All I did was call the IFI supervisor, saying "I was hoping you might help us trouble shoot some issues we're having with our IFI team."
The supervisor said, "Never mind, we're switching you to my team. Sissy's been rolled to GA medicaid."
News to me but OK then!
The last two weeks has been a blur. Meeting the new team, reintroducing ourselves and Sissy's issues and phone calls. Oh the phone calls. As the chips settle, we are getting 10 hours in-home therapy provided by three new team members, all of which have RAD experience. Our Family therapist is working on social skills with the children in one session and attachment with me in the other. The individual therapist is reviewing DBT skills and the third member is a life coach, taking Sissy out into the environment to help her navigate more appropriately. The CBAY waiver (community based alternatives for youth, a federal stimulus act grant-funded program specifically created to help kids transitioning out of RTC) is providing wrap around services which includes paying for a Family Y membership so Sissy can access the day camp program and adaptive swimming classes, respite care, neurofeedback, paying the RAD therapist and finally, assistance in payment for the IFI services. (even though she's medicaid now, in July, GA will cut the allowable hours for IFI by 50% and the CBAY waiver will pick up the some of the slack.)
Most kids are in IFI for three to six months. Sissy will get the full six months. Typically clients are on the waiver for a year but if Sissy still needs help, we can get an extension.
Do I think all of this stuff is working?
Here's the thing. I think if I took the RADQ right now, Sissy would probably score 50% better than she did last November (she scored all but 2 at that time.) And I haven't had to call the crisis team to deescalate in four weeks. She's had volatile moments and limits-testing moments including setting off her alarm, but I was able to manage it all. (Don't think I'm a fool though, I made sure the IFI team knew about it afterward.) But back to the question, do I think all of the interventions are helping her? I can't say.
Now I'm going to go geek on you, as is my right as a science teacher on indefinite leave. An experiment must have only one manipulated variable by which to test the hypothesis and to draw conclusions upon. If more than one variable is changed, you can not determine which variable affected the end result. The experiment and any analysis and potential conclusions as it pertains to the original hypothesis is null and void. Sissy's experiment has a second variable. Meds.
A month ago, the pdoc increased her anti-psychotic and added a new ADHD med. Her violent rages stopped. Immediately. She still can't sleep, still manipulates and annoys us deliberately, still tries the waters to make sure her family isn't going to turn into a cesspool of writhing, electrified eels and generally is not "better" per se but the violence? Gone. The crisis calls to IFI? Non-existent. It would be wonderful to say all the therapy has helped, that she's cautiously attaching but I can't say it isn't just the meds.
We are about to discover the proof in the pudding. Sissy has had tremors from the meds and I don't know if it's the increased anti-psychotic or the ADHD med. If it's the anti-psychotic, on Friday, the pdoc is going to take it back down to the original dose. If her rages immediately reappear then we'll know, won't we?
Yes. I am dumbfounded that some how by an act of God we have gotten help finally. I really wish I knew how we landed on the door step of OZ so I could tell you to just follow our yellow brick road but I think Glenda the Good Witch waved her magic wand and that's how we got here. What's more, we'll be getting some for Aspie Boy too since we did an intake with the IFI team just this morning to address HIS issues. But still I'm thinking that the meds have been the true reason for the emerging peace in our home. Four weeks ago I would have still told you were were hitting all but 2 of the RADQ statements. In addition, it seems only I am soaking up the therapeutic techniques so that when Sissy has a crisis moment, I can talk her through it better and therefore we aren't escalating to a crisis situation that requires outside intervention. Sissy's not actually internalizing these things to use of her own recognizance, she really just likes getting all the attention.
The real question I find myself pondering is at what point is RADs a psychoses that requires medication as opposed to a diagnoseable syndrome that can be retrained and reconditioned through the often odd RAD therapy techniques? In other words, does trauma irrevocably alter brain CHEMISTRY and PHYSIOLOGY, not just cognitive reasoning and psychology? Does trauma induced RAD actually become a MEDICAL condition that would show altered brain functioning in an MRI? Have psychology and psychiatry researchers ever performed a functional, waking MRI in which the RAD is asked triggering questions to see what happens in the various regions of the brain?
Indulge me for a minute. If you consider another severe mental health condition like schizophrenia in which the individual displays odd, challenging, defiant and sometimes violent behaviors toward himself or toward others, the first question is usually, what is the medication treatment plan? Not, as it is more likely to be with RADs, what is the therapy plan? On fMRIs, schizophrenia is very distinct, often including smaller than average brain regions and in research, even diminished neurotransmitter receptors in the hippocampus. Once the sufferer of severe mental health conditions is adequately treated with medications so that his symptoms are minimized to manageable levels, he then approaches his therapy plan to help problem solve and trouble shoot the challenging circumstances that are specific to the patient.
With RADs, at least to me and in our situation, the opposite occurred. Sure, we tried meds for Sissy but all of them addressed her ADHD specifically and then over time, adding to address her bipolar. But with the RADs, straight from the start at diagnosis when she was only 18 months old, the treatment was only therapeutic. In fact, the psychologist and therapist only ever talked about the therapy plans to treat the RADs. It wasn't until RTC that the med plan became aggressive enough to batten down the hatches on Sissy's mounting mental health needs. Six months later, she's on a cocktail that has ceased her rage, dulled her mood swings and her yen to exacerbate and made it possible for us to begin building a bridge toward acceptance and appropriate affection.
For four years, I have built friendships with amazing families that have kids impaired with lots of different mental, emotional, genetic and physical impairments. They are all different but one constant has held true, when they are escalating, they have required a med adjustment.
Sissy will always be "off norm" and I accept that. It would be folly if I didn't. But maybe I'm also beginning to accept that her RADs is just one component to her conglomeration of mental health needs. yes, I know. RADs mimics everything but Sissy has needs akin to her birthmom's and BM never had RADs. Likewise, I think my acceptance of Sissy's mental health needs has made it easier for ME to attach to her regardless of HER desire, an unconditional love that has inadvertently become the doorway of opportunity for her to feel safe in considering to love me back. (See, one more variable skewing the results in our science experiment)
Finally, so many of our adopted RAD and alternatively challenged kids were available for adoption because their parents were alternatively challenged and thus ill-equipped to parent a child. I've said it many times, if you have a special needs child, quite often you have a special needs parent. Think about it. Let's say the parent was an alcoholic that abused a child when drunk. WHY was the parent an alcoholic? Was their bipolar disorder unmedicated or undiagnosed and the alcohol became the only way the parent could "help" themselves through his own needs? Was the parent abused as a child and never recovered? I know many parents of Asperger's and Autistic children that are a little quirky themselves and it makes me wonder maybe the MOM's on the spectrum but never diagnosed? And if you ask anyone that's been in mental health professions for any length of time, they'll admit to it. Individuals with unaddressed mental health needs are more likely to be attracted to other adults with unaddressed mental health needs so that they have children that have unaddressed mental health needs, children that are traumatized inadvertently BECAUSE of the parents' unaddressed mental health needs. It's a horrible vicious cycle that I suspect alters brain chemistry as opposed to just individuals perpetually modeling bad behaviors that psychologists say can be retrained by cognitive and dilectical behavior techniques.
Anyway, that's food for thought, eh? I'd love to hear your two cents.