Based on the YMH Boston Vignette 5 video, the practitioner did well in her approach to the adolescent client, such as asking why he is there with an open-ended question, as well as inquiring about the clients condition with specific questions addressing depression and anxiety, while allowing moments of silence to truly listen to the adolescent client. This is important as it demonstrates empathic engagement, making him feel heard, which is a crucial step toward establishing a therapeutic alliance (Hartley et al., 2022). However, there are areas for improvement on behalf of the provider in the video, such as the lack of a formal introduction on when first meeting the client, or explaining HIPAA /confidentiality to the client in order to provide a more trusting atmosphere and further explain her role.

At this point in the clinical interview, there is a compelling concern, as the client mentions having thoughts/feelings of not wanting to be alive, with a possible plan. My next question would be regarding the plan of self-harm and assessing the possibility of the client actually carrying out the plan. I would also find out whether he has previously attempted to hurt himself and how, as well as whether anyone close to him has previously died from a suicide attempt. This is extremely important as certain fixed factors which increase the risk of suicide are previous attempts by the client, or a successful attempt by someone they were close with, amongst others. Due to this, providers must place great emphasis on gaining a clear understanding of the sequence of events leading up to the client feeling this way and/or previous and current thoughts on acting upon it (Shain et al., 2016).

A thorough psychiatric assessment of a child/adolescent is important as it provides all the essential information needed to formulate the most accurate diagnosis and plan of care for the client, based on consideration for data and information gathered regarding their history and past treatments, family history, etc. Two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent include the Pediatric Symptom checklist which is helpful in gaining better insight into psychosocial issues being experienced by the client, or the Short Mood and Feelings Questionnaire when trying to assess for a diagnosis of depression  (Hilt & Nussbaum, 2015). In addition, two psychiatric treatment options for children and adolescents that may not be used when treating adults can include playing therapy, as well as child art therapy. Parents and guardians play an essential role in facilitating the assessment of the client, as they, naturally, spend a great deal of time with the client and are able to provide insight, from their perspective, regarding the clients current and past behavior, as well as pertinent health history, and much more. The parents and guardians can not only share their concerns but also express their goals for the client and give the provider an idea of how these goals may or may not align with the child/adolescent’s personal goals and ways to achieve common goals.

References

Hartley, S., Redmond, T., & Berry, K. (2022). Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff. PLOS ONE, 17(1), e0262070.

Hilt, R., & Nussbaum, A. (2015). Dsm-5 pocket guide for child and adolescent mental health (3rd ed.). American Psychiatric Publishing, Inc.

Shain, B., Braverman, P. K., Adelman, W. P., Alderman, E. M., Breuner, C. C., Levine, D. A., Marcell, A. V., & OBrien, R. F. (2016). Suicide and suicide attempts in adolescents. Pediatrics, 138(1).

 (847.971 KB)