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But the alternatives didn't work for David. In February, Jefferson County Social Services moved him from Colorado Christian Home to a therapeutic foster home, where he was to receive intensive day treatments and other supports. Two months later, the foster family asked that he be removed from the home because he was "too disruptive." The following month, while he was living at the Gemini Shelter in Lakewood, David ran away. He was later arrested after he fought with another student and trashed a classroom.
"It got to the point that David got so dangerous, there was just no way he could be maintained in the Mallamo home or anywhere other than a residential treatment center," Tomski says. "Someone was going to get hurt. What are you going to do? He's running. He's a danger to himself. I don't know how much more medical you can get."
Tomski and other child-welfare advocates fear that county agencies are using dual-diagnosis findings in order to negate their obligation to cover kids who obviously need care.
"I have seen them meticulously go through records to see if a kid has fetal alcohol syndrome -- or even a bump on the head," says one mental-health expert in the child-welfare system. "Anything in his past that can be used to deny treatment, they'll find it. You can have a file that's four inches thick that says, over and over, "mental health," but they'll still go searching for that one thing."
"The [mental-health providers] have to think in terms of what will be the maximum gain," says Dr. Skip Barber, former director of Denver Children's Home, the oldest residential treatment center in the city. "Sometimes they'll take the position that there's not a lot they can do for you. They have to look at it and say, 'Well, this treatment or this placement could wind up costing us $75,000 -- and to what gain? I think that's the thought process: 'We've already treated this as much as we can. Is this going to move us anywhere?'
"Everyone comes through and thinks they deserve a Cadillac level of care," Barber adds, "but the reality is, they're probably going to get Rent-A-Wreck."
JoAnne Doherty, JCMH's vice president of mental-health operations, says her agency uses the same criteria as other county agencies in determining when to deny or approve requests for residential placement and operates well within federal guidelines about what services JCMH is required to provide.
According to George del Grosso, executive director of the Colorado Council for Behavioral Health, like all county agencies, JCMH is struggling to meet the care requirements of its contract while making the most of a limited budget. "Before budget cuts, they had a little more flexibility," he says. "But now they've started following their own guidelines more closely. They've started getting tighter on who could get in. And it's part of a philosophical change in care -- to save money, but also to provide care as close to the child's community as possible."
Paul Mallamo says he accepts the reality that in tight times, services may not be plentiful, or premium. But he still feels that JCMH subverted its responsibility to cover his son's care and provide access to Medicaid benefits -- an entitlement that David brought with him when he entered the Mallamo household in 1996. Although Colorado's Child Mental Health Treatment Act -- passed in 1999 to help non-Medicaid kids with inadequate insurance get residential treatment center services -- created a grievance process for parents who wish to appeal a denial of treatment request, the Mallamos say they were never fully informed of their rights.
"If they would have sat down with us and said, 'Look, we've got a problem here, and we're going to need to work together,' we absolutely would have been game," Paul says. "We would have stayed up all night brainstorming with them; we'd have offered to pitch in. But instead they pull out this 'organic' argument. They could have just been honest. Instead they used subterfuge."
On September 25, Jefferson County District Judge Brian Boatright catalogued the demons that plague David Mallamo's mind and soul.
There were seventeen items on the list that Boatright read from the bench, including prenatal alcohol exposure, reactive attachment disorder, post-traumatic stress syndrome, anxiety disorder, dissociation, opposition defiant disorder, sexual impulsiveness, fascination with fire and attention deficit disorder. Lawyers from the Jefferson County District Attorney's Office, a guardian ad litem appointed by the court, social workers from the Jefferson County Department of Social Services, and a staff member from Jefferson Center for Mental Health were among the seven adults who listened as Boatright worked his way down the list.
David wasn't present that day, but his parents were. Since February, Paul and Susan Mallamo had come before the court nearly a dozen times, answering charges that they'd abandoned their son.
The Mallamos have never denied that in January, they turned David over to the custody of Jefferson County Social Services. They did so in order to secure his continued placement at Colorado Christian Home -- even though, without their knowledge and despite a court magistrate's directive that he remain there, David was moved into a foster home a week later.