Comprehensive Integrated Psychiatric Assessment NRNP 6665
Main Discussion Post: Comprehensive and integrated psychiatric assessments serve as the bedrock for precise diagnosis, effective treatment, and favorable outcomes in patient care. Clinicians engaged in these assessments with pediatric patients understand the value of gathering information from diverse sources to construct a therapeutic partnership and determine appropriate treatment. This discussion post delves into the examination of a video presentation depicting a psychiatric assessment of an adolescent male referred for depression and anxiety by their primary care physician.
What is Traditional Medicine?
The art of conducting proper interviews is pivotal in psychiatric assessments and demands adept organizational skills and practice. In the course of the interview, the practitioner displayed commendable skills by elucidating the purpose of the assessment to the patient and inquiring about the reason for the visit. The practitioner maintained eye contact, signifying active engagement in the conversation. When the patient exhibited confusion about the query “how has your mood been lately?” the practitioner adeptly rephrased the question, enhancing the clarity of the patient’s responses. The practitioner’s approach was engaging, marked by a warm and inviting demeanor, fostering a comfortable atmosphere for the patient. Moreover, the practitioner acknowledged the patient’s report of anger and expressed the importance of addressing it. Furthermore, the patient’s privacy was respected. However, despite these proficient assessment skills, some crucial elements were overlooked during the interview. Notably, the practitioner omitted introducing herself and failed to communicate the confidentiality of their conversation. While time constraints may have influenced the pace of questioning, the rapid-fire approach could inadvertently undermine the patient’s sense of validation, potentially affecting the therapeutic alliance.
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As advocated by Hilt and Nussbaum (2016), any mental health evaluation must encompass the identification and assessment of safety concerns. An astute practitioner diligently evaluates reported safety issues and implements requisite interventions. In the case of the young male patient, compelling concerns surfaced, notably his intense anger following a breakup, a lack of understanding regarding the reasons for the breakup, and expressions of not wanting to be alive. Additionally, there were indications of possible minimization of substance use. Subsequently, the line of questioning should shift to explore current suicidal thoughts, suicidal plans, and intent. Furthermore, inquiries about the patient’s living situation and access to firearms become imperative. Suicide represents the second leading cause of death among adolescents, with the peak onset of suicidal ideation occurring during adolescence. Notably, the severity of these ideations correlates with a higher likelihood of future suicide attempts (Ordaz et al., 2018).
Srinath et al. (2019) underline the fact that children and adolescents frequently refrain from initiating mental health evaluations due to embarrassment or a lack of comprehension regarding their symptoms. Consequently, accurate diagnosis and effective treatment necessitate comprehensive assessments drawing from multiple sources and involving impeccable clinical skills. Comprehensive psychiatric assessments provide clinicians, patients, and parents or guardians with the necessary tools to enhance the quality of life during challenging periods.
Comprehensive Integrated Psychiatric Assessment: Foundations for Quality Care in Children and Adolescents
In the process of conducting psychiatric assessments, practitioners leverage useful tools such as symptom rating scales to facilitate diagnostic precision and referral recommendations. One such tool suitable for assessing children and adolescents is the Level 1 Cross-Cutting Symptom Measure. This resource succinctly lists selected symptoms from major DSM-5 disorders in a format conducive to fostering dialogue during psychiatric interviews. Notably, this tool comprises versions tailored for caregivers and children within specific age groups (Hilt & Nussbaum, 2016). Another instrumental rating scale is the Pediatric Symptom Checklist (PSC), encompassing a 35-item parent-reported or a 17-item parent and child-reported measure of adolescent psychosocial functioning. The PSC stands as one of the most frequently utilized rating scales (Bergmann et al., 2020).
In the realm of treating children and adolescents, the landscape often differs from that of adults. Treatment options unique to children include Cognitive Behavioral Play Therapy (CBPT) and Reciprocal Imitation Training (RIT). CBPT, designed for younger children, ingeniously incorporates cognitive-behavioral therapy strategies into play-based interventions, promoting therapeutic work and learning during play sessions. Puppets or toys are employed in CBPT to teach children essential skills to surmount challenges (Bhide & Chakraborty, 2020). On the other hand, RIT represents a naturalistic developmental-behavioral intervention concentrating on enhancing social interaction via extended bouts of reciprocal imitation. RIT emerges as an evidence-based treatment for autism spectrum disorder (Ingersoll et al., 2017).
Parents or guardians emerge as pivotal figures in child assessments. They not only help establish a therapeutic rapport between the child and the practitioner but also provide invaluable insights into the presenting issues, medical history, and behavioral patterns in various contexts. The active participation of parents or guardians in assessments fosters trust and establishes bonds that ultimately facilitate the engagement of the child and their family in active treatment.
References
Bergmann, P., Lucke, C., Nguyen, T., Jellinek, M., & Murphy, J. M. (2023). Identification and Utility of a Short Form of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y). European Journal of Psychological Assessment, Preprints, 1–9. https://doi.org/10.1027/1015-5759/a000486
Bhide, A., & Chakraborty, K. (2020). General Principles for Psychotherapeutic Interventions in Children and Adolescents. Indian Journal of Psychiatry, 62, S299–S318. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_811_19
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent
mental health. American Psychiatric Association Publishing.
Ingersoll, B., Berger, N., Carlsen, D., & Hamlin, T. (2017). Improving social functioning and challenging behaviors in adolescents with ASD and significant ID: A randomized pilot feasibility trial of reciprocal imitation training in a residential setting. Developmental Neurorehabilitation, 20(4), 236–246. https://doi.org/10.1080/17518423.2016.1211187
Ordaz, S. J., Goyer, M. S., Ho, T. C., Singh, M. K., & Gotlib, I. H. (2018). Network basis of suicidal ideation in depressed adolescents. Journal of Affective Disorders, 226, 92–99. https://doi.org/10.1016/j.jad.2017.09.021
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. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18
Network basis of suicidal ideation in depressed adolescents.pdf
Download Network basis of suicidal ideation in depressed adolescents.pdf
Indentification and Utility of a short form of pediatric symptom.pdf
Download Indentification and Utility of a short form of pediatric symptom.pdf
General Principles for Psychotherapeutic Interventions in Children and Adolescents.pdf
Download General Principles for Psychotherapeutic Interventions in Children and Adolescents.pdf
Clinical Practice Guidelines for assessment of children and adolescents.pdf
Download Clinical Practice Guidelines for assessment of children and adolescents.pdf
Discussion: Comprehensive Integrated Psychiatric Assessment
Photo Credit: Seventyfour / Adobe Stock
Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for
treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.
Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take
into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic
challenges.
In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.
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.
By Day 6 of Week 1
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.
Note: For this Discussion, you are required to complete your initial post before you will be
able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to
Discussion Question" link, and then select "Create Thread" to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts, and you
cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 of Week 1 and Respond by Day 6 of Week 1
To Participate in this Discussion:
Week 1 Discussion
What's Coming Up in Week 2?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In Week 2, you will explore ethical and legal considerations related to PMHNP care. You
will also complete a pretest of the body of knowledge that will be on the PMHNP
certification exam. This pretest is not graded; rather, it is used to identify your current
strengths and opportunities for improvement so that you can create a study plan for the
exam. You will use this study plan in this course and update it in NRNP 6675 and after
your program, as needed.
Next Week
To go to the next week:
Week 2
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