The practitioner did several things well in conducting a psychiatric assessment of an adolescent client. The practitioner established trust and rapport by explaining confidentiality and privacy rights upfront. However, there are also some areas for improvement. The practitioner needs to improve communication skills, such as introducing themselves, and active listening skills. It would also be important to inquire about safety at home, medications, psychiatric history, coping skills, the possibility of family therapy, and screening for suicidal or homicidal thoughts.

1. 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

2. 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

3. 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

4. (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

5. 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

6. 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?Con
tentTypeID=90&ContentID=P02564