Residential Placement
ADDENDUM TO SOCIAL WORK ASSESSMENT
June 23, 2005
TLP returned to the Respite Provider's home for therapuetic respite on May 18, 2005. The family picked him up on May 28, 2005. At that time they discovered that he had bruises and red marks on various body parts. TLP reported that he was pinched repeatedly because he would not follow directions. Water and food were withheld from him for a period of time. He reports that he was given a pill, other than his prescribed medication, and it made his eyes and head hurt. He reports that someone was touching his penis when he was sleeping. A complaint was made to Children's Protective Service and the County Sheriff's Department. An investigation is on-going. The family has been reluctant in the past to use respite services because they did not want to place TLP at risk. The family had been encouraged to utilize respite so they can have relief from providing constant care for TLP. The family will continue to need intense support to maintain TLP within the family home. The Attachment Therapist has recommended residential treatment if TLP continues to disrupt the family.
-THE ANGEL (Caseworker)
August 12, 2005
Dear Family Independence Agency,
THE ANGEL, TLP's case manager through Thresholds, informed me that you needed additional information in helping secure a residential placement for TLP as needed. The treatment plan's goal includes maintaining TLP in his current adoptive home with abatement of aggressive behaviors that threaten the safety of family members. However, I believe he is currently at risk for becoming aggressive again and the ability to expidite residential placement would be appropriate, as outpatient care may not meet his service needs in keeping him and his family safe.
Since my last letter to you, significant events have occured. While waiting for a decision regarding residential placement, which the casemanager and this writer recommended, the family sought out respite services on their own. They placed TLP with a woman (who lives with her 17 year old adopted son) who provides respite to children with attachment disorders. TLP stayed one month on his first stay, and came back with improved behaviors. At the first showing of aggressive behavior, TLP was returned to this respite provider. When the family showed up early to take him back home, the respite provider admitted to pinching TLP, causing bruises. Children's Protective Services became involved; TLP also alleged possible sexual abuse which was also investigated. The prosecuting attorney of that county has filed child abuse (4th degree) and assault or assault and battery charges against the respite provider and her adopted son.
After the second respite stay, TLP presented relieved to be home but detached, blocking out feelings if possible. He also displayed trauma reactivity such as searching through feces with his hands, looking for pills that he believed the respite provider drugged him with, and being overly cautious of his surroundings. In the last few weeks, there has been an increase in agitation, anger, and oppositional behavior but no violent aggressive behaviors. Increased psychiatric medications have not significantly improved the situation.
Therefore, I hope that this letter suffices in giving you enough further information to expedite residential treatment on an urgent basis if it becomes necessary. I am comitted to continue working with the family to avoid that, but if he becomes violent and aggressive, I believe that a residential placement is warrented.
-THE KING (Attachment Therapist)
November 2, 2005
I am writing to request permission for an emergency out-of -home placement for my son, TLP. TLP continues to remain a great challenge to this family, and although we love him very much and hope to continue managing his behaviors within our home; we are all very aware that TLP could be a possible risk to family members as he continues to increase in both size and strength.
TLP currently lives with his mother, S (age 42), his father, S, (age 48), his sister, D (age 20) and his brother, M (age 18.) His father is employed full-time as a Senior Quality Engineer, and is a very involved and dedicated parent in the evenings and on weekends. His sister, D, is a full-time college student and employed part-time. His brother, M, is currently a senior in High School and employed part-time. I have chosen to be an at-home mom so that I can be available to my children at all times. Our family unit is VERY close and everyone has always been very involved in managingTLP’s behaviors when they become out of control. Yet, due to TLP’s large size, my husbands physical problems, and the older children not being home as much to help us physically manage him on the bad days… we are really struggling over here some days.
As you already know, this is the second time that we have asked for help in obtaining an out-of-home placement for TLP. The first time, we were forced to seek an emergency respite placement on our own because TLP’s behaviors were so out of control that we were unable to wait any longer for state approval for a residential placement. As you also know, the respite mother and her 17 year-old son physically hurt TLP while he was in their care, and a jury trial is scheduled for December. TLP was also sexually molested in this home, but a lack of evidence was available to pursue those particular charges. Never the less, we are still attempting to live with a child who was physically, emotionally, and sexually hurt again… and we are really struggling. As much as I sadly regret my decision to place TLP with that family, we honestly felt that it was necessary for TLP to be out of our home and we were left with no other options. For that reason, and to prevent TLP from ever being hurt again; I am asking that an emergency residential placement plan be set up that can be utilized on an as needed basis during the times when we feel he is a threat to family members.
We are working closely with TLP’s psychiatrist, Dr. JVH, who has been adding and increasing medications to help us keep TLP’s behaviors under control. Although we have seen some positive changes with the medications, TLP’s behavior still remains a grave concern to us at times. We sincerely worry about what they future holds for all of us as he continues to increase in size (150 lbs) and strength, and Dr. JVH continues to speak to us about the reality that TLP may eventually need a residential type living situation for everyone’s safety.
TLP continues to attend weekly therapy sessions with THE KING (Attachment Therapist,) which has been very helpful for the most part. In fact, I honestly believe that THE KING is the main reason that we have been able to manage TLP for the past three and a half years. THE KING has given us the tools that we’ve needed for behavioral management and has provided intensive therapy as needed (sometimes three times a week,) but TLP continues to act out really bad some days to seek control. A sudden increase of sexual gestures and comments to family members has been of great concern to us, and I am most worried about his recent anger and his need to seek control by invading the personal body space of others. As much as we try to always monitor TLP, I still fear that he could be a possible risk to younger children and animals if left unattended. Obviously, we are living with a child who is at risk of hurting others and I feel that we have done the best that we can with the services we’ve received, but as TLP continues to grow, I fear that he could someday soon be a physical threat to our immediate family members too.
We continue with our monthly in-home services with our caseworker, THE ANGEL, through Thresholds. THE ANGEL has also been a great source of support and strength to me as she often runs interference for us throughout the difficult periods of time. Thresholds continues to offer this family a $100 respite reimbursement (per month) but when the behaviors are out of control and we need help the most, we are unable to find a respite provider (extended family) that is willing to deal with his difficult and controlling behaviors. THE ANGEL and I have spoken about the possible need for a temporary residential placement for TLP.
TLP has been a part of this family for nine years and we love him very much. We DO NOT want to send him off to live in a residential treatment facility, but the reality is that someday soon, we may have to make that decision for the best interest of everyone involved in his life. My hope is that if we can set up an emergency clearance for a residential placement now, that we can use it once or twice when TLP is out of control to show him that we mean business, and that we will send him a strong message that we will not put up with being bullied, threatened, or allow him to invade our personal body space any longer.
We have tried 2 two partial hospitilazations at Psychiatric Hospital #1 in the past, and one hospitilization at Psychiatric Hospital #2 without success. In my opinion, we are dealing with a very confused boy who has been hurt by many adults in his life, and is now testing us to see if we will eventually hurt him too. I believe that a part of him truly loves us, but I am acutely aware of the part of him that becomes so frightened to trust, and starts acting out in an attempt to push us all away. In my opinion, this is not something that can be medicated away or helped by sending him to a psychiatric hospital for 3-5 days at a time. TLP’s history has proven that he saves this type of controlling behavior for us (his family) and that it WILL return shortly after he returns home from the psychiatric hospital. I believe that this is a severe problem that will only go away as he learns that he will be consequenced (sent elsewhere to live on a temporary basis) for physically and emotionally abusing his family members. Please feel free to call and speak with THE KING about his recommendations for TLP, as we feel thatTHE KING is intimately aware of TLP’s special needs and will agree that a psychiatric hospital is NOT what TLP needs when the power controls are in full swing. I think that THE KING will agree that TLP needs to be sent away as a consequence to reinforce that he can only be at home with us if we are feeling safe…. And yes we will send him away if he challenges our authority and invades our personal body space.
If we are forced to make the decision to place TLP temporarily in a residential setting, his father and I would be very active in TLP’s treatment program with the main goal of getting him back home as quickly as possible. It is my opinion that TLP may have to go back and forth between home and a residential facility a few times (for short periods of time) before he learns what he needs to do to continue to live at home with his family. I believe that TLP is attached to this family (although I see it as a very confused and fractured type of attachment right now) and that he WILL want to work to come back home where he feels safe and loved. But there is no doubt in my mind that he will test us a few times to make sure that we are serious about not allowing the behaviors.
We are all so very tired over here and there needs to be a plan for tired families like ours, so that we do not get so frustrated that we want to give up on our children and permanently send him away. We promise to visit TLP often and make sure that he understands that he is not being abandoned by us… but we truly are in need of help and for someone to help us send a message to him that families do not have to put up with physical and emotional abuse. We live in a society where we remove children from abusive parents, and set up safe houses for women and children that are in abusive relationships, but there are no safe places out there for parents and families that are being abused by their children… and I find that to be very sad.
I love my son and I’m not looking to dump him and walk away. I’m not trying to reverse an adoption. I’m just asking someone to offer us a safe place that we can bring TLP when his control issues become too controlling for us to live with in a healthy manner. Nobody deserves to be hurt. TLP didn’t deserve to be hurt as a baby and he certainly didn’t deserve to be hurt again in this respite home. But my family has been hurt over and over for the past nine years and all we are doing is asking for someone to help us send him the message that this behavior will no longer be allowed. In order to do this, we NEED to have some safe place that we can bring him as we say, “YOU CAN NOT LIVE IN OUR HOME WHEN YOU HURT US!” Please consider helping us help send TLP this important message.
I am ready to make a call to Eagle Village Residential Facility (because I need TLP to be close to our home) and see if they will help us set up an emergency placement plan, but before I can do that, I need to know that Adoption Medical Subsidy will authorize payment for these services.
-TLP's Mother
A Letter to The King (TLP's Attachment Therapist)
I'm having a really hard time with this. Yesterday when I told TLP that he was leaving... and he started crying... and begging me not to send him... and I saw his fear... I couldn't stop the tears. He cried and told me he was going to be afraid of the men in the white coats with the ropes and chains (a big thanks to Miss Respite Provider.) : ( I hugged him and cried with him as I explained that she had lied to him, and was only trying to scare him into being good.
TLP cried and told me that he was sad because I never hugged him anymore. I felt bad... and cried... as I explained to him WHY I felt I couldn't snuggle up with him and hug him like I used to. I told him that every time I touched him... he tried to make it an angry sexual thing... and it scared me... and made me not even want to touch him at all. I apologized and hugged him, and it felt as if I was hugging that little boy part of him that was terrified and needing his mommy. The part of him that I don't see often enough... the part I don't want to send away... the part of him that hugged me so tightly that I knew how badly he was frightened.
The angry part came out at bedtime though. When I tucked him in and kissed him goodnight, he told me that this would be the last night that I ever saw him. That worried me... but I reassured him that everything would be okay... that I loved him... and kissed him on the cheek before I left his room. Mr. S and I hid all of the knives... meat forks, and all other sharp objects before we went to bed. We put away anything that he might be able to use to hurt himself. We had his door alarmed, had our bedroom door locked, and instructed M and D to keep the door to their upstairs bedrooms locked last night too. Very sad. Very hard to live this way.
This morning he was fine. Sad.... but fine. The angry part of him was gone and he wanted to be close to me. Very appropriately too. We shared some hugs... talked more about the residential placement and what he could expect... how scary it must be for him going away again... and what kind of things he can work on while he is there.
Later, I was sitting in a chair in the living room and he rolled over to me in the computer chair. He laid his head on the arm of my chair and I started rubbing his back and telling him how much I loved him... that I was going to miss him. He stayed there so long... with me rubbing his back... that he fell asleep. I helped him walk over to the couch and covered him with a blanket as I started rubbing his back again. He went right back to sleep and I just sat there rubbing his back and staring at him.... and crying.... because I could see the little boy in his face... and I feel so bad for what I'm about to do... knowing that he's so frightened. I wish there was some other way. I wish that I could keep him here at home where he belongs. He's not even gone yet but my heart aches already... just at the thought of sending him there. I guess I should thank you that I have those feelings for him.
Mr. S told me last night that I have a good "poker face" when I'm in your office... and pointed out that I often avoid looking at you. As if it wasn't something that I was already aware of. ?????????? Since we won't be seeing you for a long time, I just thought I would be honest with you in saying that I sometimes try to analyze you as we are sitting in there too. HA! I often wonder if your teary eyes are real.... or just something that they taught you to do as they trained you to become a therapist. I wondered how you did that.... and what sad things about your own life you had to think about to make those tears appear so quickly. I wondered if you could see my pain as you stared me down... or if you just wanted me to think that you could see my pain.... so I would open up about what I was feeling. I wondered if you really cared as much as you said you did... or if it's just all part of the job... you know... ALL IN A DAYS WORK. : ( Quite honestly, I'm a bit like my daughter... who once said, "I don't want to talk to someone that gets paid just to be my friend." That's not meant to be an insult to you.... to what you do... or for trying to help us... it's just who I am. I know that I unconsciously put some safeguards into place a long time ago... and I always made a point to be the strong one... to never cry... so these last few years have taken quite a toll on me. Not just in raising TLP... and with working with you in your office... but in many different aspects of my life. I find myself changing... and I am finding that my own personal needs are different than they were four years ago. As I find myself crying more and more... and as my family appears to be quietly freaking out about it... maybe even seeing it as a sign of weakness... or a sign that TLP has to go away... or that I'm maybe ready for a bed at the psychiatric hospital... I am seeing this as a sign of some healing. BUT healing that I MUST do on my own... on my own terms... as I figure out a few more things about myself.
I'm rambling.... but what I really wanted to say was Thank You. Although I usually try to avoid you... I know deep down that you're a really good person... and I do know that you care. Although I'm really stubborn sometimes.... I'm usually listening... and I often discover that you are right about most things in the end. BUT last night... when I saw the tears forming in your eyes... for the first time... I let myself believe that MAYBE... just maybe they could actually be real. We've been through a lot with you these last four years... and I thank you for being there... and directing me... and helping TLP trust you... and reading my rambling emails... and helping both of us learn to trust you... and pretty much... just for not giving up on us.
I don't know where we're going now. I don't know if we're even going to make it. But I do know that I love him... and don't ever want to give up on him. Thanks for helping me find that little boy inside of him... and also the little girl inside of me. We both have some rocky roads ahead of us... but we're both so damned stubborn... I think we might actually make it some day.
Ummmm.... that was kind of an awkward handshake and goodbye that I gave you last night. What I really wanted was to give you a big hug like TLP did... and cry... and say thank you... but I knew that that would be just a bit inappropriate on my part. So.... as you read this... just consider yourself hugged (if that's okay with your wife)... and know that I sincerely thank you for being such a huge part of our lives... and putting up with us... for going that extra mile... and for caring. Please give TLP's appointment times to someone else... but thanks for offering them to me if I needed them. I just don't want to waste your time... because I know me well... and I know that it would take YEARS for me to sit there and agree to let you totally analyze all of my thoughts and fears. That's something that I just need to do on my own... while TLP is safely tucked away.... hopefully getting the help that he so desperately needs.
I plan to leave home for a while right after Christmas. I haven't told my family yet... so please don't shoot this email back into my email box where someone can read it. I'm not sure WHERE I'm going... or for how long... but I think I need to go somewhere and find myself. Somewhere where nobody wants anything from me... where I can figure out how I got where I am in life... where I need to go from here... and how I'm going to get there without hurting anyone else.
Merry Christmas.... to you and your family...
HUG
-Suz
TLP went to a Residential Treatment Facility on December 22, 2005. : (
