APPROACH TO COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT DISCUSSION

 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 ch