A group of child protection advocates including the state ombudsman and a lawmaker will push for a massive overhaul of Colorado’s residential centers for kids in foster care or with severe mental health issues.
They’ve set their sights on copying a Florida law that revamped the way centers in that state are evaluated to make sure kids are getting better – not worse – after a residential stay. The plan, expected to come up for debate at the state Legislature in 2022, comes after months of meetings that included the child protection ombudsman, directors of several Colorado youth residential facilities and, at times, officials from the state child welfare division.
The meetings began soon after The Colorado Sun and 9News published a series of stories exposing a dangerous runaway problem at residential centers. The joint investigation found that two boys, ages 12 and 15, were struck by cars and killed in the night after running away from different centers in the Denver area. The facilities, which under state law are not allowed to lock the doors, routinely send staff to follow children and teens down the streets in an attempt to coax them back. And they call the police – multiple times per week and in some cases, an average of once per day – to help round up the children.
The push for reform also comes as Colorado faces a shortage of beds for children in mental health crisis. Children’s Hospital Colorado in Aurora reports that its emergency department is often filled with kids who are suicidal, and that children sometimes stay for weeks while their families search for an available bed at a residential facility.
Since 2007 in Colorado, 44 residential child facilities have closed, a loss of 2,200 therapeutic beds, according to a count by the Colorado Association of Family and Children’s Agencies, which represents residential centers.
The state child welfare division, within the Department of Human Services, has called for adding more beds, and Gov. Jared Polis in November authorized $12 million in emergency spending of federal coronavirus aid intended to create 45 youth beds. Also, the human services department, in its budget request for next year, has asked the Legislature’s Joint Budget Committee to fund another “facilities monitor” position for its team that inspects youth residential centers and follows up after reports of abuse or neglect.
The additional employee would reduce the caseload per monitor from 40 facilities to 33, according to Adrienne Baxter in the state Office of Children, Youth and Families. Monitors will help residential centers build “trauma-informed care” programs, meant to help children recover from abuse and neglect, which will in turn cut down on runaways, Baxter said.
The department also has requested funding to create a new, two-person “specialized response team” that will help counties dealing with high turnover rates among caseworkers and prevent kids from getting stuck in hospitals and juvenile detention centers when what they need are beds in residential treatment centers.
While child advocates welcome the added support, they’re hoping for bolder reform.
Stephanie Villafuerte, the state’s child protection ombudsman, said that simply adding more beds won’t fix problems at residential facilities or solve the children’s mental health crises when the way those facilities function also needs reform. The current system for licensing and monitoring youth centers is a “gotcha” system that doesn’t go deep enough, she said.
“You can keep adding beds all you want, that isn’t going to solve our problem,” she said via email. “As long as we keep focusing strictly on monitoring violations and not long-term quality outcomes, we are just going to have the same results – more monitoring violations and facility closures. We need to focus on the quality of the treatment beds or the quantity won’t matter.”
Colorado is “in a bad loop,” Villafuerte said. Residential centers were shut down because of licensing violations, or closed down on their own because of low funding and bureaucratic requirements, forcing Colorado to send kids out of state for treatment or linger in hospitals. Now, everyone from parents to hospitals to district attorneys and county human service directors is crying out for more beds.
“We’re missing the complexity of this – it’s not about supply and demand,” Villafuerte said. “We keep repeating the same cycle – monitoring violations, facility closures, bed shortages, add more beds, repeat. We must break the cycle of dysfunction here and think more deeply.”
Villafuerte and others are looking at a 2017 Florida law upon which Colorado could model its reforms.
The law required the Florida Department of Children and Families to put in place a new accountability system for residential centers by July 2022. State regulators were ordered to work with child welfare experts at Florida State University to come up with a new way to evaluate residential care and follow up with kids and their parents to see whether the treatment worked.
Florida has tested its new system in 238 youth residential facilities and gathered hundreds of surveys from young people and residential care providers. The next step is to analyze the data gathered from each center and create a public website where parents, caseworkers and others could research which center is best for a child’s specific mental health and behavioral issues.
Colorado Rep. Dafna Michaelson Jenet, a Commerce City Democrat, believes the model would work here. Similar to Florida, she wants to involve Colorado’s higher education institutions in building a new evaluation system that would make sure facilities are using the best methods for treatment of kids and teens.
“We know there’s a problem,” she said of the high number of runaways and licensing violations at youth treatment centers. “It’s not researching the problem. It’s researching the solution. What academia has that governments don’t have is the flexibility to study, to look, to question.”
Michaelson Jenet envisions a system in which residential centers, instead of getting dinged with violations when kids get injured, or fight or run away, instead work continuously with regulators to improve their programs and restore kids’ mental health. And with better follow up, Colorado would understand which programs work best at returning kids to their families instead of sending them to juvenile detention or a string of other residential centers.
“Ultimately, it’s the way that we keep tabs on our providers,” the lawmaker said. “Are we working with them for continuous quality improvement?”
Many of the rules and regulations that residential centers operate under were written in the 1990s, when children’s mental health issues were not as acute and emergency departments weren’t filled with suicidal young people. Universities, child advocates said, could bring cutting-edge research to the reform package.
Even the residential facilities in Colorado welcome the reform.
Becky Miller Updike, director of the Colorado Association of Family and Children’s Agencies, said that adding more oversight and regulation won’t help residential centers stay open or result in better outcomes for kids.
What residential centers need are more staff as they face an unprecedented workforce shortage and a stronger partnership with the state, she said. The current monitoring system looks only at how a young person is doing while in a facility – not how well they do after returning to their family, or in school or in a subsequent job, Updike said.
“Adding a regulatory person is not a systemic reform that is significant enough,” she said. “In the landscape of this unprecedented mental health crisis, we really need to look at bigger reforms.”