Children are NOT their labels, but labels ARE relevant

I understand why some people are hesitant to diagnose small children and children in foster care. I understand that they are afraid, and sometimes rightly so, that applying labels and/or diagnosis to these children will stigmatize them for life possibly hindering their placement with a forever family. It is important to diagnose though so that these very children can get the help they need. It is also very relevant to mention behaviors and diagnosis to potential foster/adoptive placements. I'm not trying to imply that foster/adoptive families are saint like or free of their own issues and diagnosis, what I am saying is that I am in favor of an informed consent of sorts. A foster/adoptive family should be able to make the decision to accept or not accept what they can handle. This isn't an option for bio family members of course, you get what you get and you deal with it the best you can.

My rant is about how so many serious issues are minimized and often times not even mentioned so that a worker can finalize a placement and head on home herself. Social Work is a hard ass job and I imagine it is pretty thankless and in general our local workers rock, so this isn't a SW bashing post by any means. I do think that if every worker had to foster for about two years prior to becoming a SW that things would go significantly different than they currently do. Ideally during this two years the worker would have to accept, with only 5 to 15 minutes notice, a host of issues including RAD, ODD, Conduct Disorder, and other mental, physical, emotional, and behavioral issues. To keep them on their toes, they wouldn't be told of any of the diagnosis until after the child had been with them overnight. Because that is the scariest thing ... sleeping with a complete stranger in the house, one who may or may not be violent, angry, or mentally ill.

I'm all riled up because of a call I got today and I'm still running on adrenaline so I'm going to be all wordy. The weather is leaning toward tornadic activity so the schools let out early and I had just picked up The Daughter when CPS called. I love the lady who called me and she told me some of the background on the kid but didn't know it all so she told the supervisor of the case to call me. I did tell the first lady that I was uncomfortable taking a teenage boy, period. The problem was that many people were refusing to take him due to his race. This is the south and unfortunately there are a lot of people who are racist and prejudiced. This is also the bible belt and I suppose I'm the only one who sees the irony in that, but I digress.

Sixteen year old boy has a history of theft and truancy and running away and stuff (all minor things that I can handle). The second lady who called said he was "polite" saying "yes ma'am and no ma'am" and that his only request when they took him to WalMart to purchase clothing was that he wanted an art sketch pad (how many of my deadbeat cousins are uber polite to authority's face but uber defiant once they turn their back? all of them!). He likes to write poetry and watch NBA. Cool, sounds like he would fit fine if he doesn't mind sleeping in a pink bedroom with pink sheets until we can change it all. No history of violence or being inappropriate with kids, great. Went through a group home treatment center thingy and graduated the program, fine but that just means he tolerated the counseling and probably learned new bad behaviors while there. I mentioned at least four or five times how uncomfortable I was as a single-ish mom with two small children taking in a 16 year old male. He'll be in the Independent Living Program (ILP) and will stay in foster care until he ages out because his grandma doesn't want to deal with him anymore. Then I asked about his schooling and psych eval ... that's when it got interesting.

Oh, he just takes Seroquel to help him sleep. Really? Cause my schizophrenic sister takes Seroquel. And what's that other med for? Oh, ADHD? So he is hyper? I see, you think in the past few hours you've spent with him while he was medicated that he doesn't have ADHD or ADD but was misdiagnosed by a professional with experience in such things. Gottcha. Could it be that the meds were working to calm him, maybe? Oh, and Conduct Disorder? Hmmm, you think that was the label they slapped on him because he happened to steal a little iPod and Mp3 player and all that other stuff? Yeah, I'm sure Conduct Disorder means nothing, you're right. He's just a typical teenage boy, completely harmless.

What is conduct disorder? Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely when symptoms continue for 6 months or longer. Conduct disorder is known as a "disruptive behavior disorder" because of its impact on children and their families, neighbors, and schools.
Symptoms of conduct disorder include:

* Aggressive behavior that harms or threatens other people or animals;
* Destructive behavior that damages or destroys property;
* Lying or theft;
* Truancy or other serious violations of rules;

So she wanted me to say yes or no and this is all within 15 minutes of first being called by the first lady, and I was driving! I hate when people drive and talk on the cell phone and there I was doing it, ugh! She needed an answer because they were going to have to appoint someone to stay at CPS overnight with him if I didn't say yes. If I would just keep him overnight, I might see how great he is and want to keep him (like a puppy?). But if I could keep him until Monday they were sure they could find him a permanent group home, its just all the ones they've called so far said no because of his involvement with the criminal justice system.

All the while I couldn't wait to get home and look in my books about conduct disorder. I was almost certain that back in college in all my psychology classes, that was a pretty serious diagnosis. In Forensic Psychology (my most favorite class EVAR) I distinctly remember reading Without Conscience: The Disturbing World of the Psychopaths Among Us by Robert D Hare, PhD and one of those early warning signs was an ODD and later Conduct Disorder diagnosis. Being charming and polite but harmful are par for the course. I so wished I didn't have to make such a rash decision. If they had had him all day, why didn't they call me earlier? They knew after court they would need a placement for him, why wait until closing time to begin calling foster parents? Why not give me time to think without stress and make an informed decision? So I asked what happens to him if I say no and they told me someone would have to stay overnight with him in their office at CPS. So I said yes, he can come here and stay until Monday when they promised to get him into a group home, but anyone with experience knows really means he'll be here for the next few years. I called The Husband kind of panicky and rambling and talking far too loud and after accidentally cutting off the phone call, tried calling him back and he wouldn't answer so I must have interrupted his work. But then the first lady calls me back and says "Great news. We have another placement for him." Just like that. She said that she forgot about my husband not being here and when Lady #2 told her, she said that teen boy didn't need to be here then. Apparently there was some issue about potential harmful behavior ... or something. Nice, huh?

I felt forced and coerced and resentful at having to say yes to a placement that made me uncomfortable and then just like that they get another placement for him, one that they hadn't been able to get a mere 25 minutes earlier. Amazing.

Never once was I allowed to come down and meet him myself before giving an answer. How hard would that be really, to allow placements to meet first. Wouldn't that potentially prevent disruptions?

But anyway, my rant was about the label/diagnosis. They don't define the person, not at all. Depression doesn't define someone any more than Diabetes or any other mental or physical condition, but it is part of the person and while the worker may not find it relevant, the foster family might.

And then they asked me to do respite for a teen girl with ODD "and some other diagnosis" because her current foster family doesn't want to take her on their upcoming vacation. The worker said "You know how teens get comfortable with you and start being bossy and defiant. That's how she is, nothing abnormal really." Again with the minimizing! She is in a therapeutic foster home which means her issues are severe enough to not be placed in a non-therapeutic home. Why not just call and say "Do you feel capable of doing respite for a difficult to handle child with XYZ?" Be upfront so that I can make an informed decision. Please.

DISCLAIMER: I am fully aware that other single parents have taken on more children with multiple diagnosis. I think they rock! I am fully aware that these issues are minimal to what some others face. The diagnosis may very well have been made by an inexperienced but label happy doctor. I am fully aware that judgment may befall me for not feeling that I can adequately meet certain children's needs.