Fortifying the Foundation for Effective Youth Mental Health Treatment Plans

Adolescence – that challenging development phase all children must navigate as they transition to adulthood – is rife with issues involving independence, social relationships and sexuality. Clearly one of life’s most angst-laden developmental labyrinths, adolescence is also an age when mood, anxiety, behavioral and process disorders, self-harm and suicidal thoughts may make their initial appearance, much to parents’ already-heightened concerns.

Such mental health struggles are known to cause significant pain, suffering and fear for the entire family, and accurate diagnoses and effective treatment plans to help get everyone’s lives back on track can be complicated, with major obstacles to accessing necessary resources encountered along the way.

Enter Lindner Center of HOPE’s new 3½-day outpatient comprehensive diagnostic program for children, adolescents and their families. The program is designed to provide quick access to thorough mental health assessments; early, accurate diagnoses to ensure the correct treatment; expedient referral to recommended treatment providers; and assistance in coordinating next steps in the treatment process.

All in a half week’s time.

The program, which began in mid-May, accepts children as young as six years old up to age 17; 18 if the patient is still in high school.

"This program fills an ongoing need for comprehensive diagnoses of adolescent mental health issues in a short period of time," explains Dr. Paul Crosby, M.D., chief medical officer at Lindner Center of HOPE. "We wanted to make mental health care available to more patients, and when we looked at our strengths, we realized what we are really good at in the adolescent realm is providing the comprehensive assessments that we had been doing at Williams House. So, we decided to open that unit to adults, and move adolescent assessments to an outpatient basis."

Child psychiatry is the most underserved of all medical specialties today, he notes, and it has been for a long time. So, it’s very difficult for parents to get a child psychiatric help in a beneficial time frame.

The average wait time between making an appointment and beginning the new Lindner Center of HOPE adolescent mental health assessment program is two weeks.

"The numbers I hear consistently for national wait times to get in to see a child psychiatrist is generally 90 days, though often closer to six months," Crosby adds. "Our new program is designed to provide an affordable option for families who want to get their children in quickly, identify problems immediately, and get on the road to treatment as soon as possible.

"The real challenge is getting the patients who need help in front of the people with the expertise," Crosby continues. "Increasingly, child psychiatrists are realizing they need to play a consultative role within the medical system, and that means doing assessments and often referring patients on to the right providers who can implement the correct treatment plan. We provide not only recommendations but actual referrals to treatment providers in families’ own communities because that is where the real work is going to take place. By positioning our new adolescent program as a diagnostic service only, we will be able to touch more lives and have a greater impact.

"If, as a parent, you’re concerned about your child at a young age, it’s better to address the issue at that time rather than wait another seven or eight years. Kids are resilient. Those of us who treat kids know that they tend to respond pretty quickly if you get them on the right treatment early on."

Comprehensive Assessments

A comprehensive assessment followed by a clear, correct diagnosis fortifies the foundation of an effective adolescent mental health treatment plan, Lindner Center of HOPE officials emphasize.

Throughout each individualized assessment, the center’s skilled and experienced diagnostic team considers genetic, psychological and social factors affecting the patient’s functioning and well-being. Consulting specialists are available in the areas of obsessive-compulsive disorder (OCD), behavioral addiction, chemical addiction, depression,

anxiety, trauma and eating disorders.

The comprehensive psychiatric diagnostic assessment performed by a skilled multidisciplinary team includes: pre-admission screening and evaluation of records; psychiatric assessment; neuropsychological evaluation and testing; specialty diagnostic and therapeutic consultation as clinically indicated; psychosocial assessment; strengths-based family assessment; genetic testing for medication with results review; feedback session with diagnostic team; written assessment summary with recommendations at discharge; a comprehensive written report of the full diagnostic assessment three weeks after discharge; and a follow-up call with a clinical social worker  six weeks after the feedback session.

Anne Polasko, Lindner Center of HOPE licensed independent clinical social worker, leads each family through the program.

"The diagnostic outpatient program we’ve created is in response to the two-week residential program we had at Williams House," Polasko explains. "Some parents could just not afford that. We heard other parents who expressed that they were feeling desperate because their children’s issues were getting worse, affecting home and school life, and they were not getting real answers in a quick, comprehensive way.

As one might imagine, parenting a child, adolescent or teenager who is experiencing mental health issues is complicated.

"We might have a bright student who is suddenly not doing well in school or refusing to go to school, and we have to figure out what is happening," Polasko continues. "Is it a cognitive issue that has not come to light? Are there social issues that are hidden? Maybe the child did well in elementary school, but now expectations are different in middle or high school; they have to be better at organizing things themselves and are struggling. It can manifest itself as avoidance or anxiety."

Kids today experience a lot of anxiety, she notes, because they feel they must be "on" all the time. They feel that they are being evaluated and compared constantly, whether they are at school, with friends or at home because social media does not stop.

"So, we look at the neuropsychological testing results, the patient’s behavior at home and school, as well as the parents’ perspective, so that we can give them the necessary tools to move forward," Polasko points out. "Before they come to Lindner, I provide parents with a lab order so they can get lab work done ahead of time, as well as an order for genetic testing to see which medications will work best for their child. We have those results when the child comes to us, and they are incorporated into the assessment."

Another integral piece of the program is the final 90-minute feedback session with Polasko, the patient’s psychiatrist, neuropsychologist, specialty clinician and the parents.

"We provide all the diagnostic information from the assessment and testing, and we help with scheduling the needed follow-up appointments," she says. "That’s a challenge parents have faced in the past – they often can’t immediately access good follow-up treatment, so we make sure that when they leave here, they have an assessment, diagnosis, medication recommendations and follow-up appointments in hand."

Internet Use Disorder

"This new adolescent program just makes a lot of sense. It’s more accessible and more affordable," says Chris J. Tuell, EdD, LPCC-S, LICD-CS, clinical director of Addiction Services at Lindner Center of HOPE. Dr. Tuell, a clinical psychotherapist and a chemical and behavioral addiction specialist, has more than 30 years of experience in the field of mental health and addictions.

As if adolescent and teenage substance use, abuse and addiction involving alcohol, cannabis, heroin and other drugs and the accompanying mental health implications aren’t terrifying enough for parents, there is another mental health issue – internet use disorder – that, according to Tuell, is growing in

prevalence and causing concern among mental health care providers.

Children with unhealthy internet habits, he explains, often also suffer from one or more co-occurring mental health disorders such as depression or anxiety. And research suggests that depression/anxiety can lead to gaming addiction.

"There is, of course, a spectrum here," Tuell emphasizes. "Take alcohol, for example. Some people don’t drink, and as you move down the spectrum, some people drink alcohol but it’s not a problem. Further down the spectrum, alcohol becomes more of an out-of-control issue for some people. It’s the same thing with the internet.

"For kids who suffer from anxiety or depression, have experienced trauma or have been diagnosed with ADHD, the internet may provide an easy way to regulate their moods or otherwise escape or disconnect from those mental health concerns. And for some kids – as well as for some adults – it becomes problematic."

An estimated 1 in 8 Americans of all ages suffer from some type of problematic internet use, Tuell points out.

"When we talk about internet use disorder, it can be everything from pornography to hyper-texting, hyper-surfing, sexting, gambling, spending, gaming – all variations of what the internet provides, and for some people it is certainly problematic and negatively impacting their lives and relationships."

He suggests considering the following Three Cs when trying to determine if you, your child or other loved one is in the throes of problematic internet use:

1.  Is there a loss of control?

2.  Has internet use become compulsive or obsessive?

3.  Do you or your child or other loved one continue to participate in unhealthy internet behavior despite the negative consequences? Is it affecting school or job performance, or causing marital or legal problems?

Those red flags, Tuell says, represent the true essence of any addiction.

"We saw mental illness in young people spiking in 2007, which coincides with when Facebook first came out," Tuell continues. "Last summer, the World Health Organization identified gaming disorder as a mental health issue. We believe it is only a matter of time before gaming and problematic internet use will become an official part of our mental health diagnostic process."

Some mental health experts recommend no digital devices for children until they are 2 years old, and then half an hour of screen time a day, at most.

"The internet is in our homes, our office, our schools, our cars – how do we regulate it? What is healthy? What is unhealthy? How do we moderately use the internet to stay healthy? The internet is like sugar. You can’t have a steady diet of it. But it is part of our daily lives, and we have to learn how to effectively manage it."

Scheduling an Assessment

The Lindner Center of HOPE admissions team works with families and existing referral sources to identify and understand issues and expectations to determine if the outpatient comprehensive diagnostic assessment will meet a potential patient’s needs. Assessments, planned and scheduled through admissions and the clinical social worker, typically begin on Mondays or Tuesday during business hours through the work week. To discuss scheduling an assessment, parents should call 513.536.0537

Lindner Center of HOPE is located at 4075 Old Western Row Road, Mason, OH 45040. For more information, visit www.lindnercenterofhope.org.