Comprehensive assessment

Discussion: Comprehensive Integrated Psychiatric Assessment

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Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.

Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.


In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents. 

To Prepare


Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the 
Mental Status Examination B-6 and
 Simulation Scenario-Adolescent Risk Assessment videos.

· Watch the YMH Boston 
Vignette 5 video and take notes; you will use this video as the basis for your Discussion post.


Based on the YMH Boston
 Vignette 5 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?


Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

· Explain why a thorough psychiatric assessment of a child/adolescent is important.

· Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.

· Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.

· Explain the role parents/guardians play in assessment.


Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Required Reading

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). 
Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

· Chapter 32, “Clinical assessment and diagnostic formulation”

Chp. 1 Introduction

Chp 4. 15 Minutes pediatric Diagnostic interview

Chp 5. 30 minutes Pediatric Diagnostic Interview

Chp 6. DSM 5 Pediatric Diagnostic Interview

Chp 9. Mental status examination. A Psychiatric Glossary

Chp 13. Mental Health Treatment Plan.

Required Media

Recommended Reading

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

· Chapter 31, “Child Psychiatry” 

Respond to this discussion post. Use at least 2 references (L)

Discussion: Comprehensive Integrated Psychiatric Assessment


            As mental health providers, it is imperative to be able to assess all age groups, including children and adolescents. It is important to know how to assess them in order to provide the best treatment. It is also important to be mindful that they might not be interested in treatment, but it is important to educate them and include them in the decision-making process (Srinath et al., 2019). As psychiatric mental health nurse practitioners, comprehensive psychiatric evaluations, screening tools, rating scales, and treatment plan will all be part of a daily routine.


Based on the YMH Boston Vignette 5 video


            Based on the YMH Boston Vignette 5 video, the practitioner asked some important questions about the patient’s mood, but also could improve some. The practitioner did a good job asking assessment questions, but did not ask additional questions. The interview lacks follow up questions, such as, when the patient reports that he has chest pain, there were no follow up questions to assess his anxiety or possible panic attacks. She also did a great job assessing when the symptoms started and creating a trusting relationship with the patient. At the point when the interview cuts off, the main concern is the patients safety. He reports thoughts of suicide. At this point, the next questions need to be safety questions, such as, do you have a plan? Do you have access to weapons or guns? It is important to ask this question, because this can increase the risk of suicide (AACAP, 2020).  Do you feel comfortable telling your parents when having these thoughts? Adolescents can be a risk for their safety due to lack of development and stress during adolescence (Farley, 2020). The practitioner at this point, needs to involve the parents to develop a safety plan or possibly consider inpatient care.


Additional Questions

            A thorough psychiatric assessment of a child/adolescent is important for a couple different reasons. The psychiatric assessment should be completed with the goal of identifying the presence of psychopathology, making a diagnosis, and developing a treatment plan with the child’s care provider (Thapar et al., 2015, p. 407). It is also important to take this time to create rapport with the patient and family. Developing a rapport with the child can have positive long-term effects, such as increase communication, provides the child with a safe place to talk about their feelings, and increase compliance (Srinath et al., 2019). One symptom rating scale that would be appropriate to use during the psychiatric assessment of a child/adolescent is the Development and Well-being Assessment (DAWBA), which is combined of interviews, questionnaires, and rating techniques to help develop a DSM-IV diagnosis (Thapar et al., 2015, p. 412). Another symptom rating scale that would be appropriate during the psychiatric assessment would be the Achenbach System of Empirically Based Assessment, which can be used to assess behavioral and emotional problems (Thapar et al., 2015, p. 421). One psychiatric treatment option for children and adolescents that may not be used when treating adults is the treatment plan for safety might include collaboration with the parents, family, school and other providers (Thapar et al., 2015, p. 415). As with adults, safety is always important, and most of the time will involve a collaborative team to ensure they child/adolescent has a safety plan at all times. Another psychiatric treatment option for children and adolescents that may not be used when treating adults is strength building, which helps with the child’s development (Thapar et al., 2015, p. 415). The overall treatment plan will involve the parents/guardian, so it is important to understand their role in the assessment. The parents/guardians play the role of providing consent and information (Srinath et al., 2019). It is important to provide the child/adolescent with the opportunity to be involved in their treatment plan and make the decision if they want the parent/guardian present during the interview. Overall, it is import to be able to assess, implement rating scales, provide treatment and involve the parents in the when treating children and adolescents.




Aacap. (2020, July). Suicide Safety: Precautions at Home. Suicide safety: Precautions at home.

Farley, Holly R. EdD, RN. 
Assessing mental health in vulnerable adolescents. Nursing: October 2020 – Volume 50 – Issue 10 – p 48-53 doi: 10.1097/01.NURSE.0000697168.39814.93

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for Assessment of Children and Adolescents. 
Indian journal of psychiatry, 
61(Suppl 2), 158–175.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

YouTube. (2013). Vignette 5 – Assessing for Depression in a Mental Health Appointment. YouTube. from



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