Acronym Alphabet Soup!

 There are sooo many acronyms in our life that it's hard to keep track. Plus there are a lot of acronyms that have more than one meaning! Here's a brief overview of the ones used frequently in the adoption/trauma world. Please add any you know in the comments!

Diagnoses:

AD - Attachment Disordered

ADD/ADHD - Attention Deficit Disorder - Attention Deficit Disorder with Hyperactivity

ASD - Autism Spectrum Disorders

BPD - Borderline Personality Disorder - Officially this cannot be diagnosed until the person is 18 but prior to that the child can be diagnosed with BPD Traits. Many medical health professionals are reluctant to use this diagnosis because insurance often will not cover it as it is not "curable" with medications and most types of therapy. Many therapists refuse to treat people with BPD because they are very difficult to work with and the symptoms are very difficult to treat. EMDR and CBT are often recommended treatments.

Continuous Traumatic Stress (CTS) - Especially common among parents actively living with kids with trauma issues. Also known as Caregiver/Compassion Fatigue, PTSD (that is not "post" yet), Secondary PTSD, burnout...

C-PTSD/ DTD/ PTSD - Complex Post-Traumatic Stress Disorder, Developmental Trauma Disorder, Post-Traumatic Stress Disorder

DSED - Disinhibited Social Engagement Disorder

FASD - Fetal Alcohol Spectrum Disorders / Alcohol-Related Neurodevelopmental Disorder (ARND)

IDD (formerly known as MR/ mentally retarded) - Intellectual development disorder (IDD) is a neuro-developmental disorder characterized by deficits in general intellectual functioning such as reasoning, planning, judgment, abstract thinking, academic learning, and experiential learning.

ODD/CD - Oppositional Defiant Disorder vs Conduct Disorder. Both involve defiant and disobedient behavior toward authority figures, but Conduct Disorder is used when it is believed that the behavior is under the child's control and the child is willfully being defiant and disobedient.

PDD - Pervasive Developmental Disorder

PTSD -Post-Traumatic Stress Disorder

RAD - Reactive Attachment Disorder - a severe type of attachment disorder found in children who may have been abused or neglected and do not form a healthy emotional attachment with their primary caregivers — usually their mothers — before age 3,. The DSM V has changed the diagnosis of RAD  - while Reactive Attachment Disorder (RAD) still exists, it is now used to describe "Inhibited RAD." What used to be called "Disinhibited RAD" is now called Disinhibited Social Engagement Disorder (DSED).  

SMI - Severe Mental Illness - often used by health insurance. A mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.

For more information about Diagnoses in children with trauma and attachment issues - 
OVERLAPPING DIAGNOSES IN CHILDREN**
Overlapping Behavioral Characteristics Chart

Foster Care/Adoption Terms:

CPS – Child Protective Services – a governmental agency in many US states responsible for investigating reports of abuse and neglect of children

DFPS - Department of Family and Child Protective Services

DSS – Department of Social Services – State agency in charge of social programs, including those for children in foster care.

FCW - Family and Child Welfare

ICPC - Interstate Compact on the Placement of Children – a legal agreement between 2 states made before a foster child can be placed out of state,

ICWA - Indian Child Welfare Act - Federal law regarding custody and placement of Native American children. Preference is to be given to the child's extended family or a member of the child's tribe over a non-Native American adoptive parent.
LOC - Level of Care
TFC/TFH - Therapeutic Foster Care/Home
TPR – Termination of Parental Rights – court-ordered legal removal of a parent’s rights to their child(ren),

Medical Terms:

DSM V - Diagnostic and Statistical Manual of Mental Disorders (DSM–5) - The latest version of the manual used by psychiatrists and other medical professionals treating mental health disorders

Pdoc - Psychiatrist
Phosp - Psychiatric Hospital
Tdoc - Therapist - usually refers to a psychologist 
ER - Emergency Room

Tx - Treatment. Can also mean Texas.
Rx - a medical prescription
Bx - behavior
Sx - symptom

RTC/RTF - Residential psychiatric Treatment Center/Facility

People:

These are often used with a number for age. Ex. AD16

AD - adopted daughter 
AS - adopted son

FD - foster daughter
FS - foster son

SD - stepdaughter
SS - stepson

BioDD/BioDS - your biological child
Biosib, Biomom, Biofather... your adopted child's biological family

BM - birth mom or biomom
BD - birth dad or biodad

BF - usually boyfriend 
BFF - best friend forever
SO - significant other

I see these less often in the adoption/trauma world, but I still see them in certain forums:
DD - dear daughter
DS - dear son
DH - dear husband
YDD - youngest daughter
ODD - oldest daughter (this one always makes me laugh when I type it).
YDS - youngest son
ODS - oldest son

SAHD Stay-at-Home Dad
SAHM Stay-at-Home Mom
WAHM Work-at-Home Mom

CASA – Court Appointed Special Advocate – a person appointed by the court to advocate for abused or neglected children.
CM - Case Manager
CW - Caseworker
CWSW - Child Welfare Social Worker
FAW - Foster Adoptive Worker
GAL – Guardian Ad Litem – a person appointed by the court to represent the “best interest of the child”
SLP - Speech/Language Pathologist
SW - Social Worker

School:

ARD - Admission, Review, and Dismissal. This appears to a term specific to Texas. An ARD meeting is a meeting of a group of people who help to determine whether or not a student is eligible for special education and develops the Individual Education Program (IEP) for eligible students.

ED - Emotionally Disturbed. This is not a diagnosis. Created by Federal law, it is used in schools to label kids with severe emotional problems (like bipolar disorder, schizophrenia, conduct disorder, C-PTSD...) that adversely affect their ability to learn in an educational setting. The label allows them to receive services and accommodations such as special ed. 

IDEA – Individuals with Disabilities Education Act – US Federal law that requires schools to provide students with a disability an education that is tailored to their individual special needs.

IEP - Individual Education Program - a written document that's developed for each public school child who is eligible for special education. It addresses their individual learning needs, accommodations needed, and educational goals.

OHI – Other Health Impairment – a chronic condition (such as ADD, ADHD, epilepsy, Tourette syndrome...)  that causes the child to struggle in the classroom, 

SED - Special Education

Slang: 

BRB - Be Right Back

BTDT - Been There. Done That.

BTW - By The Way

DM - Direct Message. Used mainly in social media-based conversation (Twitter or Instagram). A message between 2 people sent privately outside of the social media group or chat. 
FB - Facebook. This has other inappropriate meanings so be sure to use it in context!

FML - F*ck My Life

FWIW - For What It's Worth

FYI - For Your Information

HTH - Hope This/That Helps

OMG - Oh my God/Goodness/Gosh

IMHO - In My Humble Opinion

IRL - In Real Life

OTOH - On The Other Hand

PM - Private Message. Used mainly in computer-based conversation (instant messaging, email, text messaging, etc.

SMH - Shaking My Head
SSDD - Same S#it. Different Day.

TTYL - Talk To You Later

YOLO - You Only Live Once

Treatment:

 BIT - Brain Integration Technique/ Crossinology A stress management process said to permanently improves the flow of information in the brain in less than ten hours, with no drugs or surgery.

CBT- Cognitive Behavioral Therapy  - talk therapy that combines behavior therapy and cognitive therapy to address dysfunctional emotions, behaviors, and cognitions.

DBT - Dialectical Behavior Therapy- talk therapy used to treat people with borderline personality disorder (BPD). DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness

EMDR - Eye Movement Desensitization and Reprocessing.  This is a great therapy for people with PTSD

EFT - "Tapping"  Emotional Freedom Techniques - "Tapping" on the meridian points of the body while saying certain statements.Works well for children of trauma (and their parents too).

RRHAFTBALL - Respectful, Responsible, Honest, Fun To Be Around, Loving, and Learning.

TBRI - Trust-Based Relational Intervention by Karyn Purvis - an attachment-based, trauma-informed intervention focused primarily on Connection

Other: 

SSA - Social Security Administration

SSI/SSDI - Social Security Income/Social Security Disability Income {Getting SSI for an Adult Child}

NAMI-CAN - National Alliance for the Mentally Ill Children and Adolescents Network

Title IV	Child Welfare Act Section of the Social Security Act
Title IV-A	Aid to Families with Dependent Children (Section of the Social Security Act)
Title IV-B	Child Welfare Services Program (Section of the Social Security Act
Title IV-D	Child Support Enforcement Program (Section of the Social Security Act)
Title IV-E	Foster Care and Adoption Assistance Programs (Section of the Social Security Act)
Title V	Maternal and Child Health (Section of the Social Security Act)
Title X	Federal Family Planning Program (Section of the Social Security Act)
Title XIX	Medicaid (Section of the Social Security Act)
Title XVIII	Medicare (Section of the Social Security Act)
Title XX/SSBG	Social Security Block Grant (Section of the Social Security Act)

Self-Harming/ Cutting

Marythemom Disclaimer:
I have not personally dealt with a lot of self-harm with my children. I have one child that self-harmed but for only a short time because she was very afraid of pain. For her, the self-harm was triggered by being put on an anti-depressant (she is bipolar so this triggered severe mood swings) but continued even after the anti-depressants were out of her system. 

"Luckily," the types of self-harm she chose were digging her fingernails into her arms and erasing (rubbing skin with an eraser to the point that it rubs off the epidermis leaving it raw). Neither action left a mark longer than a couple of days. 


Cutting and Self-Harm: Warning Signs and Treatment By Jeanie Lerche Davis
Cutting. It's a practice that is foreign, frightening, to parents. It is not a suicide attempt, though it may look and seem that way. Cutting is a form of self-injury -- the person is literally making small cuts on his or her body, usually the arms and legs. It's difficult for many people to understand. But for kids, cutting helps them control their emotional pain, psychologists say.


This practice has long existed in secrecy. Cuts can be easily hidden under long sleeves. But in recent years, movies and TV shows have drawn attention to it -- prompting greater numbers of teens and tweens (ages 9 to 14) to try it.

Karen Conterio, author of the book, Bodily Harm. Twenty years ago, Conterio founded a treatment program for self-injurers called SAFE (Self Abuse Finally Ends) Alternatives at Linden Oak Hospital in Naperville, Ill., outside of Chicago.

Her patients are getting younger and younger, Conterio tells WebMD. "Self-harm typically starts at about age 14. But in recent years we've been seeing kids as young as 11 or 12. As more and more kids become aware of it, more kids are trying it." She's also treated plenty of 30-year-olds, Conterio adds. "People keep doing it for years and years, and don't really know how to quit."


"The problem is particularly common among girls. But boys do it, too. It is an accepted part of the 'Goth' culture," says Wendy Lader, Ph.D., clinical director for SAFE Alternatives. "Self-injury is definitely a coping strategy for unhappy kids."

Very often, kids who self-harm have an eating disorder. "They may have a history of sexual, physical, or verbal abuse," Lader adds. "Many are sensitive, perfectionists, overachievers. The self-injury begins as a defense against what's going on in their family, in their lives. They have failed in one area of their lives, so this is a way to get control."

Self-injury can also be a symptom for psychiatric problems like borderline personality disorder, anxiety disorder, bipolar disorder, schizophrenia, she says.


Yet many kids who self-injure are simply "regular kids" going through the adolescent struggle for self-identity, Lader adds. They're experimenting. "I hate to call it a phase, because I don't want to minimize it. It's kind of like kids who start using drugs, doing dangerous things."

"Yet self-harm is different from taking drugs," Conterio explains. "Anybody can take drugs and feel good. With self-injury, if it works for you, that's an indication that an underlying issue needs be dealt with -- possibly significant psychiatric issues. If you're a healthy person, you might try it, but you won't continue."

Self-harm may start with the breakup of a relationship, as an impulsive reaction. It may start simply out of curiosity. For many kids, it's the result of a repressive home environment, where negative emotions are swept under the carpet, where feelings aren't discussed. "A lot of families give the message that you don't express sadness," says Conterio.


It's a myth that this behavior is simply an attention-getter, adds Lader. "There's a [painkiller] effect that these kids get from self-harm. When they are in emotional pain, they literally won't feel that pain as much when they do this to themselves."

About 8-10% of all people with Borderline Personality Disorder (BPD) commit suicide.  This does not include those who engage in risky behavior that results in death.  

Suicide (and other impulsive, dysfunctional behaviors) are seen as solutions to overwhelming, uncontrollable emotional pain.  Self-injury is a coping mechanism that may release chemicals that lead to a general feeling of well-being.  There are many reasons for self-injury, and it may be done intentionally or unconsciously (unaware and in a haze).  An intellectual understanding of why they do it doesn't make it any easier to stop.  There is a misperception that all people with BPD harm themselves or are suicidal.  Many high functioning people with BPD do not, but those that do, however, may seek professional help more often than those who don't.  ~Stop Walking on Eggshells

Child to Parent Violence

Child-to-Parent Violence

Abuse of parents by their children, also known as child-to-parent violence (CPV), is a form of domestic violence and is one of the most under-reported and under-researched subject areas in the field of psychology. Parents are quite often subject to levels of childhood aggression in excess of normal childhood aggressive outbursts, typically in the form of verbal or physical abuse. Parents feel a sense of shame and humiliation to have that problem, so they rarely seek help.

‘Parent abuse’ has been defined by Cottrell (2001, p. 3) as ‘any harmful act of a teenage child intended to gain power and control over a parent. The abuse can be physical, {verbal abuse (for example, swearing at or threatening a parent)}, psychological/emotional {such as intimidation, threats, gaslighting...}, or financial.’

It may be a one-time incident or it may escalate in frequency, even to the point of a daily occurrence. And although parental abuse is often associated with explosive anger and rage, the abusive behavior may occur with no emotion: a quiet, deliberate act of harm used by a teen to maintain power over a parent. 

Though this type of abuse often takes place during the teen years (often from 12 to 17), it can happen earlier than that. There's been some reports of children younger than 10 years old. 

Effect on Parents
The effects of experiencing abuse from one's child can be profound. In the short term, ongoing parent abuse has been found to impact on a parent's and other family members’ physical and psychological health, with specific negative emotions such as fear, shame, guilt, and despair commonly reported (Cottrell & Monk, 2004) Parental abuse can leave a person feeling embarrassed, ashamed, angry, terrified, and unsure of what to do. These are feelings that we call “parent paralyzers,” feelings so intense that they overtake logic and reason and leave us questioning ourselves and trapped in uncertainty about what direction to take. 

Causes of CPV
The causes are yet to be properly studied, as there's still very little research on that, but three main variables have been suggested as possible contributors to child to parent abuse: the presence of a mental health condition, {special needs, ASD, FASD, brain injuries, impulse control issues...], attachment difficulties (which might or might not be related to a mental health issue), {substance abuse} and/or previous experiences of abuse {this can include witnessing acts of domestic violence}. [Or as is often the case with children of trauma, some combination of all of the above.] 

Children within these risk groups may have “several overlapping issues”, says social worker and CPV campaigner Helen Bonnick. Early trauma, such as neglect or living with domestic violence, may have affected the way they react to stress – or had a modeling effect. Children who are abusing substances may lash out while intoxicated or demand money for drugs. They may be living with such high levels of anxiety that it takes very little to tip them into fight, flight or freeze. 

~from the article Parental abuse by children

Tip of the Iceberg
In the US, recent estimates of the prevalence of child-on-parent violence range from 5% to 22% of families, which means several million U.S. families could be affected.

A 2008 study by the U.S. Justice Department found that while most domestic assault offenders are adults, about 1 in 12 who come to the attention of law enforcement are minors. In half of those cases, the victim was a parent, most often the mother. 

~ When Teens Abuse Parents, Shame And Secrecy Make It Hard To Seek Help

In the UK, Met Police figures show that reports of child-to-parent violence (CPV) increased 95% from 920 in 2012 to 1,801 in 2016. However, it is difficult to know whether this is because the issue is more widespread or is reported more often.

“My feeling is that it is more widespread,” says social worker and CPV campaigner Helen Bonnick. “I am seeing lots of links with CPV and children and young people’s mental health – so if, as we are told, that is worsening you would expect there to be a knock-on effect.” [For those of us who only speak "American," - "Knock-on effect" appears to mean "causes other things to happen." - In other words, the increase in mental health issues will most likely mean an increase in Child to Parent Violence (CPV).]

What is clear, is that the problem is much wider than reported – “for very understandable reasons”, says Suzanne Jacob, chief executive of domestic abuse charity SafeLives. “Those who experience intimate partner violence only call the police at a rate of one in five. We can all see the reasons why you would be even less likely to call the police about your child – and not just the police – there is so much attached in terms of any stigma people feel, and in terms of worries about consequences for themselves and the child.”

Shame and fear can prevent parents from seeking the help they need – as can a lack of understanding from family, friends, and agencies. “The kind of dismissiveness people in previous times applied to intimate partner violence is still applied to CPV,” says Jacob. “People end up minimizing what is actually an incredibly serious issue in somebody’s home.”

The insidious nature of domestic abuse also plays its part. “It can build up gradually,” says Bonnick, who runs the campaigning and resource website Holes in the Wall. “It takes a while to acknowledge that you are being abused … because it’s become so normal,” she says.

Lack of services
“I think often people do ask for help and get knocked back – passed from one agency to another,” says Bonnick. “It can be very difficult to find where to go in the first place, and then even if you do approach an agency, what sort of help do you get?”

It’s a good question. The reality is that there is no national blueprint for dealing with CPV and the quality of help families receive is patchy. “What you get is pockets of good practice,” says Condry, “but a lot of areas where there is practically nothing.”

~What Happens When Your Child Becomes Violent … With You

The United States currently protects abused children using Courts, Child Protective Services, and other agencies. The US also has Adult Protective Services which is provided to abused, neglected, or exploited older adults and adults with significant disabilities.

There are no agencies or programs that protect parents from abusive children, adolescents or teenagers other than giving up their Parental Rights to the state they live in.~from the article Parental abuse by children

Responding to Parental Abuse 

By Kim Abraham, LMSW and Marney Studaker-Cordner, LMSW

Aggressive and abusive behavior is not a part of typical childhood or adolescence. It’s not a stage that your teen will “grow out of” if you ignore it. If you’re dealing with parental abuse in your home, your child is violating the rights of others. It doesn’t matter that it’s his parent’s rights; that doesn’t make it any less serious or illegal. Your home is the place where your child will learn how to interact in the world. He is learning what’s acceptable — and what’s not. He’s learning about consequences for behavior and accountability.

One of the hardest tasks a parent can be faced with is responding to their own child’s aggression or abuse. It’s natural to feel torn. On one hand, it’s instinctual to protect your child. On the other hand, nothing can push a parent’s buttons of anger, disappointment, and hurt like a child’s abusive behavior. Some days you may feel emotionally stronger than others. Only you can decide what you’re able to follow through with at any given time. Here are some suggestions:

1. Clearly Communicate Boundaries
Make sure your child understands your physical and emotional boundaries. You may need to clearly state:

“It’s not okay to yell or push or hit me.”

If you’ve said this to your child in the past, but allowed her to cross those boundaries in the past without consequence, she’s gotten mixed messages. Your words have told her one set of boundaries but your actions (by accepting being yelled at or hit) have communicated another set of boundaries.

Make sure your non-verbal communication (what you do) matches your verbal communication (what you say).

2. Clearly Communicate Consequences For Abusive Behavior
Tell your teen:

“If you hit me, throw something at me, or otherwise hurt me physically, that’s called domestic violence and assault. Even though I love you, I will call the police and you will be held accountable for your behavior.” 

Then – again – make sure your actions match your words. If you don’t think you can follow through with contacting the police – don’t say you will. This will only reinforce to your child that you make “threats” that won’t be carried out.

You may choose to provide other consequences, other than legal, that you enforce. If a friend physically assaulted you, would you let her borrow your car or give her spending money the next day? Probably not.

3. Contact the Authorities
We don’t say this lightly or without understanding how difficult this can be for a parent. Some parents are outraged at a teen’s abusive behavior and react: “I’ve got no problem calling the cops on my kid if he ever raises a hand to me!” Other parents struggle, worrying about the long term consequences of contacting the police or unable to handle the thought of their child facing charges.

Remember, if your teen is behaving violently toward you now, there is the risk that this will generalize to his future relationships with a spouse, his own children, or other members of society. You are not doing him a favor by allowing him to engage in this behavior without consequence.
Related content: When to Call the Police on Your Child

4. Get Support
Parental abuse is a form of domestic violence. It’s a serious issue and needs immediate attention and intervention. Domestic violence has traditionally been characterized by silence. As hard as it is, break that silence. Get support from family or friends – anyone you think will be supportive.

If your natural supports tend to judge you and you’re afraid it will only make the situation worse, contact a local domestic violence hotline, counselor, or support group. For support and resources in your community, you can also call 2-1-1 or visit 211.org, a free and confidential service through the United Way.

The road to a healthier relationship with your child will very likely take time. There’s no shortcut or quick fix. It starts with an acknowledgment of the issue and accountability. If you’re facing this issue in your family, we wish you strength and empowerment.

     ~Parental Abuse: What to Do When Your Child or Teen Hits You 

So What Do You Do About It?!
Some ideas (in no particular order):

Handling Rages

Handling Dysregulation and Meltdowns- helping them learn to regulate their own behavior independently. Calming and Relaxation Techniques 

You Have not Failed!! 

I had to reread this post (You Have not Failed!!) often after my son moved out and got into serious trouble. Part of me believed that I could have/ should have done more and that this was all my fault. One of the hardest (and most important) things I've done was to accept that I did the best I could and that was enough. 

My Top 10ish Things I Couldn't Do This Without

Document, Document, Document! - this helps you get services for your child and can help protect you and your family from false allegations.

Call the Authorities
I know it's scary, but often it's best to get the authorities involved when your child is violent. In addition to protecting you and your family, this provides documentation, and can often give you access to services you might not normally be able to access.
Some authorities that might help:
Police, Mental Health Authority, Child Welfare Agency (Child Protective Services, Post Adoption Services, Adoption Agency...)


National Domestic Violence Hotline - 1-800-799-7233 | 1-800-787-3224 (TTY) | En Español | If you’re unable to speak safely, you can log onto thehotline.org or text LOVEIS to 22522.

Safety Plan - It's easier to make that call to the police ( or mental health authority, adult protective services, child protective services...) if you already resolved to make it and under what circumstances. You can research in advance who to call (ex. our area has a "Mental Health Police department" but a regular police officer has to come out and determine that it's needed). This gives you time to have contact information gathered. You can also contact them in advance and make sure they understand the situation they might be walking into. This is a good time to establish a relationship with them without a screaming, raging child present or a triangulating child who is doing his/her best to make it appear that you are the one who is abusive/ raging/ out of control... 

Understanding The Child's Behavior
Why Won't My Child Just Behave? 

Why Do They Do That? If You Find Out I'm Not Perfect You'll Leave

Why Doesn't My Child Feel Safe?

Recognizing Triggers

Prevention/ Setting Up A Successful Environment For The Child

Structure and Caring Support
Therapeutic Parenting Based on Emotional/ Developmental Age
Chores, Responsibilities, and Other Things My Kids Can't Handle

Setting Boundaries
Boundaries are essential for the safety of the child and the family but when dealing with an aggressive/ out-of-control child, especially when your life hasn't been set up that way from the beginning... it can feel impossible. This post has a lot of information about how we handled it - Structure and Caring Support.

Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder by Paul Mason MS, Randi Kreger - I found this book to be helpful for anyone dealing with a child with an attachment disorder, not necessarily borderline personality disorder. It helped me better understand why they acted this way, which helped me be more empathetic. It also helped me with setting boundaries when my kids were teenagers, all of them, not just the adopted ones. 

Get Support! 
Find people who "get it."  Real-life, online... just find them, and share!! Remember, "You are not alone!" There are people out there who have been and/or are in similar situations. Reach out and ask for help and support - and accept it! You need help.  You deserve help.  Ask for it.  Accept it.  Please!

Diagnoses/Labels for Services
I found it helped to get full neuropsych evaluations to access services but all medical professionals, psychologists therapists. and even school evaluations can provide useful information. Trauma and other issues can cause results like IQ and mental health diagnoses can change dramatically. Try getting multiple assessments and then cherry-pick the results you need to get the services you want. [When Is a Label a Good Thing?]

[I carry a one-page document [Current Meds and Diagnoses Document] that has a summary of my child's information including diagnoses and medications. I'm the one that wrote it, so it is easily changeable. I could, and did, include (and/or leave out) whatever test results we needed to get what my child needed. To be clear, I did not falsify the information! I just carefully chose which to present and emphasize. [Persuasive Writing - How To Get Your Document Read]. 

Psych hospitalizations - Psych hospitals are designed for short-term crisis care only, but often just the fact that the child has been in a psych hospital is enough to open doors to services. Our insurance required that "all other interventions be tried" before it would pay for residential treatment so while multiple psych hospitalizations rarely changed/improved my child's current situation, they were helpful in getting our child into an RTC. 

Most importantly, psych hospitalization allowed both our family and the child to get a little respite from each other in a way that ensured the child was safe - I quickly learned to stop feeling guilty about enjoying the break and using the time to recharge my batteries and spend time with the family. 
. 
Unfortunately, the psych hospitals often sent the child home before any changes had been made (even my child stating to the discharge nurse that she was actively suicidal didn't stop her from being sent home after the standard 4 days that was all our state Medicaid covered). 

We did use a "revolving door" technique. The moment the child was suicidal/ aggressive again, we went right back to the ER/ psych hospital. I know one family that pretty much just circled the block (during which, the child was aggressive and threatening) and walked back in the front door to apply for admission. 

Residential Treatment [Finding and Funding Residential Treatment (RTC/RTF)] - I know some parents worry that RTC will damage the parent-child attachment relationship but we didn't find that to be the case. Possibly because we stayed in touch with the child and took the child home again when they were released (something that didn't always happen before the child came to live with us).

PINS / CHINS Petition / YIC - Sometimes a teen's misconduct is so extreme or has been an ongoing problem for so long that his or her parents can no longer manage and feel they have no recourse but to remove the child from the home. His or her parents would have to go to their state's family court to file what is called a PINS (Persons in Need of Supervision) petition. In some states, it may be known as a CHINS (Children in Need of Supervision) petition or a YIC (Youth in Crisis) Law [Parental Options For Out-Of-Control 16-Year-Olds by Susan Price, Principal Legislative Analyst]. 

The process may vary somewhat from one state to another. Typically, before filing, the parents and child must meet with a representative of a government social-service agency, who attempts to resolve the family crisis and keep the case out of court. This step, called diversion, can last ninety days. If reconciliation proves unsuccessful, the parents may then file the petition asking the court to order supervision or treatment for the child. (Legal guardians, school districts, or social-service agencies charged with looking after a child may also file a PINS petition.)


The court will appoint an attorney for the young person and for the parents as well if they cannot afford one. While the case is under consideration, the teen will continue to live with his or her parents, unless the court decides that is an unwise arrangement. In that event, the teen may be released to the temporary care of a relative, foster care, or possibly a group home. A hearing is then held. The family may place the teen in either a treatment facility or in foster care. ~Out-of-Control Teens: PINS Petitions & the Juvenile Justice System

Juvenile Justice System - If a person commits a crime while still a dependent minor, then it is considered not a criminal act but a delinquent act. Accordingly, the case is heard in family court or juvenile court rather than in criminal court. Exceptions may be made, however, for minors who have perpetrated particularly serious or violent crimes, called designated felonies. They may be treated as juvenile offenders in a criminal court, although the criminal court may return the case to family court.

An initial hearing is held to determine whether or not the teenager should be released to his or her parent's custody and allowed to go home. With minor or first-time offenses, that's usually what happens. But if the teen is felt to be a danger to the community or unlikely to return to court, he or she can be detained in a locked or unlocked facility until his or her day in court.


A minor found guilty of a delinquent act may be sent to a detention center, a shelter, or even a boot camp. But the growing trend is to place teenagers in the least restrictive environment possible, such as a non-secure group home. Ideally, the teen can eventually come back home and return to school. The goal of the court is not to punish, it's to rehabilitate and create a productive adult capable of functioning in society. A delinquent act does not become part of a minor's criminal record; a designated felony, however, does. ~Out-of-Control Teens: PINS Petitions & the Juvenile Justice System

Legal Guardianship/ "Rehoming" - whether with a relative, friend, or someone else, one option might be to temporarily (or permanently) place the child with another family. Be aware that there can be many legal and other repercussions from this and it is strongly advised that you do a LOT of research and discuss it with a family law attorney.

Emancipation - A teen who wishes to live on his or her own legally, without running away from home, can appeal to the family court for a declaration of emancipation. Emancipation grants many rights of adulthood to teens who are approved by the court.


The criteria for emancipation vary according to jurisdiction. In some states, children as young as age fourteen may seek legal independence. It helps if the child can prove that being emancipated from the parent(s) is in his/her best interest and can prove that he/she can financially support him/herself financially and are capable of making decisions independently. Other criteria frequently include marriage, parenthood, or enlistment in the armed forces. Emancipation is also sometimes granted if the parents give their permission. Parents can remain involved with emancipated teens pending court approval. ~What You Need to Know to Become an Emancipated Minor

Last Resorts

Joint/Shared Custody with the State - This can be the equivalent of voluntarily placing the child in foster care with the parent retaining a limited amount of control over the child's care/ placement. Unfortunately, parental rights might be involuntarily terminated if a child is placed in foster care. However, this is up to a judge and the likelihood of this occurring varies from state to state. Also, some states may require the parent(s) to pay child support to the state.

Second Time Foster Child: One Family's Fight for Their Son's Mental Healthcare and Preservation of Their Family by Toni HoyAs an infant, Daniel entered the foster care system as a result of severe neglect, which manifested in violence and aggression later in his childhood after he was adopted by Jim and Toni Hoy. Denied the opportunity to get him into a residential treatment center and keep their other children safe, Jim and Toni were given two options by the state of Illinois: "If you bring him home, we're going to charge you with child endangerment for failure to protect your other kids.And if you leave him at the hospital, we'll charge you with neglect." "If any of our other kids got hurt, once we brought him home, they would take the other kids," Jim says. "They put our backs against the wall, and they didn't give us any options."  

The Hoys were investigated by DCFS and charged with neglect. They appealed in court and the charge was later amended to a "no-fault dependency," meaning the child entered state custody at no fault of the parents. 

Mental health professionals recommended abandoning Daniel at the hospital after the state denied all viable sources of funding for his treatment. So Daniel re-entered the foster care system for no other reason than he was mentally ill.

A year later, Daniel’s mother discovered that his treatment was covered by a funding source that he was awarded as part of his special needs adoption. For two years they fought the state government to re-gain custody of their son and get the services he needed. Their fight eventually led to the Illinois Custody Relinquishment Prevention Act, which became law in 2015, orders six state agencies that interact with children and families to intervene when a family is considering giving up custody to get access to services. 

Terminating Parental Rights -  To get the child access to mental health services that the family can't afford and/or access, to ensure the child's safety (from him/herself and/or others), and/or to protect family members from a violent, dangerous child, some families have felt their only option is to legally terminate their parental rights. 

Voluntary Termination of Parental Rights - Courts will not grant voluntary termination of parental rights unless parents can objectively prove this is in the best interest of the child. (This is where all that documentation comes in [Document! Document!! Document!!!]). Judges are generally hesitant to terminate parental rights, even if they're being given up voluntarily. Consult a family law attorney to figure out how to best argue for the termination of parental rights. He or she can help you draft a strong statement illustrating why giving up your parental rights is in the child's best interest. 


This may mean admitting to fault on your part - which, unfortunately, can lead to criminal charges for "child abuse" (child "abandonment" can be considered abuse) and even lead to the loss of custody of other children in the home. Parents who work in helping fields (teachers, medical professionals, police officers...) risk losing their careers if they are convicted of child abuse. 

Involuntary termination of parental rights - Legally terminating parental rights through the courts can occur when "the parent has failed to correct the conditions and/or parental behaviors that led to State intervention and is unable to provide a safe home for the child, despite reasonable efforts by the State agency to provide services to prevent out-of-home placement or to achieve family reunification after out-of-home placement." 

“Psychiatric lockout” - When the child goes into a hospital for psychiatric care, the parent has to refuse to pick the child up. The hospital may call and call and call, but the parent repeats, ‘I’m not coming.’ It may sound cruel, but there’s a goal: once the parent refuses to pick up the child, DCFS takes custody of that child. That means, legally, the state has to give the child the mental health services he/she requires. This can include a residential program --one of the services many states don't fund and that families often can’t afford on their own. ~Excruciating Choice: Trading Parental Custody For Mental Health Care
By Shannon Heffernan

Because legally this can be called "Child Abandonment" the parent(s) will most likely lose parental rights. 

Obviously, terminating parental rights is considered a last resort. 

DON'T MAKE THE MISTAKE OF SACRIFICING EVERYTHING FOR ONE CHILD!! 

Prioritizing Yourself, Your Marriage, Your Family, and Your Child - In That Order
Protect yourself and the rest of your family and prioritize the needs of the family as a whole! 

Continuous Traumatic Stress(CTS) - When Your PTSD is Not Post/Past Yet What to do when you are burnt out, empty, drained physically/mentally/emotionally, have 'Caregiver Fatigue'...

Prioritizing Yourself 
I know it probably sounds impossible but you HAVE TO put yourself first. It's not selfish. It doesn't make you a bad parent. Like they say on an airplane, you have to put the mask on yourself first before attending to the needs of others. If you are completely drained, there is nothing left for ANYONE. I know many Trauma Mamas who after years of damage caused by stress and trauma (and lack of sleep!) have permanently damaged their health and immune system. 

One of my biggest regrets is that my "squeaky wheel" kids drained all my time and energy leaving nothing for my family. 

Self-Care: Caring For The Caregiver
Giving Until There's Nothing Left (But My Child NEEDS Me!
Finding The Joy
Getting Respite

Marriage - Keeping it together
My marriage suffered (many trauma mamas I know are now divorced). Since the kids will (hopefully) be out of the house eventually and Hubby is the man I plan to spend the rest of my life with. I've learned that next to myself, my marriage

Parenting Biokids And Adopted Kids Together
Especially now that my kids are adults, I realize that having scary, severely mentally ill siblings was not the biggest problem for my biokids. 

In addition to missing the happy memories, fun, family stuff like vacations, baking cookies together, and hanging out at the neighborhood pool, we missed a lot of the important-to-kids stuff like attending sporting events or seeing Bob's art displays on Parent's Night at school because we talked to Kitty's teachers instead. 

Also, there were also a lot of issues that I didn't catch. I didn't discover until his junior year in high school that Ponito had severe ADD causing him to almost flunk out of high school despite having an extremely high IQ. It wasn't until they were in their 20s that one of my children finally confided to me that they'd been sexually molested as a teen. 

Looking back, it breaks my heart that I spent most of my children's childhoods being so busy and overwhelmed that I missed out on so much of the important stuff. 

I wish someone had told me that it was OK not to focus everything on trying to heal one or two kids. That even if my efforts were 100% successful (which did not happen and was never going to be possible)  it was not worth the sacrifice.

 I'm not saying we shouldn't have adopted (although that might be true). I'm saying that I should have prioritized maintaining a balance. 

There is no right way to parent, and even if you could do everything "right" that does not ensure the outcome you want, or that it will happen when you want it to.

Resource Posts:

**MY TOP 10 THINGS I COULDN'T DO THIS WITHOUT**

**SELF-CARE! Caring For The Caregiver**
**Finding The Joy**

**Prioritizing Yourself, Your Marriage, Your Family, and Your Child - In That Order**

**Handling Continuous Traumatic Stress(CTS) - When Your PTSD is Not Post/Past Yet**
**Marriage - Keeping it together**

**You Haven't Failed!!**

**Giving Until There's Nothing Left (But My Child NEEDS Me!)**