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 vide
o and take notes; you will use this video as the basis for your Discussion post. (https:/ /www.youtube.com/watch?v= Gm3FLGxb2ZU)
By Day 3 of Week 1
Based on the YMH Boston Vignette 5 vide
- 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 Psychiatric Assessment
What was done well and what to Improve
One of the things that the social worker did well was mixing the types of questions she asked the patient. She used prompting questions to ask the patient about the exact symptoms of depression. These direct questions allowed her to identify the symptoms of depression the patient has. She also used open-ended questions. These questions allowed the patient to express himself easily. The social worker also had good communication skills during the assessment. She provided instant feedback, nodded, maintained eye contact, and listened to the patient narrating his feelings. Her facial expression showed empathy when the patient was narrating about his break-up. The social would have improved the data collection process during the assessment by taking note of the symptoms the patient highlighted.
Concerns
My concern is that the social worker did not tell the patient sorry for the break-up. She should have told him sorry to make the patient feel valued. She also did not wait for the patient’s consent to continue her assessment. She should have waited for the patient to allow her to continue asking questions.
Next Question
My next question should be about his sleep habits. According to Santini et al. (2020), depression causes insomnia. Therefore, I would ask the patient about his quality of sleep. I would also ask about his appetite. Depression causes increased or decreased appetite (Francis et al., 2019).
Importance of Psychiatric Assessment
Psychiatric assessment is significant for many reasons. One of the importance of psychiatric assessment is that it allows the psychiatric nurse knows the history of presenting illness. History of presenting illness will help the nurse know when the disease started and what triggered it. Second, the psychiatric assessment also helps psychiatric nurses identify the causes of the mental health problem. In this case, the patient’s depression might have been caused by the break-up. His girlfriend broke up with him. Lastly, psychiatric assessment help nurses connect the patient’s mental health problem is his or her family history.
Rating Scales
One of the rating scales that can be used when assessing a child’s mental health is the Mood and Feelings Questionnaire (MFQ). This tool provides psychiatric nurses with data about the patient’s current moods and feelings (Thabrew et al., 2018). It is often used to screen for depression and anxiety in children and adolescents. The second tool is the Revised Child Anxiety and Depression Scale (RCADS). This tool can be used to assess panic disorder, MDD, anxiety disorders, and obsessive-compulsive disorder in children and adolescents (Klaufus et al., 2020).
Treatment Methods
One of the treatment therapies used to treat only children and adolescents is interpersonal psychotherapy for adolescents (IPT-A). The therapy decreases depressive symptoms in children and helps them recognize their feelings and how interpersonal conflicts and events can affect their mood (Mychailyszyn & Elson, 2018). It also reduces stress and enhances social functioning. The patient can also receive youth residential treatment program. According to Barnett et al. (2018), youth residential treatment programs provide mental health services for children and teens with mental issues.
Role of Parents/Guardians in Assessment
Parents and guardians are critical to children or adolescent psychiatric assessment. They support the assessment by giving their consent to assess the patient. They can also provide data on when the patient experienced mental health problems and what triggered them.
References
Barnett, E. R., Yackley, C. R., & Licht, E. S. (2018). Developing, implementing, and evaluating a trauma-informed care program within a youth residential treatment center and special needs school. Residential Treatment for Children & Youth, 35(2), 95-113. https://doi.org/10.1080/0886571X.2018.1455559
Francis, H. M., Stevenson, R. J., Chambers, J. R., Gupta, D., Newey, B., & Lim, C. K. (2019). A brief diet intervention can reduce symptoms of depression in young adults–A randomised controlled trial. PloS one, 14(10), e0222768. https://doi.org/10.1371/journal.pone.0222768
Klaufus, L., Verlinden, E., Van Der Wal, M., Kösters, M., Cuijpers, P., & Chinapaw, M. (2020). Psychometric evaluation of two short versions of the Revised Child Anxiety and Depression Scale. BMC Psychiatry, 20(1), 1-12. https://doi.org/10.1186/s12888-020-2444-5
Mychailyszyn, M. P., & Elson, D. M. (2018). Working through the blues: a meta-analysis on interpersonal psychotherapy for depressed adolescents (IPT-A). Children and Youth Services Review, 87, 123-129. https://doi.org/10.1016/j.childyouth.2018.02.011
Santini, Z. I., Jose, P. E., Cornwell, E. Y., Koyanagi, A., Nielsen, L., Hinrichsen, C., … & Koushede, V. (2020). Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. The Lancet Public Health, 5(1), e62-e70. https://doi.org/10.1016/S2468-2667(19)30230-0
Thabrew, H., Stasiak, K., Bavin, L. M., Frampton, C., & Merry, S. (2018). Validation of the mood and FEELINGS questionnaire (MFQ) and short mood and feelings questionnaire (SMFQ) in New Zealand help‐seeking adolescents. International Journal of Methods in Psychiatric Research, 27(3), e1610. https://doi.org/10.1002/mpr.1610
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