Savior Complex and Lack of Competent Mental Health Care Options in Russian Disruption Story

Love was not enough to help this child the first or second time. We really hope competent care can be found. That proof of insurance that a homestudy requires isn’t worth much for these real-life scenarios. A few years ago, I was told by a DC-based adoption advocacy group (not CCAI) that I shouldn’t worry about health care coverage for international adoptees because the homestudy “proves” that the APs have insurance. These are actual lobbyists (a physician was one of them) who were/are trying to expand international adoption and they had NO CLUE about coverage. They were and still are *stuck* on stupid.

Crabbina says that this illustrates that no ” miracle”  can cure this kind of brain damage.

Reformatina says “Poor Katie….can you imagine growing up with a dog in your room to protect you from someone in the house? I want to know what agency placed this girl with unprepared PAP’s in California to begin with? ”

Additionally, I find it very disturbing that this family has weapons and compares themselves to Adam Lanza’s mother.

As for the end result…this child will be institutionalized…here in the US. “Forever family”…NOT. Not all children will be able to live outside institutions. That is the painful truth.

Kentucky families struggle to care for violent, mentally ill children [Courier-Journal 3/17/13 by Laura Ungar] says “Each night when their 14-year-old daughter, Lucy, is home, Cynthia and Dan Davies keep watch.

Dan stays awake in the living room until midnight, when Cynthia takes over until around 6 a.m.

Someone has to be awake at all times, they say, to keep their family safe from Lucy’s rage.

Lucy has threatened to kill her 16-year-old sister, Katie, and herself. She’s tried to throw Katie and her father down the basement stairs. She’s hit and bitten her mother and viciously poked at her eyes.

“I’m getting terrified,” Dan Davies said. “She is my daughter, but I don’t know what to do.”

The Davieses are among the uncounted families in Kentucky, Indiana and across the nation desperately struggling to care for violent, mentally ill children — and they fear they are losing the battle.

They see their lives all too closely reflecting bits and pieces of the terrifying outcome in Newtown, Conn., where 20-year-old Adam Lanza, who media reports say had sensory-integration disorder and was under his mother’s care, went on a shooting rampage in an elementary school that left 20 students and six staff members dead.

Although people with mental illness commit only 5 percent of all violent crimes, according to a 2006 study in the American Journal of Psychiatry, experts and advocates say consistent, appropriate treatment is essential to curbing such violent outcomes. And too often, family members say, the treatment their mentally ill sons or daughters receive is neither.

“Every one of us is Adam Lanza’s mother. We understand where Adam Lanza probably came from, and nobody’s listening,” said Cynthia, who lives with her husband and daughters in a log home in rural Western Kentucky. “There is no help. Parents try to get help. They don’t want to see their kids hurt someone.”

The Davies family, like many, has faced obstacle after obstacle in the odys­sey to obtain appropriate care for their Russian-born daughter, whose nickname Lucy is being used in this story because she is a minor.

Since Lucy was adopted at age 9, she’s received disjointed treatment in more than six facilities and doctors’ offices — none of which have been able to stop her violent outbursts, her parents say.

Now, Dan said, her Medicaid managed-care insurer, Coventry Cares, won’t cover her treatment in an Illinois facility called NeuroRestorative that the Davieses and several doctors believe offers her best chance at improvement. Neither Coventry Cares nor some facility officials would comment on her case, citing patient confidentiality.

Their story is similar to others told by families who would not go public for fear their children could be stigmatized. And Kentucky professionals say they too often see children moving in and out of facilities, with insurance a major driver of care.

Instead of pinpointing the right facility for a certain diagnosis and keeping a child there for consistent treatment, “we see children go from one facility to another. We’re ineffective when we do that,” said Dr. John Gallehr, a child and adolescent psychiatrist at Our Lady of Peace in Louisville. “A child doesn’t have an attachment to a therapist when they go to place after place. It’s very damaging to children.”

It also puts the public at risk, said Terry Brooks, executive director of Kentucky Youth Advocates, and state Rep. Mary Lou Marzian, D-Louisville.

“Young people with mental health issues may more easily fall into illegal or violent behaviors, so that is something of an immediate threat,” Brooks said.

“It’s a snowball rolling downhill,” Marzian added. “And we’re heading for disaster.”
‘The best we can’

Virginia neuropsychologist Dr. Ronald S. Federici, who has evaluated Lucy, said she suffers from a long list of disorders: neurological problems from Fetal Alcohol Spectrum Disorder, a mood disorder, Post-Traumatic Stress Disorder and cognitive difficulties that place her at a second- to fourth-grade learning level.

Federici noted in a report that she “has been violent, wild and out of control with prominent mood instability and homicidal and violent tendencies,” and needs long-term, residential treatment that will help with the brain disorder at the root of her problems

Instead, he said, “she’s warehoused. She’s never been in the right facility. She’s never been given the right treatment because it’s too expensive and it’s too specialized. It’s an abysmal mistreatment of this child. … And this is common. I deal with this all day.”

Cynthia Davies desperately longs for more. Beneath Lucy’s boiling rage, she sees a sweet girl who loves animals, babies and cooking, who still colors in coloring books, builds with Lego blocks and dresses up in pretty costumes for Halloween.

“The person she was born to be is a very nurturing person, a very caring person,” said Cynthia, who keeps a 3-year-old photo of a smiling Lucy with silky, long hair and deep gray eyes, which she says “just gives me hope.”

She and Dan cling to the good times, such as when Lucy and Katie recently built a huge snowman in their yard.

“She tries so hard to ‘be good’ and be ‘normal,’ ” Cynthia said. “But her (illness) defies her best efforts.”

Dan said Lucy has told them: “I want to go to the doctor’s so I can get better and come home and be happy.”

Instead, Cynthia and Dan have had to restructure their lives to help their daughter.

He works in computer sales, while she stays home full time since losing her medical sales job because of Lucy’s constant therapy appointments. She’s the primary caregiver when Lucy is not in a mental health facility or in school, where she is a seventh-grader in special-education classes.

But Cynthia and Dan acknowledge that their love and attention are not enough. The same girl who lovingly hangs her sister’s painting of a cat in her mural-covered bedroom also threatens Katie at night, calling through her locked door, “I can hear you. I can get in,” Dan said.

Katie, who was also adopted from Russia, keeps one of the family’s three dogs in her room each night to help alert her to danger.

Dan and Cynthia say they struggle to give Katie the attention she needs. They encourage her interest in archery and take her bow hunting in nearby woods.

Katie has excelled at the sport, earning corporate sponsorships and an archery scholarship to Southeastern Illinois College. Dan travels with her to conferences and competitions and bow-hunts with her

“We do the best we can,” Dan said. “We have two children. I don’t want to leave one aside.”

They keep the family’s bows and arrows in locked cases in Katie’s locked room, trusting that Lucy wouldn’t have the strength to use one even if she somehow managed to get hold of it.

The family also has guns, but Dan said he keeps them in a 700-pound gun safe with a combination lock, separated from the ammunition, and no one has used them in four years.

Dan and Cynthia said Lucy has shown no interest in guns or bows, but she has tried to push people down the stairs — especially dangerous because Cynthia has a bad back, Dan has a paralyzed arm, and Lucy is 5-foot-3 and about 180 pounds.

“It’s not the weapons that are the problem,” Dan said.
A difficult start

Federici traces Lucy’s disorders to her birth — to a mother who died of alcohol poisoning when Lucy was a toddler — and her early years in Russian orphanages that have reputations for “shocking levels of cruelty and neglect,” according to Human Rights Watch, a New York-based international advocacy organization.

The group’s 1998 report on Russian orphanages found that “infants classified as disabled are segregated into ‘lying-down’ rooms, where they are changed and fed but are bereft of stimulation and lacking in medical care.”

Lucy’s life remained unstable when she arrived in the United States. Cynthia and Dan were her second adoptive parents. They said a California couple kept her for five weeks, but couldn’t control her violent behavior and placed her at the Ranch for Kids Project in Montana, a respite home for troubled adopted children.

The Davies family knew Lucy had PTSD and mostly likely Reactive Attachment Disorder, in which children don’t establish healthy bonds with parents or caregivers.

Katie also had Reactive Attachment Disorder, but she was thriving. In fact, the family received an Angels in Adoption award in 2006 for their work with Katie from the Congressional Coalition on Adoption Institute, which raises awareness of foster care and international adoption.

Lucy, however, proved much more difficult to handle. As soon as they brought her to the home in Wisconsin where they lived at the time, she began flying into daily rages. Anything could set her off, even a simple request to pick up toys or go to bed.

Cynthia and Dan set up therapy appointments. And they held her a lot, giving her juice afterward so she would connect closeness with sweetness.

Over six months, they gradually eliminated the violent outbursts — for a while. But the outbursts returned shortly after Lucy’s adoption was finalized two months later.

They took her for a neuropsychological evaluation, continued talk therapy for another year, and eventually sought help from a Reactive Attachment Disorder therapist experienced with children adopted from abroad.

Cynthia said they made “marginal progress” before moving to Kentucky in October 2010 to try to get better veterans care for Dan’s father. But the improvements never lasted.
Threat of violence

In late fall of 2010, just before turning 12, Lucy first told Katie: “I’m going to kill you.”

Shortly after, Lucy pinned her sister in the corner of their basement bathroom and beat her while she was tangled in a sweat shirt she’d been trying to take off.

“It would be fun to kill you and watch you die,” Dan recalled Lucy telling her much-smaller sister, who is now 5-foot-1 and around 100 pounds.

Dan and Cynthia arranged an emergency placement for Lucy at Rivendell Behavioral Health Services in Bowling Green, an acute-care inpatient psychiatric hospital where she stayed for five weeks while they adjusted her medications.

She became violent with the staff there after two weeks, Cynthia said, and then raged again during two weeks at home. She went back to Rivendell for seven more weeks.

Janice Richardson, chief executive officer of Rivendell, wouldn’t say whether Lucy had been a client, but she said her facility generally stabilizes patients so that they are no longer a danger to themselves or others and can be released into a lower level of care

Dan said Rivendell officials proposed putting Lucy into residential care in Texas, but the family didn’t want to send her so far away and break their bond with her, and instead brought her home.

With occasional outpatient visits, Lucy’s outbursts waned for about nine months.

But “the threat of violence always hung over us,” Cynthia said. “A simple request to brush her teeth could result in … shoving, hitting or biting.”

Cynthia called it “flash anger,” or going “from zero to angry to violent in a fraction of a second.”

At one point, Dan said, Lucy told a therapist her mother was beating her. State social service officials investigated, but the allegations were determined to be unsubstantiated, according to the Kentucky Cabinet for Health and Family Services.

Dan said a social worker suggested he and his wife call the sheriff if Lucy tried to hurt someone. When Lucy subsequently tried to throw Dan down the basement stairs, they did. But they said the sheriff simply warned them not to lay hands on their daughter.

Over time, Lucy’s outbursts again grew more frequent — and haphazard. Once, after a morning of playing and giggling, Lucy told her mother she wanted lunch food instead of breakfast food.

“She quickly escalated to elbowing me across the head,” Cynthia said.

Lucy’s parents brought her back to Rivendell, then to a residential treatment program at Buckhorn Children and Family Services, where President Louise Howell said staff members remember her as “an extremely troubled” child.

Cynthia said Lucy got violent with Buckhorn staff members, and they made an emergency transfer to Our Lady of Peace in Louisville, which could handle her high level of violence. There, Cynthia said, she also “exploded and hurt some of their staff members,” pulling one teacher by the hair.

She was ultimately released when she moved from the Medicaid plan Kentucky Spirit, which plans to break its contract with the state, to Coventry Cares, with which Our Lady of Peace severed ties. Our Lady of Peace officials declined to comment on her case.

Late last year, Dan saw Lucy in a fit of uncontrolled rage pulling Katie backward down a flight of stairs. When he tried to intervene, Lucy attempted to shove him down the stairs.

Afterward, he said, she pounded her head on a glass door, muttering that she wanted to kill herself. On the way to a behavioral health center in Hopkinsville, the closest place with an open spot, Dan said she tried to open the locked doors of the family van and jump out.
No stability

Cynthia said the more facilities Lucy goes to, the “exponentially more harmful” to her daughter.

“Every time you switch her caregiver,” she said, “you increase the trauma.”

Experts agreed, but say the U.S. mental health system fails on this score.

“The care tracking is just so fragmented and we have managed care companies that determine from afar what care people can get. They go from provider to provider. It’s a tragedy,” Howell said. “This child is a perfect example of someone in need of a strong therapeutic community. And there’s so many of them.”

Brooks, of Kentucky Youth Advocates, agreed the current system lets children “get bounced around like pingpong balls,” with “sporadic, random kinds of interventions” and too few step-down services when patients get out of intensive inpatient care.

Marzian said mental health in Kentucky has long been “woefully underfunded”; the state spent $54 per person on mental health services in 2010, less than half the U.S. average of $122 per person, according to the National Association of State Mental Health Program Directors.

“The whole system is inadequate to provide continuity of care,” Gallehr said. “You need to have the same person, the stability.”

Lucy’s parents contend that she would have stability at NeuroRestorative, which is about two hours away and provides long-term care that would address her fetal-alcohol syndrome.

But Cynthia and Dan said two doctors associated with Coventry Cares, who have never examined their daughter, told them they won’t cover the placement because there’s no evidence that inpatient care for brain trauma is medically necessary.

It’s also more expensive than the care Lucy has been getting. Federici estimated it would cost $100,000 to $120,000 for an 18-to-24-month stay, which he said is at least double what Lucy’s care costs now.

But failure to cover the right care “is an abuse of a child — a severely psychiatric and neurologically damaged child,” Federici said. The insurer is “looking for the lowest cost, hoping to provide bargain-basement funding.”

Kentucky Medicaid officials wouldn’t comment on the case. But in response to questions from The Courier-Journal, state officials issued a statement saying more than 115,000 Kentucky children covered by Medicaid received mental health services in fiscal year 2011, and “Medicaid is extremely committed to ensuring that the children it serves are provided with the medical care they need.”

Officials said Medicaid covers all medically necessary psychiatric services. Out-of-state placements are allowed if no Kentucky center can or will treat a child’s specific condition.

Kristine Grow, spokeswoman for Coventry Cares, said the managed-care organization may make exceptions to pay for treatment with an out-of-network provider if, for example, specialized clinical needs are not available within the network.

The Davies family has appealed the coverage rejection, and has requested a hearing with the Department for Medicaid Services, which hasn’t been scheduled.

Meanwhile, Lucy is again threatening suicide, her parents say. After recent violent outbursts, they placed her in an acute-care facility in Radcliff. And when she gets home, she will go to the end of a weekslong waiting list for an intensive behavioral health program offered to children on Medicaid.

But the Davieses feel these are just stopgap measures.

“You cannot look into my daughter’s eyes and tell me she doesn’t deserve care,” Cynthia said, her eyes full of tears. “She’s a human being.”

Without the right treatment, Dan said, “she’s looking at institutionalization or incarceration,” and “we’re doing everything humanly possible” to prevent that.

“Without us, there’s no one who would fight for her,” he said. “God’s plan is for her to be with us. And our job is to get her the help she needs.”

“The best-case scenario is she can grow up and have a family of her own,” said Cynthia, who envisions Lucy working in a bakery.

“That would take a miracle,” she said, “but miracles happen with the right treatment.””

REFORM Puzzle Piece