Psychotropic Medications

Oklahoma Child Welfare Resource Parent Guide to Emotional and Behavioral Health Care For Youth in Child Welfare

As a parent, kinship parent, foster parent, case worker or other caring adult for youth in child welfare it is important to effectively advocate for your child’s emotional and mental health needs. As the caring adult in your child’s life the information you provide to his treatment team is imperative in ensuring an accurate diagnosis. A team-based approach valuing your observations and the youth’s voice and respecting the clinical education and experience of the treatment team is important to successful treatment.  

Often times youth have been struggling for years; often with limited treatment and support. As caregivers caring for youth it is important to be aware of who is and can be a part of your team. Communication between youth, caregivers, schools and mental health clinicians is imperative to ensure we are all on the same page. Mental health teams can include a variety of professionals. These services might be provided in the school or an outpatient settings. The information below is provided by the National Alliance on Mental Health, a helpful resource for individuals and families wanting to know more about mental illness.  Below are professionals that might be a part of your child’s treatment team:

School Involvement

Many schools contract with mental health agencies to provide therapy. Although many schools have school-based counselors and psychologists these professionals often have additional duties that limit their ability to see youth individually. Schools need partnerships with the adults in a child life; so if you have concerns about your youth’s education or behavior be in contact with your school.

Schools operate on the least-restrictive setting principal. Meaning if your child can learn in the general education setting, that is where they will be best served. Schools are able to adopt behavior plans or school-based interventions to help support individual youth. This might not always get communicated to families. If you have concerns talk with your child’s teacher or principal. If the school feels like typical behavior plans are not working they might implement a 504 plan or ask about additional evaluation for an individualized education plan (IEP). In order for an evaluation for an IEP to occur guardian permission is needed. Both teachers and guardians can request an evaluation for an IEP. Guardians are encouraged to put their request in writing and date it. Important to note that just because a guardian requests an evaluation does not mean a school has to do the evaluation. Effective communication around needs and expectations is imperative for school success.

Assessment And Therapy 

Psychologists 

Psychologist hold a doctoral degree in clinical psychology or another specialty such as counseling or education. They are trained to evaluate a person’s mental health using clinical interviews, psychological evaluations and testing. They can make diagnoses and provide individual and group therapy.

Counselors, Clinicians, Therapists 

These masters-level health care professionals are trained to evaluate a person’s mental health and use therapeutic techniques based on specific training programs. They operate under a variety of job titles—including counselor, clinician, therapist or something else—based on the treatment setting. Working with one of these mental health professionals can lead not only to symptom reduction but to better ways of thinking, feeling and living.

Psychiatrists

Psychiatrists are licensed medical doctors who have completed medical school and psychiatric training. They can diagnose mental health conditions, prescribe and monitor medications and provide therapy. Some have completed additional training in child and adolescent  psycghiatry (2 years additional training).

Primary Care Physicians (Family physician or pediatrician) 

Primary care physicians and pediatricians can prescribe medication, but you might consider visiting someone who specializes in mental health care. Primary care and mental health professionals should work together to determine an individual’s best treatment plan.

Advanced Practice Nurse practitioners

Psychiatric nurse practitioners can provide assessment for mental health conditions or substance use disorders. Psychiatric nurse practitioners should have received additional training specific to psychiatric illness.

Treatment of Psychiatric Illness in Youth

It is important to note that for the majority of psychiatric illness, therapy that includes the care-giver is often the firsts line of treatment. This is even more important the younger the child is. Additionally,younger children are not immune to psychiatric illness. Psychiatric symptoms might present differently in younger children compared to their older counterparts. For younger children therapy is the first therapy that should be used and medications should be reserved for the most severe cases. A therapist skilled in infant mental health; with specific training in younger populations will be the most appropriate for children under the age of five. For youth in the child welfare system; a trauma-informed approach is imperative, and it is important to ensure that the treatment team working with your child has experience working with you in child welfare and is trauma-informed.

Psychotherapy/Therapeutic Interventions  

Psychotherapy is a form of treatment that involves therapeutic conversations and interactions between a therapist and a child or family. It can help children and families understand and resolve problems, modify behavior, and make positive changes in their lives. There are several types of psychotherapy that involve different approaches, techniques, and interventions. In some cases, a combination of medication with psychotherapy may be more effective. Regardless of the age of the child the caregiver of the child should be involved in the therapy on some level. The younger the child is the more important care giver involvement is.

As a caregiver you might be asked to participate in therapy, learning effective behavioral management  skills. You might be asked to help the child enforce effective coping skills at home. You might be asked to help relay information to and from the child’s school.  

• You should be talking with your child’s therapist on a regular basis what your concerns are and how therapy is progressing or not.
• You, your child and your therapist should have an agreed upon safety plan if a crisis arises.  
• You should know how to contact your therapist or crisis service 24 hours a day 7 days a week.

Use of Medications to Treat Psychiatric Illness in Youth.  

For some youth the severity or duration of illness might warrant the use of medication.  

Medication can be an effective part of the treatment for several psychiatric disorders of childhood and adolescence. A doctor’s recommendation to use medication often raises many concerns and questions in both the parents and the youngster. The physician who recommends medication should have experience treating psychiatric illnesses in children and adolescents.  

Psychiatric medication should not be used alone. The use of medication should be based on a comprehensive psychiatric evaluation and be one part of a comprehensive treatment plan.  

As a guardian you have the right to ask questions about treatment to ensure you are comfortable with treatment. Additionally, youth should have a voice in the medication treatments. The older the youth the more important their input and agreement is.

Discontinuing Medications 

If the youth has shown a sustained period of remission or recovery and the prescriber believes the medication may no longer be necessary, a discontinuation trial may be indicated. Before initiating a discontinuation trial, the plan for discontinuation should be  reviewed with the patient and caregiver focusing on the risks of discontinuation (e.g., the risks for withdrawal symptoms and the risk for relapse or recurrence of symptoms) and the treatment plan if symptoms return. This is especially important if the youth was significantly impaired or suicidal before medication treatment.