difficult child at PRTC doing very badly..

Discussion in 'General Parenting' started by WNC Gal, Sep 9, 2007.

  1. WNC Gal

    WNC Gal New Member

    This is so challenging. My daughter has been at a PRTC for about 3.5 months so far. She REALLY needed a secure level of care as she had been hospitalized 9 times in the past 12 months for recurring suicidal ideation, self-injury and reluctance to seek help when she felt herself slipping into a serious depression. She was actually denied admission to several less "secure" placements as her suicidal risk was so great.

    Now that she has been at the PRTC for 3.5 months, I think she is getting VERY frustrated because for the first time in her very tumultuous brief psychiatric history, she cannot "call the shots" in her care. Previously, she could keep it together and appear to be much better long enough to get discharged. Then, she would be able to last about 3-6 weeks without a crisis.

    I guess the placement is a success in some respects because in 3.5 months she has only had one very minor SI episode (seemingly for attention). And as her therapist pointed out, she has not been acutely suicidal, although she at times will score VERY high on the Beck Depression scale.

    She is supposed to stay at this program for 6 months, then step down to a Level 3 program (not secured) until we see that she can handle the less restrictive environment before going to perhaps a therapeutic foster home in our area, then finally, home. We are a very good family - no abuse, drugs, divorce, etc. So - it is very hard to figure out why she has all of these issues.

    Today she told me over the phone that she is WORSE than when she went in. She said she was NOT suicidal when she 1st went there (she was at an acute hospital awaiting placement for several weeks prior), but she is now! She seemed so much better to us on our last visit about a week ago - but she says now that she was thinking the whole time of jumping out of car because she wants to die. She said she now is getting an eating disorder, becoming oppositional and all kinds of issues from being there.
    She says that she needs to move to a Level 3 now!

    Yikes! I am terrified that she will convince/"snow" the staff enough to get discharged to a lower level of care and then she might end her life. But what if this highly restrictive program is really making her worse? Any hospitalization carries the risk of your child mimicking the maladaptive behaviors and attitudes of the other clients.

    I am alerting her therapist and case manager. But I am VERY conflicted about whether or not it is appropriate/safe/ok to even consider moving her to a less secure placement when she appears to be so volatile. I ask myself if I (as a presumably normal, healthy person) were sent to live at that facility for 6 months with a lot of dysfunctional kids - how would I fare? I think I would be stressed, but I would persevere. But can an emotionally sensitive 14 year old really withstand repeated hospitalizations and being so far away from her family and still come out ok? Is this just a phase of her "recovery" that she will pass through? She has admitted to being highly manipulative in her past year of hospitalizations.... I fear I am weakening under the pressure to do the right thing for her!

    My husband and I know she needs this program... but we both are very nervous when she starts to speak this way.

    Any insight?
  2. mrscatinthehat

    mrscatinthehat Seussical

    As I don't know your daughter but found with my own kids the want of a change is a control thing. As you said right from the beginning she doesn't have control here. She wants that back and will do anything to get it if that is one of her issues. Again I don't know her but that would be one guess. Manipulation to get control is a real problem for us with difficult child 2. He thinks if he doesn't do this he will get a choice of where he goes. Not an option. Hope things get better soon.

  3. susiestar

    susiestar Roll With It

    Honey, you said it yourself, "My husband and I know she needs this program."

    She is trying to yank any chain she can, as apparently the staff are not giving her whatever it is she wants.

    Our kids, regardless of home life, tend to be superior manipulators. My own difficult child is absolutely AMAZING in the way he can find to manipulate others.

    Right now she has you thinking about pulling her out and sending her to a less secure facility. Presumably a less secure facility will give her more freedoms. More tv, junk food, friend time, or whatever she is wanting.

    And in a less secure facility she will be able to wrangle whatever she desires, or so she is thinking.

    Does she have concrete examples of the behaviors she is learning? Can staff back up that she is in fact showing these behaviors? She certainly has the language down. What can she show you to PROVE that she has these "new" behaviors? Are they truly new, or just stuff she can no longer hide?

    No matter the home, it is pretty easy to hide lots of things from parents. Maybe if each family came with 2 parents for each kid, and one parent could follow the kid at all times, maybe then the kid could truly not hide behaviors. But, even then, kids would learn how to sneak and hide stuff.

    What message will you be sending her if you take her out of there? That she can manipulate her way out of most anything? I would be very leary of taking her out, esp because you may then find it almost impossible to get this level of help for her again.

    I do wonder, and this thought just hit me, what she is working on with her therapist or in group therapy right now. Maybe something has touched a nerve, made her realize that she has some problem or responsibility for a problem that she does not want to admit?

    She had 9 hospitalizations in 12 months. This means she NEEDS help, big-time help, and she may not want all that "help" involves. It is really hard work to face yourself.

    She may have some new behaviors that she learned at the hospital. And they may not be what you wanted her to learn. But the staff will probably have some idea of what is going on.

    I strongly advise you to talk to her therapist, psychiatrist, and if at all possible one or more nurses involved in her care. See what they have to say before you get too upset.

    It is so hard when our kids hurt so much.


  4. goldenguru

    goldenguru Active Member

    Just curious how often you get to see her? Does she have phone access? Does she get home visits?

    We placed our daughter in Residential Treatment Center (RTC) for 16 months. One of her biggest complaints was homesickness and loneliness for the family. I certainly can understand that.

    I still question whether we should have institutionalized our daughter. So I fully understand your conflict with your decision.

    I am a firm believer in 'the least restrictive environment'. Only you can decide the need for such intensive care. Especially if the program where she resides is 'for profit'.
  5. Fran

    Fran Former desparate mom

    You have a lot of concerns about your daughters well being as all of us who have gone the "out of home" treatment have gone through.

    All of us realize our 14yr olds are emotionally sensitive. All of the kids in your child's program including yours are dysfunctional. Just dysfunctional in a different way. Suicide threats and hospitalizations are a pretty bright flag that is waving "not functioning well".

    Would she be better outside the program? Isn't suicide the biggest concern here? In 3.5months she has had one half hearted attempt. Seems the program is working.
    She isn't going to snow the staff but she will manipulate you. difficult child's are smart and strong willed. They want what they want when they want it. She needs you to be the rock that prevents her from repeated attempts to end her life or sabotage it.

    You will worry everyday she is away from home if you are doing the right thing. I carry that on my shoulders too. My alternative was to watch my difficult child self destruct. I did something.

    In my mind, difficult child can hate me forever. My job is to get him to adulthood to be responsible, independent and functioning. If he likes me-it's the gravy but my job is clear. It's hard to be on the receiving end of their dislike and the spewing of hateful words but keep your eye on the goal.

    If there is no indication of harm then let the program do what it does. What you were doing before wasn't working.

    in my humble opinion, of course.
  6. Sunlight

    Sunlight Active Member

    my thought is to remind you why you sent her there, what you were thinking at that time. she sounds better because she is complaining and cares rather than wanting to die.

    let it go the course you orig planned. this could be a get over the hump time.
  7. Big Bad Kitty

    Big Bad Kitty lolcat

    I remember wen you put her in there. And yes, she was suicidal.

    in my humble opinion, she's vying for a little control.
  8. TerryJ2

    TerryJ2 Well-Known Member

  9. DammitJanet

    DammitJanet Well-Known Member

    My son was put in a PRTF that was locked. It was the first time he didnt have the ability to walk out the door and leave when he got fed up with staff and the rules. He hated it and tried every form of manipulation in the first few months known to mankind.

    Oh the staff were mean, the food was awful, he was losing weight, he was going to come out worse than when he went in...blah blah blah. I simply told him that was his choice. He went there because he had problems he needed to work on. It was the first time he had to be accountable for his actions and not us.

    Normally, in the real world, punishments really fall on the parents. If schools suspend kids, it leaves parents in the lurch. If juvenile courts fine kids or put them on probation, it ends up the parents who have to monitor them and go through more stress than the kids. When in a locked facility its the kid who deals first hand with the consequences for his/her actions. Mess up, lose levels and deal with it. Really act out and get put in the time out room. Not the parents! It really had an effect on my kid...at least for a time.

    Its why I think jail has had an effect on my son now...at least for the short while again. We shall see for how long this time.
  10. WNC Gal

    WNC Gal New Member

    Well...we are still debating whether to pull her out. NOT to any lower level of care, but to perhaps move her to a different PRTF which would be closer to our home. There is one which has an opening right now which is 3 hours away (vs. 6.5 where she is now) and another PRTF program only 30 minutes from us (not sure about their openings).

    I have no idea if we can expect significant progress in 3.5 months, but I would have thought that a highly intelligent kid might show SOME tiny improvement. She does seem to be worse... she claims she wants to die, she is restricting her food intake (she lost 15 pounds in two weeks) and trying VERY hard to put everything off on others. She blames us, her parents, for not trying a lower level placement (none would accept her!). She blames the staff at the PRTF because they don't know "how to help her". And yet, she spends most of her therapy time venting about wanting to leave instead of working on goals.

    I would be ALL in favor of her moving somewhere closer to us - but I fear that she might feel that she succesfully "manipulated" herself out of her current placement - and that is behavior that we cannot afford to reward. Yet, we agree that we need more intensive family involvement which is challenging to do with a 13 hour round trip every time we go for a family therapy session!!

    Anyone have success when making a lateral move with their child to a different program of the same level?
  11. mrscatinthehat

    mrscatinthehat Seussical

    It takes both of my difficult children months (upwards of 6-9) to transition into a new facility. I don't know your difficult children transition history but if change is a big issue it can take awhile. Especially if she isn't getting what she wants. Took difficult child 1 a long time to figure out she could not manipulate with her behavior her way out of the placement she is in. (She is in a very good one) Whereas difficult child 2 has continually found ways to manipulate the situation.

    I guess what I am saying is you will have to way all your options. If you are looking at switching I would sit down with pogram folks if you could to get a read on them to see if they will be a good fit.

    Good Luck