Tag Archives: residential

Residential programs, partnering and loud music

January 16th, 2018

When my son was 16, I drove him two and a half hours to his new residential program.  Amazingly, we both stayed calm, chatting about inconsequential things and turning the music up when things got emotional and we needed to stop talking.  This was a moment I had staved off since he was eight, the first time someone suggested he go into a residential.  I’d thought of it, scowled at the thought, rejected it, marshalled arguments against it and yet, here we were.

His arrival was anticlimactic.  The staff grabbed his things and he went off to browse DVDs and video games he wished he had at home.  I was reassured, signed things and was given a list of ways to reach the program.  On the two and a half hour ride home, I alternately gave myself a lecture, sobbed and turned the music up.  (Yes, it’s a family coping mechanism.)

The first night was really hard.  I woke up a lot, half listening for my insomniac child to wake up and wander in the night, feeling an emptiness in his room down the hall.  Our dog, Bonny, who usually slept on the foot of his bed, meandered around not sure where she should sleep. We got through that night and the next and the next. We adjusted to having space where he used to be, a space that would be filled only when he was home some weekends.

Over the next couple of years, I made that two and a half hour drive a lot.  Some weekends I would drive out Saturday morning, take my son on day-long outings, return him to the program and then come home at night.  The next trip I would make a round trip on Friday so he could come home, then another round trip on Sunday to return him.  I listened to a lot of loud music in the car.

Sometimes I say that if my family were a game show, we would be Let’s Make a Deal.  This time, my son and I had made one of our deals – if he went to the program, I would be there on most weekends. It was a long drive, but he was part of our family. I called a lot during the week, calls to him, to his program therapist and often to his teacher.  When staff wanted to treat his eating issues as a behavior, I called, explained, begged, threatened and called up the ladder to resolve it.  When there were conflicts with others or medication issues or he had a favorite item stolen, I jumped in and advocated for him. I took him for his haircuts, to buy clothes and all the things a mom does.  I held on to my rightful place as his parent with an iron grip and didn’t let go.

It turns out this was one of the best things I ever did.

Residential programs in this state and others are changing, or trying to, so that they shift to make space for parents as partners.  Lots of times this is still aspirational instead of reality, but with each little change there is no going back.  The national initiative, Building Bridges for Youth, tells residential providers that children have better outcomes when their parents visit, stay in touch and are involved both in the short and long term.  They also have the research to back it up.  Children go into residential programs as family members and when they are there, they remain part of their family too.  Families have incredible knowledge and resources to offer and parents have enormous expertise to draw on.  Yet, sometimes parents are welcomed, sometimes ignored, sometimes disrespected.  Often, all three attitudes can be found in a single program.

By the time my son entered a residential program, I was pretty exhausted.  I had been fighting, advocating, collaborating and juggling for a very long time.  We both had mixed feelings about it, but had limited options.  He had been turned down by six day schools and eight residential programs.  He needed someplace to receive therapy and finish high school.  I needed someplace where they had had teens like him before and I could trust that they knew what they were doing.  I already knew that clinical and program expertise didn’t always come with a parent friendly attitude, but I figured I could change that.  My exhaustion might have initially looked like acquiescence or passivity but it was soon apparent that advocacy had taught me a few things

It also helped that my son would ask staff if they had checked in with me when there was a change.  Even better, he often told them that he had to check in with me himself before he made a major decision.  The two of us didn’t always agree, but we talked things through and figured out how to get what was needed.  Sometimes, we made a deal.  I frequently told him that advocacy was the family business.  He would say, “I guess I’d better learn it, then.”

Like many parts of the mental health system, residential programs are usually designed to operate in a way that works for the program.  Routines and schedules are the same for everyone.  Same for meals and activities.  Parents can see the program as unwilling to be flexible and programs often see parents as unwilling to change.  When an engaged pushy parent like me comes along, programs have to decide if they want to cheer or groan.

Being very involved was one of the best things I ever did, lengthy drives and all.  At first I was involved because, well, that was how I parented a son with mental health needs that mushroomed over the years.  I was also involved because it was part of the deal I made with him and keeping promises was important to both of us.  I came to realize that my regularly showing up, calls, chats with staff and meetings with therapists set the groundwork for troubleshooting when we needed it.  It blurred the lines between us so we were more of a team.  It created respect and sometimes, admiration among us.  It probably led to better outcomes, too.  Cue the loud music.

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March 4th, 2013

He was worriedMy son has been in St. Elizabeth’s Hospital for more than a month, but he can’t stay there forever. We are faced with a couple of choices, neither of them good. He can go to jail for the charges pending against him (two assaults, three stolen cars, destruction of property) or he can go to a locked IRTP, an intensive residential treatment program. For six months he wore an electronic ankle bracelet which was supposed to keep him out of trouble. But he repeatedly “forgot” to charge it, kept pushing its geographic limits, then finally managed to pull it off and fling it somewhere in the park, never to be found again. Now the District Attorney says that to keep society safe, he has to be locked away.

“He’s not a bad person,” I tell our attorney, as though he needs convincing. He stole three cars in a three week period. Why? Because he met a boy at a dance who lived an hour away and he needed to see him. He assaulted program staff when they set limits which he didn’t think were fair. Or he imagined they set those limits, it wasn’t clear.

And all of it, deep down, stems from trauma. When he likes someone, even if he’s met them only once, he becomes obsessed, he must impress, make sure they like him back. He won’t give them a chance to reject him (diagnosis: borderline traits.) And if a staff sets an unfair limit, it feels like a horrible breach, the end of their relationship. He loses it, attacks (bipolar I; impulse control disorder.) All so he doesn’t have to feel that initial pain again (PTSD.)

He was sixteen, the first time staff pressed charges for assault. Instead of adult court, there was an administrative hearing. We sat in comfortable chairs around a gleaming oak table: the lawyer I’d hired, my son, the staff member of his residential program whom he’d assaulted. The staff passed around photos of his injuries: a hugely swollen eye, purplish bruises, ghoulish; a bump on the back of his head where my son had “grazed him“ with the fire extinguisher. “He could have been killed!” the magistrate boomed at my fidgety son, who was looking alternately scared and bored. I averted my eyes from the staff, though his face was healed.

It feels more shameful to have a child who hurts others than to have one who is “just” mentally ill. My son’s probation officer promised to “get him,” claiming he wasn’t disturbed at all. I worry that people think I am trying to keep him from jail because I condone his behavior. I know the staff thought I over-indulged him. But there is a ninety-three percent recidivism rate for teenagers who are sent to prison. I feel as if I am trying to save his life.

So we wait. I need to fax psychological reports, past hospital discharges, proof that he has “major mental illness” to DMH central office. As I collect the best documents–meaning those which make him look the sickest–I feel like I am trying to gain admittance to the country club or get him into college (I wish!) It’s a scary race. Will he get into the IRTP before St. Elizabeth discharges him?

Postscript: I found out this morning that he got into Center Point, the IRTP. Now we begin a new chapter.

Our guest blogger, Randi Schalet, is a psychologist and an adoptive mother of her twenty-two year old daughter and eighteen year old son . She credits her ability to carry on with parenting her challenging son to the support of friends, family and, especially, other parents.

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