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[ANSWERED] Based on the YMH Boston Vignette 5 video, post answers to the following questions

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.

To Prepare

  • 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.(LINK: https://www.youtube.com/watch?v=Gm3FLGxb2ZU)
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 

Expert Answer and Explanation

Comprehensive Integrated Assessment

To perform psychiatric assessment, a psychiatrist asks the client a range of questions including previous suicidal thoughts, and observes the client’s behaviors in order to make a diagnosis. If the client is a child or an adolescent, the psychiatrist may have to involve the client’s parent or guardian because the former may not be comfortable to respond to some questions (Stewart & Hamza, 2017). Because effective diagnosis of the patient depends on the gathered information, psychiatric assessment should be comprehensive, and a psychiatrist should use the correct symptom rating scale.

Reflecting on the interview between the psychiatrist and the patient, it is clear that the patient comfortably answered the questions he was asked. This is what went well about the whole scenario. However, the therapist may need to improve how she communicates with the client. For example, she should express sympathy towards the client’s problem. When interviewing the patient, I would want them to explain how they spend their day, just after waking up, and before going to bed. This is necessary to understand the patient’s symptoms (Stewart & Hamza, 2017).

The Importance of Thorough Psychiatric Assessment of a Child/Adolescent

When assessing a child/adolescent, the assessment should be thorough enough so that the psychiatrist can establish the need for additional screening or the need for treatment. Such assessment is necessary because it can help the psychiatrist tell if the child has developmental issues or behaviors which can affect their lives. By thoroughly assessing a patient, a psychiatrist can understand the patient’s concerns, fears, behaviors, and symptoms, and come up with appropriate intervention methods (Stewart & Hamza, 2017). If one does not have adequate details about a child and an adolescent, they may misdiagnose the patient, and this can have negative effect on the quality of the treatment.

Symptom Rating Scales that can be useful in Psychiatric Assessment a Child/Adolescent

The Children’s Depression Inventory (CDI) is the symptom-specific tool that is appropriate for a child or an adolescent. The tool assesses up to 17 of the patient’s depression-based symptoms including sleep, crying, sadness and anger. The CDI incorporates a score of 1 to 5 with one denoting least severe to 5 being the most severe. By assessing the child or the adolescent across the 17 items, a psychiatrist can establish if client has cognitive deficiency or if they exhibit maladaptive behavior (Brent et al. 2020).

Other than the CDI, one can use Research Units on Pediatric Anxiety Rating Scale (PARS). This particular tool has a checklist for anxiety-based symptoms (Brent et al. 2020).

Psychiatric Treatment Options for Children and Adolescents that can also be used to treat Adults

The Interpersonal Therapy (IPT) and Cognitive Behavioral Therapy (CBT) are two of the interventions that support treatment of younger patients and adults. The former involves framing the interpersonal issues, and addressing these issues. With the latter, the therapist helps train the client to identify maladaptive thoughts, and train them how to cope with negative experiences or feelings that stem from maladaptive thoughts (Zhou et al., 2017).

The Role of Parents or Guardians play in Assessment

 The parents spend time with children and they can provide crucial details about the patient’s relationships, behaviors and feelings. This information can support diagnosis of the patient. They are equally responsible of making the patient comfortable during the assessment, and this makes it easy for the patients to open up and share their concerns (Zhou et al., 2017).

Conclusion

In conclusion, parent’s participation in patient assessment can help a therapist gather sufficient details about the patient, and administer the appropriate intervention. Some of the tools one can use to diagnose a psychiatric condition include CDI and PARS. While the former is a 17-item scale, the latter includes a checklist that helps test for anxiety.

References

Brent, D. A., Porta, G., Rozenman, M. S., Gonzalez, A., Schwartz, K., Lynch, F. L., Dickerson, J. F., Iyengar, S., & Weersing, V. R. (2020). Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-up. Journal of the American Academy of Child and Adolescent Psychiatry59(7), 856–867. Doi: https://doi.org/10.1016/j.jaac.2019.06.009.

Stewart, S. L., & Hamza, C. A. (2017). The Child and Youth Mental Health Assessment (ChYMH): An examination of the psychometric properties of an integrated assessment developed for clinically referred children and youth. BMC health services research17(1), 82.Doi: https://doi.org/10.1186/s12913-016-1970-9.

Zhou, S. G., Hou, Y. F., Liu, D., & Zhang, X. Y. (2017). Effect of Cognitive Behavioral Therapy Versus Interpersonal Psychotherapy in Patients with Major Depressive Disorder: A Meta-analysis of Randomized Controlled Trials. Chinese medical journal130(23), 2844–2851. https://doi.org/10.4103/0366-6999.219149.

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