Child and Adolescent Assessment NRNP 6665

COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT

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.

EXAMPLE APPROACH TO COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT DISCUSSION

The practitioner spoke calmly and softly to the patient to create a soothing atmosphere and make the patient comfortable. She had good body language that was open and facing the patient, conveying an interest in his answers. The practitioner did not ask open-ended questions, which could have gotten more information from the patient about what he was feeling. The practitioner did not have the patient expand on his answers to get more information about what bothers him, such as his anger, school problems, and alcohol use.

 The most significant concern is for the patient’s safety. He has expressed that he has thought of suicide and is not coping well. He also stated that he has been having anger issues which can lead to impulsive actions that could lead to further thoughts of suicide or self-harm. The next question that should be asked would be if the patient has any plan or intent or has thought of how he would hurt himself or others. This questioning would open up the conversation about what safety steps need to be addressed with the patient.

A thorough psychiatric assessment is vital with children and conducted with patience and time for them to answer the questions. The comprehensive evaluation will allow the practitioner to know all the problems the patient faces and determine the priorities that need to be a priority in a treatment plan. A comprehensive assessment will evaluate all aspects of the child or adolescent life, including possible family issues, trauma, abuse, bullying, or conflicts at school. The reason that an assessment is so critical is that pediatricians complete the majority of assessments in their yearly exams.

It is a quick assessment that may not identify actual problems the patient is having. Many children and adolescents get referred for further treatment, precipitating the comprehensive assessment. More than fifty percent of all mental health disorders emerge by the time a patient is fifteen years old (McGorry et al., 2022). Failing to identify mental health needs in childhood and adolescence can affect the further development of the person’s future social, educational, and economic opportunities (McGorry et al., 2022).

Two assessment tools that could be utilized when assessing a child or adolescent are the Adverse Childhood Experiences (ACEs) scale and the NICHQ Vanderbilt Assessment Scale. The ACEs screening identifies adverse childhood experiences that can precipitate or be a component of mental health issues for children(Watson, 2019). The ACEs can help identify exposure to abuse, neglect, family trauma, and other events that can affect a child’s mental health (Centers for Disease Control and Prevention, 2021). The NICHQ can help identify ADHD, Oppositional Defiant Disorder, anxiety, and depression (Kemper et al., 2018). The parent, teacher, and patient can complete the questionnaire, which gives a view from all parties on the symptomology the patient is experiencing.

Two treatments unique to children and adolescents are play therapy and occupational therapy. Play therapy is utilized in individual, group, and educational settings (Zhang et al., 2019). Play therapy gives children/adolescents a comfortable, safe place to play and addresses their issues. Play therapy utilizes games to identify problems, determine strengths, and allow the child to create a therapeutic relationship with the therapist.

Game therapy can assist with behavioral, mental health, social interaction, and cognition problems (Zhang et al., 2019). If used in a group setting, it can help build relationships between children and help them learn coping skills, improve concentration, address social anxiety fears, and teach appropriate social skills. Participating in group play can also help alleviate the fear of new situations, new environments, and new interactions with others (Zhang et al., 2019). Occupational therapy is a treatment that can be utilized to treat many physical and mental health issues.

Occupational therapy helps with autistic, ADHD, developmentally delayed, behaviorally challenged, and children with comorbid problems related to other diagnoses. Occupational therapy can address sensory and physical limitations, executive functioning, neuro-developmental issues, and many more challenges (Novak & Honan, 2019). Occupational therapy helps the child acquire skills to become more independent and includes a great deal of parental education to utilize at home.

The therapy consists of carrying over the skill implementation at home, school, and other settings where the child would spend much time. The activities that the child and parents are educated on are specific to the child’s needs to help the child adapt and change to become more independent.

The inclusion of the parent or caregiver of a child or adolescent in the assessment is essential because they will provide information that the child may not be able to express or that they see from a different perspective. Including the parent in the assessment allows the parent to give their perspective on what is happening and what they see. Without their view, the practitioner may not get the full story or may get a version of the situation that is inaccurate.

Sometimes parents or caregivers may see that a child behaves in a way the child cannot identify. Without that input, the practitioner could not evaluate the whole situation. Having the caregiver or parent involved also creates a connection for the patient that they are invested in helping the child address and treat the issues (Waid & Kelly, 2020).

The sources of reference utilized for this paper are either peer-reviewed journal articles written for the mental health profession or journals prepared for the professionals working in mental health. They include specific language for the profession, are educational, and include further references to support their information.

References

Centers for Disease Control and Prevention. (2021). Adverse childhood experiences prevention strategy [PDF]. cdc.gov. https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-Plan_Final_508.pdfLinks to an external site.

Kemper, A. R., Maslow, G. R., & Hill, S., et al. (2018). Attention Deficit Hyperactivity Disorder: diagnosis and treatment in children and adolescents [Internet] (Comparative Effectiveness Reviews, No. 203 ed.). Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK487766/table/results.t2/Links to an external site.

McGorry, P. D., Mei, C., Chanen, A., Hodges, C., Alvarez‐Jimenez, M., & Killackey, E. (2022). Designing and scaling up integrated youth mental health care. World Psychiatry, 21(1), 61–76. https://doi.org/10.1002/wps.20938Links to an external site.

Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal, 66(3), 258–273. https://doi.org/10.1111/1440-1630.12573Links to an external site.

Waid, J., & Kelly, M. (2020). Supporting family engagement with child and adolescent mental health services: A scoping review. Health & Social Care in the Community, 28(5), 1333–1342. https://doi.org/10.1111/hsc.12947Links to an external site.

Watson, P. (2019). How to screen for aces in an efficient, sensitive, and effective manner. Paediatrics & Child Health, 24(1), 37–38. https://doi.org/10.1093/pch/pxy146Links to an external site.

Zhang, A., Jia, Y., & Wang, J. (2019). Applying play therapy in mental health services at primary school. SHS Web of Conferences, 60, 01008. https://doi.org/10.1051/shsconf/20196001008Links to an external site.

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.