Chapter 32
Assessment and Interviewing
Heather J. Walter and David R. DeMaso It is estimated that 20% of children living in the United States experience a mental illness in a given year, at a cost of nearly $14 billion. In children, mental illness is more prevalent than leukemia, diabetes, and AIDS combined; far more money is spent on mental disorders than on any other childhood illness, including asthma, trauma, upper respiratory infections, and infectious diseases. Although nearly 1 in 5 youths suffers from a psychiatric disorder, 75-85% do not receive specialty mental health services. Those who do, primarily receive services in non-specialty sectors (primary care, schools, child welfare, juvenile justice) where mental health expertise may be limited. Untreated or inadequately treated psychiatric disorders persist over decades, become increasing intractable to treatment, impair adherence to medical treatment regimens, and incur
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The focus of the assessment varies with the nature of the presenting problem and the clinical setting. Under emergency circumstances, the focus may be limited to an assessment of dangerousness to self or others for the purpose of determining the safest level of care. In routine circumstances (well-child visits), the focus may be broader, involving a screen for symptoms and functional impairment in the major psychosocial domains. The challenge for the pediatric practitioner will be to determine as accurately as possible whether the presenting signs and symptoms are likely to meet criteria for a psychiatric disorder and whether the severity and complexity of the disorder suggests referral to a mental health specialist or management in the pediatric