Plenty of "newbie" Residential Treatment Center (RTC) questions

[Farmwife]

Please forgive me if these questions have been overdone before...

*What is an Residential Treatment Center (RTC)? I have a vague understanding from conversations in here but that's about it.

*In general, what are the standards and requirements a difficult child needs that get them placed in an Residential Treatment Center (RTC), or at least psychiatrists thinking that Residential Treatment Center (RTC) is a good idea?

*How awful is the insurance approval process? While I know they all try to get out of it, are there markers and situations that they HAVE to work with assuming it is covered? (difficult child has BCBS as a primary and medicade as a secondary. Aside from their red tape both provide excellent coverage)

*How complicated is the transition from psychiatric hospital to Residential Treatment Center (RTC), is it a long transition/application process or can a stop at home in between be avoided? I would like to avoid having DCFS step in, in the interim but refuse to allow difficult child home.


In hindsight I realize asking my mom to take difficult child is not a good idea. She is a classic enabler and accepts abuse mentally, she is a victim. Allowing difficult child to stay with her is only a solution to prevent violence in my home, it does not help difficult child in a therapeutic way. Essentially I would be dumping difficult child issues on her for a lack of a better solution and difficult child essentially learns that the more awful he becomes the easier life gets...not a good message to send.

I don't want to disrupt difficult child in school or have him think we are abandoning him but I think he has officially exceeded our capacity to manage him anymore, about a year ago. Right now damage control is important.

To him we hoover as parents so the conflict is with us. However, we are not the problem. As he turns 18 there will just be another victim and another set of people who irritate him like his parents did. He cannot escape his own inability to manage himself just because we the immediate stressor can be removed. ie; he won't suddenly become cured and be a good citizen just because he can move out someday and "tell us where to go".

All this time I was believeing and being led to believe that difficult child issues were my lack of skill and appropriate structure as a parent. All the professionals this far want to convince me and themselves that if I change enough he will suddenly find my role as parent less impossible to deal with and he will be a good kid. ROFL! I blamed myself for his lack of "recovery".

Enough of that. I love him but had a serious case of denial. He is a really awful person. I still love him but he is a real nasty individual and although he is mine to love and be responsible for I don't deserve to be his victim. The grown up world makes no excuses or accomadations so why should I have to? (that was a rhetorical question, lol)

I LOVE the smell of reality.

I think the system refuses to accept that in some cases the parents are the abuse victims and it doesn't mean they are bad parents. Teaching us to manage him amounts to walking on egg shells to avoid his wrath. He knows it too. difficult child isn't just an average bad kid who needs a time out, he has a mental illness so telling us to redirect him and give him choices is like putting a fire out with a garden hose.

 

[smallworld]

An Residential Treatment Center (RTC) is a treatment center. It is typically for children or adolescents who have mental health issues that need treatment, both medication and therapy, on a 24/7 basis. It includes an academic/educational component (in my son's Residential Treatment Center (RTC), that's about 4 hours a day). Children go to RTCs for a variety of reasons, but in general terms, it is typically because their needs cannot be met in the home or in their community.

You have to call your insurance company to see if it covers Residential Treatment Center (RTC). Many don't. We have BCBS through my husband's law firm, and it doesn't cover Residential Treatment Center (RTC). Sometimes SDs will cover a portion of Residential Treatment Center (RTC) through the IEP process.

I don't really understand your last question.

 

[Fran]

Farmwife, I think one of the most important issues is mindset. If you feel you are punishing him or throwing him away, he will feed off of that and/or feel that way.
This is a tool. It will not cure him but it will help him start to set boundaries. It is a gift to let him have a chance to turn his life around.
By the time I sent my difficult child to a residential program, I had tried everything else there was and had NO success. I believe that if you try something else like Residential Treatment Center (RTC), you have to let them do what they do. What we did didn't work and I had to have a leap of faith. It's difficult to entrust someone with the well being of our child but my child's well being wasn't being served by the way we (professionals, schools both private and public and us) were going about it.
I was eternally grateful to have the respite and the opportunity to have 24/7 help. I could not do it and have a family and a life.
I always told difficult child that we couldn't seem to help him and this program would help him more. As soon as he could change his behavior then he was welcome to come home. He was always loved and always a member of the family. He had to learn how to deal with his emotions to live with us though.
We had no insurance or sd coverage. Didn't even know you could get it. I hadn't found the site when I initially sent difficult child there and no one told us differently. We figured it was our problem how to pay. How uneducated we were but my difficult child was drowning and taking all of us with him.

 

[Fran]

I forgot to mention, you have serious safety concerns. When you know that your son is safe to have in the home, then he can return. It will be the single most important issue you need to address. in my humble opinion. As long as he is a danger, he should not be in your home, around the baby and around either you or husband alone. At least as a pair one can call for police help.
Again, I suggest you put a plan together for what to do in this situation. The caseworker at the hospital can help you with this too. There may be direct numbers to call to get assistance in an emergency.

 

[Farmwife]

I really think difficult child needs an Residential Treatment Center (RTC) and I think we need it as a family as well. It took me a long time to get over guilt, sorrow and then allowing myself to give up in a way that isn't actually walking away but seeking other options that seemed to painful at first. Letting go isn't easy but it is what is best, I finally see that and it isn't in a wishy washy "he's doing better for now" way. I kept concentrating on his good side and making excuses for his bad side. The danger level is simply too high to ignore anymore.

I know I am in the fight for my life to get him into an Residential Treatment Center (RTC). My only ally is his regular psychiatrist.

Regular psychiatrist- already very on board with a local childrens home referal for short term, she is easy to work with and just an awesome person. She recognizes and acknowledges the situation for what it is. Long term care isn't something we broached yet. Even though she is well known and respected in our area she is the rare gem that both values and respects my parental input and research/opinions. She actually listens.

psychiatrist at psychiatric hospital-Seems to be one of those busy important types who may or may not be on board but was VERY reluctant to admit difficult child in spite of dcfs referal because difficult child was calm at emergency room. Um, hellllooooo...he has a cyclic mood disorder and odd. Calming down don't mean squat after an assault at home.

School-Fo'get about it! Even IF they saw a need they would still cost us more in legal fees than actual Residential Treatment Center (RTC) cost. Plus, difficult child has good grades so there is no way they will see it as their problem. The outbursts are at home. In spite of some academic needs he is a perfect sweet little angel in their eyes. Unless I'm missing something I don't think they are technically responsible in our case.

DCFS-May or may not be in our lives voluntarily. They also hold very close to the theory that I need counseling, I need classes and some anger managment for difficult child will be the cure all. No matter what I suggest difficult child needs they counter it with what I "should be doing". It's just another wall to talk to. On top of that they do not want to foot the bill either. I have already been clued in that odds are I will HAVE to take him home or my only other alternative is a "lock out" and eventual having to sign him over to them or have them take him. I either tolerate his garbage with minimal help on their end or they yank him and presumably continue to have nothing much to offer and I lose custody along with potential issues with other kids in house. We will get past the "incident" unscathed but they will punish me legally with their authority if I insist on REAL HELP.

DCFS also would rather dump him on family instead of help him. IF they get custody they will just send him back to his abusive birth father, the unmedicated schizo who messed difficult child up in the first place. The ex is manipulative and can play normal long enough to get difficult child and then difficult child is lost forever to a perpetual adolescent Dad who will give him no rules, boundaries or mental health support. He'd have better odds trying to run across a highway.

Our finances-Going to mess us up at every turn. On paper we look comfortable but we have limited resources in reality. A couple to a few hundred a month is possible but it would create a rather large hardship. The thousand or more Residential Treatment Center (RTC) requires is absolutely beyond our means. Although loans and second mortgages are suggested I just can't see 30 years of financial hardship in order to help difficult child. I know that sounds cold but we have been through a lot already. Throwing ourselves and our OTHER CHILDREN into lifelong financial hardship is just more than we can deal with anymore. If I knew it would "cure" him or had a 100% chance of rehabilitating him, maybe. It's also likely adding 20, 30 or even 100 thousand in debt won't add up to much in his life and he would still come back and steal from us while we are still paying off his trip to "camp". I'm just not willing to bleed myself dry anymore. I have my own life to lead and needs too.

What do you guys think?

My only other idea before researching the link in the thread is boystown.

I'm so burnt out. Yet another battle upcoming with the powers that be...this is the LAST one. I'm done. I have nothing left to give.

 

[smallworld]

First step: You should at least call your insurance to see what is covered.

In our case, our insurance didn't cover Residential Treatment Center (RTC) and our SD didn't deem Residential Treatment Center (RTC) necessary, but we still felt our son needed intensive treatment before he was at the age when he could refuse it so we borrowed the money. In our case, it has made a world of difference because his needs were matched to an appropriate program.

 

[DaisyFace]

FW--

The only thing I have learned about financing RTCs is this: Medicaid will no longer cover the entire cost. The bill is split 2/3 to Medicaid and 1/3 to referring agency. In my area, this means that no one is willing to go on record as the "referring agency" if you have Medicaid.

I do see Residential Treatment Center (RTC) facilities advising parents to apply for "Clark Behavioral Health Financing," which is a loan program.

Good luck!

 

[Farmwife]

In my area, this means that no one is willing to go on record as the "referring agency" if you have Medicaid.

Such a short and sweet way to express what I have been feeling and sensing. I knew there was a magic trick up their sleeves.

On the plus side I think the insurance is a maybe. Maybe is good, maybe is not a no so I can work with it.

On their website coverage literature it comes down to two things, medical neccesity and diagnosis. Can't speak to a human until Monday.

Diagnosis may need to be tweaked because they had depressive stuff and BiPolar (BP). difficult child is cyclothemia which is a close cousin of both and pretty much a more specific diagnosis in that family. I know psychiatrist will work with me on the dreaded label lingo to get him in and recent psychiatric hospital stay is a good way to justify it.

Medical neccesity is up to psychiatrist, again a non issue with regular doctor but not sure psychiatric hospital doctor will be on board. Then the MH unit of our ins. looks it over. They don't have to agree that it is neccessary and may not since again, difficult child is an angel and they won't be able to predict his next violent assault. We can argue that the very nature of his disorder is being unpredictable and that we cannot offer stability in our home and community. At that point I can thank them very much for a history of paying generously for counseling that didn't prevent said assault...

After surviving and winning a brutal 9 month war for the IEP an insurance company just poses as a mere amusement for me in my time of from real worries.

The best part is that the determining agency is NOT a part of our insurance carrier. They are independant and run by no one less than a licensed counselor but have a lot of MH staff manning the lines. I called once for advice and they were very kind and willing to help. Cost was a non issue for them we just weren't this bad off back then so didn't really qualify and I agreed.

Once/if approved our coverage is very generous and our deductables managable.

The approval process is repeated for different things- admission, time of stay and something else I forgot. Though it is a lot of steps they also have a very patient friendly appeal/grievance process. There are even provisions for emergency determinations and/or appeals with an answer in 24 hours so we don't get stupid delays that prevent care.

As I see it the cost of an attorney for the appeal process is a small fraction of the cost of me paying out of pocket.

I am sooooooo doing this and someone is soooooo helping me cover it. Mark my words. I am done messing around with agency games. I am done spending years looking up boarding schools and sobbing when I see the tuition rate.

I know my rights. This warrior Momma is JUST getting reved up. I have to thank the dink school admin for the iep drama. That was perfect basic training. I have never been so determined and confident in my life. I think I feel downright cocky today.

Amazing what a couple days away from difficult child can do...

 

[JJJ]

Farmwife...does your son have impaired reality? If so, try this program for funding....http://www.dhs.state.il.us/page.aspx?item=33654

It is very tough to get but it has been a lifesaver for our family. It has very specific criteria so look around the site and if you think difficult child will qualify, it might be worth the time to apply and appeal (they deny almost everyone the first time, we got ours on the first appeal...I met another woman who did 3 applications, all denials, all appealed and finally won on the 3rd appeal).