The "New" New Behavior Therapist...

[DaisyFace]

is "eminently qualified" because she has a background in working with the criminally insane.

She's a nice woman, seems very intelligent, can get to my house when she's not working...

BUT - I'm waiting to hear that she bailed.

I had a chance to meet with her one-on-one for about 30 minutes. We went over the details of difficult child's diagnosis and history. New BT seemed to understand where I was coming from and the type of supports that difficult child needs (which largely focus on the personality disorder and helping difficult child learn healthier coping skills).

The state supervisor joined the meeting and began outlining the state's requirements for accomplishing all this. Basically, the state wants each individual behavior detailed and dealt with as a separate issue regardless of the underlying disorder. So, if difficult child is having a bad day and doesn't shower, doesn't do any school work, doesn't eat and then stomps are the house raging and destroying things - the Behavior Therapist is supposed to ignore the "having a bad day" part - and simply focus on addressing eash negative behavior. In this example, the BT needs to document that she spent X amount of time treating the 'not showering', then x amount of time addressing homework issues, then x amount of time addressing proper eating, and then x amount of time addressing the rage.

BT looked at state supervisor like she was crazy! (And remember, this is a woman who DEALS with truly crazy people!)

The BT asked if we could note time necessary for she and I to compare notes on difficult child's behaviors, since difficult child cannot be counted on to be truthful.

The answer? NOPE! Every moment of the BT's time is to be spent dealing directly with difficult child and difficult child alone. If BT decides she needs to get input from Mom or Dad, that's a separate thing and may not be part of state-contracted therapy.



I suspect the potential BT is thinking it over and deciding whether or not she wants to be part of this lose-lose situation. (And really, who could blame her?)

 

[AnnieO]

You FINALLY get a BT that seems to have a clue (and dealing with the criminally insane does seem to fit for some of our kids)... And she's being hog tied.

Jeez.

I'm pretzeling that BT is willing to help anyway...

 

[keista]

Well, there you go. in my opinion it's proof that the state is setting everyone up for failure. REALLY??? Parental input is not part of child's therapy?????????????????

Hmmmmmmmmmmm maybe they should stop setting up all these meetings with you and just have them with difficult child - problems solved!

 

[DaisyFace]

Well, I'm wondering if these bizarre requirements have been the problem all along ???

Perhaps these state folks are otherwise intelligent ( or at least minimally competent) people that have been bound by these strange rules and regulations and that's why we just keep going around and around in circles?

 

[buddy]

It is all so insane.

 

[DDD]

Ditto, Buddy. DDD

 

[susiestar]

Well, I hope the lady is familiar enough with double speak from ehr work with the criminally insane so that she can do what is needed and then make it sound like what is supposed to happen in the documentation.

The whole system is nuts but I don't think this new system of rules is the reason for the problems. I don't think anyone knew of these rules a month ago and next month they won't remember these rules but will be upset because some other idiotic set of rules isn't being followed.
The whole thing is insane.

 

[InsaneCdn]

Any chance of getting a copy of the requirements for new BT ... in writing? So that you can turn around and "leak" them somewhere?

Finally a "sane" BT... and the true source of the insanity is being revealed!

 

[buddy]

A similar thing happens with PCA caregivers, they have to document every little ADL that a person has identified and how they helped. Now if they run together, or you have to do something else in order to get to that even teh next day you are not to check off and be paid for that time, so stupid. I think it is best to just do the right thing, and check off or write that you worked on it, but be short and sweet in statements. Client prepped for shower at 8. If that means what you really did was negotiate and calm her and discuss the day then so be it.

 

[HaoZi]

Ummm... can they produce any state regs that say this is the way it must be? Or any federal guidelines?

 

[Bunny]

Now this may sound rather naieve on my part, but I'm going to throw this out there anyway. When I bring difficult child to the therapist (which I realize is different than your difficult child working with the BT) he always starts the session asking me how difficult child's week went and if there was anything, good or bad, that I wanted to bring to therapist's attention. Isn't it only natural that you would need to compare notes with the BT at some point? Especially at the beginning, since even the BT realizes the difficult child can't be trusted to tell the truth?

Seriously, to tie her down with these rules and regulations seems like it will only defeat the purpose of having the BT there in the first place.

Buddy is right. Idiots!

 

[InsaneCdn]

Fav therapist couldn't do (wasn't "allowed to" do) family therapy, etc. BUT... when it was in the best interests of difficult child to "include" the parent(s)? it just wasn't labelled "family therapy". What actually happens, and what gets written, are often quite different... not in a bad way, the written stuff is just left fuzzy enough to leave room for "interpretation".

 

[exhausted]

If BT is any good she will get that regulations are technicalities. Hopefully she won't run off and do what any competant professional would do, and that is to serve the kid in their environment. This would include you and husband. Your kid is not an island and a therapist knows this. Here's hoping she gets it and will hang around. Who in the world writes these rules?

 

[klmno]

Well, I'm wondering if these bizarre requirements have been the problem all along ???

Perhaps these state folks are otherwise intelligent ( or at least minimally competent) people that have been bound by these strange rules and regulations and that's why we just keep going around and around in circles?

I think you've hit the nail on the head. Here's what I'm starting to think happened- traditional therapy couldn't be measured so they started having to create "evidence based therapies" that included measurable goals. They don't work but never mind that- they got them approved based on picking control groups that were so specific and studied by their own peoople so basicly, they couldn't fail. Now, the only people certified to do any of them are the coordinators or directors of tthese programs and the people aactually delivering the services to the families are usually interns in training. (That's one reason they have to document every little thing they are doing so their super can look it over.) So for the past several years (at least) interns in the MH profession are being taught these evidenced based therapies tthat have all these rules and cookie-cutter stuff you just mentioned instead of how to do traditional therpy- which is why we can't find MH profs to do anything useful when we take our kids to a therapist. They never learned how to give any traditional therapy. I said more than once that I think they should look at the real-world statitics on success rates and use that to determine the "evidence" for keeping a "therapy" program or getting rid of it. Another thing- a "real" MH prof is not going to let a PO, sd, or anyone else tell them to work with a kid to change ABC - I mean a parent can say we need help with raging issues or whatever, but you can't hire a therapist to mold your kid into just whatever. I think POs try to tell these counselors to change ABC in Mom and change DEF in difficult child and if we don't change those, we are not compliant. I just can't see that working.

 

[buddy]

If BT is any good she will get that regulations are technicalities. Hopefully she won't run off and do what any competant professional would do, and that is to serve the kid in their environment. This would include you and husband. Your kid is not an island and a therapist knows this. Here's hoping she gets it and will hang around. Who in the world writes these rules?

100% agree. when a therapist has been around for a long time they are used to rules and regs changing, but the reality is that the nature of people doesn't change. The needs of difficult child's do not change. For me, over the years how to write goals and objectives has changed so many times. And in the private settings, therapists have to word things in a way to allow insurance to cover it.

A goal and the objectives to reach the goal are really to be samples that reflect overall change in the client. Most often NOT the be all/end all target. Using my profession, if a child has the problem of a "receptive language delay/disorder" then the goals selected are those that represent skills one would be able to have if one had better receptive language abilities. Not that they only learn that ONE GOAL. It is like teaching to a test in the schools. Really we want the kids to be learning the big picture. The questions on the test are samples of that bigger knowledge, not inclusive of everything that the child should be learning.

So, I hope the therapist can just nod and agree and then do what she knows needs to be done.

Really hoping ONE thing can happen right for you guys.

 

[TerryJ2]

Ditto.