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

Assessment in Child and Adolescent Psychiatry

            The assessment process of children and adolescents in psychiatry is vastly different than that of adults. Why is this? Oftentimes, children have the same emotional, cognitive, and behavioral deficits. In children and adolescents, however, the justification for behaviors isn’t always as easy to determine. Per the NIMH (2019), children are more difficult to diagnose because of their lack of understanding of their symptoms, withdrawn demeanor, and influence of external factors on their behaviors. Because of this, specific assessment tools are employed that differentiate child/adolescent assessments from that of adults. 

Why a Development Assessment of Children and Adolescents is Important

 Bellman, Byrne, and Sege (2013) suggest that behavioral deficits in adulthood are often correlated to developmental delays in childhood.  Likewise,  Shogren, et al. (2015) discussed a direct correlation to emotional support needs in children and adolescents with developmental disabilities and behavioral deficits in adulthood. Developmental delays aren’t always cognitive in nature. Developmental delays in children and adolescents can be cognitive, such as those caused by chromosomal disorders, or seizure disorders. Developmental delays can be social, emotional, or behavioral–such as autism disorder or attention-deficit hyperactivity disorder.  With certain developmental delays, alterations in brain development can affect the way these individuals process and react to information—causing difficulties in learning, communication, and interpersonal interactions (NYU Langone Health, 2019). Understanding which delays are present, if any, can assist in determining viable treatment options and potential behavioral concerns that may manifest. 

Two Assessment Instruments and Justification for Use in Children/Adolescents but Not Adults

            Two screening tools unique to the treatment of adolescents and children are as follows: The C-GAS and the HEADSSS questionnaire. The C-GAS, or Children’s Global Assessment Scale, is used for children and adolescents, ages 4-16, to determine any functional impairments that may exist (NSW Department of Health, 2015). This scale is not utilized in adults, because it specifically measures the child’s level of functioning in areas such as school, with peers, emotional functioning, and functioning within society (NSW Department of Health, 2015). The HEADSSS questionnaire, however, was developed to determine adolescent risk factors in the following areas: home, Education/employment, activities, drugs, sexuality, suicide/self-image, and safety (Heard Alliance, 2011). This assessment tool is used for adolescents only to determine specific risk factors in the child’s life. Afterall, certain risk factors can lead to at-risk behaviors. This assessment tool identifies those factors in hopes of establishing protective mechanisms. 

Two Treatment Options for Children/Adolescents that are Not Used in Adults

 There are several treatment modalities favored in the child/adolescent populations that are often not employed in adult mental health treatment. These include the use of parental participation and favoritism toward psychotherapy opposed to medication usage. Many psychotropic medications and other medications used in the mental health treatment of children and adolescents are based on evidence-based treatment regimens, opposed to actual pediatric dosing. In addition, side effects of medications warrant caution in younger age groups. Because of this, psychotherapy is the most highly recommended treatment option for children. Psychotherapy is equally utilized in adult psychiatric treatment. However, adult treatment is often augmented with psychopharmacological intervention. In addition, treatment for children entails frequent evaluation. For example, the NIMH (2019) proposed that the incorporation of “teaching skills” and “practicing skills” within the home are unique to child/adolescent psychiatric care. This requires frequent evalution to determine if these skills are resolving the child’s mental health concerns, whether it be improvements adacemically, improved social skills, or a decrease in disruptive behaviors. 

Parental Role in Assessment and Treatment of Children/Adolescents

 Parents play a major role in their child’s psychiatric care. Per Haine-Schlagel and Walsh (2015), the mental health of children and adolescents is largely influenced by their interpersonal interactions, family, and social life. A child’s family interactions and environment represents the largest contributor to childhood behavioral problems (Haine-Schlagel & Walsh, 2015). Because of this, Haine-Schlagel and Walsh (2015) discuss the importance of incorporating family, if possible, into the child’s psychiatric treatment. This can be accomplished through family therapy, or having educational sessions with the parents to discuss communication strategies, discipline strategies, and other helpful tactics. Per Haine-Schlagel and Walsh (2015), parental participation is often difficult related to feelings of “blame” or difficulty with understanding the therapeutic point of view (pg. 135). However, is is suggested that parental involvement is an evidence-based treatment modality– promoting child and adolescent treatment outcomes for a variety of disparities, including depression, defiant disorders, eating disorders, disruptive disorders, and childhood anxiety disorders. 

References

Bellman, M., Byrne, O., & Sege, R. (2013). Developmental Assessment of Children. British Journal of Medicine, 346(21), 31-35. Retrieved from Walden Library databases.

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. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433419/.

Heard Alliance. (2011). HEADSSS Assessment: Risk and Protective Factors. Retrieved from http://www.heardalliance.org/wp-content/uploads/2011/04/HEADSS.pdf

NIMH. (2019). Children and Mental Health: Is This Just a Stage? Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/publications/children-and-mental-health/index.shtml

NSW Department of Health. (2015). Children’s Global Assessment Scale (CGAS). Retrieved from http://www.thereachinstitute.org/images/CGAS.pdf

NYU Langone Health. (2019). Types of Developmental Delays in Children. Retrieved from Hassenfeld Children’s Hospital at NYU Lagone: https://nyulangone.org/conditions/developmental-delays-in-children/types

Shogren, K. A., Seo, H., Wehmeyer, M. L., Palmer, S. B., Thompson, J. R., Hughes, C., & Little, T. D. (2015). Support Needs of Children with Intellectual and Developmental Disabilities: Age-Related Implications for Assessment. Psychology in the Schools, 52(9), 874-891. Retrieved from Walden Library databases.

POST 2

Pediatric Screening, Treatment, and Parents Role in Mental Health

The human brain is amazing. Our brains continue to grow as we age, learn, and interact with our environment. The human brain is not fully formed until one’s early 20’s (Giedd, 2004). This means the brain appears different on imaging during different stages of childhood and adolescents. A child could be developing on time, then start deteriorating and losing milestones it once had. An assessment would be needed to identify areas the child was no longer developing on par in. The assessment would identify what is wrong, give a diagnosis which could open means to fund treatment and get the child back on course. Children and adolescents think differently from each other and adults. It is important to speak to these kids at their level, which is impossible to do unless the provider does a brief assessment of where the client is intellectually and emotional and developmental age. Then the provider can alter their approach to meet the client where they are at. How these kids think influences the approach to treatment.

Pediatric Assessments and Screening Tools

            The Vanderbilt Assessment Scale Parent Informant helps providers identify symptoms of ADHD. The questions listed address specific symptoms that occur in childhood ADHD, like climbing on things and running around when supposed to be sitting. If this tool was used on adults, adult ADHD could be missed because the Vanderbilt Assessment Scale Parent Informant does not target adult ADHD’s symptoms thus missing key symptoms of ADHD in adults. Adults might not climb on the furniture, but they may be forgetful and disorganized a lot.

 CRAFFT is a screening tool for risky behaviors associated with substances. This tool addresses risky behavior teens may take part in. Alcohol is illegal for teens to consume, but adults can legally drink. What is considered a risky behavior for teens may not be for adults. CRAFFT is not ideal for adults. There are other assessment tools specific to the risky behaviors adult present. Leslie (2008) stressed the importance of routine screening for substances and risky behavior among teens. CRAFFT was found to be a valid screening tool to identify substance-related problems and disorders (Knight, Sherritt, Shrier, Harris, & Chang, 2002).

Pediatric Treatment Options

            Play therapy is a type of therapy targeting the developmental age of the client. One large meta-analysis found play therapy to be efficacious and equally effective across ages, gender and presenting problems (Bratton, Ray, Rhine, & Jones, 2005). The greatest improvement was seen when parents were involved with play therapy (Bratton et al., 2005).

            Many studies use elementary school as the medium or location to treat children. Prevention of negative outcomes is a common theme in schools. Children have little to no control over their home environment. So public schools have made changes to help students have higher chances of succeeding. Mental health problems prevention strategies can be implemented in schools. There is often a psychotherapist in the school and a free period at school to allow teens to make up homework that was not done at home. Tol, Komproe, Susanty, Jordans, … & De Jong (2008) conducted multiple control trials with interventions targeting mental health in schools for kids affected by political violence. The unique aspect of providing interventions and treatment in school is it is a safe, consistent, structured environment the child attends on a regular basis. And there are plenty of adults in the school that may be able to help with the interventions. 

            School is an ideal location to promote healthy development in children and provide prevention interventions to help children have positive outcomes. Adults are not treated like this. There is not one location nearly everyone goes to on a regular basis, which is a consistently safe environment. Adults work at different businesses and on different days. Often, mental health prevention is not addressed in adults to the degree it is in children and adolescents.

Parent’s Role in Treatment

Parents are vital when working with children and adolescents. When parents are involved and support their child, the child has better chances of succeeding and healing. One way parents can help is by providing information to practitioners in the form of screening and assessment dah data. Parents may need to give feedback because the client lacks insight, awareness, ability to express or even define complex feelings. The parent can provide assessment tools or screening tools to the child’s teacher, thus allowing for more data to be gathered in another environment the child is in.

Parents can also encourage teens to participate in the assessment. Parents may bring up symptoms or events the teen or child does not want to talk about, allowing for more data or an alternate perspective on their situation. Information gathered from parents of adolescents may or may not be accurate because teens often filter details of their lives to parents. 

Parents can help children and teens follow through getting needed treatment, provide reminders and transportation to their children, and refill prescriptions.

Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice, 36(4), 376.

Giedd, J. N. (2004). Structural magnetic resonance imaging of the adolescent brain. Annals of the new york academy of sciences, 1021(1), 77-85.

Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of pediatrics & adolescent medicine, 156(6), 607-614. 

Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J., Macy, R. D., & De Jong, J. T. (2008). School-based mental health intervention for children affected by political violence in Indonesia: a cluster randomized trial. Jama, 300(6), 655-662.Leslie, K. (2008). Youth substance use and abuse: challenges and strategies for identification and intervention. Cmaj, 178(2), 145-148.

 

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Initial Discussion Post: Choose one of the primary source documents from the topic list below. Using the primary source reading, answer the following questions. Use this template provided to complete the assignment.

1. Context (25 points):
   1. Name of the document you chose to analyze
   2. Who is the creator of the document?
   3. Briefly describe the creator of the document. (To answer this question, you may need to use information obtained from the introduction to the source, or other course materials such as the Lib Guide, Intellipath, or your Instructor.)
   4. When and where was the document created? (Again, you may need to use information obtained from the introduction to the source, or other course materials such as the Lib Guide, Intellipath, or your Instructor.)
2. Summary (30 points):
   1. Write a brief summary of the source. (What is the topic or issue of the source? What are the creator’s main points about that topic? What is one interesting thing said in this source?) 
3. Connections (30 points):
   1. How does this source connect to the Unit 4 Learning Material? How does it help you better understand that moment in American History? (Here you want to think about how this source fits into the other material for the unit in the Lib Guide, Intellipath, or your Instructor.)
      Does this source support what you already know about the topic? If so, how? Or does this source change the way you think about this topic? If so, how?
4. Issue Today (25 points)
   1. Identify how the issue in the document relates to American life today. You will want to use specific examples to explain your points. Reagan, R. (1981). Remarks on Signing the Economic Recovery Tax Act of 1981 and the Omnibus Budget Reconciliation Act of 1981, and a Question and Answer Session with Reporters. Retrieved from The American Presidency Project: https://www.presidency.ucsb.edu/documents/remarks-signing-the-economic-recovery-tax-act-1981-and-the-omnibus-budget-reconciliation

Bush, G. H. (1990). Iraqi Aggression in Kuwait. Speech before the United Nations General Assembly. (See PDF)

Buchanan, P. J. (1992). Address to the Republican National Convention. Retrieved from American Yawp http://www.americanyawp.com/reader/29-the-triumph-of-the-right/pat-buchanan-on-the-culture-war-1992/

Reagan, R. (1987). Tear Down this Wall. Retrieved from The History Place: Great Speeches Collection: http://www.historyplace.com/speeches/reagan-tear-down.htm

 

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Ethical Resource Allocation

Work through the simulation titled Resource Allocation from the end of Chapter 8 of your course text.  Review the various options in the simulation, then select “Your Own Option” to type out your own solution to the scenario.  You will need to copy and paste your response from “Your Own Option” into the discussion board forum.  Here is a brief synopsis of the simulation regarding the hospital’s budget and dilemma:

Hospital costs in millions for one year:

• One 35-year-old cancer patient who needs significant time with the doctor, medical supplies, tests, and around the clock care: Cost: 100
• Emergency Room operations for daily care and treatment of about 100 people (~365,000/year) Cost: 100
• 2 Senior Patients who need hip replacement surgery. Cost: 50
• 10 patients (ranging in age from 18 to 45) receiving assistance in your inpatient drug/alcohol rehab unit: 100
• An MRI unit that is on the fritz and could die any day. Replacement Cost: 170
• One of your two X-ray machines is inoperable and must be replaced: Cost 100
• Ambulance drive-in area was damaged and needs to be repaired: Cost: 25
• Training needs for nursing staff for certification requirements: Cost: 55
• TOTAL: $700 million

For this discussion, address the following:

• You have $700 million in expenses and only $500 million to work with. How do allocate your resources?
• Who gets treated and who has to wait?
• What about your facilities?
• Determine what you plan to do and explain your reasoning as well as the ethical considerations behind your decision.

Your initial response must be at least 250 words and must use at least two scholarly sources.

 

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3 paragraphs due in 24 hours.

Overview: 

Develop a position statement regarding whether you would consider participating in a clinical trial related to heart disease.  Simply look at the pros and cons to determine which would persuade your decision and write 3-4 paragraphs to defend your position. Be sure to include at least one citation to support your work.

Breakdown:

Heart Disease Assignment

1. Review the following websites to gain an understanding of the #1 threat to women:

 http://www.consultant360.com/content/heart-disease-women

 https://www.yourethecure.org/     Explore You’re the Cure to gain better understanding.

1. Review the booklet: http://www.healthyheartsforwomen.com/whd/#/1 with close review of page 31.
2. Read the following to become more aware of the historical disparity in clinical trial that have likely had impact ;on the diagnosing and treatment of heart disease in women.  

Women make up just over half the US population and should not be considered a special, minority population, but rather an equal gender whose health needs require equal research efforts as those for men. Historically, however, the health needs of women, apart from reproductive concerns, have lagged in medical research. In 1985, the Public Health Service Task Force on Women’s Health Issues concluded that “the historical lack of research focus on women’s health concerns has compromised the quality of health information available to women as well as the health care they receive.” Since the publication of that report, there has been a transformation in women’s health research—including changes in government support of research, in policies, in regulations, and in organization—that has resulted in the generation of new scientific knowledge about women’s health. Offices on women’s health have been established in a number of government agencies.1Government reports and reports from other organizations, including the Institute of Medicine (IOM), have highlighted the need for, and tracked the progress of, the inclusion of women in health research. A number of nongovernment organizations have also provided leadership in research in women’s health. And women as advocates, research subjects, researchers, clinicians, administrators, and US representatives and senators have played a major role in building a women’s health movement. A number of non-governmental organizations have also provided leadership in research in women’s health. And women as advocates, research subjects, researchers, clinicians, administrators, and US representatives and senators have played a major role in building a women’s health movement.  

Institute Of Medicine, Committee on Women’s Health Research (2010). Women’s Health Research: Progress, Pitfalls, and Promises. http://www.nap.edu/openbook.php?record_id=12908&page=1.

4.  Review: http://www.fda.gov/forpatients/clinicaltrials/default.htm then develop a position statement regarding whether you would consider participating in a clinical trial related to heart disease.  Simply look at the pros and cons to determine which would persuade your decision and write 3-4 paragraphs to defend your position. Be sure to include at least one citation to support your work.

 

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Primary Task Response: Within the Discussion Board area, write 250-350 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

How healthcare services are provided is constantly changing.  While historically, emergency departments (ED) was physically located within the hospital building, the standalone Emergency Department also referred to as the Free Standing Emergency Department (FSED) has become a new model for delivery of emergency services within communities.   Consider yourself in the role of a consultant to a healthcare organization, financial manager, or ED administrative director. You have been asked to provide the CEO and leadership with pros and cons of establishing a Free Standing Emergency Department.  You are aware of the news stories about these types of facilities, and you will want to review The Washington Post article at this link as you prepare your review.

Include in your discussion:

• Differences between off campus emergency departments (OCEDs) and independent free standing emergency centers (IFECs).  What would be the advantage to the healthcare organization of an OCED?
• How would services provided be reimbursed either by private insurance or Medicare/Medicaid?
• What are the advantages or disadvantages to the community of an FSED?  Would members of the community favor an OCED or an IFEC?
• Why are most of the FSEDs located in Texas, Colorado and Ohio?
• Based on your research and the news stories about FSEDs, what would you recommend to the CEO and Board of Directors?

NOTE: Use at least two scholarly references and cite using APA format.

 

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