Bianca Chandler is a 14-year-old African American female who lives with her maternal grandmother, Peace Chandler, age 70, who is her legal guardian. Bianca was diagnosed with schizophrenia two years ago during a series of three psychiatric admissions when she was experiencing auditory hallucinations and paranoid delusions. She was placed on Risperdal (risperidone) 2 mg BID.

Peace brings Bianca to you for an outpatient evaluation. She reports that Bianca has been experiencing more auditory hallucinations, refuses to shower or bathe, and is not sleeping at night. She reports that Bianca has refused to attend church lately, something very important to her close-knit, extended Southern Baptist family. Her granddaughter’s appearance is always unkempt.

Bianca has poor interpersonal skills and does not interact much with you, but she does answer questions. Her affect is flat and presents as depressed. She is not suicidal or homicidal. Her grandmother monitors her medication and assures you that Bianca is taking it as directed.

Questions
From your perspective as Bianca’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.

Based on the DSM-5, what are the criteria for schizophrenia in patients Bianca’s age? Does Bianca meet the criteria for a schizophrenia diagnosis? Why?
What screening tool or instrument would you use to help determine the severity of Bianca’s symptoms? Please include how to score it and what determines a positive or negative score.
What treatment plan would you use to manage Bianca’s symptoms? What level of care would you recommend? How would you coordinate that care and monitor her progress? What type of therapy would you recommend? Provide the rationale to support these recommendations.
How would you work with the family as a unit? What issues would you prioritize and why?