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At least 2 references for each response. Respond 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.
Response 1
In the YMH Boston Vignette video scenario, the practitioner demonstrated effective techniques but also had areas for improvement. She maintained a neutral facial expression, communicated non-judgmentally, and used open-ended questions, which can foster therapeutic rapport and aid in gathering essential information for an accurate assessment. However, she did not introduce herself or clarify her role in the treatment process, which led to the patient appearing hesitant to engage and displaying a facial expression suggesting confusion about why he was being asked these questions.
At this point in the interview, there are some compelling concerns. The patient has indicated that he has been having thoughts about “not wanting to be alive” following his girlfriend’s breakup. He admitted to the practitioner that he had contemplated harming himself. She stated, “Tell me more about that.” However, my next question would be, “Do you have a plan to hurt yourself?” This would be my next question instead of “Tell me more about that” because assessing for imminent risk is a priority in suicide risk evaluation. When a patient expresses thoughts of not wanting to be alive or has contemplated self-harm, it is crucial to determine the severity and immediacy of the risk. Asking the patient about a plan helps establish the level of danger by assessing specificity, intent, and means. If the patient has a well-developed plan, the risk of suicide can be significantly higher and may require immediate intervention. “Tell me more about that” encourages the patient to elaborate and discuss his feelings; however, it may not provide the practitioner with the urgent, concrete information needed to assess the potential for immediate self-harm. By directly asking about a plan, the practitioner can quickly determine the appropriate level of care required for this patient, whether that be increased monitoring, hospitalization, or other crisis interventions.
Comprehensive Psychiatric Assessment:
A comprehensive psychiatric assessment of a child or adolescent is essential for accurately diagnosing mental health conditions and formulating an appropriate treatment plan. Children and adolescents may present symptoms differently than adults, and biological, psychological, and social factors influence their behaviors, emotions, and cognitive development. A thorough assessment considers these variables, identifies co-occurring conditions, and ensures interventions are tailored to the child’s developmental stage and needs (Boland et al., 2022).
Two symptom rating scales that could be used to assess a child or adolescent are the Child Behavior Checklist (CBCL) and the Pediatric Symptom Checklist (PSC). The Pediatric Symptom Checklist is a brief screening tool completed by parents that evaluates psychosocial functioning in children. It helps identify emotional and behavioral difficulties that may require further psychiatric evaluation (Pagano et al., 2000). The Child Behavior Checklist (CBCL) is a parent-reported questionnaire that assesses a wide range of emotional and behavioral problems in children and adolescents. It provides standardized scores for anxiety, depression, aggression, and hyperactivity behaviors, aiding in diagnosis and treatment planning (Mazefsky et al., 2010).
Play therapy is a therapeutic approach designed for younger children who may lack the verbal skills to express their emotions effectively. Through play, therapists can observe behaviors, identify emotional conflicts, and help children process experiences developmentally appropriately (Wheeler, 2022). Another intervention tailored explicitly for children is Parent-Child Interaction Therapy (PCIT). This is an evidence-based treatment for behavioral issues in young children, specifically ages 2-7 years. PCIT involves real-time coaching for parents to enhance communication, set appropriate limits, and reinforce positive behaviors. Unlike treatments commonly used for adults, PCIT focuses on strengthening the caregiver-child relationship to promote healthier interactions and emotional regulation (Lieneman et al., 2017).
Parents and guardians play a crucial role in the psychiatric assessment of children and adolescents. They provide valuable insight into the child’s developmental history, behavioral patterns, and any concerns observed at home, school, or social settings. Parents and/or guardians collaborate with clinicians to ensure accurate symptom reporting, support treatment adherence, and implement recommended behavioral interventions. “Clinical assessments with children and adolescents are, therefore, elaborate and require the clinician to be astute and conscientious in obtaining information from multiple sources and settings, i.e., the child, parents, teachers, and other caregivers. There are bound to be discrepancies in the report; nevertheless, multi-source information is a requirement during diagnosis and management (Sharma et al., 2019, p.). Their involvement is critical for a holistic understanding of the child’s mental health and well-being.
Response 2
Vignette 5 presents an adolescent male who is being assessed by a practitioner for mood symptoms. The practitioner demonstrated several strengths during the evaluation. One of these was the use of a combination of open-ended and direct questions which enabled them to obtain responses to specific issues affecting the patient and presented the patient with an opportunity to explain his current needs. Additionally, the practitioner’s use of active listening provides reassurance to the patient and motivates him to share more information about his mental state (Corey et al., 2024). Further, the practitioner encouraged the patient to share his current struggles by applying good communication skills and respectful language. However, the practitioner could have hindered therapeutic alliance due to her failure to introduce herself to the patient (Corey et al., 2024; Wheeler, 2020). Further, it is important to obtain informed consent from the patient or the parent in case the patient has not attained the legal age of consent before initiating the evaluation (Wheeler, 2020). The practitioner should also ask more relevant questions that are appropriate for the patient’s age. For instance, the patient appeared embarrassed when he was asked if he cries a lot.
There are some compelling concerns that emerge during the psychiatric evaluation. One of these is the failure to obtain informed consent which raises both ethical and legal issues (Wheeler, 2020). Another concern is the patient’s hesitancy to respond to questions which raises questions about his comfort with the presence of his parents and the completeness of the responses that he provides (Wheeler, 2020). The practitioner’s failure to follow up on the patient despite his endorsement of suicidality is a key concern. Powsner et al. (2023) emphasized the need to conduct extensive screening to determine the patient’s suicide risk while Nöhles et al. (2023) recommended initiation of support services considering that half of patients with major depressive disorder demonstrate passive suicide similar to the patient in the video and 31% of them attempt suicide at some point in their lives. Based on these concerns, the next questions should whether the patient is comfortable answering questions with his parents present and if he ever attempted suicide.
Practitioners must always perform a thorough psychiatric assessment of children and adolescents who present with psychiatric needs. Wheeler (2020) argued that a thorough assessment is key to understanding the specific needs of the patients, accurate diagnosis, and personalization of treatment plan. The author added that a thorough assessment enables providers to discern the specific causes of the patient’s symptoms considering the thin line that separates most mental/psychiatric disorders.
Screening tools could also help in performing a comprehensive psychiatric evaluation. Precisely, the Beck Depression Inventory-II is a valuable tool for this patient since it could aid in assessing the presence of and severity of depression with great accuracy considering that the patient already endorsed feeling depressed (Almeida et al., 2022). Austria-Corrales et al. (2023) also recommended the Columbia-Suicide Severity Rating Scale for such patients who endorse passive suicidality since it helps to perform a risk assessment and informs support services necessary for the patient.
Age is a significant factor when selecting treatments. Wheeler (2020) identified Parent-Child Interaction Therapy and Interpersonal Psychotherapy with Adolescents as two interventions that may be suitable for children and adolescents but unsuitable when treating adults. The author also recognized the role of parents when performing psychiatric evaluations on pediatric patients since it creates trust, builds patients’ confidence, and presents an opportunity for parents to provide additional information that could be easily missed by pediatric patients.
