What to expect at your teen’s first psychiatric evaluation

A teen psychiatric evaluation is a longer first visit where the clinician asks about symptoms, school, sleep, family history, substance use and safety, usually speaking with the teen alone and with parents. It ends with a working diagnosis and options. At Blackburn Clinical Services in Los Angeles, any medication decision is made together, never rushed.

Key facts

• A comprehensive evaluation can take a few hours, spread over one or more visits (American Academy of Child and Adolescent Psychiatry, Facts for Families No. 52, updated 2017).
• It covers current symptoms, health history, development, school, friendships, family relationships and family history.
• Teens are often seen alone for part of the visit and with parents for part.
• Medication may or may not be recommended. A plan with no medication is a common outcome.
• At Blackburn Clinical Services, psychiatric care can be arranged and coordinated with your teen’s therapist.

What happens before the visit?

A little preparation makes the evaluation more useful and less stressful.

• Gather past records: earlier evaluations, testing, hospital or program discharge notes.
• Write down every medication and supplement, with when each started.
• Bring recent report cards, teacher comments, or a 504 plan or IEP if your teen has one.
• Note when changes began and what seems to make things better or worse.
• Talk with your teen ahead of time. Tell them who they will meet, that the clinician will ask a lot of questions, and that they can say “I do not know” or “I do not want to answer that yet.”

What does the evaluation include?

The AACAP fact sheet on the comprehensive psychiatric evaluation lists the main parts. Most evaluations cover these areas.

1. The main concern. What brought you in, when it started, and how it affects daily life.
2. Mood, anxiety and thinking. Questions about worry, sadness, irritability, focus, sleep, appetite and energy.
3. Safety. Direct questions about self-harm and thoughts of suicide. A 2014 review in Psychological Medicine found no evidence that asking about suicide raises risk. Asking opens the door to help.
4. Substance use. Alcohol, cannabis, vaping and other drugs, asked plainly and without judgment.
5. Health history. Medical conditions, past medications and how they went.
6. Development and school. Early milestones, learning, grades, attendance and friendships.
7. Family. Relationships at home and any family history of mental health conditions.
8. Extra information. With your permission, the clinician may ask to speak with the pediatrician, a therapist or the school, or may suggest testing.

Will my teen be seen alone?

Usually, for part of the time. Teens often share more when parents are out of the room, and it gives them a chance to build trust with the clinician. Parents then have time to add their view and ask questions. Clinicians explain at the start what stays private and what must be shared, especially anything about safety. Our page on teen therapy privacy in California covers this in more detail.

What happens at the end?

The clinician pulls the information together into a formulation: a plain language explanation of what seems to be going on and why. From there, you talk through options. These may include therapy, family sessions, changes at school, sleep or routine changes, further testing, medication, or a mix. If medication is suggested, the clinician should explain why, what the risks and benefits are, and what you would watch for. You and your teen can take time to decide.

What happens after the evaluation?

• A follow-up visit is scheduled. Visits are often closer together at the start of any new plan.
• If your teen is not already in therapy, a referral to a therapist is common. At Blackburn Clinical Services, therapy is available in our office or by secure video for clients located in California.
• With your written permission, the prescriber and therapist share updates.
• If needed, the clinician may write documentation for your teen’s school when clinically appropriate.

If you are still choosing a prescriber, our guide on how to choose a psychiatrist for your teen lists the questions to ask. For a first therapy visit instead, see what to expect at a first teen therapy appointment.

What if something feels urgent before the appointment?

Do not wait. If your teen is talking about suicide or harming themselves, call or text 988, the Suicide and Crisis Lifeline. If there is immediate danger, call 911 or go to the nearest emergency room.

Frequently asked questions

How long does a psychiatric evaluation take?

A full evaluation for a child or teen can take a few hours, sometimes spread over more than one visit. The length depends on how complex the situation is and how much history is already available. Bringing records ahead of time can make the process smoother.

Will my teen be prescribed medication on the first visit?

Not necessarily. Some teens leave the first evaluation with a medication recommendation, and many leave with a plan that does not include medication. Any recommendation should come with a clear explanation, and the decision is made with you and your teen.

Can I be in the room?

Yes, for part of the evaluation. Most clinicians also spend time with the teen alone, because teens often speak more openly that way. You will have your own time to share what you have seen and ask questions.

What should we bring?

Bring a list of current and past medications, any earlier evaluations or testing, recent school reports, and a 504 plan or IEP if there is one. A short written timeline of when things changed is very helpful. Bring your own questions too.

Can an 18 year old high school senior be seen?

Yes. Blackburn Clinical Services sees teens, young adults and adults, including 18 year old seniors. At 18, your young adult makes their own care decisions, and they can choose to include you.

Ready to take the first step?

Our phones are answered Monday to Friday, 9 AM to 5 PM, at (888) 870-7405. Tell us a little about your teen, and we will explain how an evaluation would work and how psychiatric care can be arranged alongside therapy.