Elijah apt./medication changes/EEG/dr. says inpatient, ins. says no

Discussion in 'General Parenting' started by jcox, Feb 3, 2009.

  1. jcox

    jcox New Member

    I had a psychiatric visit for Elijah today. The psychiatrist asked me to come alone so we could quickly finish up his intake process and also because he had some things he wanted to discuss without Elijah there.

    First off he was upset at the way the situation happened the other day with the Section 12 and did not understand why he was not admitted. I explained to him how the crisis services lady said he did not fit the insurance criteria for that. He told me that next time he has an extended rage, or is seriously hurting somebody or himself to bring him back to the ER or better yet make the hour-and-a-half ride to Tufts if we safely can and go to that ER. Then they will admit him to the child psychiatric unit. He said he believes Elijah belongs in the hospital, but with our insurance it is not that easy. He is going to change his medications at our next visit in two weeks. He said that he is going to make it so Elijah meets the criteria to be admitted so the child psychiatry team at Tufts can watch him 24 hours a day to see how he really is. For our insurance he has to be hallucinating, hurting himself, suicidal, or seriously hurting somebody else. (And they don't count belly that has been talking to him for three years as a hallucination. They keep saying it is most likely an imaginary friend which I don't agree with). It seems crazy how they want children to actually be that bad before admitting them! He is going to take him off the Celexa, Clonidine, and Vistaril. He said he will change the dosaging of his Risperdal and add a stimulant to see how that would work with Elijah because he is unstable now. He did not mention if he is doing anything with the Lithium. My hubby and I discussed having him placed homebound, and then the school voiced their concerns about having him there during medication changes and that they were worried about his safety and the safety of the other children during that time. I talked to the psychiatrist about that and he said "No. Elijah needs to be at school." He said "if Elijah has an extended rage at school or is hurting himself or others then have the school send him to the hospital." I am not totally sure I would agree on doing things that way. I would rather have the school call me, then I bring him to the hospital or call an ambulance if it is unsafe. Why would he recomend that the school have him sent?

    On Monday Elijah goes for his sleep deprived EEG to check for possible seizures that could be causing his unprovoked rages. How can I possibly keep him up all night? The EEG is not until 11 am. The psychiatrist told me not to give him his night medications that night except his Clonidine, because if he does not have that his blood pressure could drop. He said Elijah is to sleep no more than four hours. I figure he will sleep two of them on the ride there... but what can I do to keep him awake all night? When would be the best time to get the other two hours of sleep?

    Also next week Elijah goes for genetics testing. We will see how that goes. They sent me a paper to fill in a family tree. Only my side is known so I will have to see if they can work with that.

    I am worried about Elijah when he starts coming off these medications in a couple weeks. I am wishing he could be in the hospital for that... but only want him at Tufts because I trust that psychiatrist, and know that they would take good care of him there. My step son Charlie has been at a few places I did not aprove of. Tufts seems wonderful.

    I wonder is there a certain way I should say things next time or certain things I should say so he will fit the insurance criteria to be admitted? Last time I think he would have been admitted if another person did his intake. She talked all to Elijah and did not want to hear my input. She would not let me answer the questions only him. Elijah can tell you what you want to hear and get what he wants. He also does not seem to answer appropriately. The new psychiatrist is saying he believes Elijah has high functioning Pervasive Developmental Disorder (PDD), ADHD, and a Mood Disorder which he is not specifying at this time. He had a conversation with the psychiatrist who filed the Section 12 on us last week. He called him while I was there to ask him what he believed to be Elijah's diagnoses and he said the same thing. The other psychiatrist was amazed to learn that he was not in the hospital.

    Well thanks for the continued prayers and support. Anything you can tell me about how to get him to meet the insurance criteria for inpatient, about sleep deprived EEGs, how to keep him awake all night, etc. would be highly appreciated.

    By the way our insurance is medicaid... MassHealth here in Massachusetts.

  2. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member


    I wish I had some words of wisdom for you, but I don't. I don't have any experience or knowledge in dealing with the situations (meeting the insurance requirements or a sleep study). I know there are members out there that will have some advice for you soon!

    In the meantime, I'm sending my support your way!

  3. smallworld

    smallworld Moderator

    Is there a day treatment or partial hospitalization program in your area that you could consider? Usually, the criteria for being admitted aren't so specific and insurance is more willing to pay. The child spends school hours there, is tutored in what his home school is covering, goes to therapy and is observed while medication changes are made. We've done this with both my son J (6 weeks) and my daughter M (5 weeks), and it was a positive experience both times.

    In your shoes, I wouldn't let Elijah sleep on the way to the sleep study. The point of keeping him awake is so he'll go to sleep during the EEG. If he takes a nap beforehand, you're going to have a hard time getting him back to sleep. The ideal time for him to sleep is probably from midnight to 4 am (or thereabouts).

    Hang in there.
  4. susiestar

    susiestar Roll With It

    For the EEG our pediatrician neuro says midnight to 4 am is the window to sleep.

    For admittance, sometimes things have to be really really bad. We had SoonerCare - the Oklahoma equivalent of your ins when my son needed to go to the psychiatric hospital. Actually I had to call the insurance people BEFORE we went to the psychiatric hospital. The dev pediatrician we saw reacted to my call about the violence by telling me to call the ins co and tell them we NEED a placement. I spoke to 3 or 4 people at the ins co and they all couldn't believe we had not had him in a hospital before that.

    We didn't know it was an option!!

    Remember, he has to be hurting himself or others, or thinking/trying to hurt self or others. with that criteria, you might try saying NO to him at times you might usually say yes to keep the peace. It will problem take a while to get him to the point he is that violent, but it is one way various nurses suggested to us after we took Wiz home from the psychiatric hospital.

    I am glad your doctor seems on top of things. Sounds like he knows his stuff. Remember to be gentle with YOURSELF and the rest of the family during this. It is rough on everyone when one person is so ill.

  5. Nancy423

    Nancy423 do I have to be the mom?

    My difficult child slept from midnight to 4 am as well. I think she was anxious on the way to the procedure because she didn't nap in the car.
    Sorry to hear you're having such a hard time getting him admitted. I don't have any advice but I'll certainly send support your way!
  6. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I'm so sorry it is so hard to get him admitted. It just isn't right. As for the not sleeping, I wish I had some advice but if with difficult child's medications there is no keeping him awake when he is tired.

    Gentle hugs and prayers going out for you and Elijah.