Hot Topics: When Should You Fire Your Child’s Mental Health Professional?

shutterstock_69175456If you do what you’ve always done, you’ll get what you’ve always got.

The majority of families we serve through our practice have sought out and utilized the services of other physicians (psychiatrists, pediatricians, family practitioners) and mental health professionals (psychologists, counselors) before they come to see us. As a result, my practice probably represents a “skewed sample” in that we have an over-representation of families with unsatisfactory experiences in seeking help. I’m often wondering why parents continue as long as they do with costly and ineffective treatments with little apparent benefit for their kids.

Before we continue, I’ll remind our readers that treating kids with mental health disorders often remains more an art than a science and everyone who works with kids and families will be routinely humbled by their inability to effectively serve all of the folks who seek our help. No mortal human being has all the answers and each of us are guaranteed to disappoint some of the time. Nevertheless, from having served thousands of kids and families over the past 28 years, certain patterns become evident when families are actively involved in ineffective treatment interventions and the sooner parents can recognize that the professionals from whom they obtain assistance aren’t the right fit for their child or family, the more quickly they might move on to another professional or clinic who might help.

So…What are some of the signs parents should look for when they’re concerned that they’re not in the right place for their child with a mental health disorder?

When your professional is unable to give you a reasonably coherent explanation of why your child is experiencing the difficulties that led to the need for treatment.

When your professional is unwilling and unable to discuss the range of evidence-based treatments for your child’s condition, even if they themselves haven’t been trained or licensed to provide some of those treatments.

When your professional is unable to share with you the intended goals of their treatment intervention at any time during the course of treatment with your child.

When your professional is unable to offer you a reasonable estimate of the time required to see significant progress from treatment, as well as the alternatives when treatment doesn’t progress as planned.

When your professional is unwilling to meet with you to discuss your child’s overall progress in treatment (while respecting their right to confidentiality) and either help you to understand how you can best support your child’s treatment needs or refer you to a collaborating professional better equipped to address your questions and concerns.

When your professional is unwilling to invite the input of other appropriately trained professionals when your child’s behavior/condition is getting worse as opposed to better.

This list certainly isn’t meant to be inclusive. But I’ll share a few very specific situation that would give me cause for concern if I needed to take my kid somewhere for treatment…

For psychiatrists/physicians: When a child is taking prescribed medication (or a combination of medications) that appear to be ineffective or produce unacceptable complications and the physician is reluctant to try to simplify the child’s medication regimen-or wants to add on additional medications without a very good reason. Your child needs a prescribing physician capable of recognizing situations in which medication is making their situation worse.

For psychologists/counselors: I have two…When you get the sense that the therapist is having a difficult time defining an end point to treatment. Some clinicians (unconsciously) have a difficult time letting go of clients. If your child’s therapist repeatedly identifies new issues to treat after your child has met their initial treatment goals, there’s a risk of your child developing an unhealthy dependency upon the therapist.

The other situation occurs when a child or teen is failing to make progress in therapy and the therapist recommends a psychiatric referral, but lacks an established relationship with one. I’d expect the psychologist or counselor to have a system for coordinating care. We don’t typically accept referrals when the child has a therapist we don’t know. First, I don’t want to be held responsible for the outcome of a case when I don’t know whether the therapist knows what they’re doing. I also think that it’s important for all the professionals to be on the same page when serving the same child or family. An excellent therapist would see the value in developing and maintaining relationships with at least one competent psychiatrist.

One last observation…If you’re considering the possibility of firing your child’s psychiatrist or therapist, you owe it to your child to meet with the professional first in an effort to get your concerns addressed. It’s tough on kids to repeatedly tell their story to strangers. You want to give someone who knows your child and your family well the opportunity to “get it right.”

Updated May 17, 2014

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KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

About Dr. G

Dr. Stephen Grcevich serves as President and Founder of Key Ministry, a non-profit organization providing free training, consultation, resources and support to help churches serve families of children with disabilities. Dr. Grcevich is a graduate of Northeastern Ohio Medical University (NEOMED), trained in General Psychiatry at the Cleveland Clinic Foundation and in Child and Adolescent Psychiatry at University Hospitals of Cleveland/Case Western Reserve University. He is a faculty member in Child and Adolescent Psychiatry at two medical schools, leads a group practice in suburban Cleveland (Family Center by the Falls), and continues to be involved in research evaluating the safety and effectiveness of medications prescribed to children for ADHD, anxiety and depression. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI). Dr. Grcevich was recently recognized by Sharecare as one of the top ten online influencers in children’s mental health. His blog for Key Ministry, www.church4everychild.org was ranked fourth among the top 100 children's ministry blogs in 2015 by Ministry to Children.
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2 Responses to Hot Topics: When Should You Fire Your Child’s Mental Health Professional?

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