| Families seeking mental health services for troubled | | | | If periodic crises send your child to the emergency |
| children in the United States today face a daunting | | | | room, ask the outpatient therapist to request all |
| challenge. Budgets are tight, resources are hard to | | | | previous records of treatment. Next, with the |
| access, and demand exceeds supply. In this climate, | | | | therapist's help, write a detailed clinical summary, |
| parents do well to become forceful advocates. Here | | | | complete with institutions, dates, psychiatric diagnoses, |
| are a few tips to get you started. | | | | and medication trials as well as medical, developmental, |
| Scarce benefits go to those who know how to claim | | | | family, educational, social, and recreational histories. |
| them. By stating your case, you can help your child | | | | Notify past providers of any errors that appear in the |
| while building public awareness of common problems | | | | records they supplied. Use the clinical summary to |
| and putting pressure on the system to improve. | | | | inform the evaluating physician in the hospital on your |
| Understand the System. The health insurance industry, | | | | next visit, and keep it up to date. |
| which makes coverage unfordable for many people | | | | Ask clinicians in temporary settings to confer at intake |
| and only partially affordable for some, also fails to | | | | with long-term outpatient providers. Keep a log on |
| compensate providers adequately. Parents whose | | | | medication and other interventions tried with your child. |
| children have mental health issues find that many | | | | Also document the apparent results. |
| outpatient providers have abandoned poor insurance | | | | If providers seem to be blaming the problems on your |
| reimbursement rates in favor of fee-for-service care | | | | parenting rather than on the disorder itself, consider |
| (self-pay). | | | | bringing in a homemade videotape that makes your |
| The picture worsens at the institutional level, where low | | | | point. If the child enters a hospital or subacute facility, |
| reimbursement makes it difficult for hospitals to keep | | | | tell the new institution what behavioral changes and |
| psychiatric beds available. Nowadays children often | | | | support services you will need when he or she comes |
| languish in emergency rooms for days or weeks. | | | | home to stay. |
| Most children entering treatment start with individual | | | | Locate Resources and Other Advocates. Much |
| and family treatment from an outpatient therapist, who | | | | information about medical diagnoses, medications and |
| can help locate a psychiatrist if a medication evaluation | | | | side effects, and treatments for different conditions is |
| seems called for. Psychiatrists are generally harder to | | | | available on the Internet. The computer at the medical |
| find when the therapist is in private practice than when | | | | school of a state university can guide you to relevant |
| he or she is part of a clinic. Clinics, however, may have | | | | books and articles in the collection. Your state's |
| months-long waiting lists. Also, because staff turnover | | | | statutes (available at the public library or online) can |
| is high, you may need to tell your child's story many | | | | help you learn, for example, about laws against bullying |
| times as new clinicians come on board. | | | | and the legal mandate of the state's department of |
| The next medical step after outpatient therapy is a | | | | child-protective services. |
| partial hospital or extended day treatment program | | | | If you skim the Diagnostic and Statistical Manual of |
| lasting a few hours a day, in which groups focus on | | | | Mental Disorders, fourth edition (DSM-IV-TR), of the |
| teaching patients how to regulate their behavior. Acute | | | | American Psychiatric Association, you'll see that its |
| or hospital care, usually accessed through the | | | | definitions are both symptom based and largely |
| emergency room, is available only when children | | | | subjective, with a gradually increasing scientific |
| threaten to harm themselves or others. | | | | foundation that lends support to some diagnoses but |
| Managed care authorizes payment for services on the | | | | not all. (You can find the DSM-IV-TR also at the public |
| basis of "medical necessity," about which providers | | | | library.) |
| may differ. Hospital stays are often so brief that the | | | | Nonprofit institutions working on behalf of children may |
| full effects of the medications prescribed are not | | | | be able to direct you to other resources. People who |
| apparent at discharge. | | | | have traveled the same path can save you lots of |
| Children who cannot be stabilized quickly may be | | | | time by telling you what has worked for them. It can |
| referred for subacute care-basically a short-term | | | | also be heartening to discover that you are not alone. |
| residential setting for assessment purposes. It is | | | | Surf the Web for disorder-specific sites. These |
| assumed that children will return home soon, whether | | | | frequently offer information, links, list serves, and chat |
| or not the system can provide the community-based | | | | rooms where people can share questions and |
| supports they need, but not all children do so. | | | | practical advice across great distances. Various local |
| Know Your Rights. If your family's policy includes | | | | mental health organizations sponsor support groups for |
| mental health benefits, your medical insurance | | | | individuals and families with different mental health |
| company is responsible for directing you to an | | | | issues. |
| in-network outpatient therapist and psychiatrist. If you | | | | Systemic problems have public policy implications. |
| are unable to find one or the other by calling the phone | | | | Consider joining one of the many parent advocacy |
| numbers supplied, your state's managed care | | | | groups. Working with others, you can help improve |
| ombudsman may be able to help. | | | | available resources and create new and better laws. |
| The ombudsman may also be able to help if you | | | | Make Your Voice Heard. Institutional bureaucracies |
| suspect that your child is being discharged prematurely | | | | grind their gears slowly. If you feel disserved by the |
| from an inpatient setting because insurance threatens | | | | mental health service delivery system, consider telling |
| to deny reimbursement even though your benefit has | | | | your story publicly. |
| not been exhausted. | | | | Write a letter to the editor about something apropos |
| If you need other resources-a therapeutic mentor for | | | | that you read in the the main newspaper serving your |
| your child, in-home help with behavior management, | | | | area. If your problem affects a number of people and |
| respite care (usually a few hours) to relieve you, or | | | | is urgent, you may be able to place an op-ed piece. |
| special recreational benefits with mental health | | | | If you don't want to take pen in hand yourself, call a |
| dividends (tae kwon do, music or dance lessons, or | | | | newspaper reporter or columnist, and explain why |
| horseback riding, for instance)-you may, depending on | | | | your situation merits public attention. You are especially |
| your financial situation, be able to get them by asking | | | | likely to succeed when a public entity has let you down |
| the state department of child-protective services to | | | | big-time. |
| open a "voluntary services" case. (To do so you will | | | | Your advocacy efforts can direct your energies into |
| probably need to have a therapist for your child and a | | | | many productive channels. Furthermore, when you |
| diagnosis.) Physicians can sometimes prescribe | | | | assert yourself, you set a powerful example. |
| in-home services from visiting nurses. | | | | Remember that your child is watching you to learn |
| No matter how many mental health providers are | | | | how to live in this world. |
| involved, you, as your child's parent, are properly the | | | | Society needs to hear from everyone, including |
| captain of the treatment team. As such, you have the | | | | children, if its changes are to be for the better. When |
| right to hire and fire other members. Demand respect, | | | | we insist on receiving fair and equitable treatment, we |
| cooperation, and timely answers from everyone. | | | | honor ourselves while also serving our community, our |
| Watch to make sure we are all doing our jobs. | | | | state, and our nation. |