The big day

Clock - The Big Day

Since our short term emergency placement transitioned to long term care thoughts of working towards any transition were dropped completely replaced by longer term planning. As primary carers this opened the door up to more involvement in David’s future planning (fictional names used) and a whole lot of appointments. From the beginning despite the temporary arrangement we had always tried our best to keep his best interests in mind from (not backing down from any challenges we could have ignored and left for a potential next carer). However when our commitment transitioned to long term this did change our perspective from working towards a smooth transition to personally handling the long term.

There were two big appointments on the radar we needed to work through – re-engaging with David’s psychiatric team and the annual case plan review. While we were already very closely working with our agencies’ clinician (helping us through the immediate challenge of the red-zone episodes) more professional help was needed to provide additional strategies and review effectiveness of current medications. We had already taken steps to work towards this because while we were fortunate that there were already specific professionals that had worked closely with David with existing relationships, previous carers were not supportive in working with these professionals so the support had lapsed. This started with a re-introduction visit with the psychologist visiting us and David in our home one day after school. The goal was very simple, keep things very casual and get David on board to participate in future appointments for additional help. The mood started light but initially there was flat out refusal for any appointments, however the psychologist is very skilled at what they do and David was supportive of a future appointment.

It worked out with the timing that around the time the first psychiatrist  was scheduled was also when we needed to participate in the annual case plan review meeting. Considering travel, each of these appointments would take up half a day and be disruptive to David both from the perspective of time off school but also the emotional toll which comes with such appointments (not to mention disruption to our own work as my wife and I both wanted to attend to support David and each other). We decided to tackle these together in one day rather than disrupt David at school over multiple days,

So the first appointment was the psychiatrist appointment. So there was my wife and I, David, our clinician, the psychologist who had visited us in our home and the psychiatrist. I’m not sure what I expected, in fact I really had no idea since we had not really worked closely with psychiatrists or been in situations like this before, however it was striking that we had all these people in one room who had experience supporting David and keen to help. In a literal and physical way it showed that there really was an entire team of people that were there to support his needs and this was a big encouragement to us.

“We had all these people in one room … it showed that there really was an entire team of people that were there to support his needs and this was a big encouragement to us.”

The session started and we were all given some fidget toys play with during (I picked a toy that was small blocks connected by an elastic string you could rearrange into different shapes, my favourite!). It started with some light discussion around why we were there and what support could be offered. Shortly into it the psychologist started to discuss some more touchy subjects around past carers and family and the change in mood was almost instant, David was becoming increasingly agitated. In the moment I was a little distressed by the display of anxiety and offered some support and encouragement to David to try and calm his mood. The agitation escalated quickly to the point where David had removed some jewellery he had been wearing (it had a sharp edge but had never been an issue in the past) and repeatedly moved it across his wrist applying more force each time in a slashing motion. Since this was happening under the table out of view (but I could see from my vantage point next to them) I hinted at what was going on and the psychologist managed to trade the jewellery for another fidget toy.

At this point I had to remind myself that we were in a very safe environment, there were professionals in control who I had a lot of confidence in and I realised it was really important that they see how David reacts in certain situations for themselves to make informed decisions about his care. In hindsight I realise it would have been better if I hadn’t attempted to reassure David and interfered, but it took me a little bit to clue on that they were deliberately discussing difficult areas to gauge the reactions. I realised while the psychologist was engaging with David the psychiatrist was carefully observing everything which was taking place. After the intense part of the session they did a good job of helping David calm back down. Despite the intensity of the meeting David was still supportive to meet again for support and work through different coping strategies. Some discussion followed about a change in medication and David agreed to the change (which was also a positive sign).

Following this meeting we kept things chill with some take-away for lunch and music in the car as we headed to our agencies’ office for the case plan review meeting. David had calmed but was still a little on edge and he decided not to take part in the meeting although we did bring him in the end to run through a few preferences with him. Mostly it was discussing around his needs and ensuring a proper plan was in place for everything. Details such as budgeting for school, extra curricular activities and holiday camps were also discussed. We had to concede that focusing on schooling was a lower priority in the short term and focusing on easing anxieties and a stable mood was required before expecting any improvement with school. There was a discussion with a teacher from his school (by phone) and it was really great to see them involved and everybody aligned on the challenges and focus areas. From the discussion a detailed case plan would be developed and sent through to us for further review.

“focusing on schooling was a lower priority in the short term and focusing on easing anxieties and a stable mood was required before expecting any improvement with school”

It was a big, exhausting day. By the time we got home everyone was mentally and emotionally drained. While certainly there was no ‘breakthroughs’, we had a lot of encouragement and hope with the future by having such an awesome and supportive team all working together for David’s best interests. The meeting with the psychiatrist and team was challenging but groundwork was laid for professional help and support for David in the future. Being involved with the case plan development was also really encouraging and gave us some real hope for working through the next steps with David.

 

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