Common dilemma faced by psychiatric nurse practitioners is determining who the “client” is.

Explaining Confidentiality and Its Limits:

• Honest and Age-Appropriate Communication: "I understand you don't want me to tell your parents. However, as a healthcare professional, I have a responsibility to keep you safe. There are some situations where I have to share information, even if you don't want me to."
• Specific Examples:
  • "If you are hurting yourself or someone else, I have to tell your parents so we can get you the help you need."
  • "If someone is hurting you, I have to report it to keep you safe."
  • "If the illicit behavior is very dangerous, I will have to inform your parents."
• Emphasize the Goal of Helping: "My goal is to help you, and sometimes that means involving your parents so we can work together to find solutions."

3. Involving Parents (When Necessary):

• Plan the Disclosure:
  • If the PMHNP determines that disclosure is necessary, they should plan how to share the information with the parents in a way that minimizes harm to the child-parent relationship.
  • Attempt to have the child be part of the discussion with the parents.
• Therapeutic Approach:
  • Frame the disclosure as a collaborative effort to support the child's well-being.
  • Focus on the child's needs and the importance of family involvement in treatment.
• Legal Considerations:
  • PMHNPs must be aware of state laws regarding mandatory reporting of child abuse, neglect, and dangerous behaviors.
  • Consult with legal counsel if there are any doubts about legal obligations.

4. Therapeutic Intervention:

• Individual Therapy:
  • Provide individual therapy to address the underlying issues contributing to the child's behavior.
  • Help the child develop coping skills and strategies for making healthy choices.
• Family Therapy:
  • Involve the parents in family therapy to improve communication and address family dynamics that may be contributing to the child's behavior.
• Referral to Specialized Services:
  • If necessary, refer the child to specialized services, such as substance abuse treatment or crisis intervention.

Key Considerations:

• Age and Maturity: The child's age and maturity level will influence the PMHNP's approach.
• Severity of the Behavior: The severity and frequency of the illicit behavior will determine the level of intervention required.
• State Laws: PMHNPs must be familiar with state laws regarding confidentiality and mandatory reporting.
• Ethical Principles: The PMHNP must balance the ethical principles of autonomy, beneficence, and nonmaleficence.

By following these steps, the PMHNP can navigate this challenging situation in a way that prioritizes the child's safety and well-being while respecting parental rights and legal obligations.

This is a complex ethical and clinical situation requiring careful consideration of the child's well-being, parental rights, and legal obligations. Here's a framework for how a psychiatric nurse practitioner (PMHNP) might respond:

1. Building Rapport and Assessing Risk:

• Acknowledge the Child's Disclosure: "I appreciate you telling me this. It takes courage to share something like that."
• Assess the Nature and Extent of the Behavior:
  • What specific illicit behaviors are involved?
  • How often are they occurring?
  • Are there any associated risks (e.g., substance abuse, self-harm, exploitation)?
• Assess the Child's Understanding:
  • Does the child understand the potential consequences of their actions?
  • What are their motivations for engaging in these behaviors?
• Assess for Safety:
  • Is the child in immediate danger?