Unfortunately, in the world of waivers, skilled ADHD pediatricians don’t trump mental-health professionals.
by Kay Marner
Our family receives respite services through a Children’s Mental Health Waiver to help us cope with the “fringe benefits” of Natalie’s ADHD.
A couple of years ago, when the letter arrived informing us that Natalie’s name had hit the top of the waiting list for this program, I was thrilled. But, wait. There were hoops to jump through before we could get started, including confirming Natalie’s ADHD diagnosis.
"I’ll get a letter from her pediatrician," I said.
"That won’t suffice," came the reply. The diagnosis must be made by a mental health professional. Pediatricians aren’t supervised by Masters-level mental health workers during their training. So, we’d see a mental health professional. No big deal, right?
Well, to Natalie, it was. Being exposed to new adults is a stressor for her. The anxiety it causes translates directly into acting-out behavior — stealing is one example. If Natalie needed an evaluation in order to guide her treatment, I argued, subjecting her to that stress would be a valid trade-off. But her pediatrician was dead-on in her diagnosis and treatment. Seeing yet another professional would be 100% in service to bureaucracy, 0% direct benefit to Natalie.
Factor in the stress on Natalie and needless expense, and I became a little indignant. Don’t pediatricians trump mental health professionals? Ours should. In addition to her full time practice, she’s treated kids with ADHD in statewide clinics coordinated by a highly respected medical school for nearly 20 years.
Unfortunately, in the world of waivers, pediatricians don’t trump mental health professionals. And Moms’ protective instincts, no matter how fierce, never trump government bureaucracy. Do you have any idea how many times I’ve repeated Natalie’s complete history to yet another stranger?
Natalie is doing exceptionally well right now. But since adding Risperdal (thank you God!) to her med regime means that Nat’s now taking three medications, our pediatrician feels it’s time for her to see a child psychiatrist. That’s fine. Yes, that means exposing her to another new person, but it’s clearly for her benefit. I have no complaints about making sure her medications are as safe and effective as possible.
But, it also means seeing another social worker to gather background info for the psychiatrist. In a different city, an hour away. Two appointments. Nat misses two half-days of school. Add in the stress factor and I do have a problem with all that.
Nat was excited and happy (about missing school, not about the appointment!) when I picked her up from school yesterday for the drive to Des Moines. But, the closer we got to Des Moines, and the actual appointment became imminent, Nat’s behavior deteriorated quickly. First, she started rocking. Rocked so hard that the car went jerk-jerk-jerk-jerk. Then, she took off her shirts, two layers. Shoes…off. They flew into the front seat. Sweet little feet clad in Valentine’s Day socks thrust repeatedly into my side, my face. Silliness, laughter. Loud, nonsensical vocalizations.
We reached the office, and parked, “I’m scared!” Almost late, because I had to get Nat re-dressed and into her shoes and coat. In the waiting room—Nat un-bent a paperclip, and dragged the sharp metal point across the play table, the wallpaper, an original painting, until I wrestled it away in exchange for pen and paper. Oops, she nearly scribbled on the wall. Touch! Touch! Touch! Fingers pushing against the painting’s canvas. Finally, appointment time. Whew! Was this the same Natalie whose behavior has been so much better lately?
As the appointment winds down, I ask the perfectly nice social worker, "Can I come to the second appointment alone?"
"You could," she admits, "except that insurance won’t pay if the child isn’t here."
“I’m never going there again, and that’s final!” Nat says, later, as I tuck her into bed. Oh boy. We get to do it all again next Thursday.
What bugs me to no end is that I arrived at the appointment with a very detailed, comprehensive, up-to-date, six-page report from Natalie’s psychological evaluation in hand. (Doesn’t a PhD trump an MSW?) Of course, I know that every agency or practice is required to produce their own intake summary, that’s just the way it works. Complaining about it or resisting it won’t change anything. But don’t you agree that in a sane world, children's mental health services would be, first and foremost, of service to the child?