For many families, being referred to mental health services during their medical appointments may cause many emotions including feeling overwhelmed, nervous, confused and perhaps having questions about where to start and how to proceed.
Here, Dr. Mercedes Palacios, CHOC pediatric psychologist, and Dr. Himala Kashmiri, CHOC pediatric endocrinologist, help parents/caregivers better understand how to navigate being referred to mental health services.
How mental health can impact physical health
“As physicians, understanding the different developmental stages throughout childhood is an integral part of how we deliver effective care to our families,” says Dr. Kashmiri. “It has been well-documented that positive mental health is associated with an improved quality of life and favorable disease outcomes.”
The World Health Organization (WHO) recognizes the importance of understanding the mental health needs of teens and how mental health plays a strong role in illnesses and disabilities among children. To this end, mental health challenges can co-exist with chronic diseases but may or may not be easily identified. Left untreated, mental health issues can then lead to worsening of the underlying chronic disease, poor compliance with management plans, increased burden impacting quality of life, and most importantly, less ownership of one’s illness as they transition from teens to adults.
Oftentimes, the concern for mental health is raised by the caregivers/guardians, school or the child themselves. As a medical team, we are very passionate about addressing this to the best of our ability, says Drs. Palacios and Kashmiri. At CHOC, we typically respond to mental health concerns by sending a referral to our internal psychology team.
Depending on the presenting concerns we also make referrals and link families to our social workers, case managers, nurses, or other members of the medical staff to help this process get started given its positive impact on the management of a child’s underlying condition. For example, even if a child is being seen for a thyroid condition, we understand how pivotal their mental health is in helping us treat their condition.
Steps parents can take following their child’s mental health referral
Evaluate insurance options
Once physicians collaborate with families to identify the need for a mental health referral, families can expect to be contacted to schedule an initial evaluation if their insurance covers services for mental health services. If families have out of network insurances and/or out of county, being referred can mean receiving resources for how to connect to community clinics and/or mental health providers that are in-network.
Once these resources are received, families can call these resources to request an initial mental health evaluation. If additional support is needed with connection, families are always encouraged to reach out to their team for assistance.
Set up your child’s first mental health appointment
Schedule an initial evaluation with a mental health expert. Parents and caregivers can best prepare by making a note of their appointment date/time, making sure that they receive information about location and check-in procedures and completing the initial intake forms/measures that are typically sent out via email.
If families have difficulties with accessing internet or email, they may also request for forms to be mailed and/or completed once they arrive to their visit. It’s important to remember that clinics may have different processes so it is important to ask what you might need to complete or what the clinic expectations are.
Typical forms include a consent form and questionnaires or screening measures that ask specific details about the child’s symptoms including behavioral and emotional changes, and overall, any issues in functioning.
Prepare for your child’s first mental health appointment
An initial evaluation typically takes about an hour and half and focuses on gathering background information related to medical history, family history, emotional/behavioral history/symptoms, social history, psychiatric history, and any additional trauma/stressors or safety concerns that may be impacting children/teens and their families.
Caregivers/guardians can also prepare for the evaluation by taking notes about difficulties they have noticed with their children/teens or areas where they are having concerns. The goal of the initial evaluation is to gather enough information to determine if a child/teen’s functioning is impacted by their mental health symptoms and identify treatment goals that can help them manage their mental health concerns.
Consider short-term mental health care for your child
Short-term mental health treatment is usually recommended when children and families are having difficulties that can be addressed in typically four to 10 sessions.
For example, children/teens may benefit from short-term mental health care if they are experiencing one or all of the following:
- They are having a hard time adjusting to a new medical diagnosis.
- Their mental health symptoms are negatively impacting their ability to carry out their medical routine.
- Their functioning at school, home or interactions with peers/family are being impacted as they attempt to navigate a chronic medical condition.
Consider long-term mental health care for your child
Longer-term treatment is usually indicated when children and families are having difficulties that may need more time to process and/or may need more help and support from the team.
For example, children/teens may benefit from longer-term treatment when they have experienced a big trauma or are having more severe symptoms. At times, group treatment may also be recommended. Families can work with their team to discuss which type of treatment may be most helpful.
Mental Health Education Program (MHEP) webinars
What to expect from the mental health treatment process
Mental health treatment and interventions typically focus on the specific needs of each child and family. Common mental health interventions include education of the impact of symptoms on a medical illness, sleep hygiene strategies, coping skills and parenting skills including strategies for how caregivers/guardians can manage a child’s behavioral problems.
At CHOC, many times, the goal of treatment includes identifying barriers, carrying out medical routines and helping families with problem solving ways to reduce these barriers. Treatment goals are usually created with families to help them meet their medical and mental health needs and live healthy lives. Once treatment goals are addressed, mental health clinicians will work with families to prepare for the end of services which typically includes identifying strategies to maintain progress and providing any resources/tools that may be helpful.
If you have concerns about your child’s mental health, please feel free to contact your medical team. Their goal should always be a relationship of partnership, collaboration, and engagement with families, especially when dealing with mental health concerns, so they can provide resources and pathways to help kids. This is especially important to our team at CHOC.
“We feel privileged to be able to serve the families of Orange County — and beyond — in this way,” says Drs. Palacios and Kashmiri.
Resources for connecting to care
- Check your insurance website or the back of your insurance card.
- Explore Psychology Today’s “Find a Therapist” Tool
- Call CalOptima Behavioral Health (Orange County, CA) | (855) 877-3885
- Suicide & Crisis Lifeline (previously National Suicide Prevention Lifeline) | Call, text or chat 988; 1-800-273-8255
- Crisis Text Line | Text “HOME” to 741-741
- The Trevor Project Crisis Lines | Text “START” to 678-678 or call 1-866-488-7386
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Get mental health resources from CHOC pediatric experts
The mental health team at CHOC curated the following resources on mental health topics common to kids and teens, such as depression, anxiety, suicide prevention and more.
