I do not need a title page for this. Just a solid paragraph or two per response.
I need two different responses with at least one reference and attached pdf for each response. And yes….they are based around the same subject.
I will add the DB postings below.
DIRECTIONS:
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.
First Posting that needs a reply::
Week 1 Initial Post
Karlie S
Comprehensive Integrated Psychiatric Assessment
As an advanced nurse practitioner, it is important to interview the adolescent alone (with consent from parent), since a developing self-awareness and self-consciousness may make them feel inhibited in front of family. Adolescents can be very concerned about not being believed, or being considered weak or different. The clinician must therefore make the attempts to make the adolescent feel comfortable at all times and acknowledge their subjectivities (Srinath et al., 2019).
Tony is a male patient was states he is referred by his medical doctor for depression and anxiety after a recent physical took place. Tony was pleasant and cooperative during appointment. Client seemed to be well groomed. When asked, Tony describes his mood as angry at times, “Like I want to fight someoneâ€. Tony reports his energy has been low over the past two months since his girlfriend broke up with him. Tony states he usually enjoys basketball but has not had the energy to play over these past few months. Tony reports he struggles to get out of bed in the morning, at times has chest pain and feels his heart is racing. Since him and his girlfriend have broken up there has recently been thoughts of not wanting to be alive.
I feel this provider did well with the presenting client during the interview. She maintained great eye contact. When the patient needed further explaining, the provider easily simplify the question to allow the patient to better understand. For example, when the provider asked about the client’s mood he wasn’t sure what she was meaning. She was able to reword the question by asking the consumer if he had recently felt sad or depressed. I do feel the provider could have done better at the introduction portion of the interview. It is important for children or any patient to feel comfortable at all times. This should include introducing self and explaining what will be taking place with patient’s consent and establishing boundaries of confidentiality. I also feel the provider should have followed up on the patient’s girlfriend and the story behind the break up. This is important due to this being said the primary cause of why the patient is feeling the way he is. It is imperative to get a narrative account of the clinical history from both parents and child. The provider may also follow up with the guardian of the patient to obtain collateral information and insight on how the patient has been acting at home (Srinath et al., 2019).
With the patient stating he has thoughts of self-harm, the next question in mind would be, “Do you have a plan to hurt yourself� It is important to follow up on such a statement. A possible risk assessment may need to be done with further detail as well as relaying this information to the guardian. Adolescents are more likely to reduce their self-harm behaviors when underlying stressors are addressed or when they learn other ways of coping. Given that self-harm is often a coping strategy taken up in desperation, simply telling the adolescent to stop is unhelpful and invalidating. The provider should dive deeper in the immediate stressor and determine possible coping skills to discuss with the patient.
The central goal of a clinical assessment is to come to a case formulation that would guide management decisions. It is often challenging to get consistent, continuous, corroborative information from the child and family. A therapeutic alliance plays a vital role. If the child and the family perceive a mutually beneficial relationship, the facts become more meaningful and useful leading to intervention goals. A clinical assessment also aids the child and family in developing a clearer understanding of their own difficulties and gives them an opportunity to reflect on the information they share (Srinath et al., 2019).
Prevention is critical in the management of childhood depression and suicide. Depression is a common mental health disorder in children and adolescents. Children and adolescents ages 11-17 can be administered a PHQ-9 rating scale to determine the severity of depression. Another rating scale that can be administered in children and adolescents includes the Revised Child Anxiety and Depression Scale (RCADS). This rating scale is a 47-item, youth self-report questionnaire with subscales including: separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and low mood (major depressive disorder).
Psychiatric treatment options for children and adolescents include play therapy and family therapy. Play therapy involves the use of toys, blocks, dolls, puppets, drawings, and games to help the child recognize, identify, and verbalize feelings. The psychotherapist observes how the child uses play materials and identifies any themes or patterns to try and understand the child’s problems. Through combinations of talk and play the child then has opportunity to better manage their conflicts, feelings, and behavior. Family therapy tends to focuses on helping the overall family function in a more positive and constructive way. This is done by exploring patterns of communication and providing support and education. Family therapy sessions can include the child or adolescent along with parents and siblings (AACAP, 2019).
Parents play an important role in the psychosocial care of their children. As adolescents cannot make decisions about their health on their own parents play a crucial role in the whole process of providing psychosocial care to their children. The provision of care starts with the ability of parents to recognize problems and access the care system, through the willingness to cooperate and adhere to the treatment until the outcomes of the care (Mackova et al., 2022).
For this discussion I used evidence based supporting sources.
2nd posting that needs a reply:
Theresa
What Did the Practitioner Do Well?
The practitioner in the YMH Boston Vignette 5 displayed several strengths during the interaction with Tony. One of the key strengths was establishing a safe and non-judgmental environment. The practitioner started the session with open-ended questions that allowed Tony to express his thoughts and feelings freely. For instance, asking Tony about his mood and how he has been feeling lately provided an opportunity for Tony to share his emotional state. The practitioner also demonstrated active listening skills, validating Tony’s feelings and summarizing the information he provided, which helped in building rapport and trust.
Additionally, the practitioner showed sensitivity by not immediately jumping to conclusions but instead exploring Tony’s symptoms gradually. This approach likely made Tony feel more comfortable and less pressured, encouraging him to express his struggles. When Tony mentioned feelings of anger and a lack of energy, the practitioner probed these areas further, which was a positive step towards understanding the underlying issues.
Areas for Improvement
Despite these strengths, there were areas where the practitioner could improve. One area needs a more immediate and focused response when Tony does not want to be alive. While the practitioner did acknowledge Tony’s distress, the response to this critical statement was somewhat delayed. Immediate and direct questioning about suicidal thoughts and plans would have been more appropriate to assess the risk of harm and ensure Tony’s safety. The practitioner could have also explored Tony’s feelings of hopelessness more thoroughly, as these are significant indicators of depression that warrant close attention.
Another area for improvement is the exploration of Tony’s substance use. When Tony mentioned having a beer or two with friends, the practitioner could have delved deeper into the frequency and context of his alcohol use. This would provide a clearer understanding of whether substance use is contributing to his mental health issues or if it is a coping mechanism for his emotional distress.
Compelling Concerns
At this stage in the clinical interview, the most compelling concern is Tony’s expression of suicidal ideation. His statement about not wanting to be alive, combined with symptoms of depression such as a lack of interest in activities, declining academic performance, and significant anger, suggests that Tony may be at risk for self-harm or suicide. Another concern is Tony’s physical symptoms, such as the tight pain in his chest and rapid heartbeat when thinking about his breakup. These could be manifestations of anxiety or panic attacks, which require further evaluation.
Next Question and Rationale
The next question I would ask is, “Tony when you say you don’t want to be alive, have you thought about how you might end your life, or have you made any plans to hurt yourself?” This question is critical because it directly addresses the severity of Tony’s suicidal thoughts. It helps to assess the immediacy of the risk by determining whether Tony has a specific plan or intent, which is crucial for guiding the next steps in ensuring his safety, such as whether emergency intervention or a safety plan is needed.
Importance of Thorough Psychiatric Assessment in Children/Adolescents
A thorough psychiatric assessment in children and adolescents is essential because mental health issues often present differently in younger populations compared to adults. Children and adolescents may not have the vocabulary or emotional awareness to articulate their feelings, leading to different expressions of symptoms such as irritability instead of sadness in depression. A comprehensive assessment helps to identify co-occurring disorders, developmental issues, and environmental factors, such as family dynamics or trauma, which may contribute to the child’s mental health problems. Early and accurate diagnosis is crucial in providing effective treatment and preventing the progression of mental health disorders.
Symptom Rating Scales for Psychiatric Assessment
Two appropriate symptom rating scales for use in child and adolescent psychiatric assessments are the Child Behavior Checklist (CBCL)and theRevised Children’s Anxiety and Depression Scale (RCADS).
The CBCL is a comprehensive tool used to assess a wide range of emotional and behavioral problems in children aged 6 to 18. It includes parent, teacher, and self-report forms that cover various domains such as anxiety, depression, social issues, and aggression. The CBCL is widely used in clinical practice and research, providing valuable information that can guide diagnosis and treatment planning (Baumann et al., 2024).
The RCADS is a self-report questionnaire designed to assess symptoms of anxiety and depression in children and adolescents aged 8 to 18. It includes subscales for different anxiety disorders (e.g., separation anxiety, social phobia) and major depressive disorder. The RCADS helps identify specific anxiety and depressive symptoms and track changes over time, making it a valuable tool in both assessment and ongoing treatment (Walter et al., 2020).
Psychiatric Treatment Options for Children and Adolescents
Two psychiatric treatment options for children and adolescents that differ from those typically used with adults are play therapy and cognitive-behavioral therapy (CBT) for adolescents with a focus on peer relationships.
Play therapy is primarily used with younger children who may not have the verbal skills to express their emotions. Children can express their feelings, explore their experiences, and learn coping skills through play. Play therapy is effective for children who have experienced trauma, have attachment issues, or are dealing with anxiety and behavioral problems (Frawley et al., 2024).
CBT is widely used for treating anxiety and depression in adolescents, but it can be adapted to focus on peer relationships, which are often a significant source of stress during adolescence. This form of CBT helps adolescents develop social skills, improve self-esteem, and manage peer-related anxieties, making it particularly relevant for this age group (De Avila et al., 2020) .
Role of Parents/Guardians in Assessment
Parents or guardians play an integral role in the psychiatric assessment of children and adolescents. They provide essential background information, including the child’s developmental history, family environment, and significant life events that may have impacted their mental health. Their observations of the child’s behavior at home and in other settings are crucial for a comprehensive understanding of their functioning. Involving parents in the assessment process also ensures that they are engaged in the treatment plan and can provide the necessary support at home to reinforce therapeutic interventions.
