Muddling through Mayhem

Too long in the Car

2012-01-28T13:16:00.002-06:00

I visited Kitty in the RTF yesterday. On the way there (it's a 3 hour drive each way), Hubby and I had a long conversation about the kids and our marriage – very draining.

Once at the Center, we had an IEP meeting (I was late for) at 11am, then we were supposed to have family therapy at noon, but the IEP meeting ran late (since we started late and because IEP meetings for Kitty are never simple).

We did manage to squeeze in family therapy from 1-2pm and Kitty was NOT happy (which might be a good thing cause it means we’re getting under her armor).

She started by reading an essay that apparently is a requirement for moving up to the next level. She spoke eloquently and it was well written. It nearly broke my heart. She basically talked about feeling that it was her fault she'd been dumped in foster care. That she used to cry for her sisters every night (who remain with birthmom). That she worries about her sisters still in the abusive home and that they don't remember her (it's been 5 years since she's seen them and she probably won't see them again for a long time).

The hardest part was that she spoke about the pain and not seeing any point in living. She was shut down for most of the rest of therapy.

Afterward we had visitation and she was ANGRY with me for bringing her there and for letting the therapist take away her books (which she’s been using to escape/ dissociate), but didn’t want me to leave early. I hope this treatment helps and we don’t end up worse off than we were before!

On the way home there was a horrible accident about ½ way home in the middle of nowhere. I ended up sitting with a ton of other cars for over an hour. It would move a little every now and then, but that could have been cars giving up and turning around. I kept thinking it would clear up soon and there were no crossroads for miles and I had no idea how to navigate them or even if they would take me far enough past whatever was happening on the other side of the “hill.” Don’t know what all happened, but saw a helicopter leave about 10 minutes after I got there, and a lot of fire trucks. When I finally drove past there was a semi burned to the ground (nothing left but the under carriage and a small part of the back of the trailer).

Of course I’d had to pee, before I got stuck and there was nowhere to “go.” Luckily I made it to dinner with the family without embarrassing myself! Still tired and stressed.

Cat vs Bear

2012-01-26T13:34:00.003-06:00

Kitty (diagnosed with RAD, bipolar, processing issues, C-PTSD, and pretty much emotionally over reactive...), after months of being extremely tough to live with and meltdowns, is currently in an RTF to work on her severe trauma issues. Bear, her bio 1/2 brother (18), has similar diagnoses, but instead of being emotional, he tends toward intimidation and verbal aggression. In the past he was physically violent, but is now better medicated.

He is severely traumatized too, and his issues with women and relationships are significant. He's spent the last several months antagonizing Kitty or avoiding her (so he doesn't have to deal with her emotional reactions), not so much maliciously as much as just he doesn't see why he should treat anyone any differently (they should understand it's just the way he is).

When they were little (before they came to live with us) they were abusive to each other (and while only a year older, he has always been significantly bigger). I know she perceives him as one of her abusers, and the rest of us still have PTSD from his violent outbursts when he first came to live with us.

Now he's asked to visit her (not sure why), but I had to tell him she doesn't want to see him, because of his most recent behavior:

He threatened to strangle her when they were alone in a parking lot after an adoption support meeting - we were still talking to other parents so not right there

He and Bob have been semi-blatant about not wanting to hang out with her due to her emotional reactivity. They've excluded her and Bear has tried to pal around with Bob more (although she's not that thrilled with him either and has taken to isolating in her room)

While riding home on the bus, he turned to the girl sitting next to Kitty and started telling her she shouldn't hang out with Kitty.

He yelled at her in front of the entire bus when she accidentally wrote on his hat (she was handing a pencil to someone else and Bear brushed her hand out of his personal space).

Bear's reaction to the news was that he's not going to deal with her ever again. Gotta love their Black and White thinking.

When I pointed out the impracticality of this, as well as the fact that he needs to be working on relationships with his family so he'll be able to have healthy relationships with other women in the future... he continued to state that he's going to ignore her until he moves out at graduation.

Problem is that's not realistic. For one thing that's months away, for another there's a pretty good chance he's not going to be able to move out when he graduates (no job, nowhere to go) and he NEEDS to work on his relationship issues (with all women not just her).

He insists that he's NOT going to work on his relationship issues with her, or me. I've been trying to figure out how to increase the "pain" enough to make him want to work on it. He's been ignoring the issue for years, and just stating that others are going to have to deal with it.

He's been having issues with his latest Kleenex girlfriend (Bailee, the "back-up girl: from our long text conversation a couple of weeks ago). He was invited to go dinner with the girl and her mom. He didn't ask us. He hasn't done chores in weeks. He's been refusing to do any relationship work in therapy... and Hubby basically said "No" when Bear mentioned it.

Next day on the way to his psychiatrist, Bear brought it up again. He started talking about feeling uncomfortable with letting the girl and her mom pay for him. We talked about this for a few minutes and needing to work on his relationship skills with family, and then I mentioned that his point was moot, because Hubby had told me he'd said, "No" to the trip. Bear tried to argue with me, but I just said that was my understanding, and refused to engage.

He pouted. We got to the psychiatrist's office and he refused to talk to anyone. Luckily he was semi-compliant and sat in the offices, and even signed some paperwork he needed to sign (for SSI when he turns 19).

That evening when he got home from school he sat down next to me on the couch and leaned in. I can count on one hand the number of times he's done that (if you don't count the inappropriately sexual hugs and cuddles when he first got here). He didn't say anything for awhile, he just sat there and watched TV. Then he asked me to give him a haircut. (Well, it's better than walking up to me and demanding I do it when I'm in the middle of doing something else or taking time to myself).

So what do I do with two seriously emotionally disturbed kids who have major relationship issues that seem mutually exclusive? I worry that Kitty can't heal with Bear intimidating and picking on her. I worry that Bear will continue to refuse to heal and we will have to continue living with him.

Videos of Cat vs Bear for your entertainment! One Two

Visiting Kitty

2012-01-25T00:31:00.002-06:00

At our last family therapy session we talked mostly about some drama that Kitty had started. Apparently her roommate had been talking about another girl behind her back. Kitty felt the other girl deserved to know what was going on. The roommate felt betrayed of course. Kitty seemed fairly clueless as to why this hadn’t been the best choice, but was trying to follow the Center's rules about accepting blame. Friday was the roommate’s last day so hopefully the Wiccan stuff will go with her.

The hair flipping/twisty thing was gone (She’d started a weird hair tugging/twirling/flip thing with the bangs right in front of her face – it was VERY distracting and annoying, but we'd made big efforts to ignore it.), and she seemed a lot calmer (and a little more distant).

When I went back to visit her this last weekend, it was as though I were a distant relative. She was nice and polite. Gave me a hug, but spent most of our visiting time talking about TV shows and movies (most of which are ones she’s not allowed to watch at home), when I tried to redirect her, she would comply and then the next thing I knew she’d be back to talking about TV.

In a couple of weeks we’ve talked about having Bear be part of the session. I don’t think Kitty is anywhere ready for it, and although we’ve been working with Bear about being kinder, gentler and less intimidating/threatening around Kitty he’s definitely not on board with it.

He’d asked to go last week and I told him Kitty doesn’t want to be around him (since she feels he threatened her life twice). So now he’s rejecting her since she rejected him. *sigh* I think we shouldn’t do it, but I’m worried that she’ll be coming home soon, and have to deal with him (his theory is he’ll just avoid her completely until he graduates and leaves, but I’m not so sure he’s going to have anywhere to go so will be around a lot longer).

Courageous Movie Review

2012-01-24T09:51:00.002-06:00

We watched Courageous this weekend (by the same people that made Fireproof and Facing the Giants). It was EXCELLENT.

I LOL (and I don't mean that thing we write when something was kind of funny - I mean I literally laughed out loud until I cried) and COL (cried out loud, tears streamed). Even Hubby and my 18yo son, Bear, "teared up." The only one not as effected was my teenage daughter, Bob (although she laughed just as hard as the rest of us). It's not really written for teenage girls.

It's like Fireproof is to improve marriage, but for Dads to improve as parents.

One of the most powerful quotes to me was, "I don't want to be a 'good-enough' father." (After his friend asked him why he wanted to change his relationship with his children, and called him a "good enough father."

It could be a tough movie for kids of trauma. How they handle it would depend on their age, maturity and of course issues.

Clearplay wouldn't be necessary for most of the movie. Although most of the main characters are police officers so there are some intense scenes involving violence, drug dealers, shoot outs, and chase scenes... but no one is ever seriously injured.

There's quite a bit of gang related stuff, including a "beating in initiation," although most of it isn't visible.

Of course there are quite a bit of issues with fathers, but it's handled pretty positively. There's a report quoted often in the movie that people who grow up without fathers tend to end up in jail or dead. My main concern was that if Hubby didn't "step up to the plate" then Bear would be resentful, but Bear thinks Hubby does an

Spoiler:

The main characters lose their 9yr old daughter to a drunk driver (while she's at a birthday party). They don't show any of it. There is a funeral though.

I highly recommend the movie, but definitely have a box of tissues. I hope it has a lasting effect on Hubby's relationship with the kids. I plan to buy it.

I text now!

2012-01-18T11:33:00.003-06:00

With my old phone, I would occasionally text when forced to, but it was a pain. I had to push the number 3 three times to get the letter F... you know, it took forever. Still I'd discovered it was fun to torture my "captive audience," by sending them love texts - telling them how much I love them. As teens (and a tween) they ignore me of course.

For Christmas I got a new phone with a little keyboard. I've probably "spoken" to Bear more now than I have in the 6 years I've known him! lol

Hubby and I were on our way back from visiting Kitty in Metro City (a 3 hour drive):

12/30/11 4:55 pm Hy mom this is Bear how's Metro and will u be back for dinner
:) love Bear <3

4:47 Metro n Kitty were ok. See you in about an hour or so.

5:04 (text from Bear's ipod app he uses for texting) Hi mom its me Bob are you gonna be in town for dinner
:) love Bear <3

5:07 I just told Bear n Poppy that we'll be there not 2 long after 6 pm depends on traffic.

5:08 Alright well I'm not with poppy and Bear didn't tell me that
:) love Bear <3

5:09 Ok. Love you Sugar plum!

5:13 She's sick now
:) love Bear <3

5:14 Who?
I <3 Hubby

5:16 Bob she's gagging so hard she fell over
:) love Bear <3

5:22 Just because I called her Sugarplum? You wouldn't gag if I told you how great u r (awesomely wonderful) or how much I love u (bunches!), would you, Sugar Britches?!
I <3 Hubby!

{Sent to all 3 kids} 5:32 Aren't y'all glad I text now my little Honey bunnies?
Love, Mom
I <3 Hubby

No response from any of 'em.

***********************************************
Bear sent this text in the middle of the night. I didn't see it until the next morning.

1/6/12 11:23pm Hy mom this is Bear I'm having problems breathing and snacking and having chest pains like crazy

On the way to drop him off at Grandma and Poppy's so Hubby and I could drive to Metro City to visit Kitty, we talked to Bear about how he was feeling (and reprimanded him for not letting us know sooner). He said his chest pains were better, although his arm hurt a little too. I thought it might be heart burn, or more likely it was the usual psychosomatic issues. I asked him to talk to Poppy (who used to work in the ER) to let him know what was going on and to let us know if it got any worse, but that I wasn't too worried about it.

Within the hour I got a text from Ponito that Poppy was taking Bear to the hospital. I immediately called and told him that wasn't necessary (and that I had Bear's insurance card anyway).

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

Less than a hour later, Bear sent Hubby a text asking if he could go to the movies with a group of friends. Hubby and I immediately started laughing. So much for being about to die. He'd been laying around on his tookus for weeks and now he wants to get to go somewhere unsupervised with a bunch of teens with nothing to do. Don't know why he can't get that he has to build trust first.

1/7 9:46am It's up 2 Grandma. She's got a lot going on 2 day, and she really needs help with the stones.

{Grandma needs some landscaping blocks laid. Ponito, only 12, has been working for days helping her. Bear has been sitting around on his tookus. Plus he had some kind of training he was supposed to go to after therapy, so wasn't going to be able to spend the night - and Hubby and I were going to have to give up our evening alone. He'd taken on a job (scam) selling knives and apparently they'd strongly suggested he get some extra training. He was fired less than a week later.}

10:38am Mom I don't have to go {to the training} tomaroow he said
I don't have to

10:41 Ok, why don't u swing by the house after therapy n pick up ur
stuff n meds.

10:45 Garandmias kinda pissing me off to

10:46 Sounds like something else to talk about in therapy.
Anything I can help with?\

11:45 Ok

1:23pm Mon I got a ride to the mall can I go if I get a ride back {friend's parent} said
he want to go c the movie to

2:48pm 4 a kid who almost went to the ER this am that's not a good choice.

3:57 Can u have Gma call me please?

{Grandma told me he had been a jerk all morning and hadn't helped at all beyond one tiny bit of help unloading one of the many loads of stones, that they'd not given him a choice about)

4:23 So I'm fine mom and it ws from stress {his therapist that he apparently called} said but I really wanna go

4:26 What did u do to help out today?

4:27 I helped move rock out of the car

4:27 After the walk then I put them in place

4:28 Today?

4:28 Yes today

4:30 Can I please

4:31 Where r u getting the $? U owe a lot.

4:32 My friend said he was pay for my christmas gift

4:34 And I get payed monday and I'll do work for gradmia tomaroow for money

4:36 All the $ u r getting paid is spoken 4.
I guess have {parent of a friend} call Dad n confirm.

{He knows one criteria for going is an adult must be present}

4:37 Ok

{Bear calls us and lets us know that the plans with the adult have fallen through. We are not shocked. In fact we'd suspected that the parent never even knew he was involved, and Bear had been hoping we'd not check}

4:48 If gramdmia takes me can I

4:49 Or poppy

4:57 I'll ask them
to

4:58 Ask who to what?

4:59 You still have no way home

5:03 It cool hay I don't want to hang out with them bailee's up and talking to me but she want to know if me and her and some friend can hang out MLK day

{Hubby and I are laughing. Gotta love sour grapes.}

5:04 At our house?

5:05 At {the mall in the city) or some thing ike that I don't want to it's to far her friend want to go there

5:09 What a weird coincidence that her friend wants 2 hangout at the {Big city mall} 2?!

5:12 Her friends and I'm trying to get Jammie and some of mine to go so we can all hang out!! And be teenagers and hang out and have fun and act like we all have lifes.!!

5:13 But me and Jammie really don't

5:15 The person whose life u r living wants it
back.

5:16 Since u r not using it

5:17 Lol really funny I'm trying to use it I just don't know how and I want to spend
that day with her

5:18 Or at lest a few hours

5:19 It's over a week away.

5:21 I know but I want make plans

5:23 After all right now she is only ur backup. In another week u could have made up w/ {really recent ex} or found a new love (and new backup girl)

{This was kind of mean, but only a couple of days before, he was devastated about recent ex dumping him. We suspected it was more about the fact that he'd had an argument with his "back-up girl," Bailee, that same day}

5:24 What makes u think I don't like bailee

5:28 I didn't say u don't like Baillee. I just called her ur backup plan. Have u noticed u usually have one? I think it says something about the depth of relationship u r ready 4.

5:30 Mom I'm sorry u fell that way but I want to be with her and she likes me and I like her

5:35 What about {recent ex girlfriend}? I'm just saying u got over her really fast. And u were engaged not 2 long ago {to a totally different girl}. I'm not sayin u don't like Bailee. I'm just suggesting u try 2 take things slower. Get 2 know a girl b4 you get emotionally committed.

{He hadn't bothered to tell us about the engagement. We'd found out from Kitty after it was all over. He lied to us in therapy about the circumstances even after he knew we'd found out - to make it seem like he hadn't told us to keep us from "getting mad at him." His therapist thinks this is a "good sign," because he knew we wouldn't approve of an engagement at this point in his life, which means that HE knew it wasn't a good point in his life to be engaged.}

5:44 That's y I want to hang out with her duff that's how u get to know people

5:46 True. Just want u 2 notice ur patterns.

5:51 I know I'm done making that mistak I want to get to know her and take things from there if things work out

5:55 I don't know wat 2 say. I hope u CAN follow through. We'll be there 2 help.

5:56 Ok I think I may take u up on that

5:58 U do realize that means u r going 2 have to talk 2 me at some point, right?

6:00 About wat

6:00 Anything!
6:01 Everything
6:02 SOMEthing!

6:03 Ok will do

Interior Design Question

2012-01-13T17:23:00.006-06:00

In order to move Ponito upstairs to his own room (and get him out of my sewing room), we have to convert the playroom to a bedroom. To do this we'll need to add a door to the opening in this room. I looked, but I don't have any pictures of this particular wall. Although I have one that shows a tiny portion (you can see the angled wall that's causing me trouble on the left.

For those who can read blueprints, the room that's causing me grief is labeled Family (the computer program I used had a limited number of label choices). It's in the lower left corner.

There's a light dotted line that makes this room look rectangular, but that's just a flaw in the software. In reality it's one big opening. One side of the opening is the wall that ends at the corner of the bathroom (the bathroom "opening" shown is really a door) and the other wall makes a 45 degree angle into the hallway. About 18 inches down the hallway is the doorway into a bedroom.

What I need to do is find a way to span the 5' 4.5" opening from the corner of the bathroom to where the angled wall meets the hallway. Which means nothing is square! (In the picture that looks like it will make the hallway too narrow by the stairs, but I must have had a measurement off because there's plenty of room). The ceilings are 8 foot.

When I was a kid, my dad made a bedroom for me out of a breakfast nook, by bolting together some louvered closet doors across the span with two of the doors being openable. (This is not a picture of my room). My doors didn't go all the way to the ceiling (they were closet door height) and if you bent down you could look up the louvers to see in my bedroom (I was 16 that was really embarassing), but the point was it was probably relatively inexpensive and could be removed when we moved on the next year.

Of course MY point was that while it did keep my siblings from just walking into my room anytime they wanted, it did NOT keep them from lobbing marshmallows and assorted items over the top of my "wall" and of course you could see into it, which really wasn't cool.

I want something that feels fairly permanent, is cheap and easy to install, and gives him some privacy.

Edited to add: I do have a safety concern for Ponito too. Our kids don't have locks on their doors and we haven't had any issues with sexual abuse in this home, but I do feel he needs to have a door that at least makes noise if someone enters. People here are in the habit of knocking on closed doors, but see open doors (or just curtains?) as an open invitation. Plus Kitty sleepwalks and his room would be right next to the bathroom.

If it muffles sound (since it's right next to the bathroom) all the better.

These things like hotels use to divide big rooms into smaller rooms are cool, but probably way out of my price range.

Suggestions?!

Starting a new business?

2012-01-12T22:31:00.010-06:00

Thinking about going back to doing seamstress work again. What do y'all think? What would be the best market to get into?

a) try to break into the Anime/costume business?
I've been making elaborate costumes for a looonng time.

**Unicorn Centaur Princess

**Teletubby

**Purple People Eater

**Renaissance

b) design clothing for those live size jointed dolls? Don't have any pictures of this, although I've done period pieces for smaller dolls

c) bridal/ bridesmaid/ prom as an independent (not for a company)

d) custom clothing for people who don't fit standard sizes or want something that's hard to find

He's 6 foot 7 inches tall

Discreet, stylish nursing top

e) bridal alterations or regular alterations for a company

f) teach sewing to teens/ adults

g) custom bedding or curtains

h) Custom machine embroidery (can't figure out how to put pictures on here)

How should I market myself?
a) Etsy shop (not that I know anything about these)

b) website and try to do long distance sewing from measurements

c) only local clients

If I do this then I need to find a way to put a door on the old playroom and move Ponito's bedroom up there so I can have my old sewing room back. We had moved me out of it when we'd decided to split up the girls so they each had thier own room. At that time the kids actually played in the playroom.

We had put Bob in my sewing room because she was the only one I trusted next to the front door and away from everyone (all the other bedrooms are upstairs). A year or so ago, Ponito and Bob switched bedrooms, don't remember why, just remember all the furniture moving was tough. Ponito likes the idea of moving to the playroom because it's twice as big as his current room. He was a little disappointed when he found out the PS2 wouldn't be staying.

I need my old downstairs sewing room for several reasons.

Having clients climb the stairs or going into the family parts of the house is never a good idea. My old sewing room was right by the front door.

What I'm using now is small enough to be a small walk-in closet and I could never work on wedding dresses or other large pieces of fabric (like bedding or curtains) or have clients in there. It's too crowded to even be able to close the door.

Has to have a door to keep out the cats. We have a long hair cat that LOVES fabric and hiding in my fabric stashes. If I leave fabric out for a moment unattended he's laying/ shedding on it. If I cover it with plastic to protect it, he's been known to pee on the plastic.

I need to be in a central part of the house for when I'm needed. Especially when Kitty gets home.

How's Kitty doin'?

2012-01-08T22:45:00.003-06:00

Hubby and I went to visit Kitty and have family therapy on Saturday. We had a bet to see what her personality would be when we saw her. I bet she'd still be regressed (chewing her finger, carrying around stuffed animals and a blankie and clinging to Mommy) - probably wishful thinking on my part. Hubby bet she'd be completely repressed (total denial that she had any issues at all, pretending everything was fine).

Neither one of us was exactly right. She was more angry. She gave me a polite hug, but didn't hug Hubby. She sat down next to me, but didn't lean in.

The therapist had given Hubby and I an option of what to talk about at the session:

Kitty's new roommate who also has RAD (we'd discussed the fact that Kitty doesn't really have an understanding of RAD - in fact I would have said she didn't even know she has it)

Kitty's most recent violent episode (after an argument on the bus with Bear, she came home and blew up at Hubby, culminating in her slapping his face, spitting on him and trying to kick him to the point where he had to physically be restrained).

We chose the episode with Hubby since her memory of it would be even dimmer later than it probably already was. We spent most of the session talking about what happened. Applying DBT techniques to what happened, and figuring out where we went wrong.

I can't pretend I know a lot about DBT. Basically it appeared to be identifying the emotions, checking the facts (like getting mad because someone was late, then find out they had a flat tire and couldn't help being late). We went through the most of the event.

Hubby and I came away from the session:

We all acknowledged that Kitty's tolerance level is WAAAAYY lower than most people (which we already knew)

Hubby and I defensively tend to start trying to "check the facts" (perception/ reality check) with Kitty, while she is still probably too hot to handle it (still in fight/ flight/ or freeze mode).

Kitty is nowhere near mastering the process of DBT (not really a surprise). I don't know that she is going to be able to do so. I'm still trying to learn it myself (if anyone has a good book they can recommend I'd appreciate it).

Kitty was definitely in a blaming mood. She wanted what happened that day to be mostly Hubby's fault for trying to do a reality check, and talking about how her perception is distorted. (Like it often is, and we often mention because we are trying to help her understand and work on this).

After the therapy session we had a family visit with Kitty. We spent most of the time talking about a new book series that she started reading when she got to the treatment center called Sweep. As far as I can tell it's a romance novel that's designed to promote the Wiccan religion. Kitty really seemed to be associating with the main character, who is manipulated into exploring being a witch and whose parents are strict Catholics who are adamantly against it.

We let Kitty know that we would be supportive of her exploring other religions (although she's been adamantly Christian for years and very upset when others aren't), but this is NOT a good time to be trying a new religion. We found out later that her new (RAD) roommate has only been Wiccan for about a week and a half and the person I spoke to said that she's only doing it to tick off her parents.

Kitty says this roommate is the first person she's ever just automatically "clicked" with, and that they are best friends. She insists that her roommate prayed to the "Goddess" for Kitty to be her roommate and she was her roommate! There is no such thing as coincidence therefore this was proof that the Goddess exists.

We had a long conversation about this with Kitty. We tried to be supportive but letting her know we thought this wasn't a good time to make decisions. She was pretty anti-parents.

After visitation was over we ran into the family therapist and talked to her about what was going on. One of the books actually belonged to the roommate and they had gotten permission from someone to let Kitty borrow it from her (normally not OK). I let the therapist know I felt Kitty was vulnerable and this wasn't a good option. Of course Kitty walked up behind us, and overheard part of the conversation. *sigh*

When I got home I sent this e-mail to the therapist:

Don’t know if you realized that Kitty overheard at least part of our conversation about Wiccans and the Sweep books. Which means of course that she’s going to be upset about any changes that you might make, and blame it all on me, rather than focusing on the fact that it was against the rules (for a reason) and not in her best interest. I did do some research into this series and it really isn’t even a good representation of Wiccans, it’s just a romance novel pretending to be one, apparently with the purpose of indoctrinating kids into this “faith.”

I’m really not against Kitty exploring other religions, I just feel that the timing is wrong (she’s got enough to deal with right now), and that the only reason that she’s doing so is because she wants to please her new best friend and have a group to which she can belong (we did discuss cults with her a little). Kitty has been adamantly Christian for years, even being confirmed in the church last year and being upset about kids in the hospitals or at school who weren’t Christian. I don’t honestly believe that she’s got an adult understanding of her faith, but with her black and white thinking, processing issues and wanting to please and fit in, I worry that she’ll make a lasting decision based on faulty information.

Please let me know if you have any suggestions on how we can address this in conversations, even though it is something that I’m assuming will be handled by {the treatment center}.

Here's a review of the Sweep book I found. I plan to use it in our discussion at therapy tomorrow. I also found the books at the library and will try to read one tonight (it's bath night!).

"I am Wiccan and after reading the Circle of Three series by Isobel Bird, I was looking for some more Wiccan fiction. I had heard good things about the Sweep series and I am here to let you know that it was all lies. This author has obviously read a Wicca 101 book and used bits and pieces to produce this grotesque distortion of our religion. There were several things wrong with this book and almost all of them violate the basic principals on which we base our workings.

1. No good Wiccan would invite people to a circle without telling them before they got there what they were going to be doing. Most of us used to belong to some form of Christianity and do not appreciate it when people try to impose their religion on us, so we try not to do it to other people

2. That "grounding" they did when Megan or whatever her name is took in too much energy?
The exercise would have been believeable if they were telling her to concentrate and release some of the energy back into the earth. But they weren't, and the best thing to do in order to ground yourself is to eat something.

3. Some groups might be selective about who they let into their group, but it would be based on their attitude towards Wicca and how well they follow the basic principles, not on whether they "did it right" or "felt like witches". We are willing to teach anyone who is willing to learn.

4. The way Bree is acting about Cal ("I love him!" and so on and so forth) makes me think that she might be under a love spell. The fact that she slept with him also concerns me. If she is under a love spell, Cal has committed a very serious breach of Wiccan laws. We DO NOT do
spells that will mess with a person's free will. It's the basic rule you first learn when studying Wicca "If it harm none, do what thou will". The only circumstance I could think of where this would be acceptable is if you were doing a spell to bind someone from causing harm. The reason Cal sleeping with Bree concerns me is because some people will use the fact that Wicca is very open when it comes to sexuality to take advantage of people. As their teacher, it would be a breach of the coven's trust to take advantage of a fellow member like that, especially if Bree is under a love spell.

5. The scene where they're all skinny-dipping in the pool is not cool at all. Being skyclad (Wiccan term for naked) while performing rituals helps some to get closer to the earth. It's
not for everyone and even though they weren't working any magick, Cal should have let the main-character-who's-name-I-can't-remember leave if she was uncomfortable in that situation.

6. There are such things as blood witches, but they don't have supernatural powers. They're human, just like you and me. The only difference is that they might have a stronger connection to Wiccan teachings at first, but anyone can build that up over time. If you aren't really
concerned about the religious facts being right, this book is horrible even from a literary standpoint. The whole book comes off as being soap-operaish. So if you're looking for a mature look at the Wiccan religion, check out the Circle of Three series by Isobel Bird and stay far, far away from this series."

Parents of Trauma "Find a Friend" Network

2012-01-06T22:00:00.002-06:00

An amazing lady and blogger, who just organized a Christmas "Trauma Mama gift swap, is starting a new networking for parents of kids of trauma. I'm definitely participating. She sent me the following letter:

I've realized there is still a great need out there for parents of hurt or otherwise intense special needs kids to be able to find others in their area who are living this same crazy life. I'm reaching out to all my trauma parent friends to let them know about a parents network I'm putting together. My hope is that this will be a means of helping parents from all over the place and from all walks of life be able to find each other and support each other in real life.

If you are interested in learning more about this network, the details can be found on my blog at http://goldtorefine.blogspot.com/2012/01/find-friend.html. I'd love to have as many people as possible sign up. The more people that do, the more likely it will be that people will be able to find each other and make connections with each other.

By all means, feel free to pass this info on to your other friends who may be interested as well.

Diana

How is Kitty doing?

2012-01-05T14:56:00.000-06:00

The holidays were laid back and quiet (a refreshing change!). We pretty much decided to keep Kitty’s world as quiet as possible before Kitty left, although it was tough to keep her from raging and overreacting. She did finally admit the meltdowns were because she was scared we were going to leave her at the treatment center, and not because we were doing anything inappropriate (two meltdowns over me helping with her laundry and packing, lots of accusations and moaning). With assistance she was able to keep from escalating to violence or hospitalization.

When we got to the treatment center they kept me busy with paperwork and so there was a lot of time when Kitty was just standing there and I wasn’t able to comfort her. We had to leave and go find a specific pharmacy which took over an hour because Poppy (my step-dad who drove Kitty and I), got lost. When we got back they almost didn’t let us see her again. She clung and begged and bawled, but was compliant when they told her it was time to go after a few minutes.

Kitty and her family therapist called on Christmas day, but it was much earlier than it was supposed to be, so the family was in the middle of opening gifts before the grandparents had to leave. I had to balance her needs with getting back to Christmas and finishing unwrapping presents (which sucked!). She only wanted to talk to me and Ponito. She did ask Hubby to come to family therapy so he worked extra hard so he could go (he does contract work and we can't afford for him to miss hours so he worked 11 hour days). Bear asked me to tell her he loved her and missed her, to which she responded, “Yea, right.” Gotta love that black and white thinking. She refused to accept that he could love and miss her after he was mean to her earlier. She cried and begged to go home. She promised to “be good.” It was heart wrenching.

The following Friday, Hubby and I attended family therapy. The family therapist had at least skimmed the 50+ page life history document ( I later e-mailed her a cleaned up version with a table of contents). We talked for awhile about Kitty’s need to work on her trauma, which I reinforced with Kitty when she got there (that the stuff she needs to work on is that with which she least wants to deal). Kitty wasn’t crying and begging (much), but she has obviously regressed (and we were told she’d behaved this way the whole time she’d been there). She came in wrapped in her new Tinkerbell blanket and carrying stuffed animals (all of which she got for Cmas). She had her fingers all twisted and was chewing on her ring finger a lot (something she’d started during the last hospitalization, but hadn’t done during the 2 days she was home – with the occasional reminder to quit from me) and now had broken skin on the finger. She quit with redirection from me, but the minute she walked away it was back in her mouth.

Apparently the day before family therapy, two girls had gotten into a fist fight in a hallway (right next to Kitty) and at least one of the girls ended up in juvie. All the girls were told to go to their rooms when it had started. Kitty said she ran into the nearest room, curled up in the fetal position and hid. She was still obviously freaked out by the whole thing.

She was excited about getting to wear her own clothes when she reaches a certain level the following week, and being able to have visitation and make phone calls. When those start we’ll be able to talk to her on the phone on Thursdays and only be able to visit for 1 ½ hours on the weekend and no more than 2 people at a time. We’ve already decided not to bring the kids for a little while. There’s group therapy on Wednesdays, but we can’t make that many trips to the nearby Big City (3.5 hours one way).

After therapy she gave us hugs and walked away.

Hubby and I are going for family therapy again this Saturday. Afterward we’ll be able to stay for visitation. It will just be Hubby and I this time. Kitty's therapist can’t meet the following weekend, and we can only afford to travel to Big City once a week so I’m leaving it up to the family therapist as to whether or not we should call in family therapy on Tuesday and visit on the weekend so it won’t be so long between getting to see her.

Adult Attachment Disorders: Dismissive

2012-01-04T21:43:00.002-06:00

Child: Anxious Avoidant attachment.
Adult: Dismissive Attachment

As infants and young children, they usually grew up in environments where their parents were not able to provide them with consistent and reliable emotional support, although their functional needs were met (ex. food, lothing, educational opportunities...). They grew up in an emotional void. They learned how to shut down thier needs for care and comfort by focusing on play and exploration (ex. sports, school, music, working...) because it was too distressing to keep reaching out and not receive the love and support they needed. They were praised for their competence.

As adults they cope with distress by fending for themselves, focusing on achievement, shutting off dependency needs and just carrying on. They tend to be loners, regarding relationships and emotions as being relatively unimportant. Their typical response to interpersonal conflict and stressful situations is to avoid them by distancing themselves (or organizing them). They have a difficult time with letting people in; they do not trust that others will really be there for them when they need them. It is comforting/ soothing for them to be by themselves. Their lives are not balanced: they are inward and isolated, and emotionally removed from themselves and others.

They desire a high level of independence, which often appears as an attempt to avoid attachment altogether. They view themselves as self-sufficient and invulnerable to the feelings associated with being closely attached to others. They often deny needing close relationships and seek less intimacy. They deal with rejection by distancing themselves from the sources of rejection.

Obviously this means I have serious difficulties in my relationship with my RAD kids who reject me constantly!

People with a dismissive style select relationships and lifestyles that prioritize work, achievement and intellect over intimacy. Relationships with friends, parents, spouse and children are important to them, but family and friends may complain they don't feel that important to dismissing individuals. This is because dismissing individuals value thier individual strengths and abilities to solve problems over emotional connections in relationships. They are often highly successful because they can focus on problem solving and disregard the emotional aspects of the situation.

On the whole they seem to be strong, confident, capable people who have very little emotional distress. Negative emotions are considered private and sometimes seen as unimportant or unnecessary, or as interfering with the problem-solving process. As a result, these emotions are often pushed aside and the individual is no longer aware of them fully. This creates a dilemma about becoming more connected emotionally to themselves and other people: to do so, they may have to first deal with their own underlying feelings of insecurity, rejection, unworthiness, sadness and anxiety before they can be available to themselves and others.

This is the diagnosis I received after I was tested during Bear's recent intense neuropsych eval. It does not come from dealing with my children's issues (although that has aggravated it); it comes from my childhood. I believe this diagnosis probably describes my father, and while my mom is an amazing woman, her bipolar disorder was not diagnosed and treated until I was in high school.

I always knew I had attachment issues. This diagnosis surprised me though. I just assumed my attachment problem was more about trust issues, particularly with men. When we were dating, Hubby put up with a lot, and just wouldn't go away no matter how hard I tried to push him away. Turns out he has a combination of Dismissive and Secure Attachment.

One reason I felt comfortable adopting teens, was I assumed Hubby would be able to hang in there like he did with me, and that I would have empathy and be able to emulate what Hubby did to help me.

I do have lots of empathy for the kids. This attachment issue does help me to approach discipline less emotionally. It is NOT helping me deal with Bear's attachment issues though. Instead I'm struggling to try to force myself to continue to connect with him. Most of the time, I just want to walk away from him. In the letter written to me by the person that did Bear's neuropsych eval. She stated I was an excellent case manager for Bear, but I need to work on the emotional connection. We're still filling out a daily questionnaire, and one of the questions is, "How close to Bear did you feel today?" Every single day it feels wrong to answer, "Not at all" so sometimes I answer "Slightly" even though it's rarely true. I can't wait until we're done with this assessment.

Adult Attachment Disorders: Fearful/ Unresolved

2012-01-04T15:29:00.003-06:00

Attachment disorders in adults are called by different names, but still have the same causes.

Child: Disorganized attachment.
Adult: Fearful Unresolved Attachment

As infants and young children, the children's parents were there for them sometimes, but at other times failed to protect them from trauma or make them feel safe. (Could be due to caregiver's drug use, mental illness, and/ or their own attachment issues). As children they detach completely from their feelings during times of trauma for survival, and as adults, they continue to be somewhat detached from themselves.

They desire relationships and can be somewhat comfortable in them until emotion closeness is expected or desired by the significant other. At this point, the feelings that were repressed in childhood can begin to resurface and, with no awareness of them being from the past, they are experienced in the present.

Bear has developed what we call "armor" to protect him from responding as though he's reliving the attachment trauma. We have been unable to breach it and help him process his trauma.

Hot/ cold; come here/ go way. These mixed feelings are combined with negative views about themselves and their partners. They commonly view themselves as unworthy of responsiveness from their partners, and they don't trust the intentions of their partners.

Little events are often interpreted as frightening, scary, and can easily dysregulate them. Often when the attachment system is activated and leads to disorganized behaviors, being overwhelmed and flooded and losing the ability to think and use good judgment and coping skills. Behavior may be out of control and explosive. They are unable to see resolution to problems and feelings.

Kitty has been working on attachment for over 4 years, and while she was physically and emotionally numb when she came to live with us, she has been slowly removing the protective layers. I believe this is why she's becoming more overwhelmed and dysregulated as she becomes more attached.

Similarly to the dismissive attachment style, people with a fearful/unresolved attachment style seek less intimacy from partners and frequently suppress and hide their feelings. Their lives are not balanced, and they do not have a coherent sense of themselves, nor do they have a clear connection with others.

This is the type of attachment disorder that Bear was diagnosed with, and Kitty probably has too. Due to drug use and mental illness, their biomom was most likely inconsistent in her parenting, and definitely didn't protect them from abuse.

Don't know what all this means for Bear down the road. His armor is thick and firmly in place. I hope Kitty is healing, and that's why she's struggling more.

New Year's Eve and Resolutions

2012-01-04T13:42:00.010-06:00

We had an extremely quiet NYE. The kids stayed at Grandma's, except Bear who spent the night at a friend's. Our traditions include eating black eyed peas (the more you eat, the more luck you have - it's a Southern thing!) and to spend the day doing what you want to do all year. So Hubby and I

New Year's Resolutions:
Do this more often

Get more and quit leaving Hubby like this

Get more exercise so I stop looking like this
Find out more about attachment disorders in adults and work on my own healing

Find and get a good job

Give the house a good cleaning

Word for 2012

I used to do this, but haven't done it in years. My friend GB's Mom inspired me.

The word I've chosen this year is "PRESENT." As in being present and engaged in life (not gifts).

Since being diagnosed with a "Dismissive" attachment disorder (during Bear's thorough neuropsych evaluation), I've struggled with trying to figure out how to heal and work on this.

Part of Bear's neuropsych evaluation is a daily questionnaire where one of the questions is "How close did you feel to Bear today?" It hurts to check the box for "Not at all," and sometimes I chose, "Slightly," just because I can't stand to check "Not at all" every day.

More Christmas Pics

2011-12-31T10:38:00.014-06:00

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.

"Pre" Christmas pictures

2011-12-29T21:40:00.011-06:00

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!

Nobody likes her. Everybody hates her

2011-12-27T21:50:00.003-06:00

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.

Kitty is in Residential Treatment

2011-12-24T16:26:00.004-06:00

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.

Kitty's coming home

2011-12-19T11:06:00.003-06:00

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!

2011-12-19T01:14:00.005-06:00

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!

Kitty's coming home?

2011-12-17T22:49:00.001-06:00

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.

Hospitalization #8

2011-12-15T23:32:00.002-06:00

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.

Bad choices, emotional instability & the Surgery Analogy

2011-12-11T09:51:00.005-06:00

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.

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

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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.

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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).

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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?

2011-12-11T09:12:00.004-06:00

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.

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Anxiety Scale Rough Draft

2011-12-06T18:14:00.016-06:00

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.

Kitty's Armor

2011-12-04T22:34:00.003-06:00

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:

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.

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.

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

2011-12-04T12:19:00.003-06:00

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:

Treat yourself and other family members with courtesy and respect.

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

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

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

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

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

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 _______

Crisis Plan and Alternative Placement

2011-12-01T23:53:00.004-06:00

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.

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 (no pun) 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.

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 behav. prog. staff (like counselors, school psychologists, the AP, case manager, time in Learning Lab…), and does not include ALL of the time spent with the behav. prog. 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?

Perfect mask

2011-11-29T22:42:00.004-06:00

I HATE that Kitty's mask is so perfect that she can even convince the hospital staff that she's "cured" as soon as she gets homesick. The school thinks she's mostly "fine," even though she's been hospitalized 7 times this year (3 times this month!). They're ignoring all the reports from the doctors and therapists, because obviously Kitty's issues are "all at home.' Even when Kitty is at her most unstable she usually only "acts in" when in public.

Her self-esteem is almost nil, and she is desperate for the approval of others. She can't handle even the slightest criticism. As she says all the time, she would "rather die,' then let someone see her issues. She only "lets down her hair" at home where she feels safe (and occasionally in therapy). No matter how much I push her to advocate for herself, and let the school know when she's suicidal and needs support, it's barely a whisper.

I'm so sick of looking like I have Munchhausen by proxy. I'm tired of taking her to the hospital every other week. I'm tired of fighting so hard. She's currently in the hospital again, but she'll have to go back to school when she gets out, and they've made it clear they aren't going to make any more accommodations (which means she'll be right back in the hospital). She needs me, but I'm so drained.

Trying to be Thankful

2011-11-24T23:22:00.002-06:00

Kitty’s regular psychiatrist left her on the meds that the hospital put her on! She didn’t want Kitty on Lamictal in the first place because she apparently thinks I’m lying about why we pulled Kitty off it 2 years ago (every time she broke out in hives they’d pull her off, “just in case.” Since she was so prone to hives she broke out all the time, we didn’t see a point in keeping trying).

The pdoc also refused to write any notes helping us out with school. Well, that’s not totally true. She wrote a prescription saying Kitty should be “evaluated for homebound.” Which the school can easily ignore by saying they already did that. It’s time to find a new pdoc. One more thing to add to my list of things to do.

I did talk to Nebraska about RTC, and they thought they had a couple of weeks (as did we of course). They’re still waiting for information about the two residential treatment centers we’re interested in (Settlement Home and Center for Success and Independence in Houston). Once they determine what services are offered, then they'll know how much they can pay (assuming they approve) and then they can start negotiating with the locations, at which point we can start waiting for a bed.

Poor Kitty! I see no way to keep her from having to go back to school. Only consolation is that she may quickly end up back in the psych hospital (never this one again of course!).

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Thanksgiving was lovely. We had lunch and dinner at my sister's house. Hubby made homemade rolls and they turned out perfectly! I made most of the sides. There was so much delicious food that we had leftovers even after eating both lunch and a dinner of leftovers there.

All 6 cousins (ages 9, 12, 12, 15, 16, and 18) played together ALL afternoon and evening. They played video games (mostly bowling and dancing with Mich*al Jacks*n - they videotaped the dancing- hilarious!!), they played outside on the teetertoter (after hours on it the girls were complaining of jelly legs! lol!) and noodled around with a soccer ball. Bear got a little bossy, but otherwise they had a great evening.

The guys watched football and my mom, my sister and I put together a puzzle. It was so relaxing. I even got in a little cat nap or two. I'd stayed up until 4am the night before.

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I can't believe it, but I'm goign to go shopping on Black Friday. Santa is bringing the kids a W i i and the used game store has some previously owned systems on sale.

I can't believe how little Cmas shopping I've gotten done. The kids are hard to shop for this year! I miss the days when I could buy a few used toys and they'd love them.

Kitty is home!

2011-11-23T01:41:00.002-06:00

Thursday evening Kitty was hospitalized. I gave her her regular meds before I left the new psych hospital. I warned them that she hadn’t had her laxative in almost a week (because I’d run out and so had the store) and was already having trouble.

Friday, I was told they wanted to take her off all her meds except for the Trileptal (weak mood stabilizer), because the doctor thought she was on too many meds. It was my understanding that this would be almost a med wash. I approved adding Seroquel XR to help her sleep at night.

Over the weekend I was told they wanted to add Wellbutrin (an anti-depressant, that can help with weight loss). I said I wasn’t thrilled about adding an anti-depressant, and that I thought she’d been on it before, so I wanted them to review her records before I approved it. It didn’t make much sense to me in light of them wanting to see what she was like without meds. I gave Kitty a heads up that she would be at the hospital for longer than usual while they adjusted her medication.

On Monday I was informed by Kitty’s case manager at the psych hospital that she and the psychiatrist had told Kitty about the “med wash” and that she wouldn’t be able to “skate” through this hospitalization waiting for her five days (what Medicaid typically covers) to be up. That they could keep her up to 6 weeks. She said Kitty looked like she was going to cry and admitted that she does pretend she’s better whenever she’s ready to go home. I tried to assure them that Kitty probably isn’t trying to manipulate the system. She’s mostly just homesick, and psych hospitals are not going to fix her issues anyway. Her biggest problem is trauma. You can’t fix that with meds, or a couple of sessions on calming techniques (she could probably teach the class! – she just can’t access it when she needs it). This is why we’re trying to get her in residential treatment.

The case manager gave me more information about why they wanted to replace Depakote with Wellbutrin: that it would help with her weight, worked as an anti-psychotic as well as an anti-depressant, and didn’t typically cause mania (unlike most anti-depressants). I questioned how this was a ”medwash”? but really didn’t get a good answer. Just that the doctor has a preference for different meds. I also wanted to know how do you replace a mood stabilizer with an anti-depressant? They’re not the same thing. I questioned why we’re not trying Lamictal, which is a mood stabilizer. Basically she didn’t have an answer.

So Tuesday I went to family therapy. I was late, and the therapist apparently didn’t hear the page that I was there so we got off to a great start. Kitty came in, and they announced that it was up to me, but she could be discharged as early as tonight. I WAS FLABBERGASTED! Kitty and the therapist start talking about all she learned in therapy (BS! BS! BS!). I just sat there stunned.

Finally, phrasing it as gently as possible to not trigger Kitty’s abandonment issues, I told Kitty of course we wanted her home, but how in the world can the hospital believe that taking her off most of her meds and then sending her home is at all the right thing to do?! The therapist had no idea that we’d been told Kitty would be staying for weeks. The case manager of course wasn’t working today and the pdoc was on rounds and unavailable. They got the case manager’s supervisor on the phone, but she didn’t know anything specific about Kitty.

When they finally realized I was REALLY unhappy, they assured me that when I approved the Wellbutrin, which I was assured was really a miracle med that wouldn’t cause mania even though it’s an anti-depressant (Bear takes it so that wasn’t actually my concern), they’d be happy to keep Kitty for several more days to make sure that she didn’t have a negative reaction to the Wellbutrin. I repeated that I was more concerned with the fact that this was a child with mega trauma issues that “presents well,” who is barely able to stay emotionally stable (6 hospitalizations!), and they’ve reduced her meds by more than half, and then are dumping her right back into family and school. I explained a little bit about the problems we are having with the school.

I asked for them to write a note stating that Kitty needed to be homebound for awhile. They agreed to fax us an excuse for 7 to 10 days while we wait to make sure there are no negative side effects from the Wellbutrin (– school is out for the holiday, but that only gets us through next Wednesday if we’re lucky, and then we’ll be right back to being “punished” by the school). With that taken care of albeit temporarily, I told them I was taking Kitty home right then.

When Kitty had left to get her stuff and the therapist continued to express that they could keep Kitty a few more days if I was worried, because she obviously recognized that I was NOT happy. I finally told her flat out that I wanted Kitty out of there, because I felt they’d messed up her medications and I didn’t see a point in delaying getting them fixed.

When Kitty came out with her stuff, the therapist let us out of the building and the main gate and waved at us as she drove past us walking to our van. As I was sitting in the car, still fuming, I suddenly realized there was something really wrong with this discharge. It should have been more complicated than walking off campus with Kitty and her garbage bag full of stuff. While we were still sitting in I finally called the hospital and asked if it was really that simple. They asked us to come back in and fill out the discharge paperwork.

As we drove away, I realized that it wasn’t too late to call Kitty’s pdoc. The next available appointment wasn’t until the end of December, but by a weird fluke (or Godincidence as I prefer to believe) the appointment I’d cancelled for tomorrow (Wednesday) hadn’t gotten cancelled (I cancelled it because I thought she was going to still be in the hospital) or she’d had two appointments for some reason and I’d only cancelled one. So joy of joys she has an appointment tomorrow.

She was a little manic all evening, but seemed OK, especially after she’d found out she didn’t have to go back to school right away.

Wasn’t sure what to do about meds tonight. Gave her the Trileptal, and the constipation meds they hadn’t been giving her, but didn’t want to fill the prescriptions given to me by the hospital. The only Seroquel we have in the house is 300mg and she only needed 50mg so we skipped it.

Med Wash and Due Process

2011-11-21T22:56:00.003-06:00

Not sure what this hospital's definition of "med wash" is, but I'm confused.

First, they kept her on Tril*ptal (mild mood stabilizer with few side effects). Fine with me. She's been on this med for over 5 years, and it seems to be a good one.

Then they said they want to put her on Ser*quel XR right away, to help with sleep. This confuses me, because she's been on Ser*quel before and it caused her to gain a lot of weight (70lbs in 6 months). Plus, I'm confused about the point of a med wash where you add new meds before the other med are even out of her system... but OK.

So today they call me and say they want to start her to Wellb*trin (an anti-depressant) to replace the Depak*te (a mood stabilizer). I'm OK with getting off Depak*te, we were in the process of switching her to Lamict*l anyway, but I don't get why they're switching from a mood stabilizer to an anti-depressant. So I ~~argued~~ discussed it with them. Apparently one reason they want her on Wellb*trin is to help with weight loss. I told them I thought she'd been on it before (but it could have just been Bear and I). I really want her on Lamict*l.

I asked if they'd reviewed her records, so we weren't recreating the wheel or switching her to the new doctor's favorite med cocktail for no apparent reason (has happened before). Of course they hadn't.

Why did I bother to sign consent forms everywhere?

I declined to give permission for the switch until they reviewed her records. Which they did, and I guess I'll find out the results tomorrow at family therapy.

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Finally heard back from the Advocate and Struggling to Stand was right, it doesn't matter that Kitty is not in the school district right now. The good news is I don't have to worry about what the school is going to torture her with while we wait for the due process hearing or mediation or whatever.

I did get the behavior staff notes for the last few weeks. It's hard for me to read because it's all about what I did wrong ("Mom brought her in late. Mom didn't call to say she was going to be late or wasn't coming. Mom didn't sign her in right. Mom took her home...") or only talking about things that imply Kitty's issues are minor or all at home ("Kitty was upset about something and wanted to talk - no detail on days when I'm pretty sure Kitty was upset about something that happened at school. Kitty said sometimes she tells Mom she feels like hurting herself so she can get away from the family and go to the hospital. Kitty wanted to call home, but I told her she was fine.")

Due Process

2011-11-18T20:53:00.002-06:00

To clarify, we've filed due process, and fully expect the school to agree to mediation. My concerns are what to do in the meantime since Kitty couldn't handle the changes.

Actually, my concerns were what to do in the meantime. I got a call today from the new psych hospital. They want to do an almost complete med wash. This will probably take several weeks, during which time she's disenrolled from school and enrolled in the hospital's charter school and presumably she'll still be there.

So now I'm worried about:

the fact that this med wash could make her completely unstable and swing back to irrationally hating me for loving the other kids and hating her.

That she may be in the middle of it if/when we finally get approval for RTC

that I won't find an appropriate RTC.

That we can't proceed with the mediation/due process since she's not enrolled in the school, and therefore when she's released from the hospital we'll have to start all over with her suffering from the unacceptable lack of accommodations,

that she'll be missing her annual IEP meeting where they're presenting the results of her new FIE (school version of a psych eval)

Half a Dozen Hospitalizations

2011-11-18T08:59:00.002-06:00

Kitty was admitted to a psych hospital last night (this will be her 6th hospitalization since March). She's only been home 1 week since her last hospitalization.

After the most recent IEP meeting, the school has decided to punish us by not letting her call home anymore, and she isn’t allowed to leave the classroom and go to the Learning Lab if she’s feeling stressed and overwhelmed anymore (when she felt ill and went to the nurse’s office she was sent right back to class after having her temperature taken, which sounds fine, but during the last 4 IEP meetings it was agreed that Kitty goes to the nurse when she's feeling stressed and overwhelmed and needs extra support). They did let her go to the Learning Lab for additional instruction, but only if she had makeup work (she failed 2 tests this week).

Because of this she couldn’t handle going to school Wednesday morning (she LOVES school so this is a dramatic change for her), so we took her to the crisis center for an assessment, and they recommended hospitalization. The big problem is that I don’t think we can do anything to get the school to change this new approach and I don’t know what’s going to happen when she goes back to school (probably after Thanksgiving).

Yesterday we spoke to Kitty’s new Assistant Principal, and I think we're finding that a big reason the school is fighting us so hard about letting Kitty go to the Special School is because she's so good at wearing her mask. All the teachers not only believe the few times they see her giddy (manic and overstimulated) that she is actually happy, but also it's that she's a positive influence on the rest of the class and they want to keep her. She's quiet, likes school, gets her work done, understands the lesson, and is a good buffer between some of the more rambunctious students. I think the teachers are tired of having all their kids being tough, and Kitty doesn't let them see the effects of the stress on her. The Behavior Program staff probably are receiving a lot of pressure to minimize the behaviors they see (A "6" on a scale of 1 to 10 being labeled as "mild anxiety"!) No one seems to care that Kitty is being torn apart.

We’re still not receiving the Behavior 360 reports. I've asked our professional advocate what should we do? Should we start moving up the line to higher ups in the school district? Should I ask for yet another IEP meeting or Parent/Teacher conference? Should I write a letter demanding they go back to acknowledging she needs to leave the classroom if she’s stressed (like all our documentation states)? She has to go back to school (probably after Thanksgiving) and her next IEP meeting (her annual) isn’t until December 6th.

Punished

2011-11-16T21:08:00.002-06:00

Monday was Kitty's first day back to school after being hospitalized (unless you count the time she was in the IEP meeting). Kitty came home upset because the behavior staff at school wouldn't let her call me. She had a substitute in math class today, and apparently they were learning a new concept, which stressed Kitty out. The sub didn’t catch Kitty’s subtle comments that she was feeling overwhelmed. So Kitty resorted to telling the sub she needed to use the restroom to summon the behavior staff (they have to shadow her every time she leaves the classroom).

Kitty requested to call home, but was told no. After walking around with the behavior staff for awhile, Kitty again requested to call home, but was told that The Crisis Plan said she couldn’t call home. This is new so she was confused (as was I, since this wasn't how I interpreted the results of the last IEP meeting).

One change that was added to the Crisis Plan was that if she left the classroom she was supposed to be able to go to another location and continue to receive her lessons taught by a special education teacher. She was offered the opportunity to work on math in the Learning Lab, but since it was a new concept and she didn’t have any paperwork to work on, she felt that the person in the Learning Lab wouldn’t be able to help her. So she said no thanks. The staff sent her back to class, even though she wanted to call me and to go home.

When she got home, very upset, I told her that next time she needed to tell the behavior staff that she wanted to learn in the learning lab if she left class (even if it was a new concept), and that it was OK to leave class for something besides having make up work. She can leave if she's feeling stressed and overwhelmed. I told her that the staff wasn't allowed to ask her if she felt like hurting herself, so if she did feel that way she really needed to tell them. Then I assured her that I'd talk to the school the next day and find out what was going on with not being allowed to call me.

I sent an e-mail requesting a copy of the new Crisis Plan and asking why things were being handled this way. I got no response, and Tuesday was worse. She was not allowed to leave when she was stressed, and was still not allowed to call me. She did leave class twice to do some make-up work in the Learning Lab later in the day.

When I picked her up after school, we went straight to her regular therapy appointment. She started off OK, but shut down almost instantly (spent most of the session with a blanket over her head, refusing to come out. Got her home and somehow managed to avoid a major meltdown at home.

Today she couldn't even handle the thought of going to school. On the way in I called to see if I could get an appointment with the new AP (couldn't), and by the time I hung up, she was begging to go to the crisis center. We went and she needs to go back to the psych hospital. We're trying a different one this time.

Also stopped by The Settlement Home to check it out, and it seems great... but they don't have any beds and probably won't until January. So still looking.

Good News/ Bad News

2011-11-15T13:49:00.003-06:00

Nebraska finally responded on Monday that Kitty does NOT meet their requirements for residential treatment (in Nebraska she would only qualify for in-home therapy and wrap around services), BUT that they are going to assume that she has received all the services Texas is able to provide and have decided to provide funding...

BUT San Marcos Treatment Center (which was the place we'd chosen) is no longer a provider for Nebraska Medicaid so we have to find another residential treatment center (RTC),

AND they have to specialize in trauma therapy.

So far these were our next best choices:

The Center for Success and Independence

Devereux

The Settlement Home

Anyone know anything about them or a better alternative in Texas?

Urgent!! Edited

2011-11-14T13:22:00.001-06:00

OK, I'm convinced! I will tell the school, NO!!!!!! THANKS y'all!!

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Anyone read the book "Night" (I think it's about the Holocaust) or "Of Mice and Men" recently? I've never even heard of "Night" and it's been forever since I read "Of Mice and Men." Please ask around!

I need to know by tomorrow if they're appropriate for Kitty, my suicidal/ emotionally disturbed teenage daughter, to read in Language Arts. Some of her triggers: suicide/ self-harming, feeling someone "deserves to die" because of something awful they did (guilt/ shame), domestic violence, blood and gore, hurting women or children, foster care, physical/ verbal/ sexual abuse, abandonment/ loss...

Kitty Neuropsych Test Results

2011-11-14T01:48:00.002-06:00

We got Kitty’s neuropsych feedback on Friday. The official report will come in later in the week, but I wanted to share this information from my notes immediately so we can help Kitty.

Probably the most significant test results came from the WISC, which were confirmed throughout the testing. Kitty’s Perceptual Reasoning (non-verbal) and Reasoning (verbal) were average and almost average (PR- 90 and R- 87). I believe this is consistent with what we’ve seen from Kitty academically and in discussing things with her. Given time she is capable of “getting it.” The time is the key word there though. Kitty’s WORKING MEMORY was low borderline (WM- 71), but even that she could overcome. What causes the issues for Kitty is the PROCESSING SPEED (PS- 65), which is in the mentally retarded range, and appears to be where many of her issues are coming from.

WHAT THIS MEANS: Kitty will have great difficulty with immediate recall. When GIVEN TIME she can usually figure out a problem. Doing math “in her head” would be a LOT more challenging for Kitty than other children. Things like remembering phone numbers is difficult. She has great difficulty with organization and needs things BROKEN DOWN INTO LESS OVERWHELMING STEPS that are given to her in small CHUNKS. TIME CONSTRAINTS MAKE TASKS TOO CHALLENGING. She needs smaller amounts of work, because it takes her longer. Things like Modified TAKS and administering tests in a one on one situation (so she has more time and doesn’t have the pressure of seeing other’s finish before she does).

ATTENTION – Visual Kitty’s attention meds appear to be working well. Her errors in the visual area were mostly impulsive errors and seemed to be more processing issues than an attention issue.
ATTENTION- Auditory This was the area Kitty had significant trouble in. Under quiet, structured conditions she did well, BUT… when distractions and noise were added her processing issues becaume extreme.

WHAT THIS MEANS: Kitty needs a SMALL, QUIET, structured environment, with frequent, regular eye contact from the instructor, with lots of one on one “checking in” to help her stay focused, on task and “getting it.”

EXECUTIVE FUNCTIONING SKILLS: Kitty had ELEVATED DIFFICULTY. This is things like impulsivity, transitions, organization, planning, self-monitoring, changing plans and how to approach things (ex. she needs someone else to redirect her if it’s not working or to help her think of different approaches if her chosen method of execution isn’t working).

COGNITIVE FLEXIBILITY: Low Average. She has difficulty shifting gears and looking at things in a different way.

WHAT THIS MEANS: Kitty needs lots of assistance with getting organized and planning, making transitions, redirecting her as needed and helping her improve her self-monitoring.

MEMORY: Kitty LEARNS BEST: AUDITORY
Hearing: Short Term: 97(average) Long-term: 102 (average)
Visual: Short Term: 76 (below average) Long-term: 75 (below average)

WHAT THIS MEANS: Reading books and reviewing notes is tough for her. She’s not going to learn well this way. She needs AUDIO RECORDINGS of lectures and books.

LANGUAGE: The Neuropsychologist believes that Kitty’s lower scores on this were more due to her processing issues because the test was timed than language issues.

WHAT THIS MEANS: Kitty need work broken down into chunks, small tasks given to her slowly, instead of overwhelming lists.

EMOTIONS: Kitty self-reported almost no problems in anything but somatic issues and slight depression. Mom reported her as having great difficulty in many other areas.

When Kitty was tested with more open ended tests (like telling stories about pictures, finishing sentences), her results were full of LOSS (leaving, dying, abandonment), contributing to feelings of sadness and anxiety. Even neutral prompts became about family/ attachment issues.

School/ Social – Kitty feels safe and secure at school. One reason she appears to be afraid of the Special School is because she is afraid it she will not be safe. During the feedback discussion with the neuropsychologist and Mom, Kitty understood that because of her issues with processing and noise that the Special School might be helpful in achieving her goal of getting through school without going back to the hospital and going to college. While all agreed that a school with a therapeutic component would be the most beneficial, until that becomes an option, she was willing to try the Special School to see if she could feel safe there. All agreed that adding a school counselor to Kitty’s therapeutic team was not in her best interest at this time.

WHAT THIS MEANS: Kitty is having a very hard time handling and coping with the feelings that she does express in this test. She appears to be have issues with recognition/ awareness of her emotions. School needs to have a THERAPEUTIC COMPONENT. She needs to have a QUIET, place to go when she is upset. Classrooms need to be small and quiet.

Denied Again!

2011-11-10T23:15:00.002-06:00

Kitty got out of the hospital today, just in time for her IEP meeting (the hospital was willing to keep her another day, but we were concerned the school district would say we couldn't have the IEP meeting because she was technically enrolled in another school district while in the hospital).

The professional advocate was there, and she'd assured me the school had made so many mistakes we were golden. She was wrong.

Highlights:

The Assistant Principal, Mr. AP, (the one who made the comment at a previous ARD about Kitty being just as likely to commit suicide as being hit by lightening inside the school), made another non-PC comment that had our normally cool advocate almost yelling at him. At the beginning of the meeting he decided to cut to the chase and told us that they'd had a staffing and Kitty was not going to be allowed to go to the special school, and if we didn't like it we could go through due process (or something like that. Honestly I don't know why is was so upsetting to the Advocate, except he's not allowed to tell us to go through due process.). The Advocate almost walked out, but we figured we had to at least listen to what they were proposing since we're apparently stuck with it for now.

Kitty excused herself after about 15 minutes of the meeting because the arguing was stressing her out.

Despite all evidence, the school is maintaining that there is no proof Kitty's problems are related to what happens at school. One of their arguments was that Kitty tended to go to the hospital on weekends.

Another argument was that Kitty doesn't want to go to the special school.

They completely discounted the fact that Kitty's grades have dropped from As and Bs to Cs (after all she's still passing), and that she's missed almost 38% of the school days since school started (and that's not counting testing, IEP meetings, and other stuff that takes her out of class).

Their proposal:

Censor the books and movies she watches.

Anytime she gets overwhelmed she'll go to the Crisis Counselor (I'm still trying to decide if we're going to allow this. Kitty has 2 experienced therapists already).

Instead of going back to class, she'll move to an "alternate location" where a special education teacher/ aide will "continue her instruction."

This will last for 14 school days, then we'll "reassess." If she misses more school between now and her Annual IEP meeting then this "trial period" will have to continue after the meeting, and the information can't be used for placement decisions.

We're waiting to hear from TEA mediation. Next step is due process.

In the meantime we're still on hold for RTC and everything, and it's making Kitty nuts.

She still hates the idea of the special school (had convinced her to "try it," but she changed her mind again), and she's mad at me for wanting her to go. She had a small meltdown on the way home, but we got her mostly calmed down again (she decided to ignore it).

Mama Bear

2011-11-05T21:55:00.002-05:00

in response to a comment on my last post:

I admit I'm in a bad place right now, and "broken" was probably too harsh a word to describe my kids, but they are definitely seriously, permanently "damaged." I don't know if acknowledging this harsh reality is "cursing" them, but if it makes any difference I would never say anything to this effect in front of the children and I rarely say it at all. I consider this a "safe place" to vent.

I/we have struggled for every tiny bit of progress and now that they're so close to the point of launching into adulthood I sometimes despair that they've made enough progress to be able to successfully navigate this transition (it's hard for everyone, but especially for kids who have so many strikes against them).

You hear inspiring stories every day of people who overcome major tragedies and issues to do great things, and I seriously pray for this for my children, but I'm also aware that my kids have SO many serious issues that overcoming them is not very realistic.

As for the kids' biomom, I take great pains to NEVER criticise her in front of the kids, but I do have to try to explain and help the kids understand her actions WITHOUT feeling they are to blame (biomom made it very clear to the kids when she dumped them in foster care at age 9 and 10 that it was THEIR fault they were going into foster care). I do not respect biomom, but I AM sympathetic to the difficulties and issues she had to fight. They were similar to those with which my kids also had to deal.

Bear and Kitty came to live with us 2 years after they entered foster care and had had some of the "rough edges" smoothed off, plus we had a lot of resources... but they were still almost impossible to handle. I can't imagine being a single parent of 4, dealing with the domestic violence, her own mental illness, and possible drug and alcohol issues... and dealing with mentally ill, defiant, suicidal, traumatized children. I know the police and CPS were in and out of her home too. She has my empathy.

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On another note, Kitty is back in the psych hospital again... for the 5th time this year. She wasn't even out of the hospital for a month.

She was already having issues, but called BioGrandma today and found out her sisters had been visiting. The biograndma was talking about how sweet Kitty's 3 year old little sister was, and how she'd told her Grandma that she loved her. Kitty was sad that she's never met this little girl, and wished that she was the one getting the love, but mostly she was upset because she couldn't be there to protect her sisters.

Recently Bob has begun texting a boy she knows from church, who is also a friend of Bear, and who graduated early this year - so is 17 and in junior college. *EEK!* Today she invited him over to watch a movie with the family (15 is too young to be dating without line of sight adult supervision). Unfortunately, Kitty's meltdown happened right in front of him. Luckily we were able to get her moved to another room, but it was still hard for everyone to cope.

After quite a long conversation, the crisis counselor we called (who arrived minutes after the boy had left), seemed about ready to leave. Kitty was calm, and not actively suicidal or homicidal anymore. When she asked Kitty if she could contract to not hurt herself, Kitty didn't think she could make that committment, and Kitty asked to go to the hospital.

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Whenever Kitty goes to the hospital she is automatically disenrolled from her regular school district to the school district in which the hospital is located. Her school still has to provide schoolwork, and tend to ignore this technicallity, but it's still a reality.

Big problem: Kitty has an IEP meeting on Thursday. The big one for which we've hired an advocate. This will only be day 5 (possibly 6 depending on how you count it) since her admission to the psych hospital. She may not be out of the hospital yet (although she almost certainly will be by Friday). We may have to delay the IEP Meeting. *AARRGGH!* Will be talking to the advocate in the morning.

Friday morning she gets the results of her neuropsych. She's supposed to be there for that because I wanted the neuropsych to get to give Kitty the information so she can't blame me. (Yes, I acknowledge that she will anyway, but a girl can dream right?!)

Politics

2011-11-05T10:43:00.003-05:00

My dad is a conservative republican (which is ironic because he's liberal in a lot of his other views), and loves to blast his e-mail list with Obama bashing cartoons, anti-democrat articles, economic predictions (he predicted the recession years before it happened)... and I love him anyway. I've requested that he not send them to me, but I guess he forgets. Obviously we don't see eye to eye... I'm a liberal social worker for goodness sake!

Recently he sent me a video, in an e-mail titled California Poster Girl. The video was titled "Parasites are Devouring the Country" and showed a pretty young African American girl in a nice apartment with expensive extensions, talking about how California provided the best EBT (Electronic Benefit Transfer) and all the money it provides, and how you can manipulate it to get more cash (daycare is paid for per child, and then you can have a friend watch your kids and split the money with her).

He wrote: "An excellent real-world explanation of the system."

Here was my response:

And then there are people like Hubby and I. Who are trying to make ends meet and supporting 2 special needs teenagers to adulthood so they will hopefully not perpetuate this cycle. We need these monies too. When Hubby was unemployed (but looking for a job), we had our kids on the free lunch program (we had a nice house and nice cars, but you can’t eat those). We get money from the state every month (adoption subsidies). My kids are on Medicaid, because their medications alone cost $2000/mo… each. They see therapists, psychiatrists, specialists… sometimes multiple times a week.

Granted it was probably their “welfare mom” who’s been “in school” for the 5 years I’ve known her, who has 5 kids with 5 different fathers, who drank and did drugs while pregnant and raising them, who “aged out” of the foster care system, who is mentally ill and abused herself… who caused them to be like this… but is that their fault?! Should they be punished?

They are mentally ill, have low IQs, are traumatized to the point of being unable to function in real life… and will probably never be able to be functioning, productive members of society. Through no fault of their own – and despite the fact that we worked as hard as we possibly could to help them, “fix” them, heal them. They are “broken” and this was “set” long before they came to us.

I agree the woman in this video is horrid. It’s true that some people take advantage of the system and share how with their friends. It’s also true that some “rich” people cheat on their taxes and share loopholes with their friends. Who is bilking the system for more?

Fears and Anxiety

2011-11-05T00:07:00.002-05:00

Monday, Kitty did great at the IEP meeting (alert and participating, no shut downs!), but was tired from the sleep study so only went to one hour of school.

Tuesday, she got anxious when they started the new behavior charting… or something. She couldn’t say why she was anxious exactly, but she thought it might be the question of how anxious she was feeling being asked by the behavior program staff. Left class at 1:30 and called home. We talked her into going back to class, but at 2:30pm she felt even more anxious, and the nurse let her call me and said she could go home.

Wednesday, she made it through school just fine so I decided to let her ride the bus to school the next day for the first time since she was hospitalized in September. She has been for the most part more emotionally stable since that last increase in Depak*te.

Thursday, she saw that stupid movie in 1st period Teen Leadership class. I’m watching it now. It’s pretty awful from the point of view of a kid who feels guilty/ responsible/ suicidal…. I can’t imagine why they showed it even to “mentally healthy” kids (it practically advocates suicide as a solution). When she called me, I asked her if she felt like hurting herself, she said “sort of.” Later she talked about having spent all morning resisting the urge to self harm. In the car on the way to speak to someone at the MHMR (I thought it was an assessment person, but there was a miscommunication), she talked about her new fear of being in a car accident. We’d been talking to all of the kids about the responsibilities associated with driving (and that it was one reason why we were doing neuropsych testing). I tried to reassure her that car accidents can sometimes be just fender benders, and it’s normal to be nervous about this (I mentioned my similar fear in my teens). I didn’t know what to say.

Today, she called me at 11am because she felt anxious again. She told me on the way to the crisis assessment, that she is nervous about going to residential treatment.

I don’t want you to think we’ve been talking up residential. We didn’t talk about it at all when she was released from the hospital. Eventually we mentioned it briefly as an option to help give her a safe place to deal with her trauma issues. Now that it’s possible that it could happen any day, I felt we needed to discuss it. For one thing she has to get some shopping done (they require 8 pairs of jeans and bras without underwires – which she doesn’t own).

I feel like it’s a horrible Catch 22. I want to just deny it until we know exactly when it’s happening, and then not tell her until right before it happens so she doesn’t go through this anxiety of waiting. On the other hand, I want to talk to her about it. Explain why we think it will help, what she needs to work on while she’s there, let her know it’s OK to be scared and give her as much reassurance as possible that this is not an abandonment or punishment. It really could happen as early as Tuesday depending on how the review of her clinicals goes in Nebraska. They have an open bed at the treatment center we’ve chosen.

In Trauma therapy today, we talked about a minor meltdown Kitty had while trying on jeans at a thrift store. She didn’t like the jeans I’d found on the sale rack, and she didn’t want to try jeans on at all. She found one pair (not on the sale rack) and was done. When I pushed her to try on more (she NEEDS more jeans, and they wouldn’t let me use my credit card for less than $10 and I don’t carry cash), she started crying, got overwhelmed and let out a cuss word that could be heard by me on the other side of the store. When I said, “Language.” She said she didn’t care, and got belligerent. I helped her hang up the jeans and we walked out of the store without buying anything.

So in therapy, the therapist asked me what would have happened if I had just walked out of the store when Kitty had started acting up. I said I wouldn’t do that because I know it would trigger Kitty’s abandonment issues, but just our conversation did that! She started talking about how she’d call the police and get me on child abuse charges and would run away. It was very frustrating for me because she was just as upset and angry at me as if I’d actually done it! I reassured her that I wouldn’t do that, and reminded her that I hadn’t, but it took quite awhile to get her calmed down again.

It’s days like today that I really get why she’s going to residential treatment. I just hope it helps and doesn’t make things worse.

and the school thinks she's fine.

2011-11-04T16:30:00.002-05:00

Kitty went home again today (11am). I believe her anxiety about going to residential treatment is a contributing factor. We went to the Crisis Center today for assessment (and documentation).

Kitty said yesterday she thought about hanging herself, but didn't get a rope. Today she thought about doing some self harming with a lapel pin, but resisted. She'd eaten her lunch by 10am (yes, she'd had breakfast about an hour earlier). The crisis counselor sent her home with an admonition to keep an eye on her (which of course we already do).

We're still waiting to hear from Nebraska what the funding decision will be. They are meeting with someone today to assess her clinical to see if they agree she needs residential, and have asked us to document all the steps we've already tried (mentioned partial day hospitalization - which of course we can't try since Medicaid doesn't pay for it).

The Medicaid case manager did finally come up with a viable solution for getting documentation that TX Medicaid won't pay for residential treatment or partial day hospitalization. She suggested we get Kitty's psychiatrist to prescribe them, and then when Medicaid denies the request we will have our documentation! Brilliant right? Now all I have to do is get the psychiatrist to contact me. Of course she only works on Wednesdays and Thursdays (and I met with the case manager Thursday after 5pm). *sigh*

2011-11-03T20:58:00.002-05:00

Kitty was sent home on Tuesday because the school had implemented a new rating scale (Kitty needs to verbally state how anxious she’s feeling on a scale of 1 to 10)… and when asked, she started feeling very anxious (doesn’t make sense to me either). She didn’t know why she felt that way, but at 1:30pm she called me from the classroom of her school case manager and told me she was feeling very anxious and wanted to go home.

I talked to the behavior program staff she was with, and he felt he could talk her into going back to class. At 2:30pm I got another call, this time from the nurse’s office. Kitty was feeling even more anxious and wanted to go home. The nurse felt it would be a good idea for her to go home. Kitty was quiet on the way home, and went straight outside to walk/stalk the backyard talking to herself for hours (she does this almost every day for 20 minutes to 2 hours, depending on how upset she feels).

Today, in first period they played the movie, 7 Pounds (a Will Smith movie in which he feels guilty about causing his fiance’s death so he commits suicide), and Kitty was very shaken by it as it felt a little too close to home, and triggered quite a bit of trauma for her. She managed to make it through the next period and lunch, but requested the behavior program staff during math class. They spoke to her for awhile, but she called me from the nurse’s office soon after this.

When I asked her if she felt like hurting herself she said, “Sort of.” So I took her to the MHMR Crisis for an assessment (to document this absence for school since we are being super careful to avoid potential truancy issues and don't want them to change their mind and say I was overreacting). On the way there, she was very tense and spoke about a newly developed fear of being seriously injured in a car accident.

She started pouring out her trauma history to the crisis staff person she’d practically just met. He seemed a little overwhelmed. After we left, Kitty went home to stalk the backyard, and recover.

National Adoption Month

2011-11-03T09:34:00.002-05:00

This is National Adoption Month, and tomorrow is the 5 year anniversary of Kitty and Bear coming to live with us. I want to be able to talk about how wonderful adopting has been for us, and maybe I can tomorrow, but for today...

I miss me.

My husband and biokids miss me. I'm so overwhelmed dealing with mentally ill, RAD teens that I don't sleep. I've gained 80 lbs. I can't work (no time what with appointments, paperwork and dealing with the kids...). I've been off and on meds (I hadn't needed since college) and therapy for my bipolar and now PTSD. I don't laugh. I don't sing around the house anymore. I don't have hobbies. I only talk to the few friends I have left and my family about the kids - our struggles with the legal system for Bear, getting residential treatment paid for, and trying to get the school to provide services for the kids...

I thought I knew what I was getting us into when we adopted special needs teens (After all, I used to be a social worker). I was wrong. For a long time I wanted to adopt again because I thought that now that we were experienced therapeutic parents (earned through painful, extensive effort), that we had a lot to offer. I have nothing left to give.

I thought we'd made a huge difference in the life of our 2 adopted children. Now I believe that the minute Bear (18) leaves our structured (feels like a prison) home, he will stop taking his meds that are the only reason he's not psychotic, and all the trauma and issues he never dealt with will come right back to the surface. He'll end up dead or in prison. I feel like we've just delayed the inevitable.

I thought that we'd made huge progress with Kitty (16), because it felt like her RAD was healing, and she has been stable for almost 2 years, but she just had her fourth hospitalization this year and the doctors say her meds are right, and the problems have to be because of the trauma. They recommend long-term residential treatment, but we can only possibly find funding for 90 days (if I can get funding at all). They've both been in residential treatment before and it didn't do any good.

I'm just so tired.

Mary

Disagree

2011-11-01T18:14:00.002-05:00

So I brought my letter and the Intervention spreadsheet to the IEP Meeting and waited for the right moment to introduce it. The IEP Meeting Facilitator started up where we left off, with updating the Crisis Plan.

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

CRISIS PLAN

In the off campus and school setting Kitty has expressed suicidal ideation, including threatening to harm herself. According to Mrs. Themom, Kitty has expressed a fear that she may harm herself. Kitty exhibits somatic complaints, asking to go to the nurse frequently and then home.

*******If Kitty asks to go to the nurse, call parents or requests the Behavior Program support:
-Call the Behavior Program x#### or x#### to discuss request with Kitty and if necessary, ESCORT to nurse.
-The nurse will assess validity of complaint, check her vitals and if there is no evidence that she is sick, Focus escorts Kitty back to class.

(If Kitty has no fever, vomiting, or outward signs of illness, she is to return to class after emotional status discussed - see below.)
In order to assess Kitty's current emotional status the Behavior Program will utilize feeling scales and signs of "acting in" behaviors (see attached) and personal observations to discuss with Kitty her levels of anxiety. Parents will be given feedback through the Review 360 behavior data collection/progress monitoring program.

********When/If anyone witnesses evidence of SUICIDAL IDEATION including threatening to harm herself in either oral or written form, call the Behavior Program immediately; the following procedures must then be followed immediately for the Suicidal Ideation:

-Call the Behavior Program x#### or x#### . The Behavior Program then calls the following:
-Nurse x#### to assess medical needs;
-Crisis Counselor, Ms. S, general education counselor, Ms. V, x#### to assess emotional needs or any counselor;
-Asst. Principal, Mr. R x#### or any other A.P. available, Mrs. S x####, Mrs. S x####, or Mr. S x####
-Parents, Mr. &/or Mrs. Themom. Please call in this order: I) ###-#### Mrs. Themom; 2) ###-#### Mr. Themom; 3) ###-#### Mr. and Mrs. Themom
-Parents are summoned to campus as needed to take Kitty home or to the doctor, if necessary.

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

The good news is that while they wouldn't acknowledge my letter or list of interventions, they did copy the "Acting In" behaviors straight from my letter and put it in the Crisis Plan so at least we have it in somewhere. Now I wish I'd had more time to write it, but I think I covered the basics. Someone sat down and typed it in (so I don't claim the typos!) during the IEP Meeting.

Examples of "Acting In" Behaviors as reported by parents:

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

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

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

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

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

Depressed: Sad; crying whining; begging to go home

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

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

Poor Boundaries: inappropriate interpersonal interactions. Inappropriate share/ venting with peers and others, particularly about abuse and perceived abuse (past and present); participating in or allowing physical and/or emotional teasing/bullying; inability to recognize other's "boundaries" and bothering them; perceives others as threatening or abusive; tattling about rule breaking; verbal lashing out; gossip- (has spread vicious rumors regarding sibling/friends and accused them of doing the same); threatens 09r hits peers (yes, this is and "acting out" behavior, but is on that Kitty as acted on in school and the community).

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

I requested that they redo the FBA (Functional Behavioral Assessment - originally completed on "Meltdown Behaviors.") to address "Acting In" behavior, but was told by Ms. BS that it was "illegal for her to assess behaviors she can't directly observe." She did say that some of the 'acting in" behaviors had been observed by her so she would do... something. She didn't really say what.

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

At the end of the time allotted for our IEP Meeting, I asked them to add my 2 documents as an addendum to the IEP, but since we "didn't discuss them" (not for lack of trying), this was denied.

So we refused to sign the IEP. We have another IEP meeting in 9 days.

This time we will be bringing a professional advocate. We found one that is offering us some pro bono work, and we'll find the cash somehow. (Stupid car decided to start breaking down).

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

Since we didn't sign, supposedly the altered Crisis Plan will not be put into effect, but obviously it already has. Kitty called me today at 1:30pm from school too anxious to go back to class. I talked to her briefly, but she could not verbalize what was wrong. I talked to the behavior program staff, and he thought he could get her back to class. At 2:30pm I got another call. This time she was calling from the school nurse's office and the nurse said the school was OK with her going home.

I'd just been thinking she was responding positively to this latest bump in Dep*kote and we'd have trouble convincing anyone she still needed residential treatment. She was alert and participating in the IEP meeting, even though she'd just had an overnight sleep study, so I was convinced we were going to lose all ground on the school front too. Guess she took care of that.

New Direction?

2011-10-28T12:40:00.003-05:00

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

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

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

So there are definite inconsistencies.

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

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

Is the Student in Special Education? {Obviously met}

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

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

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

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

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

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

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

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

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

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

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

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

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

Examples of "Acting Out" behaviors:

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

Physical violence toward self or others

Property damage

Threats/attempts to run away

Threats/attempts to commit suicide

Threats/attempts to self-harm

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

Examples of "Acting In" behaviors:

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

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

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

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

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

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

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

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

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

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

Smaller class sizes {fairly effective}

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Predictability of routine {Fairly Effective}

Work with her on Social Skills training {Fairly Effective}

Self-Confidence Building activities and training {Fairly Effective}

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

Dismissed

2011-10-28T01:57:00.002-05:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Trauma and NeuroPsych testing

2011-10-27T22:48:00.002-05:00

Hi Ms. School Case Manager,

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

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

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

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

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

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

Mary

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

Ms. S CM's response

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

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

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

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

Thanks

Ms. S CM

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

Hi S CM,

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

Mary

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

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

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

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

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

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

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

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

IEP Meeting - to be continued

2011-10-26T09:00:00.002-05:00

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

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

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

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

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

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

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

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

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

This is the IEP Meeting Facilitator's Response:

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

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

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

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

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

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

Thank you, Ms. IEP Meeting Facilitator

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

Devil's Advocate

2011-10-22T10:54:00.002-05:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I guess next steps are

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

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

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

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

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

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

In the meantime:

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

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

Push getting Kitty's clinicals to the chosen RTC.

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

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

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

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

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

DENIED!

2011-10-21T17:37:00.004-05:00

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

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

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

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

Those in attendance:

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

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

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

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

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

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

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

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

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

Who noticeably wasn't there:

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

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

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

They started by reading the results of the FBA.

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

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

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

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

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

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

Short Term Objectives:

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

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

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

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

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

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

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

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

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

No Animal Left Behind

2011-10-20T23:01:00.003-05:00

No Animal Left Behind

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

Could use some prayers tomorrow.

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

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

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

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

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

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

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

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

Throughout it all I have to

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

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

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

clean the house before the Medicaid lady gets here

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

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

This vs That

2011-10-13T17:48:00.004-05:00

He Said/ She Said

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

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

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

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

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

TEXAS MEDICAID/ NEBRASKA MEDICAID

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

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

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

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

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

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

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

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

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

TO MED OR NOT TO MED

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

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

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

SCHOOL KITTY / HOME KITTY

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

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

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

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

Kitty's safety

2011-10-12T23:33:00.002-05:00

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

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

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

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

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

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

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

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

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

What to do when:

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

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

Kitty is exhibiting self-harming behaviors.

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

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

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

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

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

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

Mary

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

On Monday evening I got this response:

Hi Mary-

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

Thank you,

The IEP Meeting Faciliator

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

My immediate response:

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

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

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

Mary

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Getting Burned

2011-10-09T21:49:00.002-05:00

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

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

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

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

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

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

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

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

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

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

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

OMG! OMG! OMG!

2011-10-06T20:08:00.002-05:00

Freaking out now!

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

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

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

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

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

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

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

So my choices are:

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

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

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

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

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

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

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

How am I going to get this all done?!

Revised Letter

2011-10-06T15:49:00.001-05:00

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

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

To: ARD team
Re: Kitty IEP meeting

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

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

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

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

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

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

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

Placement

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

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

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

Mary and Hubby

Please Review for me!

2011-10-06T10:19:00.004-05:00

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

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

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

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

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

ADDRESS the WHOLE CHILD!

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

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

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

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

ACADEMIC NEEDS BEING MET?

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

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

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

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

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

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

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

EMOTIONAL / BEHAVIORAL NEEDS BEING MET?

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

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

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

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

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

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

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

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

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

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

LEAST RESTRICTIVE ENVIRONMENT

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

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

Areas Kitty’s current Crisis Plan does not address:

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

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

Self-harming behaviors.

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

Feeling overwhelmed or stressed

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

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

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

Time spent in nurse’s office instead of class

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

Residential Treatment

2011-10-04T20:20:00.003-05:00

For so long I've been saying that Kitty is not doing well and is getting worse. It felt like everyone except one therapist (not even totally Kitty's therapist, but the EMDR therapist who works with the whole family) seemed to think she was fine.

The school especially kept saying that she was fine at school and any issues she had were no big deal, and a "fluke." They are still maintaining that she can't go to the special school until all the testing is done. I think that's stupid. If we had documentation that she'd gone blind over the Summer would they still be doing testing 6 weeks later to determine if she needed to be taught how to read Braillle and maybe she should be pulled out of Drawing class?!

Over the weekend, Kitty escalated yet again. During an argument, for once not over chores, she threatened to jump out her 2nd story window (opened it, but shut when Hubby told her to), and had meltdown after meltdown culminating in some property damage and using an eraser to take off layers of skin with an eraser (worst self-harming she's ever done). We had to take her back to the psych hospital.

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

Now all of the sudden, we're being told that she needs to go into residential treatment for a year. The psychiatrists say there are no med adjustments that will help. They can't get her stable. They want her to go straight into residential treatment from the hospital.

Medicaid will pay for 7 days at most of psych hospitalization (maybe even less because we're not making med changes) and she went in on Monday so that means next Monday at best.

Texas Medicaid doesn't cover residential treatment, so I have to get the state we adopted from to honor the legal agreement we had added to our adoption subsidy (THANK YOU LISA!)and pay. Which means I have to get a state agency to go through beaurocratic red tape and pay money... before she's discharged.

Plus I have to find, research and make arrangements for a good residential treatment center... that can accommodate her complex issues, and that will accept her even though she's not stable, and has a bed... before she's discharged on Monday.

I'm freaking out and overwhelmed.

Levels, Privileges and Cleaning your room

2011-10-01T10:58:00.002-05:00

First, I have to post this link on cleaning your room. LOVE IT! http://www.wikihow.com/Clean-Your-Room

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As predicted, Kitty hated the new level system, until she decided that it meant she didn't have to do chores!

She decided she was perfectly happy at Basic level... until she realized Friday afternoon that that meant she couldn't spend the night at Grandma's on Saturday night. She began yelling at me for making these stupid levels and for not warning her that by not working on level 1 responsibilities she wouldn't get to spend the night at Grandma's house.

So she started trying to force Hubby and I to agree to take her to Grandma's church at 9:30am. Not going to happen!

Saturday morning on the way home from dropping off Bear at detention she asked to go to a donut shop like we did two weeks ago. I let her know we needed to go home as we both had things to do. She tried to get me to take her to Grandma's house to join Bob (who had spent Friday night at Grandma's as she often does - she needs a break from Kitty, gets to sleep in a little with no noisy Kitty to wake her up, and Grandma loves having her. They go shopping, sew, paint...). Hubby and Ponito were at Ponito's soccer game.

I reminded Kitty of the levels and told her I wanted her to work on cleaning her room on Saturday so she could take a break whenever she wanted and it wouldn't be as overwhelming. She tried to convince me that it was her space and therefore she should be allowed to leave it messy if she wanted to. I reminded her that she does better with an uncluttered room and doesn't get overwhelmed as easily. She of course disagreed. She let me know that Biomom never made her clean her room. (No way was I going to respond to that one!) Despite her best efforts I refused to argue with her.

I finally just told her it was up to her to clean her room or not, but... if she didn't, then eventually I was going to have to clean it for her since I know she needs it clean.

She then threatened to make my life miserable since Attitude was not on her Basic Level Responsibilities. I just told her that no, attitude wasn't, but threatening was, and she was threatening me. She dragged out the old, "It's not a threat if it's the truth" argument. I said, "Yes it is," and let it drop.

She supposedly picked up her room a little, but I haven't checked it yet. She doesn't want me to because she's afraid I will criticize her. I told her that (after 4.5yrs!) she knows how to clean her room to my standards so I won't be checking it until she thinks it's ready.

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I spent all day yesterday looking for residential treatment for Kitty. I'm still not sure it's the right thing to do, but we're running out of options. She is stuck at Basic levels. She forgets to take her meds. She doesn't wash her hair when she showers. She naps. She eats and eats and eats.... She cries. She whines. She gets defiant. She shuts down. She's hyper. She's depressed. She is completely emotionally dysregulated. She is unable to complete even the most basic of tasks without meltdowns.

It appears only one residential treatment center (RTC) will accept kids with Texas Medicaid or no insurance at all. It's over 1 1/2 hours drive away and has a 6 to 9 month waiting list. We don't have private insurance, and we don't qualify for sliding scale places because Hubby makes a very good salary doing contract work (no benefits and we have major debt from losing our company earlier this year after 3 years of struggling to keep it afloat).

The only hope I have is that there is a rumor that, like partial day hospitalization, Medicaid doesn't actually pay for residential treatment. If that is the case, and the RTC is actually using state or community funding to pay for treatment (in which case we won't qualify because of the sliding scale thing), then we can hopefully get a statement for denial of services. I say hopefully we get denied because if we can prove that we've exhausted all resources then we have it written into our adoption subsidy that the state of Nebraska (where the kids were adopted from) has to provide residential treatment!

If Nebraska is paying then we can take the kids to a private RTC. There is one only an hour from here that does work with kids with RAD and mental illnesses. The RTC we've used previously (paid for by Nebraska because Bear's adoption wasn't finalized) was great for neuropsych, but did not touch either kids' attachment issues and was designed for the short term (their average stay was 4-6 weeks - although Bear was there for 6 months). {Kitty was there for 2 weeks. Our private insurance only paid for 5 days, and then the RTC itself picked up the rest of the tab!}

I should know more on Monday.

Feeling Overwhelmed

2011-09-28T22:58:00.003-05:00

8:40am Get a call from the MHMR reminding me that Bear had a psychiatrist appointment at 11am. Not on my calendar. Let Bear know he was going to have to miss a school field trip for the meeting. Call Hubby because I can't be in two places at once. I'll need him to pick up and take Bear to his appointment and meet me there.

8:45am Bear leaves for school. Normally I would be leaving to drive Kitty across town to school (20 minute drive and she has to be there by 9am), but today she has a doctor appointment to check up on the diagnoses from the psych hospital (thyroid enlarged on one side - they recommended an ultrasound, but wouldn't give the orders. She was also diagnosed with a UTI and put on an antibiotic.

I know that in elderly patients that a UTI can cause dementia like symptoms, but I'm assuming it wouldn't have the same effects on a healthy teen. Anyone have any information? The doc said she thought it would only be a problem for the elderly because they might have renal failure, but this is the same doctor that told me my daughter couldn't be having night terrors because those only happened in very young children.)

I start suggesting Kitty do some laundry (she's got several loads of very dirty laundry to get caught up on). She insists she doesn't have to do chores and it's not her laundry day, so she decides to take a nap instead. *sigh* There are some flaws in our new level system.

9:15am I write an e-mail to Hubby about all the things that need to be covered with Bear's psychiatrist in case I don't get there in time... but find out later that I didn't manage to hit send. *sigh*

9:30am Leave for Kitty's doctor appointment. Stop by the Special school to make sure they have a medication form the psychiatrist needs so the school can continue to administer his lunch meds at school, and to drop off Bear's ticket (I called the number on the back to find out what time we're supposed to be at the court house since it has an appearance date, but no time. Only to find out that the "Appearance date" is just the mail by date for his plea of No Contest, Not Guilty or requesting a trial... which is Friday. I had wanted Hubby to talk to him about it on the way to the psychiatrist.

9:40am Kitty's doctor office has you come in 20 minutes before the appointment, so we're bored in the waiting room. I start talking to a lady with a 1 and 5 yr old. The 5 yr old girl is showing off and mildly acting up (kind of playfully head butting mom, won't stop messing with mom when asked to stop). The woman grabs the little girl by the chin a couple of times and makes some threats to swat her. Kitty starts getting agitated.

10am Finally see the doctor. She decides to allow Kitty to get the ultrasound, and deigns to look at Kitty's hands when they break out in hives and itching while we're sitting in the exam room (I had to insist). Really don't like this doctor! Still not sure what caused it, but they got better after she removed her recently washed sweatshirt and washed her hands.

Bob texts me to remind me I'd promised to get her a doctor's appointment for her ear pain and cough. No health insurance for anyone but Kitty and Bear... *sigh* I get her a 1:30pm appt.

11am Kitty and I run to the MHMR and I leave her in the lobby while I step into Bear's psychiatrist appointment. We talk about Bear's not being good about taking his meds, and I request a sheet listing his diagnoses and IQ so we can take it to court (to try for community service). Bear starts insisting he'll just pay the ticket, but of course he has no job and no money. He of course always thinks that he'll get a job any minute... not that he has time to work between school, therapy and detention. Bear is just focused on the fact that he doesn't want to do community service because that is doing work for free (Hubby and I remind him that he already does volunteer work and enjoyed working at the horse therapy place - which also offers community service hours for many).

Stupid psychiatrist starts talking about how when he was 19 he got a ticket for driving a motorcycle without a helmet or a license, and it was no big deal and has no effect on his life now. I point out that Bear is graduating in 8 months and having a misdemeanor on his driving record (assuming he ever gets a license) could make the kinds of jobs Bear will qualify for very difficult to get (unlike the psychiatrist whose job would probably not be effected by something like this, especially after he got out of college).

I tell the psychiatrist I want Bear's IQ on the document for court and he doesn't understand why since Bear's IQ is average. I tell him No, Bear's IQ is borderline (I know Bear won't understand what this means), and where to look for the IQ is in Bear's records. The pdoc finds it and is surprised. He comments out loud that Bear's IQ is below average at 79. I don't know how I feel about him saying this in front of Bear. On the one hand, Bear needs to understand that he has issues and labels. On the other, is this the best way for him to hear it? Was he even listening? Does he internalize it? Is that why he was in a bad mood later?

11:45am Run by the house to pick up the lunch Kitty forgot and get her some Clair*tin for her hives.

Noon Run to the attendance office at school to get the kids a pass for class (Bear refuses to stop for one and allegedly goes directly to class). While there I brought Bear's med refills to the nurse.

Got a call from the MHMR. They're rescheduling our meeting yet again. I'd asked for this meeting the day Kitty went in the hospital so we could discuss strategies before she was released from the hospital to help us deal with her. They scheduled for Monday even though she was supposed to be home by then. They told me on Friday that they'd decided their supervisor should be there so we could "discuss services" and he couldn't meet until Thursday. Now we're supposed to meet next Monday. Kitty has a psychiatrist appointment on Thursday evening which is when she usually meets with her MHMR skills trainer. So the skills trainer just cancelled and will meet with her the following Thursday (3 weeks since the last time she saw her with a phosp visit in between). Yeah, this makes sense (sarcasm). *sigh*

12:30 I visit Grandma who lives near the kids' school, and she feeds me a sandwich. we get to chat a little about the kids and life. I end up talking to her longer than I should and I'm late picking up Bob.

1:20pm I arrive to pick up Bob, who informs me that Kitty is in the nurse's office. Kitty is sitting with Ms. V and says she can't resist the urge to self-harm. Of course it's a 20 min. drive to the pediatrician and Bob's appointment is in 10 minutes. *arrgh!* I ask Kitty to verbally contract not to harm herself. She says she can only do it if someone is watching her. The counselor, Ms. V, assures me there is an aide in the special ed class Kitty is in. I tell Kitty I'll be back in one hour when the class period ends. Then I'll see how she's doing and stay on campus until school gets out (assuming she feels she can stay).

1:35pm We zoom into the doctor's office. Luckily they aren't busy and see her right away. Not allergies, causing congestion, leading to an ear infection, after all. Just a cold (and lots of ear wax). Already healing. So good news is no antibiotic. Bad news is it cost $90 to figure that out.

2:10pm Run to local pharmacy which just opened and I have coupons! to buy D*lsym for her cough and a snack (but end up picking up a few more items since I got a free discount card). The total comes to over $100! Coupons bring it down to $80, but still way more than I thought it should be.

2:30pm Got a call from Kitty wondering where I am, and saying she's struggling so I reassure her that I'm on my way and we run. I'm assuming I'll be picking Kitty up and going home so I decide not to go by the house to drop off Bob.

2:45pm Check in with Ms. V to see how Kitty did after I left. She assures me that Kitty seemed OK. I have her call the classroom, and I convince Kitty she should stick it out to the end of the day, but if she needs me I'll be doing volunteer work in the library (standard for me - I like to stay busy). Then I vent to Ms. V for a little while until Bob comes in bored, cold and hungry. I tell her we're probably going to stay till school gets out at 4:05pm.

3:45pm I take Bob to the school library with me, but she decides to go to the car and warm up and eat the snack food we'd bought. I put library books in numerical order until school ends.

4:05pm I take Bob home. I return with Kitty to the pharmacy because they had poorly labeled the supplements I bought (looked like they were $2 each, but they were almost $12) so I returned them.

4:25pm Redirect the boys who, realizing Hubby wasn't supervising them, had decided to play Playstation instead of doing chores. Ponito does one chore and disappears with friends. Bear goes to hide in his room (claims his chores are done). Kitty grabs a snack and heads out to stalk in the back yard. I sit down at my computer and start going through e-mails, Facebook, online support groups, and yes, I play a few Facebook games.

5:30pm Hubby takes Ponito to soccer practice. Bear wants to go until Hubby fusses at him for not really doing his chores. I tell Bear he has to go because I don't like having him at home in this kind of mood.

5:35pm Kitty says she's "bored." I suggest she do some chores. She naps for awhile, and then asks to make a phone call. I get her to do a load of laundry first.

630pm Kitty wants to take a shower. I get her to switch over her laundry and allegedly pick up a little of her room floor first.

7pm Kitty's out of the shower and needs something to do. I suggest she make dinner (she likes this). She fills a huge pot with water (didn't realize until it had already been on the stove for 1/2 an hour and still wasn't boiling). She starts a movie, but wanders off after it starts (as usual).

8:30pm Noodles are finally done and Kitty has wandered off. I realize she's used up most of the ingredients I was planning on using for this meal and didn't put them on the grocery list, so there's not enough noodles and not enough noodles to make a good sauce. *sigh*

8:45pm Boys and Hubby come home wanting dinner (I'd thought they were eating out). No one likes dinner anyway so there was plenty.

9pm Finally get Kitty off to bed (so much for 8:30pm). The boys suddenly have homework (Ponito is now grounded from Playstation since this is not the first time he suddenly remembered assignments after bedtime when he'd played all afternoon).

2am So now I still need to send out e-mails to everyone, but instead I'm exhaustedly staring at my computer and blogging.

Guess I better go put dinner away and crawl in the bathtub, and then I can get a few hours sleep before tomorrow.

*SIGH!*

Kitty's Coming Home

2011-09-25T21:55:00.002-05:00

Kitty will be coming home at 4pm today. I decided to create a new chore chart with the responsibilities and privileges done in levels.

Basic Responsibilities are Self Care (hygeine, taking meds, eating meals) and Basic Safety (No meltdowns, no threatening self or others.
Basic Privileges are Approved music and books, slightly earlier bedtime, and family activities.

Level privileges requires daily completion of ALL the responsibilities of that level and ALL prior levels. Non-completion of ANY responsibility will move child back to the privilege level containing that responsibility. To move up to the next level's privileges, she needs to demonstrate an ability to maintain that level's responsibilities for a period of time. This will hopefully demonstrate an emotional ability to handle the privilege (for example, not having nightmares before being allowed to watch media I think triggers her).

Level 1 Responsibilities are Personal Responsibilities (room and clothing chores) and Emotional Responsibilities (being respectful, and no gossip).
Level 1 Privileges (2 days maintenance required before can get privileges) are regular bedtime, less supervision on media, being allowed to spend the night at Grandma's and go to church/Sunday School with direct supervision.

Chores will be inspected by Mom and must meet her standards. If child is unable to accept feedback then child will be redirected to another activity.

Level 2 Responsibilities include the Chores (maintaining one of the bathrooms) and Emotional Responsibilities (No whining)
Level 2 Priviliges (3 days maintenance required) include riding the school bus, having (female) friends over, and being allowed to do stuff and make choices without direct supervision (media, church...)

Level 3 Responsibilities include some Kitchen Chores which can be triggering for Kitty, but aren't the ones that specifically do so and Emotional Responsibility is sleeping well without nightmares (because the privileges include potentially triggering media).
Level 3 Privileges (1 week maintenace required)- Lot less monitoring

Level 4 Responsibilities include Kitchen Chores that are triggering. The Emotional Responsibility is not dissociating or isolating.
Level 4 Privileges (2 week maintenance required) include a cell phone and dating. The cell phone is what triggered this latest episode.

Level 5 Responsibilities include a few more Kitchen Chores, handling her own meds, and being RRHAFTBALL.
Level 5 Privileges (1 month maintenance required) this is the life of a typical 16yo.

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I'll be telling Kitty that we expect her to work her way slowly through the steps, and that we expect her to maintain at about Level 2. In order to head off a meltdown, we will be putting everyone on this system for a week to show her why they are at the levels they are at. Bob will have homework as her major chore. We'll probably switch out "Be Where You're Supposed to Be When You're Supposed to Be There" for "No Whining" for Bear.

She's going to hate it. She's going to protest, even though it's as concrete and positive as I can make it... but she's mentally ill, and this is our life. This is really to give to all the people who've been saying we can fix this if we just...

IEP Meeting Denied

2011-09-25T19:23:00.003-05:00

Hi Mary-

I am glad to hear that Kitty is expected to be released on Monday! I hope she is looking forward to returning to school. In order to determine the purpose of your IEP Meeting request I would like to make sure I understand your suggestions from your email.

Double Block math class: Kitty is in an applied Geometry class (smaller class taught by a special education teacher). This class is only offered as a double block class. The applied setting contains a smaller number of students and allows for teacher instruction and students to work on the same math skills in 180 minutes that a general education class covers in 90 minutes. I would suggest you speak with Kitty's teacher, regarding Kitty's reports to you. I understand from the Behavior Specialist, Ms. BS that she observed Kitty in this class and Kitty was on task and engaged in the learning process. Ms. BS also indicated that she will be contacting you, if she has not already done so.

{Ms. BS and I spoke. She did a version of the BASC - a behavior survey, and I think is the first and only person to actually have a good understanding of what a meltdown is and how often we see them - once or twice a day. Of course she isn't anyone who actually has much to do with Kitty. Her observations just determine if Kitty will go to the Special School. She did listen when I pointed out that observing Kitty in class, where she's working the hardest to keep it together means she won't see much.}

Ms. BS, you are welcomed to provide any feedback on this topic.

Nurse visits: I believe this is a behavior that staff is looking at through the functional behavior assessment.

Special Education Transportation: I completely understand that this might impact you negatively in Kitty's 'eyes', if you were to suggest. Typically, to qualify for special education transportation a student must be receiving services on a separate campus, has inefficient mobility skills, unable to communicate effectively, and/or have tendencies toward hyperactivity or aggression. This in no way is an exhaustive list, but I am unaware of any data showing that the general education bus has not been effective for Kitty. The Assistant Principal, Mr. AP may have further information regarding the bus.

Mr. AP, if you have information regarding Kitty that negatively impacts her ability to ride a special education bus as it relates to her educational needs, please let Mrs. Themom and I know.

Lunch and Hallway: This might be something Ms. Case Manager could question Kitty's teachers and lunch room monitors (the APs) by sending an email to gather information about what they see in these areas.

Ms. CM - Could you gather some feedback on this? After reviewing the suggestions, it looks as though most of this might be best handled by a parent / teacher conference or contacting the case manager or specific teachers. Are there any specific areas of the IEP that an IEP committee would discuss regarding changes to the IEP that I have overlooked? Please let me know so that we may schedule an IEP meeting.

Please keep in mind that the school will request an IEP meeting to review the assessment that is currently being completed. I look forward to hearing from you!

Sincerely, IEP Meeting Coordinator

Letter to Kitty's teams

2011-09-22T22:45:00.002-05:00

I’d like to officially request an IEP meeting.

We had a meeting today with Kitty’s psych hospital therapist, and I have to admit I have some BIG concerns. He’s already talked to one of her therapists, and would like to talk to someone at the school about his recommendations for how to help Kitty in school. The school psychologist said she’d contact him tomorrow. It looks like Kitty will probably be discharged on Monday.

The good news:
· They’ve reduced the sleep med that we were concerned might be triggering mania (Traz*done - 300mg to 100mg), and she’s slept a full 8 hours for the last couple of nights.
· She’s increased the new mood stabilizer, Dep*kote, from 250mg to 750mg with no apparent negative side effects.

The bad news:
· The self harming behavior is increasing. She’s actually leaving marks with her nails, and she’s now restricted from using pencils without supervision because she’s been using them to hurt herself.
· She appears to be in a constant fight/flight/freeze mode, and very hyper. She said others have been commenting on her mood swings, and she made several aggressive, nasty comments in the short time she tolerated our presence before demanding to be allowed to go back to her friends. {I left the hospital practically in tears. We'd just had a great session with Kitty's therapist who really "gets it," and he was totally reassured that we were good therapeutic parents... and then we met with Kitty and she was even worse than she's been the last few weeks. She blamed everything on us, and was obviously LOVING the kids at the hospital and getting tons of validation. She was reinforcing all the negatives and reasons she wanted to leave home and didn't want to come home. When I called her later she continued with the diatribe and was angry because she feels I'm discounting her feelings by saying it's her "perception" when she says things like, "Daddy thinks I'm ugly" or "You're punishing me for having issues." Plus, I get "everyone" on my side - "everyone" being the "therapist and my friends."}
· She presents to the therapist at about a 10 yr old maturity level (which coincides with our estimate) and this is about the level of responsibility she seems to be able to handle (except for those chores/issues that are trauma triggers which cause her to react in a fight, flight or freeze manner), but she is adamant that she must have “16 year old” privileges, even though she often admits she doesn’t want the responsibilities that come with them. She is constantly comparing herself negatively to her super responsible, mature, YOUNGER sister Bob who is in the same grade at school.
· She is forming friendships at the hospital with the same kinds of kids she’s attracted to at school. Our current theory is that because of her black and white thinking, she is attracted to “bad boys” because they make her feel like a “good girl,” they are tolerant of her issues because they have issues of their own, they make her feel part of the group, and they validate her feelings about us (we are “overly strict, over-protective, we care about the other kids more than her…”) which justifies her pushing us away and the feelings of anger that she has against her “mother” (which she takes out on me).
· She is blaming EVERYthing on Hubby and me (with some special hate for Bob), especially because she is really afraid if she admits any problem at school it will mean she’ll end up in the special school.

Suggestions:

Kitty had some ideas on how school could be more comfortable for her. Apparently she ends every day with the double block of math, which she says means she goes home all stressed out. She said this class is too loud and chaotic and ends her day on a stressful note, which means she has no reserves left for dealing with the rest of the day.

She also doesn’t think she needs the double block of math. That of course is up to her math teacher.

Of course most of her visits to the nurse, including the day she wet her pants, have been earlier in the day.

She continues to have big issues with social skills. The boy, she is accusing of teasing her by calling her “ugly,” rides her bus. As does the senior boy who is into “shrooms” that she is highly attracted to. She continues to spread rumors about Bob and accuse Bob of spreading rumors about her. My personal feeling is that the unstructured time on the bus to and from school is a huge source of stress and until she can get some help improving these skills, maybe we should consider having her on the special ed bus. As you can imagine she would be highly against this option, and if it’s considered I would greatly appreciate if it was not attributed to me.

Lunch seems to also be a big source of stress for her for the same reason. Time in the hallway too. (Ms. V, the school guidance counselor, relayed a story of hearing Kitty announce to a friend that she was pregnant. It was possible she was joking, but Ms. V was too far away to talk to her about it. I asked Kitty about it, and she denied the incident, but seemed to understand that even if she was joking, all the people who overhear her when she’s teasing and joking like this don’t always know she’s trying to tease (or that she can’t handle being teased in return).

The therapist is suggesting we start the ball rolling on getting her into residential treatment (since the only place that accepts Medic*id has a 6-9 month waiting period). He’s also suggested partial day hospitalization/ intensive out patient, but her insurance does not cover this. He is not familiar with the special school so didn’t feel comfortable making this recommendation.

Kitty is in Psych Hospital again

2011-09-21T23:23:00.002-05:00

Sunday after a rough day at Sunday School (something about Bear teasing her - threatening to go to her Sunday School class next week) she returned to Grandma’s house (where she’d spent the night the night before). She claimed she didn’t feel well and took a nap. I woke her for lunch and after she ate a little she went back to sleep.

At 3pm we sent Bob in to let her know she needed to clean up the room because it was time to go home. She refused so Hubby went in to get her. She started yelling at him for getting her up when she wasn’t feeling well. She was pretty irrational (screaming, crying, threatening to hurt herself and claiming we hate her) and started claiming that Hubby was yelling at her and threatening her (he wasn’t, although at one point he had told her if she didn’t get in the car he would carry her out, which she chose to perceive as a threat).

She did eventually get in the car with me. Everyone else went with Hubby (he took Bob to buy a cell phone, which Kitty was HIGHLY jealous about).

She and I made it home, but when I told her she still needed to do her chores (which she’s been avoiding all week) before she would be allowed to watch TV, and that she couldn’t just nap all evening… she started ramping up again. She also started talking about having a headache again, but never once asked for Tylenol (the “pain” disappeared again quickly when the pressure was off). When I also mentioned that I thought it would also be a good idea to apologize to Hubby and offer restitution, she got even more upset and started verbally attacking me in addition to ranting about him.

When I still wouldn’t escalate with her, she demanded to talk to her skills trainer. I happily gave her the number, but the skills trainer didn’t answer. Kitty then tried her MHMR caseworker, and told her she was feeling suicidal (Kitty hadn’t told me this before so I was caught by surprise). The CW told her to call the Crisis unit, and Kitty informed the person she spoke to there that her feelings of suicide were about a 4 on a scale of 1 to 10.

Kitty requested to be admitted to the psych hospital. After checking with me, the Crisis counselor offered to contact a psych hospital about an hour away if I would contact the closer one. Kitty wanted the closer one because it was familiar, I was half hoping for the other in cases we might get better results than we have the last 3 times she's been there.

I put Kitty on the “4 foot rule” (she has to stay within line of sight of a parent). She became quiet and calm and even cuddled with me for awhile. The local psych hospital said they had no beds, but expected to have an opening the next day because they usually have quite a few discharges on Mondays. The Crisis person did come out and talk to Kitty, during which Kitty remained calm, but still wanted to go to the hospital (although not the one that was farther away because she’d never been there before). Kitty took her meds and went to bed early.

I kept Kitty home from school and contacted the psych hospital the next morning. They had an opening. On the way there I reinforced with Kitty that she NEEDS to let them know what's going on, and not just pretend she's all better because she wants to come home. She was in the hospital less than 6 months ago, and we want her to get the help she needs to stay out!

Of course when we got there she didn't mention the nightmare. Then when I brought it up she started talking about ALL the nightmares she's been having about killing herself! In addition to the one about stabbing herself in the stomach with a knife that she'd been having when Hubby woke her up Sunday afternoon (which she'd mentioned to the crisis person), she talked about all the others in which she'd shot herself in the head, jumped off a cliff, drowned... I was trying not to show how shocked I was. She hadn't mentioned ANY nightmares before, probably because she was afraid I'd send her to the hospital, but I do believe her. No wonder she hasn't been sleeping!

She also admitted that she feels most of the time that no one cares if she lives or dies so she might as well die. She is adamant that she is unloved. I did know she was unhappy, unstable and escalating, but until she spoke to her caseworker, I honestly didn’t think she was suicidal or I would have jumped at the chance to get her hospitalized. She has been so emotionally unstable she was almost impossible to live with, but the hospital won't take her unless she is suicidal, homicidal or psychotic.

She’s been on edge for months now. Following the directions of her psychiatrist, we reduced her Traz*done (her sleep med which is also an anti-depressant in higher doses and can trigger mania in a person with bipolar) on Wednesday in case it was contributing to her mania and sleeplessness, and she started on low dose of Depak*te two days later (couldn't do it sooner because we don't want to make a lot of changes all at once or we won't know what's working or causing side-effects). She’s still wasn't sleeping well.

She’s also been talking obsessively (and non-stop) about a boy on her bus who is calling her ugly and teasing her, and a senior boy she has a crush on who is defending her, but also teasing her for being a “goody goody.” She is highly defensive about her relationship with the senior boy whom she likes, and it bothers her a lot that I do not approve of him because he teases her, encourages her to feel that her life is too restricted, and she told me he used to “do ‘shrooms.”

Her perception is so distorted that she thinks an off-hand comment Hubby made about whether or not Cleopatra was really beautiful (like she's portrayed on TV), as him saying that Kitty is ugly?! Under my breath to Hubby, I had called her Cleopatra (the queen of DeNial) and Bob had accidentally overheard and caught the reference. Kitty wanted to know what we were talking about, and I said Kitty reminded me of Cleopatra the Queen of Egypt. When Kitty started crowing about being beautiful (in a way that intentionally tried to slam Bob), Hubby had made the comment about how did she know Cleopatra was beautiful.

In Kitty's black and white world, if Bob is pretty then Kitty is ugly. She cannot seem to accept that we think both girls are beautiful in different ways. She's looking for the insults, and like an anorexic person refuses to believe she's not fat (or ugly). Bob is tired of arguing and has decided to just agree with Kitty, but I'm trying to stop this (because Kitty takes it at face value).

So Kitty seems to be doing well at the hospital. We don't hold a lot of hope for what she'll be like when she gets home because she'll be surrounded by teens reinforcing her belief that we're overly strict parents who don't love her, but she does seem to be responding positively to the reduction in Traz*done and claims she slept 8 hours last night.

Glass of water

2011-09-14T09:10:00.002-05:00

A fellow trauma mama sent me this:

STRESS

A young lady confidently walked around the room while leading and explaining stress management to an audience; with a raised glass of water, and everyone knew she was going to ask the ultimate question, 'half empty or half full?'..... she fooled them all... "How heavy is this glass of water?", she inquired with a smile.

Answers called out ranged from 8 oz. to 20 oz

....

She replied, "The absolute weight doesn't matter. It depends on how long I hold it. If I hold it for a minute, that's not a problem. If I hold it for an hour, I'll have an ache in my right arm. If I hold it for a day, you'll have to call an ambulance. In each case it's the same weight, but the longer I hold it, the heavier it becomes." She continued, "and that's the way it is with stress. If we carry our burdens all the time, sooner or later, as the burden becomes increasingly heavy, we won't be able to carry on."

"As with the glass of water, you have to put it down for a while and rest before holding it again. When we're refreshed, we can carry on with the burden - holding stress longer and better each time practiced. So, as early in the evening as you can, put all your burdens down. Don't carry them through the evening and into the night... pick them up tomorrow.

Whatever burdens you're carrying now, let them down for a moment. Relax, pick them up later after you've rested. Life is short. Enjoy it and the now 'supposed' stress that you've conquered!"

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I think that just like holding that glass of water, we get used to the weight over time and it becomes normal to stand there holding a glass of water… or a tray of water glasses… eventually I think we look up and realize we’re juggling gallons of water without breaking a sweat as though that were normal and expected.

So many people trivialize what we do, I mean, duh, anyone can hold a glass of water or even bring in a couple of jugs of water from the car after doing the shopping. What they don’t realize is that we’re not putting the water down. We hold it in the middle of the night when it’s screaming. We fix it if it spills or breaks (yesterday, I had to bring clean clothes to my 16 yo when she had a potty accident at school). We stand there and hold it while we’re being screamed and cursed at or even beaten.

Most of these people who trivialize are focused on only one glass and don’t even notice our juggling act. Worse, they often start critiquing us. Still others just say, wow, I couldn’t do that, put us on a pedestal… and walk away.

I have found that it’s ME who tends to add water, no one else. Yes, I realize that I didn’t know what I was getting myself into when I first picked up that glass (or glasses), but now it feels like I can never put them down. Thanks for the reminder that we can put the glass down, or even just hand it to someone else who “gets it” for a short period of time.

That’s why I love being part of this community. All of you understand that this is HARD, and even if you aren’t able to lighten my load, just having someone who really understands because they’ve carried a similar load, makes a huge difference. So THANKS for the reminder fellow trauma mama, and thanks to everyone else who read on while I beat this metaphor to death!

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

1 * Accept the fact that some days you're the pigeon, and some days you're the statue!

2 * Always keep your words soft and sweet, just in case you have to eat them.

3 * Always read stuff that will make you look good if you die in the middle of it. (I TOTALLY DISAGREE WITH THIS ONE! I THINK WE SHOULD READ WHATEVER WE WANT. WE DESERVE TO ESCAPE FROM REALITY SOMETIMES. SO PUT DOWN THAT BOOK ABOUT YOUR CHILD'S DIAGNOSIS, THE SELF-HELP BOOK, OR THAT BOOK FROM OPRAH'S BOOK CLUB THAT YOU "SHOULD" READ AND PICK UP A TRASHY ROMANCE NOVEL THAT HAS NOTHING TO DO WITH REAL LIFE - I recommend Katie MacAlister books because they're sexy and funny at the same time.)

4 * Drive carefully... It's not only cars that can be recalled by their Maker.

5 * If you can't be kind, at least have the decency to be vague.

6 * If you lend someone $20 and never see that person again, it was probably worth it.

7 * It may be that your sole purpose in life is simply to serve as a warning to others.

8 * Never buy a car you can't push.

9 * Never put both feet in your mouth at the same time, because then you won't have a leg to stand on.

10 * Nobody cares if you can't dance well. Just get up and dance.

11 * Since it's the early worm that gets eaten by the bird, sleep late.

12 * The second mouse gets the cheese.

13 * When everything's coming your way, you're in the wrong lane.

14 * Birthdays are good for you. The more you have, the longer you live.

15 * You may be only one person in the world, but you may also be the world to one person.

16 * Some mistakes are too much fun to make only once.

17 * We could learn a lot from crayons. Some are sharp, some are pretty and some are dull. Some have weird names and all are different colors, but they all have to live in the same box.

18 * A truly happy person is one who can enjoy the scenery on a detour.

19 * Have an awesome day and know that someone has thought about you today.

20 * It was me, your friend!*

Save the earth ... it's the only planet with chocolate!

Kitty meltdowns

2011-09-12T12:47:00.003-05:00

Ok, Kitty’s meltdowns are getting more intense and the “flipping a switch” thing really freaks me out. I would be ecstatic if I thought it were her getting more control over her emotions, but it feels more like dissociation. After she’s flipped the switch, she usually can’t even tell you what happened, let alone what she was upset about.

The somatic illnesses are already interfering with school. I’ve taken her home from school twice and finally told her that she would have to stay even though she didn’t feel well. She’s called me almost daily from a classroom, but isn’t going to the nurse anymore. I did talk to the guidance counselor about learning the calming techniques from the Skills Trainer, and she knew Kitty might come to her, but knew nothing about Skills Trainer (I gave her the contact info).

Kitty's still not sleeping well. I don’t think she gets quite as little sleep as she claims (1-2 hours a night), but she’s definitely not getting a full 8 hours. I’ve been working with the new psychiatrist to adjust her sleep meds, but the new pdoc is not comfortable making a lot of changes since she doesn’t really know Kitty. The last time I spoke to her we discussed increasing the Traz*done (in low doses is used for sleep, but in higher doses like Kitty is taking it is used as an anti-depressant) from 300mg to 350 or even 400mg, but she suggested we try 2mg of Melat*nin since we haven’t used it in awhile. We tried up to 6mg of Melat*nin with no effect at all. I contacted the pdoc, but she had changed her mind about increasing the Traz*done, and honestly I’m starting to wonder if the Traz*done isn’t triggering mania – which could cause the lack of sleep and increase in meltdowns.

Yesterday Kitty was told that we’d decided she wasn’t ready for a cell phone (the day before we had gone to the phone store and told her we were considering it for all the kids because Bob and Ponito are getting to the point where they need one because of all their extra-curricular activities). She had the expected meltdown - wailed and cried, whined and moaned, got verbally abusive, ran out of the room…. but Hubby followed her and was able to get her calmed down enough to get in the car (we were at Grandma’s and we needed to go home). In the car she began biting her arm (she claimed she was removing dead skin with her teeth because her nails were too sharp) and sucking on her finger, she was a little verbally nasty, but no one would engage.

Then we got home, she wanted to get on the computer but was told she had to finish chores first. She started screaming and crying and saying her chores were unfair (2 weeks ago she’d demanded “sixteen year old chores” so she could have more teen privileges – like watching PG-13 movies. I’d assigned her the main bathroom and the kitchen, including a couple of loads of dishes). She said some rude things and went to her room.

A few minutes later she’d “flipped the switch” and tried to apologize to Hubby. Hubby told her he did not accept her apology because he was tired of her having a meltdown and then acting like her behavior didn’t matter and all was forgotten… especially since she was just going to repeat it. Not accepting her apology is apparently a trauma trigger for Kitty. Apparently it’s something that Kitty’s foster mom did to her on occasion. Kitty flipped and ran outside. Hubby followed and tried to calm her, but had to leave to take everyone to Ponito’s soccer game. Kitty and I were going to an adoption group social gathering about 20 minutes later.

Kitty came to the back door and seemed calm, but a minute later she was storming out the backyard side gate. I went to the front door to see what was going on and she told me that Hubby had locked her out of the house so she was running away. I called her back and talked to her about the fact that the back door sticks all the time, and Daddy wouldn’t do that on purpose. Unfortunately when we checked, Hubby HAD apparently automatically locked the door. I got her regulated enough to keep her from running while I called Hubby, but was unable to reach him. She requested to talk to her skills trainer, and I agreed, but asked her to wait while I tried to reach Hubby once more and we had gotten in the car to leave for the meeting.

I was worried that if I hadn’t talked to Hubby yet, that she’d use that as an excuse to escalate during the conversation with the skills trainer who advocates that we treat Kitty more like a "typical teen" which makes Kitty feel justified in her entitlement. She returned a couple of videos for me, and while she was out of the car I tried calling Hubby one more time but still couldn’t reach him. I told her she could call call the skills trainer, but she’d flipped the switch and didn’t want to anymore.

She had a great time at the meeting, playing with all the little kids. Tears gone, no one had a clue that I’d been considering driving straight to the psych hospital instead of the meeting. On the way home she started making threats again (“If we’re having leftovers for dinner, then I’m going to scream! I’d rather starve.”), but since she’d eaten quite a bit at the meeting I wasn’t too worried.

We got home and she demanded to get on the computer again, and I reminded her she still had chores to do. She made a small attempt, but when she told me she was done, without getting up, I listed some of the things I suspected she hadn’t done. She hadn’t. A few minutes later she demanded I check. When I went to check she hadn’t finished the job (still food on the counters she was supposed to wipe, the cleaning supplies were still out, there were still items on the counter she’d already been reminded to put away…).

A few minutes later she demanded I come check her chores again, but I told her I was eating, and she would have to wait). When I was ready I checked again and she STILL hadn’t completed the few tasks I’d given her – when I commented on the rags and pitchers that were still out, she said, she “forgot.” I left the room again (staying in the room usually causes her to feel nagged and escalate). A few minutes later, she insisted she was done and demanded I check. This time I told her I was busy and quite frankly tired of being a therapeutic parent at the moment.

She went into a dark room and pouted for about 10 minutes. It was after 8pm at this point (bedtime is 9pm) so I told her she could take her meds and get in the shower or take her meds and go to bed (since she hasn’t slept much she could go to bed early). She started insisting she was hungry, but I reminded her she’d eaten a lot at the meeting and said she wasn’t hungry (we’ve been talking a lot about emotional eating). She wasn’t happy, but she decided to go to bed. This morning she hugged me and went off to school as though nothing had happened.

I checked the chores after she went to bed and they still weren’t done well. *sigh* I’m NOT a super picky person y’all. We’re talking food spills, used utensils and dishes still on the counters, items I’d specifically reminded her needed to be put away still out…

She has an appointment Wednesday with the new pdoc. Don't even know what to ask for.

Exhausted

2011-09-08T09:49:00.002-05:00

I'm still not sleeping (not in bed before 3 am in forever). I thought I'd narrowed down what I was allergic to to my laundry detergent, but it's 3 weeks later and the itchy rash is still there. Since now it's mostly my scalp, neck and pointer fingers, I'm going to assume it's my shampoo, even though I've been using the same shampoo/conditioner for forever. Maybe they reformulated.

We're still in no danger from the fires, but you can definitely smell the smoke and all of us are suffering from allergies (it's allergy season anyway). Kitty especially has been miserable (she hasn't been eating allergy cookies!). I told her earlier this week that unless she has a fever, rash or vomiting (or the equvalent) then she can rest, but she'll need to go back to class. We were in danger of truancy at the rate she was going.

... so of course Bob called me the next morning and asked to come home from school. Honestly I think it had more to do with some homework she hadn't completed, and all the tests she had that day (she said she was ready for the tests, but since she didn't feel good she was afraid it might cause her to lose concentration and not do well). I debated, but finally decided that Bob NEVER does this and she won't take advantage of it (unlike some of the other kids -if you give them an inch they demand a mile), so I brought her home.

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

Bear's IEP

2011-09-07T08:19:00.002-05:00

Bear is only at the special school for his first period class each day. We had an ARD this morning and they decided to keep his schedule as is (Special Ed - English, Government, Reading and Speech, a PE that's mostly field trips, and Vocational classes - Metal working, Small Animal Management and Auto Shop) since it seems to be classes he'll benefit from, but quite honestly we believe the main reason was because they ran out of time. The teachers all had to get back to their classrooms (the team had to take a lot of time walking Bear through all the paperwork requesting a new FIE (full school evaluation including IQ, academics, and behavior} and IEP meeting procedures because he’s an "adult" now). I think Bear knows he needs the structure too (he even asked if he could continue with ISS or have to sit with the FOCUS staff/ principal at lunch daily!). He’ll be in ISS {In-School Suspension} until the “investigation is complete” which means through Wednesday at least.

FYI, Bear did advocate for himself. He stated that his Applied Government class was too easy and since history was his best subject, he requested to go into regular ed with inclusion. Everyone politely told him that he doesn’t have the skills needed that all seniors have developed over the last 4 years (analytical writing and note taking were but two examples given). It was suggested that the school will request that his current teacher “step it up a notch.” Bear disagrees that he's behind and thinks he can do it. I reminded him of what they said, then just backed off.

Bear reads and writes on a 5th grade level at best. He doesn’t have math or science classes this year because he's met all the requirements. He agreed to the FIE testing, even after he was told it wasn’t required until December 2012, because he was told it might help him with getting services and getting into college. Somehow he did manage to pass all the standardized state testing last year (we didn’t see his scores)?

Bear basically said at the IEP meeting that this behavior “wouldn’t happen again,” but he’s said that a thousand times before. Bear’s school case manager (and former teacher) said Bear has lied so many times he doesn’t believe him anymore, but he’d go along with the IEP team’s decision. Bear’s regular ed teacher (the last period class that Bear missed because of the car accident) said of the 4 times Bear was supposed to come to class he’s only made it for the whole class once, and even during that class he was asking to go call Hubby because he was trying to arrange things before the football game (he lied and said Hubby had called him). The teacher said if Bear wants to continue in his class, auto mechanics, then he has to show up on time every day and stay the whole period. Hubby and I agree that based on what everyone is saying, that if we’d had even 20 more minutes, Bear would probably be back at the special school half time like last year.

Honestly I don’t believe this schedule is in Bear’s best interest, but at this time I’m also looking at what in the world is going to happen to Bear when the school mascot team/football stuff is over and we lose our leverage on him running away (Hubby said if he doesn’t live with us then he’s off the team). Hubby thinks he’ll just move out and drop out of school.

Quite frankly I’m terrified at what’s going to become of Bear. He can’t hold a job (he gets bored and scared so he acts out). He’s not bright enough to go to community college and probably not to technical school either. He’s unable to accept the structure and family support we know he needs. I think we need to have him assessed for a group home, but don’t know what the criteria would be or how to go about it. We’ve looked at legal guardianship in the past, but I doubt his psychiatrist has changed his mind about wanting Bear to “fall on his face” first, and honestly if we’d had legal guardianship than this whole car thing could become a financial nightmare. I think Bear needs to be court mandated that he has to be on meds, but in reality, most of what’s been going on has been while he’s ON his meds!

We have started him on the Conc*rta and it didn’t seem to cause the scary side effects that the non stimulant ADD meds did (vomiting/diarrhea, facial tics, uncontrollable body movements, acting as though he were on speed…). He did seem a little more jittery than usual, but honestly that could have been purely circumstantial. It’s not like he’s not under a lot of stress! I’m still hearing the slurred speech on occasion too (he claimed the morning of the IEP meeting that it was because he had a dry mouth).

So that's where we're at with Bear. For now we're kind of ignoring what happened, although last night he wanted to go to an FFA meeting and Hubby was working (gotta make up for the time spent at the school), and I needed to supervise everyone and make dinner. He said something about not being able to get a ride, so I didn't have to remind him that we don't allow our kids to ride with people under 21 (did remind Hubby). He asked what I was going to do about it, and I reminded him that not only did I have other stuff to do, but he's on in-school suspension so I don't think he's supposed to be going to school activities, especially not unsupervised.

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

Got a call from the parents of the girl whose car Bear wrecked. They want us to pay their $500 deductible. Which is actually pretty reasonable, but they want the money now, and they want it from Hubby and I (since Bear is a dependent they believe we're legally responsible. Need to call Pre-paid Legal and check that. *sigh*). We don't have the money to pay it, or the tickets either.

Bear insists he can get a job at the local grocery store near his school. I told him he needs to find a job near his home and he tried to say that no one was hiring (then he claimed that the only job the local grocery store was offering was a shift that ended at 4am). Truth is he wants an excuse to not have to come home on the bus and he thinks he and a friend are getting an apartment near the school.