Discharge Meeting Today...Any ideas/advice?

[Alisonlg]

So...1 pm is my discharge meeting at the psychiatric hospital to go over our discharge plan for M (and Lord help me, I have to bring my unruly 3 1/2 yr old along because I can't find anyone to watch him!). Here's the tentative plan and what I know about the situation and my concerns (I will find out more at 1 pm)...

The Plan is: Discharge M early Thursday morning for me to pick him up and take him in my van to his new school (the one he is refusing to go to and has yet to attend). He will spend 1/2 day there and then will be allowed to spend the afternoon at his old school (which he insists is the only school he will return to) to ease the transition. He will be allowed to do the 1/2 day routine for approx. 1 week (there is only 1 week and 2 days left of school...then July 9th there is a Summer Program at his new school).

If he rages/flips out/becomes unsafe, he is to be immediately re-admitted (this way, I am not left dealing with it at home with no support team or endangering my family, obviously).


My concerns: M has already stated he is NOT going to the new school. I just don't see how we're even going to get him discharged out of the psychiatric hospital on Thursday. My only hope is that he'll SHUTDOWN rather than MELTDOWN and that we can physically just carry/drag him to school. I'm not convinced that will happen, but he hasn't raged in almost a week so *maybe* it's possible?

But, let's say he MELTSDOWN and begins to rage. Does this mean he doesn't leave the psychiatric hospital? HE WINS. He told me last night he would rather live in the psychiatric hospital the rest of his life than go to the new school.

If he makes it out of the psychiatric hospital and rages and does not get readmitted, but refuses to go to school, HE WINS. Again, the school refusal means he wins. And then I'd be left with no support and the inability to get him to school or psychiatrist. And if I readmit him, HE WINS again.

I can't seem to think of a scenario where WE WIN. Unless the Celexa has really stabalized him (at 10 mg for 1 week?) where he won't rage and he'll just shutdown and let us take him. But then what happens on Friday when I have to get him to school by myself? And who's going to get my 3 yr old on his bus if I have to drive M to school in another town?

AGH!

So, if any of you have any experience, suggestions, advice to offer to help me bring to the table when I meet with the team today, I'd be forever grateful! I feel my anxiety rising and my thoughts starting to get scattered and I want to have a good discharge plan this time...because the last two times, we simply did not have enough support when we left and it S*CKED!

Oh...and other than having something like DCF Voluntary Services, does anyone know of a way to get in-home help? I think if we had in-home help, that would be VERY helpful for situations like getting M to school and Dr's visits and such, don't you? But, dispite husband's readiness to sign up, I am petrified of DCF!

 

[timer lady]

Alison,

Your difficult child is 8 - you do have some ability to control (via holds, if necessary) his actions. Additionally, I'd lay it on the line; this is the plan. We're going to have to follow the plan for you to get back to your "real" school. Start laying down the idea that difficult children choices have repercussions. The idea of responsible & respectful choices.

The tweedles were both home at 8; I remember them trying to control every situation. kt & wm were both informed that at 8 years of age, they didn't have the experience or wisdom to make these decisions - period. Parents make choices of this nature for their children & they needed to back down.

Alison, other than county provided services I really don't know how you would get experienced, background checked services in the home. As you know, we have a plethora of services here for kt. It's been a journey to get & receive these services & it has been a godsend.

PCAs are used daily for behaviorial redirection & help in crisis moments. When times are calm there are teaching moments - from reading to help with household chores.

Good luck at your meeting today. Will be keeping my fingers crossed for you today.

 

[Alisonlg]

The problem is how "out of control" M gets (and we'll have to see how "stable" he is on the new medication). When he's raging, I am NOT able to control his actions. I can hold him to a degree, but I'll tell you I still have bruises healing from his admit 2 weeks ago! And when I work SO hard both physically and emotionally to get him somewhere (psychiatrist, school, etc.) those places are usually not prepared or willing to take him or deal with him...instead they think he's too unstable to be there. THIS is what I am anticipating.

Trust me, I've been laying down the law for 8 1/2 years now...we've been consistant parents and we've not waivered.

But if M goes out of control Thursday or Friday or even Monday, I don't know what I am going to do...I don't know what I am going to do with my 3 yr old and I don't know how I am physically going to dress/restrain/transport M to school.

And will the school even TAKE him if I go through all of that effort and he's raging? Will it even be safe to transport him by myself? There have been times I've contemplated pulling over and calling 911 because I feared he was going to seriously hurt one of us with the way he was pulling my van apart.

I'm scared. This admit has been so comfortable for him that I don't think they've really seen the true M. He LOVES it there in the psychiatric hospital. I'm afraid of what is going to happen when he comes home and I don't know who I can turn to when the other shoe drops.

 

[timer lady]

Alison,

If difficult child is that out of control you'll need to call 911 & ask for help in transporting a mentally ill child to ER. Honey, this isn't about winning or losing for either of you.

It's about helping difficult child gain some semblance of control through medications if necessary, & then behaviorial interventions. None of this is about you or your parenting abilities. It's about difficult child & his instability.

And having said that I know those bruises, that exhaustion. I really do understand & I don't say this lightly.

I'd take the time at discharge planning to ask about needed interventions if difficult child gets out of control, refuses school attendance, rage, etc what is your plan of action. Who can you call for help in transportation? Is there a possibility for a PRN medication to help calm the situation? (I'd personally prefer a chemical restraint over a physical restraint.)

In the past, I've refused to pick wm up from discharge; fortunately I had a mental health case manager to step in & resolve the situation (he backed me up). That's where help from DCFS can help

I hope I didn't sound glib in my previous response - it wasn't my intention. I'd be worried as well.

 

[oceans]

Alison- what happened to the evaluation that your insurance approved? They are going to discharge him before that?

If you are having this many concerns, it does not sound like he is ready for a discharge to me. It takes several weeks of being on an AD to know if it is going to work. Why do they feel he is ready?

Maybe you should make a plan to get him to the other psychiatric hospital that was mentioned here the next time things go out of control. It does not sound like he is really getting what he needs by going into this one like a revolving door.

If he needs something longer term for stabilization and medication trials, why are they not suggesting an Residential Treatment Center (RTC)?

 

[smallworld]

Or a day treatment program instead of school? It sounds to me as if needs at least that level of supervision instead of two schools in one day (which might in and of itself lead to meltdowns because of transition issues).

 

[totoro]

I am so sorry Allison. I have been dealing with my own BS for a couple of days... so I haven't been around much... :frown:

While I don't have any advice I want to send you lots of support! I do know the feeling of having to drag my 3yo with me everywhere K goes though! It so unfair and horrible at times... At times I worry about what poor N is seeing and hearing... and as if our difficult child 2's didn't have enough issues!!!

Anyway I just saw your post and wanted you to know my heart goes out to you and I am thinking about you and your family today... stay strong. I hope the best outcome will prevail for dear M...


{{{{{HUGS}}}}

 

[guest3]

Hi my meeting is at 4PM so we are in the same boat today.

I think my difficult child II will be being discharged on Sunday and he is not allowed to go back to his old school (after assaulting principal). His case worker already told me they'd be pushing to have him in a daily treatment program (Mon-Fri 9-3PM) so my fingers are crossed that the school will be paying the bill for all this!

of cousre my d/h is home from work "sick" again today and seems to have a liquid lunch and is asleep on the bed. My distain for him is growing by the day! It looks like I am going to the "family meeting" alone.

*and insult to injury I fell on my way into work today and my ankle is swollen up like melon!

 

[Alisonlg]

They're keeping M until Monday. As soon as they said that my anxiety level dropped! Rather than set him up for the weekend at home, they wanted to keep him inpatient. PHEW!

The SW from his old school drove in and was an invaluable asset at the meeting...other than me, she's the only other one that truly *knows* M. I'm so happy she came. We also had the SW from his new school on the phone, which was great- she's wonderful as well (too bad she's only a fill-in for someone who's on maternity leave). Then there was also the psychiatric hospital SW and the psychiatrist sat in for a bit as well.

psychiatrist is switching out the Straterra (finally) and bringing in Tenex to help with his impulsivity and to keep him from "boiling over" when he gets angry.

Somehow SW from old school has a way with M and she talked to him about going to the new school and how there are some other kids there from his old school and how both schools work together and how we're all on the same team...the "M Team" (and I joked about how I liked that and I wanted to have shirts made LOL) and M smiled (though he tried not to!) and she asked him how the plan sounded and he said it sounded....are you ready....GOOD!

So, as of right now, M is staying put until Monday "until his new medication starts to work" (gotta love that placebo effect) and then his SW from the old school and I are going to pick him up and take him to his new school :::fingers crossed:::

M is the master of telling you what you want to hear if he's in the mood to do so, we'll see how Monday *really* goes...but right now I'm going to take a trip to the State of Denial. LOL

Oh...and the idea of him going to both schools in one day was thrown out...too many mixed signals. And, I was so in shock from M suddenly agreeing to go to the new school and just so overwhelmed that I completely forgot to ask about the neuropsychologist. Ugh. This is how scattered my brain is. And I even brought it up with the school SW as we sat outside in the hallway waiting for our meeting! I swear I should be covered in Post-It Notes!

 

[smallworld]

Alison, this all sounds really positive. I'm glad you all came up with a plan that sounds more workable. Keeping fingers crossed for you. Hugs!

 

[oceans]

That sounds like a better plan. I hope that the Tenex works and things go well on Monday.

 

[busywend]

Sounds like a great plan to move forward. I know how it is to have that scattered feeling. It was frustrating. Fortunately, it really was related to being in the midst of difficult child chaos that brought that on. Now I just can't remember anything.

 

[On_Call]

Gosh, I know the feeling of a unsettled discharge meeting. Glad they are waiting the extra time til Monday.

Our difficult child also can stick in his heels when he thinks he's made up his mind about something. Usually, he comes around and accepts the decisions and plans that the team makes, but it's not easy.

Sending understanding {{{hugs}}} to you. Hope a complete plan is in place before Monday's discharge. Try to enjoy your upcoming weekend.

 

[Wiped Out]

Glad to hear they will keep him through the weekend. It sounds like a better plan. Hugs.

 

[guest3]

I wish my news was like yours, difficult child II is worse and they're sending him home, ugh!

 

[timer lady]

Alison - thanks for the update. I'm glad that discharge is being held off until Monday. :thumb: