Social networking sites (SNS) have flourished with the advent of technology in the 21^st century.  We are now able to share, connect and interact with individuals from all walks of life through these virtual communities. While social media plays a pivotal role in our greater internet experience, there are legitimate dangers associated with its use by the child and adolescent population. Children are much more vulnerable to online security breaches that affect their privacy and safety. Fortunately, there are guidelines from bot the American Academy of Child & Adolescent Academy and the American Academy of Pediatrics (see references, below) that offer specific measures that parents take to help ensure the safety of their children on SNS.

Professional consensus, first and foremost, suggests that parents should discuss and develop an agreed-upon media contract at home that can provide both parents and youth parameters around use of technology that set forth clear ground rules for social media activity to include advanced discussion of potential consequences of breaking these rules.   This “ounce of prevention approach” can help children understand the concerns related to improper social media use early on so there is a greater likelihood of preventing harm.

Most particularly for younger children, but relevant for all, the implementation of parental controls on devices is an excellent way to monitor social media use, particularly setting age and time limits on SNS. Obtaining passwords for your child’s phone, email and SNS are crucial in enforcing these guidelines. This will allow parents to freely check for tracking software or friend requests from strangers.  As part of this process, it is recommended that parents provide complete transparency about the perils of chatting with strangers online and posting personal identifiable information. It is difficult for many children to understand the permanency of their posts, messages and photos and sifting through past posts is just a click away. Inappropriate posts can lead to both immediate danger and they can have larger life implications if future college administrators and employers find them. Encouraging proper social media etiquette and keeping tone respectful can prevent these untoward outcomes.

Parents leading by example is key. The designation of screen-free zones and screen-free times can help youth set limits around use.  Keeping phones out of bedrooms and disabling Wi-Fi connections after bedtime can be useful interventions.  When problems arise, it may also be appropriate to make household rules that all electronic devices need to be accessed from a central location rather than the privacy of the bedroom as an extra layer of protection. The American Academy of Pediatrics Family Media Plan is a great place to start for families (see references).

It is important to recognize and accept that SNS are the new wave of communication in the younger generation, and can have important beneficial outcomes if utilized appropriately. It is never too early and never too often for parents to coach their children in appropriate use.

References:

• American Academy of Child and Adolescent Psychiatry, Facts for Families: Social Media and Teens. Updated March 2018. Available at: https://www.aacap.org/AACAP/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Social-Media-and-Teens-100.aspx
• American Academy of Pediatrics Family Media Toolkit: https://www.healthychildren.org/english/fmp/pages/mediaplan.aspx

Thanks to Sree Reddy, D.O., PGY-4 Fellow UCSD Child & Adolescent Psychiatry and Shawn Sidhu, M.D. Associate Professor, UCSD Child & Adolescent Psychiatry for their contribution of this article.

A recent consult received on our provider triage line [(858) 880-6405] involved a single, middle aged gentleman who had presented on his own steam to a clinic with a mix of mental health, substance use and medical problems— each presenting the provider with risk concerns of various dimensions.  Sorting through these issues with appropriate deference to confidentiality concerns was the focus of the consultation process.

The patient appeared marginally competent with prior behavioral health problems including a history of episodic substance abuse binges.  He also had underlying medical problems that had potential to spin out of control if his medication compliance and self-care were to falter, as seemed likely were he on his own.   He was depressed and angry, not well organized in his thinking, and made several veiled passing references to both potential self-harm and/or harm to others.   There was no clear indication of intoxication, but his past history of substance abuse was well documented. Though he might likely benefit from psychotropic medication intervention, he showed little insight or motivation to request or obtain care.

While not deemed to be acutely or intensively at-risk, the PCP called SmartCare wondering how to respond.  Would it be appropriate to contact law enforcement?  And if so, could he be safely maintained at the clinic until they responded?  If contacted, would the officers come in a timely manner and then be willing to bring him to the “not so” nearest psychiatric facility?   And, finally, if transferred would he ultimately be admitted for treatment or, as seemed more likely, would he simply be released angrier, more frustrated and perhaps a greater risk?

On the other hand, it was felt that the patient could not be released to his own recognizance given his clear deficits in judgement, insight and impulse control.  The patient’s visit to the clinic had been occasioned by a relatively minor medical concern.  He was clearly not seeking a behavioral health intervention, yet the clinic provider felt on the horns of a dilemma given the potential for harm.

After review of the presenting problems and past history, it was decided to ask the patient for his permission to contact his relatives, so that the safety concerns and a management plan could be discussed with them.   He agreed and details of monitoring, oversight, follow up care, and a safety plan were put into place with the family.

Bottom line:  Family, neighbors, friends and others in the community can be an important resource for patients and providers when additional information or community support is required as part of addressing a perceived safety concern—psychiatric or medical.  With patient consent, confidentiality requirements can be waived and provider confidence restored.