Comprehensive Integrated Psychiatric Assessment

Discussion: Comprehensive Integrated Psychiatric Assessment

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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.
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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?
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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.
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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.

Required Reading
https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=134126845&site=eds-live&scope=site&authtype=shib&custid=s6527200

https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=134126845&site=eds-live&scope=site&authtype=shib&custid=s6527200

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”

https://search.ebscohost.com/login.aspx?direct=true&db=cat06423a&AN=wal.EBC5108631&site=eds-live&scope=site&authtype=shib&custid=s6527200
Chp. 1 Introduction
Chp 4. 15 Minutes pediatric Diagnostic interview
Chp 5. 30 minutes Pediatric Diagnostic Interview
Chp 6. DSM 5 Pediatric Diagnostic Interview
Chp 9. Mental status examination. A Psychiatric Glossary
Chp 13. Mental Health Treatment Plan.

Required Media
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series

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

⦁ Chapter 31, “Child Psychiatry”

Respond to this discussion post. Use at least 2 references

Clinicians must establish a therapeutic alliance when interviewing young individuals by establishing rapport, building trust, and showing kindness (Carlat, 2016). Young individuals may be unwilling to participate in the psychiatric interview and sometimes have age-related or limited cognition abilities. These individuals may disagree with the treatment they did not plan or wish to pursue (Hilt &Nussbaum, 2015).
The interview
The practitioner did well when she assessed the patient if he knew the reason for seeking treatment. She also asked about the patient’s mood, substance use, and safety concerns ( YMH Boston, 2013). She could have improved by introducing herself and asking how he would like to be called. She also should have set expectations and explained how long they would meet and what is the goal of their meeting. The clinician should have discussed confidentiality and limitations due to safety risks. When interacting with young people, clinicians should start the conversation with a subject of interest to encourage young people to get engaged and build therapeutic alliances. An effective psychiatric interview occurs when the clinician understands young people’s inner world, thoughts, emotions, and motivations (Hilt &Nussbaum, 2015).
The clinician did not ask questions to obtain information about the patient’s past psychiatric illness, such as the onset of presenting symptoms, history of past psychiatric treatments or hospitalizations, medications, and the effectiveness of previous treatments. She should have assessed the patient for anxiety, auditory and visual disturbances, delusions, eating and sleeping routines, or any history of physical, sexual, and emotional trauma (Hilt &Nussbaum, 2015). The next question should inquire about the patient’s safety and suicidal thoughts in depth. The clinician must assess for immediate danger to the patients, access to firearms, history of previous suicide attempts, and if the patient has a specific plan to hurt himself.
The importance of a thorough assessment
A comprehensive psychiatric assessment is essential to identify psychopathological factors to make the most accurate possible diagnosis. Clinicians can formulate an effective treatment plan in collaboration with legal guardians and multidisciplinary team members based on existing evidence from various resources. Children’s past and present physical symptoms, family history, school performance, cultural factors, developmental abilities, and resiliency can affect the treatment outcomes (Hilt &Nussbaum, 2015). Sharma et al. (2019) described collecting detailed information about the child’s unique situation as a vital element in identifying the factors affecting the onset of the illness, remission, and response to treatment.
Symptoms rating scales
The level one and level two Cross-Cutting Symptom measure tools are provided by DSM-5 that can be used in both primary care and psychiatric settings (Hilt &Nussbaum, 2015). Meaklim et al. (2018) described these tools as assisting measures for mental health providers in decision-making and tailoring treatment plans for better outcomes. The level one tool can be used during the primary evaluation, and level two can be used for specific concerns. Specific problems include impulsivity, nervousness, depression, attention deficit, mania, obsessive and compulsive thoughts and behaviors, sleep disruptions, physical symptoms, and substance use. A version of these tools is available for children six to 17 years old and includes 25 short questions using a scale of zero to five (none to severe) that children or caregivers can complete. These tools can assist clinicians in detecting and distinguishing the problems, and they can help to measure the effectiveness of the treatment progression toward improvement and recovery. The tools can help clinicians identify patients’ baseline symptoms, and in each visit, they can assess the progress. These tools assist clinicians in evaluating the aspects of the disorder rather than diagnosing the illness and help the providers identify the area of symptoms such as depressive and psychotic symptoms (Hilt &Nussbaum, 2015).
Two psychiatric treatments
Parent-Child Interaction Therapy (PCIT) and play therapy are two treatments only used for children and adolescent patients with mental illness. Zlomke and Jeter (2029) described PCIT helps parents who struggle with children’s behavioral problems, and the goal is to enhance parent-child positive interaction during instructed therapy sessions. Treatment goals include increasing the quality of parent-child rapport, decreasing problematic behavior, increasing appropriate social behavior and parental skills, and reducing parental stress. During play therapy, children use toys to verbalize their emotions, and the therapist observes children during play to identify and understand the child’s problems. The children convey their feelings spontaneously, with the therapist maintaining their safety to verbalize their emotions, fears, and anger. The therapist helps children to name and acknowledge their feelings and assist them in learning problem-solving skills (Wheeler, 2020).
Parent/guardian role
Parent participation in assessment is a significant factor when interviewing young patients. Clinicians can learn about parents’ interaction with their children, each other, and healthcare professionals, which can help identify risk factors, including parents’ mental illness. A comprehensive assessment requires asking parents about the child’s history and present problems. Although the child should be assessed individually, clinicians should provide support and information to parents who have been affected by their child’s mental illness. Studies show that assisting parents with their children’s mental illness promotes more positive outcomes for children and their families (Thapar et al., 2015).

References
Carlat, D. (2016). The psychiatric interview (4th ed.). LWW.
Meaklim, H., Swieca, J., Junge, M., Laska, I., Kelly, D., Joyce, R., & Cunnington, D. (2018). The DSM-5 self-rated level 1 cross-cutting symptom measure identifies high levels of coexistent psychiatric symptomatology in patients referred for insomnia treatment. Nature and Science of Sleep, Volume 10, 377–383. https://doi.org/10.2147/nss.s173381
Robert J. Hilt; Abraham M. Nussbaum. (2015). Dsm-5® pocket guide for child and adolescent mental health (3rd ed.). American Psychiatric Publishing, Inc.
Sharma, E., Srinath, S., Jacob, P., & Gautam, A. (2019). Clinical practice guidelines for the assessment of children and adolescents. Indian Journal of Psychiatry, 61(8), 158. https://doi.org/10.4103/psychiatry.indianjpsychiatry_580_18
Thapar, A., Pine, D., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley-Blackwell.
Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
YMH Boston. (2013, May 22). Vignette 5 – Assessing for Depression in a Mental Health Appointment [Video]. YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU
Zlomke, K. R., & Jeter, K. (2019). Comparative effectiveness of parent-child interaction therapy for children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(6), 2041–2052. https://doi.org/10.1007/s10803-019-03960-y
Comparative Efectiveness of Parent–Child Interaction.pdf
This is a research article from the journal of Autism and developmental disorder

the-dsm-5-self-rated-level-1-cross-cutting-symptom-measure-i-110218.pdf

This is a research article from the Nature of Science of Sleep journal

Clinical_Practice_Guidelines_for_Assessment_of.6.pdf
This is a journal article from Indian Journal of Psychiatry