Free and low-cost online subclinical services for minors

I have begun creating this directory. Please feel free to add more resources, and please share in relevant spaces. 

From the intro: This is intended to be a listing of affordable online subclinical services serving those under 18. The intention here is to provide resources for families whose child's needs are not currently at the level of requiring medical therapies (or who have financial difficulty in accessing these), but are higher than requiring no formal support. 

Resources should focus on those provided by folks with professional degrees or connection to a mainstream clinical or social services organization, as the intention here is that families are able to assure schools and pediatricians that their child is receiving appropriate services. 

While the owner of this resource places high value on lived experience and community-based healing over "evidence-based practices,"* resources here should be free of blatant pseudoscientific approaches and must be trauma-informed, antiracist, queer/transgender-inclusive, neurodiversity-affirming, disability-positive, fat-positive, and so forth. Religious resources may be included, provided they are truly inclusive, including of those who express skepticism toward their faith background or may be looking to leave it. No ABA providers may be included, unless they publicly and consistently identify as someone who has left the field due to its problematic nature. 

*Research is important, and I constantly seek it out and cite it – or cite that no research has been done that adequately takes into account the intersections at play in the situation at hand. The majority of research, particularly that which is used in recommending and funding treatment approaches, reflects ableism and cultural bias. We absolutely should be looking at well-designed studies that are done or advised by people of the same demographics as those being studied. "Evidence-based practice" literature usually isn't this. 

Financial disclosure: One of my own LGBTQ+/neurodivergent youth spaces is included. I do make money off of this, though you can see based on the prices that this was not my primary goal in creating the space. 

Can we add a little nuance to the discussions of trans kids who aren't out to their parents?

Let me start by saying that of course kids (cis, trans, unsure, and so forth) should all have the freedom to use a name in any space and ask that this not be shared with their parents.

What I am tired of seeing is the rhetoric from well-meaning queer folks and allies of "if your kid is only out at school, this means they feel unsafe telling you they are trans, so you have failed as a parent."

As someone who has worked with literally thousands of trans and gender-expansive kids, this just doesn't follow. Yes, sometimes I have kids tell me their parents are transphobic and would react in unsupportive ways. This is a real thing that happens, and which we need to be aware of and be prepared to address.

What happens much more frequently is that kids tell me they know their parents are supportive of trans folks in general, their parents often even are queer/trans themselves, and the issue isn't about transphobic parents, but just that they are wanting to experiment and practice experiencing how less-important people respond to a new name/gender before they are ready to share with the most-important people in their lives.

I don't want to 100% liken someone's gender identity or expression to a hobby, as we often have hobbies that we pick up and quickly discard, and I don't want to feed into the transphobic "it's a phase; they'll get over it" rhetoric. However, I do think we need to make less of a big deal overall with people exploring gender. It's completely normalized for cis children to try on different names and forms of self-expression, especially during early adolescence. Why should it be extremely different for a cis middle-schooler to take on a goth expression and ask to be called Raven or Onyx than for another middle-schooler exploring identity to include a name and pronouns that differ from their birth sex? So along these lines, do people assume that a child has horrible abusive parents if they aren't planning on mentioning just yet that they wear black lipstick at school and have their friends call them Onyx? Probably not. Does this suddenly change if Onyx uses pronouns that differ from the ones their parents know? It shouldn't. For many adolescents, it's just easier to try something on with people who are less close and whose opinions matter less. It might be easier to have kids in the cafeteria tell you something doesn't really work for you than to observe and process your parents' reaction.

Let's focus more on allowing young people to live in the here and now. If they want to be called a particular name and use particular pronouns for any reason, that should always just be their choice. It doesn't need to involve parental permission, it doesn't need to be likened to any sort of "concern" or mental health issue that their parents need to be informed about, and it doesn't need to be a big deal. Let's just let people be called what they want, regardless of the reason. 

More free Zoom LMHC CEUs

I was actually looking for free yoga classes, and found that there are hundreds of them on eventbrite (set location to "online," set price to only free offerings). My family and I have done a few classes and have found them to be pretty solid. Many of the classes are one-time offerings from healthcare organizations and community centers. Some are organizations that look a bit culty, but I'm able to look past that for a free class where I can log right off at the end and don't have to engage in small talk.

One of the yoga classes I found was for professionals, and mentioned CEUs. I assumed that they would be CEUs for one of the professions that doesn't require formal approval, but was surprised to see that the organization offers NAADAC CEUs, which is an NBCC-approved provider. The organization is Aliya Academy, and they have a number of different free trainings offering 1 CEU each. Most of them are focused on those who have substance use disorders, as this is the organization's mission. 

If you've read my blog before, you know my feeling about CEUs: There is nothing in place to assess whether clinicians are actually engaging in relevant learning and applying it to our work. CEU credits do not accomplish this goal. Those of us who are committed to practicing ethically and effectively are constantly engaged in learning through keeping up on research and listening to experiences of marginalized people, and our participation in formal CEU courses is pretty immaterial. CEUs are just a formality we must go through, most of the available courses are massively overpriced yet contain outdated and disturbingly biased content, so we might as well go with free CEUs of potentially questionable quality. I personally get my actual continuing education by reading and watching content from autistic and other disabled folks, former foster youth, systems-involved parents, people affected by carceral systems, and so forth. I get my CEU credits by attending Zoom workshops that explain what ADHD or depression is –– usually badly, with a white-middle class bias, and with no content from folks with the conditions –– and wonder how there are licensed clinicians who do not already know this material.

William James College is also hosting a free Zoom CEU workshop on stalking behavior in autistic folks. It doesn't appear to have any content from actual autistic folks, so I'm skeptical, but it's free. It's worth signing up for their CEU e-mails, as they frequently have free ones. A few have actually been quite good and have been largely based on lived experience, while others have been typically poor-quality CEUs of things that people should already know. 

[Usual disclaimer that I am not affiliated with these organizations. I have no experience with Aliya Academy and minimal experience with WJC. I am not specifically endorsing the trainings. I post free and low-cost CEUs I encounter for the reasons stated above.]

White autistic people engaging in racist behavior aren't doing this "because they're autistic"

I keep seeing posts from white non-disabled clinicians about some variation of "a neurodivergent child used slurs, got punished, and punishment for something they don't understand is wrong."

The posts usually focus on how punishment isn't effective (true, in general), consequences for not exhibiting a skill someone really doesn't have are pointless and demeaning (yep), but basically ending there (hmmm...). There is no talk about impact vs. intent, or why the child doesn't have the skill to understand the impact of slurs.

Well, there is discussion about why the child doesn't understand not to use slurs, except the posts and ensuing comments always tend to say that the child doesn't understand the impact of slurs because they are autistic or otherwise neurodivergent.

Wow. OK, if this were true, then Black and brown autistic folks would be going around using slurs and having no idea what they mean. As someone who is frequently around many Black and brown autistic adults and youths, I can tell you that this isn't occurring.

White autistic people who are engaging in racist behavior are not doing this "because they are autistic." They are doing this because of white privilege. 

[Image description: Photo of a Black toddler or preschooler in tattered overalls in a field next to a photo of a white toddler or preschooler in a KKK robe in front of a group of adults in KKK robes. Text reads "If the child on the left was old enough to pick cotton and the child on the right was old enough to attend Klan rallies, then today's children are old enough to learn about both of these and how they've led us to where we are today." The instagram account AfricanArchives is credited.] 

The reason that a number of white autistic youth are using slurs with no idea of their impact is because of white privilege, not because they are autistic. And sure, non-autistic white youth may be quicker to intuitively pick up on the meaning and impact of slurs than autistic white youth. But the overall dynamic is still due to white privilege, not that they are autistic. Black children experience racism, thus have to talk about it, much earlier than white children are typically taught about it. 

Black or brown autistic children (with sufficient verbal or spelled language) are no different in this regard. Their families are talking about racism essentially from the time they are born. They know the impact of slurs, because their families are talking about themselves or people in their communities being on the receiving end of these. Black children of all neurotypes are given The Talk starting at an early age, in which they are taught the importance of things such as always getting a receipt and not touching things in stores. Particularly given the rates at which Black and Latine autistic people are undiagnosed, parents aren't holding off on discussing these things with autistic children -- they often don't officially know they have autistic children! In my experience, Black and brown parents who notice that their children struggle with impulse control or language (with a diagnosis or not) are particularly focused on working with their children on being cautious about what they say to whom and how they say it -- because they have to, for safety reasons. 

Similarly, parents of white children who notice they may have differences in how they pick up on and use social information need to be particularly focused on educating their children from an early age as to the meaning and impact of slurs, along with other anti-racism skills such as recognizing microaggressions and responding to these. All parents of white children should be teaching their children to be anti-racist from birth, and autistic or otherwise neurodivergent children may not intuitively pick up on all of this teaching and may need to have the meanings of slurs spelled out. Rote rules around slurs are actually easier to teach than a lot of universal social skills*:

• these words are violent and hurt people
• white people may never use them
• any white person using them is committing a harmful act
• they might occur in media, and the choice to include them is a separate discussion
• if you are reading from a text or quoting something and are white, you need to use the censored forms of them

This is probably one of the easiest social skills among those we teach, honestly. There isn't a lot of nuance. If a parent has neglected to teach their white child about slurs, there should be some reflection here. It isn't because it's a hard topic to teach in an education sense; there is clearly something going on where the parent hasn't fully accepted that it is their role as parents of white children to actively teach their children how not to perpetuate racism. 

Finally, low expectations are a form of ableism. We really don't want to perpetuate "they don't know any better because they're autistic," especially around a dynamic where this is objectively not the case. Autistic folks typically have a strong sense of social justice. If they are raised in a way that includes all different perspectives and teaches them about the existence of different types of oppression, they are typically amazing allies for marginalized groups to which they do not belong.

*Universal social skills are the skills that all people of all neurotypes need to learn (consent, boundaries, self-advocacy, negotiation, etc.), which is distinguished from the flawed idea of teaching autistic people "social skills" that really mean to engage in masking or changing their behavior to appear neurotypical with no real functional benefit. 

Free online DC 0-5 training with 16 MA LMHC/LICSW/NBCC/NASW CEUs

For Massachusetts providers only. Get half of your biannual CEU requirement completed for free. It's this October, which is unfortunate for those of us who already have 2022-2023 completed, but fortunate for those who have waited until the last minute. (Or social workers; I think y'all renew in even years?)

I've taken the training in the past and it's actually quite good. I definitely encourage people to sign up if you can, especially if just to let folks know there is demand for online/accessible options for these types of trainings. 

Information here.

[Usual disclaimer that I have no affiliation with this training or organization and just am passing along free/low-cost CEUs.]

Found in the wild: A textbook example of well-meaning adults jumping to conclusions

This Reddit forum, r/foundpaper, is a place where people post, well, found paper – basically any sort of note, doodle, list, etc. that someone found and thought was interesting. The commenters then chat freely about who the author might have been, what they might have intended, and so forth.

Page from a lined composition notebook, in pencil, in what looks like a child's handwriting, and says "I have every right to feel sad. I'm allowed to make mistakes. I can be kind to myself. I'm doing the best I can. My best is good enough. Calm place: Grandma's house."

So, this post and the ensuing comments particularly spoke to me as a child welfare clinician, advocate, and reformer. 

The comments on the original post are largely along the lines of people expressing concern, stating things assuming the child has a very hard life, and expressing that this is extremely sad as an elementary-schooler shouldn't have any reason to have these kinds of thoughts. A number of commenters state that they hope the child is able to go to grandma's regularly, and even a few stating they hope grandma can get custody. (Note: We have no way of knowing who is the primary caregiver.)

I also noticed the post has been reposted to a C-PTSD subreddit, with the headline, "can’t help but think that kid might end up using this subreddit in a few years."

For those who are unfamiliar with Reddit, let me mention that compared to the general population, Reddit's demographics skew very heavily toward young (teens and 20s), male, white, highly educated, and higher income. Reddit also skews sociopolitically toward those who vote democratic, but at the same time aren't particularly who I would call progressive, as they don't have a lot of direct experience with marginalized folks, don't really believe in systemic oppression, and tend toward some savioristic attitudes. 

Those of us who are experienced parents and/or who have worked in schools of course recognize that this journal entry is most likely from a student participating in a standard elementary school social-emotional curriculum. In these groups, students do exercises to teach coping skills for stressful situations and learn about healthy ways of framing things. The students might do something like look through a list of affirmations or a "child's bill of rights"-type document and write down some items that are particularly important to them. They might be given an assignment such as visualizing somewhere where they feel particularly calm, so that they can visualize this place when they are feeling stressed. Those who are only familiar with wealthier, whiter schools may not have encountered this type of learning, which is unfortunate, as students can benefit from this learning without it needing to be a reaction to community trauma. 

Students before late adolescence are not typically authoring these kinds of statements independently nor seeking them out, regardless of stressors in their lives. This wouldn't be language that children would have outside of having learned it from social-emotional media – or from engaged caregivers who are actively teaching their children social-emotional skills at home! 

The attitudes in the thread mirror many of those that I see from well-intentioned adults who make inappropriate reports to the child welfare system or display similarly poor savioristic boundaries with families: 

• Assumptions that a child using mental health language is traumatized (come on -- are people really not familiar with the current trend of all the pop-psych content on TikTok, some good and some questionable, that gets filtered down to younger kids?)
• Assumptions that the presence of positive coping skills indicates that these were developed in response to severe issues rather than taught proactively by caring adults
• Lack of familiarity with child development and failure to recognize that this language is being parroted from somewhere appropriate, likely school, or could be from a scouting program or the OWL health education curriculum
• Lack of familiarity with what is routinely taught in schools at various ages
• Projecting adult experiences onto pre-adolescent children ("As a 26-year-old, I only find myself needing to reminding myself that everyone makes mistakes in pretty extreme situations, so this must be the same for someone with only 8 years life experience who is just starting to learn how to tolerate distress")
• Assumptions that preferring to seek out Grandma or a friend's parent suggests a serious deficiency in the primary caregiver(s) rather than understanding that this is not unusual in healthy children (or recognizing that a child who is prompted to visualize a calm place is not likely to choose home or school, as these places are by definition not a calm respite from routine life stressors)
• Overidentification with the child, especially involving the logical fallacy of affirming the consequent ("I am an adult with C-PTSD and I use these coping skills, thus a child who knows these skills is experiencing trauma")
• A "divide and conquer" conceptualization of the primary caregiving unit in which someone believes a child has been through some hard things, therefore this means the child is alone without adequate support ("kids from good families don't have these issues"), rather than the more common scenario in which parents are adequately supportive but this doesn't magically stop the child from experiencing difficult things
• A lack of familiarity with the experiences of marginalized people, thus not having mental models of communities and families who have experienced difficulty through no fault of their own and have used resources to get through it adequately 

For those who want to support children (and adults!) in a non-alarmist way, you need to be familiar with what constitutes the wide range of normal for kids of all different backgrounds. This requires curiosity, listening, and cultivating a mindset in which the practices of all different races and income levels are seen as valid. 

If your daily interactions with friends and family don't put you in contact with a sufficient degree of exposure to different experiences, social media is free. Follow, but don't engage, in spaces where parents are discussing what's being learned in urban public schools. 

Practice your own mindfulness skills and notice when you are jumping to conclusions or filling in information that isn't there. Use something like the THINK skill from DBT to consider several possible explanations for something that is observed. As clinicians, we should strike a balance between Ockham's Razor (when you hear hoofbeats, it's probably a horse, not a zebra) and Hickam's Dictum (though it could be a zebra, or one of each). We don't want to rule out the possibility that a child writing about coping skills is doing so because of a concerning situation, but it's also most likely that everything we are seeing is pointing to this not being the case based just on what the child has written and what we know about child development and social-emotional curricula. 

How to put feelers out for a referral without sharing client information

No:

Looking for a therapist for an English-speaking 12-year-old Latino trans boy with a diagnosis of ADHD, taking a stimulant medication, currently attending Lepidoptera therapeutic school in West Batman via public school IEP process, school is appropriate and uses wraparound model where they will want to consult frequently. Has mentor and support group through Esperanza Community. Child witnessed the severe assault of his cousin who he is close to. Child lives in Old Poptart Village with parents and maternal grandparents, family doesn't have a car, able to travel by subway, can get rides if it's on Wednesday evenings when the aunt watches him. Plays Dungeons & Dragons, interested in anime, Minecraft, Roblox, likes to draw, likes 3D printing, likes reading. Has Purple Shield HMO plan and able to private pay on a sliding scale.

Yes:

• Looking for a therapist for a middle-schooler (sharing with family's permission)
• Telehealth or transit accessible in Metro area, some potential for further out areas
• English-speaking
• Trauma-informed
• Willing to collaborate with wraparound providers
• Competent with multi-generational Latino families
• Competent with trans/queer/gender-diverse folks
• Neurodiversity-affirming
• Arts-based approach and/or approach incorporating gaming/geek culture a plus
• Purple Shield HMO or sliding scale

See what I did there? When sending referrals to one person, a forum, a listserv, or absolutely anywhere, just state what qualifications the clinician needs. Don't share any information about the client or family. Even when you have permission, don't share personal information. Note that when we focus on the therapist's qualifications, it is easier to focus on broader demographic or clinical needs, rather than specifying exactly what the issues are or to which family member(s) they apply.

Also, don't do this:

Looking for therapist for an 8-year-old.

Even if the person is of the dominant culture in most every regard, there are still cultural considerations, as well as considerations for an appropriate fit for a particular individual and family. Get out of the habit of dominant-as-default. These postings also suggest that the person making the referral isn't trusting that the client/family are the experts on themselves and get to decide what approaches and knowledge are needed, as well as imply a dismissive and saviorlike view of the person in which any therapist is surely an improvement over what is currently happening. Asking someone to engage in therapy is asking them to take extensive risks and do hard work; surely we owe them a little more care than this sort of "any therapist will do" approach.