Provider Fatigue – Yours and Mine

Today my son and I meet with a new mental health provider. I’m not holding my breath. I’m not expecting anything.

We’ve both learned from past experience that high quality mental health providers are in short supply, especially when Medicaid is the source of payment.

And they can do more harm than good. Frankly, I don’t want to spend weeks or months undoing the work of an unprepared, untrained or unkind individual who assumes he or she knows more about my child than me.

But we are stuck so to speak. In order to see the agency’s psychiatrist on a regular basis – which my son needs for medication management and whom we dearly like, he must also see a Behavioral Clinician or BC. These individuals are charged with assessing the child’s level of functioning and reinforcing appropriate, tailored skills at home, in school and within the community.

That’s where the problem begins. Teaching such skills isn’t easy. Furthermore, Behavioral Clinicians simply need a Bachelor’s Degree – but no further education or licensing in my state. From past grumblings from several BCs, the pay must be weak, since they routinely talk about looking for a better job.

Three years ago the first BC seemed sincere, but she didn’t like the fact that I remained involved in the session. Not directly, mind you – but from a safe distance to make sure my son’s needs were being met. And that my parenting skills are not being called into question in front of him. The two usually sat at the dining table or in the family room while I worked in the kitchen.

Hearing everything, just in case.

Too often she strayed from her assigned responsibilities and attempted Cognitive Behavior Therapy – something for which she wasn’t trained and an approach that my son couldn’t rightfully grasp. Early trauma and Fetal Alcohol Spectrum Disorder necessitate a carefully balanced, sensitive intervention.

Sadly, this “power” dynamic happens way too often in mental health settings and needs to stop.

Teens and young adults who have a history of trauma and who have been adopted don’t need a third party creating chaos – thus pitting one adult against another. It’s called triangulation and it generates some of the worst negativity that parents can endure, as I know from experience.

Over the years my six children did fine without anyone stirring the pot!

chaos 1

Bottom line, the first BC suffered from the all-too-common “I will save this child” syndrome – rather than building a healthy “partnership” with the family. After less than a year, she decided to pursue a Master’s Degree and left. I wished her well but wondered if her disposition was a proper fit for mental health.

The second BC lasted less than a month after demanding responses from my son – then escalating his behavior. In his state of dysregulation, he made threatening comments to her and me.

She not only quit her job but left the field.

The next BC had the longest tenure and brought the most experience. She clearly made a point during every session – multiple times, no less – about my role as his parent and her role as the BC. She even incorporated our pets. As the sessions became highly predictable, my son felt safe. He actually looked forward to seeing her.

Progress!

At the same time, my son started working with a Master’s Level therapist who truly knew her stuff. She gently pushed my son out of his comfort zone and reduced his knee-jerk, paranoid response to anyone or anything new in his life. She even returned his calls off hours.

Then a problem with transferring her license from another state erupted – and she was gone in a flash. My son cried for days.

Nevertheless, the BC picked up the slack the best she could for the next sixth months.

Unfortunately, she suddenly took a leave of absence when a newborn became available for adoption. She promised – and I mean a swear-on-the bible-type promise – to return in eight weeks.

We never saw or heard from her again.

Abandonment x 2.

This time my son’s frustration turned to anger – and two brief hospital stays after he twice broke into a locked room and overdosed on medication. Not a suicide attempt. Just a desperate plea for attention from someone who cared.

At the hospital he received the opposite. In fact, one nurse threatened to report me to authorities for not properly securing medication – then telling my son that he might be better off in a group home.

Thank you very much.

After a three-month wait, a new BC arrived. Since he and I engaged in a mostly productive, hour-long conversation ahead of the first appointment, I assumed all would go well. Sadly, this guy liked to talk and talk and talk. About himself, while trivializing my son’s challenges.

Do this and you’re life will be great. You can do anything you want.

Please! How about a little common sense?

My son soon dreaded their weekly encounters. The sessions improved slightly when I took my personal time to email a specific agenda each week – hoping to keep the BC on task.

Meanwhile, a new therapist entered the mix too. When he reviewed my son’s case history with me but overlooked his FAS diagnosis – and didn’t seem to care when I mentioned it, the handwriting was on the wall. He lasted less than two months.

I’m not sure if he quit or was fired.

Six weeks later we went a month without seeing the remaining BC. One excuse after another. A funeral. Caught in traffic. A flat tire. His car’s brakes. I finally had to let him go. The inconsistency was causing my son to regress, as if he was to blame.

So today with a fifth BC entering our lives, I will wait and see. Will we experience more of the same? Or will we be pleasantly surprised?  DCP

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Craig Peterson publishes EACH Child every Tuesday. To subscribe, open this link and “Like” the page. EACH Child is Special: Working Smarter Not Harder to Raise Every ONE

To follow Craig’s journey in raising his six children with special needs, click here: Adopting Faith: A Father’s Unconditional Love

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4 thoughts on “Provider Fatigue – Yours and Mine

  1. Too many in my field dismiss FASDs and are all too often trying to treat trauma without that context. It always blows up, wounding the child further. Hats off to the parents who advocate, advocate, advocate for their children. Never give up.

    1. Context is key. FASD can be a huge part of the context for those both diagnosed and un-diagnosed. Deficits in processing language make therapy an extra challenge.

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