Residential Treatment for Non-Extreme Cases?

Discussion in 'General Parenting' started by firehorsewoman, Apr 17, 2015.

  1. Hello Everyone:

    I am back. I seem to check in once a year or so. I was quite active when I joined ten years ago, when difficult child was three years old. I have received wonderful support here. Yet, over the years find it too painful to hang out here too often. I hope that you all understand.

    But I am back for the expert advice I feel I can only get here.

    When I last left off a year ago, difficult child was living with me for several months (dad has primary custody.) His behavior and the situation with his father, stepmother and sister calmed down enough for him to return to their home at the start of the school year last fall. Since then, I moved to accept a job (finally got a good job!) about 85 miles from where I used to live and where difficult child lives with his dad.

    difficult child has continued to see a pediatric psychiatrist who specializes in mood disorders (he has been her patient for 1.5 years now) and the same therapist (for over a year) at the Children's Hospital that he has been going to since he was 2 years old. (Lots of p-docs, neurologists, psychologists over the years but the past 1.5 years have been stable with this one doctor who I think is excellent.) The p-doctor thinks that his medications and doses are appropriate and I agree. The problem is that his behavior is not one bit improved at home and as he gets older and we all become more weary the situation deteriorates. Both the p-doctor and therapist think it is time for difficult child to go to a Residential Treatment Center (RTC).

    I have read past posts regarding RTCs. Most of them seem to involve very severe cases. My son is not on the extreme. Bad enough for all of us to be miserable. But not as extreme as most of the cases I read about going to Residential Treatment Center (RTC).

    The main problems with my son at both homes are:
    purposely provoking family members, pestering, starting fights, constant arguing with adults and his sister
    mood swings-though much better than pre-lithium years ago still lots of yelling, screaming meltdowns
    lying, manipulative
    breaking rules
    constantly negative about everything, and it is always someone else's fault
    cannot be trusted alone at home for even a few minutes
    You get the picture.

    Doing fine at school although we all worry about how he is going to handle Middle School next year. Gets all A's, working several years above grade level in most subjects especially math. Only minor behavior issues at school since lithium but at home, no improvement at all. His doctors, dad and I had all hoped that once he was able to cope at school some of that would transfer to home life. It hasn't.

    So, I would really like to hear from parents who had similar (bad yet not extreme) situations with their difficult children and who also have experience with Residential Treatment Center (RTC). Did Residential Treatment Center (RTC) help or hurt? Did you consider it but then back off? Etc.

    If we don't do the Residential Treatment Center (RTC) recommended by the p-doctor, I am considering having difficult child come live with me for the summer. I will need to employee a respite type nanny or similar since I am now working full-time and have no other help. difficult child will hate it almost as much as being sent to a Residential Treatment Center (RTC). He hated it last time and worked hard on his behavior so he could get back to his dad's double income house with the cable TV, game room, X-Box, going out to eat all of the time, vacations, etc. My house is low-income and low frills. He hated that.

    I am also thinking about regular boarding schools. It is hard to say what is best for him. But something has to change. Both homes are really suffering.
    His father and stepmother are at the end of their rope and the time when he comes to my house with his sister (every other weekend) is just miserable.

    Thanks in advance,
  2. InsaneCdn

    InsaneCdn Well-Known Member

    No input on Residential Treatment Center (RTC), but...
    We had to split up our kids. (long story)

    Maybe if the kids alternated having weekends with you, it would give everybody some respite?
  3. Nice to see you again IC. I am sure splitting up your kids was difficult. Hope that it helped.
    Some weeks I have to work weekends so alternating the kids every weekend is an option but one that would take outside help just like if my son comes and lives here full-time for awhile. It may be what we have to do until the kids are out on their own.

    thanks for the reply
  4. slsh

    slsh member since 1999

    Hi there. Your question really got me thinking.... My son was in Residential Treatment Center (RTC) from age 9 to age 16 and then went to a transitional living program (TLP, supposed to prepare him for adulthood - NOT) from 16 to 18. My gut reaction to your question was do *not* send him to an Residential Treatment Center (RTC) if there is any way to avoid it - and then I was really surprised that I had that reaction. I guess I hadn't really thought about it in a very long time.

    difficult child was in 3 RTCs - the first one from age 9-12 was geared toward the younger kids. I think 13 was the oldest a child could be. The thinking behind that was children have different abilities/issues/cognitive development/behavior from teens and hopefully by keeping them away from a teen population, it might be easier to address things. He was discharged at age 12, came home for I think 6 weeks, was hospitalized once or twice during that time, then moved on to Residential Treatment Center (RTC) #2. Residential Treatment Center (RTC) #2 was simply awful. He was there for 11 months before I pulled him out due to, quite frankly, abuse by staff. It was shut down a couple months later by the state. He lasted another 6 weeks at home, with his usual revolving door hospitalizations, and ended up in Residential Treatment Center (RTC) #3, which was a locked facility (only one in this state) and ... well, they tried with him. We won't even discuss the TLP which was horrible because it was a client-driven program, meaning my difficult child got to decide what he was going to do (or not). So let's just skip talking about the TLP.

    Based on our experience with 2 good RTCs and 1 snake pit, I think my caution to parents considering Residential Treatment Center (RTC) is that no Residential Treatment Center (RTC) is going to raise your child the way you would. There are so many things that were done extremely differently by staff, even at the good RTCs. Even with visits every weekend, I think my son suffered from a lack of actual parenting. Does that make sense?

    I guess a better way to put it is that an Residential Treatment Center (RTC), in our experience, is an institution and is run that way. Absolutely there will be staff who will be caring and concerned, but there will also be staff who are there for the paycheck and unfortunately there may also be staff there who have their own issues and ... well, should never be allowed near a kid. I think you also have to understand that a pretty big proportion of kids in RTCs may be wards of the state, which means staff may not be prepared and/or willing to communicate with an involved parent as much as you may like. And - let's face it - most kids in RTCs are the absolute worst case scenario - either horrifically abused/neglected, severely ill, or completely out of control.

    Education is not going to happen in an Residential Treatment Center (RTC). It's really as plain as that. IEP be darned, they will teach to lowest common denominator and only when the behaviors of *all* the kids allow. If your kid has got it together in school right now, I would think long and hard before changing that.

    Now, my kid was most definitely an extreme case. He was hospitalized 16 times before he left for Residential Treatment Center (RTC) #1. I stopped counting hospitalizations when he hit #25, somewhere around age 16. He was extremely violent towards not only hubby and me but also his sibs. By the time he left for Residential Treatment Center (RTC) #1, the only utensils not padlocked in a tool box were spoons. My home decor wasn't Martha Stewart - it was "what will hurt least when difficult child launches it at my head." He was equally violent in school, having broken a teacher's arm at age 9. We were on a first-name basis with the police and EMTs in our town. He was a mess. We were too.

    Residential Treatment Center (RTC) did not help him, at least not in an immediate sense. Yes, there were folks who were not completely burnt out, who were able to handle his meltdowns and never-ending behaviors, but .... for my kid, anyway, nothing occurred that made it possible for him to live at home again as a child. Nothing got fixed. Residential Treatment Center (RTC) #3 actually had to resort to chemical restraints (a shot of Ativan) for a while to manage him.

    What Residential Treatment Center (RTC) *did* do was save my other kids. Not that they don't have some pretty significant emotional scars from life with difficult child, but it would have been *so* much worse if he had lived here his entire childhood. To be brutally honest, that's really all Residential Treatment Center (RTC) did for us and difficult child - kept him from annihilating every member of this family, including himself.

    Now, I know that Fran (long-term member and former owner of the board) sent her son to an "emotional growth boarding school." I wish I could remember the details of that, but he went for 18 months and then I believe was able to live at home for the remainder of his childhood. That might be something that would be more appropriate for your kiddo.

    I truly remember how utterly exhausting it is to live with a difficult child whose sole mission in life seems to be to create chaos and turmoil. Seems like all I did for years was put out fires (figurative only, thank goodness) and make sure the other kids were safe. It's emotionally exhausting and so much more. I really do feel for you. Home-based services were pretty much nonexistent in my day, but certainly respite sounds like it would be very helpful both for you and your ex. Maybe a special needs summer camp also? Mentoring?

    If I had to do it again, we would still have to go the Residential Treatment Center (RTC) route, if only to protect the other kids - but *only* to protect my other kids. It was not a good way for my difficult child to grow up and there are still moments when he will share something from his childhood that just makes me ill. We had no choice - and he was unable/unwilling to change his behaviors to make it possible to live at home. But we are talking about really severe violence in my kid's case. I would just very strongly caution parents to make sure they have completely exhausted every possible resource at home before going the Residential Treatment Center (RTC) route.

    On a positive note, my kid is doing pretty darn well now. I wish his childhood could have been different, but it is what it is.
  5. 4Tall

    4Tall Member

    Hello, new to board. My 11 yr old Difficult Child has been in Residential Treatment Center (RTC) for approx 1 year and is actually improving! We have a tentative discharge plan for Aug if things keep going well. A year ago, he had been becoming increasingly violent & angry. Several 5150 hospitalizations over 6 months & blowing out at school & at childcare.

    Residential Treatment Center (RTC) was the best thing for him. He is not a very abstract thinker, but he is definitely becoming more conscious about his behavior. And I am able to talk to him about things that happened to him in the past (before he joined our family at age 3) that created the need for him to develop survival skills that he needs to change now.

    Just had a great 5-day home visit with- him over Spring Break & I have a lot of hope for his return.

    On the other hand, my 16 yr old Difficult Child is also in Residential Treatment Center (RTC) for 3+ years and I doubt if he will ever live at home again, due to safety issues.

    Residential Treatment Center (RTC) has been a lifesaver for our family. The bottom line is that change had to happen. The violence and out-of-control behavior had to stop.
  6. MrConcerned

    MrConcerned New Member

    Did an insurance company pay for Residential Treatment Center (RTC)? If so, were there any deciding factors that led to them being willing to do so?
  7. Copabanana

    Copabanana Well-Known Member

    I have no experience with Residential Treatment Center;s for my child but want to put my two cents in anyway: I really like your idea of a boarding school. It seems like it would build on and reward your son's strengths: academic achiever, bright, motivated in school and able to or motivated to control his behavior in that sphere.

    There are many, many highly successful adult people that are very limited socially. Your son, one day, could well be one of them. There are some very high end, residential treatment programs that are okay.

    But, if your son is functioning in a school setting, why would he need this? I fear like the previous posters,that many Residential Treatment Center (RTC)'s would squelch the good stuff your child has achieved...Why take this risk if you do not need to?
  8. dayatatime

    dayatatime Member

    My Difficult Child is 17 and has been in a Residential Treatment Center (RTC) for 5 months (was in rehab for a month before that)- so has been out of the house for 6 months.

    I gave physical custody to the state through a voluntary placement, then was insistent with the state that this is the level of care he needed. I am low income and don't have any out of pocket expense.

    My kid is a miracle. He has changed so much. Is actually thriving for the first time, has a plan for his future, is pleasant to spend time with….. Not all of the kids are having that experience. My gut feeling is that for many the intervention didn't come early enough.

    If my kid was attending school, I might not have gone this route, but I also might have. *I* couldn't take it any more. And we were one another's trigger. And we weren't able to work with mental health professionals because he wasn't compliant….

    I'm not sure where he falls of the spectrum, but he had never had a psychiatric hospitalization (though there were a couple visits to the psychiatric er at the end)….. but they never seemed to care that I didn't feel safe with him in the home. It was all- so what if 4 hours ago he was screaming and melting onto the floor saying that everyone would find him justified if he were kill you… in the context of him having gotten somewhat psychical with me in the past. Right now he's telling us he isn't going to hurt you- so- bye- and by the way- he needs x, y, and z treatment. And you are his mother, so you are responsible for making that happening. Never mind the fact that he's 6 feet tall, 200 pounds, rages at you, breaks things, and will not comply with any intervention you put in place…….

    I did 5 years of trying to get help here, there, and everywhere. The problems where getting worse. One mental health professional along the way pointed out that what we needed was therapeutic foster care-- that might have been enough 3 years ago or so when she said it-- but I couldn't figure out how to get it-- now I know. I could have called cps and reported myself, then negotiated for it. But she couldn't tell me how. And I couldn't figure it out.

    At the end of the day the decision was about my own boundaries. It was an act of faith that my "self-sacrificing" was not good for anyone and that the best thing I can do is take the steps I need to take for me and then let the cards fall where they may. It's just full of grace that things have really turned around. He is actually *nice* to me these days. And my life is so much better- I am so much healthier- without him around all the time.

    But there was a lot of letting the cards fall. I half think that creates the space for what needs to happen to happen (for grace)- and I half think we really lucked out. I all the way know that my child was headed down a very dark path and that now he's on a path of recovery.

    The structure the Residential Treatment Center (RTC) provides is fabulous for him. Staff isn't perfect, but it's a good learning experience for him figure out how to get along with them anyway. And the treatment team is wonderful. But the way the system is set up I had no say in where he was placed, and they don't match placement and kids-- kids just go where there is a bed available.

    The fact that it's through CPS might actually help a bit because the case worker is required to visit me twice a month. I don't feel at all shut out. I felt very sad dropping him off there last night-- but that's fine. A little sadness isn't going to hurt me.

    As for education…. that had been a big problem. My kid is academically inclined but hadn't gone to school for a year and half. I tried working the DOE to get an IEP for emotional disturbance, but wasn't successful. When they gave him the education tests he was still scoring quite high, so there was no demonstrated need and they closed the case (and I was working with an advocate from family court- so I was putting in maximum effort and not taking an easy no). It seemed like they wanted to say that no, there isn't a problem here that needs treatment. He's just Bad. You should discipline him….. Make him go to school…. you're his mother…. He doesn't have educational issues. Meanwhile he wasn't *getting* an education. So, do I like the schooling the Residential Treatment Center (RTC). No. I don't think he's being challenged. It concerns me that there is no homework, because he needs to learn how to cope with homework if he's going to go to college, which he does plan to do (miracle). But, also, yes. They moved him into a more appropriate math class mid-year and he quickly caught on there too and is now helping others to learn the material-- that is self-esteem building. And he's engaged in school (miracle). Yesterday he told me stuff about the French Revolution that I didn't know. ….And, at the end of the day, it's a strength of his that can excel academically, but so what. Jails and psychiatric hospitals have plenty of bright residents. He's getting a less than optimal education, but much more than he was getting at home, and even if it wasn't more than he was getting at home-- In life being bright can be asset, but not if a person is bogged down with emotional needs that they can't apply themselves.

    For me, the Residential Treatment Center (RTC) is a gift from God. It has returned my child. …and he's returned himself. He needed to see the writing on the wall-- the staus quo is over. And he saw it. I think I already said this, but I'll say it again-- my gut is that some of the other kids can't see the writing on the wall, because they got this level of care too late.
  9. 4Tall

    4Tall Member

    Since I adopted both of my sons thru foster care, their Residential Treatment Center (RTC) is paid for by the Adoption Assistance Program (AAP). Their treatment team (therapist, psychiatrist, school therapists) had to recommend that the child needed this level of treatment in order for AAP to fund it. One of them had to write a letter for the County of Origin (where I adopted the child from).

    I still have all the legal rights for my child in Residential Treatment Center (RTC) and the treatment team includes me in all decisions, incidents, and updates. I go to family therapy there weekly.

    I have heard of some school districts funding Residential Treatment Center (RTC) through the IEP process for children with emotional disability (ED), but not lately in the state that I live in.

    Also, I have heard of insurance companies funding Residential Treatment Center (RTC), but not for a very long term.
  10. Thanks to ALL of you who have taken the time to reply and share your stories. It helps so much.

    To answer your question, Copabanana, the p-doctor and the therapist believe that since my son has been functioning well in school for the past few years that boarding school will not address his therapeutic needs. They believe he needs intensive therapy and help that he will not get at a boarding school. I see it another way. If he now succeeds in school, why not keep in that atmosphere versus both homes where it is constant chaos or worse? My son is very opposed to the idea of boarding school though. He does not know that the doctors are recommending Residential Treatment Center (RTC).

    Several of you mentioned that the Residential Treatment Center (RTC) were more about protecting the other family members than helping your difficult child. It seems like that is another reason my son's doctors are recommending this route. The collateral damage and fallout from living with a child like this is extensive. They see the damage that is being done to both households. I still think if the goal is saving the rest of us as much as helping him, a boarding school may be a better option.

    I have sent his father several e-mails communicating my thoughts but have not heard back from him. I told him that I am willing to have our son live with me over the summer to relieve the stress on his wife and our daughter. I have no idea what he is thinking about all of this.

    Thanks again for all the replied.
  11. Copabanana

    Copabanana Well-Known Member

    Hi again Firehorsewoman.

    I SO agree with you.

    Questions/thoughts: Could intensive psychotherapy not be an adjunct to boarding school?

    I understand your son may not WANT boarding school but is well-aware of the havoc (collaterol damage) he is causing in the family. He may not be in control, or (yet) have the tools to change...but do you not think he is aware?

    What about laying it out for him...(perhaps in a therapeutic context) like any other situation that needs a solution. Such as, you are doing great in school...however.... family life needs to be xxx and xxx. These are our options.

    It is not only a question of what he wants or does not want. We know this. He seems to be tyrannizing everybody when HE is unhappy with a given situation. Is there some kind of family conversation that is going on that HE is involved in, that is not just about him but WITH him? Really, he seems to have strengths that are not being called upon.

    I will go back and read some of the other responses but it seems like others, too, have the visceral reaction to his being sacrificed to save the family. There is something very (can I say) impressive about him, that amidst all of the drama he is involved in, he can be serenely and productively functioning in school. :angel: Or, can the situation be viewed another way? Perhaps he is the VOICE of the family?

    I don't know why but I am identifying with this young man. So maybe you need to read everything I have written through that lens. Copa
  12. Copabanana

    Copabanana Well-Known Member

    I just skimmed the responses. How much wisdom and experience!. In bigger cities there are paid consultants that parents can hire that work with families such as ours to find solutions that lie at the interface between child/family/school/mental illness/behavior. (I do not trust schools entirely, but that is just me.)

    They can help find the exact type of school situation that will address a specific child's needs, including colleges, and work with the child and family to put it into place.

    Such a person helped us, and easily suggested a solution that was PERFECT at the time. (She didn't charge us. I don't know why. And the remedy ended up being something I could afford.)

    Perhaps a professional such as this would have the knowledge, neutrality and the skills to assist you.
  13. We have been laying it out for him. His therapist is great. Last year when he was living with me he was going at least weekly. Since he has been going there for nine years and we are all satisfied (as best as we can be) with his current diagnosis and medications the main focus is helping him. We are no longer spending so much time trying to figure out the basics. So, yes, the therapist and his p-doctor do lay it out for him. Even weekly didn't help so we backed down to monthly because he was missing too much school and that was stressing him out. This has been the main issue that we all have been working his behavior is affecting the family. His therapist spelled it out quite clearly for him last week, Still, how can one really be sure these kids are aware on the level they need to be to make changes? I mean, that is part of their problem...some disconnect in the wiring it seems.

    She explained to him once again that all children must obey rules and listen to their parents and most kids are not too keen on that idea. i.e. that it's not just him. He tends towards the "I have such a horrible life" and it always everyone else's fault, etc. Blames his stepmother, sister, etc. That we are all out to get him. That WE never follow the therapy advice but are "happy" when she gives him behavioral techniques, journals, work-sheets, breathing exercises, any technique really to work on because it is more work for him. He says that we are happy to burden him. She explained quite well why HE needs to be doing most of the work and that she doesn't buy that we aren't following her advice and doing our part. He likes her and she has been great in my opinion. Last week she got firm with him. Gentle yet firm. So, yes, he has had this all spelled out. And he is a smart kid. Very manipulative and cunning as well.

    I wouldn't call how he behaves at school "serene" LOL nor productive LOL. It is a total struggle to get him to do assignments, turn in and not lose homework, etc. He gets excellent grades in spite of that though. When the p-doctor and therapist asked him why he can now (wasn't always the case) hold it together at school, he replied, "Because I can be my real self at school." I almost fell out of my chair. "His real self?" I think it is the opposite. I think he has to hold it in all day and he gets to unload once he is at home. Also, as he has gotten older and more academically advanced, I do believe his teachers are more tolerant. When a kid misses only on question total on the state standardized tests it makes the teacher and the school look good. I don't think it is a coincidence that his teachers became more tolerant and he has had less issues once he got to second grade. I may be cynical but I think they are more willing to deal with a difficult kid that makes them look good. The schools sure weren't tolerant of him when he was in preK and lower grades in elementary before he started academically standing out from his peers.

    And yes, he is included in this discussion in both homes. It's not like the big elephant in the room that nobody talks about. That nonsense ended many years ago. It is the main focus of both homes all day and every day even when we try our best to make it not be. "It" usually wins. That's one of the main problems with "it." It just won't let us be. There is no escaping it. When he was a baby or toddler or younger child and we were trying everything under the sun, when he was getting kicked out of school after school, all the phone calls from principals, all of the different doctor appointments, then got a divorce, finally got a diagnosis that fits, got him on medications that helped tremendously, maybe at that time there was not the discussion with him. It would have been premature. But the past two years or so he has been included all of the way. Last year when he came to live with me was an intense time. He didn't want to leave his father's house. But it was made quite clear to him the reason why he was sent to live with me. His sister and stepmother were at the end of their ropes. He is included in the discussions. The reason he doesn't know about the Residential Treatment Center (RTC) idea (at least I think that he doesn't know-still haven't heard from his dad-he may have told him) is because his therapist and p-doctor came to that conclusion after our appointments with them last week and only e-mailed that recommendation to his father and me this past Friday afternoon.

    None of us want to sacrifice him for the rest of the family but that is a tough decision most of us here are faced with it isn't it? There is no good answer. We all know that. And that is what sucks the most.

    Thank you for identifying with him. I love him. His father loves him. Like most of you we are just helping our difficult children battle their demons. But it is not easy. And we have others we love and care about (not to mention ourselves!) who are suffering. It is a tough position to be in. You all get that. Most people don't.

    Thanks again,
  14. Copabanana

    Copabanana Well-Known Member

    So tough, Firehorsewoman. Nothing more to add, except, your son so lucked out to have a Mother like you.

    And, I can't help myself: From your description he seems so special. In a good way. His intellect. Motivation. And his personal power. Copa :hugs:
  15. InsaneCdn

    InsaneCdn Well-Known Member

    If it was just you and ex... that would be one thing.
    But you have a daughter who deserves to have a LIFE. And she's getting to the age where it matters a LOT.

    Do you pour everything you have into your son - and maybe not even make a difference and possibly turn your daughter into a difficult child too?

    Tough call. I know.
  16. Copabanana

    Copabanana Well-Known Member

    Good point, Insane Cdn. Perhaps there is a course of action that can be identified that serves everybody's needs.
  17. dayatatime

    dayatatime Member

    Very quickly, because I've got to run---

    But it's important: I do not see making the decision based on your limits to be sacrificing your son. This is where all my alonon "training" kicks in. One thing is that the kids learn behaviorally-- so really defining what is and what is not acceptable in a home-- and having a clear boundary-- on this side of the line one lives at home-- on that side, nothing against you and we still love you-- but we love you so much that we are not going to make sure your needs get met, even if you aren't happy about it-- on this side of the line your needs are a higher level of care. We simply can't manage at home.

    I think that the only problem with self-sacrifice is that it doesn't work.

    I always think about my son as a future man who will be married to a future woman. I want to raise a son that will know how to behave in a home-- I do NOT want my son to learn that abusive behaviors are ok. And I do not want him to expect women to self-sacrifice, to curve their own self around him. I want him to be able to have a fully human relationship with another fully human person.
  18. Rina

    Rina Member

    My son has just started his stay at an Residential Treatment Center (RTC), so I can't provide much information just yet.
    However, I want to add this: protecting the other kids is extremely important. My son was never physically violent towards us (although I did find out that he was violent towards other people when it helped him get money to fund his habit), but the kids are not blind or deaf - they feel the extreme tension we're under, they walked on eggshells around their brother, and they were depressed. Add to that the fact that we had no time or emotional energy for them. That is NOT fair to any of them.
  19. 4Tall

    4Tall Member

    This is so well put!! Thank you!