From the Guidelines
The recommended approach for a psychiatry interview in a pediatric unit involves creating a comfortable, developmentally appropriate environment while using a flexible interview structure, as outlined in the 2019 study on mental health competencies for pediatric practice 1.
Key Components of the Interview
- Establishing rapport with both the child and parents, explaining the purpose of the meeting in age-appropriate language
- Including separate time with the child alone (if age-appropriate) and with parents, gathering information about presenting concerns, developmental history, family dynamics, school functioning, and social relationships
- Using play techniques, drawing, or storytelling with younger children to facilitate communication, while direct questioning may be more effective with adolescents
- Paying attention to non-verbal cues and behavioral observations throughout the interaction
- Adapting mental status assessment to the child's developmental stage, focusing on appearance, behavior, mood, thought processes, and cognitive functioning
- Maintaining a warm, non-judgmental demeanor while setting appropriate boundaries
Importance of Family Context
The family context plays a crucial role in pediatric mental health, and the interview should take this into account, as noted in the 2007 study on practice parameter for the assessment of the family 1.
- Gathering information about family dynamics and relationships
- Assessing the impact of family factors on the child's mental health
- Involving parents in the treatment plan and providing them with support and guidance
Developmental Considerations
The interview should be tailored to the child's developmental stage, as outlined in the 2020 study on practice parameter for the assessment and treatment of psychiatric disorders in children and adolescents with intellectual disability 1.
- Using developmentally appropriate language and techniques
- Adapting the interview structure to the child's attention span and cognitive abilities
- Considering the child's developmental stage when assessing mental status and diagnosing psychiatric disorders
Risk Assessment and Management
The interview should also include an assessment of risk, particularly for suicidal ideation or behavior, as noted in the 2016 study on suicide and suicide attempts in adolescents 1.
- Asking about suicidal thoughts or behaviors
- Assessing the child's risk factors for suicide, such as depression, substance use, or trauma
- Developing a safety plan with the child and parents, including removing access to lethal means and providing crisis resources.
From the Research
Recommended Approach for Psychiatry Interview in Pediatric Unit
The approach to a psychiatry interview in a pediatric unit should be tailored to the child's developmental level and abilities.
- The interview should be semi-structured and include open-ended questions to gather clinically relevant information about the child's presenting problems, behavior, affect, temporal details, thoughts, people, environment, and physical experiences 2.
- The assessment process should focus on the child's emotional, cognitive, physical, and behavioral functioning, and should include interviews with both the child and their parents 3.
- The interviewer should consider the child's cognitive, social, and emotional maturity when assessing their mental health problems and developing a treatment plan 4.
- Different styles of psychiatric interviews, such as the Diagnostic Interview Schedule for Children (DISC), the Child and Adolescent Psychiatric Assessment (CAPA), and the Development and Well-Being Assessment (DAWBA), may be used, and the choice of interview style may depend on the specific needs of the child and the goals of the assessment 5.
Factors to Consider in Psychiatry Interview
- The presence of parental depression/anxiety and possible child abuse may be associated with higher rates of psychiatric disorders in children 6.
- Financial stress and single parenthood may be factors related to seeking mental health services for children 6.
- The pediatrician's role in identifying and referring children with psychiatric disorders is important, and routine screening may be a useful method for improving rates of identification and referral 6.
- The interviewer should be aware of the potential for false-negative results and take steps to ensure that the assessment is comprehensive and accurate 5.