Quick note: This is a long post and it does get a little ranty for a moment, so if you're pressed for time or this isn't a subject you're interested in, you may want to skip it and wait for our next post. You've been warned ;)
If you have a child in outpatient therapy and they've had the same therapists for some time, you may feel a certain emotional attachment to those people--assuming the majority of your experiences have been positive. Let's be serious, you see these people at least 1x per week every week all year long--that's likely far more than you see your best friend (wait, did I just assume we have time to actually see our friends?)! These people are a constant in your life and as a result, you've probably formed some sort of connection with them.
Our boys have both been in multiple out-patient therapies for years and while we've had a few therapists change, there have been a couple that have been constant for several years. While it's nice to have a "long-term" relationship with your children's therapists, I also find it can be a bit difficult to remain 100% objective the moment you realize you may have outgrown them or you simply need something more specialized or different from what they can provide.
I used the term "breakup" in the title of this post because the choice to end your relationship forever with one of your children's therapists is similar to a breakup in my experience. You feel guilty, sad and you question whether or not it's the right move to end the relationship. And let's be serious, the last thing any of us need is more guilt!
I thought it might be helpful to share my experience going through this as a parent as I'm sure many of you have, will or are dealing with this as well.
The Politics of Out-Patient Therapy
You know that nagging little voice in the back of your mind that sets off warning bells about your children? I'd had a feeling for a little while that things were going to come to a close with our older son's OT therapist. Little things here and there had set off red flags, so I'd begun to question whether or not it was time to move on. I started exploring our options, all the while feeling sad and guilty. I honestly felt as though I was somehow cheating on our current therapist to even entertain the thought of leaving! It was absurd, yet how I felt.
Then, my son's OT therapist said the one thing we'd been worried about most.
Then, my son's OT therapist said the one thing we'd been worried about most.
"Your son's quarterly eval is coming up and ... did you really want to continue OT? He's met all of his current goals and (her voice dropped) I have to keep in mind the policies put in place by those at the top regarding who we can continue to service."
We knew instantly what this meant. Over the years, we've observed a not-so-subtle push to only service kids until they've hit their "expiration dates". Kids find they no longer qualify for services at times simply because they've been in therapy for a while and ... well, they function "well enough" in most areas, right? We've had long-time, esteemed professionals that work with our kids remark on this many times as well. This isn't some conspiracy theory we've concocted, it's a legitimate problem.
I disagree entirely with this! If a child does not naturally develop certain necessary or socially expected skills and abilities he/she needs additional assistance in a hands-on, repetitive, consistent fashion to enable him/her to acquire those skills. So what do these kids need? Therapy.
Sadly, politics come into play with everything pertaining to ours kids--IEPs, services in school, etc. If there is a need (not defined by politics and budgets) it should be met. Period.
Telling me it's "good enough" if my son can't ride a bike because there are other forms of transportation is not okay.
Telling me it's "good enough" if my son has to live in velcro shoes for the rest of his life when he is capable of learning to tie his laces (with a great deal of intentional skill building) is not okay.
While some of these things are more social requirements than necessary-for-independent-survival skills, should that really matter? Why shouldn't our children be able to fit more comfortably in society if at all possible when they have enough stacked up against them already?
Anyway, enough of this tangent. The therapist made it clear in the brief conversation we had with her that sometime in the near future she would no longer be able to recommend our son remain in OT. What blew my mind more than anything was the fact that our pediatric neurologist and neuro-psychologist had both wanted him to be in OT at least 2x per week (double what OT would give him) and felt the need was stronger than ever to push for skills they hadn't even touched on despite some prodding from us.
Ironically, this conversation proved to be the push I needed. Perhaps it was a blessing in frustrating disguise.
Optimizing Services While They're YoungWhile beginning this process I questioned myself a lot. The problem was, deep down I knew it was time to find someone/somewhere else. That became more apparent fairly quickly, especially once we had the lovely conversation I mentioned above with his therapist who had no idea how I felt at the time.
My son's therapist isn't a bad therapist by any means. We've been with her for a couple years and been fairly happy. She simply doesn't specialize in the specific areas our son is beginning to require additional attention in and she's part of a system that decides (unfairly, in my opinion) when kids no longer require services. Since he's getting older, we recognize that we really need to optimize his services as much as possible. As the parents of kids with any sort of special needs, there's often that invisible clock ticking in the back of your mind telling you, you need to push as much as possible early on because someday the door to drastic progression and development in certain areas may close.
Resolving to Do What's Best for Your ChildI remember discussing my feelings with my husband and then my sons' neurologist (who agreed). I resolved to make the right choice for my son without letting my emotions or even the therapist's reaction (I still have no idea how it will play out in the end) affect my decisions.
It's been about a month since we got the ball rolling and we're currently scheduled for a re-evaluation with a new facility to determine my son's eligibility (so irritating to have to go through that over and over when you're already in therapy). We decided that we wanted to avoid a lapse in services, so rather than end therapy with his current therapist then wait to get in somewhere else, we chose to continue services and begin the process of enrolling in the new facility. One thing I've found is that some of the best outpatient therapy groups have the longest evaluation waits, much like other professionals that cater to kids with special needs. His eval isn't scheduled until May, so we've got plenty of time for me to work myself up over muddling through ending this relationship as gracefully as possible.
I have to come up with my plan of attack for ending my older son's OT services at his current facility, while keeping his speech therapy there and possibly both of my other son's therapies. It would be easier if we were making a clean break and moving everything over to this other group, and we may move my younger son there eventually for OT and PT, but for now the immediate need is getting my older guy started with the right new OT therapist ASAP. Time is always of the essence!
In the end, I really had to tell myself that while I don't want to be completely insensitive, my sons' progress and getting them what they need are the most important things. I'm good at fighting some battles (you don't want to sit across from me in an IEP meeting), but sometimes I stumble upon situations like this where there's that little fear of hurting people's feelings. In reality, this shouldn't be personal.
My advice to you, fellow ADHD parents: Make your decisions based solely on your child and family. If it hurts people's feelings, it's unfortunate, but not worth stressing yourself out over or changing your mind for. We're working towards the most successful futures for our kids--period.