Provoking stress for residential treatment?

Got a call from Nebraska today (finally), they basically said go ahead and apply for Kitty to go to residential treatment. It took them 3 weeks of dithering about to say, well, put her in and if we want to, and your primary insurance won't cover it, we might cover it. Really reassuring and helpful! (insert sarcastic snarl here)

I could have had her in 3 weeks ago and she might not have missed any school! Now we have to see her psychiatrist again because we have to have a recent evaluation and it's been a whole 2 weeks since we saw the psychiatrist last! Are you kidding me?! *sigh*



This has been a long journey. We've had Kitty with us for almost 3 years - since she was 11 years old. She is diagnosed with RAD, complex PTSD, bipolar disorder,ODD, ADHD, learning disabilities, and was abused and neglected...

We had to put her biological half-brother, 13 at the time, in residential treatment within 6 months of the time he moved in with us because he was violent, suicidal and at 5'9" and 200+lbs he was dangerous. He was out 6 months later with new diagnoses and new medications - and for the one and a half years since we've mostly been able to feel safe with him.

So here's my dilemna, maybe because I think of kids needing residential treatent as extremely violent like my son was, I'm not always sure it's right to send our daughter to residential treatment. I want her to get the neurological assessments this treatment center is known for, and to get her medications in order. I do not expect the turn around that we got with her brother, but I think she would benefit from 4-6 weeks in this treatment center.

She constantly talks of vengeance and threatens us with physical violence (although she doesn't follow through). She was hospitalized in January for unstable mood fluctuations and again in April for suicidal threats. Her meds have been mucked with substantially. We're in the process of removing it, but one of her many mood stabilizers makes her sleepy. She naps for 3-4 hours a day.

We have removed as much stress as we possibly can. I'm working from home so I can be there to help her regulate and stay calm. We've stripped her room of all but the essentials, and she's always under direct adult supervision, and we rarely do anything more stimulating than Sunday school once a week (she tends to be an aide in the 2 year old room instead of hanging out with kids her own age. Even though chronologically and intellectually she's 14, emotionally and developmentally she's closer to 4-6 years). It's working. Her meltdowns are less frequent, milder, and she recovers quicker.

Right now anyone looking at her might see her as stable (or at least too stable to be in residential) and think it's because her meds are working. To write the referral for residential, her psychiatrist will be asking how she's doing, and at the moment she's "OK." I can't protect her forever though, for one thing, school starts in less than 2 weeks and that will trigger all the stress that's boiling below the surface. She never acts out at school - she'll be saving it all up to vent at home.

My daughter can honeymoon for weeks and weeks, and because of her RAD may never allow them to see a meltdown. Even when she was raging at home, the school system and the partial day hospitalization program she attended never saw it. This residential treatment center knows little of RAD.

So do I stretch the truth with the psychiatrist? Do I stop protecting her and allow her stress levels to increase back to the way they were? Do I wait until she starts school when there's nothing I can do to about the stress? And what about the interview with the residential treatment program? Should I bring up something I know will upset her so they see how close to the edge she is or just hope that they take my word for it from all the paperwork we've filled out?