RileyDMFT6104-9

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6104

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Psychology

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Dec 6, 2023

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Week 9: Mock Call with a Physician Danae Riley School of Social and Behavioral Sciences, Northcentral University MFT-6104 v2: Family Therapy with Children Dr. Chisato Hotta December 30, 2022

Outline This transcript depicts an interaction between myself, an MFT, and a physician I am hoping to collaborate with. I am seeing an 8-year-old boy named Peter who is presenting with symptomology indicative of ADHD. I am seeking to understand from his physician whether he has had any prior medical history that would bear weight on any of my decisions for treatment and I also want to be sure that I am including his physician in my recommendations for treatment to ensure that he not only agrees with the go-forward plan, but also to ensure that he has a proper holistic treatment history documented on his end. Peter is the middle child of three boys, all of whom I have met in my initial few sessions with their parents, Susan, and Greg. Transcript Doctor Ring: Hello, this is Dr. Ring. Me: Good morning, Dr. Ring. My name is Danae Riley, and I am a Licensed Marriage and Family Therapist. I have recently begun working with one of your patients, Peter Stevenson, and I wanted to reach out to you regarding a few questions I have about his medical history. Peter’s birthdate is November 23, 2014. His parents Susan and Greg have both consented to the release of his medical records. Doctor Ring: Not a problem. Have you sent over the consent forms yet? Me: Yes, I faxed them over to you about an hour ago from my office, R & R Therapy Group. Doctor Ring: Perfect. I see those now. I have a few minutes right now, so let me pull up his file and we can discuss any questions you have. Me: That’s great, thank you so much for your time today – I really appreciate it. Doctor Ring: Not a problem. I am ready when you are. Me: Great. The background here is that Susan and Greg are concerned that Peter is showing symptoms of ADHD. I have had three sessions with the entire family so far, and during those sessions I have noticed that James is trying to stay engaged in the sessions, but he is quickly

distracted and seems to have emotional outburst when his parents attempt to keep him in one place as we discuss some of the family background and symptomology that concerns them. Peter shared in our last session that he has lots of friends, but he hates school because it’s boring. He also mentioned that his parents yell at him too much, and I am definitely seeing the frustration they are facing with their seemingly useless attempts to keep him in one place or focused, Doctor Ring: That is all interesting. Susan and Greg have mentioned that Peter is a high-strung child and have commented on him being more active than their other children, but it has not been brought to my attention that they have actual concerns about this diagnosis. Based on your early assessment, what are your thoughts? Me: Well, I am curious about his medical history. Has there been any former treatment or assessment findings that would indicate anything outside of the norm or that may impact my treatment planning with Peter? I want to be sure that I am getting a holistic picture of his health prior to moving forward with medication, or psychotherapy recommendations. Doctor Ring: From my perspective, he seems to be reasonably behaved in my office. However, he has had a few injuries throughout his childhood that resulted from risky behaviors that mad be an indication. He broke his ankle after climbing a tree and jumping out of it to scare his brothers and he also, just a year later, was assessed for head trauma which he needed stitches for following his attempt to do a backflip off the side of his pool. Me: That definitely alludes to some of the symptomology common to ADHD, so that is helpful information. His parents mentioned as well that he consistently struggles to stay on task when asked to do things, and that he doesn’t seem to even hear them when they are asking him to do things. They are concerned as well because his teachers have recently brought up behavioral challenges that they are noticing along with mention of his schoolwork not being completed.

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Doctor Ring: Yeah, with all of these indicators, I think some formal assessments are warranted, and based on the results we can move forward with medication recommendations if needed. Did you discuss options with the parents yet if we do determine ADHD diagnosis? Me: I talked through the different treatment options available to them and let them know you and I would partner together on medication recommendations which they seemed open to. They had concerns about side-effects which we can provide more specifics on when or if we get to that point. Until then, I will work through the psychotherapy treatment and collaborate with his school to gain more insight into behavior in another setting and will do some formal testing with Peter and his parents in our session this Thursday. I plan on using the ADHD Rating Scale and the Child Behavior Checklist (Pliszka, 2007). Have any other concerns come up at all during your time treating him? Any developmental concerns, sleeping issues, depression or anxiety symptoms, or anything else that we should consider as a possible condition? Or that may be a comorbidity to consider? Doctor Ring: Nothing that I have recorded here would indicate any of those concerns to me, but as you continue to assess him and work with the family, I would love to be updated on your findings so we can collaborate moving forward on a medical and mental health plan that works together to give Peter the best outcomes. Me: Absolutely. I will keep you updated as I work with the family. In fact, I will contact the school today or tomorrow to get their perspective and following my session with the family on Thursday I should be able to give you a more definitive diagnostic update. At this point, based on my observations of Peter in my office, I do feel that an ADHD diagnosis is likely, but I will get the formal assessments completed and will let you know definitively Friday. Given the high likelihood of comorbidity with Oppositional Defiance Disorder, I will also assess for that (Pliszka, 2007).

Doctor Ring: That sounds like a good plan. Based on this diagnosis, what would your typical treatment planning look like? Me: I have already begun Psychoeducation with Peter and his family about what may be causing these behaviors, but a diagnosis can at times help families feel a sense of relief, knowing that there are successful treatment options available, especially with detection this young. Discussions about heritability and other genetic factors will hopefully allow Susan and Greg to see that this is not something that they need to blame themselves for, which is common for parents (Pliszka, 2007). Given that ADHD has no cure per say, we will discuss the lifelong care management planning and skill development for me and the family to work on to help them cope with Peter’s diagnosis, allowing them to have a more positive and cohesive family system. I will let them know that you and I are working together on medication recommendations and that I will also help them to facilitate proper accommodation at Peter’s school if they would like my help. My strong recommendation with ADHD kids is a combination of medication and psychotherapy inclusive of skill training with parents, so if they are open to this approach, I would lean on you for your expertise in dosage recommendations for Peter (Pliszka, 2007). Doctor Ring: That sounds like a great plan. I prefer working in a multi-modal approach as well with these cases, so I appreciate your outreach early on and looking forward to working with you moving forward. Me: Although Peter’s parents seem to be onboard with discussions about medication, I know that adherence to proper medication recommendations can be tough to consistently maintain for some families, so I am curious to know your stance on medication so that we can work together to share the same message with Susan and Greg on what to expect when starting their child on a new medication (Waterman et al., 2015). Doctor Ring: ADHD has very positive outcomes from my perspective when using dual treatment of psychopharmacology and behavioral therapy, so I fully agree this would be the best course of

action for us to start with (Pliszka, 2007). I appreciate you asking these kinds of questions as well, because there has been some resistance to medication from parents and I have had challenges in the past with former patients getting mixed messages from other health providers causing them to stop taking their medication. I think that this partnership in holistic care for Peter will be beneficial for the family to feel fully supported and for us to work as a team on making sure that all aspects of his managed care are monitored successfully (Fox et al., 2012). Me: I appreciate your partnership a well, Dr Ring. Thank you so much for your time today. I will talk to you again on Friday with the updates. I hope you have a wonderful rest of your day. Doctor Ring: Thank you Danae, you as well. Goodbye. Me: Goodbye. Reflection This collaborative communication with the physician is core to the success of the client outcomes and ensures that with multiple health providers being in sync with treatment recommendations, the parents and child are more likely to follow through with the recommended medication and/or therapy (Clark et al., 2009). A few things to consider when looking at this mock interview versus the roadblocks typically experienced in real life include, busy schedules, differences in opinions for treatment recommendations, or medical history which may challenge the original assessment. Physicians are incredibly busy, as are most mental healthcare providers, so coordinating times to discuss client histories and recommended treatment plans may take numerous attempts. Therefore, there are benefits to collaborative care options inclusive of mental health providers joining physicians in a hospital setting versus independently of one another (Bischoff et al., 2012). This mock call also depicted a very agreeable and accommodating physician whereas sometimes, certain diagnoses may cause some disagreement, or challenging of treatment recommendations from the perspective of a medical practitioner versus a mental health

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specialist. Finally, the medical history in this case helped to solidify the originally expected diagnosis in this case. That may not always be true which could indicate a need to re-evaluate your original assessment and/or treatment plan. As an example, the review of a medical history may show comorbid diagnoses requiring more tailored accommodations to medication side- effects, or further discussion with the physician about dosage changes, different medication options, or other treatment options altogether. Clients should be seen as whole people. Their mind and body function together and as such, the specialists in each of those care options should be working together in a collaborative fashion to ensure that the treatment makes sense holistically and that they feel secure and supported by a team focused on their general health and wellbeing.

References Bischoff, R. J., Springer, P. R., Reisbig, A. M. J., Lyons, S., & Likcani, A. (2012). Training for collaboration: collaborative practice skills for mental health professionals. Journal of Marital and Family Therapy , 38 Suppl 1, 199–210. https://doi.org/10.1111/j.1752- 0606.2012.00299.x Clark, R. E., Linville, D., & Rosen, K. H. (2009). A national survey of family physicians: perspectives on collaboration with marriage and family therapists. Journal of Marital and Family Therapy , 35(2), 220–230. https://doi.org/10.1111/j.1752-0606.2009.00107.x Fantini, F., Aschieri, F., & Bertrando, P. (2013). “Is Our Daughter Crazy or Bad?”: A Case Study of Therapeutic Assessment with Children. Contemporary Family Therapy: An International Journal , 35(4), 731–744. https://doi.org/10.1007/s10591-013-9265-3 Fox, M., Hodgson, J., & Lamson, A. (2012). Integration: Opportunities and Challenges for Family Therapists in Primary Care. Contemporary Family Therapy: An International Journal , 34(2), 228–243. https://doi.org/10.1007/s10591-012-9189-3 Pliszka, S., M.D. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 894-921. doi:10.1097/chi.0b013e318054e724 Waterman, Y., Hales, L., & Glackin, M. (2015). Prescribing for children and adolescents in mental health. Nurse Prescribing , 13(6), 296–300. https://doi.org/10.12968/npre.2015.13.6.296

RileyDMFT6104-9

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