Parents & Caregivers

As the person who cares for your child, you usually know your child better than anyone else. As your child develops and grows, they may have problems from time to time. If your child is acting unusual or seems to have a lot of distress for a long period of time, it may be time to get help. Other times to worry are when your child is showing highly unusual behavior that is causing them or others harm. A good question to ask is, “Are my child’s problems getting in the way of his or her day-to-day functioning?” Also ask yourself, “Is my child having problems with eating, sleeping, concentrating, or doing his or her usual tasks such as social activities, school and family relationships?”

All children have trouble from time to time. It is normal for children to have times when they are sad, angry, frustrated, and act shy or show anxiety– especially when faced with new situations. But, when your child is often distressed, cannot be soothed or comforted or is having problems that seem to be getting worse, it is a good idea not to worry alone. Just like your child’s physical health, there is a certain time when you may need to get a professional’s help. Also, if you are feeling overly concerned, have questions, or think that your child needs help or support, it is probably time to reach out to a qualified professional.

It is sometimes hard to know whom to turn to when your child has mental health concerns. A good place to start is your child’s doctor or pediatrician. You can talk to your child’s doctor about your worries and they can help you understand whether these concerns are a normal part of your child’s growth, or whether they need help. Some pediatricians can treat mental health issues, while others will send you to a specialist. It is important to remember that your pediatrician is trained to understand child development and to know what is normal for any given age or phase of development. However, your pediatrician may not have specific expertise in treating mental health issues. Your pediatrician can help assess the level of concern and then help refer you to a mental health specialist. Your pediatrician’s office should also be made aware of other types of help or treatment your child may be getting – just like when you see any other type of medical specialist for your child.

Many areas also have community mental health centers or child guidance clinics that provide support to children and offer a wide range of mental health services to children and families. To find a provider in CT you can call 211. Some parents choose to get help from a mental health professional in their area that is part of their health plan. A list of these health professionals can be found by asking your health insurance carrier, or if you are a HUSKY member, through the Behavioral Health Partnership.

Other places to turn for help include your school counselor, clergy or trusted teacher. These people can often help you get the support you need. However, in some cases, families may find that no one seems to have the answers, or that others seem to reduce their concerns. Remember that you can always call a mental health professional directly if you have concerns or would like a meeting. It is sometimes hard to know who to call and where to start. However, most communities have qualified mental health professionals who specialize in treating children.

If your child is experiencing a crisis, you should get help right away.

If there is an immediate danger, call 911.

If your child is experiencing a mental health crisis or is at risk of hurting themself or others, get crisis help:

In Connecticut, CALL 988 or 211 MOBILE CRISIS: You can call 211 (press 1 for crisis, and 1 for youth) to access Connecticut’s youth Mobile Crisis Intervention Services, which provides free rapid, urgent, face-to-face crisis response for children and their families from a trained counselor 24 hours, 7 days a week, 365 days a year. Youth Mobile Crisis can also be reached by dialing 988.

From Anywhere, CALL/TEXT/CHAT THE 988 SUICIDE & CRISIS LIFELINE: Call 988, or text 741741, for the National Suicide and Crisis Lifeline. You can also Chat at www.988lifeline.org. Learn more at https://www.preventsuicidect.org/get-help/ct-988/.

If you have private insurance, you may need to choose a provider in your network. Families may also choose out of network providers but may have to pay some costs of the service. HUSKY families can get services anywhere that takes your plan. Families who do not have health insurance can often get services from public agencies or clinics.

Finding a mental health professional is like finding any other qualified professional to help your child. If you live in Connecticut there are many resources, such as Help Me Grow or the 211 Infoline that you can use to help find the right referral for your child. If you were searching for an orthodontist you might start with your dentist or ask friends whose kids had to get braces. For mental health concerns, a good place to start is by asking your child’s regular doctor or pediatrician for a referral. You can also ask trusted friends, teachers, school counselors or your clergy. Sometimes you might need to use the phone book and call some providers in your community. Clinics, agencies or practices that specialize in working with children and families are usually a good place to start. There are many questions you can ask to help make your decision and things you should look for when choosing a therapist. You might have to speak to several therapists before you find one that is a good match. You and your child should feel at ease with the therapist, although sometimes it takes a few sessions before children become engaged or build enough trust to open up. It is important to know that the therapist you choose has experience working with children as well as experience in treating the main issues that concern your child.

The Department of Children and Families has a program called Voluntary Services that provide mental health services for children in the state of CT.  You can also search for providers trained in specific evidence-based practices by searching the Connecticut Evidence-Based Practices Directory.  This directory lists providers trained in some of the evidence-based practices that are available in Connecticut for children and families with behavioral needs.

Contacting a family advocacy group, such as FAVOR, is also good way of getting help in your community.

There are many types of professionals that provide mental health services to children. When choosing a therapist it is best to seek the services of a licensed mental health professional or accredited clinic or agency. Ideally, you may seek services from someone who has been trained to work with children or families. Children have their own special needs and should be treated differently than adults. Most mental health professionals specialize either by training or experience that focus on children.

Psychiatrists are medical doctors who have all gone to medical school and completed residency training and fellowships to specialize in psychiatry. Psychiatrists must pass a state-licensing exam. Child psychiatrists have completed more specialized training (usually in the form of a fellowship) in working with children. Psychiatrists can provide evaluation, diagnosis, psychotherapy and also can prescribe and monitor medication. Conducting a medical evaluation and prescribing medication are two important ways that set psychiatrists apart from other mental health professionals. Because there are not many child psychiatrists in CT or throughout the United States, they often work as part of a team or are asked to be involved when there are more serious psychiatric concerns, especially the need for medication. At times, your pediatrician can prescribe some medication to treat mental health issues (often for milder concerns such as ADHD, anxiety or depression), but if your child has more intense mental health issues, it is recommended that you get more help from a qualified child psychiatrist. To learn more about psychiatrists, you can visit the American Psychiatric Association website.

Psychologists are doctoral level, trained behavioral health specialists that have expertise in providing services (psychotherapy), conducting assessments (including psychological testing), evaluation, diagnosis and research. Psychologists all complete a doctoral degree in psychology and perform years of training in providing psychotherapy and assessment. Psychologists must pass a state-licensing exam. As part of their training, psychologists complete two years of pre-doctoral and post-doctoral training in clinical psychology. Child psychologists focus that training on working with children and families. Psychologists do not prescribe medication, but often have advanced training in assessment and behavioral treatment for children and families. To learn more about psychologists, you can visit the American Psychological Association website.

Social workers are mental health workers who have been trained to work with adults, children and/or families in a variety of settings. These include; home-based settings, school-based, hospital-based, agency based and office-based locations. Social Workers often have a two-year graduate degree followed by a one to two-year training for clinical licensure. Social Workers also must get “continuing-education” on a yearly basis. If choosing a Social Worker as your child’s therapist, it is important that they have specific training and experience working with children and families. To learn more see the National Association of Social Workers website.

Licensed Marriage and Family Therapists (LMFTs) – These are clinicians that have graduate school training, working specifically with families and/or children. LMFTs approach their work by looking at family systems and how they work. Often, LMFTs do two years of graduate education and are licensed after two years of a supervised internship. To learn more visit the American Association for Marriage and Family Therapy.

Licensed Mental Health Counselors – (or Licensed professional counselors-LPC)-Mental health counselors typically receive a two to three year training in counseling to work with adults, families or children. A licensed mental health counselor must earn a master’s degree in counseling or a closely related mental health discipline; complete a minimum of two years post master’s clinical work under the supervision of a licensed or certified mental health professional; and pass a state-developed or national licensure or certification examination. Like Social Workers, it is important if working with a mental health counselor, you identify a professional who has specific training and/or experience working with families and children. To learn more go to the American Counseling Association website.

Advanced Practice Registered Nurses (APRN) – These are registered nurses with a post graduate level degree and advanced, clinical education, knowledge skills and scope of practice. APRNs work closely with patients to achieve optimal outcomes through critical analysis, problem solving and evidenced-based decision-making. To find out more consult the American Nurses Association website.

Therapists/Para-Professionals – In many health settings, Bachelor’s degree level professionals also provide services to children and families, usually under the supervision of a licensed professional and usually give support to the child or family.

Non-degree/Indigenous Support Providers – In some cases, parents, advocates and other concerned adults can provide services and supports to children and families based on their needs. In many cases, these people have a special talent or skill such as speaking a specific language, coaching or mentoring. It is important that they are supervised by a licensed mental health professional or an established agency or provider who works with children and families.

Other Supports – It is important to note that many children and families benefit from services and supports other than traditional providers. Often, these services are provided with other forms of services. It is well researched that many children benefit from after-school activities, athletics and community-based and faith-based activities.

The most important question to ask a therapist is about their background and if they have experience working with children, and with children who have had some of the same problems or concerns that your child is facing. Experience in working with children may indicate that the therapist can help you, but it is also important that the therapist has been well trained and makes efforts to stay current and knowledgeable about best practices in child mental health. You should feel comfortable talking to your child’s therapist and not be afraid to ask questions. This is your child’s health, and no question is wrong. You should have an active role in your child’s treatment from the very start. For a list of more detailed questions you might ask your therapist, click here.

The mental health field has come a long way in knowing which treatments work best for some issues and concerns, but there are often not easy answers. If your child has an ear infection, a course of antibiotics may be prescribed to target the problem. If your child has a mental health concern, the answer might be less clear, but a well-trained mental health professional can work with you to plan a treatment that best meets your child’s needs and includes our knowledge of best practices.

The first place to start in identifying the right treatment is by having a thorough evaluation. During the evaluation, the clinician will collect history about your child and family, his or her symptoms, events leading up to the distress, school performance, relationships and other issues. It often takes many sessions to collect the right information to do a comprehensive evaluation. During this time the clinician may also ask you or your child to take some simple screening tests and other assessments to better understand the nature of your child’s concerns. Some providers use certain screening and assessment measures with all patients to make sure that they get the best treatment and no hidden concerns are missed. Using objective measures is a recommended practice.

To learn more about specific disorders and their treatment, please visit the AACAP parent website.

Testing is a generic term that can be used in different places and often means that a professional, such as a teacher, pediatrician, counselor or special education consultant wants to learn more about your child. Testing can show a child’s strengths and weaknesses, and it can help diagnose a child, based on their symptoms. It can give us information about their intelligence and academics as well as behaviors that are a problem.

Screening is when several brief tests and/or instruments are used to identify children who may be at risk for certain mental health issues. For example, children in the juvenile justice system in Connecticut are screened for mental health issues to determine the types of services/supports they might need.

Assessment is a more comprehensive process that uses a series of different tests or instruments to help create a picture of your child. Assessment may look at specific areas such as your child’s educational needs, or your child’s psychological functioning. Assessments are often done by child psychologists, either individually or part of a team. Results of assessments can be used to determine the best level of care, the right services and help point to the needs of your child.

Evaluation is the most comprehensive. It may include screening testing and assessment as well as clinical interviews of you, your child, service providers and other adults in your child’s life. Evaluations often include gathering your child’s history and background and to know all the things that contribute to your child’s mental health issues. Often, a team of mental health professionals including psychiatrists, psychologists, social workers and other educational and mental health professionals will conduct evaluations. Results of an evaluation may be used by court systems, schools, state agencies and treatment providers to help find out the best services for your child. Family members should be an active part of an evaluation.

There are many types of treatments for children who have mental health issues. Individual outpatient treatment is where your child will see a counselor one or more times weekly to help them with their difficulties. For younger children it is most helpful to have the child’s parent or caregiver involved in the treatment. Outpatient services can be provided as individual, group, and family services. In-home services are also given by many agencies and are an effective way of treating many mental health concerns. Other treatments include school-based, after-school, partial hospitalization and inpatient hospitalization and residential treatment.

Some parents choose faith-based support, recreational activities, native or local healers, or nutritional plans to help with their child’s mental health concerns. Parents must find out whether these treatments have worked in the past and if they are safe. It is important to know that the service provider you choose has a good track record of working with children and demonstrates successful outcomes.

Depending on the type, how serious and how long your child has had the symptoms, your pediatrician or child psychiatrist may prescribe medication for your child. Often, medication is prescribed with some type of behavioral treatment, such as counseling. However, in an increasing number of cases, especially in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), some providers may only prescribe medication. Parents and caregivers often are very concerned when they first learn that their child might be prescribed medication. It can be a scary idea. But in most cases, parents find that medication can be a helpful tool in relieving their child’s symptoms. Questions about your child’s medication should be directed to your pediatrician or the prescribing physician.

Typically, no. Medications will not usually significantly change personality, but should affect your child’s symptoms. This is a common concern for parents because giving your child any medication is always a concern. Psychotropic medications (drugs used to treat mental health issues), often do not change your child’s personality but can lessen their psychiatric symptoms. For example, children who have depression or acute anxiety may get relief from these symptoms when taking certain medications. Parents should closely monitor their child when taking medications and report any concerns about side effects, changes in mood and personality to the prescribing physician.

Side effects differ with each medication. Common side effects include symptoms such as drowsiness and changes in appetite. It is best to ask your doctor and/or the pharmacist about the possible side effects for any medications your child is taking.

Medications that have been approved for use for children must go through an intense review by the Federal Drug Association (FDA). All medications have risks and it is important to discuss these with your prescribing physician and/or pharmacist before taking them. Overall, psychiatric medications prescribed for children, when used in the right way are usually safe. However, any medication can be dangerous if not used in the right way, or under certain circumstances. It is important to ask a qualified physician, pharmacist or nurse practitioner about the medication’s safety.

Medications differ in price and in some cases can be expensive. Most common psychiatric medications are paid for by insurance plans and HUSKY. If your family is getting HUSKY/Medicaid coverage in CT, ask the Behavioral Health Partnership (BHP) if the medicine is covered, and if not, what is the cost of the prescribed medication to you and your family. For those with private insurance, it is best to ask your private insurance carrier. If you do not have health insurance you may want to ask your family doctor about your options.

It is not likely that your child will take medications forever. How serious and what type of diagnosis your child has will affect how long your child will need his/her medications. The prescribing clinician should assess your child on an ongoing basis to see if medications are still needed. Over medication is also a concern for some parents and if your child is taking a combination of psychiatric medications, it is suggested that your doctor assess your child on an ongoing basis.

It is a common feeling for parents to blame themselves for their children’s issues. Children’s mental health issues are a result of many different things including biological (genes), environmental, family, and individual factors. It is helpful for parents and caregivers to take an active role in their child’s treatment. But blaming yourself for your child’s issues will not help you or your child.

Some disorders are biologically linked and children are more likely to have some problems if close family members suffer from these problems. There are no known psychiatric disorders that are 100% hereditary. If a child’s parent has a certain mental health concern, it does not mean the child will suffer from the same difficulty. However, if the child’s parent does have a psychiatric issue, it does increase the risk for the child to have similar difficulties. The way your child develops is due to both heredity (biology) and their environment.

Both boys and girls can have mental health concerns and sometimes these issues show themselves in different ways. The way in which mental health issues develop depend on many things, but the child’s gender can have a role. Because boys and girls are often socialized in different ways, boys often show outward signs of anger, aggression and acting out behaviors. Girls on the other hand sometimes tend to hold in these feelings and this can lead to problems, such as depression, anxiety and other “internalized” disorders. However,  new research has shown that the differences in the way in which girls and boys experience mental health issues is getting smaller. For girls, as they develop and have relationships, treatment that focuses on relationships and is sensitive have been found to be very helpful. Some agencies and providers offer gender sensitive counseling and services designed for the needs of girls. As a parent or caregiver, you know your child best and can help point to the issues and concerns that will be most important when finding the right help.

It is common for people to worry about what others think and have concerns about the stigma (shame) of mental health issues. Stigma can sometimes get in the way of enabling your child to get the treatment he/she needs. Different cultures have different views about mental health issues and concerns and in some cultures it is not okay to talk about such issues. However, in our society it is becoming more accepted to talk about mental health concerns. Parents often say that a safe place to talk about their issues is with other parents who have some of the same concerns or experiences. Mental health issues should be treated like any other health concern that your child might have. However, if you have concerns, laws can protect you and your child’s privacy and information cannot be shared without your consent.

Like other health problems your child may face, many mental health problems take care of themselves with time and the right treatment. It is important to get treatment for your child when problems first happen to help stop them from getting more serious. Some disorders can last a lifetime, but many children will respond well to treatment and may improve with time.

How your child acts at school may or may not be affected by his/her mental health issue. It depends upon the type of issue. Many times, it is helpful to talk with your child’s school counselor or social worker (or other school-based mental health staff), to inform them of your child’s diagnosis and treatment so they can give the right support at school. In some cases, school-based services can be very helpful. For more serious mental health concerns, your child’s issue may be recognized through an Individualized Education Plan (IEP) that provides your child with added services and supports in school. It is important to work closely with your school to make sure your child is observed and tested so that he/she can get the right support and services if needed. For minor mental health concerns, some parents choose not to share the information with the school and are not required to share it, as this information is considered confidential.

Parents and caregivers often say that talking to other parents is one of the most useful forms of support. Connecticut has many family advocacy and support centers where trained parents can assist you and link you to local resources. A link to these services can be found here and you can also consult CT’s Community Collaboratives which can link you into other resources. At times, parents may need to get their own treatment and support, and if needed, find a referral at their local community mental health center, private provider, or through their insurance/HUSKY network.

It is important for parents to be honest and use words your children can understand. A good place to start is by asking your child to talk about what is worrying them or bothering them. It is important to create a safe place where your child can talk with you in the open about their issues. Some parents find that a certain time or place is best for talking to your child. It is important for you to use the words that your child can understand and to answer their questions in a simple way so that you do not burden them with unnecessary information.  Explain to your child that because of the concerns they have been having, you are going to talk to someone who can help. As your child continues getting help, it is important to keep talking with your child so that they can share their ideas/concerns. If you are having problems talking to your child, developing a better relationship and open communication can be one of the goals of treatment.

If you talk to your child’s brothers and sisters, use words that are right for their age and that they can understand. Be careful not to burden your other children with too much information, but respect their questions and concerns. In some cases, siblings or other family members may be asked to take part in some of your child’s treatment. If the treatment is home-based or involves new skills in the home, it will be helpful if the family understands and supports your child. However, it is vital to help your child feel safe and protect their privacy even within the family setting.

Over the past 20 years we have learned a great deal more about which services work best for children who have mental health issues. Services that have been found to work very well for children and have research supporting them are called “evidence-based practices”. These evidenced-based practices have also been proven to work in the real world with children who have real issues and concerns. Best and promising practices are services that we believe to be the best available services for children but have yet to have had enough research to back them up (demonstrating that they work) to be called evidence-based practices. It is important to note that evidence-based practices have not been identified for all mental health issues that children face. Providers should involve parents and caregivers in developing a treatment plan for your child with clear goals where results can be measured over time. In Connecticut, evidence-based practices are only available in some places, depending upon your child’s issues and concerns. Many community-based providers offer these services for children with mental health issues and you can ask your mental health professional about them when you contact them for help. For example, an evidence-based treatment for children who have been affected by trauma is called Trauma Focused Cognitive Behavioral Therapy  (TF-CBT). For a list of these agencies, please click here.