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!

Saturday, December 31, 2011

More Christmas Pics


This was a gift from Bear (necklace and earrings). He was the only kid to give me a gift at all, and it was a pretty good one. I never know what to expect from my kids.


Time for a diet! Never allowing anyone to take my picture from this angle again!


Bear's regular expression can be pretty intimidating. Add that to his deep voice, usual irritated tone, and tendency to isolate, and he can be quite hard to approach. (Kitty just didn't want her picture taken!)


A rare smile!


Bob watching movies with her sleeping boyfriend a few days after Christmas. He worked a double night shift at the fast food restaurant for the second day in a row, but wanted to spend time with her. He slept through 3 movies. It was a lovely, laid-back relaxing day. "Mooommmm! Quit taking my picture!" (I have about 15 shots like this!)


Mom is sneaky! Caught her when she wasn't looking (although Kitty saw me).
"This feels weird on my face and I like it!"



Silly string!

He asked for this orange H*llo Kitty doll! Weird child.


Texting his girlfriend. My baby is almost a teenager! Tweens - such a mix of contradictions.

Thursday, December 29, 2011

"Pre" Christmas pictures

We had Christmas with Kitty the day before she left to go to the RTF (residential treatment facility). I'm printing out pictures to give to her while there, and decided I needed to share pictures with y'all. I've also got to remember to send pictures to Biomom.

Here's one of my favorite pictures this year! This is 12 year old Ponito. He'll be 13 in February, but this was his favorite gift - a HUGE stuffed animal to complete his collection on his bed (now he has enough stuffed animals to go around the entire perimeter in his bunk bed.

He's been "married" many times since his first "marriage" at age 3 that lasted 1 1/2 years, but he finally seems actually attached to his new girlfriend. They talk on the phone and text, watch movies and play. He's brought her to the house and had a double date with Bob and her 1st boyfriend. It's beyond cute (and extremely well supervised). Crazy part is... his new girl friend is 14 and in 8th grade (he's only 12 and in 7th). My baby is apparently a catch!


Bob doesn't like having her picture taken. (I have a dozen pictures of the back of her head now).



Too bad Bob, if you act like this, this is what gets posted!



Bear with our little house guest, Sandy. We were "doggie sitting" this little 7lb poodle for a week. I have to say I don't like yap/lap dogs, and this one was not well house trained, had to sleep in someone's bed or she cried and yapped all night, and then pooped and vomited in the bed, and pretty much everywhere. Most of our dogs are literally 10 times her size, and even the cats are double, luckily the indoor cats were fine with her, and the big dogs stayed outside for most of the time (Bear forgot and let them in once, but I managed to snag Sandy before they could do more than sniff noses with her.) She left on Christmas Eve... best Christmas present ever!


My kids and most of the cousins at my Lil Sis's house before they left for to visit relatives.


Kitty's Christmas before she left for the residential treatment facility. I managed to get the silly putty out of these pajama pants (she'd slept with it - and it was all over her sheets, pjs and my furry jacket she'd borrowed and slept in?!)


One of the few pics that hides my double chin!
















Tuesday, December 27, 2011

Nobody likes her. Everybody hates her

It's so hard with our kids to explain why others don't want to be around them. You don't want to hurt their self-esteem, but at the same time, they need to know they can't treat other people that way.

The other kids had been avoiding/ shunning Kitty because she is an emotionally unstable basketcase and not fun to be around to say the least. She gets mad at them and wants them to be punished for being mean to her. I admit, they're not subtle, and sometimes they can say extremely inappropriate things to her (Bear especially), but they're young kids (even Bear... maybe mostly Bear) and I can't expect them to just handle her issues like adults have to.

Not too long ago I told her that while the family loves her, they don't like her right now. It was right after she'd physically attacked Hubby, and he couldn't even look at her without getting angry. Even at the time, I knew it was probably too harsh, but I was tired of sacrificing everyone else and forcing them to pretend they want to be around her. After I said it, I discovered that in her black and white world that means I told her everyone hates her. *sigh*

Now that she's finally in RTC, the kids are enjoying this time with her away. I still feel guilty about feeling the same way. It hasn't quite sunk in yet.

I'm going to need to start job hunting soon.

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

We'd been told we could talk to Kitty after noon on Christmas day, but instead she and her family therapist called in the morning, just as the grandparents got there and we were about to open presents. She only wanted to talk to me (crying, saying she wanted to come home and she'd be good) and Ponito. She was willing to talk to Hubby, but no one else.

When Bear asked me to tell her he loved her and missed her, she said, "Yea right." We talked for a minute about that. Honestly I can see why she'd have her doubts, and she lives in a black and white world so she can't believe he can have mixed feelings.

I really wish they'd called when they said they would. I had to rush her off the phone a little because the grandparents only had a short time to watch the kids open presents before they had to leave for church, and I had to start making Christmas lunch.

I'll see her on Friday for Family therapy. Hubby was going to just call in, but after the phone call, he's decided to try to go with me. It's a 3 or so hour drive each way so he'll miss a lot of work hours.

Saturday, December 24, 2011

Kitty is in Residential Treatment

I've been having lots of trouble with my computer, and we've been frantically getting ready for Kitty to go to the psychiatric residential treatment center.


Monday, home from the hospital. She had a minor meltdowns about doingllaundry. We had our traditional Christmas Eve presents for all the kids. This is usually PJs and books, but since this year we all got new pjs for our Cmas pics... they got books and other "sleepy" items, lap throw for Kitty, a giant stuffed animal for Ponito's bed, speakers for Bear's ipod (since he sleeps with his ipod playing all night)...


Monday night I stayed up until after 5am, working on Kitty's paperwork and Time Line/Life history. This is a 52 page document that lists diagnoses and treatment history, cast of characters (including brief bios and diagnoses as appropriate), a timeline and all the detailed information I've learned over the years... it hadn't been updated in over 1 1/2 years (although I did do some work on the early years this Summer based on info that came out in sibling therapy with Bear). So all the recent hospitalizations wasn't in there. I did manage to get all the hospitalizations this year added, but it's missing a chunk of time I just couldn't get to.


Tuesday morning, Kitty opened her presents. All day Tuesday we did more laundry (meltdowns). She struggled all day, but managed to hold it together because we mostly sat around watching the DVDs she got for Christmas.


Tuesday afternoon, Kitty and I saw her attachment/somatic therapist. Therapy was tough, but we talked about the fact that she has different layers with ANGER being the top layer. The inner layer was her abandonment issues and trauma. Her nervous system is going to fight hard to protect that layer. So she needs to work hard to focus on that layer, despite how hard it is, in fact the harder it is... that's how she'll know what to work on.


We've been repeating to her over and over how much she needs to take advantage of this opportunity to be at a treatment center and needs to work on her trauma while she's there, and doesn't have to worry about hurting her family or her reputation with her friends. We know it will be scary, but she can do it - she's ready. OH, HOW I HOPE SHE DOES!!!


Tuesday night we went to my sister's house for Christmas dinner. (She and her family are traveling for Christmas so we had Cmas early). Kitty played with the little cousins and seemed to do OK. All the other kids went home with Grandma since we were leaving early in the morning and figured Kitty might do better if they weren't there to trigger her. I stayed up until almost 6am trying to finish her Time Line/ Life History.


Wednesday morning, I started sorting and folding the mountains of laundry (lots of towels and sheets), which upset Kitty into a meltdown. Then she quickly packed when I was doing something else. She got upset when I repacked (I needed to be sure she was taking appropriate stuff, and wasn't missing anything). I also made her get some more laundry out of the dryer. She hates anything to do with laundry (technically all chores).


She finally admitted the meltdowns were because she was afraid we would never come back and get her (like Biomom did). What could I say?! I just reassured her that we love her, that WE always come back, that we'd been through worse and were still here and still loved her, and most of all that she NEEDS this, and needs to work on her trauma.


Hubby had to work, and we were concerned Kitty would freak out, so my Step-Dad (Poppy) drove us to Houston. She and I slept a lot of the way (me because I'd only had a few hours of sleep in the last 3 days and her as a defense mechanism). She asked to go home several times. She promised to "be good." Oh my heartstrings!


Unfortunately they had me doing paperwork the whole time so I couldn't comfort her. Poppy did and was concerned about her obvious upset and that she was shaking like a leaf. Pretty soon they took Poppy and I into another room so she could get checked in, and I could fill out more paperwork.


We'd realized we'd forgotten one of her meds, and had to go to the pharmacy to pick it up. Should have only taken us less than an hour... but Poppy got seriously lost. Luckily when we got back, they let Kitty come back out and say a quick goodbye (usually they don't let them leave again once they go "upstairs."). She cried and begged. All I could say was we love you, you need this, work hard on the hardest stuff. Then we had to leave.


We normally can't talk to her, besides family therapy, until she reaches a certain level, which can take at least a couple of weeks, but the family therapist said we'll be able to talk to her Christmas Day.

Monday, December 19, 2011

Kitty's coming home



Kitty has 3 areas that cause her extreme anxiety:






1. diagnoses/trauma - which is with her always of course



2. family



3. school/peers



The minute she enters school she no longer has to deal with family, and can usually hold it together. When she enters the hospital most of 2 issues (family and school) are gone and she can hold it together even better.






Plus, school and the hospital are looking at the short-term so they can bribe her, placate her, and put off and ignore her issues. They also are comparing her to other teens who act out, and in comparison, Kitty's issues look less severe. (She has admitted to staff that she feels like hitting some of the girls at the hospital that are picking on her, but to them the important fact is that she's not doing it. To us the important fact is that she's having those feelings at all! She's usually not aggressive like this).






Add in the fact that Kitty doesn't trust them, and her self-esteem is totally dependent on other's positive opinion of her so she won't act out in front of them... and Kitty can hide her issues for a really looooonnnng time.






I did find out from the social worker during the family session, that Kitty's issues are because we haven't been letting her see her trauma therapist independently. Apparently she needs to have her own therapist, and then she'll be all better. *sarcasm drip*






I talked to a friend of mine and she pointed out that Wellb*trin which Kitty started taking recently can make her aggressive. The "miracle" drug Ser*quel that she's taking (suposedly to replace a mood stabilizer and anti-psychotic that was at a super high level) is nowhere near a therapeutic level. The mood stabilizer, Tril*ptal she takes is actually a fairly low dose and is not considered a strong mood stabilizer to begin with.






We still haven't had a conversation with the psychiatrist at the hospital, but received a call from the hospital social worker that we need to pick her up today after meeting with him. Obviously he won't be making any med changes. I'm ticked. *major understatement!*






There's a possibility that Kitty will be going to residential treatment on Wednesday. If she's as angry with us as she appeared to be on Sunday, then I'm not sure we're going to make it.

New Christmas Pics!




Aren't they gorgeous! We decided on PJs this year instead of formal wear or anything else. As always we love Photography by Jenny Rhea!


Saturday, December 17, 2011

Kitty's coming home?

During Kitty's IEP meeting on Friday we got 2 calls from the hospital. They wanted to discharge Kitty immediately, because :





  • she was "fine" there


  • she didn't need any med changes (we disagree),


  • since she's been hospitalized so many times they have to assume hospitalization is "not working"


We had an appointment with the pdoc that afternoon so we told them we wanted to wait until the meeting to decide. After waiting 1/2 hour we found out that the pdoc had been called away on an emergency sometime before we'd arrived, but no one had realized it.



We managed to meet with the new social worker. We expressed our disagreement with their reasons for sending Kitty home. We don't care what she does at the hospital, she's becoming increasingly aggressive at home, and she's not "fine" there. The hospital may not be "working," but we don't have any other alternatives.



We were supposed to hear back from the pdoc by phone on Saturday and me managed to convince them to hold onto her until then. He didn't call.



We're meeting with the social worker in an hour. I have a feeling she's going to try to send Kitty home today.





The good news is that we finally heard from the residential treatment center. Kitty's been accepted and we're just waiting for the financial negotiations with our funding source. She may go as early as Wednesday.

Thursday, December 15, 2011

Hospitalization #8

Kitty was admitted to her eighth psych hospitalization Wednesday evening.

When I picked her up from school, she was an emotional mess. She started screaming at Bear when he commented on the fact that she was drinking a soda (she's allergic to citric acid). She took off her seat belt and refused to put it back on. She started screaming at me, when I tried to correct her. I dropped Bear and Bob off at Grandma's and Hubby and I took Kitty to the phosp (I took Hubby because I didn't trust her to cooperate and not get violent).

Should be interesting to see if she can still keep her act together.

Still waiting to see if we can get her into residential treatment. I hate bureaucracy.

Sunday, December 11, 2011

Bad choices, emotional instability & the Surgery Analogy

Emotionally Kitty is falling apart. Bear hasn't been helping.

Wednesday she stayed home with me and we had a fairly quiet day. Earlier Bear had told me that she owed him $3.50 for a sandwich he'd given her at school (I asked him why he'd expected her to be able to pay him money since she's pretty much always broke, and he claimed she'd been buying snacks from the vending machine so he thought she could afford it). So I asked Kitty about it. She insisted that Bear had a wooden horse he'd made that he wanted her to take, so he'd bribed her with his sandwich since he knew she was hungry.


Doesn't make sense to me either, but honestly I tend to believe Kitty over Bear. Bear has a nasty habit of being generous when he has funds, and then when he doesn't, or he's mad at someone, then he demands they pay him back, although it's not been previously agreed upon.

Over an hour after bed time (Kitty had probably gotten up to go to the bathroom), I heard Bear and Kitty going at it. Don't know which of them broached the subject, but Bear was demanding repayment. Kitty denied owing him anything, and he started verbally attacking her. I didn't hear it all, but at one point he stated he was never going to give her anything again, even Christmas presents, because she turned everything to crap. At that, I yelled up a reprimand, and they stopped (Ponito came out of his room and thanked me because he'd been trying to sleep).


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


Thursday, Kitty called me and asked me to give her a ride home from school rather than ride the bus. I'd run into her earlier in the day and asked if she wanted a ride home, because Bob was staying after school and Bear has manipulated his way into riding the regular ed bus. She said no at the time, but called me later and said she didn't feel up to riding the bus.


On the way home, kind of out of the blue, she stated she was not going to therapy the next day with the trauma therapist, because she "hates" the trauma therapist and "it doesn't help anyway." We had a heated discussion, in which I informed her that, "yes, it has too been helping and you don't have to like your therapist, in fact, since she's forcing you to deal with stuff you don't want to have to deal with, you probably won't. Just like sometimes you get mad at me, especially when you're in a bad place. Later when you feel better you know that we really do love you." We talked briefly about my "Surgery Analogy." Then she escalated to screaming irrationality, and I finally just had to shut her down and refuse to speak of it anymore.



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

Friday, Kitty called me for a ride home, but I was picking up my car from the shop (several cracked brake shoes and a new battery). Bob was staying after school for tutoring. So Kitty would be riding home on the bus with Bear. Unfortunately the girl Kitty wanted to sit with was apparently sitting in the seat behind Bear and his friend.

I don't know what happened. Bear has been really in everybody's space lately. Kitty is constantly accusing everyone of hating her and deliberately pushing her buttons.

The gist: Kitty was holding a pencil, her hand was in Bear's space. Bear knocked her hand away. The pencil marked on Bear's hat. Bear verbally jumped on Kitty.


After picking up my car, I decided to do a bit of quick Cmas shopping before running home. So when Kitty came home hot, I wasn't there. Poor Hubby. He's having trouble talking about it, and Kitty's version is distorted, but...


The gist: Kitty walked in the door and told Hubby she was refusing to go to therapy. He insisted. He called her a liar (trigger for her because she prefers to see herself as truthful and in her black and white world, she basically is truthful) because she's been pretending there's nothing wrong with her to everyone but family, and she apparently told him she's faking it at home to get to go to the hospital. She cussed him out, spit in his face, slapped him, and tried to kick him. He called her a bitch (she freaked over this because she assumed it meant he was calling her a slut. In therapy, he apparently defined it for her).


He managed to get her in the car to therapy. It took awhile, but I managed to convince him to let me talk to her, so I could get her to calm down. I was able to get her to do some deep breathing with me. After about a minute of me telling her when to breath (in, hold, out, count out loud...), she was finally calm enough to come out of fight, flight or freeze.


Hubby took a couple of days to calm down and get to where he could stand to be near her. He feels if she can control it elsewhere, then she should be able to control it at home. It doesn't help that she's told him that she's faking, and he believes her.


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


Saturday, meltdown because we didn't let her spend the night at Grandma's with the other kids.


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


Sunday, meltdown because when we arrived at Grandma's for lunch, Bear walked into the kitchen where Kitty was standing, and started an argument with Poppy. Since Bear was helping make lunch, I called Kitty out of the room. It wasn't "fair" that I made her leave and let him stay, even though he was helping with lunch, and she was the one that was upset by arguing.


When I went in to calm her down, we had the usual argument ... I hate her. I love the other kids more. She's fine. It's not her fault. She promises to be good.... At one point I made a bad choice and told her that no one in the family really likes being around her right now, and while we love her, we don't really like her when she's acting like this. I know. Not a nice thing to say, but I'm trying to get her to understand she can't treat the family this way.


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


By Monday, Hubby had gotten himself together enough to be able to be in the same room with Kitty. I decided to see if we could keep her home, because she's missed soooo much school and it's finals week. I called her psychiatrist to see if she had any suggestions, but she has decided Kitty's issues are trauma based, so doesn't really want to mess with her meds. She increased Kitty's Ser*quel to 300mg (which is still pretty low).



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

SURGERY ANALOGY


When we first got Kitty, her mental illness and trauma issues were buried deep inside like a malignant cancer. She'd suppressed them to such an extent that not only couldn't she feel her emotions, she couldn't feel her body. She thought it was cool that she couldn't be tickled or feel her extremities. She was constantly offering to let people pinch her forearms or kick her shins, bragging that it didn't hurt.





After many years of therapy, Kitty finally started to get in touch with her emotions, and her physical body too. When she gets angry she can tell you that she feels it in her chest and fists. She's even a little ticklish.





With Bear, we describe his defense mechanisms as armor... very thick armor. He uses it to protect himself, and it keeps everyone from getting too close. When we first got him at age 13, it was more like he was wearing porcupine spines, but after a rage we'd see his soft underbelly for about 10-20 minutes. After residential treatment the rages stopped, but so did those glimpses of underbelly. He is able to wear the armor 24/7 and we don't seem to be able to convince him that it's no longer needed and while he wears it he's stuck. He can't change or grow. He can't feel hurt, but he can't really feel anything at all. Not happiness, pride, love...





I think Kitty's protective gear is more like super thick mummy bandages. They restrict her movement and feelings. The good news is that we've been slowly unwrapping her and have finally reached the hurt parts. The problem is, that she's now completely exposed with the trauma right out in the open, for every little bump and stray remark to feel like a lash against her tender skin.





The school is worried that if we let Kitty call home, leave class, go to homebound... then she'll never want to go back to regular classes. I believe that when someone is in a lot of pain, and preparing for surgery, the hospital will prescribe M*rphine or Hydr*codone, even though they are highly addictive. When the (hopefully successful) surgery is over, then the doctor will start working on weaning the person off the medications. People heal faster when they are not in pain.





The problem is that Kitty is not having surgery. She's in pain, she's prepped to start work on the horrible, cancerous trauma... but it isn't like we can just rip it out or give her a transplant. This is something that's going to take years, and she's going to have to stay exposed most of that time. So what do we do?

We win?

Kitty got home from the hospital Monday evening. The hospital increased her Ser*quel (which I’ve been told in higher doses is a mood stabilizer in addition to being an antipsychotic and sleep aide) from 100mg to 200mg (increased by her psychiatrist on Wednesday to 250mg). They kept the mood stabilizer, Tril*ptal at 1800mg and the Wellb*trin at 150mg. All but the Trileptal are VERY low doses. At the hospital Kitty was her usual “fine” self so the hospital declined to put her back on the mood stabilizer Lam*ctal (her regular pdoc doesn’t prescribe it).

She came down with a cold/allergies on Tuesday morning, but made it through most of the school day until her IEP meeting at 2:45pm anyway. One of her teachers let me I thought she was upset when she had her head down for most of it, but found out afterward that it was because she didn’t feel good.

This Annual IEP meeting was frustrating. The school adamantly maintained they would not place Kitty in an alternative education environment and denied the recommendation for homebound from the psychiatrist, even though the pdoc submitted their completed recommendation form as requested. They insisted that what they were doing was working, despite the fact that she was only in school one day before leaving to go back to the hospital this time, and only 2 days in school before being hospitalized last time. She went from being an A/B student to failing all but Teen Leadership.

We discussed the Crisis Plan trying to get everyone to agree on how to best help Kitty deal with her anxiety, and I brought in the rough draft of the level system with concrete examples, since Kitty’s definition of a 6 on a scale of 1 to 10, sounds more like an 8 or 9 to me.

The school was just telling us we’d run out of time and were going to have to continue the ARD on January 9th (which wasn't going to work, considering we hadn’t even decided what electives she’d be taking for the classes that end at the end of the semester…) when someone came back into the room after receiving a text stating that we’d filed Due Process so everything came to a screeching halt.

Filing Due Process means that everything has to stop and that all we’d discussed for the last 1 ½ hours didn’t count, but in reality it didn’t matter because nothing useful had been addressed anyway. Stinks for Kitty because it meant nothing would change on being able to call home when she was stressed (which the school hasn’t allowed since the last IEP meeting).

They did determine that the Anxiety Levels weren't technically related to the IEP so Kitty could work on them with her case manager, using my chart as a jumping off point.

The next day I got a call from our professional advocate. After many CYA threats and accusations of the advocate’s bad behavior (unfounded), the school district informed the advocate they’d approved the special school for Kitty. The school district’s attorney said if we hadn’t filed due process on the day of the ARD, we would have found out that they’d approved the special school… ummmm, NO THEY DIDN’T! Apparently the school district’s attorney didn’t realize we’d held the ARD.

So we’ll have an IEP Meeting sometime next week, and Kitty will go to the special school starting next semester. She made it through school all week (except Wednesday. I kept her home and took her to psychiatrist and doctor) although she had a tough time. The pdoc didn’t seem to care that they didn’t accept her recommendation for homebound. She thinks Kitty should be in RTC so it doesn’t really matter what’s going on in school.

Next week is finals week and we still have no idea how the school is going to handle that. To say she’s unprepared is an understatement. She hasn’t been to class consistently in months.

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

Tuesday, December 6, 2011

Anxiety Scale Rough Draft



ANXIETY SCALE



0 – Cool as a cucumber.
EX: On second day of long vacation, soaking alone at a spa.

1 – Everyday minor stress needed to function. Occasional twinges of minor discomfort.
INTERVENTION: No intervention needed
EX: Alarm clock goes off. First bell rings.

2 - Minor bother.
INTERVENTION: Self-initiated calming skills. No outside intervention needed.
EX: Need to move quickly to get to class. Momentarily can’t find homework. See a cute boy.
3 – Anxiety annoying enough to be distracting.
INTERVENTION: Coping/calming skills still work, but might need outside reminders to use them.EX: Loud, chaotic environment. Quiz you’re prepared for. Ex-boyfriend standing 15ft away.

4 - Can be ignored if you are really involved; still distracting. Somatic symptoms.
INTERVENTION: Brief breaks with adult support and assistance using coping/calming skills. Can be redirected back to class.
EX: People arguing. Test is prepared for. Presenting a well-prepared presentation with a group.

5 - Can't be ignored for more than 30 minutes. Thoughts of hurting self intruding, but controllable.
INTERVENTION: Brief breaks with adult emotional support. Might be able to access coping skills with assistance. Can probably be redirected back to class or work independently in less stressful environment.
EX: Giving a speech to a group. Getting feedback or gentle teasing. Feeling behind in schoolwork

6 - Can't be ignored but still can work. Wants others to keep her safe from acting on feelings of self-harm.
INTERVENTION: Leave stressful environment and continue work. Learning Lab? Talk with behavior specialist. Coping skills might work after calm down a little.
EX: Picked on/teased by peers. Test in class struggling in.

7 - Hard to concentrate, bothers sleep. Can still function. Feels need to escape. Suicidal thoughts. Needs stressors limited by others or will escalate.
INTERVENTION: Leave stressful environment and not able to access cognitive part of brain for school work. Can’t access coping skills.
EX: Feels personally attacked by someone close to her. Overwhelmed because behind in classes.

8 - Activity limited a lot. Can read non-school books and talk with effort. Suicidal thoughts with plan, but not seeking out means. Paranoid others hate her and are out to get her. Acting out behaviors if can’t escape.
INTERVENTION: Reduce stressors as much as possible. Consider hospitalization, but can wait for open bed.

9 - Unable to function. Crying out or moaning. Acting out. Fight/ Flight or Freeze Reactions. Suicidal thoughts with plan and means, threatening, but not actively attempting to commit suicide.
INTERVENTION: Immediate removal from all stressors. Hospitalization.

10 – Totally Stressed Out. Eyeballs explode.

Sunday, December 4, 2011

Kitty's Armor



Grandma and I visited with Kitty at the hospital, and she looked great! A tiny bit manic, but you had to know her to see it. Even her jackhammer leg was not vibrating more than the average person's might, and it didn't even start bouncing until we started talking about school. I was thinking, no wonder the hospital is sending her home... this is the best I've seen her in a long time.


I started thinking, maybe she doesn't really need all these meds after all. Maybe the new meds are working. Maybe without the stress of home and/or school, she's OK.


I decided to test her a little, and started talking about going back to school on Tuesday, and what she'll need to do. That she HAS to verbalize what's going on inside. We talked about the rating scales, and I gave her a homework assignment to start writing these down (as of Sunday afternoon she hadn't started - no, I'm not surprised).


She held it together although the leg started tapping (no jackhammer).


I left wondering if she was playing me. NO ONE else was seeing her issues, especially the school, and she hasn't had a strong rage in months. Most of her meltdowns have been relatively minor and she's even toned down the talk about hating the family.


...I know that's not true, but I have to question how this child's armor can be so perfect. Is the school really oblivious and evil?


Another explanation? Usually when Hubby and I visit Kitty in the hospital we see her in a small private room. She usually prefers not to even hug us unless it's out of sight of everyone. If the door is open, she spends the whole time staring obsessively out of it, completely distracted.


This visit was during regular visiting hours and there were 4 other kids and their families in this not so big room. It was fairly loud... and most definitely public. When a staff came in to do a head count, Kitty smiled and laughed with him. At the end of the visit when she stepped away from us to throw something away, one of the male staff said something teasing to her. She laughed and was appropriate, but when she came back she was visibly flushed.


I think she was acting "normal" because she was in public during our whole visit. Which means as soon as she gets home, things will go right back to the way they were before she left... but it also means that she may not ever be able to get the help she needs.


There are 3 major stress causes in Kitty's life:


  1. Trauma, history, diagnoses... issues. All of which Kitty takes with her everywhere she goes of course. She's working on these, but it takes time... a looong time. We're running out of time, so can no longer only do "trauma work" in the Summer, like we used to try to do.

  2. Family. She has come very far with her attachment issues, but family life still causes stress. We've removed a lot of the stressors, but don't really want to remove more.

  3. School. Kitty is outgoing and loves school, but this is still a major cause of stress in her life, and it's one we have very little control over. It's not that school is the ONLY cause of her stress, it's just the only one that still has room to manipulate.

She appears to be able to wear her full armor as long as she only has to deal with 2 of these. No idea what that means for residential treatment. By removing Family, is she going to be able to hide what's going on underneath so well that it looks like she shouldn't even be there so she'll get sent home, or will she be able to process her Trauma better because we've removed one or two of her stresses.


^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^


Speaking of school, Lisa commented that she was surprised Kitty was still doing well in school. The truth is she isn't. When she's in school she usually gets 100s on classwork (which are more about participation), but she's failing the tests and quizzes. Of course she hasn't actually been IN class in weeks. She spends a lot of her time talking to the behavior staff or in the Learning Lab. I think she's getting work done there, but...


First six weeks she had equal As and Bs. Second six weeks she had 3 As, 2 Bs, and 3 Cs. Third six weeks is almost over. She's barely been to class. She has 2 As, one incomplete and all the rest are failing.


One of the As is in Team Leadership (a general ed class. She has all 100s. I get the feeling that's the only grade you can get).


The second A is in Special Ed History. She only has 2 grades in the class (both 90s) and all the other assignments don't have anything next to them at all. I'm assuming they're all missing so she isn't really passing.


The incomplete is in the only other class that also gave her an A last six weeks. This is the teacher that 2 years ago told me that she wasn't allowed to flunk Bear - even though he most definitely deserved it (26 going into final exams, failed finals, but still managed to miraculously pass the class).


Kitty is stressing out about how behind she is in all her classes, even though everyone tells her she'll be fine. She'll probably be out of the hospital on Monday. Her IEP meeting is Tuesday. Finals start a week after that. We've got a request in for home bound. No idea what's going to happen.

Re-upping

I've been so focused on Kitty here that I haven't been keeping y'all up to date on what's going on with Bear. Long story short (and I'll probably blog about it soon).


We've been working for months with a local university doing what's called a "Therapeutic Assessment." This is much more intense than the neuropsych eval Kitty just had done, and Hubby and I even had some testing done (more on the results of the attachment assessments later).


Something Hubby and I have known for a long time is that Bear is in no way ready to live on his own when he graduates high school this year. After much consideration, and with the help of the assessment team, we have decided to approach Bear with the idea of staying for at least 2 more years. It was finally broached at the meeting last night (supposed to be the final one, but he was caught so off guard -we weren't supposed to tell him - that they felt he needed time to digest this before they finished discussing the rest of their findings and answers to his/our questions as to how his diagnoses will effect his life and future planning).


Since Hubby and I don't want to be in this same position 2 years from now... after Bear laying on the couch eating Bon Bons for two years, we have some major ground rules we'll want to put in place. Last night all we did was make the offer for him to stay and an emotional commitment.


Eventually we plan to let him know what we expect from him in order for this to work. Basically, life won't change much in regards to us providing structure and expectations (at least until and unless he shows he doesn't need it). BEAR has to take ownership of making forward progress, but we will not allow him to remain stuck, or worse, regress.


The following is the document I'm considering having us all work on together and sign:


Commitment Agreement and Consent

____ Commitment Agreement and Consent for Care, Discipline and Therapeutic Support:
I, “Bear’s Full Name”, hereby commit to being a contributing member of the “Themom” family and agree to voluntarily submit to the care, authority and therapeutic support of my parents, “Hubby’s Full Name”, and Mary Themom, until I am ready to become a healthy, independent, contributing member of society.

____ ____ Commitment to Care and Treatment
We, “Bear’s Full Name”’s parents, “Hubby’s Full Name”, and Mary Themom, have committed to working in the best interest of “Bear’s Full Name”, in helping him become a healthy, independent, contributing member of society capable of developing meaningful relationships. We will do this to the best of our ability, while honoring our commitment to each other and each member of our family.

____Therapeutic Activities
I acknowledge the importance of participating in family therapy, treatment planning, and transition preparation. I authorize my parents to participate and assist in organizing these activities.

Commitment to Healthy Living
This family has undertaken the task of assisting in the care and treatment of “Bear’s Full Name”. It is vitally important that all Bear’s energy and effort be focused on treatment issues in order for him to progress and to change past behaviors. For this reason, Bear must commit to ceasing (or not starting) any and all activities that could be detrimental to his growth and maturity, including, but not limited to, illegal drug and alcohol use, criminal activities, and sexual activities outside of a committed, monogamous relationship (when ready). He commits to making healthy living choices wherever possible, including, but not limited to; exercise, healthy eating habits, taking his medication as prescribed, reporting and following up on health and hygiene issues, attending school and/or work and therapy.
____I acknowledge the importance of healthy living in achieving my goal of becoming a healthy, independent, contributing member of society, and commit to striving toward achieving and maintaining a healthy mind and body.

____Commitment to being a RRHAFTBALL, Contributing Family Member
I acknowledge the importance of following the family rules, participating in family activities, and contributing to the well-being of the family (including doing chores) and its individual members. I also acknowledge the importance of being RRHAFTBALL (Respectful, Responsible, Attitude, Fun To Be Around, Loving and Learning). I commit to striving toward the advancement of the family and to becoming a fully functioning and contributing family member.

Family Members Responsibilities:




  1. Treat yourself and other family members with courtesy and respect.

  2. Behave in such a way as to protect yourself and others from emotional and physical harm, while striving to progress in your treatment.


  3. Make your concerns and needs known to parents and ask questions when you need information.


  4. Provide caregivers with accurate and timely information to help them give you the best possible care.

  5. Follow the family rules and therapeutic guidelines provided by caregivers and professionals, and accept any consequences for failing to do so.


  6. Promptly report any perceived risks of treatment or threats to your safety.


  7. Meet any agreed upon financial commitments.


____Commitment to Obey Family Rules, School Policies, Society/Church Moral Codes, and Legal Laws
I acknowledge the importance of following the rules and laws of the family and society in general. I understand that if I am in breach of any of these guidelines and laws, my parents will take appropriate actions which may include, terminating this agreement, committing me to a psychiatric or drug rehabilitation facility or other alternative residential placement, or contacting school or legal authorities. I commit to following these guidelines to the best of my ability and to stay (not run away) and accept any consequences for failure to do so.


____Acknowledgement of Receipt of Behavioral Information, Rights and Grievance Process (The FAIR Club)
I have been provided with a written copy of the Philosophy and Practices of this Family (The FAIR Club), including rules and interventions used. My rights and responsibilities as a contributing member of this family have been reviewed with me until I understand. I have been made aware of the Grievance Process (FAIR Club Committee) should I have concerns or wish to make changes.


____Acknowledgement of Parental Commitment to “Bear’s Full Name”
I understand that my actions, behaviors, issues, or breach of this commitment on my part or that of my parents in NO WAY affects my parents’ love and commitment to me.


____ ____ Commitment to “Bear’s Full Name”
We, Bear’s parents, commit to continuing to love, honor and cherish “Bear’s Full Name”, regardless of his actions or issues, until death do us part.


____ ____ ____Right to Revoke Commitment
We understand that each of us has a right to revoke this Commitment at any time by giving written notice to the other members of this agreement. This authorization will automatically expire or be renegotiated upon Bear’s change of address, serious breach of family rules or criminal activity, or at age 25. The termination of this commitment DOES NOT affect the emotional commitment made on the part of the parties mentioned herein.


POTENTIAL BENEFITS TO MAKING THIS COMMITMENT


1. You my learn more about your physical, emotional, psychological needs.
2. You may be able to avoid future detrimental activities and behaviors and the consequences that would result.
3. You may learn valuable skills that can help you be more honest and open with others –allowing deeper, more meaningful and satisfying relationships in the future.
4. You may learn to recognize and change harmful thought patterns and defense mechanisms.
5. You may learn to handle stress and emotions more effectively.
6. You may get a feeling of accomplishment and increase your self-esteem.
7. You may be better prepared to live a healthy, independent, productive, successful life.
8. You may have the opportunity to help others that have problems similar to your own.



POTENTIAL RISKS TO MAKING THIS COMMITMENT


1. You may find it distressing to recall your past.
2. You may find it distressing to trust others.
3. You may find it distressing to share things about your past that you had kept secret.
4. You may discover how your issues and behaviors have caused problems for you and those around you.
5. When you find yourself repeating old patterns and behaviors, your awareness and understanding of these patterns and behaviors may make future behaviors and interactions distressing.


By my signature below, I agree that I have read (or had read to me) this document. I understand the potential risks and benefits to this commitment and I agree to make this commitment for the benefit of myself and others.
_____________________________________ Date ________________
________________________ __________________________ Date _______

Thursday, December 1, 2011

Crisis Plan and Alternative Placement

Here's the letter I just sent the school:

1. I am officially requesting that calling parents for emotional support when Kitty is displaying "Acting In" behaviors needs be added to Kitty’s Crisis Plan. Until she’s able to consistently demonstrate that she can meet her Behavioral IEP goals of being able to express her feelings to school staff, she needs to have easy access to a person she knows and considers safe (myself or one of her therapists) during this time of emotional instability. I will continue to encourage her to share her feelings with school staff, and to return to class as appropriate. Until Kitty is more stable it is detrimental to her emotional health and feelings about school, to not allow her access to these trusted adults.
Behavioral IEP Goals:
Using a scale, Kitty will verbalize or express her feelings to a trusted adult in the school setting a minimum of 1 time a day
When Kitty is expressing anxious feelings or exhibiting "acting in" behaviors, she will request the assistance of a trusted adult 5 of 5 times

2. Kitty is still working on trusting staff enough to express her feelings, but she’s expressing that when she tries it feels like she’s not being heard, which of course defeats the purpose.

  • Establish concrete definitions. When Kitty says she doesn’t feel “safe.” It needs to be figured out what this means to her. Generally it means she is struggling not to hurt herself.

  • Establish concrete scales for Kitty. On a scale of 1 to 10, a 5 is NOT mild. Kitty at a 5 is beyond coping skills and cannot function in class. She told Ms. M, a school psychologist she just met, that her level of anxiety on a scale of 1 to 10 was a 6. {I came up with an Anxiety Scale for Kitty to use at school  - posted here - so she can get help while her anxiety level is still low enough for her to "access" and comply with calming techniques}

  • Trust issues preventing compliance. When asked to try different methods for calming herself on Monday, she was unable to comply. We all know that Kitty would comply if she possibly could, as she gets her self-esteem from the positive regard of others and would rather die (literally) then trust others to see that she is not perfect or struggling.
  • Actions speak louder than words. Until Kitty can express what’s going on inside, the "Acting In" behaviors need to be closely observed. For example, Kitty’s leg was vibrating like a jackhammer on Monday, and while she was able to control the self-harming behaviors (wanting to use a pencil and eraser on her skin), the fact that she even mentioned them to staff is huge for her. Her actions speak louder than her words, especially when she is too scared to express what’s going on, or sometimes is just unaware of her own body and feelings.
  • Calming Techniques. A staff member (preferably more than one in case someone is not available) needs to be trained in the use of calming techniques with Kitty so she can try to get calm without having to leave school.
3. Rating scales need to be more concretely defined for Kitty. Kitty needs to understand exactly what the scores on the rating scales mean. When asked, “on a scale of one to ten, how suicidal do you feel?” she told the crisis assessment counselor she was a 6. When asked to elaborate, she said she felt suicidal, had a plan, but unlike a 10 she didn’t have the means (no rope or belt). To me, this would be more like an 8 or 9! Obviously the crisis counselor agreed, because she sent Kitty to the hospital.

4. We have still only received two Behavior Reports to date.

5. We are officially requesting alternative placement for Kitty again. for the following reasons:

  • Obviously things are escalating. Kitty has been hospitalized 3 times this month alone!

  • Safe place so can focus on trauma work. Kitty MUST continue doing intense trauma work in therapy, and only has so much energy/strength to cope with the other areas of her life (personal/trauma history, home/family, school/community). School is one of the few areas that still has the ability to reduce some of the stress. Right now Kitty is spending all of her energy trying to maintain a positive image with her peers and teachers. When she comes home and in therapy, she has nothing left. We’ve done all we can to structure Kitty’s home life to give her as little stress as possible so she can focus on healing. She needs to be able to reduce that stress in school to give her more energy/strength for doing this key trauma work.

  • Lessen the shame and stigma of her disabilities. While Kitty definitely needs the shadowing and support by the behavior program staff and other school staff, being singled out and feeling different is feeding into her shame, and feelings of being excluded/ singled out and criticized. At the special school, ALL the children receive this type of support so Kitty wouldn’t feel the stigma.

  • Not receiving an education. Under the current schedule, Kitty is still missing significant amounts of school (see attached) over 50%. This includes hospitalizations and doctor and therapy appointments, but also the significant amount of time she is out of class due to her emotional issues (walking the halls, sitting in the nurse’s office, talking to behavior program staff and school staff…). This report does NOT include testing, time spent with school staff who are not behavior program staff (like counselors, school psychologists, the AP, case manager, time in Learning Lab…), and does not include ALL of the time spent with the behavior program staff out of the classroom (there is at least one undocumented event that I am aware of involving Kitty having symptoms of a panic attack at the thought of giving a speech and being out of the classroom during the time the speeches were given. Her current placement cannot be correct if she can’t stay in class long enough to learn!

  • Classroom environment. According to Kitty’s recent neuropsych report (filed with her school psychologist), when Kitty is in a loud and/or chaotic environment, her ability to process and learn drops significantly. Calm and quiet, does not describe the environment of some of her classes.

  • Classroom environment. The recent neuropsych eval recommends that because Kitty is an auditory learner, that having her doing worksheets or studying independently is not effective for her. Sending her to the Learning Lab to do makeup work without an experienced teacher to work with her is not likely to work well.

  • Kitty requires extensive emotional support to get through the day. School staff are obviously spending an extensive amount of time trying to provide this for her, but of course their actions are focused on providing academics and keeping her in class, not skills training – such as training her on HOW to achieve her behavior goals.

  • Kitty needs consistent, qualified support. There have been a LOT of different people involved in working with her. Her Behavior IEP states she needs to express her feelings, but to do that she needs to establish trust with one or two staff.
6. I’ve heard a lot of concern that if Kitty is allowed to continuously leave the classroom then she’ll develop issues with not wanting to return. My response to this is that Kitty is in crisis mode. Like a person undergoing major surgery needs morphine, despite the fact that it is a highly addictive drug, we need to focus on what is best for Kitty right now and deal with the fall out later when she’s stable. I also want to point out that although Kitty normally LOVES school, forcing her into the classroom when she’s overwhelmed is a big part of what is making her not want to return.

7. Final Exams. Kitty will most likely be released from the hospital just before finals, and the stress of being behind is already causing her anxiety. I doubt she has mastered the material enough to exempt exams. Possibly she should be given Incompletes?