Comprehensive Integrated Psychiatric Assessment
Section 1: Video Review
Mental health professionals are bestowed with the sole responsibility of assessing the mental health of clients and helping them improve on their overall wellbeing. Regarding the video, I believe the nurse did a good job assessing the adolescent who presented with symptoms of depression and anxiety. First, she focused on assisting the client in understanding why he was referred to her. This was critical in creating a work environment that fosters trust, engagement, and a sense of belonging. The social worker also did a good job maintaining effective communication skills where she engaged the client extensively as she asked him simple, comprehensive questions (YMH Boston, 2013). She also maintained eye contact with her client. Eye contact is a vital non-verbal cue used purposefully by medical officers to build a good rapport with their assigned patients. Most patients may take it as a sign of respect and attention from their primary physician or care provider. Most crucially, the questions were important in assisting the care provider in noting the patient’s overall emotions, feelings, thoughts, perceptions, and cognitive abilities.
One area of improvement was how she worked with children. From my viewpoint, she failed to show her concerns about how her patients were feeling. For instance, she seemed distant and did not show any feelings of remorse, empathy, or compassion while assessing the adolescent. This was fundamental in motivating the patient to become more open and cooperative throughout the session. In the interview, one concern that may have risen was suicidal ideation. It is important to note that depression may cause suicidal thoughts. This occurs mainly when one feels unable to deal with an unbearable or rather overwhelming situation.
The next question I would ask the patient is; Do you ever feel like life is no longer worth living? This question would allow me to understand better how the patient perceives himself and the environment he is in.
Importance of a Psychiatric Assessment
Conducting a thorough psychiatric assessment of children or adolescents is critical to note the reasons why they behave the way they currently do. Healthcare professionals must understand their client’s cognitive functioning, including individual thoughts, values, beliefs, emotions, and concerns. It is worth noting that psychiatric assessments are based on their general behaviors or conduct. A thorough psychiatric evaluation is mandatory in helping care professionals diagnose behavioral, emotional, and developmental problems.
Symptom Rating Scales
There is a wide array of different symptom rating scales that could be relied on to assess the mental health of children or adolescents. One of the most commonly used tools is the Behavior Assessment System for Children- Second Edition (BASC-2). This version comprises mainly of Self-Report of Personality (SRP), Teacher Rating Scales (TRS), and Parent Rating Scales (PRS) (Cama et al.,?2020). These items are used to assess a child’s adaptive behaviors and their overall behavioral and emotional issues. Another recognizable assessment scale that is worldly known is the Brief Psychiatric Rating Scale for Children (BPRS-C), suitable for children from six to eighteen. The BPRS-C was innovated to note variations in mental problems among children and adolescent clients. In addition, it can also be used to assess problem scores changes to particular treatment options.
Psychiatric Treatment Options for Children and Adolescents
Early intervention practices are highly recommended for parents who believe their children require medical attention. One of the most effective treatment options that many parents are increasingly adopting is parent-child psychotherapy, also known as parent-child interaction therapy (PCIT). According to research, PCIT plays a vital role in assisting parents in interacting efficaciously with their children and managing their daily behaviors (Luby et al.,?2018). Apart from this, the initiative has been recognized to improve the parent-child bond. Here, parents are required to receive in-the-moment coaching from a proficient therapist. It is necessary to note that once educated, PCIT may be less costly yet workable in the long run. Another psychiatric treatment option for young individuals is dialectical behavior therapy (DBT). DBT relies on a combination of personal and group sessions and additional extensive coaching to teach vulnerable groups coping initiatives necessary to manage extreme emotions and conflicts. Following research, DBT is mostly applicable for high-risk circumstances like adolescents with suicidal thoughts (Zhou et al., 2019).??
Role of Parent or Guardians in Assessment
Mental health professionals should include parents or guardians in the assessment process. For starters, these individuals can help provide crucial information that could be used to assist the therapist make an informed conclusion regarding the client. Additionally, they may play a critical role in advocating, informing, and collaborating with the mental care professional to ensure that the best intervention processes are put in place.??
Psychiatric health professionals are worldly popular to help improve the mental health and wellbeing of community members. Children and adolescents may have little knowledge about mental health problems. Therefore, their parents, teachers, and guardians must take an active role in assisting young individuals to gain the necessary skills for boosting self-awareness, self-confidence, and self-worth.
Cama, S., Knee, A., & Sarvet, B. (2020). Impact of child psychiatry access programs on mental health care in pediatric primary care: measuring the parent experience.?Psychiatric Services,?71(1), 43-48. https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201800324
Luby, J. L., Barch, D. M., Whalen, D., Tillman, R., & Freedland, K. E. (2018). A randomized controlled trial of parent-child psychotherapy targeting emotion development for early childhood depression.?American Journal of Psychiatry,?175(11), 1102-1110. https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2018.18030321
YMH Boston. (2013). Vignette 5- Assessing for depression in a mental health appointment.?YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU
Zhou, X., Zhang, Y., Furukawa, T. A., Cuijpers, P., Pu, J., Weisz, J. R. & Xie, P. (2019). Different types and acceptability of psychotherapies for acute anxiety disorders in children and adolescents: A network meta-analysis.?Journal of the American Medical Association?Psychiatry,?76(1), 41-50.?https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2709652
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I believe the practitioner did really well with the assessment of the client by asking the right questions to form a good relationship. There was good eye contact, open communication and compassion shown by the practitioner. All of these help the client to feel at ease during the assessment interview and its a crucial period for alliance building between the client and practitioner which aids in the client making a decision on the trustworthiness of the practitioner to continue with their treatment (Carlat, 2017) .
The practitioner could have improved her introduction to the client by introducing herself better so the client would feel more at ease.? The practitioner should also go into details about the purpose of the interview assessment and why it is important to the client. ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?? My concerns are the clients mentioning of feelings of frustration and anxiety. The practitioner should address any safety issues to reduce any risk of the client harming himself or someone else. ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?? The next question to ask the client should be, Do you have any plans or intentions of harming yourself? If so, how are you planning to harm yourself? Also ask the client has he ever harmed anyone else on purpose.
A thorough psychiatric assessment of a child/adolescent is important to form a therapeutic alliance for the groundwork of the clients treatment. If the practitioner is careful and prepared and pays close attention to logistic preparations it will ensure to be attuned to the relationship with the client within five minutes into the assessment. The?practitioner will sometimes have trouble with interviewing a child, due to the child not wanting to answer truthfully; the practitioner? should recall their? own childhood experiences, and from the lives of siblings or peers,? to truly understand what the child may be? feeling or going through (Srinath et al, 2019).
Two different symptom rating scales that are appropriate to use during a psychiatric assessment of a child/adolescent are?Children?s Depression Rating Scale-Revised (CDRS-R) ( Stallwood, Monsour, Rodrigues, Monga, Terwee, Offringa, & Butcher, 2021) for depression to address the clients sleep, sadness and appearance to name a few (Isa, Bernstein, Trivedi, Mayes, Kennard, & Emslie, 2014) and Multi-Attitude Suicide Tendency Scale (MAST) (Verhulst & van der Ende, 2020).?The practitioners choice of a rating scale will depend on the purpose for which it is to be used and its psychometric properties. That is why it is important to have a comprehensive understanding of the rating scales to assess the psychopathology of a child/adolescent and to apply criteria when judging each scale that best suits the clients problem (van der Ende, Verhulst, & Tiemeier, 2012).
Two psychiatric treatment options for children/adolescents that are not used for adults are?Play Therapy which?involves the use of toys, blocks, dolls, puppets, drawings, and games to help a child recognize, identify, and verbalize their feelings. The practitioner will observe how the child uses play materials and identifies themes or patterns to understand the child’s problems; through a combination of talk and play the child will have the opportunity to better understand and manage their conflicts, feelings, and behavior ( American Academy of Child and Adolescent Psychiatry (AACAP), 2019). The other treatment is?Parent Child Interaction Therapy (PCIT) which aids parents and child who struggle with behavior problems or connection through real-time coaching sessions. The parent/guardian can interact with their child while the practitioner guides the family toward positive interactions ( AACAP, 2019).
The role parents/guardians play in the assessment process is the parent/guardian make any decisions for the treatment of the child. Any issues with confidentiality, privacy, or consent has to be addressed by the parent/guardian. A good relationship must be formed with the client and the parent/guardian in order to aid in helping the client during the assessment interview, treatment plan, and overall mental health (Carlat, 2017).?Parenting is a key risk factor in the development and maintenance of a child, but can be developed to change for the better of the child?(Ryan, O’Farrelly, & Ramchandani, 2017).
? Articles are considered scholarly when?written by an expert in their field of expertise to communicate new
information. The peer review process is performed before being published by other experts who decide whether it contains
good ideas,?sound methods, and accurate research which can be used in treating clients. Scholarly articles should have an abstract, introduction, methods and materials, results, discussion or conclusion, and references.
American Academy of Child and Adolescent Psychiatry (AACAP) (2019). Psychotherapy for Children and Adolescents:
??????? Different Types. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Psychotherapies-
? ? ? ? For-Children-And-Adolescents-086.aspx
Carlat, Daniel J. (2017).?The Psychiatric Interview?(4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
? ? ? ?Carlat The Psychiatric Interview (1).pdf
Isa, A., Bernstein, I., Trivedi, M., Mayes, T., Kennard, B., & Emslie, G. (2014). Childhood depression subscales using repeated
????? sessions on Children’s Depression Rating Scale – revised (CDRS-R) scores.?Journal of Child and Adolescent
? ? ??Psychopharmacology,?24(6), 318?324. https://doi.org/10.1089/cap.2013.0127
Ryan, R., O’Farrelly, C., & Ramchandani, P. (2017). Parenting and child mental health.?London Journal of Primary Care, 9(6),
????? 86-94. https://doi.org/10.1080/17571472.2017.1361630
?? ? ?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694794/pdf/tlpc-9-86.pdf
Stallwood, E., Monsour, A., Rodrigues, C., Monga, S., Terwee, C., Offringa, M., & Butcher, N. J. (2021). Systematic Review: The
?????? Measurement Properties of the Children’s Depression Rating Scale-Revised in Adolescents With Major Depressive
?????? Disorder.?Journal of the American Academy of Child and Adolescent Psychiatry,?60(1), 119?133. https://doi.org/10.1016
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for Assessment of Children and
?? ? ? Adolescents.?Indian Journal of Psychiatry,?61(Suppl 2), 158?175. https://doi.org/10.4103
Van der Ende, J., Verhulst, F. C., & Tiemeier, H. (2012). Agreement of informants on emotional and behavioral problems
?????? from childhood to adulthood.?Psychological As?sessment,?24(2), 293?300. https://doi.org/10.1037/a0025500
??? ? ?https://drmsimullick.com/wp-content/uploads/2020/07/Assessment-Scales-in-C-A-psychiatry.pdf
Verhulst, F. C. & van der Ende, Jan (2020). Assessment Scales in Child & Adolescent Psychiatry.?Boca Raton, FL:?Taylor &
? ? ??Francis.
?? ? ? https://drmsimullick.com/wp-content/uploads/2020/07/Assessment-Scales-in-C-A-psychiatry.pdf
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