One of my goals for 2014 is to get organized, I've been going room to room clearing things out and preparing to get this all under control over here. When my three boys first came I tried to prepare the best I could, but you don't really know what you don't know, LOL! One of the areas that I totally could have done better in is organizing the massive amounts of paperwork, records, notes, and observations you have when dealing with foster care/adoption or children with medical/educational/mental health issues. For the boys I have a HUGE Rubbermaid filled with papers, it is completely disorganized. Today I am going to show you what I have been working on to get it all organized so I have a binder of documentation as it relates to the boys many needs and to make it easier to keep track of things going forward.
Documentation is extremely important when you are dealing with children from trauma or children with mental health issues. There are so many providers and professionals in and out of our lives that it is hard to keep track. Every time we see someone new, I swear we leave with a new diagnosis or therapy to try or recommendation. It doesn't matter if I tell them we have already tried X, Y, or Z for some reason they think I must not have tried it right or for long enough. The unfortunate thing about mental illness is that it is not easily seen by a casual observer. If my child had a cast on his leg and was taking awhile to walk down the aisle in the supermarket, no one would question that, people would try and help him or empathize with his situation. When my child is screaming profanities and hitting me in the supermarket, the response in one of judgment, there is no help or empathy. In the couple of incidences when we have had to take Matthew to the Emergency Room it has been hard to explain to the initial responders and later the hospital staff that we are here as a last resort, that we have tried all of our tools and strategies. They see a cute little boy, but they don't see the years of trauma and abuse he has suffered. They don't take you at your word when you try to explain the behaviors exhibited just mere minutes before. We are not there because we are lazy parents who don't feel like dealing with our kid who is having a "tantrum". This child that I am coming to you with has real issues, that are not his fault and not my fault. He doesn't need coddled, I don't need a lecture, we need help. By having all of your documentation in order and showing a history and pattern of behaviors you will have a much easier time getting the help you need and getting insurance coverage for some very expensive services that may be needed now or down the road. Several parents I know have also had the unfortunate experience of having to deal with their local Child Protective Services or their children have been involved in the criminal system. It is vital that you are able to protect your family from any accusations. Having all of your documentation in one place certainly helps during these times and can help keep your responses and actions fact-based rather than emotion-based!
I decided a Binder for each child would be the best way to keep everything in one place and well organized.
I've included individual links to most of my covers/forms, etc. as google docs so that you can modify them to meet your needs. If you want just one file to download the entire binder, click here.
BINDER COVER: You can get a copy of my Binder Cover here. I choose to leave the child's name off of the front, that way if I need to bring the binder with me the name is not visible to anyone. If you had more than one Binder you may want to put Initials or design a different cover to distinguish each child.
BACK OF BINDER: I have a copy of this quote from Mother Teresa on the back outside cover of my binder.
Flash Drive: Any time I receive paperwork, notes, emails, cards, etc. I scan them into my computer and put a copy on the child's flash drive. By having your information in several places (Binder, Flash Drive and Computer file) you also prevent anything coming up "missing". This is also a great way to keep copies of school work and crafts, just scan them onto the drive and you don't have to feel guilty about throwing away the weekly spelling test! If you need to get the information to someone, you can always burn everything from the flash drive onto a CD that you can give them or email the specific documents they need. I keep the Flash Drive and a few pens and post-its in a zipper pouch in the front of the binder.
BASIC INFO SHEET:This sheet goes in the front of the binder and contains any pertinent information such as, Name, Birthdate, Age, Grade, Height/Weight, Allergies, Medical Diagnosis. I also put a current picture of the child on this sheet too. If for some reason your child ever ran away or went missing this sheet could easily be given to the police. I also have my child's fingerprint card and DNA samples on the back side of the plastic sleeve this sheet is in, you can get a free kit at http://www.pollyklaas.org/index.html.
CONTACT SHEET:This sheet includes the names, addresses, phone numbers, fax numbers, and emails for anyone involved with the child. Behind this sheet is one of those plastic baseball card collector sheets to place business cards in from various professionals involved with the child. Always ask for a card or if they don't have one get their name and jot it down. You never know when you will need to recall someone who had an interaction with the child.
Siblings and Extended Family
Placements of siblings
Residential Treatment Facilities
In Patient Programs
Out Patient Programs
Partial Residential Treatment Facilities
CONTACT LOG: You can get a copy of my Contact Log here. Rather than tying to make all the information fit into columns, I've found it is easier for me to give myself as much space as needed to write notes or things I need to follow up on. I will also insert written communication such as emails, cards, etc. in plastic page protectors. I will still log these into the main Contact Log and then write "See Attached" in the notes section. That way I can keep track of everything in chronological order. Get a copy of the cover sheet for this section here.
IMPORTANT PAPERS: This section contains any important papers I need frequently, including copies of Adoption Decree, Birth Certificate, SS cards, Medical Cards. The other sheet I keep in here is a timeline of the child's life, including past placements and important events. This can be very helpful when you are talking to various therapists and doctors, I find that having a visual of all the dates is helpful in getting a full picture of the child. I can also add events to it as they come up or as new information is disclosed by those involved with the case. Get a copy of the cover sheet for this section here.
CALENDAR: I have a monthly planner that I picked up at the dollar store in this section. I find it is an easy way to keep track of appointments as well as jot down any behavior notes or incidents that I want to remember. It is very thin so doesn't take up much space and it is bound, so I can store it each year much easier than having a bunch of loose monthly calendar pages. I find it is helpful to develop some kind of rating system for the day (Red=Bad, Yellow= OK, Green =Good day OR a 1-5 scale), this way you can keep track of mood swings or patterns. I keep the calendar indefinitely, this way you can compare patterns yearly as well. For example, maybe you notice that every year around the date of the child's removal from birth parents things go downhill. Once you get an idea about the patterns you can better anticipate and head off issues.
MEDICAL SECTION: If you have a child with significant medical issues you may find it best to have a whole binder divided by type of Doctor/Specialist. For me, I keep a summary sheet in the front with doctor/dentist information, how often and when they are supposed to see them, when the last appointment was and when the next one will be. If the child has medical issues that require medications (not psych related) I keep a separate sheet listing current medications, dosage, directions, who prescribed them as well as a medication history sheet showing past medications and notes on any side effects or how well they worked. I have a medication log to document that I have given any medications. I then just keep all medical documents by date, if something is important and I will need to find it quickly or often I will put a post-it note on it that sticks out a little from the binder. In the back of this section I keep Incident Reports which I fill out if there are any bumps or bruises that I want to document. Get the cover sheet for this section here.
EDUCATION SECTION: I keep a sheet of important information up front, School contact info, teacher name, grade, room #, schedule including "specials" (for example 'Gym Day' so we bring sneakers), school calendar, IEP dates. Next is a copy of the current IEP and Evaluation in page protectors as well as a copy of the most current Procedural Safeguards for the state. Afterwards all important documents are hole punched and put in reverse chronological order, with the most recent up front. If a child receives early intervention I keep that paperwork in this section rather than medical section. Get the cover sheet for this section here.
PSYCHIATRIC SECTION: In this section I keep a summary sheet listing all current therapist/counselors with contact information as well as current medications. I keep a separate sheet listing current medications, dosage, directions, who prescribed them as well as a medication history sheet showing past medications and notes on any side effects or how well they worked. I keep the pamphlet that comes with the child's medication from the pharmacy and place a copy in the binder, it is a good summary of the possible side effects as well as useful for medical history when you are trying to find the right combination/dosage of medications. I use the back to write detailed notes and observations on the medication. I usually keep a few copies of their current medication sheet so I can hand it out when asked what medications the child is on ( I also include any Over the Counter medications or vitamins that are given regularly). I have a medication log to document that I have given the medications. I then just keep all medical documents by date, if something is important and I will need to find it quickly or often I will put a post-it note on it that sticks out a little from the binder. I then have a copy of any current treatment plan in a page protector with all past treatment plans or therapy information hole punched in reverse chronological order. This would include psychiatric evaluations, intake/progress/discharge records from psychiatric emergency room visits, inpatient/outpatient treatment centers, residential facilities as well.
SAFETY PLAN SECTION: In this section I keep a copy of our family's current safety plan in plastic page protector. Any past safety plans are hole punched and placed in reverse chronological order behind the current one as well as any notes as to why it needed changed. A safety plan is extremely important for a family to have BEFORE you are caught in the middle of a crisis. It is very hard to think clearly when all hell is breaking loose and you are trying to keep everyone safe. See my post on creating a family safety plan here. Click here to see my post on creating safety plans.
BEHAVIOR SECTION: This section will vary depending on what behaviors need to be addressed in each child. I keep a Monthly Calendar at the front of the binder where I can jot down things, but keep note pages where more detailed summaries can be placed here. Its often easier to make some quick notes on the calendar so I don't forget and then come back a the end of the week and put in some more detailed explanations here. If we are using a specific behavior sheet or reward program I will include those here. I have an incident report form that I use to document events that I feel are bigger or more serious than the minor daily issues. Get a copy of this sections cover sheet here.
COURT RECORDS: If your child is involved in any court actions you can keep a summary sheet of any court info you may have, court house address and contact information, judge assigned, attorney information, case number, important dates. The rest of the Court paperwork gets organized by date. I will also include a note page with a summary of what happened at a court date and include it accordingly. This section can also be used for any Police reports you may have, for example if Police had to be called to help get an unsafe child to the hospital. Get the cover sheet for this section here.
ARTICLES/DIAGNOSIS EXPLANATIONS: I keep a copy of important articles as well as summarized versions of the child's diagnosis in this section, along with a few extra copies. These are great to hand out to people who are not knowledgeable about the diagnosis or who genuinely show an interest in learning more. I also keep a copy of the side effect sheets for any medication they are on. Get the cover sheet for this section here.
I've heard a lot of talk this week about RAD kiddos and Christmas presents. Parents at the end of their ropes contemplating not giving any presents or leaving a note from Santa saying their behaviors don't warrant the presents they wanted, but here's some socks.
Do I get this? 100%, in fact I have stared at the Nintendo DS box wrapped up under the tree every morning and contemplated taking it away. My son has been particularly challenging and I have been particularly annoyed and irritated by his behavior. Does he "deserve" the Nintendo DS? Absolutely not!
I could go into a diatribe about how Christmas isn't about deserving presents and Gods love has covered us despite our sinful nature, so shouldn't we also put aside our kids "sins" and show them love this Christmas. I could, but I won't, this year I want you to stop and think about yourself on Christmas not your child.
As parents of special needs kids we've given up a lot of "normal". Our holidays are often stressful as we hyper-vigilantly plan out every minute. We don't get to sit around the adult table and converse with friends and family as our kids play nicely in the next room, we are stuck watching our child like a hawk trying to put out fires before they are started, all the while holding our breath waiting for the next crisis. If we do get a chance to talk with adults we end up listening to others critique our parenting or telling us that 'boys will be boys' or 'oh my kid does that, it's normal'. Worse yet we hear about all of the perfect kids the other adults have as our son waters the plants with pee.
We've already lost so much at the holidays, do we really want to lose presents too? The rest of the day may totally suck, the kids will be ungrateful and unappreciative. They may break the very thing you bought them and that they wanted so badly. BUT before all that there is a moment where they are excited and happy, truly happy. It may only be a second, but YOU did that. That happiness you see, the twinkle in their eye, it's not there often is it? That smile is what "normal" parents live for, and YOU have given that to them. This year on Christmas morning I want you to take that moment, however brief it is, and cherish it, because you brought joy to an often joyless child. YOU had a moment where you felt like a "good" parent, a "normal" parent enjoying their kids happiness on Christmas.
What will you get for YOU if you take away the presents? Your child will NOT learn a lesson, there is no logic or cause and effect thinking with attachment disorders. Your child will not remember this next time and say "Hmmm...last year I misbehaved and didn't get any presents, by golly this year I'm going to behave so I can have what I want." Not. going. to. happen. Likely the lack of presents or a note will only solidify what they feel inside, worthless, bad, un-loveable. They will take that feeling and run with it the rest of the day their years. You can guarantee a raging tantruming melt down will be had, ruining not only their day but certainly YOUR day, cause you will now spend your Christmas trying to contain a crisis and keep everyone safe.
Why do that to yourself on Christmas? Sure you may have a moment of satisfaction, a moment of "See what happens when you don't behave! See what happens when you treat me like crap, the one person who pours out their heart and soul to help you every single day!". But is it worth it? I for one would much rather have the fleeting moment of joy in my child's eyes then that moment of satisfaction. A moment that in reality continues to make me feel like crap, a crappy mom who cant even enjoy Christmas with her kids, a crappy mom who can't help this child, a crappy mom who will never be enough. This year I am going to be enough for me and enough for my kid. I'm going to watch him open that Nintendo DS and see the quick twinkle of his eye however brief it may be.....and Ill hold on to that twinkle and remember it when he breaks this Nintendo DS (just like he broke the last three**! LOL).
***To my oldest son's credit the third DS was dropped in the toilet by his younger brother (he also has attachment issues) who thought peeing and playing at the same time sounded like a GREAT idea ;)
ENJOY YOUR CHRISTMAS THIS YEAR MOMMAS, DO IT FOR YOU BECAUSE YOU ARE ENOUGH!
We are still trucking along with our Christmas Challenge. I did MUCH better at getting hugs in this week. Matthew still pretends to resist physical contact but it is clear he needs and enjoys getting hugs. I had a babysitter coming to the house on Friday night and no real plans on what to do, so I took Matthew out for a Mommy and Me date. We had a great time. We went to a movie and then over to Dave and Busters for dinner and games. He really is such a great kid! I am constantly amazed at how far he has come.
The other night Matthew and I were watching "Rudolph the Red Nosed Reindeer" on TV. As riveting as the movie is, I was scrolling through face book at the same time. I ran across a post from Matthew's birthmom that she was watching "Rudolph the Red Nosed Reindeer." Three years ago I would have just kept scrolling. Three years ago I wouldn't have wanted to deal with the fall out from mentioning his birthmom. I figured it would be best to just ignore it, he doesn't bring her up, so why push the issue.
What I have realized over the last three years is that even though he doesn't bring it up or talk about her, there is still a connection. It doesn't matter if that connection is rooted in trauma and hurt, it is there deep within his heart. That connection can grow in his heart towards resentment and confusion, anger and guilt if left alone to fester without guidance. If the fall out isn't dealt with now while he is young and can be guided, imagine how large that dark stain on his soul will grow. Trauma like that when not dealt with is not easily contained when we are adults.
So I shared with him that his birthmom was watching the same thing right now. He was giddy and excited that evening, it grew to a manic episode over the next few days. BUT it was manageable, contained. We discussed big feelings and holidays and missing birthfamilies. We discussed that it is okay to be mad and sad and happy and curious and all the things that come with adoption and trauma, but it is not okay to hurt others, to be defiant and disrespectful, to be unkind and unfun to be around. We discussed that he has all the tools he needs to handle his emotions, to sit with them and feel them, acknowledge them, and to be okay.
Three years ago I would have kept scrolling, today I relish the chance to practice everything we have learned, to look at how far we have come, to appreciate the fact that despite everything his birthmom will always be connected to him and love him even if she wasn't able to keep him safe.
Balancing openness in adoptions with kids who have suffered early childhood trauma is difficult, but worth it.
I was reminded on facebook today about "special needs" business cards a dear friend of mine had made years ago. When I saw these cards I just had to make my own, so that is what I did. About a year ago I made these business cards to keep with me when we are out and about. They have come in handy not only when my children are having some issues, but also to spread the word about early childhood trauma, mental health, and attachment issues. You can easily make these to fit your unique family situation or answer questions and comments that you frequently here.
December 1st- I got in my hugs with Joel and James, but not with Matthew! Ill have to work harder on his hugs tomorrow :) We read "The 12 days of Christmas" and did a craft together followed by a family dinner. It may have all taken place around the coffee table BUT we did it! After I got everyone to bed Matthew and I played Speed and I didn't even cop out after a couple rounds, I played all the way through,
December 2nd- seriously it's the second day and I'm already failing miserably at this hug thing, ugh, it's just not something that comes naturally to me and I don't think about doing it! I did eat together and read the book. We did some drawing together as a family. BUT I'm most proud about the fact that despite Matthew pushing my buttons I still played the game with him. I SO wanted to just leave him in his room, but I called him down and played for awhile! Now hugs tomorrow.....I can do this!
December 3rd- I did pretty good on hugs today! Got in 5 with each of the boys! Did our book and ate together, we didn't have time for a craft since it is the mobile therapist night.
December 4th-We read our book and ate our dinner together. I played a game with Matthew, he didn't like loosing and began yelling that I was a cheater....things went downhill from there. BUT I did eventually get him to his room so we could both calm down. He came down a little later and apologized, we had a good talk so I guess it was a win!
December 5th- Got in some hugs today, played several games. Of course Matthew had yet another blow out for not winning the game which resulted in him breaking the security/video camera upstairs....he is still up there dysregulated, but not breaking anything so Im taking a minute! We had dinner together and illustrated a story we made.
December 6th- It was a busy day today and we had a rough morning, but we got everything in!
December 7th- I may or may not have just hugged my kids 20 times in a row to get in my hugs this week, LOL. I am going to do better next week, I have to do better! Everything else went pretty smoothly this week, despite Matthew really working on sabotaging the games. 2 more weeks to go :)
Having a safety plan in place is vitally important when you are dealing with a child who struggles with mental illness, whether it is a threat of suicide, manic or aggressive/threatening behavior, knowing what to do when in the midst of crisis needs to be second nature to ensure everyone's safety.
When developing the safety plan it is important to have input not only from any family members or caregivers who it may effect, but also additional third parties such as counselors, therapists, first responders, etc. It is important to know what your options are and what supports are available to you before a crisis occurs. Having input from other trained professionals can help you find other available supports you may not know about as well as determining the best course of action for your particular child. Involving others also protects you in the future and helps you to explain to first responders/hospitals/treatment centers the actions you took before contacting them and how the family has gotten to this point in the safety plan. Most importantly don't forget to include your child in this process. Keeping the discussion open may help them recognize their own warning signs for crisis and respond better. asking your child about what would help them in crisis is a great place to start.
Having a written safety plan is only helpful if everyone in the family knows their role and what to do in an emergency. It is extremely important that all family members participate in "practice" runs much like a fire drill. In our house we have a code word we use to indicate that they are to go to the play room, lock the door, and pick a TV show to watch. I use the code word every once in awhile when they least expect it and give out treats for good listeners. By making it fun and non threatening I think it reduces any stress or fear when an actual need arises.
Our safety plan includes a page (front and back) of basic/background/summary information including:
Common Behaviors including known triggers/antecedents, things that can escalate/calm the behavior, strategies that may work.
The second page includes the actual plan "If child is doing X, then you do Y." This will be very child-specific, but here is a copy of ours so you can get an idea.
So now that you have your safety plan, you can just stick it on a shelf and forget about it right? NO, the safety plan will have to constantly be amended and changed based on your families current needs and support systems. It is also important to reflect on the safety plan and any changes that need to be made following a crisis. You may want to ask What situations or triggers led to the crisis? What worked and didn't work? What can we do differently to keep everyone safe and calm?
I like to make notes right on my safety plan and then develop a revised version based on my notes for the next crisis.
If any of you have ever sat in a psychiatric emergency room for hours on end, you know how boring, stressful and unproductive you can feel. Creating a bag that can be left in the car or near the door is a great idea to prepare for a crisis. Things are happening so fast when you reach the point of transporting or having your child transported to a hospital or emergency unit. The last time we were in crisis the first responders wouldn't even give me the time to find my youngest kids shoes!!
This bag should include your crisis plan, documentation binder and some snacks, games, music or books for both yourself, the child in crisis, and any others who may be waiting for long periods of time.
You may also want to pack an emergency bag that includes a change of clothes and basic hygiene supplies in case it is determined the child in crisis will be admitted or transferred to another unit.
Here's the picture I found this morning on our coffee table:
This was MY interpretation:
In the top left corner is a boy scribbled over in black, he has an arrow next to his feet pointing to a heart and breathing fire onto the house. I interpreted this to be Matthew burning the house down and not having a heart. At the bottom of the house is a boy smiling holding a bloody knife, which I interpreted as Matthew. There are three ghosts with stabbed hearts in the house which appear to be throwing up blood, I interpreted this to be myself and Matthews two brothers.
I started freaking out......I contacted some of my other Moms who get "it" and they calmed me down. They told me to take a breath and just ask him to tell me about the picture when he gets home. Don't react, thank him for sharing his feelings with me and keep the conversation open.
So tonight after Matthew and I played a few rounds of Speed, I pulled out the picture and asked him to tell me what was happening in the story.
Here is the explanation:
There was a Halloween drawing contest at school. He drew this picture of a black crow shooting lava at a house. The good guy is going into the house to kill the evil vampire ghosts. The ghost have broken hearts because they asked a girl out and she said no. He didn't win the contest, another kid who had a picture of evil zombies won. He was pretty mad he didn't win.
I totally overreacted, MY PTSD took over, LOL.
Let this be a lesson for you, don't freak out till you get all the facts :)
As Thanksgiving comes to a close and we enter the Christmas season, I am finding my "therapeuticness" is being tested more and I'm failing miserabley! When my boys are excited their behavior goes downhill fast, when you throw in the excitement if the hilidays with all the trauma history holidays bring up it is a disaster. When my stress level is up u loose my temper quickly, my patience is minimal and I ten to blow small behavioral incidents into massive ones. Something has to change this holiday season and its gonna have to start with me!
Here's my goals for this holiday season, will you join me in one or all of them?
25 books to read this month: For the last few Christmases I have tried to wrap up 25 Christmas books and read one each night. Any time I find a Christmas Book at Goodwill I grab it and put it in my stash. I have yet to actually make it through all 25 days! Inevitably an evening starts going downhill, I get frustrated and send everyone to bed without the story. This year I am going to do it!! There is nothing they can do to loose the story, I am going to remain calm and patient and read that story as if my life depended on it :)
25 games played this month: Matthew loves card games of any kind, he usually waits till the end of the night when I am drop dead tired and then starts begging me to play. I end up denying him way to much cause I'm tired and worn out from the days activities. This month I am going to play a game every day. Ill try and play earlier in the day so I'm not too tired to do it and I will try to ask him to play instead of the other way around :)
25 crafts this month: As you probably already know from my Art Therapy Thursday posts, my kids LOVE crafts. My goal is to get at least 25 crafts done this month with them! I'm sure Ill be sharing them on Art Therapy Thursdays!
25 meals eaten together this month: I love the idea of eating together, but in all honesty what happens is I get everybody everything and by the time I sit down to eat they are all done. Nobody is getting up from the dinner table till we are ALL done.
25 hugs per week: James is anxiously attached he has a constant desire for hugs. I usually require him to ask first because of boundary issues and personal space issues he has. I am not a touchy feely person, I generally don't like hugs all that much! BUT this month I am making myself initiate hugs at least 25 times per week! This morning I came down and asked everyone for a morning hug. Afterwards, James says, "We should do this every morning Mommy, have a morning hug right when you come down!" He was so excited. How can you say No to a cute face like that!
25 minutes of family time a night: This could be reading the book, making the craft or playing the game, but it has to be ALL of us spending time without electronic distractions!
Any takers? Ill keep you updated on how it goes for me! Follow me on Facebook and let me know what you will be doing this holiday season to connect with your difficult kiddos! (Click the facebook badge on the right to follow me on FB).