Mommy....Am I going to be like that?

In the wake of the tragic events that occurred this week I feel it important to share how that effects our family. While many might have to answer the questions of their children asking " Am I going to be safe at school?" or "What if someone like that comes to my school?" But in our family every time one of these tragedies happens I have to answer the question " Am I going to be like that?"
You see what Joey hears is that these bad people where sick in the head. Joey knows he's sick and knows he can be violent. So while trying to process all the events that happen I have to convincingly tell my son that "No, that won't be him."  When in all reality I don't know.
This might not be the politically correct thing to talk about but I am going to put it out there. I really don't know what the future will bring for my son. I know that the older he gets the less control I have to ensure he takes his medications and goes to the doctor. I know I can instill in him day after day how important it is to take his medications but when he is old enough there will be nothing I can do. I know how devastating the last weeks events were but my mind does not just go to the victims of the crime but to my son and how I have no way of knowing if he will slip into a dark future.
Now I don't think of this daily or even monthly but the thought is there. Everyone can say, "your doing all you can for Joseph" and "it's different." But if I am honest with myself, it's not. Joey has been so psychotic at times he didn't know who Paul and I were, he thought we were poisoning him and he's "protected" himself with weapons. We continue to struggle everyday with Joseph. We tell him all the time how much he is loved and how many people care for him but in the end I don't think that is enough. 
Who knows what lies ahead of us but I will say if there are not changes to the mental health system in this country events like this will continue to happen. My greatest wish is that Joseph is not only protected from acts like these but that he will never be the one who causes such sadness.

A damn cruel disease

"It must be remembered that for the person with severe mental illness who has no treatment, the most dreaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our powers to describe."

-Anthony M. Kennedy
U.S. supreme Court Justice


Here we are 11 months into treatment. Joseph has shifted from uncontrolled random outbursts and violence to controlled random outbursts and violence. I would rather the first of the two. At least I could forgive the actions. I know in my head he is still sick but I still have a hard time because on some level he is making calculated choices to do bad things.

I feel I may be slowly loosing my sanity in this whole process. The stress is killing me. I can't sleep and when I do I am plagued by nightmares that are difficult to differentiate from reality. What if Joey's disease make me insane? Not in the contagious disease type way but the there is only so much one person can take kind of way.

We are filing an extension for Joseph to stay in the facility for another 6 months. They are starting to say that there goal for discharge is June of next year. There is a part of me that is relieved and another part that is terrified. I am mostly terrified for my ability to get everything together by than. I just got the joyous news that the child support would be increased to nearly 600 a month to pay arrears owed. Than the cascade of  things that effects. Paying off Joey's medical bills, saving money for a house so we joey is discharged he has somewhere to call home, saving money so when he comes home we can afford what it costs to have a mentally ill child. And here comes the tears and panic attacks. I know everyone keeps telling me to take it one day at a time but when you have a chronically ill child you have to think forward. I'm 31 years old and this was not supposed to be my life. I worked hard to get through school and provide for my family and now I am working days on end and still not getting anywhere. Day in and out I think, this is it, this is my life.

In the midst of all of this Joey going forward and backward never really making progress for long. Will anything ever at least be ok? And will it be ok before I loose my grip?

What if this is as good as it gets?

So a few weeks ago Joseph had an overnight visit. I was anxious I'm not going to lie. The last time I had Joseph with us unsupervised max and I were locked in a bathroom with him beating the door as I called the police. However I set out trying to be as positive as I could. It's not as though there was any "big" incident that caused my disrepair it's just as though nothing had changed. The tension was palpable. It's hard for those who haven't lived with Joseph can understand but I will try to explain.

In a typical household there is inevitably push back from children when asked to do tasks. With Joseph when you ask something as simple as please pick up the blanket from the floor the response is "no" and his body tenses as he glares at you almost daring you to push the subject. Its difficult because the parent in me wants to have him do what he is told to do but the other part of me knows the danger that everyone can be in if he is pushed. This situation is nothing different than how he was prior to going into treatment. Do you parent your child and pray he doesn't go ballistic or do you let him call the shots and in turn not parent him?

How? How could we be three years into all of this and almost a year at this facility and have made no progress?! What if this is as good as it will get? What if this is life until he is 18 and an adult? This can't be my life or his. I prayed that the following visits would go better but this left me deeply discouraged.

Are we at baseline?

I had a disturbing thought the other day while working in mental health at the hospital. Far too often we have patients come in during crisis however there are no services we can offer because they are functioning at their "baseline". The more I thought the more disturbed I became about this situation. Just because someone with a mental illness is functioning at their baseline they are not necessarily functioning at a level appropriate for society. I again think back to many of Joseph's hospitalizations and subsequent discharges where his GAF score was no higher than 40. A GAF score of 40 may not require acute hospitalization but it does not mean that he is functional for society either. A panic fell over me as I thought about Joseph being in placement for the past 10 months and how we have progressed from where we were we still are not a level that is safe for him to be at home. What if this is Joey's baseline? What if he will forever be at a level not considered in crisis but not functioning? There are no more institutions for placement of people with mental illness who are not fully stable for society. What will become of my son when he is of age? I know much of this is forward thinking that I need to be wary of but I can not totally block out the fact that he will not be in residential treatment forever.
That being said I have yet another panic point. He will not be in residential treatment for forever. At this point us becoming financially stable is getting more difficult. Despite our best efforts I feel the court could have cared less about our situation and the child support amount ordered. That being said how can we get things where they need to be for Joseph? He can't come home to my father in laws house where we have no space for him and all his belongings are piled in boxes in the basement. How will that provide the stability needed?! Shit! I am so overwhelmed I just wish there was an easy way. I know I must take things one day at a time but on the other hand how can we be prepared for Joseph as well?
Well we keep moving forward than backward and over again. I watch with anticipation for Joseph to have a "breakthrough". We will get there someday..... I hope. Until next time. Thanks for reading and supporting us in our journey.

Project Believe: Our Biggest News Yet

project Believe: Our Biggest News Yet: Project Believe grew this week! As we have geared up to make Christmas Magic happen for the kids at Cincinnati Children's Hospital Co...

The Miracle Med?

So its been awhile since the last blog update. The last time I wrote Joseph had had a major meltdown. It took me awhile to get over the anger, hurt and frustration of it all. When we went to see Joseph's psychiatrist following that incident I laid the cards out that something needs to happen. I simply stated that how at this point in time and Joseph being 8 months into his program are we still having major outbursts that put him and others in danger. Joseph's psychiatrist suggested another medication, naltrexone. Originally used for opiate dependency they have started using it for people with problems of obsessive thought. The rational in how it could help Joseph is that if we lower his obsessive thinking we will lower his anxiety and therefor lower the incidents of outbursts. Many thoughts run through my head, Oh great ANOTHER medication however I am so desperate to help my son get better I guess I would do anything.
 So down the road we go again trying something new and so far its working. Since Joseph has started the medications he appears to be better. Its not that he is not still having struggles but he appears to be able to stop himself and process what to do before just acting out. Everyone is celebrating and part of me is as well however I am cautious. Joseph has a very long history of  doing amazingly well on a drug for a sometime and than poof its almost as though he's switched with a placebo. I just don't want to act as though this is the cure all till we have substantial amount of time behind us.
That being said Joseph did really well for about 3 weeks and than this past week started having struggles again. Now its not nearly to level hes been at but he still cant make it through a full day of school. I don't know if Joseph will ever reach a time he is fully functioning. I just hope and pray that when he comes home we have services in place to help us out.
Now for the neurologist. Well I think he was a very capable neurologist who did absolutely nothing! We spent 40 minutes explaining everything for the past 11 years of Joey's life to have him looked totally puzzled and than suggest more medication. He spouted of something about there being the possibility of some temporal lobe dis regulation something or other. Either way still no imaging. I just wonder if we will ever have the answers to Joseph or how to help him.
I know that Joseph has to start to process his life. I know it seems like a hard thing to ask a child to do but he has some major unresolved issues. Especially with his biological father. He still has an idealized idea of his dad. He will talk about him and acknowledge he has done bad things but in the same breathe he will talk about how he wishes he could talk to him. Its hard to handle. Joey calls Paul dad and there relationship is that of a father and son. I would never tell Joey what has happened I simply say that his dad loves him but he has made a lot of bad choices in his life and Joey needs good people around him and if when he gets older he wants to contact his dad he can do so. I hate that this is how it is but it is what it is. I hope Joey will continue to move forward with the loving family he has.
We continue to fight for our son in the hopes he can come home to us soon. I pray we can soon get to the bottom of his issues and treat them appropriately instead of the shot gun effect of treat it all and hope it sticks. We still have a long road ahead but maybe just maybe we are headed down the right path.

It was just supposed to be a dentist appointment

So Joseph had a dentist appointment today which I wanted to go to because he has some serious issues with plaque etc that I want to address. I went up to the facility and everything was fine, I rode along to the appointment since it was 45 minutes away. It was Joseph, myself and a staff member who works with Joseph regularly.
Joseph had a little issue at the dentist so I stepped out to the waiting room and the staff were able to get Joseph to calm down and finish his exam. However when he was done he left the office before the staff from the facility was ready to go. I told Joseph to wait but he went ahead anyway visibly agitated for some reason unknown.
We got into the vehicle and started to head back to the facility when Joseph began acting up, throwing things at me and at one point he grabbed the seat belt of the staff member driving trying to choke him. the staff tried to redirect Joseph but the efforts were futile. We pulled over to a gas station to try and get the situation under control.
The next bit is simply flashes of what I can remember from the chaos that ensued. Joseph got out of the van and went immediately for anything he could get his hands on. The staff member was trying to control the situation but they are limited on what they can do. Joseph was throwing rocks and anything he could his hands on at the staff. I moved to get out of the way and Joseph grabbed a clipboard ran after me and hit me with it in the arm as I tried to shield myself. I went into the gas station hoping to prevent further chaos but Joseph followed. He picked up and apple from the stand and from a foot away threw it at me striking me on the left side of my face, the apple burst and people just looked on horrified at what they were seeing. He went back outside and continued to throw things, even opening a package of water bottles displayed in front of the store. I felt trapped, if I went out of the store everyone and everything was a target but it was the same  in the store. There was no where to go but wait for the police to arrive.
People walking in and out of the store stared asking "what is wrong with the boy?"  what can you say to that?
After what seemed like an eternity the police showed up. five cars in all as we are quickly trying to explain the situation Joseph runs. It took several minutes of them chasing on foot and in cars before he circled back around to the gas station where a officer was able to get a hold of him. Joseph was fighting it so they placed him in hand cuffs and put him in the back of the car.
The officers gathered to try and understand what was going on and all I could do is stand there as if I was watching a movie. I snapped back to reality when the officers asked me to fill out a statement. One very kind detective had me sit in his car. It took every ounce of my being to concentrate on what I was writing. Each word was difficult to form. After some time I manged to had over a piece of paper that looked like chicken scratch. The officers stated at that time they were going to take him down to the station till they heard from the judge. The staff and I fallowed.
We arrived at the station and one officer called the judge. Given that Joseph is 11, he is already in a facility and is already in CSB custody they determined to release him back to the facility and forward the complaint to Miami county where his file is. We still had to wait for a supervising staff to come from the facility to the station to transport Joseph.
I felt a fool in the police station telling the officer that Joseph really is a good kid just with problems as she looked at me with the sad, pathetic look. I hate being this person. I fear I will one day be a parent on tv saying, he was such a good kid. I don't know at this point how Joseph will ever be a part of society. I have no idea what set him off or why he does what he does. I sometime just want to scream at him and tell him if you'd just knock this crap off life would be so much easier for you. I wish it was that simple, but right now I don't know what the answers are. I will just put this day away and keep praying this comes to an end someday.

Ten steps forward.... Fifty back....

It has been quite awhile since I have posted and much has happened. Joseph did really well with his family visiting and we were even able to enjoy his 11th birthday party but life certainly fell apart when everyone left. The week after everyone went home Joseph had some of his most violent outbursts to date. I am frustrated that his counselor didn't work with him more to prepare him to cope with this adjustment. Joseph seems incapable at this point to deal with any of life's problems in an appropriate manner, lashing out violently only to end up crying and depressed about the real problem he cant deal with. We are working very hard as a family and agency to have him get a new counselor who will be more effective for him.

We had also begun taking Joseph off the ablily in hopes to minimize the amount of medications he has to take. That did not work out so well. Joseph takes 7.5mg twice a day and with just the little adjustment to 5mg in the morning and 7.5mg at night Joseph started having hallucinations again. I fear he will never walk through life without the daily effects of psychosis unless he stays on his medications. To hear the fear in his voice when he talked of the shadows chasing him in the hallways and the vivid scenes that played out during the night where terrifying for me let alone a 11 year old boy. I can only imagine what its like to live day in and out without knowing what is reality. I made sure at the first discussion of Joseph having psychotic hallucinations we moved to put him back on his regular dosage of abilify, since than he has not expressed the daily onslaught of hallucinations but I see him at times still weary of his surroundings.

My husband and I have also had to leave our home behind us and move in with my father in law. Josephs medical bills are burying us and we took a hit when the child support order for Joseph came out to be $500 a month. We cannot afford our home and the cost of Josephs treatment and stay afloat. Hopefully with this change we will be able to save money and start chipping away at the debt we owe to the hospitals.

Josephs placement has been extended for at least another 6 months. I feel as though we have hit a hard stop again. Joseph has made little improvement in effectively being able to deal with daily life events. I worry that his life up until 18 will be institutions. Don't get me wrong I certainly have not given up hope in my son I however see this continuing to be a struggle for years to come. I pray that those helping him in this journey continue to fight for this young man who has the potential to be great. I hope that he will reach a point in maturity that someday some of his conduct issues will resolve because he will realize how much easier and more amazing life can be if you don't make it a constant battle. I hope all of you continue to pray and support us in this journey. Once life has settled I will make a better effort to update more frequently. Thank you for your support.

A brief update

Joseph has been showing improvements with new changes to his treatment plan since the neuropsych evaluation. It was reported today that Joseph has had only 8 restraints in the last month which is down from 25! With this information I was able to have Joseph's psychiatrist agree to start tapering off his Ablify. I am praying that we can continue to get Joseph on the least amount of medications possible. His visits with the family from Arizona have also gone very well. I am concerned of how he will do when they leave but we will cross that bridge when we come to it I guess. Joseph is making small gains still but it is still expected he will remain at the facility for up to another year. I will take all the small steps we are making and just hope they continue.

Which is the lesser of two evils?

So a lot has happened since the last post. Sorry for the delay in updating everyone. Christian has arrived and has been staying with us. I couldn't be happier! The first night with Christian was rough get more doses of how this effects everyone in the family. Christian went to bed for the night and I decided to peak in on him before going to bed. I found Christian sitting on the bean bag on the floor. When I asked Christian what was wrong he just started crying. Christian says he misses Joseph so much and it was hard being in Joey's room without him. Christian and I cried together. Christian asked questions I didn't really know how to answer, Why did Joey have to get sick? It was one of the first times I think Christian really opened up about his feelings, I'm glad I could be there for him, I just wish I had more answers for him.

Now on to Joey. The neuropsych evaluation report is very thorough and I am extremely impressed. I won't go into the history portion of the report because well I've all ready done that in the blog but here is the rest.

Findings:
 Behavior: Joseph was on time for the appointment, and was accompanied by his mother and staff from the residential facility. Joseph appeared to be slightly older than his stated age, and was properly dressed and groomed. His level of cooperativeness was variable throughout the evaluation and he was alert with consistent eye contact. He completed paper and pencil tasks using his right hand with appropriate grip. Joseph appeared to understand test instructions and did not require frequent repetition. Spontaneous speech was fluent with no noticeable articulation problems or word finding difficulties. There was no unusual voice intonation. His thinking was goal-directed, with no evidence if a formal thought disorder. No difficulties with social reciprocity were detected until he did not want to complete a task. At this point he became defiant and required frequent prompting which resulted in variable responses to positive reinforcement. Joseph made the examiner uncomfortable on occasion due to his quick tempered nature. Nevertheless, he calmed down when tasks were stopped and something else was initiated. Joseph exhibited difficulty with behavioral self regulation including impulsivity. He also presented with mild physical restlessness, All other areas of motor functioning appeared to be normal, except for mild bilateral resting tremors of his hands. Joseph demonstrated no difficulty with sustaining attention. He reported sad mood and presented with frustrated and irritable affect. He would react with frustration and anger in response to failure or difficult tasks . His overall approach to testing was frustrated and testing could not be completed, as later in the afternoon Joseph refused to continue. He became very angry and walked out of the room. Thus, the evaluation was discontinued. Unless otherwise noted, results are believed to be an accurate assessment of his current neurocognitive functioning; variable effort/impulsivity appears to have vitiated a few of his scores.

The next several pages of the report are all the scores so I am just going to jump to their impressions.

Impressions:

1. Joseph has been historically diagnosed with ADHD, psychotic disorder NOS, bipolar, ODD, PTSD and IED.
2. Because of Joseph's emotional and behavioral challenges, current testing was limited to the morning session, as he refused to continue after lunch break and effort was variable on a few tasks. Nevertheless, we were able to assess multiple cognitive domains. Results indicate intellectual functioning to below average. He scored consistently or better than this level on tasks of gross motor strength, visual perception, expressive language, and speed of processing. While his scores on attention testing were lower than expected, hos effort of these particular tasks is questionable.
3. Although Joseph has a history of an ADHD diagnosis, a description of his behavior from both Ms. DiCola and facility staff as well as unsuccessful treatment with neurostimulant medication do not support this diagnosis. Rather, it is more likely that his aggression and impulsivity is better accounted for by a psychiatric disorder. Based on Ms.DiCola and facility staff report, it appears Joseph's aggressive and explosive outbursts are more behavioral in response to not getting his way.
4. Information from a review of records and clinical interview with his mother and facility staff indicate that Joseph has had a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms have been violated. For example, he often bullies others, initiates physical fights, has used a weapon that can cause serious physical harm to others, has been physically cruel to people, has deliberately destroyed other's property, lies and has run away from home on multiple occasions in which police have been called. Also, Joseph appears to have little concern for feelings, wishes, and well-being of others given his aggression towards people. Also, it was reported Joseph can misperceive the intentions of others as more hostile and threatening and can respond with aggression. Facility staff reported that Joseph lacks appropriate feelings of guilt or remorse as he frequently tries to put the blame on others. Thus, Joseph meets criteria for Conduct Disorder. Research states that self-esteem is usually low with those of conduct disorder and facility staff reported that Joseph frequently makes statements indicating low self esteem. Associated features are also usually poor frustration tolerance, irritability, and temporary outbursts, which are observed with Joseph. These problems have precluded his attendance in school or living in the home. A diagnosis of Conduct Disorder precludes one from being diagnosed with ODD or IED.
5. Emotionally, results from self-report and parent/caregiver report are consistent with the diagnosis of Major Depressive Disorder, Recurrent, Mild. His conduct behaviors are likely exacerbated by his depressed/irritable mood. Reportedly, Joseph has reported feeling sad/empty, irritable, fatigued, difficulty thinking, recurrent thoughts of death, and has experienced past auditory hallucinations. It may be that the hallucinations were secondary to the severity of his depression/mood given that they were congruent with his mood at the time. Joseph has a historical diagnosis of bipolar disorder. This is a diagnosis best determined by multiple observations rather than a one time assessment. However, Joseph's changeable mood during the day, which has been termed "rapid cycling" is too rapid and not typical of bipolar disorder. Therefore, we suggest that the diagnosis be reverted to a rule out diagnosis of bipolar disorder. Joseph has a historical diagnosis of PTSD; we had hoped to ask him more questions about his current symptomatology regarding this diagnosis, but testing was discontinued secondary to his refusal to continue. We believe it highly unlikely that a traumatic event that occurred at such a young age could result in current PTSD symptoms, as a person must remember the traumatic event.

Recommendations:
1. Joseph's physician is encouraged to refer him for a neurology consult for a more comprehensive medical work up. While a remote possibility, it is important to rule out an organic cause given the severity of his violent outbursts. His neurologist may want to consider an MRI or EEG.
2. Ms.DiCola reported no successful treatment of Joseph's behaviors with his current medications. She is encouraged to discuss this with his psychiatrist. Joseph may benefit from treatment in an inpatient psychiatric facility for medication assessment.
3. Joseph is encouraged to continue with outpatient psychotherapy. To date, the most promising approach is multisystemic therapy for conduct disorder.
4. Due to the severity of Joseph's behaviors, we recommend continued placement in a residential facility.




So there it is in brief. The whole report is actually 12 pages. So how do I feel? I'm torn. There is more research and approaches to treating conduct disorder however those who are unsuccessful in treatment grow to be termed antisocial personality disorder. Secondly I feel the time clock is running out on treatment for Joseph. Where he has should minimal improvement they have started home visits. We are past the 6 month mark of funding from child services and I think that because Joseph has parents and family who are involved they will push to move him out. Now please don't misunderstand me I want Joseph home more than you can imagine but not before he is ready otherwise all progress we have gained will be lost and things will get worse. I guess time will only tell right now. Joseph has court on the 26th and I believe the court will be a HUGE power figure in deciding what the next few months will bring. In the mean time I am scared and tired. I am tired of always having to fight to get him care. And scared because we aren't rich he will pushed out before he is ready. In the meantime I just keep fighting.

Pictures

A small victory

So where I left off.... We had the appointment with Joey's psychiatrist. He didn't necessarily agree with my theories however he agreed to start trying to tapper Joey down off the medications. I guess all we can do is see. The psychiatrist doesn't celebrate the small victories like we do but Joey is making small, baby steps in forward motion. The only stipulation to taking Joseph down from medications is he has to see an improvement in violent behavior or at least no back sliding, which I can agree with. We started with the propanolol  which is the least of my worries but it's a start I guess. If Joey does well over the next month we will look at the Abilify next which is defiantly on the top of my list. With the elimination of Abilify we can also tapper him off of cogentin. So with fingers crossed we go forward. The hardest part of the appointment was when Joey looked at me and said "Mommy when am I going to get better?" Ugh break my heart and all I could say was soon.

Joseph has been doing well. That same week he performed in the facility's play The wizard of Oz. Joseph has always been involved in drama so I am glad he can continue. To my great surprise he also performed a piano song he had learned this year. Joseph's artwork is also a huge accomplishment as many of you have seen on my facebook page. With all these new outlets opening up to him I can continue to hope he will find coping skills and outlets to express himself in a healthy way.

Tomorrow is a big day. I will be waking up at the crack of dawn to drive to Toledo for Joey's neuropsych evaluation. I just hope and pray that this gives us a direction to continue to help Joseph.

In the meantime I try and stay positive and continue to advocate for Joseph. I had gone on a letter writing tirade when the insurance company continued to deny us residential coverage for Joseph. I wrote letters to the Senator and even President Obama. I had received phone calls from various agencies in the government giving me avenues to explore. I was unbelievably surprised however when I received an email from The White House and President Obama himself. It's great to know that my frustrations and concerns have not fallen on deaf ears. On any level I will take these small victories last week and pray that this is the beginning of things looking brighter for my family. Stay tuned for more on this journey and thank you to all those who read and share.  

STOP STOP STOP!!!!!!

So when we last left off Christian had been diagnosed. A week into Christians treatment on lithium we had an incident. Christian had been in the pool with his Grandpa and was going to ride his bike to a friends house. Christian got down the street and started to feel "funny" I thank God he was smart enough to know something was wrong and turn around. He was headed home when he lost coordination and fell off his bike. By the time he got to my parents house he was having terrible tremors. My stepdad knowing we had been down this road before rushed Christian to the ER. The amazing ER staff brought him right back and started a work up to check him for lithium toxicity.

Lithium Toxicity can present the following symptoms:

• Diarrhea
• Dizziness
• Nausea
• Stomach pains
• Vomiting
• Weakness
• Coma

• Hand tremors
• Incoordination of arms and legs (ataxia)
• Muscle twitches
• Seizures
• Slurred speech
• Uncontrollable eye movement (nystagmus)

By the time the physician had examined Christian he was having the ataxia, hand tremors and muscle spasticity. They drew labs and took and EKG to make sure he was not having cardiac arrhythmia.  The EKG was fine... Thank God. More interestingly enough when his lab work came back Christian was not toxic he was actually sub therapeutic! The physician diagnosed Christian with sub therapeutic Lithium toxicity, yeah that's right.... This means Christian had a toxic reaction at a below therapeutic level. The physician gave Christian IV fluids and rechecked his levels to make sure they were dropping and I said he is not taking that medication any more. I have been down this road with Joseph and I am not doing it again. The psychiatrist has called a few times to say there are other options for medications we could try... I DON'T THINK SO!!!! Christian is much better and thank God has no residual effects from the reaction. 

This brings me to my next mission. For months I have been advocating that we need to try to bring Joey down from his medication and my feelings and requests have fallen on deaf ears. Joseph has been on medications for almost 2 years with NO improvement. At this point because of his sensitivity I don't know if the medications make things worse. Take Abilify that Joey takes, side effects may include increased aggression. Now don't get me wrong I know Joseph has some issues that need to be dealt with but at this point I don't know what is him or what may be because of his medications. Josephs levels are always therapeutic even during the most violent outbursts. How can that be possible? These medications are supposed to make him better. Its very easy for the doctors to put a child on medications but than no one wants to take them off. I know I agreed to medications for Joseph because I feel that at the time I was so desperate to try anything to help my son. Well now we are two years in and need a new game plan. I know the doctors will not do a true medication wash but at this point we need to start one at a time and see what happens. If Joey gets worse well we know they were helping some. If he gets better well than awesome! If he doesn't change at all than there was no benefit to having him on these medications anyway. I know what these medications do to peoples bodies and what they have done to Joseph's at this time I want to start fresh and see where are true baseline is with him. 

I spoke with his case worker and the director of his house at the residential facility and thankfully they are both on board with me. We have our medication review on Thursday both of them are coming to the meeting and hopefully with a united front we can get somethings changed and fingers crossed maybe Joseph will improve. Until than we are just running the coarse. Joey has his good days and bad but we continue to hope and pray that we figure out the key to making him better. 

Genetic Holocaust

The likelihood of developing bipolar disorder is many times greater in children with parents who have mood disorders. Researchers have observed that a first degree relative of a bipolar patient has a 13-35 % risk of developing a mood disorder. It has been consistently reported that the risk for a child increases significantly if a sibling has a mood disorder. That being said the psychiatrist have just diagnosed Christian. He started on Lithium last week. The bright spot in the sea of clouds is that the psychiatrist believe Christian is more of a "typical" presentation and not a severe as Joseph. Either way this sucks. The fear that we could be going through all this again. The fear that I will have another child I can't help. In all of this I am starting to question my own sanity. I am consumed with feelings of guilt, of every choice I have made as a parent. I get advice from everyone. Unfortunately it has come to a point that I don't think people even know what to say anymore. every direction I turn for answers I come up empty handed or with more questions. I am trying to put faith in the choices I am making and that the treatment or even diagnoses are right but the truth is I really don't know anymore. I feel so afraid and alone. I know that I have support from my family and friends and yet I feel a terrible weight on my heart that I am perpetually screwing up. Only time will tell I guess. Until I see positive results for both of my children I try desperately to hold on to hope that their lives will be happy and successful.

Change A Mind About Mental Illness

This Ad is amazing and so true.

Round and round we go

So Joseph has been at the residential since the first week in January. I would like to say he is getting better but I can't. The staff keep trying to give me hope but I feel lost. I keep trying to put on a strong front that this is where he needs to be and he is going to get better but I don't know what to think anymore. Nothing much changes from day to day. Some days are better than others but I feel something has to change soon. When he entered the facility he had court dates set because he was facing charges stemming from the last incident at our house. He was assigned a public defender and had a competency evaluation ordered. Last week Joseph had court and it was determined that they had found Joseph competent. I am not sure how to feel about it. Part of me knows this might help Joseph because the court can order treatment and evaluations etc however to sit in court and hear that my son knew what he was doing that day and knew it was wrong but did it anyway hit me like a ton of bricks. Anyone who has been with Joseph since the beginning of this mess will tell you how it has changed. Joseph's episodes used to be blind range and delusion in which you could see he had no control over what was going on or at times any idea where he was but now, now its different. He is calculated in his actions and at times even has a smile on his face when he is in the middle of a violent outburst.

I want them to start all over. He has been on this medication regiment for almost 2 years and not only has he not gotten better but he has gotten worse. The ramifications of my choices for my son way heavy on my heart and mind. What is this doing to his body and brain development? Is any of this making things better because it certainly doesn't appear to. Unfortunately this is a area of medicine that has little research especially for children, we don't know what the long term effects will be.

We visit Joseph every week and some visits are better than others. He is sometimes very happy and joyful and other times is so angry at me. He blames me you know.... He says I've put him there, I have done this to him. The times I really have to bite my tongue is when he tells me he wishes his real father were here because he wouldn't have let me put him there. Oh my gosh child if you only knew.

Joseph can not manage on any level. He is unable to maintain in school, home or in public. At this point in time he is restricted to the ground because he had a violent outburst off property with staff and put himself and others in danger.

As difficult as it is to have him home it is also very difficult to have him away. I have no control or knowledge of what is happening all the time. I know I need to learn to let go a little but this is my child and I can't make him better. My heart is heavy right now and on top of Joey's struggles Christian is struggling as well and I cant be there for him. I feel like a complete failure as a parent. I know what most of you will say is that I am doing the best that I can but when you cant help your children its hard to feel that way.

The ray of hope.... Joseph has a neuropsych evaluation at the end of May. I hope with the in-depth testing they perform we will have some new understanding of what we could be dealing with or how to help Joseph.  Until that time we just take it day by day and pray that we will see some changes soon.

This is Joey's favorite song.

It just keeps falling apart

Im not exactly sure what happened in October but it started small. Joseph was having difficulty with school and at home. He had quit football which was okay because those meat head, over weight wanna be pro football once were good 30 years ago coaches sucked every joy out of the game for Joey. Anyway it all started to fall apart and with each incident things got worse. Joseph was doing the in and out dance of hospitalization again. I cant even count how often we had to have police come to our house. I was getting phone calls from the school that Joey was becoming so aggressive and violent he would have to be removed.

I was starting down the path of residential for Joseph again and happy to find out that our insurance through my work had Cincinnati Childrens as their in network provider for residential. I did not get help from the hospital to help set up the referral for Joseph so it was up to me. I called Cincinnati Childrens and they remembered me from before. Joseph had no problem meeting their criteria and being excepted. But the insurance.... By the time we had gotten to this point Joseph had been hospitalized in Ohio 6 times. The insurance denied Joseph stating that we had not exhausted our efforts for less intensive means of treatment. Excuse me here but what the hell hadn't we tried!!!!!!!!! Meanwhile while fighting with the insurance Joey kept deteriorating. We couldn't get Joseph on medicaid for supplemental insurance because Paul and I make too much money lol.  We enlisted the help of Child Services. This would take us down another path. Our fist case worker was great she got to witness Joseph at his finest. He had been kicked out of school because of violence and was having a meltdown when she showed up at our house. We had meeting after meeting with every service the county had to offer. The problem was none of what they could give us we hadn't done for years already. We were getting nowhere with the insurance so child services started looking into being able to fund part of his stay at a facility. The day after Joseph was denied again by our insurance I received a phone call from his school. Joseph was with the school police officer and I needed to come pick him up. Joseph had assaulted his teacher. We had him admitted to the hospital again. I could not believe no one could help us. Assaulting teachers, jumping out of our car on the interstate, giving me a bloody lip, how could he not meet their "medical necessity"?!

Joseph had missed every holiday with us because he would end up in the hospital. child services eventually placed him in a therapeutic foster home till we could get funding lined up for residential. Joseph had problems in the foster home too. No matter where he went he was getting worse. Christmas was fast approaching a Christian was coming to visit. Joseph was going to come home to us for the holiday. He was home less than 6 hours. Joseph's I pod was not charged and wouldn't work right but he wanted it now! I told him he would need to wait until it charged and that set him off. He came at me swinging and screaming. I picked up max to get him out of the way as Joseph began throwing things. I made it to the kitchen where Joey cut me off and grabbed a BBQ fork, raising it up he charged at Max and I. I pulled the baby into our half bath and called the police. I could hear the destruction going on outside the door as I told dispatch to hurry. I thought he was going to break the door in. I heard the police come through the front door and started shouting stop police! Joseph took off outside and was running from them. The police officer got a hold of Joey and Joey kicked him several times. I stood in the house surveying the damage. The bathroom door had a dozen holes in it. All my Christmas nutcrackers were knocked over several of them broken. There were holes in the walls, an overturned table and broken lamp. The police officer told me not to touch anything. It was some officers I knew they had been here before. The officer asked what they are doing to try and get Joseph treatment and I gave him the short version of the story. They called the district attorney and filed a report this time with the hopes that with court involvement they could order treatment and the insurance company couldn't do anything about it at that point. So right before Christmas away Joey was again to the hospital.
After the first of the year it had been decided that Joey would go to treatment we were just waiting on Child services director to say yes to funding. We were running out of time on the therapeutic foster home and couldn't safely bring him home either. When we finally got an answer it was the worst choice of my life to make. I got a phone call at 6 pm and was told that Child services could fund Joseph's visit if we gave temporary custody to the state. To make matters worse I only had till midnight to make the choice because once I got paid at midnight we would have "too much money". After all the fighting and pushing I would have to give him up to get him help. Now everyone will say its only on paper and just for funding but does it really matter? We are still decision makers for him in a round about way and still 100% involved but this is what I have to do to get him help. I cried for days. I couldn't believe I had to do this. Joseph was transferred in the beginning of January to the facility and that is where he is today. We see him every week and talk to him everyday. I see such little improvement at this point I don't know what to think. I know it will take time but I am not seeing forward motion. I sometimes worry that I will know Joseph the rest of his life in institutions. The hardest part of all this is the inability to be able to help me son. I cant fix him, I cant take away his pain. I would give everything I own in this world to make him better.

The summer bliss....

Joseph was home. I spent the few weeks that I had before I went back to AZ scrambling to get the house together and Joseph set up with a summer program. I enrolled Joseph in a summer YMCA program that had a ton of fun activities. I was truly hopeful Joseph was going to be able to enjoy all of them. I returned to AZ and spoke with Joseph and Paul daily. Everything was going well for Joey. I thought maybe we finally had this thing under control. Paul and I were less than impressed with his out patient psychiatrist but that was something I was going to work on when I moved out to Ohio. I came back out to Ohio for a visit in August and got Joseph prepared for the start of school. We did some clothes shopping and I met with the Tipp City school district to determine what placement would best accommodate Josephs needs. We decided on a partial self contained classroom very similar to what Joseph was in when we were in AZ. He would be in the self contained class for his core subjects but mainstreamed with "typical" kids for his extra courses, lunch and recess. We felt it was good that Joseph only had one other kid in his class. We also enrolled Joseph in tackle football. Something he could not wait to be a part of! He had played flag for years and was very good at it until he got sick. See the medication he was on had caused Joseph to gain a lot of weight and he was slower and tired more easily. Joseph's size however gave him great advantage to play defense in tackle. Joseph started out doing really well in school and in football. I was anxious to join my family and be there for Joey. Here is where I must make a side note about Christian Josephs younger brother. When we decided to move to Ohio we made the choice for Christian to stay in AZ with my mom and stepdad. Not an easy choice by any means but here is our rationalization. Christian had been with mom and Don for a long time because of Josephs instability and violent behavior it was best to keep their contact with one another minimal. We wanted to give Joseph the time to transition and not have Christian get unintentionally neglected because Joseph is very time consuming. Its not easy and everyday I am not sure if I have made the right choice. I miss christian so much. Our family is not complete and my heart hurts that I am missing so much of his life. Hopefully we can have him with us or at least closer to us soon. Anyway back to Joseph. Things were going well until about October.... 

Freaking Fox Run

So picking up where I left off. Joseph was in the residential facility and our family was all separated. Joeys GAF score at admission 27. At the beginning I had truly believed that this facility was going to help Joseph. I was excited at the fact they were willing to accommodate the unique situation we had and work with our family. Looking back now and knowing what I know I would not have placed Joseph there. The facility housed 150 kids all with emotional and behavioral issues. I don’t care what anyone says about the amount of staff you have, there is no way to effectively work with these kids when you have so many of them. I would try and call every night to talk to Joseph but so many times we could not get through and when I did Joseph usually was sad and crying or angry.

Joseph had family sessions with me over the phone along with his counselor. I think his therapist did the best he could with Joseph but as time passed I could see little improvement in Joseph. I called several times to speak with the psychiatrist assigned to Joseph only to never get a return phone call. Weeks passed and the facility was doing everything the can within the first month to tell me he was going to be discharged soon.

Paul and I had already scheduled that at the end of May he would be flying into Arizona when we would than load up the moving truck and proceed to drive all of are stuff across country and move into our new home. We started driving on a Monday morning and the next day received a phone call from the facility stating that Joseph was going to be discharged as soon as we arrived in Ohio and could pick him up. The facility asked where we were in our trip and we explained we were in Texas, only Texas they said. I than informed them it was a 2000 mile trip and we were driving a 26 foot truck with everything we owned in it and it was going to take us a few days to get there.  They asked when we would be able to pick up Joey, I lied and said Friday, figuring that would give us enough time to get to Ohio and be able to unpack. I was very upset needless to say, not that I didn’t want Joey home with us but he had only been in the facility for 2 months when typical treatment is a minimum of 6 months. To top off all the mess the facility made virtually no follow up for Joseph when he transitioned home. Just prior to Joseph being discharged he had several violent outbursts. Joseph on one of those occasions attacked staff and other kids but the facility or should I say the insurance did not feel he met medical necessity.


Paul and I rushed to drive across country making the move in three days. We arrived on Wednesday and managed to unpack and put the house together by Friday so Joseph could just come home. It was very stressful to say the least. We had find therapy for Joseph and a summer program for him to attend since Paul would be working. No medications were ever changed and I never heard from a psychiatrist the whole time Joseph was there. I later found out why. After months of asking for Joeys records and never receiving them for one BS reason after another I got my hands on them. I never heard from a psychiatrist because Joey was never seen by one other than at intake. The ONLY note from a psychiatrist in his records was from admission. Can you believe it?! Joeys GAF score at discharge 47. Worst of all his discharge states " The patient was discharged due to lack of "medical necessity" with regards to residential treatment." The discharge summery goes on for 3 more pages to say that the patient continues to struggle with, has made minimal progress and continues to require intensive treatment and yet he didn't meet standards required. Sigh what a great system we have for these kids. 


When I picked Joseph up I was so thrilled to see him, hold him and hug him. He looked good, had lost weight and for the moment seemed happy. We enrolled him in a summer camp program and set him up with a out patient psychiatrist recommended by the facility. At this point all we could do was hope he would do ok and make it through the summer. I returned to AZ and left Joey with Paul who did an amazing job caring for him. Day by day passed and it looked as though Joey was finally stable..... 

Ohio here we come

Shortly after the wedding Joseph was having some trouble again. We can truly be thankful he made it through the big day without incident though. He was at my dads house and we are really unclear what sent off this occurrence but Joey ended up physically attacking my dad and breaking every window in the front of his house which totaled $1800 in damages. Joey was taking by police to the hospital  It became very discouraging that they knew us by first name when we came in the ER doors. These nurses became like family to us and I am truly great full for them. This time we were making sure Joey went to a residential facility, I only wish it was that easy. Every clinician involved in Joeys care both in patient and out patient believed this was best for Joseph however the insurance company again wanted to make a big problem of it. After one conversation with them throwing out terms like liability and endangering my son's welfare they very quickly came up with a facility in Ohio that had a ready bed and would except him and was in network. So it was done. 3 short weeks after my wedding my husband and Joseph were going to Ohio and I was staying behind with Christian and Max until my Ohio nurses license came through. Problem.... just 2 days before we were to board a plane for Ohio Joseph's WBC's dropped to a dangerously low level. This was secondary to the tegratol, which could now be added to a growing list. Seraquel = paralysis, Geodon = prolonged QT etc.  So Joseph had be taken off quickly and lithium brought back up. They could not discharge Joey to go to Ohio tell this happened and with plane tickets purchased and the facility only holding a spot for a limited time, it was very nerve racking. Needless to say we made it. Joey was discharged and we took him straight to the airport. He actually did well with all of this. This was another of the hardest days of my life. We did the intake at the facility and that is where Joseph would be for the next 2 months. I want to take this opportunity to say I have the most amazing husband in the world who moved across country from his wife and biological son, and would drive 3 1/2 hours one way every week to visit Joey for 2 hours. He did all of this for Joey and for that I love him. So there we were, Joey and Paul in Ohio, the rest of us in AZ, hoping a praying that this was going to help.

and the bottom drops out....

After some time of Joey doing well we thought well we can handle the little bumps in the road but he seemed to be doing fine. That's what we get I guess because Joey started having trouble again. Hallucinations and night terrors came back. We thought we could ride it out with a few medication changes. Joseph had had a few rough days at school and we were trying to control things. He was home from school one afternoon and playing with kids in the neighborhood. I was sitting on the couch with Max our newborn when Joey came storming in the door. I asked him what was wrong and he went ballistic. Joseph came charging at me and grabbed a Rubik's cube and began striking me in the back of head. I bent forward trying to place myself over the baby to protect him. I managed to run out the front door. The neighbors heard me screaming and came outside. I told them to call the police. Joseph was still inside the house throwing things around a yelling wildly. Joseph than came out of the house and took of running down the street. Shortly after the police showed up at our house. One officer began taking a report while a few others started looking for Joseph. Joseph was found down the street and the police brought him into the house. We were trying to explain to the police what was going on when Joseph grabbed some cellophane wrapped and tried wrapping it around his head and neck. The police intervened and Joseph screamed out "I wanna fucking die!" The police were trying to be careful  with him when Joseph went after them. Kicking, hitting and screaming. In order to keep him safe from himself and from hurting others they placed him in handcuffs. No one should ever have to see their own child in handcuffs. The police were unable to get an ambulance to come and transport Joseph to the hospital so they took him there. Joseph was readmitted for stabilization. This would be Joeys 12th hospitalization in less than one year. This was one of his longest stays at over a month. At this time we began talking about a future for Joeys care. We knew we would be unable to stay in AZ because of Joeys heat intolerance but we needed to be close to family. Paul's family were still in Ohio and we made the difficult choice that that was where we needed to go. We started to look into residential treatment for Joey. acute stabilization was not helping Joey anymore. He needed long term intensive treatment. We were working hard for Cincinnati children's Hospital  because they have such high success rates for bipolar children but it was not in network for our insurance, which would have cost us $4000 just to get a bed not including daily costs. I know it shouldn't sound like everything came down to money but in all reality we couldn't afford to send him there. With the wedding coming up all we could hope was that Joey could get out of the hospital and be able to be there for the big day.

Joseph was discharged just before the wedding and was able to attend. He was so handsome in his tux. Everything was beautiful. I have to make a side note here that despite the difficult things said about Joey, his disease and our struggles. He is an amazing child. Joseph is so loving and wonderful. Unfortunately at times his disease keeps us from seeing those great things.

Pictures

The Beginning

 I was returning from one of my weekly trips to visit him when the thought of doing a blog just hit me. My hope is this will raise awareness of the everyday struggles a family of a bipolar child can have.  I also have the hope that my friends and family who read this can know what Joey is facing a continue to be the support they have been over the last few years.

So Joey has had problems for as long as I can remember. Looking back at the huge binder of information we have kept from all his appointments and evaluations it has become more apparent just how bad it was even before the diagnosis. At the age of 3 Joseph was having extremely violent outburst. It was difficult for anyone on the outside to understand. We just constantly heard it was typical for his age or geez lady parent your kid better, looking back we know it ran so much deeper than that. We had Joseph evaluated and at that time his social emotional functioning was 3 standard deviations below the norm, which is significant for those who might not know. Joseph began having counselling and at home interventions which would increase and continue through the years. I could go on and on for years but that's not why I am here. Ill bring you up to the breaking point.

By 2010 Joseph and the family had services weekly that included; in home respite workers, in home behavioral therapists, sibling counseling, family counseling, and a psychiatrist with medication management and was on special accommodations in the school settings.  Nothing seemed to work. Joseph at this point had been diagnosed with EVERYTHING; PTSD, ADHD, ODD, IED you name it they tried to treat him for it but nothing helped, at least not for an extended period of time. So we tried a "newer" therapy called EMDR with the hopes that this would help. I wont go into the details of this therapy because its rather extensive and a little confusing but it had been shown in studies to greatly improve impulsive and aggressive behaviors. So needless to say we were willing to try anything to help Joey. I drove Joseph every week 45 minutes to therapy and waited to see results, well we got them just not how we had hoped.

4 months into EMDR therapy Joseph started discussing in his sessions about the different people in his head that talk to him and he sometimes sees. He describe "little man" as he called him who was like a baby but protected him and the scary lady who would yell and scream at him and scare him in the night. Joseph began having night terrors again and sleep walking. His behavior became more erratic and violent. Thinking back I can not remember what exactly happened leading to Joseph's first hospitalization but I remember it taking 6 staff members in the ER to restrain Joseph from hurting himself and others. It was the worst day of my life having to admit my son little did I know it would be the first of many.

On his first admission to behavioral Joseph was diagnosed to have bipolar disorder. Something we knew all along but no doctor would diagnose. Joseph was started on depakote and seroqual for mood stabilization and after 1 week was discharged. A huge weight had been lifted from more shoulders. Throughout the week he had been in the hospital and slowly stabilized on medication I saw a huge change in Joseph. I finally felt as though I had my son back. Joseph seemed truly happy for the first time in a long time. This of course would be extremely short lived.Joseph's GAF at discharge 30.

The following day after discharge, Joseph, Christian, Paul and I went to a boy scout outing at a pool and Joseph seemed to be doing great. Everything was going fine and we were there for about 2 hours. We went home and Joseph fell right to sleep on the couch. It was mid afternoon and he was exhausted. Joseph awoke about 2 hours later in what I can only describe as a "sleep walk" state. His eyes were open but he was completely unaware of his surroundings. Than he began screaming at the top of his lungs. Just a blood curdling scream. We rushed to him to try and calm him but he just screamed more. His pupils were the size of saucers and he didnt even appear to know where he was or who we were. He just kept screaming his little body just trembling and than he laid down and was quiet, asleep again. Five minutes of sleep would pass and this cycle would start all over. I called the hospital not knowing what to do. They were not much help over the phone needless to say. I was scared I had no idea what was going on with my son. Somehow Paul and I managed to get Joseph into our car. Paul sat in back with Joey and I drove about 100 miles an hour back to ER. This behavior continued while in the ER. No one could explain to us what was happening. I was worried Joseph was having another psychotic episode. After 4 hours Joseph kinda snapped out of this state and was calm finally falling asleep. He was readmitted for observation. It was determined Joseph had extreme medication sensitivity in combination with heat and sunlight. You can imagine how well this worked in AZ when the doctor explained if it was over 90 degrees Joseph would not be able to have extended time outside. Joseph's GAF at discharge 45.

Joseph returned home but we soon learned this would become a pattern. Joseph had a major meltdown and became dangerously violent one day believing everyone was trying to poison him. Joseph was admitted for the third time in less than 3 months. Medications continued to be adjusted with slow improvements until Joseph had a severe dystonic reaction. What that means is that Joseph woke one day unable to move, he was paralyzed and his arms were contracted and contorted. The hospital had to call a rapid response team and administer IM injects of benadryl. The dystonic reaction was reversed however Joseph will have residual hand tremors for the rest of his life from this. This extreme sensitivity threw a wrench into treatment with Joseph. At that time Joseph was taking the "typical" medications for stabilization and now had to medication regulated in a different manner. Joseph's GAF at time of discharge 38.

For those of you still reading and wonder what a GAF is that I keep referring to let me explain...(Wikipedia)

The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and described in the DSM-IV-TR on page 34. The score is often given as a range, as outlined below:

91 - 100 No symptoms. Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities.

81 - 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).

71 - 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

61 - 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

51 - 60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

41 - 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

31 - 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

21 - 30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends)

11 - 20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).

1 - 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

So as you can see Josephs social and emotional functioning is not very good. So how can they discharge him home might you ask. Two words and in my opinion the two most hated words in the English vocabulary; Medical necessity. What does that mean? Well its your private insurances way of saying we aren't going to continue to pay for a stay. Needless to say in all of Joseph's hospitalizations his discharge GAF was NEVER above 50.  But that's a whole other blog if you get me started. 

Joseph continued to struggle. He was given every accommodation we could avoid him having to be moved to a self contained classroom. Joseph's behavior was just to difficult to control and he was unable to maintain in a regular classroom setting. We moved him to a self contained classroom and placed him on an IEP. After countless hospitalizations and several medication changed Joseph seemed to stabilize for a period of time. Of course he was taking up to 20 pills a day and his monthly medication costs were $250. But he seemed to be better.