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Analysis Of The Psychiatric Assessment Assignment Discussion

Analysis Of The Psychiatric Assessment Assignment Discussion

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Introduction

I appreciate the thoughtful analysis of the psychiatric assessment depicted in the video. You make excellent points about areas the practitioner did well, like using open body language and rephrasing the patient’s statements, as well as areas for improvement, like asking more open-ended questions. I wanted to offer some additional thoughts on the importance of rapport-building with adolescent patients and alternative therapy options not yet mentioned. Analysis Of The Psychiatric Assessment Assignment Discussion

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Establishing rapport and trust with adolescent patients is pivotal to gathering accurate, sensitive information. Adolescents are often guarded around unfamiliar providers. Rushing into intimate questions before laying groundwork can cause them to shut down or provide misleading responses. Making casual small talk helps humanize the provider and put the adolescent at ease. Providing clear explanations of confidentiality guidelines also facilitates openness. Only once comfort and mutual understanding are established should the provider gently transition into more personal questions. Taking time to foster rapport signals respect and care, encouraging the adolescent to reciprocate with honesty and transparency. This strengthens the therapeutic relationship and enhances the assessment’s accuracy.

Additionally, other therapy approaches not yet mentioned that can be impactful with adolescents include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and interpersonal therapy (IPT) (Hashemi et al., 2023)Analysis Of The Psychiatric Assessment Assignment Discussion. CBT helps patients identify unhelpful thought and behavior patterns and replace them with more constructive ones. DBT teaches mindfulness and emotion regulation skills. IPT aims to improve interpersonal relationships that may contribute to mental health problems. Research shows these therapies are effective for conditions like depression, anxiety, eating disorders, and behavioral issues in adolescents.

While parental involvement is indispensable, adolescents may not be forthcoming about sensitive topics like substance use, risky behaviors, or mental health struggles if a parent is present (Sujarwo et al., 2021)Analysis Of The Psychiatric Assessment Assignment Discussion. Providing private time to build rapport and allow the adolescent to share openly facilitates a more accurate assessment. Separate sessions with parents to obtain history from their perspective can augment the adolescent interview. Parents are vital partners in reinforcing skills learned in therapy at home. Frequent communication ensures parents understand treatment goals and how to support their child in achieving them (Twum-Antwi et al., 2020). A collaborative approach with the adolescent, parents, and treatment team optimizes outcomes.

Conclusion

Taking time to establish rapport, considering therapy approaches like CBT, DBT and IPT, and collaborating with parents while allowing some adolescent privacy can optimize assessment and treatment. A comprehensive approach addresses an adolescent’s needs on multiple levels for improved outcomes.

References

Hashemi, N., Malik, S., FRPsych, N. I., Zeeshan, M., & Nazeer, A. (2023). Psychotherapeutic intervention with children and adolescents. International Journal of Child Health and Human Development16(2), 155-165. https://www.proquest.com/openview/81795ebb248f4994e2903d7e0e9a8338/1?cbl=2034871&pq-origsite=gscholar

Sujarwo, S., Kusumawardani, E., Prasetyo, I., & Herwin, H. (2021). Parent Involvement in Adolescents’ Education: A Case Study of Partnership Models. Cypriot Journal of Educational Sciences16(4), 1563-1581. https://eric.ed.gov/?id=EJ1316243

Twum-Antwi, A., Jefferies, P., & Ungar, M. (2020). Promoting child and youth resilience by strengthening home and school environments: A literature review. International Journal of School & Educational Psychology8(2), 78-89. https://doi.org/10.1080/21683603.2019.1660284 Analysis Of The Psychiatric Assessment Assignment Discussion

Comprehensive, Integrated Psychiatric Assessment

Instruction :
Hi, please respond to those 2 discussion posts separately with their references separately by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence. Please add the PDF of the resources used for each separately.

#1
Julie D.

YMH Boston Vignette 5: Comprehensive, Integrated Psychiatric Assessment
Until now, I feel a vast majority of my education has been spent on adults. I learned early on in my career as a nurse that working with children, although very rewarding and refreshing, can be much more difficult as you try to navigate their lack of ability to help the practitioner understand their problem. Pediatric psychiatry is even more difficult as children lack the understanding of what they are feeling. It is easy to see a wound, see the blood, and know that your leg hurts because you have an “Ouchy.” It is much more challenging to coordinate the pain in their stomach with the fear or anxiety they have about school. A vast majority of my life has been spent caring for children, as a mother and grandmother, as a foster parent, working with Boystown at-risk youth, as a NICU and PICU nurse, working in the Children’s Hospital ER, and as a case manager for pediatric cancer patients. I love the aspect children and adolescents bring to the situation. They are not concerned with getting everything they need into the 50-minute session. They take things as they come and, in my experience, answer questions openly, sometimes telling you more than you wanted to know, and often using very concrete ideas to describe nebulous thoughts and feelings. I once had a child tell me he had a horse running around inside his head and that it would slow down after he fed it meals, but would stomp very hard in the night to wake him up. I donâ€t think I could have asked him enough of the right questions to gather all that information. Analysis Of The Psychiatric Assessment Assignment Discussion
In the discussion below, we will discuss the YMH Boston Vignette 5 and review the practitioner techniques, discussing why pediatric assessment is important, what she did well, where she can improve, concerns I would have, and how I would proceed. We will also look at appropriate scales and treatment options for children and adolescents, including what part the parents play in pediatric assessment.

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What Went Well and What Did Not
Reviewing the YMH Boston (2013) Vignette 5, I saw many positives in how the practitioner interacted with the youth. She was soft spoken and came across as kind and not judgmental. She nodded in understanding, encouraging the youth to continue telling his story. Her body language was relaxed, and she was on the same level as Tony. She did not push or interrupt him, but gave him time to think and respond. She rephrased what he told her to ensure correct understanding and allow Tony to make adjustments. She did an ok job of completing a depression screening on him without sounding too much like she was checking off boxes. At the end, when he was discussing suicide with her, I felt it was her best moment, and she seemed genuinely interested. She also did an excellent job of getting a timeframe for his symptoms to apply to the DSM-5 criteria. Analysis Of The Psychiatric Assessment Assignment Discussion
As I watched the video, I also saw areas where there could be improvement. The practitioner could have given more of an introduction, which is a great way to help the patient feel more comfortable with her. He should have also been made aware that he could tell her things that did not go beyond the room, and what things must be passed on. In working in addiction, I have many patients who do not want to reveal what or how much they are using. They are much more forthcoming once we explain that the information is only used to better care for them and medicate them appropriately and that their boss or family is not informed. Tony appears to be withholding information that may have come out had he better understood the ground rules of the session. She also asked a lot of closed-ended questions. I would have preferred she say things like “Tell me about…” or “Why do you think…” to gather more free-flowing information from him on what he sees as the problem. Tony was instantly able to discuss his wanting to fight but was not ready to discuss crying (YMH Boston, 2013). I think asking a teenage boy forty seconds into a conversation if he cries a lot will be off-putting, and should be saved for further discussion after establishing a small quantity of trust. It also seemed he did not fully understand some of her terminology (YMH Boston, 2013). Perhaps her questions could have been asked on a more basic level. For instance, instead of asking how his mood has been lately, maybe she should have asked him to tell her about how he has been feeling and given a few descriptors like, if he has been happy, sad, grumpy, had a good or bad attitude recently, if others have been concerned, why, and how he is sleeping. Lastly, I feel she could have asked him to elaborate on things he did say, such as why his doctor sent him, why he wants to fight, why he does not like homework anymore, or more information on his substance use and what led to his relationship ending (YMH Boston, 2013)Analysis Of The Psychiatric Assessment Assignment Discussion.
Compelling Concerns and My Next Step
I am glad she began to address the suicidal thoughts. This would be my biggest concern at this point. According to Roaten et al. (2021), suicide is the second leading cause of death for kids aged 10 to 17 in America, and of the youth presenting to the emergency room with suicide concerns, just under half were aged 5-11. A thorough suicide risk assessment should be completed with Tony to determine the intensity of the thoughts and navigate the next steps. He certainly has many of the markers of depression, and suicide and depression often go hand in hand (Zhang et al., 2023). I would ask Tony when was the last time he had thoughts of hurting himself and if he is having any thoughts currently. I would ask if he has a plan, and I would ask questions to determine access to lethal means and previous attempts. All this information should be used to determine his risk and the level of services needed.
Importance of a Thorough Psychiatric Child / Adolescent Assessment
An accurate diagnosis is the principal constituent of an effective treatment plan. In order to get to that critical conclusion, it is imperative that we gather enough of the right kinds of evidence to make an accurate determination. The DSM-5 has made the diagnosis of psychiatric disease much more manageable with its detailed required criteria. It has also streamlined the process from provider to provider, ensuring that, if followed, their diagnosis will be basically the same. I think a lot in story form, so lets look at this like making a sandwich. I might tell my husband I would like a sandwich and get out the bread, butter, and cheese for him before going back to writing my paper. If he came back with a grilled cheese, I would be elated. If he returned with a cold cheese sandwich, I would not touch it, and his efforts would be wasted. To understand exactly what I was asking for, he would have to ask the right questions and follow the recipe. Assessing our patients is much the same but in reverse. The DSM has all the recipes with the ingredients to make up various disorders like depression, schizophrenia, or ADHD. We must ask our patients enough questions to determine which recipe we have enough ingredients to make. Analysis Of The Psychiatric Assessment Assignment Discussion
Appropriate Psychiatric Child / Adolescent Assessment Symptom Rating Scales
In my clinical setting last quarter, my preceptor did not use any assessment tools. I had to ask if I could use rating scales because school required them, and he allowed me to do so. However, he insisted I keep it independent of the facility charting because he felt they were unreliable indicators of disease. I believe part of making the most accurate diagnosis is using assessment tools. Rating scales are an easy way to obtain information that can be evenly compared from visit to visit so progress or regression can be evaluated and handled. Not all rating scales are the same, and not all are appropriate for children and youth. Outside of the DSM-5, there are two scales I have used when assessing the at-risk youth I interact with that are very helpful. We deal a lot with anxiety and depression when patients are admitted to our facility, and rating scales assist us in measuring the progress of our patients and the effectiveness of our program. Both of these rating scales are appropriate for assessing youth.
The first is the PHQ-A. This rating scale is the same as the PHQ-9 we use with adults, but adapted to youth ages 11-17 (Psychiatry.org, n.d.). This is an excellent form to assess depression from week to week. We currently use it in our substance abuse practice. It asks nine separate questions about a person’s mood, rated on the scale of “not at all” (1 point), “some days” (2), “more than half the days” (3), or “most days” (4 points) (Psychiatry.org, n.d.). A rating of 0-4 indicates no depression, 5-9 indicates mild depression, 10-14 indicates moderate depression, 15 to 19 indicates moderately severe, while a score above 20 indicates a severe rating of depressive symptoms (Psychiatry.org, n.d.). I like this scale because it is completed by the patient each session (twice a week), and thus it is easy to see the trends in the patient’s mood as therapy progresses. It is an easy nine-question assessment with a tenth question to assess the severity of symptoms. Analysis Of The Psychiatric Assessment Assignment Discussion
The second rating scale I like is the scale we use to assess anxiety in our youth. It is called the SCARED or Screen for Child Anxiety Related Disorders, and there are both patient and parent questionnaires. This screening is for youth ages 9-17(Ohsu.edu, n.d.). The downside of the assessment is that there are forty-one questions on each assessment. This can be daunting to complete, especially when the youth is intoxicated or detoxing. The forty-one questions are rated as “not true,” “sometimes true,” or “very true” (Ohsu.edu, n.d.). The grid that the scores are entered on helps to delineate which answers point to which of the five types of anxiety assessed: somatic, generalized, separation, social, or school avoidance. A 7 or more out of 13 score in the Somatic column indicates a problem in that area, while a score of 9 out of 9 in the generalized column indicates a generalized anxiety disorder(Ohsu.edu, n.d.). A 5 or more out of 8 in the separation column indicates a problem in that area, a score of 7 out of 7 in the social column indicates a problem in that area, while a score of 3 out of 4 in the school avoidance column indicates a problem in that area (Ohsu.edu, n.d.). The patient and parent scores are then compared to lend more direction to the type of anxiety manifested. A score of 25 or more indicates anxiety, but a score of 30 or more will generally point to a specific type of anxiety (Ohsu.edu, n.d.). A PDF of both tools is attached to the bottom of my discussion research PDF if anyone is interested in using them. They are in the public domain and also listed in my references.
Child and Adolescent Appropriate Treatment Options
A vast array of therapy options is available to help our clients deal and heal. When working with children and adolescents, some therapy options may be less appropriate, while others may be more appropriate. Although I have never taken part in this therapy, I have seen it used at the facility. Play therapy, while very appropriate for children, does not lend itself as well to a mature and cognitively intact adult. I saw it used very effectively with two small girls from our town who were traumatized from being made to watch their mother getting raped.
In play therapy, the girls were able to act out what had happened and what should have happened, and through the process, they developed the skills to deal with the trauma and the ability to handle such things that may come in the future. They developed a strong confidence in themselves through the process and their anxiety left. Analysis Of The Psychiatric Assessment Assignment Discussion
Dance or movement therapy is another type of therapy that lends itself well to children and adolescents. Because children learn about their world through movement and interaction and often express themselves physically, like crying, stomping, laughing, and running, it makes sense that a therapy involving movement would be beneficial. Because young people have a difficult time regulating their emotions and have the disadvantage of not being able to express verbally or even fully understand what is going on, they often automatically turn to movement as a way to self-regulate (Tao et al., 2022). Movement gives them a physical outlet to express their pent-up emotional energy. Therapists use this to help patients put their feelings into action, and eventually, they can put words to their feelings.
Role Parents Play in Assessment of Youth
The role of the parent or guardian in the assessment of children cannot be dismissed. First and foremost, they are the ones giving consent. They are also most often the first to notice an issue and can provide much collaborative data. They give the framework of the home and relationships surrounding the youth. They often have information from teachers, doctors, and coaches that can also support a diagnosis. In my clinical I always meet with the youth and, following that meeting, will call or meet with the parent separately, asking about birth and childhood history, family dynamics, family medical and mental disease history, and any other pertinent data they may have, to clarify a diagnosis. It also helps to get a feel for the family finances and parenting the in the home, and the likelihood of success of the measures I will be taking to address the issues presented.
Conclusion
In this discussion, we discussed the YMH Boston Vignette 5 video, reviewed the positive and negative aspects of the practitioner’s techniques, and discussed changes I would make to obtain more valuable information, steps I would take in light of his suicidal ideation, the importance of pediatric assessment, the use of assessment scales PHQ-A and SCARED, and the dynamic role parents play in pediatric assessment. This information is critical to understand as we move forward in our practice, especially if we plan to work with pediatric patients and families.
The CDC compiles Youth Risk Behavior Survey data every few years and looks at trends in issues facing our high school students. According to the Centers for Disease Control and Prevention (2021), in their 2011 to 2021 trend report, there is alarming evidence that trends in mental health issues our kids face are heading in the wrong direction, with a sharp increase since COVID-19. This report states that nearly half of the students in America felt hopeless or sad almost every day for at least two weeks (Centers for Disease Control and Prevention, 2021). One-third report a decrease in mental wellness, over 20% say they have seriously contemplated suicide in the last year, and nearly all of them made a plan, with that number growing to almost 60% if the person has been involved in a same-sex relationship (Center for Disease Control and Prevention, 2021). Half the 20% who made a plan followed through with an attempt (Centers for Disease Control and Prevention, 2021). These alarming statistics tell me that we will face an ever-growing population of children and youth who require our services, and a thorough assessment is the first step in helping these youth. We must be up to the task. This is job security I wish we did not have. Analysis Of The Psychiatric Assessment Assignment Discussion
References
Center for Disease Control and Prevention. (2021). Youth Risk Behavior Survey. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdfLinks to an external site.
OHSU.edu. (n.d.). Screen for Child Anxiety Related Disorders (SCARED). Retrieved February 26, 2024, from https://www.ohsu.edu/sites/default/files/2019-06/SCARED-form-Parent-and-Child-version.pdfLinks to an external site.
Psychiatry.org. (n.d.). PHQ-A. Retrieved February 26, 2024, from https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Severity-Measure-For-Depression-Child-Age-11-to-17.pdfLinks to an external site.
Roaten, K., Horowitz, L. M., Bridge, J. A., Goans, C. R. R., McKintosh, C., Genzel, R., Johnson, C., & North, C. S. (2021). Universal pediatric suicide risk screening in a health care system: 90,000 patient encounters. Journal of the Academy of Consultation-Liaison Psychiatry, 62(4), 421–429. https://doi.org/10.1016/j.jaclp.2020.12.002Links to an external site.
Tao, D., Gao, Y., Cole, A., Baker, J. S., Gu, Y., Supriya, R., Tong, T. K., Hu, Q., & Awan-Scully, R. (2022). The physiological and psychological benefits of dance and its effects on children and adolescents: A systematic review. Frontiers in Physiology, 13(925958). https://doi.org/10.3389/fphys.2022.925958Links to an external site.
YMH Boston. (2013). Vignette 5 – Assessing for Depression in a Mental Health Appointment. In YouTube.https://www.youtube.com/watch?v=Gm3FLGxb2ZULinks to an external site.
Zhang, C., Zafari, Z., Slejko, J. F., Castillo, W. C., Reeves, G. M., & dosReis, S. (2023). Impact of under treatment of depression on suicide risk among children and adolescents with major depressive disorder: A microsimulation study. American Journal of Epidemiology, 192(6). https://doi.org/10.1093/aje/kwad022Links to an external site. Analysis Of The Psychiatric Assessment Assignment Discussion

# 2

Dawit H.
Introduction
A child’s or adolescent’s comprehensive, integrated psychiatric assessment is crucial. This project aims to review and criticize a mental health practitioner’s approaches and procedures while the practitioner completes an extensive, integrated psychiatric assessment of a teenage client. Anxiety and depression are the leading causes of morbidity in young people globally, accounting for almost ten million years of life adjusted for disability each year. This is partly because these two conditions cause half of all teenage suicides. Adolescents diagnosed with depression or anxiety are also more likely to experience reduced academic performance, comorbid behavioral issues like conduct disorder and attention deficit hyperactivity disorder, and risky behaviors like drug and alcohol abuse and risky sexual behavior. In the long run, kids with these circumstances are less likely to have stable family ties and can anticipate 30% lower lifetime wages, partly due to reduced academic achievement (Chodavadia et al., 2023).
The YMH Boston Vignette 5 Video
What did the practitioner do well?
The social worker was easygoing, calm, grounded, and captivating. She avoided using medical language, which some clients can find confusing. She also established excellent eye contact with the client.
In what area can the practitioner improve?
I first observed that she didn’t greet or introduce herself. Social workers can improve by acquiring additional data. She should have used open-ended queries instead of closed-ended ones. She should ask guardians, friends, teachers, and caregivers for collateral information for children and adolescents. She also took no notes. I saw his self-harm response last. His parents would be notified to take him to the ER for medical clearance and inpatient care. Suicidal and homicidal ideations defy confidentiality (Boland, Verdiun, & Ruiz, 2022).
Do you have any compelling concerns at this point in the clinical interview?
It was worrying that the client’s family or guardian was absent or in the waiting room. The guardian should sign a treatment consent form at the first appointment. It was not shown if the social worker gathered client information before the visit. Tony’s suicidal thoughts raised concerns. The social worker should have asked more probing questions, such as if he had a plan, had access to suicidal intent, recent attempts, precipitates, and what that plan was. Tony needed a thorough suicide risk assessment because he was at high risk. Bilsen (2018) reports that suicide is the second largest cause of mortality for 15–29-year-olds worldwide and for 10–19-year-olds.
What would be your next question, and why? Analysis Of The Psychiatric Assessment Assignment Discussion
I want to confirm if his parents are in the waiting room. If present, I would invite them in to answer questions. Why they thought their son needed a mental health evaluation would also be helpful so that they know his condition. You must hear their opinion. The client may leave out crucial information. Talking to loved ones will broaden their perspective.
Why a Thorough Psychiatric Assessment of Children/Adolescents?
A thorough child/adolescent screening helps psychiatry clinicians diagnose patients. An accurate diagnosis is vital for effective medical and psychological treatment and psychoeducation, which helps patients and their families comprehend symptoms. Treatment regimens require accurate and proper diagnoses to develop accurate actions (Danielson et al., 2019).
Appropriate Symptoms Rating Scales for Child/Adolescent Psychiatric Assessment
Suitable symptom rating scales for children/adolescents include the CDRS-R (ages 6-12), CDI, and RADS. The thirty-item self-reporting RADS measures adolescent depressive symptoms in school and therapeutic settings. One of the most extensively used instruments to measure childhood and adolescent depression is Kovacs’s CDI. Negative Mood, Interpersonal Problems, Anhedonia, Negative Self-Esteem, and Ineffectiveness comprise the 27-item CDI. After its 2003 release, practitioners and researchers immediately adopted the CDI, which has 23 language modifications (Thapar et al., 2015).
Two Exclusive Psychiatric Treatment Options for Child/Adolescent
Thapar et al. (2015) describe multisystemic treatment (MST) as a family- and community-based intervention for juvenile offenders. MST has since been developed and evaluated for major externalizing issues such as violent offending, substance misuse, and clinical issues that put adolescents at risk for out-of-home placements. Child protection programs for youth are another possibility. Child protection and welfare systems balance family harmony with child protection. These programs may remove children from their homes or help parents raise them.
The Parentâ€s Role Assessing Children/Adolescents
Assessment of children and adolescents is complex because they may not grasp the need for mental examination and are poor historians. According to Hilt & Nussbaum (2016), clinical assessments with children and adolescents are complex and require the clinician to diligently gather information from the child, parents, teachers, and other caregivers. Family history is essential to assessing a child/adolescent, yet they may be ashamed to discuss it or not know it. Parents must be willing to provide the physician with a complete family history, including embarrassing ones (Hilt & Nussbaum, 2016)Analysis Of The Psychiatric Assessment Assignment Discussion.

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References
Bilsen, J. (2018). Suicide and Youth: Risk Factors. FRONTIERS IN PSYCHIATRY, 9, 540. https://doi.org/10.3389/fpsyt.2018.00540Links to an external site.
Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadockâ€s synopsis of psychiatry (12th ed.). Wolters Kluwer
Chodavadia, P., Teo, I., Poremski, D., Fung, D. S. S., & Finkelstein, E. A. (2023). Healthcare utilization and costs of singaporean youth with symptoms of depression and anxiety: results from a 2022 web panel. Child & Adolescent Psychiatry & Mental Health, 17(1), 1–9. https://doi.org/10.1186/s13034-023-00604-zLinks to an external site.
Danielson, M., Larsson, J.-O., Månsdotter, A., Fransson, E., & Dalsgaard, S. (2019). Clinicians†attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry. Child & Adolescent Psychiatry & Mental Health, 13(1), N.PAG. https://doi.org/10.1186/s13034-019-0269-0
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health Links to an external site.Links to an external site.. American Psychiatric Association Publishing
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutterâ€s child and adolescent psychiatry (6th ed.). Wiley Blackwell. Analysis Of The Psychiatric Assessment Assignment Discussion

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