Does RTC make it worst?

[sad_soul]

Hi I'm new to this group. I thought it was a good idea to join this group because it seems like most of you know exactly what I'm going through. No one in my life comes close to understanding the constant turmoil I feel inside, the worry, stress, pain, sorrow, guilt, shame, sadness and how could they if they don't have a child with BPD? It's so hard for me to understand what's happening half the time and I'm living it! Even my husband doesn't get it, so I'm really alone in this struggle so I'm happy to have found this group.  After 4 short term RTCs (2-3 months), many PHP and IOP programs and multiple hospitalization for suicide attempts, psychotic breaks, self-harming etc I was finally able to get my daughter into long term residential through the school board.  I had been fighting for a placement for her for almost 2 years and when it finally happened I was so relieved because I thought she would finally be getting the help she needs instead of being bounced in and out of programs because of insurance or "behavior issues" and needing a "higher level of care". But today I feel so helpless and hopeless. I got a call from the program that my daughter snuck the mirror out of her makeup compact and cut her wrists.  Although she's "ok" (whatever that means these days) I'm worried for her.  I'm worried because she knows she is in residential for at least a year and before she was always able to get out of programs by exhibiting extreme behavior, being violent etc and this program is a locked facility and they are trained to deal with those type of behaviors.  She has tried all of her "tricks" to get herself kicked out (multiple physical altercations) telling me she feels "unsafe", that everything is gross and dirty, that the food is awful, that they do nothing there everyday, that she just wants to come home and she isn't going to participate in anything there so it's a waste of time.  She is refusing to meet with her psychiatrist and her therapist so not sure how she will get treatment if she continues that way... .But the scary part is that now she is threatening suicide and self-harming.  I fully feel like she is doing it to punish me for "sending her there" to make me regret and realize how bad things will be if I leave her there.  I feel totally manipulated because her tactics are working - I'm terrified.  I don't think she wants to die but I do think she is impulsive and desperate to get her way at all costs without weighing the real consequences.  So i fear that in her effort to "show me" she might end up hurting herself and worst  She is getting into fights almost daily and I'm starting to question how therapeutic the environment is also... .Will she get better there? Is she going to be there for a year a come back worst and resenting me more for "sending her there"? I keep telling her that the alternative would have been jail as she almost was taken to jail at her last short term RTC for assaulting a staff but the police allowed me to take her in the promise that she would be going to this long term treatment facility.  She doesn't care, though - she just wants to do anything to get me to let her come home and I'm not sure where this will stop.  And ultimately I guess I'm wondering if anyone has had experience with long term RTC and did it work? Was it worth it? And what their experience was.  It's also really hard because with the other RTCs I could go see her and physically see how she is doing, here is she far away and I can only see her maybe once every couple of months so I can't gauge whether what she telling me is true or not.  For example she told me she got into a fight and the girl pulled half her hair out but then the staff said she got her hair pulled but she was fine?  Who to believe? Obviously not her, all she does is lie but then am I ignoring her when something is happening that's really wrong and not ok, how will I know? I'm so confused if I've made the right choice but I feel like I have no other options.  None of the the short term RTCs in my area or IOP or PHP programs will take her because they all say she needs a higher level of care... .also I can't keep her safe at home, when she's home I barely sleep trying to check on her in the night to make sure she didn't do something to herself.  I have to take a deep breath every morning before I open her bedroom door because I'm terrified of what I will find... .so that doesn't work for sure I know... .but will RTC hurt her? What if she hurts herself there? I will never forgive myself for sending her... .I just feel like I'm a prisoner in my own life and have no good options... .Any advice? 

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

[abk123]

Dear Sad Soul,

Welcome to the group. I am a newbie myself. I do not have any first hand experience to lend you on your question. However, my husband and I are currently researching schools to send our d (16). Reading your post, I can feel your fear and guilt. And I can definitely relate to how you are feeling. I would remind you to try to keep in perspective what you know for a fact. You know that you could not keep your daughter safe. So sending her to a RTC is you doing what you believe to be in her best interest. Secondly, you know that your d lies all the time. And of course, she's trying to manipulate you. So although it is difficult to hear her accusations about the facility, there is most likely no reason to worry. And finally, if she's just recently been sent there, it's new to her too. It will take time for her to adjust. Just as it will take time for you to adjust. But try to use the time you have away from her to renew yourself. Take good care of yourself and allow your batteries to recharge. Just breathe. It will be okay.

abk123

[lbjnltx]

Hi sad_soul,

I'm glad you are here and so sorry to hear the troubled road you and your daughter have been traveling. 

I think my question initially, to get a better understanding, is... .did you choose this RTC?  If so, what about it makes it the best choice of facilities for your d?

Most RTC's, even one's that are not lock down, would not allow a patient/student to have a glass object of any kind in their possession.  They simple do not have them available to the residents.  Even the scissors that they must ask for and use in the presence of a staff member are blunt point. 

Is this a clinical environment that she is in?  As in hospital type setting?

lbj

[sad_soul]

thank you for reply and support both of you!  Well yes and no.  I got an IEP through her school board and they gave me 4 residential facilities to choose from.  2 accepted her and 2 did not.  This was the better of the 2 facilities.  I was not able to find the "best suited" RTC for her I feel but this was the best of the ones contracted with our school board.  Unfortunately, I'm not in the financial position to pay out of pocket the $15K + a month fee for RTC and insurance will only pay for max 3 months and I've fought them ferociously to even get coverage extended that long in the past... .so this was my choice based on my available choices... .The facility has been around for 70 + years, they are joint commission accredited and have a large board of directors from around the country of industry professionals - so on paper they look great... .but do I trust them to keep her safe - not really... .do I trust them more than myself - yes  

[sad_soul]

I should also clarify that there are other facilities contracted with the school board but not ones that offer the level of care (locked facility) that my daughter needs... .They also have therapists and a psychiatrist, pediatrician and nursing staff there but it's not a hospital... .

[lbjnltx]

I understand the limitations and all we can do is work with what is at our disposal.

Unless a facility is a complete fraud and is abusive any patient can learn and thrive there.  It is up to the patient to choose to do the work and we all know how defiant and in denial pwBPD can be.  Your initial question is can they do more harm than good.  Yes, if they improperly treat a patient it can be harmful.  Also, patients who are in inpatient clinical settings for too long can become "institutionalized".   

Is there a step down program planned for once she no longer needs a lockdown facility?  Can her working towards the step down program be a goal to get her to cooperate in her own healing? 

Having regular contact with her and her therapists (together and separately) really does help ease our fears, address our relationships with our kids, and keep things moving in a positive direction.

If you are interested in reading (a lot!) you can click on my signature line "keep believing in miracles" at the bottom of my posts.  It is a 10 month case study of my daughter's stay at Falcon Ridge Ranch in Virgin Utah.  Stay with it, it gets very interesting and is a good example of what affective RTC care for families looks like. 

lbjnltx

[sad_soul]

They do have step down within their program so there are different "units" so right now she is in the locked down unit but as she "phases" up she will move to another unit that has outside privileges, passes off campus etc.  She is at Devereux Cleo Wallace? Does anyone know if this is a good place? More harm than good at this one? The problem is, even if I knew this might not be the best care for her, I'm not sure what other options I have and I have fought tirelessly to get her care over and over and over... .now she's here and I don't know what to think... .

we do family sessions with our therapists but so far my d has refused to participate at all... .so it makes it hard to figure out where she is at with things... .when she talks to me it's not with her therapist there and so there is no one there to "interject" and redirect the conversation - I'm just there trying to figure out what to say so she doesn't hang up the phone and hurt herself... .

when you say improperly treat the patient it can be harmful, what do you mean... .what do you think is improper treatment do you mean abuse or do you mean not providing the right therapy? I'm really trying to get a sense if this place will make things worst or better and I can't tell at this point and it scares me ... .

ok thank you I will read your story... .

[lbjnltx]

What I mean by improperly treat... .medications based on misdiagnoses, any kind of shame based peer accountability, and in my opinion behavior modification programs can keep our kids stuck.  They need to learn skills to cope with their feelings, not learn how to avoid their feelings by behaving a certain way to gain ground and privileges.  To me, that seems like a form of manipulation.

When my d was at Falcon there were many girls there on IEP's.  I know of one Mom in particular that got her d moved to Falcon (which was not on her ISD's list of facilities) from another place that was. 

How long has your d been at Devereux?  I have heard of it but am not educated about it.

Be lenient with yourself sad_soul.  You are doing the best you can with what you have to work with.  Most of all, don't make decisions based on fear.

lbj

[sad_soul]

she's only been there since May 25th 2016.

I looked at Falcon Ridge website and they say they don't accept patients history of extreme violence... .I'm not sure what their definition of "extreme" is but that's the problem with what I consider nicer facilities is that many of them won't take her because of her violent history.  In every RTC she's been in she has physically attacked other residents or staff and been removed... .she's been in 3 fights since she got to Devereux... .this is where I'm finding it hard to get the treatment she needs in an environment that will accept her with her violent tendencies... .Do you know if they take kids that are violent?

The last thing I would want to do is move her to a program that she gets released from it for violent outbursts because in the past that's how she ended up slipping through the cracks and ending up back at home. But I'm not certain if Devereux is right for her either? When I was doing research for private pay facility there were many that looked amazing and I contacted SOO many of them, but none of them would enroll her due to her history of violence  

The thing is I don't think she has these uncontrollable psychotic violent outbursts like other kids in this type of program (Devereux) I think because of the BPD this is one of the "tools" she uses to manipulate and get what she wants which in most RTC cases is to leave... .she uses it to control others and to feel in control herself.  She has a poor sense of self and sometimes being the "tough girl" is her identity of choice... .but I think she gets lumped in the with uncontrollable angry, violent kids because of her history even though that's not really her... .am I making sense? I feel like when I talk about my d I never sound like I make sense? Like I'm in denial about what and who she is... .

[lbjnltx]

Yes, worry not, you are making sense.  We all speak the same language here... .'tis one of it's mysterious charms.  

Falcon does not take kids with conduct disorder. Has she been dx w/conduct disorder?  If I were you, I would call and talk to any facility that you are interested in and explain exactly what is happening and if they can/will be able to help your daughter.  Mark 'em off the list as you go down.  

Have you established a search criteria for other facilities to possibly move your d to?  I created a form to help me in my search so I wouldn't end up lapping myself and wasting time and energy.

I started by doing internet searches for rtc/theraputic boarding schools... .after seeing how many there were, I knew I had to develop a criteria to start eliminating the ones that were not a good fit for my d.  My criteria was based on what I believed would help my d.  The one's that were left on my list of possibilities were contacted.  If after speaking with them, if I believed they were still a possiblity, I would request printed information packets.  After reviewing the packets, I would call for a list of references.  If after speaking with their references (asking some really personal questions)and they were still a possibility, I then went to visit the facilities (by this time there were only 2 left on my list of possibilities).  :)uring my visit, I requested a meeting with staff and some of the students at the facility.  At the end of this part of the journey it was very very clear which facility I would choose.

Here is MY search criteria.  It was necessary for me to create it in a document form to keep all the info straight!  By the way... .this process took me 2 months FULL TIME!

Name___________________

Classification      RTC     Theraputic Boarding School          Clinical RTC

Location____________________     Airport__________

Age Group Served?_____     Group Size______  How long in business_____

Co-ED?______

Level of training for Therapists   Masters       PhD         LCSW    Other

Behavior Mod Program  Yes          No

Individual Therapy hours p/week__         Group Therapy Hours p/week_____

Group Therapy model___________________   DBT?  ______

Family Therapy via/phone p/week__________  Group Therapist p/week?_____

Family visits/frequency______________________________

Off campus visits/home visits, frequency_________________________

Population served?__________________________________

Conduct disorder/violent allowed?     Yes          No

NAPSAT?    Yes           No           Year round school?      Yes         No

Discipline style__________________________________

Address Spiritual Aspects/How?______________________________

Cost p/Month__________          Enrollment Fee______________

Exclusions________________________________________

Average length of stay______________

Contact person___________________Title______________

Waiting list?___________________

Email address___________________  Phone #_______________

Impressed     Yes            No

Requested packet?     Yes          No                  

Requested references  Yes         No

Schedule a Visit? _______________

Hope this helps.  Just a note... .I was/am more focused on the therapeutic aspects of the rtc experience... .education is secondary.  I asked my d last night about the educational aspects of Falcon Ridge... .If they were allowed to work at their own pace without being slowed down... .she replied "sure, as long as it doesn't interfere with personal growth"... .

lbjnltx

[sad_soul]

thank you for this... .I'ts overwhelming the thought of getting back on the treatment search bandwagon... .but I'm not sure if I'm going to have a choice here... .this is really helpful thank you!  She has been given a diagnosis of ODD and DMDD along with BPD, generalized anxiety and major depressive disorder. I'm not sure how one little girl can have so many things going on but I'm told this is the case... .Devereux however is doing their own assessment and I'm waiting for them to get back to me with their master plan for her now. 

I'm just starting to come to the realization that I may need to move her... .but I don't want to make the wrong choice and she end up back at home without treatment... .

how do you not make decision from fear when everything is soo scary  :'(

thank you for your help, I'm going to just take a minute to get my bearings then start with some research... .

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]

By being well educated and in wise mind.  

I read in another of your posts in someone else's topic that your d had good experiences in short term RTC's so you are probably aware that using extreme guilt, manipulation, and complaints of unfair or abusive treatment is common during the first months of RTC.

It is possible that this what is going on with your d right now.  BTW... .it may not be wise to put time labels on inpatient stays.  When asked "how long do I have to be here?" a sound and honest reply is "that depends on you and how much work you put into your own progress".

It took my daughter until pretty much month 3 to get down to real work.  

lbj

[sad_soul]

yes Polaris was AMAZING, if we could have done 10 months there, I think we'd be in a totally different place now... .but ti's a short term place and because of her violent tendencies she couldn't stay even to complete the short term program  

I don't think that Devereux is a bad place, I don't think it's the BEST place either... .but I don't think the BEST place will take Heaven because of her history... .and also private pay is not an option for me so I'm at the mercy of the school board, which I'm willing to fight for a new placement but as you said, it might be premature and this may just all be her manipulation... .It's hard being out of state because I can't be there every week to see for myself... .I'm planning a trip there for the beginning of July and I think once I go there I will see and reassess but as you know I'm sure so much can happen in a few days/weeks... .I have real concerns that my daughter was able to access that mirror to cut herself... .

Yes I agree with you that's what I was saying her when she asked how long she had to be there and I would say as long as you need to be there... .but when she asked the treatment team they said the same thing then she asked how long does that usually take they said it varies but the average stay there is 9 months-12months.  I feel like they shouldn't have told her that because it's adding to her despair, thinking things like she's there for that long anyways how can she possible "suffer" there for that much time... .

I feel on one side I want to give it more time and yet on the other side I'm worried that she's not safe... .but then again, she's no less safe than when at home or any other RTC I suppose... .I definitely don't feel like they are abusive towards her and they have very open call and visitation policies so that is not my concern thankfully... .but just not sure if she's gonna get the help there she needs... .

I'm glad (not glad but you know what I mean) to hear it took that long for your daughter to adjust and now she is doing well - gives me hope!

[saphirewidow]

My son wanted to go to Deveraux because a friend said he like it.  I don't know if it is good or not but it wouldn't take our insurance so we didn't go there.  My son is currently in a center in Utah.  I found that in his previous placements that didn't seem to really help him much, he got to a point of acting out and pushing limits before he realized it wasn't working and settled down to work with his therapist.  The place he is at now works with DBT so and he has individual therapy 3 times per week with biofeedback also.  He hasn't been there very long yet so I dont know how things will turn out but I think you should give it some time and she may need to get worn down a little and stip trying to manipulate her circumstances through her drama before she is able to settle into therapy and getting better.  Hang in there. 

[sad_soul]

thanks saphirewidow. She got there through her school board IEP, so I didn't have too many places to choose from.  This place seemed good on paper, but I'm just not sure anymore. Yeah, I think I should give it more time and I will try... .hopefully we get in a groove with her treatment team, I haven't been having too much response outside of the weekly family sessions so I feel like a lot of time goes by between being able to talk to anyone about my child's treatment/progress... .anyways, staying on this road... .for now... .Good luck with your son's placement  

[Bright Day Mom]

Hi Sad Soul

RTC was the last resort for our family as our stories have many similarities.  I think all of us second guess ourselves at one point or another;  but as other posts have said your child could not be kept safe home and needs the additional support at this time.

Our 16D has been RTC since Feb and is doing remarkably well.  A combination of her motivation to getting well, weekly family counseling, the consistent supportive environment RTC and her private therapeutic high school I feel are all key.  Your D has only been in for a couple of weeks, it may take some more time to acclimate to the new environment. 

In terms of if your daughter's placement doing harm? that's a good question. Are you able to pop in unannounced?  It may be worth your while to make a trip at least you would be able to see some aspect of the program without any planning on their part. 

In the meantime perhaps use the checklist and start calling alternative programs to see who may be able to handle her as a Plan B in case this placement isn't a good fit.

Wishing you the best -