Assignment: NRNP 6665 Comprehensive Integrated Psychiatric Assessment

Assignment: NRNP 6665 Comprehensive Integrated Psychiatric Assessment

Assignment: NRNP 6665 Comprehensive Integrated Psychiatric Assessment

NRNP 6665 Comprehensive Integrated Psychiatric Assessment Peer Responses
Response to Denise
Hello Denise. There are additional symptom rating scales that can be used during psychiatric assessment of children or adolescents. For instance, there is the Pediatric Symptom Checklist-17 (PSC-17) which is a psychosocial screening instrument formulated to help in the determination of cognitive, emotional and behavioural issues. This is critical since it enables prompt initiation of necessary interventions. The tool is a short version of the 35-item PSC which is considered beneficial since it is a universal screening tool (Liu et al., 2020). This is because the 17 items are efficient for universal screening. The form is given without any fees and is downloadable online. It has three subscales including internalizing, attention and externalizing. The internalizing subscale assesses internalizing issues such as depression and anxiety (Liu et al., 2020). There is also the attention subscale which assesses attentional problems. Lastly, there is an externalizing subscale which assesses externalizing problems. Another symptom rating scale is the Revised Children’s Manifest Anxiety Scale (RCMAS-2) which is a 37-item tool (Riquin et al., 2021). The scale is self-administered for quantitive assessment of anxiety traits. Therefore, it measures stability and the possibility of experiencing anxiety. It offers complete anxiety scores and scare scores.

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References
Liu, J., Guo, S., Gao, R., & DiStefano, C. (2020). Investigating School Children’s behavioral and emotional problems using pediatric symptoms checklist-17 in a structural equation modeling framework. School Psychology International, 41(3), 257–275. https://doi.org/10.1177/0143034320912301
Riquin, E., Le Nerzé, T., Pasquini, N., Barth, M., Prouteau, C., Colin, E., Amati Bonneau, P., Procaccio, V., Van Bogaert, P., Duverger, P., Bonneau, D., & Roy, A. (2021). Psychiatric symptoms of children and adolescents with mitochondrial disorders: A descriptive case series. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.685532

Response to Ursla
Hello Ursla. Evidence shows that children and adolescents have had to deal with mental health issues. As a result, it is important to have tools used for the assessment of their mental health condition so that appropriate measures can be taken. The discussion has examined the Children’s Psychiatric Symptom Rating Scale (CPSRS) and the Pediatric Anxiety Rating Scale (PARS). There are other scales such as the Conners Scale which is a reliable assessment tool for aiding in the assessment of attention deficit hyperactivity disorder (ADHD) (Riquin et al., 2021). It offers a comprehensive assessment of attention deficit whether is the presence of hyperactivity or not. It measures mental disorders related to ADHD including conduct disorder and oppositional defiant disorder. Another tool is the the Children’s Depression Inventory which is a redesign of the Beck Depression Inventory for grown-ups. It measures the extent of depression in children and adolescents (Anant et al., 2023). It assesses emotional and functional issues. It provides three different rater forms including for parents, teachers and a self-report.

References
Anant, N., Kaur, D., Nadarajan, R., Phua, D. Y., Chong, Y. S., Gluckman, P. D., Yap, F., Chen, H., Broekman, B., Meaney, M. J., & Ang, Y.-S. (2023). Validating the children’s depression inventory-2: Results from the growing up in Singapore towards Healthy Outcomes (GUSTO) study. PLOS ONE, 18(5). https://doi.org/10.1371/journal.pone.0286197
Riquin, E., Le Nerzé, T., Pasquini, N., Barth, M., Prouteau, C., Colin, E., Amati Bonneau, P., Procaccio, V., Van Bogaert, P., Duverger, P., Bonneau, D., & Roy, A. (2021). Psychiatric symptoms of children and adolescents with mitochondrial disorders: A descriptive case series. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.685532

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COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT

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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check. Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

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.

DENISE

Main Post

What did the practitioner do well? In what areas can the practitioner improve?

The practitioner did well in terms of engagement and building rapport. The practitioner effectively started the conversation by acknowledging the referral and asking Tony about his understanding of why he is there. This sets a collaborative tone. Also, the practitioner uses an open-ended question like “How has your mood been lately?” This allows Tony to express himself in his own words. The practitioner uses the follow-up questions to clarify and explore Tony’s feelings and behaviors in more depth, such as inquiring about feelings of anger and his lack of energy. Another thing that the practitioner did well is reflective listening. The practitioner summarized Tony’s experiences to show understanding and to ensure clarity, such as restating Tony’s challenges with school and basketball. Lastly, the practitioner was able to identify concerns such as she sensitively brought up Tony’s potential substance use and his declining school performance, which are important areas to address.

Areas for Improvement:

The practitioner utilized direct questions about sensitive topics. When asking about crying or feeling hopeless, the practitioner used direct questions, which might make Tony feel defensive or uncomfortable. Instead, framing these in a more open-ended way could be more effective.

The practitioner could have provided more immediate validation of Tony’s feelings, especially when he expressed significant emotions like anger and hurt from the breakup.

The practitioner could have thoroughly assessed patient’s risk for suicide. When Tony mentioned not wanting to be alive, the practitioner should have immediately conducted a thorough risk assessment for suicidal ideation to ensure his safety.

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

Compelling concerns at this point include suicidal ideation, anger and aggression, and decline in functioning. In terms of suicidal ideation, Tony expressed that he doesn’t want to be alive, which is a major red flag. This requires immediate attention and a detailed risk assessment. In terms of anger and aggression, Tony’s anger and desire to fight could indicate underlying issues that need to be explored further, including potential risks to himself and others. Lastly is the decline in functioning where Tony’s drop in academic performance and lack of interest in previously enjoyed activities (anhedonia) are concerning and could be signs of depression.

What would be your next question, and why?

Given Tony’s statement about not wanting to be alive, the next question should focus on assessing the risk of suicide. A sensitive yet direct approach is necessary: “Tony, you mentioned that sometimes you don’t even want to be alive. Can you tell me more about those thoughts? Have you ever thought about how you might hurt yourself or made any plans to do so?” This question is crucial for assessing the severity and immediacy of Tony’s suicidal ideation. Understanding whether Tony has specific plans or means to harm himself will guide the necessary interventions to ensure his safety. It also shows Tony that his feelings are being taken seriously and that the practitioner is there to support him.

Reference for above discussions: YMH Boston. (2013, May 22).

Explain why a thorough psychiatric assessment of a child/adolescent is important.

A thorough psychiatric assessment of a child or adolescent is crucial for several reasons such as for accurate diagnosis, early intervention, individualized treatment, and safety and risk management. In terms of accurate diagnosis, holistic understanding, children and adolescents often present with symptoms that can be indicative of various psychiatric disorders. A detailed assessment helps in accurately diagnosing the condition, which is essential for effective treatment. Next is early intervention, identifying psychiatric issues early can lead to early intervention, which is often more effective and can prevent the progression of the disorder. Holistic understanding allows clinicians to understand the child’s or adolescent’s behavior in the context of their developmental stage, family dynamics, school environment, and social interactions. Another reason is for individualized treatment, a thorough assessment provides the necessary information to develop a suitable treatment plan that targets the specific needs of the child or adolescent. Lastly, safety and risk management help in identifying any immediate risks, such as suicidal ideation or self-harm, ensuring that appropriate safety measures are put in place.

Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.

Child Behavior Checklist (CBCL)

The CBCL is designed to assess a wide range of emotional and behavioral problems in children. It is a parent-report questionnaire that includes various items related to different behavioral and emotional issues. It provides results for internalizing problems (e.g., anxiety, depression) and externalizing problems (e.g., aggression, delinquent behavior). A study shows that CBCL can aid in the identification of individual and comorbid mental disorders affecting youth seeking mental health services by providing specific information about the presence and the severity of specific suspected disorder (Biederman, et. al., 2020). This helps in the utilization of resources and identification of different mental disorder symptoms.

Revised Children’s Anxiety and Depression Scale (RCADS)

The RCADS is a widely used instrument for collecting information on depression and anxiety symptoms in children and adolescents, with favorable psychometrics and evidence of cross-cultural invariance, suggesting comparable performance of the tool across different cultural groups (Carvajal-Velez, et. al., 2023). It is a self-report scale that includes subscales for various anxiety disorders (such as Generalized Anxiety Disorder, Social Phobia, and panic disorder) as well as depression. This tool helps in differentiating between different types of anxiety and depressive symptoms.

Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.

Play Therapy

Play therapy uses play to help children express their feelings, develop coping mechanisms, and improve communication skills. It is especially useful for younger children who may have difficulty articulating their emotions verbally. The analysis from the sample included 53 children, experimental results show significant associations between automated affect predictions and CPTI (Children’s Play Therapy Instrument) affect dimensions with small to medium effect sizes (Halfon, et. al., 2021).

Differences from Adult Treatment: Adults typically engage in more verbal forms of therapy, such as cognitive-behavioral therapy (CBT), rather than play-based interventions.

Parent-Child Interaction Therapy (PCIT)

PCIT is a dyadic behavioral intervention that addresses improving the quality of the parent-child relationship and changing parent-child interaction patterns, PCIT is a behavioural therapy that is an alternative to classical intervention for children with behavioural problems and their families (Valero-Aguayo, et. al., 2021). It is used primarily for children with behavioral problems and had shown to be effective. A systematic review and meta-analysis of 100 comparative group studies on the application of PCIT in children with behavioral problems has been carried out, in short, PCIT is an effective and efficient treatment for child behavior problems including ODD and ADHD, with more than 40 years of research behind it (Valero-Aguayo, et. al., 2021). The difference of this from adult treatment is that this therapy involves both the parent and the child and focuses on improving parenting skills and the parent-child relationship, which is not applicable to adult therapy.

Explain the role parents/guardians play in assessment.

Parents/guardians can provide critical historical context, including developmental milestones, previous medical and psychiatric history, and family dynamics, which are vital for a comprehensive assessment. They can also provide observational insights and can offer valuable insights into the child’s behavior across different settings, such as home and school, which the child may not be able to accurately report.

Parents/guardians are essential in supporting the child throughout the assessment process and giving consent for treatments and interventions. Their collaboration in treatment planning and involvement is crucial for implementing and reinforcing treatment strategies at home, ensuring consistency and effectiveness of the therapeutic interventions.

Overall, parents/guardians play an integral role in the assessment process by providing detailed information, supporting the child emotionally, and participating actively in the treatment plan.

References

Biederman, J., DiSalvo, M., Vaudreuil, C., Wozniak, J., Uchida, M., Yvonne Woodworth, K., Green, A., & Faraone, S. V. (2020). Can the Child Behavior Checklist (CBCL) help characterize the types of psychopathologic conditions driving child psychiatry referrals? Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 8, 157–165. https://doi.org/10.21307/sjcapp-2020-016

Links to an external site.

CBCL.pdf

Download CBCL.pdf

Carvajal-Velez, L., Ottman, K., Ahs, J. W., Li, G. N., Simmons, J., Chorpita, B., Requejo, J. H., & Kohrt, B. A. (2023). Translation and Adaptation of the Revised Children’s Anxiety and Depression Scale: A Qualitative Study in Belize. The Journal of Adolescent Health?: Official Publication of the Society for Adolescent Medicine, 72(1S), S34–S39. https://doi.org/10.1016/j.jadohealth.2022.05.026

Links to an external site.

Revised.pdf

Download Revised.pdf

Halfon, S., Doyran, M., Türkmen, B., Oktay, E. A., & Salah, A. A. (2021). Multimodal affect analysis of psychodynamic play therapy. Psychotherapy Research?: Journal of the Society for Psychotherapy Research, 31(3), 402–417. https://doi.org/10.1080/10503307.2020.1839141

Links to an external site.

Play Therapy.pdf

Download Play Therapy.pdf

Valero-Aguayo, L., Rodríguez-Bocanegra, M., Ferro-García, R., & Ascanio-Velasco, L. (2021). Meta-analysis of the Efficacy and Effectiveness of Parent Child Interaction Therapy (PCIT) for Child Behaviour Problems. Psicothema, 33(4), 544–555. https://doi.org/10.7334/psicothema2021.70

Links to an external site.

PCIT.pdf

Download PCIT.pdf

YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointment. [Video]. YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU

Links to an external site.

URSLA

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Comprehensive Integrated Psychiatric Assessment

Children and adolescents face various challenges as they grow and interact with different people. A comprehensive mental assessment allows a specialist healthcare provider to establish the cause of their problems and resolve them. Based on the YMH Boston Vignette 5 video, the practitioner did well by allowing Tony to express himself, and she was keen to listen to his concerns. The practitioner did not interrupt the patient, thus enabling him to air all his problems. The area of improvement for the practitioner is to use specific and easy-to-understand terms. For instance, Tony found it challenging to describe his mood, as it seemed like a new concept (YMH Boston, 2013). The compelling concern I have for this patient is his desire to harm himself. It is a concern because it could hurt him if the practitioner fails to address it. My next question for Tony would be: how often have you contemplated harming yourself, and how strong is this urge? The question would assess the patient’s risk of harm.

A thorough psychiatric assessment is essential for children/adolescents as it establishes the mental conditions they might be suffering from, their extent and damage to their mental wellness. The symptom rating scales appropriate for the psychiatric assessment of children/adolescents are the Children’s Psychiatric Symptom Rating Scale (CPSRS) and the Pediatric Anxiety Rating Scale (PARS). The former allows clinicians to quantify their treatment and capture clinical judgments related to the psychiatric symptoms children experience (Wambua et al., 2020). Relatedly, PARS assesses the frequency and severity of anxiety symptoms in children, allowing the clinician to rate the level of damage to their mental wellness (Maddox et al., 2020). The psychiatric treatment options suitable for children/adolescents are play therapy and acceptance and commitment therapy (ACT). The former balances symbolic play with linguistic expression and treats emotional problems by meeting the child’s developmental needs (Koukourikos et al., 2021). The ACT is also suitable for children with autism because it allows the patient to feel accepted by society. The role of parents in assessment is to explain the development of behavioral problems, how the issues have advanced over time and the causes of these problems. Early detection and intervention through comprehensive assessment can mitigate long-term consequences, fostering better emotional, social, and academic outcomes as they mature.

Answering these questions allows the psychiatrist to understand the child’s behavior. All the articles used in the paper are scholarly because they are peer-reviewed, current, and written by reputable authors.

References

Koukourikos, K., Tsaloglidou, A., Tzeha, L., Iliadis, C., Frantzana, A., Katsimbeli, A., & Kourkouta, L. (2021). An overview of play therapy. Materia Sociomedica, 33(4), 293-297. https://doi.org/10.5455/msm.2021.33.293-297

Maddox, B. B., Lecavalier, L., Miller, J. S., Pritchett, J., Hollway, J., White, S. W., Gillespie, S., Evans, A. N., Schultz, R. T., Herrington, J. D., Bearss, K., & Scahill, L. (2020). Reliability and validity of the pediatric anxiety rating scale modified for autism spectrum disorder. Autism, 24(7), 1773-1782. https://doi.org/10.1177/1362361320922682

, G. N., Kumar, M., Falkenström, F., & Cuijpers, P. (2020). Process and outcome of child psychotherapies offered in Kenya: A mixed methods study protocol on improving child mental health. BMC Psychiatry, 20(263), 1-10. https://doi.org/10.1186/s12888-020-02611-2

YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointment [Video]. YouTube. https://www.youtube.com/watch?v=Gm3FLGx