Child and Adolescent Assessment NRNP 6665
Child and Adolescent Assessment NRNP 6665
Child and Adolescent Assessment NRNP 6665
INTRODUCTION
All diagnoses, from infancy to adulthood, begin with an examination. While an organic basis for most medical disorders can be determined through the use of diagnostic testing, the field of psychiatry is different in that patients cannot be sent to the lab for blood tests to determine the degree of depression. Similarly, patients cannot be sent to the radiology department for a “scan” to determine the severity of their bipolar disorder. Instead, the field of psychiatry must use psychiatric assessments, such as the comprehensive integrated physical exam, diagnostic interviews, and questionnaires to make diagnoses. These tools must be specialized to address the needs of children and adolescents.
Diagnostic assessment of the child and adolescent is a specialized area of expertise. The PMHNP will often see children who have already been seen by a primary care provider. Many PCPs are comfortable handling attention-deficit/hyperactivity disorder (ADHD) and other straightforward childhood disorders. That means that the PMHNP will often treat the more complicated patients. This week, you explore psychiatric assessment techniques and tools for children and adolescents. You also examine the role of the parent/guardian in the assessment process for this patient population.
Child and Adolescent Assessment NRNP 6665 LEARNING OBJECTIVES
Students will:
- Evaluate comprehensive integrated psychiatric assessment techniques for children and adolescents
- Recommend assessment questions for child and adolescent patients
- Explain the importance of thorough psychiatric assessment for children and adolescents
- Identify rating scales that are appropriate for child/adolescent psychiatric assessment
- Identify psychiatric treatments appropriate for children and adolescents
- Explain the role of the parent/guardian in child/adolescent psychiatric assessment
COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
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.
BY DAY 3 OF WEEK 1
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.
Read a selection of your colleagues’ responses.
EXAMPLE APPROACH TO COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT DISCUSSION
The practitioner spoke calmly and softly to the patient to create a soothing atmosphere and make the patient comfortable. She had good body language that was open and facing the patient, conveying an interest in his answers. The practitioner did not ask open-ended questions, which could have gotten more information from the patient about what he was feeling. The practitioner did not have the patient expand on his answers to get more information about what bothers him, such as his anger, school problems, and alcohol use.
The most significant concern is for the patient’s safety. He has expressed that he has thought of suicide and is not coping well. He also stated that he has been having anger issues which can lead to impulsive actions that could lead to further thoughts of suicide or self-harm. The next question that should be asked would be if the patient has any plan or intent or has thought of how he would hurt himself or others. This questioning would open up the conversation about what safety steps need to be addressed with the patient.
A thorough psychiatric assessment is vital with children and conducted with patience and time for them to answer the questions. The comprehensive evaluation will allow the practitioner to know all the problems the patient faces and determine the priorities that need to be a priority in a treatment plan. A comprehensive assessment will evaluate all aspects of the child or adolescent life, including possible family issues, trauma, abuse, bullying, or conflicts at school. The reason that an assessment is so critical is that pediatricians complete the majority of assessments in their yearly exams.
It is a quick assessment that may not identify actual problems the patient is having. Many children and adolescents get referred for further treatment, precipitating the comprehensive assessment. More than fifty percent of all mental health disorders emerge by the time a patient is fifteen years old (McGorry et al., 2022). Failing to identify mental health needs in childhood and adolescence can affect the further development of the person’s future social, educational, and economic opportunities (McGorry et al., 2022).
Two assessment tools that could be utilized when assessing a child or adolescent are the Adverse Childhood Experiences (ACEs) scale and the NICHQ Vanderbilt Assessment Scale. The ACEs screening identifies adverse childhood experiences that can precipitate or be a component of mental health issues for children(Watson, 2019). The ACEs can help identify exposure to abuse, neglect, family trauma, and other events that can affect a child’s mental health (Centers for Disease Control and Prevention, 2021). The NICHQ can help identify ADHD, Oppositional Defiant Disorder, anxiety, and depression (Kemper et al., 2018). The parent, teacher, and patient can complete the questionnaire, which gives a view from all parties on the symptomology the patient is experiencing.
Two treatments unique to children and adolescents are play therapy and occupational therapy. Play therapy is utilized in individual, group, and educational settings (Zhang et al., 2019). Play therapy gives children/adolescents a comfortable, safe place to play and addresses their issues. Play therapy utilizes games to identify problems, determine strengths, and allow the child to create a therapeutic relationship with the therapist.
Game therapy can assist with behavioral, mental health, social interaction, and cognition problems (Zhang et al., 2019). If used in a group setting, it can help build relationships between children and help them learn coping skills, improve concentration, address social anxiety fears, and teach appropriate social skills. Participating in group play can also help alleviate the fear of new situations, new environments, and new interactions with others (Zhang et al., 2019). Occupational therapy is a treatment that can be utilized to treat many physical and mental health issues.
Occupational therapy helps with autistic, ADHD, developmentally delayed, behaviorally challenged, and children with comorbid problems related to other diagnoses. Occupational therapy can address sensory and physical limitations, executive functioning, neuro-developmental issues, and many more challenges (Novak & Honan, 2019). Occupational therapy helps the child acquire skills to become more independent and includes a great deal of parental education to utilize at home.
The therapy consists of carrying over the skill implementation at home, school, and other settings where the child would spend much time. The activities that the child and parents are educated on are specific to the child’s needs to help the child adapt and change to become more independent.
The inclusion of the parent or caregiver of a child or adolescent in the assessment is essential because they will provide information that the child may not be able to express or that they see from a different perspective. Including the parent in the assessment allows the parent to give their perspective on what is happening and what they see. Without their view, the practitioner may not get the full story or may get a version of the situation that is inaccurate.
Sometimes parents or caregivers may see that a child behaves in a way the child cannot identify. Without that input, the practitioner could not evaluate the whole situation. Having the caregiver or parent involved also creates a connection for the patient that they are invested in helping the child address and treat the issues (Waid & Kelly, 2020).
The sources of reference utilized for this paper are either peer-reviewed journal articles written for the mental health profession or journals prepared for the professionals working in mental health. They include specific language for the profession, are educational, and include further references to support their information.
Child and Adolescent Assessment NRNP 6665 References
Centers for Disease Control and Prevention. (2021). Adverse childhood experiences prevention strategy [PDF]. cdc.gov. https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-Plan_Final_508.pdf
Kemper, A. R., Maslow, G. R., & Hill, S., et al. (2018). Attention Deficit Hyperactivity Disorder: diagnosis and treatment in children and adolescents [Internet] (Comparative Effectiveness Reviews, No. 203 ed.). Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK487766/table/results.t2/
McGorry, P. D., Mei, C., Chanen, A., Hodges, C., Alvarez‐Jimenez, M., & Killackey, E. (2022). Designing and scaling up integrated youth mental health care. World Psychiatry, 21(1), 61–76. https://doi.org/10.1002/wps.20938.
Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal, 66(3), 258–273. https://doi.org/10.1111/1440-1630.12573.
Waid, J., & Kelly, M. (2020). Supporting family engagement with child and adolescent mental health services: A scoping review. Health & Social Care in the Community, 28(5), 1333–1342. https://doi.org/10.1111/hsc.12947.
Watson, P. (2019). How to screen for aces in an efficient, sensitive, and effective manner. Paediatrics & Child Health, 24(1), 37–38. https://doi.org/10.1093/pch/pxy146.
Zhang, A., Jia, Y., & Wang, J. (2019). Applying play therapy in mental health services at primary school. SHS Web of Conferences, 60, 01008. https://doi.org/10.1051/shsconf/20196001008.
BY DAY 6 OF WEEK 1
Respond to at least two of your colleagues on 2 different days 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.
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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
LEARNING RESOURCES
Also Read: NURS 6003 Assignment Transition to Graduate Study.
Week 2: Ethical and Legal Foundations of PMHNP Care Across the Lifespan
In your role as a PMHNP, you will regularly encounter situations that require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidence-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their background or worldview. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action.
LEARNING OBJECTIVES
Students will:
- Analyze salient ethical and legal issues in psychiatric-mental health practice
- Analyze the impact of cultural considerations on ethical/legal decision making in advanced practice nursing
- Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination*
Week 2 Discussion: Ethical and Legal Foundations of PMHNP Care
Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.
For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
TO PREPARE
- Select one of the following ethical/legal topics:
- Autonomy
- Beneficence
- Justice
- Fidelity
- Veracity
- Involuntary hospitalization and due process of civil commitment
- Informed assent/consent and capacity
- Duty to warn
- Restraints
- HIPPA
- Child and elder abuse reporting
- Tort law
- Negligence/malpractice
- In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.
BY DAY 3 OF WEEK 2
Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the PDFs of your articles.
Read a selection of your colleagues’ responses.
BY DAY 6 OF WEEK 2
Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.
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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
Week 2 Example Discussion
Ethical and Legal Foundations of PMHNP Care – Autonomy
Autonomy in medical practice is the right of competent adults to make decisions on their own healthcare based on information from medical professionals. The principle of autonomy requires healthcare professionals to acquire consent from the patient before engaging in any investigations or treatments. Typically, a decision is considered autonomous when two conditions are met; the individual must have all relevant mental capacity to make rational decisions and must be unaffected by external constraints (Chapman, Toretsky, & Phoenix, 2019). In the healthcare field, a decision is viewed as autonomous when the patient has sufficient information, the capacity to make a decision and arrives at a decision voluntarily.
According to Chapman, Toretsky and Phoenix (2019), medical practitioners are expected to respect the principle of autonomy by disclosing medical information including the available treatment options to allow patients to make their own decisions. The principle of autonomy is not applicable to people who do not have the capacity or competence to make autonomous decisions such as infants and young children and patients who lack competence due to mental, developmental, or physical disorders (Chapman, Toretsky, & Phoenix, 2019). To make informed consent, there are several requirements; the patient must have the capacity to understand and decide based on the information provided to them, understand the disclosure, and acts voluntarily to give consent.
According to the article by Gómez-Vírseda, De Maeseneer and Gastmans (2020), patients have the legal right to make decisions as long as they are in their right mental status. Patients can decide whether or not to get treatment even if their decisions do not align with the physicians’ recommendations. Legal precedents have advanced the necessary requirements for patient autonomy such that patient autonomy is now the dominant principle instead of the physician’s beneficence.
McGee, Dingle, & Edelsohn, (2016), note that the welfare and health of children are maintained by their guardians. However, children and adolescents should also be involved in the decision-making process on the types of treatment they receive. Medical professionals should explain the medical issues and possible treatment options in a way that both the children/ adolescent patient and the guardian can understand. The child/adolescent should then be allowed to participate in decisions about the care they will receive to the best of their abilities to act rationally and comprehend their options. Children or adolescents have the right to agree or disagree with the treatment options presented to them. The guardians of the children or adolescents have the right of proxy consent where they can make decisions for the minors under their care. In some jurisdictions, the consent of adolescents of a certain age is required.
The psychiatrist of the child/ adolescent is required to obtain the minor’s assent whenever it is reasonable and the legal guardian’s consent before any medical actions occur. However, as noted by McGee, Dingle, and Edelsohn (2018). There are some provisions for emergencies, such as the case of emancipated minors. During emergency medical care, medical professionals can consider assent and consent as secondary considerations to provide urgent medical care to the minor patient. Emancipated minors are legally responsible for their care and their consent must be obtained before any actions take place. In some jurisdictions, minors involved with sexually related situations, minors are allowed to make autonomous decisions regarding their care.
Song et al. (2020) argue that there are cases when the decisions of the child or adolescent and the guardians are in conflict. In situations where the guardian consents to treatment while the minor dissents, medical practitioners may opt to treat the minor patient in spite of their dissent. It is up to the minor patient’s psychiatrist to determine the consequences of treating the patient without their consent and encourage the minor and guardians to collaborate to enhance the health of the minor.
Psychiatrists and all medical professionals have the ethical responsibility to maintain their patient’s autonomy through providing the all necessary information and allowing them to make their own decision. In my practice, I will strive to maintain my patient’s autonomy and in cases where my ethical responsibilities conflict with the law or other governing legal authority, I will take the necessary steps to resolve the conflicts using the Ethical Standards of Ethics Code and General Principles. I will also ensure that I never use any conflicts or standards to violate my patients’ right to autonomy.
References
Chapman, S. A., Toretsky, C., & Phoenix, B. J. (2019). Enhancing psychiatric mental health nurse practitioner practice: impact of state scope of practice regulations. Journal of Nursing Regulation, 10(1), 35-43. https://doi.org/10.1016/S2155-8256(19)30081-X
Gómez-Vírseda, C., De Maeseneer, Y., & Gastmans, C. (2020). Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities. BMC Medical Ethics, 21, 1-14. https://doi.org/10.1186/s12910-020-00495-1
McGee, M. E., Dingle, A. D., & Edelsohn, G. A. (2018). Review of the revised 2014 American Academy of Child and Adolescent Psychiatry code of ethics. Journal of the American Academy of Child and Adolescent Psychiatry, 55(4), 257-261.
Song, S. Y., Wang, C., Espelage, D. L., Fenning, P., & Jimerson, S. R. (2020). COVID-19 and school psychology: Adaptations and new directions for the field. School Psychology Review, 49(4), 431-437. https://doi.org/10.1080/2372966X.2020.1852852
LEARNING RESOURCES
Required Readings
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.
- American Psychological Association. (2017). Ethical principles of psychologists and diagnostic formulation.
- American Academy of Child & Adolescent Psychiatry. (2014). Code of ethics.
- American Psychiatric Nurses Association. (2020). APRN psychiatric-mental health nursing practice.
- Anderson, S. L. (2012).Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. American Academy of Child and Adolescent Psychiatry, 51(9). 957–974.
- Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
- Chapter 2, “Addressing Behavioral and Mental Problems in Community Settings”Links to an external site.
- 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 19, “Legal Issues in the Care and Treatment of Children with Mental Health Problems”
- Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
- Chapter 1, “Preparing to Pass the Psychiatric-Mental Health Nurse Practitioner Certification Exam”
