Mental Health Assessment for Children and Adolescents

           In the video, the practitioner did well at getting to the point of what triggered the change in the patient’s behavior and mood in the last 2 months. She was asking the right questions. However, I felt she could have established a therapeutic relationship at certain times in the interview that were missed. I would have asked a few more questions regarding the anger the patient was feeling. During the discussion of homework, there was an abrupt, “why not” question from the practitioner. This was followed by the question on alcohol where her body language could have come off judgmental to some patients. The practitioner looked as though she was looking in the air or rolling her eyes when asking the question. There was an uncomfortable silence at that point. I would have let the patient know there is no judgment in any of the questions asked or answers provided. The questions will allow me to see how I can best help. I always sit at eye level with patients, make eye contact, ask questions in a caring nonjudgmental way and sometimes lighten the mood with a joke, if appropriate.(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

          My primary concerns for this patient are suicidal ideation, anger, depressed mood, somatic symptoms, and if he will act impulsively. I would ask more questions about suicidal ideation and anger. I would ask the patient if there is a history of self-harm or a current desire to commit self-harm. I would also ask him more about his anger, his ability to control his anger, and what that anger looks like. I would ask the patient about any desire to hurt others. So far, the interview has revealed that this episode of depression has been going on for two months and was triggered by a breakup with his girlfriend. I would ask more about the patient’s history to confirm this is a new condition. I would also want to know about the parent’s mental health history, coping skills, and the dynamics of the patient’s relationship with his parents. I would want to know if the parents are modeling good coping skills, have a history of mental health conditions or addiction, and if the relationship is impaired in any way.(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

          A comprehensive mental health assessment for children and adolescents is going to require that the practitioner gather information from more than one source including the child, parent, teachers, and other caregivers. It’s important to gather as much information as possible(Comprehensive Essay on Mental Health Assessment for Children and Adolescents). A comprehensive assessment could uncover details that point to a risk of the development of mental health conditions or worsening of a mental health condition. Reiss, et al., (2019) found families with a low socioeconomic status suffer from a higher number of stressors related to finances, relationships, employment, and health issues than those with a high socioeconomic status. Parental education and socioeconomic status were significant predictors of children and adolescents developing mental health problems. Uncovering all aspects that could put our patients’ mental health at risk is important for their long-term outcomes. Expeditiously addressing the risks, and providing education and appropriate treatment for the patient and family could prevent long-term mental health problems. In a worldwide estimate, it was found that 13% to 20% of children and adolescents suffer from disabling mental illness. When mental health problems occur early in a child’s life, it has been shown to increase the risk of mental health problems in adulthood (Reiss, et al., 2019).(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

         Two psychiatric scales that I would use for this client are the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Revised Children’s Anxiety and Depression Scale (RCADS). The C-SSR scale can be used on patients 11 years old and older. This patient is an adolescent so it would be appropriate. The scale is easy to use, valid, reliable, and accessible. RCADS is used to measure anxiety and depression and can be used for the ages of 8 to 18 years old. There are different versions, it can be broken down into subscales when using RCADS 47, it’s easy to use, valid, reliable, and accessible. Krause, et al., (2021) are a part of the International Consortium for Health Outcomes Measurement (ICHOM). They have already developed a consensus-based standard set of outcomes for anxiety and depression in adults, which included the PHQ-9, the GAD 7 Scale, and the WHO Disability Schedule. In the study being referenced, they provide recommendations specifically for anxiety, depression, OCD, and PTSD in children and young adults between 6 and 24 years old. The scales they recommend include the Revised Children’s Anxiety and Depression Scale, the Obsessive Compulsive Inventory for Children, the Children’s Revised Impact of Events Scale, the Columbia Suicide Severity Rating Scale, the KIDSCREEN-10, the Children’s Global Assessment Scale, and the Child Anxiety Life Interference Scale (Krause, et al., 2021).(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

        The treatment options for children and adolescents may include individual psychotherapy like play therapy for young children, CBT, or Supportive Therapy; or other therapies that may include group therapy, family therapy, behavioral management training, and or pharmacological treatment (Hilt & Nussbaum, 2016)(Comprehensive Essay on Mental Health Assessment for Children and Adolescents). This patient is an adolescent with a brief history of symptoms, so the option I would use first would be CBT. This option could be used across the lifespan. Amos, et al., found CBT to be very effective and well received by adolescents with depression in the ages of 13 to 18 years old. In this study, eighty percent of the intervention group achieved remission compared with only 15.8% of the controls. It is also important to note, in this study CBT was delivered by school teachers, due to the gap in care in Nigeria. Another treatment, that may be valuable to an adolescent is group therapy. Adolescent Coping with Depression Course was found to be effective in the reduction of symptoms of depression, rumination, and perfectionism. This group therapy is a group cognitive-behavioral program for depressed adolescents ages 14 to 20 years, with mild or moderate depressive symptoms (Idsoe, et al., 2019). Another option that would be considered is medication if psychotherapy or group therapy wasn’t as effective as expected. Zhou, et al. (2020) found Fluoxetine plus CBT for the treatment of acute moderate to severe depression in children and adolescents was the most effective treatment than either one alone.(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

       The parent’s role in the assessment is to provide the clinical history of the patient, their description of the problem, and other needed information which can help the practitioner develop a case formulation that will guide management decisions. The child will also provide their version of the problem and clinical history for the assessment. The parent is also there to support the child or adolescent in their journey to obtain improved mental health and coping skills. The parent is usually present in the assessment of younger children unless there is a reason to assess the child alone. Generally, an adolescent will be assessed alone, after an assessment with the parents and consent is provided (Srinath, et al., 2019).(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

  References

Amos, A., Olisah, V., Bella-Awusah, T., & Ani, C. (2022) Controlled clinical trial of teacher-delivered Cognitive Behavioural Therapy (CBT) for adolescents with clinically diagnosed depressive disorder in Nigeria, International Journal of Mental Health, 51:1, 4-23, DOI: 10.1080/00207411.2021.1891361(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health Links to an external site. American Psychiatric Association Publishing.(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Idsoe, T., Keles, S., & Olseth, A.R. (2019). Cognitive behavioral treatment for depressed adolescents: results from a cluster randomized controlled trial of a group course. BMC Psychiatry 19, 155 (2019). https://doi.org/10.1186/s12888-019-2134-3(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Krause, K. R., Chung, S., Adewuya, A. O., Albano, A. M., Babins-Wagner, R., Birkinshaw, L., Brann, P., Creswell, C., Delaney, K., Falissard, B., Forrest, C. B., Hudson, J. L., Ishikawa, S. I., Khatwani, M., Kieling, C., Krause, J., Malik, K., Martínez, V., Mughal, F., Ollendick, T. H., & Wolpert, M. (2021). International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. The lancet. Psychiatry, 8(1), 76–86. https://doi.org/10.1016/S2215-0366(20)30356-4(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Reiss, F., Meyrose, A.K., Otto, C., Lampert T, and Klasen, F. (2019) Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study. PLOS ONE 14(3): e0213700. https://doi.org/10.1371/journal.pone.0213700Links to an external site.(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

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. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T., Weisz, J., Li, X.,  Cuijpers, P., Coghill, D., Xiang, Y., Hetrick, S., Leucht, S., Qin, M., Barth, J., Ravindran, A., Yang, L., Curry, J., Fan, L., Silva, S., Cipriani, A., & Xie, P., (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis, The Lancet Psychiatry, 7(7), 581-601, ISSN 2215-0366, https://doi.org/10.1016/S2215-0366(20)30137-1(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Comprehensive Essay on Mental Health Assessment for Children and Adolescents-Discussion Response

Following your post, I could not agree more that asking trigger questions enables healthcare personnel to gather more subjective information from the client to aid in evaluation and diagnosis. Nevertheless, mental health personnel must maintain appropriate therapeutic relationships with the client to further aid in sharing subjective information on the client’s condition’s root cause, development, and present status. Hartley et al. (2020) assert that a therapeutic relationship is crucial for rapport-building and effective conversations between mental health personnel and client. Consequently, an effective therapeutic alliance is associated with trust and confidence in mental healthcare services and contributes to client satisfaction.(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

You have mentioned the significance of suicide ideation in the case scenario, and I agree with your concern for such thoughts, considering the case involves an adolescent and research has associated higher incidences of suicide and homicides among adolescents and young adults diagnosed with anxiety and depression (Brahmbhatt et al., 2019). Consequently, it is crucial to ask relevant questions to get more information on the client’s plan related to suicide ideation, which includes administering an age-relevant suicide risk assessment tool. Besides, observing body language is crucial in evaluating and identifying the risks an individual poses to self and others (Del Giacco et al., 2019). Therefore, body language is a signpost of crucial information in a psychiatric interview.(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Furthermore, it is a consensus in mental health practice that psychiatric evaluation should be comprehensive, particularly in pediatric care, considering the different presentations of mental health concerns. A comprehensive mental health assessment among children and adolescents requires collateral information obtained from parents, caregivers, and other close associates (Owoyemi et al., 2021). In my studies, I noted that collateral information contains additional crucial information to help mental health personnel make informed diagnoses and treatment interventions. (Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

References

Brahmbhatt, K., Kurtz, B. P., Afzal, K. I., Giles, L. L., Kowal, E. D., Johnson, K. P., … & Workgroup, P. (2019). Suicide risk screening in pediatric hospitals: clinical pathways to address a global health crisis. Psychosomatics, 60(1), 1-9. https://doi.org/10.1016/j.psym.2018.09.003(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Del Giacco, L., Salcuni, S., & Anguera, M. T. (2019). The communicative modes analysis system in psychotherapy from mixed methods framework: introducing a new observation system for classifying verbal and non-verbal communication. Frontiers in Psychology, 10, 782. https://doi.org/10.3389/fpsyg.2019.00782

Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490. https://doi.org/10.1016%2Fj.ijnurstu.2019.103490(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)

Owoyemi, P., Salcone, S., King, C., Kim, H. J., Ressler, K. J., & Vahia, I. V. (2021). Measuring and Quantifying Collateral Information in Psychiatry: Development and Preliminary Validation of the McLean Collateral Information and Clinical Actionability Scale. JMIR Mental Health, 8(4), e25050. https://doi.org/10.2196%2F25050(Comprehensive Essay on Mental Health Assessment for Children and Adolescents)