Read and answer questions

1 scholarly resource in APA format.  

Answers Do Not Have to be in APA Format. 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

THE JOB IS TO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. WITH 2 COMPLETED (EDUCATIONAL  REFERENCE) includidig retrival or doi, IN APA WITH CITATION ABOVE 2013 PER COMMENT.

  POST 1

Comprehensive Integrated Psychiatric Assessment

Following recent research, the level of mental health problems among children and adolescents has risen dramatically (American Psychiatric Association, 2013). The present-day life and current associations within the society contribute greatly to these adversities. Culture, environmental exposure, social and economic status are frequent predisposing factors to mental and behavioral disorders. For example, domestic violence, sexual assault and the rising prevalence of divorces are the most common causes of mental health problems among the youth (American Psychiatric Association, 2013. Nonetheless, assessing and treating children and adolescents is very challenging. Psychiatric mental health nursing practitioners (PMHNPs) ought to be patient and diligent when practicing mental assessments to this type of clients.

Based on the YMH Boston Vignette 4 Video

What did the practitioner do well?

At the beginning of the session, the nursing practitioner expresses his respect for the nursing code of ethics, conduct and autonomy. This is a good approach since it assures the client of his protection and the nondisclosure of his/her health information. Additionally, the nursing practitioner was keen to establish a sense of rapport between himself and his client. This was necessary to necessitate voluntary and ease of information sharing.

In what areas can the practitioner improve?

The nursing practitioner fails to warm-up the client at the start of the interview. It is advisable to start with a casual conversation before jumping into the main point (Kaplan, 2016). Failure to this (as evident in the Boston Vignette 4 Video) the patient keeps his guard up and even suggest that his mother should answer some of the PMHNP’s question. Also, it is imperative to

apply cognitive testing to help determine the client’s mental status at the time of visit (Kaplan, 2016). Contrary to this aspect, the PMHNP appears more interested in the patient’s history than his current status. Ideally, the PMHNP should improve on the areas noted above.

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

 The nursing practitioner in the YMH Boston Vignette 4 Video seats causally and speaks rather sparingly. In comparison to the PMHNP in the YMH Boston vignette 1 video the practitioner seats and speaks directly to the client to capture his attention and cognitive status. This makes his client attentive unlike the patient in video 4. As a matter of facts, the practitioner shares a little enthusiasm in the client’s interests (basketball) to help improve the mood of the interview and consequently, derive more information (Merrell, 2013).

What would be your next question and why?

Question: Do you often lose temper on people other than your mum?

This question is necessary to help determine the specific triggers of the client’s anger. If the answer is ‘NO’, then it’s true that the mum triggers his anger through excessive pressure and nagging. However, if the answer is ‘YES’, then the frequent loss of temper would qualify as one of the symptom for mental health conditions such as intermittent explosive disorder (Kulper, Kleiman, McCloskey, Berman & Coccaro 2015).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Kaplan, B. J. (2016). Kaplan and Sadock’s Synopsis of Psychiatry. Behavioral Sciences/Clinical Psychiatry. Tijdschrift voor Psychiatrie, 58(1), 78-79.

Kulper, D. A., Kleiman, E. M., McCloskey, M. S., Berman, M. E., & Coccaro, E. F. (2015). The experience of aggressive outbursts in intermittent explosive disorder. Psychiatry research, 225(3), 710-715.

Merrell, K. (2013). Behavioral, social, and emotional assessment of children and adolescents. Routledge.

POST 2

Comprehensive Integrated Psychiatric Assessment of an adolescent

What did the practitioner do well?

In the YMH Boston Vignette 4 YouTube Video, the therapist was professional by telling the teenager at the beginning of the session of the right of confidentiality and privacy unless he has suicidal or homicidal thoughts. This information built a good rapport and trust with the client which then enabled him to share his feelings. The adolescent may be worried about confidentiality, and clinicians can reassure them that approval will be requested from them before any detailed information is shared with parents, except situations involving danger to self or others (Price, 2017). The practitioner built a good rapport with the client by making good eye contact, trying to focus more on the client and not the parents, as well as asking him about his hobbies. Rapport is built by enabling patients to feel easiness during stressful situations. The practitioner also does a good job as he allows the client to explore his feelings. “When adolescents become able to cope with the controversial and problematic situations, anger affects self-perception because it is displayed in a situation where individuals are restrained or challenged” (Lok & Bademli, 2018). Moreover, the practitioner asked about his school and by asking him about what he liked doing after school.

In what areas can the practitioner improve?

The therapist needs improvement is communication because he did not introduce himself to the patient at the beginning of the video. In addition, the therapist was not firm with his statements as he agreed mostly with the client putting faults oh his mother. The client just wants someone to listen to him which explains why he praised his girlfriend because she listens to him. The practitioner failed to find out why the client thinks his mom is irritating. Moreover, the practitioner needs to improve on listening skills as a lot of time was spent taking notes during the interview which can be distracting for both the therapist and the patients. The practitioner could have politely asked the patient if it is okay for him to take notes during the session and explain the reason for that.

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

A very important compelling concern is to inquire if the client feels safe at home with his mother. In addition, medications being taken by the client and psychiatric history and, lastly coping skills.

What would be your next question, and why?

I would ask the client about the possibility of having a family session which could be beneficial by making the people involved understand themselves more. It is important for the therapist to remain neutral and validate each family member`s feeling with the goal to improve communication among them and enable the therapist to develop an appropriate care plan for the client (Renee, & Ballas, 2018). Lastly, the next question would have been the practitioner to find out if the client is using drugs or having any suicidal or homicidal thoughts.

References

Lok, N., Bademli, K. (2018). The effects of anger management education on adolescents’ manner of displaying anger and self-esteem: A randomized controlled trial. Archives of Psychiatric Nursing. 32(1), p. 75-81.

Price, B. (2017). Developing patient rapport, trust, and therapeutic relationships. Nursing Standard. 31(50), p. 52-65.

Renee, W., & Ballas, P. (2018). Comprehensive Psychiatric Evaluation for Children. N.p.: University of Rochester Medical Center. Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02564

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

THE JOB IS TO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. WITH 2 COMPLETED REFERENCE IN APA WITH CITATION ABOVE 2013 PER COMMENT. 

POST 1

Individual vs. Family CBT

Cognitive behavioral therapy is short-term psychotherapy that emphasizes the need for attitude change in order to maintain and promote behavior modification (Nichols, 2014). Cognitive behavior therapy (CBT) has been found to be effective in a broad range of disorders. CBT can be done as an individual treatment or in a family setting. Individual CBT has a broadly defined framework with an emphasis on harm-reduction, especially with clients that have anxiety and substance abuse (Wheeler, 2014).

Cognitive-behavioral therapy for families is also brief and is solution-focused. Family CBT is focused on supporting members to act and think in a more adaptive manner, along with learning to make better decisions to create a friendlier, calmer family environment (Nichols, 2014). An example from practicum is a male (T.M) that participates in individual CBT once a week and family CBT once a week. T.M is struggling with alcoholism.

He originally presented for individual CBT because he had been “told by his wife” that he had a problem with alcohol. He reported that he drank “a few vodka drinks” three times a week but none for six weeks. Individual CBT therapy is a collaborative process between the therapist and client that takes schemas and physiology into consideration when deciding the plan of care (Wheeler, 2014). We worked with him using open-ended questions to assist with obtaining cognitive and situational information.  He would become angry easily and it was a felt that he was not being truthful about his alcohol use. Each time he was questioned about it, the story would change. He attended two individual sessions and it was then recommended he begin family CBT with his significant other (S.M) because “things were not going well at home.”

With family CBT, cognitions, emotions, and behaviors are seen as having a mutual influence on one another (Nichols, 2014). The first session was stressful, to say the least. T.M began talking about his alcohol use. S.M interrupted and said, “what about that one-time last month at the hotel. You were seeing things.” He became defensive, raised his voice, and said, “I was drugged. It had nothing to do with drinking.” She then looked down and was tearful. When he left the room to use the bathroom, S.M questioned if he could be tested for alcohol. This led the therapist to believe that T.M’s last use was not six weeks ago.

T.M’s automatic thoughts were that his alcoholism was not a problem in the marriage or in life. One of the core principles in using CBT for SUDs is that the substance of abuse serves as a reinforcement of behavior (McHugh et al., 2010). Over time, the positive and negative reinforcing agents become associated with daily activities. CBT tries to decrease these effects by improving the events associated with abstinence or by developing skills to assist with reduction (McHugh et al., 2010).

It was noticed that when T.M was alone, his stories would change. But when his wife was in the room, he would look at her while he spoke to ensure what he was saying was accurate. The therapist informed the client that it would be appropriate to continue individual therapy and family CBT once a week with the recommendation of joining the ready for change group. The CBT model for substance use states that, when a person is trying to maintain sobriety or reduce substance use, they are likely to have a relapse (Morin et al., 2017).

Ready for change meetings was recommended because like this week’s media showed, clients may relate to others that are going through similar situations. Getting T.M to realize that his alcohol use is a problem, is the primary goal currently. This example was shared because it shows the difficulties that may be encountered with psychotherapy and that both individual and family may be needed to ensure that goals are met. Some challenges that counselors face when using CBT in the family setting are wondering if the structure of the session and if the proper techniques were effective (Ringle et al., 2015). Evaluating and consulting with peers may also assist with meeting client and family goals.

References

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of North America, 33(3), 511-25. doi:10.1016/j.psc.2010.04.012

Morin, J., Harris, M., & Conrod, P.  (2017, October 05). A Review of CBT Treatments for Substance Use Disorders. Oxford Handbooks Online. Ed.  Retrieved fromhttp://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199935291.001.0001/oxfordhb-9780199935291-e-57.

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

Patterson, T. (2014). A Cognitive-Behavioral Systems Approach to Family Therapy. Journal of Family Psychotherapy, 25(2), 132–144. https://doi-org.ezp.waldenulibrary.org/10.1080/08975353.2014.910023

Ringle, V. A., Read, K. L., Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., & Beidas, R. S. (2015). Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. Psychiatric services (Washington, D.C.), 66(9), 938-45. doi:10.1176/appi.ps.201400134

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to

       guide for evidence-based practice. New York, NY: Springer.

POST 2

Cognitive Behavioral Therapy is one of the most effective psychotherapy approaches, whether it be used in group, family, or individual treatment. It is important to understand the purpose of it what its process consists off. It can be used to treat different mental health conditions, ranging from addiction to more severe illnesses. Its approach is to work with the patient into strategizing ways to change unhealthy thoughts and behaviors. Throughout the process, the patient not only learns solving skills, but also to re-evaluate and learn how to understand other’s perspectives, skill that helps build their confidence. 

           Some believe group therapy is more effective than individual therapy, as established by Kellett, Clarke, and Matthews (2007, p. 211). It has been established that CBT in general can be effective, but based on the Johnson Family Session video, it leads me to believe that either group/family or individual would be effective depending on the condition that is being treated. It is clear from the video that the girl who had been sexually assaulted at the fraternity does not believe talking or sharing her experience, even if it is with other girls who went through the same experience, will help in any way. She still has some internal issues that need to be addressed individually in order to make progress and get her to a place where she can participate in group/family therapy with an awareness that it will help her and purpose to it. Another important aspect of having a client be committed to the treatment is that research has showed “Poor compliance can adversely affect the remaining group members who may become worried or insecure” (Söchting, Lau, Ogrodniczuk, 2018, p. 185). 

 An example during practicum that supports my belief is the case of a terminally ill patient who had been recommended comfort care through hospice. She was ready to do so, understood and accepted her prognosis, but her daughters and husband were in denial. Every time they participated in a family session the patient held back on her wishes and verbalized whatever their wishes were as if they were her own. When treated as an individual client, she would express her concerns of not being able to “disappoint and abandon my family”. She had suffered all her life from anxiety, insecurities, severe depression, and low self-esteem. Those were issues that should have been addressed individually before she could fully engage in a family session in a healthy and productive way, if she would’ve had the time. CBT would have still been the choice of treatment for individual therapy for this client, as evidenced by Driessen et al. who stated it “is the psychotherapy method with the best evidence-base in the treatment of depression” (2017, p. 654). Not being fully engaged in the program, or believing the treatment will not help, or having other issues that need to be addressed on an individual basis, are all challenges presented in a family setting when relying on CBT. 

References

Kellett, S., Clarke, S., & Matthews, L. (2007). Delivering Group Psychoeducational CBT in 

 Primary Care: Comparing Outcomes with Individual CBT and Individual 

 Psychodynamic-Interpersonal Psychotherapy. British Journal of Clinical Psychology, 

           46(2). 

Söchting, I., Lau, M., & Ogrodniczuk, J. (2018). Predicting Compliance in Group CBT Using the 

 Group Therapy Questionnaire. International Journal of Group Psychotherapy, 68(2).

Driessen,E., Van, H. L., Peen, J., Don, F. J., Twisk, J. W. R., Cuijpers, P., & Dekker, J. J. M. 

           (2017). Cognitive-Behavioral Versus Psychodynamic Therapy for Major Depression: 

           Secondary Outcomes of a Randomized Clinical Trial. Journal of Consulting Clinical 

           Psychology, 85)7). 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

attach,attach too my assingment of unit 5 about the theory

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

When caring for pediatric patients, you do not just assess and treat the patient but rather the entire family unit. This often poses challenges for advanced practice nurses because of the dynamics of the various types of family units (i.e., two traditional parents, a single parent, same-sex parents, divorced parents, stepparents, adoptive families, foster families, military families, grandparents as the primary caregiver, etc.). Care strategies that might work for a two-parent family, for instance, might not work for a single-parent family or a foster family. Additionally, family units also present with differences in backgrounds, cultures, and religions. All of these factors have the potential to impact the care of patients and their families, making it essential for you to tailor your assessments and care plans to meet the individual needs of families.

Note:Throughout this course, the term parent will be used to represent a pediatric patient’s caregiver, which may include a parent, stepparent, foster parent, guardian, and so on.

To prepare:

• Review this week’s media presentation, as well as “Child and Family Health Assessment,” “Cultural Perspectives for Pediatric Primary Care,” and “Developmental Management in Pediatric Primary Care” in the Burns et al. text.
• Consider how a provider’s personal definition of family and family roles might impact the assessment of a child and the child’s family.
• Reflect on how the culture of the provider and/or the patient may further influence the assessment.
• Think about three strategies that a provider can use to assist families with making health-related decisions for children at different stages of growth and development. Consider how these strategies might change when assessing patients at different stages of growth and development and with different family backgrounds.

By Day 3

Post an explanation of how a provider’s personal definition of family and family roles might impact the assessment of a child and his or her family. Then, explain how culture (both the culture of the provider and that of the child and his or her family) may further influence the assessment. Finally, explain at least three strategies that the provider can use to assist families with making health-related decisions for children at different stages of growth and development. Also, explain how these strategies might change when assessing patients at different stages of growth and development and with different family backgrounds.

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"