Question
What can I do as a respiratory therapist to recognize or provide the care needed if there are more than three to four Adverse Childhood Experiences (ACEs)?
Answer
Many times as respiratory therapists, we get caught up in our to-do list. I commend any therapist who truly assesses what is happening with their patient and is really engaging and involved. It is easy for us to overlook the signs and symptoms of potential mental illness or associated stressors with ACEs. Our adult COPD population is typically going to tell us that they are fine. They are going to try to camouflage those issues. For the RT to identify that and to see that this person is potentially in need is going to be absolutely huge. However, this will be more than walking into a room, giving a breathing treatment, and doing a quick assessment. It is going to be engaging and talking to that patient. The more time we spend talking and engaging with the patient and family members, this will give us a better idea of what is going on. We may be able to identify those at high risk (4+ ACEs) as they start talking about divorce or family members that struggle with addiction. They may also be caring for a loved one that has addiction issues. We may even see signs and symptoms of abuse. Once we identify those, we are going to have to tread lightly. Oftentimes, there is a stigma associated with mental health help. No one wants to concede that they are not strong enough to handle what has gone on in their life. As an RT developing rapport with that patient, especially with the frequent flyer patients, developing those relationships helps open that door to getting them the resources they need. Reaching out to the physician or referring for a psych eval is a very direct approach. It might work, but there is a potential to alienate the patient. I would personally also advocate for the nurse to be involved. One of our most overlooked resources in healthcare is the social services case management department. I have met some fantastic social workers in my years in practice. If we identify an issue, we might have a social worker help them identify resources inside and outside the hospital setting.
Many communities have seen a reduction in mental health resources. This is going to be a tougher sell. Social workers and case managers will be very helpful in navigating this and can access resources via insurance companies like Medicare and Medicaid.
I do not have a lot of pediatric experience. In this area, it is definitively about building relationships with the caregivers to build trust. You can take advantage of the five to seven minutes that you are giving a nebulizer treatment. It is all about interacting with the patient and caregivers to advocate for them on a broader scale.
We see patients all the time, and they'll say, "What do you suggest I take as a herbal supplement?" Or, "What do you suggest to help me stop smoking... reduce the stress levels...help me work through some issues that I experienced many, many years ago." There are many things that we can use to fill in the blank.
This Ask the Expert is an edited excerpt from the course, Revisiting Adverse Childhood Experiences: Is This the Key to Managing COPD, presented by Tammy Kurszewski, D.H.Sc., RRT-ACCS.
