About Child and Adolescent Psychiatry 1. Why do parents and families bring their child or teenager to a child and adolescent psychiatrist? Parents and families often worry when their child or teenager seems to have a problem which causes them to be sad, disruptive, rebellious, inattentive, unable to cope with things, or to get involved with drugs and alcohol. They may be concerned about their child or adolescent’s development, eating and/or sleeping patterns, and how they are getting along with family, friends, and at school. Many families first discuss their concerns with a family physician, school counselor, or clergy. Following this, the family may be referred to or seek out a Child and Adolescent Psychiatrist. The Child and Adolescent Psychiatrist is uniquely qualified to understand the full range of factors associated with emotional difficulties and mental disorders that can affect children and adolescents. 2. Are parents and families responsible for their child's problem? Parents and families often have this worry. Some families even delay seeking help for their child for fear that they will be blamed. Feeling responsible for the child's problems or distress is a normal sign of caring and attachment. There can be multiple causes for many of the problems that children and adolescents experience. Sometimes the cause of a problem is not known, but all disorders are treatable. A Child and Adolescent Psychiatrist will help parents and families understand that they should not blame themselves for their child or adolescent's problem and resolve the feelings of "Why me? Why my child?." 3. What about stigma? Parents and families are sometimes concerned about their child being labeled with a psychiatric disorder. Just as children and adolescents may become physically ill, they may experience emotional and behavioral problems. Many problems can be completely overcome and symptoms can almost always be improved with treatment. Once a child starts to improve, many parents feel good telling their friends and relatives: "Yes, my child did have a significant problem, but we got the help we needed." 4. What kind of evaluation is offered? As a physician, I begin by carefully listening to your concerns about your child and the family. I also review the full medical history with parents, and frequently will ask to obtain additional information from other members of the family, the school, child's personal physician, and other significant adults in the life of the child. I will talk with parents and families about how to anticipate and answer their child or adolescent's questions about the psychiatric examination. The meeting with the child or adolescent may involve talking, drawing, or playing with toys to help me better understand what is going on. Questions may be asked about the child's view of the problem, as well as how the child is getting along with family, friends, teachers, and students in school. An assessment is made of the child's strengths as well as their problems. 5. What if a physical problem is causing the symptoms? As a physician, I am trained to recognize physical disorders that may be affecting how people think, feel, and behave. In addition, I consider how emotions, feeling, thinking, and behaving may influence your child or adolescent’s physical health. I may consult with your child's family physician to develop a comprehensive treatment plan. 6. What kind of treatment is offered? The individual plan of psychiatric treatment will take into account your child or adolescent's problems as well as the strengths that are identified in your child's personality, your family, the school and other community resources. Generally, I use a variety of treatment techniques; e.g., psychotherapies, behavior therapies, medications, and interventions with the school and family. I will discuss your child’s treatment plan with you and your child. This discussion includes the advantages and disadvantages of various treatment approaches as well as availability of programs and services in the community. 7. How long does psychiatric treatment usually take? Some children and adolescents will respond to short-term treatment (for example, 12 sessions). When the disorder(s) is more complicated or has persisted for a long time, a longer term of treatment may be needed. A few disorders which are chronic, may require continuing care. We will discuss the goals of treatment after the initial diagnostic evaluation. 8. How much does psychiatric treatment cost? Fees vary in different parts of the country. Psychiatric treatment sessions are scheduled on a regular basis and length of sessions vary depending on the services provided. I will be pleased to provide you, either by phone or in writing, a list of my fees. If for any reason you feel my fees are too high, it is your right to pursue a relationship with another mental health care provider. If, on the other hand, you particularly want to see me but simply do not feel that you can afford the fees, I can discuss other payment arrangements that may reduce the economic burden on you. All cases are reviewed on an individual basis. 9. Will my health insurance plan cover the cost? In addition to the professional nature of our relationship, there is a business relationship that consists of my willingness to provide a service to you and your agreement that you will be financially responsible for that service. Due to low reimbursement rates and the large amount of time required for paperwork, I am not an in-network provider for any insurance plans. Since the contract to provide insurance is between you and the insurance company, my usual policy is that I request payment at the time service is rendered. After you pay me the full amount for my services you may request a reimbursement from your insurance company. In some cases you will not be fully reimbursed. You must read the details of your insurance plan or call your insurance office to find out the details about “out-of-network” health insurance benefits and the extent of psychiatric services covered by your plan. It is my experience that insurance companies are more likely to pay out-of-network benefits for child and adolescent psychiatry due to the lack of psychiatrists trained in this subspecialty. If your insurance company should deny you an adequate payment, I will assist you to the best of my ability with your insurance company dispute. However, ultimate financial responsibility for your bill rests with you. 10. Will information and treatment be confidential? Most state laws protect the confidentiality of communication between patients and physicians. I will not discuss information about your child with others without your consent, except as required by law. In Massachusetts, confidentiality may be broken when there is thought to be a risk of harm to the patient or others, or if the physician believes the patient is not able to care for his or herself. Also, if I believe from what you have said that a child, disabled person, or elderly person is suffering abuse or neglect, I am required to communicate that information to the appropriate authority. In addition, courts may subpoena medical records. 11. Who is a Child and Adolescent Psychiatrist? Child and Adolescent Psychiatrists are physicians who specialize in evaluating, diagnosing, and treating children and adolescents with psychiatric disorders which cause problems with feeling, thinking, and behavior. They are specially trained and qualified to treat children, adolescents, and adults as individuals, couples, families, and groups. They practice in a variety of settings, including independently in offices, on the staffs of hospitals, clinics, and HMO's. 12. What training does a Child and Adolescent Psychiatrist have? A Child and Adolescent Psychiatrist has 10 years of special training. Child psychiatric training includes: 4 years of medical school after which the Doctor of Medicine (M.D.) degree is awarded; 1 year of supervised general medical practice in an approved residency program in a hospital, 3 years of supervised training in general psychiatry in an approved residency, and then 2 additional years of supervised training working with children, adolescents, and their families in an approved Child and Adolescent Psychiatry residency. The Child and Adolescent Psychiatrist is a physician licensed to practice medicine. After completing the above training, the Child and Adolescent Psychiatrist is eligible to take an examination to become Board certified in General Psychiatry by the American Board of Psychiatry and Neurology. After successfully completing this examination, the Child and Adolescent Psychiatrist becomes eligible for an additional examination to become Board certified in Child and Adolescent Psychiatry. Copyright © American Academy of Child and Adolescent Psychiatry.