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Raymondís Story: Surviving Physical and Emotional Trauma

AMHC offers a Children’s Crisis Stabilization Unit (CCSU) and a Children’s Residential Program in Calais.  The Crisis Stabilization Unit is a 24/7 supervised and highly supportive short-term residential setting for children experiencing an acute emotional disturbance.  The Residential Program is an 8-bed child and family-focused residential treatment program and it treats moderate to severe emotional and behavioral problems.  A multi-disciplinary team works across both units collaboratively to provide a safe and supportive environment with the opportunity to make the changes necessary for a successful and permanent return home.

As young children, Raymond and his older brother were abused, battered and traumatized by their parents until they were removed from their custody and adopted by foster grandparents.  At 12, he was diagnosed with ADHD and Post Traumatic Stress Disorder (PTSD).  Because of the abuse he suffered, Ray was unable to tolerate the presence of anyone “in his space”. He lashed out physically at everyone within reach, and his main targets were his grandmother and the other grandchildren who lived in the home.  As a result these outbursts, Ray endangered himself and others and the police were frequently involved.  

As a result of his condition, in 2013 Raymond had multiple stays at the CCSU but was unable to maintain stability.  He was ultimately admitted to the residential program in January, 2014.  His stay in the program was unsuccessful.  He was incapable of engaging in meaningful communication or forming attachments; would not interact or participate in the group treatment sessions; and he was oppositional and defiant with the counselors.  He was not responding well to his medications and had frequent aggressive outbursts with peers and staff members, and he caused major damage to the agency vehicles on site.  The aggression intensified with so many unsafe situations that there was serious discussion by the treatment team about his ability to remain in the program.  In April, he was assigned a counselor to work with him 1:1 because of the safety concerns.  Three requests were made, and denied, for MaineCare to approve paying for a neurological evaluation to determine why his medications were not providing the expected results.  Unfortunately, it wasn’t until Raymond assaulted his clinician and sent her to the hospital with injury was the request approved and he was transferred to a specialty hospital for evaluation.  When Raymond returned to the program, he had new diagnoses and new medications.

The hospital evaluation confirmed Bipolar disorder, cognitive disorder, and closed head trauma.  Armed with an accurate diagnostic assessment, the treatment team developed an appropriate treatment plan and once in place, Raymond began making slow, steady progress.  Instead of lashing out at people whom he perceived as being “in his space,” he learned to take a step back and say “you’re in my space.”  A lot of work was done on impulse control; he continued to have outbursts and when they happened, he was allowed to leave the group when he felt overwhelmed.  A staff member always followed at a distance, waiting for Raymond to de-escalate before making any contact with him.  Soon he was able to move physically closer to the others in the groups, rather than off in a corner.  He began interacting with his grandparents as well, and was allowed off-site visits with them – then home visits.  He began attending school half days because that was as much as he could tolerate. Raymond eventually understood the nature of his multiple diagnoses and the need to maintain use of the medication.  He stopped refusing his medications, powerful antipsychotics, and took them as prescribed.  Efforts to reduce the dosage were met with an increase in aggression, so additional drugs were prescribed to help Ray with the side effects.

Over the next two years, Raymond’s grandparents visited him faithfully; even when he sat off in a corner and refused to make eye contact with them, or to speak with them, they came anyway – week after week, month after month.  They always told him how much they loved him and that they would not give up on him.  They attended the mandatory family therapy groups, whether or not Ray participated; they never gave up hope.

Raymond left the facility in May, 2016 and moved back home with his family.  He participates in outpatient therapy with his family and sees a psychiatrist to help him manage his medications.  Raymond is now equipped with new coping skills and is able to form relationships with others.  He is in a vocational program at a public school – he has a great affinity for building things, for electronics and for “tinkering” with all things mechanical.  The young boy who lashed out at everyone within striking distance and was unable to build relationships now periodically calls to speak with staff at the Calais Children’s Residential unit and tells them that he misses them.