discussion responses

please provide a positive feedback along with a reference for each post 

( Erica)

The social worker in the YMH Boston Vignette 5 Video did a great job engaging the client and making him more comfortable as the interview progressed. The patient was referred by his Primary Care Provider after reporting symptoms of depression and anxiety, however he denies those symptoms at this visit. The social worker did a great job asking about his symptoms in different ways that eventually resulted in the patient engaging and she also displayed reflective, empathic listening. He began disclosing the information she was soliciting as well as raising other symptoms. The social worker also did a great job both asking direct questions as well as open ended, providing multiple pathways for him to express his concerns. (YMH Boston, 2013).  

Multiple concerning issues were raised for this patient, including his decline in functioning as exhibited in his worsening school performance, as well as his reported suicidal ideation. My next questions would be to further understand his suicidal intent and if he has formulated a plan. I would ask if he has any history of suicidal ideation or attempt in the past as well as attempt to determine any additional risk factors or protective factors.

A detailed, thorough assessment of a child or adolescent is crucial to high quality psychiatric care. Correctly identifying the presenting illness guides treatment options and establishes a plan to reach optimal outcomes. (Srinath et al., 2019). There can be several barriers to accurate assessment of children and adolescents. These can be related to the patient not understanding compelling reasons or wanting to engage in care, decreased ability to mark the timing or duration or symptoms, decreased ability to identify and express their symptoms, or stigma and embarrassment related to their symptoms and obtaining care. When available, involving the patient’s parents or guardians can add greatly needed context and details to the assessment (Srinath et al., 2019).

Psychiatric screening tools can be used to capture more information. One of these tools that has been used for this population is the Childhood Anxiety Sensitivity Index (CASI), which is an 18-item scale used to reflect anxiety symptoms. A 2019 systematic review looked at 50 studies extending back to 1991, that were examining the efficacy of this tool. While this is the most widely used anxiety scale for children, their findings indicate the CASI did not yield consistent results. Alternative scales have been created but they have yet to be evaluated in the literature and is an important area for further analysis. (Francis et al., 2019). Another tool used in this population is the Children’s Social Behavioral Scale (CSBS) which is a 15-item scale that measures young children’s behavior with peers at school. A 2021 study looked at the reliability and validity of this scale in its use to evaluate aggressive behavior. They evaluated 3,102 youth and their caregivers across 6 different communities. They found this scale produced consistent results and has further use in both clinical and research environments. (Brandes et al., 2021).

Some approaches are appropriate for children or adolescents but are less useful in the adult population. An example would be play therapy, which is modeled around developmental stages and is used to facilitate expression in children (Frawley et al., 2023). Adults may benefit from other forms of recreational therapy, like art or dance therapy. Another treatment variation between the two age groups is the use of clonidine. While it is one of the first line options for ADHD in children, the decreased efficacy for adults, coupled with blood pressure side effects make it a better option for adjunct use.  (Geffen & Forster, 2018).

References:

Brandes, C. M., Reardon, K. W., Shields, A. N., & Tackett, J. L. (2021). Towards construct validity of relational aggression: An examination of the Children’s Social Behavior Scale. Psychological Assessment, 33(9), 855–870. https://doi.org/10.1037/pas0001005.supp (Supplemental)

Francis, S. E., Noël, V. A., & Ryan, S. L. (2019). A systematic review of the factor structure of anxiety sensitivity among children: Current status and recommendations for future directions. Child & Youth Care Forum, 48(5), 603–632. https://doi.org/10.1007/s10566-019-09502-yLinks to an external site.

Frawley, C., Lambie, G. W., Stickl Haugen, J., & Dillman Taylor, D. (2023). The Assessment of Play Therapy and Child Counseling Competencies (APTCCC). International Journal of Play Therapy. https://doi.org/10.1037/pla0000208Links to an external site.

Geffen, J., & Forster, K. (2018). Treatment of adult ADHD: a clinical perspective. Therapeutic advances in psychopharmacology, 8(1), 25–32. https://doi.org/10.1177/2045125317734977

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescentsLinks to an external site.Links to an external site.. Indian Journal of Psychiatry, 61(2), 158–175. http://doi.org/10.4103/psychiatry.IndianJPsychiatr…

( Tamara)

Comprehensive Integrated Psychiatric Assessment

Comprehensive, integrated psychiatric evaluation is a critical element for managing patients with various mental health issues. The comprehensive psychiatric evaluation comprises collecting information on different elements, including the history of present illness, family history, psychosocial history, past psychiatric history, substance use history, system review, physical exam, and diagnostic testing (Dreimüller et al., 2019). A mental health provider’s capacity to make accurate patient diagnoses and formulation of a patient-centered therapeutic plan is dependent on comprehensive psychiatric assessment. For children and adolescents, the comprehensive psychiatric evaluation should be completed in the presence of their parents or guardians, as they are critical to providing information and assisting in decision-making. The selected video for review, Vignette 5, is for a social worker completing the psychiatric assessment for an adolescent referred for depression evaluation.  

What the Practitioner Did Well

The practitioner did well in different areas during the evaluation of the adolescent. Foremost, the practitioner questioned relevant concerns relating to depressive symptoms. She asked most questions targeting to assess all depressive symptoms the patient may be having. She had insight into depressive symptoms that patients should be asked about, thus ensuring comprehensive evaluation. Furthermore, the practitioner demonstrated effective verbal and non-verbal communication skills. She maintained eye contact with the patient during the assessment and was audible enough, thus showing her interest in the patient’s case.

Areas the Practitioner Should Improve

The practitioner should improve on the following elements based on the evaluation. Foremost, she should improve her questioning skills by asking open-ended questions. Most of the questions asked were leading questions that did not allow the patient to offer a comprehensive response. Moreover, she should enhance her rapport-building skills. She needs to make a formal introduction of herself and establish the goals of the assessment with the client. Building rapport with the patient is essential to improving his comfort in sharing detailed information on his health concerns.

Compelling Concerns

The compelling concerns for the patient considering the assessment include. Foremost, more information on the patient’s plan about ending his life. The patient accepted that he was not willing to continue living and had suicidal thoughts. More evaluation of the patient’s plan for suicide should be collected, which will be essential to formulating appropriate suicide prevention initiatives. Moreover, details on the available social support for the patient. The patient’s depressive symptoms had been triggered by the breakup with his girlfriend. Assessing the available social support is essential for the patient to formulate an appropriate support system.

My Next Question

My next question for the patient will include the following. Foremost, details about the patient’s plan for committing suicide as he didn’t feel like living anymore. The patient should offer detailed information on his suicide plan, which is critical to formulating the most appropriate intervention. While evaluating his suicide plan, it is essential to question anyone else with whom he has shared his thoughts of committing suicide.

Significance of Thorough Comprehensive Assessment of a Child/Adolescent

Comprehensive psychiatric assessment for children and adolescents is critical for various reasons. Foremost, the comprehensive evaluation aids in understanding the factors contributing to psychiatric symptoms in children and adolescents (Shah et al., 2023). As interactions between the cognitive, educational, social, genetic, developmental, physical, and environmental factors lead to psychiatric disorders, comprehensive assessment aids in identifying the interacting factors. Moreover, comprehensive psychiatric assessment aids in identifying the precise psychiatric disorder the pediatric is having and illuminating other issues relating to the child (Shah et al., 2023). Comorbid disorders in pediatrics following psychiatric diagnosis can be recognized following a comprehensive evaluation. Furthermore, comprehensive psychiatric assessment assists in determining the most appropriate evidence-based intervention for managing pediatric psychiatric disorders. Accurate diagnosis for pediatric psychiatric mental health issues is critical to formulating patient-centered, evidence-based interventions.  

Symptoms Rating Scale

Various symptom rating scales are available for assessing pediatric psychiatric symptoms. Foremost, the Child PTSD Symptom Rating Scale (CPSS). The CPSS aids in evaluating post-traumatic stress disorder severity in pediatrics aged 8-18 years and is used as a patient self-report or clinician-administered interview (Hermosilla et al., 2020). Moreover, the Young Mania Rating Scale (YMRS). The YMRS is an eleven-item rating scale completed by parents and used by pediatricians to identify whether pediatrics who have suspected bipolar disorder need a referral to a mental health provider (Fristad et al., 2021).  

Psychiatric Treatment Options for Children and Adolescents

Pediatric psychiatric disorders should be managed using the following treatment options. Foremost is Acceptance and Commitment Therapy (ACT). ACT is used for managing pediatrics to help them understand and accept their inner emotions (Parmar et al., 2021). Therapists using ACT allow children and adolescents to use their deeper comprehension of emotional struggles to commit to moving forward positively. Moreover, Parent-Child Interaction Therapy (PCIT). PCIT assists parents and children with behavioral problems or difficulties through real-time coaching sessions (Campbell et al., 2023).  

Roles of Parents/Guardians in Assessment of Children and Adolescents

Parents or guardians have a significant role in assessing children and adolescents presenting with various psychiatric and mental health issues. Foremost, parents/guardians offer additional information on behavioral changes in children and adolescents. Parents stay with pediatrics most of the time, which allows them to have more details on how their behavioral changes occurred (Sharma et al., 2019). Moreover, the parent/guardian offers details on the family, environmental, and developmental history. The information can aid in identifying childhood experiences likely to contribute to mental health issues. Moreover, parents/guardians participate in decision-making during pediatric assessment. Parent’s consent is vital to completing comprehensive psychiatric evaluation in pediatrics and formulating their treatment plans.

All the articles used to support ideas in this paper are scholarly since they were published in the last five years, have reference lists and in-text citations, are published by recognized journals, and are peer-reviewed.