Treatment for selective mutism at the SMart Center www.selectivemutismcenter.org

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'At the SMart Center'

Initial Consultations

School services. In-office and on-site Evaluations, Development of accommodations/interventions (IEP/504 Plan)

Treatment Follow-Ups and Convenience Consultations

Medication Questions

Interested in a workshop or online webinar? --> GO

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'At the SMart Center' at

The treatment used at the SMart Center is: Social Communication Anxiety Therapy (SCAT) that has been used successfully on 1000+ children/teens. SCAT evolved over time while working with children/teens with SM. Dr. E's belief that SM is 'more than just not speaking' has fueled the development of SCAT. We encourage you to read about our philosophy of treatment.

What is the success rate of SCAT?
Based on patient data, for ALL children who go through the complete course of recommended treatment that includes:
(1) Consistent recommended follow-ups.
(2) Parent education
(3) Education of school personnel about SM and individual child's needs
(4) Development of school accommodations and interventions (Note: Academic achievement is dependent upon the correct placement and appropriate accommodations)
(5) Child involvement and willingness to receive help.

Over 95% of patients have overcome their silence, are verbal communicators and are now significantly more comfortable socially. Most no longer require school accommodations to aid in communication!
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What is Social Communication Anxiety Therapy (SCAT) ?

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I have taken my child to many other professionals and not one has used SCAT with my child. Why is this?
Quite simply, Dr. E has developed SCAT from the multitude of data and clinical information gathered from working with so many children with SM. Since clinical experience precedes research, it is common for clinical efficacy to exist prior to documented research. Fortunately, research is presently being done and is confirming SCAT's effectiveness!

Understand that SCAT is not ONE type of therapy technique but involves various types of treatment strategies and interventions that are proven within the scientific literature. For example: Systemic desensitization, modeling, fading, positive reinforcement, etc. etc. that enable the child to development social engagement skills and to progress communicatively in a stepwise manner in the 'real world' and within the school setting. Treatment is individualized and based on the child's particular needs.

SM Conferences, workshops, professional trainings are done throughout the year to help educate parents, treating professionals and educators about SCAT. Dr. E also trains treating professionals regularly via teleconference and in-person direct trainings. Fortunately, SCAT Is becoming more popular and more professionals are realizing the effectiveness!

As more research is published, many more professionals will begin to understand and adapt SCAT as a form of treatment!
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I am interested in references from families who have gone through treatment at the SMart Center. Is this possible?
Absolutely! Please contact us directly at: SMartCenter@selectivemutism.org and place 'references' on the subject line.
Another option is to post on the forum of the SMG~CAN or any of the Yahoo e-groups. Since Dr. E is well known in the field and has treated so many children &teens you are certain to encounter others who have gone through or are going thru treatment at the SMart Center!
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Your office is located in the NE suburbs of Philadelphia, PA. Do you treat children from other locations?
Absolutely! The average distance to our office is over 2 1/2 hours...with many traveling via train or plane to reach our location. We are proud to state that we have treated children and their families from almost every continent in the world!

IN addition, we perform many long distance teleconferences or video conferencing for families unable to present for an in-person consultation and school personnel from out of state.
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We do not live close to the SMart Center. can my child still be seen for an evaluation and treatment?
Absolutely! Over 3/4 of the families travel long distance to the SMart Center!
We can do evaluations either in-person or via teleconference. Please see our initial consultation information.

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IF we live out of state or quite far from the SMart Center, how are follow-up appointments arranged. We can't possibly be traveling to the office every week!
Since most families are seen every two weeks to every month, you could schedule follow-ups in a variety of different ways. Some families present for the initial appointment (for long distance families, we recommend a two-day initial appointment that consists of 2 hours the first day and 1-2 hours the second day). Follow up can begin with a teleconference approximately 3-4 weeks later. We often recommend a 30-60 minute teleconference with school personnel as well. Depending on the treatment approach recommended you can present monthly or every 3 months..or possibily consult via teleconference ongoing (When this is done, we recommend that you have a local clinician who you and your child can work with to follow up and implement strategies)

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What is the average range of the children that receive treatment at the SMart Center?
The age range for children/teens in our practice is 3years old - 19 years of age. In rare and unusual situations, we have worked with young adults.
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How long do most children receive treatment at the SMart Center?
This question is impossible to answer. However, based on patients who have been seen at the SMart Center over the past many years, the average time frame for treatment is approximately 6-12 visits or every two- four weeks for 7-12 months. For less impaired children treatment has been as short as 4-6 visits. For more impaired children, especially older children, some have needed every two -four week treatment for up to or more than a year.

Approximately 1 in 10 children require more than a year of treatment.

Therefore, most children are discharged from the SMart Center after an average of 10-12 sessions.

Also note that the more consistent parents are in follow-up appointments, the more involved the school is in our efforts and the more a child is willing to partake in treatment, the easier and faster the child progresses communicatively and feels more comfortable socially.

We have had mildly impaired children who have had sporadic and poor follow-ups and therefore need significantly more treatment then a more severely impaired child who attended treatment regularly and did their goals/games in between treatment sessions consistently.

Keep in mind that every child is different and many children who are seen at the SMart Center have already seen multiple professionals in the past. Also note that if a patient begins at an every two week appointment interval, this does not mean that your child will be seen that often throughout the course of treatment. Patients usually 'graduate' to monthly approximately half-way through treatment.
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Please describe the typical treatment course for a child who receives treatment at the SMart Center:
(View Typical Treatment Course)typical

Results from your initial consultation will help our professionals develop a unique treatment plan for your child that is based on SCAT.

Families leave the SMart Center at their first visit with beginning treatment recommendations. Based on whether your initial appointment was a Comprehensive or Per Service consult will dictate what you will be provided.

Most families consult again approximately 4 weeks after their initial appointment. This gives families time to implement treatment recommendations and for school personnel to begin with recommendations.

You will receive a confirmation email for your scheduled follow-up appointment prior to your next appt that will include access to the SM Follow-up Questionnaire (c) and the SM -School Evaluation Form(c). These should be filled out prior to each follow up visit to enable Dr. E to be updated so that time during your consultation is spent on treatment not 'catch-up.' In addition, results of the questionnaires help Dr. E develop a treatment focus for your upcoming session.
Note: The SM - School Evaluation Form should be filled out at least every other visit or per your clinicians' request.

During your in-person visit at the SMart Center, your child's session will usually begin with the parent(s) present. Parents will have the opportunity to meet with the clinician at each visit to discuss questions/concerns.

During each follow-up visit, your doctor or therapist will work with your child (and YOU) to develop games/goals that will be worked on during the time between treatment sessions. Parents will be provided with an APPOINTMENT SUMMARY, accompanying handouts and other printed material when necessary. Since the school is so key in the treatment, you will often get information for school personnel to update school based interventions.

Your child is given rewards (small toys, stickers, candy, etc) after each visit to reward him/her for their hard work during their session.

You are encouraged and your child is encouraged to write us emails as often as you like but at a minimum of once weekly in the beginning of treatment.

Your child's teacher, school psychologist, etc are encouraged to update your doctor or therapist by email as often as they like.
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Initial Consultations: initial

I am not sure which consultation format to choose. Any advice?

There are Four types of initial appointments for child/teen evaluations.
(1) Comprehensive: In-Person only
(2) Per Service: In-Person, Teleconference
(3) In-School Evaluations: Performed at the school
(4) Ask the Doc: NONpatient consultation.

ALL initial consultations include evaluation of various parent/teacher assessment forms, review of past (relevant) records, parent Interview, child evaluation (In person/Video) and, in some cases, IEP/504 review and/or discussion with outside treatment professionals and/or school personnel.

(1) Comprehensive Evaluation: This format is for children who require a full evaluation and comprehensive report.

Ideal for children who have never been diagnosed, for children who have been diagnosed but past treatment has failed or minimal progress has been made and parent would like another full evaluation/report. This is also IDEAL for families who are NOT able to present to the SMart Center for ongoing Follow-UP appointments.

The comprehensive report is an excellent way to provide detailed information to other treating professionals and/or school personnel working with your child.

Comprehensive Evaluation appointments are 2 hours in length. Additional time is spent evaluating multiple parent/teacher assessment forms, past records and developing the Comprehensive Report.

The Comprehensive Report consists of: A of summary of relevant history, summary of child evaluation results, explanation of child's stages of social communication from setting to setting, Assessment results (explanation of results of SM CDQ, and symptom inventory, multiple 'anxiety' forms (parent/teacher), summary of etiology (causes), precipitating and propagating factors, Diagnosis (if applies) and specific recommendations for home/school, approach to treatment, Detailed handouts with beginning goal/game charts and treatment follow-up recommendations.

(2) Per Service Consultation: This format is ideal for:
A. Families who are searching for 'additional recommendations' and a different treatment approach and simply need to 'just begin' a new treatment or need treatment advice.
B. For school personnel in need of advice on their students current social communication status and recommendations for school based accommodations and interventions.
C. Second opinions, evaluations to rule in/out SM, evaluations without a ' detailed report.' school accommodation recommendations, (504 plans, IEP plans, school oriented questions) or treatment recommendations/questions, letter writing, expert testifying, etc.

This consult is ideal for children who have already had comprehensive evaluations/report and treatment in the past.

Following the evaluation, families or school personnel will receive a written or grid-like Appointment Summary
that depends on the format most relevant to the child or student.

Per Service consultations are based on time and include a necessary 1 hour assessment review that includes development of the appointment summary. The average time in the office is usually two hours, but one hour appointments can be arranged. The average time within the school is usually two hours, one hour observing the child and 1-2 hours consulting with school personnel.

(3) School on-site evaluations. SMart Center staff will present at the child's school, observe the child and meet with school personnel to discuss findings and suggest school based accommodations, interventions. If requested, our staff can be present for 504 and IEP meetings either at the school or via arranged teleconference. ** Similar to Per Service Consultation above.

(4) Ask the Doc consult is a nonpatient consultation that is ideal for parents, school personnel or treatment professionals who are interested in a Question/Answer type consultation.
This format is ideal for:
A. Parent are in active treatment with a local therapist but have unanswered questions or need more advice.
B. School personnel who have specific questions related to a student with SM.
C. Treatment professionals who are working directly with a child or teen with SM and are in need of advice on treatment strategies and direction.

The Ask the Doc format includes a the assessment of a brief questionnaire. There are no reports or summaries following the Ask the Doc consultation; however, handouts may be provided.

There is NO Dr-Patient relationship established with an ASK THE DOC consult.
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What is the process for scheduling an appointment?

Please review information on services/fees.

If you would then like to schedule an appointment, contact our office via email: smartcenter@selectivemutism.org or call our front desk at: 215-887-5748. Provide your email and other contact information. We will then contact you back via EMAIL or phone depending upon your requests.

Once we schedule you an appointment we will send you an email (or letter if requested) that will include ALL of your appointment details. You will be given instructions on what is required for your consultation in terms of specific assessment forms, etc.

Due to the tremendous demand on our services, we require a $100 deposit to hold your scheduled appointment.

This deposit is refundable if you cancel your appointment prior to 2 weeks of your scheduled date. If you cancel within 2 weeks, you forfeit your initial deposit regardless of the reason. If your child is ill or you have another urgent situation, we will do our best to reschedule you however, we cannot guarantee a time frame for rescheduling. NO-SHOW appointments forfeit their deposit with no chance for rescheduling.

Your Deposit must be received within ONE week of scheduling (postmarked). This is the families responsibility. Your deposit guarantees your appointment slot.

Please note that if you schedule an appointment and we need to make a change in the professional performing your consultation or the date of your appointment, we will inform you of the change ASAP. You can then decide if you would like to keep your appointment or change to an alternative date. If requested, we will return any deposits regardless of the time frame prior to the appointment.
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What if after I choose the Ask the Doc initial format, I decide to pursue regular treatment?
This happens often. Families will need to fill out the SM-CDQ, the SM School Eval form and perhaps other recommended assessment forms. Depending upon what was accomplished during the Ask the Doc consultation, will dictate the level of service to begin treatment.
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Can I schedule and appointment with a particular doctor or therapist?
You can certainly make a request for a specific treatment professional however, based on scheduling and a professional's availability will dictate whether we can honor your request. You will be informed at the time of appointment scheduling who you will be seeing at the SMart Center. If a staff change needs to occur, we will inform you as soon as possible.

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I am very interested in speaking to parents who have gone through treatment at the SMart Center. Is this possible?
Very possible and also highly recommended! Dr. E and our other clinicians have wonderful relationships with the children and parents she works with and most are more than happy to correspond with another parent who is 'in the same shoes' they were in not too long ago. . Please speak to your doctor or therapist about this during your consultation. She will match you with another parent or a few parents with a child similar to yours.

We encourage patients to communicate with other children/teens who have had SM or who are still undergoing treatment. Your therapist or doctor will mention this to you during your consultation. if your child desires a pen pal, we will do our best to find a match for your child!
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School Services: (Please contact us via email or phone: 215-887-5748 for information on fees for the services listed below!)

We have a student who we believe has SM. Can we send the child to your center or do you do on-site evaluations?
Fortunately we do both! You can certainly send the family to the center, do a phone consultation or perhaps hire our staff to come to your school to do a full evaluation. Please note that school on-site evaluations are limited to: PA, NJ, NY, DE

We would like to hire your staff to come to our school to consult about a student. We need help with the development of accommodations and interventions. What is the process?
Please view information on School ON-SITE evaluations.

Our staff needs help in implementing interventions. Can the Smart Center help?
Absolutely! Our staff can consult with school personnel either via PHONE or on-site. On an as-needed or scheduled consultant basis our staff can present regularly to work directly with the student and school staff! Some of the services we provide are: Direct staff training, friendship-based groups, social pragmatic work with students during scheduled small group time, facilitation of communication strategies during class time, One on one work with the student to work on specific interventions both in-class and out-of-class, Buddy-work, etc. You may also consider on-site trainings for staff such as workshops and webinars!

Accommodations (IEP/504 Development) sc
I am not sure whether my child/STUDENT needs an IEP or a 504 plan. How do I know which, if either, is necessary?
If the child has SM that is impacting on his/her emotional, social and possibly academic well-being, then your child most definitely needs some form of accommodations. Dr. E or another one of our professional staff can provide expert opinion after performing an initial consultation. You should ask as many questions as you can during your consultation. If requested, your clinician will provide a written report with recommendations.

IF our professional staff believes your child should have testing for possible special education services and an IEP or 504 accommodations you will be provided with a letter that you can submit to your school principal or other relevant school personnel. This letter will inform the school of your requests which will then be followed up on according to IDEA.

Most school personnel welcome suggestions on the development of accommodations and school based interventions. We can help in this process by being present at your school meeting either in person or via teleconference.

It is important to note that accommodations are necessary but specific school based interventions are also highly recommended to help the child PROGRESS communicatively and to build social comfort. Without interventions, progress may be limited.
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If my child has qualified for an IEP or perhaps a 504 plan and we need recommendations for accommodations and school-based interventions, which consultation format do you recommend?
There are two possible routes to go:

(1) The Per Service and Comprehensive Consultation are initial consultations that enable for an evaluation of your child. These are not 'accommodation plans.' These consultation choices enable for an evaluation that will help our staff determine your child's specific treatment/accommodation needs. Consultations with school personnel to develop school accommodations and interventions, etc are then billed at an hourly rate.
(2)SCHOOL Accommodation plan. This plan includes an initial consultation and the development of an IEP or 504 plan or perhaps 'general' accommodations within the school setting. This School Accommodation plan also includes a follow-up consultation with school personnel.

Note: There is no child who just needs an IEP or 504 accommodations. This is not treatment.

Your child should be involved in treatment aside from any school accommodations. an IEP. However, accommodations and school-based interventions should complement what is being done in therapy and during the times between therapy when 'in the real world.''
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What if my school teacher or another school professional wants to speak to my treatment professional, Can he/she just call her during the day?
NO, we ask that you schedule a short phone call with our scheduling department. Our Professional staff's intense schedule does not allow for 'sudden' calls unless there is a true emergency. Again, based on reasons for the call, the family will be billed for any time spent consulting.
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What is the SM - School Evaluation form (c)? This is the questionnaire that Dr. Shipon-Blum developed to help assess the child social comfort, communication level, academic performance, overall anxiety level, etc within the school environment. Teacher's should fill out this form as often as your therapist or doctor needs. Information submitted helps inform your clinician of your child's situation in school. This information is then used to plan for your upcoming consultation which will then enable for updated school based interventions. View SM-School Evaluation Form (c) * Professionals are welcome to use the SM School Eval form (c)to assess child's social, communication, response to accommodations/interventions and academic status within the school environment. Respect to copyright is required.
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Follow-Up Consultations: FUS

HOW often are children/teens seen for follow-up visits?
MOST children/teens are seen every 4-6 weeks with Dr. Shipon-Blum. For children/teens who need more frequent follow-ups visits can be scheduled every 2 weeks. Associates at the Smart Center are also available for clinicial follow-ups for families who request more frequent visits.
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What is included in a follow-up consultation?
--Evaluation of the SM Follow-Up Form (c) for parents to fill out.
--Evaluation of the SM School Eval form (c) for teacher(s) to fill out. This is usually done every 1-3 months.
--Evaluation of older child/teen Follow-Up form (c) (* When appropriate)
--55-60 min office visit (or teleconference)
--Written appointment summary that includes new or tweaked games/goals
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Why is my child NOT seen weekly or multiple times weekly?
Dr. E's clinical experience dictates that children need time in-between sessions to work on treatment goals/games both at home and within the school setting. Therefore, children are seen every two-four weeks at the SMart Center.
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What If I want my child to be seen more frequently or I feel I need more help with the games/goals can this be done?
Of course. When you consult with Dr. E (or associates) please mention this. We will then schedule accordingly.
For many patients, in-between visits with Dr. E, they see one of our associates for in-person or Real World appointments (helping the child with games/goals within the real world). Also, teleconferencing is available on a scheduled basis.
Bottom line, Your needs will be met at the Smart Center. We are conscious of the varied needs of our families. We will do our best to accommodate all!
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What If I feel I need an appointment outside of my regular scheduled appointment. Ie, some issues have come up or I have additional questions. HOW is this handled?
NO worries. We offer our patients the flexibility of what we call, 'Convenience Consultations.' These are appointments that are scheduled no more than two weeks in advance and are on a first come/first served basis. These appointments are prior to our regularly scheduled appointments. These appointments range from 10-30 min. If more time is needed, we can extend assuming time is available. These appointments are usually a teleconference consutlation, but in-person consultations are available for those who request.

If interested in a Convenience Consutlation, Please call our Direct Patient Line (supplied to all our patients and located in the Established Patient Section of our website) or email us at: smartcenter@selectivemutism.org subj: Convenience Consultation.
We will then schedule you accordingly.

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Where can I locate the Follow-Up forms that need to be filled out and how do I submit them?
ALL follow up forms are located at the following link: http://www.drelisashiponblum.citymax.com/AllForms.html

Directions on submission are indicated on the link above.

You will also be supplied the link to the SM- Follow Up Forms when our office sends you an email confirmation. This is approximately 3-7 days prior to your appt.

You can also access the SM-Follow Up Questionnaire directly from the first page of our website. Simply click on 'Smart Center patients---> Established patients--> You will see the link to the FOLLOW-UP forms on the top right side of the grid.
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How do I schedule my Follow-Up appointments?
Please email our scheduling dept at: SMartCenter@selectivemutism.org and write: "follow up needed' on the subject line.
We will then contact you back by email and begin the scheduling process. We usually schedule out approximately 3 months to ensure that you are in our schedule.
If you prefer telephone correspondence, please call our Direct Patient Line (Provided to all our established patients and located in the Established Patient section of our website). You can reach our Front Desk Call Center at: 215-887-5748
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What is the office policy for appointment canceling?
Families must let us know about cancellations within 3 days of a scheduled appointment.
Obviously children will get sick, travel may be difficult due to weather, etc.
However, we ask that if you need to change or cancel an appt that you give us as much notice as possible. As you know, we have a long waiting list for appointments and the sooner you let us know, we can inform another patient in need that an appt space has opened up.

If a parent has cancelled with minimal notice more than 50% of the time, we will ask for payment upfront and patients will be responsible for an office visit charge.

If a new patient (a patient scheduled for an initial consultation or a patient who has been under our care for less than 2 months) does not show-up for a confirmed appt, no new appointments will be scheduled unless full payment is made in advance.

Our policies are strict since Dr. E has limited office time and our demand for services is high
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http://selectivemutismcenter.org/appt/insurpay.htm
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Medication questions: meds ** For those with many questions on medication, we suggest the NEW CD-ROM/Audio CD's presented by Dr. E. Medication: Why, When and HOW to use Safely and Effectively in the Treatment of Selective Mutism.

What percentage of patients at the SMart Center are placed on medication?
Based on our present patient population, for approximately 30-40% of patients, medication is recommended as an adjunct.
However, please keep in mind the following:
(1) Since children/teens with SM are our entire focus, we see patients of varying degrees of severity. Due to Dr. Shipon-Blum's specialty, many families who present to the Smart Center have been to multiple treatment professionals in the past and minimal progress has been made. By the time many present at the Smart Center, they have exhausted many forms of treatment.
(2) The older the child, The more severe and co-morbid problems that exist, the more likely medication may be recommended.
(3) The younger the child, the less co-morbid problems that exist the less likely medication will be recommended.

If my child needs medication, can our child receive medication and monitoring at the SMart Center.
Absolutely!. Dr. Shipon-Blum is a medical doctor. Therefore in addition to providing SCAT, she will prescribe medication if necessary. Monitoring is individualized and done carefully and ranges from every two weeks/ONCE per month in the beginning of treatment to every three months once stable. Monitoring is done very carefully. Dr. E requires parents to update via email or phone (to staff) every week (in beginning of medication usage) to indicate child's tolerance and response to medication.

What if we are against medication, but Dr. E recommends medication, will my child not be treated at the SMart Center?
Dr. E respects your decision whether to use or not to use medication as an adjunct to treatment. However, many parents are uninformed about 'medication' and form opinions without completely understanding. If Dr. E recommends medication and a parent is against medication, Dr. E will simply ask the parent to read about the medication and to ask her about the questions they may have. IF after a thorough understanding, parents are still against the use of medication, treatment will continue without medication being used.

What types of medication are used at the SMart Center?
If medication is recommended, 99% of patients are placed on a Selective Serotonin Reuptake Inhibitor (SSRI) (I.e., Prozac, Zoloft, Paxil, Celexa, etc) or a medication very closely related to an SSRI (I.e., Effexor)

Why is medication recommended?
Medication is used as an adjunct to help lower anxiety just enough to do the necessary behavior therapy necessary to build coping skills. For some children/teens, anxiety is so high, that a short course of medication enables for the lowered anxiety needed to accomplish therapy.

How long does a child remain on medication?
The goal is 6-12 months depending upon clinical response.

How does Dr. E monitor medication?
Very Carefully! Dr. E believes that 'less is more.' and manages 95% of her patients on less than the equivalent of 20mg of Fluoxetine (Prozac). Prior to using medication, Dr. E will ask a series of questions to be sure medication is safe to use with your child. She will exam your child, supply you with a handout, answer your questions about medication and will explain to you the purpose and how medication will be used. Side effects will be discussed in detail. Your child will return within 2 weeks of beginning medication.
Dr. E will ask you to email her after the first few days of beginning medication. Prior to your follow-up visit, you will be asked to fill out the SM-Follow-Up Eval. (c) that assesses your child's treatment progress and clinical response to the medication. At your visit, after treatment status and degree of progress has been determined, Dr. E will exam your child and determine whether to continue present dosage, increase or decrease the dosage. It is very rare to have to decrease dosage.

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To learn about SMart Center services

Please contact us for further questions.