There is no need to be embarrassed about asking questions or reaching out for help. It is okay to be concerned about your child and it is your job as a parent to make sure that you are doing everything you can to get them the support they need. As a parent, you have instincts about your child, and if your instinct tells you that something is wrong and this is not “just a phase” then you should listen to yourself.
Sometimes our embarrassment comes from not knowing where to turn. The mental health system can be confusing for people who are reaching out to get help and the goal of this article is to assist you in better knowing what resources are available and then finding out how to access them.
The first thing you need to do is get some clarity about what is worrying you. One of the best ways to try to pinpoint the specific behaviors or feelings that have you concerned is to think about the ways in which these behaviors are ‘changes’ from the way your child normally acts. Are things different just at home or also at school? How about with friends? Siblings? Listing examples of the behaviors that have fueled your concerns is a concrete and objective place to start.
Your Pediatrician or Family Doctor
A good place to start looking for help for your child 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.”
The outpatient therapist is someone who can treat mild to moderate symptoms of depression, anxiety, some experimentation with drugs or alcohol, attentional issues, acting out behaviors and family conflict. Just as portrayed in movies or on television, the therapist usually sits across from an individual patient or client, and asks questions or makes comments. These sessions typically last from 45-60 minutes and take place about once a week. The frequency can vary, though, from 2-3 times per week to once every other week depending on the therapists’ availability and the severity of the symptoms.
Therapists can have any number of different degrees and credentials, which can be confusing when you are trying to figure out which professional to see. A licensed social worker (LSW or LCSW), licensed mental health counselor (LMHC), licensed family counselor (LMFT), licensed associate or professional counselor (LAC, LPC) all have Masters Degrees in the mental health field. From a practical viewpoint, it does not matter which degree or letters therapists have after their names; they are all trained to provide clinical care in the community. What matters is how comfortable you and your family member feel with them.
Nurses with advanced mental health training
Nurses with specialized training (CRN) provide mental health care in a variety of settings. They also function as case managers and patient advocates. They can provide group and individual therapy, can assess and diagnose mental health problems and in some states can prescribe medications.
Psychologists also can provide outpatient therapy. A psychologist (PhD, PsyD or EdD) has advanced training and a doctorate in the mental health field. Psychologists are the only mental health professionals qualified to administer and interpret psychological tests that can be helpful in diagnosing and understanding complex cases.
Outpatient therapists also may provide group therapy that is designed to allow individuals of similar ages and problems to be treated within a group setting. Many of these groups occur for 1-1.5 hours a week and generally deal with specific topics. Some of the most common groups for adolescents include social skills groups, and groups to assist teenagers with attentional difficulties. For example, if you are concerned that your child is struggling socially, group therapy can be a great resource to assist with development of these skills in an appropriate and therapeutic setting.
These are medical doctors (MDs or DOs) with advanced training in dealing with serious mental illness. Most psychiatrists primarily prescribe and monitor medications. Often the psychiatrist will see individuals for an initial evaluation, and then follow up monthly for medication management sessions. Some psychiatrists will see patients weekly while others will provide both individual talk therapy sessions and medication management sessions. However, this varies from doctor to doctor.
Many people who are seeking help for the first time will try to make their initial appointment with a psychiatrist. Some psychiatrists do not take insurance and some have longer waiting-lists for appointments than other kinds of therapists. So if you are concerned about a family member, it can be easier and quicker to get them in to see an outpatient therapist first. They can begin talk therapy and if the clinician believes that medication is necessary or should be considered, they can assist with making a referral to a psychiatrist.
Intensive Outpatient Programs (IOP)
These programs, which meet for multiple hours, multiple days per week have higher levels of care and are designed to treat individuals who are experiencing moderate to severe symptoms. Most IOP’s are scheduled from 3 – 5 times per week and typically run for about 3-4 hours per treatment day for approximately 2-3 months. However, all IOPs are designed with a strong emphasis on group work to assist clients in developing specific skills to improve their level of functioning. There are usually a variety of groups that address particular problems like substance abuse, eating disorder or psychiatric disorders (such as mood, anxiety and psychotic disorders). If your child is using drugs or alcohol on a semi-regular to regular basis, then this is most likely the appropriate level of care for them. Similarly, many individuals who are struggling with eating disorder symptoms are often referred to this level of care.
If you have a child who has been in therapy with an outpatient clinician and has not made the progress you were hoping for, then an IOP may be the next step. Conversely, if your family member has not been in treatment before, but their symptoms are raising safety concerns (for example, you have recently discovered that they are harming themselves through cutting or burning) or if they are struggling with suicidal thoughts, then an IOP may be a more appropriate level of care for them than just outpatient therapy.
Partial Care Programs/Partial Hospitalization Programs (PCP/PHP)
This level of care is the step between an IOP and an inpatient hospitalization program. This program is designed for individuals who are not at immediate risk of harming themselves, but are experiencing significant symptoms which make it difficult for them to function in their daily lives. PCPs usually run 5 days a week for 5-6 hours. Like IOP’s, they are group based programs but also provide family work, individual work as well as medication management with a psychiatrist. Patients usually attend these programs from 2- 4 weeks, with the specific goals of getting their medications adjusted, improving level of functioning, addressing any safety concerns and creating an appropriate aftercare plan. Many Partial Care patients will go directly to an IOP once they are more stable. If your child is not attending school, not functioning well, having severe depressive symptoms, self-injuring, or expressing suicidal thoughts with regularity, then this may be the appropriate level of care for them.
Just like you’d do if your child broke an arm or leg, when you are worried that your child is in immediate danger the best thing to do is take them to the emergency room for an evaluation. Any suicidal behavior or attempt should be taken seriously, so if your child is telling you or someone else that they want to die or have a plan to harm themselves, this is the level of care you may need. When you take your child to the emergency room, they will be provided a quick medical exam by the emergency room physician, after this a psychiatrist, nurse or social worker will provide assessment to determine the next step.
Many times children who are suicidal will be recommended for admission to the hospital for a week or so. Although this recommendation may sound scary, it really may be the best course of action for a child who is in crisis. As an inpatient, your child will attend groups, family sessions and be seen regularly by the psychiatrist for medication management. Once your child is more stable and no longer at high risk for self-harm, there will be an assessment by a social worker to assist you with determining what level of care is appropriate for follow up.
Some helpful links