Managing the Unmanageable; Support for Parents with Troubled Teens and Youth

One of the most challenging systems, in my experience, lands here – the schools want to fine you, your child refuses to be on your side, your job wants to fire you and is there anyone not out to get you?

It’s completely irrational and consuming, growing into an anxiety we end up trying to escape because it leaves us feeling helpless and, in a way, easier to give up on our children than face a system that threatens more than it supports.

The sad part is that our children need us much more in these moments than ever yet, at some point, ended up more on the systems side then theirs.

Having my own diagnoses to manage daily, I also have two children on opposite sides of needs – the extremes here have been an incredible learning curve in their own to gain peace back in the home, but we did it and we’re stronger than ever. I have been there both professionally and personally; I get it.

Working with teens and children with various ranges in behaviors, becoming an advocate, funneled the most personal growth because I was able to see and learn a lot of the data outside of my own bubble – it was my job now, less personal with an outside view.

I’m going to share that view with you and the obstacles often in the way, giving you a roadmap to work with it. I promise you, by the end of this write up, you’ll not only understand the basics but see, for the most part, it was never you or your child failing but the system.

Assessing and Addressing Behaviors

Depending on the age of the child in your care, your starting point will look very different, but it all begins with assessing and addressing the behaviors.

A large factor to rooting the behaviors will also be up against the insurance companies and ability to afford the care one can see is needed; the lower end of the middle-class spectrum tending to fair the hardest with few resources but there are some potential solutions to assist, which we’ll cover.

Your first step is to identify and understand potentially what you are seeing and get it officially addressed.

Anxiety, anger, depression, attention barriers, school refusal, sensory processing difficulties, PTSD, etc. – you need to do more than recognize it; you need to have it diagnosed.

School’s provide assessments, even diagnosing Autism, but in my experience, they may as well be your neighbor stating the same diagnosis (with Autism) because if they aren’t doing the official screening then you still need an official diagnosis that holds up with the system.

Your child will not qualify for programs unless an official screening is completed.

You can read more about the four main screening tools here:

You want a psychological evaluation completed for official diagnosis.

For low-income families, there are often long wait lists for an evaluation from a private provider that is covered by insurance – think Autism specific or comprehensive neuropsychological evaluations. We have two where I am and one’s current waitlist is ten months out. For younger children with Autism needs, there are more private locations to review and have evaluations completed sooner, but for children older than seven, it becomes less available.

Autism is usually not diagnosed by general mental health providers, nor potential other neurological needs. You may need a referral from your family doctor to for specialized testing, which would require calling and reviewing for possible needs.

For other diagnoses, it is possible to find availability with a mental health provider and review availability and request a psychiatric evaluation – you do not have to do medication, but they are able to prescribe as part of the evaluation.

For those who can afford a private evaluation, it’s a matter of reviewing if a general evaluation is needed or specific screening and scheduling one or even both, as needed. If you have insurance and it covers it, review with your insurance company on providers.

If you don’t have insurance or even if you do, you may be able to onboard with state insurance if your income is over the general MA income level. State Medicaid has an amazing behavioral health support system and generally covers all costs for care.

Your child would have to qualify by already being diagnosed as having a disability, behavioral or autism spectrum disorder.

For example, I had a middle-class family whose income was over the level for MA, having a child already diagnosed and receiving MA but the other sibling, having emerging behaviors, was not and had no diagnosis.

Costs for an evaluation was a barrier (that low-end middle-class clause where you qualify for no support and end up being broker than low-income families for it) but, she did have a PCP (family doctor) and an IEP at school.

Her family doctor did diagnose for anxiety and depression, having them obtain this official diagnosis and then, we took that and qualified her for MA which in turn, were able to onboard multiple behavioral health supports at no costs.

If you are struggling financially and have an official diagnosis already for the child in your care, you may still qualify for MA despite your income level and can apply with your state to review.

There is also MAWD which qualifies for MA if you are a disabled worker and have less then 10k over in assets, paying a premium monthly, which also may be a potential route.

Find where to apply for your state here:

If you don’t have a diagnosis, you could visit your PCP for review of anxiety, depression, and/or ADHD to obtain some form of diagnosis there, and you also should have the school completing an IEP or 504 plan if they haven’t already.

In Pennsylvania, it is qualifying under the PH-95 plan, you can read more about it here:

Another amazing website I found is, providing state by state information on waiver programs available that you could review and find potential support with:

There are a lot of programs and supports with services and your first step is getting that official diagnosis on paper – think of it as a ticket that qualifies your statements of needs as valid.

The School’s Role

The next point of your power is with the school, and I have…look, buckle up here because it’s the wild west and what you will face as a result of it will make you question life.

You don’t know it, but you have so much power here and they will work to destroy it at each and every point. I’m sorry, but I have had to fight multiple schools’ tooth and nail. I mean, from the door to court here and it’s made me a vicious adversary for it; I can’t hide it nor my contempt in the fact it’s real.

And you know what else is maladjusted here? If you have brown skin, you’re going to have to fight even harder. I believed that at least in this respect, the needs would overrule bias but that wasn’t what I faced; it just bled out and smothered the needs. This is a real factor that needs to be addressed throughout all services, among other things.

Fortunately, no matter your race or starting point, the most powerful tool will be your ability to document and hold accountability, which doesn’t discriminate or bias; it speaks it.

I sat in a court hearing for a client, watching another case with a single father raising two teens with mental health disorders with anxiety; he stated even taking the children to the school himself, coming to find out they left the school premises still (they blamed him for this…not uncommon). He worked during the day and all these behaviors emerged after the COVID pandemic (this also extremely common), trying to navigate and find solutions, realistically unable to quit his job and support his family.

The school in question I was familiar with; suburban high-end area, incredibly funded – these tend to be the worst while the inner-city schools with less funding are actually more pro-active. These are your tax dollars hard at work, yea?

The judge, who I am also familiar with, had no concept of mental health despite Pennsylvania updating code with Magisterial judges having ability to flex here; I literally argued this particular judge about mental health barriers and realistic hardship – she had no knowledge of terminology, no understanding of actual needs, just…void. Her solution? Tell them to go to school! I mean, yes! Why didn’t we think of that?!

The Pennsylvania ACT 138 and Truancy guide I am speaking of can be found here:

So, basically, I am watching this father pleading for help for his children and being railroaded by the school and judge, ultimately slapped fines, and told “Make them go to school, we can’t help.”

The same school, that with my support, offered to let my client come to school even for an hour a day and went as far to review with a possible support pet for her to attend.

It crushed my soul and I had to hold back every urge to get up and argue for him; I couldn’t, I’d have needed him to sign forms and he didn’t know me, in any case. It was absolutely disgusting and triggering, likely because I grew up with a single father and I knew that pain because I saw it in my own father’s face when he felt hopeless dealing with me and my brain, and my own reflection with my own children’s mental health needs.

You’re not alone – they all state the same thing and slap you with a fine, for the most part. It was actually a judge who turned my life around by not fining my father but challenging me to do better. Judges have the power to change lives and during court hearings, don’t be afraid to ask them to.

Now if you have data sets and services involved that can pull their cards, you can force their hand and avoid court.

You start by requesting an IEP evaluation – you have review here for both learning and behavioral barriers and is absolutely a tool of power. You want this more than a 504 plan; fight them because mental health barriers are a cause of a learning barrier.

You see, it is Federal law with FAPE – that is, every student is entitled to a Fair and Appropriate Education for kids with disabilities. Please, 100% know FAPE rights and use that word with the school – it scares them.

The IEP becomes your child’s personal plan that the school is expectedto follow and implement so your child can have a fair and appropriate education – it isn’t your job to get your child to succeed inside the school as much as it’s the school’s job to tailor and affix so your child can succeed.

Do you understand what I am saying? If your child is failing, the school is failing your child.

You absolutely want to know the Federal IDEA laws in your state and what that means for IEP regulations in the state – you can review state by state regulations and IEP laws by state here:

There are specific timelines to complete tasks, implement, review, and track – this may mean writing in a notebook all correspondence, statements, and tracking requests with specific dates just to have data on hand. You can sue the school if they fail to provide FAPE and follow IDEA regulations.

For instance, if you disagree with implementations, put it in writing and date it within the time frame to disagree and force a new meeting to review. If you don’t, they consider you agreed legally. You can get an IEP overview here, though this is PA related, but you’ll see timeframes and general details of why it matters to know them.

They may say, as well, your child doesn’t qualify for an IEP. One case, for example, who has extreme paranoia (reviewing to the level of Paranoid Schizophrenia), has been to court already for beating up another child, has left the school multiple times, and experienced panic attacks even attempting to get her to school – I mean, extremes, yea?

Another high-end funded school, whose school psychologist and social worker on board sat crossed armed with snide expressions and told me there was nothing they could do to help, as well as dismissed need for an IEP in the end. This is the same school that blamed one of my family members for their sexual harassment at the school so, I mean, less shock there.

There are a lot of stories; I even had a case where a behavioral support at a school informed the parent to reach out to a program that was non-existent and I had to interject with assigning the staff to find this mystery program, sharing fake enthusiasm that they had secret knowledge about unicorns that didn’t exist and attempted to get my client’s parent to search for. They would have penalized the mom, while on paper stating the mom failed after apparently enriching her with all these lies.

My clients were lucky to get me as a case manager; I am at heart an advocate and will go above and beyond to take down the broken in the system. Unfortunately, this isn’t universal; I witnessed a case manager five plus years in the field who didn’t even know what FAPE was. I’m just…seriously, it’s all disappointing in reality.

What you want is an Educational Advocate or Special Education Attorney; there are those who work similar to SSI attorneys, meaning they don’t get paid unless they sue and win a case (attorney) or work with a service and have no cost.

They will review your case and ultimately decide if they will take your case on or not, which means the data should be telling violations.

The school will generally flip their script once you introduce an educational advocate or attorney, they are now being held accountable and have less ability to dismiss you or your child’s needs. Also, these services are specialized in educational law and know the system, able to know and work realistically with the schools on programs available and what makes sense in the steps.

You can find a write up about Special Education Advocates and roles here:

And you can review special educational attorney information here:

This a particular one in Pennsylvania I have worked with and is amazing, the website briefly explaining their role. You can find one in your area by searching for similar context.

Again, some services are provided free until a case is had and won, so review and see what is all available in your area.

What else is available?

What you are looking for are interventions, these able to change and look different between states but there are often commonalities and base services no matter where you live.

Most often, you need qualifiers and sometimes having a diagnosis isn’t enough.

Let’s look at that first because, as parents, we tend to try to save our children from the behavior rather than document it. This tends to be with more extreme cases, as in there is avoidance to report or follow through with accountability in extreme behaviors.

This, though, is crucial – if you are dealing with a child who rages, attacks you and has excess other issues and you aren’t going to the fullest length to address it then you aren’t showing anyone in data how much support is needed.

Now, to be fair, dealing with the police is its own level of another void to dive into that often comes back with no help, no outcomes, and possible barriers with the police going on to tell you they are tired of your calls and begin actually disliking you. There is a way of dealing with this aspect, but mostly, if the calls are constant – either you or the system is failing in your role.

I worked with a mother who would never follow through with hospitalizations, giving in to the child wanting to take her home, or wouldn’t call and report actual incidences. This child was extremely unstable mentally and was the power holder in the home, to the point she threw knives at the parent and regularly verbally abused her for no reason and mom still would downplay the situations or just cry, but not actually enforce expectations.

It came down to mom stating these extremes, but nothing reflected that on paper – even the therapist and psychologist had no idea about situations, each and every time the child saying all was good, basically, while a stack of bodies sat off camera in the background.

Understand, fundamentally, this is child abuse. Why? Because your child has a problem, and you are hurting them more than you are helping them. They need support and you’re actively blocking them.

Understand, also, you are in an abusive relationship with your child, and this can lead to the same behaviors as victims in abusive domestic relationships; you may need support and counseling, as well, to help shift dynamics and empower yourself again. You are a victim of abuse, be it mental or physical.

If your child runs off without permission, call emergency services and report your child as a runaway.

If your child becomes violent and threatening, call emergency services and report a mental health crisis.

They break items in your home, destroying property? Call and report, follow through with charges.

Period. Absolutely period.

Behaviors will fall into two areas, psychological or juvenile court related.

Unfortunately, for the more extreme cases where a child refuses help and is self-destructive and violent, the juvenile court side tends to provide more results with consequences, and it may be where they need to be. If they are able to see and obtain consequences for their actions, they may be able to move forward to actual mental help by seeing they don’t want the alternative.

If the child is willing to work with services and support, the psychological side has programs and is easier to manage.

For issues with mental health barriers, there are partial hospitalization programs (PHP) available. These replace school by the child being picked up and dropped off daily, just like if they were going to school, but attending at a location where there is therapy and a psychologist on hand to work with them on stabilizing. The school’s work with the programs and provide light classwork and planning to help the child stay on track while not in regular school.

Inpatient psychiatric hospitalization, on the other hand, is where a child would go and stay daily for x amount of time for mental health needs.

Further long term, there are Residential Treatment Facilities (RTF) where a child would be referred to for staying at for a longer term and working on stabilizing to return back home.

It’s all good on paper, but again…you know I can’t lie to you, another general void.

In our county, there are two PHP programs, they are overcrowded with long wait lists and some barriers with diagnosis and history which makes them refuse the child. I know…a facility meant for diagnosis disqualifies for diagnosis – no sense and it’s why it’s important they want help and are not hostile, as the more they are, the more they will be denied.

Same with RTFs, if not more. Literally. Suicidal behavior has been a denial reason…to the long-term therapeutic service for unstable children with suicidal behaviors. You see why this is exhausting; I have had to constantly report and/or go over people’s heads to get expectations met, you will have to, too.

The child’s age is also put into question, a seventeen-year-old easily denied despite ability to take and even keep this age group over eighteen.

Learn the word appeal and know you can appeal just about everything. You can have success in an appeal, so don’t give up on the first denial.

For RTF placement, you need approval from your insurance company. In MA, there is a behavioral/mental health department in its own and who manages it is determined by county. There are less options with regular insurance, generally, but there is some participation.

For behavioral/mental health needs in the home, it is a good place to start onboarding your insurance as an ally – as much as possible, realistically. I have seen amazing agents who are extremely supportive and helpful to families, becoming invested in the child’s care; one agent was with a client for years and was trusted like another family member.

I have experienced most push back with RTF placement with insurance companies, this being due to RTF placement not showing extensive positive results overall, plus costs. For some children, though, it becomes a desired placement because…the parent is the major issue and allows the child to get out of the home, experience some consequence, and obtain higher levels of mental health support with consistency.

You will also need a recommendation from a psychologist, usually when reviewed under an evaluation, that will start the referral for RTF placement. PHP placement needs a referral, as well, but there isn’t a whole meeting to approve or deny the request.

You have a secret weapon, as well, if facing a lot of denials and barriers – in Pennsylvania, we have Complex Case Review, both County and Regional. It’s not information easily or readily found, I found it because everything was irrational, and I knew there was somewhere to report the insanity.

I find everything with the same skill; if it smells funky, follow the trail to the head and you will usually find accountability. You follow the money or the irrationality, I guarantee you’ll strike gold.

The mere mention of a case review had the same flinching as the word FAPE. During a meeting with actual behavioral health insurance staff giving a presentation, after listening to statements on procedures I knew damn well they didn’t actually do after countless crisis situations, I inquired on complex case reviews given realistic situations occurring and denials.

Their expressions are still imprinted in my brain – I can’t make this stuff up, it’s just wild and I have to laugh, or I’ll implode with the ridiculousness of it all. You’d have thought I threw my lunch at their head, and it was at this moment I knew the power in those words precisely no matter how much they attempted to back walk from the need of it.

At the county level review, it will bring multiple services together and review the case to find solutions and why services are not working as intended. It’s now forcing everyone’s hand to address your child’s needs and barriers.

Reigonal is a level up, again now drawing services to review and find solution and then you get to the State level review, and even more services are drawn in for solutions.

You will get solutions, but part of getting solutions is keeping your data in order and all the information that goes along with it. State appeals, state denials, state all those reports of service staff not fulfilling their roles, state all the damage and occurred trauma, state all the emergency service calls, state all the times the hospital sent your child home because they were “stable,” despite cuts up and down their arms and knowing you’d be back in a week (they didn’t have beds available is a thing and yes, I watched them send home a teen with cuts up and down her arms after being found by police during a fight, all while she was reported missing for running away over a week before – yes, sure, she was the embodiment of stable).

In PA, you can find more information and forms with Complex Case Review here:

And you can find a PDF write up here on PA Complex Case Reviews with detailed state information:

I do not know each and every state but review the information and search for similar checks and balances in your state. There are likely similar programs.

Some other services are available for intense cases, such as Assertive Community Treatment (ACT) but the issue is, you have to qualify under their criteria – such as two hospitalizations within a specific time span, which high cases weren’t obtaining due…to being sent home because there were no beds. You see the issue here? The child has to also qualify in other areas and there has to be availability/openings.

ACT is a nice program as you get a treatment team all in one that comes to your home and is active, just good luck getting on the program.

The program is not PA specific, and you can review for information by searching with your state.

There are also case management services for mental health, targeted and blended between adults and children. Case managers are to assist you with finding support and solutions in all areas of social, financial and educational needs.

Case managers come to your home and can visit the school, as well as work with you on treatment planning and crisis management.

You can find more information about mental/social case management here:

Multisystemic Therapy (MST) is another option, in which you work with a MST worker that comes to your home and works with you and the child on treatment and crisis planning – they can visit the school, as well.

You can both have MST and Case Management services. Additionally, you can onboard a service coordinator who works, as well, on finding programs and waivers to assist with managing needs.

MST Information can be found here:

Sadly, you can have all three and get absolutely nowhere because this world is unreal and if you attempt to rationalize it, you’ll just explode.

I know I must sound angry and it’s because I am – these services owe you their title and service statements; how dare they come into your home and not fulfill themselves, instead generally repeating themselves to you while doing nothing or costing you time in actual successful movement forward. I have worked with a MST case manager who literally did nothing but talk to the mom about the behaviors and I had to direct this person to reach out to services and walk her through possible service onboarding – I have had to be a case manager and a constant add on supervisor for a huge number of different staff on top of it, even going as far as to have to tell them about their own program. No, I am more than angry, and you should be, too, because you deserve more than this.

The system fails because, on paper, they state what they are and their intention to do and be yet fail individuals and families consistently. At the end of the day, they get paid, and families continue to struggle. I don’t want you to struggle – I want you to take my words and my anger, you stand with it and grind your heel in the ground and tell them they will meet expectations.

If you have a service and your support isn’t following up, not meeting your needs, even canceling often (trust me, they are documenting you canceled more often than not), and generally, not fulfilling the contract of the service – report them.

You report the staff to the program supervisor and can request different staff.

If this is not enough, you report the service to the insurance and your state. Follow the money – who funds them? Report.

Once you start messing with their money, they’ll start spending money to train their staff appropriately and holding that accountability.

Document everything and follow through, especially if you get to a level that requires all that data to be reviewed.

What about Age of Consent for treatment?

States vary in age for consent in treatment. You can find your state’s information here:

There are clauses here, however. In Pennsylvania, the age of consent is thirteen. When a child turns thirteen, they will begin signing their own paperwork and managing their care needs independently.

There is a large issue with locations and services informing parents that their child is declining services, therefore they cannot provide them (think RTF, inpatient hospitalization). However, it’s not true and the parents can waive their rights and consent to treatment yet.

My favorite write-up for PA law and the misinterpretation with ACT 65 of 2020 can be found here:

I have used this card more than once when advocating for a parent to hospitalize a highly unstable teen.

I do not know every state, but you want to know your rights as a parent or caregiver and should look into those barriers with age and how to address the situation.

Also, you want to complete a Release of Information (ROI) when your child onboards to a service; the depth of release is dependent on what information your child is willing to sign off on with consent, but obtaining this immediately will open doors for the service to having a right to speak with you.

That’s right, that child with the bodies hidden off camera – no one would speak with mom about that child, period, without the ROI.

In PA, this also means a fourteen-year-old can manage their care without any input or review with the parent. So, that child tells the therapist everything is great despite, over the weekend, attacking dad and setting someone’s house on fire, and the therapist states that’s great! Progress!

It’s important to note, it’s a powerful tool for children with needs and being able to seek counseling as needed; parents, for instance, who are anti-LGBT and provide the child no support can take a seat because now that child can seek support on their own. Children with trauma or dealing with mental health needs can seek support, too, at this age without parental consent – there are parents who are just awful, and this makes a difference.

What is troubling is there is no middle ground; there could and should be some follow up or review, at least, with parental concerns to which they listen. If you have a child with multiple services, obviously the child in question is active with needs and the parent is active in attempting to find solutions.

You do the ROI and work on obtaining consent to discuss your child in question – it doesn’t mean you obtain a right to know what is spoken about during therapy, but you have a right to speak your concerns and needs with the reality of behaviors in the home.

Empowering Yourself

Bringing this all together, the biggest step to empowering yourself is doing just that – taking back your power by documenting every detail and forcing hands with it.

I know that pain and level of powerlessness we feel in the face of it – it is overwhelming and demanding, taxing in every area of our needs and ability to manage it.

It doesn’t have to be, though, and it starts with stepping outside the emotional bubble; you have to think of the context as…data sets. In court, emotions don’t stand but data does. Data is your power and if it’s not there, you just have an emotional plea.

That’s not to disregard the emotional space of it, but to understand what the system is asking for – it wants proof so provide it.

This is also positive for our children in that they are getting additional support, support the system created with the intent to help families and these children. Look at the current system and how much it has changed from even just five years ago, there is so much more awareness and ability to talk openly about mental health and these factors.

Onboard the services and stop understanding when those services or staff let you down; they are not your friend, they are being paid to provide that service. You see, on paper when you don’t report, the system looks good, and everything is as intended. Your child is failing because of you or their inability to succeed, not because Mary came into your home and sat there for an hour saying the same thing or not assisting with their actual service statement that is supposed to assist.

I have had to state level report workers who were asking clients to lie about billing (saying they visited when they didn’t), one literally tried bribing another, another sat in a car while the client went into an appointment they were supposed to actually go in with and help support – yea, they billed for that time like they helped…but yea, they never actually did.

People are people – do not assume degrees or a service statement mean anything in the reality of it and it’s your reporting that holds services accountable for what they are actually providing.

If you build and maintain your data trail, keep your expectations and report/appeal as needed – your data will state all the emotional pain you speak of, but in a powerful way because now people are being held accountable in that deficit.

Hopefully by following these strategies, you can begin to take back your power and find both long and short-term solutions.

I would also suggest joining support groups, there are many run through NAMI:

And you can find them through Facebook, as well as searching online for groups – local and virtual.

Other Parents Like Me has a virtual group and resources:

Groups can help with not just emotional support, but system support as information is shared and discussed. You may meet someone who went through a similar situation and obtain positive strategies that were tested and worked, etc.

On a final note, there are alternative virtual schools, as well – more have become available in the COVID aftermath. We also have Alternative School placement, in PA, for in person education – this is a different aspect, as well, to states with them. I plan on writing a post after more digging as there are a lot of legality shifts and sometimes, you don’t actually want the alternative school.

Search your state and absolutely read and review the criteria for attendance for virtual schools, they are often different. Having an unstable and hostile child can be difficult to explicitly sign in for each and every class, while some others may do attendance by logging in daily and work completion is done on their scheduling.

Read the attendance policy! It makes a difference in finding what makes sense, potentially at least getting education started this way while finding more solutions and treatment for your child versus fighting daily.

In Pennsylvania, CCA has been incredible in my experience – I will share a link to their website:

There are other areas to touch on within this spectrum, which we can discuss in another post, but for the first basics – work on your overall strategy and documentation needs as it’s absolutely what you need to build and yield those outcomes.

If there is a situation you are experiencing that you’re having barriers with, please feel free to share or if you overcame a situation through a strategy not mentioned – share!

We all are all empowering ourselves and the system can’t be fixed until we get our hands in it and demand it do more than stand on paper; it needs to be real and tangible, held accountable, and help us empower our children and ourselves with successful outcomes and not the statistics they manipulate to fund and state what is.

Remember, your child is going through a complex and mentally very real and difficult experience; they are not our enemy, they are not out to get us, and they need us on their side which may mean reporting, when necessary, as much as loving them through the chaos that is the system. No matter what, never let go and fight with them – that is the difference they need the most and succeeding here truly the goal.

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