Main question post: The practitioner did several things well during the interview, including asking appropriate and focused questions regarding his mood, substance use, and self-harm. The practitioner could improve her rapport building as she may gain more info and insight from the client if she takes a few more moments to develop trust and confidence. The point of the interview where I started to develop some concerns was when the client mentioned drinking alcohol and thoughts of or intended self-harm comments. My following questions would include any history of self-harm or thoughts or attempts of suicide. Additionally, I would ask the client if he has thoughts of harming others. The practitioner should consider informing the client at the beginning of the session that all the information he discloses is confidential, except for potential thoughts of self-harm or thoughts/actions of harming others.
A thorough psychiatric assessment is essential to establish a reason for the referral, gather collateral and supporting information, develop a clinical formulation and differential diagnoses related to presenting symptoms and information, and document findings (Srinath, 2019). Additionally, this is usually the provider’s first opportunity to develop a rapport with the client and family, which will be crucial for establishing trust and a therapeutic relationship moving forward. Additionally, an avenue for the family to communicate with the practitioner and vice versa should be shown for future communications.
Two useful rating scales for assessing children and adolescents include the Children’s Depression Rating Scale-Revised (CDRS-R) for children ages 6-19 and the Vanderbilt ADHD Rating Scales (VARS). According to Wolfe et al. (2019), the CDRS-R is a standardized assessment tool that effectively measures the risk and severity of symptoms associated with childhood depression. Furthermore, it is an objective instrument used to establish the baseline, intratreatment, and outcome measures of children treated for depression. Not all studies or outcome measures are solely based on rating scales. Markowitz et al. (2020) suggest that functional outcomes and improvements should also be considered when determining treatment and symptom goals, such as behaviors identified by the teachers, parents, client, and clinician, and that would include various performance measures associated with the specific subtype of ADHD for example and not measured by the scale difference alone.
Parents and guardians play an essential role in adolescent and child psychiatric assessment because they have the historical factors that explain why the client is being seen and have the most insight into the client’s behaviors. They will also play an essential role in maintaining medication and treatment adherence and effective communications with the provider.
References
Markowitz, J. O. (2020). Review of Clinical Outcome Assessments in Pediatric Attention-Deficit/Hyperactivity Disorder. Neuropsychiatric Disease and Treatment(16), 1619–1643.
Srinath, S. J. (2019). Clinical Practice Guidelines for Assessment of Children and Adolescents. Indian Journal of Psychiatry, 61(2), 158-175; DOI: 10.4103/psychiatry.IndianJPsychiatry_580_18.
WOLFE, K. N. (2019). Hopelessness as a Predictor of Suicide Ideation in Depressed Male and Female Adolescent Youth. The American Association of Suicidology: Suicide and Life-Threatening Behavior, 49(1), 253-263; DOI: 10.1111/sltb.12428.
Wk1MQP_PDF1_PaulsonA._6665.pdf
Wk1MQP_PDF2_PaulsonA._6665.pdf
Wk1MQP_PDF3_PaulsonA._6665.pdf
Sample Answer 4 for NRNP 6665 Discussion: Comprehensive Integrated Psychiatric Assessment
Based on the YMH Boston Vignette 5 Video, post answers to the following questions:
What did the practitioner do well?
The use of effective communication skills is essential during a comprehensive psychiatric assessment. It influences a positive treatment outcome and enhances a sustained therapeutic relationship between the provider and the patient (Robert, 2017). During the interview, the practitioner utilized some effective communication skills, which included maintaining eye contact, using appropriate terms, active listening and responding appropriately, and proper body position, which helped establish a good rapport with the patient. The practitioner explained the meaning of the term “mood” as the patient could not understand what it meant.
In what areas can the practitioner improve?
The practitioner started the interview without introducing herself to the patient, nor did she allow the patient to introduce himself. Rather she went straight to ask the patient if he had a sense of why he was there for the interview. The introduction instills trust, facilitates a positive attitude by the patients towards the clinician, and provides patients with a first impression of the clinician (Stefan et al., 2018). Secondly, the practitioner started the interview by asking the patient if he knew why he was there for the interview and then started asking him questions about symptoms. The practitioner should have validated the patient’s response about the reason for the interview to ensure that the patient understands the need for the assessment and explained to him what is expected during the interview.
The clinician appeared to be in a hurry by jumping from one question to another without taking time to explore further to gain more insight and obtain more information about the patient’s responses, especially when the patient admitted that he has anger issues and feels like he wants to fight someone. Being respectful and curious about the patient’s perspective is important, especially when interviewing adolescents (Thapar et al., 2015). The practitioner failed to ask why the patient said that he does not like school or doing his homework, which was an opportunity to gather more information and have a better understanding of what the patient is experiencing and be able to provide an effective treatment plan.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
Yes, I would be concerned about the patient’s safety and anger issues, especially as he verbalized that he does not even want to be alive and his urge to fight someone. The practitioner would have done a comprehensive suicide risk assessment and encouraged the patient to call 911 or speak to someone if he experiences unsafe thoughts to harm himself or others. The patient’s emotional instability is another concern that must be addressed during psychotherapy to help the patient become emotionally stable.
What would be your next question, and why?
My next question would be, have you attempted harming yourself, or do you have any plan to harm yourself? Then I will go further to ask when was the last time you had thoughts of harming yourself, and how often do you experience these thoughts? Safety is a key issue to consider during an assessment (Thapar et al., 2015). Suicidal behavior is the most concerning health-related problem associated with depression. Recognizing risk factors that increase the likelihood of suicidal behavior, especially in patients with depression, is an essential aspect of emergent psychiatric assessment (Weatherly and Smith, 2019). A comprehensive suicide risk assessment will help determine the level of suicide risk and provide an appropriate intervention to prevent any harm to self or others.
The importance of a thorough psychiatric assessment of a child/adolescent
A comprehensive psychiatric evaluation of a child/adolescent can be very challenging. Still, it will help gather more detailed information that reveals the emotional, behavioral, or developmental problems the child or adolescent is experiencing. The findings will help guide effective management decisions for the patient. The sequence and organization of the psychiatric evaluation depend on the child’s age and developmental level as well as the clinician’s best judgment about how best to proceed (Thapar et al., 2015).
Two rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
The first rating scale appropriate to use during the psychiatric assessment is The Behavioral Assessment System for Children (BASC-3), a broadband behavioral rating scale designed to assess a variety of emotional and behavioral difficulties. It helps the clinician understand the behaviors and emotions of children and adolescents and determine their strengths and weaknesses.
The second rating scale would be The Strength and Difficulties Questionnaire (SDQ) designed to be used as a brief behavioral screening tool for youth 2-17 years old that can be completed in 5 mins (Thapar et al., 2015). It helps to assess behavioral and emotional symptoms, conduct problems, hyperactivity, and peer problems.
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
- Play Therapy: Play therapy is a therapeutic technique for the treatment of children with disorders such as depression, children’s fears, behavior problems that stem from anxiety, enuresis, nail-biting, lying, aggression, hyperactivity, attention deficit, etc. During play therapy, the children are provided with toys or games as they play in a structured environment. The therapist assesses their behaviors during the therapy to better understand their thought process and behaviors. Studies have shown that the use of play therapy helps to reduce aggression in children with conduct disorder and that play therapy on learning, self-control, responsibility, enthusiasm, respect, acceptance of self and others improve social skills, self-esteem, depression, and anxiety effectively (Rahnama et al., 2014).
- Multisystemic Therapy (MST): MST is an intensive family, community-based, well-established, and evidence-based intervention for families of youth with social, emotional, and behavioral problems. MST therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behavior. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks (Littell et al., 2021). The therapy addresses all systems and environmental factors that impact the youth, such as friends, schools, homes, families, and neighborhoods.
The Role parents/guardians play in assessment
Parents and guardians play vital roles in child/adolescent development, including their behaviors and mental health. Parents or guardians share essential information that is essential for the diagnosis and development of effective therapeutic interventions. The information may include prior treatment history, symptoms, and medical and developmental history. Children generally benefit the most from therapies when their parents or guardians are involved.
The articles utilized in this research are academic journal articles written and published by experts in the field.
References
Littell, J.H., Pigott, T.D., Nilsen, K.H., Green, S.J., & Montgomery, O.L. (2021). Multisystemic therapy for social, emotional, and behavioral problems in youth aged 10 to 17: An updated systematic review and meta-analysis. Campbell Systematic Reviews, 17 (4). Retrieved from https://www.proquest.com/nahs/docview/2610806810/E6964C8D20554769PQ/10?accountid=14872
Rahnama, F., Hamedi, M., Sahraei, F., & Parto, E. (2014). Effectiveness of play therapy (lego therapy) on behavior problems in children. Indian Journal of Health and Wellbeing, 5 (9), 1084-1086. Retrieved from https://www.proquest.com/nahs/docview/1629021502/F0EB38E0005B4EF6PQ/8?accountid=14872
Robert, L. (2017). Improving communication between patients and providers surrounding the legal basis for admission. The American Journal of Psychiatry, 11 (11), 3-5. Retrieved from https://psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2016.111102
Stefan, P., Claudia, P., Sajjad, A., Nadia, S., Jelena, J.G., & Stephen, B. (2018). How psychiatrists should introduce themselves in the first consultation: An experimental study. The British Journal of Psychiatry, 202 (6). Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/how-psychiatrists-should-introduce-themselves-in-the-first-consultation-an-experimental-study/92BB1CB2A7669A02342EDEC01BF78624
Thapar, A., Pine, D.S., Leckman, J.F., Scott, S., Snowling, M.J., & Taylor, E. (2015). Rutter’s child and adolescent psychiatry. (6th ed.). Wiley Blackwell.
Weatherly, A.H., & Smith, T.S. (2019). Effectiveness of two psychiatric screening tools for adolescent suicide risk. Pediatric Nursing, 45 (4), 180-183. Retrieved from https://www.proquest.com/nahs/docview/2278736298/DC48DF1A93C64E2FPQ/2?accountid=14872
Effectiveness of play therapy on behavior problems in children.pdf (75.734 KB)
Sample Answer 5 for NRNP 6665 Discussion: Comprehensive Integrated Psychiatric Assessment
The practitioner did well in some areas when assessing the patient. Firstly, the practitioner employed open-ended questions in the assessment. Open-ended questions are effective during assessment since they allow the patient to express himself in detail. The practitioner also incorporated non-verbal communication skills during the assessment. This included maintaining eye contact with the patient and nodding to show her attention during the assessment. Non-verbal communication skills keep the patient attentive to the questions asked in an assessment. The practitioner also used effective questioning skills. This can be seen in how she rephrased the client’s responses before probing him further (George et al., 2020; Kaltman & Tankersley, 2020). I am concerned about the practitioner’s failure to provide a therapeutic space between her and the patient. My next question to the patient would be a history of mental health problems in his family. The risk of major depression is high among individuals with a family history of the disorder.
A thorough psychiatric assessment of a child or adolescent is important to understand better their actual and potential needs. The assessment also enables the practitioner to develop prioritized diagnoses to guide the treatment process. A practitioner also understands other factors such as social support, psychological status, and social determinants of health affecting children or adolescents when a thorough psychiatric assessment is performed. Some of the symptom rating scales that would be appropriate to use during the psychiatric assessment of a child or adolescent include the Parents’ Behavior Rating Scale and the Teacher’s Behavior Rating Scale. Treatment options utilized for children or adolescents and not adult patients include play therapy, and acceptance and commitment therapy. Parents or guardians provide information about their child’s problems during an assessment. They also help regulate a child’s behavior during an assessment (Musetti et al., 2021). Parents or guardians also provide children the comfort they need during a psychiatric review. Each source used in this essay is peer-reviewed, relevant to psychiatric practice, and published by scholars in psychiatric practice.
References
George, T. P., DeCristofaro, C., & Murphy, P. F. (2020). Self-efficacy and concerns of nursing students regarding clinical experiences. Nurse Education Today, 90, 104401. https://doi.org/10.1016/j.nedt.2020.104401
Kaltman, S., & Tankersley, A. (2020). Teaching Motivational Interviewing to Medical Students: A Systematic Review. Academic Medicine, 95(3), 458. https://doi.org/10.1097/ACM.0000000000003011
Musetti, A., Manari, T., Dioni, B., Raffin, C., Bravo, G., Mariani, R., Esposito, G., Dimitriou, D., Plazzi, G., Franceschini, C., & Corsano, P. (2021). Parental Quality of Life and Involvement in Intervention for Children or Adolescents with Autism Spectrum Disorders: A Systematic Review. Journal of Personalized Medicine, 11(9), Article 9. https://doi.org/10.3390/jpm11090894
Sample Answer 6 for NRNP 6665 Discussion: Comprehensive Integrated Psychiatric Assessment
I do agree with you that treating psychiatric disorders among the adolescents requires a better understanding of their environment and enhancing the privacy and confidentiality of the shared information. Therefore, as a PMHNP one is required a establish a rapport that will inspire trust and lasting friendships that transcends the usual patient-nurse interaction. One has to dig deeper and gather substantial information from the patient that would be critical in helping the patient to recover fully (Kim, 2019). Some of the psychiatric disorders common among such age groups include; anxiety, attention deficient disorder and depressive mood disorder. It is important to incorporate the treatment regimen with psychotherapy options where these age groups will be guided through a mentor and follow up measures to avoid relapse of such behavior. Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and worry about a variety of events and activities. Worry is typically difficult to manage (Ströhle et al., 2018). For at least six months, anxiety and worry are associated with at least three of the following symptoms:
Irritability, Muscle Tension, and Sleep Disruption (Thomsett & Cullen, 2018). GAD was a differential diagnosis based on the patient’s history of fear and anxiety about having a panic attack in public. The patient’s symptoms, however, did not meet the criteria for GAD, ruling it out as a primary diagnosis.
References
Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Arzteblatt international, 155(37), 611–620. https://doi.org/10.3238/arztebl.2018.0611
Thomsett, R., & Cullen, L. (2018). The assessment and management of chest pain in primary care:’A focus on acute coronary syndrome’. Australian Journal of general practice, 47(5), 246. https://doi.org/10.31128/AFP-08-17-4304
Kim, Y. K. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry Investigation, 16(1), 1–3. https://doi.org/10.30773/pi.2019.01.08
