DENVER — Olivia Couch followed as the boy hopped two fences and climbed into a drainage ditch filled with water.
Her job was to keep the 12-year-old safe, and protocol at the residential treatment center was to “shadow” children who ran off campus but not restrain or block them. Couch had never given up on sticking with a kid before, thinking it was an important part of creating a bond with children in her care.
But then the boy reached into the water and pulled out broken glass.
“It was like he had memorized the location of weapons,” said Couch, who was 22 when she started working at Mount Saint Vincent in northwest Denver last year. “He found a broken glass bottle in the water and he just pulled it up and started swiping at me.”
Couch called for help and was joined by two more workers. “As soon as his back was turned … I took that as my opportunity to scramble out of the ditch and I just started sobbing,” she said.
“That was like my first breaking point.”
Editor’s note: This is the second story in a joint Colorado Sun/9NEWS series examining residential treatment centers where Colorado houses foster youth and kids with severe behavioral issues. See more from The Colorado Sun by signing up for The Sunriser newsletter.
Workers at Colorado’s residential treatment centers — considered among the last options for youth who’ve been through numerous foster homes or who have severe mental health issues — are strung out because of low pay, inadequate training and daily sacrifice of their own safety, a Colorado Sun/9News investigation found.
Former employees of various 24/7 facilities for Colorado’s most troubled children and teens left their jobs with physical scars — from bite marks and cuts. And each described feeling like there were often not enough workers to handle the extreme needs of children, who threw desks, spit on them and regularly ran away.
Residential treatment centers, many of which are nonprofits that supplement public funding with donations, said the starting salaries they can afford are typically about half what caseworkers who work for county child welfare departments earn. Staff turnover is high. More than 40 youth residential centers have shut down in Colorado since 2007, and the 52 that remain are concerned that years of underfunding and new, costly federal regulations will make it even harder to operate.
Though staff injuries have always been a risk when caring for children with such acute behavioral issues, children’s advocates question whether the intensity of the institutional environment has become untenable.
“We’re at a cliff,” said Becky Miller Updike, director of the Colorado Association of Family and Children’s Agencies, which represents some of the largest residential centers in the state.
It’s time for Colorado to “reinforce” its residential programs, said Kent Moe, an association board member who for decades has operated residential centers. “Here’s the business model: You’ve got regulators that are on you. You’ve got kids that are on you. You’ve got parents that are on you. You’re not sure if your staff are going to show up. You’re stretching the peanut butter pretty thin across the bread.”
“That commentary really goes to the system itself, not the people,” Moe said. “They are only operating a machine that’s already built.”
When Couch was hired at Mount Saint Vincent, she had one year of experience working in a school district day care program. Her pay at the residential child care center was $16.40 per hour. The job began with a few weeks of training, including shadowing other workers, and then she was tasked with managing children who were often running away, hurting each other and hurting staff, Couch said.
“It was exhausting,” she said. “It becomes such a norm that nobody really thinks that it can get better, so you put up with it, until you snap.”
The staff coped by getting drunk together and comparing scars, said Couch, who has a bachelor’s degree in psychology.
“There was kinda like a competition to see who’d get the least amount of bites in their career there,” she said. “It became sort of like a battle scar competition for us to cope. Somebody had their hand broken in a situation with a kid. You have kids who throw entire desks at you.”
Couch compared working at the center to a toxic relationship, one that she wanted to leave but felt guilty walking away from the children. She was still processing the stress three months later.
“You basically become like the parent of these kids and they know you’re paid to be there and you know you’re paid to be there and at the end of the day, you can go home,” she said, pausing to cry. “There were nights where I would go home and finally process what I had heard. And I would just sob on the floor, because it’s just so sad.”
“The system is broken. The kids can’t be kept safe because there is not enough staff. The staff can’t be kept safe because there’s not enough staff or resources. At the end of the day I kind of wonder if we did more harm than good with the kids.”
Colorado has lost 30% of residential beds in 5 years
The child welfare system in Colorado is in the midst of a major shakeup.
State officials are plowing ahead on a plan to put the bulk of public spending at the front end of the system, focusing on child abuse prevention and keeping families intact. As a result, there has been a massive decrease in the number of children sent to institutions. Colorado had just 365 foster youth in residential centers at the end of 2020, compared with 1,295 in 2010, according to data from the state Department of Human Services.
No one argues on the principle — kids are better off in families than they are in treatment centers.
The conflict, though, comes as Colorado’s remaining residential centers say they’re already struggling to keep their doors open, and the funding is inadequate. County child welfare departments call them in desperate need of a bed for a child who has already lived in sometimes more than 12 foster homes, and those beds will become even harder to find, they warn.
The state already has lost 30% of its residential treatment beds in the past five years.
When beds in Colorado are full, counties can send foster kids out of state, at a cost two or three times higher, according to a legislative analysis. So far this year, county child welfare departments have placed 17 kids in out-of-state residential care.
Now, with changes under the federal Family First Act residential centers must become accredited as federally qualified trauma-informed treatment centers, including by employing round-the-clock nurses. And they will have to limit capacity to no more than 16 kids in order to receive Medicaid funding.
The new requirements, center operators fear, will make it even harder for them to keep their doors open, let alone pay staff better and improve outcomes for kids.
Many of the facilities are nonprofits that raise funds from donors to stay open, some up to one-third of their budgets, said Updike, with the Colorado Association of the Colorado Association of Family and Children’s Agencies. “That’s just to get them up to the levels where they can function.”
She’s concerned that several more centers will close without more funding to offset the cost of the new federal requirements. “We are really down to the bare minimum of beds already,” she said. “At the end of the day, the referrals are still really high. The level of acuity of these kids is higher than they’ve ever seen in general.”
Colorado, she said, needs to focus on two things at once: prevention efforts to keep kids from ever reaching institutions and adequate funding of institutions to help kids who are already there.
“The damage happens every time a child moves,” she said.
Legislation this year could fortify residential centers
The centers have a long history of funding battles in Colorado.
In 2017, an actuarial study ordered by the legislature found that counties had spent $78 million the prior year on placing children in out-of-home settings, including residential centers. But, the analysis found, that was $53 million short, when accounting for the going market rate for what it costs to operate centers and pay staff, as well as foster homes.
The legislature’s Joint Budget Committee launched on an aggressive funding plan to pump $53 million in federal, state and county dollars into the child welfare system over a four-year period, which ends this year. The funding infusion went into the overall child welfare system, and counties were allowed to manage the new money.
A package of legislation this year attempts to ensure that daily, per-child rates paid to residential centers will rise with their operational costs under the new federal requirements, depending on available state dollars. The bills are the work of Robin Smart, a staffer for the Joint Budget Committee who has been studying child welfare funding for nearly a decade.
Smart, who presented the bills to the committee last week, said she was concerned that the massive system reform would end up hurting the children with the most intense needs. “The most critical thing in system reform is that you keep the current system stabilized so it doesn’t fall apart when you are making such drastic changes,” she said.
Moe, the association board member, said Colorado has changed its funding model at the same time “the kids have gotten more acute and more dangerous.”
“Seven years ago, our referrals would have three or four failed placements and maybe one or two hospitalizations,” he said. “Now we’re seeing kids with 10 or 15 failed placements and 20 hospitalizations.”
“Hoping someone would find me”
Lizzie Guyberson spent her teenage years in a string of Colorado residential treatment centers, running away as often as she could.
After fleeing Tennyson Center for Children, she would sit alone for hours beside Sloan’s Lake, a few blocks from the center in northwest Denver.
“I’m just hoping that someone would find me and ask you, ‘What’s wrong?’ And they would take me somewhere else,” she said. “Even though that never happened, but that’s something I always wished a random bystander would just come and be like, ‘Are you OK?’ And I could tell them? ‘No, I’m not.’”
Guyberson, now 23, counts the centers where she lived on her fingers: Tennyson, Remington House, Denver Children’s Home, Devereux Cleo Wallace, Third Way Center and Excelsior Youth Center, which closed in 2017.
She ran from them all. She ran because she hated living there. Because she wanted to die. Because she thought no one loved or wanted her.
Guyberson was in trouble often, she recalled, often because she would resist if staff tried to restrain or touch her. “Every time I got in trouble, they would restrain me. And one of my biggest triggers is people putting their hands on me,” she said, sitting under a gazebo near her home in an Aurora apartment complex. “And I blacked out. They restrict me and then I run.”
She once ran away four times in one day. The residential centers where she lived typically called the police, and Guyberson was often returned in the back of a patrol car, she said.
Guyberson is still healing from her childhood, a process she expects to last her whole life. She’s raising her 2-year-old son and studying to become a medical assistant. But the emotional scars are deep.
She was adopted at 6 weeks old, and when her adoptive parents split up, she lived with her dad in Michigan. Guyberson moved to Colorado to live with her mom when she was 11, but within six months, she was in residential treatment, she said.
Guyberson was suicidal, beyond her mother’s control. She was medicated to the point of feeling like a “zombie” and at one point was taking six medications at once.
Her parents eventually relinquished their parental rights and Guyberson became a ward of the state, she said.
“Every day, even to this day, it’s like I really am not wanted,” she said. “That’s something I struggle with on a daily basis. That’s all routed to being in facilities and what happened with my family and them just giving up.”
“The impact of unspeakable trauma”
Mount Saint Vincent leaders said their employees receive 28 hours of de-escalation and restraint training during the first month of employment and that the northwest Denver home maintains a staff-to-child ratio of 2-to-1.
The center, which is allowed under state law to house up to 33 children, said employees must follow “tightly prescribed and monitored interventions” of physical restraint when children become violent. “These are situations where a staff member can experience cuts or bruises,” the center said in a statement. “This is a risk inherent in such work, and staff is presented with this reality before accepting employment.”
Mount Saint Vincent is one of the oldest children’s homes in Denver, in operation for 138 years, and raises $1 million to $3 million in donations each year to “close the operations funding gap.”
“It is a tough job as we care for kids who at times kick, hit or spit as they act out the impact of unspeakable trauma on them,” center officials said. “For the courageous caregivers who take on the responsibility of working with traumatized children, our goal is to provide ongoing training each week to equip them with the skills and tools necessary to keep themselves and our children safe.”
Tennyson Center, which closed its residential program earlier this year after a series of safety issues, including the death of a 12-year-old boy who ran away and was struck by a car, cited high staff turnover as one of the reasons for its troubles. Also, children were suffering from abuse and neglect more intensely during the pandemic before they reached Tennyson, making workers’ jobs more difficult than unusual, said James Young, the center’s interim CEO.
Youth at Tennyson have already lived in seven or eight failed foster placements, on average, he said.
And while it costs about $400 per day per child to operate the residential program, Tennyson was getting reimbursed $238 by the foster system. Young said Tennyson was losing about $40,000 per year, per child.
Tennyson briefly employed an armed school resource officer on its campus, in an effort to keep staff safe and cut down on calls to the police department. But the center did away with the position after the Colorado Department of Human Services, which licenses youth residential centers, said it was against state regulations to have a gun on campus. The center also had $180,000 allocated to put up a fence to deter runaways, but the project required special zoning permission and never happened.
Devereux Advanced Behavioral Healthcare, which operates the Cleo Wallace residential treatment center in Westminster, said it costs $547 per day to care for its high-needs youth, yet the center is reimbursed $505 per day.
“There are many challenges to operating in a historically underfunded, nonprofit health care environment,” said Leah Yaw, a senior vice president for Devereux. “The implications of our operating environment are numerous, but one critical, industrywide challenge is equitably compensating the most important people who work in the health care field – direct care professionals.”
Employees are required to complete 120 hours of training after they’re hired and 40 hours of refresher training each year, she said.
“Are you going to leave me?”
Samantha Kahle, who worked at Mount Saint Vincent for eight months in 2020, put it bluntly: “There was never a time where I felt like I had control over the situation.”
Kahle, who started at about $16 per hour straight out of college, said kids’ behaviors grew worse as the monotony of the pandemic dragged on and that eventually, they were trying to run away “every day.”
She was punched in the face, sometimes five or 10 times per day, she said. One boy “grabbed me by my hair, took me to the ground and started just ripping out my hair,” she said.
Kahle and other staff once followed a group of runaway children for nearly 2 miles, dangerously close to the highway. “We’re not supposed to physically block, but I mean, if they’re going to put their lives in danger like that, then I’m going to intervene,” she said. Staff ended up calling the police, who helped round up the kids and then drove them back to the center.
Another day, a girl chucked a rock at Kahle’s head. She tried to block it with her hand, but it smacked her in the forehead, sending blood trickling down her face.
A boy who had been sexually abused touched her inappropriately.
Each day she went to work felt like chaos.
“It was a constant state of just like preparing because you knew something was going to go wrong,” she said. “Everything goes wrong. It was just constantly being aware of what can be used as a weapon towards me, what can be used as a weapon towards themself.”
Nightmares about taking care of the kids jolted her awake at night. Three months into the job, Kahle started to look for a new one. She was gone within eight months. And like Couch, she felt guilt about leaving.
“You get those little moments where you feel like you’re making a difference and you have your relationships with these kids, no matter how much they’re attacking you,” she said. “At the end of the day, they’re sitting there apologizing and crying over it, saying how sorry they are and how much they care for you. And they’re like, ‘I don’t want you to leave. Are you going to leave me?’ I don’t want to be another person abandoning them.”
Now she delivers packages for Amazon.
Erin Henderson worked for about two years at Tennyson Center for Children in Denver and one year at Devereux Cleo Wallace in Westminster. She chose the work because she wanted to help children heal from the trauma of abuse and neglect, but Henderson said she often felt powerless to make a difference.
“It’s just the kids that they have there are extremely acute and they just don’t have the staff for it,” she said.
Henderson was working the night three boys ran away from Cleo Wallace and one was struck by a drunk driver in the dark on Wadsworth Parkway. Andrew Potter, 15, died in 2018. Henderson left the job not long after.
She recalled how much Andrew loved “High School Musical,” basketball and the color pink, and that he would ask staff to watch his dance moves. “He was a great kid. He made a lot of progress,” she said. “He was supposed to go home that next week, so that was really unfortunate.”
Henderson said staff at the centers regularly got concussions and hair pulled out of their heads. She has a scar on her hand from a child biting her and ripping off her skin. The children seemed so accustomed to living in institutions that they struggled to function in normal society, Henderson said.
“It’s just chaos all the time,” she said. “‘I didn’t realize how traumatized I was by it until I left.”
9News reporter Jeremy Jojola and 9News investigative producer Zack Newman contributed to this report.
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