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.
SECOND COLLEAGUE
Esther Chukwu’s week one discussion post
Week one discussion: Comprehensive Integrated Psychiatric Assessment
Most adults with psychiatric problems had their initial symptoms during childhood or adolescence. (Stewart & Hamza, 2017). Mental health disorder negatively impacts the affected children, including poor academic performance, increased risk of suicide, criminal tendencies, and underemployment as adults. Children with mental health issues must receive proper care to prevent these problems. (Stewart & Hamza, 2017).
A provider cannot adequately manage a patient without a thorough assessment. Assessing children and adolescents is not an easy task. And this is because, in most cases, the child or adolescent with a psychological issue is not the one that initiates the move to seek care. It is usually the parent, guardian, or caregiver who starts the sought for treatment. (Srinath et al., 2019). The caregiver seeking treatment may pose a challenge initially because the child may not admit that they have a problem. In some situations, the child or adolescent may not be able to accurately report their symptoms, onset, or duration of the symptoms. There is a need for the provider to involve caregivers or parents in the treatment journey, starting with the assessment. (Srinath et al., 2019).
In this week’s discussion, I will be critiquing a mental health professional who performed a comprehensive, integrated psychiatric assessment for an adolescent in a video in the week’s learning resources. I will also determine screening tools, and management approaches suitable for children and adolescents.
The areas the practitioner performed well
As discussed in this paragraph, the mental health practitioner did well in some aspects of the interview. The practitioner informing the patient of what she will be doing is an area of strength. The interviewer assessed the patient’s mood. She also evaluated the patient for other mood disorder symptoms, including anhedonia, crying unnecessarily, lack of energy, and anger. The practitioner interviewed the client in a safe and private environment. She assessed the patient’s insight about why he was in the facility. The practitioner evaluated the patient for the use of alcohol and drugs to ascertain if they affected him or could increase his risk of being in danger. She also established how long the client has been having mood disorder symptoms (which the patient said has been going on for two months after he broke up with his girlfriend). In addition, she assessed the client for suicide risk, including suicidal thoughts and plans. The provider also evaluated how the patient’s mood disorder impacts his functionality, including his performance in school.
The areas that the practitioner needs to improve
Although the mental health practitioner performed well in certain areas, she needs to improve in some areas discussed in this paragraph. The provider needs to improve on the aspect of introduction. It is appropriate for a health care provider to introduce herself and her role in patient care. The provider also needs to build on obtaining patient consent and discussing confidentiality. She also needs to work on collecting collateral information about clients from the people that have a close relationship with the child or adolescent client, including parents, caregivers, and teachers. The provider needs to improve on evaluating the patient for risk of self-harm and harm to others. She also needs to improve in the area of handing over to colleagues.
Compelling concerns and possible follow-up questions
At this stage of the interview, my concerns will be around patient safety and the safety of people around him. I would be concerned that the patient may harm himself or others. This patient may be a potential danger to himself and the people around him. He verbalized that he sometimes feels angry, like wanting to fight someone, and that he has had thoughts of hurting himself. The patient verbalizing that he does not want to be alive and that he has thoughts of hurting himself is a significant cause of concern. My next question to the patient will be, do you have a suicide plan in place? I will also ask, have you attempted hurting yourself or other people in the past? Thirdly, I will ask, are there specific people that you want to fight or hurt? In addition, I will ask, are there weapons in the house, and do you have access to them?
Importance of a thorough psychiatric assessment of a child or adolescent
Every treatment plan should begin with an assessment of the presenting client. A comprehensive evaluation guides the provider to suitable treatment options. A careful review will help the provider determine the signs and symptoms in children with such mental disorders. (Srinath et al., 2019). A thorough assessment is significant to help the practitioner gain insight into the nature of the problem, its onset, duration, and impact on the child or adolescent client and the people around him. (Srinath et al., 2019). A detailed assessment is crucial to arriving at an accurate diagnosis which precedes the development of a treatment plan. A comprehensive evaluation of the child will help the provider to obtain the necessary details about the patient’s presenting problem. A detailed review allows the provider to identify the presence of signs and symptoms that guides the provider to the correct diagnostic criteria for the differential diagnoses. (Danielson et al., 2019). In addition, a comprehensive assessment of the child or adolescent will help the child and family to adequately understand the changes in behavior associated with the psychiatric disorder. A good understanding of the symptoms could make the family provide other relevant information not previously mentioned and be involved in the treatment process. (Srinath et al., 2019).
Two symptom rating scales suitable for a psychiatric assessment of a child or adolescent
Two symptom rating scales that I will use during a psychiatric assessment of a child/adolescent are the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and Children’s Depression Inventory (CDI)
Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is a tool used to evaluate the severity of the obsessive-compulsive disorder (OCD) in children and adolescents presenting with symptoms of OCD. CY-BOCS is also used to measure a child’s response to management for symptoms of OCD. (Srinath et al., 2019). CY-BOCS is the gold standard for determining the severity of OCD in children and adolescents with OCD. CY-BOCS has proven to be highly reliable and valid in assessing children with OCD and is the most commonly used scale in OCD research. (Yan et al., 2021)
Children’s Depression Inventory (CDI) is the most commonly used screening tool for evaluating children and adolescents for symptoms of depression, including the severity of depression. It is used for people aged seven to seventeen and can be self-administered within 15 minutes or less. (Jelinek et al., 2021). The CDI includes 27 symptoms related to depression. Health care providers and researchers use this tool a lot because it is easy to administer within 15 minutes and is suitable for clients within a broad age group of seven and seventeen years. (Jelinek et al., 2021).
Two psychiatric treatment options for children and adolescents that I may not use in the treatment of adults
Play therapy and Parent-Child Interaction Therapy (PCIT) are two psychiatric management choices used in children or adolescents, but I may not use them in treating adults.
Play therapy is a treatment approach often used for children with anxiety disorders. It is used for preschool and school-age children. Research has shown that it is effective in reducing the level of anxiety and improving social skills in these children. Play therapy is used both in clinical and research settings. Children communicate, study, and become aware of their society through play. (Nursanna & Ady, 2020). Psychotherapists and caregivers use play therapy to connect with children and encourage them to communicate their emotions. Play therapy can be performed individually or in a group. Play therapy provides children with a secure, genuine, and discreet approach to being unoccupied by the troubles of life occurrences. Children with complex behaviors, including anxiety, aggression, regression, acute anger, and fear, may benefit from play therapy. (Nursanna & Ady, 2020).
Parent-Child Interaction Therapy (PCIT) is an evidence-based behavioral intervention for children with disruptive behaviors, including autism spectrum disorder and intellectual disability. (Parlade et al., 2020). Research has shown that PCIT lessens disruptive behaviors by boosting the relationship between the affected child and parents. PCIT involves two phases: child-directed interaction (CDI), which targets improving effective parenting behaviors, and parent-directed interaction (PDI), which coaches parents on an organized and constant strategy to discipline. (Parlade et al., 2020).
Role of the parents or guardians in assessment
During an assessment, the parents or guardian discuss symptoms or changes in the child, including changes in behavior that they observed that the child may not be aware of or may feel uncomfortable mentioning. The parents also provide answers on the child’s level of function before the onset of the disorder and deviation in the level of function following the onset of the disorder. (Srinath et al., 2019). The parents also tell the provider the treatment approaches they may have tried before the current visit, including the effect of those treatment options on the child (good or bad). The parents also provide answers to the family history profile, including past and existing medical and psychiatric history. The parents also provide information on the child’s development from pregnancy, delivery, and development throughout the stages of growth. (Srinath et al., 2019).
Conclusion
There is a need to promote mental health during childhood and adolescence because most mental health problems start at this stage. Poor management of psychiatric problems may persist throughout their adult life or affect their development. Thus, accurate assessment, diagnosis, and treatment are vital during this stage of life. Their mental health care is as critical as that of adults.
NB: The articles I used for this writing are considered scholarly because they were written by researchers in the field and were peer-reviewed by other professionals in the discipline.
References
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