Vol. 18, No. 1 • November 2013

How to Ensure Your Child Receives Effective Mental Health Treatment

by Donna Potter, LCSW

If you are a resource parent (foster, therapeutic foster, adoptive, or kinship), at some point you are likely to care for a child who is receiving mental health treatment. When this happens, you will want to know the answer to one important question: how can I make sure mental health treatment helps my child get better?

Greater Mental Health Needs
Before we answer that question, let's consider what we know about the mental health needs of children in foster care.

While not all children in care require mental health treatment, many do. It makes sense: these children have almost always experienced serious stressors, and their primary attachment figures aren't around to provide support and buffer these stressors.

Research confirms that kids in foster care have greater mental health needs than children in the general population. For example, about 80% of children in foster care have attachment problems so serious they lead to behavioral disorders, anxiety, depression, and dissociation, compared to 14% of children in the general population.

The Northwest Foster Care Alumni Study found that young adults who had been in foster care had rates of PTSD higher than those of war veterans. The National Center for Child Traumatic Stress's analysis of 2,000 children in the child welfare system found more than 4 in 5 had a psychiatric diagnosis.

Clearly, ensuring children in care receive mental health assessments and treatment is a logical way to promote their well-being.

Your Role on the Team

Work closely with your supervising agency to ensure children get effective treatment. Attend child and family team meetings, especially when children's mental health needs and treatment are being discussed. Document and communicate. Track and log any changes you see in your child's behavior, wellness, or functioning. Share this information with other team members.

Recognizing Effective Treatment
Not all mental health treatments are equally effective, however. Fortunately, there are a couple of key ingredients that make up effective treatment. They are:

Assessment. Effective treatment starts with a thorough, trauma-informed assessment. This assessment should specifically analyze any symptoms or problem behaviors and determine which psychiatric diagnoses the child is experiencing--if any.

A really good assessment will include standardized measures administered to several people: to the child (if the child is at least 8 years old), to the caregivers, and to secondary caregivers, such as teachers. Why gather information from different sources?

1. Often children behave differently in different environments.
2. Children tend to report their internal symptoms, like sadness, worry, etc. better than their caregivers because often their caregivers are unaware of these issues.
3. Children tend to minimize their behavior problems, whereas their caregivers are better able to report on those.

An assessment should also include a review of previous records and consider how health issues, social skills, academics, and involvement with social services and the birth family might be impacting the child's functioning.

To be trauma-informed, an assessment must also screen the various potentially scary events a child may have experienced. This should be done with the child, the caregivers, the DSS social worker and, ideally, the biological family and the GAL.

Diagnosis. Information from the assessment may lead a clinician to give the child one or more psychiatric diagnoses.

A Caution: Sometimes clinicians diagnose children with psychiatric disorders without insuring that the child meets all the criteria for that diagnosis. For example, a child may have exhibited a behavior on one occasion, but the diagnosis actually requires that the child demonstrate a pattern of the behavior.

To guard against misdiagnosis, it is very reasonable for caregivers or social workers to ask for a print-out of the diagnosis right from the Diagnostic and Statistical Manual, version 5. Don't rely on descriptions of diagnoses from other sources (including the internet)--they can be misleading or wrong.

Treatment. If a diagnosis is made, the mental health clinician should follow the American Academy of Child and Adolescent Psychiatry Practice Parameters (www.aacap.org) for the effective treatment of that diagnosis. This should involve an evidence-based treatment.

Is Your Child's Treatment Evidence-Based?

"Evidence-based" is a tricky phrase. Just because someone calls something "evidence-based" does not necessarily mean that it is. So how can a caregiver tell if their child's treatment is evidence-based? Actually, it is fairly easy. Ask the therapist for the name of the intervention, then look it up on one of these two websites: http://www.nrepp.samhsa.gov or http://www.cebc4cw.org. If you don't see the intervention listed, ask the clinician why. The clinician may provide you with a website designed by the developer of the intervention. While that can tell you what to expect, it is better to look to outside, unbiased organizations for an assessment of the intervention's usefulness.

Throughout the course of treatment the clinician should be measuring the child's symptoms. If symptoms are not decreasing, interventions should be adjusted.

Other Key Ingredients. Two other ingredients are also crucial for effective treatment: Caregiver involvement and therapeutic rapport (a good fit between clinician and child).

Finally, to be trauma-informed, interventions must actively take into account the losses and scary experiences kids have had and see their behaviors as ways they have learned to cope with those things.

Caregiver Involvement Matters!
When children get treatment or therapy that never or only minimally involves caregivers, they can sometimes be in treatment for years without ever feeling or functioning any better.

As a caregiver, the more you are involved in your child's treatment, the better able you will be to report to the therapist about symptoms and behaviors you are seeing, work to help your child feel more emotionally safe in your home, and help them master the skills that will get rid of their symptoms.

If your child has behavioral problems, you are a big piece of the solution! Without your active involvement, those behaviors are unlikely to get better.

Treatment Should Be Trauma-Informed
Whatever intervention your child receives, the more trauma-informed it is, the better! That means the clinician should be working with you to figure out how the child's scary experiences have affected their beliefs about themselves, caregivers, and the world. Trauma-informed care recognizes that beliefs are what drive a child's behaviors.

When we are more aware of the ways in which a child might not feel emotionally safe in a particular situation, we can begin to change the child's behaviors by changing our own responses. This, in turn, will start to change the child's beliefs about the world, which will help them leave behind beliefs--and behaviors--that aren't helping them.

Donna Potter is Training Project Coordinator of the North Carolina Child Treatment Program and a Clinical Instructor at Duke University School of Medicine.

To view references cited in this and other articles in this issue, click here.

~ Family and Children's Resource Program, UNC-CH School of Social Work ~