Peter Clark, Ph.D. a Child, Adolescent and Family Psychologist in Covington, Louisiana

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1. Where exactly is the office located?

My office is located in downtown Covington at 203 West 21st Avenue (corner of West 21st and Madison.)

2. Do you accept health insurance?

The general answer to this question is "Yes" ... but the issue can be complicated.

For services that are clearly designed to 'treat' a condition that insurance companies consider to be an 'illness' or a psychiatric disorder, then traditional health insurance often provides at least partial coverage. Different insurance companies have different guidelines and it is important to clarify these at the outset.

At our first meeting I will take from you all of the pertinent insurance information and check on your coverage for you. Alternatively you can do this for yourself before the first meeting. If you wish, I can file your insurance claims on your behalf and have your insurance reimburse me directly. Under this circumstance you will be responsible for paying the deductible (if applicable) and/or co-payments at the time of the meetings. It is important to be clear that the contractual relationship with the insurance company is yours. If your insurance company does not pay, then responsibility for payment rests with you.

This arrangement is considerably more complex if your health insurance uses the services of a managed care company (MCC). A MCC is essentially a layer of administration between the health insurance and the provider, ostensibly to ensure that the services provided are appropriate and efficient, (i.e. they purport to provide some quality control). In reality, however, they serve as a means of 'cost control' in order to save the insurance company costs. One way that MCCs do this is by having specific contracts with the providers that limit the fees that can be charged by the provider. Another is by introducing layers of bureaucracy that, if not accurately complied with, result in the denial of payment. Under these circumstances the client is only responsible for the co-payment and the provider is responsible for absorbing the cost of claims that are denied as a result of any non-compliance with MCC procedures.

In my opinion, managed care does not serve the best interests of the patient. Very often clinical decisions are made by individuals of uncertain qualifications and at a geographical distance. They rely on unvalidated and superficial assessment forms that are filled out by the treating clinician. They dispense treatment sessions sparingly. Many skilled clinicians are not prepared to accept the severely reduced reimbursement rates offered by MCCs, nor accept the considerable paperwork that is required. Consequently they choose to work outside the managed care system, leaving the less qualified and less experienced clinicians to provide managed care services.

When managed care first appeared, there was a belief that the MCCs would control all of the referrals to clinicians and that it was essential to be a member of their provider panels. This has turned out to be untrue, and as a consequence I prefer to work outside of managed care as much as possible. I choose to work with a few MCCs that I believe are acting responsibly. Many other MCCs have requested that I join their provider panels, but I have declined. It is important that we clarify these aspects of your health insurance unambiguously before we embark on any clinical services. If it turns out that your insurance company is not one with which I work, and if we are unable to come to some other mutually agreeable arrangement, then I will do everything I can to see you situated with a clinician that can meet your needs.

Another thing to consider is that not all of the services I provide are necessarily covered by health insurance. Getting authorization for psychological testing is sometimes problematic but usually possible. Forensic work, such as child custody evaluations is not covered under health insurance and I never make any attempt to get reimbursement from an insurance company for this kind of service.

I do not accept Medicaid, but again, I will be happy to meet with you and help you find services that fit your needs.

3. Do you prescribe medicine?

No.

A psychologist is not qualified to prescribe medicine (although this might change in the near future). However, I work closely with many local physicians (psychiatrists, pediatricians, family practitioners, neurologists etc.) who do. If I am of the opinion that your child will benefit from an evaluation by one of these prescribing physicians, with the possible result that medicine will be prescribed, then I will refer you in that direction.

4. How do I know if I need to make an appointment for my child?

If you are asking yourself this question, then you probably need to go ahead and give me a call!

Signs of a child needing psychological intervention include changes in behavior (such as eating or sleeping habits), increasing surliness or withdrawal, increasing irritability or aggression, conflict with authority or peers, changes in school performance, loss of interest in previously pleasurable activities. Any of these can be signals that something is going on that needs to be addressed.

In addition, adjustment difficulties associated with significant life events (such as illness in a family member or parents divorcing) can be alleviated by addressing the issues before the matter becomes problematic.

If you have any concern, give me a call.

5. Do you just work with the child? Are the parents involved?

The initial assessment is almost always conducted with at least one parent and the child (or children). Exceptions to this might be if sensitive issues that the child should not know need to be discussed (but this is less frequent than you might think) or if the client is a teenager who might be able to present the primary issues without the parents being present.

This initial assessment is used to get a description of the presenting problem (usually from a parent!), to get a detailed developmental history (biology, family and education), and to formulate some initial treatment goals. Addressing these treatment goals might subsequently involve one-on-one meetings with the child, meetings with the parent(s) to discuss parenting and behavior management issues, or meetings with the entire family to address communication and family system issues. Or a combination of all of the above!

My philosophy here is that children do not exist in a vacuum. Nor do the problems they are experiencing reside entirely within themselves. Effective treatment is a mixture of helping the individual behave more adaptively and helping the 'system' adjust to make the individual's behavior more amenable to change.

6. Do you test for Attention Deficit Disorder?

This is a very complex issue and one which has generally been oversimplified by many clinicians.

I have written elsewhere about the profound implications surrounding the the process of diagnosis in general, and the diagnosis of Attention Deficit Disorder (ADD) in particular. In summary, however, there is little justification for the notion that ADD is something you either have or don't have, little justification for believing that attention difficulties can necessarily be related to a single cause, and little justification for believing that medicine alone can solve the problem.

That is not to say that ADD does not exist, nor that medicine cannot be hugely helpful. However, it is the case that there is no such thing as a single 'diagnostic test' for ADD that can accurately distinguish children with attention problems from those that do not, and that can accurately rule out other explanations for the difficulties that the child presents.

So, if the request is from a parent to evaluate for the possibility of ADD, I recommend an evaluation that can paint a broad picture of a child's strengths and weaknesses, rather than one designed to narrow down on a particular diagnosis. In this way it is possible to see the extent to which a child meets the diagnostic criteria for an attention disorder and explore competing or co-morbid conditions that should not be overlooked. Any competent evaluation for ADD should include one-on-one testing with the child, detailed descriptions of the child's behavior obtained from parents and from teachers, and observations of the child in, say, the classroom.

7. What is a Child Custody Evaluation?

When parents get divorced and are unable to agree as to the best custody and visitation arrangements for their children, the Court will often request an evaluation of all parties to be carried out by an expert in these matters. The expert then makes some recommendations to the Court to assist the court in making the determination that the parents are unable to make.

As a Child Psychologist I am often called upon by the Court to carry out such an evaluation and to make recommendations regarding custody and visitation.

It is usual for the Court to make available a list of three or four such evaluators and the contesting parties (the parents and their attorneys) are advised by the Judge to select one that they can all agree upon. The choice is an important one because enormously important decisions are based upon the recommendations of the expert. Make sure your attorney is familiar with the work of the expert and has confidence in that expert's ability to be objective and impartial. Always check and compare the credentials of the experts on the list.

When I carry out custody evaluations I make it clear to all parties that I am the client of the Court and that it is my explicit goal to serve what I consider to be the best interests of the children. Evaluation consists of clinical interviews with both parents (separately) and with the children, and any psychological testing that is indicated. Interviews might also be carried out with other relevant parties (such as teachers and step-parents). Home visits are also carried out if indicated. Fees are based upon the length of time the evaluation takes (in terms of numbers of hours of face-to-face interviews) and the final cost (usually shared equally by both parents) depends upon the complexity of the case and the number of children that need to be included in the evaluation.

8. Are Your Assessments Accepted by the School System?

The local public school system has a Pupil Appraisal Team that carries out competent and expert psycho-educational assessments on children that need them. These are performed according to a detailed set of procedures that are specified in a document call the Pupil Appraisal Handbook - Bulletin 1508 (usually referred to as Bulletin 1508). This handbook contains guidelines for assessment as well as criteria for defining a child's academic status as "exceptional". Examples of "exceptionalities" are 'learning disabled', 'gifted', 'language disordered', etc.

The school board also accepts assessments done by non employees of the Pupil Appraisal team as long as these assessments meet exactly the guidelines set down in Bulletin 1508 and as long as the people carrying out the assessments are appropriately qualified.

Assessments carried out in my practice can be done to meet the Bulletin 1508 guidelines. These are acceptable to the local school board and are incorporated into the Individual Educational Plans that are drawn up for students who are in need of special education resources.

Bulletin 1508 requires a 'team' approach to carrying out the evaluation and in this regard I work together with Yvette Endom MA, Certified School Psychologist. We carry out the testing jointly and prepare a coordinated report.

We do not carry out speech and language evaluations, but refer these components of an assessment to local skilled language therapists.

Assessments for placement in the Gifted Program are carried out in my office. Assessments for specific learning disabilities (e.g. reading and/or math) are carried out in my office and also require observation and intervention in the classroom by myself or another member of my evaluation team.

It is important to be aware that evaluations performed by the school's Pupil Appraisal Team are done at no cost to the student's family. This is obviously not true if it is done through my office. However, assessments carried out 'privately' can be done at much shorter notice than is often the case with the Pupil Appraisal Team. In addition, while assessments carried out by my team meet the necessary conditions for acceptability by the school board, they can - and often do - go beyond those criteria. It is clearly important to accurately determine whether a child meets the Bulletin 1508 criteria for designation as 'exceptional', but it is also important to go beyond this classification and gather as much information as might be useful in the educational planning process.