Hospitalization #5, Days 7-8

Javan has had a rough couple of days. He was in the seclusion room twice yesterday and once today. The first time yesterday he had gotten in another child’s space and when the child asked him to step out of his space he pushed the kid down. I guess he got aggressive towards staff too after that. The seclusion room isn’t padded or anything; it’s just a plain room with white walls, a regular floor, and a window that allows him to converse with a nurse. He had to stay in there until he could calm down enough to be safe. It lasted 29 minutes. I learned that they can keep a child his age, 9, in the seclusion room for up to two hours at a time. I think the second time was due to aggression against another nurse and he was in for maybe 15 minutes. First they try verbally deescalating the situation, then move to physical holds, and then use the seclusion room as a last resort. Today’s visit to the seclusion room was 15-20 minutes after he took a swing at the doctor. The nurse told me that every person he sees he raises a fist at them. When asked why he said, “Well, sometimes I get angry and sometimes I don’t.” When asked why he swung at the doctor he said, “I just saw him and knew I had to pound him.” I think she may have felt it inappropriate that I giggled when she told me that. I couldn’t help it; it was such a thoroughly Javan thing to say.

The doctor is going to restart him on Depakote, which he’s been on unsuccessfully before. I wish there was something new to try. He said he had to try something that could help with Javan’s “impulsivity, mood swings, and erratic behavior.” Well, that’s a nice thought.

It turns out that it doesn’t matter so much that Javan can’t be helped through this hospital’s long-term program. I had a couple of lengthy discussions with an unintentionally abrasive representative from our insurance company who informed me that our policy wouldn’t allow him to stay in the hospital for sub-acute care anyway. The patient has to be considered acute in order to qualify for further days in the hospital. Basically, they have to be “suicidal, homicidal, or psychotic.” Otherwise, they’re clear to be discharged. For now, he’s clear to stay through tomorrow. Then they have to do another review every two days to see if he still meets those requirements.

After her review of Javan’s case with the hospital psychiatrist, she reported to me that the psychiatrist is not recommending residential treatment for Javan. She had looked into residential options and told me that “most residential treatment centers don’t have programs for children this young anyway due to the rejection and attachment issues that placement outside the home can cause in young children.” I may have been imaging that she used an accusatory tone. I can be overly sensitive and she did seem to genuinely want to help. But good grief, could she possibly believe that I hadn’t considered the ramifications of residential placement? That any parent could take this decision lightly? Highlighting the highly negative consequences of a choice I would only make if it was forced upon me by life circumstances is anything but helpful. I was pretty much thrown into full-on panic mode.

She went on to suggest that I find intensive outpatient therapy in my area and find a therapist in my area that specializes in autism. When I informed her that those services are hard to find in my area, if not completely non-existent, she got kind of huffy with me and informed me that her searches show that we have plenty of therapists in our area and that the fact that he isn’t receiving these services is not due to a lack of services in my area. She called back an hour later to tell me that she had found one, read ONE, therapist specializing in autism…65 miles away from me. Why do apologies never follow conversations like this?

Not only did she not apologize to what basically boils down to accusing me of being too lazy to find easily available therapies that my child needs, but she went on to ask, “Why have you been homeschooling this whole time instead of taking advantage of state resources through the school?” Floored. I was floored. Too much so to answer with the snark that loaded question deserved. I answered as calmly, honestly, and concisely as I could. And after hanging up I was left feeling so harrassed. Still, I got the feeling that she truly did want to help and in her frustration at this not being an easy to fix situation, began turning her frustration on me. It’s easier to blame a parent than to admit there may not be a solution.

Today we had a meeting with the school district to get the wheels rolling on the assessment and evaluation process to form a plan of how best the public school system could serve him. These women, bless them, are so supportive and understanding. They never make me feel like any of this is my fault and I am always impressed with their flexibility and willingness to help my child in any way they can. My husband and I filled out three long developmental profiles to give them as much information to work from as possible. If he’s home, they’re ready to begin assessments next week. They even came up with the idea of letting him do as much assessment as possible in the sensory room with the beans bags and tricycles and he can just move around while he answers questions. As soon as they finish the assessments, they can put together a plan to transition him into school as comfortably and successfully as possible. They can even have their behavior specialist come to our house and help us identify problems and offer solutions. So right now, my hope is with the school district. I just hope I can keep Javan out of the hospital for long enough to get this thing started.

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