Recently, there’s a lot of discussion about Individualized Educational Plans (IEPs) on one of the mailing lists I belong to. This discussion used to make me jealous, because, in the Netherlands, educational programming for students with disabilities may formally be based on a plan, but the plan is rarely followed and often, the student or parent isn’t even being informed. At least, when I was in high school and attending meetings with my visiting teacher of the visually impaired, these meetings were so informal that there really was no way of knowing whether what had been agreed upon, would be followed through on. Actually, in 2005, I received a copy of a document my visiting teacher had sent to the rehab center, and was surprised to find the strangest goals in it, that had neither been addressed nor worked on. I used to think that the reason was that most were social skills goals, and my teachers had long given up on that, but now I know better. Plans – whether they are school-related intervention plans, rehabilitation plans or treatment plans in mental health – are meant to be useless formalities that only serve to provide written documentation of what the professionals are already doing anyway. If any change of goals or strategies is suggested during a formal meeting, be guaranteed that it will not be followed – at least not if you happen to agree with the change. The nurses in the psychiatric hospital try to use the fact that I’ve been here for a year as an excuse, claiming that after this long, everything should be clear or will never become clear. Well, I tell you, it’s been this way ever since I came here last year: almost anytime anyone suggested that the current intervention might not be working or might not be the most desirable, this was put nicely into the treatment plan but forgotten the minute after the meeting had been closed. This happened to the suggestion that, rather than just putting me into time-out or threatening time-out in order to shut me up, we try to figure out why I had meltdowns. This suggestion was done on the January 24 treatment plan, so nowhere near the time when any change would mean nothing would ever become clear anymore. Not only was the time-out threat system continued without any change in intervention, and only terminated because I’d shut up for enough time, but it was the first thing my doctor came up with the day after I had a bad enough meltdown again. The only way to shove the ineffectiveness of the time-out stupidity into the people’s face, was by pointing out it was a major reason for the resocialization ward to turn me down. Now any meltdown is supposedly “normal” or “to be expected given circumstances”, regardless of the fact that I exhibit the exact same behavior, in roughly the same context, that earned me the time-out policy last June.
It’s not the hospital’s fault. Blindness rehab never gave me a plan, either, and skipped the ninth-week evaluation. They introduced formal rehabilitation plans only a few weeks after I’d started, so I never benefited from them, but I guess now that it wouldn’t have made a difference anyway. The training home put together three goal-achievement plans in eighteen months, while you should be getting one every three months, and only revised my care plan when a new request for funding was due.
<PIt isn’t saying that no changes in intervention occur. In fact, they always happen inbetween planned meetings, so that you have no time to go over the implications and discuss them reasonably. Both of my time-out policies were introduced inbetween treatment plan discussions – the second only a week after my treatment plan meeting -, and so was the vast majority of my follow-up placement decisions. No wonder that it was such an unclear mess: the open admission ward vs. resocializatioon ward battle was finally resolved when we did discuss it at a formal treatment plan meeting. But don’t ever think that you, as the client or patient, can change the way you’re being dealt with inbetween treatment plans. When I withdrew my consent for the time-out policy in the middle of August, anticipating being refused by reso ward if the policy continued, I was told to wait till my treatment plan and was then threatened with forced discharge. Treatment or care plans are important if the staff need them to be – ie. if you want to make changes that they disagree with -, but are just formalities if it suits them better – ie. if they don’t want to answer your critical questions. Monday’s my next one, and one nurse has already sort of vowed to be personally responsible for making it a totally useless formality.