Living in Fear

Powerless. That’s how I feel. I watch as she avoids saying one word to her speech therapist the entire session. She’s so stubborn. She isn’t making progress. Her peers try to communicate with her and her responses are unintelligible. I know it will come. It will come in her own time.

Sienna doesn’t see the giant clock counting down over her head. She doesn’t know it’s there. How much time do we have left? Her outpatient therapists are her biggest cheerleaders. Yet, they could be ripped away from us in the blink of an eye.

 

How? Medicaid. A controversial topic today. This post isn’t meant to be politically divisive. It’s meant to explain why this government program is so important to our family and families like ours. If you’re anything like I was before I entered this world, you might not know.

When Sienna was born, one of the nurses said to me, “You won’t have to worry about the overwhelming costs associated with raising a child with a disability – all the therapies and medical equipment. You live in one of the best states (Pennsylvania) in the country for services.” At the time, in the fog of Sienna’s diagnosis, I didn’t realize the significance of that conversation.

Pennsylvania is one of the few states that provide Medicaid to families raising a child with a disability, regardless of their income. You might think that’s unfair. If we have a decent income, we should pay for our child, right? What you might not know is Sienna’s primary insurance covers 20 therapy sessions per year. This is typical of most insurance companies. Sienna receives 8 therapies per week. We’d burn through what our insurance covers in 2 1/2 weeks. After that, we’d be paying out of pocket. How much? $3,400 per week or roughly $163,000 per year. I have the EOB statements to prove it. Someone in my life once said to me, “So what? You can afford it. Sell your boat.” If only it were that simple. I’d give up the boat in a heartbeat. I’m not even talking about the dozens of extra doctor visits and medical equipment like her walker, adaptive stroller, and orthotics. Sienna’s needs are minimal compared to other kids in the different abilities community.

Another Mom and I spoke with a government official a few weeks back over a conference call asking if the proposed Medicaid cuts could affect our families here in Pennsylvania. He informed us that the possibility of Sienna losing her access to these services is real. Medicaid operates with funding from states and the federal government. For each dollar a state spends on Medicaid, it receives a matching amount of federal funds—without limit—making Medicaid a statutory entitlement for states participating in the program. The Trump administration wants to convert Medicaid to a block grant system. The least complicated way to explain it is to say this….it would put caps on everything. They wouldn’t be obligated to match that funding, and because Pennsylvania spends so much, they don’t have any extra to cover the gap that would be left by the federal government. Families like mine would be first on the chopping block. We have a decent income and no complex medical needs. When and if this happens, we will be forced to cut therapies. I will have to decide if using a utensil to eat or talking to her peers is more important. We would never be able to provide her with everything she needs. She would suffer in the long run.

Study after study has shown the importance of early intervention. Childhood therapies are linked to positive outcomes in the following areas; cognition and academic achievement, behavioral and emotional competencies, educational progression and attainment, child maltreatment, health, delinquency and crime, social welfare program use, and labor market success. It benefits ALL of us to give children the proper supports they need to succeed.

Last week, Sienna and her speech therapist had a groundbreaking session. After months of presenting Sienna with options, asking her to verbally acknowledge her choice, she finally gave in and spoke her preference. Elsa or Elmo, Sienna? Elsa! It was magical. It’s crossed over at home, at school, in other therapies, and in her behavior. She was starting to develop some concerning behaviors because she couldn’t communicate her needs. Because of speech therapy, hell BECAUSE OF MEDICAID, she was able to mitigate those behavior issues. She has developed a sense of independence. She deserves that. She deserves to gain those skills in her own time, not the government’s time.

If you want to know how you can help, share. Share this blog piece. Call your lawmakers and tell them you do not support the proposed changes to Medicaid. If you want to get even more involved, reach out to me. I can help. Thanks for reading.

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Fear of the Future

How is it possible that I am still awake? I have knots in my stomach and a flutter in my chest. I think I’ve played out every worst-case scenario for Sienna’s future. I don’t know when it happened. When did I start spending so much time being anxious? I think it all began with school. 

Sienna began preschool this fall. It’s a difficult transition for all parents. We have to learn to let go of our kids. As a mom of a child with special needs, I have found it more challenging this time around. We enrolled Sienna in a program called gentle separation. She struggles with detaching herself from me, so this seemed like a natural fit. I could be in the classroom until she gained her independence. I decided to start her out in the two-year-old program, because developmentally, she aligns with these children more.

Since school began, I find myself waking up in the middle of the night over and over. I wrestle with the fact that time is passing and no matter how hard I try, I can’t stop it. When Sienna began school, the bubble we’d been living in popped. I quickly realized that I’d been sheltering myself from reality. When forced to see her side by side with other children on a daily basis, the reality of her development hit me like a 2×4. I had to observe her side by side with peers much younger than her. I watched as they physically and developmentally did things with ease. I watched as her entire class walked to the playground and she fell behind. Her teacher was always by her side. But the visual image of children soaring past her while she slowly walked down the long hallway is one I play over and over in my mind. It’s a metaphor for this stage we find ourselves in. It’s the stage where the differences in her development between herself and her neuro-typical peers become glaring. There is no hiding from reality anymore.

Let’s start with the positives of the process. The gentle separation program involves a series of steps. The parents and I spend our time in the hallway and library. We are present in case our children have separation anxiety. This time also allows us to share parenting challenges with each other. It’s opened the doors to meaningful conversations. I was able to explain Sienna’s challenges. Every single parent in this classroom is welcoming and inclusive. I worried the parents might think Sienna was dominating the teacher’s attention. I couldn’t have been more wrong. This has been a nice surprise. 

The biggest challenge involves the fulfillment of Sienna’s IEP. I never anticipated challenges this early on. I had heard the horror stories, but up until this point, we’ve had all positive experiences with therapists. Here is what I’ve learned. They don’t always show up. They don’t always tell you they aren’t going to show up. They don’t come at the time you’ve scheduled. They don’t communicate with me. They communicate with the school. Had I not been in the school, I might not have been able to confront them and demand they fulfill her plan in the way she deserves. There are points during the day when Sienna needs assistance -the physical demands of recess and during times of transition. This is why they’re scheduled at specific times. In my opinion, they view Sienna as a box they have to check off their list. This has led to many worries about her future. I cannot explain how much this wakes me up at night. What if she can’t communicate her needs in kindergarten? I opened up to other parents in the different abilities community during Special Olympics, and what I learned is this problem is all too common. A father shared a story about his son being placed in the special education classroom too often and the school did not communicate that. He was made aware because he knew someone inside the school.

It’s just another part of this journey that is new and scary. It’s a fear most parents don’t face. I am hands-on in every single therapy session. It’s always been that way. I am still able to play that role in outpatient therapies, but at some point we will need to rely solely on the school system. As I learn more, I realize the aides and therapists are underpaid and overworked. My plan is a charter school for Sienna, but it’s an extremely competitive lottery system, so there are no guarantees. When the walls of her nursery school are no longer there to protect myself and her, what will it look like? It’s terrifying and it’s out of my control.

This week, I left school. I went to two hot yoga classes. That’s my plan. I am fitting in self care to help direct my frustration and anger about my lack of control. Sienna’s transition has been seamless. She hasn’t asked for me once. The teachers share stories of her holding hands with friends. The kids love her and each other. This is a wonderful time in her education. For now, I can relax and celebrate the fact that inclusion does work. I can celebrate that there are parents that value it. But in the middle of the night, when I wake up, the future looms and my lack of control suffocates my rest. The image of Sienna falling behind in the hallway plays over and over in my mind.

 

 

 

 

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Lessons from a Mom that Values Inclusion

Two months after Sienna was born, Haley started preschool. As we walked into her classroom on the first day of school, I mentally took inventory of all the mothers. I assumed they all had perfect lives with perfect newborn babies. At the time, I was resentful. My husband was traveling constantly. My family all lived far. Sienna was not sleeping well, and as a result, I was sleep-deprived. I was living in a fog, still processing Sienna’s diagnosis. If I am truthful, this was a time full of despair. It was probably the hardest point in my life. On top of feeling like a victim, I was angry.

In my selfish mind, I owned the rights to hardship. I had no idea I was standing among warriors that had fought battles of their own. What kind of battles? There was a mom who had lost a pregnancy and endured medical trauma. She had to resort to surrogacy to have children. There was a mom holding a newborn. I didn’t realize her children were adopted. I didn’t know she had almost died of heart failure while pregnant. She subsequently lost that pregnancy. There was a pregnant mother with two boys. I resented her the most. You have to remember I had been through four miscarriages. I didn’t know this mom had been through a miscarriage of her own. I didn’t know she had endured the most unimaginable of tragedies, the swift loss of her own mother to cancer. I didn’t know these women were about to become my village.

I was not in the mood to make friends, but there was a mom in the class, Diana Rodgers-Genuardi, that refused to accept that. She was the kind of mom that wouldn’t let you refuse help. In the midst of my selfish misery, Diana invited us to her house for a group playdate. I assumed no one knew about Sienna’s diagnosis. I was nervous about explaining, but Diana made me feel comfortable from the moment I entered her home. She could see that I was at a breaking point. This simple interaction changed my life. She gifted me with a support system. She gave me friends that became family.

Last week, Diana texted me to check-in, as she often does. She knew I was struggling. She asked what she could do to help. I had no answers for her. She did what Diana does. She took the reigns and made an executive decision. In the midst of a terrible week, I received a love letter in the form of a blog post from Diana. Please read her wisdom below. I hope you will find inspiration in her words.

Lessons from a Mom with Typically Developing Children

Louisa and Haley met in Mrs. Davin’s three-year-old class at nursery school. Their love of princesses, space, and each other was instant and deep. Their strengths couldn’t be more opposite. Haley is an extrovert who raises her hand eagerly, makes friends with ease, is unafraid to be silly. Louisa is soft-spoken, gentle, and seriously focused. And yet, they became the kind of ride-or-die best friends that you hope your daughter will have throughout her life. It was the first time Louisa made a friend without me.

The ride-or-die best friends, Haley and Louisa.

Because of Haley and Louisa’s friendship, I got to know Shannon who had just had Sienna. I knew before Shannon shared it with me that Sienna had Down syndrome—I’m an educator—but we didn’t discuss it because I wasn’t sure she was ready to talk about it with almost-strangers. At the time, I wasn’t really focused on Sienna, and I had no idea what Shannon was going through. I wish I could go back in time and be a support for her in those early months. I’m actually getting teary writing this knowing that I knew her and was totally unhelpful. But, I was going through our own crazy medical journey that resulted in our daughter, Susanna, and maybe I was a little self-absorbed at that point. However, over time, Haley and Louisa became closer and Shannon and I went from carline acquaintances to casual mom friends to also being the kind of ride-or-die best friends that you hope your daughter will have throughout her life.

The more I got to know Shannon and Sienna, the more I wanted to know and be able to be a support system. It was becoming increasingly clear to me was that Sienna, like Haley and Louisa, and Shannon and me, was going to need girlfriends. Maybe even more than we do, she was going to need girlfriends who would love her wholeheartedly because, despite, and irrelevant of her diagnosis. When my daughter, Susanna, was born about a year after Sienna, we started calling her Sienna’s bestie. Susanna, Sienna, and their other girlfriend Ellen are still toddlers and the differences between them are limited at this point. But Ellen’s mom, Maggie (one of Shannon and my other close friends), and I have normalized this friendship, so hopefully when those difference do become apparent, their love for each other will transcend diagnosis. I imagine them together, twenty years from now, as bridesmaids in each other’s weddings.

From left to right, here are the besties Susie, Ellen, and Sienna.

At the same time that Shannon and I were becoming close, Louisa made her second ride-or-die best friend without me at her ballet class. Cooper saw Louisa and understood her in ways that I didn’t know were possible for a four-year-old. She drew Louisa out of her serious focus and into uproarious giggling games of detective and Star Wars and knew when Louisa’s anxiety was heightened and she needed to hold hands or a tight hug.

Just like how Haley made me become friends with Shannon, Cooper’s mother, Annie, has become one of my close friends, too. Annie is forthright and direct about the fact that Cooper has autism, and I’ve seen, over the four years of our friendship, how Cooper has responded to therapy and become more confident, social, and resilient. After Cooper had a particularly bad day with a monster meltdown when the girls were four, I had to talk to Louisa about Cooper’s diagnosis. I didn’t want her to think that her friend was mad at her or that she had done anything wrong, and I wanted her to be sensitive to the fact that this might happen again. I also knew that transparence is what Annie wanted. Louisa thought for a while after my feeble attempt at explaining what it means to be neuro-atypical, and concluded that Cooper has “superpowers,” a word she continues to use in her own explanation of what makes Cooper Cooper. Annie and I were tickled to hear that Greta Thunberg also describes her autism as superpowers. A coda to this story is that Haley and Cooper are classmates and Annie and Shannon have become friends, too.

I have, as far as I know right now, three typically developing girls. If you would have asked me 5 years ago about my children’s friendships, I would have imagined them having typically developing best friends. That’s not what happened, but I’m grateful every day for the love, friendship, and diversity that our friends who are more deeply affected by disabilities bring to our lives. Last summer we left Pittsburgh and the friends whom we love. Louisa still says Haley and Cooper are her besties, and Susanna still proudly wears her Sienna’s Squad shirt. I’m trying to find a buddy organization here so they can keep making friends with kids with disabilities. I am still learning how to be an ally and a friend to families with children with disabilities, but in the meantime here are some things that I have learned on this journey so far:

  1. Learn as much as you can about the child’s diagnosis. I read a bunch of blogs (I had been reading Girl in the Party Hat about Down syndrome far before Sienna came into my life), articles, and medical posts about these diagnoses. I needed to make sure that I used person-first language and accurate terminology. I also wanted to learn enough so that in an emergency, Shannon and Annie felt comfortable dropping their kids with me with no lengthy explanation.
  2. Give your child permission to ask questions. By saying that your friend’s child with autism is just like your typically developing child misses the point. Explain to your child in an age appropriate way what makes them different and what they should do best include a child with a disability. Questions are going to come up. Louisa knows that she can ask me and my husband anything about her friends, and if we don’t know how to explain it, I text Shannon and Annie right away to use the language they want.
  3. Offer to help and mean it. Families with kids with disabilities have some rough weeks with therapy or surgeries or extensive testing. Drop off a meal. Take the other siblings for a fun day. Just send a text offering support and don’t expect a response. Host a fun fundraiser for the family’s favorite charity. March, dance, walk, whatever with the family. By doing this, they will stop feeling bad about asking you for help.
  4. Listen and be a source of stress relief. Your friend who has a child with a disability has a lot on her plate. Let her vent to you. Ask questions and try to learn what you can. Also, do stuff together. Annie, Shannon, three other friends, and I had a standing monthly dinner and an annual spa weekend. We make time for our friendship and know that while we all have complicated lives, our friends with children with disabilities have a totally different level of crazy. The rest of us are thrilled to be the comic relief and the distraction.

 

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