Brains

We live this every day, and it’s so hard to explain to others. The reactions that children have, even if they are now in a loving home, their ability to focus, their need for any kind of attention, their maturity, their ability to take criticism… it was all decided long ago when they were neglected for years. And even in a warm, loving and caring home their brains will not recover from the damage. Kids that have been neglected don’t just “get over it.” The damage I’m talking about is living in 11 different homes in 5 years, all before reaching 4th grade, 2nd grade, or 1st grade. We have to do better for our kids. We have to break the cycle.

http://www.telegraph.co.uk/news/health/children/9637682/Whats-the-difference-between-these-two-brains.html

Reactive Attachment Disorder

If you google “Reactive Attachment Disorder,” about a half a million results come up immediately. It’s a well documented concern with adopted children, or children that have gone through immeasurable trauma and neglect. When we first accepted placement of our three adopted kiddos, we were concerned with the youngest, Scarlett, and RAD. We did a lot of reading and perusing online articles. I read “The Connected Child” like all good adoption forums will recommend. Our fears of RAD with Scarlett were quashed very shortly after their placement as she settled in. Scarlett is very much a middle child and gets her feelings very hurt if she feels that someone has gotten more of something than her–time, presents, clothes, etc. But she does not have RAD.

We’ve only had placement of our children for just over a year. This is nothing in terms of fostering an attachment in child development. And yet, it feels like 25 years! Hubby and I have become adept at changing our parenting strategy, with kind of a trial and error, in order to find what works. This week we had to work on some strategy in order to get Huck back in a good place. I made the executive decision to cut off his anti-depressants. I am concerned that the medicine was causing him to become agitated. Sure enough, the lack of medicine seems to be much better. (He was only on 10 mg for about 3 or 4 days before we noticed the agitation. It was not noticeably present after 5 mg). We’ve also been working really hard to lighten up on a few things and stand united where we’ve decided we need to draw the line. We’ve been looking for behavior to praise and doing so above and beyond. He seems to be responding well. This morning he seemed to be a in a good humor, didn’t pick fights with anyone like he had for the last month. We’ve made it clear to him what is punishable (peeing pants, yelling/being disrespectful) and what the consequences are. Now we are just keeping the line and lightening up about other things. The true test will be this weekend when he is home more!

ADHD

I’ll be the first to say that there’s a problem with over-medication in our foster care system. Well, as in all things, it’s a problem in society in general but only heightened for our foster youth. My kids surprisingly have never been medicated. They didn’t come with a long list of diagnoses. So I found that we are actually on the other side of the problem with foster care– incorrect or lack of diagnoses. With the adoption paperwork we received, I was able to read through the kids’ past mental and behavioral health history. More often than not, they were discharged before I believed that they should have been (granted, without firsthand experience at the time). None of the children actually had intensive, ongoing counseling when we accepted placement. This despite over five years in and out of care with more than fifteen different placements. Call me crazy but any child that goes through that much change should be counseled by a professional. We’ve been fighting an uphill battle since we accepted placement to find the right programs for our kids and get them the help that they need and have needed for years!

With that being said, I am always a proponent of finding alternatives to medication. But I found this article on girls and ADHD and it IS our Anne. Every single bit. Every action they write about, it is Anne. I am going to ask for her to be tested in her current counseling program. Anyone have experience with girls and ADHD?

http://www.scholastic.com/teachers/article/girls-and-adhd-are-you-missing-signs

Behavioral Health

I think we’re at our end with the current behavioral/mental health situation.

Anne goes to her “intensive” therapy three days a week. She gets picked up from school at 2:30 and either hubby or I pick her up from the counseling office at 6:00. They cover a breadth of therapy approaches, including individual and group therapy. I’m not sure what certifications the counselors have but there are two “mental health professionals” that she sees on occasion (seems like every other week or so). She’s been there almost four months and they have worked mainly on coping skills, including getting through the adoption and the holidays. They have yet to really delve into issues with her birth parents/birth family. I have not noticed a huge difference in behavior but it is always nice to have her counselor reinforce what we go over at home. She has told me on occasion that she used one of her coping skills before “hitting” one of her siblings but in general I don’t think her aggression, resentment or sibling rivalry has really been addressed. I have talked with her to see what she thinks will help her the most. She said that the one on one time with her counselor helps much more than being in group with the other kids, and that she’d rather go one day a week than three. I realize the importance of the counseling, especially at the age of 10. I’m concerned at the actual amount of counseling she receives in ratio to the number of hours a week she is away from home. I think we feel her absence a lot and she misses being at home and seeing her siblings. Anne has her 6 month evaluation at the end of January to determine whether she continues in the program (a formality for insurance) and I’m thinking of using that time to discuss our options. I know that she needs counseling and neutral sources for information and encouragement. I’m just not sure how much she is getting out of this intensive program versus the number of hours per week that she is there. I also think that being at home more often would keep her from being so overwhelmed at school and feel more attached to myself and hubby.

Huck is still in the Family Based Behavioral Health program. Our “team” comes twice a week for 45 minutes to an hour. When just June comes, we stick to the schedule and she has a clear cut idea of what to go over. We’ve done things like talk about emotions and what happens when we bottle them up. We’ve read books regarding parents loving their kids no matter what their behavior is. She’s a very calm presence which works well in our home, but just her visit causes a ruckus every time. Her team partner, we’ll call him Ed, does not come with a concise picture of what needs to go on. He derails the visit every time, as if he doesn’t understand the agenda or doesn’t care. He actually has gone against June and given an opposite opinion on a matter of things. I don’t particularly care for his personality or his methods, but I’m also partial to June because we’ve been with her since the start of the program. I have actually told the program supervisor that I would prefer if only June comes, but it is a team based approach so that was denied. We are at the point that we feel a more individualized approach for Huck will work better. He likes having attention all to himself (what kids doesn’t, especially what sibling of four kids doesn’t!) which we learned over the Christmas break when we had no issues, either behaviorally or physically. The Family Based approach is a wonderful concept. This program usually helps natural parents who are working towards regaining (or keeping) their children from foster care. In fact our children and their parents were under this program before when the children were at home. Technically, my husband and I have been at discharge level since the start of the program. The only reason they can continue is because our son, who the program is billed under, is not at discharge level. But I’m not sure how much more my husband and I can learn to help. We’ve gone over a lot of parental philosophies and behavior charts and June keeps telling us that we’re teaching her more than she’s teaching us. So if we’re doing what we’re supposed to do and not seeing huge changes, maybe it’s time to try something different? I hate to switch already after I fought so hard for this but I hate to waste another month of aggravation if we could see big results after chasing another avenue.

I realize that this will be ongoing. We will ebb and flow with counseling and therapy. I thought you all might like an update on the mental health front because it seems so elusive when you start out with fostering!

Counseling: Update 20192358332749082

First, I have updated the “About” section of this blog to include all of the kids’ pseudonyms in case it gets a little confusing. Make sure you check it out!

https://fosteringourhope.wordpress.com/about/

Second, let me rant some more about counseling. Soon we will have placement of our kids for four months. While Anne is two months into her trauma-based intensive counseling, our son has yet to start his counseling. The initial referral was sent in August. He had his psych evaluation for his counseling three weeks ago. That is the last piece that we were waiting for in order to have his in-home, multiple day a week counseling. He NEEDS it so badly. We are having so many issues and we just can’t get through to him. He is broken. His soul is broken. He is sad. He’s having trouble at school. He’s having trouble at home. He doesn’t listen. He seeks negative attention. He’s having toileting issues, the kind that comes from major anger and frustration and a last-ditch effort for control. He’s been broken. I don’t know how he lasted in foster care for five years without any kind of intensive counseling. I don’t know why someone didn’t help him before. But I will advocate forever so that these children and others like them have the services that they need.

Foster children (really, all children) need to have counseling EVERY time they move homes. Foster children need to have counseling as soon as termination of parental rights (TPR) occurs. These should be automatic. A referral needs to be sent and processed immediately for children who move homes or who have been through TPR. We need this in writing and it should be a rule for all agencies and counties. New foster/pre-adoptive families can only do so much. The families/parents need back up from professionals and people who have degrees in childhood development/trauma/neglect. I only wish that we had as much help on the counseling front as we did from our case manager. Our case manager came out once a week for the first month and every other week since then. The kids need someone like that who comes for THEM. Just them! I have someone that I can call and bounce things off of and ask any silly question that I can think of. But these kids have me or my husband and each other. But they have a lifetime of questions to ask. And they have a lifetime of needs that have not been met. Why is there not some regulation on the mental health front? There needs to be closer monitoring so the issues don’t get too bad and then it takes years to fix. My children need healing from their childhood. Their childhood! My childhood was fun and exciting and these children have to recover from what happened during their childhood. Does that make any sense to you? It certainly does not make sense to me. They should be healed or in the process of healing. But they haven’t even begun counseling!

We are also waiting on the referral for the adoption prep class. Our permanency specialist recommended this class. It’s particularly for kids who have just gone through TPR. It’s an attachment process and helps them work through their often hidden emotions.

When I saw my dad over the weekend he kept saying how excited the kids must be for adoption day. And I couldn’t get it through to him that no, they are not. They are not excited. They might be excited for balloons and candy or cupcakes, and they are certainly excited that they get to miss school. But they are not excited to officially leave their old world behind and join a new one that they’ve only just met! It’s bittersweet for everyone involved. The kids are old enough to have been affected by this mess, but they also aren’t old enough to remember all of the bad times. They remember seeing their parents at visits and getting to eat McDonald’s and getting new presents. They don’t remember what the home conditions looked like or how bad the youngest had diaper rash. They don’t remember how many times their water was shut off or their parents were under the influence while caring for them. I am thankful that they don’t remember specifics but I am also aware that every behavior they have is due to survival. They were badly neglected and they act like they were. I only hope that time will help to heal their deep wounds. Time, and some really good counseling.

Advancing One Day at a Time

Today our oldest daughter began her 12-18 month intensive counseling program after school. She gets picked up from school at 2:30 three days a week and then we pick her up at the counseling office at 6:00. We definitely all missed her. She’s such a true older child, always wanting to help with her siblings and being the peacemakers. She is always very compliant and eager. It will be hard to have her gone that much during the week but I know it’s the best for her to work through past trauma.

I also got the call for Little Man’s psych evaluation. We will have that on the 29th of this month, then it will be a few days before his in-home therapy starts. Phew! Nothing like waiting three months or more for some therapy! I know I’ve said it here before but if birth parents are getting the same support after eight weeks as we are, then our “system” and all of us are failing these parents. If this is how quickly foster children receive care then what is really happening on the other side of the equation for the birth parents? Do they get as much red tape as the kids do so that it is just as hard if not harder for them to get the help they need? How could they ever get their kids back? I think of the poverty and lack of education and no wonder they can’t make it through the judge’s orders. It makes me pretty pissed off with the system.

Today I heard from the permanency staff at our agency. We actually met with this Permanency Specialist back in April (here’s the link from April 15th https//fosteringourhope.wordpress.com/2014/04/15/adoption-here-we-come/). Basically, she called with great news. She said that since she has met with us before (and did our adoption orientation?!?! supposedly) and our profile is so new that there is not much she has to add. We need to do new health histories for ourselves and all of the children, a new adoption application, add anything to our biography section to include these kids, and basically sign a bunch of stuff. She said that she should have it done in November. So I emailed our county case worker to see what day she was considering (since google says that National Adoption Day is November 22nd not November 7th as she told me). I am wondering if they already had these kids penciled in and now that our placement is going so well they just want to stick with it. Plus does anyone know if it looks good for their numbers if these kids are adopted this year?? Can’t hurt I am sure. Anyway, it is looking better and better for these kids to be adopted before the Holidays, which would just MAKE. MY. YEAR!!

Anyone have some good links to Happy Adoption Day parties? I need to start planning!

Behavioral Health

Friday I took our Little Man to his evaluation for in-home therapy. We were told a few days in advance and I expected his evaluation to be similar to our oldest daugher’s evaluation. Her evaluation was with one man (social worker? psychologist? psychiatrist?) who went over her background, transition to our home, and current emotional state. I figured it would be similar for Little Man and prepared him for lots of talking. We arrived early and while we were waiting our county case worker showed up, which was a surprise because I had just talked to her and she didn’t mention that she was coming with us. She called me at 8:30 to tell me that she had been in training all week when I called/emailed. Obviously we were already driving to our appointment so there was no need to move it.

We went into the room and there were six adults, plus myself and Little Man. Apparently it is part of some “Children’s Clinic” through the county so there were people from various different county offices and nonprofits. They began by introducing themselves and their organizations. Little Man was not having it. He shut down. He is usually very outgoing and active but he was already super nervous for the evaluation and all those adults did nothing to assuage his fears. He sat with his head on the conference table or on my lap for the entire meeting. Poor baby. I’m still not sure why he had to be there, no one had to talk to him directly and I couldn’t be open and candid about his behavior since he was sitting right next to me and I did not want to embarrass him or make him angry.

The head of the county’s behavioral health outlined three choices for us. The first choice was something called  PCTI which is a parent and child therapy where the child is in the room with a parent who has an ear bud from the therapist. The therapist watches from a two-way mirror in the other room and directs the parent and child through the ear piece. 

The second choice was in-home mobile therapy just for Little Man. Seemingly once a week.

The third choice was called Homekeepers, something that is in every county in Pennsylvania. These therapists come to the home after school/in the evening a few times a week and hold individual, group and activity sessions for the whole family and focused on only one child. The “team” will sit through routine activities and watch for behaviors to crop up, then will guide the whole family through the resulting feelings/actions.

I could only choose one of these options at a time because of insurance and I felt pressured to choose on the spot (I felt that it might allow everything to move quicker). I was deciding between the in-home mobile therapy and the Homekeepers option. I finally chose the Homekeepers option so that we could work together as a family to stop bad behavior and not just have Little Man holed up with a therapist.

I think I have made it clear that I strongly dislike our county worker. Our social worker again used the excuse that she “just got their case” when asked about pertinent information regarding his past therapy. Our social worker also talked about permanency in front of Little Man, talking about the potential adoption date of November 7th despite our agency worker saying they have not yet received the referral for the adoption home study and that these home studies usually take three to four months.

I am glad that we have progress for Little Man. Now we just have to wait for the insurance so that he is approved for the services.