New Direction?

Picked up the packet of information from the school "answering my questions."

The behavior program staff notes was interesting, but incomplete (at least I have to assume so since it doesn't mention the panic attack she had last week before she was supposed to give a speech). Plus another inconsistency for which I was present. There is the amount of time they spent with Kitty - ranging from 5 to 50 minutes, but not when and what period. Most of them involve taking her to the nurse. The guidance counselor gives no details at all on the two times she saw Kitty - not amount of time spent, not time of day, and certainly not information about Kitty's affect, state of mind, what she was upset about, how she responded to any "calming techniques"...

It did list a self-harming episode (scraping her hand with an eraser) I was not made aware of, and that was NOT in the nurse's notes despite the behavior staff stating the nurse confirmed Kitty hurt herself.

So there are definite inconsistencies.

I did get information about the requirements for the special school. It states placement is made on a case by case basis, but Least Restrictive Environment considerations need to be at the forefront of decision making. This is considered the most restrictive placement in the district and by law all intervention strategies must be exhausted before considering the special school.

Here are the questions they suggest to decide if placement is appropriate:

1. Is the Student in Special Education? {Obviously met}




2. Is the Student currently served by the Behavior Program? {Check}




3. Has the staff exhausted interventions to help the student be successful AND has the support staff been contacted for observation and consultation? {Yes, she was observed by the support staff, but for the "wrong" behaviors. The following are their examples of some possible interventions to try:

• FBA/BIP revised to address behavior - {obviously we're having issues with this since they're still looking at the "wrong" behaviors. }




• Escorts to and from class if student is having difficulty during passing period or skipping class {Ironically we were told this wasn't an option for Bear over a year ago but now they've implemented for Kitty.}




• Behavior contracts written with the student with clear expectations and desired behaviors. {We've written a crisis plan, but this one is clearly not designed for kids who "act in" instead of "act out"}




• Schedule change {Did this at the end of last year - once to put her on alternating half-days and once to change her to part-time with study skills classes to replace all classes but Math, and at the beginning of this school year when they pulled her out of two general ed with inclusion help classes and PE}




• Counseling {We have always had a big issue with the school providing counseling since they are not skilled in working with children as complex as ours. Kitty has seen the school guidance counselor twice though. The counselor let Kitty vent, attempted to calm her down and point out the errors in Kitty's thinking, and then sent her back to class - ready or not}.




• Involving truant officer if attendance is an issue {Currently Kitty has only one unexcused absence and we're positive she was on campus, but no one knows where for sure - it's possible she was meeting her new Assistant Principal.}

That's all they have listed. There's a second page of questions designed to "trigger interventions and to be considered during staffing:" I can post those if anyone is interested.

********************************************

So here's my thought. I'm going to try to approach this from a new direction. Rather than try to show that Kitty really is a "behavior problem" or that her issues are interfering with her academics to force the school to change her placement, I'm going to try to approach it from an "Interventions" Perspective.

Kitty is a severely traumatized child with well-documented issues with stress and anxiety (see current FIE). As evidenced by her repeated trips to psychiatric hospitalization, partial day hospitalization, residential treatment, and the current recommendation for immediate placement in residential treatment, this has obviously not changed significantly over the last 5 years since she was first placed in this school district.

It is well-documented that Kitty tends to demonstrate this stress and anxiety in a variety of ways, which is greatly influenced by her perception of her environment (ex. She tends to show both "acting out" and "acting in" behaviors at home and places she feels safe, but tends to only "act in" at school and in the community).

Examples of "Acting Out" behaviors:

• Meltdowns (crying, screaming, yelling, threatening self or others, property damage)




• Physical violence toward self or others




• Property damage




• Threats/attempts to run away




• Threats/attempts to commit suicide




• Threats/attempts to self-harm




• Threats/attempts to harm others physically and verbally (ex. spreading vicious rumors)

Examples of "Acting In" behaviors:

• Manic/ Hyper: agitated; overly-sensitive; loud, pressured speech; over-zealous in relationships; loud, barking laughter; "vibrating" leg(s); popping knuckles (only does this when under stress); impulsive; difficulty concentrating




• Self-Harming: gouging skin with finger nails; stabbing with pencil; burning skin with eraser... technically this is an "acting out" behavior, but Kitty has been known to do it secretly in public and often expresses concerns that she might self-harm and asks for supervision to prevent it.




• Depressed: Statements she wishes to die; statements or acting as though she wishes to "give up;" statements that others "hate her;" belief/ statements that she is worthless/hopeless/unlovable...




• Escape/Dissociate: physically leaving room or "checking out;" unfocused; changing subject (often apparently at random); distracting (asks question or makes comment that changes the subject); napping/head down; appearance of being exhausted; "shutting down"




• Somatic issues: aches; pains; exhaustion; hunger. Has difficulty identifying correct emotional and physical feelings so is prone to emotional eating and ascribing real or perceived aches and pains to incorrect sources. Ex. If Kitty is feeling depressed or suicidal (possibly because she forgot to take her meds, skipped a meal, hormones, chemical imbalance, was triggered by a traumaversary or event...), she might blame this on a recent event (such as a fight with her sister) that may or may not actually be related.




• Depressed: Sad; crying; whining; begging to go home




• Overwhelmed: low frustration tolerance; disorganized; needs others to "chunk" assignments (break down into smaller more manageable pieces); forgets assignments or needed materials; hurries through assignments; requires frequent breaks to relax and regroup; frequent requests to leave the room; needs frequent redirection and individual attention; difficulty remaining focused and on task - needs frequent assistance/ reminders.




• Anxious: hyper-vigilance; worry; hurries through assignments; obsessed with following the rules




• Poor Boundaries: inappropriate interpersonal interactions. Inappropriate sharing/ venting with peers and others, particularly about abuse and perceived abuse (past and present); participating in or allowing physical and/or emotional teasing/ bullying; inability to recognize other's "boundaries" and bothering them; perceives others as threatening or abusive; tattling about rule breaking; verbal lashing out; gossip (has spread vicious rumors regarding siblings/ friends and accused them of doing the same); threatens or hits peers (yes, this is an "acting out" behavior, but it is one that Kitty has acted on in school and the community).

Over the years MANY accommodations and Interventions have been suggested and implemented with varying degrees of success. I've decided to put thses in a spread sheet and present them to the school. Then we can move on to discuss new interventions.

• Smaller class sizes {fairly effective}




• Reduce # of trips to nurse by asking Kitty to assign a number between 1-5 as to how much pain she was in {not very effective, probably since the somatic issue were actually to alleviate stress and anxiety}




• Assign people for her to talk to (consistent, readily available, caring, qualified) {mixed results, depending largely on Kitty’s perception of their empathy and Kitty’s level of distress}




• Allow her to leave class when stressed/ overwhelmed {fairly effective as long as Kitty really believes she won’t get in trouble, but she accesses this a LOT when she’s under a high level of distress}




• Escort her during unstructured times and any time leaving classroom {fairly ineffective. Is unnecessary when Kitty is not actively suicidal or self-harming (occurrences of this behavior are difficult to predict), Kitty appears to find this stigmatizing and triggering even when she is actively suicidal. }




• Limit unstructured time with peers {mixed results, as evidenced in therapy, Kitty is usually severely triggered by peers; however, she craves this interaction and is triggered by it’s removal}




• Reduction or removal of homework. {fairly effective, but makes general ed with inclusion assistance difficult to impossible}




• Study hall and/or time at school to work on assignments. {fairly effective, but generally doesn’t have enough homework to keep busy}




• Study skills class {Ineffective. Teachers appear to have difficulty implementing due to the need to work one on one and lack of homework to use for practice}




• Modifications/ Accommodations: extra support, extra time, chunking assignments, assistance with organization, homework folder, modifications like word banks {fairly effective, as long as someone else is helping her maintain.}




• Private school – small class sizes, independent self-paced, check own work, individualized instruction {Mixed results. Thrived when the program was tailored to fill in the gaps in her education (from moving and during times of trauma), but started to struggle when teacher’s began expecting her to be on grade level, grasp abstract concepts, didn’t know how to accommodate her learning disabilities, and became less empathetic to her need for accommodations}




• Reduced schedule – alternating part-time and ½ days with study skills class. {Mixed results. Had difficulty getting Kitty to attend because she didn’t feel good and worried about how far behind she was getting (despite assurances).}




• Medication – Mood stabilizers, anti-psychotics and meds for ADHD. {Fairly effective, but do not work on trauma. Wrong medications and med trials also made school very difficult for her.}




• Counseling (school) - at the recommendation of Kitty's doctors, we've avoided school counseling due to the complexity of Kitty's issues. {Unacceptable, Kitty has seen the school guidance counselor a couple of times to work on calming techniques, but she does not feel she got what she needed the few times she's gone, so has apparently stopped requesting this option. I've actually been present twice, and the counselor did NOT provide the calming/ relaxation techniques provided by Kitty's skills trainer. Which was all we had approved.}




• Partial Day Hospitalization - provides school and therapy combined. {We tried this for 3 weeks, but aren't sure if it could have been successful because the environment was so toxic.}




• Reduce Responsibilities and Expectations {Effective, but with drawbacks. This works well in the short term, but obviously can't continue forever}




• Safe Environment - structured with consistently, enforced rules {Effective. Received this in residential treatment, seemed to do well, but it was short term (less than 2 weeks). Is what we provide at home, but we're unable to treat all kids exactly the same as they are of extremely differing abilities and levels}




• Consistent, caring staff - with consistant enforced expectations {Effective. Responds well}




• Frequent reminders to stay focused and on task {Effective.}




• Teachers/ staff monitor her stress level and cue her to take a break. {Effective at home. Not sure if it's been tried at school.}




• Staff trained in helping Kitty with stress management/ relaxation techniques. {Effective at home and Summer Camp}




• Predictability of routine {Fairly Effective}




• Work with her on Social Skills training {Fairly Effective}




• Self-Confidence Building activities and training {Fairly Effective}




• Provide goals for managing stress and anxiety on her own. {Currently ineffective as she is unable to access these skills independently when she is actively stressed and anxious - although responds well to cuing by someone when she is starting to escalate.}

Dismissed

Today was a big day for Bear. He had a DARS job specialist come to talk to him about finding a job at 8am. He was still asleep at 7:50am. He was sleepy and rude to the specialist.

Bear's court date (for driving without a license) was at 5pm. I picked him up from school and he took offense to a comment I made about him being in trouble (he felt that this was the only trouble he'd gotten into in a long time). He was a little bossy and obviously stressed on the way to the court, but he laid his head on my shoulder while we were seated waiting outside the court room.

The court made a mistake with his case (they had recorded that he'd brought in his driver's license - which he couldn't have since he doesn't have one) so they dismissed his case (I guess since they hadn't prepared). I admit to not being happy about this. The judge looked at me like why are you still here? when I questioned why they were dismissing the case.

While it's good since we didn't need the expense of the court costs, I worry that it's teaching Bear the lesson that what he did wasn't that important and didn't need consequences. He does still owe $500 ($100/mo) for the deductible for the car he crashed and only has $50 saved so far for the November 1st payment. I know he's worried about that, and I think is hoping biofamily will bail him out. He didn't even ask us (not that we would have bailed him out and he probably knew that).

He'd made no provisions for the court costs at all. I think he thought he'd have time to pay them, and didn't believe us when we'd told him they would demand payment on his court date. It would have been about $200.

***********************************************

So is this God's way of taking care of us? Financially everything seems to be coming at once. This month Hubby gets an extra paycheck, so when the TV broke we decided to spring for the $400 it would cost to fix it (it's a good quality TV that Santa brought us 3-4 years ago).

Then the service engine soon light came on in my car, but it went away again. Unfortunately it refused to start after I went to pick up Hubby for court, but when we got back from court it started again!

Recently I got pulled over by a police officer because my brake lights weren't working, but he only gave me a warning so I need to get that fixed. Will have them look at the brakes too because the squealing is beyond loud and annoying.

The worst was the water heater biting the dust. Luckily no water damage, but it had to be replaced.

Need to hire a pest control person to catch the rat or squirrel that went tearing around the ceiling in the game room for an hour or so. Made the cats nuts. Plus got to figure out how he got in and fix that too. In college we had some raccoons move into our walls and have babies, and they all sat around scratching their fleas for hours at a time. NOT an experience I want to repeat.

**********************************

Hubby and I went back and forth about whether or not to hire an advocate for Kitty's IEP meeting on Monday morning. We pretty much just ran out of time. If we don't get what Kitty needs at the IEP meeting on Monday then we probably will go for a due process hearing in which case we'll need representation.

Kitty has had a lot of doctor appointments this week (all day Tuesday for the neuropsych testing), psychiatrist and thyroid testing onWednesday (she has an enlarged thyroid and will need to see an endocrinologist).

Wednesday evening was Bear's neuropsych testing (he goes twice a week), and Kitty had to stay with me for the whole 2-3 hour session.

Then we went to the psych hospital to sign some release forms for getting info for residential. I've spent a lot of time all week trying to get clinicals and other information gathered for residential treatment, and leaving messages with tons of people, still trying to get Kitty into residential.

Today was mostly about Bear, DARS in the morning, he was supposed to meet with his psychiatrist, but after being rescheduled once that got cancelled completely. And of course court in the afternoon.

Ponito is doing too much this year (football, band, and soccer). Hubby is counting down the days until the season is over so the practices and games will finally stop!

Trauma and NeuroPsych testing

Hi Ms. School Case Manager,

I want to apologize for not sending this directly to Kitty’s teachers and Behavior Program staff, and not sending it sooner, but I’ve been super swamped and only some of it has recently come to my attention.

PLEASE do not discuss her biofamily or other drama/ trauma with her, even current drama with peers or family. Due to the complexity of Kitty’s issues, these are topics best kept in the hands of her very experienced therapists. Please notify me as quickly as possible so any issues she brings up at school can be addressed in Kitty’s next therapy session (Tuesdays, Fridays and sometimes other days). If Kitty is distressed, you can certainly contact the Behavior Program staff to take her to a counselor to give her time to regroup and calm.

A major concern is that Kitty has been receiving assignments to discuss her history/ life story. This may not seem like a big deal, but there is very little of Kitty’s history that is not trauma-filled (as I’m sure the teacher who asked her to write on the topic, “A Family Emergency,” discovered when she received a paper about the death of Kitty’s “brother.” I know Kitty greatly edits out some of the worst trauma (we’ve told her it’s OK to lie so people will not have access to this personal information), but she is still having to process it. It is my understanding that some of these assignments are being edited/ reviewed by peers as well.

Especially with Kitty so recently out of the hospital, I’m sure the teachers can appreciate that this subject (and really any assignment on books or topics about death (particularly via suicide), trauma, vampires (Peeps), teenage drama, domestic violence….) is obviously very triggering for Kitty and is bringing up lots of issues for her. I know Kitty claims otherwise, but the fact that she’s been hospitalized twice in 2 weeks, should let you know that she is not as stable and able to handle things as she claims.

Of course if Kitty expresses to you that she wants to hurt herself or others I know that you would follow her Crisis plan and contact the Behavior Program or 911 immediately.

As always I can be contacted via e-mail marythemommy @ gmail dot com or phone (###)###-####. I know you all have Kitty’s best interest at heart and keeping her stable and safe is of primary importance to us all.

Mary

****************************************************

Ms. S CM's response

Will be happy to share this with Kitty's teachers. I know that none of them would do anything to upset Kitty. Should you have questions about any of her other assignments, please let me know in which class the assignment was given. I will be happy to discuss it with the teacher, and come up with an alternative assignment.

*****************************************************

A second e-mail sent less than an hour later by Ms. S CM

Ms. "Some lady I've never met before unless she's the one who did Bear's Transition Plan to years ago" has agreed to do Kitty's Transiton Plan for her annual IEP Meeting on the 16th of Nov. Ms. S is available on Monday after Kitty's revision IEP Meeting at 10:30. Will this be convenient for you?

Thanks

Ms. S CM

**********************************************
My response:

Hi S CM,

I’d prefer to delay the Transition Plan meeting until after we have the results from Kitty’s neuropsych testing from X Child Guidance Center (feedback session will be Friday morning, November 11th) so that we have a better understanding of her capabilities. We have specifically asked XCGC to focus on transition topics like driving and independent living since we are assuming these will be seriously affected by her IQ, diagnoses and issues. We would like the school’s Transition Plan to be as realistic as possible since it is extremely unlikely that Kitty will be going to college so this will be applicable soon.

Mary

**************************************

Kitty had the NeuroPsych testing on Tuesday this week. Such a different experience from Bear's Neuropsych testing which is a 3 month long process (twice weekly meetings of approx. 2 hours each) with a 10 point questionnaire filled out nightly by Hubby, Bear and I, extensive testing for Bear and even Hubby and I (we're used to the BASC which asks for our perception of Bear and his Behavior... but we'll also be doing an assessment of our attachment to him, have already done several interview type assessments, and will be doing other testing).

When I talked to Kitty's neuropsych at the end of the 5 or so hours of testing, to confirm that she'd be willing to present Kitty's feedback to Kitty, I wanted some assurance that she'd address some of our concerns about Kitty's future and not reinforce or gloss over her challenges. Kitty's last neuropsych was only 2 years ago, but we hadn't had the same concerns then that we're looking at now, things like, driving, independent living, college... So far Kitty's Transition Plans at school have been things like "Neurosurgeon" and now, "Teacher," even though she's on the "Minimum High School Graduation" track.

I don't think Kitty is college material, but my biggest concern is stress and stability. Most jobs are high stress, and Kitty can't handle it. If she becomes a preschool teacher what happens if the father of a child gets verbally abusive, a child has a behavior problem, or a coworker starts some nasty gossip?

The psychologist did mention that she'd already finished Kitty's IQ testing. The results were concerning. Here's three significant scores that I remember.

Verbal Reasoning 89 - this one is why Kitty presents well.

Working Memory 70 - (70 is the cut off for mental retardation). This is a tough one for her and one reason she struggles with math, even though her learning disability is in reading.

Processing 65 - This is the one that most concerned the psychologist. Kitty could overcome a lot if not for this trait.

IEP Meeting - to be continued

This is the letter I sent to the school on Monday after consulting with an attorney and an advocate. I don't know if we're going to be able to afford having the advocate at the IEP meeting ($75/hour - 2 hour consultation, plus the actual meeting). This month has 3 paychecks (yea!), Of course all the sudden we start bleeding money and we didn't know it was going to be a problem until we'd already spent some of the money on lower priority items (My sewing machine needed repair, $400 repair for the TV, multiple car repairs - luckily I only got a warning ticket because my brake lights aren't working right, the washing machine needs repair, had to replace the hot water heater completely, Bear's court costs...)

1. Kitty is still in imminent danger and safety measures need to be implemented now. Due to the high likelihood that Kitty will again be of imminent danger of suicide within the immediate and midterm future, before she can be placed in a residential treatment facility and before the next IEP Meeting, we are repeating our request that certain safety measures be instituted immediately. It has been well documented by multiple mental health professionals that Kitty is in serious physical and psychological danger. The High School is endangering our child’s life and health, by continually delaying an appropriate response with distant IEP Meeting dates, irrelevant FBA (Functional Behavioral Assessment) results and an insufficient Crisis Plan and Behavior IEP. In particular, it is not reasonable or responsible to expect an emotionally disturbed 16 year old girl who has been hospitalized twice in the last 30 days to self-report. At a minimum, Kitty needs to be accompanied during all unstructured periods such as lunch and passing from one class to another to ensure that she does not attempt and complete suicide on campus.



2. Need a new FBA if that’s a requirement for the Special School. I do not understand why a Functional BEHAVIORAL Assessment is being used to assess my daughter’s EMOTIONAL disorder; however, I am officially requesting that the FBA be redone to assess the RELEVANT documented behaviors that are inhibiting and disrupting her ability to access an appropriate education as well as are frequent precursors to her suicidal behavior. We cannot be deterred in our efforts to get Kitty the supervision and programming she requires, based on this assessment of irrelevant (because they are primarily home-based) behaviors, particularly when Kitty has displayed significant behaviors in school.



3. I am requesting the requirements for placement in the Special School.



4. Kitty is truant and we cannot account for these absences. I received a letter stating that Kitty has truancy issues again. The missing periods are from times that are not covered by doctor’s or hospital visits, nurse visits and/or times when I know we took Kitty home.



5. We require the Behavior Program and Ms. V (guidance counselors) notes for this school year (and it would be extremely helpful to have the Behavior Program notes for the end of last school year as well to document this as an ongoing issue). We need this information both to document the amount of time Kitty spent out of class, and because we need information as to why she was out of class so this information can be addressed in Kitty’s treatment, and court if it comes to that. We were assured at the recent IEP Meeting that the Behavior Program keeps careful documentation, and that we would begin receiving this information in some kind of summary form in the future as well. We were also assured that we would be informed of incidents that require more immediate attention (such as what Kitty described as a panic attack late last week – before giving a speech).

Mary Themom cell (###) ###-####

Founder: http://groups.yahoo.com/group/PCT_ParentsofChildrenofTrauma/

There are no seven wonders of the world in the eyes of a child. There are seven million. ~Walt Streightiff

This is the IEP Meeting Facilitator's Response:

Please see the preliminary responses to your concerns and if necessary, further discussion may continue at the IEP Meeting on October 31.

1. The Behavior Program team will keep Kitty in visual sight during all transition periods and times she is not in the classroom effective immediately. All teachers have been instructed to call The Behavior Program, if Kitty should need to leave the room.


2. The Functional Behavior Assessment (FBA) must be completed in order to determine the need for a Behavior Intervention Plan (BIP). The FBA and BIP are only one part of the process for the Special School consideration.


3. Yes, we will provide guidelines for placement consideration for the Special School along with the notes you requested from the Behavior Program.


4. We will be happy to research this - please clarify the periods in question and we will review our records.


5. We will gather the the Behavior Program notes you have requested and
   anticipate delivery to you prior to the continuation of the IEP Meeting.

Thank you, Ms. IEP Meeting Facilitator

So they are being extremely helpful. On Tuesday, Kitty was in neuropsych testing all day (I found a place that will do her testing for free, and is willing to discuss the results with Kitty, especially as it relates to her future). The school called to check where she was, and if she was OK. Today she had a psychiatrist meeting in the morning so I held her out of school until it was over. Got another call from the school today asking how she was doing.

Devil's Advocate

I keep getting madder and madder as I read over the old e-mails and information. One thing the Facilitator stated was that this meeting was not about placement, and therefore talk about moving Kitty to the special school wasn't even supposed to be on the table. Which of course is totally ridiculous.

I admit we should have gone in with more legal advice… part of the issue is the cost. Most of the Advocacy places won’t touch us because we want a MORE restrictive environment. At the last IEP meeting, we brought a friend who was a lawyer in NY (she gave up her practice because she has a kid like ours, is a single parent, and had a serious heart attack awhile back). She was our “NAMI advocate” (if you bring a lawyer then they can bring one too, and she really does do work with NAMI). They steamrolled right over her (they just kept stating their hands were tied until the assessments were done). Everyone we have ever brought in with us has said that we’re great advocates so they just stand back and watch, or this group steam rolls right over them.

Hubby pointed out that the facilitator is the same one that wwwaaaaayy back when Bear was in 7th grade wanted to know HOW we knew about the special school (because it is a big secret). She seems to be determined to make sure the school has no liability for providing services and to that end just continually repeats that Kitty is not showing behaviors in school and it is not effecting her academics. I think the school is going to make sure they follow the rule book to the letter, so they won’t get hung with a bill for residential treatment.

Honestly I didn’t see how they could argue with ALL the evidence we had, but I didn’t count on the fact that we were going to have a bogus FBA completed. I figured the worst it would say is that they didn’t observe her behavior (shut down, self-harming, depressed...), not that they were going to only use full meltdowns as the only quantifiable data. Sucky part is that Kitty’s going to have a new FIE full of this BS and we’re going to lose what little credibility the old FIE gave us.

I guess next steps is to contact ARC or Advocacy Inc again and see if they can help us fight this bogus FBA and what our option are. We can get some legal advice from Pre-paid Legal, but they’ll start charging us pretty quickly. I’ve been so focused on trying to get funding for Kitty to get into RTC that I probably let this slide.

I have to admit that a small part of me is wondering if the special school really is right for Kitty.

After 5 years of basically getting Bear as stable as possible in a structured environment that minimizes the damage his issues can cause… he is now an “adult” who is one handful of pills away from being back to his old psychotic, trauma-ridden self (in other words if he ever goes off his meds). He has never really addressed his trauma because there has been no reason for him to bother, and therefore, in many ways, nothing has changed. On the other hand, it did give him some relief from the trauma so he could mature a little. It’s a fine line.

Should we protect Kitty from the stress of “real school”? The academics are definitely worse at special school. No one cares if they’re spoon fed the answers. If we leave her at the high school will she have more breakdowns sooner so she qualifies for more services? (I have to worry that right now she’s on an upswing so if someone were to assess her right this minute they’d find that she’s not currently actively suicidal or self-harming – will we not be able to get her into residential treatment where she can work on her trauma issues and we don’t have to deal with the emotional repercussions?)

The other half of this is that while Kitty is ALWAYS suicidal (how could she not be when she thinks/KNOWS she is worthless, unloveable, unwanted, stupid, ugly and forgettable), BUT she is terrified of actual pain. EVERY time she has threatened/attemted suicide it has always been with a rescuer 5 feet away to STOP her (standing in front of an open window, laying down in the street, running away, holding a knife to her wrist - when I didn't stop her she actually put the knife down and tried something else). I do not believe she is doing this for attention. I believe this is a cry for help from a miserable child who doesn't have the ability to fix it. It can't be ignored, but at the same time I hate to rely on it too heavily when we're trying to get her services because it's NOT actually a risk.

We're 99.9% positive that Kitty would never kill herself at school. When she feels like hurting herself, she will gouge herself with her fingernails enough to cause pain, but a pain that stops immediately. Erasing the skin with an eraser was an escalation of this, but I don't believe she will ever do it again - it continued to hurt after she stopped and therefore was out of her control, plus it left a mark that was difficult to hide from others and will probably scar. On the other hand, Kitty will report to the school when she feels like hurting herself because she needs the emotional support of someone watching her.

We brought up to the school that they are risking that she will kill or hurt herself by not listening to our concerns, because they should not be able to make this determination themselves. The school's position seemed to be that this was out of their hands (hence the comment, she could be struck by lightning too). Honestly if we believed Kitty was this much at risk, we would have her in the hospital again, but we were trying to get them to acknowledge the point that she can quickly become suicidal and there is nothing they would be able to do about it under the current system (unless she decides to tell someone).

I do honestly believe if someone tells Kitty a painless way to kill herself she would probably take it (and it wouldn't matter if they lied, it would be too late!). She may not do this today, but if she's in a downward spiral or in a fight/flight mode...

*****************************************

After the meeting, trying to process the events, Hubby and I were playing Devil’s Advocate and proposed a scenario that included us saying to the school,

"OK, you don’t think she needs the special school? Then fine, show us why she needs Applied Classes {small class sizes and simplified material} at all? Academically she’s bright enough to do general ed with inclusion help, right?! {The teachers keep recommending it} She passed all her Modified State Skills tests. We'll put her back on the bus too. She's allegedly caught up on all her makeup work, so start giving her homework and treat her like a "normal student."

She’s not having “meltdowns” at school, so therefore she shouldn't need behavior staff support. She hasn’t actually killed herself at school or done more than slightly break the skin with self-harming behaviors so she shouldn't need the support of the counselor or nurse. So let’s say she can’t go to either of them at all unless she’s actually sick (fever, vomiting, rash…). She doesn’t qualify for therapy services from the school so she shouldn't need to see either the guidance or crisis counselors. Her teachers need to stop babying her as well, so no more being allowed to call Mommy or the behavior staff from the classroom phone, no leeway on homework, no excusing her from assignments like speeches, no letting her putting her head down on her desk..."

Ever since she'd returned from the hospital the second time, we'd slowed down on “applying therapeutic heat” (chores, holding her accountable, taking her to the trauma therapist she hates…), because we were too exhausted to deal with the emotional fallout, but now maybe we need to step it back up a notch. Dump the attachment therapist and go to 100% trauma therapist. The overly sympathetic skills trainer already fired herself so we don’t have to worry about her (her theory was that if she couldn't work with Kitty in school while the issues were current, then it became too much like therapy which she's not qualified to do with Kitty. Since the regular high school won't allow her to work in the school, then she "fired" herself until Kitty got into the special school which does allow skills trainers).

All I know is it’s going to be awhile (if ever), before we can get funding for RTC. Once she get in, she’s going to be out in probably a few short months. Then we’ve got to figure out what to do with Kitty next. I've contacted the partial day hospitalization program that said they could take her, except there was a "clerical error" on the part of TX Medicaid so they couldn't get funding right away. Haven't heard back yet.

I guess next steps are

• Contact the school and request information from the behavior staff on what kind of behavior they're seeing and how often they pulled Kitty from class.


• Confront Ms. BS about doing the FBA on Meltdowns instead of the school behaviors we'd discussed.


• Disallow the guidance counselor having "private sessions" with Kitty and go back to only allowing her to use the "calming techniques" taught to her by the skills trainer.


• Rewrite the "Crisis Plan" to include the behavior staff using calming techniques taught by the skills trainer and having to report episodes to me (this was discussed in the IEP meeting).


• Stop "babying" Kitty and go back to normal (for us!) chores and discipline, so we can see if this latest lull in meltdowns and self-harming behaviors is due to the latest med tweak or the fact that we've provided more structure and fewer expectations. Obviously it could be a shift in body chemicals from the bipolar, but there's no way to really prove that until the next up or downswing.


• Contact local Advocacy agencies and get ready for the next IEP meeting in 10 days.

In the meantime:

• Continue to pursue getting documentation that TX Medicaid does not pay for residential treatment before Nebraska asks for proof.


• Continue to pursue whether or not TX Medicaid will pay for partial day hospitalization.


• Push getting Kitty's clinicals to the chosen RTC.


• Get the clinicals ready to be sent to Nebraska when they find a psychiatrist who will review them (keep riding them on this).


• See if I can get Kitty's psychiatrist (once she's back from vacation) to recommend alternative education and partial day hospitalization.


• Pursue partial day hospitalization for the meantime and after release from residential.


• Deal with Bear's extensive vocational (trying to get him a job that works with his school and therapy needs) and legal needs (court date is Thursday for the ticket for driving without a license).


• The usual day to day stuff like grocery shopping, therapy (more therapy, and more therapy), neuropsych testing for Bear and Kitty...


• ...

DENIED!

Kitty's IEP meeting was today. I had requested it while she was still in the hospital two and a half weeks ago. I had sent an e-mail requesting an immediate parent/teacher conference and requesting an IEP meeting - citing my concerns for Kitty's safety, and that we felt another placement (special school) would be better. I had told them about the psychiatrists' plans for residential treatment, and gave them a letter sent by the hospital psychiatrist stating that she needed an alternative education placement (and to follow the parents' directives).

For today's meeting, I reprinted the therapist and skills trainer's letters (from an IEP meeting earlier this year) stating that she needed more supervision and services than she was receiving in her current school environment. I had brought a letter (written mostly by my wonderful friend Struggling To Stand) which I passed around. I'd also printed out the safety letter I'd sent out earlier in the week to refresh my memory.

I had requested documentation regarding the number of visits to the nurse (9) and counselor (only 2 documented), but wasn't given access to the behavior staff visits and class pullouts (a lot I'm sure). Of course her panic attack yesterday (she was supposed to give a speech) and all the visits to the nurse since her last hospitalization weren't documented. I'd also printed out her grades (but never bothered to pull them out).

We were told that the results of the FBA (Functional Behavior Assessment) were ready so these would be discussed at the meeting. We knew the FBA was a requirement for a change in placement so had requested that the results be discussed even though the entire FIE {school version of a psych eval} wasn't complete yet.

Those in attendance:

• Kitty - for only the first half of the meeting while they gave the results of the FBA - {during which she ate lunch, because she'd forgotten to pack one, and was supposed to take her morning meds, which she'd forgotten this morning, but forgot them AGAIN! I'd taken Bear to a meeting so wasn't there this morning when she got ready, and Hubby didn't know how much reminding she needs.}



• Hubby and I - {I have to say I was VERY impressed with how much restraint he showed during the meeting, the few times he lost his temper he managed to rein it in very quickly.}



• Kitty's MHMR Case Manager (affectionately known as "the useless lump of flesh") - who only spoke to ask repeatedly why Kitty's skills trainer couldn't come on the school campus, when other schools allowed it. She was told over and over it was "district policy" and wouldn't be allowed, and they had no idea why other schools allowed it. That's all she contributed to the conversation.



• IEP Meeting Facilitator - who has told us repeatedly that Kitty is doing fine in school so therefore there is nothing the school can/ should change regarding her placement.



• Mr. New AP - who replaced the old Associate Principal two weeks ago. He was distracted toward the end by something going on with some students and basically kept pushing to wrap things up since we weren't going to get anywhere on placement changes and were out of time.



• The Behavior Specialist (hereafter known as Ms. BS) - this is the one I've spoken to on the phone. She only works part time on the campus so I'd never actually met her before. She had interviewed me, the teachers and observed Kitty in class, and written up the FBA. {The FBA determines if a child needs a BIP - Behavior Intervention Plan (apparently Kitty does not - according to the Behavior Specialist). Allows them to come up with behavior items to place in Kitty's IEP. And of course can show if Kitty qualifies for a change in placement.}



• District Behavior Specialist - she didn't talk much. Never seen her before. I'm guessing she was there to make sure no one spoke out of turn.



• School Casemanager - she taught Kitty last year, but doesn't actually have her in any classes this year. She didn't talk much either. Except to say that Kitty was supposed to communicate to her with hand gestures any time she saw Kitty in the hall, about how Kitty was feeling {Get your mind out of the gutter! Thumbs up, thumbs down or off to one side for so-so}



• General Ed teacher - never met this teacher before. She teaches "Reading 180." She didn't speak at all.

Who noticeably wasn't there:

• The part-time school psychologist - who'd actually spoken to the hospital social worker about his recommendations for Kitty, and has been doing testing with her.



• The school guidance counselor - who Kitty is supposed to go to if she's feeling overwhelmed and stressed. Who has actually seen Kitty as close to a meltdown as she gets at school, and has had to send Kitty back to class when she absolutely doesn't want to go because she doesn't feel safe or feels overwhelmed.



• The behavior program staff - who have been interacting with Kitty all school year when she gets upset.

They started by reading the results of the FBA.

A month or so ago I was contacted by Ms. BS for a phone interview. She asked me what was my primary concern for Kitty. I informed her that MY primary concern was the meltdowns (which were happening once or twice a day), and she asked me several questions about what comprised and caused meltdowns. I told her many times that I know that meltdowns only happen at home, and my concerns at school involved her obvious anxiety (which was contributing to the meltdowns at home) as evidenced by Kitty "shutting down," frequent trips to the nurse and counselor, self-harming behaviors, poor boundaries with peers, nervous laughter and pressured speech... which of course she was internalizing and bringing home where it was "safe" to express (in meltdowns and suicidal ideations).

The FBA stated that Kitty was being assessed for "Meltdowns" (described as crying, screaming, yelling, threatening self or others) through observations and interviews with school staff (including her case manager who no longer has Kitty in any classes).

The FBA found that KITTY DIDN'T HAVE MELTDOWNS AT SCHOOL!

I know, you're shocked right?! Therefore based on the FBA results it was determined that Kitty did not need a BIP (Behavior Intervention Plan).

In the process of interviews, it was determined that Kitty's frequent visit to the nurse's/ counselor's office might be an issue. (although the nurse "didn't see the frequency of the visits as a problem at this time"). So they added added a Behavior IEP:

Measurable Annual Goals: Kitty will improve her emotional well being by mastering short term objectives by the next annual IEP meeting.

Short Term Objectives:

• Using a scale, Kitty will verbalize or express her feelings to a trusted adult in the school setting a minimum of 5 times a week {this will be a thumbs up, thumbs down, thumb to the side gesture to her case manager and/or the AP}.



• When Kitty is expressing anxious feelings, she will request the assistance of a trusted adult 5 of 5 times.

We then moved on to discuss her "Crisis Plan." Hubby showed a great deal of restraint. (*understatement*)

Basically we were told the Crisis Plan that was already in place looked great and although they tweaked it a little, we ran out of time.

At one point, Hubby confronted them on the fact that they were stating that a child only 2 weeks out of the hospital for suicidal ideation and self-harming behaviors, was to be trusted to tell someone if she felt like harming herself. He asked them what they were going to do if Kitty left the lunchroom walked into the bathroom and hung herself. The AP stated well, she could walk into the school and be hit by lightning too. I asked him if he was seriously comparing the odds of being hit by lightning (while inside a building) with the odds of a teen recently hospitalized for suicidal ideation of actually committing suicide. He backed down a little.

Hubby and I kept trying to discuss the real issue of placement, but were told in no uncertain terms that the FBA clearly showed Kitty did not need other placement.

We were told that the letter from the hospital social worker signed by the psychiatrist only stated that Kitty "be considered" for admission to an alternative education environment and the statement to "accommodate Kitty's academic and social needs per the family's request" was not within the psychiatrist's power to grant.

Summary: There is nothing wrong with Kitty at school. Therefore nothing at school will change.

We have been granted another IEP meeting in 10 days since we disagreed with the results of this one (but mostly to finish revising the "Crisis Plan". We weren't even offered the page to sign if you agree or disagree. Possibly because this is was a Revision IEP Meeting.

No Animal Left Behind

No Animal Left Behind

Sorry I haven't kept y'all up to date. It's been crazy busy around here.

Could use some prayers tomorrow.

8am Take Bear to DARS (Dept. of Assistive and Rehabilitative Services) to see if they can find him a job - he has no car and is still in high school, but his court date for driving a car without a license is next week and he promised the car's owner he'd pay $100/month for the next 5 months and has NO money. {Today I was dealing with the fact that he's apparently been tardy (up to 20 minutes!) to his last period classes and no one is bothering to report it. This of course "teaches" him that this is OK. Which is going to be great when he tries to get a real job. Plus of course, where is he during this time?

He still cannot get the concept that he MUST be "Where he's supposed to be. When he's supposed to be there." He seems convinced that if he's not "in trouble" - meaning being overtly punished - then there's no problem. He had a strong reaction to the new Level privilege system at home, because Level Systems remind him of his many times in treatment programs and the special school. We tried to help him understand that he's ALWAYS on a level system, we just haven't bothered to write it down before. He's pretty much on level 2 (out of 5) which is why he has so few priveleges. I think he actually prefers this much supervision and structure though so I need to stop letting this surprise/bug me.

Last night he lost his internet privileges (Hubby changed the network password) because he hasn't done chores in weeks. I spent 2 hours at home with him ranting about how he couldn't access the internet, or reach Hubby - who was at soccer practice with Ponito. He didn't know that I knew what was going on. When he finally got hold of Hubby he got pretty angry and was in total denial. Hubby got the brunt of it, but I went to bed that night with a sick headache. I rarely get headaches, and this was a doozy. *sigh*}

9:05am Kitty has to be at school (she's still not allowed to take the bus). It's 30 minute drive from where Bear's appointment is and I have no idea how long that will take. Hopefully Hubby can take her although he's missed a LOT of work this week due to appointments (Bear's IEP meeting, meeting with the MHMR casemanager aka "useless lump of flesh," skills trainer and new supervisor - who decided to pull Kitty's skills training services because she was using them like therapy and she's "too severe" for that. Makes sense right?! Whatever.)

11am Meet with the TX Medicaid Casemanager to see if I can get her to acknowledge (and help me find someone who'll put in writing) that TX Medicaid does NOT pay for residential psychiatric treatment so I can provide documentation to the state of Nebraska so they will pay for it as promised. {After I spent all day Friday calling her list of "RTC"s that weren't really RTCs or didn't take adolescents or didn't take Medicaid -no one does! I informed her Monday I was done with her list. Wednesday night she called me and told me she was out of town. Today she called and said she'd re-called one of the places I'd spoken to and they would take Kitty. I informed her I knew that, but it wasn't MEDICAID paying for it, and this place that uses community funds was one step above Juvie and I needed documentation stating that Medicaid wouldn't pay for RTC so I could put Kitty in a private RTC that might actually HELP her. She gave me another phone number for Medicaid and said they wouldn't speak to her about benefits. I called them and asked do they pay for RTC? They said, "No." I asked would they put that in writing. They said, "No." I would have to talk to the local Medicaid office. I informed the Medicaid casemanager of this and she was shocked. Don't know why. I'd just been telling her ALL ALONG that TX Medicaid does not pay for RTC! I still think it's weird to have Freelance Contract Casemanagers.}

2:45 IEP meeting to determine whether or not the school district is going to let Kitty in to the special school for emotionally disturbed kids that she desperately needs (although doesn't want). {Still think it's pretty good odds that she won't get in despite all our documentation. I think they're going to fall back on their observations and state that she's "fine" in school. Did I mention that this week they gave her a Language Arts assignment to write about her childhood - which was reviewed by one of her peers? Her teacher was asking her about how her biosisters are doing. She informed me that she'd lied some on the report and not talked about the sexual abuse. I told her that was fine. In another class she was supposed to write about a "Family Emergency." She couldn't think of anything else so chose to write about her half sister's half brother who had lived with them when they were younger, and was shot at age 16 under mysterious circumstances (possibly by his younger brother, possibly by his mother's boyfriend who convinced the younger brother to take the blame, and some more possibilities even more sordid). Kitty worshiped this boy who once pierced his nose just to make her smile. She hates Bear for accusing him of sexually molesting Bear. Can you say, "Opening a can of worms?" Can you say, "NOT a therapist?" Can you say, "This kid has only been out of a psych hospital for less than 2 weeks?"... I knew you could.}

5:30pm Take Kitty back to the trauma therapist that she HATES, who usually triggers a meltdown (temper tantrum) in Kitty, but the trauma has to be addressed or we're going to end up with another kid like Bear, who has not even touched his issues, and the second he goes off his many meds will become psychotic and scary. {Did I mention that he applied for the military? I wish they WOULD take him, but he's not really eligible because of his diagnoses and medications. One more thing for him to pout over, and find a way to blame on me.}

6:45pm We're supposed to be at dinner with Grandma and the rest of the family, but therapy always runs over {did I mention being late for food is a trauma trigger for Kitty?}

Throughout it all I have to

• finish gathering documentation for the IEP meeting showing Kitty needs this special school




• continue to research residential treatment centers to find a good one for when/if we finally get authorization for treatment (that was supposed to happen when she was released almost 2 weeks ago).




• find someone to fix the big TV (it won't turn on, just makes a clicking noise)




• clean the house before the Medicaid lady gets here




• deal with a pouting 18 year old who lost his internet privileges because he hasn't been doing his chores




• ... and all the things that the mother of four kids, including two who are special needs, has to do on a daily basis

This vs That

He Said/ She Said

So we walk into the Principal's office and he invites us to sit down and asks how he can help. Then Hubby did something totally frustrating. He started at the beginning.

He started talking about how we came to adopt the kids almost 5 years ago. I don't think the principal knew much about us, but at one point he'd either randomly decided that we were trying to get the school to pay for residential treatment (not that we'd be adverse to it) or he really did know more about us than he'd/we'd thought, and let us know the school district hadn't paid for residential treatment in over 25 years.

Hubby and I have had many discussions about me interrupting him, talking over him, and taking over conversations. I'm always exhausted and therefore I apparently do this often. I do know that my short-term memory is shot so I tend to speak my mind before I forget it!

So I was nervous about taking over the conversation, but I felt we were headed down a rat hole with this particular conversation, so I jumped in anyway. I explained that our primary concern was the safety of Kitty, particularly during unstructured times like in the hallways and a lunch. The principal assured me he'd look into it. Not holding my breath that anything will come of it. (Ironically Hubby describes this conversation differently and felt it went well. He told Grandma the main reason he'd initiated the conversation was because he felt I was overwhelmed and he wanted to "fix it."

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TEXAS MEDICAID/ NEBRASKA MEDICAID

We've always known that TX Medicaid stinks when it comes to providing mental health services (there's a reason we're like 48th in the country when it comes to mental health services). So we delayed the kids' adoptions for months to have residential treatment written into the kids' adoption subsidies. Many months ago we tried to get Nebraska Medicaid to pay for intensive outpatient/partial day hospitalization (not covered by TX Medicaid) and they absolutely refused because our agreement was for residential treatment (RTC) only.

Now we had two psychiatrists stating she needs RTC, no private insurance to confuse the matter, and every RTC I had approached (given tons of numbers by TX Medicaid - none of which actually accepted TX Medicaid and most of which weren't actually RTCs) looking for someone who took TX Medicaid, had stated that no one took the type of TX Medicaid we had... so I figured we had NE Medicaid in the bag!

I called them and discovered that they'd had a major revamping of their system. I was told that NE wouldn't even look at whether or not she qualified for RTC unless she already had NE Medicaid. The only way she could get NE Medicaid was if she was physically in Nebraska and no longer had TX Medicaid (earliest that could happen was November 1st. Then she had to show that she was severe enough to need RTC, but capable of responding to treatment in 90 days... and we decided that the price was too high to pay.

In the meantime I was still trying to get Texas Medicaid to put in writing that they wouldn't provide RT. We managed to get a case manager and I met with her today. She seems to think she can find an RTC. Now I'm worried that she will! Then we'll be stuck with whatever program they scrounge up.

My friends have only recommended 3 places in Texas as being semi-decent. One, we've already sent the kids to, and it's great for diagnosing and proper medication, but stinks for therapy - which is what Kitty needs. One has a mixed review, basically it depends on which therapist you get. Both of these accept NE Medicaid. The third was the most recommended, and I've been playing phone tag with them for over a week. No way TX Medicaid would pay for the the first and last, and probably not the second.

Just to make things more complicated. Nebraska called last night. They've decided to eschew NE Medicaid and provide funding from another source. Which means we'd keep TX Medicaid for any medical health issues that crop up, and can choose (within reason) the treatment center.

Now I have to wait and see what RTC options the new TX Medicaid case manager comes up with tomorrow (assuming that she does), and then call all of them to see if they're valid options. If not, then maybe we can see if Nebraska will step up and we can go straight to the RTC we prefer.

Have been talking to Pre-pa*d Leg*l so that when we're ready we can charge forward when/if we need them.


****************************************

TO MED OR NOT TO MED

Met with Kitty's psychiatrist today. We talked about changing Kitty's meds. I want to try Lamict*l because I've heard it's often a "miracle" drug for kids with bipolar (it certainly was for Bear), and I've also heard it's beneficial for people with brain injuries (which both my kids have). We tried Kitty on it many years ago, but she's prone to hives and Lamict*l is associated with a fatal rash, so every time Kitty got hives they'd yank her off the Lamict*l until they subsided. It takes forever to work up to a therapeutic dose, so I got tired of putting her on and pulling her off.

The new pdoc doesn't like Lamict*l, and feels that Kitty's issues are not med based so doesn't want to make any changes. I keep hoping that since Kitty was stable for over a year, that maybe there is a med out there that would help. The pdoc said that while she doesn't know Kitty very well yet and Kitty's not old enough, that she's seeing a lot of traits of borderline personality disorder. This is not a surprise to me. Believe me, we see it too!


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SCHOOL KITTY / HOME KITTY

Behavior testing is finally done (supposedly), and now the school psych has to write it up and have it ready for presentation at the IEP Meeting in a week and a half. As far as I can tell she didn't talk to the guidance counselor yet.

After complimenting me on the level sheet and chore charts, The TX Medicaid case manager did suggest that I apply myself to a thorough list of all the reasons Kitty should be in the special school for emotionally disturbed kids that we've been trying to get her into (the one that Bear is in part-time). Yes, Beemommy this is the small campus for kids like Kitty! So now I need to find the time to sit down and do this. I have it in places, but need to make sure it says what I need to say clearly and logically.

I got the letter from the psychiatrist at the hospital, which I think will definitely help us with getting Kitty in the special school.

“Due to three separate inpatient psychiatric hospitalization at the Hospital in 2011, it is recommended that Kitty be considered for admission into an alternative education environment. Consistent with her behavior at the hospital, Kitty may present with little psychological distress while at school. Nevertheless, providing an educational setting that minimizes interpersonal and environmental stress may help Kitty regulate her mood and behavior in all phases of her life, at home and at school. Please accommodate Kitty’s academic and social needs per the family’s request.”

Kitty's safety

I sent out this letter on Friday to all of Kitty's teachers and the school admin. I had forgotten that Monday was a school holiday.

Kitty will be released from the Hospital either today or Monday, in which case she’ll be back in school on Tuesday at the latest. Her IEP meeting is not scheduled until October 21st at 2:25pm. In the meantime I am very concerned about her safety, therefore I am requesting a parent/teacher conference ASAP.

As you know, Kitty is returning to school after her second psychiatric hospitalization in less than 2 weeks (4th psych hospitalization this year). Her psychiatrists are recommending residential treatment upon release from the hospital; however we are struggling to secure funding, so she will be returning home for now. Obviously an RTC-bound special education student simply does not meet the criteria of the lesser restrictive environment.

Safety: Kitty is in a state of unstable mental illness that includes self-harming behaviors and suicidal ideation. During her educational day, Kitty’s mental status must be monitored by qualified staff that do not have their attention constantly diverted by the needs of many other students. Although we have all been lucky that Kitty appears to have not made any suicidal gestures at school without alerting someone to her state of mind, this behavior cannot be relied upon! To require Kitty to be responsible for knowing when she needs help puts Kitty’s life in danger.

For Kitty’s safety and protection, we are requesting the maximum equivalent education environment and accommodations to residential psychiatric treatment that the school district can provide. If the school cannot offer the accommodations Kitty needs, even if they are on a temporary or trial basis, then she must be placed elsewhere, immediately. I don’t think any of us want Kitty to hurt herself or anyone else while on campus or to have to be return to the hospital.

Areas that Kitty’s current Crisis Plan does not address:

• There are no description of interventions and supports beyond the behavior program staff taking her to nurse or counselor’s office for assessment


• At what point should parents take Kitty home if not sick (fever, rash…) – what are the alternatives?


• How should we handle the large chunks of time that Kitty is spending in the nurse’s/counselor’s office instead of class?

What to do when:

• Kitty is not willing to return to class from nurse’s office, despite not being sick (fever, rash…).


• Kitty is having subjective symptoms – exhaustion, headache, stomach ache…


• Kitty is exhibiting self-harming behaviors.


• Kitty is feeling she is not “safe” (in particular from urges to self-harm unless she’s being actively supervised by someone aware of this behavior, but also from threats, criticism, and judgment of others– real, implied or perceived)


• Kitty is exhibiting signs of stress* and being overwhelmed but is not requesting support (*feeling ill or tired, non-participation in class, inability to focus, sleepiness/head on desk, vibrating body parts, self-harming behaviors, pressured speech or laughter, disruptive talking or laughter, inappropriate emotional responses, lashing out physically or verbally …)


• Kitty is having difficulty during unstructured times such as between classes and lunch (she no longer rides the bus so before school is no longer an issue, but after school…)


• Kitty is feeling overwhelmed or stressed (we had discussed sending her to the NON-behavior specialist, Ms. V).


• Kitty is discussing her issues/concerns/ stressors with a non-trained professional (such as nurse and Ms. V) vs. a trained behavior specialist {I did find out later that Ms. V has a counseling degree}

I can be reached at (###)###-#### or home (###)###-#### and of course via e-mail marythemommy@gmail.com.

Mary

************************************************

On Monday evening I got this response:

Hi Mary-

We would like to have a parent - teacher conference to discuss your safety concerns regarding Kitty. In order to gain pertinent information regarding Kitty's safety at school,the school psychologist, has tried to contact, Mr. B, Kitty's psychiatrist, at the Hospital and has been unsuccessful. She is unable to leave a message as his voicemail box is full. This would be valuable information to have prior to the conference.

Thank you,

The IEP Meeting Faciliator

*******************************************************

My immediate response:

Actually Mr. B is the social worker. Her psychiatrist was Mr. L. We’ve had difficulty getting in touch with Mr. B as well. I know he was out sick today so I was unable to get any info from him when Kitty was discharged this evening.

So how should we proceed? Kitty is still very emotionally volatile and unsafe. She really needs this extra supervision.

I feel I should warn you that tonight Kitty went to an adoption teen support group with her siblings, and despite my warnings ahead of time not to burden other kids with her issues, she proceeded to monopolize the group, divulging to a brand new group leader she’d never met before, and all present (including her siblings) about how much she wanted to stay at the hospital, and her sexual abuse history among other things. Apparently all of the children present were extremely uncomfortable, and all of her siblings are now furious with her. Kitty didn’t seem to understand the boundaries she’d crossed. They’ve been attending this group for years, so she should know better. I’m VERY worried about what she’s going to say to her friends at school.

Mary

*********************************************

Tuesday morning I took Kitty to school and immediately started trying to make sure that she was going to have the support and supervision she needed. No one knew anything about a parent teacher conference.

Then I discovered that our favorite Assistant Principal who knows us and Kitty and Bear and has always been uber supportive... got a promotion and his last day was Friday. *AAARRGGGHHH!!!!!*

So I spent a couple more hours waiting to meet the replacement AP (Of course I kept busy getting attendance reports, info on how many times Kitty went to the nurse's office - she'd already gone once that morning for a bandaid, and making tons of calls to TX Medicaid and NE Medicaid and half a dozen other people). I ended up meeting with a different AP, still not sure why. She was very sympathetic and sounded like she was going to make sure Kitty was taken care of (specifically lunch), but as I walked out the door, she walked into another meeting.

I decided to run by Ms. V's office to get records of how many times she'd interacted with Kitty. While I was waiting to speak to her, Kitty showed up. She didn't feel good (stomach ache and tired) and wanted to go home. She'd already eaten her large lunch (at the beginning of second period - an hour and a half before her actual lunch time), and she was starving! I told her that was up to Ms. V. We cuddled while we waited.

Ms. V talked to Kitty for about 30 minutes (I mostly listened). She let Kitty vent, and yell at me for not "trusting" her enough to back off on making the school protect her by escorting her. To which I responded, "You're right out of the mental hospital. I CAN'T trust you right now. You need to show me with your behaviors that you can handle this, not just say it with words. Then Ms. V basically said, you're getting old enough that you need to start acting like an independent adult - to which Kitty continued to rant about me not giving her the chance.

Then Ms. V said, "OK, it's time to go back to class."

Kitty's reaction was almost comical. The teen who had been almost rationally insisting that she just needed a chance to show me that she was ready to be trusted with independence in the hallways, not to hurt herself, and handle her feelings... immediately melted. We tried to point out that she'd just said she was able to handle it, but Kitty was not rational. She'd thought she was going home. Still, Ms. V, did not give her any options and sent her back to class (with an escort from the behavior staff).

When the escort showed up I tried to confirm the plans for Kitty to be supervised at lunch. She knew nothing about it. Frustrated I tried to explain to her the need for supervision, in front of Kitty who totally disagreed. Finally I just said it was what the AP and Ms. V had agreed to. The escort went and talked to Ms. V, and they compromised by telling Kitty she had to stay in line of site of one of the teachers. NOT what had been agreed to, but I wasn't given a choice and didn't know what happened until after school.

***********************************************

I left the school totally frustrated and went to Grandma's for lunch. Called Hubby and expressed my frustration. He decided that we needed to go over to the school and talk to the Principal of the school. I thought that was jumping too many levels, but he was insistant. So he took off work, and since I got nothing but voice mails we just showed up.

The Principal was happy to talk to us. Of course he knew nothing of our kids (although he had heard of Bear's joyriding escapade last month - just didn't know Bear by name). The school has over 3000 kids.

Will tell you what happened tomorrow. I'm tired and still need a bath.

Our potential TX Medicaid casemanager will be here early tomorrow and I still need to clean the house.

Getting Burned

Kitty has now been in the hospital for 6 days. She was home for only 7 days after her last hospitalization and honestly should have gone back sooner, but Bear had a neuropsych appointment (free through a University research group!) that we couldn’t cancel, and so she came with us. We knew that she would be fine while being supervised by all the grad students and she loved it. Plus the hospital tends to discharge patients on Mondays so we knew they’d be more likely to have a bed available if we waited until Monday.

Despite the fact that she is obviously not stable, it is not possible to keep Kitty at the hospital longer. Technically Medicaid only pays for 5 days. If they keep her longer it will only be if they can justify it based on her behavior. I spoke to the hospital social worker Friday morning and he warned me that she seemed stable enough to send home that day (at least according to Medicaid standards). Since she shuts down and internalizes if she possibly can, I asked him if I should, as her attachment therapist puts it, “apply therapeutic heat” aka “poke the bear” to get her to show enough emotion to qualify her to stay. He said he couldn’t tell me to do that, but I chose to read between the lines and decided to do it anyway because this weekend was going to be nuts and I knew she couldn’t handle it:

7am –noonish Garage sale (NOT my first choice to do it this weekend, but I was already committed)
9-noon Bear has Saturday school detention (for skipping school to joyride in the borrowed car)
3-4pm Bear has therapy
4-? Ponito has a soccer game
5-7pm Bear has to be at the University for neuropsych testing (which I was supposed to be working on all the paperwork for, but didn’t have time)
And to make the weekend complete? Grandma and Poppy are out of town so won’t be helping out like they usually do and we won’t get respite Saturday night.
Sunday
9-12pm Church (Bob teaches Sunday school)
12:30 – 3pm Lunch at Grandma’s! (Assuming she’s up to it after being out of town all weekend)
2-? Ponito has another soccer game

Plus throughout the whole weekend I knew I was going to be on the phone trying to find out how/if to get funding for residential treatment for Kitty. We’ve always know that Texas ranks 48th in the country for mental health services, and were blessed to be warned by my friend Lisa to have residential treatment written into our adoption subsidy agreement. So when I finally tracked down enough proof that Texas Medicaid wasn’t going to pay for residential, and the only place that would take her does sliding scale fees (which we can’t do because Hubby makes too much and they don’t take into account our debts).

Of course if they decided to send Kitty home on Friday anyway then that “therapeutic heat” was going to burn ME in the bum! On the phone Friday, Kitty asked me if she was going to be allowed to ride the school bus (not a privilege she’s eligible for until Level 2) . I chose to let her know that not only was she still not going to be allowed to ride the bus, but that I was asking the school to provide supervision during less structured times (between classes, lunch…). She immediately told me she wanted to hang up (our calls are usually only 5 minutes anyway), but I made her stay on for a few minutes longer to really turn up the heat and she actually decided to process this with her social worker. I’m assuming it “paid off,” since she’s still at the hospital, but of course now she’s furious with us.

The complicated part is that Nebraska has decided NOT to pay for residential treatment despite our adoption subsidy agreement. So I’ve been on the phone to everyone trying to figure out next steps.

Here’s what I found out so far: Nebraska has “revamped” (read as “broken”) their Medicaid system. Now mental health is no longer considered a medical issue so is treated differently. Anything that can’t be fixed in 90 days of RTC is considered “chronic” and therefore untreatable. So ADHD, Autism, RAD, ODD, Conduct disorder… no RTC coverage. The criteria is that the child has to not be bad enough for acute care, but need more than therapeutic foster care (which probably has to be tried first… at $88/day out of our pocket). The criteria to be hospitalized that she meets is feeling suicidal. If she doesn’t appear to be making progress, then she’s discharged. If she makes enough progress to not appear to need RTC, then she’s discharged. First priority for placement would be IN Nebraska, not Texas. If she gets physically ill while in the hospital (appendicitis, asthma attack, thyroid issues…) it comes out of our pocket. To top it all off, we would have to give up Texas Medicaid to get on Nebraska Medicaid, and would be taking a chance that we couldn’t get it back. Since her current meds cost over $2K/month… that would be BAD. So looks like we won’t be making the trip to Nebraska after all.

I have no idea how we’re going to handle her being home. Honestly while she might do some self-harming (80+% of the time she doesn’t even leave a mark), I don’t actually think she’d commit suicide. I don’t think she’ll use an eraser on her body again either! It hurt too much. BUT she’s still very emotionally volatile and unstable.

I talked to our EMDR, trauma therapist on Friday night. For years, she has been the only one saying Kitty needs RTC, but since she was the ONLY one saying that, I'd kind of decided that she was over reacting, because my Kitty isn't usually violent, is attached (anxious), and was making progress (when we got her at age 11 she was practically feral, and now can take some direction... if phrased correctly and she's in a good place emotionally).

This time I was ready to listen to the therapist and she said in her 30+ years of working with seriously disturbed teens, that Kitty was the worst she'd ever seen. She thinks that there is something else wrong (besides bipolar, RAD, C-PTSD, ADHD...). She doesn't think it's borderline personality disorder or Dissociative Identity Disorder (multiple personality disorder) either (although Kitty definitely shows some signs).

Over the years I've readjusted what I expect from Kitty, and I knew she'd always have major issues, but I'm feeling pretty despondent now. Now that I have multiple pdocs saying she needs to be in long-term RTC, it makes it more real that she's probably as good as she's going to get, and this is pretty scary. Especially if we can’t get her stable.

OMG! OMG! OMG!

Freaking out now!

Kitty (adopted from Nebraska foster care 3 years ago) was just rehospitalized (after being out for only a week). This makes her 4th psych hospitalization this year.

We've always known that TX Medicaid doesn't provide long-term residential psychiatric hospital (RTC), so we specifically had it written in to both kids' adoption subsidies that Nebraska would pay for RTC (negotiations delayed finalization several months, but my good friend Lisa recommended it because she hadn't added it and RTC had cost her tens of thousands of dollars). Since Bear was actually IN an RTC at the time, it made a lot of sense.

We knew that to access the service we would have to prove that:

1) she needs the services (NOT a problem, we have 2 psychiatrists who'll state that she needs to go straight to RTC from the hospital, and she's already been hospitalized 4 times this year, twice in the last 2 weeks) and
2) that we've exhausted all other funding sources (TX Medicaid doesn't cover RTC and the school system won't pay either).

We tried to access the funding 2 years ago, when our private health insurance would only pay for 8 days of RTC for Kitty. She was denied, but we were told that was because our insurance had denied her so Nebraska Medicaid felt that she didn't meet the first criteria.

I finally got hold of someone in Nebraska and they say rules have changed, and they won't pay for anything unless Kitty ALREADY HAS NE Medicaid, which she can only get if she LIVES in NE.

IF we get her to Nebraska, AND they decide to give her NE Medicaid, AND they determine she needs RTC (and NOT therapeutic foster care for which we'd have to pay $88/day room and board), THEN oh by the way, we would have to pay for any medical issues not specifically handled by the RTC (so if she gets appendicitis, has an asthma attack, or her thryroid issues turn out to need treatment... then we have to pay for that treatment out of pocket).

So my choices are:

1. To leave my husband and other children and move to Nebraska for an indeterminate amount of time (probably at least 2 weeks) to get her to all the appointments with Nebraska DHS to get her NE Medicaid, and eventually examination by a Nebraska psychiatrist). Then, if we can get her admitted to an RTC, it will probably be to a Nebraska RTC (even though there are at least 2 RTCs in the area that have taken Nebraska Medicaid in the past). At which point I can return home, leaving her in Nebraska for up to a year.


2. To keep taking Kitty to acute care hospitalization, while Hubby continues to try to find a non-contract job with medical insurance... which will necessitate a pay cut... which means we won't be able to keep up with our massive debts (from the purchase of and trying to keep our company afloat for three years) OR try to get a job myself - that has health insurance and won't mind me leaving every 10 minutes to deal with Kitty, won't mind me leaving often to take the kids to appointments and attend meetings about the kids, plus, leaving by 4:30pm to be home in time to supervise Bear after school, and of course won't care that I never sleep due to stress and therefore am not always coherent... ).


3. Find the money to hire a lawyer and force SOMEone to pay for Kitty to go to RTC.

Did I mention I'm supposed to have updated Bear's 35 page Life History by tomorrow (haven't touched it in 6 months at which point I had decided to completely revamp it based on info from sibling therapy, but then dropped it when I got busy... so it's pretty much a mess.

Plus, my good friend and neighbor and I have been talking about having a garage sale for months (I desperately need to empty my completely full 3 car garage - we've been saving furniture and things for a friend who now cannot afford to come get it... although if I'm driving to Nebraska then I can swing by her house with a rented trailer... hmmm!). Of course the community-wide garage sale is THIS weekend. So she wants to have it THIS weekend. Most of the stuff is in the garage and I rarely price or organize things, but there is a ton of clothes and other things in my bedroom that need to be gone through.

Hubby is not working this weekend, but Bear has 9am to noon Saturday detention, 3-4pm family therapy, and a 5-7pm meeting with the research group that is doing his NeuroPsychological exam. Ponito has a 4pm soccer game. And Grandma and Poppy are out of town. So a 7am to noon garage sale is nuts.

This is all assuming that Kitty won't be discharged until Monday. It's entirely possible she might be released on Friday.

How am I going to get this all done?!

Revised Letter

Check out this great article my friend Terry sent me. It really helped me accept these changes. http://www.wrightslaw.com/advoc/articles/Letter_to_Stranger.html

Now that I got the impassioned, emotional, LENGTHY version out of my system. I'm ready to accept this amazing version that Struggling To Stand wrote for me, and save the version with all the research and documentation that she and my good friend Terry provided, along with all the specific details, for the actual meeting.

To: ARD team
Re: Kitty IEP meeting

We feel it is imperative that the school district, as represented by this IEP team, recognize that Kitty's need for safety, as well as her rights to access to education, and her academic goals are not being met. Kitty is returning to school after her second psychiatric hospitalization in less than 2 weeks (4th psych hospitalization this year). Her psychiatrists are recommending residential treatment upon release from the hospital; however we are currently unable to secure funding so she will be returning home for now.

1. Safety: Kitty is in a state of unstable mental illness that includes self-harming behaviors and suicidal ideation. During her educational day, Kitty’s mental status must be monitored by qualified staff that do not have their attention constantly diverted by the needs of many other students. Although we have all been lucky that Kitty appears to have not made any suicidal gestures at school without alerting someone to her state of mind, this behavior cannot be relied upon! To require Kitty to be responsible for knowing when she needs help puts Kitty’s life in danger.


2. Access to Education: As noted in Kitty’s current FIE, Kitty’s way of handling her mental viability is to withdraw by either physically leaving the classroom or by “shutting down” (often putting her head on her desk.) Kitty’s withdrawals are not always obvious to an observer. During these times of withdrawal she cannot access the education that is being offered to her.

• Kitty withdraws for so many different reasons it would be impossible to list them all, much less address each individual one in an attempt to prevent her from needing to withdraw during active academic time.


• Because Kitty is being “taught” without regard to her frequent withdrawals due to her mental disability, she is being denied access to education and the school is in violation of the law.

3. Academic Goals: If Kitty’s current grades are in the acceptable range that is only because she has been “forgiven” grades, had assignments dropped, not been penalized for lack of classroom participation, etc. While these modifications are appropriate for a child who has been hospitalized for, say, appendicitis, they only serve to mask Kitty’s lack of academic progress due to her increasing mental disabilities.

• Every year the IEP team has requested and evaluated whether Kitty can be placed into general education classes with inclusion help. This request is made because it is believed Kitty can, from a purely IQ point-of-view, learn in such an environment. Assuming this is correct, Kitty’s mediocre progress in special ed classes show that the modifications currently in place for her are not allowing her to be “academically successful.”
  

Placement

According to the legal definition of LRE, Kitty is NOT in the Least Restrictive Environment APPROPRIATE to her as the nature and severity of her mental disability is such that her education is not being achieved satisfactorily. Her placement is inappropriate.

Since we have been told that Kitty is already receiving the maximum accommodations that the high school will provide, it is clear that Kitty’s most appropriate placement at this time is therefore at an RTC.

To that end, and in compliance with her psychiatrists’ recommendations, we are officially requesting that Kitty’s placement be changed to inpatient RTC with all expedience possible. If this IEP team does not agree to such placement, then we will place her in an RTC ourselves and bill RRISD for the costs.

Mary and Hubby

Please Review for me!

I plan to send this to the school along with a letter from Kitty’s social worker at the psych hospital with his/the hospital's recommendations for Kitty.

Please let me know what you think I should add/take away (I know it needs some IEP transition to adulthood goals - since Kitty is on the “minimum high school plan” instead of college track these can/need to be addressed).

I spoke to the IEP Meeting Facilitator yesterday and she implied that while they would hold an IEP meeting because I requested it, that she felt nothing needed to be or could be changed (she’s the one I refer to as saying Kitty’s “academic needs are being met,” and the new FIE is not complete, so there is no point in holding this IEP meeting). Their plan is to continue with status quo because Kitty is already receiving the maximum accommodations that the high school can provide and isn’t acting out in school, but obviously this is not working.

As of now, Kitty needs RTC (residential treatment center - long-term psychiatric hospitalization), but we’re waiting on funding from Nebraska. I don’t actually believe the school district will pay for RTC, but it can’t hurt to let them know I mean business right?

Oh and THANK YOU Struggling To Stand for all the research you sent me and hooking me up with ARC who also provided valuable info! I couldn't have written this without you!

ADDRESS the WHOLE CHILD!

Kitty needs to be able to function both at school and at home. If she’s “functioning” at school, but then coming home with all her internal resources depleted resulting in emotional breakdowns and hospitalizations then how is that addressing her needs?

Changes need to be made because she is clearly not functioning with the current system at school. It is unacceptable that she has to continue with no interventions or supports from trained professionals at school where she spends the majority of her day.

It has been recommended by several psychiatrists Kitty be placed in residential treatment, yet she is still not receiving the maximum equivalent education environment that the school district can provide. Kitty is entitled to a Free Appropriate Public Education. She is not receiving this. Therefore the school district should be reimbursing us for a private placement in residential treatment.

I acknowledge that the school wants to complete the assessment process before making changes, but I believe Kitty is in danger while the school struggles to make observations on a child that is frequently not in class due to hospitalization, appointments and visits to the nurse, and I have to question the validity of testing and assessments of a child who is clearly not stable. I believe the school needs to accept the IEE (Independent Educational Evaluation), which is in agreement with Kitty’s current FIE (Full Individual Evaluation - the school version of a psych eval), and make placement decisions immediately. I’m sure the school does not wish to be legally liable for her bodily harm (escalating self-harming behaviors) and potential death by suicide.


ACADEMIC NEEDS BEING MET?

I was told that a new IEP meeting need not be held, because Kitty is “successful academically.”

At school her anxiety, stress, and feelings of being overwhelmed, have typically been expressed as being “shut down” and in somatic illness. Because her behavior and issues are not generally disruptive to the classroom, teachers have been very empathetic, and Kitty attempts to be mindful of her academic responsibilities, I believe that although Kitty is “functioning” most of the time, she is not getting the full education she is intellectually capable of receiving.

This is a child who loves school, and according to her last FIE has an average IQ (although low). {The recorded school IQ is much higher than the one recorded by the neuropsych testing less than a year later} She is in special education classes primarily for her emotional issues and her learning disabilities. Every year we are approached with requests that Kitty be put back in general education classes with inclusion help, and the primary reason this is not done is cited as her repeated demonstration that she is incapable of completing and turning in homework. So how is struggling through special ed classes, being “academically successful”?

Is she meeting her IEP goals? If she is, then are they too low?

When she is at school, how much is she actually participating in class? She calls me from class at least once or twice a day (I redirect her to call FOCUS {FOCUS is the behavior support aides. The 3 of them service the entire school of 3000 students so they're always busy, and are not especially well trained}). She is in the nurse’s office and/or talking to the guidance counselor for hours at a time. She tells me that she frequently rests with her head down in class, and her teachers are sympathetic because she isn’t feeling well or just got out of the hospital.

When I commented on how little school work she was given for the weeks she’s been in the hospital (this week only one assignment from World History – nothing from any other classes), I was told the other classes must be doing mostly class participation activities. So she is missing all of that. (I was also told the teachers may not have been given enough time to get the materials to Kitty – I felt 24 hours was sufficient, but I was not notified that there was more to come or I certainly would have picked it up). How will this be addressed in the future?

Many of her grades/assignments over the 6 weeks were excused because of the hospitalizations. In math she received 100s on her assignments, but 65s and 70s on quizzes and tests. How can you know if her academic needs are actually being addressed?


EMOTIONAL / BEHAVIORAL NEEDS BEING MET?

Kitty is currently so overwhelmed from dealing with her illness, personal history, and emotions that she is unable to cope with any additional burdens. She tends to expend extensive effort in just dealing with daily living.

She comes home daily, anxious about bullying and teasing on the part of fellow students (I have no way of knowing if this is accurate or her perception of normal teenage behavior), and she told me that her response became physical at least once, but she refused to divulge the details (Apparently the boy had been “sexually harassing” her. She “hit him in the face” and he stopped sexually harassing her. She believes that because he stopped, and she apologized for hitting him, that this is unimportant.) I have repeatedly requested that she be given assistance with social skills, but the school has been unable to accommodate this request.

SPECIAL SCHOOL {closed campus public school program for the whole district, designed for emotionally disturbed youth in 6th through 12th grade that Bear attends part-time. It is considered the most restrictive environment the school district can provide and has only 11-25 students total}- She is anxious about others’ responses to her repeated absences, falling behind in school, what others will think of her if she goes to the Special School (she believes others will think she’s “stupid,” has “bad behavior” like Bear, and that her “friends will forget” about her. Not coincidentally, these are the same reasons and results, she believes about why she was placed in foster care and was abandoned by her biofamily). She prefers going to residential treatment (RTC) because it will be “over in a couple of months” (we haven’t told her it could be a year), and “all of my friends know I am suicidal” so she can explain it away without them making value judgments. She is also nervous because the special School is a new situation.

I believe Kitty’s IEP needs to be changed to reflect her obvious Emotional and Transition needs.{need to include some transition goals}

• Behavior Intervention Plan developed from a Functional Behavioral Assessment that uses current data related to target behaviors and addresses behavioral programming across home, school, and community-based settings;




• Daily schedules reflecting minimal unstructured time and active engagement in learning activities (for example: lunch, snack, and recess periods that provide flexibility within routines; adapt to individual skill levels; and assist with schedule changes, such as changes involving substitute teachers and pep rallies);




• Planning for integrated living, work, community, and educational environments that considers skills necessary to function in current and post-secondary environments;




• Suitable staff-to-student ratio appropriate to identified activities and as needed to achieve social/behavioral progress based on the child's developmental and learning level (acquisition, fluency, maintenance, generalization) that encourages work towards individual independence as determined by, for example:
  (A) adaptive behavior evaluation results;
  (B) behavioral accommodation needs across settings; and
  (C) transitions within the school day;
  




• Social skills supports and strategies based on social skills assessment/curriculum and provided across settings (for example: trained peer facilitators (e.g., circle of friends), video modeling, social stories, and role playing);




• Professional educator/staff support (for example: training provided to personnel who work with the student to assure the correct implementation of techniques and strategies described in the IEP).
  
  

LEAST RESTRICTIVE ENVIRONMENT

“In General. To the maximum extent appropriate, children with disabilities, including children in public or private institutions or other care facilities, are educated with children who are not disabled, and special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily” 20 U.S.C § 1412(a)(5)(A).

Kitty is currently in the most restrictive environment that her high school can provide… and still struggling. I believe the severity of her disabilities is not being served satisfactorily.

Areas Kitty’s current Crisis Plan does not address:

• Kitty not willing to return to class from nurse’s office, despite not being sick (fever, rash…).




• Kitty having subjective symptoms – exhaustion, headache, stomach ache…




• Self-harming behaviors.




• Kitty’s feelings of not being safe (in particular from urges to self-harm unless she’s being actively supervised by someone aware of this behavior)




• Feeling overwhelmed or stressed




• Discussing her issues/concerns/ stressors with a non-trained professional vs. a behavior specialist




• At what point should parents take Kitty home if not sick (fever, rash…) – what are the alternatives?




• Time spent in class with head down/ not participating when feeling bad




• Time spent in nurse’s office instead of class




• No description of interventions and supports beyond FOCUS taking her to nurse or counselor’s office for assessment