Discussion: Comprehensive Integrated Psychiatric Assessment
What did the practitioner do well?
The practitioner is interviewing the client in a private area in the hospital that assures confidentiality and privacy of the interview. Confidentiality assures the client that the information he shares with the practitioner is only shared for treatment purposes and cannot be shared with a third party without the client’s express permission. Moreover, conducting the interview in a private area makes the patient feel comfortable sharing information with the practitioner. When the client enters the room, the practitioner stops everything else and gives the client all the attention he might need. The patient should feel valued to enable them to have a strong therapeutic alliance.
The practitioner also begins the interview by confirming if the patient is alert and oriented. She asks him if he knows why he is in her office. The patient had been referred by his PCP, who was concerned about his symptoms of depression and anxiety reported in the patient’s physical exam. The assessment begins with asking the client questions about the signs and symptoms that the PCP pointed to. She seeks to establish if the client has noticed having signs and symptoms of depression and anxiety. Throughout the interview, she keeps the client engaged using different nursing therapeutic communication techniques, including open-ended questions, reflection, and restating (Costello, 2016). For instance, after answering her questions, the practitioner restates that the client plays basketball but sometimes has trouble waking up in the morning, has lost interest in school, and sometimes gets angry. She uses this technique to express what she believes the client feels underneath his words.
In what areas can the practitioner improve?
The practitioner did not introduce herself to the client and did not give the patient the chance to introduce himself. Since this was the first session, it would be appropriate to begin the interview with introductions and create a strong therapeutic alliance. Having a good first impression between the provider and her patient helps prolong the sessions and avoids ending them prematurely. Secondly, the practitioner could have used other techniques such as active listening, giving recognition, and acceptance. When the patient speaks about her symptoms, the practitioner should acknowledge without giving over compliments or being judgmental. For instance, during the interview, when the client was talking about basketball and school, the practitioner insisted on asking the next question without acknowledging the client’s concerns. Acknowledging the client shows empathy and strengthens the bond between the patient and his practitioner.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
The provider is struggling with building a rapport and validating the client to gain his trust. If she continues to validate the behaviors, the client might feel that there is nothing wrong with him and insist on his negative behavior. While empathy is necessary, the practitioner should provide an opposing point of view for the client’s negative behaviors. She should strive to stabilize the patient is emotionally stable before selecting the best therapeutic approach to apply to the client’s condition.
What would be your next question, and why?
My next question would be to ask the client about his relationship with his close family members, including his parents and siblings. Additionally, I would like to establish his relationship with the teachers and other students who do not play basketball. Finding about the client’s relationship determines his support system and what it takes to mend these relationships for a functional treatment program. If medication therapy is preferred, a strong relationship with family members may encourage medication compliance (Bailey & Kodack, 2011).
Explain why a thorough psychiatric assessment of a child/adolescent is important
A comprehensive psychiatric evaluation or assessment is essential in the diagnosis of a number of behavioral, emotional, and developmental disorders. The assessment assists a PMHNP in understanding the causes of the client’s distress. In children, the assessment is conducted based on the child’s behaviors ad how they affect the child’s life. In most cases, parents are the first to suspect behavioral, developmental, or emotional problems in their children or teen. Children often present with challenges with their family or friends’ relationships, sleeping, school, substance abuse, eating, or other aspects of their daily life. A comprehensive child psychiatric assessment describes the behaviors present, including when they happen and how long they last, the conditions that facilitate the behavior, past interventions to curb it, and how they impact school performance and relationships with family and friends (Tolchin et al., 2020). Additionally, the assessment is necessary to describe physical and psychiatric symptoms, ascertain the family and personal history of emotional, behavioral, and developmental disorders, complete health history, and lab tests.
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
i. Children’s Obsessional Compulsive Inventory (CHOCI) – The rating scale was developed to assess the content and severity of obsessive and compulsive symptoms as a self-reporting tool. It comprises two parts addressing compulsive and obsessive problems in the first and second parts, respectively (Aspvall et al., 2020). The assessment tool has been effectively used in children and adolescent patients aged between 7 and 17 years with OCD symptoms.
ii. Conners’ Rating Scales-Revised (CRS-R) – The rating scale comprises six standardized measures used to evaluate the behavioral symptoms of attention deficit hyperactivity disorder (ADHD) and is completed by the adolescent, parents, and teachers. The versions of the rating scale include Conners’ Parent Rating Scale-Revised (CPRS-R), the Conners’ Teacher Rating Scale-Revised (CTRS-R), and the Conners-Wells’ Adolescent Self-Report Scale (CASS) (Abdullah et al., 2019). The reliability of the scales as measured by test-retest correlations and internal consistency is generally satisfactory.
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
i. Child-Centered Play Therapy (CCPT) – The therapy believes that children possess a natural drive towards growth and embrace play as children’s language. The therapy allows children to express themselves freely through games, using toys and playing (Hillman, 2018). The goal of the therapy is to foster growth, discovery, and healing and allow the kid to lead the way during the therapy.
ii. Parent-Child Interaction Therapy (PCIT) – This type of therapy is designed for young children with behavioral disorders. During the therapy, the therapist coaches the parents in their office through an earpiece and provides guidance on managing difficult behaviors and interacting with the child (Thomas et al., 2017). The goal of the PCIT is to reduce the behavioral issues in duration, frequency, and severity, and improve the parent-child bond and develop a secure attachment. Moreover, the therapy improves the child’s self-esteem, attention span, and prosocial skills.
Explain the role parents/guardians play in assessment.
Parents spend a substantial amount of time with their children. Therefore, their input is needed to assess the child’s behavior. Parents have knowledge of their child’s needs and provide care for the child. Additionally, parents provide a personal and family history in different cases that the child would not otherwise remember or know. For instance, the parent can provide surgical or hospitalization history about the child that was done earlier in life that the child does not remember. The parent is also required to complete specific rating scales that describe the child’s behavior as assessed at home to compare the child’s relationships at home with school.
