Monday, December 17, 2007

Looking at the World through Rosie D. Glasses

It is beginning. Screenings are being done by pediatric practitioners across the Commonwealth even as we speak. (Want to try one? Click here)  If your child screens positive, then you and your child's pediatric practitioner will have a chat, in which he or she will suggest referral to mental health resource.   And then what?  Why, your child will receive treatment.  At which point most parents will say,  "Do we have to receive treatment? What kind of treatment?  What are the risks and benefits?  Are we talking pills, or therapy?  Will my child need to lay down on a couch or go to hospital?"  
All reasonable questions.  The first one is the key-  no one can force you or your child to enter therapy or take medications.  Parents always have to right to ask questions.  As far as the other questions go, your practitioner may not have a good answer.  Why?  In part, because our current system of mental health care is not set up to let us know what is going on inside.  In many instances, we actually don't have a clear idea of which therapeutic intervention works best.  Finally, because the "system" "carves out" mental health services for the medical care system, without always allowing for the free flow of information between the providers of physical health and the providers of mental health services.
For most families, this is the frustrating part.  When a physician identifies a "problem", most people want there to be a solution.  In this case, the solution is often to send you and your child from a practice with which you are comfortable to a stranger:  an agency, a counselor (talk-therapist), a psychiatrist (physicians, licensed to dispense medication); or a family therapist, who wants to meet with you first and then your child. (By the way, check out this cool site that lets you search the resources available in Worcester County).   The wait for this initial visit can be 2-3 weeks (0r 6-8 weeks), during which time you are guessing about what to do next.  When the visit happens, you tell the story again, and so does your child.  You may wish that the mental health provider had some of the background, the sense of "how you got to this point?".  After a while (1-3 visits), the clinician will develop a "formulation" of the problem, and suggest a mode of treatment.  Sometimes, that information will get back to your primary care practitioner, completing the loop that began with screening and giving your practitioner enough information to tell you what will happen next.
 So, to figure out what is going on after a positive screen, it may well take 3-4 months to even begin your treatment.  Long time to wait to address the problem detected by the now recommended screening.  What are we going to do about this?
1)  In the words of Douglas Adams, DON'T PANIC!  The system is creaky, but it can work, with a bit of patient (or impatient) advocacy.  
2)  As a parent, you can encourage the various parts of the system to work together.  Give permission for the various components of the system to talk to each other.  
3)  Ask questions about the things that they are telling you.  Remember always to ask each person "What do you think is going on?  What do you think we should do about it?  How long do you think it will take to change or get better?"  I can almost guarantee that different people will give you different answers.  Somewhere within those answers is likely to be the truth.
4)  Find support.  The Parent-Professional Advocacy League is a good place to start-  they know a lot about children with mental health, and have a lot of parents in their system.  In Massachusetts, the MCPAP program may also be helpful;  ask your PCC for a referral.
5)  Lobby for change:  In my mind, co-location and home-based services is probably the best ways to get services more quickly to children and youth- ask if your health plan covers those services.  If not, well-  that's tomorrow's story.
Rosie D. is a beginning.  More to follow.

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