u/Automatic_Acadia_565

Hi. I currently work with a middle school kiddo who has a tendency to elope prior to session, (ABA therapy or other therapies). The client will lie to caregivers about whereabouts and does not have a phone/watch for location purposes.

Client has done this two times already for ABA, BCBA and I agreed we do not want this to be inadvertently reinforcing. As per policy I should leave after 15 minutes if client is not present. Client is very smart and knows this, typical preteen/teen behavior.

As this is happening prior to session there is nothing I can necessarily do. BCBA recommended I stay until client arrived home which was roughly forty minutes.

My problem here is the caregivers. They were unable to locate the client, and I had to walk them through what should be done (reach out to clients friends and their families, drive around to spots client usually hangs out around, and if nothing else get emergency services involved which they refused to do.) Both caregivers were home, and they asked ME to drive around and look for my client. I care about the client yes, but I can not have them in my car as I am not their caregiver. The fact that I had to tell them what to do kind of irked me because

#1 I am not a parent! I do not have children of my own, I should not have to spell out to parents why things like safety habits (knowing where their child is) is important! Especially with the area and the fact that attempted kidnappings have been increasing!

#2 My job is to provide ABA therapy, I am not a babysitter and do not enjoy that they view me this way. I am here to help your child with the goals that the BCBA decides.

#3 I haven't worked with this kid long but I know that they are smart, aware, and in their rebellious phase. Not to mention that this client runs with a questionable crowd that puts not the greatest of ideas into their head.

I have noticed with working in home more, some parents and caregivers just do not care to the extent that they should and it truly makes me worried for their children. On paper the caregivers do what they should (provide home, clothing, food, etc) but when it comes to safety aspect they seem to not care as they should because "they have done this before and they always come back home"

Do other RBTs feel that the parents/caregivers do not care as much as they should?

I am on the fence about reporting this as child endangerment, it was the clients choice (they are high functioning and are aware of their choices) to leave prior to session, they lied to caregivers about where they were going (it is avoidance/access to friends, we have tried to have friends present for ABA therapy and it is not conducive) and the client is still adjusting to changes within the family as one caregiver has left and a new one has stepped in. I do not want to cause more stress for the client. BCBA feels we should continue with ABA and not remove demands/cancel session when they elope prior to session as that reinforces the behavior.

I know consistency is important, but the safety of the client is important as well. I know this is an avoidance and access behavior, I know that this behavior is also pretty normal for middle school aged kiddos (not necessarily leaving, but lying and hanging out with friends prior to responsibilities as avoidance). I know that me leaving will only reinforce the behavior. I make session as fun for the client as possible with things that they enjoy doing throughout session, I always ask what they want to earn (videogames, sports, science experiments, games like uno) and include plenty of breaks and reinforcement after non preferred tasks (this includes chores as it is part of routine per caregivers request).

I feel I am walking a fine line and am unsure of what to do. Morally, everything in me wants to keep the client safe and not add to any trauma they have experienced with caregiver changes, but there's part of me that sees that caregivers are burnt out and do not seem to care much for my client as they view them as a problem. I also know that the family is doing the best they can. I fear reporting would send my client down a rabbit hole of even more trauma if they get put into Foster care/ removed from the home.

I guess working with older kiddos puts a strain on my heart because they need just as much love and care as the littles do, but caregivers view them as trouble makers and problems and throw their hands up.

Just because caring and loving your kids when they are older does not look the same as when they were younger does not make them a problem. I know some kids can be abrasive when they are hurt and they are growing up and going through all the changes that preteens go through, but that does not render them as problematic and something to "deal with later".

I am not a parent, but I do see their thought process and I do see that they are burnt out. I also see a kid who misses their caregiver, a kid who is hurt and is running from things because that's what they witnessed their caregiver do. I want to help this kid. I know they can do the things that are goals, but if the client does not see these things as worthwhile at what point do we close out services? Progress only happens with the most reinforcing thing (ending session early). I don't know what to do honestly.

Hi yall,

I wanted to rant about my terrible experience post surgery while in recovery. So my Dr actually did great, I trusted him and he made me feel comfortable as the first urologist they tried to put me with had a very much "GTFO my face with your pain IDC" attitude. My problem was my first set of nurses right after recovery.

They had me on a bed that would raise and drop every 15 minutes or so, I asked for a different bed because it felt like my JP drain was on fired everytime the bed shifted. So they moved me to a recliner while they waited for a new bed. The RNA put my catheter on hanging on the bed. When they arrived with the new bed, RNA pulled the bed (which still had my catheter on it) and pretty much yanked both my catheter and JP drain. Found out the JP drain wasn't even sutured to me and part of the tube was pulled out which hurt like hell.

After this/ the JP drain felt horrific. Burned everytime I moved. When I expressed this I was told it was normal and they would just put morphine in my IV. The following morning (new nurses) they said they would have to suture the JP drain because the previous nurses did not. Then they found out the JP drain wasn't even inserted correctly and was not doing what it needed to do. So they removed it. They made me stay two more nights to make sure they didn't cause any internal damage. They took me to CT.

I asked for the records when I was discharged because I know the hospital is going to try and leave me with the charge for the extra days and the CT scan, medicine included. I found out while going through my patient portal that they never documented messing up the JP drain and catheter, but they kept in the extra days and the CT they made me do.

Should I try to dispute it because they messed up and told me I had to stay until they could figure out if they messed my kidney up right after having my pyleoplasty?

Hello. My boyfriend (24) and I (24f) have been together for two years. I have expressed this last year that I was interested in couple therapy because there has been a lot of rough water. He said "alright fine whatever I don't care" which discouraged me because it feels like he doesn't care.

My boyfriend is very much a one step forward two steps back type of individual and it has been very frustrating. He will acknowledge things on his own but then days later he will act worse towards me. I have spoken about my feelings in a "I feel (emotion) when (event/behavior) happens, what did you mean?" prompt, it is something I learned from my theater teacher to avoid placing the blame on others (this happened a lot with our techies). That hasn't worked, he would interrupt and shift the blame, etc. I expressed multiple times that I did not appreciate him interrupting and set a boundary that I would like to speak and feel heard, not talked over. That did not work. So I resulted to writing on paper how I felt or sending him a well thought out message. I got the five love languages book to read with him, which we did together. I hoped this would show him that just because I need love in a different way does not mean I am less than him or that my needs are a nuisance. I have stayed as calm as possible, set boundaries, texted him, etc. I tried to talk to him because two days in a row it seems he has been avoiding me and I did not appreciate feeling like chopped liver, which has been a re-occurring problem in our relationship. I will give him 30 minutes (his idea) like we agreed for time to himself, with his family, etc. and when he comes back I make a bid for attention, try to start a conversation, ask to do activities like painting, play minecraft, go for a walk, etc. and he always has something to say. Like "Im going to the QT" "I am going to play GTA" "Im going to the hot tub".

So after him doing this two days in a row, I expressed how I felt. He called me names and was annoyed when I was crying because I was getting frustrated feeling unheard. I went to a separate room for space and had clearly said "I need some space". He did not listen, followed me, started pushing me, calling me more names, calling me toxic, calling me broken, and similar stuff. He pulled me back to the room and was holding my wrists tight enough to leave red marks and was berating me for crying. He told me to leave but then blocked the doorway. He kept pushing me when I tried to leave and go past him. Then started saying "you're broken. I am broken. We're both hurt" and was trying to be affectionate and proceeded to act like nothing happened the next morning. He does this a lot. What behavior is this? It is draining. I feel like I am going crazy.

I feel like I have tried everything. Should I call it? Am I the problem? Should I just sign up for couples therapy like he said a year ago?

Hello. I have done therapy before, and each therapist I have had says the same thing; "you already know, you're very self aware." It is a little bothersome, because yes I do know a lot because I took Psychology classes in college, but when I am actively trying to change my thought patterns and my trauma, I do not want to inevitably be told "you know why you are the way you are". So do I have to specifically say that I do not want a therapist who says this kind of stuff?