Early Childhood

PCIT is an evidence-based behavioral intervention recognized as a gold standard treatment for addressing behavioral challenges such as aggression, defiance, behavioral rigidity, and tantrums in young children (ages 2-7) but we are also trained in adaptations including PCIT for older children (ages 7-10). PCIT is unique for its method of training and then coaching parents in the moment with their child. Rather than working with children directly in a more traditional model of play therapy, PCIT provides parents with specialized coaching in behavior management skills through an airpod, to assist families in managing daily child interactions with greater ease. In our older child model however, we do incorporate some brief recommended time for the child to build rapport with the clinician. Additional PCIT adaptations provided at Milestones are described further below.

PCIT and many of its adaptations can be provided through the evidence-based formats of in-person using our one-way mirror in office, or via telehealth as the one-way mirror and coaching model translates over quite seamlessly to a virtual format. Research shows that PCIT provided by telehealth is just as effective as the in-person model if not more, with additional benefits related to parent satisfaction and “ecological validity”, as it is delivered right in the home.

Just as in the case of in-person PCIT, children are not expected to speak with the therapist, or spend time by the telehealth screen, aside from a generally brief initial greeting. Instead, they spend the majority of the session spending time one-on-one with their parent, while the clinician coaches the parent in real time, via bluetooth headphone, out of earshot and eyesight from the child.

PCIT-CALM is an evidence-based cognitive-behavioral treatment used to address anxiety disorders in young children ages 2-7 by reducing parental accommodation and increasing more bravery, resilience and independence in children.

This evidence based behavioral therapy improves verbal and non-verbal participation and reduces parental over-accommodation for children with selective mutism, leading to gains that persist and generalize to real-world settings.

• Certified SM Providers

Through our adversity and resilience center as well as this behavioral therapy for young children, PCIT-Care trained staff at Milestones are able to ensure that caregivers and school staff are confident in how best to respond to adversity and stress when it occurs within their home or school environment. If the individuals in a child’s life are armed with the tools to help a child cope in a healthy manner following a traumatic event, the development of symptoms of post-traumatic stress disorder and other mental health conditions can be managed most effectively.

Parent Management Training (PMT) is a behavioral training intervention that can help caregivers develop effective methods to improve a child's behavior and tendency to comply with directions. This evidence-based approach works with parents individually through training, role-plays and discussion to identify and change problem behaviors through positive reinforcement, effective communication, and empowering limit setting techniques. We work with you to incorporate your family’s values and goals into our work and help you to follow through with effective tools to assist your family with behavior and emotional support to help your child and in turn, the whole family.

Parent Management Training (PMT), will equip you with skills to:

• Use positive reinforcement to encourage desired and expected behavior

• Communicate effectively with your child

• Set clear rules and expectations for your child's behavior

• Manage challenging behaviors in a positive and effective way

SPACE is a parent training and support program specifically designed for parents who are interested in learning techniques for themselves to help their children ages 4 to 10 years who are experiencing symptoms of anxiety such as excessive worry, fear, panic, and avoidance. Research shows that SPACE treatment for parents alone can reduce symptoms of childhood anxiety. We understand that raising an anxious child can be challenging, but with the right support, it is possible to create a positive and healthy family dynamic.

Habit Reversal (HR) is a multi-component behavioral therapy that targets intrusive or bothersome repetitive behaviors through strategies tailored to your child's unique needs and challenges. Habit Reversal (HR) aims to increase your child's awareness of their behaviors, teach them alternative behaviors to replace the unwanted ones and help them build the motivation and skills to maintain these changes over time.

• This is a group support program for new parents.

• It provides an opportunity for new parents to connect, share experiences, and receive guidance on parenting and child-rearing.

Parents learn from one another as well as experts who facilitate conversations. Curriculum topics are tailored by student age group and may include social/emotional development of toddlers/young children, toilet training support, sleep training, behavior management, supporting friendship skills in children, navigating difficult conversations, homework support, assisting children with transitions, learning about the Kindergarten application process, etc. Each week may have a slightly different ‘loose’ topic and be organized as a back-and-forth conversation amongst parents.

Our peer dyads involve pairing parents and/or children together to work collaboratively to learn and practice similar target areas such as social anxiety, distress tolerance, social skills, or behavior management goals.

• Mini intensives are shorter, more concentrated therapy sessions designed for patients that focus on specific issues, such as childhood anxiety or behavior management.

• Intensive and Abbreviated PCIT brings you the training and coaching of a full-length PCIT program in a condensed time-frame. Rather than a typical weekly format of PCIT, through a model that is skill mastery based, this program provides you with basic competency in PCIT skills and can help you make progress at an accelerated pace. This model typically takes place over the course of 60 mins daily sessions, 4 times per week, for you and your child over the course of approximately 3 weeks.

Through our compass program, we provide in-person therapy or intervention services directly in the classroom or home setting to provide support to children with behavioral challenges and real time specialized coaching as needed for teachers or parents to manage behavioral or emotional concerns.

• Our early childhood team knows that there is so much for teachers to teach in a day, and so much for kids to learn! Children learn academics alongside skills like teamwork and problem solving, all while developing their own unique identities and interests.

• We offer in-school push-in social/emotional lessons that are uniquely designed to support teachers with more explicit social-emotional skill teaching. Our 30-60 minute lessons are structured in a developmentally appropriate way for groups of children aged 4 through 12. For younger children, sample topics might include collaborating or asking for help. Older children may benefit from a curriculum that provides introductory psychoeducation and coping strategies for use in times of anxiety or peer conflict.

• Lessons may include use of books, games, craft activities and small group collaboration.

• The range of discrepancies that are typical in learning profiles

• When to feel concerned about a student

• How to use strengths to build areas of vulnerability

• Ways to monitor over the year to assess concerns

• Books to help children with separating and starting school

• Assisting with the morning drop-off

• Supporting children through expected transition season challenges

• Distinguishing different types of screentime

• Best practices for screentime routines and promoting childhood social skills, responsibility, self-regulation, and impulse control

• Strategies to help your child transition off of screens

• What anxiety looks like in the classroom

• Typical versus atypical anxiety

• The relationship between anxiety and learning difficulties

• Different types of ADHD

• Identifying when there a clinical concern

• How ADHD presents in girls at different ages

• The common occurrence of ADHD and anxiety

• When ADHD underlies learning weaknesses vs. learning disabilities

• How to support girls with ADHD in the classroom

• How to strengthen parent-child relationships as kids become ready for more independence

• How to communicate when children’s emotions are high

• How to provide clear, fair, and effective instructions that kids are most likely to listen to

• How to assess the function of the behavior

• How to partner with the student in targeting the challenging behaviors

• How to collaborate across the home and school settings to target concerning behaviors

• When social-emotional challenges impact the school setting

• A review of Social-Emotional school-based curriculums

• Strategies for how to support students struggling with social dynamics and/or emotion regulation

We speak with families every day about when and what type of therapy may be most helpful for you and your child. We invite you to set up a free 15 minute consultation call to help answer this for you.

We typically start with our diagnostic evaluation process which includes a parent-only 90 mins intake, then a 45 mins parent-child observation/intake, and finally a 60 parent-only feedback session.

The length of treatment can vary due to a number of factors. Generally, weekly parent-child sessions take an average of about 4 months. We never want to keep kids or families in treatment for longer than is needed. For that reason, we will make sure your child is responding positively to treatment while always bearing in mind their graduation criteria for treatment. We want to set you and your child up for a positive experience with therapy as needed. Even after graduating from treatment, we are always here for our families to return to and consult with as needed.

We generally recommend sharing information with your child in a way that is transparent, feels appropriate to you, and helps ensure they do not feel alone in this experience. We invite you to share your ideas about how to best introduce your child to therapy. You can use words that you’ve already been using at home related to feelings or whatever reasons are bringing you in for support. You could say something like, we’re going to learn ways of getting along better as a family or we’re going to be working with a “feelings doctor” who has helped many other kids with big feelings before.

Our virtual model tends to help children feel at ease faster, in their comfortable home environment. And in our virtual parent-child services, children are not expected to interact directly via screen for more than 5 minutes or so, if at all. In the case of Internet-based Parent-Child Interaction Therapy (I-PCIT), parents do a quick check-in with their clinician at the start, but spend most of their session directly engaging with their child as they practice new skills with you through activities that are away from the screen.

That’s okay! Although some children are on their best behavior during initial sessions, they soon warm up and reveal challenging behaviors. During times when acting-out behaviors are not occurring, therapeutic work is still being accomplished. It can actually be helpful if your child behaves well during the first few sessions. That can increase their buy-in to participate in this process. That way, they may be even more on board, which is helpful when it comes to discussing and practicing more challenging skills in and out of sessions.

Milestones does not work with insurance. We are an out-of-network practice and can provide superbills that you can submit for your out-of-network benefits.

We are a group of social workers, psychologists and neuropsychologists. We are not psychiatrists so we are not able to prescribe medication. However, we work closely with a number of psychiatrists and pediatricians who are trained to prescribe medication. Every family is different. For some children, depending on the presenting concern and what makes the most sense for a child and family, behavioral intervention alone is most effective, some benefit from a combination of medication and behavioral treatment. From our experience in this field, we are here to work with you collaboratively, track behavioral progress through our cognitive and behavioral interventions, and help you navigate those decisions.