When an issue arises that affects the mental health of a child or adolescent, the process for getting help involves multiple steps and probably twists and turns along the way. From identifying the symptoms, severity and nature of behavioral health issues through to establishing a long-term strategy, treatment and support system, a plan of action needs to be defined and chosen, experts say.
Identifying the problem
Depending on severity of symptoms, mental health issues can be identified, addressed and explored by a myriad of counselors, informal and formal.
First and foremost, talk to your child. Talk to whomever can provide support: teachers, coaches, religious leaders, your family pediatrician.
Talk
Get a doctor's referral to mental health services.
Referral
The mental health provider, perhaps a licensed counselor, intake specialist or psychologist, will develop a behavioral health assessment, including medical and psychiatric history and an evaluation of the condition.
Mental health provider
Levels of care
Knowing what kind of treatment might be involved can calm a child or parent's uncertainty. Levels of treatment will depend on the severity of a child’s symptoms and how they’re impairing day-to-day life. In an emergency, for example, when a child may be in danger of hurting themselves or others, care might begin with paramedics stabilizing a child and transporting to an emergency room, before transfer to an inpatient behavioral health hospital.
Residential programs
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Beyond an emergency, a program may include
Inpatient care
The assessment can be as simple as a conversation with a professional or as thorough as a more costly, time-consuming neuropsychological examination.
Assessment
A treatment plan will be developed suggesting the most appropriate level of care from team members such as nurses, behavioral health professionals, occupational therapists, dietitians, clinical therapists and psychiatrists.
Treatment
For patients whose conditions are not being resolved with less intensive care. Lengths of stay to care for these chronic impairments are often 30 to 90 days.
For patients who are unable to function without supervision. This is crisis intervention, as the patient may have suicidal or homicidal thoughts, paralyzing anxiety or psychosis.
IOP is for patients who don’t need to stay in a hospital overnight. IOP typically offers six- to nine-hour intensive therapy multiple days a week.
Intensive outpatient programs
Navigating a child's
mental health journey
By Jon Asplund
Illustration by Getty Images
John Parkhurst, a child and adolescent psychologist and coordinator of the Mood Anxiety ADHD Collaborative Care program and at Lurie Children’s Hospital
“At some point a mental health professional might be needed, but first, your pediatrician is a great point person. A pediatrician, ideally, will know the child and the family, and certainly have a sense of what’s normal developmental issues and what’s not. Parents sometimes miss where their kids are at, developmentally, but a pediatrician brings a wider perspective.”
Ryan Lauterwasser, manager of adolescent inpatient and swing units at Linden Oaks Behavioral Health in Naperville
“Families need to really explore whether conditions can be handled at the lowest level of treatment needed. You’ve always got to err on the side of safety, but it’s easy to get into a psychiatric hospital, and hard to get out.”
Partial Hospitalization program
Outpatient therapy
Community support
For patients who aren’t functioning at school or work, PHP offers structure, typically around six hours a day of group therapy and coping skill education.
The lowest level of professional care. It features one-on-one, family and group therapy options for patients who are still functioning, but struggling with their mental health condition.
Mental health requires health care, but at the earliest stages, conditions can be improved, impairment can be avoided when children, families, educators, pediatricians and supportive members of the community step in early.
From one level of care to the next, there is a need for continued vigilance, adherence to medication and therapy, and flexibility. Here is what experts advise:
Navigating the treatment plan
Jacinda, mother of a Chicago teen Leo with ADHD (who asked that her family's last name not be published)
“You’ve got to be able to self-advocate. Both the child and parent need to know that that comes with it, there’s a whole lot happening, and you need to stay on top of it.”
Dr. Mashana Smith, psychologist at the Lurie Children’s Hospital Center for Childhood Resilience
“Our schools and communities have to play a major part in supporting mental health. We’ll never address it trying to get every child into independent therapy and counseling. Every child doesn’t need that level of treatment, and there aren’t enough therapists to handle what our children need from their families, communities and schools.”
Childhood and adolescent mental health conditions are often seen in the school setting. Teachers, coaches and school counselors are an integral part of the care team, from catching a condition early, to identifying the need for help to providing a supportive environment for a child to overcome behavioral health issues. Beyond treatment, children may need additional support, guidance and accommodations at school to cope with their condition. Families, teachers and school counselors need to talk to each other about what’s going on. Once treatment has been started, you’ll likely encounter IEPs and 504 plans.
School considerations
Teletherapy
The isolation of COVID-19 served to prove that telemedicine, particularly teletherapy, can work. It’s not for everyone, but when seeing a provider proves difficult, either because of a shortage of therapists or a child’s busy schedule, it increases access to care.
Objectives
Identify the objectives of treatments with your child’s counselors and have a clear timeline for achieving objectives. Also, be attuned to the objectives and what it takes to get there.
Follow-up care
Stick to follow-up care, help your child make all appointments. “Once you step down from one level of treatment, the work isn’t done,” Lauterwasser says. “The first week of step down (for example from getting out of the hospital and into a PHP) is when the patient is most at risk.”
Insurance
Understand your insurance benefits. What kind of pharmaceuticals and therapy are covered, and for how long.
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504 plans
IEP
Not as detailed as an IEP, a 504 plan lays out where the child struggles and what needs to be supported or accommodated. For example, providing down time during instruction or extra time to take anxiety-inducing quizzes and tests.
Individualized Education Programs are legal documents, developed by the school, student, family and health care practitioner and used when a child has a specific, diagnosed disability, to establish a student’s special education instructions, support and available services.
Alyce Henson for Crain's Chicago Business
IEPs and 504 plans are used for a student’s physical and mental health conditions. Each can serve as a guide for treating behavior as a behavioral health issue, not simply solved through disciplinary means.