At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
The video stopped as the practitioner was about to explore Tony’s suicidal ideations (SIs). My concern at this point will be to establish if this is the first time Tony had SIs, and if not, what other situations have triggered these thoughts. A history of self-harm and/or SI is a strong risk for suicide (Gee et al., 2020). Another concern would be if Tony has ever discussed his feelings with anyone – parents, school counselors, teachers, etc.? Who and what are his support systems (Gee et al., 2020) and have they been utilized at any time?
What would be your next question, and why?
My next question would be if Tony has any plans for suicide and what the plans are. I will also be interested in any self-harming activities- past and present. (Gee et al., 2020). I will also explore how Tony has been coping with these feelings of edginess, anger, sadness, loneliness, etc. to explore the presence, use, and adequacy or otherwise of coping skills. Coping skills are needed to successfully transverse the complicated world of adolescence and beyond (Melnyk, 2020).
Explain why a thorough psychiatric assessment of a child/adolescent is important.
Carlat (2017) notes that there are four tasks associated with a psychiatric assessment of a patient – building a therapeutic alliance, establishing a psychiatric database, garnering adequate information to arrive at a diagnosis(es), and having the patient buy into the proposed intervention. To achieve these, a thorough assessment is required because ultimately, the goal of the patient is symptom alleviation or reduction, and it is important to understand what these symptoms are. Srinath et al. (2019) also agree that a thorough clinical assessment will aid case formulation which will derive from the therapeutic alliance, a thorough H & P, exploring the context and presentation, and the treatment and interventions.
Two different symptom rating scales would be appropriate to use during the psychiatric assessment of a child/adolescent.
Two common psychiatric pathologies in children and adolescents are anxiety and depression (Zuckerbrot et al., 2018). To this end, the GAD-7 and PHQ-C are symptom-rating tools that are readily applied to children and adolescents in the clinical setting for measuring the levels of anxiety and depression respectively. Srinath et al. (2019) also recommend using the Child and Adolescent Psychiatric Assessment (CAPA). CAPA has been used for diagnosing several psychiatric disorders and also has a DSM5 version (Angold et al., 1987/2022).
Two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Psychiatric treatment options for children and adolescents take into consideration the stage of development of the child, family involvement and engagement, continued promotion of the patient’s development, and promotion of resiliency in the patient (Wheeler, 2020). In this vein, there is evidence in the literature of the exclusive use of Play Therapy and the Acceptance and Commitment Therapy (ACT) in children and adolescents. Play Therapy can be tooled to meet the above considerations while ACT utilizes mindfulness exercises to help the acquisition and use of coping skills and can help patients steer the complicated course of adolescent developmental millstones.
The role parents/guardians play in assessment.
Parents and guardians provide collateral during the assessment. This information can be a crucial part of the assessment data. Information on the patient’s developmental history can be provided by the parents and this gives a picture of the patient’s development history. This data forms an important framework for the planned intervention (Thapar et al., 2018). Secondly, they may be the support system needed for the intervention to be implemented and so play a crucial role in the case formulation. Finally, as someone once noted that the family is stronger than therapy. In other words, the patient is in therapy for a few hours or so in the day but spends a lifetime with the family (environment). The role of the home environment must be recognized and integrated into the intervention to effect lasting positive change in the patient.
References
Angold, A., Cox, M., Prendergast, & Rutter. (1987). CHILD AND ADOLESCENT PSYCHIATRIC ASSESSMENT (CAPA) Core Diagnostic Modules for DSM 5 CHILD INTERVIEW. In E Simonoff Copyright. https://devepi.duhs.duke.edu/files/2018/06/Child-CAPA-Core
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