Relevant Experience and Knowledge is Needed for Systems of Care Success

Sea Turtle Caretta Caretta

Claudia Gold, M.D. writes Child in Mind and recently she wrote about the ongoing debate about the widespread use of antidepressants in the pediatric population.  She brought some much needed clarity to one aspect that I don't think gets enough attention. This pediatrician writes: "Rather it is a question of what is not done when psychiatric medication is used to treat symptoms in children."   It is noteworthy to me that this statement does not only apply to depression.  read it here.


Amy Webb who writes The Thoughtful Parent wrote about the importance of the parent/child relationship in the development of the skills necessary for a child to effectively exercise self control:
"In my latest post on Notes on Parenting, I discuss research that illustrates the important link between a close, mutually responsive parent-child relationship and a child's development of self-control. We all know that self-control is an essential skill for children to learn for their own well-being as well as their success in school and life. Perhaps equally important is the fact that these close parent-child relationships also make it less likely that parents will use forceful discipline tactics such as corporal punishment. This is especially relevant in light of the recent well-publicized "real-time" study of spanking."


These two posts really resonated with me.  There is nothing that can be done now about the fact that instead getting cognitive behavioral therapy and psycho-therapeutic services that were recommended for  my son who instead was given psychiatric drugs, prescribed "off-label" to treat his behavioral symptoms.  His symptoms were the result of being traumatized, and having severe PTSD.  We were repeatedly discouraged by mental health professionals when we tried to point out we wanted help with dealing with what he and I both believed to be the CAUSE of his symptoms.  The therapy and services I mention above were in fact recommended as the best way to help my son, by three different psychiatrists; however there was no effort to provide these evidence-based therapies and supportive services to my son or other youth who needed them in this community.   There was and is a bias towards drugging the symptoms of distress, whether it works or not; "med management" is all that was offered by CWCMH.   I am grateful that Behavioral Health attempted to provide the needed services; but the Mental Health care provider's efforts were hampered by the fact that the bias to drug symptoms of distress is, in all reality, built into Washington State's Medicaid managed care mental health contracts!  


Not surprisingly, my son's condition did not improve but declined without recommended treatment.  The failure of this "treatment" was blamed on my son and myself.  Ironic really, considering the drugs were not even approved for pediatric use, and there was no valid clinical trial data that would have recommended their use for PTSD!  He could not focus his eyes after being prescribed Risperdal (a decade before it was approved for any use whatsoever in children) Neuroleptics cause some people to have "accommodation" issues when they take the drugs.  What this means is their eyes do not focus properly, and it is difficult, if not impossible to READ.   Instead of this difficulty being recognized as an effect of the drug by the psychiatrists who prescribed it; my son was given another additional label he was, "oppositional defiant" for not reading and doing his schoolwork.  I was the only one who believed him when he said he couldn't see right any more.


My son's and my family's experience is not uncommon in this community; that is why the SAMHSA Children's Mental health Initiative grant is such an awesome opportunity for this community.  This community has an opportunity to change the outcomes for youth who are at risk of being institutionalized, whether in correctional or psychiatric facilities or therapeutic foster care or group homes.   The grant is to assist them and their families by giving them a voice and a choice about what they need to achieve health and recovery, and these at risk youth and their families need to be invited to the table and encouraged to participate in transforming the systems that serve them. 


I recently read a report which states that the youth who are supposed to be served, the ones identified as being at risk for out of home placement, are not in fact the ones getting these services.  I know from experience, that children and youth whose unmet needs for the type of therapies and services that my son went without, end up in trouble with the law and going to expensive group homes, psychiatric hospitals, incarcerated or dead.  The grant is pretty specific about who is to receive these high intensity services; and I would like to know WHY these are not the youth and families who are in fact getting them?   The following is one page from the project update dated June 2011 from the evaluation providers for this grant project: