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 video and take notes; you will use this video as the basis for your Discussion post.
By Day 3 of Week 1
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. 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.
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.
Expert Answer and Explanation
Comprehensive Integrated Psychiatric Assessment
What was Done well and what to Improve
One of the things the practitioner did well is suspending judgment. She did not judge the patient based on his answers. Patients, especially adolescents might avoid being open if the practitioner engaging them is judgmental. The practitioner also did well by avoiding making assumptions without claims. She was also so engaging and maintained eye contact with the patient. Her communication skills were unremarkable. She showed empathy by seeking out and understanding the adolescent reasons for her behaviors. However, the practitioner should have improved her understanding of the adolescent’s beliefs and thoughts of some depression symptoms.
My only concern at this point of the interview is that the practitioner’s questions are too open-ended. I think the practitioner should have used closed-ended questions to allow the patient to give a longer explanation about his feeling. Overall, the assessment was great.
My next question would be what made you think about hurting yourself. This question would help me understand why the patient is depressed and why he thought of committing suicide. After getting answers to this question, it would be easy for me to work with the patient and plan his treatment plan.
Importance of Psychiatric Assessment
A thorough psychiatric assessment of adolescents or children is vital due to the following reasons. First, a thorough assessment will help the practitioner understand the cause of the patient’s presenting symptoms. The practitioner will get the full detail of what is happening to the patient after an exhaustive psychiatric assessment. Second, a thorough psychiatric assessment will help the practitioner make an accurate diagnosis of diseases affecting the patient. Assessment will also give the practitioner an idea of what psychiatric series and types of treatment therapies can help recover back to normal health.
One of the rating scales that can be used to diagnose adolescents or children is the Adolescent Depression Rating Scale (Krause et al., 2019). This scale rating scale has 10 items that the practitioner will look for in the patient. According to Krause et al. (2019), ADRS is a short, applicable, self-report and clinical report scale that can be used to evaluate adolescent depression levels. Another scale is the Children’s Depression Rating Scale. This scale was developed to rate the level of depression among children aged 6-12 years (Pakpour et al., 2019). It has seventeen items rated by a psychiatric interview with the kid and their parents.
One of the treatment methods that can only be used in the teen residential treatment. This treatment therapy is exclusively made for adolescents. de Andrade et al. (2019) note that residential programs are effective in treating depressive adolescents. The second treatment method is inpatient teen mental health treatment. This teen treatment program is also focused on helping teens with mental problems. This program should not take more than thirty days. In the inpatient program, the patient will be closely monitored by practitioners to ensure that they are taking medications that are prescribed.
Role of Parents/Guardians in Assessment
Parents or guardians are vital in adolescents’ psychiatric assessment. Their main role is to provide informed consent so that the patients get to be assessed and then treated. Children or adolescents are underage and are not lawfully allowed to sign informed consent (Blease et al., 2018). Another importance of involving parents in assessment is that they understand their kids and can give vital information that can improve diagnosis and also support their children.
Blease, C., Kelley, J. M., & Trachsel, M. (2018). Informed consent in psychotherapy: implications of evidence-based practice. Journal of Contemporary Psychotherapy, 48(2), 69-78. https://link.springer.com/article/10.1007/s10879-017-9372-9
de Andrade, D., Elphinston, R. A., Quinn, C., Allan, J., & Hides, L. (2019). The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug and Alcohol Dependence, 201, 227-235. https://doi.org/10.1016/j.drugalcdep.2019.03.031
Krause, K. R., Bear, H. A., Edbrooke-Childs, J., & Wolpert, M. (2019). What outcomes count? Outcomes measured for adolescent depression between 2007 and 2017. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1), 61-71. https://doi.org/10.1016/j.jaac.2018.07.893
Pakpour, A. H., Chen, C. Y., Lin, C. Y., Strong, C., Tsai, M. C., & Lin, Y. C. (2019). The relationship between children’s overweight and quality of life: A comparison of Sizing Me Up, PedsQL and Kid-KINDL. International Journal of Clinical and Health Psychology, 19(1), 49-56. https://doi.org/10.1016/j.ijchp.2018.06.002
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