5 ideas to improve mental health care for Iowa’s kids
Here are five suggestions from Iowa and national experts to improve mental health care for Iowa children.
Use proven treatments
Dr. Mitch Prinstein, director of clinical psychology at the University of North Carolina
Too many families try unproven techniques and treatments to help troubled children, he said. The tragedy is that those families could instead try methods that have been confirmed by scientific scrutiny, he said.
Prinstein believes more people would support public funding for treatment if people saw how persuasive the evidence is for the best methods. “Unfortunately, it’s become a chicken-and-egg thing at this point,” he said of the public perception that many treatments have little evidence of success.
Prinstein, editor of the Journal of Clinical Child and Adolescent Psychology, helps run effectivechildtherapy.com, a website that highlights proven methods of treating mental illness. The site includes clear descriptions of disorders, plus the treatments that have been shown to ease symptoms.
For example, he said, families shouldn’t quickly agree to have their children simply take pills for issues such as depression or attention deficit/hyperactivity disorder. In many cases, the children also should receive counseling. “The science is very clear that the best outcomes are produced from a combination of psychotherapy and medication.”
Talk up profession
Dr. Steven Schlozman, a child psychiatrist at Harvard University
Current members of his specialty should be talking up its benefits to doctors in training, he said. Surveys routinely show that medical students join the profession because of a sincere desire to help people. Few specialties offer more direct opportunities to help people at a time of great need, he said.
“Why wouldn’t people choose a field that to me is endlessly fascinating, that has a pretty good lifestyle associated with it? It doesn’t pay as well as being a plastic surgeon, but nobody’s starving. We’re all doing fine.”
Schlozman said some medical students also must be encouraged to overcome stigmas about child psychiatry. “People get really riled up by the idea that a kid could get manic or depressed or even have ADHD,” he said. Also, he said, psychiatrists deal with issues that can be subjective, and their diagnoses can be open to dispute and controversy. “Compare that to orthopedics, where if a bone is broken, you can see it very clearly on a scan.”
Better coordinate care
Wendy Rickman, an administrator for the Iowa Department of Human Services
In too many cases, different branches of Iowa’s system fail to work together, she said. “We can sometimes get in each other’s way when it comes to what a kid actually needs.”
For example, she said, school officials, social workers and health care providers might fail to share information about a troubled child because of fears they will break confidentiality rules. That can be a particular problem when a child moves from place to place in foster care.
Rickman served on a state committee that helped suggest changes to the children’s mental health system. She said the organizational problems could ease later this year as the state uses federal grant money to add “specialized health homes,” which would attempt to coordinate services from multiple agencies to individual children.
Realize impact of trauma
Tamra Jurgemeyer, an associate vice president of the Orchard Place agency in Des Moines
Iowa professionals are doing a better job of recognizing that children’s mental health problems often stem from traumatic events, such as abuse or neglect, she said.
In some cases, the children’s underlying issues trace back to problems their parents had as kids. She said it’s often important to change the question from “What’s wrong with you?” to “What happened to you?”
“The families feel judged a lot,” she said. “The schools and the communities just see the behavior. They don’t see what that child and that family have been through.”
Get kids help sooner
Dr. Warren Phillips, a psychologist who practices in Ames and West Des Moines
Parents should know that the sooner conditions such as autism, anxiety and attention deficit/hyperactivity disorder are diagnosed, the better off their kids will be, he said. The longer parents wait, the further kids fall behind their peers socially and academically.
Phillips, who also teaches psychology courses at Iowa State University, said the stigma surrounding mental health issues still hasn’t lifted enough. He believes many families avoid seeking help from a mental health professional because they don’t want a kid labeled as needing such care.
“I think that’s why so many folks go to their medical doctor and use medication as their first choice,” he said. Instead, many patients could try counseling first, he said. Sessions with a skilled therapist can be especially effective for kids with anxiety or depression, he said.
Too many people still have the impression that therapy involves endless sessions talking vaguely about their pasts, he said. Modern therapy tends to focus on helping patients recognize and avoid destructive thoughts and behaviors, he said.
Counselors help children identify and face their fears, pay attention in class and learn social skills. They also can identify ways families can help. “The parent should expect that not only will the child learn skills, but the parent will learn skills,” Phillips said.
Phillips agrees with many other specialists that medication tends to be particularly effective for children with attention deficit/hyperactivity disorder.
Phillips, who has the disorder himself, said even people who receive relief from the pills should also consider taking at least a few counseling sessions. Topics can include strategies to improve organization and to maintain healthy routines for getting up, going to school or work, completing schoolwork and going to bed at a standard time.