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Q:  My son was diagnosed with Bipolar at age 7. He is highly delusional, setting fires, being very violent. He was just released from the childrens hospital the other day. Is is ussual for a parent of a bipolar child to not be able to work and deal with the childs issues. I am feeling very guilty about this. i want to go back to work, but i can t because of my son s issues. what do you suggest? his caseworker is saying that the only chance we have at a normal life is to place my son in a rtc. what are your thoughts?

Dear J,

     I'm not certain I have enough information to properly answer your questions but I will certainly try.  How old is your child now?  As he becomes older, his behaviors left relatively untreated will become much more difficult to manage.  Was your son released from the hospital in a condition staff considered stable?  If so, what were their discharge recommendations besides residential treatment center?

 To answer your question, I would think it is NOT unusual for a parent to be unable to handle a violent, delusional, firesetting child.  I am concerned however about why he is carrying out these behaviors and not getting the proper care other than crisis intervention.  And, yes under the circumstances I think it's quite natural to feel guilty about a situation with your own son that is out of control.  Even with limited information, let me attempt to make some helpful suggestions.

First and foremost, federal law requires that your son receives a free and appropriate public education (FAPE) in the least restrictive environment (LRE) possible.  This does not guarantee that he will never see the inside of a residential treatment facility but there are MANY options between a regular classroom and a public school setting and an overnight, long term care facility.  I would recommend if you have not already done so that you ask for a meeting with and a full evaluation by your child study team at your local school district.  If your son did not have a comprehensive psychiatric evaluation performed recently or if you have concerns about the results, you may want to consider a second opinion at this time along with the child study team.  You have several choices.  You can use the school district's contracted psychiatrist or research your own.  The latter may be preferrable if you don't already have one for your son's long term followup and medical treatment.

The beginning point for parents concerned about their child's behavior or emotions should be an evaluation by a qualified mental health professional such as a child and adolescent psychiatrist. At the conclusion of the evaluation, the professional will recommend a certain type of service(s) or program(s) from the continuum available locally. The professional is then usually required to obtain approval from the insurance company or organization managing mental health benefits (e.g. managed care organization). In the case of programs funded publicly, a specific state agency must authorize the recommended program(s) or service(s). If the program or service is not authorized, it will not be paid. Many of the programs on the continuum offer a variety of different treatments, such as individual psychotherapy, family therapy, group therapy, and medications.

A brief description of the different services or programs in a continuum of care follows:

Office or outpatient clinic    Visits are usually 30-60 minutes. The number of visits per month depends on the youngster's needs.

Intensive case management    Specially trained individuals coordinate or provide psychiatric, financial, legal, and medical services to help the child or adolescent live successfully at home and in the community.

Home-based treatment services    A team of specially trained staff go into a home and develop a treatment program to help the child and family.

Day treatment program    This intensive treatment program provides psychiatric treatment with special education. The child usually attends five days per week.

Partial hospitalization (day hospital)    This provides all the treatment services of a psychiatric hospital, but the patients go home each evening. 

Emergency/crisis services    24-hour-per-day services for emergencies (for example, hospital emergency room, mobile crisis. .team).

Respite care services    A patient stays briefly away from home with specially trained individuals.

Therapeutic group home or community residence    This therapeutic program usually includes 6 to 10 children or adolescents per home, and may be linked with a day treatment program or specialized educational program.  Crisis residence  This setting provides short-term (usually fewer than 15  days) crisis intervention and treatment. Patients receive 24-hour-per-day supervision 

Residential treatment facility   Seriously disturbed patients receive intensive and comprehensive psychiatric treatment in a campus-like setting on a  longer-term basis.

Hospital treatment     Patients receive comprehensive psychiatric treatment in a hospital. Treatment programs should be specifically designed for either children or adolescents. Length of treatment depends on different variables

**adapted from the American Academy of Child & Adolescent Psychiatry

David Schafer, M.Ed.
Staff Psychologist

Published April, 2006


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