NRNP 6665: PMHNP Care Across the Lifespan I
Discussion: Comprehensive Integrated Psychiatric Assessment
Photo Credit: Seventyfour / Adobe Stock
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.
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 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 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.
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.
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 important to use follow-up questions to allow the patient to elaborate on various issues.
The practitioner is still trying to establish quality rapport with the client and gain trust. It is important 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 is important 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.
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.
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.
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.
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.
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.
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.