When do you know to get day treatment or IOP for your d/s?

[mom4jenna]

Hi all, my dd is 14 and lately getting worse. I called her P doc and he lowered her anti depressant where she had some regulation but now she is really out of it. Back to some of the old behaviors and thoughts. Now she is adding wanting to run away and tired of living this way. So my question is, when should more intensive treatment be warranted? She has been with a family t for almost a year, DBT since Jan. It's coming up on summer so maybe that's a good time to get day treatment or IOP. I put in a call to the children's hospital. I am sure it has a waiting list is a mile long.

   I can hardly work or concentrate. Help me with some ideas. Especially posters who have older kids. Did it help if you put your teenager in for more intensive treatment?

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

[eac]

I am interested in feedback on this as well.

I am in the same boat, mom4jenna.  14 yr old dd didn't make it through the school day again today. States she doesn't want to live daily.  I have been getting paperwork to ins company to see if they will approve RTC.  Not holding out a lot of hope for that. Regardless, she is going.  I just think I need to do everything possible and she is a mess already at 14.

[heronbird]

Oh dear so terribly worring.  My dd refused to go to therapy at about 14, its complicated but our local service was useless and let us down badly so I complained and we got a transfer to another place which was a bus and train ride away, dd used to go on her own she wasnt diagnosed at this point and on no medication. dd would go on her own because she said she wanted to, she would have a panic attack and not go in to see P so in the end we gave up, so she wasnt seen for about two years when she had her first crisis and ended up in hospital.

One doc said to me that dd would always be like this and its best to learn to live with it.

So, she had no help for over two years from around 14 to 16. I get the feeling that that will happen again soon.

I mean, my question is, how long do pwBPD have therapy for, my dds been having MBT for 18 months apparantly and I think shes dropping out now and I dont think she will go anymore. I dont know what difference any of it makes.

[Vivgood]

DBT makes a huge difference if they want it to. So can meds.

One doc said to me that dd would always be like this and its best to learn to live with it.

  Ohhh, this would SO get a pile of letters from me .

My DD was always BPD lite, so never reached the point of seriously considering RTC, but she's been in DBT twice and one IOP fro depression/anxiety. DD is now 21.5yo.

I think the big indicator is age+SI. If this kid is under 16 and has chronic SI... .I would start calling RTCs. Insurnace and docs may very well want to take a step-up approach (start with the least intensive and work your way up), but I think thats a big mistake(and is done for cost reasons not clinical). The difference that an RTC can make at these younger ages is huge, and the IOPs are just not consistant enough- its the total change in environment that does the  heavy lifting, not just the DBT. It also allows very close oversight of medication trials, which helps because the way younger kids respond to psychotropic meds is different, qualitatively and quantitatively, than YAs and adults. Reactions can be so variable and idiosyncratic anyway, and its exacerbated by a still rapidly developing frontal brain and massive hormonal changes in younger adolescents.

My DD was 1st in DBT at 16 and then at 19 for a "refresher". Both were invaluable. She started at an IOP, but it was a poor fit because she is so high functioning and the program was geared to people who should have been (IMO!) in-patient. Most in fact were put directly into the IOP from in-patient. 


FWIW, I was a friggin trainwreck at 15 (and had been for a couple of years) when my parents put me in RTC. Didn't transform me into a high-acheiver by any means, but it saved my life (so I could wait around until 25 to start acheiving highly )


vivgood

[eac]

thank you heronbird and vivgood.  Vivgood - you are sing my song!  I agree with all.  My dd is a chronic self injurer.  She started around age 8 and for the last year she has injured herself in one way or another (mostly cutting) almost everyday. It is an addiction and it needs to be broken.  The younger the better I think.  I suppose in some weird way I am lucky she is such a severe case because the is no questioning her dx or her needed treatment.  Strange thought.

[twojaybirds]

If your kiddo is under 18 in the USA then you have more options.  I had a two week window between her 'explosion' and turning 18. 

Here there are some long term (180 day) facilitites for youth 12 - 18.

I thnk there are some day treatment as well for teens.

Start googling

Children's Hospital resource line are good

NAMI might have some websites or resources

Which hospital near you does short tem crisis intervention for youth - call and ask them.

Advocate - advocate - advocate.

It's a full time job!

[mom4jenna]

Thank you everyone for weighing in. I think the earlier the better before all the really bad behaviors set in. She is a cutter and thinks about suicide often. It will only be a matter of time before she has a substance abuse problem. It's all over both sides of our families. So waiting until all this happens is just not a good use of time, money or resources. Advocate for sure. THis is a full time job.

I got a call from Children's hospital and she is on a waiting list. FIGURES!

[twojaybirds]

I refused a waiting list when we were in ER.  Good thing I was working with a student social worker.

She said they could send wrap around services to the house and peolpe with meds.

I told her I provided wrap around services as a job and could do that - not the answer for my d.

I told her if she had meds for lying and stealing then to bring them on

I told her not to come back into the waiting the room until she had contacted every hospital in our state with a psych ward and had found her a placement.

I asked her how she could sleep at night if as a social worker she could refuse someone who clearly needed a bed in a hospital

She found her a placement in a psych hospital that she had told me was unavailable half hour earlier.

I have learned to be a mama bear because of the lifetime of  medical needs of my d.

I would call childrens and ask for all the hopsitals in the area with a psych ward

I would ask a list of all the psych hospital.

I would call DSHS/CPS and file a report of your efforts in case anything too sad happens,  CYA

Check your insurance as well.  Mine covers inpatient psychiatric and if my d asked I woudl fly her to McLean in MA in a heartbeat.


You are so right that earlier is better than later however our system is set up to be reactive rather than proactive.

Gathering resources is always a good idea - time consuming but good to have.

Let us know please

[mom4jenna]

twojaybirds, you are so right. I wish I had the gumption you have. I have to think like that. My dd hasn't even been to the hospital yet but why wait until it gets to that point. Wouldn't it make more sense to "get her in RTC" before she is half crazy under the influence of drugs, sex and running away. Or am I jumping the gun?

I am looking into Mercy Ministries here in the US. I called and asked them these questions. All they could say "is she wanting help" It takes a 6 month commitment to go into the program. Which, yes, may be extreme right now but in the long run, no. All she wants to do is party with friends and everyday is a fight with her. Even when my d and I are trying hard to reign her in. I keep her on lock down pretty much and this is depressing for her. It would be for me too. So why not go get some help now before really nasty behaviors set in and I don't even know where she is at/

I love the line, If there is a drug for lying and stealing, bring it on! No kidding!

[twojaybirds]

as a SPED teacher my admin. love to hate me.  They know I will totally advocate for all the kids with IEP's which they love cause they know they are being taken care of but they hate me because sometimes I have to call them on their decisions.

I brought my d to the ER before she had done any physical harm, wasnt drinking or drugging.

It was my concern that she had gone from 'perfect kid' to having stolen all that $ and jewelry and lied about it for so long and made up stories and even lied to the police.  I insisted upon a psych eval saying  none of this was typical.

This got her into the psych hospital for 2 weeks.

If I had know then what I now know I would have gotten her into a 180 day place when she was discharged for on the 2nd day went for the knives. SHe did nothing with them, it was kind of  for show  BUt I thought I could handle it - help her transition.  \Well 10 days later she turned 18 and now there is NOTHING I can do, shes an adult.

The threads a while back about all those small nuances many of saw in our kiddos when they were little - but we let them slip by because they werent extreme enough.  DOn't let any opportunity slip by between now and when she turns 18.

Even if we can't make or force or fix them, for me I have to know that I have tried everything. 

[heronbird]

twojaybirds,

I dont know how you managed that, I told the mental health weird people that we found knives in dds room, that she had paranoia, she was high on drugs, we found bottles of alchol under her bed, shed kicked her dad and he has marks to prove it, they still said she is not sectionable so let her home. She is under 18, now everyone is worried about her but nothing anyone can do.

I am wondering if I might just put this in writing to them now to say all this, because if anything happens to dd, Im going to have their heads on a plate.

I wanted her in hospital.

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

[mikmik]

In reading all the posts on this thread, both for the UK and USA, it is such a powerful comment on the state of the Health Care System.  What happens with insurance coverage here in the USA with "pre-existing condition", and when these kids are off (if they even have insurance) our insurance due to age or not being in school fulltime, how will they pay for meds or trips to the hospital?  How frustrating it is to be emerged in this disorder, and know some help is out there, but so many obsticles are placed in the way of getting our loved ones even some care?

I am waiting for the person with the clipboard and questions to ask ":)oes you "person" refuse help?  Do they think everything is your fault?  Do they lie, cheat, and steal?  OK... they meet the standards, we will admit them."

mik