by: Meghan Barlow, Ph.D., Meghan Barlow and Associates

Telemental health is the term used for mental health sessions that are conducted via phone or video conferencing.

Research on telemental health suggests that it can be as effective as in-person therapy in terms of clinical outcomes. Clients engaged in telemental health report high levels of satisfaction and rapport with their clinicians. It’s actually the clinicians who tend to be more hesitant to engage in telemental health. The legal, technical, and practical aspects of offering telemental health can be daunting and many clinicians report that it’s harder to pick up on nonverbal communication during virtual visits. Clinicians who work with younger children may find it hard to develop rapport with kids over video conferencing.

Mental health clinicians should be specially trained to deliver telemental health. There are ethical and legal considerations that need to be understood by a clinician. Additionally, there are also clinical issues to consider.

Under normal circumstances, platforms like Zoom, Skype, or FaceTime should not be used to deliver telemental health. These systems are not HIPAA compliant. However, during this pandemic, some rules have been “relaxed.” Clinicians are encouraged to make every attempt to comply with the usual regulations, but are given some leeway to use their best clinical judgment in order to make sure that their client or patient’s mental health needs are being met while we are all being asked to stay at home.

Telemental health sessions are not always covered by insurance or Medicaid/Medicare. You should check with your carrier to see if your sessions will be covered. In the past, video conferencing sessions were more likely to be covered than phone sessions because they are considered “face to face” care. During this pandemic, it is acknowledged that not everyone has access to the required technology for video sessions and, therefore, phone sessions may be covered.

One aspect of telemental health that clients and clinicians need to be aware of is confidentiality. It is sometimes difficult for a clinician to know whether or not a session can be overheard by someone else and therefore, clients share some responsibility in making sure that they are in a private area. Clinicians working from home during the pandemic have a responsibility to make sure sessions can not be overheard by others in their home.

While we’re all getting used to using video conferencing platforms, we have to be prepared for technology related glitches. If the internet connection is poor, clients and clinicians should have a back up plan for how to get in touch.

If you’re going to engage in telemental health, your clinician (or your child’s clinician) should provide you with an informed consent form. This document outlines the potential limitations of telemental health and the roles and responsibilities of the clinician and client/family.

If a child is already working with a therapist who can offer telemental health, I would encourage the parents to talk to their child’s clinician. A clinician should be able to make a recommendation for a specific client regarding the utility or need for televisits. If parents are looking to begin therapy for their child, I would encourage them to call the clinician they have in mind to get some information and give some information. There isn’t necessarily an age criteria for when and if a child could participate in telemental health. If it is determined that the child might not benefit from telemental health sessions, there is still a possibility for the clinician to work with the parents through televisits.

Personally, I would make a decision about whether or not I thought we should have a virtual consultation - an initial visit where the parent or caregiver would give me pertinent background information, share their current concerns, and answer any questions I have related to their child’s development, behavior, or emotions. I might “meet” the child during the televisit and try to gauge the child’s willingness and ability to interact over the video conference. For a very young child, I may be observing their play in the background while I talk with the parent. I would be able to give some recommendations about how to move forward. That might include parent coaching (me working with the parents who would then adjust or modify their approach with their child in order to achieve the identified and desired outcome), me working with the parent and child together, or me working with the child individually. I also might make recommendations about involving other specialties or services. It would depend on the questions and concerns the parent brings to the table and the information and observations that I could glean from the televisit.

Clinicians can utilize telemental health in ways that are innovative and convenient with children. Using creativity, clinicians can find ways to engage with younger clients in a playful way. Screen sharing can help clinicians use visuals in therapy, as they would if they were meeting in person. My colleague, Dr. Dukes-Murray, recently attended a training in assessing autism in toddlers using telemedicine. In one of the telemedicine webinars I attended, the psychologist leading the training mentioned that she runs groups for children as young as 8 years old through video conferencing.

Transitioning my practice to telemental health has been eye opening for me. Until a few weeks ago, I only engaged in telemental health on a very limited basis and only under certain circumstances (an established patient away at college, phone sessions with a parent whose work schedule prohibits attendance at in-person sessions, etc). As I adapt to the need to stay at home and keep others at home while still being able to meet the needs of my patients and families, I’ve been able to stretch my own skill set and learn new approaches. I’m excited about the possibilities that will open up for me and the families I work with now that I’ve had training in telemental health and the necessity to become comfortable with the technology.

Linda M. Gorczynski, Attorney, Hickman & Lowder Co., L.P.A.

If your child has an IEP, he may be entitled to receive special education or related services in the summer, at the school’s expense. This is called ESY or Extended School Year services and you’ll see it in section 4 of the IEP form.

A student should qualify for ESY IF the IEP team determines that the services are “necessary” in order for the child to receive a Free Appropriate Public Education (“FAPE”). The most traditional way to qualify is if the student has a history of regression after long breaks, as can be seen with behavioral needs. Another common qualifier is if the student is on the cusp of mastering a particular skill (such as reading) and the extended break would curtail that progress. But it all comes back to whether ESY is necessary for THIS particular student to receive a FAPE.

ESY looks different for every child, and it must be tied to a specific goal(s) on the child’s IEP. The school cannot limit the “type, amount or duration” of ESY services. So if you’re told that the house ESY program is the only option, this is not supported by the law. The team needs to find or develop an ESY program that meets the child’s unique needs. Wilson tutoring? Social skills camp? Small group math? The team can get creative to meet the need.

If you think your child may qualify, ask for an IEP team meeting to discuss eligibility. Always put your request in writing so there is a record, and include your reasons for making the request. It takes time to locate or develop an appropriate program, and sometimes there is a dispute as to the child’s eligibility, so you don’t want to wait until the last week of school to start the process.

If you want to read Ohio’s legal guidelines on ESY go to OAC 3301-51-02(G).

Ely is from Bratenahl and has four children.

What do you do to relax?

I love to go out to a really great, local restaurant with my husband. I also enjoy going to church, watching Masterpiece Theater, playing the piano, reading a good novel and walking our new Labrador Retriever. And just recently, I started my first professional position since having my first child 10 years ago. I am a virtual reference librarian and am helping non-traditional university students with their research, which is a a fun escape and challenge at the same time

What else would you like to tell us about yourself?

I am the mother to four children with special needs. Our first born has autism, our second born is gifted, and our twins are both diagnosed with autism. All four of our children were born within 38 months of one another. Our family life is unique and we have found great support and help from the CFK community.

What benefits has Connecting for Kids brought to you and your family?

The connections to other families with children who struggle! I've met so many amazing and selfless parents through CFK. I also appreciate that CFK has expanded its coverage to families with gifted children. As a family who has twice exceptional children, I've often struggled finding resources that pertain to my twice-special kids. CFK is always thinking ahead about how it can expand its benefits to ALL children and I appreciate that.

Which have been your favorite Connecting for Kids resources?

The Facebook group has been the easiest for this mom of four to connect with others. I also appreciate the Playground guide and the Music Therapy & More sessions.

My greatest lesson learned is...

to never give up advocating for my child, no matter what the "experts" or the school administrators may think. I've always heard "you know your child best" but never believed in my own capacity as "mom" especially when compared to child psychologists or other health professionals. I've recently learned to trust my own intuition, knowledge and experiences over those who barely know my child at all. This is a lesson I wish I would have learned sooner.

What I worry about most…

is the future. But I've learned that I need to get beyond that worry. That struggle is daily for me and my husband. I've also learned this is a normal struggle and that if I need to talk, another CFK mom is having a better day than I am and that we can work through it together. And I know that I can be a person who can help another mom focus on the "now." It’s all about what we surround ourselves with to help us with not being overcome by worry...whether that be our faith, our spouse, our friends, or even a mental health professional. I've learned that I can only do so much to address the future of my children with special needs and then, I need to jump in and address the issues of the present day.

The best thing about parenting a child who struggles is...

seeing all the therapy, all the extra socialization and all my own advocacy, pay off. When you see your child master that ONE skill you've been tirelessly working on you can't help but smile, cheer or even cry. A skill that we've worked on with my son is having a reciprocal (back and forth conversation). On a random visit to his "new" school, the school librarian pulled me aside and told me how nice it was to see our son initiate a conversation with a new friend and be the leader within that interaction. I was so pleased that he had applied what he had learned in his natural environment. And even though I missed this successful moment, I'm so happy that my son could manage this once difficult skill without the extra support of me or a therapist! These are the moments I carry with me to get beyond the difficult situations that special needs parents often experience.

Do you have any recommended resources such as blogs, websites, or books that we can share?

As a former consumer health librarian, I can't say enough about the librarians at your local public libraries. They are there to help you navigate the plethora of information related to your child's needs and your needs as a special needs parent. Be candid about what materials you need to understand your child better and be forthcoming about what you want to learn more about, whether that be new autism research studies or how to improve your child's diet, or even searching for a fiction novel to help you escape your reality for a little while (we all need a break). There is not much that is beyond the scope of your local public or consumer health hospital librarian!

By: Nikki Rotshtein, OTR/L, Occupational Therapist, Galvin Therapy Center

Before we can improve on executive functioning skills, we must first build them in our children – starting from a very young age. What we do for them when they are young will become glaring deficits as they get older. Let's remember to coach them and not criticize to make them want to do more.

Preschool

• Tidy bedroom or playroom with assistance. (Often by using a backward chaining method – start with you doing the first 75% and have them complete). This takes a huge mountain of a job and makes it into a small hill. They will also feel accomplished vs. overwhelmed. You can continue to scale back as you see they are managing it as their "just right challenge.”
• Perform simple chores and self-help tasks with routines such as clear dish from table after mealtime.

Kindergarten – Grade 2

• Run errands (with two to three step directions).

• Perform simple chores and self-help tasks with reminders such as making the bed before going downstairs in the morning.
• Bring papers to and from school. Complete homework assignments (20-minute maximum).

Grades 3—5

• Run errands that may involve time delay or greater distance such as going to a nearby store or remembering to do something after school.
• Tidy bedroom or playroom (ask them what they might prefer, for example, vacuuming or dusting).
• Perform chores that take 15—30 minutes such as cleaning up after dinner, raking leaves or cleaning up from the cake they just baked with you.
• Keep track of belongings when away from home (sleeping at a friend's, returning library books).

• Plan simple meal prep or baking activity and create menu/shopping list needed.

• Keep track of changing daily schedule such as different activities after school.

Grades 6—8

• Help out with chores around the home, including both daily responsibilities and occasional tasks (emptying dishwasher, raking leaves, shoveling snow). Tasks may take 60—90 minutes to complete.

High school

• Make good use of leisure time, including obtaining employment or pursuing recreational activities during the summer.

Soon they will go from helpless to helpful!

Jaime is from Bay Village and has two children.

What do you do to relax?

Go for a walk, have some wine, take a hot shower.

What else would you like to tell us about yourself?

I’m a stay at home mom to a 20-month-old, a 5-year-old and 3 fur babies. I survive on coffee, wine and laughter.

What benefits has Connecting for Kids brought to you and your family?

CFK has given me a place where I feel understood and validated in my feelings and struggles. It’s so nice to read posts from other parents who have gone or are going through similar experiences as us. It’s also a great feeling to be able to help other parents who are struggling with something we might have dealt with ourselves.

Which have been your favorite Connecting for Kids resources?

The CFK events are great ways to interact and meet other families and gain knowledge. We haven’t been to many unfortunately due to our wild schedules, but we hope to attend more this year. We have found some great doctors for our son based on other parent’s recommendations. This has been huge for our family, we all know how hard it is to find a good doctor or specialist, and when you add in our son’s special needs it makes it even harder. Having parents to ask first has been beyond helpful.

The area where I have grown the most...

The area where I have grown the most is being confident in myself and my child. Looking back, I spent so much time skirting around his struggles, making excuses and brushing things off. It took me a long time to tell people outside of our close family and friends about his diagnosis. Even then it almost felt like it was someone else’s kid I was talking about. I’d stumble over the words and question if I was saying it the right way.

Two years later, I am very confident and comfortable talking about my son’s Autism, his therapies and his struggles. When I meet a new person it’s one of the first things I mention about my life, even though Autism doesn’t define him or our family, it is a big part of our life that affects daily decisions and routines.

What I worry about most…

What I worry about most is my son’s future. It feels so far away, but it also feels like it’s right here, dangling over my head. What will it look like? Will he ever live independently? Have a relationship? Or will he live with me forever? And then enter the fears of what will happen to him if something happens to me. It goes on and on and on.

We thought getting the diagnosis was the hard part, but looking back it was almost the easiest part of it all. We know he has Autism, we know it’s forever. But no one knows what that means. No one can tell us what is going to happen, or what we need to do to give him the best outcome. Everyone has ideas and opinions and knowledge for us, but when they start conflicting each other ... then what? We make choices as we go, based on our gut and what we think is best for our son.

The best thing about parenting a child who struggles is...

The best thing about parenting a child who struggles is what it has taught me about life and being a mom. To celebrate all the small things, and see the beauty in all of it. Things that would be easily overlooked by some, can stop me in my tracks and leave me staring in awe of my child. I appreciate every little hug, every kiss and every word spoken. Without his diagnosis I can’t say I would see things the same way I do now.

Do you have any recommended resources such as blogs, websites, or books that we can share?

Finding Cooper’s Voice and Carrie Cariello Exploring the Colorful World of Autism are two of my favorite bloggers. I highly recommend The Explosive Child by Ross W. Greene, PhD. to parents with kids who struggle with their emotions.

by: Bridget S. Richard, LISW-S, Owner, Lamplight Counseling Services, LLC

Bullies are everywhere. Even as adults we run into people who use aggression to influence others and get their way. Though most parents want to protect their children from bullies we can’t always be with them. The next best thing is to enable your child to handle a bully with assertiveness skills.

Bystander awareness teaches us how to assert ourselves if someone else is in a helpless situation. Teaching our children about bystander awareness empowers them not only to avoid confrontation but gives them the tools they need if they, or anyone they know, is in a dangerous situation.

These skills can be broken down into 4 steps C.A.R.E.

Create a Distraction: Your child can start a new game which will bring others closer to them. They can walk up to the person, while ignoring the bully and state that the teacher or principal needs to speak with them…right now!

Alert Authority: School counselors, teachers, principals, and resource officers are all good resources for when situations get out of hand. You can ask to have desks moved, lunch times changed or other accommodations which will separate your child from the person they are having trouble with.

Redirect: Try using 'fogging' to deflect the bully. Fogging means making a joke or funny comment that makes it seem you don't care about what the bully said. You can also pretend to agree with the person. For example, you could say something like, "Guess you must be right", or "Well, since I'm such a …. I’ll just go, bye."

Engage Others: It’s hard to stand up to a bully alone, and they know it. Therefore, helping your child to develop a peer group within and/or outside of school is so important. When children have other people their age to rely on it is difficult for a bully to make them feel isolated.

If your child needs help with a bully or with learning assertiveness, reach out. There are many wonderful programs which are ready to assist them.

Jennifer is from Westlake and has two boys.

What do you do to relax?

Sew, cook/bake

What else would you like to tell us about yourself?

I am a single mom.

What benefits has Connecting for Kids brought to you and your family?

CFK helped me figure out the steps to take to get both my boys a formal diagnosis. CFK helped me find resources to help THEM thrive at school and at home.

Which have been your favorite Connecting for Kids resources?

The Resource Fair to find local classes/camps/therapists was invaluable. And the Speaker Series parent education sessions are great too.

My greatest lesson learned was...

We are all doing the best we can with the resources available to us. Seeking access to better resources is the key to growth and change.

How parenting a child who struggles has changed my ideas on parenting...

Before I had kids. I thought I knew what parents "should" do and how children "should" behave. Then I had kids. The first couple of years seemed to fall in line with my uninformed expectations. My children seemed to grow and behave similarly to those of my sister's and my peer's children. That is, until they didn't anymore.

I remember vividly going to a preschool concert for my youngest son — he was almost 4 at the time — and all the other children were happily singing along to the Christmas carols. He, however, was sitting on the floor quietly rocking back and forth with his hands over his ears not participating, no matter how the adults tried to coax him to stand up. I was, at first, terribly embarrassed and ashamed. I thought everyone would now know that I was a terrible mother and that I couldn't control my child. It was all my fault. But in that moment, something snapped in me. I was somehow able to shake off my own ego and realize this had zero to do with me, and everything to do with him. It was right after that day I started asking for help. Sarah was just getting CFK off the ground back then and she was a fount of knowledge. She helped me figure out how to get started getting a diagnosis for my son. Then, helped me find therapists for him, get me on the road to getting accommodations at school for him, and help me figure out his second diagnosis a few years later.

My biggest parenting "ah-ha" moment happened at that concert that winter day. I came to realize that judging yourself or others on how a child "should" behave is 100% rooted in your own insecurities and fear, which does nothing to serve the child. Parenting children who struggle has given me a wealth of compassion for all children who are misunderstood. Surprisingly, it's also allowed me to understand and have deep empathy for those outspoken, judgmental people who secretly live in fear of being judged too.

The hardest thing for me to learn was...

The hardest thing for me to learn — and, believe me, I still have to revisit this all the time— is to step back and let my children struggle and grow on their own timeframe.

Yes, growth comes from overcoming obstacles. Yes, learning through doing is key. Yes, the end goal is having the kids function independently. And yes, change takes time. But that doesn't make it easier for me to sit back and watch them struggle with their issues while having big emotions and not always swoop in to take the weight off their shoulders and make it all better. Because that's a temporary fix. It doesn't make the situation better. It just makes ME feel better in the moment.

So instead, I've learned to celebrate the small, incremental victories with them. And over time, we've been able to look back and say "WOW!! Look how far you've come!"

Do you have any recommended resources such as blogs, websites, or books that we can share?

We loved the books by Julia Cook. Lots of great topics. The Social Detective series was great too. And Whole Body Listening Larry is another favorite.

Is there anything else about your journey that you would like to share with other parents?

My kids are growing now and are close to aging out of CFK. My oldest son was diagnosed with Generalized Anxiety Disorder and Depression in 3rd grade. He's 13 now and doing great! And my youngest son was diagnosed with SPD combined with auditory processing issues at age 5, and then ADHD at age 7. He's 11 now and is also thriving. We used a lot of resources found through CFK to get to where we are now. We are forever grateful for CFK's commitment to helping parents who don't know where to turn.

By Mario Mastroianni, Sales Executive, Life, Oswald Companies

For parents with a child who has a disability, securing the financial future of their children is of utmost importance. Government assistance programs can provide some support, but may not provide everything you as a parent would want your child to have.

With so many other financial challenges, planning for the untimely death of a parent or caretaker could prove daunting.  However, obtaining life insurance and professional advice has become easier and more affordable than ever.   A healthy 45-year-old (male or female) can acquire $100,000 of ten year term life insurance for less than $13 per month. 

In many instances, healthy individuals can obtain $1 million or more of death benefit in less than 48 hours without a blood draw or other medical requirements.  Technology has streamlined the acquisition of life insurance so that now qualified individuals can complete 100% of the process online.   

If you think your medical history would prevent you from qualifying for this accelerated underwriting process, full underwriting is still an option.  An insurance broker should have access to many life insurance companies, many of whom specialize in insuring certain medical impairments.  The advances of modern medicine have made it possible to insure cancer and heart attack survivors, and number of other health conditions such as high blood pressure and diabetes. 

Providing a lump sum benefit to your child with a disability can be easy and affordable.  Do not let health complications prevent you from exploring life insurance as an option.  A qualified life insurance broker with access to many carriers has the tools available to help you acquire term life insurance in a cost effective and efficient manner.   

Contact Info: 

Mario Mastroianni

Sales Executive, Life
mmastroianni@oswaldcompanies.com

Oswald Companies
O | 216.367.8787   F   | 216.916.4279

D | 216.369.8489   M| 216.956.9887

1100 Superior Avenue | Suite 1500
Cleveland, OH 44114

oswaldcompanies.com

Kevin has three children and lives in Lakewood

What do you do to relax?

Read, play trivia, watch tv

What benefits has Connecting for Kids brought to you and your family?

We have become a part of a community and family of other parents and children who we would have never otherwise gotten to meet. Because of CFK, we never feel that we’re struggling alone with our kiddo, but rather that we’ve got a whole team of people alongside us with whatever we need.

Which have been your favorite Connecting for Kids resources?

Coffee and Chat, Dads’ Nights Out, CFK golf outing, and of course CFK Softball!

The area where I have grown the most...

I’m not all the way there yet, still a work in progress, but I’ve gotten much better not caring or worrying about what other people think. My kiddo can look, sound, and behave differently than what a lot of people are familiar with. He can swear in public, be too loud, he’s got some big scars on his head from surgeries, and he’s now in a wheelchair. It’s a lot of things that other people can be uncomfortable with. But the best thing I can tell myself, and the best way I can be present and helpful to him, is to just not care about all of that stuff. Other people will think whatever they want, and I can’t control their experience. I can only control my own.

I worry most about not knowing what I’m doing as a parent, especially a special needs parent. I worry about my kids or wife needing me in a way that I don’t know how to provide or that I won’t be good enough to be who they need me to be.

The worst thing about parenting a child who struggles is...

The way your patience is tested. He can’t control his impulses or his reaction to most things, so his behavior can be very frustrating and difficult to manage. The hardest thing to remember is “he can’t help it” and tell yourself “it’s not his fault.” When your instinct is to “parent” the behavior and yell or scold, it can be really hard to remember to just slow down and be patient.

Do you have any recommended resources such as blogs, websites, or books that we can share?

Learning about vulnerability from Brene Brown has been game changing!

by Beth Mishkind Roth, a licensed clinical social worker/therapist, and owner of Cleveland Integrative Counseling

As a therapist, I am frequently asked the question, “what should a parent do if their child/adolescent refuses to come to therapy, let alone actively participate?” More often than not, this question comes from the exasperated parents of children with anxiety and obsessive compulsive disorder. Up until recently, I would encourage the parents to emphasize the importance of self care to their child, educate them on ways to model anxiety reduction techniques, and find ways that the school system can augment support (if they are not already refusing to attend). Fortunately, I am now able to respond with SPACE.

SPACE, Supportive Parenting for Anxious Childhood Emotions, helps parents learn supportive ways to respond to their child’s anxiety and communicate their confidence in their ability to cope with their feelings. SPACE is conducted with the parents, not the child, thus bypassing the obstacle of the child’s willingness to attend and/or practice newly learned skills. Over the course of several months, parents work with a therapist to identify ways in which accommodating behaviors (e.g. not inviting friends over if their child has social anxiety, buying more soap if they have contamination OCD, or repeatedly answer the phone if child has separation anxiety) may be perpetuating their child’s symptoms, and develop a plan to reduce these accommodations. Parents are also given problem-solving strategies for responding to their child’s reactions to the changes.

Through SPACE, parents learn that by changing their own behavior, they can avoid much of the escalation that stems for trying to force their child to act differently. Studies show, not only does SPACE reduce anxiety symptoms in the child just as well as conventional therapy, but parents also report a much better relationship with their children. Moreover, there is an increase in therapeutic engagement, both in attending therapy and practicing skills, amongst the formerly resistant children/adolescents.

Beth Mishkind Roth is a licensed clinical social worker/therapist, and owner of Cleveland Integrative Counseling, who specialize in evidenced-based treatments for children, adolescents, and families. Beth’s has a strong passion for working with the siblings of children with developmental disabilities, special healthcare needs, and significant mental illness. She also works closely with children/adolescents struggling with anxiety, depression, OCD, low self-esteem enhancement, and high-functioning ASD. To schedule an appointment with Beth, please call (216) 600 - 8008 or visit www.clevelandint.com