the frequency of the sessions.
This patient should undergo psychiatric assessment and treatment due to presenting symptoms of depression, anxiety, and emotional dysregulation. Psychotropic medications such as selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers are necessary (Edinoff et al., 2021; Laux, 2021). A psychiatric evaluation will ascertain the medication necessary, which a psychiatrist will administer. Although she may be hesitant to seek psychiatric help, the nurse or physician needs to advocate for her to see a psychiatrist. Additionally, referrals to non-governmental organizations and community-based programs are recommended to augment support and resources.
Self-Care and Community Resources
The provider should encourage Melanie to engage in self-care activities. She should also utilize community resources to support her well-being. For example, she can participate in recreational activities or art therapy if she likes art (Hu et al., 2021). She can also join peer support groups or online mental health resources. Regarding self-care, the provider should encourage her to create positive social connections and adopt healthy lifestyle habits. She can use creative outlets as coping skills; for example, she can use art to express her pain or anger through community art therapy.
Another recommended treatment is school-based interventions. The provider should collaborate with Melanie’s school to implement a trauma-informed approach within the educational setting (Community Care in Australia, n.d.). The collaboration will ensure that she receives support from school counselors or psychologists and is integrated into the school environment. This treatment will be facilitated by her provider and school counselors (Farley, 2020).
Stepped Care Approach and Progress Evaluation
Tier Placement
Melanie will begin at Tier 3 of the stepped care model and receive moderate to intensive interventions (Community Care in Australia, n.d.). The provider must ensure that the interventions are tailored to her level of risk and symptom severity. She is in tier 3 due to the type, frequency, and severity of her symptoms. She will, therefore, use interventions such as dialectical behavior therapy (DBT). These interventions will help reduce the severity of her symptoms and equip her with more effective coping mechanisms.
Progress Evaluation and Stepped Care Adjustment
Regular assessments will help the provider monitor their progress. It is also essential for the provider to employ outcome measures, as they help monitor the efficacy of interventions and inform decisions on stepped care modifications (Churruca et al., 2021; Al Sayah et al., 2021). Standardized symptom rating scales are among the evaluation tools that can be self-reported by the patient. Clinical interviews with mental health experts can also be considered. Other methods can involve using feedback from family members and school personnel about changes in their mental health symptoms and risk levels.
If Melanie shows significant improvement in her mental health symptoms and functioning, she may be stepped down to lower tiers of care. For example, she can move from tier 3 to tier 2 (Community Care in Australia, n.d.). The move will mean she will use less intensive interventions and maintain ongoing support. However, if she experiences worsening symptoms or if she still has the same difficulties despite treatment, she may have to step up to higher tiers of care. As such, she can go to tier 4 and get high-intensity services.
Anticipated Trajectory
The patient is expected to improve in her mental health symptoms and functioning. She is expected to develop skills that help her process her traumatic experiences and show that she has understood what she was taught about emotional regulation. A primary goal of family therapy is to enhance communication patterns within the family. As a result, family members may develop more effective communication skills, including active listening and constructive expression of emotions. Lastly, Melanie should also return to school, show some progress in her academic work, and ensure she has some form of employment.
Access Gaps and Barriers
The gaps and barriers to Melanie getting help may include the limited availability of specialized services. Another barrier is wait times for appointments, especially for NGOs and free mental healthcare services (Looi et al., 2021; Jeste et al., 2022). One disadvantage of free services is that many people need them, so they often have to wait due to a high number of appointments. Due to Melanie’s financial problems, she may have challenges with transportation. This shows the gap in healthcare in terms of helping mental health patients from lower economic classes.
Conclusion
In conclusion, many issues with Melanie are unique to her and not any other patient. As such, the patient needs a recovery-focused care plan tailored to her needs. The treatment plan focuses on her goals, treatment recommendations, funding and referral opportunities, self-care and community help resources, and her stepped-care model placement. The provider should assess the effectiveness of the care plan through regular assessment and monitoring; this will help evaluate the treatment progress.
References
Al Sayah, F., Jin, X., & Johnson, J. A. (2021). Selection of patient-reported outcome measures (PROMs) for use in health systems. Journal of Patient-Reported Outcomes, 5(Suppl 2), 1-5.
Churruca, K., Pomare, C., Ellis, L. A., Long, J. C., Henderson, S. B., Murphy, L. E., Leahy, J. C., & Braithwaite, J. (2021). Patientāreported outcome measures (PROMs): A review of generic and conditionāspecific measures and a discussion of trends and issues. Health Expectations, 24(4), 1015-1024.
Community Care in Australia. (n.d.)
Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, D. A., Viswanath, O., Urits, I., Boyer, G. A., Cornett, M. E., & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology International, 13(3), 387-401.
Fresco, D. M. (2022). Neuroscience: Emotional regulation, mindfulness, and relieving distress. Integrative and Complementary Therapies, 28(3), 115-118.
Farley, H. R. (2020). Assessing mental health in vulnerable adolescents. Nursing2023, 50(10), 48-53.
Gunasiri, H., Wang, Y., Watkins, E. M., Capetola, T., Henderson-Wilson, C., & Patrick, R. (2022). Hope, coping and eco-anxiety: Young peopleās mental health in a climate-impacted Australia. International Journal of Environmental Research and Public Health, 19(9).
Headspace. (2024). Welcome to Headspace Centres.
Social Futures. (n.d.). What can we do for you?
Hu, J., Zhang, J., & Xu, J. (2021). Art therapy: A complementary treatment for mental disorders. Frontiers in Psychology, 12.
Jeste, D. V., Koh, S., & Pender, V. B. (2022). Perspective: Social determinants of mental health for the new decade of healthy aging. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 30(6), 733-736.
Kondirolli, F., & Sunder, N. (2022). Mental health effects of education. Health Economics, 31, 22-39.
Laux, G. (2021). Serotonin reuptake inhibitors: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. In NeuroPsychopharmacotherapy (pp. 1-13). Cham: Springer International Publishing.
Looi, J. C., Allison, S., Bastiampillai, T., & Kisely, S. R. (2021). Headspace, an Australian youth mental health network: lessons for Canadian mental healthcare. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 30(2), 116.
Minuchin, S., Reiter, M. D., & Borda, C. (2021). The craft of family therapy. In The Craft of Family Therapy (pp. 3-11). Routledge.
Orben, A., Tomova, L., & Blakemore, S. J. (2020). The effects of social deprivation on adolescent development and mental health. The Lancet Child & Adolescent Health, 4(8), 634-640.
Rickwood, D., McEachran, J., Saw, A., Telford, N., Trethowan, J,. McGorry, P. (2023) Sixteen years of innovation in youth mental healthcare: Outcomes for young people attending Australiaās Headspace centre services. PLoS ONE 18(6).
Stallman, H. M. (2020). Health theory of coping. Australian Psychologist, 55(4), 295-306.
Syros, I., Karantzali, A., & Anastassiou-Hadjicharalambous, X. (2022). Trauma-focused cognitive behavioral therapy (TF-CBT), cognitive behavioral intervention on trauma in schools (CBITS), and other promising practices in the treatment of post-traumatic stress disorder in children and adolescents: Evidence evaluation. OBM Neurobiology, 6(4), 1-34.
Umberson, D., & Thomeer, M. B. (2020). Family matters: Research on family ties and health, 2010 to 2020. Journal of Marriage and Family, 82(1), 404-419.
