Philadelphia Community Services for Children and Adolescents

I. Mental Health Evaluations, Diagnosis and Treatment

The process of getting help for your child varies from family to family, but it usually includes getting some kind of evaluation, formal or informal. This is followed by therapy or treatment, if recommended. This section provides important information to parents who are just starting to seek help. But, it can also be useful to parents whose children have already entered the mental health system.

A. Evaluations

Many parents enter the mental health system by having their child evaluated. An evaluation is the examination and/or testing of a child by a professional evaluator and/or evaluators to determine the child's strengths and/or weaknesses in particular areas and the specific needs that may be addressed in treatment or educational planning or both.

1. Who Recommends Evaluations and Why?

a. School

Your child's school may recommend that he or she be examined, either for educational or emotional reasons. If your child is having difficulty in school, the school will need to know why. Is it a learning disability, an emotional problem, or an intellectual problem? The school needs to know more before it can provide the most appropriate educational program. If the School District recommends that your child be evaluated, or you request the School District to evaluate your child, certain procedures must be followed, certain groups of tests must be included, and you and your child's legal rights must be respected. See Special Education.

Some private schools require that children be evaluated before they will be considered for admission. Requirements vary, but usually include both educational and psychological tests.

b. Preschool Teacher

Sometimes your child's preschool teacher may suggest that your child be evaluated. The teacher may be concerned that he or she is not ready for kindergarten, either socially and emotionally, physically and maturationally, or intellectually.

c. Pediatrician

Concern about your child's development or social/emotional growth may lead a pediatrician to recommend further examinations.

d. Therapist

If your child is already in therapy but has never been given a full battery, or group, of psychological and/or educational tests, the therapist may suggest that he or she be evaluated in this way.

e. Parents

You have a right to have your child evaluated through the public school system. For more information see Special Education.

No test or group of tests alone can provide a complete picture of your child's development. In addition to tests, it is important that your child be observed in different environments and that the evaluators talk to you and others who know your child well.

2. What Are the Different Kinds of Evaluations?

A physical examination is given by a doctor or other trained medical professional to identify any medical problems that may affect your child's ability to function.

An educational assessment determines a child's academic strengths and weaknesses (for example, the child's math or reading skills). This type of assessment is usually performed by the child's classroom teacher or another educational professional. Specific achievement tests can be given by school psychologists to assess the child's school-related skills. For more information see Special Abilities Tests.

A psychiatric examination is administered by a child psychiatrist or a general psychiatrist to determine whether a child has an emotional problem that may affect his or her ability to function.

A private psychiatrist's or child psychiatrist's examination usually involves one to three sessions in which a child is seen alone by the psychiatrist and sometimes observed at play. Psychiatrists will want to speak with parents regarding the nature of the problem and the child's social, developmental, and medical history. He or she may also want to see the whole family.

A mental health evaluation is often performed at a mental health center or mental health agency during the child's first appointment or "intake." This is conducted by a therapist and does not include a full battery of psychological or educational tests. The therapist conducts the evaluation by talking to the child and the parents and by observing the child's behavior.

Parents will assess the child's problem, describing the problem from their point of view. This information is very valuable; parents know the child best, and competent professionals will realize that they have a wealth of information.

A psychological evaluation is an examination and testing by a psychologist to obtain information about a child's intellectual ability and emotional state. A complete evaluation measures four areas of a child's development: intelligence, achievement, personality, and perceptual/motor skills.

In Pennsylvania, only a licensed psychologist or a psychology intern under the supervision of a licensed psychologist is authorized to test a child. If the information is to be used in placement decisions at school, the psychologist must be a certified school psychologist.

The most common types of evaluations given to children are psychological and educational tests. Therefore, the following pages focus on those types of evaluations.

If a particular clinic or private psychologist has a long waiting list or an unaffordable fee, ask to be referred to another place.

3. Preparing Your Child for Psychological Testing: Tips from Parents and Professionals

Most children will be anxious about being evaluated. This is especially true if a child has been identified for evaluation because of poor school performance or difficult behavior. Children may think that the tester will be able to "read their minds" or will punish them for bad thoughts or behavior. Anxiety can interfere with a child's performance on the tests.

You can help your child by telling him or her (a) why he or she is being tested, (b) what the testing will be like, and (c) how it will be used.

a. Help your child understand why he or she is being tested

Keep in mind that children usually know they are having trouble in some area, so you can begin by telling your child you are concerned about this trouble area and want to help. You can explain that you have made an appointment (or the school has made the appointment) for him or her to see a person who will help figure out why he or she is having trouble in whatever area - school, getting along with friends, controlling his or her temper, or just because he or she seems so sad.

b. Explain to your child what it will be like

You can say that a psychologist will find out how to help by having your child do some tasks. (The word "tests" usually implies school and may make your child even more anxious.) He or she can be told, "These tasks are activities that will help us and help you. They will tell us what things you can do well and what we can do to help you get along better" or "what things will help you do better in school." If your child is already in school he or she can be prepared by being told that they will be doing some school-like things (e.g., answering questions, making up stories, drawing pictures, etc.).

Some parents choose not to say that children are going to the "doctor," because this often means a medical doctor to young children and they may fear needles or some other unpleasant experience. Other parents find that it helps to call the therapist a "counselor," "worry doctor,""problem doctor," or "talking doctor".

Ask the tester to prepare you and your child for how long the test will take. If your child is young and the tests are lengthy, the tester may decide to spread them out over two or more days.

c. Tell your child how results will be used

You might tell your child that what the psychologist finds out from the tasks will help teachers, parents, and your child's therapist - if there is one - understand the areas in which he or she needs help and how best to give that help. Assure your child that evaluations are not used to punish.

4. Parents' Role in Evaluations

In most situations, parents are asked to meet with the psychologist before the child is evaluated to provide background information on the child and the family. You will be asked questions about the family environment and family relationships. The psychologist will also ask about many developmental aspects: the pregnancy, labor, delivery, and early milestones (e.g., when your child first sat up, walked, and so forth). You will also be asked about your child's current behavior at home, with friends, and at school. The psychologist may also ask you what the problem is from your point of view. This information is very valuable; parents know the child best and competent professionals will realize that they are an excellent source of information.

Remember to ask for another referral if a particular clinic or private psychologist has a long waiting list or an unaffordable fee.

5. Getting Feedback

When the psychologist has finished evaluating your child, you will have the opportunity to hear the results of the tests. This is called feedback. If the tester advises that you read the report, do so with the tester present so you can ask questions and you fully understand the answers. If you are afraid you won't understand the results or ask the right questions, bring someone else along with you to the feedback session.

Look for a balance of strengths and weaknesses. No matter how disturbed a child is, a good psychologist will always present the child's strengths. This is so a treatment plan or educational program can be designed that will use your child's strengths.

Children also have a right to hear feedback. If your child is about 8 years or older, feedback can be communicated privately to him or her by the psychologist although you may be present if both the psychologist and your child agree that this is important.

6. Planning Ahead

If you think your child may need to be tested before entering school, plan ahead. Some clinics that specialize in this kind of testing have waiting lists at certain times of the year. The School District may also have a waiting list. Check with them to find out how long it will be before they could evaluate your child.

7. Confidentiality

If your child has been tested by a private psychologist or at a clinic for school-related purposes, you will be asked to sign a form releasing the report to the school. However, you can ask to see the report before it is sent to the school. If you choose not to sign the form, the report will not be sent to the school, and instead, can be sent to you at home. If your child has been tested on the recommendation of a therapist, you will also be asked to sign a release form. If the report is to be released to a third party (for instance, the school), both you and the testing psychologist must sign a release form.

All test results become part of the school record and, therefore, are available to school personnel. However, the results of psychological tests cannot be released with other school records without parents' special permission.

8. Fees for Evaluations

Private insurance usually pays for part of the cost of psychological evaluations if the policy contains Major Medical coverage and the psychologist is licensed.

a. Medicaid

Philadelphia has one managed care company for psychiatric, or behavioral health care, Community Behavioral Health. It is always a good idea to call the managed care company in your county to find out the procedures for obtaining an evaluation. Some companies require that you obtain pre-authorization or obtain permission to make an appointment for an evaluation, others do not. If you are on Medicaid, and you want to have your child evaluated by a psychiatrist or a psychologist who participates in your managed care organization network, there should be no fees for the evaluation.

In Philadelphia call:
Community Behavioral Health (CBH)
215-413-3100
888-545-2600
215-413-7198 TTY/TDD
www.phila-bhs.org

b. School System

The educational system evaluations must be provided free of charge. Also, if you as parents disagree with the School District's evaluation and believe that it is not appropriate for your child, you may make a request that the School District pay for an independent evaluation. The School District must either agree to pay or request mediation or a due process hearing to show why it should not have to pay. For more information see Special Education.

9. Questions To Ask Before Your Child Is Evaluated

How long will the testing take?
What kinds of questions are on the tests?
Does the psychologist's fee include a visit to your child's school or a conference with another therapist?

Results of psychological tests cannot be released with other school records without parents' special permission.

B. Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition-Text Revision), or DSM-IV-TR, is published by the American Psychiatric Association for the purpose of providing a common language for professionals to use when discussing mental disorders. The manual defines disorders found in infancy, childhood, adolescence, and adulthood by describing specific behaviors that must be present for the mental health professional to diagnose that particular disorder. A similar manual used by mental health professionals is the International Classification of Diseases (Ninth Edition), often referred to as ICD-9 CM.

Although parents often do not like their child to be "labeled," a diagnosis is necessary for Medical Assistance or a private insurance carrier to pay for your child's treatment.

A diagnosis determines the treatment that will be prescribed for your child and therefore has serious implications. If the diagnosis is incorrect, the consequences for your child can be grave. Other parents suggest that you get two or three opinions if you are concerned that your child may have been misdiagnosed. See Evaluation and Treatment for other resources.

There is a space for diagnosis on all forms submitted to insurance carriers. The professional treating your child must complete this blank with a standardized diagnosis taken from either the DSM-IV or the ICM-9 CM. "Adjustment Disorders" and "Relationship Disorders" are two common diagnoses of children and adolescents. Listed below are some other common diagnoses of children and adolescents, classified according to the main area of disturbance.

1. Intellectual Disorders

a. Mental Retardation

If a child's intellectual functioning is significantly below average, the primary diagnosis would be mental retardation. If a child is also having emotional problems, this would be considered the secondary diagnosis. This diagnosis is established by individually administered, nationally standardized psychological tests.

2. Behavioral Disorders

When a child's behavior is the main problem, they may be diagnosed as having one of the following three disorders:

a. Substance Abuse Disorder

Young people who persistently abuse or become addicted to drugs or alcohol often have other mental health problems.

b. Conduct Disorder

A Conduct Disorder involves persistent violations of the customs of society, often with harm to others. This may be accompanied by aggressive or non-aggressive behaviors. Behavior may include repeated rules breaking, stealing, running away from home, fighting, vandalism, truancy, etc. Oppositional Defiant Disorder is another disruptive behavior disorder that is similar to Conduct Disorder, but the behaviors involved are not as serious.

c. Attention Deficit/Hyperactivity Disorder (ADHD)

Children with this disorder are often but not always hyperactive. The child with ADHD is impulsive and unable to pay attention in class or at home, despite good intentions. If hyperactivity is involved, there is restless and fidgety behavior. There also may be excessive running and jumping.

3. Emotional Disorders

a. Depression

Depression is more than a low mood that lasts for a short time; it is a state of mind that limits all activity. Things that were once fun will bring little joy to the child who is depressed. He or she may withdraw from activities he or she used to enjoy. This is often accompanied by changes in or disturbances of sleep, appetite, and school performance. In some cases, depression may lead to suicide, which is the second leading cause of death among teenagers. Adolescents may also be afflicted by manic-depressive illness (also known as bipolar disorder). Bipolar disorder involves having times when an adolescent has excessive energy, has little time for sleep, may spend a lot of money, or is very preoccupied with sex. These problems last for weeks rather than days and will alternate with depressive episodes. See Suicide for more information.

b. Anxiety Disorder

A child with this disorder is very fearful and avoids certain situations, such as spending time apart from parents, going to school, making friends, or new situations. The child may also be very worried or self-conscious. Obsessive Compulsive Disorder is a type of anxiety disorder that often shows itself in using some behaviors over and over again-for example, hand washing even when there is no good reason to do this.

c. Adjustment Reaction

A mild or brief disorder usually produced by a stressful situation such as the death of a family member, divorce, a family move, or separation from parents.

d. Relationship Problems

A disorder characterized by problems with significant others such as parents, teachers, or siblings.

4. Physical Disorders

Some emotional problems in young children involve a physical problem as well.

a. Enuresis or Encopresis

Bedwetting or soiling would not be diagnosed as mental illness, but may indeed be a problem for a child after a certain age and indicates that he or she needs professional help.

b. Stereotyped Movement Disorders

This includes sudden, repetitive movements or tics beyond the child's control, such as head banging. Tourette's Disorder is a combination of muscle tics and vocal tics such as saying words or coughing repeatedly.

c. Eating Disorders

These include anorexia nervosa (a refusal to eat leading to a drastic loss of weight) and bulimia (binge-eating followed by self-induced vomiting or the use of laxatives). The disorders usually affect teenage girls, although the occurrence among teenage boys is rising.

5. Developmental Disorders

A developmental disorder may be diagnosed when a child's psychological development is affected by biological or non-biological factors. There is either a delay or a distortion in the child's emotional growth.

a. Learning Disorders

A learning disorder is usually defined as one aspect of development - often reading, language, or math skills - differing from the normal path of development - also called "learning disabilities." The Pennsylvania State Standards on Learning Disabilities defines them as "a deficiency in the acquisition of basic learning skills, including, but not limited to, the ability to reason, think, read, write, or spell or do mathematical calculations as identified by an educational and psychological evaluation." In DSM-IV-TR, there are two further diagnostic criteria. First, the child must have a discrepancy between his or her IQ and his or her academic performance and, second, he or she must have had adequate opportunity to have acquired academic skills. We do not often know why children have these disabilities, but we believe that there may be some biological base.

b. Pervasive Developmental Disorder

This is defined as having severe problems in development in several areas. One example is autistic disorder. Babies with autism do not respond to others, cuddle, or look at their caregiver. These children may never learn to talk or else may use peculiar speech patterns. Autistic children also find it very difficult to cope with change. This disorder typically manifests itself in the first 36 months of life.

6. Schizophrenia

This disorder is characterized by a profound disturbance in social relations and multiple oddities of behavior, including delusions (absurd beliefs not based in fact), hallucinations (most frequently hearing voices), and extremely disorganized thoughts. Onset is typically between 15 and 30 years of age.

C. Who are the Mental Health Professionals?

If you decide that your child does need help from a mental health professional, your next step will be to choose an agency or private therapist.

A mental health professional is a person formally trained to help people in emotional distress and who has earned some additional credentials, usually in the form of state licensing, certification, or both.

"Therapist," "psychotherapist," or "counselor" are terms most often used to refer to mental health professionals. But these are all general terms that could refer to a professional who is well trained and experienced - as well as to one who may have no formal training and little experience. When looking for a therapist, inquire about his or her professional training and experience. Every profession has its skilled, dedicated, and helpful practitioners, as well as those who are unskilled, incompetent, and even destructive. Be sure the person chosen has extensive training and experience in treating children and families and is well respected in the community. Equally important is that he or she can be trusted and treats people with understanding and respect.

It would be far too complicated to explore in depth all of the differences in training, licensing, and/or certification among these major mental health professions, but here is a brief summary:

Psychiatrists (M.D., D.O.) are medical doctors who specialize in the diagnosis and treatment of emotional difficulties and who spent four years in residency training after completing medical school. A child psychiatrist will have had additional special training in understanding and working with children and adolescents and their families. Psychiatrists, because they are physicians, are the only mental health professionals who can prescribe medication and supervise its use.

Clinical Psychologists (Ph.D., Psy.D., Ed.D., M.S.) are specially trained in the evaluation and treatment of emotional problems. They work with individuals, couples, families, and groups in an effort to treat and prevent serious problems by helping people cope with stress or crisis, or by helping them reduce stress in their environment. A licensed psychologist has at least a master's degree in psychology (two year's graduate training) and often has a doctorate (five years of training).

Psychiatric or Clinical Social Workers (M.S.W., A.C.S.W., L.C.S.W.) are professional social workers who have earned the degree of Master of Social Work (M.S.W.) and may have completed additional training. Social work training includes working directly with people and under the supervision of other professionals. Social workers who have completed a program approved by the National Association for Social Work receive an A.C.S.W. degree. Some social workers are certified for clinical or psychiatric practice through state licensure (L.C.S.W.). Social workers staff many of the community-based programs in Philadelphia.

Family Therapists (M.F.T., M.S., M.A.) have been trained in graduate programs or special certificate programs designed to give them specific experience and training with families.

Psychiatric Nurses are registered nurses (R.N., B.S.N.) who have had special training and experience working with people in emotional distress. Some may have earned a master's degree (M.S.N.) in a psychiatric/mental health nursing program. They often work closely with psychiatrists or other professionals.

Pastoral Counselors are not always ministers, priests, etc. In the Philadelphia area, the Pastoral Training Institute offers a post-master's residency program in pastoral counseling and psychotherapy.

Trainees, Interns, Residents are training for the professions listed above and spend varying amounts of time working as staff members in clinics, counseling agencies, and hospitals as part of their education. They are supervised by members of the permanent staff.

With so many types of mental health professionals, you must be an INFORMED CONSUMER. You have the right to question the training and qualifications of the therapist you are considering or who has been assigned to your child. Whether your child is seeing a private therapist or is being seen in a clinic or community MH/MR center, parents have the right to ask questions. The following list of questions can be used as a guide:

What is your professional training and degree?
How much specialized training and experience have you had with children and/or adolescents? Are you experienced with special needs children?
Please explain your theoretical views. What theoretical school of thought do you follow?
How would you handle acting out in your office?
Do you usually see the child alone or with the family?
What procedures will you use to evaluate our situation?
Will my child be tested? How much do you or does your agency charge for testing?
How frequently will my child have sessions? How long will each session be? Will these sessions be set at a convenient time for me so that I don't have to miss time from work and/or my child will not have to miss any time from school?
What is your policy on videotaping sessions and/or using one-way mirrors?
What is the cost of each session? Does our insurance cover the cost?
Can I still be seen for therapy if I don't have any money? What is your policy on canceled appointments? Is the full fee still due?
Are you doing an internship or residency? If so, who is your supervisor and when will you be leaving? If therapy is still needed after you are gone, what will happen?
How much "outreach" do you do? Can you come to see my child in our home environment? Will you work with the people at my child's school?
What happens if there is a crisis with my child? Do you have access to crisis intervention services?
Will you keep me apprised as to how you feel my child's therapy is progressing?

If you feel uncomfortable with the answers or if the therapist seems reluctant to answer your questions, do not hesitate to ask the clinic for a new therapist or look for another. Often the clinic has a long waiting list and no other therapist may be available to see your child, but there are other clinics where your child could be seen immediately. If you cannot pay the full fee or you do not have insurance, ask about sliding fee scales.

D. Outpatient Treatment or Therapy

1. What About Different Approaches to the Treatment of Children?

There are several schools of thought about the best way to approach the treatment of emotional problems. Treatment may be psychoanalytic, cognitive, behavioral, humanistic, ecological, or family oriented; all are accepted approaches to treating mental health problems.

No one treatment technique has been proven definitely more successful than any other. Many therapists use whatever technique or combination of techniques they believe may be helpful to their client.

2. A Helpful Distinction

It is possible to divide the wide variety of treatment approaches available to children into two categories: (a) those that focus on the child, and (b) those that focus on the family.

To better understand the difference between the two, think of them as different lenses on a camera. The child-focused therapies are like a zoom lens, which allows the therapist to examine closely and in detail a child's feelings, thoughts, and behavior. The family-focused lens is wide-angled. It allows the therapist to look at the child's behavior as he or she interacts with the entire family and/or people who live with the child. Family therapists believe that each person's behavior affects others with whom he or she has relationships, and that everyone must work to overcome problems. Of course, many therapists use a combination of these two approaches.

3. Key To Success

The important thing to remember is that the key to the success of any treatment is not necessarily which theoretical approach is used. Success may depend more on the quality of the relationships among the therapists, the child, and the family; the commitment and skill of the therapist; and the willingness and ability of the child and the family to make changes in their lives.

4. What To Expect

The therapist or agency intake worker usually will not be able to talk when the first call is made. Be prepared to leave a name and phone number so that the call can be returned.

Parents often feel uncomfortable or embarrassed about asking for help and this may make it difficult to remember everything they want to say when calling an agency or therapist. Before making that first call, it is a good idea to make a list of statements and questions to use as a guide. Here are some suggestions:

Prepare a brief description of your child, including his or her problems and why you are seeking help.
Be ready to supply background information about your family and its members. For example, who lives with the child and the ages and marital status of all members of the family.
Ask whether the therapist or agency has time now or in the near future to do an evaluation to see whether treatment is needed.
If treatment is indicated, will the agency or therapist be able to schedule it in the near future?
When can the first appointment be made? With whom will you talk, and how long will the appointment take? Which members of the family should come to the first session?
What is the fee? Does the agency or therapist accept Medical Assistance or payments from your insurance company? Will the Medical Assistance or insurance payments cover the agency's or therapist's fee? Will it cover an evaluation if necessary? If you don't have Medical Assistance or private insurance, does the agency or therapist offer a sliding fee scale, or will it obtain funding for you?

Once they have made the first contact, most parents feel not only relieved but encouraged to know that they will be helped to understand their child's problems and to find a way to assist the child in solving them.

It is important to be prepared for the fact that the first person you meet may not be the person who will treat your child. You may be asked to give a history of your child to an intake worker or therapist. That information then will be used by the clinic to assign your child an ongoing therapist. Some outpatient clinics assign one therapist to your child and another to you.

5. If You Have To Wait For Service

Unfortunately, many agencies - especially community MH/MR centers - have waiting lists, and the wait may be longer than expected prior to evaluation, treatment, or both.

If the waiting period is too long, contact other similar agencies or your service representative at Community Behavioral Health at (888) 545-2600. If your child needs immediate help, let the agency know. If your child is in a crisis, be very sure to say so when the call is made.

The agency should then arrange an immediate appointment. If they do not schedule an immediate appointment for you, and you need immediate help:

With a mental health or substance abuse emergency, call the DELEGATE LINE at (215) 685-6440. It's best to make this call before you go to a service, if that is possible.
In some emergencies, you may need to call the SUICIDE HOTLINE at 215-686-4420.
Someone will always be able to take your emergency call 24 hours a day, 7 days a week.
The Delegate Line will be able to help you in an emergency. They will direct you to the nearest service that will meet your needs.
If necessary, the Delegate line will send the Mobile Emergency Team (MET) to your location.
If you are a family member of someone who is in a mental health or substance abuse crisis, you may also call the Delegate Line to get help for that person.
Because not all emergency rooms serve children, call the Delegate Line to get immediate help for children. They will send someone to your home or tell you where to take your child.
If your emergency is life threatening, go directly to the nearest emergency room.

For more information see Psychiatric Emergencies.

6. How Long Does Therapy Take?

Occasionally, one or two sessions with a therapist will be enough. More often, either short-term therapy (lasting 10 to 12 sessions) or longer-term treatment (continuing for as much as a year or longer) will be recommended. Some agencies have special day treatment programs for children. These are group programs that offer more intensive treatment. See Day Treatment Programs for further information. This may be recommended instead of, or in addition to, outpatient therapy.

7. What Determines the Length of Therapy?

The length of time your child's or family's therapy will take depends on a combination of the following factors:

The severity of the problem.
The clinical approach chosen by the therapist.
The capacity of the child, the parents, and other family members to make changes.
The outcome expected by the family.
The treatment goals of the therapist.
The financial resources available to pay for therapy.

8. How Much Will Therapy Cost?

It is important to discuss all aspects of the cost of a treatment plan before therapy begins. Unless unlimited funds or extensive health insurance benefits are available, financial considerations will probably play some role in the decisions made about treatment.

The cost of therapy can depend on many factors, including:

The type of treatment program.
The therapist's training.
Where treatment takes place.
Whether the fee will be covered by insurance.

The following is a description of typical costs at various kinds of treatment centers. Remember to ask about the policy regarding canceled appointments. Many clinics and therapists charge for canceled appointments unless notice is given at least 24 hours in advance.

a. Community Mental Health/Mental Retardation Centers

Charges are determined according to a sliding scale of fees, based on personal income and expenses. The fee will be set at registration and will be the same whether a social worker, psychiatrist, nurse, or psychologist is seen. The fee may range from no charge to full-fee ($100-$150 per hour), depending on ability to pay. Families eligible for Medical Assistance pay no fee. Families have the right to appeal the fee set. The request for an adjustment or elimination of the fee must be made within 30 days by letter to the county administrator. The community MH/MR center can provide assistance in processing this request.

b. Private Therapists

Fees range from less than $50 to over $100 per hour. Rates for clinical social workers, family therapists, pastoral counselors, and psychiatric nurses tend to be at the lower end of this range, and those for clinical psychologists, psychiatrists, and child psychiatrists are at the upper end.

c. Hospital-Affiliated and Private Clinics

Although established fees are in the $40 to $70 range, most of these clinics have a sliding-scale system that may qualify the family for a lower charge - sometimes as low as $5 per hour. The rate is usually the same regardless of the therapist's training. The fee for group therapy is lower.

For more information on Medical Assistance coverage and private insurance coverage, see Financial and Health Benefits.

9. What About Privacy?

Families have a right to expect that privacy will be preserved and that information shared with a therapist will be kept confidential. Bound by professional ethics, a therapist usually will not release any information about the parents, the child, or the family without prior written permission. The therapist may break confidentiality with your child if he or she makes suicidal or homicidal statements.

There are other rare exceptions, as in the case of legal proceedings. So if there is any concern at all about this issue, it should be discussed with the therapist.

If your child's therapy will be paid through private insurance or Medicaid, the therapist will have to provide some information to the insurer about the problem. Typically, this information is in the form of a diagnosis, for example, "depressive reaction" or "anxiety neurosis." Ask the therapist exactly what information he or she is furnishing to the insurance company or Medicaid. For more information, see Advocacy and Support.

10. What If You Think Treatment Isn't Helping?

If the treatment of your child or family seems to be going well, you probably will have no reservations about continuing therapy. Sometimes, however, progress is not apparent at first and, in fact, problems may seem to be getting worse instead of better. Treatment may not be progressing smoothly for any number of reasons. If you have feelings of dissatisfaction with the way things are going, there are some positive steps to try.

a. Talk About Your Doubts

It is helpful to first discuss your doubts with your spouse, a friend, or a relative to clarify and understand your feelings. Then discuss them clearly with the therapist.

Talk openly with the therapist, keeping in mind that a competent professional will be eager to discuss reactions to the therapy. Many clients feel at least some discontent during the course of treatment, and it is the therapist's responsibility to help them sort out their feelings.

b. Get Another Opinion

If discussion with the therapist is not helpful and you are undecided about whether to continue treatment, ask to speak to the supervisor of the therapist or the executive director of the agency. If these people cannot help, seek another opinion. This is called a "consultation" and is an accepted practice; the therapist should support the decision. Ideally, the consultant will be a well-established clinician who can be expected to provide a fair opinion of your child's or family's treatment.

Some parents may feel that they do not have a choice once their child has a therapist. If you do not have private health insurance and cannot pay the full fee for therapy you might feel powerless to change the situation. Remember, many clinics have sliding fee scales.

If you feel dissatisfied with the therapist and see no alternative, contact

The Mental Health Association of Southeastern Pennsylvania
215-751-1800
www.mhasp.org

E. Resources for Evaluation and Treatment

Each of the agencies detailed below can evaluate your child and can provide or refer you for treatment, if it is necessary. Agencies serve children up to age 18, except where noted. Call for more information on fees, hours, eligibility, etc.

Inclusion in this list does not imply our recommendation, nor does absence imply our disapproval.

1. City Of Philadelphia

a. Philadelphia Behavioral Health System (BHS)

Philadelphia's Behavioral Health System currently provides services to approximately 75,000 adults and children annually out of an eligible population of more than 1.4 million city residents.

BHS connects you to Adult, Child and Adolescent Mental Health and Substance Abuse services. Everyone who is on Medical Assistance (MA) in Philadelphia must use the Behavioral Health System to get his or her Mental Health and Substance Abuse services. BHS, however, will assist any city resident, whether a recipient of Medicaid or not, so that he or she can obtain care from all programs for which he or she is eligible.

To be connected to the Mental Health or Substance Abuse services you need, you must go through an agency called Community Behavioral Health (CBH), the City's behavioral health managed care organization (see below). Through CBH, you can find the service you need, get approval for treatment and help with appointments, transportation and emergencies. Please note that although you will receive your Mental Health and Substance Abuse services through CBH, you will still get your medical services through your HMO (Health Maintenance Organization).

Philadelphia's Behavioral Health System consists of three major components that work together to help you receive coordinated and effective mental health and drug and alcohol treatment services. Learn more about the three BHS components.

b. Community Mental Health/Mental Retardation Centers: Children's Outpatient Services

View the catchment area map to find the community mental health center that serves your neighborhood or call 215-685-6440.

If (and only if) you are uninsured, the fees for outpatient mental health services provided at a community MH/MR center are determined on a sliding fee scale basis. This scale will determine the amount you will need to pay, if anything, for services that you receive. The fee scale is based on your annual income. The lower your income, the lower the fee is for services. In many cases, there will be no fee at all.

If you are insured under Medicaid, it is illegal for facilities to charge a co-pay for mental health services rendered. This means that if you are covered by a managed care plan, such as Community Behavioral Health (CBH), you should have no out - of - pocket expense when you see a mental health practitioner. As of November, 1997, in Philadelphia county under Medicaid, there are no annual limits on the number of sessions that you may have if you are receiving mental health services.

If you are insured under a private health care plan, such as Personal Choice or the like, there is probably a co-pay, or out - of - pocket expense that you must pay at the time of your visit. These co-pays vary from plan to plan. It is best to check with your member services representative to determine what is involved and how much you will need to pay out of pocket before you set up an appointment. There are limitations on the number of visits you are entitled to per year with most private plans. If you exhaust your private insurance, you may be eligible for the sliding fee scale at your local community mental health center.

All Philadelphia Community Mental Health/Mental Retardation (MH/MR) Centers provide outpatient mental health services to children, including individual, family, and sometimes group therapy. Fees are determined on a sliding-scale basis.

Community MH/MR centers are mandated by law to serve people regardless of where they live. If you have trouble getting services outside of your catchment area, contact:

Parents Involved Network
1211 Chestnut Street, 11th Floor
Philadelphia, PA 19107
215-751-1800
www.pinofpa.org
PIN is a parent-run, statewide network and technical assistance center for families of children and adolescents with emotional or behavioral disorders. PIN assists families by providing support, advocacy, information, and referral. PIN provides families an opportunity to share common concerns, exchange information, identify resources, and influence policy issues affecting children and adolescents who have emotional or behavioral disorders.

5. Therapists In Private Practice

a. For Private Psychologists (reduced fee)

Philadelphia Society of Clinical
Psychologists and Human Services Center
8460 Limekiln Pike
Wyncote, PA 19095-2699
215-885-2562

b. For Clinical Social Workers

Pennsylvania Society For Clinical Social Work
215-942-0775