Keystone Talks about Children’s Mental Health Issues

Dr. Max Horovitz talks about teen suicide.
Keystone clinical child psychologist Max Horovitz, Ph.D., is interviewed by CBS 47 Action News reporter Bridgette Matter about teen suicide.

When local media want to report on news stories about behavioral health issues that children and young adults face and how they affect families and others in our community, they often turn to Keystone Behavioral Pediatrics’ highly educated and experienced therapists for their observations about these issues.

Here are some recent media interviews with Keystone clinical child psychologist, Max Horovitz, Ph.D.:

  • Child misconduct – Dr. Max was interviewed by First Coast News reporter Ken Amaro about a disturbing allegation of misconduct by one child to another child in a local daycare center and why a child might act in such a manner. http://fcnews.tv/2tu15Xn
  • Child abuse – A Nassau County deputy was put on administrative leave while the Florida Department of Children and Families looked into child abuse claims, after a video surfaced of the deputy spanking and yelling expletives at a young girl. Keystone’s Max Horovitz, Ph.D., was interviewed about whether his discipline was appropriate. While spanking is legal if done according to the law, Horovitz said it can do more harm than good, leading to social and legal problems in adulthood. – http://bit.ly/2su3Wvk
  • Teen suicide – When a popular Netflix series, “13 Reasons Why,” began sparking a serious conversation among teens centering on the sensitive topic of suicide, Max Horovitz was interviewed about how parents should handle the topic with their teens. He said suicide is a topic parents should discuss with their kids. http://bit.ly/2qCm4SW
  • Children killing children – Two boys were put behind bars at just 12 years old, accused of killing. When interviewed about the killings, Dr. Max said that there’s no way to predict which children will kill. He noted, however, that children who have been neglected can develop differently and begin to act out and that some killer kids may have turned out differently if reared in a loving environment. http://bit.ly/2spIV9X

Dr. Max is director of Keystone’s ADHD Clinic and co-director of its Educational & Learning Assessment Clinic. Thanks, Dr. Max, for helping Keystone get the word out into the community about how we can help children, their families and the community in which they live!

Keystone Staff Invited to Present Childhood Trauma Study

Brian Ludden, Ed.D., MS, LMHC, NCC, CCMHC Licensed Mental Health Counselor National Certified Counselor Certified Clinical Mental Health Counselor Director, Anxiety & Obsessive Compulsive Disorders (OCD) and Military Transitions Clinic

Children with trauma are often misdiagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), mood disorder or a combination of these disorders, because diagnosis can be difficult without knowing about any abuse history. This is what Rea Romero, Ph.D., neuropsychologist, and Brian Ludden, Ed.D., M.S., LMHC, NCC, CCMHC, also noted in their work with Jacob, an 8-year-old boy, who was permanently removed from his mother’s care due to abuse and neglect, possibly including sexual abuse.

They submitted a case study about Jacob that was accepted in late 2016 for a poster presentation at the 2017 American Psychological Association (APA) Convention. Dr. Romero will present the poster of their work on Aug. 5, 2017 in Washington, D.C.

Jacob has a history of erratic mood swings, anger outburst, impulse control, fire-setting, stealing, lying and aggression. Before coming to Keystone Behavioral Pediatrics to work with Dr. Brian and Dr. Rea, Jacob had been given Adderall for two years, with minimal benefit. Prior to receiving a neuropsychological assessment at Keystone, Jacob’s treatment had focused on ADHD and disruptive behaviors.

 

Regilda Romero, Ph.D. Neuropsychologist Director, Trauma & Grief Clinic Co-Director, Neuropsychological Clinic and Educational & Learning Clinic

Jacob’s assessment revealed average to superior cognitive functioning, and academic achievement, visual-spatial skills and language skills also ranged from average to superior. Likewise, other neuropsychological assessments results were at the expected level or well above the expected level.

The assessments did reveal that Jacob has problems with adaptive, emotional and behavioral functioning. Research shows that abuse and neglect can affect neurobehavioral development that is necessary for efficient behavioral/emotional control and regulation. This led Dr. Rea and Dr. Brian to believe that Jacob’s difficulties in emotional and behavioral regulation are related to his history of significant traumas associated with abuse and neglect.

Patients will receive a better treatment plan and interventions if complete biopsychosocial history is taken into account

While Jacob denied suffering from increased startled response, flashbacks and psychological symptoms, which are usually an indication of posttraumatic stress disorder (PTSD), his emotional and behavioral problems and patterns are indicative of trauma. Jacob also struggles with handling interpersonal relations and maintaining meaningful relationships, also symptoms of trauma.

Currently, Jacob is receiving a combination of individual mental health sessions and family mental health sessions. Dr. Brian and Dr. Rea have focused on helping Jacob improve his communication with his family and on reducing behavioral concerns, anxiety and the impact of persistent thoughts related to traumatic childhood experiences. He has been taught the use of mindfulness meditation, guided visualizations, compartmentalization, diaphragmatic breathing and other adaptive coping skills for managing and reducing his emotional and behavioral issues.

Over the course of six months of treatment, Jacob’s behavior has improved considerably. As a result of ongoing family mental health sessions, Jacob has come to develop a relationship with his biological mother. Jacob should continue to progress through treatment and master the various mindfulness and self-regulating skills that he has learned in treatment.

As a result of this case study, Dr. Rea and Dr. Brian are presenting to conference attendees that patients will receive a better treatment plan and interventions if complete biopsychosocial history is taken into account. Keystone supports Dr. Brian and Dr. Rea’s research efforts and encourages all therapists to engage in research that continues to improve clinical results for the kids we serve.

For Keystone, Dr. Rea is the director of the Trauma & Grief Clinic and co-director of the Neuropsychological Clinic and Educational & Learning Clinic. Dr. Brian is the director of Keystone’s Anxiety & Obsessive Compulsive Disorders Clinic and the Military Transitions Clinic.

Keystone Supports May National Mental Health Month

As the largest provider of integrated, collaborative healthcare in northeast Florida for children who have behavioral, developmental, mental, emotional and learning issues, Keystone Behavioral Pediatrics recognizes May as National Mental Health Month.

One of Keystone’s child psychologists, Max Horovitz, Ph.D., was interviewed by Action News CBS 47 Fox 30, about the connection between mental health issues and suicide by teenagers. Specifically, the news station was reporting on increasing concern by educators, schools and parents about the Netflix show, “13 Reasons Why,” which tells the story of the main character, Hannah Baker, who took her own life, leaving behind 13 tapes for the 13 people she said were responsible. Schools are beginning to send letters home to parents warning them about the show’s potentially dangerous message.

During the interview, Dr. Horovitz noted that some children are more easily influenced than others and parents might consider talking with their child about the show’s message. “We want kids to know there are a lot of ways they can be helped that don’t have to be suicide,” Horovitz said.

Several other occasions spotlight mental health issues throughout the month:

May 4 – Children’s Mental Health Awareness Day

May 7-13 – National Anxiety and Depression Awareness Week

May 13-17 – Children’s Mental Health Awareness Week

Keystone advocates every day for the importance of integrating behavioral health and primary care for children, youth and young adults is mental and/or substance use disorders by working with children in its Southside clinic, in their homes, at their schools and in the community. This year’s national theme, “Partnering for Help and Hope.” is especially meaningful, in light of the number of news stories recently that report instances of police having negative interactions with children and young adults who have special needs.

Keystone would welcome the opportunity to help local media discuss children’s mental health issues in a variety of subject areas to bring attention to National Mental Health Month. Its team of child psychologists and therapists can make themselves available for interviews as needed.

Keystone’s team also provides in-service training to educators in schools and other community organizations, police officers and emergency medical service providers. Keystone can share information and techniques to help them understand why children with special needs may act and/or react the ways that they do in stressful situations and what methods can be used to deescalate a potentially unpleasant or potentially dangerous situation.

To schedule an interview or an in-service training, contact Karen Rieley, director of marketing and communications, 904.333.1151, rieley@keystonebehavioral.com.

Aggression, Tantrums and Refusal—Annoying and Frustrating but Treatable

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Dr. Scherbarth works with a child and his parent to help them understand and relate to each other better by building reasonable and enforceable limits.

The trifecta of terrible problem behavior in children is physical or verbal aggression, with tantrums and refusal to follow instructions. These symptoms are often consistent with the diagnosis of Oppositional Defiant Disorder (ODD). It is very annoying and frustrating for parents and peers—to say the least. Parents often try their best to manage it—including seeking out anger management for their child—but nothing they try seems to work. That said, ODD is entirely treatable by a clinician skilled in one of several Behavioral Parent Training programs.

ODD is a pattern of behavior for over six months that has three parts: a child or teen being argumentative in general or defiant when given instructions; the child being very angry and irritable most of the time; and at times the child may be vindictive and deliberately trying to make others angry. It can seem from the outside that the child is totally fine one minute and blows up the next minute. This appearance has led many people down the wrong path to think it’s bipolar disorder—especially when the tantrums last 45-90 minutes or when they are very destructive at home or school. However, bipolar disorder is a very different diagnosis.

ODD not only causes frustration in the moment for the parent and child, it also spreads throughout the family’s entire social life at all levels.

Parents of kids with ODD often do not want to go to stores or restaurants anymore for fear that something will set their child off. Parents may hear that other parents don’t want to set up play dates anymore. Schools may send these children home early because of the disruption they cause, or they may totally refuse to enroll these kids altogether. Kids with ODD often have little or no friends, and the friendships they do develop may be very conflicted. Clearly, it takes a serious toll on everyone and this toll creates resentment in the family towards the child and from the child back towards the family.

ODD typically emerges in younger childhood (before age 5). Without treatment, up to 2
5 percent of kids may lose ODD traits on their own; however it persists for many years in half of all kids, whereas the other 25 percent have behavior that starts to become downright cruel or even criminal in nature. With a total of 75 percent of kids with ODD having years of difficult or even criminal behavior ahead of them, it’s clearly to everyone’s advantage to seek treatment by a qualified therapist who goes beyond individual anger management counseling to also include some form of behavioral parent training.

There are a number of risk factors related to development of ODD (Barkley, 2013). Individual factors from the child include having ADHD, a mood/anxiety disorder or just an irritable temperament from birth. Parent factors include if they have ADHD themselves, irritable temperament, high stress due to a number of reasons and/or being young parents. Family social environmental factors include living in an area with a high crime rate, being influenced by delinquent peers, or having conflicted marriages or a conflictual extended family. How parents raise their children is one of the most important factors. Inconsistent parenting, highly negative parenting (or by contrast, low negative but also low discipline parenting), inappropriate expectations, as well as lack of monitoring of the child, and/or low positivity in parenting are all  risk factors.

At least one parent and the child engage in the Coercive Family Cycle (Patterson, 1982). A parent gives an instruction (possibly a harsh instruction or nearly impossible instruction), then the child reacts with negativity and both continue with negativity (yelling, harsh tone, possibly escalation to destruction) until one or the other gives up. It’s not healthy for the child, even if it “works” in the moment. Worst case scenario, the child gets away without having to do what they’re told and the negative behavior reinforced. In the “best case scenario,” the adult is able to force compliance BUT then the child learns the social lesson that to be respected in the family and society, that is that a child has to be big, loud, angry and bad. That’s not a very good outcome.

By contrast, Behavioral Parent Training (BPT) aims to make an impact by changing the parenting factors. It’s NOT about finding better ways to punish children more harshly. Rather, it has two aims—to improve warmth between parents and kids, as well as to build reasonable and enforceable limits. Warmth can be provided by making sure that there’s always positive interaction time and that when the child follows the instructions, good things happen—like acknowledgement and normal daily privileges. Limits include expectations that school work must be completed school work, children are expected to clean up after themselves to whatever extent that they can in relation to their age, destructiveness leads to consequences and rude or obnoxious behavior doesn’t pay off. The consequences for destruction shouldn’t be harsh, just consistent and providing for everyone’s safety.

Of course, BPT has limits. It only addresses the parenting factors. At times, the child’s individual factors (irritability, impulsivity) have to be addressed as well, possibly in conjunction with Cognitive Behavioral Therapy or anger management. However, anger management alone is insufficient. A course of treatment may take 3-6 months or even longer, depending on how longstanding the issues are and other factors. Therapy may require a lot of effort and be difficult at times, but it can’t be any more difficult than having these behaviors affecting the family for years or decades.

Behavioral Parent Training can allow the parents to enjoy their kids again, and kids to enjoy their parents. Contact Keystone Behavioral Pediatrics to learn more about how BPT can help.

Resources for Parents/Caregivers:

Centers for Disease Control

Mayo Institute

Child Development Institute

National Institute of Mental Health—DMDD

National Institute of Mental Health—Treatment of children with mental health issues in general

 

Macy’s Makes a Special Wish Come True at Thanksgiving for a Special Young Person

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Katie Falwell, CEO, hugs Sam LaManna, 14. She and other Keystone therapists have worked with Sam since he was six years old.

Sam LaManna is 14 years old and a student at Mainspring Academy a school for students with special needs. When he celebrated his birthday this past January, he had just one wish – to get an autograph from Macy’s Thanksgiving Day Parade Executive Producer, Amy Kule. Sam first saw Amy cut the ribbon at the parade a few years ago and she has been his hero ever since!

Sam’s mother had placenta previa, which caused birth trauma and low heart rate and oxygen levels for Sam. Five days after his birth, the doctors discovered that he had two intraventricular brain hemorrhages. Sam survived but now lives with hydrocephalus, the buildup of fluid in the cavities deep within the brain. The excess fluid increases the size of the cavities and puts pressure on the brain, which damages brain tissues and causes a large spectrum of impairments in brain function.

Macy’s has invited Sam and His Family to be Special Guests at the 90th Anniversary of its Thanksgiving Parade

Last year, with the help of his teacher, Sam made a video message asking Amy for her autograph. The video went viral, eventually Amy saw the video, and she was honored to make his wish come true. Not only did Amy send Sam an autograph, she made a video herself inviting his family, Sam and his former teacher to be her special guests at the 90th annual Macy’s Thanksgiving Day Parade! Amy and Al Roker, weather anchor on NBC’s Today and Sam’s other favorite person, have a special Thanksgiving Day planned for Sam.

Sam still attends Mainspring Academy, a private, nonprofit school located in Jacksonville’s Southside. The school opened in 2010 to serve children with a broad range of special needs from elementary through high school.

Sam also receives a number of therapies provided by Keystone Behavioral Pediatrics, which offers integrated healthcare for developmental, behavioral, emotional and learning issues. Using a collaborative team approach, more than 120 therapists are available to help children.

Sam’s lead therapist is Angela Chionchio. Keystone has worked with Sam since he was six years old. When his mother first brought Sam to Keystone in 2008, she described him as happy and affectionate, noting that he loved to read, learned quickly and had excellent memory. Yet, she was concerned that he was stubborn, easily distracted and developmentally delayed. He didn’t sit up until he was 13 months old and didn’t walk until he was 27 months old. Socially, Sam struggled to make friends and seemed disinterested and withdrawn around others.

According to Sam’s lead therapist, Angela Chionchio. “Sam has trouble with ‘first time listening,’ meaning he can be noncompliant when he impulsively sees an object that he wants play with but should not be available at the moment. In the classroom, his teacher and I prompt him to raise his hand to ask permission to do these things and offer him alternatives.”

Sam also has a problem with schedule change. “We help by preparing him for upcoming changes and praising him when he accepts change appropriately,” Angela says.

“Sam is doing great this year,” she says. His new classmates offer him opportunities to grow socially and behaviorally.

“When I asked Sam why he loved the parade so much, he said that it was because he loves when the producer cuts the ribbon at the start of the parade,” she laughs. “He said he also is very excited to see Santa Claus at the grand finale  and meet the host of the Today Show.”

“Sam is a wonderfully unique little guy,” his mom says. “I knew great things were inside him, but I needed Keystone’s help for Sam to bring out all that he has to offer the world.”

Sam’s trip to New York City is made even more special by the fact that his parents and he tried to visit the city last year, but had to cancel at the last minute because Sam needed emergency surgery. The IV shunt that was implanted in Sam’s brain unexpectedly quit working, so Sam had to endure hours of major surgery.

An implanted shunt diverts cerebrospinal fluid from the chambers within the brain to another body region where it will be absorbed. This creates an alternative route for removal of cerebrospinal fluid which is constantly produced within the brain and usually restores physiological balance.

Sam has blossomed under the therapy he receives at Keystone and in his classes at Mainspring Academy. All of us at Keystone and Mainspring are so excited for Sam that he has been able to achieve and even exceed his dream of getting autographs from Amy Kule and Al Roker.

“Sam is a wonderfully unique little guy,” his mom says. “I knew great things were inside him, but I needed Keystone’s help for Sam to bring out all that he has to offer the world.”

Sam’s trip to New York City is made even more special by the fact that his parents and he tried to visit the city last year, but had to cancel at the last minute because Sam needed emergency surgery. The IV shunt that was implanted in Sam’s brain unexpectedly quit working, so Sam had to endure hours of major surgery.

An implanted shunt diverts cerebrospinal fluid from the chambers within the brain to another body region where it will be absorbed. This creates an alternative route for removal of cerebrospinal fluid which is constantly produced within the brain and usually restores physiological balance.

Sam has blossomed under the therapy he receives at Keystone and in his classes at Mainspring Academy. All of us at Keystone and Mainspring are so excited for Sam that he has been able to achieve and even exceed his dream of getting autographs from Amy Kule and Al Roker.

Military Transitions Clinic Helps Children Cope

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Brian Ludden, director of the Military Transitions Clinic, is a licensed mental health counselor, national certified counselor and certified clinical mental health counselor.

Under the direction of Brian Ludden, MS, LMHC, NCC, CCMHC, Keystone’s Military Transitions Clinic focuses on those issues that are unique to service members and their families. Our experience with military families allows us to provide the support these families need through a variety of military-life transitions; for example, preparations for permanent changes of station, deployment readiness, deployment separation, reintegration, separation from the Armed Forces, and even death and loss.

Keystone’s proximity to Mayport Naval Station and Naval Air Station Jax (NAS Jax), as well as NAS Jax’s designation as an EFMP (Exceptional Family Member Program) provider makes us ideally situated to meet the mental health and behavioral health needs of Northeast Florida’s very mobile military service members and their families. The clinic uses evidence-based therapeutic practices to treat military-transition related concerns. Some of these therapies include Cognitive-Behavior Therapy, Rogerian Therapy, Family-Systems Therapy, and more. Keystone’s compassionate and caring clinicians acknowledge and va

Our highly trained, experienced and compassionate staff is eager to support and assist families through any and all transitions, struggles and successes they may experience, military related or not.

Common diagnoses include:

  • Separation Anxiety: The experience of inappropriately extreme or excessive fear or distress when separating from parents/caregivers or other major attachment figures or items in the child’s life. It can cause a reluctance to leave home or significant individuals, as well as causing nightmare, sleep disturbances and physical symptoms including headaches and stomachaches.
  • Generalized Anxiety Disorder: Uncontrollable worry about multiple situations, performance, social, academic and health; “what if” concerns that span far into the future, physical symptoms including headaches and stomachaches, inability to unwind, low risk-taking and needing constant reassurance
  • Major Depressive Disorder: A significant depressed mood, loss of interest in pleasure and activities, or both, nearly every day. It can impact appetite, sleep, concentration and cognitive function, and reflexes.
  • Adjustment Disorder: Emotional or behavioral issues in relation to an identifiable stressor. Stressors can include changing schools, moving, parental separation, loss of friendships, and more and can be accompanied by depression, anxiety and conduct issues.
  • Posttraumatic Stress Disorder (PTSD): For children of military service members, learning that their parent/sibling/loved-one has been involved in a traumatic event can be enough for them to experience PTSD symptoms. It is characterized by intrusive thoughts of the event; hypervigilance; extreme avoidance of distressing thoughts, memories, or feelings about the event; frightening dreams; problems with concentration; sleep disturbances; irritability, and more.

Before joining Keystone, Brian spent three years working as a mental health counselor in Clay County School in northeast Florida as the county’s Military Connected Student Support Specialist, where he provided counseling support for military families and children coping with transitions, deployments, separations and grief.  Brian’s primary experience has been in supporting and assisting children with anxiety disorders through art therapy and guided visualization, as well as intensive cognitive behavior therapy and exposure and response prevention. 

Brian is a licensed mental health counselor, national certified counselor and certified clinical mental health counselor with a Master of Science degree in clinical mental health counseling from the University of North Florida.  He is currently a doctoral candidate in educational leadership at UNF and will be defending his dissertation later this year, with a focus on the availability of adolescent mental health services in urban public school settings. 

In addition to serving as director of Keystone’s Military Transitions Clinic, Brian serves as the director of the Anxiety and OCD Clinic and provides mental health counseling and support to children and their families.  Additionally, he provides supervision to master’s level mental health interns seeking to gain experience in the field of counseling.

Resources for Parents/Caregivers:

Military Child Education Coalition (MCEC)

Tutor.com for U.S. Military Families – Free Academic Tutoring for Dependents of Active Duty Service Members

Military Connect – “Connect with Kids Like You”

Neuropsychological Clinic Assesses Brain Injuries

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Keystone’s Neuropsychological Assessment Clinic is co-directed by Regilda (Rea) Anne A. Romero, Ph.D., licensed psychologist, and Rebecca J. Penna, Ph.D., NCSP, neuropsychologist and clinical psychologist.

Keystone Behavioral Pediatrics’ Neuropsychological Assessment Clinic can provide a comprehensive evaluation of brain functions and processes that is particularly useful for children who have experienced a brain injury. The assessment includes a profile of a child’s processing strengths and needs so that treatment, rehabilitation and educational plans can be developed. Clinic Co-Directors Regilda (Rea) Anne A. Romero, Ph.D., licensed psychologist, and Rebecca J. Penna, Ph.D., NCSP, neuropsychologist and clinical psychologist, can help with making “return to play” decisions.

Kids’ Concussions Cause for Concern

ABC News reported in September on an alarming new statistic: Kids only report one out of every 10 concussions. The danger in not reporting concussions is the possibility of post-concussion syndrome, a complex disorder that, according to Mayo Clinic’s website, can last for weeks and sometimes months after the injury that caused the concussion.

What makes the disorder even harder to diagnose is that a child who has suffered a blow to the head doesn’t necessarily lose consciousness. In fact, the injury may not even have seemed that severe.

The ABC News story reported on 15-year-old Willie Baun who was hit on the field during a game. His father, Whitey Baun, said, “It was absolutely a normal hit, nothing that made me go, ‘Oh! That was a real hit!”

But, in fact, they learned later that it was his second concussion in just six weeks. And, it resulted in Willie losing his memory. It took eight months and help from doctors for Willie’s memory to return.

According to Mayo Clinic, post-concussion symptoms include headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration and memory and noise and light sensitivity. Parents should seek help if their child experiences a head injury severe enough to cause confusion or amnesia, even if their child hasn’t lost consciousness.

Coaches play an important role in preventing post-concussion syndrome as well. They should not allow a player who has suffered a head injury to return to the game. ABC News refers to the HeadMinder test as one way to test cognitive ability. After a hit, the player is asked a series of questions by the coach or parents. The score is tested against a baseline number to see whether there’s been an injury and whether the play is ready to go back on the field.

However, none of the diagnostic studies are completely objective and should never be used as the sole means of assessment or in deciding when to return an athlete to play.

The November/December 2011 issue of Practical Neurology reports that “the best way to assess an athlete or any individual who has sustained a concussion is still a comprehensive neurological history and detailed neurological examination performed by a properly trained physician.”

Keystone’s Neuropsychological Assessment Clinic also diagnoses other medical conditions that impact the central nervous system and complex clinical conditions that impact the way a child thinks and learns, for example, epilepsy/seizure disorders; neurodevelopmental disorders such as ADHD, learning disabilities, autism spectrum disorder and/or language delays; and various medical issues and illnesses that can impact the integrity of the brain, such as cancer and cancer treatment late-effects, viruses and infections, congenital or genetic disorders and stroke or Sickle-cell “silent strokes.”

Keystone child psychologists are eager to share information on neurological assessment with urgent care centers, school counselors, coaches, community and faith groups, pediatricians and other health care providers, as appropriate. To arrange an in-service training or presentation, contact Karen Rieley, director of marketing and communications for Keystone, 904.333.1151. If you are a parent who is concerned that your child may have suffered a brain injury or other medical condition that is having an impact on your child’s ability to think clearly and learn, contact Keystone, 904.619.6071, to set up an appointment with the Neuropsychological Assessment Clinic.

Keystone offers Free Developmental Screenings Targeting Birth to Five Years

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Keystone Behavioral Pediatrics is offering community infants and toddlers from 1 month to age 5½ free comprehensive screenings to help parents identify as early as possible any physical or developmental issues that children may have. Study after study has shown that the earlier a delay is recognized and intervention is begun, the better chance a child has to substantially improve. Developmental screening is one of the best things you can do to ensure a child’s success in school and life.

Parents are invited to complete an ASQ Developmental Pre-Screening Survey, which involves answering a series of simple questions regarding your child’s abilities (for example, “Does your child climb on an object such as a chair to reach something he wants?” or “When your child wants something does she tell you by pointing to it?”).

Parents’ answers to the screening go directly to Keystone for therapists to identify any possible concerns. Then, parents are scheduled to bring their child in for a 1-hour session that includes free screenings by a licensed child psychologist, pediatric occupational therapist, pediatric speech/language therapist and pediatrician trained in developmental growth. Parents who participate will have access to a number of free resources about developmental stages to anticipate and ways to help their child.

Keystone CEO and child psychologist Katie Falwell, Ph.D. and RJ Navarro, Keystone’s director of rehabilitative medicine and occupational therapist, were recently interviewed on WJXT’s The Morning Show about the importance of early intervention and the Right from the Start Clinic.

Dr. Katherine Falwell
Dr. Katherine Falwell, founder and CEO of Keystone, focuses on the whole child and making sure that each child has the best chance of success.

Contact info@keystonebehavioral.com or 904.619.6071 for more information.

Keystone Clinic helps Children deal with Trauma and Grief

Prince Harry brought an important pediatric mental health issue to light recently when he revealed to the BBC (British Broadcasting Corporation) that he regrets not talking about how the death of his mother, Princess Diana, affected him. The now 31-year-old was only 12 when Diana was killed in a car crash.

Prince Harry knows, as do the therapists at Keystone Behavioral Pediatrics, that all of us need an outlet for expressing feelings of grief. For children, it is likely the first time that they have had some kind of loss, and they have no experience in the course that grief may take and the impact it may have on their lives.

To help children cope with grief and other types of trauma, Keystone Behavioral Pediatrics offers Trauma and Grief Clinic in Jacksonville, Fla., to evaluate and treat children and adolescents dealing with these issues. Exposure to traumatic events can affect children’s cognitive, social, emotional, and behavioral functioning. Early therapeutic intervention can minimize the harmful effects of experiencing psychological trauma.

The most common diagnoses associated with trauma and grief are PTSD (Post-Traumatic Stress Disorder) or Acute Stress Disorder. Kids with this disorder may avoid things associated with the event and may have difficulties remembering parts of the event. Parents, caregivers and others, such as teachers and coaches, may notice changes in their mood, thoughts or behavior.

If you suspect that you child is suffering from trauma or grief, you may bring your child to Keystone for an initial evaluation. One of our therapists or child psychologists will interview you and, when appropriate, your child. The therapist may use rating scales and screening forms as well.

The Trauma and Grief Clinic offers evidenced-based trauma-focused cognitive child behavior therapy (TF-CBT). TF-CBT has been shown to help children, adolescents and their families overcome trauma-related difficulties. It is designed to reduce negative emotional and behavioral responses after witnessing domestic violence, experiencing traumatic loss, or experiencing abuse.

The first step to get help for your child is to complete Keystone’s online appointment form. Once we receive the completed application, a client care coordinator will call you to set up an appointment for the initial evaluation.

Keystone’s Trauma and Grief Clinic is one of 15 clinics that together offer comprehensive, collaborative and integrated healthcare for all children, from infancy to 22 years old, to deal with all mental health issues and child behavior and developmental disorders. In addition to the Trauma and Grief Clinic, Keystone clinics include Right from the Start, Health & Wellness, ADHD, Anxiety and OCD, Autism & Developmental, Disruptive Behavior, Educational & Learning Assessment, Feeding, Mood, Neuropsychological Assessment, Occupational Therapy, Speech/Language, Early Intervention and Day Treatment clinics.

Behavior Therapy Education for Police Reduces Misunderstandings

By Matthew J. Delaney, MSW, BCBA

Director of Applied Behavior Analysis

If you have tuned into the news recently, you are well aware of the behavior therapist in Miami who was shot by law enforcement as he was trying to bring his client who has autism back to the group home from which he had wandered. The video footage going viral on social media shows a behavior therapist with his hands up pleading with the man with autism to remain still and to lie down on the ground for fear that the police will shoot if he does not comply. The 23 year-old man with autism holding a toy truck continues to rock back and forth not adhering to the therapist’s request.

The fact that the individual did not comply with the demands of his therapist, and likely the demands of law enforcement, placed him at significant risk for harm. While many details will come out in the next few days regarding this unfortunate event, I think it is a great opportunity to spark discussion about the need for greater collaboration’ between behavior analysts and our law enforcement community in an effort to prevent events like this from reoccurring.

The Substance Abuse and Mental Health Services Administration funded a global initiative called Mental Health First Aid. The premise behind this initiative is that if an individual had a heart attack in a public venue, it is likely a witness in the community could come and provide CPR. However, if an individual was contemplating suicide or having a panic attack, the odds are less likely that a bystander would know how to adequately respond. These trainings are open to anyone, but are particularly marketed toward law enforcement and our first responders.

While this initiative is meeting a huge need within the mental health community, it does not address information and techniques specific to individuals with autism and related disorders. Similar to this initiative, there is an urgent need for behavior analysts to partner with first responders to provide training on the many presentations of autism symptoms and train law enforcement agencies on ways to interact with individuals who may have autism or related disorders that protects them from further escalation or harm.

Keystone Behavioral Pediatrics is eager to partner with law enforcement and other first responders in the Jacksonville community. We will provide educational training sessions as a community service to help empower these professionals with the tools and knowledge necessary to work with individuals with autism and related disorders.

We take seriously our role as advocates for the children and young adults we serve, and, in that role, we hope to build lasting partnerships with Jacksonville’s first responders and be a community resource for education and training on working with individuals with autism and related disorders.

You may contact Matt Delaney, 904.619.6071, delaney@keystonebehavioral.com, to discuss a potential educational training session or other ways that we may be helpful.