Discussion | NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent | Walden University



The importance of a developmental assessment of children and adolescents 

Child and adolescent development is characterized as a continuous, predictable sequence of biological, psychological, and emotional changes that occur between birth and the end of adolescence (Choo et al., 2019). Specific developmental milestones are used as guidelines to gauge the child’s functioning level within their given age group. By performing a developmental assessment, clinicians can track growth and engagement patterns and identify developmental problems that will require the implementation of interventions to improve the child’s functioning. Determining the extent to which behaviors and experiences are appropriate for a child’s age and stage of development is critical in evaluating mental health conditions. Effective screening and assessment maximize the potential to direct patients and their families to the help they need before problems become entrenched (American Academy of Child & Adolescent Psychiatry [AACAP], n.d.). Awareness of a pediatric patient’s development enables caregivers and clinicians to perceive the world from their perspective. Individualized care is best achieved when the provider’s interaction is based on the patient’s developmental level.

Description of two assessment instruments used for children and adolescents but not adults

BASC-3 Behavioral and Emotional Screening System (BASC-3 BESS)

The BASC-3 BESS is a quick and reliable, systematic tool to determine behavioral and emotional strengths and weaknesses of children and adolescents from preschool through high school (3 to 18 years) (Evidence-based Intervention Network, 2011). This assessment has three forms: parent and teacher forms (ages 3 to 18 years) and the student self-report form (ages 8 to 18 years). The screening tool uses a Likert scale to assess four dimensions of behavioral and emotional functioning, which includes internalizing problems, externalizing problems, school problems, and adaptive skills (Evidence-based Intervention Network, 2011). The tool has 25 to 30 items depending on the form in use. A T-score of 60 or below indicates normal risk level; 61 to 70 indicates elevated risk; and above 71 indicates extremely elevated risk level that may require support planning from a behavioral specialist (DiStefano et al., 2013).  

Ages and Stages Questionnaire-Social Emotional (ASQ-SE)

The ASQ-SE is a highly reliable, parent-administered screening tool that assesses children’s social and emotional development between 3 to 66 months. It looks at the domains of self-regulation, communication, autonomy, compliance, adaptive functioning, affect, and social interaction. The assessment results can determine if a referral for intervention services is necessary (California Evidence-based Clearinghouse for Child Welfare [CEBC], 2015). The test is broken down into age ranges, with cutoff scores varying by age. Scores above the cutoff for age indicates that a mental health assessment is warranted for the child (Squires & Bricker, 2009).

Describe two treatment options for children and adolescents that may not be used for treating adults

Child-centered Play Therapy (CCPT) is an effective treatment option for children ages 3 to 10 years experiencing social, emotional, behavioral, and relational problems (CEBC, 2019). In the pediatric population, language development lags behind cognitive development. Play therapy is an effective intervention to allow children to communicate their awareness within their world. Emotionally significant experiences can be expressed through the symbolic representation toys provide. Anxieties, fears, fantasies, and guilt are transferred to objects rather than people (Wilson & Ray, 2018). Therapeutic interactions and a therapeutic environment that includes play and symbols allow the child to experience full acceptance, empathy, and understanding while processing inner feelings and experiences (CEBC, 2019). The goal of CCPT is to decrease symptomatic behaviors and improve the child’s overall functioning.

Multisystemic Therapy (MST) was developed to address risk factors among children and adolescents with serious externalizing problems at-risk for out-of-home placement (Henggeler et al., 2009). Children and teens are conceptualized by their family, social, school, and community systems. MST uses a home-based model that limits treatment barriers, such as limited access to transportation, lack of childcare, or parent work hour restrictions. Young clients are treated within their real-world settings. The MST providers work with the client, their families, and the school community to encourage adherence to the nine core principles. Interventions are developed to eliminate drivers that influence undesirable behaviors and symptoms. Examples of effective interventions include reframing negative behaviors and family interactions, emphasizing familial strengths, and contingency management. The treatment duration is typically four to six months, in which the MST team is available to families on a 24-hour basis through an on-call rotation (Zajac, Randall, & Swenson, 2015). 

Explain the roles parents play in assessment and treatment

According to Sadock, Sadock, and Ruiz (2014), it is necessary to involve parents in the assessment process to get a chronological picture of the child’s growth and development, details of stressors or important events, accurate family history, and their perspective of the family dynamic. Parents also help make informed decisions about goals and treatments. Many studies show that parent participation in treatment improves client outcomes. Empowered with information and strategies, parents increase compliance through assisting their child in treatment engagement, learning new skills, and becoming more independent (Haine-Schlagel & Walsh, 2015). Parent participation is needed to continue the intervention delivery within the home.


AACAP. (n.d.). Assessment of young children. Retrieved on December 9, 2020, 

     from https://www.aacap.org/AACAP/Member_Resources/AACAP_Committees/Infant_and_


CEBC. (2015). Ages & stages questionnaire: Social-emotional (ASQ-SE). Retrieved 

     on December 9, 2020, from https://www.cebc4cw.org/assessment-tool/ages-stages-


CEBC. (2019). Child-centered play therapy (CCPT). Retrieved on December 9, 2020, 

     from https://www.cebc4cw.org/program/child-centered-play-therapy-ccpt/

Choo, Y. Y., Yeleswarapu, S. P., How, C. H., & Agarwal, P. (2019). Developmental 

     assessment: Practice tips for primary care physicians. Singapore Medical Journal

     60(2), 57-62.

DiStefano, C., Greer, F. W., & Kamphaus, R. W. (2013). Multifactor modeling of emotional 

     and behavioral risk of preschool-age children. Psychological Assessment, 25(2), 467-476.

Evidence-based Intervention Network. (2011). Behavioral and emotional screening 

     system (BESS). Retrieved on December 9, 2020, 

     from https://ebi.missouri.edu/wp-content/uploads/2014/03/EBA-Brief-BESS.pdf

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.

Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, 

     P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents 

     (2nd ed.). New York: Guilford. 

Squires, J, & Bricker, D. (2009). Ages & stages questionnaires (ASQ-3) (3rd ed.). 

     Baltimore, MD: Brookes Publishing. 

Wilson, B. J., & Ray, D. (2018). Child-centered play therapy: Aggression, empathy, 

     and self-regulation. Journal of Counseling & Development, 96, 399-409.

Zajac, K., Randall, J., & Swenson, C. C. (2015). Multisystemic therapy for externalizing 

     youth. Child and Adolescent Psychiatric Clinics of North America, 24(3), 601-616. 

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