. Ethics Rounds

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2 references

Comprehensive Integrated Psychiatric Assessment

In the YMH Boston Vignette video, the practitioner is completing a psychiatric evaluation to an adolescent client. The content addressed in the assessment includes problems presented, symptoms, psychiatric history, and medical history. Establish initial rapport with the patient, use open-ended questions and ask about the presenting complaint or problems. During the interview mental status observations can be made from the moment the clinician meets the patient. Pertinent medical and family history may be brought up while presenting other concerns, and patients may pose important questions about treatment recommendations as they present their initial history.

What did the practitioner do well?

            The practitioner did well to establish initial rapport with the patient. The practitioner sat facing patient and spoke in a soft tone, open-ended questions were used to allow greater communication. The practitioner did discuss confidentiality with the patient. Adolescents are concerned about confidentiality and family or friends knowing, this causes then to shut down and not communicate as much. According to Behnke & Warner (2002) first, early in the relationship the psychologist should make clear what relationship she will have to each of the parties. Second, central to that early discussion should be an explanation of how information-sharing will work–what information will be shared, with whom and when, in a manner appropriate to the child’s age and understanding (Behnke & Warner, 2002). Third, as the child develops, the structure of the therapy may change for clinical reasons. The child’s greater sense of self and enhanced capacity for autonomy may require greater respect for the child’s need for privacy (Behnke & Warner, 2002). Such boundary renegotiation, while complex with certain adolescents and families, is clinically and ethically indicated.

What areas can the practitioner improve?

It is always good to make a point to tell the client what you are going to do and why you are asking certain questions. An introduction did not occur between the practitioner and patient. Also, the practitioner did not obtain consent. It is always good to introduce yourself this helps in developing rapport. The general principles of a psychiatric interview, which include the practitioners’ self-introducing to the client and obtaining consent before proceeding with the interview (Sadock et al., 2015). I would ask more in detail specific questions regarding past behavior. According to Stone et al. (2020) with children, in addition to asking specific questions of the child and parent regarding past suicidal thoughts and gestures, an assessment of past behavior in general may provide useful information for determining past suicidal ideation and behavior. For example, does the child have a history of placing himself in potentially dangerous situations (running out into the middle of the street without looking; engaging in dangerous sports and recreational activities without appropriate safety equipment; playing games such as trying to fly from a tree or the roof of a house) (Stone et al., 2020). These behaviors may indicate impulsivity and poor judgment, or they may represent past suicide attempts.

Importance of Through Psychiatric Assessment in Children and Adolescents

A through development assessment is of importance when assessing children and adolescents. This includes cognitive, social, linguistic, emotional, physical development, as well as numerous adaptive behaviors such as self-care and self-direction. A standard psychometric assessment is also used to evaluate the development of a child in various areas. Presentation of symptoms differs, and, in the case of children, a greater emphasis should be placed on social and environmental factors (Stone et al., 2020).

Most common mental disorders, including those with the greatest morbidity, have an onset in childhood or adolescence (Stone et al., 2020), with the peak incidence for common disorders occurring during adolescence (Stone et al., 2020). While some disorders (e.g., depression) typically develop during adolescence, others (e.g., attention deficit disorder) may have an earlier onset, but remain undiagnosed due to developmental context or limitations in screening and assessment (Stone et al., 2020).  Childhood and adolescence provide critical periods for prevention, early detection, and intervention to promote child mental and behavioral health.

 The CBCL/6-18 obtains reports from parents, other close relatives, and/or guardians regarding children’s competencies and behavioral or emotional difficulties (Splett et al., 2011).  The CBCL/6-18 has 112 items that describe specific behavioral and emotional problems, plus two open-ended items for reporting additional problems (Splett et al., 2011). Parents rate their child for how true each item is using a 3-point scale from 0 (not true) to 2 (very true or often true). Parents also provide information for 20 competence items covering their child’s activities, social relations, and school performance (Splett et al., 2011).

            The TRF is designed to obtain teachers’ reports of children’s academic performance, adaptive functioning, and behavioral or emotional problems (Splett et al., 2011). The scale has 118 problem items, of which 93 have counterparts on the CBCL/6-18 (Splett et al., 2011). The remaining items concern school behaviors that parents would not observe, such as difficulty following directions and or disturbance of other pupils (Splett et al., 2011). Teachers rate the child for how true each item is using the same 3-point response scale used on the CBCL/6-18.

The role of parents and guardians is to answer questions regarding the child/adolescent such as: Parent and family health and psychiatric histories, Information about the child’s development, Information about family relationships (Sadock et al., 2015). Most children and adolescents with serious emotional and behavioral problems need a comprehensive psychiatric evaluation. Comprehensive psychiatric evaluations usually require a few hours over one or more office visits for the child and parents. With the parents’ permission, other significant people (such as the family physician, school personnel, or other relatives) may be contacted for additional information.

References

Behnke, S., & Warner, E. (2002). Ethics Rounds: Confidentiality in the treatment of

adolescents. Monitor on Psychology33(3), 44–45. Retrieved from

https://doi-org.ezp.waldenulibrary.org/10.1037/e300482003-026

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th

 ed.). Wolters Kluwer.

Splett, J. W., & Maras, M. A. (2011). Closing the gap in school mental health: A community-

centered model for school psychology. Psychology in the Schools48(4), 385–399.

https://doi-org.ezp.waldenulibrary.org/10.1002/pits.20561

Stone, K. J., Kanine, R. M., Kuckelman, S., Jackson, Y., & Thomas, A. (2020). Methodological

 design and procedures of program evaluation of therapeutic day treatment and outpatient

program for preschool-aged children exposed to maltreatment. Children and Youth

Services Review110. Retrieved from

https://doi-org.ezp.waldenulibrary.org/10.1016/j.childyouth.2019.104583

YMH Boston. (2013, May 22). Vignette 5-Assessing for depression in a mental health

appointment [Video]. YouTube. https//www.youtube.com/watch?

v=Gm3FLGxb2ZU