Getting to Know Kids

Welcome to a different area, where I’m focusing on kids and mental health care. As usual, you have the standard, textbook world, then it’s the real world! and so developing some type of guidance for focusing on children is not easy.

Many things are NOT FDA approve for children and most textbooks and standards are very superficial yet there’s a tsunami of complexities with mental health. But I thrive in chaos and it’s almost like providers don’t have a choice. How do you thrive? trying to simplify as much as possible.

Of course, it’s challenging but I will try to keep it straightforward with tips that have helped me with kids. Here’s a brief intro about getting to know them:

The NUMBER 1 RULE: Focus on TRUST (aka the best baseline): Parents or the family already feel vulnerable due to being in this circumstance in the first place and rightfully so apprehensive about taking more risks. Therefore focus on the trust and instill HOPE.

After a person exhausts all other means, prior stuff didn’t help, spoiling the child, and nothing is working, can make anyone feel hopeless. However, for providers, it gives a quick opportunity to start a fresh new beginning and make a good impression. How to focus on trust: 

  • Step 1: Try not to take things personally. Kids are a vulnerable population and so are their families. Sometimes the parents feel like a failure and other times a parent will blame everyone else and try to normalize dysfunction. As a newer provider, I had the tendency to just “fix” the problem but quickly learned that the best encounter is learning how to go with the flow, even if you don’t agree (granted if it’s nothing seriously major)… 
  • Step 2 with these kids: KNOW your options. For example, I had a child that was very combative while on medications. I normally would at least suggest switching but looking in hindsight, I probably made it an ultimatum since this particular kid was beating on his family members and had the cops called multiple times. However, the parents didn’t want to change anything and I should’ve respected their wishes. At the end of the day, they have the final say but yes continue expressing your concerns, establish trust, and focus on stability despite limited options. (+DOCUMENT as much as you can)

In reality, when treating kids, you are stuck between multiple hard places. I’ve switched medications and the mother called me as if I’ve just performed a miracle. Other times I’ll get a phone call about the child getting better but can’t stop raiding the refrigerator and other issues etc. The moral of the story is establishing trust is the best foundation and don’t take things personally. I used to think, how dare someone rejects my options when a situation isn’t getting better or the child isn’t that bad…

  • Now I know, which is Step 3: you have to somewhat treat the WHOLE family and not just the kid. Parents may be so overwhelmed that they haven’t processed too much of anything objectively. Families may feel too scared to make any changes, thus changing anything will make them feel like it’s adding fuel to the fire… It’s NOT but providers have to gain trust so they won’t feel more burdened. In the first encounter, establish trust, show empathy, and be patient. If a medication or any change occurs in the first meeting GREAT! but if not, then continue to work on improving the rapport, promote stability, and instill hope in the family.

With trust, the rest of your encounters should be easygoing. I have other kids doing well with no medications and some I’m weaning off because they are doing so much better. Trust me, things can get better with time. 

The Grueling Intake 

Assessing kids can be difficult and even intimidating however I’ve found some tips that have truly helped me. I like to start very simple, where have you [or the child] been treated prior to this facility? This question knocks multiple birds with ONE stone… It usually makes the patient/family feel more comfortable talking about past experiences.

The first meeting can make someone feel scared and nervous so getting the child/family to open up can be difficult but it is MANDATORY. Because you must make everyone involved feel comfortable. So this technique works with my adults/older kids as well and asking about where they have been prior can help you get the gist of what’s going real quick. 

If they name a facility, then I f/u with what did they treat the child for and did they start any medications?….. From here you have a good portion of the assessment and can ask what helped/didn’t help? What other places did you receive treatment? Were there any hospitalizations? What medications did they use?… 

However, if this is a little child’s first time receiving mental health services, then you can still ask some basic questions, how’s everything at home? Have you ever felt uncomfortable? What happens when you feel sad…etc. but for most of your information, you will have to rely on the parents or another source. My job’s intake is pretty straightforward but for this area, I’ve found good references that are great for kids (and sometimes adults):

A Quick Guide with Assessment

  • Start with inquiring about normal development, health, school, home, family/friends, and sources of enjoyment: Is the child a product of vaginal birth/C-Section? any issues with pregnancy or delivery? Any vision or hearing problems? This area I ask every parent. Even though kids are relatively healthy, don’t assume anything. I have a small child at the moment that’s going blind and honestly bounces and runs around everywhere with no problems. Just be mindful that early childhood is the most important time to treat and avoid bigger issues. With adults, I usually just ask how was childhood and if they graduated from HS/have a GED.
  • Ask about the quality of sleep, appetites, energy, hygiene, milestones, interests, and daily activities: again checking for any concerns in early development.  
  • Triage for (Psych/Social) Emergencies: This can be assessed at any time but definitely if it’s suspected. Psych Emergencies: SI, violence, psychosis, ETOH/drug use. Social Emergencies: sexual/physical abuse, threats, domestic violence, and inadequate family resources that pose urgent health or safety risks.   
  • Emphasize function: this is very important and almost my selling point as to why medications should be a priority. Sometimes I pose the following questions to a parent: How is the child functioning or is the child responding properly at school/home? How’s the quality of life? Is the child processing information correctly? Why is the child failing classes? If parents are hesitant about medications, I try to describe the consequences and pros/cons of why some form of treatment is really important.
  • Assess Sleep Pattern: When is bedtime? What are the activities before bed? How well is the child waking up? A lack of sleep can exacerbate poor behavior and affect learning and mood symptoms. I almost always prioritize sleep with children and will sometimes base the stimulant on how well the child is waking up and focusing throughout the day. 
  • Access Environmental Stressors and Adverse Childhood Experiences: This information sort of lets you have a peek into the family dynamics and how they deal with stress. Again, children can only express so much, and understanding how well the family is getting along with each other is key to the child’s success. Therefore in a section, i.e. biosocial I put who the kid is living with, any safety or environmental concerns, if there’s a lack of transportation or housing instability…Socio-Economic issues are things I almost always ask about and assess even in the f/u’s. This is also part of treating (assessing) the family’s strengths and weaknesses. Also, check out Family Theories & Assessment Tools
  • Screen for Substance Abuse: The drinking age limit for the United States of America is 21. I sometimes have to remind myself of this. I’m getting so many teenagers doing all types of activities that I feel like someone quickly changed the laws and didn’t tell me. Plus, when I asked them the source it’s usually the PARENTS (supposedly “locked up” cabinets). So I do have to give my quick little PSA about securing guns, alcohol, drugs, sharp objects…etc. Like please don’t end up on the news. Now a side note: drugs are usually just marijuana/ETOH and the laws are changing so don’t be too quick to call CPS and really assess the situation. For example, if a 4yo has access to heroin or alcohol then that’s something completely different and a definite call to CPS/police.
  • Differentiate New Problems from Old/Chronic: Sometimes I simply ask this extremely watered-down PHQ9/GAD question for current problems, –How have you felt in the last two weeks? I’m having issues with screening tools lol where I worry about the patient is getting fed answers. In the MOST basic terms, with kids be careful NOT to feed them answers. Really let them express themselves. I still like screening tools but you have to be mindful that some people will just agree with anything and you don’t want a kid (or an adult) to have that kind of habit. This is the part where you should ask about voices, ideations… You’ve already got the prior (chronic information) by inquiring about the last facility and their treatment.
  • Non-Psych: Ask about allergies, medical/surgical, height/weight, and vitals. As previously mentioned, don’t assume anything about a person’s health and this is the part where I explain to the family what labs and testing will be monitored.

Almost Done! if you made it this far in your intake and the kid didn’t start head-butting you, then Congratulations! Yes, it happened at one of my visits so things may not always go smooth sailing but keep it straightforward (what worked previously? r/o what’s new, etc.) continue to stabilize and obtain information as you go along with care. 

Kids Mental Health Topics

Common Disorders: a link that gives a quick DSM-5 review of psych diagnosis that’s frequently seen in children, and the following are simple guides and topics about personal experiences for treating these main disorders:

Clinical Pearls with Medications & Symptom Management: 

Common Kid Issues

Additional References & Resources

This intake assessment was roughly based on Pediatric Psychopharmacology for Primary Care, mainly just the underlined parts above. Another helpful book is DSM 5 Pocket Guide for Child & Adolescent Mental Health. 

Posts about Kids:

Pages About Kids:

CDC recommends that healthcare providers:

  • Use the WHO growth charts to monitor growth for infants and children ages 0 to 2 years of age in the U.S.
  • Use the CDC growth charts to monitor growth for children aged 2 years and older in the U.S.

What’s New?

  • Childhood Trauma: simple explanations about things that are complex
  • Educational/School Tools: this page is for helping kids/parents at home
  • Normal Child Development: to know what’s normal, you have to know what’s not
  • Quick Notes with Psych Management and Kids: this came from working on my certificate about specializing in children’s
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