Difficult Choices

[ProfDaddy]

ds10 has been at an RTC for 1.5 years now.  He has made some progress, frequent SI has stopped, rages are shorter, he can tolerate some frustration.  On the troubling side is that he still rages about every other week in both the school and residential environment, with no specific triggers.  It isn't safe for him to transition home.  There are no services for this kind of problem -- it would take just a few months for acting out in school to land ds10 back in juvenile detention.  Also, his instability would make life for me, d13, and my new wife impossible.  

Been speaking with the treatment team at the RTC about next placements and changes to his medication profile.  He is on abilify for mood stability and clonopin for restless legs waking him up during sleep (probably due to a side effect of the abilify).  I'm thinking they need to add lithium to his meds, something to add control for the anxiety driven mania.  He can't slow down.  We'll see what the pdoc has to say during rounds this coming week.  As for next placement, we will continue through the end of this school year.  Either ds10 will show some growth and be able to be placed in a less restrictive setting or if he continues to be this unstable, we might need to find a more permanent psychatric facility.  

We have done one home visit from the RTC, it is on the other side of the US and the flights are expensive.  ds10 had trouble before and after the visit (rages, acting out, etc.) and was manically nervous during the visit.  Everyone was exhausted from just a few days.  We're trying another home visit in December.  The first home visit and continuing outbursts have shown us that what we want to know now is whether ds10 is capable of VISITING home... .not if he could STAY here.  That's what the adults and treatment team have come to, but not discussed with ds10 yet.  He's half way thinking about what it would be like to stay home, but he is also realizing (but not discussing yet) that his behaviors and level of stability don't match what he has seen from friends at the RTC who have transitioned home this past year.  

Finding a less restrictive residential placement after an RTC is really confusing and difficult, even with help from a good educational consultant.  Of course there is uncertainty that he could even succeed with less support.  Thereapeutic boarding schools, especially for a 10 year old, are rare, and often shoddy.  A bit of digging shows that many facilities have weak staffs without proper training, teachers who have been fired from conventional teaching jobs, no solid curriculum, and other problems.  T at the RTC suggested that since ds10 has trouble forming and maintaining close relationships due to "pre-borderline tendencies" that somewhere with a great deal of structure but no focus on forming and healing relationships could be a good placement.   Military school came to mind, so I asked, and T said that could actually work for him.  

Military school is not a great option, but there aren't any great options for ds10.  Bringing him home isn't safe for him or others, it would set him up for failure and he would wind up back in the juvenile justice system.  Therapeutic boarding schools are isolated, sad, frightening places rife with neglect and abuse.  Military schools aren't much of a home, but could they educate him and keep him safe?  

Anyone have experience with children at military schools?  What happens when they test the boundaries with screaming, hitting themselves, scratching themselves, abusive language, suicidal and homocidal language?  Are I delusional thinking that a child who sometimes presents as a case beloinging at a psychiatric facility could ever be safely handled elsewhere?

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]

dear profdaddy

I am glad to see your post. I have been wondering about your son and how he was doing. He seems to be such an extreme case and I admire the way you have stood by him and tried to find the best help for him. I don't have any experience with a millitary school but I would wonder how they would treat someone like your son who doesn't have the self control needed at times but then again I am sure there are other kids at millitary school that have some of the same issues. I just wanted to wish you luck with your search. I am glad you have seen some improvements and that is hopeful.

[pessim-optimist]

Hello ProffDaddy,

Thank you for your update, I was also wondering how you and your family are doing... .

It sounds like there has been some progress with your ds10, and that is definitely a reason to celebrate. The fact that he seems to realize he isn't making enough progress might be a good sign, and maybe even motivation for him.

On the other hand, the realization that he may not be able to come home is really sad. But better to be safe and realistic than have rose glasses on. How are you coping with that possibility? How does he handle the separation?

Is there a possibility for sd10 to stay at the current RTC? If they have been able to stabilize him and are making progress albeit slow, it might be good for him to keep working in the same environment that he is used to, rather than to undergo a drastic change that he may or may not respond well to. Or is it an issue of funding/insurance and it's not an option?

I personally don't have experience with military schools, but wonder if they are equipped to deal with psychiatric issues. I was always under the impression that they are schools that provide strict structure and order for troubled kids, however healthy ones. If I were in your situation, I'd research several and ask them specifically about their resources for children w/mental illness... .

[ProfDaddy]

DS10 can stay at the current RTC through summer, making it a full 2 years at the facility.  They are able to manage his behaviors and keep him safe.  We can see if another 6 months of consistency helps him get it.

Pessim-optimist is probably right, military schools aren't equipped to deal with the psychiatric issues.  Thereapeutic boarding schools are not equipped either.  Many of the violent behaviors were red flags for them 1.5 years ago when I was first looking for a placement.  They want those behaviors extinguished by an RTC before they work with a child.

So, what are the options when an RTC fails?  He still experiences rage, sexualized language and urinates on the floor for shock value, hits himself, has dissociative rages.  What kind of facility can handle those behaviors, long-term? 

[jellibeans]

Dear profdaddy

I am so sorry things are so up in the air for you and your son. I really have no advise for you. I wish I knew what you could do. Has your son ever been tested for PDD? Could he be autistic?

Can no one at the RTC suggest a plan going forward?