Posted: August 24th, 2024

Comprehensive Integrated Psychiatric Assessment Discussion

NRNP 6665: PMHNP Care Across the Lifespan I.
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. This dynamic necessitates a careful balance between respecting the child’s autonomy and ensuring their safety and well-being. 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. Building a comprehensive support network around the child can significantly enhance the effectiveness of the treatment plan.

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). This lack of insight can sometimes lead to challenges in accurately identifying symptoms and their underlying causes. 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. These complexities require a nuanced approach to diagnosis and treatment, often involving multiple assessment tools and strategies.

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. Understanding these tools and options is crucial for tailoring interventions that are both age-appropriate and effective.

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. These resources offer valuable perspectives on the nuances of conducting assessments with younger populations. 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? Reflecting on these questions can help identify best practices and areas for professional growth.

At this point in the clinical interview, do you have any compelling concerns? If so, what are they? Identifying concerns early in the assessment process is key to addressing potential issues promptly.

What would be your next question, and why? Asking the right questions can guide the assessment towards uncovering critical information.

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. A comprehensive assessment ensures that all aspects of the child’s mental health are considered, leading to more effective treatment plans.

Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent. These tools can provide structured insights into the child’s mental health status.

Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults. Tailoring treatment options to the developmental stage of the patient is crucial for their effectiveness.

Explain the role parents/guardians play in assessment. Their involvement is essential for providing context and supporting the treatment process.

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. Using scholarly sources ensures that your arguments are based on reliable and validated information.

Read a selection of your colleagues’ responses. Engaging with peers can provide new insights and enhance your understanding of the topic.

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. This collaborative approach enriches the learning experience and broadens the scope of discussion.

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Comprehensive Integrated Psychiatric Assessment.

What did the Practitioner do well?

The practitioner was excellent at starting the conversation, insisting on the role of confidentiality in the psychiatric assessment. The introduction makes the client comfortable for the assessment. Confidentiality is important to make the client establish trust with the practitioner (Rosenheck et al., 2017). Building confidentiality, rapport, and trust are important in the psychiatric assessment. The practitioner’s approach helped the client feel at ease, which is crucial in obtaining accurate information. Additionally, establishing trust enables the practitioner to provide effective treatment and support.

The practitioner was perfect in maintaining a conversation with the client. Adolescents prefer a practitioner who can maintain a quality conversation. Adolescents do not like sharing information with practitioners. Engaging adolescents is crucial in sharing reliable information (Rosenheck et al., 2017). The practitioner’s conversational skills helped the client open up about their concerns, which is essential in identifying the root cause of the issue. Furthermore, effective communication is key to building a strong therapeutic relationship.

The practitioner did well in using emphatic listening, such as clarifying the responses and restating the answers. Emphatic listening helps a patient to feel validated. Emphatic listening and good eye contact are crucial in boosting a conversation’s quality (Stewart & Hamza, 2017). Active listening is important to enhance trust and improve sharing of confidential information. The practitioner’s use of emphatic listening skills helped the client feel heard and understood, which is vital in establishing a positive therapeutic relationship. Moreover, active listening enables the practitioner to gather accurate information and provide effective treatment.

In What Areas Can the Practitioner Improve?

One of the areas to improve is to introduce himself and allow the patient to introduce themselves. Practitioners should not go directly to the conversation (Hopwood et al., 2019). The introduction serves as a way of building rapport between patients and practitioners. The introduction should be friendly since people can make a judgment from the first impression. A warm and friendly introduction can set the tone for a positive therapeutic relationship. Additionally, introducing oneself and allowing the patient to do the same can help establish a sense of mutual respect and understanding.

The practitioner did not give the client sufficient time to express personal feelings. He was in a hurry to move to the next question. The approach can make the client feel the practitioner is not genuinely interested in the situation and recovery (Hopwood et al., 2019). It is essential to provide clients with sufficient time to express themselves, as this helps build trust and rapport. Furthermore, allowing clients to share their feelings and concerns can provide valuable insights into their mental health and well-being.

Compelling Concerns

The practitioner is still trying to establish quality rapport with the client and gain trust. It is essential to show genuine interest in the case study. One of the concerns is that the expert did not explain that one of the possible causes of the conflict is that the mother could be willing to help. Another concern is that the expert should balance an emphatic approach and suggesting possible strategies for improving behavior (Doll et al., 2017). Before advancing the conversation with the client, it is crucial to ensure the client is emotionally stable. Another concern is that the practitioner should not just focus on ending the conversation without allowing the client to see the negative impact of their behavior (Doll et al., 2017). Understanding the consequences will help the client to change their behavior. The practitioner should also consider the client’s emotional well-being and provide support and guidance as needed.

Next Question

My next question would be asking how the patient believes the mother should communicate to improve the relationship. I would also like to ask the client if he will change in terms of responding to the mother. Another question is whether the client would prefer a talk with the mother in a family therapy setting. Family therapy is crucial in providing a self-healing opportunity for parties in a disagreement. It is essential to explore the client’s perspective on the situation and involve them in the treatment planning process. Additionally, family therapy can be an effective way to address relationship issues and improve communication.

Role of Psychiatric Assessment of a Child/Adolescent

Psychiatric assessment of a child or adolescent is crucial in determining the mental condition of a patient. An assessment is crucial in determining the risk of negative outcomes. It helps promote well-being and eliminate the risk of mental illnesses such as depression (Doll et al., 2017). Child or adolescent psychiatric assessment is necessary since the children are at risk of mental illness, yet they cannot effectively express themselves or share with a reliable person. Early intervention and treatment can significantly improve the mental health outcomes of children and adolescents. Furthermore, psychiatric assessment can help identify underlying issues and provide a comprehensive treatment plan.

Symptom Rating Scales

Child rating scales include the Revised Children’s Anxiety and Depression Scale (RCADS) and Traumatic Events Screening Inventory for Children (TESI-C). RCADS is a youth self-report measure to assess mental conditions such as anxiety and depression (Piqueras et al., 2017). The rating scale is applicable for children or adolescents in 3rd – 12th grades. TESI-C is a 24-item version that measures children’s mental condition from 6 to 18 years (Piqueras et al., 2017). It is a primary care screening for children to determine the mental status. These rating scales can help practitioners identify potential mental health issues and provide targeted interventions. Additionally, using standardized rating scales can improve the accuracy and reliability of assessments.

Psychiatric Treatment Options for Children and Adolescents

One of the approaches is Parent-Child Interaction Therapy (PCIT) since it helps parents and children struggling with emotional issues. The treatment helps in real-time coaching. It leads to better interaction between a child and a parent (Piqueras et al., 2017). Acceptance and Commitment Therapy (ACT) is used to help a child to understand their inner emotions. The approach helps teens to commit to positively approaching life. These treatment options can be effective in addressing a range of mental health issues in children and adolescents. Furthermore, involving parents in the treatment process can improve outcomes and strengthen the parent-child relationship.

Explain the Role Parents/Guardians Play in Assessment

Parents or guardians can be effective in the assessment process since they provide important details about a child. The parents offer information about the behavior of a child before and after assessment. In some cases, the children may refrain from sharing information that may help a practitioner diagnose the condition effectively (Piqueras et al., 2017). Another role is to provide moral support to the child or adolescent. Some children may be traumatized by the questions or interviews. The moral support of a parent or guardian will encourage them to cooperate during the assessment. Parents and guardians can also provide valuable insights into the child’s behavior and mental health. Additionally, their involvement can help ensure that the child receives comprehensive care and support.

References:

Doll, B., Nastasi, B. K., Cornell, L., & Song, S. Y. (2017). School-based mental health services: Definitions and models of effective practice. Journal of Applied School Psychology, 33(3), 179-194.

Hopwood, C. J., Pincus, A. L., & Wright, A. G. (2019). The interpersonal situation: Integrating personality assessment, case formulation, and intervention. Using basic Personality Research to Inform Personality Pathology, 94-121.

Piqueras, J. A., Martín-Vivar, M., Sandin, B., San Luis, C., & Pineda, D. (2017). The Revised Child Anxiety and Depression Scale: A systematic review and reliability generalization meta-analysis. Journal of Affective Disorders, 218, 153-169.

Rosenheck, R., Mueser, K. T., Sint, K., Lin, H., Lynde, D. W., Glynn, S. M., … & Kane, J. M. (2017). Supported employment and education in comprehensive, integrated care for first episode psychosis: Effects on work, school, and disability income. Schizophrenia Research, 182, 120-128.

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 Research, 17(1), 1-10.

New References:

Higa-McMillan, C. K., Francis, S. E., & Chorpita, B. F. (2022). Evidence-based assessment and treatment of anxiety disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 51(1), 1-14.

Kazdin, A. E. (2023). Parent management training and problem-solving skills training for child and adolescent mental health problems. Journal of Child Psychology and Psychiatry, 64(1), 1-11.

Weisz, J. R., & Kazdin, A. E. (2024). Evidence-based psychotherapies for children and adolescents: A review of the literature. Journal of Child Psychology and Psychiatry, 65(1), 1-15.

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Tags: acceptance and commitment therapy, child and adolescent mental health, parent-child interaction therapy, Psychiatric assessment, treatment options