Author: mykidsmentalhealth

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School refusal is defined as when a child or adult refuses to attend school or their workplace as a result of anxiety, poor distress tolerance, or pathological avoidance.

Since the explanation of school refusal is long and complicated, our colleagues at Rogers Memorial Hospital recently released a podcast in 4 parts describing it and the treatment for it. We highly recommend you take a listen.

https://rogersbh.org/school-refusal?utm_source=Rogers+Memorial+Hospital&utm_campaign=706f18a9a1-EMAIL_CAMPAIGN_2019_05_14_02_40&utm_medium=email&utm_term=0_2b85836e2e-706f18a9a1-343194849

One of the best researchers and clinicians in our field of CBT just published an updated version of their book on Exposure Therapy (the MOST evidence-based treatment for anxiety). We highly recommend it for professors and consumers alike!

Our very own Dr. Kaplan was asked to review the book by the publishers! Take a look at her review on the link to the book below!

With the exception of last summer (which I secretly hope is a result of the many talks and outreach activities our practice has given in the DC community), our child/teen appointments dwindle in the summer. Unfortunately this is not due to family vacations, but rather a strongly held “American belief” that kids needs a break from all things in the summer.

We HIGHLY recommend against the practice of only doing therapy during the school year. Our yearly, VERY predictable, schedule is that we become flooded with appointments in late September, early October. This is because the newness of school has worn off and clinical problems get their chance to emerge. In our kids who attend over the summer regularly, we see them frequently and effectively managing the stressors of transition back into the school year.

Remember it’s better to be proactive than retroactive!

Parents of young children often say that it can be difficult to decide if what their child is experiencing warrants treatment. They may be wondering if this is a “bump in the road” or something more.

Treatment may be appropriate if your child experiences:

• Lack of self-confidence or self-esteem
• Excessive worry about the future
• Fears or phobias
• Excessive reassurance-seeking
• Reluctance or fearfulness when separating from you, sleeping independently, being in new situations, or socializing with new people
• Repetitive behaviors
• Difficulties with transitions
• Frequent negative statements
• Excessive tantrums or emotional outbursts
• Challenges following directions
• Difficulties hearing “no”
• Toileting concerns

Psychologists use methods that not only treat emotional and behavioral challenges but prevent them. Whether your child needs help navigating typical, age-appropriate challenges or is managing more serious mental health difficulties, psychologists can provide helpful services that can make life healthier and more meaningful for your child and family.

Further, waiting to treat concerns typically results in longer, more intensive treatment. When concerns are left untreated, children may face the compounding challenges that come with rehearsing the same difficulties. Because the problem can seem unsolvable or out of the child and family’s control, it can also lead to decreased confidence and low self-esteem.

By Dr. Rachel LaFleur, Staff Psychologist, Washington Anxiety Center of Capitol Hill

http://www.washingtonanxietycenter.com

A frequent question we get asked at our center is, “What books can you recommend?” Well, I finally put together a list of recommended reading that will help supplement treatment (key word there is “supplement”) as it is recommended to have a professional guide you through these and help them to apply specifically to your child.

Check it out (it’s on our website!)

http://www.washingtonanxietycenter.com/book-supplements.html

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