30 Aug 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 cl

Transcript from video YMH Boston 2013 Vignette 5- assessing for depression in a mental health appoinment

tony has been referred to a social

worker by his medical provider who is

concerned about symptoms of depression

and anxiety that Tony reported in his

physical exam

do you have a sense of why you're here

yeah my doctor sent me so I'd like to

ask you some questions about how you're

feeling how is your mood been lately um

I don't know what you mean

have you been feeling sad or depressed

not really have you been crying a lot

I don't really cry have you been feeling

hopeless

yeah how about feeling edgy you're angry

well yeah I guess I feel angry sometimes

um like kind of like I just want to

fight someone you can definitely talk

more about that do you ever feel like

you don't have much energy or like

you're not very interested in things

well I like basketball um but sometimes

I don't have enough energy to play don't

like school how are you doing in school

well I used to get all A's and B's but

my grades are kind of going down that's

mainly just cuz I don't do my homework

anymore

why not don't like it it's even hard

getting up in the mornings do you use

drugs or alcohol

I guess I'll have a beer or two with my

friends sometimes sounds like things are

not always going so great you like

playing basketball but sometimes you

have trouble getting up in the morning

and getting interested in school and you

can sometimes get pretty angry how long

have you been feeling that way for like

two months um since May my girlfriend

broke up it makes me like really angry

with her or just with anyone mm-hmm

when I think about it I get a tight pain

in my chest and my heart beats really

fast

I don't know Hey I don't even know why

she did break up with me but it hurts

and I don't yeah I don't even want to be

alive have you had thoughts about doing

something to hurt yourself yeah yeah

tell me more about that

,

Discussion: 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.

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.

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.