Online Training Courses and Distance Learning Programs in Child Psychotherapies (e.g., cognitive behavioral therapy, behavioral therapy, and collaborative problem solving therapy)

The need for new, high quality online learning courses in child psychotherapy has never been greater.  Given parents' understandable concerns about using psychoactive medications in a developing child, parents are more and more seeking non-medication therapies.  However, most therapists have not been trained in the latest, evidence-based therapies for children, such as cognitive behavioral therapy (CBT), parent management training (also called behavioral therapy), or collaborative problem solving (CPS) therapy.  In part, this "science to service" gap is a result of the over-reliance on lectures to teach clinicians new skills.  But skills are best learned by feedback and practice, and fine-tuning of these skills over time, often with the help of a coach.  Just as a lecture never really taught anyone how to swim or ride a bike, child psychotherapy skills take time, chances to practice and problem-solve, and feedback and support of a coach, plus sometimes other learning partners/colleagues.  Another difficulty related to why most therapists have not learned these skills are the simple facts of costs: although the REACH Institute provides hands-on, sustained learning courses for therapists in CBT, CPS, and behavioral therapy, these face-to-face programs have always required the therapists to leave the office to travel to a distant city for 2-5 days to participate in continuing  educational programs (CME) in child psychotherapy. While such approaches can have great advantages for learning and skill development, they may represent a barrier to learning for many therapists, if we consider all of the associated costs - loss of practice income, hotel, meals, and travel expenses, plus the costs of the continuing education program itself.

The Need for Online and Distance Learning Training Programs in Child Psychotherapies

Understanding the urgent need for more accessible continuing education training programs in child psychotherapy the REACH Institute is pioneering new online training courses delivered via the web, using a combination of 2 state of the art but different learning approaches: 1) asynchronous: video materials (e.g., brief didactic video lectures and vignettes), followed by personal application and practice, quizzes, and downloadable clinical tools, all of which will facilitate your learning at your own convenience, anytime day or night;  orsynchonous: interactive webinars organized into small peer learning groups, with live demonstrations of techniques, role plays, and interactive group work all delivered live over the web, coupled with the availability all of the online learning materials listed under the first option. These synchronous training programs are scheduled at a times convenient for busy practitioners, such as during the noon hour, early mornings, or at the end of the work day.

Skills Taught  and Topics Covered in REACH's Child Psychotherapy Online Learning Programs

In both types of distance learning programs, psychotherapists learn the key skills and pearls that will help you obtain all of the essential assessment information, and arrive at an accurate diagnosis.  Video vigenettes and demonstrations of clinicians who are interviewing and evaluating patients the "right way" vs. the "wrong way" are offered.  Webinars in synchronous trainings provide live demonstrations of the optimal interviewing and diagnostic methods. Clinicians are also taught the use of rating scales and other assessment tools that can efficiently guide through your differential diagnosis.  Depending on how many online learning modules you enroll in, these distance learning programs address all of the key diagnosis and treatment challenges now faced by psychotherapists: the diagnosis and psychotherapeutic treatment of childhood anxiety disorders, depression, ADHD (including complicated, comorbid cases), aggression, and autism and spectrum disorders.  If you are interested in any of these new online learning programs in child psychotherapy, contact Lisa Hunter Romanelli, PhD, Executive Director of the REACH Institute via the "Contact" link at the bottom of this webpage.

Online Training Courses and Distance Learning Programs in Child Psychopharmacology (aka "Pediatric Psychopharmacology")

The need for new, high quality online learning courses in pediatric pharmacology (specifically child psychopharmacology) has never been greater.  More and more, parents are turning to their primary care doctors to get help for child mental health problems, in view of the continuing severe shortages of child and adolescent psychiatrists.  Leaving the office to travel to a distant city for 2-3 days for a continuing medical educational program (CME) can be a barrier to learning for many physicians and other primary care practitioners , if one considers all of the costs - loss of practice income, hotel, meals, and travel expenses, plus the costs of the continuing education program itself.

The Need for Online and Distance Learning Training Programs in Child Pharmacology

Understanding the urgent need for more accessible continuing education training programs, the REACH Institute is pioneering new online training courses in child psychopharmacology (also sometimes called pediatric psychopharmacology) delivered via the web, using a combination of 2 state of the art but different learning approaches: 1) asynchronous: video materials (e.g., brief didactic video lectures and vignettes), followed by personal application and practice, quizzes, and downloadable clinical tools, all of which will facilitate your learning at your own convenience, anytime day or night;  or synchonous: interactive webinars organized into small peer learning groups, with live demonstrations of techniques, role plays, and interactive group work all delivered live over the web, coupled with the availability all of the online learning materials listed under the first option. These synchronous training programs are scheduled at a times convenient for busy practitioners, such as during the noon hour, early mornings, or at the end of the work day.

Skills Taught  and Topics Covered in REACH's Online Learning Programs in Child Psychopharmacology

In both types of distance learning programs, primary care doctors and other clinicians learn the key skills and pearls that will help you obtain all of the essential assessment information, and arrive at an accurate diagnosis.  Video vigenettes and demonstrations of clinicians who are interviewing and evaluating patients the "right way" vs. the "wrong way" are offered.  Webinars in synchronous trainings provide live demonstrations of the optimal interviewing and diagnostic methods. Clinicians are also taught the use of rating scales and other assessment tools that can efficiently guide through your differential diagnosis.  Even better, you will learn which billing codes can be used so that you can get paid for this work.  Depending on how many online learning modules you enroll in, these distance learning programs address all of the key diagnosis and treatment challenges now faced by primary care clinicians: the diagnosis of childhood anxiety disorders, depression, ADHD (including complicated, comorbid cases), aggression, autism and spectrum disorders, and tics.  Specialized courses in child/pediatric psychopharmacology will also soon be ready as "advanced" topics for those who have mastered the earlier programs, and cover complicated topics such as how to reduce polypharmacy, manage side effects, and provide ongoing monitoring of complex medication regimens.  If you are interested in any of these new online learning programs, contact Lisa Hunter Romanelli, PhD, Executive Director of the REACH Institute via the "Contact" link at the bottom of this webpage.

SCHOOL MENTAL HEALTH TRAINING PROGRAMS

Schools are where the kids are.  15-20% of kids have mental health problems.  These problems not interfere with learning for these children, but their problems also affect school learning and achievement for their classmates.  So why do we not have more programs that provide state-of-the-art training programs in "evidence-based" interventions for helping children in our schools?

At the REACH Institute, we have worked over the last 7 years with school principals, superintendents, school psychologists, school mental health researchers, teachers, school counselors, nurses, and other educational professionals to identify the very best of proven methods that help children learn more, and learn faster in their schools, as well as special programs coaching teachers, playground supervisors, and principals how to improve classroom and playground behavior, increase children's attention and time on task, reduce bullying and school violence, and improve early identification and low-cost screening of children with mental health problems in schools.

MENTAL HEALTH TRAINING COURSES

REACH now offers training courses for school mental health and educational professionals in how to deliver proven strategies shown to help our children and our school environments.  These easy-to-use intervention methods include the Good Behavior Game, the Olweus Anti-Bullying Program, and different forms of school-based psychotherapies (CBT, etc.) for children with trauma, disruptive disorders, aggression, anxiety, depression, and off-task behavior.

THE GOOD BEHAVIOR GAME

One big problem faced by many teachers is "crowd control".  How does a teacher effectively exert personal influence over a large group of children who are being asked to do things that do not at all come naturally, sit for long periods in a chair, subject themselves to artificial light, refrain from talking to other child, attend to an adult who is 15'-20' away who is talking about things that do not seem immediately interesting?  How does a teacher exert this degree of personal influence on children?  The skill is often called "classroom management."  The Good Behavior Game is one highly effective means for a teacher to put an efficacious classroom management strategy into place, using a game format. Teachers will typically need one day of face-to-face training, and ongoing follow-up and support for any problems they encounter along the way, when implementing this program. Both the initial period of teacher training, plus the ongoing problem-solving support, are available through the REACH Institute.  Teacher Good Behavior Game supervisors can also be employees of the school itself, allowing this supervisor to coach the new teacher in this form of classroom management, observe any implementation problems, and problem-solve with the teacher when obstacles or difficulties are encountered.

Click on the link "Contact" either here or at the bottom of the webpage below to send a message to REACH staff, and will provide you dates and details.

The Role of "Parent Advocates," "Parent Coaches and Mentors," and/or "Family Parters"

Many parents and families, and other mental health consumers have found that getting high quality mental health care for a child or a family member is very difficult.  Many parents and families find not only many barriers to care, but misdirection, bad advice, and lack of information.  Increasingly, parents, other consumers, and parent and family advocates have learned that the very best persons able to offer them sound advice -- i.e., where to go, what service to use, which provider to see, etc., is best known by other expert parents...parents who have become advocates to other parents who are new to the system, so that new parents will not struggle with the common experience that too many parents are traumatized by -- 5-10 years of delay, confusion, and misdirection, before they finally become experts through hard-won experience about their local mental health system, and "how to make the system work" for the child with ADHD, depression, bipolar disorder, autism, or other severe mental health disorders. If an analogous situation involved food and groceries, all of us would find that we were still roaming about like hunter-gatherers, wondering where good food sources, roots and berries, and edible plants and animals could be found.  Word of mouth from trusted members of the tribe and from our family members would be what we would have to rely on.  Thus, as many senior policy makers, researchers, and the US Surgeon General have observed, the child mental health system is "broken", if indeed it was ever intact.

The Need For Parent Activation (aka "Parent Empowerment")

A parent who confused and bewildered about their child most often does not know where to turn: some may ask a trusted teacher for a referral, i.e., "Do you know a good doctor?", while others may turn to relatives, or ask their child's primary care doctor.  Many parents are frustrated when they call their insurance companies' "preferred provider" list, only to find numbers that are no longer in service, or doctors who say they no longer work with that insurance company.  Consider instead the benefits to a novice parent seeking for a local mental health expert of a "parent advocate," "parent coach or mentor," or "family partner": this person works within the mental health system, has been trained about local resource and their availability, is experienced both personally (through their own child) and professionally (through an intensive parent empowerment training program and subsequent official certification or credential) with experience and knowledge about what an IEP is and how it differs from a 504 Plan, how and where one obtains local services for a child, and how challenges an insurance company's determination not to pay for a given procedure or disorder/problem.

Through a 10 year program of research, the REACH Institute has developed as just such a program, its "Parent Empowerment Training Program", or PEP for short.  In this year-long course, experienced parents "who have been there, seen it, and done it" complete a week-long program with other expert parents, learning about how to become a professional parent advocate, and how to serve as a parent mentor, coach, and partner to new parents just beginning this long journey.  REACH has developed such parent empowerment-parent activation training programs, not just for the mental health system, but also for the child welfare system, the juvenile justice system, and the school system.  In each of these programs, experienced parents become expert parent advocates as they formally acquire new knowledge and skills to fill in any gaps in their experience.   These parent empowerment training programs usually entail 3-5 days of hands-on, intensive training, skills practice exercises, role plays, didactic lectures, and small group exercises, all taught by a very senior and experienced parent advocate and a mental health professional, followed by one year of twice monthly group conference calls, where new parent advocates get help, guidance, and peer supervision in how to better help the new parents they are working with.  If your want to learn more about how you can obtain training for prospective parent mentors, coaches, and partners in your setting, region, or agency, contact Lisa Hunter Romanelli, PhD, REACH's Executive Director on our "About Us" link.  Trainings are available not only for parents to become parent advocates, but also for clinicians and agency directors, so that they and their colleagues can be prepared to take full advantage of this vital, new, and urgently needed expert workforce that is increasingly available in many states trying to "fix" our broken child mental health system.

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TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY TRAINING AND SUPERVISION

Trauma-Focused CBT: What is It?

Trauma-focused CBT, also sometimes called TF-CBT, is a form of cognitive behavioral therapy specifically adapted for children who have experienced trauma, and who are having significant emotional and/or behavioral problems related to these  traumatic life events.  Children who have experienced traumatic events may have a few or many post-traumatic stress disorder (PTSD) symptoms, and meet the criteria for full-blown PTSD.  Thus, the experience of a trauma does not necessarily lead to PTSD, and might in fact result in other emotional or behavioral symptoms, such as disruptive behaviors, depression, or anxiety due to trauma.

Symptoms of child traumatic stress include but are not limited to:

• Repeated, upsetting memories of the traumatic event

• Flashbacks, reliving the experience

• Very upset by sights, sounds, or smells that trigger the memory of the traumatic event

• Avoiding places or people that are reminders of the event

• Being easily startled

• Showing very little emotion, seeming “numb” regarding the event

• Nightmares

• Difficulty sleeping

• Difficulty concentrating

• Lack of interest in usual activities or personal relationships the child once enjoyed

How Was Trauma-Focused CBT Developed?

TF-CBT is a hybrid treatment model that incorporates a number of trauma-sensitive intervention components, based on cognitive, behavioral, humanistic, and family-ecological conceptual foundations.   This TF-CBT training course teaches therapists how to individualize TF-CBT techniques to children and their contextual circumstances.  In all instances, this requires establishing and maintaining therapeutic relationship with child and parent, psycho-education about childhood trauma and PTSD, individualizing relaxation skills taught to the child and parent, adapting skills related to affective modulation to the child, family, and culture, and building the child's cognitive coping skills by connecting the child's thoughts, feelings, and behaviors related to the trauma.

Although TF-CBT was designed to treat trauma symptoms and full-blown PTSD in children who have experienced a trauma, TF-CBT has also been shown to:

• Improve child externalizing behavior problems (including sexual behavior problems if related to trauma)

• Improving parenting skills and parental support of the child, and reducing parental distress

• Enhancing parent-child communication, attachment, and ability to maintain safety Improving child's adaptive functioning

• Reducing shame and embarrassment related to the traumatic experiences

• Children will benefit most from TF-CBT if a parent or caregiver participates with them in the treatment.  However, even when children do not have a consistent caregiver, they can still benefit from TF-CBT.  TF-CBT studies in children and youth have shown that the intervention can yield improvements for periods up to two years after treatment.

Importantly, more than most types of CBT, TF-CBT was designed to be used with some flexibility, based on the individual's situation. Skilled TF-CBT clinicians may change the order of skills being taught, but all appropriate components  are generally used during the course of the training.  Therapeutic elements of TF-CBT can be easily remembered, based on the "PRACTICE" acronym.

Trauma Focused Cognitive Behavioral Therapy:

The PRACTICE acronym

• Psychoeducation and Parenting skills

• Relaxation

• Affective Expression and Regulation

• Cognitive Coping

• Trauma Narrative Development and Processing

• In Vivo Gradual Exposure

• Conjoint Parent - Child Sessions

• Enhancing Safety and Future Development

TF-CBT therapists work with both the parent and the child.  Therapeutic components taught to parents are: 1) Effective parenting skills, 2) Increasing parental support of the child, 3) Stress management skills „for caregivers, 4) Reducing inappropriate parenting practices, 5) Reducing parental trauma-related emotional distress, and 6) Improving personal safety skills, and 7) Enhancing parents' ability to manage trauma reminders and future stressors.

Several psychoeducational components of TF-CBT are taught to both the parent and child intervention, including 1) Teaching parent and child about sexual abuse and PTSD and typical „reactions of victims, 2) Teaching parent and child about healthy sexuality, and 3) Educating parent on child behavior management skills.

Child-specific components include:

• Relaxation, often done using relaxation tapes or scripts.  This may also include practicing deep breathing/Belly Breathing, Listening to music, and progressive Muscle Relaxation

• Affective Regulation.  This component includes "Feelings identification" intended as a relatively non-stressful way for children to begin talking about their feelings with the therapist.  By sharing common everyday feelings with each other, the therapist is able to gauge the child's  verbal and emotional ability to accurately identify and express a range of different feelings.  The child gets to know a little about the therapist, sees that the therapist has had "bad" feelings, and that the therapist  "good" as well as open about sharing these feelings with the child.

• Trauma Narrative.  One unique component of TF-CBT is the trauma narrative.  The goal of working with the child's trauma narrative is to "unpair" the thoughts, reminders, or discussions of the traumatic event from the child's overwhelming negative emotions such as terror, horror, extreme helplessness, or rage.  Over the course of several sessions, the child is encouraged  „to describe more and more details of what happened before, during and after the traumatic event, as well as the child's thoughts and feelings during these times.

• In Vivo Exposure (Facing Your Fears).  In vivo exposure is used to desensitize the child to “trauma cue” or “trigger”.  This is done at child’s pace and only after teaching them other components such as relaxation and cognitive coping. Another means of helping the child face his/her fears includes “gradual exposure” to triggers (ex. scene of the crime).  This may be especially important for children who need to continue to be around where the abuse took place (school, a room in their house etc)

• Cognitive Coping Strategies.  After the trauma narrative is complete, the child and therapist directly explore and correct any cognitive errors (inaccurate or unhelpful thoughts).  One way to do this is to re -read the child's trauma narrative book in the session, focusing during the session on all of the thoughts the child has been able to express.  As each thought is verbalized in the book, the therapist and child examine whether the thought was accurate and helpful.  Alternative thoughts are identified that can replace unhelpful or inaccurate thoughts.

CONJOINT SESSIONS

Both the parent and child are prepared for conjoint sessions ahead of time.  The therapist shares the trauma narrative with the parent ahead of time, and the parent is taught about appropriate responses, including questions or challenges to incorrect cognitions.  Then during the conjoint session the child reads the trauma narrative aloud, and at the end, the parent and therapist praise the child for bravery.  Likewise, the child is also prepared ahead of time.  With the therapist, the child asks questions (prepared ahead of time by the therapist after reviewing these issues with the parent).   During the conjoint session the therapist serves to facilitate communications between parent and child directly, only intervening if there are difficult (inaccurate or unhelpful) cognitions that the other one does not challenge and correct.

The REACH Institute works with a number of national TF-CBT experts  to provide state-of-art training courses to teach therapists in its use through proven strategies, including distance learning methods such as webinars, and web-based self-paced training programs, and face-to-face training followed by ongoing phone conference calls for up to one year.  For more details, see our page on Psychotherapy Training Courses. Alternatively, for additional details about how to register for this program, go to the "About Us" webpage, and contact the REACH Institute's Executive Director, Lisa Hunter Romanelli, PhD

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A Child Depression Training Course for Health Care Professionals: Change a Child's Life for the Better...

The non-profit REACH Institute now offers primary care and specialty mental care professionals intensive coaching in the diagnosis and treatment of child and adolescent depression (major depressive disorder, dysthymia, and depression NOS).  This course is designed for family physicians, pediatricians, GPs, nurses and nurse practitioners, psychiatrists, and neurologists (as well as child and adolescents psychiatrists who want to be up to speed on “the state of the art” in delivering the latest scientifically proven treatments for child depression.  Because this depression training course teaches an integrated (psychotherapy AND medication) approach to treatment, non-prescribing health care professionals may not find that this training course fully meets their needs, and are encouraged instead to consider another one of REACH's training courses, such as a training course focusing specifically on how to provide cognitive behavioral therapy (CBT) for depressed children and teens.

Led by Peter S. Jensen, MD, former Associate Director of NIMH (Child & Adolescent Research), author of over 300 peer-reviewed articles and chapters, and author/editor of over a dozen books for researchers, clinicians, and parents, this course brings together four crucial components in diagnosing and treating depression and depression-related disorders, and achieving optimal outcomes for children and families.

These four components of childhood depression knowledge and skill are 1) providing an accurate diagnosis of depression using reliable rating tools, 2) delivering state-of-art medication titration and medication monitoring, while minimizing side effects, 3) learning how to deliver an evidence-based cognitive behavioral therapy intervention that helps children (and families) learn skills that medication cannot teach, such as social skills, improved parent-child relationships, coping and problem solving, and self-monitoring, and 4) how to individualize your depression treatment plan for each child and family, including considering the role of parent and youth treatment preferences.

1. Depression Assessment and Diagnosis

Students learn the differential diagnosis of depressive symptoms, and how to clearly differentiate it from other conditions such as bipolar disorder, anxiety disorders, and demoralization and low self-esteem.  This depression training course assists health care practitioners in identifying the DSM symptoms and impairments related to the various depression diagnoses.  Practice in using and scoring depression symptom rating scales is provided, not just to help evaluate the child, but also to educate and improve therapeutic communications and the treatment alliance between the health care professional and the child and family.  Appropriate use of other symptom rating scales are also included in this depression training course, such as anxiety, bipolar disorder, and oppositional defiant disorder.  Rating scales for all relevant disorders are provided for free and continuing use with your patients.

Comprehensive and complete depression assessment methods also require that the health care develop expertise in interviewing skills, and learn how to elicit sensitive information such as suicidal thoughts and behaviors or harsh parenting methods, become skilled in developing a therapeutic alliance so that parents and youth are able to adequately provide a thorough medical and psychosocial history and mental status exam.  These skills are taught and modeled in engaging lectures, and further consolidated through skills practice exercises, role-plays, and small group learning formats.

2. Depression Medication Management

Even experienced clinicians may be uncertain how medications such as SSRIs should be titrated, and how full adherence to the medication components of your treatment plan is achieved. This depression training course provides medical health care professionals the essential knowledge and skills about which medications should be selected next if the first or second medication treatment trial fails, hand how to counsel parents and help them overcome fears or resistance to use of medication or pursue a mental health referral. In this training course, health care practitioners will also learn to apply specific methods for optimal monitoring of medication benefits, effects, and side effects.  All of these depression treatment management skills are taught and further reinforced through the various training course methods – role-plays, skills practice, and small group learning.

3. Cognitive Behavioral Therapy (CBT) Training

The third component of this depression training course consists in learning how to deliver cognitive behavioral therapy that helps children (and families) learn what medication cannot teach, specifically social skills, improved parent-child relationships, problem-solving and coping skills, and self-monitoring.  Specific CBT techniques taught and practiced for delivery and teaching to children and parents are: 1) monitoring depressive symptoms; 2) identifying negative automatic thoughts and beliefs; 3) disputing negative beliefs; 4) coping and problem-solving.

4. Individualizing  Your Depression Treatment Plans

One major problem many health care practitioners experience is how to optimally tailor their intervention plan to each child and family so that it works for that specific family.  For example, medication adherence is a problem for 50% of families, but few clinicians are aware of how to deal with this, and how to encourage families to candidly describe their fear, anxiety, and guilt that often undermine treatment adherence.

Other problems related to individualizing treatment plans for depressive disorders relate to essential skills for all physicians treating depression: 1) selecting the optimal medication, 2) titrating the medication to best dose effects, 3) implementing strategies to minimize common side effects; 4) choosing alternative medications when the initial medication is either ineffective or has too many side effects; 5) individualizing the treatment when the child has comorbid disorders such as anxiety, ADHD, oppositional defiant or conduct disorder, tics or Tourettes, or severe mood dysregulation and irritability.

This depression training course also guides students in using youth and parent rating scales to track treatment response, individualize the child’s treatment plan for specific problems at home or school or in special areas of functioning (social skills, academic performance, parent-child relationships), how to use rating scales to increase parent, child, and teacher understanding of depression and participation in the treatment plan, and how to use them to maximize treatment outcomes.

Finally, all four of these essential treatment components are applied and practiced with specific cases, and students learn when each component should be applied.  This course is ideal for many current practitioners – pediatricians, family practitioners, GPs, psychiatrists and neurologists, most of whom were  were not trained during residency in depression medication management or cognitive behavioral therapy procedures. This course is of value for all qualified healthcare practitioners, with or without previous psychotherapy experience.

Training is available that provides accreditation for continuing medical professional education. Students learn how to work with children and families, using a combination of hands-on practice of skills, engaging lectures that are applicable to your daily work, role-play, experiential exercises, small group practice sessions, video demonstrations, and skills practice exercises. The total training period is up to 12 months, beginning first with an intensive face-to-face coaching program, and followed up with distance learning methods and conference calls in small peer learning groups.

Please contact us to learn about our next available depression training course dates, or help us bring a training to your city: usually, 20 therapist-participants need to enroll for the training to be effective (and cost-effective, from a REACH perspective).  Or for more details about how to register for this program, go to the "About Us" webpage, and contact the REACH Institute's Executive Director, Lisa Hunter Romanelli, PhD

A Hands-on Training Course in ADHD Diagnosis and Treatment

The non-profit REACH Institute offers high impact training for health care professionals in the diagnosis and treatment of ADHD (attention deficit hyperactivity disorder).  This course is designed for family physicians, pediatricians, GPs, nurses and nurse practitioners, psychiatrists, and neurologists (as well as child and adolescents psychiatrists who want to be “at the top of their game” in delivering the latest scientifically proven treatments for ADHD.  Led by Peter S. Jensen, MD, NIMH lead investigator of the NIMH multisite MTA Study and author of over 300 peer-reviewed articles and chapters, and author/editor of over a dozen books for researchers, clinicians, and parents, this course brings together four crucial components in diagnosing and treating ADHD, and achieving optimal outcomes for children and families.

These four components of ADHD knowledge and skill are 1) accurate ADHD diagnosis using reliable rating tools, 2) state-of-art medication titration and medication monitoring, selection among available agents based on treatment targets and environmental demands, determine which of the various psychostimulants or non-stimulants should be used initially, determining necessary methods for maximizing benefits and reducing medication side effects, 3) individualizing an ADHD treatment plan for each child and family, including the role of parental treatment preferences, and 4) learning how to deliver behavioral therapy that helps children (and families) learn skills that medication cannot teach, such as social skills, improved parent-child relationships, peer relationships and social skills, improved self-esteem, responsibility-taking, and self-monitoring,

1. ADHD Assessment Diagnosis

Students learn the differential diagnosis of ADHD, and how to clearly differentiate it from often over-diagnosed bipolar disorder.  This ADHD training course assists health care practitioners in identifying the DSM symptoms and impairments related to the ADHD diagnosis.  Practice in using and scoring ADHD symptom rating scales is provided, helping clinicians discriminate between the three ADHD diagnostic subtypes (Inattentive, Hyperactive, and Combined), not just to help evaluate the child, but also to educate and improve therapeutic communications and the treatment alliance between the health care professional and the child and family.  Appropriate use of other symptom rating scales are also included in this ADHD training course, such as depression, anxiety, oppositional defiant and conduct disorders, bipolar disorder, learning disability, and Aspergers.  All rating scales for each of these disorders are provided for free and continuing use with your patients.  Students also learn when psychological and neuropsychological testing is needed, and how to interpret testing results for your use in helping parents develop an school individualized treatment plan.

Comprehensive and complete ADHD assessment methods also require that the health care practitioner develop expertise in interviewing skills, and learn how to elicit sensitive information such as parental abuse and harsh parenting methods, become skilled in developing a therapeutic alliance so that parents are able to adequately provide an thorough medical and psychosocial history.  These skills are taught and modeled in engaging lectures, and further consolidated through skills practice exercises, role-plays, and small group learning formats.

2. ADHD Medication Management

Surprisingly, even many experienced clinicians remain confused and uncertain how ADHD medications should be titrated, how titration can be done easily during the first month to increase parental “buy in”, and how full adherence to the treatment plan is achieved.  This ADHD training course provides medical health care professionals the essential knowledge and skills about which medications should be selected next if the first or second medication treatment trial fails, and how to counsel parents and help them overcome fears or resistance to use of medication or a mental health referral. Correct choice of medication often depends on time of day dosing effects, and requires that practitioners use duration of action information about the medication classes and formulations to choose among agents.  Prescribing medication optimally also requires that prescribers learn and master the general principles and necessary skills for managing side effects. In this ADHD training course, practitioners learn to apply specific methods for optimal monitoring of medication benefits, effects, and side effects.  All of these ADHD treatment management skills are taught and further reinforced through the various training course methods – role-plays, skills practice, and small group learning.

3. Individualizing  ADHD Treatment Plans

One problem many medical professionals face is learning how to optimally tailor their intervention plan to each child and family so that it works for that specific family.  For example, ADHD medication adherence is a problem for 50% of families, but few clinicians are aware of how to deal with this, and how to encourage families to candidly describe their fear, anxiety, and guilt that often undermine treatment adherence.  Another problem faced by many health care professionals is that some families do not fully take on the challenges of addressing and managing their child’s ADHD, hoping that somehow “the doctor will do it,” perhaps with magic pills.  They may have problems taking time out in their busy schedules, in partnering with their child’s teacher or working collaboratively with schools, educating themselves (with your guidance, using tools that you provide) about problems such as obtaining an individualized educational plan (IEP) or 504 Plan, learning and exercising their educational rights, and/or in advocating for their child.

Other problems related to individualizing treatment plans for attention deficit hyperactivity disorder relate to essential skills for all physicians treating ADHD: 1) selecting the optimal medication, 2) titrating the medication to best dose effects, 3) implementing strategies to minimize common side effects such as sleep, appetite, and “rebound”, or problems with weight loss and growth retardation; 4) determining when to offer and support “drug holidays” in summer or on weekends, 5) choosing alternative medications when the initial medication is either ineffective or has too many side effects; 6) individualizing the ADHD treatment when the child has comorbid disorders such as anxiety, depression, oppositional defiant or conduct disorder, tics or Tourettes, or severe mood dysregulation, irritability, and temper problems.

This ADHD training course also guides students in using teacher and parent rating scales to track treatment response, individualize the child’s treatment plan for specific problems at home or school or in special areas of functioning (social skills, academic performance, parent-child relationships), how to use rating scales to increase parent, child, and teacher understanding of ADHD and participation in the treatment plan, and how to use them to maximize treatment outcomes.

4. Behavioral Therapy Training

The fourth component of the ADHD training course consists in learning how to deliver behavioral therapy that helps children (and families) learn what medication cannot teach, specifically social skills, improved parent-child relationships, peer relationships and social skills, improved self-esteem, responsibility-taking, and self-monitoring.  Specific behavioral therapy techniques taught and practiced for delivery and teaching to parents are: 1) choosing behavioral targets, 2) measuring and reinforcing appropriate child behaviors and reducing inappropriate or undesirable behaviors; 3) paying positive attention and strengthening the parent-child relationship, 4) delivering effective commands to a child, and 5) the use of time out.

Finally, all four of these essential treatment components are applied and practiced with specific cases, and students learn when each treatment should be applied.  This course is ideal for many current practitioners – pediatricians, family practitioners, GPs, psychiatrists and neurologists, most of whom were  were not trained during graduate school in ADHD medication or behavioral therapy procedures. This course is of value for all qualified healthcare practitioners, with or without previous psychotherapy experience. Training is available that is accredited for continuing education. Students learn how to work with children and families, using a combination of hands-on practice of skills, engaging lectures that are applicable to your daily work, role-play, experiential exercises, small group practice sessions, video demonstrations, and skills practice exercises. The total training period is up to 12 months, done using distance learning methods and conference calls in small peer learning groups.  For more details about how to register for this program, go to the "About Us" webpage, and contact the REACH Institute's Executive Director, Lisa Hunter Romanelli, PhD

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CONTINUING PROFESSIONAL EDUCATION TRAINING COURSES

Despite many millions of dollars spent on continuing education programs, including CME, most research has shown that typical continuing education programs are not effective.  At the REACH Institute, we agree with this finding as it applies to most continuing education programs, which are "hit-and-run" trainings, rather than the type training that is needed, such as REACH's hands-on, sustained "mini-fellowship" in topics of interest, such as our 6-month-long mini-fellowship in Primary Pediatric Psychopharmacology Program (PPP).  REACH's PPP fellowships are intended for pediatricians, family physicians, nurse practitioners, physician assistants -- essentially any licensed healthcare provider who wants to learn more about, or even master pediatric psychopharmacology.

REACH's PPP fellowship in child psychopharmacology is in fact a sustained mentoring, coaching, and skill development program. Thus, while most CME programs appear to be largely ineffective, do not confuse what you have experienced as the "typical" CME and other continuing education programs with the type of training in child psychopharmacology offered by the REACH Institute.  All of our continuing education programs use evidence-based teaching methods, and are guided by basic behavior science-proven change methods.  There are not your grandmother's CME programs!  All of the REACH's Institute training courses are distinguished by 7 characteristics:

1. Multi-disorder & Evidence-based: Children almost always present with a combination of problems. And so REACH provides state of the art training programs in evidence-based interventions for children with some combination of disruptive behaviors, anxiety, depression, and trauma. Training for a given problem is always integrated with training for other problems. Procedures and therapeutic techniques are applied consistently across problem areas. While we have found that multi-disorder training is usually more useful and less costly than single disorder training, there are cases when the latter is preferable. For such cases, our training is also well suited.

2. Distinguished faculty lead workshops and coaching sessions. Our faculty is distinguished by its seniority, breadth of expertise and level of involvement. All are graduate level professors with deep mentoring experience. All teach the leading edge evidence-based treatment programs that they themselves have developed, usually supported by NIH funding. REACH faculty include leading experts in each of the key pediatric psychopharmacology problem areas. Faculty lead not only the workshops but on-going coaching sessions which take place every other week for six months to a year.

3. Customized. Before REACH delivers any continuing education or CME training, we conduct a needs assessment. Training courses are then tailored to the unique skill levels, capacities, and criteria of our clients For example, clients with a background in child psychopharmacology may skip to more advanced training. Subject areas can be dropped or added, topics emphasized or not. Training can be tailored in this way because our faculty has the necessary sophistication and expertise. We need not use the highly prescriptive, packaged approach common to most training.

4. Outcomes Oriented: Training focuses on skill development, hands-on practice, and role-playing. The goal is to help primary care providers change their clinical practice procedures and improve their patients’ outcomes, which is why on-going case-based coaching plays such an important role in REACH training.

5. Transportable: Once key members of your organization's leadership team have been effectively trained, REACH teaches them how to train new primary care clinicians within your organization.

6. Integrated training materials: Training manuals and materials have been designed by our faculty, based on their carefully research treatment programs and decades of experience, specifically for you. All manuals and materials are carefully integrated, available online, and constantly updated to reflect your needs and input. Easy to understand handouts for patients and families are integrated into all of your assessment, diagnostic, and treatment approaches.

7. State of Art Online and Distance Learning Methods. Similarly, all of our continuing education training programs make extensive use of rating scales to help clinicians conduct a thorough assessment by offering manyuser-friendly toolkits and free materials on our website.  We take full advantage of the new technologies available through distance learning and online training methods, such as webinars, chat rooms, and listservs.

LEARNING ABOUT REACH'S TREATMENT TRAINING COURSES

To learn more about the REACH Institute's training courses, including our continuing education and continuing medical education (CME) courses in state-of-art child psychopharmacology treatments for ADHD, depression, anxiety disorders, conduct and oppositional-defiant disorders, bipolar disorder, autism and autism spectrum disorders, please click on our Continuing Education and CME programs link. All of our CME and continuing education training programs make extensive use of rating scales to help clinicians conduct a thorough assessment by offering many user-friendly toolkits and free materials on our website.

There you will find information on continuing education and CME programs in how to deliver cognitive behavioral therapy (CBT) for all major childhood mental health disorders, parent training programs for teaching behavior therapy procedures and principles to parents, collaborative problem solving (CPS) therapies based on Ross Greene's work, and trauma-focused CBT training programs based on Judy Cohen and Tony Mannarino's research. All of the major forms of child psychotherapy proven to work with children and teens are available here.

Delivering safe and appropriate pharmacotherapy - medication prescribing - regardless of whether you are a nurse practitioner, pediatrician, work in family practice, are a physician's assistant, a pediatric neurologist, psychiatrist, or child and adolescent psychiatrist, and whether you are just beginning pediatric pharmacology or are eager to learn advanced skills in child pharmacology and medication prescribing, the CME and continuing education training courses provided by the REACH Institute cover stimulants, mood stabilizers, SSRIs, and antipsychotics, and even more importantly, what needs to be done before you pull your prescription pad!

Given REACH's non-profit status and our growing donor base, free or low-cost CME and continuing educationmay also be available.  Please inquire if you think you, your practice, or your healthcare organization might qualify.

WHY IS THE ISSUE OF MENTAL HEALTH DIAGNOSIS SO IMPORTANT?

ISN'T IT JUST A LABEL?

The topic of assessment, diagnosis, and classification is boring to some, but this function is absolutely critical to our science and to quality clinical practice. Although the DSM is intended to be a guide and scientifically should be viewed as a “work in progress,” given its highly structured and definitive nature, clinicians are at some risk to reify it, essentially taking it too seriously, and acting as if the diagnosis were the complete story, rather than one essential component of the patient’s, client’s, or family’s story. Given the rapid strides that are being made in the developmental neurosciences, the attractiveness of lovely neuroimages, and the persuasive stories of brain differences between some clinical group and controls, there is a risk that we forget, or at least underestimate, the impact of family and peer environmental influences in shaping brain development, personality function, and psychopathology. This area is among the most difficult to study, since the phenomena are often so “fuzzy,” but given pervasive impact of family and peers on development, this area is also among the most critical.

COMPREHENSIVE, ACCURATE PSYCHIATRIC DIAGNOSES ESSENTIAL:

The REACH Institute views a comprehensive assessment to be the sine qua non of high quality evidence-based prevention and treatment intervention approaches. Tools that can assist busy clinicians in performing comprehensive assessments are tools such as parent-and patient- self-report rating scales. Rating scales may focus on specific symptoms that are part of a diagnosis, or they assess important risk factors such as severity of recent stressors, family functioning, peer relations, or any of the risk and protective factors that affect children’s outcomes. Such rating scales may have immediate clinical relevance: if a particular risk factor is elevated or a protective factor is below normal, clinicians can use this information in their clinical efforts to move these factors to more therapeutic levels, in their efforts to assist children and families. All of the REACH Institute training courses and continuing education (CME) programs place a strong emphasis on helping clinicians identify and apply the rating scales and other tools that will aid them in conducting comprehensive assessments of the child’s complete “story." With an adequate and comprehensive assessment, the treatment will always be either flat out wrong, or at best incomplete.

TRAINING PROGRAMS IN CHILD PSYCHIATRIC ASSESSMENT AND DIAGNOSIS

To learn more about the REACH Institute's training courses, including our continuing education and continuing medical education (CME) courses in ADHD, depression, anxiety disorders, conduct and oppositional-defiant disorders, bipolar disorder, autism and autism spectrum disorders, please click on our Continuing Education and CME programs link. All of our continuing education training programs make extensive use of rating scales to help clinicians conduct a thorough assessment by offering many user-friendly toolkits and free materials on our website.

We take full advantage of the new technologies available through distance learning and online training methods, such as webinars, chat rooms, and listservs.  Given REACH's non-profit status and our growing donor base, free or low-cost CME and continuing education may also be available.  Please inquire if you think you or your agency might qualify.

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CHILD MENTAL HEALTH TREATMENTS

Psychotherapies

Behavioral Therapy

Cognitive Behavior Therapy

Cognitive Therapy

Family Therapy

Individual Therapy

Interpersonal Psychotherapy

Pharmacotherapies

SSRIs

Stimulants

Mood Stabilizers

Antipsychotics

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Under-recognition of Child Mental Health Problems

Despite well-documented levels of child mental health disorders in our nation’s youth, studies have repeatedly shown that most children with mental health problems are not identified and do not receive needed care. These children are not readily identified or referred for treatment due to concerns about stigmatization as well as a pervasive lack of awareness/knowledge among the general public, providers, and parents. Therefore, there is a need for consistent messages based on evidence-based information concerning what are the most pertinent early warning signs of mental illness; how to determine which children are at risk, and what steps to take when children exhibit such early warning signs.

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Under-recognition of Child Mental Health Problems

Despite well-documented levels of child mental health disorders in our nation’s youth, studies have repeatedly shown that most children with mental health problems are not identified and do not receive needed care. These children are not readily identified or referred for treatment due to concerns about stigmatization as well as a pervasive lack of awareness/knowledge among the general public, providers, and parents. Therefore, there is a need for consistent messages based on evidence-based information concerning what are the most pertinent early warning signs of mental illness; how to determine which children are at risk, and what steps to take when children exhibit such early warning signs.

The Need for Warning Signs, aka "Action Signs"

To address these and related problems, the Surgeon General issued a “call to action” in January 2001, urging the development of “early warning signs” or indicators that when present, warrant additional professional assistance.  In response, CMHS and NIMH awarded a contract to REACH Director Peter S. Jensen (while he was at Columbia University) to identify a set of indicators using rigorous research methods, guided and further refined with input from parents, doctors, teachers, and youth. Working with a Steering Committee composed of experts in the fields of epidemiology, public policy, and advocacy, staff identified a number of indicators or “action signs” that if present in a child may warrant professional attention. These warning signs have been formed and sculpted by two methods: analysis of large epidemiological data sets and feedback from various stakeholders in nationwide focus groups. The current list consists of 11 indicators, and have also been translated into Spanish.

Recently, the Center for Mental Health Services of the Department of Health and Human Services, the Centers for Disease Control, the National Alliance for Mental Illness (NAMI), the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, and 14 other national family and professional organizations endorsed the final wording and use of the Action Signs.

A research paper supporting the rationale and scientific validity of the action signs was recently published in the most prestigious journal for children's health, Pediatrics, and released to the press, October 28, 2011.  Copies of this paper, "Overlooked and Underserved: "Action Signs" to Improve Recognition of Child Mental Health Problems," are available from the lead author, REACH President Peter S. Jensen, MD.   Members of the press may contact the REACH Institute to obtain a copy.

• Phase I Document
• Action! Signs Toolkit

OVERPRESCRIBING IN CHILDREN?

Rapid rises over the last 2 decades in the prescribing of stimulant medications, such as Ritalin, Concerta, Adderal, Vyvanse, Focalin, and Metadate, have drawn national attention to the issue of the frequency with which psychotropic (psychoactive) medications are being prescribed to children and adolescents.  After these issues were first raised about stimulants, medications have generated similar concerns, first the SSRIs (selective serotonin reuptake inhibitors), such as Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), and Lexapro (escitalopram).  Most recently, issues have been raised about atypical antipsychotics, such as Risperdal (risperidone), Abilify (aripiprazole), Zyprexa (olanzepine), Geodon (ziprasidone), Seroquel (quetiapine), and others.

In fact, the exact extent of possible over- or under-prescribing is unknown, because national increases in prescribing would be welcome, if children previous untreated were now getting appropriate treatment.  But if children with problems were getting specific medications for problems warranting some other treatment, then the national concerns and media attention are well justified.

HOW SHOULD WE EVALUATE THE ROLE OF CHILD PSYCHOPHARMACOLOGY -- USING MEDICATIONS TO TREAT CHILD BEHAVIOR AND EMOTIONAL PROBLEMS?

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PSYCHOTHERAPY FOR CHILDREN AND ADOLESCENTS: IS IT EFFECTIVE?

Just like anything product that should be well-tested and but then fit to an individual, the answer always has to be divided into two parts.  So for the general question, have psychotherapies been shown to be effective in children?  Yes, certain forms of psychotherapy have been shown to be effective in children and adolescents, BUT... remember, many products that are sold in an open market society may be defective or ineffective.  There are many psychotherapy "products on the marketplace, and many health care providers are essentially small business owners, and need to pay the rent, just like a clothier or grocer.  Therapists, like all other types of health care providers, must be licensed to practice by their state, but the products that therapists actually deliver behind the doors of their office varies widely in whether it is "evidence-based", that is, shown in multiple independent research studies that "it works" for the disorder and population of interest.

So "Yes, but caveat emptor" (let the buyer beware) is the more complete answer, whether it be a medication or an psychotherapy.

WHAT IS PSYCHOTHERAPY FOR A CHILD OR ADOLESCENT, AND WHAT THE ITS "TECHNIQUES"?

Psychotherapy encapsulates a variety of techniques and methods to help children and adolescents with emotional and behavioral difficulties. The REACH Institute was developed to bridge the gap between science and current child mental health practices, and to offer psychotherapy training courses for clinicians that believe in the prompt application of research findings.

In the past decade, evidence based psychotherapies for children have come to the forefront of clinicians’ minds. The over 500 named therapies that have been used for children and adolescents have prompted questions and curiosity about psychotherapy, but have also left practicing clinicians wondering how they can become trained in evidence based psychotherapies for children. By far, most psychotherapies offered in the market place have not been proven to be effective, or even safe.

Evidence based psychotherapies require an active therapist who, instead of applying older psychodynamic treatment models that focused on a patient’s past, spends considerable time assisting the child and family to develop skills to deal with the present. Evidence is derived from rigorous tests of psychotherapy performance against some type of comparison method, and such therapies can the applied to a specific child or adolescent with greater confidence that they are likely to be effective – hence the name evidence-based psychotherapy – it is based on evidence, not from a single study, but by multiple studies done by independent investigators - not the original developer.

At the REACH Institute, we believe that this scientific approach can reveal truths about what works for children with behavioral and emotional problems, so as science progresses, these new findings must be brought to bear on clinical practices.  The REACH Institute offers psychotherapy training courses and programs in evidence-based psychotherapies to child mental health therapists, to deliver those types of treatments.

Our CATIE program, the Child and Adolescent Training in Evidence-Based Psychotherapies, includes a variety of training sessions that cover specific emotional disorders including ADHD, depression, anxiety, aggression and tantrums, bipolar disorder, and PTSD. These training programs, many of them based on cognitive behavioral therapy or behavior therapy techniques, equip clinicians with specific treatment skills that have been proven to work for children and adolescents, and in some instances, even to benefit their families as well.

The REACH Institute also offers courses on Evidence-Based Approaches for Systems Serving Youth (EASSY). This program is tailored to the needs of a specific organization, whether a school system, mental health program, or juvenile justice setting, and offers comprehensive training in integrated methods, ranging from mental health assessment and diagnosis, child mental health treatment, and parent empowerment.

For more information, we encourage you to browse our website or contact us at info@thereachinstitute.org.

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WHY ARE THERE SO MANY TYPES OR KINDS OF PSYCHOTHERAPY

REACH offers training for child psychotherapists clinicians across a wide variety of evidence-based psychotherapeutic areas. In partnership with leading child psychotherapy experts, therapy developers, and researchers, The REACH Institute created the CATIE program, - Child and Adolescent Training in Evidence-Based Psychotherapies. Within the CATIE program, there are a variety of child psychotherapy training courses that address the range of behavioral and emotional disorders in children, including ADHD (sometimes called ADD) and other disruptive disorders, autism spectrum disorders (autism, PDD, and Aspergers), depression, anxiety, impulsivity, aggression and temper tantrums, and bipolar disorder.  Some of our programs focus fairly narrowly on specific conditions such as trauma, i.e., post-traumatic stress disorder (PTSD) using specific forms of CBT, such as Trauma-focussed CBT (TF-CBT).

CONTINUING EDUCATION TRAINING COURSES IN PROVEN PSYCHOTHERAPIES

Regardless of the form of psychotherapy taught, the REACH Institute’s training courses equip clinicians with the latest scientific information and evidence-based treatment techniques that have been shown to be effective with children and adolescents, i.e., "treatments that work." Many of the REACH Institute therapies utilize cognitive behavioral therapy (CBT) and behavior therapy (also often called “parent management training”, "parent skills training", or just “parent training”) principles and procedures.  Just like aspirin has a number of brand names (Bayer, Bufferin) but still has the same effective ingredients, all of the latest “evidence-based therapies” share a small set of common therapeutic techniques, even though some of them are given specific names, like “Trauma Focused CBT” mentioned above. So in addition to CBT, there exists a range of closely related, scientifically proven forms of psychotherapy for children - behavior therapy (BT, sometimes called "parent management training" or "parent skills training"), cognitive therapy (CT), collaborative problem solving (CPS), and interpersonal therapy (IPT) for adolescents.

For example, CPS, one of the types of therapy offered by the REACH Institute, differs from many commonly used approaches.  CPS was developed especially for children with severe temper tantrums and explosive behavior...the “explosive child.”  Collaborative problem solving (CPS) therapy can be very useful for those children that seem to get worse with discipline…almost as is these child need to be in control, and to win their battles with teachers and parents.  Parents can be confused and overwhelmed by this behavior, because to them, it appears that the child “wants” to misbehave, and to cut off the nose to spite his/her face (or the parents’ face). Collaborative problem solving therapy was developed principally by Ross Greene, Ph.D. as well as other colleagues.

CPS requires therapists to help parents understand why a child is having tantrums and explosive behavior, and then to help them develop a work-around solution that helps the child solve “his problem.” Please note, the child’s problem is not the tantrums…the tantrums are the parent’s problem.  For the child, tantrums are just the outward symptom of his or her underlying problem, which needs to be understood.  REACH offers CPS to interested and experienced therapists, and this training course is delivered by Ross Greene, PhD, CPS developer.

The REACH Institute’s CBT training course (cognitive behavioral therapy) for depression, anxiety, its Trauma Focussed CBT course for trauma, its Collaborative Problem Solving (CPS) training, and behavior therapy training programs (for ADHD, conduct, oppositional, and tantrums/explosion problems) are based on interventions ranging from 8 to 12 sessions.  All of these child psychotherapy training programs take advantage of psychotherapy treatment manuals and parent- and patient-friendly handouts, provided to each therapist as a part of the training program.

ARE PSYCHOTHERAPY MANUALS HELPFUL?

Do not worry about the treatments being guided by manuals: these psychotherapy methods include strategies for developing strong therapeutic partnerships with families, and the interventions are very flexible so you can easily adapt them to your patients or clients, as well as your busy clinical operations. In addition to building strong working alliances with patients and families, these methods also strengthen parent and child coping skills, problem solving strategies, family communication, learning to approach problems from a new perspective (i.e, cognitive restructuring), and other key skills.

ONLINE AND DISTANCE LEARNING METHOD FOR TRAINING IN CHILD PSYCHOTHERAPIES

Also, busy clinicians need not worry about taking too much time away from their clients or patients, or loosing income from their practice.  All psychotherapy training courses offered by REACH rely heavily on state-of-the-art distance and online learning methods, and learners work together in small groups in a fun and friendly, non-competitive manner, facilitated by psychotherapy treatment experts and therapy developers.  Because REACH is a non-profit, every effort is made to raise donations and gifts from benefactors who want to ensure that "more children get better, faster."  With these gifts, free online education or reduced cost training coures are available whenever possible, based on need and the population being served.

COMBINED TREATMENTS WITH PSYCHOTHERAPY AND PHARMACOTHERAPY

In addition to psychotherapy, The REACH Institute offers training courses in primary pediatric pharmacology, "parent empowerment" (also called the "Parents as Agents of Change" program), and evidenced-based treatments for healthcare systems serving youth (EASSY).  The EASSY program brings many of the current assessment and treatment training programs together into a single, integrated approach that allows clinicians within a given healthcare organization to transform their entire child mental health care system. In EASSY, therapists are taught to deliver CBT, CPS, IPT, or behavior therapy, or some combination, prescribers are taught how to provide safe and effect pharmacology treatment (e.g., use of stimulant medications, SSRIs, anti-anxiety agents, mood stabilizers, "atypicals", etc.), both groups are taught how to use state-of-the art assessment and diagnostic methods, how to join their therapeutic efforts into more effective combined treatments, how to organize clinic information flow, optimize efficiency, manage costs, and increase appropriate billing, and how more effectively engage and partner with parents, such as through REACH's "Parents as Agents of Change" program.

SCHOOL-BASED PSYCHOTHERAPY TRAINING PROGRAMS

REACH also has evidence based training courses for therapists and counselors (as well as teachers) in schools, teaching the lastest proven skills that work within classrooms or on the school playground. Some of these REACH training courses target bullying on the playground, such as the anti-bullying program (Dan Olweus), disruptive or off-task behavior in the classroom (optimal and easily used classroom management programs such as the "Good Behavior Game"), as well as the more typical, individual-child-focused CBT methods for use by school psychologists, therapists, counselors, social workers, and special education professionals.

The REACH Institute is constantly updating its offerings according to the needs of today’s youth. For example, in addition to its current psychotherapy training courses, REACH Institute is rolling out several new training programs for school psychologists, counselors, and social workers, trying to help children with autism spectrum disorders (autism, PDD, and Aspergers). Another new training now coming online focuses on teaching pediatricians, social workers, nurse practitioners, teachers, and school counselors in state of the art parent engagement methods for use in health care and schools settings -- how to engage, partner, and work with challenged (and challenging) parents and youth.  Yet another program soon to be released focuses on reducing polypharmacy and over-prescribing - i.e., over-relying on medications to control child behavior instead of more mobilizing more appropriate psychotherapy and parent support resources.

To learn more, please continue browsing our website, where you will find a wealth of information about The REACH Institute and our offerings. Also review the free resources available online at the bottom of our webpage under "Resources".  In addition, on the home page, top right, we encourage you to join our mailing list to receive the latest information, delivered straight to your email inbox.  If you are interested in bringing a psychotherapy, pharmacology (safe and effective medication prescribing), or other type training course to your community, please go to the "Contact Us" link at the very bottom of the webpage.  Special arrangements can often be made to take full advantage of your needs for distance learning and education and use of online methods, and in selected instances, reduced cost or free continuing education training courses. Please note, because REACH focuses on the true quality transformation of how mental health problems are diagnosed and treated for children.  As a consequence, we largely avoid doing "hit and run", one-shot workshops or simple lectures, since these over-used approaches have been shown to be ineffective in yielding any meaningful or significant changes in clinicians' assessment, diagnostic, and treatment practices.  Transformation and change is the objective.

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DIAGNOSIS AND TREATMENT OF ADHD

Even while still young, many children and adolescents can exhibit mental, emotional, and behavioral problems that, when left untreated, carry over into adult life. Current estimates suggest that at least 10 million, and perhaps as many as 14 million children in the US have significant behavioral and emotional disorders, including ADHD, depression, anxiety, PTSD, autism, severe aggression, OCD, and other significant problems.

Attention Deficit Hyperactivity Disorder, or ADHD, is the most common of these conditions.  Many people are unclear as to whether ADHD can be treated or not, and even whether it is simply childhood misbehavior. However, ADHD is the best studied and understood disorder in all of pediatric medicine, is one of the most treatable of all conditions in pediatric health.  Many treatments have been tested, and include stimulant medications, psychotherapies such as behavior therapy, and more recently, even new computerized training programs that help train the brain’s attention systems.

ADHD is often misunderstood, and many people think that it is a caused by too much sugar in the diet, poor parenting, or simply crowded classrooms. Of course, school environments can change children's responses, so these factors must always be considered. However none of these factors “cause” ADHD.  Yes, school environments can make the child’s problems with sustaining attention more difficult to deal with. Similarly, parents are not of the causes of ADHD. Yes, problematic home environments can affect children's ability to sustain their attention, but do not lead to ADHD per se.

How about diet?  Do food additives or sugar cause ADHD?  No.  However, that does not mean that such factors are unimportant.  In fact, there is some evidence that such factors care linked to small increases in motor behavior in grade school children, but these changes do not appear to cause ADHD --- though conceivably it might slighten worsen the hyperactive behaviors in a child with ADHD.

ADHD is sometimes called attention deficit disorder or ADD. ADD is actually an older term and was used to refer to those children who have just a little, some, or none of the hyperactivity and impulsivity problems, but severe problems with inattention and distractibility with boring or tedious activities. So it does not really matter whether or whether one uses the term ADHD or ADD, and most scientists now just use the global term, ADHD, which applies to children with varying degrees of the 3 key symptoms - inattention, impulsivity, and hyperactivity. At this point in our knowledge, the distinction between ADD and ADHD is not terribly important, and we use the same methods to diagnose and treat these children.

ASSESSMENT AND DIAGNOSIS OF ADHD: BEST PRACTICES

Assessment and Diagnosis. How should ADHD be diagnosed?  In fact, there is no reliable blood or brain test that will prove that a child has ADHD, even though some doctors are claiming that they can do brain scans to make the diagnosis.  This is incorrect, and no scientists have been able to do this yet.  So if a non-doctor claims he/she can do this, let the buyer beware.   But this is true in other areas of medicine as well.  The diagnosis of migraine can only be done by an expert who carefully assesses the specific type of symptoms, takes a history about any other symptoms, and then does to careful physical examination to "rule out" other possible causes, such as brain tumors, tension, low blood sugar, etc.

This does not mean that the diagnosis of ADHD can be haphazard.  The healthcare provider should obtain information about the child's positive and problems behaviors in all of the settings he/she interacts - at home (including differences in the child's interactions with mothers, fathers, and siblings), at play with peers, and at school.  In addition to the doctor's careful interview of knowledgeable adults, ADHD experts performing state-of-the-art assessments nowadays use carefully-researched "rating scales" or behavior checklists, completed by adults who know the child well (e.g., parents, day care providers, other relatives, teachers).  But because rating scales, just like laboratory tests, can sometimes give a "false positive" or a "false negative," the careful history (based on the doctor's interview) and a physical examination are always essential.  Brain scans are not, unless one has reason to suspect a brain tumor or other structural abnormality in the brain (e.g., the child with new-onset headaches, abnormal physical exam, or specific neurologic symptoms).

ADHD TREATMENTS: BEST PRACTICES

Treating ADHD. So what can be done for children with ADHD or ADD?  What are the best treatments, and do doctors know how to deliver these best treatments for children with ADHD and ADD?  Unfortunately, the training of pediatricians, family practitioners, and therapists is seriously behind the times, and optimal treatments for ADD and ADHD rarely are provided across the US.  If parents are unaware of what the "state-of-the-art" treatments for ADHD are, their child is likely to "so-so" or even mediocre treatment. Currently, the REACH Institute is the only national non-profit organization committed to seeing that doctors in every community are up-to-date and trained in providing optimal medication treatments and effective psychotherapies.

Unfortunately, doctors are just as human as everyone else, and it is very difficult to learn a new set of complex skills, such as diagnosing and treating ADHD and ADD, from a simple PowerPoint presentation or a boring lecture, just like one cannot learn to swim by reading about it.  Doctors’ training must entail hands-on coaching, opportunities to practice, applying adult learning principles, and a thorough understanding of basic behavior science and behavior change principles. To learn more about basic science methods for training doctors and transforming their practices, visit the REACH Institute.

TRAINING COURSES IN ADHD DIAGNOSIS AND TREATMENT

Getting Up to Date with ADHD State-of-the-Art.  Many pediatricians, family doctors, and child mental health specialists such as child psychologists and child psychiatrists, have dedicated their lives to treating and/or studying ADHD and ADD, as well as other behavioral problems and emotional disorders in children. However, many of them are also frustrated with the gap that exists between the science of ADHD and ADD, and current practices.  Unfortunately, even now across the US, most doctors get very little or no training in diagnosing and treating ADD/ADHD during their residencies.  And for practicing doctors therapists, the science is so new they have not had a chance to learn it, since they are so busy just being doctors!  What doctor has time for training?  Also, in most communities, how does a doctor go about finding where to get training in the latest evidence-based psychotherapy and medication treatments?  It is not like shopping for a car, where you can drive to the “auto row” in your community, and check out all of the latest psychotherapy models or medication models, and take them out for a test drive.

TRAINING IN SAFE AND APPROPRIATE USE OF ADHD MEDICATIONS

What happens, what a doctor who wants to get state-of-art training in how to use ADHD and ADD medications, such as the stimulants?  What happens, if they want to get trained in how to talk to families, children, and youth, and how to talk with a prepare families for what they will have to learn and do?  In fact, all doctors can usually do is attend one of their state-wide or national conferences, where at best, they will get a 2-3 hour set of lectures in new ADD and ADHD diagnosis and treatment methods.  This is wholly inadequate, if we think about trying to learn to swim or ride a bike after a few lectures!  ADHD diagnostic and treatment procedures are complex skills, and require coaching and support while one learns and practices the new techniques.

In fact, that is the purpose of the REACH Institute.  The “REACH” of the REACH Institute is exactly that – to create a bridge into communities, across the gap of current practices and evidence based medicine to offer evidence-based psychotherapy training and evidence-based prescribing training to doctors, pediatricians, child psychotherapy providers, family doctors, child psychiatrists, and even neurologists whom sometimes treat these children.  All need to know about how trainings for doctors and therapists can be brought to their community, not just safe medication prescribing, but also training of therapists cognitive behavioral therapy, behavior therapy, parent management training, collaborative problem solving (CPS) therapy, and other state of art methods that can be "life-saving" for children with ADD and ADHD and their families.  Training programs for physicians and therapists interested in learning about these methods are essential for each community.

In case you did not know this, the name of the REACH Institute is name is actually an acronym.  “REACH” stands for “REsource for Advancing Children’s Health.”  So what are the resources of “The REACH Institute”?  REACH "reaches" out to communities, and offers training in state-of-art ADHD methods for doctors and psychotherapists, as well as in a variety of other areas.

TRAINING COURSES IN ADHD PSYCHOTHERAPIES

In the area of ADHD, one of the best studied types of psychotherapy is what is called “behavior therapy,” “parent training,” or “parent management training.” The fact that this form of therapy is called “parent management training” does not mean that parents are at fault or are unskilled.  Instead, during this type of therapy, taught by the therapist or doctor to the parent for them to apply, parents learn new skills that are not needed for children without ADHD.  In effect, parents obtain an advanced degree is specialized parenting techniques for use with their ADHD or ADD children.  Parents don’t usually need such techniques with their children, but with children with ADD or ADHD, they most definitely do need and benefit from them, over and above what medications can do!

To learn more about the REACH Institute’s psychotherapy and medication treatment training programs for doctors and therapists managing ADHD and ADD, as well as for other conditions, please visit our Child & Adolescent Training in Evidence-based Interventions (CATIE) and our Primary Pediatric Pharmacology (PPP) program pages.

• Child Welfare Mental Health Best Practices.
• Mental Health Practices in Child Welfare Guidelines Toolkit
• Parent Empowerment Programs for Agencies
• Juvenile Justice Agencies

REACH receives support for its work from individual donors, federal grants and contracts, state/county grants and contracts, and private foundations.

The 100% Founding Donors

As Founding Donors, each of the following individuals have donated 1% of their income in a single year. Please let us know if you are willing to join this group, eventually including a total of 100 donors who have given 100% to REACH  (100 persons x 1% of annual income each):

Lawrence Amsel, M.D.; L. Eugene Arnold, M.D.; William R. Beardslee, M.D. and Barbara O'Brien Beardslee; Daniel Callister, Esq.; M. Lynn Crismon, Pharm.D.; John Curry, Ph.D.; Kimberly E. Hoagwood, Ph.D.; Lisa Hunter Romanelli, Ph.D.; Donald G. Jacob, Ed.D.; Cornelia M. Jensen; David C. and Penelope Jensen; Jon and Michelle Jensen; Peter S. Jensen, M.D., Rebekah Jensen; Andrew Klingenstein; Thomas Klingenstein; John E. Lochman, Ph.D.; Robert Marshall, Esq.; Sally Klingenstein Martell; David A. Mosman, M.D., Thomas H. Ollendick, Ph.D.; Jeffrey C. Schmidt, M.D.; Victoria Sharp Wheatley Schmidt; Stephen Setterberg, M.D.; Nancy Simpkins; Martin T. Stein, M.D.; Seth Thomas; Henry K. Watanabe, M.D.; Karen C. Wells, Ph.D.; Amsel Family Foundation; Center for the Advancement of Children's Mental Health, Inc.; Heymann Wolf Foundation.  If you share  REACH's vision for a brighter future for our children, please contact us.  Additional Founding Donors are urgently needed to REACH all children with mental health needs.

Additional REACH Donors

Joel Baumwoll; Cathryn Galanter, M.D.; Stephen P. Hinshaw, Ph.D. and Kelly Campbell Hinshaw; Danielle Laraque, M.D.; Christopher M. Layne, Ph.D.; Peter Pecora, Ph.D.; Gregory A. Prince, M.D. and JaLynn Prince; Clarke Ross, D.P.A.

Federal Grants and Contracts

National Institutes of Health: 5RC1MH88922 Enhancing Pediatric Psycho Pharmacology in the Medical Home, 2009-2011

State/County Grants and Contracts

New Jersey Counties of Bergen, Hunterdon, Morris, and Warren: CATIE Training

New York State Office of Mental Health: PPP Training

New York State Department of Health: PPP Training

Nebraska Department of Health; PPP Training

North Carolina Medicaid Network, PPP Training

Health Care Organizations

Geisinger Health Systems

Private Foundations

REACH has previously received funding from the Annie E. Casey Foundation, Casey Family Programs, and the Thomas Klingenstein Foundation

CHILD MENTAL HEALTH RESOURCES FOR FAMILIES

• What Parents Know and Need to Share with Others - Parents, Doctors, and Teachers
• Advocating for Your Child: 25 Tips for Parents
• Profiles of Behavioral and Emotional Disorders
• Family Education and Support

• What Parents Know and Need to Share with Others - Parents, Doctors, and Teachers
• Advocating for Your Child: 25 Tips for Parents
• Profiles of Behavioral and Emotional Disorders
• Family Education and Support