Residential Care: A Story of Love and Caring for a Traumatized Daughter

Written By: Lizzie Vance, Aleksandra Corwin

Resource Creation By: Leeann Sanders

Designed By: Sunny DiMartino, Christy Bui

Lori’s* feet pounded against the soft grass as she ran back and forth through the yard, her heart beginning to race in her chest.

“Nadya,” Lori yelled, hoping her daughter would emerge from behind a tree or between the bushes at any moment. “Nadya, where are you?” Lori’s heart beat harder: what if she’s out in the street? Or worse, What if she’s been abducted? She tried to keep her panic at bay.

“Nadya! I have a treat for you,” Lori yelled again, desperate. She crossed the grass to the spot where she had seen her daughter just moments ago, then ran toward the row of bushes at the far back corner of the yard, all the while yelling Nadya’s name into the evening.

Just minutes ago Lori had called Nadya inside for dinner, and in the moment Lori turned to finish putting the food on the table, Nadya disappeared from view. It was always difficult to get Nadya to come inside, as transitioning between tasks often set her off, but even Lori was caught off guard by how quickly Nadya was gone.

After three years of violent outbursts, Nadya’s flight instincts seemed to be increasingly overtaking her fight impulses whenever she was triggered. To that end, her newly developed pattern of hiding took their entire family by surprise, and even more so in moments like this when obvious triggers were not apparent to other family members. The family was familiar with the house-wrecking, the throwing and shattering of sentimental objects; they were familiar with the screaming, Nadya’s little nose bleeding with the pressure; and they were familiar with the silent refusals, her frequent retreats into her own mind when she was faced with a decision she couldn’t make. But this? Nadya just . . . running away? This was new and Lori did not know how to deal with it yet.

Their home was in a mixed residential and commercial area on a busy street, and only one small office complex separated them from a major intersection. When Lori lost sight of Nadya, her heart swelled into her throat. While there were houses on the north side of the Hetzels’ home, Lori was always aware of the faint buzz of busy street noise one block away to the south. It would be easy for Nadya to make her way between the bushes and find herself in the parking lot of the office building next door, with easy access to the street.

Nadya had been diagnosed with reactive attachment disorder (among many other mental health labels that had been applied to describe her erratic behavior and emotional reactions). Others labeled her behavior as consistent with “complex developmental trauma” — an umbrella framework that described her pattern of impaired development as a neurologically wired reaction to neglectful, abusive treatment and poor care prior to the Hetzels adopting her.

Lori scrambled forward, her eyes darting back and forth. “Nadya, where are you!” The panic she had worked to keep abated grew.

Lori’s husband Karl heard her yelling and came outside. “What’s going on?”

“She was just here a second ago,” Lori answered, out of breath. “I was getting dinner ready and saw her though the window and I looked away for a minute and she was gone!” Lori’s mouth was dry as Karl joined in her frantic search. The two ran to the street and back, not sure what to do.

About 20 minutes later, both Lori and Karl noticed a police officer and a woman in the distance, walking down the street toward their house with Nadya beside them, staring down at the sidewalk.

“Oh, Nadya!” Lori shouted as she ran up to her daughter. Relief washed over her as she put her arms around her.

One of the office workers had seen Nadya wandering around the parking lot by the bushes, the police officer explained, but she wouldn’t say whether she was lost or where she lived. Only when the police officer arrived had Nadya pointed in the direction of her parents’ house.

The group stood on the street, and Lori tried to calm her shaking body as she explained to the officer and the woman that Nadya was cognitively delayed and had slipped from her view for only a minute. They nodded, but Lori could tell that, like most people, they didn’t understand; Nadya gave no obvious impression of having a disability to those who just met her.

“Come on, Nadya,” Lori said, beginning to steer her daughter toward the house. “Let’s go back inside.” But Nadya looked up at Lori with what the family had dubbed her “mean eyes,” and Lori’s stomach sank. Those “eyes” had become the signal to the outside world that Nadya was unlikely to cooperate (perhaps aggressively so) with whatever request had been made of her. Nadya kicked and flailed and screamed as Lori, Karl, and even the police officer tried to usher her inside, turning the relief that she had been found into another point of crisis.

From that day on, it seemed that almost every time Nadya’s emotions escalated, she made a beeline for the door. Sometimes Lori was able to get there first and block her way, at which point Nadya would rush to the back door. If Lori was lucky, she would again get there just in time to slide her body between Nadya and the back door, which triggered a strong “fight” response, escalating into a rage that preceded efforts to hit and kick as she tried to twist the door handle.

Lori knew that it was important to model healthy, neutral, and calm behavior for Nadya during these moments, but it was almost impossible to keep a totally cool head during such battles. Nadya’s erratic behavior always threw Lori off center. All Lori could do was bear the beating if it meant keeping Nadya inside the house. If she couldn’t — if she let Nadya run outside the way she wanted, how could she keep her safe? And what did all this mean for Nadya’s future? How long could they keep this up?

After several weeks of this new, fearful cycle layered on top of Nadya’s already-violent rages, Dr. Wilson, Nadya’s psychologist, paid the Hetzels a house visit one evening.

Dr. Wilson knew of the family’s resistance to out-of-home care, so although the idea was the elephant in the room, she led the conversation with alternatives. “Maybe you can get some motion-activated lights, or an alarm that would go off if the door is opened,” she suggested. “Parents whose children have autism use those.”

But Lori didn’t think that would help, as Nadya liked to play outside and sometimes it wasn’t a matter of running away so much as wandering away. “I don’t know what to do short of handcuffing myself to her,” she said.

“Well,” Dr. Wilson began gently. “Maybe now is the time to consider residential care.” Gauging Lori’s body language carefully, she went on. “It would give you a chance to get your family back together—”

Lori cut her off. “No, no way.” She shook her head. “I’m not putting her back in another institution.” Lori and Karl had rescued Nadya from the Russian orphanage three years earlier, and they couldn’t help but feel that residential care was just another version of orphanage care.

Dr. Wilson nodded and sighed. “I hear you. Maybe you could just think about it.” She saw the emotion in Lori’s eyes and reassured her that they were good parents. Dr. Wilson reminded her that a key to Nadya’s healing was that calm, well-regulated caretakers surround her. Dr. Wilson’s gentle observation reminded Lori of her own concern: that her family was under such duress that no one was happy or well-regulated, giving Nadya little hope for improvement. There were no moments of calm or connection in their household. In residential care, however, trained staff worked within a robust support structure and were able to recharge, without the personal responsibility of 24-hour care. Without this 24/7 responsibility, Dr. Wilson reminded Lori that she would be more capable of modeling the calm, thoughtful behavior that Nadya needed to make developmental progress and maintain a relational connection with family members.

As Lori, Karl, and Dr. Wilson talked, Lori felt a hole open up in her heart at the decision before them. How long could they keep patching the wounds of Nadya’s rage cycles and protect their daughter?

She kept praying their love would stop the proverbial bleeding, but was there evidence that real healing was happening? Lori felt defeated because the truth was, she just didn’t know. In that moment, out of the haze of pain and confusion, it became clear that it was time to try a new path. After carefully weighing all the factors for and against, and honestly assessing their own diminished emotional reserves, the Hetzels made the heart-wrenching decision to place their daughter in a residential program. It was becoming clear that around-the-clock care was the only thing they could count on to keep Nadya safe.

They began the process of enrollment, but the relief at entrusting Nadya’s care to Genessee Lake School in Wisconsin would take months to sink in. Karl and Lori felt desperate and wanted the best for their daughter, just as they wanted for all their children, while at the same time they felt guilty and wondered if they were letting her down. Lori was secretly afraid that a residential program meant she had given up on Nadya — that after all their years of hard work and therapy, they were throwing in the towel and had failed as parents.

In the time that Nadya spent at Genesee Lake School, the compassionate staff and organizational focus on trauma-informed care gave Lori comfort that she and Karl were doing the right thing. When Nadya returned home two years later, her violent rages had decreased so much that the Hetzels knew, without a doubt, that Nadya had received care and education that was life-saving. She had begun to implement skills to help her regulate her emotions, and function on a higher level than ever before, giving her a chance at a new beginning with her family.

A parent’s job is never done, and the work of Nadya and her family continues — Nadya still receives weekly visits through an in-home mentorship program provided by state-funded programs. Lori and Karl still wonder how Nadya will develop throughout the rest of her teenage years and into adulthood, but they know that their entire family is now working from a place of greater strength and understanding than ever before. They also know that there is a whole community of caregivers and parents available to help them. They know that they are not alone.

*Lori Hetzel is the author of a forthcoming book about her family’s experiences adopting an older, traumatized child, due in spring 2015 as part of the MyPath Library of books on disabilities. "Alina's Story" and "An Unlikely Trust" are also based on interviews with the Hetzel family and others finding their way through RAD.

Residential Care Assessment: Is It the Right Time?

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