Not sure about letting 15 yo return after psychiatric hospital ...

[pajamas]

It's been awhile since I've posted, been in and out and busy with work and the kids and you all know the drill ... I think the last time may have been when CeCe was released from Residential Treatment Facility (RTF) in February because insurance said enough! after 3 weeks, or maybe my delight in finally getting Medicaid approval a month ago. That came while she was back in psychiatric hospital for the usual ranting and threats - clearly prefers hospital to home.

She's back in again (#5 since December not counting Residential Treatment Facility (RTF)), and while I'm expecting this will lead straight back to Residential Treatment Facility (RTF) admission for a long time this time - what if it doesn't? husband and I are just not sure we can safely let her come home.

The issue is - she's escalated to playing with fire. Something happened at school Thursday. (No idea what and she won't say. I was out of town on business and returned to an urgent VM with no details from school counselor whom I can't reach.) She tried to convince Dad that only seniors had to go to school Friday, and when that didn't work, she ditched school (first time), caught a ride from a stranger, and came home. In retrospect, I think she may have been hiding outside before I even left for work!

Sometime during the day, she found the grill lighter (took effort), gathered up and lit candles all around, burned other stuff (not sure what, just can smell it). She got into other stuff too - unused prescription medications that had never been a problem before, maybe kitchen knives that we knew could be a risk - but nothing scares me like fire. When Huck got home around 4:30 he smelled smoke and called Dad. She denied everything - and "no idea" how candle wax got on her glasses. Otherwise, she was acting happy as a clam (usually a sign of trouble to me, but Dad never reads it that way). He was irritated, but rationalizing her behavior (all kids experiment, etc.). Then, when I get home a little later and he's telling me about it, we get the automated call from the high school that she wasn't there.

We called her IFI team, but before we could really get a plan together (they were coming out today anyway), Tink discovers a STILL BURNING candle HIDDEN behind a door! IFI called psychiatrist and (PTL!) there was a bed available at the hospital so off to the 6-hour admission ordeal (but at least we didn't have to detour through the children's hospital evaluation for Baker Act).

We'd been working with the mental health agency to get her back in Residential Treatment Facility (RTF) and it was progressing well, so I'm 90% sure that's where she's going from the psychiatric hospital. But what if it falls through? She is a RADish with no conscience and even less judgment - lacks cause-and-effect thinking. We have a pretty good support team, but it's not enough to have 24x7 on call - right now, I don't feel safe unless she's under 24x7 observation.

Have any of you faced this? What did you do?

PJ

 

[helpangel]

(((PJ))) I know it doesn't seem like it now but have faith that it will get better. Angel was diagnosis in 2001 and I thought I had problems back then but what you are describing sounds like 2006. It seemed like it was all day every day with her, so many psychiatric hospital admissions/ crisis center visits. The 6 hour camping out sessions at crisis center to find out meets the criteria but no beds available.

It will totally suck all the energy out of you and leave you wide open to get ill yourself. Try to use some of the time she is inpatient to rest and regroup - get adequate sleep, proper diet & drink lots of water. Talk to the team about your concerns about her coming home because it looks like there would be some real safety issues if that were to happen. Hopefully they will be able to come up with a plan B in the unlikely event Residential Treatment Center (RTC) falls thru.

I've been there done that it's a cruel world when you want to buy a nanny cam to spy on your 17yo; or when come home to yard full of police cars before you check the children you look to see if have coffee cream and a book in your purse because you know it's gonna be a long night.

I look at your signature (a lot of kids) and realize you probably know everything I wrote. I just remember back in 2006 there were times I needed to be reminded to breath. Going days without sleep and living off of coffee can really do some damage to a parents health. Try to take care of you - rattling the beads for you

 

[buddy]

Will hold out for the Residential Treatment Facility (RTF) in my thoughts/prayers for you! She clearly needs that level of 24/7 monitoring so can't imagine you having to decide what to do if they say no. I think I hear you saying that really is not an option. So, what kind of plan B can you make now? Has anyone suggested anything? Other than a treatment/therapeutic foster care home a typical foster home would never know how to handle that better than you could. Can they supply in home PCA or Integrated Listening Systems (ILS) types of workers for all non school hours until bedtime/wake time? It costs less than residential so if money is the issue, at least that could be an argument. I'm sorry you are in the position to even have to wonder.
HUGS to you...praying she gets the support she needs.

 

[pajamas]

I actually used to have a nanny with a black belt and a half-done psychiatric degree - was tougher than the kids (sometimes too tough). And I know of what you say about the book.

Just heard from our case manager - they get the fear and promise she won't be released from psychiatric hospital for 10 days and we should hear about Medicaid approval for Residential Treatment Facility (RTF) next week. I asked for a meeting to talk about plan b ...

 

[susiestar]

It sounds like you have some very valid fears. It also sounds as though it is not safe to have her spend any time unsupervised anywhere, and this is an impossible thing to manage in a home - even if the difficult child is an only child and both parents are home 24/7. It just cannot be done.

Do you know what the options are if you refuse to take her home from the psychiatric hospital if she does not go to Residential Treatment Center (RTC)? Can you find a phone number for the hs principal or counselor or whomever and call them over the weekend to find out WTH??? is going on that they cannot even return your call but can leave panicky voicemail. You need that info before you make any decisions.

I would look to see what would happen and what placements are available. I would also talk to my ins agent to find out if I have enough insurance coverage. NONE of the other chldren wuold be allowed in the home if difficult child was there and an adult was not. NONE of them, for their own safety.

You must sit down and prepare a WRITTEN safety plan to take this new threat into place. You need to have some family fire drills after you plan them out. Who does what, when, where everyone goes if there is a fire, etc... this site will help you create a fire drill plan: http://www.firesafetycouncil.com/english/home_escape_plan.pdf

You must make each person in the home aware of how to get out of every single room - 2 ways. If anyone will need help getting out, figure out who will help them and practice that.

Go and make sure that you have fire extinguishers. One for the kitchen, the garage, the living room, the bedrooms (NOT difficult child's bedroom as it will be seen as permission to play with fire) and anywhere that might have a likelihood of a fire starting or of difficult child starting or hiding a fire in that room.

get rid of all candles, lock up all lighters and if possible lock up the grill.

Contact the local fire dept to get some help and advice with how best to handle this. Make sure they know that this is a young woman with multiple problems including a lack of conscience, so you must prepare for the unthinkable as much as possible. Ask NOW if families are charges when fire depts are called out. Some communities do this if you live outside a certain area or depending on the budget. You must NEVER let a possible bill keep you from calling the fire dept. but you CAN see about minimizing that cost by paying an annual fee (some areas offer this) and you can also find out what you can do to help get your ins co to fully cover any fire.

Make sure you have enough smoke and CO2 detectors and that they ALL have fresh batteries. I have always had the habit of checking them on Halloween and Easter - roughly 6 mos apart - but you need to check more often to make sure that difficult child has not disabled them.

Be sure to check your laws regarding when a 17yo can refuse treatment, your legal rights, if you will be charged if you refuse to pick her up from the psychiatric hospital because it is too dangerous to have her at home with the famly. I would speak to an atty regarding your rights and the consequences of refusing to take her home.

I am sorry this is happening. be very careful to take care of yourself!

 

[pajamas]

... Other than a treatment/therapeutic foster care home a typical foster home would never know how to handle that better than you could.

Having been a foster mom, I'm not sure even a therapeutic home would work. They still have parents who need sleep. It would have to be a group home, and I have no good feelings about those. And even less about involving the DFACS/CPS and legal systems, although they are familiar with her. (We at least would be spared the child support payments others are faced with.)

I don't know the acronyms you used, but the idea of in-home supervision is good, and opens my mind to alternatives. We had a twice daily behavioral aide for a foster son once - maybe with the right sleeping medications ...

 

[buddy]

PCA is a Personal Care Attendant, they work with people of all disabilities to help with going to activities, dr. appointments, social things, hanging out at home, whatever is needed. Not a well paid position but there are some great ones out there. Depends where you live, your insurance, if the county would offer a way to provide it, many options....

I work with the county, many people do and it is not CPS. It is the disability unit and they provide a case manager (in our county they also divide it by mental health versus some of the other disabilities but they all provide financial options and support). So since my son has such behavioral issues (and you would be in the same category if here)... his level is bumped up...

For him he has a Traumatic Brain Injury (TBI) (traumatic brain injury due to a brain mass/surgery) waiver on his MA and it is at a higher level due to the behavioral issues and the high chance that he then would cost the county a lot more money (of course it is said that it is to help HIM to stay out of residential living/hospital care)....if he had to go into a residential living situation of any kind. So, we have Integrated Listening Systems (ILS) workers which are Independent Living Skills workers who hare trained to work on goals and are supervised by a behavioral company. They are educated at a higher level to start with and then have lots of training like crisis prevention and management, how to restrain safely (but it still has to be in a plan to use it unless an emergency) and how to teach appropriate behaviors.

Every county, state is different but I suppose if you dont ask you wont know... it can take lots of phone calls though, and with all of your kids you are no stranger to that!

(even if she goes to Residential Treatment Facility (RTF), that could still be a goal to work on since she is likely to visit or stay with you sometimes I suppose....)

Hoping the best for you.....

 

[TerryJ2]

Hmm. That's a tough one. She was an adopted foster child, right? (Not sure what you mean by ward from age 4.) My son did the lighting matches thing a few yrs ago and I *think* he's over it ... but we've had him from birth and I know pretty much what to expect now. I have no idea if she will continue to escalate or if she has learned anything. I love how naive these kids are; she's got wax on her glasses and has no idea who lit the candles. Uh huh.
Sounds like she needs more psychiatric hospital work but it may be a bit soon to totally throw in the towel.
I do agree with-the others that while she's in psychiatric hospital, you should use the time to sleep, exercise and take care of yourself.
{{hugs}}

 

[pajamas]

Thank you all. Some of our posts seem to have passed in the ether, so I missed some comments yesterday.

Re: "ward" - we're in somewhat of a legal gray area thanks to what amounts to malfeasance by the county attorneys and staff in the next state over. I check the "guardian" box, but it's more complicated than that. We have not adopted because I knew we would lose the option of accessing Medicaid if CeCe ever needed it. Although we were given custody of a sibling group with known special needs, we receive no support from their state (although we were awarded $56 per week in child support we never see - oohboy!). A well known child advocate attorney (just mentioning her name makes state execs nervous) suggested that we had a great case against 2 states, but we'd rather spend what we have on our family rather than her fees. Thankfully, the prior state acknowleges that we have custody legally (in loco parentis?).

Holden played with fire when he was younger - may 9 or 10 (which, come to think of it, is where CeCe is emotionally) - and we did involve the fire department who did a combo of scare tactics and coaching. What he was doing was actually more dangerous that CeCe's actions, open flames vs. candles. What freaked me out most was discovering the candle hidden on the floor behind a door still burning despite her protestations.

We don't want to throw in the towel, but have to keep everybody safe when she's here. Susie - your suggestions are very appropriate and practical, and a little overwhelming (time for the big-girl panties). I need to take the same disaster planning skills I use at work and apply at home.

More later ... the younger ones have developed a liking for church - a good thing, so off we go ....

 

[TerryJ2]

I hope Church went well.

I like the idea of disaster planning. One thing is to keep your cell phone on you at all times. Even in bed.

Keep us posted.

 

[pajamas]

The cell phone ... I do. Because I wasn't kidding about the disaster planning stuff. At one time I carried a 2-way radio 24x7 as part of a state emergency team. Now everyone just uses Blackberries.

Spoke with the psychiatric hospital weekend case manager this afternoon. CeCe's heavily playing the victim. She's called home and asked for husband to come visit - with a list of requests for novels and fast food. He suggested she spend more time thinking about why she's there instead. She very likely meant no specific harm with her candles - probably forgot the lit one even as she was lying about the others. But that doesn't change the situation ...

 

[TerryJ2]

Well, someone who is that impulsive that she can't take the time to think, after lighting more than one candle, needs to get some therapy and put on the brakes. Not thinking about one candle, yeah, I can see that ...

 

[pajamas]

yes, she's been getting therapy twice a week. ADHD is part of the issue, which accounts for not remembering how many - and there were a lot. She said 10, we found 12, but the 13th was the kicker ... we have to protect the rest of the family. The other part is that at 15 she takes zero responsibility for her actions or the effect on others. Not that any teen has perfected that.

It still looks likely that she'll go to PRTF, which is good. We saw some positive results from the last residential stay, but 3 weeks just isn't enough to have a long term effect.

 

[JJJ]

You are lucky that you have not finalized the adoption. You should be able to refuse to bring her home and to access additional services because of her status as a ward.

We refuse to ever bring Kanga home again. The risk to the family is just too great.

 

[pajamas]

Yes, but it breaks our hearts.