For David Mallamo, fantasy has always been kinder than reality. At fifteen, with scruffy brown hair and glasses, he resembles his hero, Harry Potter -- a boy who's abused by his family but finds power and adventure in an alternate world.
Now living in his tenth home since birth, David learned early of the impermanence of human bonds. He says he doesn't have a single friend in the world: Other kids don't get him, and neither do adults.
"I like a lot of things that other kids don't like, so we don't get along a lot of the time," David says. "My dad has always told me that I am special. I have my own way of looking at things, because I have imagination. A lot of the people, the kids, they don't use their imagination."
When David uses his imagination, he dreams of being a different person, living a life much different from his own.
Paul and Susan Mallamo didn't know much about seven-year-old David when they adopted him through Pueblo County in 1996. But they knew that they wanted to enlarge their family, and they were willing to take a chance on the brown-eyed boy so many others had given up on.
The first time the couple met David, he struck them as small and hyperactive -- so excited he couldn't stop moving.
"His whole body was shaking," recalls Susan. "He was bouncing off the walls. He said he just wanted a family, but he'd been afraid no one would adopt him because he had freckles."
Because David was an older child who had spent more than half his life in Colorado's child-welfare system, he was considered at high risk for developmental and behavioral problems. A caseworker in the Pueblo County Department of Social Services suspected that his biological parents suffered from mental illness and had abused David. The foster parents he'd been living with most recently said he'd been disciplined at home and school for "strange behaviors" and had a hard time separating reality from make-believe.
But the Mallamos wanted David anyway. "They probably could have told us that he was the son of Dracula and it wouldn't have mattered to us," Paul says. "That was our inexperience. We were living in a small town; we were very unrealistic and maybe even cocky in our parenting. We thought, 'Well, he hasn't been our kid yet.' Let's see what we can do."
They felt uniquely equipped to deal with whatever came along. Paul holds a degree in psychology from Brigham Young University, where he and Susan met as students; they were married in 1973. Before moving to Colorado from Utah, Paul worked at both a residential-services program for youths and in a psychiatric hospital. In Pagosa Springs, where the family was living at the time of David's adoption, Susan worked as a substitute teacher and also studied alternative healing therapies. The Mallamos already had three children -- one biological son, then eighteen, and thirteen-year-old twin girls adopted privately as infants in Utah -- and considered themselves able parents. (The names of the children in this story, including David's, have been changed.)
But David challenged their parenting right from the start. On his first night in the family home, he spent most of his time in the bathroom, screaming uncontrollably. Soon he began fighting with Paul and Susan, threatening to call social services when they disciplined him. Although he resisted the couple's attempts to show him affection, he hugged complete strangers.
Two months into his stay in the Mallamo home, David tried to hang the family dog.
The thoughts that David shared with his new parents were peppered with disturbing recollections. He said he remembered sleeping on a department-store bed after his birth parents had abandoned him at the mall; he said he'd called 911 numerous times by the time he was three. Confused by the interplay between his biological mother's fervent Christianity and his new family's Mormon beliefs, he was afraid to go near air ducts because he feared the Devil would pop out of them.
"You have an idea that whatever is going on with the child, you can find a way to love it out of them," says Paul. "We thought that maybe by exposing him to a new world of stimulation and taste, we might be able to open him up, to tap into some of the charm and brightness that we suspected was there."
"He had absolutely zero intellectual stimulation in his earliest years," says Susan. "We thought we could just redirect him."
In late 1996, the family moved to Lakewood, and Paul got a job as a counselor and case manager at Lookout Mountain Youth Services Center in Golden, one of the primary facilities used by the Colorado Department of Corrections. They took in a succession of foster children -- an arrangement that brought in additional income and allowed Susan to stay home with the kids. Soon after the move, David enrolled at Hutchinson Elementary School, where he repeated first grade because of his poor reading skills. When the Mallamos first met him, he could spell only about ten words.
David was placed in Hutchinson's special-education program and eventually moved into an isolated classroom where he received one-on-one instruction. Over time, his spelling and reading skills improved and he took some interest in Boy Scouts and art. Some of his teachers described him as creative and imaginative, with a good sense of humor. But others noted his hyperactivity, anxiety and bizarre behaviors. One teacher reported that he'd hidden under a desk and barked like a dog; another said she'd found him on the floor choking himself because, he said, a parrot told him to.
"He wanted to have friends, but he had absolutely no social skills, no idea of how to go about sustaining a relationship," says Paul. "He had imaginary friends that were as real as you and me, this whole realm of fantasy that was very true to him."
The unsettling incidents at school became so frequent that Susan rarely left the house for fear that she'd miss a call from Hutchinson telling her to come get her son.
"Around this time, there was kind of a little lightbulb that went off," Susan says. "It was kind of like, hmmm. This is a little bit more than what was presented to us, a little bit more that we don't know about this kid."
What they ultimately learned changed not only the Mallamos' understanding of their child, but their lives.
When David was four, his mother told him that she wished he'd never been born. She wanted a girl, not a boy, so she sometimes dressed David in girls' clothes, even after she gave birth to a daughter, Mary.
Physically and psychologically abused as a child, David's mother was wild as a girl and often ran away from home. She first received psychiatric care at sixteen, was often depressed and thought about suicide. In July 1995, diagnosed with bipolar disorder and schizophrenia, she committed herself because she "liked being in the hospital." By then, David had been in the child-welfare system for almost two years.
In the four years that David lived with his birth mother, she would fly into rages, beating him with coat hangers and kicking him. Although she denied drinking or taking drugs during her pregnancy, she had a history of alcohol and drug abuse, as did her father, mother, brother, ex-husband, grandfather and grandmother.
David's father was a drifter who dated David's mother for two boozy months before marrying her in Pueblo. He'd done time in an Oregon prison for molesting two boys; David was born in 1988, less than a year after his father's release. David told one foster parent that his father had frequently touched him in a sexual way while he was a toddler. A doctor who examined him suspected a "history of genital and rectal fondling." David's father was questioned by the police but never charged.
Paul and Susan Mallamo didn't learn any of this until nearly two years after taking David in, when Pueblo County finally sent them David's complete social history -- a nightmare narrative condensing the boy's beginnings into fourteen pages.
"I call it the paperwork from hell," Susan says. "I remember the day it showed up here, I was on the phone with David's therapist, just reading it, saying, 'Can you believe this?' This is information we should have gotten before we even met him."
In addition to describing his biological parents' various addictions and abuses, the report chronicled David's trek through foster care. By the time he was four years old, he had come to the attention of social services, which charged his biological mother with abandoning her children, dependent and neglected. In 1994, his then-divorced mother and father terminated parental rights altogether and turned both of their children over to social services for adoption. After Mary was placed in a permanent home in early 1996, her new mother cut off all communication between brother and sister. Despite his attempts to contact her with the help of his foster and adoptive parents, David never saw Mary again.
David himself bounced through five foster placements, lasting just four days with one family. One couple who described him as a "co-operative, pleasant child" they "loved a lot" moved to Germany after four months. In another home, he retreated into a fantasy world, insisting to his foster mother and schoolmates that he was a lion and a prince. After two years, that family decided to move to Kentucky without David -- another attachment broken.
Although the deluge of new information confirmed some of their worst fears about their son, the Mallamos were relieved to at last have some insight into the past of the child they'd struggled to understand. David had received counseling both in and outside of school since they'd taken over his care, but neither the family nor the various therapists who saw him knew much about the pathology they were chasing. Therapists, pediatricians and psychiatrists had suspected intrauterine exposure to alcohol and drugs, but now they finally had specifics to guide their treatment.
"With the team of people we knew and respected, there's a whole range of things we could have done to be more proactive, to intervene," Susan says. "Instead, we were just operating out of ignorance, aside from what my instincts would tell me."
Between 1996 and 2002, David saw nineteen different therapists outside of school, who tried everything from thought-field therapy to eye-movement desensitization and reprocessing, to biofeedback, allergy elimination, talking therapy, homeopathy and hypnosis. Medications, including Clonidine, Zoloft, Ritalin, Dexedrine and the anti-schizophrenic drug Seroquel, had little effect on the boy. Some of the treatments were covered by the Jefferson Center for Mental Health (JCMH), the agency that provides mental-health services to Medicaid-eligible residents of Jefferson, Gilpin and Clear Creek counties. Other were paid for out of the Mallamos' pocket, cutting into a monthly adoption-subsidy stipend.
The family collected diagnoses like baseball cards: post-traumatic stress disorder, personality change due to in utero toxic exposure, attention deficit hyperactivity disorder, opposition defiance disorder. Although the diagnoses differed, therapists all agreed on one thing: Isolating the root of David's problems would be complicated, if not impossible. "This is a complex and interacting constellation of possible disorders and will be a challenge to sort out," wrote a doctor at the University of Colorado Health Sciences Center in 1999.
Instead of improving, David worsened. Police were called to Hutchinson numerous times after he threatened classmates, destroyed property and yelled at teachers. At home, David fought with his siblings and parents. Family meetings designed to address some of the domestic problems disintegrated into shouting matches.
In the summer of 2002, Liz Smith, a JCMH therapist who'd made regular visits to the Mallamo home, presented a new theory. She believed David had reactive attachment disorder, an odious emotional and biochemical mixture that severely limited his ability to trust, control impulses and rages, give and receive affection, and experience empathy or remorse.
After hearing that, Paul and Susan began thinking less about fixing their son and more about just learning how to live with him.
"We were looking for a magic bullet, but there is none," Susan say. "You're trying everything; nothing is making a single dent."
"Nothing works, so you keep looking and looking and looking," Paul says. "There are so many unknowns. Sometimes all that you're doing is making your best guess and hoping for the best."
As harrowing as David's history is, it's fairly typical of an older child in the welfare system. Seven out of ten are estimated to have suffered some type of prenatal exposure to toxic substances, usually drugs and alcohol; many have biological parents who are mentally ill themselves.
These high-risk kids often develop a wide strata of psychological, physical and behavioral problems and, increasingly, are diagnosed with reactive attachment disorder, which, among other things, infuses a child with an inherent distrust of family dynamics or bonds. Although still far less understood or accepted than some conditions linked to childhood abuse, reactive attachment disorder is now seen as a condition that's shared by children who suffer extreme trauma and parental neglect as infants and toddlers. Attachment disorder is exhausting for both a child and his caregivers: Kids with the disorder are known to lie constantly, fear their own and others' emotions, struggle to dominate parents and siblings and, sometimes, believe that they have special powers that negate responsibility for their actions.
Two high-profile Colorado cases brought reactive attachment disorder out of clinical obscurity and onto the front page. Renee Polreis is currently serving an eighteen-year sentence for the 1996 beating death of her two-year-old adopted son, David. As part of Polreis's defense, her lawyers argued that the boy beat himself to death with a wooden spoon, so powerful were his attachment disorder-fueled rages. In 2000, ten-year-old Candace Newmaker suffocated while undergoing rebirthing therapy for attachment disorder; her therapists, Connell Jane Watkins and Julie Ponder, were convicted of reckless child abuse resulting in death; each was sentenced to sixteen years in prison.
"A lot of times with a RAD child, you can know them before you adopt them and never see any sign of it," says Deborah Cave, who heads the Colorado Coalition of Adoptive Families. "All of a sudden, when that child gets in the home, it triggers those attachment issues. Suddenly there's a dynamic where they're supposed to be calling you Mommy and Daddy, and it terrifies them. You show them a little bit of love, and it can send them into rages. You don't even realize how disruptive it is for a marriage."
A child's problems intensify the longer he stays in the system, although even children adopted as infants are known to present a wide array of problems in later life.
"There's a strong correlation between the number of moves a child in social services makes and the types of problems he's likely to show later in life. After the age of eight, the chances of being adopted really start to drop," says Cave. "A child doesn't move into an adoptive home and become cured. But it's still better to see that child in a home, because every child deserves a home. And it's better for the state, in terms of expense -- and that doesn't even point to the costs to society when kids stay in the social-service system for long periods of time."
County social-service departments are required to move children out of the foster system and into permanent adoptive homes within twelve months of their removal from their original homes, thanks in part to Colorado's Expedited Permanency Planning policy, which was approved by the Colorado Legislature in 1994. But the demand for permanent homes far exceeds the supply -- and some parents wind up taking in high-risk children without a full understanding of the difficulties ahead.
"Most people going into these adoptions don't understand the impact that these children can have, even when they have some information as adoptive parents," says Maura Klene, executive director of the Rocky Mountain Fetal Alcohol Syndrome Resource Center. "Or they think that the problems will be easy to get out of. They'll think, 'Oh, he'll be all right. I've heard about trouble with adoptions, but not my kid.' When that reality sets in, it can be very, very difficult."
"A great many children that come through the system are abused or neglected, if not exposed to drugs and alcohol," says Jan Tomski, clinical director of Adoptive Family Resources, an outreach and advocacy agency in Denver. "People don't understand the amount of trauma that a lot of these kids have been through."
According to Tomski, many adoptive parents don't understand the trauma that children with problems as serious as David's can inflict on their new families. And many parents who find themselves unequipped to deal with their troubled children say they don't receive support from a system or a society that places responsibility for a child's problems on the parents.
"The attitude is, 'Why can't the parents take care of this kid?'" Tomski says. "But you get a kid who was abused horrifically, you put an attachment disorder on top of something like fetal alcohol syndrome -- it's something that cannot be cured with parenting. It's like trying to make eyeglasses for your child, or trying to treat cancer at home."
No official count exists on the number of adoptions that fail each year in this state. But some parents who find themselves unable to care for their high-risk child feel they have no choice but to give him up, terminating their parental rights and putting the child back in the system. In addition to the emotional upheaval caused by such a move, individuals who terminate their parental rights in Colorado also risk having their names added to a central registry of child abusers.
The Mallamos say that giving up on David was never an option. Their confidence in their ability to help him was bolstered by protections guaranteed as part of his adoption contract, which originated in Pueblo County and was finalized in Jefferson County in 1998. In addition to a monthly stipend for child-care expenses, the contract guaranteed David full coverage under Medicaid, the state- and federally funded health-care program. That entitlement would cover everything from David's general health needs, such as eye exams and immunizations, to specialized mental-health-care treatments. It was their safety net, their assurance that they'd always have help, no matter how bad things got.
But when they needed help the most, the Mallamos say, the system punished them for asking.
"It's just so cold the way things work," Paul notes. "When you're there and you're one of the parents that comes along who's interested in adopting a child -- and those are few and far between -- it's so sweet and cozy and ŒWe'll give you this and that.' That's until you sign on the dotted line, and then it's, 'See ya.' There's very little distinction made between infant and older adoptions, but the differences are tremendous, and by the time you figure that out, you're pretty much on your own."
As adolescence dawned, David's troublesome behaviors escalated. There were new, sexual undertones to his personality, and the Mallamos worried about leaving him alone with Molly, the newest addition to their family -- a young girl adopted from Denver County in 1999. On a trip with members of a church youth group, David asked two girls to remove their tops and was incredulous when the horrified girls reported the incident to a church leader, who told the Mallamos. Paul once found David downloading porn on a computer in the middle of a busy public library, completely unaware that it was inappropriate.
"I remember being that age and how crazy that whole time is," says Paul. "You think about a child who's already got such severe confusion about the world coming into that period, and you've got a real problem on your hands."
There was also a new violence to David, who was no longer a little boy but a lanky young man. One day at church, he pinned an adult member of the congregation against a wall and wouldn't release him for several minutes. A male therapist called Paul after an upsetting session with David, who'd shown up with satellite photos of the man's home that he'd downloaded from the Internet.
"He asked me, 'Is this something that I should be worried about? Is he going to come and do some harm to me or my family?'" Paul recalls. "I've always felt that he wouldn't really do anything to hurt anyone -- and if he did, he would feel terrible about it. But the older he got and the bigger he got, it became a real concern, because it's an untested area. You just don't know what he would do."
David was slated to enter Dunstan Middle School in the fall of 2002, but his parents questioned the school's ability to deal with him. They requested that Jefferson County Public Schools put him in a facility for special-needs kids, but they were convinced by the school and the district that Dunstan would be able to handle whatever problems David had. Dunstan had a comprehensive program for special-needs students and employed a full-time psychologist, who saw David weekly.
But by early 2003, it was clear that David was beyond the reach of both his family and his school.
"I remember once, he was sitting in the TV room with Molly, and he was taking these sharp pencils and sticking them in her ear," Susan recalls. "He was defiant of me and Paul. He refused to do anything we told him to. He wouldn't go to church. He wouldn't do anything. He was menacing, and it got to the point where I couldn't leave him alone for a minute."
The Mallamos' oldest son found evidence that David had started fires in the basement. Obsessed with Star Wars films and Harry Potter books, he became increasingly disconnected from, and frustrated by, the world around him. He lied, destroyed his books and ran away three times over an eighteen-month period. He ran twice from Children's Hospital, after Susan took him in for routine visits with his longtime pediatrician. Every incident rocked the household a little more. The police would visit. The older Mallamo children were resentful of David and angry with their parents for bringing him into their home.
"The girls had always loved him and protected him," Susan says. "They respected him; there was a kind of curiosity there at first."
"But after the behaviors got really horrendous, they started asking, 'Why did you do this to us?'" Paul says. "The police were coming here; there would be these horrific disruptions, huge explosions."
On January 15, David had his biggest explosion yet. Teachers at Dunstan called Lakewood police to report that David was in the throes of a dissociative fit that was beyond the experience of even the school psychologist. As David was moved from a classroom into a staff resource room, he screamed at teachers, kicked doors and banged his head against tables and walls, then fell on the floor in a fetal position and began wailing. Police took him to the emergency room, where he was placed on suicide watch.
He was later moved to Colorado Christian Home, a residential treatment center where he'd been evaluated the previous year. David was fourteen years old.
The school psychologist called it an "acute psychiatric incident." For the Mallamos, it was the last straw.
"By this point, we were at the end of our rope," says Paul. "We had the safety of the family to think about. It felt like a hopeless situation, but we knew he couldn't come back here. His behavior had spiked. He was out of control, and we were just desperate to get some help."
They wanted David to stay in the treatment center until he'd gotten that help.
But in late January, the Jefferson Center for Mental Health determined that David's problems might not be the agency's problem. In a letter to the Mallamos, JCMH said it couldn't determine "whether David's current behavior is organically driven, a willful choice on his part, or directly related to a covered mental illness."
In other words, JCMH was positing that David was primarily damaged in his brain, not his psyche, and that his behavioral problems likely stemmed from real physical damage from prenatal exposure to alcohol or drugs. This theory shifted his primary diagnosis out of the realm of mental illness and into the quagmire of organically based disabilities -- thereby placing it outside the agency's jurisdiction as a provider of mental-health services covered by Medicaid. Until a neuro-psychological test proved otherwise, the JCMH letter said, the Mallamos' request for residential treatment center placement for David was denied.
David's pediatrician believed such an examination would be inconclusive, invasive and traumatic. The doctor never performed the test, and the Mallamos and JCMH reached an impasse.
"You've got a kid who is lighting fires and threatening to kill people," says Paul. "He's been evaluated and diagnosed upside down and every which way for most of his life, and time and time again they're coming back with mental illness. How can you tell me that, all of a sudden, because there's a suspected so-called organic component, there's no mental illness?"
Two weeks after David's outburst at Dunstan, JCMH therapists concluded that David was stable and should be returned to the family home. When Susan insisted that he needed more time at Colorado Christian Home, she was given a choice: She could take David home, or she could turn him over to the Jefferson County Department of Social Services. If she chose the latter, she and her husband would be served a dependency and neglect petition for effectively abandoning their child to social services -- the very same charge used to first remove him from his biological mother's care a decade earlier.
"We were told that David would receive the best care from social services, that it would open up a whole new range of options," says Susan. "What we found was exactly the opposite."
Eleven months later, the Mallamos' decision to give up their child still haunts them -- because it's a decision they believe they should never have been forced to make.
A conclusive determination as to whether David has fetal alcohol syndrome or another toxic-exposure-related disorder has never been made. That's partly because such an assessment is, to a large degree, a speculative science: There's no single test or diagnostic system that can completely isolate fetal alcohol syndrome to the exclusion of all other disabilities and mental impairments.
"There's a lot of difference of opinion on the issue of organic versus non-organic," says Jennifer Green, a psychologist who works at the CU Health Sciences Center with children who have been exposed to alcohol prenatally. "The definition of 'organic' typically is that you're dealing with brain damage as a result of a physiological or structural difference in the brain. But there's a lot of crossover with other mental-health problems, and the distinction is not always clear or well-defined."
"The conventional medical wisdom is that you never assume multiple diagnoses unless you can't account for all behaviors with a single diagnosis," responds Dr. Donald Bechtold, medical director for JCMH, who evaluated David in 2002 and was part of the assessment team that denied the Mallamos' request for residential treatment center placement. "The question is, 'What does the bad behavior derive from?' If you have a primary brain insult with secondary behavioral disinhibitions, you have to assume that it's all related. You may have something that kind of, sort of looks like ADHD, but if you treat it repeatedly for ADHD and there's no impact, then you start to link it back to some organic brain pathology."
At the time JCMH denied the Mallamos' request, David's file was full of information indicating he'd experienced some form of prenatal exposure to toxic substances; the social history provided by Pueblo County said that his biological mother was a known drinker who used marijuana and lithium. JCMH therapists and doctors were among those who'd surmised that David's problems had both organic and non-organic components. In March 2002, Bechtold had listed "personality change due to intrauterine toxin" as David's primary diagnosis, with attention deficit hyperactive disorder, a learning disability and developmental coordination disorder listed as related conditions. Yet the issue of dual diagnosis was never raised before David's parents tried to place him into a residential treatment center.
"JCMH knew that this was in his history -- and usually the only place they got that information was from things that Susan and I would tell them, because we did suspect that there were some exposure issues at play. We told them from the get-go that we thought we were probably dealing with a fetal alcohol syndrome kid," Paul says. "But they never made a big deal of the prenatal piece in all the time they were treating him -- over a period of years. This question of organic versus non-organic just never came up.
"Why didn't they deny the benefits then?" he says. "Once we requested the residential treatment center, it was a whole new ballgame. It felt like JCMH was willing to work with us until they really had to get involved and start spending money."
The idea that the presence of some other brain-related disability could limit David's mental-health treatment troubles Tomski, who has known the Mallamo family since 1996. Even if David does have fetal alcohol syndrome, she points out, he's also been repeatedly diagnosed with a host of mental maladies that are included on the Medicaid list: anxiety disorder, explosive personality disorder and attachment disorder, to name a few.
"We know that there can be physiological effects from the psychological trauma experienced by kids like David. The younger the child, the more pervasive the neurological trauma. So them having a dual diagnosis is almost inevitable," Tomski says. "I could walk up to the average person on the street, hand them David's case history and ask them, 'Do you think this kid's mentally ill?' They're going to say yes. In this case, the only one who would dispute that would be JCMH."
Bechtold acknowledges that separating brain from mind is a tricky business. "There's no question that it's difficult," he says. "Part of it is based on family history, but even that can be problematic. Someone will say, well, 'His grandmother was bipolar.' Maybe she was, maybe she wasn't. Unless you've got good clinical records on Grandma, you're just making the best judgments you can.
"One thing that we look at is, if it's mental illness, you expect it to respond over time to treatment," he adds. "But if you've tried everything under the sun, over a period of time going from A to Z, and nothing works, then it ends up being a pretty compelling profile for an organically based condition."
Even if JCMH was in complete agreement with the Mallamos' interpretation of David's pathology, the agency still might not have placed him in a residential treatment center. The agency relies on respite care, day treatments, clubhouse programs and in-home therapy over out-of-home placements, a regimen both less expensive and less restrictive. Although a stay at a residential treatment center costs less than hospitalization at state mental institutions at Fort Logan or in Pueblo, it's more costly than other intensive treatments such as therapeutic foster care or day programs.
"A lot of good treatment is not medically necessary," says Bechtold. "You're trying to spread a limited resource across a wide system. JCMH's posture is that it's better to have a child in the community instead of in an institution. You have to see what alternatives might work better."
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.
Five months later, the Mallamos had to repeat this scenario. On June 16, Jeffco social services agreed to move David to Lost and Found, a residential treatment center in Morrison. But that morning, the Mallamos learned the initial D&N charge filed against them had been dropped a month earlier, after they had refused to plead guilty to it. That meant that David was retroactively back in their custody. They'd be billed for the services he'd received in the interim, and if they wanted David to go to Lost and Found, they'd have to pay for his placement themselves. So essentially, the family was forced to give custody of David to social services once again in order to get him the care he needed.
Social services stepped in and filed another D&N petition against the Mallamos. Under the custody of Jefferson County, David went to Lost and Found, where he's been ever since.
The Mallamos have repeatedly refused to accept the court's characterization of them as neglectful parents -- in part because such an admission could land their names on a registry of child abusers, affecting their future employment and possibly their custody of Molly. And they say their relationship with caseworkers and other social-services staffers has been adversarial from the beginning.
"They've been making treatment plans for David without ever having read his case file or visiting this house," says Paul. "They've constantly described our Œfamily dynamic' as being one of the factors here, without knowing anything about our family. It's very distasteful to have to constantly defend your parenting."
"Most parents don't fight for their rights like the Mallamos have," says Mark Henningsen, a therapist who treated David for two years. "They've asked for what they need and what they're entitled to, which probably doesn't put them in the top ten of the county."
Because the case is ongoing and involves a juvenile, the Jefferson County Department of Social Services declined to comment specifically on the Mallamos' case or David's treatment. But the department did note that the number of D&N cases filed in Jeffco has increased by 15 percent, to 432 so far this year, partly because of a poor economy and a growing population. The county, which has seen its share of budget cuts over the past two years, has a static number of employees to handle a ballooning caseload. And when parents such as the Mallamos turn to the counties to provide mental-health services, they compete for resources in an already crowded pool.
"If you look at what's happening, everyone is understaffed and undermonied," says one state mental-health advocate. "There have been huge layoffs across Jefferson County. People who went from having a caseload of fifty now have eighty. You can't always expect the most personal or unlimited services when you have people coming to work every day thinking, 'What if I'm next?'"
"The counties are aware of the problems, and they're scrambling to find ways to deal with them," says Henningsen. "The problems are system-wide."
At the September hearing, Boatright ruled that David should remain at Lost and Found, in the custody of social services, but said that the Mallamos were not to blame for his situation. David was dependent and homeless, not neglected, and through no fault of his parents.
For the Mallamos, it was a minor victory. Their case remains open while the court waits to see how long it will be before David can be safely returned to the home. And that could be a long wait. The average stay at Lost and Found is between three and six months, but some who know David expect him to stay at the center for at least a year. When he's released from the program, he'll be a likely candidate for a step-down treatment, such as therapeutic foster care. In the meantime, David visits his family every Sunday, and Paul, Susan and David receive weekly family counseling.
Paul and Susan continue to pay a portion of David's residential treatment center costs. When a child is placed in a center, social services requires his parents to cover a portion of his room and board, a fee determined on a sliding-scale system. In June, Paul's wages were garnisheed to cover back payments for the various treatment center, foster and shelter placements that David has been through since January.
If JCMH had approved their initial request for help, the Mallamos say, they wouldn't have been charged a dime. They're contemplating civil action to recoup the money they've spent on lawyers and David's treatments.
At Lost and Found, David lives with seventeen other boys and receives 24-hour supervision.
"We provide behavioral monitoring, on-site schooling and a self-contained environment, and constant supervision and safety," says Terry Rogers, Lost and Found's executive director. "Most of things we do are things you just can't do at home, like make sure someone stays awake all night to keep an eye on the kids."
So far, David's stay has been rocky: He's run twice from the home, gotten into fights with other residents and made a list of the boys in the center that he'd like to kill. In early November, he threw a bucket of salt on a staff member, then kicked him in the head and the chest. He was charged with felony assault, and a preliminary hearing on the matter is scheduled for January.
"The litany of failures with this kid is just endless, endless, endless," says Paul. "I've never been in such a discouraging situation -- one that didn't seem amenable to any kind of solution. It tells you you've been totally ineffective as a parent, because nothing you've done has made a single difference in the character of this person, in who he's become."
Paul and Susan feel that their son is receiving the most effective possible treatment at Lost and Found. But they wonder what, if anything, can ever really save him.
"Something's either going to happen where his brain changes a little and he starts to settle down," Paul speculates, "or he's going to wind up one of the guys on the side of the road with a sign, or worse. It could go a criminal route. It could go a lot of ways. We just don't know. So we just pray."
They pray, and they hope that one day David will be able to rejoin their family.
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But David knows he won't be going home for a while. "My parents are nice to me, and they help me, and I like to come and visit them," he says. "But I have to improve my behavior before I can come back to live with them, and it hasn't been improving, because I always sabotage everything."
At Lost and Found, David spends his days in therapy or reading. Although he doesn't have any friends, he's getting to know a few of the car thieves, criminals and sex offenders who live at the center. But he doesn't want to spend his whole life surrounded by trouble, he says.
Someday, he wants to be a pilot.
"They're not going to let me be a pilot because of my behavior, so I'm trying to get better," he says. "But it always seems like every time I get better, I get worse instead. I'm kind of getting tired of that. I want to be better all the time."