Children are usually referred to psychiatrists by their parents or caregivers. Parents should be made aware that a collaborative approach to diagnosis and treatment is essential and that their children older than 3 years of age should be prepared for the diagnostic encounter. The initial contact is usually made over the telephone by the parent or referring agent. The importance of the impression made at that first contact cannot be underestimated. The initial intake staff member gathers identifying information and a brief history of the presenting complaint. Emergency situations must be dealt with at once and urgent situations within 24 hours. Table 5–1 lists situations, roughly in the order of frequency, that require immediate evaluation.
Table 5–1Situations Requiring Immediate Evaluation |Favorite Table|Download (.pdf) Table 5–1 Situations Requiring Immediate Evaluation
|Homicidal impulses |
|Dangerous assaultiveness |
|Dangerous risk-taking (e.g., running away from home) |
|Drug or alcohol intoxication |
|Psychotic thought disorder (e.g., hallucinations, delusions) |
|Impending parental breakdown related to the child's disruptive behavior |
|Recent trauma (e.g., as a result of rape or civilian catastrophe) |
|Recent loss with abnormal grief reaction |
|Acute school refusal |
|Suspension or expulsion from school |
|Police involvement |
|Physical deterioration in a patient known to have an eating disorder |
If the initial interview is prompted by a crisis, or if the family has come a long distance, the clinician should see the whole family together. Even if there is no crisis, some clinicians still favor interviewing the whole family first, whereas others prefer interviewing the parents first, before interviewing the child or adolescent at a separate later interview. Even if the parents are separated or divorced, it is preferable to interview both parents, unless the tension between them would be unmanageable. Other clinicians prefer to interview an adolescent first, before interviewing the parents. In any case, the clinician should try to avoid having the child wait anxiously in the waiting room while lengthy parent interviews are conducted. At some point, the parents will need to be interviewed to obtain a detailed history (see "Interviewing Parents" section) and the family interviewed together to throw light on family dynamics (see "Interviewing Families" section).
INTAKE QUESTIONNAIRES & CHECKLISTS
Important data can be collected even before the first interview. For example, the parent can complete a Child Behavior Checklist and a developmental history form. Teacher versions of the Child Behavior Checklist can also be obtained if the child's behavior in school is an important issue. Previous mental health evaluations, psychological reports, medical records, and school records are also available in some cases. Thus, the clinician can focus during the parent interview on the developmental issues and symptom patterns that emerge from the preliminary data.
PURPOSE OF THE PARENT INTERVIEW