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12 <br />• Probing in sessions twice a week to try to learn the causes <br /> of death threats and violent outbursts by an adolescent. <br />• Play therapy with children and verbal discussions with <br />adolescents, following the taking of medical histories. <br />• Receives a referral, has an initial session for intake of history, <br /> scheduling of future sessions, payment terms, and then a <br />period of talking therapy plus medications lasting from <br /> 2 to 9 months. <br />• Gets a referral to a boy who appears depressed and uses <br /> lots of marijuana. Meets with the youth and sometimes <br /> includes the parents. Contacts the school for details, often <br /> visits school for a professional meeting. Takes a day to day <br /> approach rather than an analytical or historical one. <br /> We also asked an open-ended question about whether there are better practices <br />for service and treatment now in use, or better practices from state or local agencies than <br />there were some years ago. Some of the typical responses to this question were as follows: <br /> My experience with the state is one of movement toward <br /> privatization through agencies which operate like private <br /> practices. The state seems to support large corporate <br /> institutions. Fewer people are going to work in community <br /> agencies. Social and political change has led to lots of <br /> isolation for those who are practitioners. <br /> No better practices: we’re going backwards. Neuropsychiatric <br />rates have gone down. Now, under state laws, parents can <br /> no longer get a second evaluation paid for. The state used to <br /> pay for an independent evaluation if parents were not <br /> satisfied with the one provided by the school. <br /> There need to be more connections between services. In <br /> some ways, this is improving. HMO referrals, for example, <br /> now require a contact with a primary care physician. <br /> Employee assistance programs of today are helpful. <br /> Replace is a good community resource but is <br /> underutilized. It is not thought of as a referral by <br /> referring parties. <br /> The Lexington Police are wonderful; they use their <br /> resources to best advantage! The problem is finding <br /> a psychiatrist to just do medications, without therapy <br /> <br />