And many of you don't need to read this.
But some of you do. And for that I am sorry.
It is so sad.
But. If your child is battling serious mental illness... If your child has been exposed to drugs or alcohol in utero... If your child's trauma is causing them to fall apart...
You need to read this..
When you start to see patterns of escalation growing in your home, it is important to come up with a plan. You might not need to use it, but it is essential to plan out ahead of time a few key elements so that you are prepared if you ever have to execute it. So just like you know what to do in a fire drill, you will know what to do in a mental health emergency.
1. Brainstorm behaviors
What behaviors are happening in your home and how do you feel about them? Sit down and first list all the troubling behaviors that are already occurring. What is going on in your home that is worrying you? Write those down.
2. Organize the list
Now you need to analyze it a bit. First of all, parenting kids is really really hard. Then, if you have teens it changes, but is still really hard. When I think back to myself as a teen (and I was a pretty good kid), I had a couple rough seasons where I lied to my parents and broke rules and drove them nuts!
So look at your list and split it up. Separate the stuff that is normal annoying kid stuff. The stuff that you didn't sign up for, wish would stop... but is not dangerous. Separate the stuff that is stuff you would never do, but you can manage it either by lowering your expectations or compromising a bit. Separate the stuff that might be against your value system, but are not serious crimes. These are tough situations, and you may want to deal with them in family therapy, but are not constituting a crisis.
Here I am talking about...
Music: They may loudly play music that drives you crazy either because of the style or lyrics. Or they may walk around the home with ear buds in and refuse to talk to you because they are listening to their music all... the... time.
Screen Time: They may seem obsessive about screens (video gaming, youtube, social media) and spend hours on them every day, but are able to go to school, participate in some activities outside the home and have 1 or 2 friends.
Substance Use: They may use alcohol, cigarettes, or drugs occasionally when out with friends
Curfew: They may occasionally come home a bit past curfew or ignore your texts asking where they are. They may stay up late but are still able to get up and go to school on time.
Sex: As a teen, engaging in sexual activity with a mutually consenting similar age peer, occasional viewing of porn
School Issues: Sleeping in or cutting class occasionally, bullying other students, mild to moderate actions of disrespect to school staff, or other issues resulting in detentions.
Chores: Refusing to clean their room or help out around the house.
Verbal Aggression: Talking back, swearing, verbal arguments with siblings and disrespect towards parents.
Moodiness: They are depressed or angry for a couple days but with your attempts at connection they are able to come out of it.
But, then ... there might be some moods or behaviors beginning to escalate or are already bad. These are the ones that scare you because they could lead to actual harm to your child or someone else in your home.
Here I am talking about:
Self harm: cutting themselves, punching objects, piercings, etc
Depression: depressed mood lasting more than a couple days with low energy, suicidal thoughts, isolation, difficulty sleeping (too much or too little), low self esteem, irritability, significant changes in appetite or weight (too much or too little).
Anger: physical aggression in the community, home or school, damage to property, serious threats of harm to others, plans to harm others
Substance Abuse: inability to control their use, daily use, use at school, use in the home, use when they are alone, physical withdrawal symptoms when they do not use
Running Away: not coming home at night, disappearing for long periods of time when it is dark or cold
Sexual Behavior: Sexual interactions (over the internet or in person) with individuals more than two years older or younger than them, Inability to control use of pornographic material or masturbation or Inability to control engaging in unprotected sexual activity with strangers (esp if it is frequent or increasing) or sexual aggression towards others.
School Crisis: Significant school absence resulting in truancy and / or failing grades, behaviors resulting in suspensions.
4. Create your plan
If you have some items on the crisis side of your organized list, it is time to create a crisis plan. If you are suspicious that your child is engaging in these more dangerous behaviors, or if you are confident that they are, it is time to know what you are going to do, why you are doing it and how you will do it.
Often it is helpful to create this plan with a professional (therapist, caseworker, etc). I am happy to schedule a session to help you create this plan if you would like an outside perspective.
Parts of your plan may look the same as for other families. But then there may be discrepancies based on your home. For example, if you only have one child at home you may be able to tolerate more disruption before involving 911. However, if you have younger children in the home you may need to call 911 faster in order to protect the younger children. If you feel you have a strong connection with your child and have some professional training in crisis management you may be able to provide some deescalation support for your child before calling in other professionals, however, if this is your first time dealing with these types of issues you may need to get help more often. Be aware of your unique family season and what you are realistically able to handle, and what you cannot.
In your plan you may want to write out who will take care of what and when. For example, if you are in a two parent home you may want to say that one parent (better able to work with the child) will stay with the child while the other parent will go away with the other children. You could then add that this plan will stay in place for 1 hr, however if the child is still agitated after that 1hr of support you will move to step two which could be a tag team to give the first parent a break, or you could call the psychiatrist or 911.
If you are like me, you know your kids. You know what their moods are like and when you are having a medium sized bad day, and then when you are in a crisis and need help.
So in your plan, you might want to indicate the specific signs that make you worried and will cause you to step up your intensity of support for your child. For example, you know that a medium sized bad day might include a 30 min meltdown involving some threats, throwing, yelling and slamming. But a crisis might involve serious damage to property or people. So you might want to be watching the clock and the level of escalation during the crisis and then as soon as you see it hitting those moments you can call for help.
Each plan will be uniquely tailored to each child and could involve any number or creative steps that will help the child deescalate. There are any number of ideas that you will want to choose for your family. It may involve extended family or neighbors stepping in, it may involve siblings leaving to another home for the evening or overnight, it may involve calm down music playlists, it may involve taking the child for walks or it may involve keeping the child at home. 911 may or may not be included on your plan. You need to thoughtfully decide what will help your child in crisis.
4. Consult with your team
Depending on where you live and who is on your team it will be important to have a meeting to go over what is in your control and what is not. For example, if you are a foster parent, there are some times you will have to call 911, whether you feel it is necessary or not. These are legal requirements you cannot ignore.
We have found our local police department to be very helpful at this planning stage. You may want to simply visit the station and ask to speak with an officer who can help you create your plan. They can let you know their protocols and referrals so you know what to do and, just as importantly, what not to do in the event of a 911 call.
If your child is in treatment, your professional team of therapists and physicians will have educated opinions that can help you create your plan. So set up a meeting where you can take notes. Make sure you clearly understand what they are simply recommending and what is legally required of you.
It is also helpful to go over the crisis plan in a therapy session with your child. That way they know ahead of time. For example to gently express your love for them and how you need everyone to be safe, but that if they choose to hurt themselves or someone else that you will be doing X, Y or Z. Then when they engage in the behavior they know what to expect. They might be angry about it, but they are not surprised.
Here are some pretty clear and simple boundaries you must follow if things get serious:
If your child is engaging in self harm, they must see a mental health professional who can help you make decisions regarding their safety and level of crisis.
If your child is demonstrating depression and has indicated a suicidal plan you should take them immediately to your local emergency room. If they will not go willingly call 911.
If your child has attempted suicide you should immediately call 911
If your child is demonstrating anger or depression and has indicated a serious plan to harm someone else and they have the means to act on it, you should immediately call 911.
If your child is engaging in substance abuse they must see a substance abuse professional who can recommend a treatment level for you.
If your child is engaging in running away behavior I would recommend you speak with a professional to come up with a plan. Calling 911 for assistance may be required by law in your area in some situations, in other situations it may just be a smart idea.
If you discover (or have serious suspicions) that your teen has engaged in sexual activity (over the internet or in person) with a person more than two years older or younger than them, you should call 911.
If your child is engaging in serious behavioral problems at school I would recommend a plan that involves your school team and perhaps a mental health team depending on the root causes. If it is rooted in depression or anxiety or bullying you might want to enroll your child in a mental health program that specializes in school refusal issues.
As a foster mom and as a former emergency department mental health assessment specialist I have "been there and done that" from both sides. Walking through a crisis with a child or teen can be one of the worst days ... but, it can also lead to healing. What I have learned is that in the crisis we are able to be raw and vulnerable and begin the process towards wholeness. It is a time to let our kiddos know that we see them, we will protect them and that we are in the mess with them. We are not going to let this get worse. We are going to help them feel better.
I'm happy to help you brainstorm over your list and come up with a plan. If you need an online coaching session please feel free to reach out, firstname.lastname@example.org We cannot do this stuff alone.