Writer’s note: The story below is about our last visit with PT’s Psychologist whom I refer to as Dr J. or sometimes Dr P. I have decided to document our current renewal to show you how we go about getting our Medical Assistance Behavioral Health Management Organization (yes, they make HMO’s for behavioral health too) to authorize and pay for Behavioral Health Rehabilitation Services, which is just a fancy phrase for therapy and behavioral support provided where the child needs its. Like at school, or in the home, or even out and about in the community. This documents the the first part of the process, the evaluation for services. When you are first coming into the system, the psychologist will have an intake appointment to help assess the child, and families, needs. If the psychologist decides that BHRS is needed, then they will have a separate BHRS evaluation appointment. This post talks about the last evaluation PT had. I was there, as was his current BHRS service provider, Mr. M. I will be continuing this series throughout the renewal process. There are a number of meetings that take place and I aim to outline all of them so you can get some idea of the process.
So we had our psychological evaluation with Dr. J today. For anyone thinking we have been dreading this, we have not. She gets us, and she gets PT and we were luck to keep her when she left the care agency we use to use and went private practice (yay for my private insurance!!). I love how she does this process, I feel like we get so much done in so little time. We don’t really come out with solutions, which is kind of disappointing. What we get is the confirmation that he needs services, and the framework of a plan. That plan is left to the people who deal with him on a day-to-day basis, so in these evaluations we talk about the big picture, with an eye on the even bigger picture. So how does this all work?
Dr. J starts with her evaluation from six months ago. We use it as a guide. I always bring notes too, because sometimes new stuff comes up and if we didn’t talk about it last time, and I don’t remember, we don’t discuss it. Dr. J writes all over her old evaluation, updating information, making notes for herself, etc… Today we started in with the basics, did we move, anything change, still going to the same school this fall, etc. Then we talked about existing services. We talked about Mr. M working with PT for 4 hours a week now and during the public school year, he doesn’t really have any “wrap-around” supports because the school is providing everything we need. Dr. J told us how lucky we are that they are willing to go with the flow and see what works without re-opening the IEP at every turn. We talked about the accommodations they make, like “brain breaks”. Or, being able to take test in the Autism Support teacher’s room so that he can play when he finishes with the test without disturbing anyone else.
Then we moved on to his “interests” and how they play into his interactions with the other kids in school and summer camp. We talked about how bossy PT can get and how he had physically moved other kids away from him, and how he told The Mommy that he didn’t like a friend because they didn’t want to do what he didn’t want to do. He didn’t realize that his friend may have wanted to do other things. So what are these interests, you ask? Well, first of all the technical term is “perseverative interests”. What this means, at least for PT, is that it is something he fixates on and everything must revolve around it. It could be a movie, or a toy or something else entirely. Right now he has two main interests going on being a Minion from Despicable Me (and reenacting the movie) and Thomas the Tank Engine. The problem with these interests is that they interfere with his relationship with others. If others don’t play what he wants to play, then he can get very upset, physically remove them from his space, or just go off and do his own thing. We talked about how he was handing his socialization and interests. PT is still having problems because of his interests and it is something that we are working on.
Then we move into behaviors. We started talking about tantrums, we started talking about how we aren’t seeing a lot of them (maybe once every 1 – 2 weeks when we don’t have homework to do), but the quality is increasing. And by quality I mean spectacular, losing-his-ever-loving-mind screaming, crying, combine with some biting and hitting and spitting on himself. We talked about how, we are seeing these more and more when we are out and about or in the car, where he doesn’t have anywhere to go to de-stress. We also discussed how our reaction as parents maybe causing rather than helping these issues and that we will need to watch and see what works.
We also talked about pottying. He still isn’t going #2 on the potty. We agreed if we can’t get him regular it will be harder to potty train him. We have been taking a laid back approach, because we realize as Dr. J put it, he isn’t going to college in a diaper. We are just trying to get him to admit when he pooped so we can get him cleaned up. We are going to see if getting him regular doesn’t help a bit. Dr. J suggest miralax because we can better control the amount and therefore the indented effect.
Dr J. wrapped things up by talking to PT. He was tired and would talk but didn’t make eye contact or get into too much detail, except about riding a train pulled by Thomas the Tank Engine.
When PT and Dr J finished, we talked about what we wanted for the next treatment period. It is amazing to me how we plan the next six months of our lives and PT’s life in a matter of an hour… We asked for something call Mobile Therapy, Extended. This means that Mr. M will function as a therapist working with PT on his feelings. How he manages anger, anxiety, and provide him with emotional support. He will also be able to act as a Behavior Consultant if we need him to. This allows him some flexibility with PT while we resolve behavioral issues, but still help PT learn to communicate and fit in with the world around him.
I am sure there is a lot I am forgetting and perhaps I will update this post when our written evaluation comes in, in a few days. But this ladies and gentleman, this is how we start the process of getting behavioral treatment and support of PT’s autism/asperger’s issues. This meeting we had today, that I just described. This meeting helps to prove the need for behavioral support and treatment and provides the document that serves as the prescription of treatment. Similar to a pharmacy prescription, except this one is for behavioral issues. Believe having an Autism diagnosis helps, but we have to show proof that there is a problem first.