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InStride Health – Evidence-based Anxiety and OCD Treatment

Long before COVID-19 began, we were having conversations about the mental health crisis that is happening for our children and adolescents. Unfortunately, COVID-19 exacerbated many underlying challenges, including access to care. We are hearing from parents all the time that they cannot find a therapy provider for their child, and sadly, we have not had the capacity to take on many new patients here. We are doing our best to point families in a useful direction though, and InStride is one program that we’re hearing good things about! You can learn more about their evidence-based anxiety and OCD treatment HERE.

This post is not a formal recommendation for treatment with InStride Health. If you feel like this program may be of benefit to your child, speak with a medical or behavioral health professional who knows your child well to discuss further. We are not affiliated with InStride Health in any way.

I’m a licensed psychologist and the owner of Kuehnel Psychological Services, PLLC. For over 15 years, I’ve been working with children, adolescents, and their families to provide social, emotional, behavioral, and learning supports.

You have the right to receive a Good Faith Estimate of what your services may cost; see No Surprises Act Notification

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Educational Consultation

Supporting a child with social, emotional, behavioral, or academic challenges can be an overwhelming experience for many parents. It’s not uncommon for families come to us with questions about whether testing is warranted, if the school is providing the most appropriate services, etc. Others desire some support with understanding Individualized Education Programs (IEPs), Section 504 Plans, progress reports, behavior support plans, and/or neuropsychological test results from other centers. In these cases, we are happy to meet with families for consultation. We’re also happy to connect with school Teams to share evaluation findings or other relevant information.

Evidence-Based Group Intervention

We have lots of experience with running parent-assisted intervention groups, where children and parents work together to learn strategies to improve social, emotional, and behavioral functioning. This approach blends the benefits of parent training and individual support, and groups are structured with both components offered simultaneously to increase accessibility for families. As these programs become available, more information will be listed here and sent out via our newsletter.

Behavioral or Cognitive Behavioral Therapy

When children are displaying challenging behaviors at home, behavioral parent training can be a very effective intervention. In fact, some research shows that for children under the age of 10, parent support is more effective than individual therapy for the child. Behavioral parent training involves teaching parents specific strategies, which are grounded in behavioral psychology, so that they have more successful tools to manage behavior on a day-to-day basis. We have lots of experience working with parents of children with autism spectrum disorder, anxiety, attentional challenges, and oppositional and defiant behaviors. Sessions are held with the parent(s) only, though it may be appropriate on occasion for us to meet your child.

When tweens and teens are experiencing significant symptoms of anxiety or depression, cognitive behavioral therapy (CBT) can be a very effective treatment modality. In short, CBT is an approach that makes the connection between thoughts, feelings, and behaviors more explicit, so that individuals become more capable of shifting negative thoughts, viewing situations more clearly, and responding in ways that foster improved day-to-day functioning. While we work directly with children and adolescents in CBT, we do also feel strongly that parent involvement is important for generalizing strategies outside of therapeutic sessions, and we welcome the opportunity to collaborate closely.

Short-Term Solution Focused Therapy

Solution-focused therapy is an approach that centers on current circumstances, future hopes, and solutions that will directly foster progress towards those goals. There is less of a focus on past problems or causes, and a more explicit focus on solutions. This approach aims to minimize the time spent in therapy, as well as the time spent struggling. Often, it involves 5-8 sessions. Please note that solution-focused therapy is not a particularly effective approach for complex mental health conditions, but can be a good fit for some with anxiety, stress, adjustment challenges, family conflict, or children with behavioral issues.

School or Community Observation

We greatly value the opportunity to collect real-time data on a child’s functioning in the classroom or other community settings, such as a preschool center, afterschool program, extracurricular activity, etc. When used as a prevention tool, these observations can lead to incredibly helpful recommendations for parenting and behavior management. When paired with a comprehensive evaluation, this add-on service can allow for an even more exhaustive analysis of your child’s day-to-day functioning, and can lead to more detailed, high-quality recommendations for intervention and supports.

The frequency/duration of an observation is determined on a case-by-case basis, often informed by a review of relevant clinical information and input from other relevant stakeholders (e.g., parents, teachers, therapists, etc.). If you are interested in having your child observed, please contact us and we can discuss the specifics of the case, so that you have a clear understanding of the process. Please know that these observations are not considered “medically necessary” and are not covered by insurance.

Educational Evaluation

Although a complete neuropsychological and educational evaluation is most appropriate for the large majority of referred clients, there are some cases where a thorough, educational evaluation is most suitable to specifically identify a learning disability or monitor progress. For example, if a complete neuropsychological evaluation was previously completed and recommendations were offered to address social and emotional issues before a learning disorder could be ruled in/out, a follow-up educational evaluation may be warranted after the child has responded to social and emotional interventions. This service can be offered on a case-by case basis, and we encourage you to contact us for more information.

Comprehensive Developmental or Neuropsychological Evaluation

Our comprehensive evaluation approach pairs developmental, psychological, and/or neuropsychological testing with an educational evaluation, in order to obtain an in-depth understanding of the child’s performance across domains. The evaluations that we conduct typically involve about 25 hours of professional time, some of which is billable to insurance and some of which is not. More information about billing procedures can be shared by our practice manager when you call to book your appointment – it is our aim to ensure that you have a complete understanding of the process and options available to you.

The evaluation process begins with a clinical intake, which is typically about an hour and involves both the parent and the child. Following the intake, we review supporting documents (e.g., medical records, school records, and other information about the child’s developmental and educational history). This information allows us to determine a) if testing is warranted and medically necessary, and b) what specific tests are needed in order to effectively answer the referral question(s).
The next step is for the child to participate in formal testing, which may range from four to six hours of direct, face-to-face administration. In addition to formal testing, evaluations also typically include some combination of social, emotional, behavioral, and adaptive rating scales.

After all relevant information is collected, we then spend time scoring tests and developing the conceptualization that will inform our impressions and recommendations to the family. A feedback meeting is scheduled for approximately one to two weeks after the final testing session. Feedback meetings are typically for parents and any other relevant adult professionals (e.g., educational advocates), though in some cases, it may be appropriate to have older teenagers participate. Most often, an additional feedback meeting is scheduled to provide evaluation information directly to the child or adolescent, if desired and appropriate. At the conclusion of an evaluation (i.e., after the feedback session), a clinical report is written to document the evaluation findings.

Brief Evaluation (targeted)

At times, a comprehensive neuropsychological and educational evaluation is not necessary, and a brief, targeted evaluation is more appropriate. Perhaps your child has already had an extensive amount of testing done elsewhere, and you’re looking for a second opinion or diagnostic clarity. As another example, maybe your prescriber wants confirmation of a diagnosis before making medication recommendations. If our clinical team feels that a comprehensive neuropsychological and educational evaluation is not warranted, we will offer more targeted, individualized evaluations. However, please note that this is not an a la carte service where families can pick and choose what tests they want; our assessment protocols will always be informed by evidence-based practice and aligned with our ethical guidelines for professional practice.

Progress Monitoring

The assessment and identification of behavioral health challenges is not always clear-cut! At times, data may suggest that your child falls in the borderline or the at-risk range for a particular condition, and waiting multiple years for a follow-up evaluation is unhelpful. Similarly, for those who do meet criteria for a particular diagnosis, it is often reasonable to expect some meaningful progress within four to six months, if the right interventions are in place. Without more frequent progress monitoring though, many children and adolescents wait years before any formal data is collected to examine responsiveness to intervention. To address this gap in service delivery, we are now offering progress monitoring appointments.

Specifically, when there’s reason to believe a child is at-risk following an annual mental health wellness exam, we can schedule a six-month follow-up appointment to assess progress over time and determine if further assessment or intervention is warranted. Additionally, for those who have had a comprehensive evaluation at KPS, we offer six-month check-ins to assess whether your child is demonstrating an appropriate response to intervention.

Primary Prevention Workshops

We strongly believe that prevention is the best intervention. We’re in the process of developing a number of primary prevention workshops to support parents of young children, with the aim of lessening the likelihood of future challenges. As these programs become available, more information will be listed here and sent out via our newsletter.

Anticipated Topics:
• Becoming a Child Behavior Detective – Tools for Understanding Why Kids Do What They Do!

• Sticker Charts, Schedules, and Signs, Oh My! – Structuring Your Home for Positive Behavior

• The Screen Time Battle – Strategies Proven to Decrease Meltdowns and Improve Family Functioning

• Anxiety Pitfalls – Identifying and Avoiding Common Parent Behaviors That Reinforce/Exacerbate Anxiety

• Supporting Kids with Social Weaknesses: A Crash-Course in Evidence-Based Practices

In addition to these primary prevention workshops hosted by KPS, we are also available for community workshops and presentations (e.g., with SEPACs, preschools, or other parent groups). If you are in need of a speaker and feel that we could potentially be an appropriate fit, please don’t hesitate to contact us with specific questions.

Parent Coaching

We love working with parents, especially those who are proactive about learning best practices for supporting their child’s development. On the very best days, parenting can be exhausting, confusing, and overwhelming. Parenting support should not be reserved only for those who are experiencing clinically significant challenges, and we welcome the opportunity to support parents before problems become more severe or suggestive of a diagnosable disorder.

If you’re a new parent, a tired toddler parent, or the parent of a preschooler with big feelings, we would love to work with you. There are so many research-supported strategies for parenting in the early years that foster healthy emotional and behavioral development in the elementary years and beyond. Let us help you with parenting for the future!

If you’re already through the early years and your child is now searching for more independence in the elementary, middle, or high school years, we can help with that too. Need some guidance on best practices for managing screentime, supporting extracurricular participation, navigating peer/dating relationships, talking to your kids about alcohol and substance use, etc.? These years are challenging, and you don’t have to navigate it alone – we can help!

Annual Mental Health Wellness Exam

Insurers are now required to cover an annual mental health wellness exam, in order to improve patient access to behavioral health care. This exam may be completed by your pediatrician as part of the annual physical, but you have the right to seek care with a licensed behavioral health clinician, if you wish. Without any significant family history of behavioral health challenges, the annual visit with your pediatrician may be sufficient. However, if your child is at higher risk for social, emotional, behavioral, or learning challenges, we can help!

Once per year, we can meet with you to discuss your child’s developmental progress and any related social, emotional, or behavioral concerns. We will have you complete some evidence-based screening tools, provide recommendations for strategies/supports that can foster healthy development, and inform you if more frequent progress monitoring or detailed assessment seems necessary. If/when appropriate, we can provide referrals for further prevention, assessment, or intervention services.