To determine treatment--Multidisciplinary team assesses each child's strengths, weaknesses

To determine treatment
Multidisciplinary team assesses each child's strengths, weaknesses

by John Hendrickson, M.D., Medical Director, Bridges Treatment Center

Children and staff psychiatrists alike benefit from ongoing multidisciplinary assessments at Bridges Treatment Center. Multiple clinicians from various disciplines work together as a team to conduct ongoing assessments, providing different perspectives of a child's psychiatric issues and insight into the best course of treatment.

Initially, treatment is determined by a team assessment during the first two weeks of a child's admission, followed by a comprehensive staffing meeting during which the assessments are discussed. Monthly reviews and discussions regarding the child's progress continue throughout the child's stay at Bridges.

The first two weeks of the child's stay include:

A full psychiatric assessment within the first 24 hours by one of four board-certified child psychiatrists at Bridges. This evaluation includes the history of the child's present illness or reason for admission, previous treatment, past psychiatric illnesses, medications, allergies, social history aspects such as family dynamics, history of abuse or neglect, hobbies, peer interaction, substance abuse and developmental, legal and educational histories. The psychiatrist conducts a formal mental status exam at which time the formal diagnosis is made. The psychiatrist then initiates an initial treatment plan until the comprehensive staffing meeting when a more formal treatment plan is determined.

Nursing/medical assessment. Timberlake Family Physicians focuses on the medical health of the child.

Family therapy session. Family dynamics are assessed during this session held during the first week after admission.

Psychosocial assessment by the child's primary therapist, who is a licensed clinical social worker, a licensed professional counselor or a psychologist. The therapist evaluates the patient's initial presentation in individual therapy, family dynamics, the patient's and family's perception of the problem, strengths the child brings to treatment and the family's social history (parental background, family history of psychiatric illnesses, etc.)

A milieu assessment by the cottage coordinator. The child's day-to-day peer interaction, response to authority, room organization, hygiene, leisure activities, table manners and telephone communication with family members are evaluated.

Group therapy assessment. The therapist reviews the child's performance in the group therapy setting, including willingness to talk about their issues, feedback to peers, reaction to being redirected or limited.

Educational assessment. Behaviors, assignments, special education services, functionality at the current grade level are assessed, and a speech screening is conducted.

Psychological assessment, if necessary. If clarification of the diagnosis is needed, a psychologist evaluates a patient's intellectual functioning, IQ and personality style.

The assessments are compiled into a report and presented at the comprehensive staff meeting, which is also attended by family members and referral sources. The review results in the identification of the child's three major problem areas, from which the treatment plan, objectives and intervention techniques are determined. An Initial Interdisciplinary Assessment Summary, a compilation of each assessment, is generated and sent to the family members and referral sources.

The treatment team convenes monthly and reviews and updates each child's treatment plan. A staffing meeting is held quarterly, and family members and referral sources are invited. The diagnoses are reviewed, and issues such as length of stay are discussed. Prior to discharge, an exit staffing meeting is held at which time aftercare is discussed.

John Hendrickson, M.D., is a child and adolescent and general adult psychiatrist with Centra Health's Piedmont Psychiatric Center. He is medical director of Centra Health's Bridges Treatment Center. Dr. Hendrickson earned his medical degree from the Medical College of Virginia, where he also completed his residency in adult psychiatry and a two-year fellowship in child and adolescent psychiatry. He is board certified in general adult psychiatry and child and adolescent psychiatry. His specialty services include psychiatric assessment, medication management, insight-oriented and supportive psychotherapy.