Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video
Discussion: 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.
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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.
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video 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. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video. 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?
By Day 6
Respond
to at least
two
of your colleagues by offering additional insights or alternative perspectives on their diagnosis or provide alternate next questions and why you selected those. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video 1
Based on the YMH Boston Vignette 4 video, post answers to the following questions:
•
What did the practitioner do well? The practitioner built report with the client and informed Sean of his right to privacy and confidentiality. By building trust with the client, it allows the client to be honest and more open during the evaluation process. The practitioner also asked questions that lead to the client stating what he felt the problem at hand was before giving feedback. During the evaluation process, the practitioner was able to aid the client into revealing his prospective of the current situation such as his mother’s nagging behaviors and the client revealing that he does not feel comfortable opening up to his mother. Further on in the evaluation process, the practitioner identified what makes the client feel comfortable talking to others such as his coach giving him advice, someone being there to listen, and not feeling pressured into following the advice. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
•In what areas can the practitioner improve? In the evaluation process, I didn’t observe any information given on the parents/family health or psychiatric history. More information should have been given about the adolescent’s health, illness, treatment, and current medications.
•At this point in the clinical interview, do you have any compelling concerns? If so, what are they? No, there are no compelling concerns. Since the problem was identified during the evaluation, a treatment plan can be established.
•What would be your next question, and why? The next question would be if the client or parents have any concerns regarding the evaluation. “Parents are often worried about how they will be viewed during the evaluation. Child and adolescent psychiatrists are there to support families and to be a partner, not to judge or blame. They listen to concerns, and help the child or adolescent and his/her family define the goals of the evaluation” (American Academy of Child and Adolescent Psychiatry, 2018). By asking questions about any concerns, it helps to address any worries that might hinder treatment Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
American Academy of Child and Adolescent Psychiatry. (2018).
Comprehensive Psychiatric Evaluation. Retrieved from
https://www.aacap.org/aacap/families_and_youth/facts_for
_families/fff-guide/Comprehensive-Psychiatric-Evaluation-052.aspx
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video Response 1
A concern that I had after watching the scenario was the patient’s anger. The reason for referral was that the patient’s mother thinks that he has an anger management problem and the patient confirmed that he“loses his temper” (YMH Boston, 2013). The initial session is identified as a key time to focus on specific problems and previous interventions ( Nichols, 2014). My next question regarding his anger would be what does it look like when he loses his temper? How does his mother respond? The practitioner helped to identify persons with whom the patient was comfortable talking to. The patients identified hid coach as “ Yoda” this was also mildly concerning related to the” myth of the hero” ( Nichols, 2014).
References
Nichols, M (2014).
The Essentials of Family Therapy
(6
th
ed). Upper Saddle River, NJ: Pearson Education
YMH Boston. (2013c, May 22).
Vignette 4 – Introduction to a Mental Health Assessment
[Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video Response 2
I agree the counselor was informative from the beginning about confidentiality; however, he could have improved his initial interview with the client by asking more questions his and his mother’s relationship. The client expressed annoyance towards his mother, but the counselor failed to explore this further. The counselor could have asked how many times per week do you disagree with your mother and how do you feel afterward if an argument results? The question is quantitative but nonjudgmental, creating an effective therapeutic alliance between client and counselor. Carlat (2017) described the therapeutic alliance as a feeling one should create over the course of the diagnostic interview, a sense of rapport, trust, and warmth (p. 17).
Reference
Carlat, D.J. (2017).
The psychiatric interview
(4
th
ed.). Philadelphia, PA: Wolters Kluwer.
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video 2
What the Practitioner did Well
Sean is a 16 year old client who presented for evaluation. The practitioner after watching the YMH Boston
Vignette 4
Video did some few good things.
Firstly, he set up a comfortable relaxing environment for Sean.
He told Sean all about the procedure of the therapy process; by explaining his privacy rights. When dealing with teenagers, using this approach will let them feel comfortable and at ease and ready for the therapy.
The practitioner’s initial approach was honest when he made Sean to understand that whatever he says here will be private. Private except when it is absolutely necessary as an exclusion to confidentiality to disclose in the event that it might be a threat or harm towards Sean or others. This gave Sean enough confidence to feel free. Teenagers like their things kept secret and in confidentiality. Client confidentiality is the basis of a healthy therapeutic relationship and the therapist has an ethical and legal responsibility to protect the confidentiality and privacy of his/her clients ( Pope & Vasquez, 2016).
Areas to Improve on
There are also some few things that need improvement on. The practitioner did not greet or introduce himself to Sean. Not greeting or introducing oneself can always be seen as arrogance especially when culture has to be taken into consideration. Not greeting and introducing oneself can be negative and can sometimes cause a barrier to a successful therapeutic approach. It is always advisable to master the questions to be asked a client and let writing be very minimal. The practitioner could be seen writing during this interview, causing distractions and communication breakdown. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video..
Sean does not like school but the practitioner did not ask about his school and why he hates school. More could have been gotten just by asking that question. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video. Another ignored spot was his relationship with his mother. The practitioner should have been able to get more from this too. Allowing Sean to participate by encouraging him to use his own words in describing his problem would have led to more information. As said and emphasized by Goldstein, & Findling (2006), an open inquiry followed by more focused questions later in the interview provides the most information and how a provider should also seek detailed descriptions of the behavioral or emotional symptoms and ask for specific examples of the behavior.
Another area where the practitioner needs improvement is to avoid asking leading questions. He asked Sean “I bet that really made you angry, right?” An obvious answer is “yes.” A better question would be, “How did you feel when that happened?
Compelling Concerns during the Clinical Interview
Sean’s deep rooted anger towards his mom is a compelling concern. Knowing that Sean has this deep rooted anger should have led to more questions to find out why. Knowing that many teenagers do not like to confide in or talk to their mothers, the practitioner should not have seen it as a reason not to ask, but instead find out if Sean’s mother even know about this deep rooted anger and why. Also, the practitioner should be concerned about the coach being his father figure. Where is his biological father, and how often if at all do they see each other, and why? Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
Next Question and Reason Behind the Question
Just for curiosity sake, questions like what makes Sean angry, if angry does he feel like hurting himself or someone or not, if he likes his life, what he enjoys doing besides basketball and talking with his girlfriend, and also get more insight into his relationship with his girlfriend and its seriousness. His performance in school, questions like “what is going on at school that makes you hate it so much?” According to (American Psychiatric Association, (2013), struggling academically may indicate an inability to concentrate which may point to a psychiatric diagnosis such as depression, anxiety, or attention-deficit hyperactivity disorder. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
References
American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental
` disorders
(5th ed.). Washington, DC: Author.
Goldstein, A., & Findling, R. (2006). Assessment and evaluation of child and adolescent
psychiatric emergencies.
Psychiatric Times
,
23
(9), 76-111.
Pope, K. S., & Vasquez, M. J. (2016).
Ethics in psychotherapy and counseling: A practical guide
. John Wiley & Sons.
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video response 1
Thanks for your nice post. I concur with all you said and also believe that Sean is depressed too. Depression may have an influence in the adolescents’ abhorrence for school or may even piece of his reaction to the enthusiastic issue caused by the pressure he is experiencing at the time the practitioner saw him. “SIG E CAPS” is a simple and fast strategy for evaluating for depression particularly in the medicinal setting (Carlat, 1998). They are the abbreviation for Sleep, Interest, Guilt, Energy, Concentration, and Appetite, Psychomotor, and Suicidal Ideation. For the diagnostic criteria of depressive disorder, the client, must have somewhere around five out of nine symptoms, and the client(s) are also required to have lost interest in generally agreeable interests as one of the five manifestations.
Something like 5 of the symptoms must be available for no under about fourteen days for the diagnosis to be positive. Thanks for you good posting Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
Reference
Carlat, D. J. (1998). The Psychiatric Review of Symptoms: A Screening Tool for Family Physicians Retrieved from https://www.aafp.org/afp/1998/1101/p1617.html
response 2
Great post. I like how you really observed the questions and how the practitioner asked the questions when interviewing the client. Open-ended questions help you establish a working relationship with your patient:
• They give the patient the greatest possible latitude in coming up with a response, so you don’t limited the scope of your information.
• They serve as bait when you are fishing for the sorts of problem you’ll need to explore.
• Because the patient does most of the talking, they allow you to assess your patient’s thought and speech patterns.
• Patients who are encouraged to talk freely tend to like the person doing the encouraging (Morrison, 2018).
Reference:
Morrison (2018). Retrieved from https://www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/psychiatry/education-and-training/medical-students/upload/MSE-Psychiatric-Interviewing.pdf
response 3
I enjoyed reading your post! It contained a lot of information in it regarding the evaluation. I totally agree that confidentiality is the basis for a healthy therapeutic relationship. “Privacy rights and protection of health information take on special meaning in mental health care, whether because of the stigma associated with mental health conditions, or issues of family dynamics, or a variety of other reasons” (Bernstein, 2017).However, the practitioner could have asked more questions concerning the client’s family relationship and client’s mental health history.
Bernstein, J. (2017). Patient Privacy in Mental Health:vBalancing Rights while Trying to Ensure Appropriate Treatment.vRetrieved from
https://careforyourmind.org/patient-privacy-in-
mental-health-balancing-rights-while-trying-to-ensure-appropriate-treatment/
post
A Mental Health Assessment is one of the most important parts in diagnosing; it allows the provider to evaluate needs, level of impairment or detailed picture of what the person may need (Hill, 2014). Based on the YMH Boston
Vignette 4 video:
What did the practitioner do well?
I feel the practitioner explained to the client of the right of protection/privacy, “A special issue concerning confidentiality is when the patient indicates that he or she intends harm” (Sadock, Sadock, & Ruiz, 2014). He did notify the client of his rights and everything is confidential unless there are any safety issues of the client discussing wanting to hurt him or others.
Also the practitioner was able to make the conversation at ease to understand why the client’s mother scheduled the appointment. I liked how he transitioned to find out more like why did he think his mom want him to come or if he has any support systems (coach and girlfriend) seeing he doesn’t feel comfortable talking to his mom, the practitioner also validated the client’s thoughts “you just want someone to listen and not be a parent”
In what areas can the practitioner improve?
Suggested in our reading from Kaplan & Sadock’s states of “Premature Advice” and “Judgmental Question/Statements” I feel the piece of how the client thinks his mom is just nagging and doesn’t listen to him. I understand where the provider is trying to make it comfortable to get the client to talk but he never speaks how your mom is your parent and making sure he understands even at his older teen age she is doing what she is to be doing parenting not being a friend. And encourage him to still talk to his “mom” and perhaps they can both work on communication of listening
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
Not really a compelling concern but I would like to see an overview of what
the client
wants to work on during his time, making reasonable goals possibly in communication with mom and/or work on coping strategies with his anger.
What would be your next question, and why?
I would want to find out more of his temper/anger; how well can he control it, does he becomes physically aggressive (throw items, break things, hit/ punch people or objects), how does he control himself (at home or school). If this maybe problem that can be solved with therapy like CBT or does he possibly need medication along with therapy. “Anger control training (ACT) aims to improve emotion regulation and social-cognitive deficits in aggressive children. Children are taught to monitor their emotional arousal and to use techniques such as cognitive reappraisal and relaxation for modulating elevated levels of anger” (Sukhodolsky & et al., 2016).
Reference:
Hill,T. (2014). Preparing for a Mental Health Evaluation. PsychCentral. Retrieved from www.psychcentral.com
Sadock, B.J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11
th
ed.). Philadelphia, PA: Wolters Kluwer.
Sukhodolsky, D. G., Smith, S. D., McCauley, S. A., Ibrahim, K., & Piasecka, J. B. (2016). Behavioral Interventions for Anger, Irritability, and Aggression in Children and Adolescents.
Journal of child and adolescent psychopharmacology
,
26
(1), 58-64.
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video response 1
Thanks for sharing your thoughts on the video. At first, when I watched it all I did not see anything wrong with the approach of the clinician. Mary L (2015) says, anger causes distress and family dysfunction and often leads to more serious issues. It is overwhelming, can produce physical and emotional discomfort and the way of expressing it can be a source of problems. It leads to acting rather than thinking and thus the difficulty. Having anger is not a problem for most people, the problem is expressing it. Seppalla, (2018) says that the direct expression of anger while intending to convey a point often leads the confronted party being defensive when emotional centers of the brain flare up and both parties not able to think clearly. It would, therefore, be important for the counselor or nurse also meet with the parent to find out the root of the cause of his problem. This is just but the introduction of the video the continuation would have been interesting. Thanks once Beth and all the best in the rest of the semester. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
References
Lowth, M. (2015). Managing anger in adolescents.
Practice Nurse
,
45
(12), 18–23. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=111561584&site=ehost-live&scope=site
SEPPÄLÄ, E. M. (2018). How to Express Anger.
Psychology Today
,
51
(4), 44–46. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=130238138&site=ehost-live&scope=site
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video response 2
Your point on the practitioner needing to improve on encouraging communication between the minor client and the parent is a valid one, while I do not think the intention of the practitioner was negative, through his statements he actually encouraged further contention between the client and his mother. Adolescents are at a phase of development where they seek validation for their feelings and actions and the practitioner gave validation to the feelings of the client that were negative towards the mother without first seeking clarification or at the very least having a family session with the mother present to observe the family dynamics before giving a premature analysis. According to Karver, De Nadai, Monahan & Shirk (2018), “although parents occupy varied roles in youth therapy ranging from the youth’s transport to collateral participation, failure to maintain a strong alliance with parents/caregivers can have serious implications for treatment continuation and early dropout.” Seeing as though the practitioner discussed with the client that he would maintain confidentiality regarding their conversations unless the risk of imminent danger to the client or others, how would the client go about discussing the concerns of the client with the mother without breaking confidentiality? Would this create further bias against the mother if the practitioner cannot delve deeper into the family dynamics without discussing what the client has said in the private sessions? Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video. Does the mother even know what is contributing to her son’s increasing anger? According to Sadock, Sadock & Ruiz (2014), “in some cases, especially with older children and adolescents, the parents may be unaware of significant current symptoms or social difficulties of the child.
References
Karver, M.S., De Nadai, A.S., Monahan, M., & Shirk, S.R. (2018). Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy.
Psychotherapy, 55
(4), 341-355.
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.
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video response 3
Thanks for your post! Yes, a thorough mental health assessment is crucial to accurately diagnosing the client. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video. “Assessment is a process for defining the nature of that problem, determining a diagnosis, and developing specific treatment recommendations for addressing the problem or diagnosis” (U.S. National Library of Medicine, 1989). Furthermore, during the assessment process the practitioner could have asked more questions about Sean’s anger problems and ways that he manage his anger. Knowing about Sean’s relationship with his family is also important.
U.S. National Library of Medicine. (1989). Screening and Assessment.v Retrieved from
https://www.ncbi.nlm.nih.gov/books
/NBK83253/
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video -Main Question Post:
What did the practitioner do well?
Began the interview in a relaxed, non-structured manner to establish rapport and build therapeutic alliance. Spoke in language appropriate to client’s developmental age. Addressed privacy concerns and limits to confidentiality.
In what areas can the practitioner improve?
Greet client and introduce self; ask how the client wants to be addressed.
Relieve client anxiety and diffuse tension/strangeness of the situation by asking how client feels about coming in; and by explaining the assessment process and duration of the interview.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
Interviewer does not clearly identify the reasons and factors leading to referral; does not obtain an accurate picture of the clients developmental function, nature, and extent of the behavioral issues, functional impairments, and/or subjective distress; and does not identify potential individual, family, or environmental factors that may be influencing difficulties. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
Interviewer does not follow client’s lead and moves to questioning other topics (i.e. When asking about how client is doing in school, client responds with negative comment “Kinda sucks” but is not asked to elaborate by interviewer). Interviewer switches back and forth between topics (i.e. school and leisure activity) that appears to provoke annoyance and confusion in client.
What would be your
next
question, and why?
What would you like to see different from coming in today? Open-ended question that provides client time to tell their story. Creates a level of comfort and helps to build/strengthen rapport; gives client sense that you are interested in listening. Provides insight into what issues client views as most distressing Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
References
Carlat, D. J. (2017).
The Psychiatric Interview
(4
th
ed.). Philadelphia, PA: Wolters Kluwer. Sadock, B. J. & Sadock, V. A. (2003).
Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry
(9th ed.). Philadelphia, PA: Wolters Kluwer.
YMH Boston. (2013c, May 22).
Vignette 4 – Introduction to a mental health assessment
[Video
file]
.
Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video response 1
You have good insight on what this provider could have improved on his mental status exam. This provider does neglect to take any action or inquire about more information when the client brings up different subjects. The client also portrays a negative attitude when speaking of his mother and the responses by the provider do not offer insight to the parent/ son relationship. Instead his responses could almost show acceptance of the possible poor relationship. These types of lack of response, initiation of conversation, and supporting negativity can affect the provider’s credibility. A therapeutic bond is very important in psych, in fact it can be the most important factor in being successful in providing mental health care/ therapy. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video. Factors that influence a therapeutic bond include: credibility, trustworthiness, and expertise (Ardito & Rabellino, 2011). When any of these factors are lacking the relationship can be negatively affected.
When I viewed this video I felt as though the provider was trying to build a therapeutic relationship through identification with the client. I felt he was trying to identify with the client by offering a nonjudgement, supportive, reaction. However, I feel he was going about this in the wrong manner. What do you think?
References
Ardito, R. B., & Rabellino, D. (2011). Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research.
Frontiers in Psychology,
2
. doi:10.3389/fpsyg.2011.00270 Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video response 2
Excellent Post! Your further assessment question was admirable. When speaking with an adolescent in therapy, the experience can be unsettling for the client. Teens are sometimes unaware of the benefits of therapy and find the experience useless. When interviewing an adolescent, some methods can be implied to help the process. Motivational Interviewing is a method that can be used that has been proven to be favorable. Motivational Interviewing allows the client to see that the provider is advocating for them to be better individuals. The client can recognize their mannerism that is problematic and modify their performance (Brakman & Gold, 2014). This therapy would provide aid for the teen being counseled and boost the individual’s self-esteem and receptiveness to treatment. Psychotherapy has been determined to be useful in releasing tension and managing quandaries (Mayo Clinic, 2016). Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video. These were some of the issues the client was dealing with and causing problems of concerns.
References
Brakman, A., & Gold, M. (2014). Use motivational interviewing with teens.
Contraceptive Technology Update
, 35(12), 142–143.
Mayo Clinic. (2016).
Psychotherapy
. Retrieve from https://www.mayoclinic.org/tests-procedures/psychotherapy/about/pac-20384616
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video response 3
Your post was very informative and brought some valuable points pertaining to the clinical interview of adolescents. Adolescents obtain their health information from a number of sources. Health care providers are high on the list of the most valued of these sources. Therefore, providers must develop an approach and communication skills with their adolescent patients. One of the challenges of adolescent medicine is helping your patients in finding a path to a healthy lifestyle they are comfortable with. It is essential to get the information needed to assess and diagnose health issues, and for the patient to get the information he/she needs to deal effectively with (these) health issues. Adolescents want very much to show they are mature and ‘can handle things themselves’, but at the same time, some of the medical and psychosocial issues they confront may require them to be more dependent. The health care provider must deliver information in such a way as to allow the patient to participate in their own care to the limit of their capabilities developmentally, physically and emotionally, whether they have a short-term, chronic or life-threatening condition (Sacks, 2015).
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video Confidentiality is the cornerstone of any therapeutic relationship with youths. Without clarifying the limits of confidentiality you may well get incorrect or incomplete information during history taking. A great concern is often about treating adolescents without parental or guardian consent for fear of being sued. Start the interview with an adolescent by detailing the law and the facts of confidentiality and its exceptions in the circumstances of serious thoughts of homicide or suicide, or recent physical or sexual abuse. This is important to be repeated often at subsequent visits. It is possible to get the youth to disclose to the family something that is appropriate or that would be helpful for them to know; however, this may take some time to get to the appropriate trust level. The confidentiality of the visit is reinforced by having the interview in a room that ‘feels’ private, ie, with a door, not a curtain, and far enough away from the waiting area so that the discussion cannot be overheard (Sacks, 2015).
The Home, Education/Employment, Activities, Drugs, Sexuality, Safety, (violence and abuse), and Suicide (HEADSSS) mnemonic is very useful to remind us of important information we need to obtain from adolescent patients. This approach starts with nonthreatening, open-ended, nonjudgmental questions and progresses to more sensitive areas such as sexuality, feelings of depression and thoughts of suicide. The discussion of the presenting complaint or reason for the visit should be addressed at some time during the visit even if other important issues are brought forward. Ensure the youth that all the questions are asked in an attempt to help the adolescent improve their health (Sacks, 2015).
Reference
Sacks, D. (2015). An approach to interviewing adolescents.
U.S. National Library of Medicine
.Retrieved fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2794315/
Comprehensive Integrated Psychiatric Assessment of YMH Boston Vignette 4 Video
The objective of the patient interview is to elicit a description of their experience(s) as to why they have presented for treatment and their own viewpoint on the treatment they will receive. The psychiatric interview of children and adolescents can be more complex due to the fact that the information will not just come from the client themselves but also from the viewpoint of the parent or guardian and other resources such as teachers or guidance counselors that can offer information that will allow the practitioner to have a greater understanding of the minor client. According to Sibeoni et al. (2018), “in adolescent psychiatry, the lived experience and the expectations of patients and their parents have a central role in treatment.” Based on the topic video, the practitioner quickly established the terms of the interview with the client including the terms of what is protected by confidentiality. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video. By doing so, the practitioner established a connection with the minor client that is supportive, reciprocal and non-judgmental. According to Pumariega et al. (2013), clinicians should explain the importance of confidentiality in psychotherapy to the family, so that they are not perceived as “driving a wedge” between the child and the family or used by the patient to resist dealing with family issues. The adolescent client is in a period of transition in their identity where they desire more autonomy in decision making and want to be seen as a separate individual from their parents. The practitioner placed attention on validating the viewpoint of the client by asking open-ended questions which allowed for the client to explore the reasons that may have led to the need for mental health services. The practitioner can improve in his interaction with the client when discussing his grievances with his mother as he seemed to give several premature interpretations. According to Sadock, Sadock & Ruiz (2014), “even if it is accurate, a premature interpretation can be counterproductive as the patient may respond defensively and feel misunderstood.” While the client did discuss his reasons for frustration with his mother and did not respond in a defensive manner, the practitioner made comments that placed the blame on the mother without fully exploring all of the variables that led to the compounding issue and also gave more credence to his belief that his increased anger is warranted. The successful mental health evaluation/assessment of the minor client is unique as it requires that the practitioner maintain objectivity with both the client and the parents/guardians Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
At this point in the interview, one concern that I would have would be his potential for violence towards his mother. My next question for this client would be, “Could you help me understand what changes within yourself when you get frustrated?” I would ask this type of question because it is an open-ended question which do not lead the client into a specific direction for an answer and also requires more than a yes or no response. This question posed to the client in an open-ended format would illustrate the central issue for treatment which was his anger management but also left an arena for the client to discuss from his point of view not only what triggers his frustration, but also what happens when he reaches his frustration threshold. Furthermore, this question acknowledged why the client presented for services, however it did not place blame on any other party and would require the client to verbalize his emotions in his own words.
References
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
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. Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
Sibeoni, J., Orri, M., Podlipski, M.A., Labey, M., Campredon, S., Gerardin, P., & Revah-Levy, A. (2018). The experience of psychiatric care of adolescents with anxiety-based school refusal and of their parents: A qualitative study.
Journal of the Canadian Academy of Child & Adolescent Psychiatry, 27
(1), 39-49.
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video Great post! You are right to mention that one of the interviewing skills the practitioner employed in the video is the use of open-ended questioning. The purpose of an open-ended question is
to inspire the client to provide an answer by looking into his own knowledge, interests, feelings, and thoughts in ways that are more expansive
(Weller, Vickers, Bernard, Blackburn, Borgatti, Gravlee and Johnson, 2018). Open-ended questions require more than ’yes’ or ‘no’ responses and allow clients to uncover more about themselves or their concerns.
Prior to responding to open-ended questions, a client would need to articulate his perception about the issue in order to reveal more about how he see things allowing both the practitioner and the client to take the conversation to a deeper level (Lewis-Beck, Bryman and Futing Liao, 2004). Since the client’s issues are centered around his frustration and anger toward his mother, asking him questions that are open-ended will allow him enough room to explore his own feelings and verbalize his thoughts from his own point of view (YMH Boston, 2013c). This client’s responses gave the practitioner some insight into the possible cause and the underlying reason for the client’s outbursts toward his mother (YMH Boston, 2013c). It is obvious that some tension exists between the client and his mother, and so, the practitioner has a responsibility to explore the feelings that trigger the client’s frustrations and anger
before they get out of control and evolve into more volatile situations (YMH Boston, 2013c). At some point during future sessions, the need to recommend family psychotherapy for the client, his mother, and other family members may become necessary to address their family issues and to provide a significantly therapeutic outcome (Ezpeleta, Granero, de la Osa, and Domènech, 2015) Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.
References
Ezpeleta, L., Granero, R., de la Osa, N., & Domènech, J. M. (2015). Clinical Characteristics of Preschool Children with Oppositional Defiant Disorder and Callous-
Unemotional Traits. Plos One, 10(9), e0139346. doi:10.1371/journal.pone.0139346
Lewis-Beck, M. S., Bryman, A., & Futing Liao, T. (2004).
The SAGE encyclopedia of social science research methods
Thousand Oaks, CA: Sage Publications, Inc.
doi: 10.4135/9781412950589
Weller, S. C., Vickers, B., Bernard, H. R., Blackburn, A. M., Borgatti, S., Gravlee, C. C., & Johnson, J. C. (2018). Open-ended interview questions and saturation.
PloS
one
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13
(6), e0198606. doi:10.1371/journal.pone.0198606
YMH Boston. (2013c, May 22). Vignette 4 – Introduction to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE
Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video response 2
Hello Dr. Fleming,
While the questions were posed in an open-ended format, the tone of the questions seemed ”leading” and gave the client cause to feel that his anger issues primarily stemmed from being stifled by his mother. The interviewer’s first task is to engage the child and develop a rapport so that the child is comfortable (Sadock, Sadock & Ruiz, 2014). When watching the interview, the practitioner wanted to establish a rapport with the adolescent client and used aggreeing with all of the client’s summations of the issues as a way to establish therapeutic alliance. In the long-run this tactic could have a negative impact on the therapeutic outcome when the times comes for the practitioner to confront the client on negative behaviors or does not agree with all of the clients thoughts or perspectives.
Reference
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 Comprehensive Integrated Psychiatric Assessment discussion essay examples – YMH Boston Vignette 4 video.