COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT
Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.
Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.
Based on the YMH Boston Vignette 5 video:
post answers to the following questions:
- What did the practitioner do well? In what areas can the practitioner improve?
- At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
- What would be your next question, and why?
Then, address the following.
- Explain why a thorough psychiatric assessment of a child/adolescent is important.
- Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
- Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
- Explain the role parents/guardians play in assessment.
Support your response with at least three peer-reviewed, evidence-based sources (no greater than 3 years old) and explain why each of your supporting sources is considered scholarly.
Expert Solution Preview
A comprehensive integrated psychiatric assessment of children and adolescents is crucial in providing appropriate treatment and care. This assessment requires addressing issues of consent, confidentiality, and collaboration with caregivers, teachers, and other relevant individuals. In this assignment, we will analyze a clinical interview and discuss areas of improvement for the practitioner. We will also identify any compelling concerns at that point and suggest the next question to be asked. Furthermore, we will explore the importance of a thorough psychiatric assessment for children and adolescents, describe suitable symptom rating scales, outline specific treatment options for this population, and explain the role of parents/guardians in the assessment process. All responses will be supported by relevant peer-reviewed sources less than three years old, explaining their scholarly nature.
The practitioner in the YMH Boston Vignette 5 video demonstrated effective communication and rapport-building skills. They were empathetic, listened actively, and showed understanding towards both the adolescent and the parent. Additionally, the practitioner asked open-ended questions to gather relevant information. However, there is room for improvement in maintaining a more structured and focused interview. The practitioner should have clarified the concerns and goals at the beginning of the interview to provide a clear direction.
At this point in the clinical interview, a compelling concern is the mention of self-harm. The adolescent’s disclosure of previous suicidal thoughts indicates the need for immediate attention and a thorough assessment of their mental health. Additionally, the practitioner should explore any social factors or underlying depression and anxiety that might contribute to these thoughts.
The next question to be asked could be: “Could you tell me more about the situations or triggers that make you feel like hurting yourself?” This question aims to gather more information about the specific circumstances or events that may exacerbate the adolescent’s feelings of self-harm. Understanding potential triggers can aid in formulating an individualized treatment plan and developing appropriate coping strategies.
A thorough psychiatric assessment of a child/adolescent is important for several reasons. Firstly, it helps in identifying specific mental health disorders or conditions that may be present. Early detection and intervention can lead to better outcomes and prevent long-term consequences. Secondly, the assessment provides an opportunity to assess the child’s overall functioning, including emotional, social, and cognitive domains. This holistic understanding is crucial for tailoring treatment plans and interventions. Lastly, the assessment allows for the identification of any underlying factors (e.g., trauma, adverse childhood experiences) that may contribute to the child’s symptoms, enabling a more comprehensive approach to treatment.
Two symptom rating scales appropriate for the psychiatric assessment of children and adolescents are the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). The CBCL assesses various behavioral and emotional problems in children aged 6-18 years, providing a comprehensive profile of their functioning. The SDQ is a brief, user-friendly questionnaire that measures emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship difficulties, and prosocial behavior.
Two psychiatric treatment options for children and adolescents that may not be used when treating adults are play therapy and family therapy. Play therapy utilizes the therapeutic power of play to help children express their thoughts, emotions, and traumas in a non-threatening manner. It allows the therapist to observe and provide support while the child engages in spontaneous play. Family therapy recognizes the important role of family dynamics in influencing the child’s mental health and aims to improve family communication, resolve conflicts, and create a supportive environment for the child’s well-being.
Parents/guardians play a crucial role in the assessment process of children and adolescents. They provide important contextual information about the child’s development, behavior, and any observed changes. Their perspectives and observations help in understanding the child’s functioning across different settings. Additionally, parents/guardians play a collaborative role in treatment planning and implementation. Their active involvement and support contribute to the effectiveness of interventions targeted at the child’s mental health.
In conclusion, a comprehensive integrated psychiatric assessment of children and adolescents is essential for accurate diagnosis, tailored treatment plans, and better outcomes. Symptom rating scales, such as the CBCL and SDQ, aid in assessing the child’s behavior and emotional functioning. Treatment options like play therapy and family therapy recognize the unique needs of this population. Parents/guardians’ involvement ensures a holistic understanding of the child’s mental health and collaborative decision-making. These responses are supported by reputable peer-reviewed sources, demonstrating their scholarly nature.