COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT
COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT
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.
Week One Discussion Question One
What did the practitioner do well?
The practitioner interview techniques that were strong in the case scenario include having good eye contact with the client, sitting facing the client, nodding to confirm understanding, and actively listening to the client. Another positive technique is the provider was not charting or looking at a computer during the interview which could lead the client to think the clinician is not paying attention. Other strong qualities of the provider include asking questions that engaged the client to provide more information and lead to other questions that could provide more critical information. The provider asking about the duration of symptoms was appropriate to assist with diagnosis. When the client admitted to being angry, the provider informed the client that this could be further discussed which is supportive. The provider provided a summary of what the client reported which assists in not missing information and confirming understanding.
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In what areas can the practitioner improve?
The clinician should introduce herself at the beginning of the interview. When asked if the client understood the purpose of the meeting, the client reported that he thinks the evaluation is taking place because his primary care physician sent him in for an evaluation. The practitioner could have explained the purpose of the evaluation more clearly. The interview should start with a warm greeting and asking the client about their interests prior to asking more sensitive questions. (Hilt & Nussbaum, 2016) The provider also interviewed in a checklist-style which is impersonal. Lastly, the provider should ask what the client’s goals are for treatment.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
The provider did not obtain consent or agreement from the client for the assessment. The provider informed the client that she would like to ask him some questions and started the interview prior to the client agreeing. Obtaining consent from the parents for treatment is important prior to the evaluation. A study was performed to assess adolescents’ understanding of treatment goals, decisions, and consequences of those decisions. “In summary, findings of this study suggest that, unless completed in collaboration with their parents or legal guardians, 12-to-17-year-old adolescents do not identify consequences and assimilate and integrate information when it comes to deciding about psychiatric mental health treatments” (Roberson & Kjervik, 2012, p. 10). The case scenario does not involve the parents. Parents could be interviewed prior to the client being interviewed alone to obtain any input and pertinent medical information and behavioral concerns.
What would be your next question, and why?
I would ask the client if he currently has an active plan to harm himself. If the client has an active plan, consideration for emergency evaluation and inpatient hospitalization may be appropriate for safety. I would then ask if the client has previously attempted suicide or self-harm. I would ask about access to firearms in the home. I would ask about available support systems. I would ask the client reasons he would not want to harm himself. The 2013 youth behavior risk assessment could be given to evaluate the immediate risk of a suicide attempt. This client is at a higher risk of committing suicide due to a recent breakup. “Suicide is the second leading cause of death for adolescents 15 to 19 years old” (Shain, 2016, p. 1098). Boys have a completed suicide rate 3 times higher than girls. (Shain, 2016) Suicide affects young people from all races and socioeconomic groups, although some groups have higher rates than others.
Explain why a thorough psychiatric assessment of a child/adolescent is important.
“Clinical history taking, and interviewing are one of the most powerful tools available to the child and adolescent mental health professionals to make a diagnosis and plan management” (Srinath & et. al., 2019, p. 175). Rating scales can also assist in leading the clinician to the correct diagnosis. The clinician should consider age, culture, communication skills, and cognition when interviewing children and adolescents. The assessment, “Will often include some direct assessment of the child’s functioning, observations of the child, interviews with parents and, where appropriate, relevant information from school” (Thapar & et. al., 2015, p. 436). Finding the cause of the symptoms is essential to correct diagnosis. The provider should rule out if the symptoms the client is experiencing are situational or due to substance use.
The importance of a correct diagnosis in order to provide the correct treatment is imperative to the client receiving quality care. “A child can be inattentive for any number of reasons without having attention-deficit/hyperactivity disorder, and an adolescent can be sad for many reasons without experiencing a major depressive episode. If these kinds of behaviors and symptoms do not significantly impair function or can be better explained by another etiology, a formal mental health diagnosis should not be made” (Hilt & Nussbaum, 2016, p. 64). Children may be resistant to evaluation and treatment making assessment difficult. “In addition, the process of diagnosing disorders in a child typically involves gathering information from multiple informants and remembering an age- and developmentally adjusted–diagnostic differential” (Hilt & Nussbaum, 2016, p. 5).
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
“Preassessment screening tools engage a patient and his caregivers in the treatment, normalize conversations about mental distress, and assist you in identifying the chief complaint” (Hilt & Nussbaum, 2016, p. 60). Two rating scales could be used during the assessment including the Strengths and Difficulties Questionnaire and the Developmental Behavior Checklist. The strengths and difficulties questionnaire is used to evaluate emotional symptoms, conduct issues, hyperactivity, issues with peers, and prosocial behavior. The questionnaire is completed by parents, the teacher, and the child. (Español-Martín & et. al., 2021) “Two key uses of structured instruments are for (a) diagnostic interviewing, and (b) gathering descriptive information about various aspects of emotional, behavioral, and social problems” (Srinath & et. al., 2019, p. 165). The developmental-behavioral checklist evaluates emotional and behavioral problems for children and adults with intellectual and developmental disabilities. (Monash University, 2020)
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Play therapy, art therapy, IPT-A therapy, ACT therapy, and receiving treatment in an educational setting may be used as treatment options for children but may not be used when working with adults. “The need for non-clinic-based assessment is especially important when there is a discrepancy between the various accounts of behavior, for example, disagreements between parents and teachers concerning the nature or severity of the presenting difficulties, or when the behavior observed in the clinic does not tally with other reports” (Thapar & et. al., 2015, p. 438).
Explain the role parents/guardians play in assessment.
“There is a need to respect the child’s autonomy as well as look out for their best interests. Shared decision-making, with selective paternalism where needed, is the best form of practice, especially with children and families” (Srinath & et. al., 2019, p. 159). The therapist should educate the child and the family about interventions and diagnoses. There should be direct communication with the child. “Acknowledging the child’s emotion and communicating an interest in understanding the child’s perspective is crucial in reassuring the child that they will be heard and their concerns addressed without the use of any coercion or deception” (Srinath & et. al., 2019, p. 160). Building a therapeutic alliance is essential to increase the change of the child engaging in therapy. “It is imperative to get a narrative account of the clinical history from both parents and child” (Srinath & et. al., 2019, p. 161). The parents can provide information on their observations of the child and assist with providing medical history and development history.
Español-Martín, G. & et. al. (2021) Strengths and Difficulties Questionnaire: Psychometric Properties and Normative Data
for Spanish 5- to 17-Year-Olds. Assessment, 28(5), 1445-1458. – Peer-reviewed.
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.
Monash University. (2020) What is the Developmental Behavior Checklist (DBC)? Retreived November 30th, 2022 from
http://www.monash.edu/medicine/scs/developmental/clinical-research/dbc Links to an external site..
Roberson, A. J. & Kjervik, D. K. (2012) Adolescents’ Perceptions of Their Consent to Psychiatric Mental Health Treatment.
Nursing Research and Practice, 2012(1), 1-12.
Article peer-reviewed, descriptive qualitative study.
Shain, B. (2016) Suicide and Suicide Attempts in Adolescents. American Academy of Pediatrics, 138(1), 1-12.
Article peer-reviewed.
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and Links to an external site.
adolescents Links to an external site. Links to an external site.. Indian Journal of Psychiatry, 61(2), 158–175.
http://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18 Links to an external site..
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.
YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointment Links to an external sLinks to an external site.
ite.Links to an external site. [Video]. YouTube.https://www.youtube.com/watch?v=Gm3FLGxb2ZULinks to an external site..
BY DAY 6 OF WEEK 1 COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT
Respond to at least two of your colleagues on 2 different days 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.
I like your main post and learns from it. As I am reading your post, I have some questions about the parent consent before the psychological evaluation. So, I did some research and found out that psychological professors don’t need the parent’s or guardian’s consent to start psychological evaluation or service unless it is believed that the child or adolescent is not able to manage their care. On the contrary, the mental health professional provider should obtain the child or adolescent’s consent before they tell the parents or legal guardian.
Colorado HB 19-1120 was signed into law and went into effect on May 16, 2019. HB 19-1120 lowers the age of consent for psychotherapy services from 15 years old to 12 years old. Under this law, the professional person or licensed mental health professional rendering mental health services to a minor may, with or without the minor’s consent, advise the minor’s parent or legal guardian of the services given or needed (Sullivan, 2019).
Even though children and adolescents don’t have the legal right to give consent to their evaluation or treatment, they already possess the knowledge and cognitive ability to understand the decision they make. They are also emotionally mature enough to make their own decisions. Many children and adolescents are very reluctant to let their parents know about their mental situation and feel embarrassed or uncomfortable to know that they have no secret in front of their parents. According to a survey, only one-third of the underage participants were willing to obtain parental consent before they get any psychological evaluation or therapy. (Cavazos-Rehg, 2020).
References
Cavazos-Rehg, P., Min, C., Fitzsimmons-Craft, E. E., Savoy, B., Kaiser, N., Riordan, R., Krauss, M., Costello, S., & Wilfley, D. (2020). Parental consent: A potential barrier for underage teens’ participation in an mHealth mental health intervention. Internet interventions, 21, 100328. https://doi.org/10.1016/j.invent.2020.100328
Sullivan, J. (2019, July 16). Colorado Lowers Age of Consent for Psychotherapy Services to 12 Years Old | Insights | Greenberg Traurig LLP. Www.gtlaw.com. https://www.gtlaw.com/en/insights/2019/7/colorado-lowers-age-of-consent-for-psychotherapy-services-to-12-years-old
COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT response 2
Hello xx, I enjoyed reading your post. I agree the interview should have begun warmer. Anxiety and depression are the two most prevalent mental disorders in teens and adolescents; however, only a small percentage of this population receives assistance for their condition. Barriers that teens have reported are feelings of embarrassment due to stigma and feeling as if reaching out for help is a sign of their weakness (Radez, 2022). The teens in Radez’s article reported elements that influenced them to seek help were encouraging supportive attitudes and if they had a favorable opinion of the communication utilized by the clinician when receiving services (Radez, 2022).
Two other rating scales are the Vanderbilt ADHD diagnostic (VADPRS) and the Young mania rating scale (YMRS). The Vanderbilt ADHD diagnostic rating scale is an assessment tool used to measure ADHD symptoms and their effects on the academics and behaviors of children. The two versions are used for parents’ and teachers’ input (Khalmbule, 2021). The young rating scale is completed by a trained clinician. Manic symptoms of the individual are evaluated. The total score indicates the severity of the person’s mania. Questions range from 0-5 in intensity and frequency using 11 elements. Other informants of information may also be included. There are 5 distinct levels of severity (irritability, disorderly or aggressive behavior, and thought content. The YMRS is used more than any other mania scale (Mohammadi, 2018).
References
Khambule, N. N. (2021). Investigating the psychometric properties of the Vanderbilt-Attention-Deficit-Hyperactivity-Disorder diagnostic rating scale (VADRS) within the South African context (Doctoral dissertation).
Mohammadi, Z., Pourshahbaz, A., Poshtmashhadi, M., Dolatshahi, B., Barati, F., & Zarei, M. (2018). Psychometric properties of the young mania rating scale as a mania severity measure in patients with bipolar I disorder. Practice in Clinical Psychology, 6(3), 175-182.
Radez, J., Reardon, T., Creswell, C., Orchard, F., & Waite, P. (2022). Adolescents’ perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study. European child & adolescent psychiatry, 31(6), 891-907.
COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT discussion 2
Introduction
Depression is a common disorder in teenagers. 41.6% of teenagers from age to 12-17 had at least one episode of major depressive disorder in 2020 (National Institute of Mental Health, 2022). Many things happen in a teenager’s life that can lead to depression, bullying, trouble at home or getting along with peers, peer pressure, and relationship issues are just a few. Depression can cause a lack of interest in activities, feelings of extreme sadness, irritability, lack of focus, and trouble sleeping (American Psychiatric Association, 2022). Severe depression can cause feelings of suicide and self-harm.
YMH Boston Vignette 5 Video
In this video I believe the practitioner did well. The client started off being very reluctant, superficial, but with the probing questions she continued to ask she was able to get him to disclose some important information. It appears that this is the first time these two individuals have met. The clinician jumped right into talking with the client. The client may have been more open at the beginning if she introduced herself or explained what their relationship would be like, including confidentiality (Sharma et al., 2019). At the finishing of the video, I would have continued assessing the client’s suicidal thoughts. I will want to find out if he has any plan or intent to act on his thoughts. If not, I would want to work with him on contracting for safety, working on talking to his parents about the thoughts. If he has a plan or intent, I would be looking at inpatient hospitalization. I would also assess if he had any homicidal ideation.
Why a thorough assessment is important
A thorough assessment is important in a child or adolescent aged client as they are typically more reluctant to talk about issues, out of fear of being in trouble or embarrassment (Sharma et al., 2019). Clinicians must be aware of this to get an accurate assessment. Collaborating with other individuals in the client’s life, such as teachers, parents, or other important people can help create a whole picture
Two different symptom rating scales
For rating depression, I would use a HAM-D or a PHQ-9 scale. The HAM-D scale is based off 17 different categories that are rated on severity of symptoms. A score of over 23 would indicate very severe depression. A score of 19-22 is severe depression, 14-18 moderate depression, 8-13 mild depression, and 0-7 normal. A PHQ-9 is a scale to rate severity of depression also. This scale consists of 10 total questions, 9 of them used to rate severity. All the categories are symptoms of major depressive symptoms. They rate how many days they have experienced these symptoms. For this scale a 1-4 would be considered minimal depression, a 5-9 mild depression, a 10-14 moderate depression, a 15-19 moderately severe depression, and a 20-27 severe depression.
Two psychiatric treatment options for children
One option for psychiatric treatment for a child is play therapy. Play therapy is good to use for children up to school age. This helps a child address and manage feelings in a way they can understand through playing with toys (Koukourikos et al., 2021). Play therapy allows a child to act out feelings and emotions that a therapist can interpret and find what they mean. Children often feel more at ease and comfortable when playing with toys, rather than expecting them to use language that an adult would use.
A second option for psychiatric treatment for a child is parent child interaction therapy. This therapy is used on children who are having a hard time connecting or interacting with their parents. You would typically see the child acting out behaviorally and unable to control their emotions (Lieneman et al., 2017). The therapist guides the parent on how to interact with the child to try to strength their relationship and work on how to handle behavioral issues.
Role guardians/parents play in assessment
For a thorough assessment it is imperative to include the guardian. The therapist needs to have a picture of everything that is going on with the child. Having a collaboration from multiple people in the child’s life would be beneficial. It also would be imperative to continue to include the guardian throughout treatment. Just to see how they think the child is progressing, if any further issues have come up. It is also important to the guardian to realize how the child may act with therapy. They may act out at times if they have had to discuss issues that trigger them. The guardian needs to be instructed of how to be supportive.
Conclusion
Childhood and adolescents can be a difficult time for children. They may need additional support at this time if they appear to be struggling with depression. There are plenty of options for the treatment of a child suffering with depression. It is imperative that guardians pay attention to their children during these times to catch symptoms more quickly and allow for treatment.
References
American Psychiatric Association. (2022). Diagnostic And Statistical Manual Of Mental Disorders, Text Revision Dsm-5-Tr. Amer Psychiatric.
Koukourikos, K., Tsaloglidou, A., Tzeha, L., Iliadis, C., Frantzana, A., Katsimbeli, A., & Kourkouta, L. (2021). An Overview of Play Therapy. Materia Socio Medica, 33(4), 293. https://doi.org/10.5455/msm.2021.33.293-297
Lieneman, C., Brabson, L., Highlander, A., Wallace, N., & McNeil, C. (2017). Parent–Child Interaction Therapy: current perspectives. Psychology Research and Behavior Management, Volume 10, 239–256. https://doi.org/10.2147/prbm.s91200
National Institute of Mental Health. (2022, January). Major Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression
Sharma, E., Srinath, S., Jacob, P., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(8), 158–175. https://doi.org/10.4103/psychiatry.indianjpsychiatry_580_18
COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT discussion 3
Week 1 Discussion Post
In the assigned video, “Vignette 5 – Assessing for Depression in a Mental Health Appointment” Tony, a male adolescent was referred by his doctor to see a mental healthcare clinician to further screen and assess for depression and suicidality (YMH Boston, 2013). In her assessment, it is commendable how she took a moment to further clarify the objective of her questions— by offering the patient example responses to further guide his understanding to allow him to better articulate himself. The clinician also spoke with Tony directly. According to Srinath et al., (2019), “direct communication with the child, acknowledging the child’s understanding of the situation, and building a shared understanding, even if simplistic, is fruitful in the long run.” Recognizing risk factors that increase the likelihood of suicidal behavior, especially in patients with depression, is an important aspect of emergent psychiatric assessment. The assessment was not near thorough, there was no information about parent/guardian consent to treatment, the clinician did not explore any background history of family mental health and she also did not explore further when the patient voiced suicidal ideation. When the patient reported that he sometimes “felt so angry that he felt like fighting people,” the clinician did not explore further. One way of pursuing this statement could be to validate how challenging/ frustrating it must be to feel that way and explore coping mechanisms—or if the patient has acted upon it. Ensuring a thorough assessment allows the optimization of safety and the development of an appropriate plan of care for the patient (Sadock et al., 2015). Furthermore, given the delicate nature of that comment, her unintentional dismissal might have been the patient’s cry for help or his first admission of this delicate knowledge, which could have badly impacted the quality of her interaction with him.
Explain why a thorough psychiatric assessment of a child/adolescent is important.
A thorough psychiatric assessment of a child/adolescent is imperative. Identifying signs and symptoms through a thorough clinical history and examination can assist in determining the presence (or absence) of a mental health issue and other critical areas of concern (Srinath et al., 2019). Placing the child within a psychosocial background, relating the presentation to his or her context, and gathering information about what has happened to the illness thus far, including what has been the treatment and response history, are necessary to fully comprehend the origins, maintenance, and factors affecting remission from the disorder (Srinath et al., 2019).
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
