Friday, February 28, 2014

Visits are hard

A lot of people simply do not understand trauma. I sat in a room full of foster parents last night as we went through a required annual training called "Placement Stability". Basically, they took almost two hours to tell us that foster kids have behaviors and we shouldn't give up on the kids and disrupt placements. The instructor briefly went over the idea that trauma changes brain chemistry. But still...several foster parents spoke up about kids they had parented in their home. I heard comments like, "The kids don't understand. I tried to explain it to them - that their behavior was the reason they were being moved all the time - but they just didn't get it."

Trying to explain something like that to a foster child tells me that you, the foster parent, probably don't get it. (Especially since the woman that spoke the most was talking about a kid she did respite for that she was trying to "explain" this to. She didn't even have a real relationship with him.)

So - that said - let's just put this out there...
ALL FOSTER KIDS HAVE LIVED THROUGH HORRIFIC TRAUMA.

If I hear one more person halfheartedly add "neglect" in to the list of things a foster kid may have suffered I just might scream. The child doesn't have to have nearly died in order to have suffered trauma. Ricky has just a food issue or two that is likely the result of a very neglectful upbringing.

If a kid is in foster care, they have lost their family. Even if that family hurt them to where they ended up in intensive care, that child LOST their family and it still hurts. We (all of us...not just foster kids) are drawn to our biological families. Even if you think you hate yours, you still think about them all the time. They are connected to you. Imagine just for a minute if you were ripped from that connection. Because even if you hate your family, it's likely that YOU chose to leave them and there's something to be said for having that kind of power.

Daisy has no power right now. And Daisy has been ripped from her first family.

Daisy is starting to express her frustration with the situation.

Children have very little control over their lives. That's why it's so common to see kids from the hurt places taking control with the only things they can control: eating, toilet issues and sleeping. Adults simply cannot make a child eat, or go to the bathroom, or fall asleep.

Daisy has been having visits with her mom for a long time now. I always tried to make it so that Daisy would need to eat during the time she was with her mom. To me, it seemed like the right thing to do. It is not my job to help sever the ties between Daisy and her mom. It is my job to do what I can to maintain the connection. In the case of an infant, a LOT of bonding is done during feeding time.

Miss Daisy has started saying "E E E E" when she's ready to eat. It's a verbal cue that she tosses out there before she's super hungry and crying. In fact, she rarely cries now because we know to get the bottle ready when she starts saying "E E E E". Recently, things have timed out so that Daisy has just starting vocalizing that she is ready to eat when it is time for us to leave. The CPS office is less than 10 minutes away from my house. It's been perfect. Daisy was ready to eat and she was on her way to see her mom.

For the past two weeks I have dropped Daisy off and told her mom that Daisy was ready to eat. Two hours later when I came to pick her up, Daisy's mom told me that Daisy had refused to eat. Refused! This happened for three visits in a row.

In an effort to help and not sabotage, I offered to bring a bottle from our house. We've started thickening the formula ever so slightly with rice cereal to help with her reflux. I also use a different bottle than what Bio Mom does. Maybe that's why Daisy was refusing to eat?? (Keeping in mind I've got one bottle that is like Bio Mom's and if I feed Daisy when we're out and about I don't thicken the formula and Daisy always eats for me.)

For visit #4 I brought a bottle prepared from our house. This way all the variables would be the same – except for the location of the feeding and the person holding the bottle.

When I picked Daisy up from the forth visit Bio Mom looked a little concerned. Not only had Daisy completely refused to eat at all, but she had also cried inconsolably for over 15 minutes. Bio Mom quizzed me pretty hard. She wanted me to tell her why her baby was crying. She seemed convinced that the vinyl couch in the visit room must remind Daisy of a doctor's office or something.

Eventually I looked at Bio Mom and said, "This separation is hard on Daisy too. She's acting out the only way she knows how. No, I don't have issues with Daisy at the doctor's office. I'm sure she's just confused and sad and this is the only way a baby can express it."

Bio Mom didn't know what to say. I know I made her uncomfortable. Awkwardly, since I already had Daisy in my arms, I just walked out of the office and to my car.

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I've decided that I will make sure to feed Daisy prior to every visit at least for awhile. Yesterday, when I dropped Daisy off (she gets two 2-hour visits a week with Bio Mom), I looked at Bio Mom and said, "Daisy just ate around 2:00PM. She probably won't need to eat for you." Since the visit was at 3:00PM it wasn't like I fed Daisy RIGHT before the visit in an attempt to be mean. And if Daisy really wanted to eat with her mom she probably could take a few ounces. Bio Mom looked a little disappointed, but she didn't say anything.

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It would be lovely if foster care looked like a mentoring program. But I've got to look out for myself and I'm going to protect Daisy from as much trauma as I can. I also found out yesterday that Daisy's new CPS caseworker is NOT a high ranking, well experienced staff member put into place to coordinate the complexities of Daisy's serious case. No, Daisy's new caseworker is brand spanking new to CPS. He's literally at the bottom of the totem pole. He's incredibly young. He's a guy. It's doubtful that he's a parent himself. So I'm not going to go to him with parenting issues like this. Not if I can solve the problem myself by feeding Daisy prior to her visits.

I can't go to the visit supervisor(s) either. CPS has contracted out with a third-party to come in and supervise the visits. It's not the same person every time. Lord knows if they are keeping good notes or doing anything more than staring off into space during the visits. They never tell me anything that happens during the visit. I only know what Bio Mom shares with me.

So, if Bio Mom tells me that Daisy isn't eating and Daisy is crying, I'm going to fix what I can fix.

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Visits are hard on everybody. Even the babies!!

Thursday, February 20, 2014

Daisy has a new caseworker

Ahhhhhh Foster Care....

I got a phone call yesterday. The male voice on the other end of the line was a new one to me. He asked if he could make a home visit between 9:00-10:00AM.

After just a bit of conversation it was established that he is Daisy's new CPS caseworker. I said that he could come over and I got the house ready for a visit. I do not clean for caseworkers. But I do go through paperwork and make sure my calendar is easily accessible so I can answer questions quickly. I also prep the children and get them involved in something out of the main area of the house. Home visits go so much faster when the 9yo and 10yo aren't chiming in to add to my stories or correct anything I have to say. TT and Bart finished their math and went upstairs to their bedroom to play a board game. All was well.

Mr. CW (sounds like good blog name for now) showed up on time. He was dressed nice and got down to business immediately. From what I can tell, Mr. CW has a clue, and that is a very good thing.

We went over the basics. I gave him the contact sheet that lists all of Daisy's specialists. He never did explain why he's taking over Daisy's case but I do know that Daisy's other worker is still employed by CPS.

I've got two guesses as to why the switch happened.
  1. CPS simply did a shuffling of cases and this is where Daisy ended up.
    Nothing more. Nothing less.
  2. CPS recognizes the severity of the criminal charges and the likelihood of at least one bio parent getting their parental rights terminated. I believe that maybe this new caseworker is a "CPS Specialist IV" which would give him higher credentials should he need to testify in a trial.
Either way, I don't know much now. Mr. CW took the information, made a quick tour of the house and left. The whole thing was rather uneventful.

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Uneventful for me anyway. I was a little nervous prior to Mr. CW's arrival. However, I did some self-care by lighting a calming essential oil and I turned on some classical music. I calmed down pretty quickly after he left.

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I thought everything was fine with TT and Bart. They came downstairs and reported that they had been getting along. Both boys fixed themselves lunch and ate without issue. Then they went into the living room to play another game.

Not too long after they started, Bart quit playing. He reported that TT was dysregulated because he (Bart) was winning the game. Typically this is enough for cause a mini WWIII in my living room. I tensed up and waited for the explosion.

It never came.

Then TT came up to me all on his own and said, "Mom, I'm dysregulated and I don't know why."

TT let me use a ton of self-calming techniques from our bag of tricks. TT seeks sensory input...especially when he's dysregulated. Sometimes when he's completely wonking out he'll throw himself on the floor or up against a wall. When he's willing to accept sensory input, we can do it in a much healthier way than restraints (which have been sometimes necessary when it's gotten really bad). I keep a personal massage-thing in the living room just for this occasion. He sat on the floor in front of me and let me massage his back. And since he was WILLING to do this, he even made it more effective by pressing back against the pressure.

We talked. I actually figured out the problem right away. Of course I told him it was a guess - because I always want him to correct me if I'm wrong! But I gave him words for his feelings.
TT...you're scared. The new caseworker worried you. You didn't know if the new worker was going to be a good one and do his job. That uncertainty upset you. You worry about Daisy and you don't want anyone to hurt her.

You didn't like the way we had to hide Granny and Papa's things. (G & P have gone through ALL the background checks but our agency lost them and I've been unwilling to force my parents to pay for fingerprints again. Therefore, because they are here to see us from Iowa, they had to leave this morning during the home visit.) You don't like being dishonest - neither do I, TT - but you understand why we did it this way.

You are safe TT. And Daisy is safe. I think this new caseworker is going to be just fine.

Granny and Papa came back. No one got in trouble today. It's all OK.
Not only did TT listen and let me massage him, but he looked up at me and said, "Look mom. I'm strong sitting too." I did some bilateral tapping on his knees and we sat there together a little while longer. You could practically see the anxiety wash off of him.

The triggers can be so small sometimes and yet manifest so big. TT has made HUGE amounts of progress!! He's very protective of Daisy (VERY protective)! TT doesn't want anything bad to happen to her. And because of his own story, he feels an empathy toward her unlike the other boys in our family. But I can promise you, two years ago he probably would have gone into full blown rage over these big feelings. The fact that he came to me and used words is amazing!

I'm so proud of him!!

Saturday, February 15, 2014

Traumaversaries and Collections

TT has been struggling a little bit lately. Out of the blue the other day (and I do mean COMPLETELY out of the blue), he said, "Ya know, I was really worried when Dad had that motorcycle accident."

Interesting enough, he was only 2 weeks off from the anniversary of the actual date of the event.

Traumaversaries are very, very real.

I don't have any links to scientific data. I can't explain much about them except for the fact that they are real and I do believe that all people can experience them. Simply put, the body remembers the trauma and "big feelings" result on the annual anniversary of the event. Thus...traumaversary. Sometimes the big feelings are anxiety. Sometimes depression. Sometimes anger. Sometimes a person can be aware of the reason behind the feelings. But when it comes to kids, they often don't make the connection.

For example, I bet that every summer Dude and Dolly will feel a deep sense of abandonment sometime around the month of June. They have two traumaversaries: the original date they came in to Care and the summer they were abruptly removed from me due to the bogus investigation. I noticed it in both kids last summer. They both got a little wonky right after school got out for the year. And I'm guessing, but I bet next September doesn't flow too well for them in Dallas because of the memory of court and having to move to Grandma's forever in 2013.

Anyway...the traumaversary of the motorcycle accident (coupled with life in general and a visit from my parents) has TT all stressed out. And when his stress elevates, I become acutely aware of other issues that may or may not be due to the fact that he is adopted.

I don't like to pile everything negative on top of adoption. But I've got to be honest, the negative stuff often is connected whether I like it or not. TT was abandoned by his first family. (TT was adopted through the foster care system but it was really more like a domestic infant adoption that just happened to be orchestrated by the foster care system. But as pretty as that all sounds...that there was no abuse, neglect or exposure to harmful substances...he was still abandoned.) That abandonment is no easy feeling to escape. He never really will. And the fear of abandonment permeates life regularly.

In fact, after 10 years of parenting TT, I just personally made another connection between TT being adopted and some of his behaviors.
See the two sets of brown shelves above...can you guess which set belongs to TT?

How about these?

I'll give you a clue....the sets of shelves that are covered with more things belong to TT.

Herman is a collector too. He's always had a messy room. I've always had to help him clean up. I just figured that TT was the same way. A little messy. A kid that likes to keep things.

I never made the connection.

But here we are in the middle of high anxiety due to a traumaversary. We're talking about abandonment and loss a lot. We're trying to remind TT that we are here for him and that he's safe. We're pointing out the obvious - that Daddy is OK and we all survived that scare a year ago.

Through it all I was trying to get the house clean too. And one night, when I looked at the crazy messy shelves FULL of tiny things that TT just cannot bring himself to throw away, I got it.

TT can't throw things away because any kind of loss scares him more than the typical child.

It's been right in front of my face all along and it took me years and years to make the connection.

It was bedtime and I was making the mistake I make 7 nights a week. My mouth always gets the better of me at bedtime and I sit and point out all the stuff that needs to be taken care of.
"Bart, hang up your towel."
"TT, you put your socks in the laundry all in a ball. Please fix that."
"TT, don't leave your jeans all wadded up like that."
"Bart, pick up your robe."
"Bart, would you please wear your pajamas or put them in the laundry?"
"Boys, must you leave ALL the Legos all over your floor like that?!"

Most of the time I do this after the boys have actually crawled into bed. Often I go on entirely too much. (It's really quite pathetic on my part. I'm working on it.)

On this particular night I was looking at all of TT's little trinket things all over his shelves. I was looking at things that were broken, or had missing parts, or were really insignificant and old....things I personally would have thrown away. I started in on him about needed to cull his collections and for the first time ever I saw the pain in his face. It hit me like a ton of bricks.

I stopped myself and looked at TT. I said, "Do you want me to tell you why you like to keep so many things?"

Mr. Amazing sort of rolled his eyes. He's not a huge fan of going over big issues like this right at bedtime. But I swear...that's when they turn up 99% of the time. During the day everyone can gloss over the big stuff but once the lights go out the big stuff comes bubbling over the top.  I think it's true for most kids. I'm convinced Herman can't tell me anything about "life" until after 10:30PM. And it's especially true for TT and any of his big feelings.

So we did the prayers and the singing. Mr. Amazing kissed the kids and went back downstairs. I bent down to kiss TT and he asked me if I'd tell him why he keeps so many things. I think he already knew but he wanted me to put it into words for him.

I crawled into bed with TT. I put my arms around him. I said, like I always do, "This is big feeling stuff. If you don't want to talk about it right now I understand."

He said he wanted to talk about it.

His eyes welled up with tears when I told him the connection of loss...abandonment...adoption...and his things. I said that he hurts so bad inside because he lost his first mom that it scares him to lose other things too.

The next day I didn't make him clean his shelves off any more. He did a good enough job the first time around and he's got room for all the things he has now so it wasn't necessary.

I just have to pray that next time it IS necessary to cull the collection that I will be more sympathetic!! I have to remember the connection myself. Because if I can help him remember his truths, it might be easier for him to throw away school notebooks from three years ago.

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Funny story...
Daisy's new bouncer toy arrived in the mail yesterday. TT wanted to put it together himself. The directions were a little bit confusing and he ended up needing some help. But overall, he did most of it by himself. He was quite proud!
When it was all put together there were two screws left over. Everything looked right so we assumed they were extras. We directed TT to throw them away. He got up with the miscellaneous bags and bits of trash and took everything to the garbage can.

Right before I put Daisy in it for the first time I grabbed one of the toy bars to move the bouncer. The toy bar lifted right off. Puzzled, I turned it over to see exactly two screw holes in the bottom. I looked at TT and asked him if he had kept the screws.

His answer, "I disobeyed. And now I get to save the day."

The turkey couldn't bring himself to throw away two tiny screws. Thankfully he didn't.
But at least now I understand why!


Thursday, February 6, 2014

Private therapy for special needs kids

This post has less to do with foster care and more to do with the medical system. I'm not sure WHY I'm writing about this. Not sure how many of my readers want or need to know this stuff. But, since it seems to be information that a LOT of people (including caseworkers) don't know, I'm going to write a post about how my foster kids get in to private therapies.

I learned much of this the hard way with Pumpkin. And I do need to specify that this process is only how it works for ME in my part of Texas. I'm sure it's different elsewhere.

The first thing I had to learn is that foster kids in Texas have a different kind of Medicaid. It's safe to say that every single medical professional accepts Medicaid in Deep South Texas. (The culture of poverty almost dictates its necessity.) However, not every professional takes Star Health - the division of Medicaid that foster children are moved to.

Every one of my foster kids has come to me already on Medicaid. I now know to make sure that I specify "Star Health" when I'm contacting a medical professional. Their actual Medicaid number doesn't change when they come in to Care, but the way the insurance is processed does change. So a professional might say that they can accept my child as a patient the first couple weeks. But if they aren't an approved Star Health provider, I'm up a creek as soon as Medicaid makes the paperwork switch. The process can take up to a month.

I knew that Pumpkin (and Miss Daisy) NEEDED private occupational, physical and speech therapies. Yes, you can receive services via Early Childhood Intervention (ECI). However, it is my experience that these therapies focus mainly on educational goals. The speech pathologist currently working with Miss Daisy goes much "deeper" with the therapy than an ECI professional typically would (this information is according to Daisy's therapist). For example, speech therapy currently helps Daisy with feeding - not something that ECI usually does. A lot of stimulation, stretching and other exercises are done all while feeding Daisy a jar of baby food or even a bottle. This therapist is thoroughly trained on feeding issues and concerns. She's able to ascertain whether or not there are aspiration concerns. I feel much better about Daisy's eating after watching what the therapist does with her.

Private therapies are what I wanted Daisy to have. It is my understanding that you cannot have both ECI and private therapies at the same time. So, this is what I did:
  1. The first thing that had to happen was that Daisy needed to be evaluated by a therapy professional for each discipline. (In Daisy's case this happened when she was in the first foster home.) Generally the child's Primary Care Physician (PCP) will give you a referral to a company that provides therapies. I'm pretty sure it is also possible to call therapy companies in your area and ask for an evaluation without the referral as well. It is my preference to make sure I find a company that does in-home health care. These therapies, in and of themselves, are quite minor when it comes to overall healing. I personally need to watch and put in to practice all the things the therapists are doing with Daisy.
  2. Each discipline will do an evaluation separately. They go over as much medical history as you can provide. They also work with the child to see what the delays are and they set the goals that the child needs to master based on their development. The evaluator then draws up a formal document listing everything they believe the child needs and how frequent the therapy should be.
  3. This document is presented to the PCP to sign. If they agree, they sign and submit it back to the rehabilitation company. If they disagree, I believe that the evaluator has to rewrite the document in a manner that the doctor will agree to. (I've never had a doctor not sign what the therapist recommended.)
  4. The rehabilitation company will submit the signed document to Medicaid for approval. If all goes well Medicaid will accept what the evaluator recommended. However, this is not always the case. Pumpkin, for example, needed intensive therapy and the evaluator recommended therapy three times a week. Medicaid only approved two sessions a week.
  5. After approval, therapies will begin. The process up to this point in time can take up to a month or longer. I often call the rehabilitation company, the PCP and/or Medicaid to make sure paperwork didn't get hung up somewhere.

Daisy is currently in OT and ST. We're still waiting for Medicaid to approve PT.

This process is common for much of the things you need when caring for a special needs child. For example, when Pumpkin needed her walker the physical therapist had to write an official order. Then the PCP had to sign it. Then it had to be approved by Medicaid. Then I had to find a DME (durable medical equipment) supplier to order it from. (Often your therapist knows which DME they prefer to work with and will get them involved right away. Again - make sure the DME takes the kind of Medicaid your child has.)

When Pumpkin got her leg braces the process was the same.

Everything a special needs child needs takes at least one month MINIMUM before you can actually get it. Often, it can take much longer. I spent a lot of time on the phone chasing paperwork when I had Pumpkin trying to speed up the process.

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No real ending to this. Just figured I'd share the information rolling around in my head. Let me know if anything isn't quite clear or if you've got questions. I'd also be interested in hearing if it's different in other parts of the country.