NRNP 6665- Open Discussion Wk1

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.

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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.

THE DISCUSSION. In about 3-4 pages.

To Prepare/ RUBRIC

· 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.

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. NRNP 6665- Open Discussion Wk1

Videos

https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series

https://www.youtube.com/watch?v=wNF1FIKHKEU

YMH Video below

https://www.youtube.com/watch?v=Gm3FLGxb2ZU

Ref /Readings

Symptom Media. (2014). Mental status exam B-6. [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series

Western Australian Clinical Training Network. (2016, August 4). Simulation scenario-adolescent risk assessment [Video]. YouTube. https://www.youtube.com/watch?v=wNF1FIKHKEU

YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointment [Video]. YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

· Chapter 31, “Child Psychiatry”

Learning Resources

Required Readings (click to expand/reduce)

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

· Chapter 1, “Introduction”

· Chapter 4, “The 15-Minute Pediatric Diagnostic Interview”

· Chapter 5, “The 30-Minute Pediatric Diagnostic Interview”

· Chapter 6, “DSM-5 Pediatric Diagnostic Interview”

· Chapter 9, “The Mental Status Examination: A Psychiatric Glossary”

· Chapter 13, “Mental Health Treatment Planning”

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(2), 158–175. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

· Chapter 32, “Clinical assessment and diagnostic formulation”

Required Media (click to expand/reduce)

Shawn is a 16-year-old boy who has come to an outpatient clinic for a mental health assessment. The appointment was not his idea, and he is not happy to be at the clinic. The provider utilizing positive techniques to engage him will make him feel worth keeping the appointment. The practitioner must help the patient get beyond his closed-off presentation and help the client talk about himself (YMH Boston, 2013c, May 22). The assessment serves as a platform of interrelated purposes to present the chief complaint, formulate a primary differential diagnosis, determine the cause of the issue, and identify the risk of suicidal and homicidal ideations and gather an individualized treatment plan (Mash & Hundsley, 2005).

What did the practitioner did well?

In this scenario, the client is a 16-year-old white male whose mother wanted him to have counseling for potential anger management issues. The practitioner opened his session very well by first going over the session’s privacy and confidentiality portion. Privacy and confidentiality are held in remarkedly high esteem and considered extremely vital for providing patient care. Confidence and privacy help create and develop trust and a healthy relationship between the clinician and the patient; thus, leading to a positive patient care result/outcome. The provider maintained good eye contact and listened attentively. According to Sadock, Sadock &Ruiz, 2014, giving full attention to the patient shows that the clinician cares.

In what areas can the practitioner improve?

The practitioner could also work on his body language as he sat with his legs crossed, making the client feel as though the practitioner is tense, and the practitioner can smile a little (American Psychiatric Association, 2013). The practitioner could have encouraged Shawn to explain why “school sucks”. The topic should have been explored more with the client. The client also stated several times that he does not like school, but the provider did not ask questions as to why. There are many reasons why a young person might not be achieving academically, including bullying from other students, behavioral or emotional problems, school culture or environment, school workload, and poor relationship with the teacher and other students (Raising Children, 2017). The client seems to have had a difficult time communicating with his mother. The provider should have obtained more information about the client and his mother’s relationship and offered a more effective communication method/strategy. The provider should have used open-ended questions instead of leading questions, making it appear the provider is taking sides. Open-ended questions allow the client to explain his feelings in his own words (Smith, Duell & Martin, 2012).

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

Yes, I would be concerned about his behaviors when angry and during his outburst with his mom. Has he ever thought of harming her or physically hit her? Does he destroy things, and how long does he display the behaviors. These questions will help the practitioner will identify any risk-taking behaviors he might be engaging himself in. I would be concerned for the mother’s safety, what she does during his anger episodes, and afterward to cope with his outburst.

What would be your next question, and why?

The practitioner’s next questions to Shawn will include if he has thoughts of suicide or homicide, substance use, and sexual practices. As noted by Sadock et al. (2014), clinical interviews with adolescents should include exploration of suicidal thoughts, assaultive behaviors, psychotic symptoms, substance use, and use of safe sexual practices.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, Va: American Psychiatric Association.

Mash, E. J. & Hundsley, J. (2005). Special section: Developing guidelines for the evidence-

based assessment of child and adolescent disorders. Journal of Child and Adolescent

Psychology, 34: 362-379.

Raising Children. (2017). School problems: Children 9-15 years. Retrieved from https://raisingchildren.net.au/pre-teens/school-education/truancy-other-school-problems/school-problems-9-15-years

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Smith, S. F., Duell, D., & Martin, B. C. (2012). Clinical nursing skills: Basic to advanced skills. Boston: Pearson.

YMH Boston. (2013, May 22). Vignette 4 – Introduction to a mental health assessment [Video

file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wce.

Response 2

Hi,

Very well written and informative post. The therapist will endeavor to establish rules and regulations and reassure the client of his right to confidentiality during the visit. The practitioner should involve the client in the initial assessment to help develop a treatment plan that both of them are comfortable with. Saddock, Saddock & Ruiz (2014), in their studies, emphasize the importance and the need for the client to increasingly feel that the evaluation is a joint effort and that the practitioner will honestly invest in their story.

Many individuals lose it when it comes to controlling their anger (Tice, 2000). The client may be having many frustrations he is battling and exhibiting through anger. Because this client did not care for school, the frustration of not learning in the same way as his peers could have resulted in anger difficulties. According to Hammer (2015), children learn anger management from their role models-their parents. When parents do not manage anger appropriately, children will often imitate the same behavior. NRNP 6665- Open Discussion Wk1

The practitioner should endeavor to learn the client’s background to arrive at an appropriate diagnosis and help treat the behavior. According to Tarvis (2012), when parents are too strict and use physical punishment, the child tends to develop low self-esteem and anger difficulties.

References:

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Hammer, D. (2015). Living with our genes. New York: Doubleday.

Tarvis, C. (2012). Anger: The misunderstood emotion, 2nd Edition. New York: Touchstone.

Tice, D. (2000). 131 creative strategies for reaching children with anger problems. Chapin, S. C.: Youthlight, inc.