NURS 6660 Week 1: Comprehensive Integrated Psychiatric Assessment
NURS 6660 Week 1: Comprehensive Integrated Psychiatric Assessment
The comprehensive integrated psychiatric assessment of a child or adolescent consists of gathering information from not only the child but from several sources, most notably the family members, caregivers, and the child’s teacher or school counselor. Because of this, the diagnostic assessment becomes more complicated. Issues of confidentiality, privacy, and consent must be addressed. Also, the PMHNP must take into consideration the impact of culture on the child.
In this Discussion, you review and critique the techniques and methods of a mental health professional as he or she completes a comprehensive integrated psychiatric assessment of an adolescent.
To Prepare for the Assignment:
- Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.
- Watch the Mental Status Examination video.
- Watch the two YMH Bostonvideos.
Assignment
Based on the YMH Boston Vignette 4 video, post answers to the following questions:
- What did the practitioner do well?
- In what areas can the practitioner improve?
- At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
- What would be your next question, and why?
PLEASE, INCLUDE INTRODUCTION, CONCLUSION, 3 OR MORE REFERENCES LESS THAN 5 YEARS OLD, AND ANSWER ALL THE QUESTIONS AS INSTRUCTED
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 5, “Examination and Diagnosis of the Psychiatric Patient” (pp. 192–289)
Chapter 31, “Child Psychiatry” (pp. 1082–1107)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Kaplan, C. (2017). Ethical dilemmas. Advanced Healthcare Network. Retrieved from http://nurse-practitioners-and-physician-assistants.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 HYPERLINK “http://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”&HYPERLINK “http://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” Adolescent Psychiatry, 52(10), 1101–1115. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf
American Academy of Child HYPERLINK “http://american academy of child & adolescent psychiatry (aacap). (2012a). practice parameter for psychodynamic psychotherapy with children. 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”&HYPERLINK “http://american academy of child & adolescent psychiatry (aacap). (2012a). practice parameter for psychodynamic psychotherapy with children. 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” Adolescent Psychiatry (AACAP). (2012a). Practice parameter for psychodynamic psychotherapy with children. Journal of the American Academy of Child HYPERLINK “http://american academy of child & adolescent psychiatry (aacap). (2012a). practice parameter for psychodynamic psychotherapy with children. 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”&HYPERLINK “http://american academy of child & adolescent psychiatry (aacap). (2012a). practice parameter for psychodynamic psychotherapy with children. 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” Adolescent Psychiatry, 51(5), 541–557. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf
American Psychological Association. (2017). Code of Ethics. Retrieved from http://www.apa.org/ethics/code/
Required Media
Gajbhare, P. (2014, March 8). Mental status examination [Video file]. Retrieved from https://www.youtube.com/watch?v=VjWVYgf2UcU
YMH Boston. (2013a, May 22). Vignette 1 – Introduction to a preventive services visit [Video file]. Retrieved from https://www.youtube.com/watch?v=pQy-jwiu7gM
YMH Boston. (2013c, May 22). Vignette 4 – Introduction to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE
SEE SAMPLE ANSWER BELOW
NURS 6000N: PMH Nurse Practitioner Role I: Child and Adolescent
WEEK 1 INITIAL DISCUSSION POST
The YMH Boston Vignette 4 video, described a 16 year adolescent client who came into an outpatient clinic for a mental health assessment. He was referred there by his mother and he reported he had no idea why he was there. In the video, it was evident the client did not want to be at the appointment. The provider used many techniques to engage the adolescent client. Some techniques displayed in the vignette were helpful and some techniques should have been avoided. The following post will answer four questions provided from the discussion board in relationship to the video.
What did the practitioner do well?
At the beginning of the session the provider informed the client about confidentiality. Confidentiality is a cornerstone of healthy therapeutic relationships and effective treatment and is based upon the ethical principles of autonomy and fidelity (Wheeler, 2014). Another positive is that the provider engaged the client by asking him about his views. That indirectly communicates that the provider believes the client has his own thoughts and feelings. The client has a positive response to the engagement as he becomes more verbal and makes better eye contact. Sadock, Sadock, and Ruiz (2014) reported once rapport has been established, many adolescents appreciate the opportunity to tell their side of the story (p. 1109). Lastly, the provider asks about other people in the client’s life. In doing this, the provider finds out that the client is more comfortable relating to his girlfriend and his coach. The client feels more comfortable talking about those relationships and becomes more genuine when talking about other relationships.
In what areas can the practitioner improve?
There were a few areas the provider could improve on. When the patient states his mother thinks he has an “anger management” problem, the provider challenges him, saying that his mother must have a reason for thinking this. The provider’s tone of voice and facial expressions indicate that he is having some negative feelings about this patient. By taking the approach that challenges the client it alienates him. In the vignette the client withdraws and looked down with his hands in his lap when the provider expressed that. Learning to read a teen’s body language is an important skill. A teen who is avoiding eye contact, mumbling words, or giving one word answers may be struggling with something, and providers can often help teens open up by acknowledging this discomfort (Tomescu and Ginsburg, 2012).
At this point in the clinical interview, any compelling concerns? If so, what are they?
At this point in the interview there are a few compelling concerns. One being the provider doesn’t elicit strategies for the patient to communicate with his mother more effectively. The patient says he doesn’t like it when his mother “keeps nagging him” to talk about his feelings. This can be viewed as a developmental issue as well as a family issue, as adolescent boys do not generally want to talk to their mothers about their feelings (Sadock, Sadock, and Ruiz, 2014). Although development does not occur in a linear stage, familiarity with the primary developmental themes and transitions of each age period provides an important context from which to view current symptoms (Sadock, Sadock, and Ruiz, 2014). The provider should also recognize that the patient is saying that talking about his feelings is hard for him and he feels angry when he is pushed to try. The provider reflects and normalizes the patient’s aversion to talking to his mother by using humor. This resonates with the patient and helps him become more connected.
What would be your next question, and why?
The provider identified the client’s positive attributes, but the “at risk” behavior was not addressed. I would assess substance use, abuse, and addiction. I would start with a question from the CRAFFT screening tool “have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?” Substance abuse or dependence can have a significant impact on psychiatric symptoms and treatment course (Sadock, Sadock, and Ruiz, 2014). Substance use contributes sharply to the mortality related to injuries and violence, and to the morbidities of school failure, depression, and sexually transmitted disease acquisitions (Pollack, 2006).
References
Pollack, W. (2006). The “war” for boys: Hearing “real boys” voices, healing…
