Virtual Slime

A lot of child therapists make slime with their clients in session, or they did back when we saw people in person. Personally, it was not an intervention I used often for a couple of reasons. One, to accommodate my caseload, I would book after school appointments back-to-back, and the cleanup would put me behind schedule; and two, I just hate the feeling of slime on my hands. If, as the therapist, I can’t commit to an intervention and be fully present, I find it is better to choose a different activity instead.

Photo by cottonbro on Pexels.com

But there is no clean up in telehealth! And although the sensory experience of virtual slime is vastly different, there is still the visual element, which still works for a lot of kids. This is absolutely an intervention that will not work online with all kids because it’s so different than a hands-on experience, but it can work for some.

A lot of my clients like watching slime videos on YouTube, and watching a short slime video can stimulate conversation of what the client would do differently if they were making the slime themselves or what they think the slime would feel like in their hands.

If your client wants to create their own virtual slime, though, a YouTube video is just not interactive enough. This online Slime Maker and My Slime Mixer do let them “make” slime themselves, and you can either share your screen and grant screen control or send the link and let your client share their screen with you to use it. One limitation of these online slime games is that the client has very little say in the activity – you follow specific steps to make the type of slime allowed by the game.

My favorite virtual slime app is Super Slime Simulator, which is available for free in the Apple and Google Play stores. It has adds, but you are able to choose what type of slime you are making, or you can choose to try and match a slime auto-generated by the game. There is not a version that I can find for use on a computer (but please tell me if you find one!), so this is only an option if the client has a device that allows them to download the app. They can then share their screen with you, and you can make the slime together.

Super Slime Simulator is the most sensory of the virtual slimes I have been able to find since you “mix” the slime yourself with the touch screen, but again, it isn’t a perfect representation of real slime.

A lot of parents either don’t have the tools to make slime at home, or they aren’t able to deal with the mess. (This is understandable – slime can stain carpet and clothing!) But virtual slime can be an acceptable compromise in a pinch.

Communicating With Your Teenager

A version of this article was published in Hood Magazine in February 2019.

Photo by Budgeron Bach on Pexels.com

Many parents struggle with their child’s transition into adolescence. Teenagers often pull away from their parents in an effort to assert their independence and begin forming their own identity separate from the family. This can manifest as argumentativeness, rebellious behavior, and an “attitude problem.” Sometimes, it can feel like every conversation with your teen is a fight.

How can you navigate this difficult time and have a positive relationship with your teenager?

  1. Mean what you say, and be consistent. Many parents want their teens to come to them with their problems but do not know how to handle when an issue arises. If you promote an open door policy in your home, but you become upset, shame them, or administer punishments, your teenager will not feel comfortable reaching out to you when they need something.
  2. Find other trusted adults who they can turn to. It can be challenging to set appropriate boundaries with your teenager but still foster an environment where they can ask for help when they make a mistake. For example, if you want to teach your teenager not to drink underage, they might find themselves in a situation where they need a ride but do not want to disappoint you. If they have other adults they can trust, they do not have to choose between letting you down and keeping themselves safe.
  3. Manage your own expectations. All adults were teenagers once, but it is sometimes difficult to remember the emotional and hormonal turmoil of adolescents when we look back as adults. In many ways, teenagers are still children: their life experience is limited, and the part of their brain that regulates impulses is still growing. (In fact, new research has shown that brain development continues through most of our 20’s!)  Try to remember what is developmentally appropriate for your teenager and what they are capable of at this point in their life.
  4. Take an interest in what your teen cares about. Sometimes, the current fads seem unimportant or silly to adults. If your teenager gets the impression that you do not care about their interests, they will feel distant from you, and they might assume that not caring about their hobbies means that you do not care about them. Learning about their favorite video game or book series can go a long way in helping your teenager feel connected to you.
  5. Know when to ask for help. If your teenager is having trouble keeping friends, self-harming, or showing symptoms of anxiety or depression, consider enrolling them in therapy. Their therapist is someone that they can talk to and feel safe sharing their emotions and problems.

Adolescence is a challenging time for everyone in the family, but patience and understanding can go a long way in keeping communication open and improving your relationship with your teenager.

A Year of Resiliency

Thank you to everyone who purchased A Year of Resiliency and supported me while I have been working on this project! I am excited to share the different ways I am distributing this work.

Standard Binding

A Year of Resiliency is available in paperback with standard binding on Amazon.com for $14.99. It is printed on demand and available worldwide. Customers in the United States have told me that they received their orders within a few days, but sometimes print on demand can take up to a week.

eBook

For those who prefer typing to handwriting (or who don’t want to wait for shipping), an eBook version of A Year of Resiliency is available on my TPT store for $9.99.

Special Edition Spiral Bound Journal

When I started this project, I imagined the journal with spiral binding. Well, I am pleased to announce that this special edition of A Year of Resiliency is available on Etsy! Each special edition comes with a gel pen to stimulate your creativity (colors vary). I’m also excited to share that Etsy is going to help me offer international shipping!

I am so happy that I live in an age where I can create this kind of resource and offer worldwide distribution. I really, really hope you benefit from this journal.

Why Do Suicide Rates Go Up In March?

Content note: this post talks about suicide in general terms.

There is a common misconception that suicide behaviors spike around the holiday season in December. Although people who experience suicidal ideation might need support at any time during the year, in the northern hemisphere of the world, we actually see this surge happen around March.

Photo by veeterzy on Pexels.com

When I tell people this fact, I am often met with confusion. March is a beautiful month! The weather finally gets nicer, the snow starts melting, and the sun finally stays up past 5:00 pm. Wouldn’t people feel better around this time?

To understand the connection, we need to understand how depression zaps energy. Fatigue is a huge weight that many people with depression carry, and it makes it difficult to work, socialize, or even complete basic self-care tasks. Basically, someone who is experiencing significant depressive symptoms can’t do very much.

Someone who is experiencing suicidal thoughts but is also exhausted might not have the energy to act on those thoughts. Passive suicidal ideation can be like thinking about taking a trip: I might not have the resources to actually plan and take the trip, but I wouldn’t be upset if I woke up tomorrow and was somewhere else. But if I am not getting support for those thoughts, and I suddenly find myself with more energy, it could be tempting to act on them.

When the sun stays up longer and the days get nicer, people who have been experiencing depression during the winter (due to a seasonal pattern or for another reason), someone who was passively suicidal might suddenly find themselves with the energy or motivation to act on those thoughts.

This is something for mental health professionals to be aware of so that we can monitor for these symptoms, but it’s also important for the general public to be aware of this pattern. We rely on our brains to give us information about the world, so if your brain is telling you that you should die, it can be tempting to believe this. The more you know about the ways your brain might be wrong, the more you can question this if it happens instead of acting on that thought.

If you’re having suicidal thoughts or worried about someone else, please call Lifeline at 1-800-273-TALK (8255). They also offer chat-based services here if you are more comfortable with that form of communication.

Online Puppet Show

Dr. Karen Fried is truly the gift that keeps on giving. In addition to her online sand tray and virtual dollhouse, she has now created a website where you can do Online Puppet Shows!

Virtual Puppet Shows with Dr. Fried

Puppets help kids express emotions that they might not want to share directly. They can project that feeling onto the puppet and feel safer exploring uncomfortable feelings, or they can re-enact traumatic, stressful, or upsetting scenarios.

This website allows a variety of backdrops, diverse cast of puppets to choose from, and actions including “hugging,” “hitting,” and “jumping” to let your puppet show really come to life! Like with her other websites, you simply pull up the page and trade off with your client controlling the screen. Plus, you have none of the hassle of washing and sanitizing like you do with “real” puppets.

Although I have used real puppets in my session, holding them up to the camera and talking through them, this eliminates the issue of whether my client has their own puppets to bring to the appointment. It also makes my puppet interactions feel a lot more “real” because we are both on the same screen.

I highly recommend this as a telehealth intervention!

A Year of Resiliency: Now Available on Amazon!

After some back and forth figuring out a formatting issue, my guided journal is now live and available for purchase through Amazon!

A Year of Resiliency

I still plan to make a special edition of the journal with spiral binding, and once Lulu sends me the prototype, I will figure out distribution for that. In the meantime, the proof copy of the KDP version is actually very easy to write in!

So check it out, tell your friends, and have a fantastic day!

Psychological Evaluation 101: Health Insurance and Psych Assessments

Thank you for checking out my series on psychological assessments! My goal in writing this series was to help people who don’t have years of graduate training understand what an assessment is and what information they might seek from an evaluation. As of right now, this is my final planned post in this series, though I am in the process of finding a guest blogger to speak on neuropsychological assessments. This is a common referral that I do not have the training to do, and I would prefer to have someone with more expertise speak to it.

Do you have more questions about psych assessments? Contact me, and I will do my best to add it to this series!

Photo by Pixabay on Pexels.com
Insurance is meant to shield us from healthcare costs, like an umbrella shields us from rain. Most Americans will tell you this isn’t how it usually shakes out.

If you’re in the United States, you will most likely have to deal with health insurance at some point. Health insurance is confusing and annoying, so I am going to do my best to explain how coverage works for psychological evaluations.

Short answer: it depends.

Long answer: psychological evaluations consist of a number of different billing codes, and depending on your policy, these codes might be covered as a co-pay or toward your deductible. Most providers will call your insurance company to check coverage before doing the evaluation, but it can save a step (and some time) for you to call them yourself. There is a phone number on your insurance card, which will connect you with someone who can check your coverage.

Now, if you call your insurance company and ask, “Does my policy cover a psychological assessment?” they might get confused. Often times, the person taking that call is not trained in what a psych assessment is and can consist of, so I encourage people to call about specific billing codes. The codes that I use most frequently are:

  1. 90791: this is the diagnostic interview or intake, where I get the client’s history and information about their symptoms. Typically this is covered at the same rate as other office visits.
  2. 96136: this is the first 30 minutes of testing in-person, so if your evaluator needs to administer tests to you, this covers that time.
  3. 96137: this is additional in-person testing units, with each unit being 30 minutes. This also covers the time it takes your evaluator to score the tests administered, so if you spend an hour doing in-person testing, it is possible the evaluator will bill three units to include time spent scoring the assessments.
  4. 96130: this is the first hour spent interpreting the results and writing up your report. You will not be present when the evaluator writes your report and interprets your results, but they are still compensated for the time that it takes to put this together.
  5. 96131: this is each additional one-hour unit needed to interpret and write results. Most evaluations take me two to three hours to interpret and write up, though more complicated assessments might take longer.
Photo by Gabby K on Pexels.com

When you call the insurance company, you can ask if these codes are covered and whether they require preauthorization. Preauthorization means that the provider (me) has to call and request permission to do the evaluation before moving forward. The purpose of preauthorization is for the provider to demonstrate that testing is “medically necessary,” which is insurance-speak for “you can’t make us pay for that.” (What does “medically necessary” mean? Will you die if you don’t get an evaluation? Will your quality of life improve if you do? It’s vague on purpose. But the problems with health insurance could be a whole other series.) Occasionally when I call to ask about preauthorization, they specifically want to know if I will be testing for a learning disorder, so it’s good to know the answer to that question before you call.

To request preauthorization, I have to complete the intake first in order to document why testing is appropriate, so typically that intake code does not require preauthorization.

Now, insurance companies also make a statement every time you call to ask about coverage: “Confirmation of coverage is not a guarantee of payment.” This, like the term “medically necessary,” basically means that insurance companies can do whatever they want – even if they tell you, “Yes, those billing codes are covered at 100% with your plan,” after testing is complete they can still refuse to pay.

As a human being with empathy, I hate this, but as a provider, I especially hate that I essentially have to then stick you with a bill for the cost of testing. The alternative is that I not only did the work for free, but the testing materials are quite expensive, so my practice loses quite a bit of money. I didn’t go into this field to become a billionaire, but if my employer can’t pay the electric bill, I can’t keep working. Not to mention, I also have needs like food and rent.

So, in addition to asking your insurance provider if these codes are covered, I suggest asking the provider who will be doing the testing for an estimate of what it could end up costing if insurance refuses to pay. (They might not have an exact number because the number of units is based on how long the evaluation takes, and sometimes things do take more time than expected, but they should be able to give you a rough estimate.) You can ask what kind of payment plan might be available if you are stuck with a large bill. At my practice, we are very flexible with payment plans and never charge interest as long as your account is current, so people with high deductibles can still be seen.

I hope this series has been helpful in giving people information about psychological assessments. Being referred for an evaluation can be intimidating, but this knowledge can make it easier to understand what to expect and de-mystify the process.

Psychological Evaluation 101: What Are Projective Tests?

(If you want me to write about more types of psychological evaluations, please let me know!)

Projective tests are a type of personality assessment that uses ambiguous stimuli to get information about things you might not be consciously aware of. They can involve having you respond to images, create drawings, or say the first response that comes to your mind in response to a prompt.

Photo by Free Creative Stuff on Pexels.com

Some, like the Rorschach, have a scoring system that gives the evaluator norm-referenced information about you, but others involve interpreting patterns in your responses. There are websites that try to coach people to get certain results, but these tests have measures to identify if you are doing this, so it’s best to just be honest.

I like using projective drawing tasks with kids because it can give me insight into a child’s feelings about their family and the world around them that the child might not have the skills to tell me another way. I might have a child do a projective drawing as a therapeutic activity, but typically if I am completing a psychological evaluation, I will not rely only on projective tests.

Because they are ambiguous, projective tests can seem intimidating, but if you give honest answers, you can get some interesting insight into your personality and your mental health.

Coming Soon: A Year of Resiliency

For several months, I’ve been working on creating a guided journal to help people with self-exploration. While no journal is a substitute for mental health services, guided journaling with specific prompts can help you get to know yourself better.

Enter: A Year of Resiliency: Growth Through Adversity. I’ve developed 365 prompts with the intent of spending a year exploring your identity with the goal of becoming a better version of yourself.

Isn’t it pretty?

Unlike with I Don’t Want To Be Bad, I will be publishing this journal in two formats. With everything I create, my main goal is accessibility. I want to reach as many people as possible, which I was able to use through Kindle Direct Publishing last time. I will be publishing A Year of Resiliency with Kindle for their worldwide distribution, and I’m very excited that this journal will be available around the world.

However, Kindle has only one binding option, and I feel like a journal is easier to use when it’s spiral bound. I found that Lulu will print spiral-bound books, but this was not a viable distribution option – with printing fees, distribution fees, and Lulu’s “cut,” I would have to charge $32 per book to break even. So at that price, my royalty would be $0.

If I use Lulu’s printing and do my own distribution, I can sell the spiral-bound copy for $25 each (plus shipping) and include a special edition pen. This does limit me to shipping within the United States, but this gives my readers the option to buy the special spiral bound version.

So, once my proof copies arrive next week, I will do final edits, and A Year of Resiliency will be available for purchase! Thank you to everyone who has supported me on this journey.

Psychological Evaluation 101: Autism

Language note: although everyone has individual preferences, the overall consensus at the time that I am writing this post is that people in the Autism community prefer to be referred to as “Autistic people” rather than “people with Autism,” so that is the language I will use in this post.

Photo by Rakicevic Nenad on Pexels.com

Last week I talked about what an evaluation for ADHD looks like, and today I will talk about Autism. I’ve spoken before about the similarities and overlap between these two diagnoses, so you can check out that webinar if you want more information on this.

Even though we know Autistic children grow into Autistic adults, and even though we know that many Autistic children (especially Autistic girls) go overlooked in childhood, the existing norm-referenced measures for Autism are mostly created for children and teenagers. This does not mean that you can’t get diagnosed as an adult! It just means that the assessment has some limitations. When I get a referral for Autism testing for an adult, I explain this and move forward because that seems better than saying, “Sorry you didn’t get tested as a child! I guess we’ll never know.”

The assessment itself consists of a detailed interview where I get as much information as I can about the client’s background and symptoms, and if they have any previous psychological records, I review that as well. Since personality measures look at symptoms that overlap with Autism, I often use one to get norm-referenced information about symptoms and presentation.

With children and adolescents, parent and teacher observation measures like the Autism Spectrum Rating Scale can be used to diagnose Autism. There is also the Autism Diagnostic Observation Schedule, 2nd Edition, which gives the psychologist observational data about the client’s symptoms. I am not trained in the ADOS-2, but my understanding is that it is a very popular tool for these kinds of assessments.

It can be difficult to determine whether someone should be referred for an evaluation for Autism because, although we have diagnostic criteria, there is a huge range of ways that Autistic people can present. If you’ve seen one Autistic person, you’ve seen one Autistic person. Even though assessment materials have not completely caught up, the good news is you’re never too old to get checked out!