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.
Learning Objectives
Students will:
Evaluate comprehensive integrated psychiatric assessment techniques
Recommend assessment questions
To Prepare for the Discussion:
Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.
Watch the Mental Status Examination video.
Watch the two YMH Bostonvideos.
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 “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
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?

Comprehensive Integrated Psychiatric Assessment

Introduction

The YMH Boston Vignette 4 video is about a counseling session between a therapist and an adolescent. The adolescent client was referred for therapy by his mother. However, the client reports that he does not know why he is in therapy. This discussion will, therefore, analyze the counseling techniques used by the therapist.

Strengths of the Practitioner

The practitioner respected the privacy and confidentiality of the client. This is clear when the therapist explains to the client that his confidentiality would be respected and information shared during therapy cannot be divulged without his consent. Therapists have the duty of upholding the confidentiality and privacy of the information shared during therapy (Lamont-Mills et al., 2018). This is also applicable among the pediatric population where therapists should only disclose the information when the client is at risk of causing harm to himself or others (Lamont-Mills et al, 2018).

Secondly, the practitioner did not in any way appear judgmental and was empathetic to the client. This encouraged the client to open up and feel comfortable. Therapists should not be judgmental but instead should be empathetic in order to ensure clients feel counselors understand their experiences (Sadock et al., 2014).

Lastly, the practitioner utilized open-ended questions throughout the session. Open-ended questions help clients to provide comprehensive information and express themselves without any limitation (Apodaca et al., 2016). For example, the practitioner gave the client the opportunity to explain his view about his mother, referring him for mental assessment and reasons for being angry. By using open-ended questions, it was possible to identify the chief complaint about the client and also established that the client is freer with his girlfriend and friends than his mother.

Areas that need Improvement

First, the practitioner did not introduce himself prior to the start of the mental assessment. Introduction during counseling therapy is an important component of the therapeutic relationship and therefore introduction was necessary (Pedrelli et al., 2015).

Secondly, the practitioner did not seek informed consent from the client. Informed consent provides patients and clients with the opportunity to understand the available treatment options and make an informed choice prior to consenting to any form of treatment (American Psychological Association, 2017). The practitioner in the Vignette 4 video, did not explain anything regarding the mental health assessment. Adolescents aged 16 years and above should be allowed to take part in the process of informed consent while all minors need to assent to treatment (Sadock et al, 2014).

Concerns

The major notable concern is that the practitioner kept asking leading questions and giving his own personal opinion during the mental assessment. This is evident in the video when the practitioner says “I think mums sometimes have ideas”. Such a personal opinion is both leading and suggestive and could influence the perspective of the client. The practitioner should have ensured that such information came from the client without any undue influence.

Next Question and Reason

The subsequent question would be “explain to me how you relieve anger whenever you are angry”. The rationale for asking the question to allow the practitioner to identify the maladaptive strategies the client uses to relieve his anger. This would allow the practitioners to help the client replace the maladaptive strategies with more healthy and adaptive strategies (Grech et al., 2018).

References

American Psychological Association. (2017). Code of Ethics. Retrieved from http://www.apa.org/ethics/code/

Apodaca T, Jackson K, Borsari B, Magill M, Richard L, Nadine M & Barnett N. (2016). Which individual therapist behaviors elicit client change talk and sustain talk in motivational interviewing? J Subst Abuse Treat. 61(1), 60–65.

Grech, L. B., Kiropoulos, L. A., Kirby, K. M., Butler, E., Paine, M., & Hester, R. (2018). Target Coping Strategies for Interventions Aimed at Maximizing Psychosocial Adjustment in People with Multiple Sclerosis. International Journal of MS Care, 20(3), 109–119.

Lamont-Mills, A., Christensen, S., & Moses, L. (2018). Confidentiality and informed consent in counseling and psychotherapy: a systematic review. Melbourne: PACFA.

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.

Pedrelli P, Yueng A, Courtney Z & Timothy W. (2015). College Students: Mental Health Problems and Treatment Considerations. Acad Psychiatry. 39(5): 503–511