Getting Meds in Jail

So I finally convinced my incarcerated son that he needs to get back on his meds.  I called the jail to find out what needs to be done to make that happen.  Turns out that because he hasn't seen his Texas psychiatrist since May, stopped taking his meds almost 6 months ago, and was in denial about his issues and need for meds so never got an Oklahoma pdoc,  he can't get anyone to prescribe meds now.

There are only 15,000 people in the entire county, and almost half of them live in the county seat where the jail is located.  The jail has only 120 beds and the nurse is in only once a week for an hour.  No pdoc in this tiny town will take on a new patient who is incarcerated and uninsured.  His lawyer could request a psych eval, but he doesn't even have a public defender assigned to him yet.

My son was on 2 mood stabilizers, an anti-psychotic and an anti-depressant - most of which were black box with potentially fatal consequences if he doesn't titrate on them slowly, so he can't just "pick up where he left off."  His old psychiatrist is unwilling to prescribe medications.  Even if he does, my son would have to pay for these meds out of pocket when he gets out of jail ($1500-2000/month).  Not sure what to do next.

I guess I'll call their local MHMR equivalent tomorrow, but I don't know how they would access him in jail to treat him.

Getting Bear Services

We heard from Bear on Thursday.  He got the packet filled out for a public defender.  No one from bio family came to court, including his bio father whom he still hasn't seen, even though he's been in the same state for almost 2 months.  I convinced Bear that it would be in his best interest to get back on his meds, and that while I would help, he needed to start the process on his end.  

He spent most of the expensive 15 minute collect call asking me about whether or not we were going to give him commissary money and would I find out why his girlfriend wasn't answering his collect calls from jail.  He asked me to text his girlfriend,  “Shorty,” and ask her.  I told him I wanted her real name, because I refused to call her Shorty, even if that’s what her parents called her.  When I texted “Shannon,” she replied that this was Bear’s “other girlfriend.”  Turns out Shannon is NOT her real name… not even close.  Bear doesn’t even know her real name!  She also told me that she’s only 17 and doesn’t have a job, so she can’t afford to accept Bear’s collect calls.

I finally spoke to the jail administrator on Friday.  I told him I wanted to know how to get Bear back on his meds.  He asked which med, and I had to tell him that Bear’s been off his multiple meds for so long that he’d have to titrate back on, under the care of a psychiatrist. 

The administrator said that Bear was an adult now, and they couldn’t put Bear on meds against his wishes.  I told him that I understood that, but he’d just told me that Bear had put in the request to the nurse already.  He started to tell me that this was up to Bear as an adult, but when I explained Bear’s issues to him, he accused me of not doing ENOUGH.  I pointed out that Bear is an “adult” and living in a different state, I can’t force him to take his meds anymore than the jail administrator can!  It was a pretty frustrating call.

I faxed the jail administrator’s copy of Bear’s med list, a letter from his p-doc that stated his major diagnoses, and this letter.  When a public defender is assigned, I'll send him this documentation as well.

Mary Themom

123 Our Address

Our City, TX #####

(###) ####-#### (home)

(###) ####-#### (cell)

To Whom It May Concern,

Bear ________ is diagnosed with Bipolar Disorder, Attention Deficit Disorder, Post Traumatic Stress Disorder, Cerebral Dysrhythmia (brain injury – specifically causing issues with memory, processing, mood control, and impulse control ),  and Reactive Attachment Disorder.  He is diagnosed with a full scale IQ of 79, although his verbal skills are higher giving him the appearance of understanding more than he actually does.  He reads and writes on a 5^th or 6^th grade level or below and will need assistance completing and understanding written documents.

Until March 2012, he was taking:

Mood Stabilizer:              Trileptal (Oxcarbazepine)- 600mg am and 1200mg pm

                                       Lamictal (Lamotrigine) – 200mg am and 200mg pm

Anti-Psychotic/ Sleep:     Saphris  - 5mg bedtime

Anti-Depressant:             Wellbutrin (Budeprion XL) - 450mg am

Bear chose to stop taking his medications against the recommendation of his psychiatrist:

Dr.  M, M.D.

Child and Adolescent Psychiatrist

Community MHMR

(###) ####-####

Without his medications, Bear’s issues become considerably more severe and there is a question as to whether or not he is mentally competent.  He will struggle to control his anger, depression, impulses and other emotions.

Please contact me with any questions and for any needed documentation.  Attached is a list of the medications Bear was taking before he stopped and a letter from his psychiatrist

Sincerely,

Mary Themom (mother of Bear _____)

(###) ####-#### (home)

(###) ####-#### (cell)

Bear tried to call on Saturday, but he called my cell phone (which costs 3x as much collect and he knows we prefer he call the land line) so I didn't answer.  Found out today that the fax I thought I sent Friday afternoon somehow messed up our phone lines and they haven't worked all weekend.  Now I feel guilty.  *sigh*  

Comments on Kitty and Chores

I've been having an interesting conversation on an older post about the level system I created for Kitty last year. I wanted to share it here.

Adrian said...

I'm pretty sure I couldn't handle that when I was 16. If the end goal is teenage privilege doesn't it go with the idea that its being used on teenagers? Who will scoff at being monitored in terms of hygiene, much less having only same sex friends over or having a bedtime?
If they can't regulate themselves well enough to actually need an enforced bedtime, then they aren't 16.  I'm sorry to dismiss your idea, but you're inappropriately restrictive to such a degree I had to say something.

marythemom said...

Adrian, that's pretty much my point. She's NOT a typical 16 year old. A 16 year old SHOULDN'T need to be monitored in terms of hygiene, and SHOULD be able to have friends of either sex over and watch PG-13 movies without becoming totally dysregulated. Bob (now 16) can handle all of this stuff without needing any of this regulation (Ponito at 13 mostly can too). Kitty (chronologically 17, but emotionally and socially only 6yrs) can NOT handle this.

This level system was created for lots of reasons, but mostly to show others that we've tried to treat Kitty like she is her chronological age, and she is unable to get past level 2 and really is often stuck at Basic. Once we established this over a period of a couple of months, we felt we had enough evidence that Kitty needs a much more structured and supported life, and we dropped this level system. Kitty now gets the "age-appropriate" privileges and responsibilities that she can really handle without having these unattainable privileges dangled over head.

Mary

Adrian said...

Thanks for the explanation. You must care a lot or at least have pretty tough skin to get a 16 year old (Bob) to do chores regularly.
I don't doubt that Kitty can't handle it because of immaturity, and works better on lower age restrictions. I was just wondering how a regular teen could possibly listen to parents enough to get far on the system (which seemed to defeat some of the purpose). I didn't ever seem all that defiant growing up but I'd still do chores pretty rarely, and virtually never at anyone's request (2 people, 1 house, really not many chores period, did them when I was the one who needed dishes or some such). And I grew up with a mood disorder so I couldn't do much like that on demand just from depression.
I've read your blog for awhile and can't help but gawp a bit on how many restrictions you have on your kids, even though it makes some sense and it's your situation and works for you. Even if I disagree a fair bit, you have some good ideas, you really care, and I can't help but feel for your kids.
I wish you'd mention more about what it is Kitty does well, skills, hobbies. In the chaos for her several diagnosis she must have some small talent? :)

Adrian - I'm enjoying your comments.  One reason I blog is to explore some different perspectives and sometimes help me see the forest for the trees.  I did post more about chores a few days ago, but I didn't happen to address some of the things you brought up here.

One big point is that Bob is NOT doing chores regularly (of course she's living at Grandma's right now, but even when she is home...).  This chart was designed to put concrete tasks, and a few abstract ones, associated with developmental stages into a level system so that mastery of each level represents readiness for the accompanying privileges.  I needed to show that Kitty was NOT ready to be a teenager.  Bob on the other hand has DONE these stages and has already proved to me that she's ready for these privileges.  Kind of like once a child has mastered learning to read, you don't make them keep doing letter recognition exercises.

This is a large house full of a lot of people with some pretty major needs.  I used to be a laid-back, go with the flow kind of person who hated confrontation.  Plus, I too dealt with depression as a youth and learned to work in spurts between bouts of depression.  Unfortunately, that just flat out doesn't work in this house!  I've had to become a structured, micro manager, and I really hate it!

I'm also an "over protective mom."  I grew up in this urban area and I think one reason I came out as unscathed as I did was because my mom was strict.  Yes, I rebelled, but compared to what my friends with parents who didn't give a crap were getting in to?  I was a "goody two shoes."  My friends were raped, became addicted to drugs and alcohol, got in serious car accidents, and even went to jail for killing someone.  I survived it, but sometimes that was only because I was lucky.

Hubby grew up totally differently from me, and sometimes we disagree, but he does provide some balance to my decisions I hope!  There are some things my biokids struggle with and areas where I feel sorry for them too.  Living the life we do is hard.

You asked why I don't talk about what Kitty does well.  Some of that is because that's not the focus of this blog, but a lot of it is because there's not much to say.  Kitty has a severe personality disorder and is mentally ill.  She doesn't have a lot of interests (unless you count iFunnies).  We've talked about her needing hobbies, but she doesn't want any.   She likes working with little kids and has fun playing with them, but she's not actually good at taking care of kids and requires a lot of supervision.

Frankly, she doesn't have a lot of things she's good at - she struggles socially, academically, emotionally and physically.  Most of all, she's not fun to be around.  She's unmotivated, self-centered, and prickly, with little empathy and understanding.  Her self-image is that she's unworthy and unlovable and she tries to prove it.  She fluctuates between being depressed and miserable, anxious and angry (particularly at me), and hypo-manic (demanding constant entertainment and babbling incessantly about stuff that only she cares about).

Quite frankly she's a hard little girl to love, and even harder to praise.  I work hard to keep her busy and trying to instill in her pride in what she does.  It's also hard to keep her from comparing herself to Bob who is by no means perfect, but doesn't have anywhere near the challenges Kitty has to navigate daily.

Just a spoonful of Miralax...

Just a spoonful of Miralax...
makes the money go down....  wait what?!

The kids have weekly med boxes.  With all the different meds and supplements they take (well in Bear's case took) it's easier to fill the boxes once a week and then we know when we're running low on something before we actually run out and when they've forgotten to take their meds.

When I'm filling a med box and a med runs out, I put pennies to replace the missing med in the rest of the med box (and take the bottle to the pharmacy for a refill).  We started using pennies because we had a lot of them (Hubby keeps his change in a cup near where we filled med boxes), they fit in the boxes, you could fit more than one in each box, they don't look like meds (unlike beans)... and that's just how we do it.

Kitty takes her Miralax with juice in the morning (only way I can get her to take it).  She tosses her handful of meds in her mouth and uses the juice to wash down her meds in the morning.  This morning she noticed there was a penny in her morning meds.  Unfortunately there was a penny in yesterday's meds too.  Kitty is apparently worth a little more today than she was two days ago.

Make cents?

Bear Behind Bars

I won't go into a lot of detail, but Bear is currently in jail awaiting trial for some very serious charges.

Hubby is taking this pretty hard. He keeps thinking there was something we could have done differently. Honestly I've come to terms with the fact that there's nothing more we could do - the brain damage, the low IQ, the mental illness, the RAD, the trauma... all happened long before we even met Bear (he came to our home when he was 13.5). We had gotten him to a pretty good place, but when he moved out and went off his meds... there was nothing more we could have done. I did worry jail was inevitable and frankly I think he will thrive on the structure.

When Bear called us last Saturday for a bus ticket to Nebraska it turned out he was running from the law, not just a fight with his bio grandfather.  He made it to Nebraska, but after lying to his bio grandmother for several days, he did end up having her drive him back to Oklahoma where he apparently finally turned himself in.  He has burned a LOT of bridges with bio family, and most likely will not be able to stay with any of them when he gets out of jail.  (Lying, property damage, yelling at his 3 yr old sister "for crying", generally exhibiting out of control, aggressive behavior).

I really appreciate how much information Bio Mom and Bio Grandmother gave me.  Otherwise Bear's call from jail on Thursday would have been a big shock, and since he refused to talk about what he's being charged with we would have felt even more clueless.

Bear doesn't seem to understand the seriousness of the charges at all.  His bail is $350,000.  No one can afford the 10% bond (not to mention he's a total flight risk - since he's known the police wanted him to come in since July 8th).  He thinks he can negotiate with the bail bondsman to "work something out" to get him out (using the $600 he and his current girlfriend have saved "for a house").  He has no job and no collateral.

This is a first degree felony and he's basically admitted he's guilty to the police.  The minimum term in prison is 5 years and the death penalty could even apply.  The detective in charge of the case mentioned a 25 to 30 year sentence (didn't say that's what it would be, but kind of implied that was what he expected).  Bear is talking about getting out in a couple of months.  He's talking about all the friends and family he's met in jail - people who know his bioparents, even a first cousin.  These people are "watching out for him" and he's enjoying doing puzzles and hanging out with them.  He's hoping his bio dad will be able to come to court on Wednesday so he can see him for the first time in many, many years.

On Wednesday Bear goes in front of the judge to hear the charges, be asked if he understands them (he'll say yes, although I don't think he really does), and get a packet to apply for a public defender.  I was assured the jail personnel will help him fill this out.

I've told Bear to have the public defender contact me so I can give him information about Bear's IQ and diagnoses which might help his case.  I'm trying to convince Bear this is a good reason to get back on his meds too.  It might also help to have a current psych eval to ensure he really is capable of understanding the charges and trial.  On medication and in a controlled environment, his IQ is 72.  He's been off meds almost 6 months so they are almost definitely out of his system.  His illnesses, issues, processing speed and other issues means his judgment is impaired and he may not be completely accountable for his actions.

I most certainly am not trying to get him out of this. He needs serious consequences, and I'm not totally convinced he won't actually do better in prison than in the "real world."  I don't however think he deserves to be in prison for the rest of his life because of one really bad choice.  I wonder if this is what his stupid psychiatrist had in mind when he told Bear "this is the time of your life to experiment and make bad choices."

Reward or point systems and "age-appropriate" expectations

STICKER CHARTS DON'T WORK WITH OUR KIDS!!

Excerpts from my new favorite book Can This Child Be Saved - Solutions for Adoptive and Foster Families by Foster W. Cline and Cathy Helding.

I love that this book takes all sorts of different discipline techniques, explains them and then tells you how they work (or don't) with kids of trauma.  Here's an example of their assessment of how the reward and point system aka star charts and level systems do/don't work with our kids:

Reward and Point Systems

"Many disturbed children have not learned to take satisfaction from their own accomplishments, or have no internalized values, a reward system can help them develop both.  Provided, that is, that the rewards are something they care to work for."

Advantages:

• A reward program forces consistency.
• A well thought-out program forces parents to be logical and consequential, and encourages non-emotional responses to the children's misbehavior.  Rather than becoming angry about a job being forgotten, a parent {gets to} becomes empathetic and understanding:  "What a bummer!  I know you were looking forward to going skiing with us this weekend.  But if this job gets done this weekend, we'll sure enjoy your company next weekend."
• Reward systems encourage parents to be consistent.
• Reward systems are generally concrete and immediate, and many children {like mine!} have a difficult time conceptualizing long-term and abstract goals.  Most disturbed children have a hard time understanding statements like "grades are important so you can grow up to be a productive person."
• When children are encouraged to help design the reward system, they take ownership and are more likely to become invested in doing well.

Disadvantages: 

• Cause and Effect - Many of our children have limited ability to connect cause and effect.  A point system that requires saving up for a reward will be meaningless to them.
• Capable of Reaching the Next Level - These systems are usually designed for neurotypical children capable of achieving and handling higher levels. It is a punishment and constant reminder of failure to children incapable of achieving or handling higher levels long-term.
  {We succumbed to the pressure from school, psych hospitals and skills trainers and made a level system for Kitty.  But quickly discovered that it wasn't working, and she wasn't capable of achieving higher levels and it was downright cruel to dangle the higher level privileges over her head.}
• Parents cannot make the child buy into the system.
• Dysregulated children cannot control themselves consistently.  Reward/ point systems require higher level thought and decision making skills (if I do this, then I will lose the level/privileges I've earned). When in fight/ flight/ freeze mode the thinking part of the brain is not functioning - life or death survival kicks in.
• Some children become extremely adept at manipulating this kind of system.
  {Bear did GREAT at level systems in residential treatment centers (where he was usually very regulated due to the extreme structure and low expectations).  When he wanted something, he would weigh it against the advantage of being at a higher level.  Lower levels were not really punishments for him - he'd been through MUCH worse.}  
• The system depends on a certain amount of motivation on the child's part.
  {Many of our children don't feel they deserve the rewards. They truly believe they are unlovable and unworthy of any rewards. They will self-sabotage to prove this point and protect themselves. They know they "can't" do it, so this way they get to control the outcome.}
• Some disturbed children will sabotage themselves by never allowing themselves to achieve the reward.  They may come very close, then deliberately, or subconsciously blow it.
  {I have a friend whose private school allowed children who'd achieved a certain level to go on a field trip to Washington DC - 7th graders!  This child of trauma would never have been able to emotionally handle the trip (I don't know many 7th graders who could!), but wasn't able to let her teachers know this, so she simply sabotaged herself. Unfortunately for the child, the teachers kept giving her second chances so she wouldn't lose out on the trip!  As she escalated her behaviors in a desperate attempt to get out of this situation she couldn't handle, her mother finally had to step in and forbid the trip.}
• It is a lot of work for parents.  Parents must keep track of the points, monitor the children's performance, follow up, and so on.
• This system is used most successfully in institutions where the children have constant supervision and consistency and can't opt out of the program during part of the day.  They do not leave to attend school, etc.  Everyone they are involved with is also involved with the point system.  This is not true {or possible} in most home situations, which can make this kind of system less effective there. Why does my child act differently away from home?
• The children may become dependent on the system.  Some children never seem to internalize the controls they need to manage their behavior without earning rewards or points.
  {The system only works when it is in place and actively enforced by an outside source. Progress made while under this structure immediately disappears when the structure is removed.}
• "Blank Slate." Well-designed point systems never allow children to dig themselves into a hole so deep they cannot climb out.  A child who has just stabbed a hole in a sofa, and cursed at the parents will be docked 50,000 points for the damage and bad language.  If he follows his bad behavior by sitting down calmly on that same sofa, he will immediately be awarded 15,000 points for regaining control.  "Hey, you've just earned back 15,000 points.  You'll be out of the hole in no time."
  {Bear's favorite part of these systems was the "blank slate" you got each day.  No one held previous issues against you.  You could ALWAYS earn your way up to the next level.  Even if you couldn't handle that level of freedom and did something awful last time.}
• Not Attachment, Family or Therapeutic focused. Focused more on the individual child and their goals. Have you earned this privilege? Should the rest of the family not get to go somewhere fun because this one child hasn't earned it? If a child is always in trouble or on too low a level to get to do anything fun, where does attachment come in? Who wants to attach to a warden.
• No Logical Consequences Most systems have built in consequences and privileges that are not based on what's going on. If a child has earned enough stickers to get a treat, but just smacked the hell out of a sibling, do they still get their reward? 
• Why Bother? If you think you can't achieve it anyway, because you're a "worthless loser" or you lose your rewards because of impulsive behaviors that are not necessarily something you have consistent control over, then what's the motivation to keep trying?
  
  
  
  Level Charts

I thought I'd written a post on my decision to throw out the level system (we used briefly after Kitty got out of RTC) and our expectations that Kitty can ever be expected to be treated like a 17yo, but apparently I hadn't.

We had a long discussion with Kitty about being emotionally 6 (still ticks her off to hear that), and that it wasn't fair to expect her to be able to handle certain things and we felt it was cruel to dangle higher level privileges she couldn't achieve over her head.  So therefore, I was going to stop "punishing" her for not being able to do things she wasn't ready for yet.  This wasn't a punishment and it would have a lot of rewards.

So now I have "age appropriate" expectations for her, and she is doing better.  Every now and then she'll want something her siblings have (like any younger sibling would! Although technically she's older) and we gently explain that she's not ready for that.  She doesn't like it, but it is what it is.  

• She has fewer chores and they are very simple and concrete.  
• She does the same chores every day instead of rotating like the other kids.  
• She gets to go places even if she'd had a fit recently, because I don't hold her accountable for her behavior like I would a teen.  
• If I go places like the grocery store I take her with me.  Period.  The other kids frequently have the option to go, but you don't leave a 6 year old at home alone.
• She can have "playdates," but they are well supervised.  

It has helped ME immensely.  I'm less frustrated by her inability to do things that would be "normal" for a teen.  I do have to constantly remind myself "She's only 6!  She's only 6!  She's only 6!"

A couple of months ago, Hubby gave Ponito his old phone, which has internet access, so we decided to give Kitty Ponito's old iPod.  I debated long and hard because it has texting and internet access.  I didn't think she was ready.  

I was right.

Now we have to decide how to fix it.  But I'll leave that for another post.  (REMIND ME IF I FORGET!)

Getting Organized and Motivated

Found this great resource for getting ready for the school year and getting organized.  We do some of this already, but the advocacy and letter writing advice was invaluable! Definitely check out the resources at the bottom and Letter to a Stranger if you haven't seen it before!  http://www.wrightslaw.com/info/organize.file.htm#master

I recently joined Fly Lady (http://www.flylady.net/d/getting-started/31-beginner-babysteps/) hoping to get more organized and motivated to get the house cleaner.  Fly Lady sends motivational e-mails with manageable steps to help people get their house clean and organized.  I like her advice because it's free, practical, easy to handle and highly motivating.  (every post ends with

"You are not behind! I don't want you to try to catch up; I just want you to jump in where we are. O.K.?

Perfectionism is Shelved in 2012!"

I also joined My Fitness Pal http://www.myfitnesspal.com/ which is a free weight monitoring program.  I like it because it has a calorie counter that has a huge database of all sorts of food already entered -I can find my grocery store's generic brand, food from chain restaurants, and even create my own recipes. It not only calculates calories, carbs, fat and protein for everything, it takes into consideration how much you're exercised, and calculates and tracks what you need to achieve the weight goals I established.  It also allows me to connect with other friends in the group (including my sister).

Recently I was showing Hubby how it worked and I entered the 6 1/2 hours of scuba diving he'd done that day.  He burned something like 5000 calories!  My Fitness Pals were really impressed with me and sent me encouraging messages!  I had to explain that I'd removed it later and it wasn't me.  :<)

Created by MyFitnessPal - Free Calorie Counter