Clinical Reference Systems: Pediatric Advisor 10.0

Communities provide different types of treatment programs and services for children and adolescents with mental illnesses. A complete range of programs and services is called the continuum of care. Not every community has every type of program on the continuum.

Some psychiatric hospitals and other organized systems of care now provide many of the services on the continuum. When several of the services are provided, the organization may be called a health care system.

You should discuss concerns about your child's behavior or emotions with your child's physician. He or she may then refer you to a qualified mental health professional for an evaluation. After the evaluation, the professional may recommend a certain type of program from the continuum available in the community.

The professional is then usually required to get approval from the insurance company or organization managing mental health benefits (such as a managed care organization). In the case of programs funded publicly, a specific state agency must authorize the recommended programs or services. If the program or service is not authorized, it will not be paid for.

Many of the programs on the continuum offer several forms of treatment, such as individual psychotherapy, family therapy, group therapy, and medication. The different programs on the continuum of care are:

• Office or outpatient clinic: Visits are usually under 1 hour. The number of visits per week depends on a youngster's needs.
• Intensive case management: Specially trained individuals coordinate or provide psychiatric, financial, legal, and medical services to help the child or adolescent live successfully at home and in the community.
• Home-based treatment program: A team of specially trained staff go into a home and develop a treatment program to help the child and family.
• Family support services: Services, such as parent training or a parent support group, to help parents care for their child.
• Day treatment program: This intensive treatment program provides psychiatric treatment with special education. The child usually attends 5 days each week.
• Partial hospitalization (day hospital): This provides all the treatment services of a psychiatric hospital, but the patients go home each evening.
• Emergency/crisis services: 24-hour-per-day services for emergencies (for example, hospital emergency room, mobile crisis team).
• Respite care: A patient stays briefly away from home with specially trained individuals.
• Therapeutic group home or community residence: This therapeutic program usually includes 6 to 10 children or adolescents per home. It may be linked with a day treatment program or specialized educational program.
• Crisis residence: This setting provides short-term crisis intervention and treatment (usually lasting fewer than 15 days). Patients receive 24-hour-per-day supervision.
• Residential treatment facility: Seriously disturbed patients receive intensive and comprehensive psychiatric treatment in a campuslike setting on a longer-term basis.
• Hospital treatment: Patients receive comprehensive psychiatric treatment in a hospital. Treatment programs should be specifically designed for either children or adolescents. Length of treatment may be acute (a few days to 30 days) or intermediate (30 to 120 days).

You should ask questions whenever a mental health professional recommends psychiatric treatment for your child or adolescent. For instance, which types of treatment are provided and by whom? You should also ask about the length of time, the cost and how much of the cost is covered by insurance or public funding. What are and the advantages and disadvantages of the recommended service or program? Feel free to obtain a second opinion about the best type of program for your child or adolescent.