After the last meeting a few weeks ago, we were scheduled yesterday to meet with our caseworker's supervisor to develop a TSP for difficult child...
We arrived at the meeting to discover that supervisor was sick and would not be attending - but the RM (Regional Manager) would attend the meeting via telephone. So the meeting was husband, myself, caseworker, therapist and RM.
We began by reading my bulleted list of concerns to RM. Then when I began to say that the services we were hoping for were...
RM interuppted me and asked husband whether he agreed with my list of concerns. He said yes - he agreed with everything I had just said. He'd seen all the problems first hand and something needed to be done to help our family. He even mentioned the article that Witzend had posted in Watercooler about the boy who was angry after an argument with his mother and killed her while she was sleeping. husband told RM that he didn't want our family to end up another statistic and we'd like any help we could get.
RM asked a few questions about difficult child's behaviors - wanted to know about threats, violence, when was the last time the police came out, when was the last time difficult child made a threat, when was the last time difficult child did something inappropriate, etc... I read to her from police reports, school reports, even difficult child's own IMs where she talks about wanting to kill me.
I explained to RM that we seemed to be reaching a dead end. difficult child was not making progress in regular therapy, psychiatric hospital will not treat her any more, all the professionals seem to be saying that difficult child needs residential treatment and they referred us to the state program.
This got the RM upset. She said that they are not supposed to do that. Their program has nothing to do with providing treatment - they simply FACILITATE treatment.
RM asked caseworker what had been proposed at the last meeting.
Caseworker stated that she had proposed a person to help us create a behavior chart.
I said that my problem with that is that the behavior chart would not address any one of our top ten concerns. In fact, last year's behavior chart was the reason difficult child gave during one of her IM sessions for wanting to have me poisoned. Without getting difficult child's other issues under control, I would not be able to enforce a behavior chart. I said that we could not set up a situation in which it was difficult child vs Mom or difficult child vs the family in the implementation of this chart.
RM was clearly exasperated at this point. "So...." she said almost sarcastically "You would prefer to do nothing?"
I said "I would prefer not to be killed in my sleep."
RM began very angry at this point and directed her comments toward the therapist. She wanted to know why the violence and other issues were not being solved during therapy.
therapist explained that difficult child does not participate in therapy. It's difficult to solve issues that the client refuses to asknowledge. therapist recommended Residential Treatment Center (RTC).
RM wanted to know what the treatment team thought.
Treatment team? Well, here's where the meeting really went downhill. Because difficult child is covered by Medicaid - our only choice in MH treatment is the County MH Agency. County MH has three offices to serve the entire county. There are only two psychiatrists that treat children. One psychiatrist is located at the center office and the other psychiatrist travels between the three offices. He is at our office only one day per week. Therefore, the only person that difficult child sees regularly is the therapist.
RM said that the treatment team should be meeting about difficult child at least once per week.
therapist tried to explain that there is no treatment team.
RM demanded to know when difficult child next sees the psychiatrist. When she heard mid-April she seemed stunned. That is unacceptable! She said. difficult child needs to see the doctor a lot more often than that.
therapist explained that doctor is booked months in advance.
RM said, well what about the crisis doctor then?
There is no "crisis doctor".
Well, which doctor will difficult child see when there is an emergency?
She won't see a doctor. She will be referred to crisis center/ER and then scheduled to see doctor at his next available appointment. Openings are available in June.
RM said well difficult child needs to see doctor a lot more often. The treatment team [there is no treatment team] needs to meet about difficult child at least once a week. The treatment team [there is no treatment team] needs to decide what will be the next step for difficult child. If the team [there is no team] indeed decides that difficult child needs residential services then the team [there is no team] needs to forward that information to the office's account manager.
This office does not have its own account manager. There is one account manager that overseas the finances for all three County MH offices. therapist has already discussed Residential Treatment Center (RTC) placement with the account manager and has learned that there are no funds to place kids in Residential Treatment Center (RTC). Period.
therapist tried to explain this to RM.
RM told her that funding is not her business. She needs to have the treatment team [there is no team] handle treatment and the account manager handle funding.
Well, the reason there IS no treatment team, and no "crisis doctor" and no support groups or summer camps or workshops or anything else is that the County MH offices have had their budgets slashed.
RM would not address the issue of funding. She said any referrals to Residential Treatment Center (RTC) needed to come from the treatment team [there is no treatment team]. Then the treatment team needs to send their recommendation to account manager. Then account manager will meet with caseworker who will help account manager find a residential facility.
Problem is - referring agency is responsible to pay 1/3 of the cost of any referred treatment, including Residential Treatment Center (RTC).
County MH does not have the funds to pay this. Therefore, County MH will not refer.
So it doesn't matter whether therapist, psychiatrist or a whole team of docs recommend Residential Treatment Center (RTC) - County MH does not have the funding to pay the required 1/3. Period.
So our meeting ended with everyone feeling frustrated and angry.
Except for caseworker - who spent the entire meeting just sitting there with a vacant expression on her face.
I'm exhausted with stress and frustration...
We arrived at the meeting to discover that supervisor was sick and would not be attending - but the RM (Regional Manager) would attend the meeting via telephone. So the meeting was husband, myself, caseworker, therapist and RM.
We began by reading my bulleted list of concerns to RM. Then when I began to say that the services we were hoping for were...
RM interuppted me and asked husband whether he agreed with my list of concerns. He said yes - he agreed with everything I had just said. He'd seen all the problems first hand and something needed to be done to help our family. He even mentioned the article that Witzend had posted in Watercooler about the boy who was angry after an argument with his mother and killed her while she was sleeping. husband told RM that he didn't want our family to end up another statistic and we'd like any help we could get.
RM asked a few questions about difficult child's behaviors - wanted to know about threats, violence, when was the last time the police came out, when was the last time difficult child made a threat, when was the last time difficult child did something inappropriate, etc... I read to her from police reports, school reports, even difficult child's own IMs where she talks about wanting to kill me.
I explained to RM that we seemed to be reaching a dead end. difficult child was not making progress in regular therapy, psychiatric hospital will not treat her any more, all the professionals seem to be saying that difficult child needs residential treatment and they referred us to the state program.
This got the RM upset. She said that they are not supposed to do that. Their program has nothing to do with providing treatment - they simply FACILITATE treatment.
RM asked caseworker what had been proposed at the last meeting.
Caseworker stated that she had proposed a person to help us create a behavior chart.
I said that my problem with that is that the behavior chart would not address any one of our top ten concerns. In fact, last year's behavior chart was the reason difficult child gave during one of her IM sessions for wanting to have me poisoned. Without getting difficult child's other issues under control, I would not be able to enforce a behavior chart. I said that we could not set up a situation in which it was difficult child vs Mom or difficult child vs the family in the implementation of this chart.
RM was clearly exasperated at this point. "So...." she said almost sarcastically "You would prefer to do nothing?"
I said "I would prefer not to be killed in my sleep."
RM began very angry at this point and directed her comments toward the therapist. She wanted to know why the violence and other issues were not being solved during therapy.
therapist explained that difficult child does not participate in therapy. It's difficult to solve issues that the client refuses to asknowledge. therapist recommended Residential Treatment Center (RTC).
RM wanted to know what the treatment team thought.
Treatment team? Well, here's where the meeting really went downhill. Because difficult child is covered by Medicaid - our only choice in MH treatment is the County MH Agency. County MH has three offices to serve the entire county. There are only two psychiatrists that treat children. One psychiatrist is located at the center office and the other psychiatrist travels between the three offices. He is at our office only one day per week. Therefore, the only person that difficult child sees regularly is the therapist.
RM said that the treatment team should be meeting about difficult child at least once per week.
therapist tried to explain that there is no treatment team.
RM demanded to know when difficult child next sees the psychiatrist. When she heard mid-April she seemed stunned. That is unacceptable! She said. difficult child needs to see the doctor a lot more often than that.
therapist explained that doctor is booked months in advance.
RM said, well what about the crisis doctor then?
There is no "crisis doctor".
Well, which doctor will difficult child see when there is an emergency?
She won't see a doctor. She will be referred to crisis center/ER and then scheduled to see doctor at his next available appointment. Openings are available in June.
RM said well difficult child needs to see doctor a lot more often. The treatment team [there is no treatment team] needs to meet about difficult child at least once a week. The treatment team [there is no treatment team] needs to decide what will be the next step for difficult child. If the team [there is no team] indeed decides that difficult child needs residential services then the team [there is no team] needs to forward that information to the office's account manager.
This office does not have its own account manager. There is one account manager that overseas the finances for all three County MH offices. therapist has already discussed Residential Treatment Center (RTC) placement with the account manager and has learned that there are no funds to place kids in Residential Treatment Center (RTC). Period.
therapist tried to explain this to RM.
RM told her that funding is not her business. She needs to have the treatment team [there is no team] handle treatment and the account manager handle funding.
Well, the reason there IS no treatment team, and no "crisis doctor" and no support groups or summer camps or workshops or anything else is that the County MH offices have had their budgets slashed.
RM would not address the issue of funding. She said any referrals to Residential Treatment Center (RTC) needed to come from the treatment team [there is no treatment team]. Then the treatment team needs to send their recommendation to account manager. Then account manager will meet with caseworker who will help account manager find a residential facility.
Problem is - referring agency is responsible to pay 1/3 of the cost of any referred treatment, including Residential Treatment Center (RTC).
County MH does not have the funds to pay this. Therefore, County MH will not refer.
So it doesn't matter whether therapist, psychiatrist or a whole team of docs recommend Residential Treatment Center (RTC) - County MH does not have the funding to pay the required 1/3. Period.
So our meeting ended with everyone feeling frustrated and angry.
Except for caseworker - who spent the entire meeting just sitting there with a vacant expression on her face.
I'm exhausted with stress and frustration...