Adios, Amigo?

Friday, we had what was ostensibly a case conference to learn how a student's medication change was working, however it turned into a full-blown PPT with a discussion for change of placement. Alejandro (see previous post "The Package" from 9/23/08) has been problematic for most of the year, so it doesn't come as a big surprise, but this was a student that we gave so many resources- manpower and brainpower. When those kids leave you can't help but feel a sense of loss. It's not a matter of attachment, it's a matter of commitment. Once you decide that you're going to stick it out, it is a bit confusing when it becomes apparent that you have done all that you could and it's time for someone else to try. That's what I had to tell our principal, because she was wondering what else could be done. We worked with him for over a year and a half. He had significant issues, but we were somewhat successful at dealing with them. We were winning, dammit! But then it became too much for us to deal with.

He was on a very effective medication that controlled his impulsive behavior, but it was causing weight gain. At his mother's request, the medication was switched and he has never been the same. He has been obstinate, defiant and aggressive. This isn't the same child we worked with all of last year. It's unfortunate, because we made all sorts of accommodations to help him and we never took into consideration just how much the medication was contributing to his success.

The meeting culminated with a recommendation that he attends an alternative school that specializes in children with behavior issues. His outside therapists were the first to recommend it because at this point, a therapeutic school setting would be best.

I was warned about this: My director told me that as soon as Alejandro found out about the school change his behavior would deteriorate. Well, guess what happened today? It was pretty awful. Part of his plan was to have a check-in time with me in the morning. I am supposed to gauge his mood and see how his day will go. He was off this morning, but I hoped that he would get it together in time for class. I hoped in vain. He didn't even make it an hour. He had absolutely nothing to work for. My principal was very perceptive, she picked up on something that he said during his fit of stubbornness. In his stilted English, Alejandro said that he was angry with us. As she asked him to tell me what he said, it dawned on me that he knew about the school change. And of course, we have his mother to thank for that. His mother is not a good mother, and this was definitely something she would tell him. I think her words were that he's been misbehaving and he's being sent to another school because of it. Thanks, mom. We're still working on the paperwork now. This should happen fairly soon.

The Art of the Question II

Today I had two PPTs and they were both successful. One was for a new student who is having some difficulty making the adjustment to our school. Mom requested a PPT immediately and we've had the opportunity to meet and learn more about her son before the meeting, which is always nice. There were things that the mom told me in private about the student's history that I wanted to share in the meeting, but I felt like it was off-limits until she mentioned them. Luckily for me, she opened the door with some choice comments about her family's history of bipolar disorder, schizophrenia and depression. This admission led to other questions that we all had about the medication the student is currently on and his behavior at home. I felt like a lawyer in a tv drama where there is evidence that is inadmissable but then the defendant makes a statement that allows for a certain line of questioning. I felt on edge because I was afraid that we would end the meeting without discussing some of the bizarre behaviors we had seen, his medication regiment, or our thoughts about further testing. We were so focused on making the meeting a positive and safe experience for mom, who evidently has her own mental issues, that I was afraid we were treading too lightly and would leave the meeting with no substantial knowledge gained. Fortunately, Mom was forthcoming with some of the information, but as someone once told me, for every one thing admitted, there's most likely two or three more alarming things that are omitted. In the meeting she mentioned that her son was "institutionalized" (to use her word) over the summer. When I spoke to her before the beginning of school she told me why this occurred. During the meeting she didn't mention the reason, but she talked about the boy's issues with his absent father. Classically Freudian or Oedipal, take your pick. As the mother was talking I felt myself enter the zone and all of a sudden not only did I know what to ask, but I also knew how to phrase it in a way that would give me what I wanted without making the mother defensive. My clinical interview skills are improving. I felt like I accomplished what I wanted to do. This student will require a lot of brainstorming and program reviewing because I feel that we will have to change our strategies frequently to meet his needs.

BBC