Cumberland Spotlight: November 2005
RONNIE – PART I
A grin spread across Ronnie’s face as he turned the key to his independent living apartment for the first time. Then he laughed out loud and, turning to his companion, shouted ‘I did it! I made it!”. The group home counselor that accompanied him smiled back and with somewhat misty eyes agreed. “Yes Ronnie, you certainly have made it.”
Had you known Ronnie a few years earlier, you wouldn’t have been alone in wondering if he would ever reach a point where he might qualify for an independent living program. By the time he was referred for placement at Cumberland Hospital’s residential treatment program at the age of 13, he had either exhausted all other less restrictive levels of care or had been denied admission to other RTC programs due to the complications of simultaneously managing his medical needs and his behavioral challenges.
Ronnie was placed in DSS custody at age 7 and immediately hospitalized for severe malnourishment. He was diagnosed with psychosocial dwarfism, a medical condition more commonly known as failure to thrive, in which excessive psychological stress causes a deficiency in growth hormone production. To this day, although Ronnie has matured physically, he remains slight in stature as the result of this condition.
Ronnie’s admission to the Cumberland RTC program followed numerous unsuccessful placements in both regular and therapeutic foster care homes as well as various outpatient therapy programs, therapeutic in-home services, behavioral mentoring and several acute hospital admissions. His history included cruelty to animals, defiance and aggression towards care-takers, and physical aggression towards peers. His mood swings had grown more frequent and severe to the point that he was considered a danger to his classmates. When anxious he would frequently regress to barking and crawling on the floor.
Ronnie’s behavioral diagnoses included mood disorder, PTSD, general anxiety and rule out for bipolar disorder. His medical diagnoses included enuresis and asthma. In addition to psychosocial dwarfism, Ronnie also carried a diagnosis of mental retardation. The RTC multidisciplinary treatment team, in consultation with the referring case manager, implemented a treatment plan with goals addressing his increasingly volatile and aggressive behaviors, his regressive episodes, bed wetting, and academic deficits.
Throughout his RTC placement, a progressively evolving regimen of medication management combined with consistent behavioral intervention and therapy proved effective in stabilizing Ronnie’s conditions and fostering his use of more pro-social adaptive skills. Psychotropic medications were stopped, and a mood stabilizer was prescribed as Ronnie developed a more internal locust of control. He slowly developed nighttime bladder control and medications prescribed to assist with that control were stopped. Ronnie made progress, albeit slow, in academic achievements. The regularly scheduled individual and group therapy sessions supported his learning and practice of social skills. His problematic behaviors diminished in frequency and intensity over time, yet poor impulse control, horseplay, and periodic incidents of verbal and physical aggression toward peers and staff continued to be characteristic.
While he had achieved significant progress in all areas, his behaviors escalated towards the end of his stay in RTC. This was attributed to anticipatory excitement and ambivalence about the planned transition to a group home. That being the case, staff from both programs were able to collaborate in addressing his anxieties while moving ahead with the transition plan. After 12 months in the RTC program, Ronnie was ready to move into Cumberland’s community-based therapeutic living program as his next step towards independence.
Look for our Newsletter next month when: Ronnie escorts not one, but two girls, to the Senior Prom