suicidal thoughts and potential self-harm behaviors.
The immediate health assessment priority for Emily is ensuring her safety concerning her suicidal thoughts and potential self-harm behaviors. Addressing acute risk factors is critical to prevent any immediate harm and to stabilize her mental health condition. As discussed by Browne et al. (2020), assessing the severity of mental health conditions is equally important in preventing progression and long-term health consequences.
Interdisciplinary Approach
We would need to involve multiple disciplines to address Emily’s medical and mental health conditions. These disciplines include:
Mental Health Specialist: To provide cognitive behavioral therapy and assess the need for pharmacological intervention.
School Counselor: To monitor her school environment, address bullying, and offer support for social reintegration.
Social Worker: To assist Emily’s family in accessing community resources, financial aid programs, and potentially Medicaid or other state-sponsored programs. Bywaters et al. (2020) mentioned that social workers help mitigate barriers related to social determinants of health, ensuring equitable access to necessary services.
Nutritionist/Dietitian: Using evidence-based nutrition therapy to address her eating patterns and prevent malnutrition.
Primary Care Provider (PCP): To coordinate care, monitor her physical health, and ensure consistent follow-up.
Social Determinants of Health
Emily’s social determinants of health must be addressed to improve her access to care. These determinants include:
Access to Care: Social workers can help connect her family to low-cost or free mental health services.
Financial Assistance: Identifying financial aid through charity programs, grants, or state programs like Medicaid can help alleviate cost burdens for her parents.
School Environment: An anti-bullying intervention should be in place to ensure that Emily and other students are safe and supported at school.
Family Support: Family-based therapy or support groups can empower Emily’s parents to support her through her struggles better. Strong family and community support networks are associated with better mental health outcomes in adolescents (Laursen & Hartl, 2019).
Evidence-Based Tools for Assessment
For mental health and nutritional assessment:
PHQ-9 (Pediatric Version): An evidence-based tool used to assess the severity of depression in children and adolescents (Richardson et al., 2020).
GAD-7: A reliable tool for screening anxiety disorders in adolescents (Mossman et al., 2017).
SCOFF Questionnaire: A tool used to screen for eating disorders, particularly anorexia and bulimia nervosa (Cotton et al., 2020).
For nutritional assessment:
BMI Percentile Charts: To evaluate weight and growth patterns in adolescents to ensure an accurate assessment of malnutrition risk.
Eating Disorder Examination Questionnaire (EDE-Q): An effective tool for evaluating attitudes and behaviors related to disordered eating (Couturier et al., 2020).
24-Hour Dietary Recall: To Evaluate an individual\’s dietary intake over the previous 24 hours to identify nutritional patterns and deficiencies. It is a widely used and validated method for dietary assessment in adolescents as discussed by Diep et al. (2019).
Differential Diagnoses and ICD-10 Codes
Major Depressive Disorder, Single Episode, Moderate (ICD-10: F32.1): Supported by Emily’s symptoms of persistent sadness, isolation, and suicidal thoughts.
Generalized Anxiety Disorder (ICD-10: F41.1): Emily’s ongoing anxiety in social settings, related to bullying, fits the diagnostic criteria.
Anorexia Nervosa (ICD-10: F50.01): Her restrictive eating behaviors, body image issues, and weight concerns suggest this diagnosis.
References:
Browne, A., Carr, A., & McEvoy, J. (2020). Patterns of help-seeking behavior in adolescents with mental health disorders. Child and Adolescent Psychiatry and Mental Health, 14(1), 1-10. https://doi.org/10.1186/s13034-020-00351-1
Bywaters, P., et al. (2020). Social work and social determinants of health: A framework for practice. Social Work in Public Health, 35(7), 563-578. https://doi.org/10.1080/19371918.2020.1808141
Cotton, S. M., McGillivray, J. A., & Kissane, D. W. (2020). The SCOFF questionnaire and its use in adolescents. Journal of Adolescent Health, 67(3), 431-438. https://doi.org/10.1016/j.jadohealth.2020.03.020
Couturier, J., Kimber, M., & Szatmari, P. (2020). Evidence-based assessment of eating disorders in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 59(1), 29-41. https://doi.org/10.1016/j.jaac.2019.07.009
Diep, C. S., et al. (2019). Agreement between 24-hour recall and food records in youth. Journal of the Academy of Nutrition and Dietetics, 119(2), 304-314. https://doi.org/10.1016/j.jand.2018.09.003
Laursen, B., & Hartl, A. C. (2019). Understanding loneliness during adolescence: Developmental changes that increase the risk of perceived social isolation. Journal of Adolescence, 74, 179-183. https://doi.org/10.1016/j.adolescence.2019.06.003
Mossman, S. A., Luft, M. J., & Schroeder, H. K. (2017). The Generalized Anxiety Disorder-7 (GAD-7) in adolescents: A psychometric evaluation. Journal of Anxiety Disorders, 45, 68-77. https://doi.org/10.1016/j.janxdis.2017.01.003
Richardson, L. P., McCauley, E., & Grossman, D. C. (2020). Screening for depression in adolescents: PHQ-9 scores and their clinical significance. Pediatrics, 135(3), 684-691. https://doi.org/10.1542/peds.2020-1754
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