Time to Care: Caring for Children in Crisis

This article is part of Time to Care, a collaborative story series from Families Valued and Shared Justice, both initiatives of the Center for Public Justice.

By Chelsea Maxwell & Kaycie Maule

Kaycie Maule is a young professional and Shared Justice reader working with adolescents at a faith-based inpatient behavioral health hospital in the Midwest. Children in her care stay for approximately 5 to 10 days for stabilization after just experiencing a crisis situation, such as suicide attempts, suicidal thoughts, or to stabilize their medication. Reflecting on her role in helping children and families prepare to return home, Kaycie shares the challenges families face in finding time to participate in the healing of their children.

CM: To begin, can you describe who you serve and the type of health care your hospital provides?

KM: Our hospital serves kids and families from South Dakota, Minnesota, Nebraska and Iowa. I work in the adolescent unit, and we work with children between 12 and 18 years old.

As a behavioral health center, we don't necessarily serve people who are sick with things that people generally think brings a person to the hospital. We specifically serve patients with suicidal ideation. But we also work with patients who have been acting out at home in a way that's not safe. That could mean they are fighting with parents, or in a situation with parents that has escalated so much that they need to look at some medications for them, or just figure out what else is going on in the home. Some children may have concerning behaviors outside of the home such as at school.

A lot of our patients are referred from emergency department, schools, and outpatient therapists. Some parents bring their children to our facility to have an intake assessment.  Regardless of how they came to us, our patients always have an assessment to make sure we are the appropriate level of care for them.

From that assessment, they'll either be recommended to have outpatient services or have a stay with us. If our unit is full, they are referred elsewhere for inpatient care. From that point, the child gets either their own room or a room to share with another patient depending on their history.

The first thing we do with the kids is complete admission work, in which we have the patient tell us what brought them in and give us a little bit of their background. This is shared with the doctor. We also do psychological testing, as long as it's appropriate for their IQ level and learning abilities. After that, they attend group therapy every day.

Along with attending group therapy, our patients get one-on-one time with the doctors and staff members every day to work on their goals. Another important part of their stay is at least one family meeting. The meeting is to work with the families to discuss results of the psychological testing, discharge planning, and what parents or child may be able to do differently at home so they can all work together better. A lot of parents don't understand their child’s diagnosis, so the family meeting is important to help parents and guardians understand them.

What role do families have in caring for their children during this time period?

Families are also encouraged to visit their kids whenever they can, especially at night, after the group therapies have concluded. We attempt to call parents every day to let them know how their kid is doing. The family’s main role is to attend the family meeting, which is in-person, on our unit. It's expected for at least one parent to participate in family meetings. Another responsibility — and this is sometimes tough with parents' work schedules — is to be accessible by phone when we have questions as we prepare their child for the transition back home.

We try to schedule an in-person meeting right away with the family. The psychologists give us times that regularly work for them, usually in the morning. Our psychologists are typically only available at these hours because they have outpatient clinic responsibilities in the afternoon. The psychologist's available hours are during normal working hours which makes it challenging for working parents to attend.

They’re not abdicating their role as a parent or employee. They are trying really hard to do both.

The families that are furthest away usually can only come on the day of discharge — they can't come to regular meetings because of their work responsibilities, a lack of reliable transportation, or lack of gas money. For some families, it’s hard to just get a couple hours off of work. Even if they can get hours off of work, they often can’t afford to miss those hours if they are unpaid.

There are a lot of parents that are very concerned about their kids, but they’re only available over the phone. They will call frequently. There are many families that want to be involved, but struggle to be more involved because of work schedules or the distance. It’s important for some of the meetings to happen in person, but it’s definitely harder for some families than others to get that time.

All this sounds really time intensive. There are so many things parents have to line up right away during this crisis event and then also in continuing keeping their child healthy and safe when they return home. How are parents handling this?

There is a lot to do immediately after the crisis event and in weeks and months following. I have worked in discharge planning, and my role was to help parents process all the immediate information and think about what happens down the line. Distance from the facilities and resources vary by family, so we have to start that planning right away to ensure the kid’s needs are best met given their circumstances. We try to determine which therapy resources and community support will help the family once the kid goes home. There are a lot of questions that need answering. As the person in charge of discharge planning, you try not to throw too much information at them. But, we also require a lot from them right away, like “Where would you like your child to be seen?” We ask so many hard questions of parents at a time when their main concern is making sure that their child is stable and okay.

It's not atypical to have patients from six hours away. But, even if the family is just an hour away, that’s a two-hour round trip for the parent to come for a visit or meeting. I've had a couple of times where parents have said that they want to stay in town during the stay. They sometimes have family nearby or can stay at the Ronald McDonald House. But if not, then they have the extra cost of staying at a hotel on top of maybe not making an income while they’re there. It depends on what their jobs provide as far as family leave in such short notice, or the paid time off they have access to.

I have heard from quite a few families that it can be hard to schedule meetings because parents are not able to get off of work. The story I hear a lot is that their child has been struggling for a while, and the parents have been missing days of work to take care of their child or to make sure that they are getting to school. By the time their child is with us, many of the parents have already been given notice by their employer that, "Hey, you can't miss anymore days."

This is a big generalization, but I have noticed that families with more consistent, salaried jobs and/or two-parent households have more flexibility to take time out of their day at work. Families that are working shift-jobs or one-parent households are a little harder to schedule. There are some families that don't have a great relationship with their child, but there's also many families that have been taking extra measures for their child for years. You'll talk to them and they'll say, "Well, we already tried this. We already tried that." The parents have regularly been working with their child to help them improve. They’re not abdicating their role as a parent or employee. They are trying really hard to do both.

Kaycie Maule works with children in an inpatient behavioral health hospital. She shared her observations and insights for the Time to Care series because she believes better public and workplace policies can help her families thrive. She earned her Bachelor of Social Work from Dordt College, likes to run in her free time and occasionally indulges in a bowl of chocolate chip mint ice cream.

Chelsea Maxwell is the Program Associate of Families Valued, an initiative of the Center for Public Justice, and the contributing editor of Time to Care.

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