Thoughts racing-difficult child being released 2morrow

[jodyice]

Been trying to figure out the last 2 days what to post about difficult child being released from psychiatric hospital tomorrow and still don't have much to say that may make sense, but here goes.
Our meeting at the hospital on Friday didn't really accomplish a whole lot, what did get accomplished was, the family based team is going to put more hours during the week at the home with us as well as help on Sundays. Maybe I should back up a little bit. "You know that placement in Residential Treatment Facility (RTF) isn't going to happen overnight." That's what was said to us, and husband and I knew that. Alternative to him coming home in the meantime was to be placed in juvenile hall and I've been doing some research and those in juvenile hall it can take 6 months or longer before they're placed into Residential Treatment Facility (RTF), nor do they get any kind of mental health supports while they're in juvie. And there also wouldn't be anyone for him to communicate with while he was there, and foster care can't deal with the deafness either, so we truly didn't have a choice in bringing him home on Monday. *fast forward a little bit* One thing husband's boss is going to adjust his works schedule so I'm not alone with son by myself for too many hours. His normal psychiatrist says she has no trouble in recommending Residential Treatment Facility (RTF) for difficult child, so that's something that before she didn't want to do, but she's changed her mind on that, she still wants to try to get him placed into the one that deals with deaf children, which would mean a fight about the diabetes again, but sd said they'd pay for a nurse to be with him just for his diabetes. So my fingers are crossed. Another thing that was disheartening, a few of the other Residential Treatment Facility (RTF)'s I checked into have lawsuits against them, one for breaking a child's arm because staff sat on the person, and the other a child died because staff wouldn't get off his back and he had asthma. The kid weighed 117lbs and the staff person weighed 300. These types of stories are killing me inside. The one place that does sound promising is in another state, and insurance has to try everywhere in this state first.
During this meeting we had the family based lead there and his supervisor as well as on the phone we had the SD there, and the school he attends as well as the mh/mr case worker, and his therapist. SW said we had alot of support, I know we do from his school and from his therapist, but I'm still not sure the supports are there from the others. (just little things that have happened). SD said she didn't realize that difficult child was still having problems in school since he does have an aide during the day with him, school has called SD and has apprised them of the situation.
SW says that since difficult child has been there, there's not been any acts of violence or any agitation, but he's still been a bit oppositional but they're not sure how much that is true oppositional behavior or because he's misunderstanding the interpreter and it's causing frustration. He also says he has racing thoughts and don't know how to control them, and that he still has an evil person inside his head telling him what to do. His glucose levels still aren't under control either. They keep changing his insulin doses
After the meeting we visited with difficult child for a few minutes, the SW had to wake him up to come down to see us. He's been sleeping alot while he's there. In my opinion, I think he's been sleeping so much because they're just keeping him drugged up to not deal with any violent behaviors from him. I mean, I'm happy he's not showing the behavior he did at home, but there's got to be a different way to handle this than to keep him so doped up all he wants to do is sleep. According to the nurse the only thing they increased was the Geodon and that was only the bedtime dose.
Anyway that's the latest on what's happening.

 

[kris]

first the positives....one, they are actively pursuing an Residential Treatment Center (RTC) placement for him. two, it's likely he'll get placed at the one for the Deaf (a huge issue i'd think). three, you are getting more support in the home including husband's hours being adjusted.

negatives...why is him being a diabetic such an issue for any Residential Treatment Center (RTC)? they have to have a nurse or paramedic on staff 24/7 i would think. what if a child gets seriously hurt. they need someone medical close at hand. they can arrange for him to be transported to a diabeties specialist i would think.

i know you're scared about having him home again....i know i would be. make sure you keep your cell phone by you at all times & program in 911 so it's a button to get to them. get a safety plan in place before he comes home. sit with-husband today & discuss what the options would be.

is there a crisis team you can call?? get them on speed dial too...home phone & cell.

holding on to good thoughts for you.

what are they saying about the voices in his head? do they think this is auditory hallucinations??? no medication changes except the increase in the geodon?

kris

 

[jodyice]

hi kris.. that's one of the things husband and I have been having a hard time understanding. The one place for the deaf, they told us in a medical emergency they use the nurse at the current school difficult child attends, (that's how close the places are) until 911 can get there. They've never had a nurse on staff there, which I thought was against the law? When we checked into getting him placed there a year ago, the hospital was going to go there and train the staff about highs and low blood sugars as well as train them into giving him an emergency shot if difficult child would go into shock, they said they didn't want that sort of responsibility. And yet in the past they had a child there with a trach tube and they had to learn to clean that, etc, I don't understand the issue with his diabetes being so much harder, myself.
I'm going to program 911 into mine and husband's phone.
Also crisis team gave us their cell numbers but not their home numbers, which I still need to program into husband's phone, they're already in mine. The other crisis number we have for our county is a joke, you call them, they tell you to call 911. They're no help whatsoever, and yet, they're supposed to be able to do a psyche evaluation there.
The voices in his head, they've not responded to, we've asked questions but they keep putting us off, almost like they've never come across that before. Makes me want to just slap people sometimes, and I'm not a violent person. And from what the nurse told us on Friday was the Geodon was the only thing they've adjusted at all, they've not added any other medications or taken anything away, other than he's not had to have any ativan since he's been there, but that was only on an as needed basis anyway.
I need to sit and write out a whole bunch of questions today so I can ask them when we get to the hospital tomorrow.

 

[kris]

re: the diabetes. most people manage their diabetes quite successfully at home. what is their issue??? it makes no sense to me that they can manage a kid with-a trach & not a kid with-diabetes? is he considered brittle (i know, most juvenile diabetics are but still). does he tend to run high or does he have a lot of lows? i'm atypical in that when i get sick, upset, stressed i run low...extremely....as opposed to the usual highs most experience. my kids learned at an early age just what to do (used to know more than the health teachers in school lol) if i went low & how to give me insulin if they needed to. it's NOT that tricky. besides, you are close by & they can reach you easily if they need to be talked through anything or have questions.

love how they are ignoring his voices. doesn't occur to them that a big part of why he attacted you might be because he was *told to*. again, arrrrrrrrrrrrrrrgh!

keep plugging & pushing. he needs more intensive care than he can get at home or at the residential school for the Deaf you guys are connected with.

kris

 

[timer lady]

Joanne,

I've delayed discharge by a day or two by demanding a viable discharge plan. Given the level of aggression & whatnot displayed by your difficult child I think this is something you need to push.

Viable means guaranteed response by crisis team. Guaranteed re-admit to hospital if necessary. Possible PRN medications.

Your difficult child is in no way stable; you are in a holding pattern until an appropriate Residential Treatment Center (RTC) placement can be found. Hospital staff are asking for you to hold a bandage on an open, bleeding wound. Not viable.

wm's last hospitalization lasted 6 weeks (with a lot of noise on my part) until an appropriate Residential Treatment Center (RTC) bed opened.

Can you, do you have the energy, to push this? Who do you have as an advocate that will back you up on the need for a viable discharge plan?

Just some thoughts for you this morning.

Will be keeping you & yours in my thoughts this morning.

 

[jodyice]

Yes he is a brittle diabetic. Sounds like you and I are alot alike in that aspect Kris, I run low when upset, angry, stressed, sick, etc, but difficult child is the opposite.
Training to use the glucagon kit isn't all that hard, as husband would say, "any trained monkey could do it." Even at his current school the teacher knows how to use it as well as those in the dorm. That's why it just infuriates me that these other professionals don't seem to want to *waste their time*. We're still going to fight that.
And apparently the voices in his head they're not too concerned about. One of the things that I'm bringing up tomorrow before he's released.
The hospital has already pushed the insurance company into keeping him there past Friday, which is when they first wanted to discharge him.
The lead on the crisis team we have lives just down the hill from us, so it wouldn't take him too long to get here, if need be, so he'll be our main contact. The other person on the team lives over an hour away, so if we need to travel in her direction for psychiatric hospital or school, that's when we contact her.
The community meeting discharge plan states.. (names not given to protect the innocent.. ~laughing~)
family based with increase time spent with family.
difficult child to return to school wednesday, school policy to keep them home 24 hours after psychiatric hospital release.
psychiatrist will do a psychological evaluation for the referral for Residential Treatment Facility (RTF).
mh/mr unit will discuss funding and start a bed search.

Oh and the way I understand it, is even though psychiatrist states he needs the Residential Treatment Facility (RTF) placement, it's up to the insurance company to feel that it's medically necessary before they will agree to it. So I wonder how far difficult child has to go before the insurance company would feel it was medically necessary..

I've been searching so much online lately, I can't remember everything I've found, so I began printing things up. I think I will go through with a highlighter and mark everything to help me remember what I want to bring up tomorrow.

Besides ativan what other medications can be used as a prn that would work faster than the ativan?