interviewed Bethany Hall, MSN, the owner of Healing Connection, on the role nurse practitioners have in understanding and approaching care for children with complex developmental trauma (CDT).

In this discussion, Hall explains how the COVID-19 pandemic has impact the occurrence of CDT among children during quarantine, and the need for greater awareness of this issue in light of the potential increase in need for care in this area.

 Do you think the COVID-19 pandemic has affected the occurrence of CDT or the need for greater attention to this issue?

 So, I think we're all going through acute trauma, and something I talk a lot about with my colleagues and with my patients is this idea of the window of tolerance.

So, imagine on the table in front of you, you have 3 glasses of water. One glass of water is just barely full, another one is about halfway full, and the next one is full almost to the tippy top. So, if I shake that table in front of you, very different things are going to happen to each glass. The one with very little water probably will spill nothing, the one with the middle amount of water may spill a little bit, but likely would still contain most of that water. The cup that's full almost to the tippy top when you shake that table, water is going to go everywhere. So, the proverbial water is going everywhere right now.

These kids that have a small window of tolerance that already, because of the way their brains and their bodies have been affected by trauma, a new onset of acute trauma really just causes them to react in a much larger way on a much grander scale than a person that did not undergo significant childhood trauma.

So, 100%, yes. I think the acute impact on chronic trauma is a real issue. Then we've seen in cities—like where you're based in Philadelphia—some of these very large cities went to all virtual, so then you have all these children in already poverty-stricken areas who have parents with low resources, many of them who've also experienced trauma that are now stuck in a home 24/7 with very little resources.

So, if you think even just about the effect on the parents’ ability to parent, you have parents who already have a small window of tolerance who may have experienced abuse and neglect in their own lives that now are under an extreme amount of stress. So, I believe that we already have some data, but I believe we will see even more that childhood abuse and neglect go up significantly because of these parents’ inability to have the resources that they need, to have the break that they need, the mental health care and self-care that they need to parent well.

But also, we do see the compounded effect on children that already have a small window of tolerance. This acute trauma on them is also really wreaking havoc, and it's really imperative during this time that we understand how to increase their resiliency, increase their window of tolerance, increase the abilities that we're giving to these parents as far as tools to help promote mental flexibility, resilience, all of those things.

Again, I think, in the future, we're going to, as they say, reap the whirlwind in these coming years as these children grow into adulthood if we are not making a concerted effort to help them process traumatic events so that they do not become traumatic and cause a negative impact on that child.

Videos

Bethany Hall, MSN, the owner of Healing Connection, discusses how the COVID-19 pandemic has impacted the occurrence of complex developmental trauma among children.

Expert: The Experience of the Pandemic May Have a Compounding Effect on Children With Complex Development Trauma

Contemporary Clinic spoke with John Lee, a recent graduate from the Acute Care cohort at the University of Washington's School of Nursing, about his experience and what he hopes other PNPs can learn in their experiences.

Lee also spoke about being one of the first students in the school's acute care program and gave advice on how to be flexible in the profession.

Being an Acute Care PNP Student During the COVID-19 Pandemic

Contemporary Clinic spoke with NAPNAP President Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN and NAPNAP Secretary Jennifer Sonney, PhD, APRN, PPCNP-BC, FAANP, about their latest study regarding the pandemic's impact on pediatric-focused nurse practitioner workforce.

Peck and Sonney share their inspiration for conducting the study, highlights of the findings, and what they hope this study will teach other NPs about the workforce. 

https://www.jpedhc.org/article/S0891-5245(21)00094-8/fulltext

The Impact of COVID-19 On Pediatric Advanced Practice Registered Nursing Workforces

interviewedLea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, on a recent study she co-authored that was published in 

 on the epidemiology of functional seizures among adults treated at a university hospital.

Could you explain further the novel association in your findings between functional seizures and cerebrovascular disease?

 Yeah. So, in our data, what we saw was basically that that the presence of functional seizures and the presence of cerebrovascular disease, or more specifically stroke, tended to co-occur at a rate higher than what we would expect by chance, just based on how common those 2 conditions are independently.

So, we saw them actually occurring together more often than we would expect. We did do some work to try to figure out which might be coming first, the functional seizure condition or the stroke event.

The challenge with that though is that patients with functional seizures often experience like a 7 to 8 year diagnostic odyssey, so by the time they actually get diagnosed with functional seizures they may have been having functional seizures for a very long time and that can be really hard to tease apart in the medical record.

So, that's part of our challenge in trying to understand the relationship between these 2. I will also say that it's not uncommon for stroke patients to experience or to develop epilepsy after a stroke, and so one of the recommendations that we make in the paper is that, for anybody who's experiencing seizures post-stroke who is not pretty quickly responding to anti-epileptic medications, they should be referred to a video EEG to determine if this is a functional seizure condition or epileptic seizures.

Lea Davis, PhD, of the Vanderbilt University Medical Center and Vanderbilt Genetics Institute, discussed the results of her research showing a novel association between functional seizures and cerebrovascular disease.

Novel Association Observed Between Functional Seizures, Cerebrovascular Disease

interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

 on the use of cannabis in treating symptoms of obsessive-compulsive disorder (OCD).

 You mentioned that there may be value in investigating the treatment of compulsions, intrusions, and anxiety with pure CBD. Specifically, why might pure CBD be beneficial, and how would you define pure?

For example, there are isolate, broad spectrum, and full spectrum as common terms used for CBD products sold on the market today. Would any of these terms apply or perhaps not?

 The finding that higher levels of CBD were associated with larger symptom reduction led me to suggest that future investigations should really examine whether pure CBD effectively reduces compulsions, and by that I just meant CBD, either with no THC or with very low THC.

Really, I think all 3 products would be very interesting to investigate. The idea is really just that the intoxicating effects of cannabis, the most detrimental effects of cannabis, and the negative side effects of cannabis are really more associated to THC, so reducing or eliminating THC may be more desirable.

The other thing I wanted to mention in response to your last question was just that we really didn't have enough data on CBG, CBN, or any of the minor phytocannabinoids or terpenes to explore their potential effects, but future research should definitely do so.

Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, discusses recent findings that pure CBD may help to reduce the symptoms of OCD for patients.

Research Finds Potential Benefit of Pure CBD for the Management of OCD Symptoms

interviewed Bethany Hall, the owner of Healing Connection, on the role nurse practitioners have in understanding and approaching care for children with complex developmental trauma (CDT).

In this discussion, Hall explains why training on the recognition of symptoms of CDT in children can be essential in supporting their identification by nurse practitioners in order to best approach care for that child.

Without this training, would nurse practitioners be able to recognize the symptoms of CDT in children?

So, I can speak for myself as a nurse practitioner—I didn't know anything about it.

So, there were often times where I had this little feeling in my chest when we'd interact with the child that had come in and had a suicide attempt like I just feel like the way we're doing this isn't the best.

This child is being shut down, clearly doesn't feel safe in this environment. We bring them in the emergency department, and we strip them down for safety reasons. They're put in basically just a nightgown, so if you can imagine a child that's experienced sexual trauma, then being asked to completely disrobe in a very cold sterile environment with a security guard standing outside the door.

I just remember feeling like this just feels really wrong to me and I don't know how to do things differently or why this isn't right, but I just feel like it's not right.

So, I think probably any nurse practitioner that's encountered a child that has gone through severe neglect, abuse, childhood dysfunction in their home, there may be something that goes this just doesn't feel right. I feel like heavily medicating this 5-year-old until they can't even really cry when they're hurt kind of a thing feels unnatural to us.

I think as nurses we're often very perceptive to that, and you may feel that there should be more we're doing. I can say, in my experience, 100% I did not receive any education in this, and I wouldn't have had the tools to diagnose this, to recognize it, and much more.

I would definitely not have had the tools necessary to be a part of the solution. So, I think it's really important that, as the CDC just came out with a report on Adverse Childhood Experiences scores, and I think as there's this increasing awareness in the mental health and psychology counterparts that we really need to jump on that train and understand what we can. How can I educate myself, how can I get the tools necessary to be a part of the solution, not only to recognize the problem but to do something about it.

Bethany Hall, MSN, the owner of Healing Connection, discusses the importance of training nurse practitioners on how to identify signs and symptoms of complex developmental trauma in pediatric populations.

Training Nurse Practitioners on Symptoms of Complex Developmental Trauma in Children is Critical as a Part of the Solution

interviewed Carrie Cuttler, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

 What are the implications of your research on the use of THC, CBD, and other compounds in cannabis, such as CBG or CBN, as potential treatments for OCD? Are there any potential benefits to one compound over another?

Yeah. So, we examined whether THC, CBD, or the interaction between THC and CBD might predict the size of the symptom reductions.

We found that as CBD increased, so did the size of the reduction in compulsions. That's actually consistent with a couple of previous animal studies that showed that CBD reduced compulsive behavior in rodents.

In contrast, THC and interactions between THC and CBD really did not predict the size of symptom reductions people reported.

So, these findings suggest that cannabis with higher concentrations of CBD may be more beneficial for managing compulsions. Well, inhaling really any cannabis product might produce perceived reductions in intrusions and anxiety.

Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on recent findings that show CBD may reduce intrusive thoughts and anxiety for patients with OCD.

CBD May Reduce Intrusive Thoughts, Anxiety for Patients With OCD

interviewed Lea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, on a recent study she co-authored that was published in 

During the interview, Davis discussed the findings of her research in relation to the epidemiology of functional seizures.

Lea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, discussed the epidemiology of functional seizures.

Understanding the Epidemiology of Functional Seizures

Contemporary Clinic spoke with Patricia Ryan Krause, MS, RN, MSN, PNP-BC, from the National Association of Pediatric Nurse Practitioners (NAPNAP) about Global Health Awareness Month 2021, which takes place in May.

This second part of the interview covers how to work with refugees with chronic conditions, any special considerations while working with those who experienced trauma while/before/after immigrating, and what she hopes to see for the future of patients who are impacted by health inequalities.

Special Considerations and Helping Patients with Health Inequalities

Because several pharmaceutical companies pulled back from the federal 340B program last fall, many patients with diabetes are now seeing skyrocketing insulin prices, according to Anne Webster, NP, with UnityPoint Health.

Webster said she has been forced to prescribe less effective insulin options in recent months and has seen patients beginning to ration their medications. In addition to impacting their physical health, Webster said she has seen patients struggling with their mental and financial wellbeing over the last few months, and she sees no end in sight. The only solution, she said, is for Health and Human Services Director Xavier Becerra, JD, to enforce federal policies to ensure affordable medication access.

Because several pharmaceutical companies pulled back from the federal 340B program last fall, many patients with diabetes are now seeing skyrocketing insulin prices.