Throw Away the Key
It's 11 a.m., and two of the girls living in the treatment center in north Boulder are sleeping. The other four are still in their pajamas, lounging on couches in the living room and laughing hysterically as they recite lines from Sugar and Spice, the movie they saw last night about high school cheerleaders turned robbers. Two women in charge of supervising the girls look on with amusement. "We should put on a comedy show with you," one of them says.
That's all the encouragement the girls need before running off to the kitchen and returning with carrots stuck in their nostrils, ears and mouths. Repeating their favorite movie phrases this way is much more fun. They let out the kind of laughter that makes their sides hurt and their eyes water. One girl cracks herself up so much that she collapses on the floor.
These four girls -- whose identities have been protected because they are juveniles -- range in age from thirteen to sixteen, though each looks older and more hardened than her years. They're here either because they've committed a crime and were ordered to live in the home by a judge, or because they were abused and neglected by their parents and sent here for their own protection. Most have been here for at least a month. In that time, they've learned to function as a family, living by a set of rules, performing chores, eating dinner together, arguing among themselves and leaning on each other. Some of the girls have found in this home what they were lacking in their own: safety, compassion, and the assurance that no matter how bad their lives have been, they're not alone.
For a residential treatment center, the place is surprisingly laid-back. (According to state statutes, an RTC is a home that provides long-term care and treatment, 24 hours a day, for five or more children or teens; approximately 1,500 kids in Colorado are currently living in RTCs.) The girls can leave, unattended, for a few hours at a time, but they have to earn their freedom by proving that they can be trusted. It's a freedom they haven't had at most of the places they've been sent in the past.
The system works on an honor code; there are no locks on the doors. And the staff isn't allowed to restrain the girls if they cause problems or try to escape. That freedom is what the girls love about the home.
It's also what Boulder County officials hate about it.
For all the playfulness at the home on this July morning, there's a profound sense of sadness hanging overhead. The girls learned just a day earlier that the home will close at the end of August.
It is shutting down because the Boulder County court system gradually stopped referring anyone to Attention Homes, the private nonprofit that runs the girls' home as well as a similar home for boys in south Boulder and a youth shelter that closed in February.
The reason, county officials say, is that Attention Homes won't change to suit their wishes.
Over the last ten years, the county has moved toward a philosophy of treating troubled kids in their own homes with a variety of intensive social services. Only the most difficult are sent to RTCs. Since Attention Homes has rejected adolescents with extreme problems, however, it is no longer needed, the county reasons.
Attention Homes tried to stay in business by accepting more kids from other counties, but the county reacted by cutting the nonprofit's funding -- about $30,000 a year -- saying it couldn't support the organization if it wasn't serving Boulder County kids. Furthermore, county officials claim, since Attention Homes has refused to become a "staff-secure" facility -- one in which the doors temporarily lock if someone tries to open them without permission and where staff members are allowed to restrain kids if they try to escape -- some of the kids have run away.
Employees of Attention Homes maintain that the county sent them kids who needed psychiatric help, not the kind of treatment they could provide. They also say that IMPACT, the county entity responsible for referring kids for out-of-home placement, is driven only by the bottom line. IMPACT (Integrated Managed Partnership for Adolescent and Child Community Treatment) was created four years ago after the state legislature approved an experimental child-welfare reform system in which Boulder County has taken part. The system is designed to save the state money by letting counties handle their own child-welfare budgets.
IMPACT and Attention Homes are currently in mediation to figure out what to do with the three homes; the county reportedly wants to buy the youth shelter and lease it out to another RTC that would operate it as a staff-secure facility. Because they're in mediation, staff and board members for both IMPACT and Attention Homes have agreed not to discuss the situation, but employees who have already been laid off as part of the home closures have plenty to say.
"They were asking us to entirely change our philosophy," says Kate Goode, a three-year employee of Attention Homes who acted as operations director until she was laid off this summer. "That's a lot to ask for $30,000 a year."
Attention Homes was founded in 1966 by Bud Holmes, a Boulder district judge who saw a need for alternatives to juvenile jail. The nonprofit operated the Broadway Youth Shelter, a short-term facility for runaways and homeless kids, which closed in February; the girls' home, which served up to eight girls between the ages of twelve and eighteen (it was called the Pine Street Home before relocating to the youth shelter after the latter closed); and The Bridge, an equivalent home for boys.
Before the homes opened, Holmes took some of the kids who appeared in his court home with him and told his own six children that they were going to have roommates for awhile. Holmes died in 1998, but his widow, June, has kept current with issues affecting the nonprofit her husband started. She can't remember how many kids he brought home from court, but she knows there have been many success stories.
"Last summer a girl came to my door and said, 'I'm Linda.' She was one of the girls he had brought home. She grew up and lives in Phoenix now and has a son of her own. She is running a home for the elderly there, and she's done very well," June recalls. "We had dinner together, and it was incredible to me that she took the time to come and see me."
But Holmes couldn't bring kids home with him forever, so he established an organization that could provide the kind of compassionate care he felt they needed. He "loved children and wanted the best for them," June continues. "He decided he didn't want to send them to jail. He dreamed of giving them attention instead of detention."
Jennifer Patterson likes that approach. Patterson, who is eighteen, isn't violent, but she has broken the law.
Five years ago, she moved with her mother from Illinois to Boulder to get away from her abusive stepfather. But because she had problems with her mom, she began running away from home at the age of fourteen. That's when she started doing drugs: pot, mushrooms, acid.
Three years ago, she and three friends (ages twelve, fourteen and fifteen at the time) stole money from one of their parents, cashed out their own bank accounts and bought a car. Patterson, who had learned to drive when she was twelve in rural Illinois, drove them to Las Vegas, where they splurged one night on a $260 room at Circus Circus, then made their way to California. One day, after they'd been gone a week, Patterson pulled over at a construction zone in Independence, California, to take a nap. A police officer pulled up to investigate the stopped car, and Patterson confessed that they were runaways. She and her friends were held in jail for two days until a bounty hunter her mother had hired to find her arrived to drive them back to Colorado.
"I really messed up. I was really stupid. I can't believe I did that when I was fifteen," she says.
Because she was viewed as the ringleader on that trip, a judge placed a no-contact restraining order against her that prohibited her from seeing her three friends. She violated the order twice and had to go to juvenile jail. Since she was considered such a bad influence, her boyfriend's mother got a restraining order that prohibited Patterson from seeing her son. Her boyfriend came to her house once, and she got sent to jail for violating the restraining order. After her release, she ran away from home, a violation of her probation that landed her in jail yet again.
Over the years, Patterson has also been detained in Greeley's Platte Valley Youth Services Center, Englewood's Marvin W. Foote Youth Services Center, Denver's Mount View Youth Services Center and the Boulder County Juvenile Detention Center. She's been sent to an RTC in Fort Collins and to an independent-living program there; she ran away from both and got in trouble for doing drugs. Patterson celebrated her sixteenth and eighteenth birthdays in jail; she turned seventeen while on the run.
About eighteen months ago, she decided to change. "It's been a long process. You don't just wake up and change. I realized my life is worth more," she says. That's how she landed at Attention Homes: Her parole officer saw that she was serious and decided to refer her to the girls' home rather than jail. "My criminal days are over. I'm not a danger to society, I'm a danger to myself," says Patterson, who arrived at the home in June. "I have to deal with my addiction and abuse, and I finally found a place where I can do that, and now it's closing."
The home has been good for her, she explains, because the staff boosts the girls' self-esteem, teaches them responsibility, gets them involved in positive activities, helps them become self-sufficient and reinforces good behavior. If the kids do their chores and follow the rules, they earn a certain number of points that can be used on "auction night" to buy a variety of things, including free time, candy, makeup, magazines and movies. If a resident returns home late, gets into a fight or doesn't do the dishes when she's supposed to, she loses points.
"This place teaches us how to fill our time. For a lot of us, we spent all of our free time getting high. In a locked facility, you eat and sleep and talk about your issues, but you can never leave," Patterson says. "When I came here, they asked me what I like to do. No one had ever asked me that before. I told them I like softball and yoga, and they put me on a softball team and started a yoga group at the house. I also told them that I liked the AA (Alcoholics Anonymous) meetings I used to go to when I was up in Fort Collins. Every Friday, they drive me to Loveland for that AA meeting.
"I never felt like I could talk to the staff at the other places I'd been. Here, they don't just tell you, 'No, you can't do that.' They talk to you and help you process what's going on. If I was around drugs one day, I could come home and tell them that, and they'd talk to me about why I was around drugs. They let you make mistakes here. In a locked facility, you can't make mistakes; if you mess up, you're back in jail.
"Sitting down and listening is all that most kids need," Patterson continues. "Kids are so impressionable that most of them can change if they have a chance. If you keep telling kids that they're dangerous and lock them up, it will become a self-fulfilling prophecy. You can't keep them locked up forever, and when they get out, they won't know how to survive, so they'll commit more crimes and wind up in jail."
Senchal Jamal, a seventeen-year-old Attention Homes resident, agrees. Jamal, who can be identified because she is emancipated from her parents, didn't want the details of her criminal past published, but for several years, she's been in detention centers and staff-secure RTCs, where employees have tackled and restrained her when she acted up.
"One time a staff person called me a spic, and I went off on her. I ended up on the floor with six guards on top of me. They put me in shackles. That happened in a locked facility that they're so eager to open here," she says. "Having someone sit on top of me only makes me want to sit back on top of them. You shouldn't put someone in restraints; you should talk to them like they're a human being, not a dog."
One of the younger girls had similar experiences. "The county is saying that a compassionate, hands-off facility is ineffective and outdated. Sorry, I didn't realize compassion wasn't appropriate in our society. I've been in hands-on facilities where they restrain you and seclude you, and it doesn't work," she says. "This place teaches us effective real-life skills. The staff is really good here. They talk to you whenever you want. They'll sit down and offer advice and opinions and let you help yourself. The staff at most other places won't talk to you. If you act up in any way, they say 'QR' -- Quiet Room -- and you get half an hour there."
The young women acknowledge that the freedom at Attention Homes can be easily abused, but they say it helps most people become self-reliant. "There is some structure here," Patterson says. "We have to do chores, we have therapy and group sessions we have to attend, and if we leave, we have to be back at a certain time. But I have time during the day to plan things for myself. I don't have people telling me what to do all day. It's good for me, since I've been in the system for so long. When you've been in the system as long as I have, you become institutionalized. Someone tells you when to eat, when to sleep and when to wake up, so you become dependent on other people. I need to learn to do things on my own. I'm eighteen. I'm at the point where I have to be able to live on my own and function as an adult.
"For the most part, it works," she adds. "Some kids can't handle that freedom, so, regretfully, they run. But most of the time, those kids realize it's not the program for them before they run or relapse, so they get discharged because the staff doesn't want to see them fail and then have to send them to jail. If kids stick with the program here, they leave a better person. No one leaves unchanged."
In the late-1990s, the state legislature began looking at ways to control the rapidly increasing cost of supporting kids like Patterson and Jamal throughout the state. The method then was for the state to dole out child-welfare dollars to each county based on its need. In 1992, that cost the state $40 million; by 1997, it cost almost $140 million.
"The state was at the mercy of the counties, which were all overspending," explains Allen Pollack, who used to work for the state human-services department and is now a child-welfare administrator for the Boulder County Department of Social Services. Colorado legislators considered turning child-welfare services over to a private managed-care company, but after examining the privatized system in Kansas, they decided against it.
In 1996, Kansas contracted with private companies to provide foster care, adoption and other child-placement services. But Lutheran Social Services, the company in charge of managing the adoption program, couldn't move enough kids into new homes and ran up huge debts as a result. The company was on the brink of bankruptcy last year and only avoided filing for Chapter 11 protection by convincing its creditors to accept 74 cents on every dollar it owed. Then, in June of this year, United Methodist Youthville, a private foster-care company working with the state, filed for bankruptcy after losing a contract to provide foster-care services in western Kansas.
To avoid relying on private managed-care companies and still contain costs, Colorado lawmakers instead created pilot programs in 1997 in Boulder, Jefferson and Mesa counties to test whether those counties could effectively manage their own child-welfare budgets without state involvement. The counties agreed to receive a fixed amount of money from the state based on what they had spent the previous year; if they were able to spend less than what they got, the state would allow them to reinvest the remaining money in other programs for children. If the counties blew their budgets, though, they'd have to cover the remaining cost themselves.
A year later, Arapahoe, El Paso and Pueblo counties joined the program. Beginning this past July, all other counties were invited to join as well. So far, several, including Denver and Larimer, have expressed interest. The law expires after this year, however, at which point the state legislature will have to decide whether to extend it.
Although most of the pilot counties in Colorado don't contract with private agencies (El Paso is the only one that does), they do use some of the principles of managed care and HMOs -- namely, a "utilization review." That's "the process of putting a group together to review utilization of services," Pollack says. "In other words, are we getting the services we contracted for? Are kids' treatment plans working? If they're not, the treatment plan changes.
"Before 1997, if a caseworker needed to place a kid, the mantra was to place the kid in the first available bed, not necessarily the best available bed. What utilization review does is make the right placement," he adds.
In Boulder County, a special board of directors was created to oversee its program. IMPACT is made up of the heads of every county agency that deals with children: the social services department, the mental health center, the probation department, the health department and community corrections, as well as representatives from the Colorado Division of Youth Corrections (DYC) and the St. Vrain and Boulder Valley School Districts. The board meets once a week to discuss how the agencies can avoid duplicating services, share resources and ideas and, ultimately, save money.
A community-evaluation team was formed to help kids who have been in jail or foster care make the transition back into their homes and find jobs. A placement-review team, made up of eight administrators from each of the agencies, reviews the approximately 650 juvenile-delinquency and dependency-and-neglect cases each year in which kids have been recommended by social services or the courts for out-of-home placement.
It's the review team that decides whether kids should go to an RTC, a foster home, a psychiatric hospital or jail.
Pollack says that Boulder's review team, on which he sits, follows each case to make sure that the placements the team chooses are best. "A lot of people will argue that Colorado isn't doing managed care, but if you define managed care the way I do, it is. It's the opposite of unmanaged care, which we had before 1997."
Boulder County places a lot of importance on keeping kids in their homes with services that are coordinated through IMPACT, both because county officials think it's better for the kids and because they have found they can save money that way. In 1997, the county spent $2.2 million on out-of-home placements; in 1999 it spent just $1.9 million.
Arapahoe County, which has twice as many juveniles as Boulder County, spent more than three times as much on out-of-home placements in 1997 ($6.8 million); in 1999, it spent $7.4 million.
Boulder County has also decreased its rate of adolescent mental-health hospitalization: In 1999, the average daily population in psychiatric hospitals was two; last year it decreased to 1.09, and this year it was projected to be .56. The amount of time Boulder County kids spend in psychiatric hospitals has also gone down: In 1999, the average length of stay was 35 days; last year it was eleven days, and this year it is projected to be five days.
And since IMPACT started, fewer Boulder County kids are spending time in jail and detention, and those who do get sent to the Division of Youth Corrections are spending less time there than they did four years ago. IMPACT projects a total savings this year, in DYC commitment and detention costs, of more than $955,000.
Critics of the system, including psychologist Jan Hittelman, who held a variety of positions at Attention Homes before being laid off in late July, say the real comparison to HMOs comes with IMPACT's concern for dollar signs.
"The county uses this rhetoric of wanting to keep kids with their families, but a lot of kids are in toxic situations with their families. Clearly, their motivation is to save money," he says. "Residential treatment is really expensive compared to keeping a kid in his home. And psychiatric hospitalization is even more expensive than residential treatment, so the county tries to place kids in a cheaper level of service whenever it can. The only way to save money in child welfare is to underserve kids."
If more counties adopt Boulder County's model, Hittelman predicts, "it will translate to more homeless kids and more kids committing crime. It will cost the state more in the end because they're not providing the prevention and treatment kids really need."
Attention Homes's Goode says the county's assertion that kids either need to be treated in the home or placed in a secure facility is too black-and-white. Attention Homes serves the kids in the gray area -- the ones who can't be treated at home but who don't deserve to be in jail or in a tightly supervised RTC. "There's no way that Boulder is the only county in the state that doesn't have kids who fit this level of care," she points out.
Michael VanElzakker, a mental-health worker at Attention Homes, made the argument best in a letter to the editor that appeared in the August 1 issue of the Colorado Daily. In it, VanElzakker, who tells Westword that his letter speaks for itself, explained that there are three levels of care in the child-welfare system:
"'A' level kids may have been in trouble with the law once or twice, but have not committed violent crimes. They are not in immediate danger at home; they are not being physically or sexually abused. They can go home and meet with a psychologist once a week. That is all they need," he wrote.
"'C' level kids require 'staff secure' placement. These facilities are basically jails for kids. Locked doors, jump suits and physical restraints. That is what the commissioners want in Boulder...The commissioners are cutting down funding to two options: home or jail.
"There is a middle ground between home and jail that is being eroded," he continued. "Attention Homes deals with 'B' level children from both the DYC and the Department of Social Services. This is not an insignificant group of kids, and their needs are quite specific. For example, if a young girl is being sexually abused by her father but has never done drugs or committed a crime, where does she go? Back home? Locked up?... Attention Homes fills that middle ground. She is away from her awful home but she is not being punished. She has access to therapy but will never be physically tackled by the staff. Although I can't give exact case histories, suffice it to say that this scenario is very much based in reality."
Pollack says these criticisms of Boulder County are unwarranted. "I think it's a valid criticism in the private managed-care system, but not in this system. When you take a kid, put them in their own home and wrap services around them, that takes a lot of money, so there's no savings there," he says. "With managed care, we wanted to eliminate dollars that were unaccounted for and wasted in the past. We contain costs, that's for sure, but there haven't been any huge profits anywhere."
That's true. According to a state report, in the 1997-98 fiscal year, Boulder County saved only $30,000, which it used to hire a therapist for a sex-offender treatment program. Jefferson County saved nothing, while Mesa County saved $279,000. In the 1998-99 fiscal year, Boulder County saved $69,000, which it used to continue funding the therapist, hire a substance-abuse evaluator and provide respite care for kids living with relatives or foster families. Jefferson County saved $175,000; Mesa County saved $418,000; Pueblo County saved $269,000; El Paso County saved $1.3 million; and Arapahoe County saved nothing.
And last year, most of the counties lost money. Boulder County overspent its child-welfare allocation by almost $1.8 million; Jefferson County overspent by $2.3 million; Arapahoe County overspent by $939,000; El Paso County overspent by $996,000; and Pueblo County overspent by $360,000. According to the report, Mesa was the only county that saved money, about $422,000.
Pollack says that the overspending was caused by three things: an increase by the state of Medicaid funding for RTCs last year, which came out of the counties' capped budgets; an increase in the room-and-board costs at RTCs; and an increase in counties' salaries for social workers, mental-health workers and other government employees in order to compete with the private sector. However, the state's total allocation to the pilot counties did not increase.
Although the savings haven't been enormous, IMPACT is still regarded as a model for other counties to follow.
"Boulder County already had one of the lowest out-of-home placement rates and detention and commitment rates in the state, and we've made it even lower," says Kit Thompson, IMPACT's director. "Our out-of-home placement rate went down 15 percent in the first year, and the length of stay [in out-of-home placements] went down 20 percent."
In addition, Boulder County has gotten the cooperation of the juvenile justice system, whereas the other counties' initiatives involve only child-welfare agencies. "In typical Boulder fashion, we made it bigger than it needed to be," Thompson jokes. "We've done consultation all over the country and the state, and we're the only one in the state -- and probably the country -- that has brought youth corrections into the equation. And we have a very supportive court in Boulder County. It's very hard if DAs and public defenders aren't supportive, because there can be turf wars over who has authority over what and over whose pot of money is being used. We took on that issue early on and said that everyone has to give up a little power to make it work.
"In the past, you'd have a caseworker, a mental-health worker and a probation officer each with his own plan for the kid," she continues. "That led to a lot of arguing in court. Now that we have the placement-review team, all of those people come together and make a unified recommendation in court. That is one thing we have in Boulder that no other county has. In most counties, social services will say, 'That's not our kid, that's a mental-health kid.' They do a lot of system-dumping on each other. We wanted to look at kids as all of our kids, despite the funding stream, and we've been able to provide a seamless delivery of services."
While county officials congratulate themselves on containing costs and reducing the number of expensive psychiatric hospital and DYC commitments, the dispute with Attention Homes involves much more than a debate about what to do with troubled kids.
At a June hearing before the Boulder County commissioners, Greg Brown, who supervises juvenile programs for the county's probation department, said that working with Attention Homes had become very difficult. (Attention Homes requested the hearing so it could address the funding issue.) "The relationship is so harmed with the judicial system, and confidence is so low with Attention Homes, that it's very hard to get anyone to approve a placement there, starting with the magistrate and the probation officers," he said.
"There have been a lot of problems and a lot of difficulties in keeping kids there, and it seems to have a lot of emergencies that we have to end up handling," Brown added, explaining that every time he thought Attention Homes had resolved its problems, "the same kinds of issues come up again, and kids aren't able to be kept safely there."
Christine Highnam, director of the Boulder County Department of Social Services, who spoke to Westword just before IMPACT entered into mediation with Attention Homes, agrees. "We've had issues of kids victimizing other kids, kids using and selling substances at the homes and kids running away," she says, adding that confidentiality laws forbid her from providing specific examples. "Because kids can get out easily, they can commit additional crimes. We want to turn these kids around, not have them back in the system." (Between January 2000 and May 2001, ten Boulder County kids ran away from Attention Homes).
The problems began two years ago, when county officials urged Attention Homes to change its status from a Residential Child Care Facility -- meaning it could accept kids with mental-health diagnoses, but not severely troubled kids -- to an RTC. Since Attention Homes wasn't equipped to handle tougher kids and didn't have the staff to treat them, the county asked the organization to make serious physical, programmatic and safety improvements.
In February 2000, the IMPACT board met with Attention Homes employees. They followed up a week later with a letter outlining a list of changes they wanted to see, including: providing less free time and more structure for the kids; hiring additional therapists and child-care workers; installing alarms on the windows and doors of the youth shelter; offering more support groups and more therapy sessions; hiring additional staff to clean the homes and cook meals; installing air conditioning, additional lighting and new carpet and paint in the boys' home; remodeling much of the girls' home; and providing more staff training. IMPACT also stated in the letter that it needs "a staff-secure model of sheltering."
It was a tall order, but Attention Homes was willing to hire more staff and spend between $250,000 and $300,000 to make the improvements -- all except one.
"We don't lock our doors from the inside because of the scenario it creates," says Attention Homes' Goode. "If a kid wants to leave, he wants to leave for a reason. When the doors are locked, you have an escalated kid who wants to get out and then feels like a trapped, scared animal. From day one, we said we would never do that. That's not who we are. We were very clear about that, and [IMPACT] appeared to understand that."
But that understanding was not so apparent in a March 2000 letter from Thompson to Attention Homes. "As was stated in our joint meeting last week, the IMPACT board and our community partners feel that a fundamental chasm has developed between the kind of program we need to serve our county's kids and the type of program Attention Homes has wanted to provide. We feel that this comes down to a question of philosophy and goals. That is, whether you are prepared to modify the Attention Homes philosophy to meet the needs of a changing marketplace."
Dana Andrews, licensing administrator for the child-care division of the Colorado Department of Human Services, says RTCs can't have permanently locked doors. They can, however, have "time-delayed panic hardware." When a child tries to open the door at a staff-secure facility, an alarm will sound or lights will flash to alert the staff that a resident is trying to leave; at that point, the door will lock for a short period of time to give the staff a chance to "intervene," which, at some facilities, means tackling or restraining the child.
But staff-secure facilities are not the norm. Of the approximately sixty RTCs in Colorado, only seven are staff secure. And only two of those use time-delayed locks; the rest provide 24-hour staff supervision.
This hasn't prevented Boulder County from sending its kids to some of these RTCs, however. That's because the problems at Attention Homes are deeper than just this one issue, according to a report issued by Attention Homes's own consultant. In the summer of 2000, Attention Homes hired the consultant to help the organization develop a strategic plan; part of that involved interviewing numerous people who have dealt with Attention Homes, including Boulder District Chief Judge Roxanne Bailin, Boulder police chief Mark Beckner and Thompson. The report quoting from those interviews offers details about why county officials had quickly grown frustrated with Attention Homes.
"With RTC [designation], there is the expectation and assumption that Attention Homes can handle tougher kids," reads one comment (the names of the interviewees were removed in the report). But, it goes on, "Attention Homes will take a higher level kid and then want the kid out when s/he causes problems; staff is not setting the limits and providing clear structure that kids need to feel safe. (Recent example: Mattress thrown at another kid. Attention Homes wanted kid removed. Was it the kid or was it a supervision issue that this occurred in the first place?)"
Another observation reads: "Boundaries are not clear enough between staff and residents...Kids are allowed to swear at staff. Staff treats kids as equals and they are not equals; some staff share private information with residents. Little things send big messages...Staff is young -- they want kids to like them, but kids need clear structure and consistency. If there is a bully among the residents, kids won't feel safe if there is a weak staff member trying to be everyone's friend."
Someone else warned: "Be careful about the level of fun things -- delinquent kids need to understand the real world consequences if they blow off parents and get into trouble. Shelter shouldn't be 'reward.' They need to understand the weight of the course they have chosen. Don't be too quick to support kids' issues -- listen and understand each kid."
Thompson echoed some of these thoughts at the June public hearing. "Our kids who currently need shelter are in other shelters around the metro area that are staff-secure, which means they have various methods to keep the kids there so that they can stay safe," she told the county commissioners. "Attention Homes, at a certain point, decided they could not be that kind of shelter. We could have many more kids placed there if it was that kind of a shelter.
"We do have a proportion of our population that needs RTCs," she continued. "Compared to the population ten years ago, it is a more challenging population, with more mental-health issues, more behavioral issues than you would have seen ten years ago. That's a statewide phenomenon, not just a Boulder County phenomenon. What's happened is that RTCs across the state have adjusted, and they've changed their programs and staffing, and that's why we can send our kids to RTCs in other counties and they do very well."
The times have indeed changed since Attention Homes opened in 1966. Psychologists have noticed that kids are exhibiting more extreme behaviors than they have in the past, and RTCs, in particular, are feeling the effect.
"Residential treatment centers are getting more difficult kids because counties are trying to place kids in a less restrictive environment, but that also means a less expensive environment," says Karen Silverman, executive director of the Colorado Association of Family and Children's Agencies, which represents nonprofit adoption agencies, RTCs and other child-placement agencies. "Ten years ago, severe kids would go to Bethesda or to some other psychiatric hospital, but a lot of those places closed. So kids who would have been in psychiatric hospitals ten years ago are now in residential treatment centers, and kids who would have been in residential treatment centers are now getting treated in their homes. There's a lot of cost-shifting going on nationally, and people are looking at managing these populations without spending a lot of money."
Skip Barber, who runs the Denver Children's Home, a nonprofit RTC, used to be the chief psychologist at the treatment center for children and adolescents at the state psychiatric hospital in Pueblo. He's witnessed the extreme changes in adolescent mental-health treatment over the years.
"More than 700 psychiatric beds for kids disappeared in the last ten years," Barber says. "There are less than 300 beds left now. Where did all of those kids go? Did they disappear? No, they were redirected into RTCs."
That left county court and social services systems with little choice but to send kids to RTCs, he says. And RTCs aren't exactly cheap. It used to cost $200 a day to treat a resident at Attention Homes, which is more expensive than sending kids to jail, where, according to the DYC, the average daily cost per adolescent is $160. But it's less expensive than sending kids to psychiatric hospitals, where costs can soar to more than $350 a day.
"It's a wonderful thing that Boulder has attempted to do," Barber says of the IMPACT initiative. "Part of the problem in the system is that mental health has money here, and social services has money there. Boulder said, 'We'll put all of our money in a single pot and make decisions for all of them.' I applaud them for the effort, because it makes no sense for systems to fight each other, but the thing no one addresses is that it's a great philosophy if the pot of money is adequate to address the needs of the population you're trying to serve. If the county doesn't have enough money to pay for expensive interventions, they can't place kids in expensive interventions."
Barber blames the state for the dilemma. While treatment costs at RTCs have increased by 20 percent over the last five years, the reimbursement rate in Colorado has only risen by 2 percent, according to the Colorado Association of Family and Children's Agencies.
"They've made counties responsible, and they've pitted providers against counties," Barber says. "The reality is that the state is underfunding the system."
Between January and December 2000, only 52 of the 155 kids who lived in one of Attention Homes' three facilities were from Boulder County. Part of the reason was that Attention Homes didn't feel comfortable with the kids Boulder County was sending them.
One aggressive boy who'd been abused on his Indian reservation came to Attention Homes doped up on a variety of psychotropic drugs. "He was incoherent and staring into space when he got there. He woke up the next day and didn't know where he was. He became verbally abusive to staff," says Hittelman. The boy stayed at the shelter for six weeks before IMPACT placed him in an RTC outside Boulder County. "This is a kid who should have been immediately taken to a detox program at a psychiatric hospital. He needed a hell of a lot more services than we could provide. He was one of countless kids who were inappropriate and who the county had no interest in putting in an appropriate place."
Goode remembers another boy whom she says the county shouldn't have placed at the youth shelter. "He was severely suicidal, and within a few days, he was out the second-story window, ready to jump. One of our staff members had to put her arms around him to keep him from falling out," she says.
And so Attention Homes had no choice but to discharge the two boys in the hopes that they'd end up in a more appropriate place. Between January 2000 and May 2001, Attention Homes discharged 23 Boulder County kids and rejected fifteen kids whom the county had referred to them. During that same period, they accepted a significant number of kids from outside of Boulder County.
During the June public hearing with Attention Homes, Boulder County Commissioner Jana Mendez explained the problem this poses. "When you bring in kids from other counties, and if they should stay here and get into trouble, then it is our total financial responsibility," she said. "And if they get sent away to DYC, it's at our expense, and that takes up a bed we are contracted to buy only so many of. Those beds should be saved for Boulder County kids. [Those beds] should not be taken up by kids brought to this county from other counties."
Goode says that attitude is hypocritical. "They say kids from other counties are draining their system, but they're placing kids out of county, so they're draining every other county," she says. "We had an agreement with Boulder County to serve at least 50 percent Boulder County kids, but then we found ourselves unable to do that."
The other part of the problem was that referrals from Boulder County were dwindling. In 1997, the county referred 160 kids to Attention Homes; that number dropped to 153 in 1998, to 119 in 1999, to 57 in 2000 and to just 11 this year. By May, there were no Boulder County kids in Attention Homes.
By January of this year, the shelter was only 25 percent full, which translated to a loss of $20,000 that month; in February, it closed.
Then, in March, the county commissioners informed Attention Homes that it would no longer fund them. "We were funding care for kids in other counties, and I didn't think taxpayers would be happy with that," says Commissioner Paul Danish. "We have a big heart in Boulder County, but when it comes to tax dollars, we need to solve our own problems, not those of the whole world."
"Attention Homes is providing a service we really don't purchase anymore; it isn't providing the kind of facility we'd like to see, which is an intensive-treatment model," adds Commissioner Ron Stewart. "We're trying to find a way to get that with a compromise agreement. Our kids are our responsibility, and we don't want to send them to other places in Colorado."
The county had been giving Attention Homes $30,000 a year. Considering that Attention Homes had an annual budget of $1.3 million, the county's cut alone didn't break the organization. But Goode says a domino effect was created. When the City of Boulder heard that the county had cut its funding for Attention Homes, it decided to withhold its $25,000-a-year grant "pending a positive resolution," says Susan Purdy, the city's director of housing and human services. Then the City of Longmont withdrew its annual funding of $10,000.
On July 24, Attention Homes issued a press release announcing its closure. "Our slogan is 'Attention, not Detention,'" the release said. "It has become increasingly hard to carry this out in Boulder County. Most of our placements come from county governments who are moving toward large, institutional locked facilities for teens needing residential services. While these large facilities can be cost effective, they are in direct conflict with our mission. We have been at odds with the county on the issues of how to best serve Boulder County youth which includes our reluctance to turn our homes into staff-secure lockdown facilities."
Hittelman says the county was out of line when it tried to tell Attention Homes what to do. "The bottom line is that Attention Homes is a private nonprofit, and it should never have been pressured to accept these kids."
This isn't the first time a business has accused Boulder County of being heavy-handed. Centennial Peaks, a psychiatric hospital in Louisville, opened an RTC a few years ago, but as the organization's chief operating officer, Richard Failla, explains it, the facility couldn't permanently lock its doors. "Boulder County wanted us to provide everything for the kids 24/7, but the rules that licensing provides don't allow us to do that."
Nevertheless, he says, county officials got angry when a resident escaped or if Centennial Peaks didn't report the runaway fast enough. "We said to them, 'If you know how to do this right, tell us,' but that was never forthcoming," Failla says. "We held meetings with the county; we held focus groups. We did everything we could to get their support, but they wouldn't support our facility." In the end, the RTC closed early this year. "It was a running battle with the county," Failla adds. "We got tired of the hassle and finally said, 'To heck with it.'"
IMPACT's Thompson did not return calls seeking comment about Centennial Peaks.
Although Attention Homes will no longer provide residential treatment, it plans to remain in business in another capacity that has yet to be determined. According to the nonprofit's July 24 press release announcing the home closures, Attention Homes has "no plans to dissolve the organization. Attention Homes plans to continue to provide community services vital to the needs of teens in the community and will be restructuring their programs to better reflect those needs."
It would be easier for IMPACT to have another organization move into one of the Attention Homes properties and operate a staff-secure program there than it would be to find another property in Boulder appropriate for an RTC. Not only is it hard to find properties in residential neighborhoods zoned for such facilities, it's also difficult to find neighbors willing to embrace homes for troubled youth. Whenever treatment providers want to open facilities for juvenile sex offenders, for instance, they meet with neighborhood opposition, as happened recently in Jefferson County. And last year, when the Boulder Shelter for the Homeless wanted to relocate from the facility it was outgrowing in north Boulder to a larger building in a residential neighborhood in the center of town, residents loudly opposed the move, saying the homeless people would endanger children at a nearby middle school and lower their property values. The Boulder Planning Board, which had originally approved the move, ended up reversing its decision, and the city council concurred.
Steve Meyrich, a Boulder attorney and professional mediator, says both sides are still discussing what to do with the homes. He gave no indication of how long the mediation will last.
Jennifer Patterson and Senchal Jamal are sitting on the steps outside the girls' home, smoking. They both woke up late, and their hair is still wet from their showers. Both had bad nights. Neither wants to talk about it. Large drops of rain are beating down on them, but they don't care. They have bigger worries.
Their lives are already uncertain. With the home about to close, they now face an even more indefinite future. They're old enough to take care of themselves, though; whatever happens, they say, they'll be fine.
"I'm not worried about myself. I have a place to go when this home closes. I worry about the younger girls," says Jamal.
Some of the girls will end up in foster homes. Others will move in with relatives. Some don't know what will happen to them.
Patterson will probably move into an apartment, but she says she wouldn't have been able to live on her own if it hadn't been for Attention Homes; because she's only been there a couple of months, however, she's not sure that she's entirely ready to go it alone. The stress of the situation has gotten her down. She never smiles, and she looks exhausted. She's angry at the IMPACT board and the county commissioners for letting this happen.
"I want them to know that there are faces behind their decisions," she says. "I'm one of those faces.
"I know it's too late to change what's happened -- the homes are going to close now," she adds. "But I want them to not be able to sleep at night because of this."
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