Update: Hospital > Home > RTC?

[Elbry]

So the P at the hospital that I loved so much changed his mind about the RTC for DD15.  He called me last week and said she was doing too well and no longer met criteria for either hospitalization or Residential Treatment.  We had a phone meeting last Monday and I expressed all my concerns including what a good actress she is, and how I have no trust at all in her anymore she has lied and manipulated and schemed too much.  I asked, how are we supposed to know if it all just an act or not?  The P politely informed me they are professionals and are trained to spot things like that and that everything about her had changed.  She was working hard in groups and individual, her affect had changed, her interactions with staff and peers had changed.  She had opened up and was talking about really difficult things that she had never talked about before.  I left it that I wanted all her providers up here involved in the decision and on the same page.

So Wednesday I make the 3-hour drive down there for a meeting.  Her T was on the phone as well as her CM.  Her clinician at the hospital had spoken earlier by phone to her med manager and her med manager was adamant that DD go to a RTC.  It was unclear if she would even keep seeing DD as a patient if we brought her home.  We talked more in the meeting, DD shared a lot of things she has worked on, a new safety plan and a lot of other work.  Her T was ok with her coming home and upping her services to twice a week and making her do DBT with the T as well as in group.  Her T also wants her to get a section 28 worker which is someone that would spend hours with her every week, taking her out in the community doing stuff, working on coping skills etc.  The P felt that RTC was just putting off the inevitable, which is her coming home.  Yes, it would keep her safe for awhile, but we have to deal with her coming home at some point.  He felt the treatment she needs is not what she will get at a RTC, she needs to be home getting services. 

Soo... .I brought her home.  But we still submitted the paperwork for the insurance approval for residential.  Just in case.  Her CM just called me and she got approved.  The approval is good for 60 days.  I'm really struggling.  I don't know what to do.  The P thinks that even if we do apply to a facility, they will turn her down because the hospital clinical notes don't support it.  Not just that he no longer recommends it, but that clinically she doesn't need it. I'm not going to tell her about this because she can hold it together and fake it long enough for 60 days to go by.  Last time she made it almost 6 months.  I really wish that her providers were not so split on the issue.  I just don't know what to do.

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

[jellibeans]

Elbry

You are in a tough spot... .I really don't know what I would do in your situation. My own dd17 has shown great progress at times then out of the blue had a step back. I do think it might just be part of the process... .I am hoping there continues to be longer stretches inbetween the breakdowns until there is a point she is somewhat stable.

I don't really think I can comment on your situation because you know your dd the best. I do think it is good that she is home and they have seen improvement with her. I am not a big fan of RTC but I know they are neccessary at times when our kids are not safe at thome. Is fear driving your decision? Do you have anxeity around her return home? I certainly think I would too in your circumstances,

Is it possible to just take a wait and see approach for now? You have 60 days to watch and even if things go bad after that date I would think it would be pretty easy to get approval again. I wish I was more help to you. I know the feeling of not really knowing what is the right thing to do but try not to be hard on yourself. There really isn't a right or wrong answer... .just make your decision and go forward without the fear.

[jellibeans]

Elbry

just wanted to check in with you to see how things were going with your dd? Can you give us an update?

[PyneappleDays]

It's a good thing and a scary thing.  You should do a lot of reading try counselling for you and you and her.  My dd hates group counselling.  RTC are only temporary as well as hospitals.  They are only there to stabilize things.

There are things on this site that can help you very quickly.  What are your boundaries and house rules what are you going to do to enforce them.  This is a whole family thing.  What are your daughter triggers?  You don't have to completely step around her you just know.  What is she willing to do and does she recognize them?

There are ways to moderately discuss them.  Not a hammer situation just brings things up periodically.  This is where the counselling comes in handy.

Good luck.

[Elbry]

Hi Jellibeans and Pyneapple! Thanks for your replies.   

Things are going OK.  I'm so stressed, I'm a big woman, walking on eggshells is not easy!     I didn't tell DD she passed the IT/RT (insurance approval) for residential, I don't want her behavior affected.  I want to see if she truly is making changes.  She almost doesn't seem like herself.  She is not freaking out when I say NO, and it's really weird.  She freaked out a little bit over chores though.  I'm trying to figure things out, it's hard to explain.  Before, there was always an explosion, so I expect it and I'm ready to cringe, I'm bracing myself for it, and then it doesn't come and I'm like "huh?" I don't know how long she can maintain pretending to be someone else.

She is taking her meds for me.   They started her on Lithium to reduce sucidality 300mg twice a day and she got tremors, so it was reduced to once a day and the tremors went away.  The P said that is a really low dose to get tremors at, and they may try increasing her dose again to see what happens. 

So I just posted on another thread about my RTC story, and it really has me thinking.  We have been tossing this around for almost a year!  And writing it down like that, the pattern is glaring!  We threaten RTC, she does better for a little while.  I know it isn't a punishment or anything like that, it's just that we have tried every treatment available to us except RTC. 

Pyneapple, you are right, this IS a whole family thing.  We did in-home counseling with the whole family for a year.  Right now I have my own T, she has her own T and DBT group and med management.  My DD's biggest trigger is her friends.  Drama with her friends.  And she freely admits that. 

Jellibeans,  fear is driving part of my decision, I have SO much anxiety when she is home.  I feel so responsible to keep her safe, and it is so hard to do, she is so smart and sneaky and manipulative.  Right now we are watching for a couple weeks.