For many people, especially those who have been receiving mental health care for years without making much progress, there is often a gap in the understanding of what is going on for the person. CAS is designed to help children, adults, and families with complex needs leverage the diverse strengths of our clinicians to take the time to really figure it out. Only after we have reached a shared understanding can we offer a meaningful treatment plan.
Step 1: Initial Appointment
After our intake team reviews your questionnaire, we will schedule your initial appointment. Depending on the situation, we may schedule separate appointments for parents and their children to provide different perspectives and information.
Step 2: Obtain and review collateral information
Clinicians will obtain consent to contact others that can provide helpful perspectives. This may include having conversations and reviewing records from prior and current treaters, treatment programs, teachers or tutors. Records provide a wealth of historical clinical information. However, no matter how thick a chart, individuals are more than what is written so we do not stop there in collecting information.
Step 3: School observation (for children and adolescents)
For young people, much of their waking life is spent within the walls of a school. Our team includes mental health professionals who were trained in both educational psychology as well as clinical psychology and psychiatry. Some of us were even former teachers ourselves, and bring that experience with us to our classroom observations and conversations with teachers.
Step 3: In-home observation
Life at home with family is often hard to describe, but we have learned that spending some time “as a fly on the wall” in the home can be invaluable.
Step 4: Testing
Depending on clinical needs, we will administer structured assessments to assess cognitive functioning, educational deficits, organizational skills, and other quantitative and validated tests of less often examined things like personality traits. If more extensive testing is needed, we would refer to a trusted outside neuropsychologist for this aspect (additional cost).
Step 5: Medical evaluation:
We recognize that for people with complicated mental health concerns, medical concerns may be interrelated. We have extensive relationships with medical specialists across the New York City and the international academic community, and will coordinate care between those experts and our team to answer any medical questions that may be impacting the clinical picture.
Step 6: Pharmacogenomic testing:
It is now possible to test an individual for the genetic variations that can lead to differences in treatment response and tolerability. Interpreting these tests is very nuanced and our psychiatrists are highly skilled in placing these results in a larger context.
Step 7: Recommendations and Reporting
After all of this information is gathered, our comprehensive assessment service will have a team meeting about the case. We will draft a comprehensive report that summarizes our understanding in a way that is not heavy on medical jargon. We use the biopsychosocial model developed by George Engle at the University of Rochester to understand together the biological, psychological, and social determinants of illness. We strive to communicate that in a way that is useful in the moment and for years to come.
Step 8: Feedback Meeting
We will meet for a feedback meeting to review our understanding and address any questions or concerns about the report. We are happy to speak with current providers about our findings as well.