Need recommendations for Intensive DBT outpatient programs

[Mike worried]

Our 13 year old daughter needs intensive outpatient DBT and we are looking for recommendations on where to take her. We live near St. Petersburg Florida but are willing to go anywhere for the best care.  She has depression, suicidal ideation, one suicide attempt and most of her low moods were triggered by rejection sensitivity when rejected or slighted by friends when people told her she was fat or told her she should go look at pro Anna web site,  She has self injury/cutting and purging/anorexia and guilt even when person completely forgives her. She has not been diagnosed with BPD but her team says she has a lot of the traits. She does not have anger issues. She was Baker Acted once, did a 6 week partial hospitalization, and is about to be discharged from about 6 weeks of in patient residential care. She is a great student and athlete but has low self esteem. Her counselor and psychiatrist and prior psychiatrist all say she needs DBT. She has a lot of traits of ADHD but is able to concentrate but does try to be too perfect. We appreciate any recommendations for excellent DBT programs.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[kells76]

Hi Mike worried, glad you reached out. 13 is so young, that is incredibly difficult for all of you. I get what you're saying about the pro-ana sites and anorexia + purging, that's a whole other layer on top of her SI/depression/etc. She has a lot going on and, in a way, is sending a lot of signals that she wants you to keep helping her, so you're absolutely doing the right thing to ask for recommendations here.

Member Helena123 recently asked a similar question about inpatient, so I'll point you to that thread:

https://bpdfamily.com/message_board/index.php?topic=353999.0

Check out McLean Hospital's site (https://www.mcleanhospital.org/child-teen) as they do child/teen/young adult specific mental health care and have a very well regarded DBT program. Given your teen's multiple challenges, they sound like a good resource.

Their page with more details on care for kids includes this excerpt:

McLean’s world-class care is available for children ages 3-19. We treat an array of diagnoses, including depression, anxiety, ADD/ADHD, bipolar disorder, and addiction. Our specialty treatment programs for kids and teens with OCD and personality disorders are among the best in the world.

Our treatment options range from acute crisis management to intensive outpatient and day programs, and more. Each program helps young people and their families cope with psychiatric illness and the challenges it often brings. McLean’s state-of-the-art diagnosis and treatment are tailored to each child’s needs. Care focuses on symptom reduction and skills development. Patients and their families benefit from access to specialty consultation services throughout the hospital.

McLean’s child and adolescent services “catch kids in the act of doing the right thing so that you can praise them and raise their level of hope,” according to Chief Medical Officer Dr. Joseph Gold. He also emphasizes that new evidence-based therapies have transformed the field. These include dialectical behavior therapy, cognitive behavior therapy, acceptance and commitment therapy, and exposure and response prevention therapy. McLean uses these therapies to help children and teens build skills to manage their illnesses throughout their lives.

Make sure if/when you call them (number listed on site) you mention your kiddo's eating disorder -- while I'm sure McLean is familiar with dual diagnosis situations, they may also know of more resources or in/outpatient care settings that are a better fit, given the AN going on. Worst case scenario seems like, you call McLean, and they say "well, we're not the best fit, but try calling these 5 clinics, which based on our experience will be better for your child".

Truly hope this is helpful. Let us know how you guys are doing, whenever works for you.

kells76

[Mike worried]

Thank you Kells76!  I will call McLean tomorrow. It sounds like a great program and exactly what our daughter needs. The residential care she is receiving now has been great and she has stabilized. But now she needs DBT. I am worried she is going to be discharged too quickly and it is feeling like we are being rushed to make a decision on her care. Will let you know what we end up doing. Thanks.

[kells76]

Glad it was a helpful link. So good to hear your D13 has been getting solid care and is stable for now. You're really being wise to think ten steps ahead for long term care and recovery beyond her current situation. Check back in whenever works, we'd love to be here for you guys on the journey and hear how things are going.

[Mike worried]

Thank you. We had offsite visitation with her today and enjoyed spending time with her. She will probably be discharged soon and will start php and then io. Worried that if we tell her she should go to McLean residential she will feel like she failed and is getting worse. Will try to tell her she has done a great job and will be like HS or college level to go to McLean. I think she needs McLean and so do all of her counselors. Just need to figure out how to motivate her to want to do it. Also can’t tell is she will get more dbt in McLean residential or McLean 4 week outpatient.

[Mike worried]

Just to give an update. Our daughter is very much improved. We had a psychologist do neuropsychological testing. Tests results were very clear. Even though we had been told by numerous professionals that they do not diagnose children under 18 with BPD, he diagnosed our daughter with BPD. He said it was clear from the testing and the DSM-V does not have any limits on age for diagnosing BPD. We were a little surprised with the diagnosis at such a young age but also somewhat relieved to know what her condition was. A lot of professionals had seemed to be kind of holding  back on letting us know what was going on. In the Spring she did PHP followed by IOP and then we got her in with a truly great DBT therapist with phone coaching and weekly group meeting. She learned a lot of DBT skills. We had a Zoom consult with McLean and they recommended not going to McLean yet but continue with DBT to see how it went. McLean said they would be ready if we needed them. Happy to report that she is much improved!  She has been making new friends, started in a new school, and is playing volley ball. She has gone over 4 months with no self harm and minimal suicidal thoughts. Her psychiatrist says she is doing well and the medications seem to be working!  Such a difference a year of high quality mental health treatment has made.

[kells76]

 

So great to hear, Mike worried! Thanks for coming back to share the good news. I know it'll still be a journey with ups and downs, yet I hope you and your family can feel more secure knowing that (a) your D is doing better than she was and can engage in life more, and (b) the resources are there as a safety net in the future.

Really fantastic to hear that you were able to intervene for her at a young age. Hope she can now focus on "kid stuff" like homework and volleyball 

Drop back in any time;

-kells76