If you are like most parents, you probably have very little experience accessing or using mental health services. But if you have been encouraged by the school to have your child evaluated for mental health treatment, or you personally think your child might benefit from counseling, even beginning the process may be bewildering and overwhelming. Here’s a list of answers to questions frequently asked by parents seeking mental health treatment for their children:
What is a mental health evaluation?
A “mental health evaluation” means an assessment provided by a mental health professional to determine whether or not your child has an issue or problem that would benefit from mental health treatment. This evaluation can take the form of an interview with you and your child (both separately and together), as well some paper and pencil testing for your child.
This assessment can sometimes begin as soon as you call to make an appointment. You will probably be asked the reason for your call as well as for basic information about your child. During the initial evaluation session, the therapist will generally ask questions of both you and your child. You may also be asked to sign a paper (called a “Release of Information”) to give the counselor permission to speak to someone at your child’s school. This is usually a very important component of the assessment since your child’s behavior at school may be very different than it is at home. This release will give the school permission to share their observations about your child but, unless you specifically indicate it, the counselor is not allowed by law to disclose information back to the school. All information accumulated by the therapist is confidential. Once the necessary information has been collected and reviewed, this counselor will make a recommendation as to whether there is an issue or problem that might get better with counseling or therapy. In some cases, the counselor might recommend an additional evaluation for medication. This evaluation is done by a psychiatrist or other mental health professional who is licensed to write prescriptions.
Who are the mental health professionals who provide this evaluation?
There are several kinds of mental health professionals:
- Psychiatrists (M.D. or D.O.) are medical doctors. While they have the expertise to provide therapy, many psychiatrists limit their practice to evaluation and prescription of medication. If your child needs medication, a psychiatrist is your best choice.
- Psychologists (Ph.D., Psy.D.) are not medical doctors. Their training focuses on providing therapy or counseling; they are also trained to administer the psychological testing that assists in diagnosis.
- Social workers (L.C.S.W.) and licensed professional counselors (L.P.C.) do not prescribe medication or perform psychological testing. Their training focuses on providing therapy and counseling, often with specializations in particular problem areas like eating disorders and anger management.
- Other types of mental health professionals include marriage and family counselors and advanced practice nurses.
How do I decide which mental health professional is best for my child?
Your first step is to check with your insurance provider to find out the extent of your mental health coverage, if you need preauthorization, and whether or not you have provisions for out-of-network coverage. If you have out-of-network coverage, your choice of providers will greatly increase. If you have to stay within your network, ask the insurance representative for a list of approved providers who work with children and youth within your geographic area.
Another good place to start looking for help is through your pediatrician or family doctor. The American Academy of Pediatricians says, “Pediatricians are, and will continue to be an important first source for parents who are worried about their child’s behavioral problems.”
If I don’t have coverage or choose to go out of network, how do I get the names of mental health professionals who would be appropriate for my child?
At your child’s school, good referral sources can include the guidance staff or school nurse. They usually have a lot of experience making similar referrals. If you’re school doesn’t have staff in any of these positions, there may be an administrator who is in charge of making these types of recommendations. Other good referral sources can include your pediatrician or primary care physician, clergy members, or other parents whose children are in counseling. This last source can be very helpful, since you can get a personal feel for the practitioner.
Even if a professional comes highly recommended, I’m still not sure I’d be comfortable sending my child for counseling without talking to the person myself. Is that allowed with medical privacy policies?
Absolutely! Remember, you are technically a consumer who will be purchasing an important service for your child. It helps, of course, to frame your request in a courteous way, for example, “I don’t know much about mental health counseling, and I’m trying to approach this process as an educated consumer. I’d like to ask you a few questions to help me better understand how you work.” While you probably already have a list of questions in your head, here are a few more that you may want to include:
- Can you tell me about any specific training you have had in treating children/teens?
- My child has been having some problems in the following areas . . . (briefly provide examples of the behaviors that concern you). Can you give me an idea of what your approach to dealing with these types of problems might be?
- Do you involve parents (or guardians) in the counseling process?
- Do you provide family therapy? How do you decide if this is needed?
- What criteria do you use to determine whether or not a child needs medication? To whom do you refer for this type of assessment?
- If my child needs special accommodations at school, do you assist in making these arrangements?
- How flexible is your appointment schedule? Do you offer after-school, evening or Saturday appointments?
- If you or I decide that you and my child might not work well together, will you be able to suggest other referrals?
What kind of treatment do mental health professionals provide?
Mental health treatment for children can include talk therapy, play therapy, or activity therapy. One of the most effective types of ‘talk therapy’ is called cognitive behavior therapy. This type of treatment focuses not just on feelings but on specific behavior changes, usually related to the problem your child is experiencing. Some children also benefit from group treatment where they interact with peers who have similar problems or concerns. There may also be a recommendation for family treatment, which involves not only the child but also the parents or caregivers and siblings. When the benefits of treatment with medication outweigh the risks, psychotropic medication might also be recommended.
I have heard about something called a “black box” warning related to the use of these psychotropic medications for children. What does this mean?
In 2004, the U.S. Food and Drug Administration (FDA) mandated that all antidepressant medication prescribed to children and adolescents indicate that use of this medication could result in an increase in suicidal ideation or suicide attempts. This warning was based on studies that showed 2 to 3 percent of pediatric patients that had taken this medication had experienced an increase in suicidal thoughts during the first four weeks of drug use. While there was not a single suicide in the studies, the “black box” warning does call attention to the importance of making sure that children or adolescents who are taking antidepressant medication be closely monitored by the prescribing physician early in the course of treatment or when medication is adjusted or changed.
If this type of medication can be so dangerous, why would anyone use it?
While medication isn’t usually necessary for milder forms of depression, it can be a very important and effective component in treatment for children and teens who are moderately to severely depressed. Untreated clinical depression can be incapacitating for kids, creating symptoms that interfere with their ability to perform in school and athletics, maintain friendships, interact at home…the list goes on. As a parent, you’re not in a position to make the medical diagnosis of depression, which is why it’s so important to consult with a physician. If your physician recommends the use of antidepressant medication for your child, ask for the following:
- Information that helps you understand depression as an illness
- Clarification of the risks and signs of suicidality
- Information that addresses the benefits and risks of medication
It is important to remember that when the benefits of medication outweigh the risks and the prescription is accompanied by talk therapy, antidepressants that are carefully monitored by the patient, family, and physician have proven to be effective in the treatment of depression.
So if medication is effective, do I need to do anything else?
Yes! Medication is only one piece of the treatment equation. Several studies have shown that a combination of medication and talk therapy (counseling) is really the most successful form of treatment. As a parent, you want to remain an advocate for your child. Continue to monitor the effects of the medication, be alert for side effects, and if you’re concerned about the progress of treatment, consider getting a second opinion.
These questions only touch the surface of the things that are important for you as a parent to understand when initiating a mental health referral for your child. They are a start, but here are other places you may want to check for additional information: http://www.nimh.nih.gov/health/find-help/index.shtml