Information for Parents/Foster Parents

Children grow and change rapidly during their development years, so diagnosis and treatment of mental disorders (emotional and behavioral disturbances) must be viewed with these changes in mind. Some problems are short-lived and don't need treatment. Others are persistent and very serious, and parents should seek professional help for their children. Diagnosing a child with a specific mental illness requires time, observation and feedback from parents and/or individuals who spend time with the child.

It was once thought that many brain disorders began only after childhood as many often don't become noticeable until adolescence. We now know that some can begin in early childhood and involve many factors, such as brain development problems in the fetus, in-utero trauma, genetic factors, and environmental trauma, especially during the first eight months after birth.

The links below provide information about these issues. Additional information can be obtained from the NRBH Office of Consumer and Family Affairs by calling (970) 347-2367. Information can be mailed or picked up.

QUESTIONS AND ANSWERS ABOUT WORRISOME BEHAVIOR

1. What should I do if I am concerned about mental, behavioral or emotional symptoms in my young child?
   Talk to your child's doctor. Ask questions and find out everything you can about the behavior or symptoms that worry you. Sensory processing, language, and motor skills are developing during early childhood along with the ability to relate to parents and to socialize with caregivers and other children. Keep in mind that every child is different and even normal development varies from child to child. Ask the caregiver or teacher if your child has been showing any worrisome changes in behavior. If so, discuss these with the doctor as well.



2. How do I know if my child's problems are serious?
   Everyday stresses can cause worrisome changes in behavior. For example, the birth of a sibling may cause a temporary change. It may be difficult to tell the difference between these kinds of changes and more serious problems.

   It is a good idea to seek professional help when problems are severe, persistent, and impact daily activities.

   Seek help for your child if you notice, in the absence of a reasonable cause:
   • changes in appetite or sleep
   • social withdrawal or fearfulness
   • slipping back to earlier behavior like bed-wetting
   • signs of distress such as sadness or tearfulness
   • self destructive behavior such as head banging
   • a tendency to have frequent injuries
   Be prepared to review the development of your child, any important medical problem, family history of mental disorders and mental or physical traumas or situations that may cause stress.



3. How are mental disorders diagnosed in young children?
   As in adults, disorders are diagnosed by observing signs and symptoms. A skilled professional will review these signs and symptoms in the context of the child's developmental level and social and physical environment according to criteria established by experts. Reports from parents and other caretakers or teachers will be carefully considered. The signs of a mental disorder in a young child may be quite different from those of an older child or an adult.



4. Can my child get better over time?
   Yes! As the brain develops and the child matures, the child may be better able to cope with symptoms and learn to control behaviors without continued need for professional intervention. Some children will need medications and supportive treatment for a longer period of time, even into adulthood. However, with the newer range of medications that are effective for teens and adults and the availability of supportive interventions, children and adults can have productive lives in their communities in spite of mental illness.



5. Does my child have to be hospitalized in order to be treated?
   Not necessarily! Most treatment for children's mental disorders takes the form of outpatient services in the community. Occasionally, when symptoms are severe and behavior is completely out of control, a child may need to be hospitalized to stabilize both medication and behavior. The period of hospitalization is usually short term.

USING MEDICATIONS

Medications may be prescribed for young children when mental, behavioral or emotional symptoms are so severe and persistent that they would have serious negative consequences for the child if left untreated and psychosocial interventions alone are not effective. Although psychotropic medications affect children differently than adults, medications may be prescribed because the benefits outweigh the risks. Parents will want to ask questions and evaluate with the doctor the benefits and the risks of starting and continuing with medications. Parents need to learn everything they can about the medications and side effects, including which side effects are tolerable and which ones are threatening.

Whether or not medications are prescribed, parents need to learn about, understand and support the goals of a particular treatment (i.e., change in specific behaviors) and be prepared to follow-up consistently and report observations.

There are several major categories of psychotropic medications: stimulants, antidepressants, anti-anxiety agents, anti-psychotics, and mood stabilizers. Dosages for medications approved by the FDA for children depend on body weight and age.

WHEN HOSPITALIZATION OR RESIDENTIAL TREATMENT CENTER PLACEMENT IS APPROPRIATE

Many years ago, children with severe and persistent mental illness were placed in institutions for long periods of time away from their families and everything familiar in their lives. Today, armed with a better understanding of the negative effects of institutionalization and the availability of new medications and treatments, we understand that children rarely need to spend time in inpatient settings.

Hospitalization is generally a short-term emergency measure providing a secure setting in which to stabilize medications and the out-of-control behavior caused by episodes of illness. A child may be hospitalized when multiple medical and psychiatric issues are not clear and more time is needed to make a diagnosis and stabilize mediations for all conditions. Hospitals are not an appropriate setting when maximum benefit has been reached for inpatient care.

A child may be admitted to a Residential Treatment Center (RTC) when time is needed in a highly supervised setting to change self destructive or other anti-social behaviors. The goal of RTC placement is to prepare children to re-enter their homes. Daily public education classes (including special education accommodations) are included. Parents are expected to participate in treatment as much as possible and learn how to manage the child at home.

Occasionally, parents/caregivers/guardians cannot cope with the mentally ill child and maintain stability with other members of the family, and alternative care becomes necessary. These circumstances need to be thoroughly discussed with mental health professionals and social services caseworkers, if involved.

FINANCIAL ISSUES

Insurance:
Mental health treatment and medications are expensive, and parents discover that benefits for these services for children are discriminatory in most health plans. Because parents are responsible for payment for mental health services and medications for their children, parents should check out the benefits in their health plans and make plans for the expense before it becomes a burden.

Children with a diagnosis of schizophrenia, bi-polar disorder, depression, schizo-affective disorder, obsessive compulsive disorder or panic disorder are covered on an equal basis with physical disorders if the health plan is regulated by the State of Colorado. Treatment and medications coverage can't be different from coverage for physical disorders in these plans. Since young children usually do not have one of these diagnoses, insurance coverage is not equal. Advocacy is needed to provide equal insurance coverage for all children's diagnoses.

If the mental illness is severe and disabling, the child may qualify for Supplemental Social Security (SSI) payments. Contact the Social Security Administration office for information about applying for SSI. A child qualified for SSI will also be eligible for Medicaid Insurance, which will pay for medically necessary treatment as well as medications.

You can call the Social Security Administration at 1-800-772-1213 or visit the office at 5400 W. 11th Street. Suite A, Greeley, CO. The local phone number is (970) 353-2192.

A child in a low-income family that qualifies for TANF or a child in foster care may also be eligible for Medicaid. Call the Department of Human Services for information.
Weld County Human Services, 315 N. 11th Aveenue, Greeley, (970) 352-1551

CHP+ is health insurance coverage for low income children (18 years of age and younger) and pregnant women (19 years of age and older) who are Colorado residents. Coverage includes inpatient and outpatient hospital services, physician services, prescription drugs, dental for children and mental health care. Call customer service at 1-800-359-1991 from anywhere in Colorado, to have an application mailed to you.

Proving Disability for SSI:
The definition of disability for children:

• requires a child to have a physical or mental condition or conditions that can be medically proven and which result in marked and severe functional limitations;
• requires that the medically proven physical or mental condition or conditions must last or be expected to last at least 12 months or be expected to result in death;
• states that a child may not be considered disabled if he or she is working at a job that is considered to be substantial work.

Continuing Disability Reviews are required at least every three years for recipients under age 18 whose conditions are likely to improve and also may be required for recipients whose conditions are not likely to improve.

The child's representative payee, usually the parent, must present evidence that the child is and has been receiving treatment considered to be medically necessary and available for the disabling condition.

TREATMENT / COORDINATION ISSUES

Alternatives Available:
Mental health treatment usually includes a mix of approaches suitable to the age, diagnosis and circumstances of the child. See the NRBH web page on Intake and Assessment and Intensive Children's Services for services available at NRBH.

Coordinating Treatment Across Service Systems:
Designing the appropriate treatment for a particular child may be challenging when multiple systems, such as the school, social services or the juvenile justice system are involved. Each of these systems has its own legal requirements for working with the child and the family. For mental health treatment to be effective, it is important for parents to be in agreement with each other. It is also important for parents to understand the role of each agency, to share relevant information, and to encourage communication between agencies. Signing releases of information is the first step in getting coordinated treatment for your child.

The Role of Schools and Federal Laws:
A series of federal laws requires schools to provide equal education opportunities to all children, regardless of disability. The laws mandate a disabled child's right to free, appropriate special education and related services. The key Act P.L. 101-476, The Education of the Handicapped Act (EHA) Amendments of 1990 changed the name EHA to the Individuals with Disabilities Education Act (IDEA). This law reauthorized and expanded discretionary programs, mandated transition services and assistive technology services to be included in a child or youth's Individualized Education Plan (IEP).

The basic principles of IDEA are that schools must provide education in the least restrictive environment and provide accommodations to allow the child to learn. Schools are required to locate, identify and evaluate a child for a suspected disability. Parents usually initiate the evaluation with a written request. Schools must provide an eligibility report to parents before the eligibility meeting so that parents can request an independent evaluation. If the child is found eligible, a meeting is set to write an IEP with goals and objectives. Parents may invite anyone who has knowledge of the child, and/or of the disability to this meeting.

IEPs must address the nature of the disability, the child's strengths and needs in all physical, emotional, and mental areas, and set out who is going to provide the different parts of the plan, i.e., adaptations in the classroom, technology, transportation, behavior support plan.

Schools also are required to write an Individual Transition Plan (ITP) to prepare teens for education and training after graduation from high school.

You can request a Staffing Preparation Packet and other IEP information from the Office of Consumer and Family Affairs, (970) 347-2367.

You can subscribe to a list service managed by Advocacy for the Whole Child and the Advocacy Project, designed for parents, educators and service providers to explore special education issues and to help each other make it work for students with disabilities. Send an E-mail to: IEPsThatWork-subscribe@yahoogroups.com or check the website: http://www.advocacyproject.net

You can receive detailed information about making IEPs from the PEAK Parent Center, in Colorado Springs, 1-800-284-0251.

If you need legal advice about disability status or IEPs, you can call the Legal Center for People with Disabilities in Denver, 1-800-288-1376.

The Importance of Record Keeping:
When interacting with mental health providers, schools, social services or other service system providers, a number of records will be needed. It is helpful to have all of the child's records in a notebook or file box. When asked for information, parents should give copies of documents and keep the originals. Keep your file complete with the following information:

• Current picture
• Social Security Card
• Social Security Benefits Assignment Letter
• Birth Certificate
• Family Income Information (Under 18)
• Identifying and Emergency Information - allergies, medications
• Social History - in as much detail as possible
• Medical and Diagnostic Information
• Immunization Record
• Current Physical (ask the child's doctor for a copy)
• Education Documents (IEP, ITP)
  • IEP Individualized Education Plan
  • ITP Individualized Transition Plan
  • All school records
• Transition Planning Information
• Minutes/Documentation of meetings or phone calls
• Copies of correspondence with agencies