Discussion: 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.
In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.
- Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the Mental Status Examination B-6 and Simulation Scenario-Adolescent Risk Assessment videos.
- Watch the YMH Boston Vignette 5 vide
o and take notes; you will use this video as the basis for your Discussion post.(LINK: https:/ /www.youtube.com/watch?v= Gm3FLGxb2ZU)
By Day 3 of Week 1
Based on the YMH Boston Vignette 5 vide
- 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. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.
- 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 and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources
Expert Answer and Explanation
Comprehensive Integrated Psychiatric Assessment
What the Partitioner Did Well
Based on the YMH Boston Vignette 5 video, there are instances when the practitioner did well, but other areas could be improved efficiently. To begin with, Tony is suspected of having symptoms of depression and anxiety and has been referred to the practitioner. When asked why he has the session, Tony responds by saying that there was sent by the doctor. The practitioner was effective in helping the client to understand the issues that he has through self-reflection. The guiding questions were very instrumental, and Tony was able to relate to the questions as they progressed further. When Tony reiterates that he does not understand the questions posed to him, the practitioners take a more simplistic angle to help him have a clear understanding and meaning to the question before responding. Be that as it may, there are various areas of improvement, with the key being creating a conducive environment for the juvenile. The child seems agitated and not able to freely express his feelings. The practitioner also uses difficult-to-understand phrases that the client finds difficult to comprehend. Be that as it may, the patient is also presented with a series of questions without being informed of the essence of the question and what is expected of them in the form of answers and explanations.
At this point of the interview, there are a lot of compelling concerns with the session. The client is uncomfortable and finds it difficult to answer questions without knowing what is happening. The practitioners ask questions without informing the client of the reasons for his visit and why they need to participate in the process. To get the client to communicate, she asks questions to try and figure out the present symptoms associated with depression which makes the client unfordable or feels that his issues are being discussed.
The probable next question would ask would be, “Tell me about your relationship and how it was important to you?” The question is critical since it will help understand the anger and disappointment that the client is having concerning having depressive symptoms after partying with the girlfriend.
Importance of Thorough Psychiatric Assessment
It is important to carry out a thorough psychiatric assessment of a child or adolescent since they are still undergoing mental and psychosocial development, which might interfere with how thy interpret or respond to different stimuli (Copeland et al., 2018). The psychiatric assessment would help identify the best approach to use when offering mental care and trigger issues that can lead to the onset of unwanted outcomes.
Symptom Rating Scales
The two main symptom rating scales used for children and adolescents include the Young Mania Rating Scale (YMRS) and the Adolescent Psychopathology Scale (APS) (Lica et al., 2021). These scales are fairly easy to use and have fewer steps than those used for adult testing.
Psychiatric Treatment Options for Children and Adolescents
Concerning the psychiatric treatment options for children and adolescents, the two methods include acceptance and commitment therapy and Interpersonal Psychotherapy for Adolescents (IPT-A) (Mychailyszyn & Elson, 2018). These methods are more specific to the younger generation and would not be applied to adult patients.
Role Parents/Guardians Play in Assessment
While caring for younger patients, parents or guardians have a major role since they help provide consent and create a conducive environment for the child to be free in communication and express themselves (Kimonis et al., 2019). Parents or guardians can also help with clarifying the questions more clearly and facilitate proper and efficient communication.
Copeland, W. E., Shanahan, L., Hinesley, J., Chan, R. F., Aberg, K. A., Fairbank, J. A., van den Oord, E. J. C. G., & Costello, E. J. (2018). Association of Childhood Trauma Exposure with Adult Psychiatric Disorders and Functional Outcomes. JAMA Network Open, 1(7), e184493. https://doi.org/10.1001/jamanetworkopen.2018.4493
Kimonis, E. R., Fleming, G., Briggs, N., Brouwer-French, L., Frick, P. J., Hawes, D. J., … & Dadds, M. (2019). Parent-Child Interaction Therapy Adapted for Preschoolers with Callous-Unemotional Traits: An Open Trial Pilot Study. Journal of Clinical Child & Adolescent Psychology, 48(sup1), 1–15. https://doi.org/10.1080/15374416.2018.1479966
Lica, M. M., Papai, A., Salcudean, A., Crainic, M., Covaciu, C. G., & Mihai, A. (2021). Assessment of Psychopathology in Adolescents with Insulin-Dependent Diabetes (IDD) and the Impact on Treatment Management. Children, 8(5), 414. https://doi.org/10.3390/children8050414
Mychailyszyn, M. P., & Elson, D. M. (2018). Working through the blues: A meta-analysis on Interpersonal Psychotherapy for depressed adolescents (IPT-A). Children and Youth Services Review, 87, 123–129. https://doi.org/10.1016/j.childyouth.2018.02.011
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