When to consider RTC?

[living with crazy]

Hi Everyone-

I'm new to this board as far as posting (I posted my story in the New people post here last week) but this is my first post in this area. I have a 14yo sd that was diagnosed as BPD (which is typcially not diagnosed at this early age).  The county mental health lean to a Bi-polar diagnosis.  Frankly, I don't really know what it is, I just call it crazy.  All of these mental illnesses seem to have overlapping traits and we've been told she has BPD/NPD and bipolar with OCD... .Whatever!  She currently takes depakote and abilify, she has been on meds since she was 5 years old so I'm wondering if that isn't part of the problem, but I live in fear of what she would be like without meds.  She also has what the psychiatrist called cognitive reasoning skills that have not developed beyond that of a 4 year old.  She can't take care of her personal hygiene, she cannot do simple things like making macaroni and cheese, she cannot clean up after herself at all, she washes dishes in cold water and does a real half ___ job and then sticks the dishes back in the cupboard.  She will not do her laundry/shower/clean her room or anything unless we ask and then it is an argument.  She has no interest in anything other than sitting in her room listening to music or drawing and she has a difficult time discerning the difference between fantasy and reality.  She also says she doesn't need to go to school because she will be famous and she will be rich and so she doesn't need to brush her hair/take care of her roome etc because she will have maids to do it for her. 

Her mother is a drug addict and she hasn't seen her since Xmas, however she calls and promises all kinds of things that will never happen and sd hangs on her every word.   


SD is currently in special ed and has been since 1st grade.  Althought the psychiatric hospital recommended residential placement, the district has been pushing back on that and I've been told they will never agree to put her in residential as long as they can handle her in the spec ed classroom. BTW we live very close to Summitview which is a RTC that specializes in girls with BPD.   My husband and I are discussing putting her in RTC but are of course concerned with the cost of that.  It is difficult to have her here and we have been in couseling for 3years with not much change and have WRAP services in place with county mental health. 

My question is this; What are some factors to consider when deciding to leave them at home (she is 14 and we can't leave her by herself for too long without some kind of drama happening) and we don't have much of a support system to "babysit" .  Also, what is the range of cost we can expect for a treatment facility?

My final question - my sd is hypersexual, is this common with BPD?  I know it can be with bi-polar.

Thanks,

LWC

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

[lbjnltx]

greetings living with crazy,



glad that you are here, sorry that you need to be.  there are many stepmoms on this board with similar situation to yours. 

it is extremely common for comorbidity to occur in BPD's.  one of the criteria for BPD is engaging in risky behavior ie; reckless driving, risky sex, drug/alcohol use, etc.  hypersexuallity is also found within this disorder. 

if your sd is mentaly unstable and has reasoning skills of a 4 year old i would not advise leaving her alone at all.  too high of a risk factor.  also her dillusional thinking is BPD trait as well. 

as far as costs for a rtc, they vary.  acute care facility near here charges 575.00/day.  have read that menningers clinic in houston texas runs about 42,000/month.  so who knows!

does your family have insurance in place to cover a rtc stay?  find out which facilities would be best for her and then find out if they accept your insurance.  we are on a ppo and out of network care bumps our deductable from 2500 to 7000 and drops from paying 80% to 60%.  big big difference.  also our insurance will only pay for 15 days in patient but will pay for 30 days residential treatment. find out how the facility is classified with insurance company.


perhaps you could check into somekind of a group home situation for her.  perhaps beginning with her limited mental development and go from there.  perhaps you could check into a day treatment program for her to go into for the summer.  keep pushing the shcool to send her to sumitview on their dime.  no child left behind, remember!

keep us posted and God Bless

lbjnltx

[Mia~B]

Keep pushing the school.

I want mine in an RTC as well, We are pushing hard but not getting anywhere either. Everyones goal is to keep the child in the home. I understand that in most cases, but in a lot of BPD cases they need more help then a few hours a week with local threapists.

My 15 year- old BPD is very sexual. Not sure if it is typical BPD or not. They are also diagnosing her with a sexual addiction.

Mia

[picturelady]

Hi living with crazy,

Sounds like you are in such a difficult situation!  I am so sorry for all that you are going through.

We sent our son to an out-of-home placement last year. 

First I will back up and say that it's important to seek the help of an Educational Consultant if you're considering doing this.  An Ed Consultant specializes in placement - their job is to work for you (if you contract with them), try to thoroughly understand your child's issues, and then to assist you in choosing the "best fit" for your child.  The Ed Consultant also follows the child through the treatment process, ensuring that they get the best possible treatment.  Our Ed Consultant also happens to be a psychologist; he visits all the treatment centers and schools. You may also visit the NATSAP website (National Association of Therapeutic Schools and Programs):   www.natsap.org/

Our son started out in a wilderness therapy program called Second Nature Wilderness Program: www.snwp.com/

I cannot say enough good about this program!  A big component of the program includes parent education and "homework."  They are EXCELLENT therapists - in fact, I find it sad that we can't find this type of therapy anywhere else. 

Some questions which you might ask yourself as you consider this decision:

Do you feel your SD is progressing and maturing, gaining the skills that she needs for life?

Is your home/family life intolerable?

Are your SD's behaviors unmanageable?

If you had one last chance to help your SD get what she needs before becoming of legal age, would you take it?

Can you see how doing the same things you have been doing will get a different result than what you have now?

You can call any of these programs and talk to admissions staff - they are very knowledgable, and this can help you sort out what you want to do.  You can also ask for names of parent contacts who have sent children to these programs and would be willing to talk with you and answer your questions.

The expense... .well, it's quite hefty.  But for our son, I know that it saved his life.

My heart goes out to you - it's so difficult.  Feel free to post or message any additional questions.

[lbjnltx]

dear picturelady,

was reading your post and looked into the second nature wilderness program.  am very interested. could you post more about your son's condition and history?  could you tell us which program he entered and how you believe it helped him?  could you tell us how much it cost?  did your insurance  help with the cost of the program?  how involved were you in the program as far as being physically there?

how is your son doing now? how long ago did he do the snwp?  what kind of therapy did he continue with after the snwp?

sorry to ask so many ? but it is a big decision to make.  sounds like the program lasts about a month.  that would be a very long time to a 12 yr old girl such as mine.  sounds like a lot of $ as well.

thanks for your time and attention

God bless you and your son

lbjnltx

[living with crazy]

Thanks everyone for your response.  My husband and I are considering hiring an educational advocate that will review our daughters case and attend hearings at the district to get her placed.  I think that is likely the only way we will get her into summitview.  I have insurance, but we don't want the 30 day band-aid.  I think she needs long term therapy, and I'm not certain that even that will help. 

I feel bad for her and try to remind myself that she can't help it, but it certainly is frustrating.  I'm at the point where I just ignore her whenever possible, to keep from arguing with her.   I'm so appreciative of my DH who is the glue holding us together right now.  We try to find some humor to get us through it.  I think he's making a streetsign for our driveway (we live very rural)- it's going to be the corner of Malfunction and Dysfunction... .

 

[lbjnltx]

dear living with crazy,

i hope that the education advocate will be successful in getting help for your BPDsd.  since she is only 14 she could have a long stay if they put her into the school at summitview.  your family is very fortunate to have gotten a dx of BPD at her age.  most will not dx until 18 yrs but you probably know that already. 

the programs that i have looked into all consult with the therapist at home to ensure that treatment is continued on the same track when patients leave program facilities.  this is just another of many opportunities BPD's have to help themselves, unfortunatly most don't cash in on them. 

i hope your sd will make much progress and begin walking the road of recovery very soon. 

keep your chin up and keep the faith

and keep us posted!

x

lbjnltx

[picturelady]

dear picturelady,

was reading your post and looked into the second nature wilderness program.  am very interested. could you post more about your son's condition and history?  My son was diagnosed with early childhood depressions and ADHD (inattentive type) at about age 8.  As he grew older he began to act out a  lot in anger, also isolate himself a lot with depression, lie, experiment a little with drugs and possibly inhalants, etc.  I found a note where he said he hated himself and would kill himself (he drew a little diagram of himself hanging.)  I want to add that although he has his own issues, we also had a very, very sick family system.  His father displays a lot of BPD (unpredictable) behaviors, also my son's older sister "mushroomed" into a full-blown BP when she attempted to go away to college and launch out on her own.  Since we discovered the hard way what happens to your child when they are 18 and disappear, we felt we had to act on behalf of our son and get him some real help before he turned 18.  (We had worked with traditional therapists for years... .usually traditional therapy is not able to address deeper issues.)

could you tell us which program he entered and how you believe it helped him?  He entered the Second Nature Wilderness Program (www.snwp.com).

could you tell us how much it cost?  We worked with an education consultant who helped us get a scholarship for our son.  Typically I believe the cost is around $500 a day.  (We still had to take out a loan - we are by no means wealthy.)  I would recommend calling 2nd Nature's admissions department and asking any questions you have. I did this long before we actually made the decision to send our son.

did your insurance  help with the cost of the program?  Our insurance would only cover the cost of therapy sessions (group and individual).  We were able to claim this entire Wilderness Therapy expense on our income tax return, and we did recover a nice amount that way - truly a drop in the bucket, but well worth the trouble!



how involved were you in the program as far as being physically there?

We attended a "transition camp" - which was one afternoon of parent meetings,and a structured overnight with our son in the wilderness.  Our other involvement was as follows:

• weekly 1-hour phone calls with our son's wilderness therapist
  
  
• We were required to write weekly letter assignments to our son while he was in program

bi-weekly 1-hour webinars (broadcast via the internet)

Parent reading materials[/i][/b]

how is your son doing now? I am happy to say that he has been home since March, is working 2 jobs and living independently, and doing quite well.  But when he first came back it was very difficult - he resorted back to some of his old, unhealthy behaviors.  That's when I had to continue doing my own hard work of setting and keeping good, healthy boundaries.

how long ago did he do the snwp?  Last summer - he began in June 2008what kind of therapy did he continue with after the snwp? He doesn't want to be in therapy right now, but he stays in touch with some people from the program.  Not the way I wanted it, but since he's financially independent of us now, it was his choice.We have continued to contract privately with his wilderness therpist via telephone.  Sounds weird, but the input we get from the wilderness T in a 1-hr phone conversation is more than we'd get in 2 years from a traditional T!

sorry to ask so many ? but it is a big decision to make.  sounds like the program lasts about a month.  Students are typically in the program for 6-10 weeks.that would be a very long time to a 12 yr old girl such as mine.  sounds like a lot of $ as well.

Yes, it's a lot of money, and a lot of hard work, but worth every single penny in this case.  The wilderness therapists are AMAZING.  We tried to get our older daughter in their young adult program, but she refused and has severed all contact with us.

thanks for your time and attention

God bless you and your son Thanks much for your kind wishes!  God bless you all as well... .it's such a journey.  I wish you the best as you try to find help. 

lbjnltx

Hi lbjnltx, I will do my best to answer your questions - some answers I will insert above in your text - so sorry it took me this long to get back to you!  We were holding a graduation party for my son over the weekend.  Feel free to message me or post any other questions you have!  All the best,

PictureLady  x

[picturelady]

PS lbjnltx-

Here's a link to our education consultant just in case you're interested:

www.aerkis.com/

He is very well-thought of in this industry and he works with families all over the country.

[benjenman]

I decided to respond to this post because I understand how hard it is to make the decision to try residential treatment.  My BPDd(17) has been in an RTC since January of this year.  Prior to that, she spent six weeks at the Menninger Clinic in Houston, where she received the diagnosis of BPD and histrionic personality disorder, as well as bulimia and PTSD.  The Menninger Clinic costs $1050/day.  Our insurance covered nothing, as it deemed her hospitalization as "medically unnecessary."  Ugh.  Menninger recommended following up with residential treatment or therapeutic boarding school.  I started researching the various places, and soon became overwhelmed with the responsibility of making such a monumental decision.  Sending your child off to live with strangers is a bit daunting.  That being said, I decided to pay the 5K and hire an Ed Consultant.  She already had a trip planned to visit several RTC's and while in Utah, recommended a particular facility to our family.  Our daughter was discharged from Menninger on a Thursday night, we decided on our RTC on Saturday, flew to Utah on Sunday, and I dropped her off on Monday.  Badda-bing!  Badda-boom!

The RTC gave us a discount, dropping our expense to around 8K/month.  We travel there every eight weeks to attend parent weekends.  We have family therapy on the phone once a week.  We recieve regular updates regarding our daughter's progress.  She has always been a good student (until the final downward spiral that resulted in Menninger), and is doing well in school.  She has taken her SAT and ACT exams while in Utah, and has done very well.  The progress seems to be painfully slow, but we are hoping she will be home by December or January.

I have done alot of research and reading about BPD.  Interestingly, before her spiral downward, I began graduate school to earn my Master's degree in Counseling.  I feel I have a unique perspective, both as a parent of a child with BPD, and as a graduate student who has some experience "on the other side of the couch."

I have enjoyed reading the message boards and find myself nodding my head so much in agreement with the things you are all going through.  I look forward to continuing this amazing journey with you.

Benjenman

[lbjnltx]

dear benjenman,

thank you for sharing your story and so much information with us.  tell me, what did you think of menningers?  is it not also classified as a rtc?  what facility is your precious d in in utah?  what kind of treatment will she receive there?

is your insurance going to help cover the utah placement?  does having an ec have any effect on getting insurance to pay up?

lbjnltx

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

[benjenman]

Dear lbjlntx,

Menninger is more of a psychiatric hospital -- you wouldn't wanna have someone there for months -- you'd go broke!  My BPDd is at Kolob Canyon RTC in New Harmony, UT.  Interestingly, it is one of the facilities listed in Blaise Aguirre's book.  I was surprised there weren't more listed in Utah, since it appears to be the Mecca of RTC's (because parents still have rights until the age of 18 in Utah).  Our insurance doesn't cover anything toward residential treatment, but we did get to deduct medical expenses from our taxes for Menningers, which helped alot.  I'm not sure if an RTC qualifies for a medical deduction.  Anyone know?  I'm not sure if an ec can always help, but I have a feeling in this economy, RTC's are hurting for students, and are probably willing to negotiate. 

How are you doing?  How did your d receive the dx of BPD?  I'm acutely interested in the diagnostic process.  At Menninger, our d received two weeks of nothing but psychological testing.  I'd give alot to get my hands on the raw test data, as I'm a student and have a morbid, insatiable curiosity toward psychology, esp. BPD.

I look forward to hearing more about you and your life.

Benjenman

[lbjnltx]

hi benjenman,

thanks for the reply.  i am about to leave to go get my d from a 14 day stay at an acute care psych facility.  this is her first institutionalization and her first time on meds.  she is on 10mg prozac and 2.5mg abilify.  her attitude and demeanor are much improved.  she was the one who told her psychiatrist at the hospital that she is borderline.  i would not divulge any previous dx because i wanted their opinions untainted.  after her dr. ordered a complete psych evaluation it came back as odd, mdd, emerging BPD.  the only suprise was the mdd. she just doesn't fit the criteria of a long term consideration.

my d vacillates between "i don't have a disorder" "it's your fault i have a disorder" "i can't do anything about my disorder" and " i am in complete control of myself and what i say and do".  she is clearly a conflicted person.  she has made these statements in the context of the same discussion within a 10 min. window.  very confusing to me and i am sure to her as well.  my d is only 12 years old so we have a lot of time to work on getting her help.  i am hoping that the meds will allow her a better opportunity to work on herself in therapy.  out t is going to start training on line for dbt.  are you familiar with dbt? has your d had any dbt?  has it helped her in anyway?  or is she still in denial of her illness?

have to go now, wish me luck

lbjnltx

[benjenman]

lbjlntx,

My daughter has fully embraced her dx of BPD.  She has told many, many lies to get attention/sympathy from others, so having a bona fide personality disorder was welcome news.  She had DBT at Menninger.  Kolob does utilize components of DBT, but it is very difficult to have TRUE DBT.  I spoke with someone in our town who does true DBT, but he did not take kids under 18 in his groups.  Drag.  She may see him when she comes home, though, as I do not feel she will want to continue with her previous therapist.  One of my profs feels like adolescents are way over-diagnosed with BPD.  I understand what he's saying, but he doesn't know my daughter, does he?  All adolescents exhibit some symptoms of BPD, but all are not debilitated by them.  That's what our therapist at Kolob keeps reminding us.  I feel like you are fortunate to have gotten the heads up on your d at such a young age.  I think the earlier the intervention, the better the chance for "normalcy" (whatever THAT means!). 

I understand your d's feelings of "I am not responsible" to "I must have and do have total control".  I go back and forth with feeling like it's hard to "punish" my d for having BPD.  I wouldn't punish her for being epileptic or diabetic.  However, if she didn't take her meds, I'd punish her, so I guess she needs to learn to use her tools to "treat" her BPD.  It's tough, though.  Boundaries and structure are not my forte -- I'm a fly by the seat of my pants kinda girl.  Our daughter is doing well in the highly structured environmet of the RTC.  Guess who is gonna have to change?  Mommy! 

One plug I can give for an RTC is that our d has lots of assignments and many levels to achieve before she comes home.  Her father and I also have lots of assignments and our work must be completed before she can advance.  We are learning how to parent more successfully while she is learning to handle her emotions and stuff more effectively.  We are learning together, which is very helpful.  The RTC doesn't take the attitude of "your daughter is broken and we are gonna fix her" but rather, "your daughter has a problem and we are all gonna work together to help your family function better."  It's very supportive of the family unit.  There is no blame, but there is accountability. 

I hope you have a good day today and that your d transitions home with a minimum of drama (isn't that what we all long for?  less drama?).

benjenman

[lbjnltx]

greeting all,

just letting you know that the transition home was a good one.  we went and did a little shopping, got a bite to eat and came home.  i left d alone for about an hour while i went to our nearby town and got her rx filled.  discovered that the dr had increased her prozac to 20mg. good?

dear stepd was home when i got back and they were down at the barn looking at the tractor (i guess).  they swam in the pool, played bball, ate, played cards, played on the ps2,and watched tv.  d12 out like a lite at 10. 

d12 did talk to me a little bit and every time i bought something for her she would say "thanks mom" or "thank you mommy".  not like it was before!  i am grateful for any improvements!

when i got to the hospital yesterday, her psychiatrist was on his way out and stopped to talk to me.  i get the distinct impression that he is intrigued by my d.  he said she is a "complicated" person.  he is concerned that our t is not equipped to handle d.  we will keep an open mind about this and wait to see what happens after t is finished training online for dbt.  i think our t is much sharper than dr gives him credit for.  after all he dx BPD on our 3rd visit, mind you our visits are only 45 min. so that was really quick!  she was at the hospital 24 hrs a day and they did not dx BPD until a complete psych test was finished on day 10 of her stay.  now, i take into consideration caution and thoroughness but the clock don't lie!  dr. is leaving on vacation for 2 weeks and wants me to call his office and let him know if we need him.  never heard that from a dr. before!  kind of scares me that he doesn't think she is very stable!

will keep you guys updated.  thanks for all your support

x

lbjnltx

[picturelady]

I wanted to add that, yes, you can deduct the cost of an RTC on your taxes.  We were able to deduct the Wilderness Therapy program that our son was in (2nd Nature), and you can even deduct a boarding school if your child has a learning disability and the school directly addresses it.  So every little bit helps!  We got a nice little sum back from Uncle Sam - more than I expected.  Of course it was a drop in the bucket, but we were grateful.  Here's a link from the IRS website detailing the various medical expenses which can be deducted:

irs.gov/publications/p502/ar02.html

2nd Nature also does a tremendous job of thorough assessment.


lbjnltx, I wanted to add that my uBPDd (now 20) received tremendous benefit from Prozac.  She was started on it at age 10, and when I first gave it to her, she flew into a rage and said she knew that I was really trying to poison her b/c she was so much trouble.  After several days on the meds, she was like a different person (swore she'd never go off them.)  Unfortunately when she went away to college, she (intentionally or absentmindedly?) quit taking all meds.  Her life spiraled out of control and she ran away.  (Not intending to be depressing here.)  For some people, the right meds can really give them the control they need to be able to work on their issues.

All the best!

PictureLady 

[lbjnltx]

picturelady,

thanks for the encouraging words.  d12 continues to be the girl i remember from 3 years ago.  when she says something that might be taken as rude, she apologizes and says she wasn't trying to be mean.  3 months ago that never would have happened.  she is now hearing herself, thinking about how it might sound, and making sure it is all right.  awesome!  the first week on her meds i could still see alot of depression under her stabilized mood.  now that she has been on both abilify and prozac for 2 weeks the depression is gone and has been replaced with excitement for life.  i can only hope that it continues into infinity!

blessings

lbjnltx

[Lorisusan]

This brought tears to my eyes.  I'm so happy for you that you have your little girl back.   

Prayers and thoughts that it continues.

[lbjnltx]

hi lorisusan,

glad that you are on the raising children board!  how are you doing today?

blessings

lbjnltx