1. Why should I choose Square One for my child’s care?
Square One is the first private practice in Louisville solely devoted to managing both the medical and psychological needs of children. Our highly trained clinical staff thoroughly evaluates and treats children, adolescents, and families struggling with developmental, psychiatric, behavioral, emotional, learning, and speech-language concerns.
As a parent, you want the best for your child. At Square One, we start at the beginning to develop the best possible plan for your child’s specific needs. In addition to addressing your child’s needs directly, we equip families and school personnel with the necessary guidance and support to ensure your child’s continued success in the home and school settings.
2. When is a medical evaluation with a specialist necessary if my child sees a pediatrician regularly?
As a Developmental-Behavioral Pediatrician, Dr. Judith Axelrod is trained to interpret nuances in a child’s development particularly looking for the subtle differences that can develop into problems in learning, emotions, and behavior. The evaluation addresses the physical well being, emotional status, educational profile, and behavioral presentation of the whole child within the family system. Dr. Axelrod’s expertise allows her to serve as a consultant for the family with schools and other professionals to determine the best intervention for the child with developmental concerns.
3. How do you determine the best course of treatment for my child?
You may have been referred to Square One for a specific service in mind already, which may be scheduled accordingly. However, in many cases, parents and/or school personnel are unsure of where to begin. In these cases, based on your child’s prior records and input from the home and school settings, our doctors may opt to start with a comprehensive team evaluation performed by Dr. Judith Axelrod, Developmental-Behavioral Pediatrician in conjunction with Dr. David Causey, Child Psychologist. This neurodevelopmental and psychological analysis provides essential clues to your child’s constellation of needs and the specific topics to be addressed, such as developmental, behavioral, emotional issues, and/or learning concerns. In other instances, our doctors may work independently with your family, with the other specialists in the practice always at hand for consultation when necessary. We consult with parents, school personnel, and physicians to determine how interactions in various settings are affecting developmental progress and behavior. In necessary cases, we also offer speech-language evaluation and therapy, where speech-language needs are indicated.
4. Why is the “Team Evaluation” so helpful to understanding my child and is it really worth the expense?
Our team evaluations combine the expertise of a developmental pediatrician, child and adolescent psychiatrist, clinical child psychologists, licensed clinical social worker, and a speech language pathologist.
For example, in addition to obtaining a comprehensive clinical history, the physician will examine the child and apply specialized medical knowledge that will provide a more complete clinical picture of factors that could be impacting on your child’s adjustment or development. These findings are then assimilated with the information directly assessed by the psychologist with your child and may include cognitive development, educational functioning, emotional or behavioral observations, and other means of assessment. When necessary, a speech and language assessment can also be added to the team evaluation if concerns regarding receptive language, expressive language, social language, or articulation development are detected by the physician, psychologist, or parents.
Consider the case of a child presumed to have an attention problem due to Attention Deficit Hyperactivity Disorder but may actually be found to have a sleep disorder, diabetes, or an underlying seizure disorder as the fundamental cause of attention deficit symptoms. A pediatric specialist physician such as Dr. Axelrod can provide the insight and guidance that can help differentiate these types of issues.
Regarding the expense, many people may not realize that the cost of our team’s evaluation is very comparable to what they might pay to have only a psychological assessment completed without the input of a physician or other specialist, even after insurance has been applied.
Square One has taken into account the considerable expenses that can mount when working with multiple specialists. We take every measure to provide top notch, comprehensive evaluations and treatment while keeping costs relatively manageable. Our office manager is glad to work with families on a case-by-case basis to devise a payment plan that suits their budget.
First and foremost, our goal is to provide the most helpful, comprehensive services to families in our community and to work with other professionals to create the network of care providers that so many families seek.
5. What should I expect at my first appointment?
Your child’s appointment type will be determined by our team of doctors after we’ve received the Patient Information application and Parent and Teacher questionnaires mailed to you when you first contacted Square One for services. A staff member will contact you to schedule the recommended appointment(s) with the appropriate professional(s) best suited to your child’s needs.
Medical Evaluation: The developmental-behavioral pediatrician will meet with parents only for the first 1 ½ hours of the appointment for an extensive clinical interview during which she will determine developmental, family, and hereditary history. During the remaining 30 minutes, she will perform a neurological and physical examination of your child. You may be present during this time.
Psychological/Educational Assessment: The psychologist will greet you in our lobby and lead your child to the testing office. During the evaluation, he or she will work with your child on a variety of tests which include assessments of IQ, academic performance, and emotional and behavioral adjustment. The length of the assessment is generally two to three hours. Parents remain in the lobby for the duration of this process. If your child needs to take a break to use the restroom or to briefly visit you in the lobby, he or she may do so at any time.
Speech-Language Assessment: The speech language pathologist will meet you in the lobby and show you where testing will be performed. She will work with your child for two to three hours evaluating receptive (the understanding of language), expressive language, and social interactive aspects of language (pragmatics) including play skills. In addition, she will address articulation, feeding issues, and language and auditory processing. Parents remain in the lobby for the duration of this process, with the exception of very young children. If your child needs to take a break to use the restroom or to briefly visit you in the lobby, he or she may do so at any time.
Team-Based Evaluation: During this type of appointment, your family will be seen by both the physician and the psychologist. The appointments are embedded in that the clinical interview with the pediatrician/psychiatrist will take place while the psychologist evaluates your child. When the psychological evaluation is complete, the neurological and physical evaluation begins with the pediatrician or psychiatrist as listed above. If the doctors determine that a speech-language evaluation is necessary, this appointment will be scheduled with our staff at the end of your appointment.
Medical, Psychological, Team Consultations: These appointments generally take place two weeks after your child’s medical, psychological, or team evaluation. During your consultation appointment, you will receive your child’s testing results, treatment recommendations, and resource options. Report copies are available two weeks after the consultation. You have the option of receiving both copies or having a copy mailed to a facility authorized by you. This appointment is vital to the interpretation and your understanding of our doctors’ findings and recommendations and should be scheduled at the same time that you schedule our evaluation to ensure timely reporting.
Psychological intake appointment: Dr. David Causey or Ms. Stover will meet with either parents only at the first appointment or with parents first and then the child, as discussed when the appointment was initially set with our staff. At the end of your appointment, you will discuss appointments to schedule for the future. These appointments are scheduled by a staff member at the time of payment.
6. What does a medication evaluation include?
When medication is recommended, careful medical supervision in the form of regular medication evaluations is essential. Medication evaluation appointments include:
- Periodic 30-45 minute medical follow-up sessions and physical examinations of your child with the developmental pediatrician or child and adolescent psychiatrist
- Up to 10 minute periodic phone call updates on your child’s progress and prescription adjustment as necessary between appointments
- Extensive medical notes on your child’s developmental progress
- Consultation with professionals involved in your child’s care
7. What are your specific areas of expertise?
Our areas of expertise include but are not limited to:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Learning Disabilities
- Autism Spectrum Disorders
- Social Communication Disorders
- Communication Disorders
- Adjustment Disorders
- Reactive Attachment Disorder
- Anxiety Disorders
- Mood Disorders
- Neuro-developmental Disorders
- Intellectual Deficits
8. What is the best age for my child to be evaluated?
We offer thorough developmental, psychiatric, psychological, and speech-language evaluations (all or singly) for children – newborn through adolescence. Ideally, you would seek out services at the beginning sign of a problem.
9. Do you regularly refer to other specialists?
The value in developing a relationship with Square One is that you do not have to spread your child’s care over a variety of specialists. Our highly trained clinical staff is equipped to handle your child’s immediate needs and ongoing care on-site. In the case when a referral to an additional specialist such as an occupational therapist, physical therapist, or learning expert is necessary, our staff will work with you to determine the best possible fit. Square One could be considered the core of specialists involved in your child’s care, recognizing when additional services would enhance progress.
10. Are your services covered under my existing insurance plan?
Square One does not contract with insurance companies. In other words, our providers are “out-of-network” with all insurance policies. However, families may submit claims directly to their insurance companies for reimbursement through out-of-network benefits. Many of our services are eligible to count toward the deductible on most insurance plans, even as out-of-network services. We provide the necessary information for your claim, including:
- Our federal tax identification number
- Diagnosis (DSM/ICD) codes
- Procedure (CPT) codes
- Provider signatures or other documentation on a requested basis
Accepted forms of payment include Health Savings Account (HSA) and Flexible Spending Account (FSA) funds, most major credit cards, checks (up to $125), and cash. Please refer to our Insurance page for additional information.
11. Why don’t you contract with insurance companies?
At Square One, your family’s treatment is our primary concern. Unfortunately, insurance companies often interfere in the treatment of patients by complicating allowable services and covered providers. In addition, insurance companies routinely pay only a portion of doctors’ fees. Many doctors’ offices resort to multi-booking appointments in order to compensate for the reduced payment. At Square One, we do not book multiple patients for the same appointment slot: your appointment time is uniquely for you. Furthermore, we provide you the services best suited to your needs, regardless of insurance coverage. Instead of practicing under insurance guidelines, our doctors focus on their mission to support families and to help develop realistic and comprehensive care options.
12. What is your cancellation policy?
Cancellations for emergent sudden illness can and will be rescheduled. It is important to note that we do not book multiple patients for the same appointment slot: your appointment time is uniquely for you. Therefore, we ask that families call with a cancellation with as much notice as possible, as we maintain a waiting list for patients seeking appointment openings. In general, appointments cancelled with less than 24 hours notice are treated as missed appointments and the full amount for the scheduled appointment is charged. For group therapy programs and other programs that take place over several weeks, attendance is vital and the program fee is non-refundable in most cases. The program fee reserves your child’s placement for the duration of the program. The paid fee guarantees that our therapist(s) will render services to the patient; due to the nature of the program curricula, new participants are not generally added in after group has been established if a reservation is vacated by a patient who has committed to the program.
13. What is your missed appointment policy?
For your convenience, we place a reminder call to you the day before your appointment. Our policy is to charge for no shows and appointments cancelled without at least 24 hours notice. This fee is the same as the amount charged for the scheduled appointment.
14. How does the waiting list work?
Under the circumstances that we cannot provide an evaluation or therapy intake appointment time in your desired time frame, we will schedule you for the next best time and place you on the waiting list, to be contacted in the event that we have a cancelled evaluation appointment. However, it is necessary to have an evaluation or therapy appointment scheduled in order to be put on a waiting list for another desired appointment time.
For current patients, in the event that we cannot schedule a therapy appointment at your desired day or time, we will put you on our waiting list with your preferred appointment day/time specifications and contact you in the case that a cancellation which coincides with your desired appointment day/time occurs. You can be on the waiting list for as little or as long a time as you wish.
15. How do I request a prescription refill for my child?
To request a prescription refill for your child, simply call Square One at (502) 896-2606 or email at email@example.com and an office staff member will take your request for the doctors to complete. You should provide the following information:
- Your child’s full name and date of birth
- A phone number where you may be reached regarding this request
- Name, Strength, Dose i.e., Adderall XR 30mg, one in the AM and one in the PM or Lexapro 5mg one in the AM
- How your child is doing on the medication – if you have questions or concerns, the doctor will return your call as soon as they are able.
- For stimulant or controlled prescription requests, let us know whether you plan to pick up the prescription or if we should mail it to you.
- For non-controlled substances, we can call this into your pharmacy. Please leave your pharmacy’s phone number.
- You should allow five days of processing time for all prescription refill requests so that any insurance preauthorizations or other processes may be completed before your child’s medication runs out.
16. Are telephone messages and emails answered after hours and over the weekend?
All emergency calls should be directed to 911 for immediate assistance in dire situations. In the case that you must speak with one of our doctors about a change in your child’s behavior or other worrisome circumstances related to treatment, these concerns may be left on voice mail and will be answered in a timely manner. If you must speak with a doctor right away, there are automated instructions for how to leave a voice mail for the individual doctor to be retrieved remotely. Your call will be returned as soon as possible – this is in the case that you must speak with the doctor immediately, and that it absolutely cannot wait until business hours.