This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Wednesday, June 20, 2012

Trapped Between a Rock and a Hard Place

I don't even know where to start with discussing Kitty.  When last we "spoke" I was wondering whether or not we would be able to keep Kitty at home.  Basically we still don't know.

A lot of things have changed here at home.

Bob has gone to live with Grandma for the Summer.  I miss her soooo much, but it does seem to be better for Kitty to have her gone.  When Bob comes home on Friday nights and spends the day with us on Saturday, Kitty struggles with jealousy.  Bob has grown up a LOT and watching her interact with her little brother makes me want to cry.  They actually hug each other when they see each other and when they say good bye.  That may not sound like a big deal to you, but they've always been semi-antagonistic.

Ponito has a girlfriend, and it just makes you want to go "Aaawww!" every time they're together.  He still hasn't hit a puberty growth spurt (although he has 4! armpit hairs!) so he's just barely taller than this petite girl and when he puts his arms around her it's still cute (instead of sexual).  This girl is quiet and shy (and a year older and grade ahead of Ponito).  Her mom works, so she's got little to do during the day - so the kids are constantly arranging hanging out with each other.  On weekdays that's here.  On weekends and evenings, Ponito spends a lot of time doing stuff with her family (her mom watches them as well as I do!).  I've let him go hang out there a little more than I would like, simply because I have sympathy for him having to live with Kitty's irrational meltdowns.  His poor girlfriend has witnessed a lot of  tantrums and meltdowns, as Kitty has apparently decided that she doesn't need to keep it together in front of Ponito's friends.

Bear has decided that he's probably staying in Oklahoma, but it's still changing on a daily basis.  His 19th birthday is next month (the age of majority in Nebraska is 19 and our adoption agreement goes until then).  Wish we could have shown him that we're not kicking him out then, but he was too afraid we would, so he left first.  We'll always be here for him if he needs us, but he doesn't believe that and what we're willing to provide is limited by what we think is best for him and the family.  He did call Hubby for Father's Day.

Kitty has amped up the, "I'm leaving when I turn 18" comments, citing Bear as proof that she can (something we'd been worried about).  Since she doesn't graduate high school until months after she turns 19, we'll most definitely have to pursue legal guardianship when she turns 18.  She knows this is something we're looking into and is adamantly against it, but she is in denial as always.

I've already posted about our decision to let Kitty know that we're going to treat her like she's six.  She still hates the idea, but most of the time it's working.  It helps not to have Bob around to make the differences more obvious.  I'm not looking forward to how hard this is going to be when school starts again.

Hubby and I have definitely noticed that as the stress of school and peers lessens, it becomes more and more evident that she really is 6 in almost every way.  I wish we could think of a way to better parent her at this level.  She needs friends her own (emotional) age and not to feel she has to keep up with her siblings and friends.  We've tried to enable friendships with other adopted kids who are younger chronologically (tweens) and usually emotionally delayed too, and therefore closer to her emotional/social age, but it's hard for her to maintain friendships and they have their own issues and activities planned.

When she hangs out with Ponito and his tween friends she sounds exactly like a little sister wanting to do what the big boys are doing... whining and trying to get their attention.  That's how they react to her too, and I can't blame them.  Chronologically younger kids don't really like to hang out with her either, because she's not fun to play with - she doesn't have the same interests they do and at the same time she's not empathetic and focused on their wishes and needs like an average older child would be.

I worry about her with truly younger kids because she doesn't understand the differences.  She came home from being an aide at vacation bible school, talking about a shy little 4yo boy she'd befriended (when no one else could get him to engage) and was telling me how she felt like punching the other teens who were working with her, because they were taking pictures of him after he told them he didn't want his picture taken.  There was a lot more to it than that, but what worried me was that she didn't see that her reactions were not appropriate.  If someone hurts her (intentionally, accidentally or imagined), she will lash out without thought.  My biggest fear is that one day she will terrify or actually physically hurt a young child.

Kitty has been working as a preschool aide with Vacation Bible School and really likes it.  It runs for two weeks total and we're in the second week.  It's stressful for her, but she's handling it with relatively few meltdowns (and so far only one relapse of the double vision and dizziness).  I wish it went on all Summer.  I have a friend who owns a home daycare that has offered to let her help out a couple days a week, but Kitty hasn't been able to hold it together enough to start yet.  Will probably be easier after VBS is over.

This Summer I only have two kids most of the time, but it doesn't really feel like it.


About the same time I was dealing with the events that led to the temporary closing of my blog, Kitty's psychiatrist told us we had two choices. To move to another state with better health care (Texas ranks 50th! in the country for mental health services) or just put her back in foster care.  Not because foster care could provide better care, but because she was getting increasingly hard to handle at home and insurance doesn't cover long-term residential facilities.  They'll provide short-term residential treatment, but not long-term residential care.  Moving is just not an option I'm really willing to consider, and neither is abandoning her.

We've very clearly been told that if Kitty goes back into residential treatment she'll lose what little attachment she has left and therefore would never be able to return home.  Now that Kitty is 17, any residential treatment would technically be "short-term," because when she turns 18 she'd either have to come home or be dumped out on her own without a high school diploma, job skills or the ability to live independently.  Clearly neither option is what we want for her, and not really viable either.

I've spoken to her current psychiatrist to find out her agency's policy on recommending legal guardianship.  We ran into problems with this with the MHMR agency Bear's psychiatrist worked through. They were not willing to sign the guardianship paperwork for Bear.  It is even more obvious that Kitty needs it, but if this agency won't do it, then I want to know now while we can still switch back to the psychiatrist we went to 2 years ago.  (I know he'll do it because he's done it for a family friend's adult children).  We'd had to stop seeing him because we no longer had private insurance, but now we have the only kind he accepts again.

I'm also trying to look at long-term for after she graduates (if we can make it that long).  I'm assuming she'll need to be in a residential facility of some type - maybe a group home with other people with mental illness.  Since she's technically not developmentally delayed or intellectually disabled I haven't found a lot of alternatives.  The best option is to live with us or in a place of her own with us closely supervising, but I'm not sure she can allow that to work.

Currently, we've decided that our only option is partial day hospitalization or intensive outpatient services.  Our private insurance covers partial day hospitalization (unlike Medicaid) so I contacted the in-network programs. Unfortunately all of them have group therapy at the core of their program.  Kitty doesn't do well with group therapy for several reasons.  The main one being that other teenagers in the group are not her peers.

  • A teens normal developmental stage is to be working toward independence, which Kitty's attachment issues mimic.  Other teens provide validation and reinforcement of Kitty's maladaptive behaviors and issues.
  • She doesn't have the insight that they do and is not able to process and reason as quickly.  Nor is she able to accept her differences.
  • She is socially and emotionally much less mature so reacts differently. 

We've found a company that provides intensive outpatient services that is willing to tailor them to her needs, but of course they are out of network for our insurance and don't accept Traditional Medicaid (although they do take other kinds of Medicaid).  Our out of network deductible is almost $2K and after that they'll only pay something like 50% of the costs.  We can't afford that.  If we can't find an option that works I don't know what we'll do.

For now she's continuing with weekly attachment/somatic therapy and starting equine therapy.  We wanted to start her in a group rhythmic riding class, but our private insurance doesn't cover it and Medicaid is notorious about not paying so they aren't willing to take her unless we pay up front for the whole Summer.  Even if we could afford that, if she ends up in the hospital or other treatment (or pitches a fit and doesn't want to go), then we'd still have had to pay for the sessions missed.

While in Nebraska, we arranged a last minute meeting with our adoption caseworker and post-adoption services.  We didn't go in knowing what we wanted.  We just figured it was a chance to meet face to face and brainstorm options.  They pretty much agreed we're stuck between a rock and a hard place.  It was mostly a wasted trip.  *sigh*

If I could just come up with a plan, then I'm sure we could make it work.  I feel like I'm trapped without any choices and the avalanche is coming so we can't just stick with status quo for long.


Lisa said...

I feel like we have no options either. As you mentioned, even IF you can find a good program that will address her individual needs, it is prohibitively expensive so it becomes a non-option anyway. I guess the bottom line for me with two of my teens (now 18 and 19) was always feeling like there was something better out there to help them but also always feeling like it was a well-kept secret only the chosen few could access. I have two more now, ages 14 and 17, that are struggling mightily and am feeling more hopeless by the day.

I don't know the decision behind Bob living with Grandma all summer, but I think I would miss her an awful lot too if I were you. You really need the good stuff in daily life to balance out the frustrating things/issues. I can, however, see how it would be good for Bob to get out of the turmoil that is daily life with Kitty.

LH said...

Once again, I am sorry for your seemingly insurmountable problems but still glad you are back...

Lisa said...

Do whatever you can to obtain services. Leave no stone unturned. Once that's done - let it go. I always thought I was a failure for not obtaining the "right" services for my kids in spite of years of fighting the system. Years of advocating, demanding, begging, pleading for help to people who were only doing their jobs. Ultimately, I realize that if you can obtain everything that's out there, that's all you can do. There is no guarantee that the services will even help - Kitty has to realize that the problems she has are hers to overcome. It's not fair that she has been saddled with the issues she has, but it's the reality of it. Until she is willing to put in the effort, you aren't going to see any improvement, no matter how great the program is.

marythemom said...

Thanks guys! I'm hanging in there. I'm not giving up, but I'm trying not to let it consume me either.

Lisa, I wish I thought that Kitty was capable of "putting in the effort." I felt this way with Bear (I did feel if he could just take a chance and trust...), but I don't know that Kitty has the capacity for more. Sad but true.

Thanks again!