Kitty's safety

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

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

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

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

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

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

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


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


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

What to do when:

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


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


• Kitty is exhibiting self-harming behaviors.


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


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


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


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


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

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

Mary

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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

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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

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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.

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

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

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

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

Getting Burned

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

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

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

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

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

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

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

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

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

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

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

OMG! OMG! OMG!

Freaking out now!

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

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

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

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

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

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

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

So my choices are:

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


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


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

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

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

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

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

How am I going to get this all done?!

Revised Letter

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

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

To: ARD team
Re: Kitty IEP meeting

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

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


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

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


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

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

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

Placement

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

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

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

Mary and Hubby

Please Review for me!

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

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

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

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

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

ADDRESS the WHOLE CHILD!

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

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

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

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


ACADEMIC NEEDS BEING MET?

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

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

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

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

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

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

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


EMOTIONAL / BEHAVIORAL NEEDS BEING MET?

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

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

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

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

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




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




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




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




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




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

LEAST RESTRICTIVE ENVIRONMENT

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

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

Areas Kitty’s current Crisis Plan does not address:

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




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




• Self-harming behaviors.




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




• Feeling overwhelmed or stressed




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




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




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




• Time spent in nurse’s office instead of class




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

Residential Treatment

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.

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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

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.