NRNP 6665 Walden Wk 1 Comprehensive Integrated Psychiatric Assessment
When performing an initial assessment, gathering information and developing a positive rapport with child or adolescent patients can be difficult. The clinician is presented with an adolescent who has been dropped off by his mother for a mental health evaluation due to his alleged problems with anger management in the video provided by YMH Boston.
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The practitioner used practical methods to establish confidentiality and privacy with the patient. The practitioner also relaxed the patient from being guarded due to being taken for an evaluation into more willingly providing information. By casually discussing the patient’s life to make him feel more relaxed, the practitioner was able to segue into discussing why he felt he was brought to the clinic and was able to establish what was lacking in communication between the patient and his mother. The practitioner discovered the core of the patient’s problems with his mother by asking open-ended questions and allowing the patient to expand on his thoughts, and he can now address the issue appropriately.
While the practitioner performed admirably in this assessment, some aspects could be improved. In my opinion, the error was subtle, created by stereotyping roles between the mother and the patient, and created a compelling concern that must be addressed. “While stereotyping can be a subtle cognitive phenomenon resulting from virtually universal social categorization processes, it also occurs, often unconsciously, among people who strongly support egalitarian principles and believe they are not prejudiced” (Pumariega et al., 2013). The practitioner confirmed the patient’s belief that teenagers dislike talking to their mothers and that his mother should “kinda’ be honest, not be a parent” (YMH Boston, 2013). When empathizing with the patient, the practitioner needed to be more objective by not taking sides. While empathizing with the patient about his communication problems with his mother can be beneficial, the practitioner must do so without criticizing one party (AACAP, 2012). The patient had emotional reasons for believing his mother thinks he needs anger management. “Emotional reactions are not always incorrect, but failing to recognize and account for them rationally can be misleading” (Kaplan, 2017). The practitioner must recover from their critical stance toward the mother. While attempting to establish rapport with the patient, it was a subtle error, but the interaction could have been approached more productively.
“How do you feel about having a conversation with your mother about how you would prefer to speak to someone who is willing to listen and support you rather than making you feel pressured or constantly nagged?” I believe my next question would be addressing his communication with his mother.
I would ask this question to learn whether the patient has tried to talk about his problems with his mother and to allow him to elaborate on his feelings about communicating with her. By having the patient elaborate on how he feels about discussing these issues with his mother and his position on the viability of the approach, he may be able to open up about more underlying concerns or problems that are causing his anger and communication barrier.
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References
American Academy of Child & Adolescent Psychiatry (AACAP). (2012). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 541-557. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf
Kaplan, C. (2017). Ethical dilemmas. Advanced Healthcare Network. Retrieved from https://web.archive.org/web/20160416180027/http://nurse-practitioners-and-physician- assisstants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx.
Pumariega, A.J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., …Smith, J. (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1101-1115. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf.
YMH Boston. (2013c, May 22). Vignette 4 – Introduction to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE
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Question 
- 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.
NRNP 6665 Walden Wk 1 Comprehensive Integrated Psychiatric Assessment
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?
- Do you have any compelling concerns at this point in the clinical interview? 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 essential.
- 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.