Providers who specialize in kids/adolescents? UPDATE/ANOTHER QUESTION in OP

[ILiveInFlipFlops]

I'm looking for a mental health provider who specializes, and I am losing my mind. I keep hitting dead end after dead end, and my insurance company is no help whatsoever. I can find lots of providers in our location range on the insurance web site, but when I actually call, they're either no longer accepting patients, or no longer accepting patients with our insurance, or they're actually practicing an hour and a half away, not in the town in their listing in the insurance directory, or any of a million other stupid things. I've spent countless hours on this and I'm about to give up, which is so ridiculous because we live within spitting distance of several hospitals, and I literally pass hundreds of medical professionals when I drive down the local highway within walking distance of our house! How can it be this hard?!

 

Sigh. OK, rant over. I need to find someone in our network--we simply cannot afford to pay $400-$600 a month for this to go out of network. So I'm wondering, just how important it is that I find someone who specializes in kids/adolescents for both counseling and psychiatric care? Most of the web listings that I'm seeing say that the providers specialize in "children, adolescents, and adults," so it seems like most providers wouldn't think true specialization is that important.

 

If anyone has any experience in this area, I'd love to hear it. Thanks!

 

-------------------

 

Thank you so much for your help and thoughts, everyone. I really appreciate people sharing their hard-won experience in this area. 

 

I spent hours today going through more lists. Based on what I could find, it seems like my options are psychiatrists with bad reviews/questionable experience, those affiliated with clinics in bad areas, and those affiliated with hospitals. I'll call the hospital affiliated ones on Monday, but IME, whenever I've called hospital-affiliated specialists listed in our insurance database, they don't actually see patients (as in, they're only teaching or are administrators), or they only see patients in the hospital setting. 

 

I widened my search area today, and I finally found one about 50 minutes away who sounded great, and I was so excited. The intake guy called me back right away...and they only see clients who reside in their own county. I wanted to cry. 

 

If anyone's still reading, can you weigh in on this? What do you think is the least bad option here?

 

1) Trying to see someone in your network who didn't have great reviews (lack of responsiveness, late to or canceling appointments, etc.).

 

2) Taking your child to a clinic or non-profit in a bad neighborhood? Does a doctor's employment in a place like that make you concerned about the level of care they could provide? I just envision burned out docs phoning it in, which may or may not be accurate, since I have no experience whatsoever in this area!

 

3) Taking your child to a psychiatrist who doesn't specialize in teens but has good reviews.

 

 

We could pay out of pocket for at least the psychiatrist, probably, but it would literally take all extra cash we'd have available each month. We do have out-of-network coverage, but we have an $8000 deductible, and we will never hit it. I can't figure out what's the least awful option here. If I'm overly biased and ridiculously jaded, please feel free to tell me so. 

 

And thanks again.

Edited August 19, 2017 by ILiveInFlipFlops

[Bluegoat]

I think it probably is to some degree, but your experience seems common - it is hard to find people taking patients.

 

 

[East Coast Sue]

I've found success by asking my pediatrician to make a call on behalf of my child to get an appt at a practice that is "not taking new patients." Once I've had my child seen at a practice, we can usually move to a different provider within the same practice so I'd accept any appt just to get started.

HTH

(((Hugs)))

 

 

Sent from my iPhone using Tapatalk

[MBM]

Adolescents go through a process of pruning out neurons and other neuro changes that can cause mental health issues, so at the very least, I would think finding someone who reads up on that would be helpful. For example, pre-adolescents have a "wall" of neurons that help to buffer signals between the amygdala and the prefrontal cortex on the left side. During adolescence, if this wall is pruned out too much, signals that are normally buffered out can get through and cause distress.

 

Dan Siegel talks about some of the issues that affect adolescents in his book. I'm not at home and don't remember the name but it's the one about adolescents. You can also hear him speak about this on YouTube.

 

In a nutshell, if you can find someone who has read about these findings or is at least willing to consider them, you might be okay with a non-specialist.

Edited August 15, 2017 by MBM

[SparklyUnicorn]

A lot of them see all ages.  So I think it's ok if they don't ONLY see children.  I suppose it wouldn't be great if they didn't see any though.  I agree with Sue.  Sometimes you can get in if your doc calls for you.  Waiting times for this type of provider are quite long around here too. 

 

 

[Rebel Yell]

I don't know, but if I can't find a pediatric/adolescent provider, my next step is to find one with expertise for our specific need or diagnosis who also sees children/teens.

 

My thinking is if exactly what we need isn't accessible then I'd prefer they specialize in the diagnosis rather than just kids in general, KWIM?

 

For example, we don't use a pediatric orthopedist for foot/ankle, instead we go to a foot/ankle practice that has Drs who specialize in dance or sport injuries, and found a Dr. who was a former dancer! Much better for us than a pediatric orthopedist who mainly sees broken arms.

[Arcadia]

My friends experience when they were teens was that having mental health providers who has experience with teens were helpful, not to the extent of specializing in that age group but to the extent of having dealt with teen issues like gender identity, college admissions stress, boy girl relationships, part time jobs. For example a friend went through thinking she is bisexual, lesbian, asexual as a teen and is a happy single who decided she leans asexual when she is in her 20s. My husband has a middle school classmate who is transgender.

 

Another friend who has depression said her teen years depression was different due to puberty. Once the hormonal part of puberty stabilizes, she was better able to cope and feeling less dramatic mood swings. Medication if needed was also easier to prescribe as there was less worries about teen hormones.

Edited August 15, 2017 by Arcadia

[zoobie]

I'd want them to have some experience because medication behaves differently and the adolescent mind is a completely different animal. A provider without much experience but with a willingness to research and learn would be better than none at all. 

 

Some providers don't take insurance directly but you can submit your payments to insurance and be reimbursed. It would require "floating" the payment until you receive reimbursement, and I'd get confirmation from the insurance company out the wazoo before doing this, but it might be one way to see a preferred provider.

 

:grouphug:

Edited August 15, 2017 by zoobie

[nixpix5]

It is absolutely important. In my clinical graduate program we went through this grueling and rigorous academic track and then as soon as we got to child and adolescent focus the first professor says "ok, now throw out everything you have learned if your intention is to work with young people". He might have been being extreme and tongue and cheek but he wasn't wrong. Treatment for adults does not work effectively on children and adolescents. I have spent years of training specializing because they are a unique group with unique needs. I would definitely talk to your pediatrician to see if there are recommendations out of your clinic.

 

The unfortunate truth is mental health struggle in our young people is pretty high right now and even here in the Seattle area where we have a dense population of specialized therapists, everyone has a maxed out caseload and a waiting list. Before taking a break to settle into homeschooling I had no more referral people left as all of my referral go to people were overloaded. It is a sad state of affairs right now.

[Valley Girl]

We ran into the same frustrating problem and had to go out of network. We simply couldn't get anyone in a workable distance. What I also found is that providers who didn't specialize in kids/adolescents absolutely would NOT give an appointment to anyone under a certain age or with certain issues. Good luck finding someone. Networks are inadequate. Provider reimbursement is inadequate. And patients and their families continue to suffer.

Edited August 15, 2017 by Reluctant Homeschooler

[G5052]

We live in a metropolitan area, and we STILL have to go an hour plus each way through heavy traffic to one of the specialists one of mine needs. Every month, too. He has a dual teen/adult focus, and we're very happy.

 

There was one just as well-thought-of 40 minutes way with an easy drive, but out-of-network. I bit the bullet and called -- no openings for FOUR months. It was an issue that we had to get addressed within a month at most.

 

So we drive...

[AngieW in Texas]

You may have better luck looking for nurse practitioners with prescribing authority. There is a major shortage of psychiatrists. This is why many of them are not taking new patients or have waiting lists several months long. I have found that we get a better standard of care from nurse practitioners.

 

The first thing I would look for is somebody who says they specialize in the area that you need. OCD, for instance, is very tricky to deal with. It really helps to have somebody who specializes in it rather than any random psychiatrist. Then I would look for somebody who sees predominantly children/adolescents/young adults in that subcategory.

 

The diagnosis is more important to me. However, when I started looking my kids were at least preteens. If I was looking for a 6yo, then I would be more focused on somebody who just dealt with children and adolescents. 

[Katy]

You may have better luck looking for nurse practitioners with prescribing authority. There is a major shortage of psychiatrists. This is why many of them are not taking new patients or have waiting lists several months long. I have found that we get a better standard of care from nurse practitioners.

 

The first thing I would look for is somebody who says they specialize in the area that you need. OCD, for instance, is very tricky to deal with. It really helps to have somebody who specializes in it rather than any random psychiatrist. Then I would look for somebody who sees predominantly children/adolescents/young adults in that subcategory.

 

The diagnosis is more important to me. However, when I started looking my kids were at least preteens. If I was looking for a 6yo, then I would be more focused on somebody who just dealt with children and adolescents. 

 

I agree with this.  NP's are also advantageous for other reasons - in most states they typically are overseen by a specialist MD, so you get the oversight by the specialist, but the extra time and attention of the NP.  Best of both worlds.

[Lizzie in Ma]

Boy howdy do I hear you.  It wasn't until our recent hell on earth that I found the state's Children's Behavioral Health Initiative, they are mandated to help and services are covered by insurance.  It is under Child and Family Services here in MA.  The team we now have in place is, literally, lifesaving.  A therapist, a therapeutic mentor and a psychiatrist. But not one person in any of the inpatient or outpatient places our dd ended up told us about them.  I had to hunt them down.  Maybe you have something akin to it where you are?

[Pawz4me]

I think someone who specializes is maybe preferable, but what you absolutely need is someone who has experience working with kids and adolescents, especially if medication is in play. One thing I'd think about is that if the patient is a teen then going to someone who specializes in children and adolescents may mean that the patient will soon age out of that provider's care and you'll have to go through the process of finding someone else. A couple of years ago when DS (now 18) needed some help we had to wait five months to see a psychiatrist who treats teens (not specializes, just accepts them as patients). That was the quickest appointment we could get with anyone. Thankfully he was not an emergency situation! We also needed a referral from his pediatrician before they'd even schedule an appointment. Not because our insurance required it but because there is such a demand for services they have to limit themselves to patients who've already been working with a primary care physician.

Edited August 16, 2017 by Pawz4me

[ILiveInFlipFlops]

I appreciate all the ideas and input. I did finally narrow down a couple of providers and called them both on Tuesday. No calls back. Sigh. So more searching today.

 

I'd definitely be willing to see an NP--I'll see if I can find them in my insurance database. I know I've come across them in my searching, but I don't recall if I saw any in our plan.

 

Thanks everyone!

[gardenmom5]

kids have different brain chemistry - and how they present, as well as respond, can be different than an adult.

[Crimson Wife]

Finding in-network psychiatrists is exceedingly difficult because with the shortage, psychiatrists know that they can refuse to deal with insurance and still have a full practice. We have the pediatric neurologist handling my DD's medication needs because I can't find an in-network child psychiatrist. Fortunately we're not dealing with a serious psychiatric condition like bipolar where we would really need a psychiatrist rather than the neurologist.

 

If you truly cannot afford to go out-of-network, I think you're going to be stuck with whomever you can in to see. :(

[ILiveInFlipFlops]

Finding in-network psychiatrists is exceedingly difficult because with the shortage, psychiatrists know that they can refuse to deal with insurance and still have a full practice. We have the pediatric neurologist handling my DD's medication needs because I can't find an in-network child psychiatrist. Fortunately we're not dealing with a serious psychiatric condition like bipolar where we would really need a psychiatrist rather than the neurologist.

 

If you truly cannot afford to go out-of-network, I think you're going to be stuck with whomever you can in to see. :(

 

Yep, that seems to be the case :(

 

I updated and asked some more questions in the OP, if anyone has a few more minutes to spare. 

Edited August 19, 2017 by ILiveInFlipFlops

[nixpix5]

With a psychiatrist often times they do not provide long term counseling and get relegated to medication management. Atleast that is how it tends to work in my state. If you are looking for diagnosis and medication then a psychiatrist will be the best choice. If you need counseling as well then I would lean toward a clinic even if it is in a bad area.

 

You can certainly deal with burnout but honestly, that is usually due to non compliance and no shows common in low income clinics. The clinicians are usually just as skilled and passionate. Sometimes if you can find a strong therapist who is doing a posternship in one of those clinics they are passionate, hard working and up to date on knowledge plus they would have already completed and internship so they have some experience.

 

I can honestly say my best team has always been newer and less seasoned therapists. After a while seasoned therapists specialize so much they start seeing every case as whatever they specialize in. Fresh eyes can be good.

 

I guess it depends on what you are specifically looking to accomplish. I might start with the psychiatrist and then if you need counseling try the clinic.

[Crimson Wife]

 

2) Taking your child to a clinic or non-profit in a bad neighborhood? Does a doctor's employment in a place like that make you concerned about the level of care they could provide? I just envision burned out docs phoning it in, which may or may not be accurate, since I have no experience whatsoever in this area!

 

We have seen some wonderful providers that have their offices in sketchy neighborhoods. A lot of times non-profits have VERY lean budgets and therefore they cannot afford to lease space in middle-to-affluent areas. So long as I'm visiting during daylight hours, I feel safe enough using them. I would not feel comfortable taking an afternoon slot that might end after it gets dark, however.

 

Best of luck!

[ILiveInFlipFlops]

With a psychiatrist often times they do not provide long term counseling and get relegated to medication management. Atleast that is how it tends to work in my state. If you are looking for diagnosis and medication then a psychiatrist will be the best choice. If you need counseling as well then I would lean toward a clinic even if it is in a bad area.

 

You can certainly deal with burnout but honestly, that is usually due to non compliance and no shows common in low income clinics. The clinicians are usually just as skilled and passionate. Sometimes if you can find a strong therapist who is doing a posternship in one of those clinics they are passionate, hard working and up to date on knowledge plus they would have already completed and internship so they have some experience.

 

I can honestly say my best team has always been newer and less seasoned therapists. After a while seasoned therapists specialize so much they start seeing every case as whatever they specialize in. Fresh eyes can be good.

 

I guess it depends on what you are specifically looking to accomplish. I might start with the psychiatrist and then if you need counseling try the clinic.

 

We have seen some wonderful providers that have their offices in sketchy neighborhoods. A lot of times non-profits have VERY lean budgets and therefore they cannot afford to lease space in middle-to-affluent areas. So long as I'm visiting during daylight hours, I feel safe enough using them. I would not feel comfortable taking an afternoon slot that might end after it gets dark, however.

 

Best of luck!

 

Thank you both. That's very reassuring, because two of my best prospects are in the low-income areas. 

 

nixpix, we're definitely going to be doing both counseling and probably meds. I can see counseling making a difference in her mindset, but I think meds are going to be needed to get her to where we can make some long-term change in habits, self-care, etc. I'm hopeful that I can find a counselor locally though--we have a lot more options in that field within our insurance than for the psychiatrist. And thanks for the note on the fresh eyes vs. more seasoned. I was leaning toward looking for more experience, but you make a great point.

 

Also, I wanted to say thank you for everything you've shared with us lately WRT screen addictions etc. I had a really good discussion with my DH about it, and in turn the kids and I had a good discussion about it tonight. I'm hopeful that I planted some seeds that will be ready to sprout when the school year starts and I cut back hard on their device time!

Edited August 19, 2017 by ILiveInFlipFlops

[LMV]

I agree with this. NP's are also advantageous for other reasons - in most states they typically are overseen by a specialist MD, so you get the oversight by the specialist, but the extra time and attention of the NP. Best of both worlds.

With all of the push for independent practice from NPs (and even PAs sadly) I don't think this is a safe assumption. Regardless unless the physician is also seeing the patient on the same day then the supervision is retrospective and will be more on the order of identifying mistakes after the fact rather than ensuring quality care is delivered in real time. Additionally if the supervising/collaborating physician never sees the patient at all but just looks at the NP/PA documentation then it may look like acceptable care but in reality the diagnosis may be completely incorrect and critical exam findings may be overlooked.

[LMV]

 

Thank you so much for your help and thoughts, everyone. I really appreciate people sharing their hard-won experience in this area.

 

I spent hours today going through more lists. Based on what I could find, it seems like my options are psychiatrists with bad reviews/questionable experience, those affiliated with clinics in bad areas, and those affiliated with hospitals. I'll call the hospital affiliated ones on Monday, but IME, whenever I've called hospital-affiliated specialists listed in our insurance database, they don't actually see patients (as in, they're only teaching or are administrators), or they only see patients in the hospital setting.

 

I widened my search area today, and I finally found one about 50 minutes away who sounded great, and I was so excited. The intake guy called me back right away...and they only see clients who reside in their own county. I wanted to cry.

 

If anyone's still reading, can you weigh in on this? What do you think is the least bad option here?

 

1) Trying to see someone in your network who didn't have great reviews (lack of responsiveness, late to or canceling appointments, etc.).

 

2) Taking your child to a clinic or non-profit in a bad neighborhood? Does a doctor's employment in a place like that make you concerned about the level of care they could provide? I just envision burned out docs phoning it in, which may or may not be accurate, since I have no experience whatsoever in this area!

 

3) Taking your child to a psychiatrist who doesn't specialize in teens but has good reviews.

 

 

We could pay out of pocket for at least the psychiatrist, probably, but it would literally take all extra cash we'd have available each month. We do have out-of-network coverage, but we have an $8000 deductible, and we will never hit it. I can't figure out what's the least awful option here. If I'm overly biased and ridiculously jaded, please feel free to tell me so.

 

And thanks again.

1.) I have never looked at reviews. Verify no disciplinary action and current board certification if it is an unfamiliar physician sure. I personally also make sure that my child will be seen by a physician at least for part of the visit. [so I am ok with physicians who do use NP/PA as physician extenders but still examine all patients and sign off on the plan but not physicians who supervise only retrospectively.]

 

2.)If I had personal safety concerns with the area then I would avoid for that reason. Otherwise, no, my eldest daughter's unsung hero of a pediatrician worked in an FQHC and was amazing.

 

3.)Child/Adolescent is a subspecialty fellowship off of Psychiatry. With a teen I think if you have CAP availability you can/probably should start there but if you don't have CAP availability and have general psychiatry comfortable with teens that could be a good option. In your case I would call the office and ask if they would be comfortable. I personally wouldn't put much stock in online reviews but if you have had good success picking physicians via review sites then maybe that is a good approach to continue.

[ILiveInFlipFlops]

1.) I have never looked at reviews. Verify no disciplinary action and current board certification if it is an unfamiliar physician sure. I personally also make sure that my child will be seen by a physician at least for part of the visit. [so I am ok with physicians who do use NP/PA as physician extenders but still examine all patients and sign off on the plan but not physicians who supervise only retrospectively.]

 

2.)If I had personal safety concerns with the area then I would avoid for that reason. Otherwise, no, my eldest daughter's unsung hero of a pediatrician worked in an FQHC and was amazing.

 

3.)Child/Adolescent is a subspecialty fellowship off of Psychiatry. With a teen I think if you have CAP availability you can/probably should start there but if you don't have CAP availability and have general psychiatry comfortable with teens that could be a good option. In your case I would call the office and ask if they would be comfortable. I personally wouldn't put much stock in online reviews but if you have had good success picking physicians via review sites then maybe that is a good approach to continue.

 

Thank you, LMV!

 

1) Can you tell me how I verify board certification? No NPs/PAs showed up in our plan anyway, so I'm not even thinking about that anymore.

 

2) Thanks for sharing that.

 

3) I normally don't put much stock in online reviews either, but the one doctor I could find in our area that was on our plan and practicing privately had 7 reviews on one site alone all talking about how she never returns call, how she cancels appts all the time and makes people wait 45-60 minutes past their appt time, and one about how the patient called to talk to the doctor and instead talked to the receptionist who let slip some stuff that the patient had talked about in session, and also something about the patient's physical attractiveness. In doing further research, I discovered that the same doctor had also practiced in another state, and more patients reviewed her there with similar complaints. So I'm thinking that's probably pretty reliable, or at least a risk I don't want to take. Most doctors have 1-2 online reviews, if any. This doctor had far more, with very specific concerns! There was at least one other with similar issues, but they were further away, so I paid less attention. 

 

Worst case scenario, we'll probably go with someone who sees teens but doesn't specialize. I'm worried about getting started with someone and then finding out that we can't keep up the expense later on. I'd rather start seeing someone I know we can continue to afford. 

[Katy]

Call your local police department (not the crime reporting numbers) and ask if it's safe to go to an appointment in that neighborhood.  If they act like you're paranoid, make an appointment in the bad neighborhood first.  You can also look at crime reports online, but I no longer remember what the websites are for that.

 

Otherwise, I second checking medical board for issues rather than giving too much credence to reviews.  Maybe they were late because a kid they treated for years had a psychiatric emergency and they wanted to go to the hospital to treat the child themselves.  There could be a very good reason for that.  People like to complain a lot.

 

ETA:  I would have no trouble going to an appointment in the "bad neighborhood" here in my smaller city, or even in Denver. There are definitely areas of Chicago, New York, LA, Boston, etc where I would never go to.  An office in a bad area could be very good: it could mean the doctor cares more about what's best for patients (cheap effective generics) than getting extra income from pharmacy company kickbacks.

Edited August 21, 2017 by Katy

[LMV]

To verify board certification check with the relevant board. In your case, this would be the American Board of Psychiatry & Neurology. If the physician happens to be a DO then they may be boarded through the Osteopathic board (although many DOs are allopathically boarded or also allopathically boarded). In 2020 all GME will be fully merged everyone finishing residency then and beyond should be allopathically eligible.

[nixpix5]

Thank you both. That's very reassuring, because two of my best prospects are in the low-income areas.

 

nixpix, we're definitely going to be doing both counseling and probably meds. I can see counseling making a difference in her mindset, but I think meds are going to be needed to get her to where we can make some long-term change in habits, self-care, etc. I'm hopeful that I can find a counselor locally though--we have a lot more options in that field within our insurance than for the psychiatrist. And thanks for the note on the fresh eyes vs. more seasoned. I was leaning toward looking for more experience, but you make a great point.

 

Also, I wanted to say thank you for everything you've shared with us lately WRT screen addictions etc. I had a really good discussion with my DH about it, and in turn the kids and I had a good discussion about it tonight. I'm hopeful that I planted some seeds that will be ready to sprout when the school year starts and I cut back hard on their device time!

Oh yeah! :)

So glad you could start those discussions. We like to watch Doctor Who as a family around here and we watched 3 in a row yesterday which is out of character for us. My 6 year old son afterwards was wandering around and saying he was bored (something I never hear out of my kids) and I gave him an inquisitive look and he says "mom, I think my dopamine is bottoming out from too much Doctor Who" haha! So yep, it definitely is worth having those discussion ;)

 

Seasoned therapists are also great and obviously you will benefit from their experience. I hope you didn't hear me saying they weren't a good choice. I just wanted you to also know some real gems can be found in fresh therapists too. Quite honestly rapport is the most important determining factor in counseling success. So make sure you get the thoughts of your DC and don't be afraid to interview therapists and pass them over if you don't feel like it is a good fit. If you are doing a counseling medication combo then it is good to find someone who can do either CBT or DBT style therapy.

Edited August 21, 2017 by nixpix5

[G5052]

We have seen some wonderful providers that have their offices in sketchy neighborhoods. A lot of times non-profits have VERY lean budgets and therefore they cannot afford to lease space in middle-to-affluent areas. So long as I'm visiting during daylight hours, I feel safe enough using them. I would not feel comfortable taking an afternoon slot that might end after it gets dark, however.

 

Best of luck!

 

My last full-time-with-benefits job was in a downtown area where there were homeless people panhandling and occasional armed robberies of people in broad daylight. We went to lunch in groups, and I didn't carry a purse where it could be snatched. They advised us to put a $20 bill in our pockets to offer if we were accosted.

 

That level, I'm comfortable. With precautions, the reality is that your risk is fairly low.

 

Drug-dealing and random violence, I'd look elsewhere. I had to go to a government agency in that type of area, and I always took a taxi that could drop me at the door and had security call me a taxi when I was ready to leave.