YMH Boston Vignette 5 video Discussion essay
WEEK 1 DISCUSSIONS (Based on the YMH Boston Vignette 5 video) – INITIAL POST
What did the practitioner do well? In what areas can the practitioner improve?
The practitioner established the purpose of the meeting by asking “Do you have a sense of why you are here?”. However, the response of “my doctor sent me” should have been explored further to establish if the patient (Tony) truly understood why his doctor made the referral. PCPs are at the forefront of care in identifying mental health disorders, and at-risk individuals and providing the requisite referrals to mental health practitioners (Zuckerbrot et al., 2018). Education is a big part of mental health management and ensuring that the patient understands the mental health condition should start at the beginning of care to ensure compliance. Psychoeducation is key to successful intervention (Thapar, 2018).
The practitioner also did a good job of summarizing the salient points of the encounter and elicited a time frame from the patient. This yielded more information as the patient was able to identify a triggering event – the break-up with his girlfriend. This also made the patient reveal his suicidal ideations which the practitioner was able to explore. However, the practitioner did not introduce herself nor did she explain to the patient the confidential aspects of the encounter. There was also, no evidence of collateral and prior consent from legal guardians. Using the word “depressed” might not sit well with a patient as he may struggle to accept being depressed because of the stigma associated with mental illness (Radez et al., 2020) YMH Boston Vignette 5 video Discussion essay.
When the patient stated that he feels edgy, like fighting someone, the practitioner noted that “we can definitely talk more about that” but never did. The patient also noted that playing basketball was a hobby he used to enjoy. Talking more about this hobby would have helped the patient to relax more (I observed him to be guarded, hesitant with answers, and make intermittent eye contact), establish a rapport, and be more engaged in the encounter (Carlat, 2017). The practitioner quickly moved on to talk about what the patient does not enjoy – homework, putting him more on the defensive. Tony also mentioned having a beer or two with friends – the practitioner did not ask about frequency and access and neither did she ask about the use of recreational drugs which is common in adolescence (Carlat, 2017).
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
The video stopped as the practitioner was about to explore Tony’s suicidal ideations (SIs). My concern at this point will be to establish if this is the first time Tony had SIs, and if not, what other situations have triggered these thoughts. A history of self-harm and/or SI is a strong risk for suicide (Gee et al., 2020). Another concern would be if Tony has ever discussed his feelings with anyone – parents, school counselors, teachers, etc.? Who and what are his support systems (Gee et al., 2020) and have they been utilized at any time?
What would be your next question, and why?
My next question would be if Tony has any plans for suicide and what the plans are. I will also be interested in any self-harming activities- past and present. (Gee et al., 2020). I will also explore how Tony has been coping with these feelings of edginess, anger, sadness, loneliness, etc. to explore the presence, use, and adequacy or otherwise of coping skills. Coping skills are needed to successfully transverse the complicated world of adolescence and beyond (Melnyk, 2020).
Explain why a thorough psychiatric assessment of a child/adolescent is important.
Carlat (2017) notes that there are four tasks associated with a psychiatric assessment of a patient – building a therapeutic alliance, establishing a psychiatric database, garnering adequate information to arrive at a diagnosis(es), and having the patient buy into the proposed intervention. To achieve these, a thorough assessment is required because ultimately, the goal of the patient is symptom alleviation or reduction, and it is important to understand what these symptoms are. Srinath et al. (2019) also agree that a thorough clinical assessment will aid case formulation which will derive from the therapeutic alliance, a thorough H & P, exploring the context and presentation, and the treatment and interventions.
Two different symptom rating scales would be appropriate to use during the psychiatric assessment of a child/adolescent.
Two common psychiatric pathologies in children and adolescents are anxiety and depression (Zuckerbrot et al., 2018). To this end, the GAD-7 and PHQ-C are symptom-rating tools that are readily applied to children and adolescents in the clinical setting for measuring the levels of anxiety and depression respectively. Srinath et al. (2019) also recommend using the Child and Adolescent Psychiatric Assessment (CAPA). CAPA has been used for diagnosing several psychiatric disorders and also has a DSM5 version (Angold et al., 1987/2022).
Two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Psychiatric treatment options for children and adolescents take into consideration the stage of development of the child, family involvement and engagement, continued promotion of the patient’s development, and promotion of resiliency in the patient (Wheeler, 2020). In this vein, there is evidence in the literature of the exclusive use of Play Therapy and the Acceptance and Commitment Therapy (ACT) in children and adolescents. Play Therapy can be tooled to meet the above considerations while ACT utilizes mindfulness exercises to help the acquisition and use of coping skills and can help patients steer the complicated course of adolescent developmental millstones.
The role parents/guardians play in assessment.
Parents and guardians provide collateral during the assessment. This information can be a crucial part of the assessment data. Information on the patient’s developmental history can be provided by the parents and this gives a picture of the patient’s development history. This data forms an important framework for the planned intervention (Thapar et al., 2018). Secondly, they may be the support system needed for the intervention to be implemented and so play a crucial role in the case formulation. Finally, as someone once noted that the family is stronger than therapy. In other words, the patient is in therapy for a few hours or so in the day but spends a lifetime with the family (environment). The role of the home environment must be recognized and integrated into the intervention to effect lasting positive change in the patient.
Angold, A., Cox, M., Prendergast, & Rutter. (1987). CHILD AND ADOLESCENT PSYCHIATRIC ASSESSMENT (CAPA) Core Diagnostic Modules for DSM 5 CHILD INTERVIEW. In E Simonoff Copyright. https://devepi.duhs.duke.edu/files/2018/06/Child-CAPA-Core-Modules-DSM-5.pdf(Original work published 1987)
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Philadelphia Wolters Kluwer.
Gee, B. L., Han, J., Benassi, H., & Batterham, P. J. (2020). Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies. DIGITAL HEALTH, 6, 205520762096395. https://doi.org/10.1177/2055207620963958
Melnyk, B. M. (2020). Reducing Healthcare Costs for Mental Health Hospitalizations With the Evidence-based COPE Program for Child and Adolescent Depression and Anxiety: A Cost Analysis. Journal of Pediatric Health Care: Official Publication of National Association of Pediatric Nurse Associates & Practitioners, 34(2), 117–121. https://doi.org/10.1016/j.pedhc.2019.08.002
Radez, J., Reardon, T., Creswell, C., Lawrence, P. J., Evdoka-Burton, G., & Waite, P. (2020). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child & Adolescent Psychiatry, 30(2). https://doi.org/10.1007/s00787-019-01469-4
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(8), 158–175. https://doi.org/10.4103/psychiatry.indianjpsychiatry_580_18
Thapar, A. (2018). Rutter’s child and adolescent psychiatry. Wiley Blackwell.
Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse : a how-to guide for evidence-based practice. Springer Publishing Company.
YMH Boston. (2013). Vignette 5 – Assessing for Depression in a Mental Health Appointment. In YouTube.https://www.youtube.com/watch?v=Gm3FLGxb2ZU
Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. E. K., & Laraque, D. (2018). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics, 141(3), e20174081. https://doi.org/10.1542/peds.2017-4081
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. YMH Boston Vignette 5 video Discussion essay 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.
Based on the YMH Boston Vignette 5 video, post answers to the following questions:
Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.
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.
Week 1 discussion
Discussion About Tony’s Case
Tony is a high school male who was referred to a social worker by his medical doctor because of his depression and anxiety symptoms. This video is just part of the assessment, it is hard to tell if the social worker addressed all the necessary factors to do a thorough psychiatric assessment. From what we can see, I think she did pretty well approaching the client. But Tony appears guarded, and he was trying to minimize his symptoms initially, probably because the social worker didn’t introduce herself and the purpose of this conversation to him. Teenagers are very sensitive to their privacy, Tony may feel offended and reluctant to share his feeling with the social worker YMH Boston Vignette 5 video Discussion essay.
In this case, I am mostly concerned about Tony’s safety. He admitted that he lost his interest and motivation to attend school activities, he doesn’t want to be alive anymore, and he even has some ideation of hurting himself in some way. All these symptoms are the warning signs of self-harm and suicide. He needs some professional help.
I would ask for more details about his plan of hurting himself and how they handle it as my next question. Because a thorough psychiatric assessment will include the patient’s behavior and a closer detailed examination including the effect on their life, and how they manage their behavior and symptoms. Discussing suicide will not trigger the patient’s suicide action. According to the discussion, we will know the patient’s plan, so we can set some plans to prevent it from happening in real life. The discussion may let the patient have a better view of his situation and finally change his suicide ideation.
Why a thorough psychiatric assessment is so important for children and adolescents? Because a thorough and detailed psychiatric assessment is the basic information resource to make an acute diagnosis and set an appropriate treatment plan for the patient. It is an essential diagnostic tool employed by psychiatric providers to diagnose mental behavior problems. According to research, a thorough psychotic assessment could improve suicide prevention and affect the child’s future life. (Probert-Lindström, & others, 2021).
Two appropriate symptom rating scales for child and adolescent psychiatric assessment.
There are many useful symptom rating scales for child psychiatric assessment, the Pediatric Anxiety Rating Scale (PARS) and Columbia Depression Scale are two of the most used. PARS is used to rate the severity of anxiety in children and adolescents from ages 6 to 17 years. It determines the anxiety symptoms and the severity of the symptoms during the past week. The Columbia Depression Scale is a screening tool for depression in children ages 11 and up. A separate parent version is available for the parent too (Child Psychiatry Rating Scales for Primary Care Physicians, 2017).
Two psychiatric treatment options for children and adolescents are not used for adults.
Psychological therapy is a very effective treatment option for children with psych mental problems, it includes talking, role-playing, and other activities to help the children to express their feeling and ideations. Also, the child’s parents and teacher can be involved in the treatment team. The therapist could observe the behaviors and interactions between the parents, children, and teachers, and offer suitable treatment options.
Family counseling and support is another treatment option for children with mental health problems. It can help parents to understand their child’s challenges and their struggling, provide new strategies to cope with the children’s difficult behavior positively, coach parents to communicate and work with schools, etc. (National Institute of Mental Health, n.d.).
Guardian and parents’ role in the psychotic assessment
Parents and guardians play an essential the children’s psychotic assessment. It’s natural for guardians and parents to question how they raised the child when the child needs to be evaluated by a psychiatrist or hospitalized in a mental hospital. Their collateral information and point of view about the child’s mental health status are a very important part of the patient history. Sometimes, the patient may minimize, exaggerate, or lie about their symptoms, the parents and guardians could help the practitioner to clarify some information. Their involvement in the treatment plan is very important for the patient’s mental health to improve too.
Child Psychiatry Rating Scales for Primary Care Physicians. (2017, March 27). Healthy Bodies, Healthy Minds. https://candapediatricmedicalhomes.wordpress.com/child-psychiatry-rating-scales-for-primary-care-physicians/
National Institute of Mental Health. (n.d.). Children and Mental Health: Is This Just a Stage? National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/publications/children-and-mental-health#part_6394
Probert-Lindström, S., Vaez, M., Fröding, E., Ehnvall, A., Sellin, T., Ambrus, L., Bergqvist, E., Palmqvist-Öberg, N., Waern, M., & Westrin, Å. (2021). Utilization of psychiatric services prior to suicide- a retrospective comparison of users with and without previous suicide attempts. Archives of Suicide Research : Official Journal of the International Academy for Suicide Research, 1–14. https://doi.org/10.1080/13811118.2021.2006101 YMH Boston Vignette 5 video Discussion essay