Practicum: Decision Tree

For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.

Note:  For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

                                                              The Assignment:

Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. 

(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT)

At each Decision Point, stop to complete the following:

                                 · Decision #1: Differential Diagnosis

o Which Decision did you select?

o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

                           · Decision #2: Treatment Plan for Psychotherapy

o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

                     · Decision #3: Treatment Plan for Psychopharmacology

o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

· Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

                                                          Case #1
A young girl with difficulties in school

                                                                               BACKGROUND

In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.

For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.

When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis.

Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.

To start, consider what assessment tools you might need to evaluate Katie.

· Child Behavior Check List

· Conners’ Teacher Rating Scale

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” (Available at: http://www.doctorrudy.com/files/teacher_add_adhd_short.pdf). This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess.

When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.

 

                                                      SUBJECTIVE

You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.

Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.

 

                                                                  MENTAL STATUS EXAM

The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions.

                                                       Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 

299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics

314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

ANSWER CHOOSEN: Attention Deficit Hyperactivity Disorder, 

predominantly inattentive presentation 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

                                           RESULTS OF DECISION POINT ONE

·  Client returns to clinic in four weeks

·  You selected Attention deficit hyperactivity disorder, predominantly inattentive presentation. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer

                                                                   · Decision Point Two

· BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.
 

· Wellbutrin 75 mg orally daily

· 

· Strattera 25 mg orally daily

· 

· Adderall XR 10 mg orally daily

ANSWER CHOOSEN: Adderall XR 10 mg orally daily

                                          RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

·  Katie’s parents seem absolutely delighted upon their return stating that Katie is paying more attention in school, but note that there is still room for improvement, particularly in the afternoon

·  They report that Katie’s teacher has reported that Katie is able to maintain her attention throughout the morning classes but come afternoon, she “daydreams.”

·  Katie’s parents are also concerned about her decrease in appetite since starting the medication.

                                                     Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

 

Katie’s parents that weight loss is common with stimulant medications 

          used to treat ADHD

medication with family thearpy

a small dose of immediate release Adderall in the early afternoon

ANSWER CHOOSEN: Add a small dose of immediate release Adderall in the 

                                                         early afternoon

                                             Guidance to Student

Whereas weight loss is common with stimulant medication, this option does not address Katie’s parents’ concerns about the return of symptoms in the afternoon.

Augmentation with family therapy is also a good idea as it can help Katie with her symptoms and further help her parents to understand the unique challenges that Katie experiences, as well as ways that they can help her with symptoms, however, this option does not address the return of inattentive symptoms in the afternoon.

Adding a small dose of immediate relate Adderall in the afternoon can help Katie to maintain attention throughout the afternoon and into the early evening when she must do homework. This would be the best option.

                                                  Learning Resources

Required Readings

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.

• Chapter 3, “Contributions of the Sociocultural      Sciences” (pp. 131–150)
• Chapter      31, “Child Psychiatry” (pp. 1152–1181, 1244–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Neurodevelopmental Disorders”

o “Intellectual Disabilities”

o “Communication Disorders”

• “Disruptive, Impulse-Control, and Conduct Disorders”

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf 

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

 

                                                       Required Media

Laureate Education (Producer). (2017b). A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author. (SEE THE ATTACHED CASE STUDY SAMPLE WITH ANSWER)

                                               Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell. 

• Chapter      51, “Autism Spectrum Disorder” (pp. 665–682)

 

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As you reflect on Meilaender’s readings, what is his distinction between procreation and reproduction, as well as that of being begotten versus being made? Do you agree with his description? Why or why not?

 

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 Pls check the attached file. This is a response essay. Use APA

 

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                                      Group Therapy for Addiction

Consider the following scenario:

The psychiatric mental health nurse practitioner is working for a community health clinic that offers state mandated “intensive outpatient rehabilitation” services for individuals who face incarceration for driving while under the influence. Mr. Smith, a 24-year-old male patient, shows up for his initial intake appointment and says, “Look, this sounds like it’s going to be an AA meeting. Can’t I just go there? I only had a couple of drinks. I don’t know why the judge was such a jerk.”

Clients with addictive disorders may present for therapy for various reasons. Some, like Mr. Smith, attend because it is court mandated. Some attend because family or friends have pushed them to do so, while others may attend because life has become unmanageable. Regardless of clients’ reasons for presenting for therapy, to reach these clients and effectively treat them, you must be able to break down barriers, establish relationships, and help them see the benefits of this therapeutic approach.

PLEASE REMEMBER TO REVIEW THE ATTACHED 7 VIDEO TRANSCRIPTS BEFORE DOING THE ASSIGNMENT, and to include a title page, introduction, summary, and references

                                                              The Assignment

In a 2- to 3-page paper, address the following:

· Identify the psychotherapeutic approach that the group facilitator is using and 

   explain why she might be using this approach.

· Determine whether or not you would use the same psychotherapeutic approach 

   if you were the counselor facilitating this group and justify your decision.

· Identify an alternative approach to group therapy for addiction and explain why 

  it is an appropriate option.

· Support your position with evidence-based literature.

                                                                    Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

• Chapter      16, “Psychotherapeutic Approaches for Addictions and Related Disorders”      (pp. 565–596)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

• Chapter 13, “Problem Group Members” (pp. 391–427)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Gamble, J., & O’ Lawrence, H. (2016). An overview of the efficacy of the 12-step group therapy for substance abuse treatment. Journal of Health & Human Services Administration, 39(1), 142–160. Retrieved from http://jhhsa.spaef.org/

Kim, J. W., Choi, Y. S., Shin, K. C., Kim, O. H., Lee, D. Y., Jung, M. H., … Choi, I. (2012). The effectiveness of continuing group psychotherapy for outpatients with alcohol dependence: 77-month outcomes. Alcoholism: Clinical & Experimental Research, 36(4), 686–692. doi:10.1111/j.1530-0277.2011. 01643.x

Required Media

Allyn & Bacon (Producer). (2000). Motivational interviewing [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: You will access this media from the ATTACHED TRANSCRIPT. The approximate length of this media piece is 102 minutes.

Laureate Education (Producer). (2013d). Levy family: Sessions 1-7 [Video file]. Baltimore, MD; Author. 

 

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                                            Practicum – Assessing Client Families

To prepare:

· Select a client family that you have observed or counseled at your practicum site.

· Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram 

  video in this week’s Learning Resources. (SEE ATTACHED VIDEO TRANSCRIPT)

· Reflect on elements of writing a comprehensive client assessment and creating a  

  genogram for the client you selected.

                                                                         The Assignment

                                          Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

· Demographic information

· Presenting problem

· History or present illness

· Past psychiatric history

· Medical history

· Substance use history

· Developmental history

· Family psychiatric history

· Psychosocial history

· History of abuse and/or trauma

· Review of systems

· Physical assessment

· Mental status exam

· Differential diagnosis

· Case formulation

· Treatment plan

                                                Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).

N:B. (1)PLEASE THIS ASSIGNMENT HAS 2 PARTS, AND I HAVE ATTACHED A SAMPLE OF THE ASSIGNMENT, BUT THE SAMPLE TALKS ONLY ABOUT HERNANDEZ, BUT THIS ASSIGNMENT IS FOCUS ON HERNANDEZ FAMILY. 

(2). HERNANDEZ FAMILY GENOGRAM VIDEO TRANSCRIPT IS ATTACHED INCASE YOU CAN NOT VIEW THE VIDEO

                                                      Learning Resources

Required Readings

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

• Chapter 8, “Experiential      Family Therapy” (pp. 129–147)
• Chapter 13, “Narrative Therapy” (pp. 243–258)

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

• “Genograms” pp. 137-142

Cohn, A. S. (2014). Romeo and Julius: A narrative therapy intervention for sexual-minority couples. Journal of Family Psychotherapy, 25(1), 73–77. doi:10.1080/08975353.2014.881696

Escudero, V., Boogmans, E., Loots, G., & Friedlander, M. L. (2012). Alliance rupture and repair in conjoint family therapy: An exploratory study. Psychotherapy, 49(1), 26–37. doi:10.1037/a0026747

Freedman, J. (2014). Witnessing and positioning: Structuring narrative therapy with families and couples. Australian & New Zealand Journal of Family Therapy, 35(1), 20–30. doi:10.1002/anzf.1043

Phipps, W. D., & Vorster, C. (2011). Narrative therapy: A return to the intrapsychic perspective. Journal of Family Psychotherapy, 22(2), 128–147. doi:10.1080/08975353.2011.578036

Saltzman, W. R., Pynoos, R. S., Lester, P., Layne, C. M., & Beardslee, W. R. (2013). Enhancing family resilience through family narrative co-construction. Clinical Child and Family Psychology Review, 16(3), 294–310. doi:10.1007/s10567-013-0142-2

                                                    Required Media

Governors State University (Producer). (2009). Emotionally focused couples therapy [Video file]. Chicago, IL: Author.

 

Laureate Education (Producer). (2013b). Hernandez family genogram [Video file]. Baltimore, MD: Author. (SEE ATTACHED VIDEO TRANSCRIPT)

Psychotherapy.net (Producer). (1998). Narrative family therapy [Video file]. San Francisco, CA: Author. 

   

 

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