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If you’ve ever spent time around a toddler, then you know how they can operate—joy one minute, meltdown the next. Tantrums are a typical part of toddler life. What Brittany and Ty Ashley have experienced with their adopted daughter Mira Grace, however, is anything but typical. 
“It just rocked our world,” Brittany said.
The outbursts began suddenly when Mira Grace was about 2 and a half. Ty describes her behavior as impulsive, aggressive and somewhat violent. 
“I felt imprisoned because we couldn't do anything,” he said. “It took two to three adults 24/7 to keep her from breaking the window or hitting somebody with a two-by-four.”
Mira Grace’s problems also extended to school. And they became a burden on the couple’s four other children. Brittany worried that Mira Grace might hurt them. 
Eventually, the Ashleys consulted Mira Grace’s pediatrician, who prescribed her Zoloft. It was the first step toward dealing with the growing problem. But it didn’t take long before the pediatrician recommended that the family seek additional help from the PATHS program at Children’s of Alabama.
PATHS, short for Pediatric Access to Telemental Health Services, was created to help primary care providers throughout Alabama diagnose, treat and manage mild to moderate behavioral health conditions in children and adolescents. If a practice enrolls with PATHS, then a provider can reach out to the PATHS team to consult, usually via telehealth, about behavioral health concerns or questions involving a patient. In many cases, this leads to telehealth appointments between the patient and a PATHS team member.
For the Ashleys, who live in Florence, Alabama, the program seemed like a good fit. Driving two hours to Birmingham every time Mira Grace had an appointment wasn’t realistic. Instead, they could go to their pediatrician’s office and visit with a Children’s behavioral health professional via iPad. 
Initially, however, the Ashleys were skeptical. Would telehealth really work? “That was something I questioned,” Brittany said. “Not being in person with them, are we really going to connect?”
But after giving some thought to it, they decided to give it a try. They set up a telehealth appointment with Children’s psychiatrist Dr. Connie Chang. She told them she’d had another patient similar to Mira Grace, which provided some reassurance. And the connection between Chang and Mira Grace was no problem. Brittany says she was pleasantly surprised. Finding a long-term solution, however, would take some trial and error, Chang told them. For several months, that’s what the family experienced, going through one combination of medications after another.
“We would give the medicine and talk again in two to four weeks, reassess, change medicines, add medicines, talk again in two to four weeks, reassess,” Ty said. 
The road was bumpy, with stretches of normal behavior punctuated by flareups or side effects that ultimately led to reassessments. But after about a year and a half, they figured out the right cocktail. And for the past several months, the situation has been “relatively stable,” Ty said.
All along, Chang has provided support—not only to help with Mira Grace’s flareups, but to offer encouragement for Brittany and Ty.
“It meant a lot just for someone to grasp what we were dealing with, because a lot of people can't understand all of this,” Brittany said. “And Mira Grace is adopted, and so that's another level. It's just a world that 99% of people don't get, so to be seen and heard and understood and encouraged was huge.”
Chang also made sure that Ty, who’s a family doctor, and Brittany, who’s a social worker, had a voice in Mira Grace’s treatment. “She was really good at taking everybody’s information into account,” Brittany said.
Since they started seeing Chang, Mira Grace’s appointments have reduced from every two weeks to every four weeks to now every few months. At some point, Chang will simply be available to help when needed. That’s the family’s current goal. And while Ty says it’s still a struggle at times, they’ve moved past their need to have multiple adults containing Mira Grace. It’s clear to the Ashleys that their daughter has more peaceful days ahead.
“We live on hope,” Brittany said. “And we see progress. We celebrate every small victory. Every good day we have is huge.”
Their hope, they say, is attributable to the PATHS program—a lifeline, they call it, to improving their daughter’s behavioral health.