This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Friday, October 28, 2011

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.}

2 comments:

abrianna said...

Real name alert.

Struggling to Stand said...

ditto on the name. you probably missed it because it isn't capitalized.

"by law all intervention strategies must be exhausted before considering the special school"

Which law says ALL must be EXHAUSTED? I've become quite an expert thanks to you (OK, nowhere near an expert, but I have searched through the national and state laws a few times thanks to you, in addition to reading quite a few TX court cases.) The court cases I read did not require ALL strategies be exhausted. Only that some had been tried -- you can't go straight from regular ed classes to residential, but you don't need to attempt every step in between especially in urgent situations.

You so need a lawyer. Tomorrow it sure would be good if you said to them "Have you consulted your ISD lawyers yet? Do they know what you've been saying and doing at these ARD meetings? Because I'm sure the ISD legal types would be pretty worried if they knew."