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Week 2 discussion, Initial post.

COLLAPSE

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The assessment of child’s development is important within child and adolescent mental health services for clinicians assessing mental health issues of a child. Assessment tools are routinely relied upon to aid assessment and to monitor and evaluate treatment and service effectiveness (Bentley, N., Hartley, S., & Bucci, S. (2019). Child and adolescent care focus on mental health symptoms and diagnoses as they apply to their development and is focused on supporting children and their parents on the path to recovery.

Why Development assessment of children and adolescent important

Child development refers to the continuous but predictably sequential biological, psychological and emotional changes that occur in human beings between birth and the end of adolescence (Choo, Y. Y., Yeleswarapu, S. P., How, C. H., & Agarwal, P., 2019). Children and adolescent development assessment is important because children develop at different rates, which are determined by a complex interplay of environmental and genetic factors and the age of attainment for each milestone ranges widely. Therefore, a thorough developmental assessment may help to highlight normal or abnormal development pattern and timings and be aware of the red flags that would warrant further specialist referrals when necessary (Choo, Y. Y., Yeleswarapu, S. P., How, C. H., & Agarwal, P., 2019). Additionally, identifying signs and symptoms through detailed clinical history and developmental examination may help discover key areas of concern and presence or absence of a mental health disorder. It may also help the practitioner to come to a case formulation that would guide management decisions and develop a patient centered care plan. The developmental history of a child, across different domains gives the “background” on which to understand the current behavioral concerns and to plan pharmacological and psychotherapeutic management (Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019) According to Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019), a child with a developmental history of social and language delay, presenting with peer relationship issues and bullying in school, may probably have social skill deficits arising from autism spectrum disorder.

Two assessment instruments used for children and adolescents but not adults.

The two main assessment instruments that are used specifically for the children and adolescent are the diagnostic interviews and questionnaires (Sadock, B. J., Sadock, V. A., & Ruiz, P., 2014). One interviewer-based diagnostic interview is the child and Adolescent Psychiatric Assessment (CAPA). CAPA can be used for children from 9 to 17 years and it focused on symptoms occurring during the preceding 3-month period (Jozefak, & Berg- Nielsen,2016). Tt is tailored to feelings and behaviors pertinent to young children with somatic issues, schizophrenia, PTSD, disruptive behavior disorders, mood disorders, anxiety, sleep, eating, substance use, and elimination disorders and it can be used to collect information that may help to make diagnosis based on the DSM-5 (Sadock, B. J., Sadock, V. A., & Ruiz, P., 2014). Another interview-based tool is the children’s interview for psychiatric syndrome. According to Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014), children’s interview for psychiatric syndrome is structured interview tool used for children from 6 to 18 years of age and it is composed of 15 sections. It provide information on psychiatric symptoms and psychosocial stress relevant to 20 psychiatric disorders in the DSM-5 criteria including anxiety, OCD,ADHD, depression, mania, anorexia, bulimia, conduct and substance use disorders (Sadock, B. J., Sadock, V. A., & Ruiz, P., 2014).

One questionnaire based diagnostic instrument is the parent and teacher Achenbach child behavior checklist. It covers a broad range of symptoms and several positive attributes related to academic, and social competence. It assesses items related to mood, frustration tolerance, hyperactivity, oppositional behavior, anxiety and other behaviors. Though it is not used to make diagnosis, it may be used to identify specific problem areas that may be overlooked questionnaires (Sadock, B. J., Sadock, V. A., & Ruiz, P., 2014).

Treatment options for children and adolescents that may not be used when treating adults.

While the brain is still developing, mental health care can be a challenge in children. Treatments that work for adults may not fully address the same issues in children since their care is often  focus on using methods that may help them to develop skills to manage their illnesses in a way that they can understand and build upon as they get older. Treatment option used for children and adolescent and not for adults is positive parenting program (Triple P). Triple P-Positive Parenting Program is an evidence-based parenting program that is useful in the management of Attention deficit hyperactivity disorder (ADHD) in children. According to Aghebati, Gharraee, Hakim Shoshtari & Gohari,(2014), triple P is a parent training program that is designed to prevent severe behavioral, emotional, and developmental problems in children by enhancing the knowledge, skills, and confidence of parents. It incorporates five levels of intervention of increasing strengths that help parents of children from birth to age 12 (Aghebati, Gharraee, Hakim Shoshtari & Gohari, 2014).

The role parents play in assessment and treatment.

Parents are entrusted with the responsibility for taking care of their children. Because parents are essential to the physical, mental, emotional, and spiritual development of their children, it is vital that parents are also involved in their child’s mental health assessment and children. Parent involvement positively may influence the outcome of assessment and treatment and empowers them to continue to nurture their child’s development (Haine-Schlagel, R., & Walsh, N. E. (2015). Parents play a critical role in the evaluation process by providing information about developmental skills that cannot be easily assessed in a clinical environment and by judging the validity of the child’s performance in clinic in comparison with his or her typical behavior in home settings. Also, involving parents in treatment services may significantly increase the likelihood of positive outcomes for the child. Engaged caregivers aid the treatment process by ensuring the child’s participate in treatment to completion. Further, as the experts in the child’s life, parents can help providers in increasing treatment compliance and monitoring for effectiveness or adverse effects of treatment at home. Parents involvement in assessment and treatment may provide the child with additional supports that can significantly increase their likelihood of attaining the goal for treatment.

References

Aghebati, A., Gharraee, B., Hakim Shoshtari, M., & Gohari, M. R. (2014). Triple p-positive

parenting program for mothers of ADHD children. Iranian journal of psychiatry and

behavioral sciences, 8(1), 59–65. Retrieved from,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078694/

Bentley, N., Hartley, S., & Bucci, S. (2019). Systematic Review of Self-Report Measures of

General Mental Health and Wellbeing in Adolescent Mental Health. Clinical Child &

Family Psychology Review, 22(2), 225–252. https://doi-org.ezp.waldenulibrary.org

/10.1007/s 10567-018-00273-x

Choo, Y. Y., Yeleswarapu, S. P., How, C. H., & Agarwal, P. (2019). Developmental assessment:

practice tips for primary care physicians. Singapore medical journal, 60(2), 57–62.

https://doi.org/10.11622/smedj.2019016

Haine-Schlagel, R., & Walsh, N. E. (2015). A review of parent participation engagement in child

and family mental health treatment. Clinical child and family psychology review, 18(2),

133–150. https://doi.org/10.1007/s10567-015-0182-x

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:

Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

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

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The Assignments

Respond to at least two of your colleagues by offering additional insights or alternative perspectives on their diagnosis or provide alternate next questions and why you selected those. Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation.

Colleagues Response # 1

Working With Children and Adolescents Versus Adults

           A practitioner must be versed in conducting an assessment of a child versus and adult. There is a difference when a child is not always able to deliver the information the practitioner seeks. More people need to be involved when gathering information regarding a child in comparison of an adult (Sadock, Sadock, and Ruiz, 2014).

Developmental Assessment

A developmental assessment seeks to uncover the history of development and meeting of milestones from pre-birth to current state. The developmental history helps paint the picture for the practitioner of the growth of the child, potential risks, and flags that warrant further investigation. A developmental assessment includes intellectual, academic, physical development, history of medical and mental health, family bonds, socioeconomic status, and other information the parent, teachers, and/or child may find important to share.

Assessment Instruments for Children and Adolescents

           One assessment tool is the SDQ, which is a screen that both a parent and other adult, such as a teacher, complete to identify areas of concern in emotional symptoms, conduct, hyperactivity-inattention, peer problems, prosocial behaviors, and caregiver stress in children ages 3-16 years of age (McSherry, Malet, & Weatherall, 2019). Another assessment instrument is the CATS screen, which a caregiver completes to identify trauma that has occurred in a child’s life. The screen is used in ages 3-6 years as well as 7-17 years; there are two separate screens depending on the age of the child. The CATS screen has been evaluated and recommended internationally as a valid screen for PTSD or other trauma in childhood (Sachser et al., 2017). A third instrument is the Wechsler Intelligence Scale for Children (WISC-III-R) use din children 6-17 years which highlights the “verbal IQ, a performance IQ, and a combined full-scale IQ” (Sadock, Sadock, & Ruiz, 2014). Neither of the first two assessment instruments mentioned would be valid for adults as both instruments require the caregiver to complete the screen. An adult is able to complete his or her own screen, so other instruments would be more efficient when seeking out information related to adults. Sadock, Sadock, and Ruiz (2014) highlight that there are different assessment tools used for children and adults due to the need for caregivers to give their feedback about symptoms. Although, it is important to note that the information shared by the caregiver may be distorted due to the caregiver stress, frustration, or mental health concerns that may be present (Sadock, Sadock, and Ruiz, 2014). The third instrument is based on the average scale of the age of the child and not intended for adults.

Treatment Options for Children and Adolescents

Treatment for children and adolescents include psychological education for the caregivers and educational treatment plans. Sadock, Sadock, and Ruiz (2014) highlight the importance of a combined effort from the caregiver, teachers, clinician, and the child to obtain positive results when treating mental health concerns. Psychological education for caregivers and educational treatment plans are not used in adulthood as the developmental stage is advanced past caregivers and teachers.

Parents Role in Assessment and Treatment

           According to Saddock, Saddock, and Ruiz (2014), the parental interview is an essential aspect pf the assessment and cooperation from the parents helps support the most successful testament plan. Parents are able to relay important information of developmental history, familial history, symptoms exhibited, strengths, and weaknesses. The treatment plan needs to be “consented” to by the parent including psychotherapy and psychopharmaceutic options. The child is not able to consent to treatment without the consent of the guardian in most cases.

Colleagues Response # 2

Working with Children and Adolescents Versus Adults

          Adolescent’s and children’s  assessment should be conducted routinely as they are very important. It should be conducted on a routine basis. The purpose of performing a routine assessment on children and adolescent is to evaluate various aspects of their functioning level, cognitive development, communication, behavior, social interaction, motor, and sensory functioning. The assessment is also important because it can help identify deficiencies in the early stage of growth. Studies have indicated that about 1 in 6 children between the ages of 3 to 17-year-old is born with abnormalities which include autism, ADHA, learning, and language disorder (Eileen Haebig, April 2019).

                                                                                  Assessment instruments used for evaluating children and adolescents

          Assessment instruments are tools use in gathering developmental information about the child and adolescent functional levels. However, I will be discussing different assessment instruments that can be used for children and adolescent’s evaluation. My first assessment tool will be the Denver Developmental Screening Test. It helps to assess various risk for developmental delay or functions which includes motor function, cognitive, adaptive skills, communication skill and social interaction (Sadock, 2014). The test is suitable for children in early school-age 6-year old. As stated above, it is imperative to begin the assessment in early child development to know how well the child or adolescent progressing without any abnormalities or delay. The screening tool is structured for the evaluation of a child’s development. It is also administered only by the evaluator directly with the child and does not require direct input from any other person. Furthermore, the Denver Developmental Screening Test is aimed for early identification of risk for developmental delays.

          My second assessment tool will be the ADHD Rating Scale. This evaluation tool can be completed by the child’s parent or teacher to help guide the clinician to diagnose the child or adolescent with attention deficit hyperactivity disorder. The ADHD Rating Scale consists of 18 test question that permits the teacher or parent to evaluate how many times the child behaviors change either at home or in school. According to (Overgaard, et al., 2019), states that screening purposes, the parent and teacher ECI-4 ADHD rating scale showed acceptable accuracy in identifying preschoolers at risk for ADHD.  There are many treatments available for children with ADHD and is supportive to the child which may include changes in the classroom and at home, academic and social skills training (Sadock, 2014).

                                                                                             Treatment options used for children and adolescents

          There are many treatments options available for children and adolescents. The applied behavior analysis (ABA) treatment is used to treat kids with social disorders like autism. This treatment has been proven to increase behaviors, learning/communication skills, and social skills in children with functional delays (Matson, 2012). Additional treatments are occupational therapy and therapeutic Horseback Riding.

                                                                                                         Roles parents play in assessment and treatment

          Every parent have a vital role to play in the treatment of his/her child. As a PMHNP, it is advisable to always involve the parent of the child or adolescent in the plan of care or medication management. This will permit the parents to have a vast understanding of the child or adolescent change in development. The parent participation is predominantly important for child growth and development.

As a nurse informaticist, you may be at the forefront of managing patient data, institutional data, and other record-keeping that has reporting requirements. The reporting of accurate and truthful information is critical to policy compliance, and may affect funding, safety ratings, or other crucial measures. In this Discussion, you analyze one such example where informatics and ethics overlap. 

For this Discussion, consider the following scenario:

Imagine that you are a nurse informaticist in an ER department. The manager informs you that the duration from when a patient arrives in the ER reporting cardiac-related symptoms to being seen in the cardiac catheterization lab is above the national standard. She asks if there is a way to “adjust” the report to make the time look better before the next review.

• Review the resources and reflect on the actions you would take and the decision you would make to meet standards in an ethical manner as it relates to the scenario provided. 
• Think about what your response to the manager might be.

By Day 3 of Week 11

Post a response that explains how you would comply with policy and maintain ethical nursing practice in the scenario above. Be specific and provide examples. Next, recommend a solution to address the problem described in the scenario. Justify why you would recommend this solution.

Case Study on Moral Status

Based on “Case Study: Fetal Abnormality” and the required topic study materials, write a 750-1,000-word reflection that answers the following questions:

What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?

Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?

How does the theory determine or influence each of their recommendations for action?

What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Here are the expectations for the assignment:

You will need to apply the theories to the fetus, the fetus only and only the fetus and not the characters (this repetition is deliberate). We already have moral status, therefore applying any theory to the persons in the case study will amount to no points no matter how well discussed. We are alive because we have moral status. The assignment question is really asking you: What Moral status would Marco ascribe to the fetus? What is the fetus right to or not to live according to Marco and Why? Think the same way for each person. You are not to focus on the relationship they have with each other. The fetus is the main focus, the fetus and only how they see the fetus.

Let’s us think about Marco for a little bit. Marco does apply a theory to the fetus. We are not concerned about how he feels about his wife. We are concerned about how Marco sees the fetus and from there we undoubtedly know which theory Marco would favor.(This is a tip)

As much as possible have a structure to your paper. I recommend an Introduction containing a thesis statement as the last one or two sentences, subheadings for each of the questions asked, and finally a brief conclusion. 

I strongly recommend subheadings. I appreciate those who use subheadings. In your everyday reading, your reading is divided into subheadings to keep you focus. So it should be in your writing. Can you imagine reading pages and pages without subheadings? Your subheadings should not be the questions asked in the assignment, just the key points in the question. For example, your first subheading (which comes after your introduction of course) would be: Christian View of the Nature of Persons and Moral Status.

Case Study on Biomedical Ethics in the Christian Narrative

*THE 2 ATTACHED FILES NEED TO BE USED IN THIS ASSIGNMENT*

This assignment will incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles and four boxes approach.

Based on the “Case Study: Healing and Autonomy” and other required topic study materials, you will complete the “Applying the Four Principles: Case Study” document that includes the following:

Part 1: Chart

This chart will formalize the four principles and four boxes approach and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Part 2: Evaluation

This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview.