Crisis planning solutions for all family types faced with extraordinary challenges

Dr. Rita Laws is a recognized authority on many issues related to challenging behaviors, and she is also the mother of 12 children (by birth and adoption). In her 24 years of advocacy, support, and education, she has worked with thousands of families.

It has been said that adoptive families are like any other families, and then some. With the exception of the childbirth experience, they experience the same joys and challenges as all families, with a few additional ones added. For example, people who adopt "high risk children" and children with special needs are more likely to need the help of professionals while raising their kids. They are more likely to have extensive involvement with the medical profession, and with the mental health establishment. For those adopting children with emotional and behavioral problems, adoptive parents are also more likely to deal with the juvenile justice system and with residential treatment facilities.

Of course, adoptive families are not the only kind that face crisis situations. Foster families, stepfamilies, blended families, and families built through childbirth can also face a crisis, unexpected or not. So it's a good idea for all parents to learn the "lingo" and review the process of avoiding or minimizing a family crisis.

Table of Contents

· Definitions
Within the context of crisis-planning, it's important to know the terms that will affect your family and that are used by others who will help you along the way.
· Preparation is Key
There are four important steps to take in order to help yourself and your family be prepared for a potential crisis.

Correct diagnosis of the problem or problems creating the crisis;

Professional involvement in the treatment of problems;

Maintaining a record of efforts made on behalf of the child (the paper trail);

Developing several different contingency plans in the event of a crisis.
· Resources for Parents & Teens
In addition to resources listed in the sidebar, there are places to find help and guidance on the Web and in person.

Every child with special needs or risk factors is unique. Some are highly resilient, some are not. Some respond well to treatment and some need much longer to recover or improve. But what all of these children have in common is the fact that their best chance for normal lives lies in being members of permanent committed families who are willing to seek out a diagnosis, develop a treatment plan as soon as possible, and work to prevent or minimize crisis situations.

When it comes to children with special needs and high-risk kids, love is not enough. Love is a crucial component of the treatment plan but love by itself is just one rung on the ladder of success.

Here are five important definitions for parents who may be facing a crisis down the road.

Crisis: A family crisis is a situation involving high stress for parents and a major disruption of the functioning of the household. Often, it involves danger for children or teen-agers. In a child crisis situation, the child will be out of control (not responding to parental or any other type of authority) or will be in danger of harming himself or others. A crisis is more likely to be successfully resolved if professionals have been involved in the development of a Crisis Plan.

Early Intervention: Early intervention services are physical, mental, emotional and educational assistance for high-risk children and those with special needs that is begun as soon as it can be effective. Studies show that the sooner speech therapy, for example, is begun for children with speech delays and impairment, the faster and more fully they can recover from these problems. Many public school districts will begin occupational, speech, and physical therapy with children as young as three years of age. If your child is under age three years and you suspect a disability, or if risk factors are present, you may wish to ask your local state department of family services about the federal program of Early Intervention services for children age birth to 3 years old. Called IDEA Part C (from the Individuals with Disabilities Education Act), eligibility requirements will differ slightly from state to state, but generally speaking, children with the following conditions and risk factors could qualify: developmental delays in any area, premature and low-birth weight babies, children with chromosomal and congenital conditions, sensory impairments, metabolic problems, prenatal infections, and acquired conditions that may affect development such as abuse and neglect in the first years of life. For more information, visit the National Early Childhood TA Center.

High Risk Children: These are children who are at higher than average risk of developing emotional, behavioral, learning, or physical disabilities or conditions based on genetic, pre-natal or environmental issues. For example, some mental illnesses, such as depression and bi-polar disorder, tend to run in families. A child born of a drug addict who had not sought pre-natal care is at higher risk of developing learning problems at school age. And a baby who was abused or neglected or had multiple caregivers in the first year of life, an environmental problem, is at higher risk of developing emotional and behavioral disorders. How much risk any single child faces cannot be determined exactly due to factors such as resiliency.

Resiliency: Resiliency is the ability of an individual to recover from or "bounce back" from adversity of some type. No one can predict how resilient any one child will be to genetic, pre-natal or environmental risk factors. Therefore some children who are at high risk may develop no later problems or mild problems due to a high degree of resiliency, while some children with low to moderate risk factors but little resiliency may be more profoundly impaired. Early intervention services can work with a child's natural resiliency to overcome deficits.

Special Needs: This is a broad term that refers to disabilities and challenges faced by certain children. Special needs can be physical, mental, emotional, behavioral, or educational. Some common special needs among children waiting to be adopted include hearing, vision and speech problems, cerebral palsy, learning disabilities, attachment disorders, depression, Fetal Alcohol Syndrome, and Attention Deficit Hyperactivity Disorder. The term "special needs" also encompasses certain "placement factors" that can make finding an adoptive home more challenging. These factors differ from place to place. For example, one city may have many more boys waiting to be adopted than girls or may have many more children of a certain race than other races. But generally speaking, special needs factors include, age, minority race, gender, sibling status, legal risk and risk factors.

Correct diagnosis of the problem or problems creating the crisis

Illustrated with the example of a real life family (names changed to protect privacy).

Joan adopted her nephew, Diego, at age 3 when her sister died of a drug overdose. The birthfather is "unknown." Diego was described as a high-risk child due to lack of prenatal care, low Apgar scores at birth, and multiple caregivers in the first two years of life (in and out of foster care.)

The social worker described him as a healthy pre-schooler with mild developmental delays and high risk factors. Before placing him with Joan, he took Diego to a Children's Clinic where a team of medical doctors, psychologists, psychometrists, educators, and therapists evaluated him in all areas. Diego was diagnosed as environmentally neglected, developmentally delayed in several areas including cognitive and speech, possibly learning disabled, and showing signs of "insecure attachment."

Every adopted child who has special needs or risk factors should undergo a comprehensive evaluation by a team of professionals prior to or shortly after adoption. No parent can hope to be able to make a complete diagnosis alone. A team approach is considered the best way to formulate a complete diagnosis because no one professional specializes in all areas of child development.

These team approach evaluations (sometimes called "psych evals") can cost hundreds of dollars, but are often covered by Medicaid (which most adopted children with special needs qualify for, regardless of adoptive parent income). In cases where there is no Medicaid or private insurance coverage, the adoption agency will often pay for the tests. It is quickly becoming standard procedure to provide all adoptive parents with a recent psych eval prior to adoption.

Having a complete diagnosis rarely discourages the potential adoptive parent or parents from attempting the placement. In fact, the opposite is true. By knowing what to expect, many adoptive parents find they are more confident about taking the child into their home. This type of full disclosure is good for the child and for the whole family.

Professional involvement in the treatment of problems

Illustrated with the example of a real life family (names changed to protect privacy).

Joan took the ten page psych eval to her family doctor to develop a plan for her son. Based on the report's recommendations and her doctor's suggestions, Joan did the following:

** Enrolled Diego in speech and physical therapy at the local public school (three 30 minute sessions per week),
** Bought Early Education software so she could work with Diego on Reading Readiness Skills,
** Signed him up for a more detailed evaluation by a doctor who is an expert on attachment disorders,
** Took him on frequent outings to increase his exposure to new experiences and language, and
** Bought several books to read about the problems that were uncovered during the evaluation.

Over the next 5 years, Diego improved in some areas more than others. It didn't take long for him to "graduate" from speech therapy and to catch up academically. By third grade, he was at the age-appropriate level in all areas except reading, where he was only one year behind. However, the behavioral problems associated with the attachment disorder were more resistant to improvement and slowly getting worse. In Diego's case, these included chronic lying, sneaking, disobedience, and temper tantrums.

When Diego turned 8 years old, he stole $5.00 from a teacher's purse and was suspended for three days. Joan began taking him to a therapist once a week for psychological counseling. By the time he was 12, his temper tantrums had transformed into bouts of anger that left Joan deeply concerned, and Diego's bedroom in total disarray. The counselor added an 8 week therapeutic course called "Anger Management."

Once a diagnosis is made, parents must educate themselves to the challenges that were uncovered and then formulate a plan for helping the child overcome the difficulties. Often, the final page of the psych eval which contains detailed recommendations, is used as the basis for such a plan. For many children, a plan involves the cooperation of the family doctor and the local school, both of which should receive a copy of the psych eval.

It may sound obvious but parents should be aware that some problems may not respond well to a specific treatment. If one treatment does not produce results, or stops producing results, the parents should try something else. Don't stick with plans that don't work. There are many different ways to attack a problem.

A word of caution is in order for parents whose children suffer from emotional or behavioral problems, or have received a diagnosis of a mental illness. There are many new and innovative treatments being used and developed right now. Some are effective or will prove to be so eventually, and some are useless, dangerous, even deadly. If a therapy sounds unsafe to you or makes you feel uneasy or anxious for your child's welfare, say "no." Seek a second professional opinion, talk to your family medical doctor, and listen to your parental instincts.

Maintaining a record of efforts made on behalf of the child (the paper trail)

Illustrated with the example of a real life family (names changed to protect privacy).

Diego is now 15 years old. He is on level or above in all academic areas and maintaining As and Bs with only an occasional C. Thanks to Joan's careful planning and early intervention services, Diego has overcome all of his early problems with the exception of some behavioral problems. Even those improved quite a bit between the ages of 10 and 13. However, in recent months, Diego has shown signs of an increasingly violent temper.

Diego is no longer cooperating with his therapist and sits through most of the sessions staring straight ahead, waiting for the hour to end. He completes his homework and his household chores, but is rarely cooperative in any other area. Recently, when Joan refused to extend his curfew, he began kicking the coffee table and did not stop until it was destroyed. He showed remorse for this action, but Joan is worried. She meets with her son's weekly therapist and with the Junior High school counselor to go over the treatment plans and IEP.

Maintaining a paper trail, or a record of efforts that have been made on behalf of the child to deal with the diagnosis, is crucial to avoiding a crisis, or dealing with one successfully. If you have a file that details what has been done, and a crisis looms, the professionals who have the ability to help your child will be much better prepared to do so. They will know what has been tried, and for how long, what worked, did not work, or worked only temporarily, and more. This file is invaluable in developing a new course of treatment for the teen-ager or young adult in the throes of a crisis.

Furthermore, in the event that the child requires hospitalization or residential treatment, the insurance "gatekeeper" is likely to require evidence that all other methods for helping the child have been tried prior to taking the expensive step of out-of-home care.

In a few cases, a child will be "terminated" from a residential program due to extreme behaviors that put others in danger. When this happens, other residential programs will probably be unwilling to accept the child. In some states, a parent may be forced to ask a court to order the department of social services to temporarily accept physical custody of the child for purposes of finding in-patient treatment.

State departments have contracts with some residential treatment centers and therapeutic foster homes that will accept a youth no matter how dangerous his or her behavior has been in the past. The parents are expected to pay child support and to accept the child back into the home once he or she is stable and safe to live with. When a court hears such a request, it will expect the parent to provide evidence that a private placement is no longer a possibility and that all other possible solutions have been tried. The paper trail is the proof of this.

Developing several different contingency plans in the event of a crisis

Illustrated with the example of a real life family (names changed to protect privacy).

After Diego destroyed the coffee table, his therapist sat down with Joan and developed two crisis plans, Plan A and Plan B.

** With Plan A, Joan was to immediately call the therapist if Diego became highly agitated again. Joan was supplied with an emergency 24 hour cell phone number that she taped underneath every phone in the house. If Diego did not calm himself after the phone call or if his rage escalated too quickly to make the call, Joan was to put Plan B into operation.

** If Joan felt that Diego was capable of hurting himself or others or causing serious damage to property, she was to immediately go to her bedroom, lock the door and call a local hospital that has a ward for teens who need emergency mental health services. The hospital would decide if an ambulance should be sent, or if Joan could transport Diego. They would also assess the need for a call to the police. Joan was to follow their instructions exactly and call them back if she felt that the situation was becoming more dangerous.

Joan now had a crisis plan and was prepared for any emergency. This helped her feel more secure and confident in her mothering role. In Diego's case, Plan A was used twice but Plan B never proved necessary. A special therapeutic summer camp program turned out to be the only out of home care he needed. Slowly, Diego began to cooperate with therapy again, and after age 17, rapidly matured and gained self-control. Today, he is a 20 year old part-time student at a Vocational-Technical College and is living in an apartment with two friends. Diego wants to be a carpenter. He will be making coffee tables instead of destroying them.

Joan was wise to have two plans in place in event of a "worst-case-scenario." All parents of troubled, violent or high-risk children and teens should have a plan or plans custom-tailored to their situation and their child's needs.

The good news is that many troubled kids who have received treatment and who have loving supportive families do eventually overcome their difficulties. Many are well on their way to productive adulthood roles by their mid-twenties. Some take a little longer. Without this help and planning, the outlook for high-risk kids is bleak. Some commit suicide, other may end up in prison for criminal acts, and others may struggle with psychosis and need long-term psychiatric hospitalization.

Resources for parents and teens

In addition to the resources listed in the sidebar:

Boys Town USA
Provides support to troubled children and families in crisis. Offers program details including classroom management and crisis hotlines. Has a crisis and suicide hotline for parents and kids: 800-448-3000.

Commitment - Advice and Help for Step Families
Interview with the authors of "Positive Discipline for Blended Families" discusses the special challenges blended families face in disciplining their children.

Health Information Resource
Objective help in choosing between residential treatment programs.

How To Know When Your Family's In Crisis
A helpful article from WebMD

When to Hold and When to Fold
Dr. Nancy Spoolstra tells her personal story of parenting challenging children. Excellent insight into a family setting.

© Copyright(c) 2003 Rita Laws and Nancy Ashe. All rights reserved. No part of this material may be reproduced in any form without written consent.