Experiencing mental health challenges can be common for many kids and teens. For parents who want to ensure their kids get the help they need, it might be difficult to determine when and how to seek mental health support.

The added challenge is that mental health providers are heavily impacted, and care may be unfortunately hard to access.  

Here, Dr. Sarah Ruiz, psychologist, and Maritza Estrada-Alas, resource specialist on CHOC’s Integrated Primary Care team, provide parents with a complete guide for seeking therapy for their children and teens.

When should I seek a therapist for my child?

As parents, you will know your child best, says Dr. Ruiz. You may notice that your child isn’t acting like themselves, and these changes are prolonged — sometimes lasting weeks or months. Although every child is different, look out for the following signs that your child may need mental health support:

Emotional and behavioral changes happening in multiple settings like home, school, etc. These changes are interfering with normal activities or hobbies such as ability to go to school, withdrawing from friends. The changes are persistent, happening for weeks or months. High-risk concerns: Self-injury like cutting or scratching, or suicidal thoughts. If your child is at risk of harming themselves or others, call 911 immediately or take them to the closest ED. Common mental health conditions in kids and teens

If you noticed signs of mental health challenges in your kids, it’s possible that they are struggling with a mental health condition. The following conditions are common among kids and teens, and may require support from a mental health professional.

Anxiety

Anxiety is a common mental health concern and is a combination of emotions, physiological sensations, and behavior. Although some anxiety is healthy, when it becomes excessive and interferes with everyday life, teens may need some extra support from therapy.

Depression

Depression is different from feeling sad; it’s feeling down or hopeless, irritated or angry for weeks or even months. Sometimes, depression leads to teens thinking about injuring themselves or wanting to take their own life. If your child’s thoughts start to lead towards death, this is an important indicator they need immediate/urgent mental health support from a provider. If your child is at risk of harming themselves or others, call 911 immediately or take them to the closest ED.

Trauma

Trauma is caused by a stressful, frightening or dangerous event experienced by a child directly or witnessed happening to a loved one. Trauma can lead to a lot of changes in behavior such as anger and irritability, appearing jumpy and always being on the lookout for danger. These symptoms can lead to diagnoses like post-traumatic stress disorder or acute stress disorder.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a common neurological disorder that affects attention hyperactivity and impulsivity. It is a common diagnosis in young kids who may have trouble paying attention, controlling impulsive behaviors or being overly active.

Medical concerns

Adjusting to a new illness or a new diagnosis or chronic condition can be really challenging for kids and teens. Mental health support can be helpful for helping kids get used to a new medical regimen and care, coping with their illness as they get older and transitioning into adult-focused and independent care.

What does therapy look like for kids and teens?

Therapy is the process of developing a professional relationship with a mental health professional to meet therapeutic goals. The typical therapy session is about 50 minutes and occurs once a week.

Therapy can look like:

Drawing. Playing. Reading books. Talking. Learning skills.

For younger kids, therapist may utilize drawing and playing as a way to engage children and teach skills. For teens and young adults, therapy may utilize these tools less and be centered around more conversation. The therapy process can vary depending on the needs of your child or teen. The level of parent participation in these sessions varies depending on age; the younger the child, the more parent participation will be needed.

Privacy and confidentiality vary by age of the client/patient, too. Again, the younger the child, the more the parent will be involved in therapy. We like to remind parents, says Maritza, that if your teen is receiving therapy, what they discuss — whether it be gender identity, sexuality, or teen behaviors like dating and rule-breaking – will be confidential. Confidentiality is important for children and teens to develop therapeutic relationships, and is only broken when there are concerns like thoughts of suicide, hurting others or abuse.

Is teletherapy beneficial for kids and teens?

Teletherapy, or therapy done digitally on the phone or video conferencing, became very popular during the pandemic, says Maritza. During Covid-19 surges, many clinics had to go back and forth between offering in-person therapy and teletherapy. Teletherapy can be a good option for kids and teens because of the following:

Some clinics are offering limited in-person therapy due to COVID-19 precautions. Remote therapy may offer flexibility and increase access. Teletherapy can be just as effective as in-person therapy.

However, teletherapy also has some drawbacks, like:

Higher drop-out rates because it can be more difficult for providers to engage with their patients online. Success can be dependent on a child’s age and preference.

Teletherapy may not be as effective for younger kids who need hands-on therapy with the provider. However, many preteens and teens prefer teletherapy because they are comfortable talking to a provider on their phones or computers. For some older kids, teletherapy is a good option to potentially get a faster appointment with a mental health provider.

What level of mental health care should my child receive?

There are different levels of care that may be available for your child. The level of support that they will need depends on the severity of their symptoms.

The following levels of care may be beneficial based on levels of symptom severity: Parenting support – parenting classes on behavior management may be offered at community centers or outpatient clinics included in your insurance plan. This may be a helpful option for lower severity symptoms. School-based services — may require a 504 plan or individualized education program (IEP) from your school and the school district.   Outpatient mental health services – typically once a week therapy. You may be referred to a clinic by Medi-Cal or your healthcare provider. You may access therapy though Medi-Cal and commercial insurance, or through self-pay options. Wraparound services – these services provide additional care for those who are already connected to outpatient therapy. Individuals are connected to a behavior coach who can help provide additional sessions outside of therapy to help reach therapeutic goals. These services are available to those with Medi-Cal insurance.    Intensive outpatient services (IOP) – higher level of care in which teens can receive therapy more than once a week (up to five days a week). These programs typically require commercial insurance.  Who should my child see for therapy?

Selecting a mental health provider may be daunting for some parents. When looking for a mental health provider, you will see the following degrees and licenses listed after their name.

When it comes to selecting a mental health provider, you have some options like the following:

Psychologists Abbreviations Ph.D., Psy.D, or Ed.D will be listed after their name.  4 to 6 years of graduate school required plus 3,000 supervised clinical hours to be licensed. Social workers Abbreviations MSW or LCSW (once licensed) will be listed after their name. 2 years of graduate school required plus 3,000 supervised clinical hours to be licensed. Marriage and family therapists Abbreviations MFT, MA, or LMFT (once licensed) will be listed after their name.  2 years of graduate school required plus 3,000 supervised clinical hours to be licensed. Practicum, interns, fellows Working under the supervision of someone who is licensed.

It’s important to note that psychologists who are at the top of the list may be the most expensive to see for care, and the interns and fellows will be the least expensive.

However, all the providers listed have gone through rigorous education, supervised clinical hours and training and can offer excellent care to your child. For the interns and fellows that are working under supervision, you can even get a two-for-one deal on your care as they will discuss your child closely with a supervisor to make sure they are providing a high-level of care. You get two sets of eyes on your child, says Maritza.

What type of therapy should my child receive?

There are a few different types of therapy that are used to achieve different goals, such as:

Cognitive behavioral therapy (CBT)

I would say this is a gold standard approach to a wide variety of presentations, says Dr. Ruiz. This could be a great place to start when looking for mental health services for your child.

Cognitive behavioral therapy is a skills-based therapy that can help kids and teens with:

Learning about their thoughts, behaviors and emotions. Can address anxiety, depression, trauma and ADHD. Time limited approach of usually 12 to 16 sessions. Treating anxiety by including exposure to it. Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy is a higher level of care for more severe symptoms that you may find in wraparound or intensive outpatient programs. It was originally developed to treat chronically suicidal individuals but has been adapted to treat many other challenges.

DBT is:

Effective for substance dependence, depression, PTSD and eating disorders. Often composed of individual and group therapy in IOP settings. A larger time commitment with more sessions needed. Parent-child interaction therapy (PCIT)

PCIT is a therapy modality that’s highly recommended for young kids, ages three to six years, who are having challenging behavior, anxiety or have experienced trauma.

With this type of therapy, parents are going to have to be heavily involved. Parents will learn different skills to change their environment or change their responses to their child’s behaviors to help change the behavior and strengthen the parent-child relationship.

When should I consider medication for my child’s mental health concerns?

Parents may understandably have concerns about getting kids started on medication for mental health challenges.

Before pursuing any medications for mental health, you should consult your child’s doctor. 

But as a rule of thumb, Dr. Ruiz says the following about medications used with therapy for treating mental health conditions in minors:

Being enrolled in ongoing therapy is recommended before being prescribed medication. Improvement is gradual after a few weeks. Psychiatrists and therapists should work together to monitor the child or teen. Who should my child see for medication management?

If you think your child might benefit from medication for their mental health, you can visit the following healthcare providers:

Pediatricians – some pediatricians can prescribe medication for things like depression, anxiety or ADHD. Psychiatric nurse practitioners (NPs) – a psychiatric nurse practitioner has specialized nursing and medical training to evaluate, diagnose and prescribe psychiatric medications. Psychiatrists – a psychiatrist with a medical degree (M.D.) who is board-certified in child and adolescent psychiatry will be able to prescribe medications for your child.

In terms of accessibility, says Maritza, your pediatrician may be the most accessible and least expensive for medication and a psychiatrist may be the least accessible and most expensive.

How do I connect with a therapist or mental health provider?

When wanting to connect with mental health care, many parents may ask themselves, where do I start?

To connect with mental health care, parents can reach out to:

Primary care physicians or pediatricians – they can offer resources and referrals. Their child’s school – may offer mental health services, but sometimes only during the school day and school year. Insurance company websites – find providers that accept your insurance, but make sure to double-check with their office. College/University – short-term therapy for teens in college, which could be a bridge to long-term services. CalOptima or OC links – resources and information for families with CalOptima or Medi-Cal. Employee assistance program (EAP) – care offered by an insurance provider or employer. How to make an appointment with a therapist

To make an appointment with a therapist, you will need to have the following ready:

Insurance card. Name of the provider who is referring you to therapy. A list of symptoms and behaviors you are seeing in your child as well as when the symptoms begin (estimate). Any safety concerns or self-harming behaviors. Common barriers to accessing therapy for kids and teens

Unfortunately, with so many kids in need of mental health services, it can be hard to access therapy.  

The following are some common barriers to accessing therapy to be aware of:

Waiting too long to make an appointment. When a child’s symptoms are severe, improvement may occur slowly. Waiting for a specific provider (psychologist instead of a master’s level clinician). Minimizing symptoms when making an appointment leading to a longer wait.

Please be prepared for long wait times for an appointment. At the time of writing this article:  

Medi-Cal is two to three months. Private/commercial insurance is about six to nine months. Self-pay options may offer limited to no wait times. Coping skills to practice while waiting for a mental health appointment

There are common things that your pediatricians may have already told you or that you’ve heard before, says Dr. Ruiz, that can make a huge impact on kids’ mental health. These strategies can help them cope during a rough time:

Staying active. Enjoying walks with family and friends. Getting 8 hours of sleep a night. Talking about their feelings with someone they trust. Eating healthy.

In addition, the following strategies may help kids and teens cope:

Having a daily routine or using a schedule. Making a list of pleasurable/important activities for the day. Encouraging your kids to give something a shot even if they don’t quite feel like it. Using rewards and praise to encourage effort. Validating what your kids are feeling. Crisis Resources

If your child expresses thoughts of wanting to harm themselves or others, call 9-1-1 or visit the nearest Emergency Department.

MHSA Suicide Prevention Line:

(877) 7CRISIS or (877) 727-4747

National Suicide Prevention Lifeline:

9-8-8

Crisis Text Line:

Text “HOME” to 741741

Finding a mental health provider Check your insurance website or the back of your card Explore Psychology Today’s “Find a therapist” tool For Orange County residents with Medi-Cal, call CalOptima Behavioral Health – (855) 877-3885 OC Links Behavioral Health Line (855) 625-4657 CHOC Mental Health Education Program resources

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