Sunday, May 10, 2009

Sometimes Things Actually Work Out

The summer camp/ kindergarten/4th/7th/10th grade physical exams started up last week, bringing back a number of children that I don't see very often in for examination.  That is, of course, the very group of kids that we thought would be most in need of screening when this all began, right?  So, one morning last week, I went into to see a 10 year old boy in for his annual physical.  When I looked in his chart, I saw that we had last seen him in January 2008, when his PSC scored a 31 and he was noted in the chart to be in need of an ADHD evaluation due to poor school performance and high energy behaviors.  His mother had some troubles, as had his older siblings, and we did refer him to one of the local counseling agencies.  In the chart, it appeared, he had had one appointment with the therapists, but no more and he had had never made it back to us for a pschopharm evaluation.
My memory is sometimes faulty, but I quickly realized that the father in the room was the father on one of my other patients, and that this patient has been placed in foster care.  The father was a model foster parent; calm demeanor, clear rules, fair administration and- well, while to lad is still having some difficulties, he is now a 21 on the PSC and the school has finsihed an assessment that this young man needs help, but should be able to make it in the world.  He was a charming boy, talkative about everything, enjoying school, eager to see his mother and his biological family and really enjoying his life in foster care.  He had blossomed.  The problem behaviors of last year had responded well to a change in environment;  therapy and external rules thad obviated the immediate need for medication, although genetics and adolescence may bring us to reconsider those ideas.  He really likes is "foster brother", a patient of mine who, prior to this change had been an only child.
A cure- doubtful.  But a lot of times, a change in environment is as helpful as psychopharmocology.  I thanked the father for taking in this wayward soul, and his response was, while this may seem like altruism, in truth is was something that they could do relatively easily and that they were happy that their biological child had a "brother" with whom to play.
Nice when it works out, even if the CBHI can't claim full credit for the outcome.

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