Seeking Help For Your Child

When To Seek Help For Your Child—

Moms & dads are usually the first to recognize that their youngster has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a mother or father. The first step is to gently try to talk to the youngster. An honest open talk about feelings can often help. Moms & dads may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the youngster well. These steps may resolve the problems for the youngster and family.

Following are a few signs, which may indicate that a child and teen psychiatric evaluation will be useful.

YOUNGER KIDS

· Frequent, unexplainable temper tantrums.
· Hyperactivity; fidgeting; constant movement beyond regular playing.
· Marked fall in school performance.
· Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures.
· Persistent nightmares.
· Poor grades in school despite trying very hard.
· Severe worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the youngster's age.

PRE-TEENS AND ADOLESCENTS

· Abuse of alcohol and/or drugs.
· Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism.
· Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death.
· Frequent outbursts of anger, aggression.
· Frequent physical complaints.
· Inability to cope with problems and daily activities.
· Intense fear of becoming obese with no relationship to actual body weight, purging food or restricting eating.
· Marked change in school performance.
· Marked changes in sleeping and/or eating habits.
· Persistent nightmares.
· Self-injury or self-destructive behavior.
· Sexual acting out.
· Strange thoughts, beliefs, feelings, or unusual behaviors.
· Threats of self-harm or harm to others.
· Threats to run away.

Moms & dads are often in the best position to recognize when their youngster is having a problem. Even when moms & dads do recognize that their youngster is having trouble, it is not always apparent that professional help is necessary.

The first step in assessing the cause of your youngster's difficulty is to ask him. Sometimes, gently asking your youngster questions...

- Why are you constantly sad?
- Why are you so mad?
- Why did you steal that toy from Jake's house?
- You seem upset, is something bothering you?

...will reveal the issues with which he's struggling. Giving him adequate time to respond is necessary; talking honestly with your youngster about his feelings may also be helpful.

Consulting your child's physician or teacher, or your minister, priest, or rabbi may help you identify problems both in the youngster and within the family that could be causing the upset. Frequently, a teacher will notice your youngster's trouble and call you in. Working together, you can often get the youngster back on track before schoolwork or social interaction is affected.

As a rule, it is the combination of moms & dads' growing concerns and the observation of outsiders such as teachers, physicians, and family members, that lead moms & dads to consult a clinician for their youngster. There are a few signs, when present over an extended period time, that indicate that your youngster has problems which could benefit from treatment.

Where To Find Help For Your Child—

Moms & dads are often concerned about their youngster's emotional health or behavior but they don't know where to start to get help. The mental health system can sometimes be complicated and difficult for moms & dads to understand. A youngster's emotional distress often causes disruption to both the parent's and the youngster's world. Moms & dads may have difficulty being objective. They may blame themselves or worry that others such as teachers or family members will blame them.

If you are worried about your youngster's emotions or behavior, you can start by talking to friends, family members, your spiritual counselor, your child's school counselor, or your child's pediatrician or family physician about your concerns. If you think your youngster needs help, you should get as much information as possible about where to find help for your youngster. Moms & dads should be cautious about using Yellow Pages phone directories as their only source of information and referral. Other sources of information include:

· National professional organizations (American Academy of Child and Teen Psychiatry, American Psychiatric Association)

· National Advocacy Organizations (National Alliance for the Mentally Ill, Federation of Families for Kids's Mental Health, National Mental Health Association)

· Local mental health association

· Local medical society, local psychiatric society

· Local hospitals or medical centers with psychiatric services

· Employee Assistance Program through your employer

· Department of Psychiatry in nearby medical school

· County mental health department

The variety of mental health practitioners can be confusing. There are psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, counselors, pastoral counselors and people who call themselves therapists. Few states regulate the practice of psychotherapy, so almost anyone can call herself or himself a “psychotherapist” or a “therapist.”

· Social Worker — Some social workers have a bachelor's degree (B.A., B.S.W., or B.S.), however most social workers have earned a master's degree (M.S. or M.S.W.). In most states social workers can take an examination to be licensed as clinical social workers. Social workers provide different forms of psychotherapy.

· Psychologist — Some psychologists possess a master's degree (M.S.) in psychology while others have a doctoral degree (Ph.D., Psy.D, or Ed.D) in clinical, educational, counseling, developmental or research psychology. Psychologists are licensed by most states. Psychologists can also provide psychological evaluation and treatment for emotional and behavioral problems and disorders. Psychologists can also provide psychological testing and assessments.

· Psychiatrist — A psychiatrist is a physician, a medical doctor, whose education includes a medical degree (M.D. or D.O.) and at least four additional years of study and training. Psychiatrists are licensed by the states as physicians. Psychiatrists who pass the national examination administered by the American Board of Psychiatry and Neurology become board certified in psychiatry. Psychiatrists provide medical/psychiatric evaluation and treatment for emotional and behavioral problems and psychiatric disorders. As physicians, psychiatrists can prescribe and monitor medications.

· Child and Teen Psychiatrist — A child and teen psychiatrist is a licensed physician (M.D. or D.O.) who is a fully trained psychiatrist and who has two additional years of advanced training beyond general psychiatry with kids, teens and families. Child and teen psychiatrists who pass the national examination administered by the American Board of Psychiatry and Neurology become board certified in child and teen psychiatry. Child and teen psychiatrists provide medical/psychiatric evaluation and a full range of treatment interventions for emotional and behavioral problems and psychiatric disorders. As physicians, child and teen psychiatrists can prescribe and monitor medications.

Moms & dads should try to find a mental health professional who has advanced training and experience with the evaluation and treatment of kids, teens, and families. Moms & dads should always ask about the professionals training and experience. However, it is also very important to find a comfortable match between your youngster, your family, and the mental health professional.

Understanding Your Mental Health Insurance—

Insurance benefits for mental health services have changed a lot in recent years. These changes are consistent with the nationwide trend to control the expense of health care. It is important to understand your mental health care coverage so that you can be an active advocate for your youngster's needs within the guidelines of your particular plan. Here are some useful questions to ask when evaluating the mental health benefits of an insurance plan or HMO:

· Are there limits on the number of visits? Will my provider have to send reports to the managed care company?

· Do I have to get a referral from my youngster's primary care physician or employee assistance program to receive mental health services?

· Does the plan exclude certain diagnoses or pre-existing conditions?

· Does the plan have a track record in your area?

· Is there a "lifetime dollar limit" or an "annual limit" for mental health coverage, and what is it?

· Is there a "preferred list of providers" or "network" that you must see? Are child psychiatrists included? What happens if I want my youngster to see someone outside the network?

· Is there an annual deductible that I pay before the plan pays? What will I actually pay for services? What services are paid for by the plan: office visits, medication, respite care, day hospital, inpatient?

· What can I do if I am unhappy with either the provider of the care or the recommendations of the "utilization review" process?

· What hospitals can be used under the plan?

Managed care refers to the process of someone reviewing and monitoring the need for and use of services. Your insurance company may do its own review and monitoring or may hire a "managed care company" to do the reviewing. The actual review of care is commonly known as "utilization review" and is done by professionals, mostly social workers and nurses, known as "utilization reviewers" or "case managers." The child psychiatrist treating your youngster may have to discuss the treatment with a reviewer in order for the care to be authorized and paid for by your insurance. The reviewers are trained to use the guidelines developed by your health care plan. A review by a child and teen psychiatrist reviewer usually must be specially requested.

The review process often takes place over the telephone. Written treatment plans may also be required. Some plans may require that the entire medical record be copied and sent for review. Reviewers usually authorize payment for a limited number of outpatient sessions or a few days of inpatient care. In order for additional treatment to be authorized, the psychiatrist must call the reviewer back to discuss the youngster's progress and existing problems. Managed care emphasizes short-term treatment with a focus on changing specific behaviors.

Preferred providers are groups of doctors, social workers, or psychologists, which your insurer has agreed to pay. If you choose to see doctors outside of this list (out of network caregivers), your insurer may not pay for the services. You will still be responsible for the bill. Similarly, care given in hospitals designated as "in network" is paid for by your insurance, while care given in hospitals "out of network" is usually not paid by your insurance and becomes your responsibility. Even when using preferred providers and in network hospitals, utilization reviewers still closely monitor treatment.

Another change is the variety of services and diagnosis paid for by different plans. In the past, only inpatient care and outpatient care was covered by insurance. Now, depending upon your particular plan, other services such as day hospital, home-based care, and respite care may also be covered. These lower cost services may offer advantages to inpatient hospitalization.

A limiting feature of some mental health care plans is a low lifetime maximum or a low annual dollar amount that can be used for mental health care (i.e., once this amount is used, plan coverage ends.) You, as mother or father or guardian, are responsible for paying the non-covered bill. If your youngster/teen needs continued care, you may need to seek help from your state public mental health system. This usually means changing doctors, which may disrupt your youngster's care.

It is important to understand as much as possible about your particular insurance plan. Understanding your coverage will put you in a better position to help your youngster. Sometimes you may need to advocate for services that are not a part of your plan, but which you and your child's psychiatrist feel are necessary. Advocacy groups may provide you with important information about local services. The support of other moms & dads is also useful and important when engaged in advocacy efforts.

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