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.
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.
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Discussion Post
The prevalence of mental health disorders is becoming more mainstream, with one-half
of all mental disorders appearing before the age of 14 and 75% by 25 (Skokauskas et al., 2019).
Suicide is the second leading cause of death in children and adolescents between 10 and 24 years
old, with anxiety and depression being the most common mental illness in adolescents (Farley,
2020). As healthcare providers, it is essential to understand the importance of assessing, using
the right tools, and early recognition to help children and adolescents that suffer from mental
health disorders.
Video Vignette
Some positives in the video are that the practitioner is calm, sitting down, and facing the
patient, which appears to be more inviting and open to the patient. The patient mentions that he
has feelings of anger and wants to “fight someone.” The practitioner is calm and states that they
can discuss that more nonjudgmentally (YMH Boston, 2013). The provider is attempting to build
rapport with the client, which is important because adolescents are more willing to create an
alliance if they feel that the provider Is authentic, accepting, respectful, involved, and
understanding (Stige et al., 2021).
Some ways the practitioner can improve would be first introducing herself and asking the
patient his name, age, and disclosing that they can talk confidentially. Allow the patient to ask
questions and encourage him to talk about his feelings as he mentions he doesn’t cry. A study
showed that many patients state that they felt that they were another case and that the therapist
did not take a genuine interest in them, which created a loss of hope for the patient. The patients
were less likely to disclose information and be vulnerable around them (Stige et al., 2021). The
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practitioner continues to ask a series of questions without taking the time to understand or get to
know how the patient is truly feeling.
The primary concern regarding the patient is that he doesn’t want to be alive, and he has
thoughts of hurting himself. The next question I would ask is if he had any previous suicide
attempts. By asking this question, we can establish if the patient is at a higher risk if they have
had previous attempts. Once we determine the risk level, we can move forward and ask if they
have a plan, come close to hurting themselves, and what keeps them from hurting themselves.
When discussing suicidal thoughts, the provider needs to explain that the patient’s safety and
well-being are their top priority and ask the patient if they are ok to discuss this topic. By asking
permission, demonstrates respect for the patient’s autonomy and can decrease defenses and
makes the patient feel more vulnerable (Pettit et al., 2018).
Assessing Children and Adolescents
A thorough psychiatric assessment is essential with children and adolescents because it
helps diagnose, uncover any comorbidities, and prepare appropriate treatment. Children are
limited in explaining their symptoms, and it is collected from the parents or teachers. In contrast,
parents of adolescents may give relevant information, but the patient may choose not to disclose
it to the provider (Kuhn et al., 2016). Being able to assess and diagnose children and adolescents
correctly can help in timely and appropriate care, education to families, and clarification of the
patient’s current behavior.
Two different symptom rating scales appropriate to use during the interview would be the
Strengths and Difficulties Questionnaire (SDQ) and the Development and Well-Being
Assessment (DAWBA). The SDQ is a 20-question tool that addresses children aged 2-17 and
assesses emotional symptoms such as to conduct problems, hyperactivity, and peer issues. The
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DAWBA is a questionnaire with semi-structured and open-ended questions and interviews
designed to produce a DSM-5 diagnosis (Kuhn et al., 2016).
Behavior management training and applied behavioral analysis are two treatment options
for children and adolescents that may not be used when treating adults. Behavior management
training works with the children and parent/caregiver to create positive interactions and steps that
encourage the parents to respond to challenging behaviors from their child. Behavior
management has been used with children that have oppositional defiant disorder and conduct
disorder. Behavioral analysis is a one-on-one training that progressively teaches normative social
behavior through small, feasible aspects reinforced with rewards. This type of treatment is used
with patients with autism spectrum disorder (Hilt & Nussbaum, 2016).
Family can be a significant influence on children receiving treatment for mental health
disorders. Children and adolescents are transitional when they want autonomy but still need their
parents/caregivers’ help. It is noted that parent/caregivers versus child self-reports have
discrepancies with symptoms and behaviors. Collecting information from parents and teacher
shows high validity for assessing mental health disorders in children (Kuhn et al., 2016). It is
vital to have the support of the family as it aids in the planning of treatment, gives a clearer
understanding of what is going on, and creates shared goals that are beneficial in treatment
(Srinath et al., 2019).
References
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Farley, H. R. (2020). Assessing mental health in vulnerable adolescents. Nursing, 50(10), 48–53.
https://doi.org/10.1097/01.nurse.0000697168.39814.93
Hilt, R. J., & Nussbaum, A. M. (2016). Dsm-5 pocket guide for child and adolescent mental
health (Poc ed.). Amer Psychiatric Pub.
Kuhn, C., Aebi, M., Jakobsen, H., Banaschewski, T., Poustka, L., Grimmer, Y., Goodman, R., &
Steinhausen, H.-C. (2016). Effective mental health screening in adolescents: Should we
collect data from youth, parents or both? Child Psychiatry & Human Development, 48(3),
385–392. https://doi.org/10.1007/s10578-016-0665-0
Pettit, J. W., Buitron, V., & Green, K. L. (2018). Assessment and management of suicide risk in
children and adolescents. Cognitive and Behavioral Practice, 25(4), 460–472.
https://doi.org/10.1016/j.cbpra.2018.04.001
Skokauskas, N., Fung, D., Flaherty, L. T., von Klitzing, K., Pūras, D., Servili, C., Dua, T.,
Falissard, B., Vostanis, P., Moyano, M., Feldman, I., Clark, C., Boričević, V., Patton, G.,
Leventhal, B., & Guerrero, A. (2019). Shaping the future of child and adolescent
psychiatry. Child and Adolescent Psychiatry and Mental Health, 13(1).
https://doi.org/10.1186/s13034-019-0279-y
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.
Stige, S., Barca, T., Lavik, K., & Moltu, C. (2021). Barriers and facilitators in adolescent
psychotherapy initiated by adults—experiences that differentiate adolescents’ trajectories
through mental health care. Frontiers in Psychology, 12.
https://doi.org/10.3389/fpsyg.2021.633663
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YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health
appointment . YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU
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