Saturday, February 25, 2017

After the Adoption Order - The Medical Stuff

Last month we had an appointment at Manchester Children's Hospital to see the Immunologist again about Birdy's allergies. It took us about an hour to drive there, through what seems like a perpetual rush hour these days, and more time to find a place to park, and then a very cold walk across campus to the right building. On arrival, I tried to check us in on the automatic machine in the foyer, but it didn't work.

This was my first inkling that something was wrong.

As we made our way to out-patients reception to try to check in again, I wondered about the confirmation of appointment letter I had tried and failed to find that morning. Had I actually been sent one? I had made the appointment using the choose and book website but, come to think of it, had I actually heard from the hospital?

We queued up for quite a while. Our appointment time came and went. Finally we got to the front of the queue and it was confirmed - there was no appointment.

There had been. The hospital had received the referral from the GP and written to me inviting me to choose and book. But then the hospital had got confused. The GP's letter said that Birdy had been seen at that clinic before. The hospital checked their records. No record of Birdy. So they wrote back to the GP suggesting she had made an error and cancelled the appointment. Nobody had thought to tell me.

I was not surprised, because I had predicted it. Birdy's first appointment at the hospital had been a year ago, in her old name, using her old NHS number. When a child is adopted, they receive a new NHS number and new records are started. It's a blank slate. It takes time for this new number to be issued, and time for the GP to make summaries of old records and append them to the new ones. So for a while, there is a limbo land.

It was during this limbo land time that I approached the GP for the referral. Prior to that appointment, I called the hospital immunology department myself, explained Birdy's situation and told them to expect the referral. I knew from the tone of voice of the person I spoke to that she didn't really grasp the significance of what I was trying to tell her. When I saw the GP, I explained it all to her very carefully. At that point Birdy was going under a new name but didn't have her new number.

Somewhere between that GP appointment and the referral being made, Birdy switched over to her new number. The referral obviously went off to the hospital with the new information and the confusion was complete.

Thankfully they still saw us, we got our allergy testing and added sesame to our list of foods to avoid. And if that was the end of it, I'd be happy. But, of course, it isn't.

Birdy has a moderately lengthy medical history. She has been seen by the GP, the asthma specialist nurse, the eczema specialist nurse and two different hospitals. At various times she has had prescriptions from all of these people. Most of these prescriptions need to be put on repeat, yet it has taken me repeated requests for each medicine to actually make that happen.

When her records switched over, it apparently threw all that for a loop again. I asked for a printout of her complete prescription list this week and three items were missing from it. One of these was her anti-histamine medication that we have to carry everywhere with us. The others were eczema creams. The receptionist said there was no record of her ever having been prescribed these things, despite the fact that they issued a repeat prescription on the anti-histamine at the end of last year. I now have to go back to the eczema clinic and the hospital and get some proof so that the GP will put them on repeat.

This is something that adoptive parents need to prepare themselves for. At no time, during the adoption process of either child was this explained to me. It didn't matter for OB as he had virtually no medical history anyway and the GP's surgery we were with then seemed to manage it fairly seamlessly. 

Birdy is a different matter though. For various reasons, it's important that an accurate medical history is carried through. For instance, the immunology consultant plans to call her into hospital when she is around four years old to do a supervised peanut challenge. This won't happen if she's disappeared off the system!

And we can't assume that everybody involved understands the procedure either. When I called my GP's surgery to tell them she'd been legally adopted and ask about procedure, the receptionist I spoke to offered to just change her name on the system. Let's be clear, that would link her new name (changed for security reasons!) to her old NHS number allowing anybody that can search that database to find her new name in a moment just from looking up her old NHS number - a number that her birth mum undoubtedly has a record of.

At least I know Birdy's medical history though! For people adopting a child who may be four or five years old, with a lengthy and now inaccessible medical history, this must be a minefield. Yes, it's been a bit of a slog for us, but six months down the line and it's mostly sorted out now - apart from those pesky repeat prescriptions!

Saturday, February 18, 2017

The Perfect Age Gap

There's quite a large age gap between me and my sister. It doesn't matter now, of course, when we are both rushing madly towards middle age (one of us six years nearer than the other of course!), but when we were children, well, six years was a long time.

So I had thought to myself that maybe when I had children, I'd try to have them a bit closer together. I imagined that with, say, a two-year age gap, they'd have interests and friends in common, play together without one having to come years down to the other's level, go to the same birthday parties and kids clubs. I thought that would be nice. 

When you adopt your children, it's not so straightforward. If you adopt a sibling group, you get what you're given in terms of age gaps. I know adopters who have children less than a year apart in age. And if, as I did, you adopt two completely separate children at different times, the agency is likely to insist on a minimum age gap - in our case, at least two years.

Having experienced a few different combinations of children over the last six years, I can see why. Having toddler boys nine months apart in age was a lot of fun, and yes, they did play together and were very close, but basically it was exhausting for me, and there was a lot of screaming and fighting too.

Later, with a 5-year-old, a 3-year-old and a baby, I saw a different dynamic. The two older children were in competition the whole time. Any idea I had previously held that having children with similar interests would be lovely quickly went out of the window. For these two, similar interests meant similar needs, and therefore intense competition to have these needs fulfilled. Twinkle and OB never gelled at all. It was such hard work that, despite copious amounts of comfort eating, I actually lost weight.

This experience confirmed to me that I needed a decent-sized age gap between OB and any sibling. I began to understand that it was vital that other children living in our home had different needs from his. OB has never minded when I have taken time out to, say, feed a baby, but if I had to help Twinkle on the toilet I could bet my bottom dollar that he'd have a sudden urgent need for the toilet too - and vice versa. I can do things for other children, as long as they're not the same things that I'd be doing for OB.

Birdy and OB are just about exactly four years apart. Is it the perfect age gap? I don't know, but it really works for us. I had worried that the difference in age would be too much, that they would never play together and miss out on shared experiences. So far I am glad to have been proved wrong. Now that Birdy is fully ambulatory and into everything, they play together a surprising amount. As she still has a nap every afternoon, I can get some quality OB time in there too.

But more than that, Birdy's adventurous character has been a real boost to OB's more timid nature. She will have a go at anything, and OB finds it easier to pluck up the courage to attempt new things if he's 'helping' her or just 'going with' her. Last time we went to CentreParcs, OB was ready to throw himself down the water slides as long as he was 'just helping' Birdy. In previous years it's taken hours of patient work to get him to even try them.

Birdy has brought out a truly caring and compassionate side to OB's character too. He knows all the food she is allergic to, and looks on cafe menus for things she is safe to eat. He looks out for her, calling me if she is hurt. He is so willing to get on her level to play silly games that have them both roaring with laughter. I couldn't ask for more.

As for Birdy, well, she looks up to her older brother, seeks him out when she doesn't know where he is, and cries for him when he is not there. She copies everything he does (sometimes I wish she didn't!) and tries so hard to play his games. Today they were building marble runs together. She was thrilled with the run that OB made for her, and he was relatively calm when she later trashed it!

It's not prescriptive, I know. My children are not birth siblings, so they don't carry shared baggage from their early experiences, which helps us. Every family set up is different. Every child is different. But I think that, although I would never have planned it this way, our four-year age gap is working out just perfect for us.

Saturday, February 4, 2017

Interrogation in the Supermarket

Years ago, back when I lived a carefree, non-parent life, I used to go about my days relatively unmolested. I could walk down the street and nobody would pay me any attention. I could spend as long as I liked (preferably not too long!) in the supermarket and nobody would speak to me. I quite liked it.

As soon as OB came into my life, all that changed. Having a gorgeous, wide-eyed, cheeky-looking toddler in the trolley seat apparently attracts all kinds of attention. There were comments about his cuteness - I appreciated all of those! - and questions. Lots and lots of questions. What's his name? How old is he? And, as he got older, does he go to nursery? To school? (He's very tall!) To be fair, these were far more innocuous than the questions I got asked at the Sure Start Centre tots group, which often centred around unpleasant-sounding birthing experiences. 

All of that was fine, though. OB was (and is) fabulous and I never minded answering questions about him or accepting compliments on his behalf.

Since I've had other children alongside OB though, I've noticed a major shift. I don't get asked questions any more. Suddenly, I'm invisible, and all the questions about the babies and toddlers are directed at OB.

Is this your sister?
What's her name?
Is she good?
Does she cry at night?
Does she share your toys?

And so on and so on. Poor OB. It's torture for him. Firstly, the answers to some of those questions are not always so straightforward. Is this your sister? Or brother? Until a few months ago, none of the children that have accompanied us to the supermarket have been OB's sisters or brothers. I used to step in to save his awkwardness but, to be honest, I would struggle to answer the question too. Do I lie? Or do I tell the truth and say "No" - an answer that really feels as though it requires further clarification that I'm not sure I want to give to the stranger in the supermarket.

Secondly, OB is shy around strangers. Actually, he's shy around people he knows. When we go to his best friend's house it takes him a while to work himself up to taking off his coat. He has a hard time answering people's questions. It puts him under pressure. If a stranger even asks him what his name is, he practically turns himself inside out. A supermarket interrogation is the last thing he needs.

And for some reason, so many of these curious strangers seem to take his non-response as a personal challenge. They keep going, determined to drag some answers out of him. I assume they're trying to show him they're friendly and establish some sort of connection but the longer it goes on, the more gnarled up OB gets. If he does answer, it's barely audible, which the interrogator takes as a signal to get him to repeat his answer over and over again, resulting in five more whispers and then one strangled shout. Cue the interrogator backing off in alarm.

So do I intervene and answer for him, thus giving everyone the impression that I'm an overbearing mother and that's why he's so shy? Or do I explain that he's shy and risk shaming him? Or do I just stand there and let it happen, hoping he'll 'toughen up'? (Hint: it won't be the last option!)

I've started ordering online!

Friday, January 27, 2017

Our Sensory OT Assessment

Last week, an Occupational Therapist came to carry out a sensory assessment on OB. I had little idea what to expect, which was worrying for me as OB needs a fair amount of preparation if he's going to deal with the arrival of a stranger in the house who actually wants to interact with him. When he goes to his best friend's house it takes him ten minutes to settle in enough to take his coat off. 

Several people I had spoken to described going to a therapy centre where the OT had watched their child use the equipment there and observed them. I knew this wasn't going to be the case with this meeting as there's no equipment at our house! So, just in case anyone reading this ever has something similar coming up and needs to prepare their LO, here's what happened for us . . . no guarantees it'll be the same for you!

When she arrived, OB was installed in front of the TV, working his way through a very crunchy bag of rice cakes. I know. Not his best look. But I wanted him relatively calm as he tends to work himself up waiting for things to happen. After a quick introduction and chat with me, she set about engaging a reluctant OB. 

She was brilliant. I don't know exactly what she did, even though I was right there in the room, but within 5 minutes my boy, who wouldn't even look at her when she arrived, was roaring at her like a dinosaur, joining in with tickling games, and attempting to throw a blanket over her head. She had him playing on the floor and jumping around and laughing as if she'd known him for years!

After about 10-15 minutes of that, we went into the adjoining room to talk, and he busied himself with the TV and occasionally peeping at us through the french windows. She took a history and asked questions about when he sat, crawled and walked. Not for the first time I felt grateful that, unlike so many adoptive parents, I was there for those milestones. We also talked about his general behaviour, areas that I was concerned about, his sleep patterns, reactions to noises, food habits, sensitivity to clothes and a few other things along those lines.

She told me that in the time she spent with him she could see there were some areas for concern, particularly regarding his core strength and stability, sensitivity to touch, and proprioceptive feedback. Apparently we should consider getting a footstool for when he sits at the dining table, some specially-shaped cutlery and a crawl tunnel. That's for starters. There will be more recommendations in her full report, which should be ready in about three weeks.

And that was pretty much it. She will be recommending a course of therapy (with the actual equipment this time!) as well as things for us to do at home no doubt, but the wheels turn slowly in post-adoption world, so the wisest course would be to prepare ourselves for a longish wait and be pleasantly surprised if things move quicker than we expected! 

Friday, January 20, 2017

Pause. Or maybe 'The End'.

This week I spoke to my fostering supervising social worker and asked her to take me off-list for a while . . . maybe a few months, maybe longer.

If you've been reading along, you'll know that I was expecting a placement of a newborn baby last week. It didn't happen. Just as I was packing up the car to set off to the hospital for the discharge planning meeting prior to bringing him home, a neonatal nurse phoned to check whether I'd been told that the placement was cancelled. I hadn't.

It turns out the social worker had managed to find a concurrent placement for the baby, which is really good news for him. For those of you not in the know, a concurrent placement is where a child is placed with prospective adopters who are also approved as foster carers. If he does end up going for adoption, he'll be able to stay with the family who have cared for him since he was a few days old. This is great for the child as it means fewer traumatic transitions.

So, I was pleased to hear about this plan for him. I was not pleased that nobody had mentioned to me that this was a plan they were actively pursuing. I was not pleased that this concurrent match had been decided in a meeting two days before his planned discharge from hospital, but not mentioned to me. I was not pleased that the social worker had asked me to go down to her workplace the day after that meeting to sign the placement paperwork for his prospective placement with me (so that I could give consent for his newborn hearing test) and still, she had not mentioned it to me.

I receive allowances from the agency to cover the costs of caring for the children I look after. These allowances begin when the child moves in and not before. At the social worker's request, I have visited this little one daily in hospital for a week, sometimes twice each day. At the hospital's request I have bought and provided clothes, nappies, bottles, dummies and cotton wool for him. I have fed him, rocked him, clothed him, changed him and given him his first bath. I have deliberately taken my children there to meet the baby they would soon welcome into their home, because I knew no different.

I will likely receive no recompense for my expenditure. I will definitely not be compensated for my time - a foster carer's time is given freely even when they do have a child living in their family. I can't even take the new bottles back to the shop as they were already in the steriliser when I got the call.

But worse than that, there has been no acknowledgement of my role as a human being in all of this. It's not the first time I have expected children that have not arrived, but this time I feel as though I have been led along and used. I don't regret a single moment I spent ensuring that this precious baby had extra cuddles and love while he was in hospital, but I feel frustrated that the real situation was not communicated to me.

Not for the first time I am reminded that, for some, foster carers are basically resources, like toasters. They come out of the cupboard when you need them, and once they've done what you wanted, you can forget about them. I get that this child's social worker was prioritising the child and he will be one of many children she is working hard for, but I saw her face-to-face the day after the decision was made and she still didn't say anything.

My supervising social worker was indignant on my behalf, urging me to at least claim mileage. I had to remind her that under the new rules no mileage allowance is given for individual journeys under six miles. I made the run between my house and the hospital maybe 20 times last week. None of those trips were six miles.

This comes at a time when allowances have been cut, retainers (such as they were) have been scrapped, mileage has been cut, routine replacement of equipment has ceased, I haven't had a child living here in four months and I don't know when the next one might come. Fostering has never been exactly financially rewarding, but now it's looking increasingly untenable.

And that's the conclusion I have come to after much soul-searching. Right now, I have to admit that continuing to be a full-time foster carer is financially untenable for our family at this time. And if it was just the finances I might soldier on, but it is also reaching the point where it is emotionally and practically untenable too. All the waiting by the phone, the uncertainty, the inability to plan, the frequency with which we just have to drop everything at someone's request, the difficulties we have planning trips abroad to visit family, the months that can go between placements. It's not just the effects of all this on me, but on my children and wider family too.

I have loved the children, loved being a foster carer. I am proud to tell people what I do. I look back on the last six years with a lot of joy, but I have been applying for other jobs for a while now, and I have been offered an exciting new role. Unlike fostering, I will receive a regular monthly salary that takes account of my time and my expertise. I will be able to plan ahead. I will have a regular (albeit flexible) working week. I will have a pension, an employment contract, employee rights and protections. And, most importantly, I will still be making a difference in children's lives.

I sincerely hope that I will be able to come back to fostering in the future, perhaps when our circumstances are a little more conducive to dealing with all the uncertainty. I sincerely hope so, but time will tell.

Saturday, January 14, 2017

Best-Laid Plans

When you become a short-term foster carer there's a very real sense in which you hand over your life to Children's Social Care. This is even more apparent at the beginning and ending of a child's time with us, when the flurry of meetings and arrangements, often organised at the very last minute, seems to overwhelm normal life.

For just over a week now, we have been waiting for a new little one to join us. It's a bit of a complicated situation which I can't go into here really, but it means that from day to day, we are living with the uncertainty that our family life could radically change with just a few hours notice.

It began with phone calls. Lots of phone calls. And then I started preparing, getting out the baby equipment, washing tiny bedding and spare baby clothes, buying nappies, formula, wipes, more clothes, a new set of bottles and, most importantly, getting my two children mentally ready for the arrival of a needy, tiny baby.

Then there were delays, postponements, more waiting. The appointments I had cleared from last week's calendar were re-instated and I started working through next week's, wondering what I could cancel, rearrange or postpone.

Meanwhile, Birdy came down with a dose of winter vomiting. She managed her very first day at Playgroup, but the rest of her sessions that week had to be cancelled. Then the baby's social worker called: baby was alone in hospital. Could I visit?

So followed a time of reaching out to my support network. I couldn't take Birdy with me to the hospital as her illness would be a huge risk to the fragile babies in neonatal. My friends rallied round, my mum offered to fly over to help. We added daily hospital trips into our week's routine.

The contact centre phoned me, to give me a list of probable times and days for baby to visit with his family. It will be three times each week. None of the times are terribly convenient for us, and one of them clashes with the time I have to pick Birdy up from Playgroup. We negotiate a new time for that visit but the rest stand as they are because the service is busy and fostering means being flexible.

This weekend we are in limbo. It is highly possible that a decision will be made to discharge him from hospital any day now, but that can't happen until a Discharge Planning Meeting has been arranged. That can't be arranged until we know the date of discharge. It can't be arranged over the weekend because nobody is in the office to make the arrangements. I am mentally preparing for a phone call early next week asking me to get to the hospital in a few hours to meet professionals and bring baby home. I am wondering what I will do for childcare if I get that call.

I am not yet 'on the clock' with this baby, but I am already totally committed to him, time, energy, money and heart. I have cuddled him, rocked him, sung to him. I have taken photographs of him and shown them to my son, preparing him for the appearance of this little one in our home and our lives. We are a fostering family.

Friday, January 6, 2017

Return to Speech Therapy

Years ago, I got well-acquainted with the local Speech and Language Therapy service through NB, a little one I fostered who had no speech as he turned two, and not much more a year later, despite my best efforts. My memory of that experience is that it involved a lot of homework for me, and repeat visits to a group therapy session where NB steadfastly refused to say anything at all. We made some progress, but eventually he was adopted and it was out of our hands.

Our most recent visit has been for OB's benefit. I asked for the referral myself, partly because OB has turned six now and is still having trouble with 'r', 'w', 'l' and 'th', and also because he has developed a strange habit of stammering at the ends of his words. Since OB isn't at school I felt aware that nobody else was going to pick up on any potential problems except me, so I made the call.

We got off to an unpromising start. On the way there in the car, I was reminding OB of who we were going to see and why. I explained that the therapist was going to help us with some of the sounds he finds hard to say, like 'r'.

"Oh," he said, "Like this . . . 'r'?"

He said it perfectly. In the car. On the way to the Speech Therapist. Cue a load of eye rolling from me.

It is perhaps not surprising then that the Speech Therapist found no concerns with his sound production. In fact she said she wouldn't be concerned about those particular sounds until he reached seven anyway, and even then, they might decide not to take any action.

His stammer, though, was another story. Of course (of course!) he didn't replicate it at all in front of her (despite giving me two fine examples in the car on the way home) so she was having to go purely off what I was saying, but it seems as though this is an actual 'thing'. I'd assumed it was probably some sort of 'place-holding' noise he was making while he worked out what he was going to say next, and she did say it could be that, but then she threw around words like 'palilalia' and 'anxiety' and 'sensory feedback'.

We have an appointment pending to see an Occupational Therapist for a Sensory Integration Assessment, so the Speech Therapist advised us to bring it up there and see if anything comes of it.

In the meantime, I'm just going to have to get used to being regularly called "" and hearing random words in the middle of sentences being repeated over and over again. Apparently, I'm supposed to stay calm and ignore it, which will be no easy task for a person that needs all her mental strength to avoid finishing the sentences of slow-talkers for them!

Oh, and a little postscript . . .

During the lengthy process of asking OB questions and making notes about the way he pronounced his answers, the therapist saw fit to ask him about the best thing that had ever happened to him and . . . wait for it . . . the WORST thing that had ever happened to him!

Thankfully, OB came up with a memory about falling over at a friend's house and skinning his knee, but be aware professionals, don't ask a child a question like that unless you are fully prepared for the range of possible answers you may receive!