Hey everybody, I'm told my difficult child is safe and stable, home tomorrow?!?!?!

Discussion in 'General Parenting' started by Farmwife, Oct 5, 2010.

  1. Farmwife

    Farmwife Member

    Todays meeting went poorly. It seems the doctor who has spent a total of maybe 30 minutes with difficult child over the past several days feels he is ready for discharge. Of course I may get to actually squeeze a phone call session out of him before I'm supposed to get difficult child. Maybe not.

    In our case insurance is not an issue, we are a rare case. Though we have no Residential Treatment Center (RTC) coverage we have UNLIMITED inpatient should there be a medical neccesity.

    Hospital psychiatrist who does not know the seriousness of our situation because "difficult child seems calm at psychiatric hospital" decided he is stable. Um, excuse me, he almost killed someone a week ago. He has a history of doing this so pardon me if 5 days of kissing up to escape the psychiatric hospital doesn't reassure me.:mad: Same psychiatrist who has no long term history or contact with me determines medical neccesity.

    As far as insurance they are amazing. The actual carrier only covers benefits and payment they are not a part of determining anything. An outside agency manned by psychiatric professionals funnels psychiatric hospital info. Here is what they told me.

    From inpatient difficult child could step down to day program and from day program difficult child could transition to outpatient.

    Inpatient = hospital 24/7
    Day program = hospital during day, home at night
    Outpatient = Maintenance level with 1 therapy visit per week

    Simple enough one would like to think. Here is the fun part. Since I am rural and live over 50 miles from the closest day program there is an automatic default up to the next level of care. (inpatient) As long as I cannot take care of difficult child with JUST the outpatient 1 therapy a week he automatically gets bumped back to inpatient (skipping the stepdown care) and the insurance will pay. Medical neccesity is part of it but only part, the default sort of over rides that.

    Sorry to be so darn repetitive, it seemed like the hospital counselor thought I was trying to explain the recipe to make plutonium out of common household products.:tongue: I sort of thought the concept was simple in that even if psychiatrist thinks difficult child is ready for step down he can't discharge yet until I can manage him.

    Of course I was informed their average visit is a week or less and they are acute care. Sort of like a mental health ER. It's a pump and dump philosophy. Pump full of medications and dump them out the door. While I understand the system is taxed we have coverage that will pay them.:mad:

    I kept trying to point out the violent nature of the incident and difficult child's history and explain that they have to keep him by insurance standards and that while their protocol is to determine neccesity (by psychic vibes and happy auras it seems) our protocol is a bit different from the average joe because of the default/distance.

    Is it just me or is it totally insane that they want to discharge a cash cow so early? We are like a gravy train, I just don't get it. I don't mean to rub it in because I know how blessed we are but geez. The once in a million that there is guaranteed coverage with no hassle the uninformed doctor is going to be the issue.

    All I was flippin asking for is time for difficult child to get to therapeutic level and bypass the potential side effect stage. Regardless of this psychiatrists personal philosophy, no trained professional should imagine a violent patient can be stabilized on a new medication in less than a week. I need to know he is safe and sane to come home and considering how fast he flips out when a slight medication change happens, you must see my concern.

    How do I politely ask the doctor if he will guarantee me difficult child will not go off in the next few weeks and if his malpractice insurance is up to date in the same breath? ;)

    I'm about ready to call a lawyer. It's cheaper than a casket and burial plot...I'm not kidding either, this is very gosh darned freakin serious.
    Last edited: Oct 5, 2010
  2. slsh

    slsh member since 1999

    Farmwife - sorry, but in my experience this is SOP. It's why I stopped counting hospital admissions at some point after 24. Stabilize, discharge, treat as outpatient. Lather, rinse, repeat, until the next time around when you get to.... lather rinse repeat again. I was so frustrated at about hospitalization #10, I actually asked thank you's psychiatrist (who was also the outpatient treating psychiatrist) if staff might perhaps make a demand of difficult child while he was in the hospital (say, ask him to brush his teeth or some other innocent request) so that they could see what we were actually dealing with. He literally patted my hand, said "Don't worry, we know", and then promptly discharged him. It was, pardon the pun, insane.

    Hospitals are not equipped to deal with- any more than simple stabilization, period. They wouldn't know what to do with- your difficult child, especially since he's honeymooning. They look at such a very small part of the problem that, from their point of view, he *doesn't* need to be there.

    I don't know what to tell you. My only suggestion would be to get an iron clad safety plan in place. Carry a cell phone with- you at all times for easy 911 access. It's hard because your easy child is so young - my younger 2 were 4 and 1 when it really started hitting the fan around here, but the 4-year-old could be counted on to corral baby into my bedroom and lock door until I gave the all clear. I would roll oldest's wheelchair into kitchen since the fun and games usually took place in the living room. With it just being baby and you - I'd make sure you have a solid door to a room where you can stay until help arrives, should he flip out again. Lock up all sharps/weapons/poisons/cleaners/etc. I mean, keyed lock, unbreakable storage, and wear the key around your neck.

    In the meantime, have you checked out the link JJJ gave you?

    I'm sorry - I know it makes no sense at all. I remember just screaming at a SW in the ER one time when she was declining to admit thank you because he'd "calmed down" by the time they got him to the ER. I ripped my shirt open, showed her the plate-size bruise on my chest from not ducking fast enough when he'd launched a shoe at me (I had the gall to ask him to wash his hands after using the bathroom), and asked her if a knife sticking out of my chest would be better proof of the level of violence we were dealing with. Even that didn't work. They only care about what is going on at that very minute.
  3. Farmwife

    Farmwife Member

    Yeah, I checked the link, good stuff but nothing asap, you know?!?! I do have an Residential Treatment Center (RTC) that we can work with but there is still a 3 week application period. The thing is though, he doesn't need that yet because he will have an alternate housing set up with my Mom and we have oodles of aftercare set up, enough to drown him in it.

    All I wanted was some time to make sure he is stable in reality not just minding his manners to escape. He's no dummy. This is a new medication afterall and we all know how long those take to settle in.

    I'm just disgusted with the system and maybe I'm being naive again and you guys who have traveled this road know the deal. I'm back to the same honeymoon then disaster period I get with difficult child only it isn't difficult child. It's every last expert, agency and service provider that promises us the moon, generally at our worst moments of desperation when we are ready to jump off a bridge. Just for a moment I want to cry because I am dumb enough to trust them and feel saved, feel a sense of relief like everything may be okay this time.

    Then as you all well know I am sure, they forget to call you, they suddenly lied about resources or are just plain useless in a plethora of colorful ways. Then, again, with not a single ounce of emotional reserve you have to fight a battle that even the experts can't win, ALONE. I am so sick to flippin' death of the rolodex of calls I have to make and the 10,000 question, on phone till arm and ear aches game. All they say is no, sorry, or call this number. Usually a number you already tried or that has the same lame "help".

    I should have known better. I wish I could upload a theme song to my life like people in movies. I need the Jaws song. That way I would have a constant reminder that danger was lurking and to never ever ever trust calm waters or put down my harpoon gun.

    I guess I better scramble to prepare for difficult child's arrival tomorrow, like it or not.

    Anyway, that's life. You all get it.

    I'm over it. If I didn't have an alligators thick and scaley skin I would be road kill squished under semi tires right now. I'm learning to have a healthy detachment from agencies. I'm tired of their lies, dissapointment and dysfunction. It's time I distance myself from them, lol.

    I am so glad I was blessed with a warped sense of humor and can actually find amusement in ironic tragedy. :tongue:
  4. smallworld

    smallworld Moderator

    How much Zyprexa is he taking?
  5. susiestar

    susiestar Roll With It

    You CAN refuse to pick him up. Or insist that he be charged with assault, though the police may or may not keep him. IF/when he is violent again you can call 911 and have the cops come. Even if he is calm when they arrive you can refuse to take him home/allow him to stay. I did this because Wiz insisted on beating me when he didn't like what I said/did/asked him to do. Wiz was warned. He was told that if he made any further moves to harm me, or to get past me and harm one of the other kids, or to harm one of the other kids, I would call the sheriff (we are in the boonies here) and insist that they take him. It was less than 24hrs later that he had to do it. The deputy tried HARD to talk me into letting him stay. husband came home before they were leaving and they tried to talk him into over-riding me. (husband told them that they would BOTH be kicked out if he did that, and he wouldn't anyway because not even his son is allowed to hit his wife. They were SHOCKED at that attitude)

    Even though the assault was days ago, you can still do this when difficult child arrives home. In your case, with little ones, I would NOT let him return to your home. Not now at least. If you go the route we went, they will likely take him to a county shelter - Wiz LOVED the one here - and you will go to court the next day or the one after. Then you will tell the judge that he tried to kill your husband and you cannot safely allow him to return home. You got him emergency psychiatric care, you are trying to arrange Residential Treatment Center (RTC) care, but it isn't in place yet and he is not safe to have at home. They will likely keep difficult child where he is pending a court date in 2 weeks or so (this may happen a few times = we found a placement for Wiz before the 3rd court date so they just acted like it had never happened after I called the judge's office to tell them that we had a placement.)

    IF you and husband decide to allow him to come home, you MUST have a WRITTEN SAFETY PLAN, including who goes where and does what. This plan must include provisions to keep everyone safe at night (I recommend some cheap alarms from walmart or radio shack for the short term).

    Most of all, I understand how you are feeling. In our case, the psychiatric hospital was more a vacation place for Wiz than anything. The short term psychiatric hospital, that is. Getting the other psychiatric hospital to keep him for 4 months was a LOT of work. To see the psychiatrist I had to go there for meetings that started between 6 and 7 pm, whenever the psychiatrist got there. He stopped doing the 6 am time when he found me waiting there at quarter to 6 - that time was designed to keep me from taking part in the meeting, at least that is what he so ungraciously said. He REALLY did NOT NOT NOT want anything to do with parents, esp one who took notes and asked him about it when he contradicted himself meeting after meeting. Tee Hee, his loss. He still had to deal with me and my notes and questions - ALL of which were super polite so he couldn't be upset about them, could he?

    Is it possible they will do family therapy before they dismiss him? Is is possible for you to go and ask him things that will upset him? Wiz would have been home after a month or so except I went into a therapys session and triggered him by pushing ALL of his buttons. I wasn't mean or rude, but I didn't need to be. I just asked him questions and insisted on answers. He blew. If you can accomplish this, it would let them see what needs to be treated, rather than the Disneyland side of your son that never comes home. It isn't a fun thing to do, and I felt horrible, like a total wicked witch and awful mother. BUt it was what my son NEEDED, that time in the psychiatric hospital, and it got him the treatment he needed so badly.

    Whatever happens, I hope things go well and you can get a placement for him soon.
  6. Shari

    Shari IsItFridayYet?

    Wow, stable and safe in 5 days??!?!?! Miracle workers. Why are they not on the front page of the WSJ with their breakthrough treatment program???

    Wow. I'm not sure what you do from here, but I'd b darn sure balking at brnging him home.
  7. DammitJanet

    DammitJanet Well-Known Member Staff Member

    FW...are you using a state psychiatric hospital? You know, the ones everyone thinks of in One Flew over the Cuckoo's Nest? I dont mean to be funny but I found that at least in my state, the state hospital was a godsend. It wasnt pretty or particularly fancy but they kept the kids far longer than your average 3-5 days of the for profits. The state hospital was Cory's last inpatient stay.

    He ended up at our local hospital which had no adolescent unit and they had to find a bed for him someplace fast. They tried to fast talk me into taking him home...even threatening me with legal action...but I refused. He had been in a group home when he was taken to the ER so I told them he wasnt brought in by me and I wasnt taking him home, if the group home wouldnt accept him back, the ER had to find some place. The only place they could find was the state hospital. They tried to scare me to death but it didnt work because I had been trying to get him there for months...lol. I said send him! He was there for 15 days and the psychiatrists were wonderful. They worked wonderfuly with us and him. Changed his medications to what I had wanted for almost a year. Cory actually signed himself in voluntarily. Then the hospital hooked him up with a psychiatric residential facility associated with the state hospital. He was there for 8 months. Again, not fancy but a great place. It was a locked facility which was what Cory had been needing for years. Best step I ever took. It was also income based.

    Something to look into.
  8. Farmwife

    Farmwife Member

    Well, had fancy pants doctor even spared me 30 seconds of his self important time he may have saved just an ounce of my sanity. Of course I am just a lowly insolent peasant who should accept his word as if it were holy and need not question his dominion over my child.:tongue:

    Stable on medications may be my criteria but the hospital and presuambly legal criteria is this:

    Stable= No imminent plans of suicide, homocide and no psychopathic something or other.

    So, if difficult child doesn't want to kill us we get to pick him up he's good to go. If he flips out in the parking lot and murders someone it doesn't mean he wasn't stable at time of discharge as long as it wasn't premeditated. :confused:

    So, have a hot date and a long drive tonight. Planning on the fly where I can keep "it" chained. Juvie is a no go because according to sheriff it is a very bad place, worse than big boy jail. Although difficult child is a monster at times he is ill and emotionally young for his age. Though he is large for his age I find it hard to place him in such circumstances when it was a medication mishap. it seems like punishing him for being ill because he couldn't control his actions. Maybe I'm wrong.

    Had to scrap plan's a through g. Now making plan h and i. Working on emergency and managment plan. Making therapy appointments and doing all last minute foot work. Too much to process all at once or post here but I am gearing up.

    On the bright side the sweet remorseful side of him came out at the therapy session. I know we have at least a couple month honeymoon stage. During that time I will be double reinforcing whatever stuff I have to rush through right now. don't get me wrong, I am set up just being super obsessive meticulous so we never get here again.

    Then there is Residential Treatment Center (RTC) as last resort. for now we have family who are begrudgingly taking him but it's a start until my Mom arrives in a couple weeks.

    Just so tired. Hate idea of another 2 to 3 hour round trip. Already had to go that far earlier for sonogram. I just wanted a bath, lots of yummy food and some sleep. I almost had a nice night planned. Maybe next year...

  9. TerryJ2

    TerryJ2 Well-Known Member

    If the sheriff warned you that juvie is a bad place, take his word for it. He has info that your son has bio/psychiatric issues and he knows what he's talking about.

    I agree with-Sue, to put an ironclad safety plan into place.

    And I commisserate: Stabilize, discharge, treat as outpatient. Lather, rinse, repeat, until the next time around when you get to.... lather rinse repeat again. I was so frustrated at about hospitalization #10, I actually asked thank you's psychiatrist (who was also the outpatient treating psychiatrist) if staff might perhaps make a demand of difficult child while he was in the hospital (say, ask him to brush his teeth or some other innocent request) so that they could see what we were actually dealing with.

    I think a deliberate escalation plan in the psychiatric hospital is a very good idea. Heck, they could even get a bunch of interns in there to watch, and they'd get more out of it in regard to training.
    The kids are well behaved because 1) It's a new environment and a "honeymoon period"; 2) Staff is "professional" and authoritative, particularly the doctors, as opposed to Mom and Dad, who are the scum of the earth; 3) medications are changed and supervised; 4) The routine is VERY routine because that's the staff's job and they have no extraneous items to attend to, like we parents do; 5) No one is asking these kids to do anything except an occasional 1/2 page of homework at a leisurely pace. No chores, no errands, no large assignments, no ringing phones or distracting doorbells.

    Wish I had some advice, except to agree about a safety plan.

    Won't you meet with-the soc wkr and your son b4 discharge to come up with-a family plan? That's what we did.
  10. timer lady

    timer lady Queen of Hearts

    Farmwife, I'm really not surprised. There isn't a system in place for treating less acute (i.e. suicidal or homicidal) but still dangerous (tho a difficult child will deny it) child. Sue's analogy of rinse, lather, repeat is very accurate.

    We've been through this with the tweedles ad nauseum ~ unless there is time to set up a step down to Residential Treatment Center (RTC) or hospital day treatment while a difficult child is in "acute care" they end up home with you.

    My concern is will difficult child be any less aggressive with your parents? Why not go to Residential Treatment Center (RTC) right away? It's likely the next best step in the treatment process. He's well contained & all treatment is in the same area. Less chaotic for all concerned.

    Keeping you & yours in my thoughts ~ this is a tough time for all concerned.
  11. Farmwife

    Farmwife Member

    Can I assure he won't get violent with my Mom, not really but his history, triggers and our plan should cover all his bases. The only potential issue is a medication reaction that has him very very very "off" rather than his usual return to being a troll in general. He *usually* gives ample warning before going green and turning into the hulk if we pay attention.:tongue: There have never been any jump off out of the blue episodes.


    *eternal vigilance, never take quiet time for long term (our biggest mistake)

    *intensive therpay and counseling long term though we will step it down to just one visit with one person a week eventually, maintenance stage.

    *Alternate family can take him for overnight respite if he is feeling edgy under his usual circumstances

    *Mood journal-3 times a day he MUST journal his mood with either a smiley, flat or frowny face. He is allowed to freely express rage in journal and speak his mind without consequence. Ie: "Mom is being a $%^$%^ today". Then he is conned into thinking about where he is at emotionally, something he must learn. At the end of the week we look over the journal as a family. Therefore he feels heard in some way and if he keeps a theme of something we can have a problem solving session. If it was a one day thing we mention that it's just a bad day, how did you handle it? ect. Nice way to address his needs safely while letting him be true to himself and responsible. I will assume days he refuses to mark a smiley or frowney face as a frowney day. Still works as a tool for me either way.

    *Mom is room mate and messenger, she will not parent or discipline. I will manage him as parent just with some distance. That way she avoids triggering him, they don't get into a power struggle and they can enjoy a stress free relationship. She will keep a secret mood journal merely to see emerging patterns and warnings for medication adjust or just declines in mood. We will discuss chores and her only job is to tell if he did them and if he did them right. If he wants any priviliges he must call to ask me. At that point I ask if he did his chores and verify it first by his mood (I'll know right away) then ask my Mom to verify. In that way whatever moods or funks he is in I only get a slice of in a short call. I can say no and disengage without seeing him sulk all day and have him push my buttons. I get to walk away!! If he vents to my Mom about how evil I am all she has to do is say "I'm sorry you feel that way, maybe you should go tell her in your mood journal" Then he can tell me where to go in paper and my mom doesn't have to be a part of his bashing session. If he seems moody she is better equiped emotionally to ignore him and can remind him that she is just Grandma and not a part of it so please "play nice".

    Basically she will only be sweet grandma and not authroity figure so we don't rile up his ODD side against her. Then he has a safe place with an adult who watches over him but a lot more space to have a functional interaction with. Less pressure to perform, less stress for him. More semi normal happy family stuff. Then when we do see him we can deal with his needs in a controlled session and then reward him with videos, board games and whatever fun family stuff he still does like. He will see that by communicating effectively he gets the attention and priviliges he needs/wants...and, yes....we can get along.

    That's the plan so far anyway. I don't get vacation days but I can telecommute to difficult child work. ;)

    oh yeah, the book explosive child is on it's way in the mail!!!!!
    Last edited: Oct 7, 2010