Author: mykidsmentalhealth

As the new year approaches, also comes new years resolutions and psychological treatment may be a part of that! If so, our very own Dr. Rachel LaFleur has some tips and tricks about how to navigate your first mental health appointment.

If you’re like me, you may feel nervous when you attend your first visit with a new provider. When I feel caught off guard, I may leave the appointment with regrets about the questions I forgot to ask and the things I didn’t advocate for.

Here’s what to expect (or ask for) in your first visit with a mental health clinician who will be providing treatment.

1. Paperwork to complete in advance.
   • Oftentimes, there is very specific and detailed information that your clinician needs to gather in the first visit. If you fill out the paperwork ahead of time, we can use our face-to-face time to dialogue about why you decided to visit us and discuss what treatment will be like. I would muchrather be spending our time together listening to you tell your story and describe what would make treatment meaningful than ask you to list off information, such as whether the client has asthma or allergies.
   • I bet you’re wondering why paperwork sometimes ask about things that don’t seem to have anything to do with why you’re coming in. Because so many aspects of life can relate to behavior, we like to cast a wide net at this first appointment to be sure there we aren’t missing a piece of the puzzle. Don’t worry – once we get past this first appointment, clinicians tend to narrow their focus.
   • It is a good idea to bring:
     1. Documentation of potentially relevant medical conditions.
     2. If the client is a child or adolescent:
        1. His/her latest report card, information regarding accommodations or specialized instruction (e.g., 504 plan, Individualized Education Plan, behavior intervention plans, and behavior charts).
        2. Custody documents if a legal guardian is not a parent or his/her parents are separated/divorced and there is a court order or formal agreement.
        3. Written permission from a legal guardian if the person bringing the client is not a legal guardian. This should be discussed in advance as the clinician may have particular paperwork that need to be completed.

• If your clinician does not provide paperwork in advance:
  1. Be prepared to answer questions related to medical history, developmental milestones, academic history, and previous treatment received to address developmental, behavioral, psychological, or related concerns.
  2. Here’s something really important: it’s okay if you don’t know the answer to a question. If the client is a child and I ask his/her parent about birthweight, weeks gestation at delivery, and developmental milestones, some of the very best and most caring parents don’t know, especially when put on the spot.

2. Support and understanding in uncomfortable situations. Depending on the person and situation, aspects of the first appointment can be uncomfortable.
   • If there are others with you, let your clinician know if you would rather discuss certain topics privately.
   • It’s okay to tell your clinician that you are uncomfortable, especially if you need to pause or take a break. Do you need water, a trip to the bathroom, or a snack? It’s okay to let your clinician know!
   • Inappropriate behavior between family members or from children and adolescents happens. In fact, it may be why you scheduled the appointment in the first place. You’re in the right place. This is what we do. Depending on the goals and format of the first appointment, your clinician may not address the inappropriate behavior. But don’t worry – that doesn’t mean your clinician won’t address it soon.

3. Assistance in understanding challenging concepts and terminology.

• In mental health, a first visit is often called an “initial evaluation,” “intake interview,” or “diagnostic interview.”
• Your clinician will do his/her best to help you learn the lingo. Please let us know if there is a term or concept we can explain. The smartest and most confident people I know ask questions and it is good feedback for your clinician, who may have formed a habit of speaking over people’s heads and doesn’t know.

4. Discussion of expectations.

• On our side, in the first appointment we often discuss:
  1. Payment
  2. Limits to confidentiality
  3. Expectations for attendance
  4. Commitment to treatment
  5. How to get in touch between sessions
  6. What to expect from treatment

• It comes in handy for you to have thought about the things you expect from your clinician. For example, you might answer the following questions:

1. What type of treatment were you hoping to receive?
2. What type of clinician do you want to work with?
3. What are your expectations for scheduling?
4. In what ways can you clinician present information to you given the way that you learn?
5. What does your clinician need to know about you to be able to adapt to who you are as a person?

• While a clinician may not be able to accommodate all of your preferences, it is nonetheless important to have the conversation as this meeting plays an important role in establishing your relationship with your clinician. Because this is your treatment, it is essential that you to have clear information about what you are signing up for and to leave knowing that your requests were heard, and when possible, accommodated.

Have a very happy holiday season and a great start to the new year!

Dr. Rachel La Fleur and all the staff at WACCH

We are pleased to announce and would like to congratulate our psychologists……

Washington Anxiety Center of Capitol Hill, LLC Receives 2018 Best of Washington Award

Only 12% of the mental health profession is well-versed in true evidence-based treatments for anxiety and depression, and this percentage gets even smaller when specializing in children and adolescents. Most providers who specialize in this type of treatment have received years and years of extra training and experience to provide top of the line services. However, because of this, there are few and far between that accept insurance; most are out-of-network providers.

Don’t let this deter you from getting the right services. Here are some points to consider:

1. Cognitive-behavioral therapy (evidence-based treatment for anxiety and depression and children and adults) takes approximately 3-6 months (costing approximately $3500-$7000).
2. Patients who see “generalists” (not specialized in evidence-based treatments for anxiety/depression/behavioral disorders) usually end up spending approximately the SAME amount, but take 3-5 years to complete treatment (as a side note, we see a lot of those patients in our practice when the “generalized” approach does not work).
3. Due to the paucity of providers, especially those in network, patients stand a higher chance of a good rate of reimbursement from their insurance companies (in our practice it is roughly 60-90% per session)–pretty darn great, but make sure to check with your own plan and insurance provider.
4. You can use services that do the billing for you (send receipts to insurance companies).  I like this page for tips and tricks: https://www.thebalance.com/if-you-have-to-file-a-health-insurance-claim-form-2645672

Happy thanksgiving!!!

In the modern age, where everything is being done via the web, psychologists are now offering individual therapy sessions via the web/phone.

What does this mean for our patients and the average consumer???

Studies as far back as 10 years ago have demonstrated CBT delivered via web/phone as equally effective as face-to-face treatment. Treating clinicians and patients were also measured on the quality of their relationship, which statistically did not differ from face-to-face sessions.

It is important to note that these studies focused on the delivery of CBT (evidence-based treatment that focuses on independent skill development) via the web/phone.

We receive calls from across the country, especially in parts of Maryland and Virginia (DC is relatively small) that cannot get access to services. Please be informed of what is available to you and how to reach out to get the most evidence-based treatment for your anxiety and/or depression.

Have a wonderful Halloween and a good time facing your fears!

Dr. K

Just a small note, as things start to pick up this school season. I will be presenting at the Fairfax County Public School Mental Health Wellness Conference. Teens, parents, coaches, educators, mental health providers, and community and faith-based organizations that work with teens are invited to participate at the 4th Annual Mental Health and Wellness Conference on Saturday, September 29, 2018.

The topic I am presenting on is ““Failure to Launch” in Young Adults: How to Get Your Child to Be a Successful Adult.”

https://www.fcps.edu/mentalhealthwellnessconference#breakoutsessions

Come by and say hi!

Dr. K

The How-to’s of finding the right fit for mental health treatment:

1. Do your research. Google can be our worst and best friend, depending on how you use it. Our recommendation is to type in “evidence-based treatment for ____ (whatever symptoms you are suffering from).”
2. Use abct.org or www.adaa.org  (their “therapist finder”) to find the right therapist for anxiety and/or depression.
3. When to use Psychology today listserv (https://www.psychologytoday.com/us/therapists)
   1. We recommend using this site when you need to find someone in your local area and/or someone who takes your insurance
   2. We do not recommend using this site when you are looking for a mental health provider who has a specialty. There seems to be little oversight in regards to whether clinicians actually have the specialties they report on the website. ALWAYS check in with your future clinical about their experience in the area you which to get treatment in.
4. If you need medication services:
   1. For lower-level severity cases you can use your Primary Care Physician or Pediatrician for your child.
   2. If you have more than one diagnosis, you are on the more moderate-severe end, or a complicated case, we recommended seeing an actual Psychiatrist.
      1. TIP: Psychiatrists in-network with insurances tend to have longer wait lists than those seen out of network.

Cognitive-behavioral therapy is an evidence-based treatment for anxiety and depression (and other disorders as well) in children, adolescents and adults.

Here are some cool facts about it:

1. Only 15% of mental health professionals have learned TRUE CBT (which includes exposure-therapy)–ONLY 12% practice!
2. CBT has effectiveness rates of 60-90%. The more invested in treatment you are, the more your success rates increase!
3. CBT is geared to be short term (3-6 months)
4. CBT is skills-based; you learn the tools to handle/ cope with anxiety and depression on your own….
5. CBT can be fun! While learning a lot about yourself, you will also have some fun pushing your limits and increasing the belief that you can handle anything that comes your way!
6. CBT has better short-term AND long-term effectiveness rates compared to medication alone! Meds stop working once you stop taking them, but CBT can last a lifetime!
7. Proper CBT is NOT “manualized.” It is flexible and designed for your individual needs.
8. Ask your therapist what type of treatment they give you and WHY. Remember you have a voice in your treatment, it’s not just up to your therapist!

I recently presented on ADHD across the age spectrum at the Anxiety and Depression Association of America.

Here are some neat facts and figures from the presentation I hope you find helpful

1. ADHD is the actual diagnosis-there is no such diagnosis as “ADD”1.
   1. Diagnostic criteria
      1. A child or adolescent needs to meet six out of nine possible inattentive symptoms and/or six out of nine possible hyperactivity/impulsivity symptoms.
      2. ADHD has three iterations: (1) predominantly inattentive, (2) predominantly hyperactive/impulsive, and (3) combined, based on how many symptoms in each diagnostic category an individual meets.
         1. 6 or more symptoms of inattention:
            1. Poor attention to detail poor sustained attention
            2. Poor task completion poor organization
            3. Procrastination distractibility
            4. Forgetfulness
      3. 6 or more symptoms of hyperactivity/impulsivity:
         • Behaving as “driven by a motor”
         • Excessive talking interrupting
         • Difficulty waiting one’s turn
         • Fidgeting leaving one’s seat

1. 3-5% of child and adolescent populations have ADHD, some studies reporting as high as 11% (Michielsen et al., 2013).
2. 10% of preschool children (ages 2-5) will have pre-pathological ADHD behaviors that begin to emerge.
3. Highest rate of comorbidity is with externalizing disorders  (conduct disorder and oppositional defiant disorder) and secondarily, Depression and generalized anxiety were among the most comorbid internalizing disorders.
4. 20-30% of children (<18 years of age) will have a diagnosable, comorbid anxiety disorder with ADHD.
5. CBT treatment has better effectiveness rates than stimulant medication (longer-lasting).

More on this topic in the next blog!

Right about now, it has been a few months since your child has been on a significant break from school. In my practice, I have been witnessing children and adolescents experience high levels of stress before spring break.  In the time between Christmas/winter break and spring break parents can enact several strategies to decrease the stress in their child (and therefore increase their academic performance and emotional stabilization):

1. Give them a break as needed (e.g., 1x per 2 months). If they need to take a half day off or a full day of school, it is ok to allow them to have a “mental health day” (although make sure that it is not an unhealthy trend that is beginning).
2. Encourage them to participate in behavioral activation activities (i.e.,  combining pleasurable activities with ones that get them up and physically moving).
3. Monitor sleep and electronic use. Too much electronic use can disrupt sleep and can negatively affect how your child is regulating their emotions. Also monitor how they are currently sleeping, are they getting enough sleep? (should be 7-9 hours per night).

Try these and see if it makes a difference in your child’s and your family’s quality of life!

Parenting doesn’t just begin when the baby is born, issues arise in conception and pregnancy. Take a look at a recent article I was interviewed in.

https://www.parents.com/getting-pregnant/fights-every-couple-has-when-trying-to-conceive/