Read a selection of your colleagues’ responses.

By Day 6 of Week 1

• 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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

• Please respond to the two students

Student 1 – Beatrice N Duru

YMH BOSTON VIGNETTE 5: ANALYSIS AND REFLECTION

1. What did the practitioner do well? In what areas can the practitioner improve?

The practitioner demonstrated effective communication skills by actively listening to the patient and maintaining a calm, nonjudgmental demeanor (YMH Boston, 2023). They established rapport, which encouraged the patient to share their feelings. However, the practitioner could improve by asking more open-ended questions to explore the patient’s underlying concerns and emotional state further. Additionally, clarifying ambiguous responses and ensuring that the patient fully understands the questions could enhance the assessment’s accuracy.

2. At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

Yes, there are compelling concerns regarding the patient’s mental health. The patient expressed feelings of sadness and withdrawal, which could indicate depression or another mood disorder. There is also a concern about potential bullying at school or challenges at home contributing to the patient’s emotional distress. Additionally, the practitioner should assess for any signs of self-harm or suicidal ideation, given the patient’s mood symptoms.

3. What would be your next question, and why?

The next question would be: “Can you tell me more about what your days at school are like and how things are going at home?” This question helps explore potential environmental stressors, such as bullying or family conflict, that could be affecting the patient’s mental health. Understanding these factors is crucial for developing an effective treatment plan.

ADDITIONAL PROMPTS (GENERAL TO CHILD/ADOLESCENT PSYCHIATRIC ASSESSMENTS)

4. Explain why a thorough psychiatric assessment of a child/adolescent is important.

A thorough psychiatric assessment is vital in children and adolescents because mental health issues often present differently in younger populations than in adults. Early identification and intervention can prevent long-term consequences and improve developmental, academic, and social outcomes. Comprehensive assessments help in identifying underlying causes, comorbidities, and functional impairments, enabling clinicians to tailor appropriate treatment plans (Bayer et al., 2022).

5. Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.

The Child Behavior Checklist (CBCL): The CBCL is a widely used parent-report questionnaire assessing various behavioral and emotional problems in children aged 6-18. It helps identify issues such as anxiety, depression, aggression, and social problems (Stewart et al., 2024).

The Revised Children’s Anxiety and Depression Scale (RCADS): This self-report scale assesses anxiety and depressive symptoms in children and adolescents. It is useful for screening and monitoring treatment progress (Baron et al., 2021).

6. Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.

Play Therapy: Particularly effective for younger children, play therapy allows them to express feelings and experiences through play, which is more natural for their developmental stage (Cochran et al., 2023).

Parent-Child Interaction Therapy (PCIT): This treatment focuses on improving parent-child relationships and communication, which is critical for behavioral management in young children but less common in adult treatment (Phillips & Mychailyszyn, 2021).

7. Explain the role parents/guardians play in assessment.

Parents and guardians provide essential information about the child’s developmental history, behavior across different settings, and any family dynamics affecting mental health. Their involvement is crucial for accurate diagnosis, treatment planning, and adherence to therapeutic recommendations. Engaging parents also helps in implementing behavior management strategies at home (Kartel et al., 2022).

References

Baron, I., Hurn, R., Adlington, R., Maguire, E., & Shapiro, L. (2021). Revised Children’s Anxiety and Depression Scale (RCADS): Psychometric properties in a clinical sample in the United Kingdom. Clinical Pediatrics: Open Access.

Bayer, T. A., Van Patten, R., Hershkowitz, D., Epstein-Lubow, G., & Rudolph, J. L. (2022). Comorbidity and management of concurrent psychiatric and medical disorders. Psychiatric Clinics, 45(4), 745-763.

Cochran, N. H., Nordling, W. J., & Cochran, J. L. (2023). Child-centered play therapy: A practical guide to therapeutic relationships with children. Routledge.

Kartel, A., Charles, M., Xiao, H., & Sundi, D. (2022). Strategies for Parent Involvement During Distance Learning in Arabic Lessons in Elementary Schools. JILTECH: Journal International of Lingua & Technology, 1(2).

Phillips, S., & Mychailyszyn, M. (2021). A review of Parent-Child Interaction Therapy (PCIT): Applications for youth anxiety. Children and Youth Services Review, 125, 105986.

Stewart, L. C., Asadi, S., Rodriguez-Seijas, C., Wilson, S., Michelini, G., Kotov, R., … & Olino, T. M. (2024). Measurement invariance of the Child Behavior Checklist (CBCL) across race/ethnicity and sex in the Adolescent Brain and Cognitive Development (ABCD) study. Psychological assessment, 36(8), 441.

YMH Boston. (2013, May 22). Vignette 5 – Assessing for depress

Student 2 – Romeliato

What did the practitioner do well? In what areas can the practitioner improve?

During the session, the clinician asked open-ended questions, actively listened to Tony’s concerns, and gave him enough time to process and respond. The clinician assessed his mood symptoms of feeling sad, hopeless, or angry and if he is having suicidal thoughts. The area that the clinician could improve is that she could have introduced herself and assured the patient that the conversation was confidential unless there was a safety concern.

She could have built a therapeutic alliance by getting to know Tony first to establish rapport and gain the patient’s trust before asking him what brought him here. Educate the patient on the nature of the interview by asking if he understands the purpose of the visit and explaining what information is needed (Carlat, 2017).

Do you have any compelling concerns at this point in the clinical interview? If so, what are they?

At this point, Tony’s thoughts of self-harm, anger, depression, alcohol use, and somatic symptoms are the most compelling concern.

What would be your next question, and why?

I would ask more questions such as: What are your plans to hurt yourself? Do you have any thoughts of hurting others? How do you see the future? How often do you drink, and how much?

Peer Responses

The question aims to determine any concerns, understand the patient’s difficulties, and plan accordingly to guide treatment decisions. Diagnosis and management of adolescents are vital to clinical decisions (Sharma et al., 2019).

Explain why a thorough psychiatric assessment of a child/adolescent is important.

It is challenging to assess children and adolescents. Clinical assessments require detailed information from considerable sources and settings, mainly assessment and treatment, which are multidisciplinary. The multidisciplinary team gathers and shares information involving the child and family. The main objective of the psychiatric assessment is to arrive at a case formulation that would guide treatment management decisions.

The detailed psychiatric history and assessment will help determine vital areas of consideration and the existence or absence of a mental health illness. The formulation of the case concludes that the key component will aid in embracing a holistic view of the child’s problem that will support treatment planning (Sharma et al., 2019). An assessment of children’s behavior is crucial to understanding child development. The assessment of children and adolescents compares developmental age and clinical presentation (Hoyos, 2020).

Psychiatric assessment of a child/adolescent.

The Suicide risk assessment in children and adolescents is a thorough interview of a distressed individual interviewing current suicidal ideation, capability, intent, reasons for dying, reasons for living, plan for suicide attempts, attempts in the past, and protective factors. It is vital to assess the motivation and intent of any previous attempt and understand the harmfulness of the suicide plan. The child behavior checklist has 112 items rated on a point scale, plus social activity/academic performance for aggression assessment.

It is essential to evaluate the commonly associated psychiatric disorders with aggression, such as conduct disorder, oppositional conduct disorder, attention deficit hyperactivity disorder, substance use disorder, depression, disruptive behavior disorder, autism spectrum disorder, intellectual disability, and gaming disorder (Shah et al., 2023).

Two psychiatric treatment options for children and adolescents.

Cognitive behavioral play therapy (CBPT) is a play-based cognitive behavioral strategy. CBPT provides a chance for teaching and therapeutic work to occur during play. It involves using different toys to support the child in recognizing, identifying, and verbalizing feelings (Chakraborty & Bhide, 2020).

The development of the family therapy approach is to treat depression and suicidal thoughts in adolescents and protect them from suicidal ideation and high-risk behavior by strengthening the bond between parents and children (Shah et al., 2023).

The role parents/guardians play in assessment.

Parents play an essential part in providing psychosocial care to their children; children and adolescents cannot decide independently on their health. The parents willing to cooperate and adhere to treatment can provide care. By identifying issues and accessing the healthcare system, they will achieve the desired outcome care outcome. The parental roles in providing psychosocial care for adolescents concentrate primarily on help-seeking behavior and access to care.

Parents are the most significant source of information for professionals to identify their children’s issues—one of the critical barriers in seeking professional help is when the parents cannot identify the severity of the adolescent problem. Parents are an important factor in help-seeking behavior in adolescents facing difficulties; they play a significant role in obtaining mental health care services despite the availability of different sources, such as peers, friends, and teachers (Mackova et al., 2022). Academics and other experts write scholarly sources and contribute to knowledge in a respective field by conveying new study findings, theories, analyses, insights, news, or summaries of current knowledge.