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    What types of treatment are available?

    Following an evaluation, a mental health professional can make a recommendation about the type of treatment that is most appropriate for a child.

    Topics covered in this section

    Trauma Informed Care

    Shared from the National Center for Trauma Informed Care website

    "Trauma-informed care is an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. NCTIC facilitates the adoption of trauma-informed environments in the delivery of a broad range of services including mental health, substance use, housing, vocational or employment support, domestic violence and victim assistance, and peer support. In all of these environments, NCTIC seeks to change the paradigm from one that asks, "What's wrong with you?" to one that asks, "What has happened to you?"

    Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors so as to be more supportive and avoid re-traumatization. SAMHSA has framed its concept for trauma around three "E's": event(s), experience of the event, and effect. According to SAMHSA's conceptual framework, "Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being."

    Most individuals seeking public behavioral health and other public services, such as homeless and domestic violence services, have histories of physical and sexual abuse and other types of trauma-inducing experiences. These experiences often lead to mental health and co-occurring disorders such as chronic health conditions, substance abuse, eating disorders, and HIV/AIDS, as well as contact with the criminal justice system."

    For more information about trauma informed approaches to mental health care, check out the SAMHSA website.

    Levels of care

    Communities offer different levels of mental health care for children. They range from short-term and more supportive services for children experiencing mild problems to more intensive and specialized services for children with severe mental health issues. These different programs vary in terms of their intensity, comprehensiveness, frequency and duration. They also differ in terms of where the services are provided. Some are provided in more protective and structured environments such as psychiatric hospitals; others may be offered in a clinic or office in the community.

    The level of care that a child receives is generally adjusted as their level of need changes.

    Levels of Care

    *These services are often available without cost to the family. Most other services can be paid for using Medicaid or other private insurances. If a family does not have insurance for a child, there may be free or low-cost options available through FAMIS.


    Office-based or outpatient services

    These services are appropriate for children with mental health problems who are able to function in the community with supports. Children and their families come to a mental health professional's office for visits that usually last somewhere from 30-60 minutes. Services provided in this setting can include diagnostic evaluation, individual and/or family therapy, group therapy, medication management and substance abuse assessment and treatment. The frequency of visits can vary greatly depending on the child's needs.


    Family support services*

    These services are offered in the community and help families care for their child through parent training programs, parent support groups, etc.


    Intensive case management

    These services are appropriate for children with a greater degree of problems who need services from multiple sources to live successfully at home and in their community. Intensive case management involves assessing a child and family's needs and then finding resources in the community to meet these needs. It includes coordinating psychiatric, financial, legal and medical services. Social workers usually provide case management services, though other mental health professionals may provide this type of assistance at times.


    Home-based treatment services

    Often called "in-home" therapy or services, these programs offer help to children and families who are experiencing more serious difficulties, including children who may be at imminent risk of being placed outside their home or are returning home from residential treatment, juvenile detention, foster care or a group home. One or more mental health professionals meet with a family in their home multiple times a week to develop and implement a treatment program that can involve individual and/or family therapy and case management services. In order to qualify for in-home services, a referral from a service provider or a community service board case manager is usually required.


    Day treatment program

    These services are appropriate for children with severe behavioral or emotional problems who need more intense services than public schools can provide, but who do not need out-of-home, 24-hour care. They can also serve as a transition from inpatient care to outpatient care. A day treatment program provides mental health treatment (such as individual and group therapy, life skills development, recreation) and special education five days per week. In some instances, these services are provided within a child's public school but by an outside agency. In other cases, day treatment programs are run in a separate facility that provides both mental health services and educational programming.


    Crisis Stabilization Unit (CSU)

    In the Richmond area, this is currently at St. Joseph's Villa. This is a locked short-term facility that families can access if their child's symptoms or behaviors are severe, but not sufficient to warrant inpatient hospitalization.

    Familes must contact their local CSB for an assessment for admission. The CSB then contacts RBHA to facilitate admission if the child meets criteria. The CSU has 6 beds and 1 must be available for a local Richmond child.


    Partial hospitalization (day hospital)

    These programs provide all the services of a psychiatric hospital (mental health evaluations, individual/group/family therapy, recreational/behavioral therapy, medication evaluation/management and academic instruction), but the patients go home each evening. They are appropriate for children whose problems require more intense treatment but can be safely kept at home.


    Emergency/crisis services*

    These services should be sought if a child may be a threat to himself or others or is demonstrating severe, out-of-control behavior. Emergency services include crisis intervention and screening to determine whether a child needs to be hospitalized. These services are provided by hospital emergency rooms and by crisis intervention teams associated with Community Services Boards (CSBs).


    Inpatient hospital treatment

    These services are designed for children whose psychiatric difficulties are severe and cannot stay safely at home. Patients receive comprehensive psychiatric treatment (mental health evaluations, individual/group/family therapy, recreational/behavioral therapy, medication evaluation/management and academic instruction) and receive 24-hour-per-day supervision. Length of treatment depends on many different variables and can be short or long-term.


    Therapeutic Group Home

    These programs are designed for adolescents with serious emotional and/or behavioral issues and generally serve adolescents under the care of the juvenile justice or social welfare system. Therapeutic group homes are located in the community, where adolescents may either attend local schools or attend day treatment or specialized educational programs. Group homes usually include 6 to 10 adolescents per home and provide a variety of therapeutic interventions such as individual and group therapy and behavioral programs.


    Residential treatment facility

    These programs are appropriate for children with long standing, severe emotional and/or behavioral difficulties who have not responded to less restrictive treatments. Residential treatment facilities provide intensive and comprehensive psychiatric treatment and educational services in a campus-like setting on a longer-term basis.


    Voluntary vs. Involuntary Hospitalization

    In some instances, a child or adolescent may not be willing to go into the hospital for treatment. In these cases, a designated mental health professional can evaluate the child and then, if appropriate, ask a judge or magistrate to issue a temporary detention order (TDO), which can mandate that a child or adolescent receive inpatient care.

    Types of Therapy

    A number of different types of therapy are used to treat mental, emotional and behavioral problems among children and adolescents. Some therapies may work better than others for a particular child or situation. It is important for parents and caregivers to educate themselves about the various therapies, and to be actively involved in developing a treatment plan. A treatment plan is a written document that outlines how therapy should ideally proceed.

    Psychotherapy is a general term for conversations and therapeutic interactions between a mental health professional and a child and/or their family. These interactions help a child and family express feelings, understand patterns of thinking and behavior, change problematic behaviors and solve problems. There are different types of psychotherapy, some of which are described below.

    Types of providers: Most forms of psychotherapy can be provided by a Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC). If medication will be prescribed, a family must work with a psychiatrist or nurse practitioner. Some primary care physicians (PCPs) may also prescribe medications for psychiatric disorders; however, many will consult with or refer to psychiatrists for these services.

    Individual Therapy

    A therapist meets one-on-one with a child to help them work on issues that are negatively affecting them. This can involve conversations, activities and brief assignments completed at home.


    Family Therapy

    Family therapy involves some or all members of a child's family. The therapist helps family members to understand how their interactions affect one another and helps them to change problematic relationship patterns.


    Group Therapy

    Group therapy involves a group of somewhere between 6-10 kids who are dealing with similar problems. They meet together to explore these issues and learn new problem-solving, coping and social skills with the support of the group.


    Cognitive Behavioral Therapy (CBT)

    Cognitive behavioral therapy (CBT) is a treatment approach that focuses on helping children understand how their thoughts influence their feelings and behaviors. Children learn to identify problematic ways of thinking and behaving and to replace them with more helpful responses. Children actively participate in treatment both in and out of session. Homework assignments are often assigned to help a child master new skills.


    Cognitive Therapy

    Cognitive therapy helps children become aware of the ways their thoughts can influence their feelings in ways that are sometimes not helpful. Children learn to evaluate whether their thoughts are accurate and to then correct biased or negative thoughts.


    Behavior Therapy

    Behavior therapy focuses on how some problematic behaviors are accidentally "rewarded" or reinforced in a child's environment. These rewards often contribute to an increase in the frequency of these behaviors. Caregivers are taught how to avoid rewarding undesirable behavior and to reward a child with praise or tangible rewards for positive behaviors.


    Interpersonal Therapy

    Interpersonal Therapy (IPT) focuses on a child's issues and difficulties within relationships. A mental health professional helps the child explore his feelings and responses to relationships and improve his social skills.


    Dialectical Behavior Therapy (DBT)

    Dialectical Behavior Therapy (DBT) is a treatment that can be used with adolescents who have chronic suicidal feelings or thoughts or engage in self-harming behaviors like cutting. DBT focuses on helping an adolescent understand how they manage conflict and intense negative emotions and aids them in developing more healthy coping strategies. Treatment often includes both group and individual sessions


    Multisystemic therapy (MST)

    Multisystemic therapy (MST) is intensive, family-focused therapy for children and adolescents with serious disruptive behavior problems, delinquency and/or substance abuse. It's based on the belief that these serious problems are influenced by multiple "systems" in the youth's life, including their family, school environment, friendships and neighborhood, and seeks to make positive changes in these systems. A family is treated by a team of MST clinicians who meet with the family frequently.


    Play Therapy

    Play therapy is a treatment used with children that is based on the idea that children communicate their thoughts and feelings through play more naturally than they do through verbal communication. Children use an array of toys to express their feelings and develop better ways of managing their feelings and behaviors.


    Art Therapy or Music Therapy

    These interventions use art or music as a form of expressive therapy. The process of making art (or music) can help children express their feelings, understand their problems and develop better coping strategies.


    Medication

    Medication is sometimes used in the treatment of mental health problems among children and adolescents. Research has shown medication to be effective in reducing or eliminating the symptoms of a variety of problems including:

    • Anxiety
    • Depression
    • Attention Deficit Hyperactivity Disorder (ADHD)
    • Obsessive Compulsive Disorder (OCD)
    • Eating Disorders
    • Bipolar Disorder
    • Psychosis (though disorders)
    • Severe Aggression
    • Sleep problems

    Medication can only be prescribed by a medical doctor, usually a pediatrician or child psychiatrist. Before a doctor recommends medication as part of treatment, they will complete a comprehensive evaluation to gain a complete understanding of a child's problems. Although medication can have a significant impact on mental health symptoms, it is often only one part of a larger treatment plan for a child.


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