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
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
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
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
A brief description of the different services or programs in a continuum of care
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
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
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
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
**adapted from the American Academy of Child & Adolescent Psychiatry
David Schafer, M.Ed.
Published April, 2006