1. Mental Health Assessment of Children and Adolescents Chapter 24

2. Assessment Process for Children and Adolescents Based on Standards of PMHN of Children and Adolescents (ANA, 2000) Follows same format as adults except: Children need simple phrases (more concrete). Corroborate information with adult Direct questions, rather than open-ended May use play media May not be able to provide accurate time

3. Comprehensive Evaluation Biopsychosocial history Mental status examination Additional testing as needed Information from other agencies

4. Collecting the Data Clinical interview – primary tool Depends on developmental level of each child Establish a treatment alliance. Assess interactions between child and parent.

5. Interviewing Techniques Interview child and parent separately. Children provide better information about internalizing symptoms (mood, sleep, suicide ideation). Parents provide better information about externalizing symptoms (behavior, relationships).

6. Discussion with Children Explain the assessment process. Adapt communication to child’s age. Elicit any concerns the child may have. Be “real” in interactions.

7. Discussion with Parents Ask for a detailed description of their view of problem. Allow parents to express frustration. Be non-judgmental.

8. Building Rapport Maintaining appropriate eye contact, speak slowly, clearly and calmly with friendliness and acceptance. Use a warm, expressive tone. Show interest in what is being said. Make the interview a joint undertaking.

9. Conducting the Interview Preschool children: Have difficulty putting feelings into words, thinking concrete School-aged Children: Able to use constructs, provide longer explanations Adolescents: are egocentric, increased self-consciousness, fear of being shamed Use play; conduct assessment in play room. Establish rapport through competitive games. Let them know what information will be shared with parents. Direct, candid approach.

10. Biopsychosocial Assessment: Biologic Domain Thorough history of psychiatric and medical problems Consider genetic vulnerability Medications Neurologic examination

11. Assessment: Psychological Domain Discussion of life changes and losses Mental status Developmental assessment Psychosocial development Language Attachment Temperament and behavior Self-concept

12. Temperament Easy - positive mood, regular patterns, positive approaches, low emotional intensity Difficult - irregular patterns, negative responses to new stimuli, slow adaptation, negative mood and high emotional intensity Slow-to-warm temperament - negative, mildly emotional response to new situation, but adaptation evolves

13. Risk Assessment Ask straightforward questions. Have you thought about hurting yourself? Have you ever acted on these thoughts? How would you hurt yourself? What do you think would happened? Have you ever hurt yourself? When a child shares information regarding an intent to commit suicide or hurt others, it must be shared with parents.

14. Assessment: Social Domain Family relationship School and peer adjustment Community Functional status Stresses and coping behaviors

15. Developmental Assessment Maturation Intellectual functioning Gross motor functioning Fine motor function Cognition Thinking and perception Social interaction and play