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Families and Caregivers

Families and Caregivers

Woman consoling boy
Information about mental health services will help you make sure your child is receiving the best care possible. The following information will help you understand the world of children's mental health services including talk therapy, community supports and psychotropic medications.

Frequently Asked Questions

  • https://www.michigan.gov/mdhhs/adult-child-serv/foster-care

  • The term “mental illness” is used to talk about problems with thinking, feeling and behavior that get in the way of a person’s day to day life. These problems can also be upsetting to the child/youth and their family and friends.

    Every person’s experience with mental illness is different, but there are some things that can be seen in a number of mental illnesses. A few examples are:

    • Social Withdrawal – less time with friends, less time doing school or fun activities
    • Depression – sadness that doesn’t get better even with supports, irritability, blaming themselves for things out of their control, not being able to see good in situations, tiredness, sleeping or eating too much or not enough
    • Anxiety – fears about things that can’t cause harm, not being able to be out of sight of some adults (for example, not being able to go to sleep in their own room, afraid to go to school)
    • Attention/Focus – having a hard time completing work, making careless mistakes, disorganized, forgetful
    • Impulse control – hard time stopping to think before acting, interrupting others
    • Getting along with others – arguing with people in charge (parents, teachers), fighting with peers, not taking blame after making mistakes
    • Excessive anger/aggression

    Mental illness can cause mild or severe problems for children and families. Mental illness can be short or long term.

    When trying to understand mental illness, it is important to look at all the possible causes. Health problems, relationship problems and environment stresses can all be causes of mental health problems, so all of these must be thought about during an assessment.

    For more information:

  • Medication Monitoring and Safety:

    Medication Side Effects and Monitoring:

    Any medication can cause side effects.  Usually these are mild and only last a short time. Most of the time health care providers monitor for side effects by asking questions about problems like headaches or stomach upset.  Some medication side effects are monitored by checking height, weight, blood pressure and pulse at follow up appointments, and by looking for any changes in muscle movements. For some medications getting lab work, for example measuring blood sugars and fats, is important.

    Sometimes medications intended to help with emotions and behavior can increase emotional and behavioral problems including being more sad, angry or anxious.  Health care providers will ask about this, but it is always good to know who to call if a child, youth or caregiver has any concerns.

    On rare occasions it is possible that a child or youth will have new or increased thoughts about suicide when taking some medications. For some medications this is a known risk, even though it is a small risk. These medications have a boxed warning on their packaging directions. Health care providers are aware of these medications and will talk about checking in more often after medications are started or dose is changed.

    Health care providers will discuss what to expect when starting or changing a dose of any medication and how monitoring for side effects and safety will be done.

    For more information about using and monitoring medications see the following from the American Academy of Child and Adolescent Psychiatry

    Facts for Families:

    Psychiatric Medication for Children and Adolescents Part I – How Medications are Used

    Psychiatric Medication for Children and Adolescents Part II – Types of Medications

    Psychiatric Medication for Children and Adolescents Part III – Questions to Ask

    Weight Gain from Medication: Prevention and Management

    Parents’ Medication Guides

     

    Safety when storing and giving medications:

    Storing medications:

    It is important to store all medications safely so that a child will only have access to the medications they are taking at the time.

    See the following brief videos from the Centers for Disease Control (CDC) about storing medications safely:

    Giving medications:

    When giving any medication to a child, it is important to follow the “5 Rights”

    • Right child
    • Right medication
    • Right route (swallowing a pill, swallowing liquid, putting on the skin, inhaling a mist)
    • Right dose (making sure of the pill dose, measuring liquid correctly)
    • Right time

    The health care provider who is prescribing the medication should give caregivers the information they need to follow the 5 rights, but it is always ok to ask questions if the directions aren’t clear. It is also a great idea to ask the pharmacist about safety when picking up a prescription.

    Caregivers should take responsibility for giving medications to children and adolescents.  This includes keeping medications in a safe place, taking out the medications that the child needs at the time and making sure that the child takes the medication as directed.  As youth get into later teen years, they may be able to take on more responsibility for taking medications, but only with caregiver supervision.

  • Genetic Testing:

    Genetic testing (also called Pharmacogenetic Testing) is one source of information that health care providers use when recommending medications for emotional and behavioral issues.

    For more information see the American Academy of Child and Adolescent Psychiatry Facts for Families Pharmacogenetic Testing.

  • If you have insurance

    If you have health insurance, ask your insurance provider (private insurance or Medicaid) to explain your benefits. You can reach your insurance private provider (private insurance or Medicaid) by calling the toll-free number on the back of your card.

    If you do not have insurance

    If you do not have health insurance, the following resources may help:

    • Children's Special Health Care Services - Children's Special Health Care Services is a Michigan program within the Michigan Department of Health and Human Services that provides certain approved medical service coverage to some children and adults with special health care needs. Children must have a qualifying medical condition and be under 21 years of age. Persons 21 and older with cystic fibrosis or certain blood coagulating disorders may also qualify for services.
    • Medicaid – Medicaid is available to eligible persons under age 21. There is an income test and an asset test for this program*. Some people might be eligible but have to pay a deductible. Beneficiaries can get a package of health care benefits that may include vision, dental, and mental health services. To apply, contact the local Michigan Department of Health and Human Services in your county, or apply online using MI Bridges.

    * For youth who were in foster care on or after their 18th birthday, the income and asset test does not apply. For more information, visit www.michigan.gov/fyit.

    • Supplemental Security Income (SSI) for Children - SSI is a cash benefit for disabled children whose families have a low income. The Social Security Administration (SSA) determines SSI eligibility. If eligible for SSI, children get Medicaid, too. Most beneficiaries are enrolled in a Medicaid health plan. Medicaid may continue even if SSI stops. To apply, you will need to complete an Application for Supplemental Security Income (SSI) AND a Child Disability Report with the Social Security Administration.
    • Adoption Medical Subsidy – An Adoption Medical Subsidy is available to children who have been adopted through Michigan’s child welfare system, and are found eligible under certain conditions, the cause of which occurred before the child was adopted. Adoption Medical Subsidy is used as a payer of last resort for eligible adopted children.

  • In an emergency

    If you need help because of an emergency, for example your child is talking or acting in a way that is frightening or not safe, call 911. The 911 operator can help you and your child right away.

    For a non-emergency

    Your child’s primary care provider (family doctor, pediatrician, nurse practitioner or physician’s assistant) is one place to go for help when there are concerns about mental health problems.  The primary care provider can help you contact mental health providers.

    Sometimes your child’s school might also notice emotional or behavioral difficulties and can provide support in finding help.

    Another way to find services is to contact your child’s health insurance provider (private insurance or Medicaid) and ask about mental health providers connected to your health plan. It might take several phone calls to find a provider who has openings and can schedule an appointment. Many insurers provide services for children with mild to moderate mental health needs.

    The third way to find help for mental health problems is to call the local Community Mental Health (CMH) center. CMH helps children with serious mental health needs. CMH can help you determine if your child is eligible for CMH services, and if not, can help find other resources for your child or can refer you to services through your health plan.

    If you and/or your child do not have health insurance, contact your local Michigan Department of Health and Human Services office for help signing up for insurance.

    For more information:

  • Assessments are the first step to determining whether your child needs help, and if so what kind. The main purpose of an assessment is to get a clear picture of the needs that a child is having, the reasons for these needs, the strengths of the child and family and engage in a family-driven, youth-guided process to develop an individualized services plan. There are many kinds of assessments and sometimes a child might need several in order to figure out the best way to help. During the assessment process, parents and caregivers can ask about any specialized assessments that might be needed to understand their child’s and family’s situation and needs.

    Assessments are the most useful when the person(s) doing them has all the information available about the child including health history, past treatment, family history, and current and past living arrangements. As a parent, the knowledge and ideas you bring about your child and family are key to ensuring that the provider understands your child and family. Sometimes parents and caregivers worry about being judged or that they are doing things wrong, but you are the expert about your child. Before an assessment, the office where it is scheduled should be able to tell you how long the appointment will last, what information to bring and may ask your permission to get records from other places. This will help you know what to expect and plan your time.

    The Michigan Department of Health and Human Services works with providers in the community to make sure that children involved in child welfare services (that is, child protective services, foster care) can get the kinds of assessments they need. The first access point for an emotional or behavioral assessment is the child’s insurance (private or Medicaid). If an assessment is needed that can’t be paid for through insurance, the Michigan Department of Health and Human Services will work with the child’s Children’s Protective Services or foster care worker to schedule and pay for the assessment. Assessment is not a one-time activity. When children enter foster care there is usually an effort to make sure that assessments are done right away because these will be important to putting together an initial service plan. However, as children’s needs change over time, it is important to review how things are going and decide whether new assessments are needed.

    For more information:

  • Child and Adolescent Psychiatrists – Medical doctors (MD or DO) who have training and experience focused on assessing and treating children and adolescents with mental health problems.

    General Psychiatrists – Medical doctors (MD or DO) who have training and experience focused on assessing and treating adults with mental health problems. Sometimes general psychiatrists also work with children and adolescents.

    Primary Care Physicians – Medical doctors (MD or DO) who have training and experience in general medicine; for example, family doctors and pediatricians. Primary care physicians also sometimes assess and treat adults and children with mental health problems. A primary care physician might also want to refer a patient to a psychiatrist.

    Nurse Practitioners/Advanced Practice Nurses – Individuals with a nursing degree and have gone through additional training to provide some types of medical care. In Michigan, nurse practitioners provide care, treatment and education about health and mental health problems by working with a supervising physician. Nurse practitioners may provide services in primary care or in some mental health care settings.

    Physician Assistants – Individuals who have gone through specific training in medical care. In Michigan, physician assistants provide treatment of health and mental health problems by working with a supervising physician. Physician’s assistants work in both primary care and mental health settings.

    Psychologists – Psychologists can have a Master’s degree (limited licensed psychologist - LLP) or doctoral degree (licensed psychologist - LP) and provide assessment, diagnosis and treatment. Their primary focus is mental health and/or learning problems. In Michigan, psychologists may not prescribe psychotropic medication. Psychologists sometimes provide specialized assessments (see psychological and neuropsychological assessments).

    Case Managers – Case managers have (at least) a bachelor’s degree and training/experience in mental health systems and child/family engagement.

    Outpatient Therapists – Outpatient therapists have at least a master’s degree (for example and Masters of Social Work or MSW) and training/experience in mental health assessment, diagnosis and treatment. They may have training and/or certification in specific types of therapy, for example Trauma Focused Cognitive Behavior Therapy or Structural Family Therapy. Experience and certification is one way to decide whether a specific therapist will be good fit for the child and family.

    Home-Based Workers – Home-based workers can have a bachelor’s degree or a master’s degree depending on what kind of work they will be doing with the child and family. They can have training and/or certification in specific types of therapy.

    Wraparound Facilitators – Wraparound facilitators may have a bachelor’s degree, master’s degree or no advance degree if they have enough experience. They must have MDHHS approved training in the Wraparound model.

    Parent Support Partners – No degree is required to become a parent support partner, but they must have lived experience as a parent of a child involved in the mental health care system and hired by the Community Mental Health system or by a contract provider. Parent support partners must complete approved training.

    Youth Peer Support – No degree is required to be a youth peer support, but a youth peer support must have received mental health services as a youth and must complete MDHHS-approved training.  

    Board Certified Behavior Analysts (BCBA) – Board certified behavior analysts have at least a master’s degree and have completed a specific set of courses and exams as set by the Behavior Analyst Certification Board. BCBAs provide comprehensive behavioral assessments using Applied Behavior Analysis and put together a plan of care for children or adolescents with autism spectrum disorders. They supervise the work of Registered Behavior Technicians (RBT), and Board Certified Assistant Behavior Analysts (BCaBA) who work directly with the child and family on the treatment goals.

    Occupational Therapists (OT) – Occupational therapists have gone through an accredited OT program and have a master’s degree. They are required to pass a state licensure examination.

  • The services listed below are provided by Community Mental Health to children with mental illness, serious emotional disturbance or developmental disabilities. The services provided to you and your child are determined by an initial intake assessment, development of an individualized plan of service and what is decided to be “medically necessary.” The descriptions below will give you an idea of the services that may be helpful to you and your child and family. Although there is a large array of services, the particular services provided to your child and family will be discussed during the development of your child’s family-centered, youth-guided individualized plan.

    For more information on mental health services please see the sections on Mental Health Services for Children and Intellectual and Developmental Disability Services in the Michigan Medicaid Provider Manual.  

    Outpatient Child Therapy

    Sometimes when children and adolescents have emotional or behavioral problems, meeting with a counselor to learn new skills to understand and deal with thoughts and feelings can help them do better at home and in the community. Based on the assessment and discussion with the child and family, things like goals, treatment approaches and how often to meet are decided.

    Outpatient Family Therapy

    Outpatient family therapy is another option that counselors may use when it’s important for the family to work together on a child’s behavior. In this way, the whole family can work together on treatment goals.

    Home-Based Services

    Home-Based services are more flexible because the services occur in the home and community and can be scheduled more often than is usually true of outpatient counseling. Sometimes Home-Based services are recommended when a child and family have more intensive needs and services are focused on both the child and the family. The goals for Home-Based services, how often sessions are scheduled and what approaches will be used are decided together by the child, family and Home-Based worker. Home-Based services are designed to support the child to remain in their family home. Home-Based services also may be used when children and families who have been separated are working on being reunified.  

    Medication Review

    When children are taking psychotropic medications as part of their treatment plan, they will meet regularly with a medical provider to discuss whether the medications are helping enough and what problems, if any, the medications might be causing. These medication reviews are scheduled every few weeks or months depending on the child’s current situation. Because child and family input is important and children aren’t allowed by law to consent to medications, parents or guardians need to attend these appointments with children.

    Respite

    Respite services provide relief from the daily stress and care demands of a child with behavioral challenges. Respite care for a child can be provided in the home or in another setting to support a parent who needs relief. Respite services can be scheduled on an hourly basis, or overnight, and can be added to a child’s comprehensive treatment plan.

    Community Living Support (CLS)

    CLS services are used to help a child or youth build his or her skills to be more successful in the community. CLS services are provided by aides who can help teach skills of activities of daily living (for example personal hygiene), social skills or other things that are part of the child’s care plan. CLS is also used with older children or adolescents to build skills so that they can become more independent.

    Wraparound

    What is Wraparound?

    Wraparound is an EPSDT (Early and Periodic Screening, Diagnostic and Treatment) service when delivered to youth under 21 years of age. Wraparound was developed in the 1980’s and adopted by Michigan in the 1990’s. Wraparound became a Michigan State Plan Service in 2013. Wraparound is made available to Medicaid-eligible youth and families in all Michigan counties. It is made accessible through a network of CMHSPs (Community Mental Health Service Programs) and their contracted providers. Wraparound supervisors and facilitators receive extensive initial and ongoing training to become certified to deliver the planning process to youth and families.

     

    Wraparound in Michigan is guided by 13 values: Child Well Being, Family Focused, Safety, Individualized, Cultural Competence, Direct Practice and System Persistence, Community Based, Strength Based, Parent Professional Partnership, Collaboration, Social Network/Informal Supports, Outcome Based, Cost Effective & Responsible.

    How does Wraparound work?

    Wraparound is an individualized, holistic, comprehensive, youth-guided, and family-driven planning process. This voluntary process utilizes a collaborative team approach including youth and their family and their choice of professional and natural supports. The planning process follows four stages: Hello-Engagement and team preparation, Help-Initial plan development, Heal-Implementation, and Hope-Transition. 

    The Child and Family Team Plan is built on strengths and driven by underlying needs. The plan provides realistic strategies to meet measurable and attainable outcomes that the Child and Family Team develop. Ongoing evaluation of the Child and Family Team Plan occurs during each Child and Family Team meeting and adjustments are made as needed.

    Who is Wraparound For?

    All Medicaid-eligible youth that meet two or more of the following criteria are eligible for Wraparound: Children/youth who are involved in multiple child/youth serving systems; Children/youth who are at risk of out-of-home placements or are currently in out-of-home placement; Children/youth who have received other mental health services with minimal improvement in functioning; The risk factors exceed capacity for traditional community-based options; Numerous providers are working with multiple children/youth in a family and the identified outcomes are not being met.

    All youth served under the Children’s Serious Emotional Disturbance Home and Community-Based Services Waiver (SEDW).

    All youth in placement at CCIs (Child Caring Institutions) or Hawthorn Center (up to 180 days while in placement).

    Why Wraparound?

    The Title IV-E Prevention Services Clearinghouse conducted a systematic review and rated Wraparound as “promising”. Wraparound has shown an overall increase in functioning and self-sufficiency. The planning process promotes youth and family voice and choice. Data has shown Wraparound is an effective process in reducing out-of-home placement, promoting community inclusion and partnership, increasing youth and family confidence and resiliency, and improving mental health and interpersonal functioning.

    Where is Wraparound?

    Wraparound is available in all Michigan counties, made accessible through a network of CMHSPs and their contracted providers. Referrals may be made by anyone (child-serving agencies, professional providers, community partners, educators, parents/caregivers, families, friends, etc.) on behalf of the child/youth. A referral to Wrapround can be made by contacting the CMHSP in the county in which the child/youth resides. For a CMHSP directory, please see below.   

     

    CMHSP Directory • CMHAM - Community Mental Health Association of Michigan

    Reference Section 3.29 MedicaidProviderManual.pdf (state.mi.us)

    Case Management

    Case management services are provided when a child has emotional and behavioral needs and his or her family could use help connecting to supports and programs, like medical services, school supports or financial assistance. A case manager works with a family to figure out what supports are most needed and helps them connect to those services. They also help the family learn how to advocate for themselves.

    Parent Support Partner

    Parent Support Partners have personal experience parenting a child with emotional or behavioral needs and are experts at helping families to be empowered during the treatment process and to build confidence and skills to assist their child to improve. Parent Support Partners work with families as identified in their child’s family-centered, youth-guided, individualized treatment plan.

    Applied Behavior Analysis

    Applied Behavior Analysis is used in young children with autism to develop positive social skills and in older children with autism to help deal with challenging behaviors. Applied Behavior Analysis (ABA) has been studied and used for many years for children with autism. ABA is a way of figuring out the factors that affect a child’s behavior so that a plan to change behavior can be successful. It includes looking at situations a child may be experiencing before he or she does something, like hitting or running away. It also includes looking at how responses by adults after a behavior can make that behavior more or less likely in the future. ABA can be used at home, in school and during treatment sessions. It is important for all the individuals working with the child to be following a consistent plan. ABA providers have gone through specialized training in ABA and in helping teams to work together. 

    Intensive Crisis Stabilization Services (ICSS)

    A team from the local Community Mental Health office comes to the place a child and family is in crisis. Together with the child and family, they figure out what is going on and provide emotional support and relief. This could mean the family makes a safety plan until they can get in for an appointment, or it could mean the child will need to go to an emergency room. ICSS is available to all families and children in the community, not just those on Medicaid or in treatment at Community Mental Health. Available hours for ICSS vary for communities. Call the Community Mental Health main number and they will send the crisis team or let the family know what else to do.

    Inpatient Psychiatric Hospitalization

    Inpatient psychiatric care is used when a child or adolescent with mental illness or serious emotional disturbance needs 24/7 care because they are at a high risk of harming his/herself or someone else. Treatment usually includes individual therapy, group therapy, and medication treatment. Families are involved in treatment. Sometimes school services are available on site. For children who have Medicaid insurance, the decision about whether inpatient treatment is medically necessary is usually made by Emergency Services at the local Community Mental Health for the child’s legal county of residence. If a child is placed out of home in a different county, the county of legal residence will have to work out the best way to assess the need for inpatient care.

    Occupational Therapy / Sensory Integration Therapy

    These therapies help children build strength and coordination for day to day tasks and can help when a child has problems with how their senses react to the world around them, for example when children are extra sensitive to touch or noise. The goal of occupational therapy is to help children function better over the long term. Occupational therapy is provided by trained professionals for a specific period of time. A doctor’s referral is needed for occupational therapy assessment and treatment.

    Speech, Hearing, and Language

    Children who are struggling with making letter and word sounds, understanding language, or expressing themselves might get speech, hearing and language services for a specific period of time. A doctor must refer for assessment and treatment, and the services must be determined to be needed for the child to function (medical necessity). Services might be provided to the child alone or in a group, depending on the child’s needs.

    Evidence Based Practice (EBP)

    Evidence Based Practice is a general term used for treatment that has either been proven effective by research studies, or seems very likely to be useful based on the best opinion of experts in the field. Across Michigan, treatment providers are expected to use Evidence Based Practices.

    Substance Use Disorder Services

    Substance Use Disorder Services help people struggling with alcohol or drug addiction. It may include a number of interventions that are decided according to the individual’s need. When someone also has a mental health disorder it is addressed when developing the treatment plan.

    Youth Peer Support

    Youth Peer Support (YPS) is designed to support youth with a serious emotional disturbance through shared activities with the Youth Peer Support Specialist. The goals of YPS include empowering youth, developing skills to improve overall functioning and quality of life and working collaboratively with others involved in delivering the youth’s care. YPS services are provided by a trained youth peer support specialist, one-on-one or in a group, for youth who are resolving conflicts, enhancing skills to improve their overall functioning, integrating with community, school and family and/or transitioning into adulthood.