At 4:45pm yesterday, I got a call from the business office of the partial day hospitalization program that Kitty attends. They just wanted to let us know that as of Wednesday, Kitty was being "stepped down" to their outpatient program. The only thing this changes is she would see the psychiatrist once weekly instead of twice, and family therapy goes to every other week or stops all together ( I forget which). She still attends school and group therapy.
Which would have been fine except for the next part. Insurance pays for all of the partial day hospitalization, but SURPRISE this new program is considered "out patient" which means we have to pay a co-pay for the services. That's $25 A DAY! Starting that day. $125 a week! They don't take Medicaid so we have to pay the co-pay, which, by the way, they want to discuss how we plan to pay this and the $1500 deductible that their records show is still owed! If we don't pay then this will be like any other debt and will be charged off (sent to a collections agency).
Needless to say, I FREAKED out! We are broke. Beyond broke. Kitty's doctor bill co-pays are already draining, Summer is coming which means we have to find all day care (Grandma will do it, but 4 bored kids, two of whom are emotionally disturbed, requires some sort of activities - which will cost money and lots of supervision (unwanted by the kids) - which is asking a lot of my mom).
So on the way to family therapy this morning, I called our insurance. Medicaid had met/ paid our deductible when Kitty was hospitalized in January so even though the hospital hasn't submitted a claim for April (which I still find hard to believe - don't they want their money?), we are still covered. *Whew!* Nothing they can do about the co-pay though.
The hour and 45 minute "Family therapy" ended up being more about case management then family therapy, and we didn't even bring Kitty into the room. Every family therapy session we had, we questioned whether or not we were doing the right thing by keeping Kitty in this program.
- Kitty is exposed to kids with way worse issues then we were led to believe. The kids in the PDH often interact with the kids from the residential treatment center (RTC), and the kids in the PDH are often just released from RTC and seem to quickly end up back there. This was the RTC we wouldn't even consider for Bear (who they planned to put in the ward for "aggressive boys"), because one of their first questions was "Are you OK with him getting beaten up daily?" Uh, NO!!
- Kitty has been kicked, cussed at and told she "smelled like a litter box," had her seatbelt repeatedly stepped on in the van, had her hair pulled, allowed to listen to Hip Hop on the radio (very big trigger for her), was exposed to a picture of a scantily clad female classmate while working on a team project on the internet, witnessed kids fighting and punching each other in the face...
- She has to be at the school bus stop (20 minute drive) at 6:45am and doesn't get home until after 5pm. Let's just say she is not a morning person, and often has difficulty with insomnia.
- This environment is SOOO much more stressful then public school that Kitty was coming home so triggered she had meltdowns almost every night. We had to remove everything stressful we could think of so that Kitty wouldn't get more overwhelmed then she already was (taking chores to a bare minimum with little enforcement, allowing Kitty to spend almost unlimited time outside on the swings, removing Grandma from any responsibility for disciplining Kitty...).
- The psychiatrist was on vacation for a week so Kitty had no med changes for the first 1 1/2 weeks in the program and then they seemed to want to change every thing at once to "make up" for lost time. They actually called me something like 5 times in one day changing their minds about what to start, when and how (the last call was at 9:30pm) and they still made yet another change the next morning.
- The Family therapist, who also does group therapy with the kids, seemed very inexperienced, and is actually only an intern.
- Kitty was not participating in group therapy, and while not completely superficial does not seem to really be dealing with any of her issues.
- Kitty has begun to mimic the behavior and attitude of the other kids. Trying on new personalities at the drop of a hat. Parroting attitudes and language at home. Often its talking "gangsta," or "I'm a teenager, I DESERVE to have..."
- She realized that she needed to behave at home as well as in the program in order to be released, and her behaviors at home miraculously improved (mostly). The PDH used this as a reason to "step down" her program.
- Kitty "has" to have a BFF (best friend forever), but has very poor social skills so has trouble maintaining friendships. The girls at the school also have issues, usually including poor social skills as well, so Kitty is constantly dealing with girl drama.
- If we remove her from the program and send her back to public school this sends a message to the insurance company that she is "better," and if we decide we need additional treatment (including RTC), we might have to start the process over again (probably including another trip to the psychiatric hospital).
- Our AT (attachment therapist) can only see her every other week, while therapy at the PDH doesn't seem to be helping much is it better than nothing? (She still sees the AT even though she's in the PDH). There don't seem to be any other alternatives.
The good things about the program:
- Until her meltdown last night (over being asked to clean up toilet water from a toilet she clogged and attempted to flush), she hadn't said she "hates this family" or talked about going back to Nebraska for a week. Of course we don't expect this to last when she is out of the program.
- There is generally a quick response to my/our complaints.
- They are actually required to care what happens at home (public school doesn't care what her behavior is like at home if it doesn't reflect on what happens at school).
- Someone is there to supervise med changes and watch for side effects and results.
- Adding Lithium has seemed to have a positive effect, although it's a little early to tell (5 days).
Once she's been "stepped down" we can't step her back up to the PDH, even if we start reintroducing stress into her life (like, Heaven forbid, actually expecting her to wash a dish!) and allow her to meltdown/rage again.
So after a long talk with the PDH psychiatrist and the family therapist we have decided to remove Kitty from the PDH on Monday. The public school has already said they will be happy to welcome her back and she will just go right into her old class schedule - which of course she was in when this (suicidal ideations and being miserable and angry) all started. Nothing is changing at home, so I'm thinking we might need to rethink the school structure. Possibly taking away electives and putting her in resource room classes instead.
OK here's the TMI (too much information) part about Kitty's bowels (I did promise to tell you how it all came out) so please feel free to stop reading now.
It's not too late!
OK, you asked for it.
Kitty finally pooped last night! The crazy doctor recommended I give my 14 year old, emotionally disturbed, sexually abused, major mom issues, daughter an enema. Luckily the nurse practitioner knew that was pretty much not going to happen and gave me some other alternatives.
Kitty took 2 doses of Miralax in apple juice, 6 teaspoons of mineral oil (to smooth the way) in an Activia yogurt, and a small bag of sugar free candy (she loved me for that one!). I didn't see this one so no disgusting descriptions of the anaconda in the toilet, but it did of course clog the pipe when she tried to flush it and the toilet over flowed (1/2 an inch of water everywhere). Hubby had to help it along and then insisted that Kitty help dry the floor. This triggered a meltdown, which while not of epic proportions was still pretty bad - no restraints or physical violence thank goodness.
She was disappointed that her tummy was not instantly flat. I assured her that there was probably still more in there, and this morning gave her Miralax in her Smooth Move tea (chocolate flavored laxative tea - can you imagine?!). If that works, the school can deal with it.
So now we'll see what the day brings.