From The Desk of Pamela Bisceglia
Ten years ago, a child in crisis could be transported from a school or their home to Denver Health or The Children’s Hospital for a 72-hour hold for professional/psychiatric evaluation. Today, the child of a family with resources is more likely to be admitted and care is taken to make sure that wrap around services are put in place to support the child and family. However, today the larger group of children in crisis never make it past the emergency room; they are drugged and sent home with their parents and put on a list for mental health services. If the family has private insurance the family may need to wait until their child’s name comes to the top of the list or the family may also find the child is discharged based upon an insurance company’s determination of medical necessity (a standard which does not often mean the child is ready for discharge but rather that private insurance will no longer cover the child’s care). If the child is Medicaid eligible, the rules prohibit a wait list; if that child is lucky he/she might see a counselor bi-monthly. If the child needs a therapeutic day treatment program, there is not always clear path to treatment.
Over the past ten years, over 50 percent of licensed facility programs for school age children within the metro area/Colorado have closed; today there are 37 left in the State. Facility programs are licensed through the Colorado Department of Education and Colorado Human Services. Some facility programs are designed for children with significant emotional disabilities; some of the up and coming programs target children with autism, a few treatment programs specialize in treating trauma. A school district can refer a child to a facility program, but the facility selects who they enroll, who they serve. Most facility programs offer therapeutic services (day treatment services). By definition, day treatment services are daytime programs that provide integrated, comprehensive treatment; educational, pre-vocational or vocational, and activity services to individuals; and therapeutic services to their families.
As facilities closed, but children’s needs remained constant, Denver Public Schools opened a “District run” facility program. Denver Public Schools first approached the for-profit Arizona subsidiary of Cenpatico Behavioral Health, LLC (Cenpatico) in 2012. The elementary and middle school programs opened fall 2013. The elementary facility program was located on the 3rd floor of Trevista Elementary School; the Middle school facility program was located on the 2nd floor at Skinner Middle School. Students were provided instruction in grade level curriculum. For behavior, the facility used a daily and ongoing level system. All students were required to have five behavior goals. The privilege earned for the day was in accordance with points earned; if the student was able to demonstrate appropriate behavior over the course of time they earned additional privileges.
AdvocacyDenver began receiving reports in relation to the excessive use of (prone) restraint. Agency staff placed their hands on children over and over again in order to gain compliance; the agency failed to provide the parent/district with a written report when restraint was used. The agency had DPS Safety and Security on speed dial; if the school could not gain compliance via restraint, Safety and Security offered mechanical restraint and would handcuff the child until they calmed or with older youth, until Denver Police Department arrived. On a good day the elementary and middle school program shared a psychologist. The school did not offer therapeutic services. Almost the entire enrollment were students (males) of color. The students did not “get better” nor did they transition back to a less restrictive environment. The trauma and emotional scars were significant.
There were significant concerns with the middle school program (small number of students, significant number of arrests, disciplinary removals, restraints) and so the contract with Cenpatico for the middle school program ended in 2016. That same year Cenpatico provided a report in relation to the number of restraints (prone restraints) used in their elementary school program for the 2015-2016 school year. The average enrollment was 15 and the number of restraints lasting 5 minutes or longer was 557 for the school year. The next year Cenpatico changed their name to Lifeshare and the elementary program remained open through the 2018-2019 school year.
In 2019 Denver Public Schools entered into a contract with out-of-state, for-profit Catapult Learning to take over DPS “District run” facility program. AdvocacyDenver received blueprints for locked seclusion rooms to be constructed at District run facility school (Sierra at Barret School). Denver Public Schools Board of Education policy bans the use of seclusion, accordingly, Special Education Director assured AdvocacyDenver that the seclusion rooms would not be built. In June, the Executive Director for Catapult invited AdvocacyDenver to tour their contract facility program in Littleton Public Schools. They discussed their philosophy, educational programming, point system; they explained that their model calls for staff to be trained in physical restraint, but also their model calls for seclusion. Like Cenpatico, the school does not offer therapeutic services.
“Seclusion” means the placement of a student alone in a room from which egress is prevented. A seclusion room must have adequate veneration, lighting (not natural light) and size (approximately 4 feet by 4 feet). The primary purpose of a seclusion room is to confine or isolate a student. The Director walked us to the area to view their seclusion rooms. There was a small child standing just inside one of the rooms, a member of staff stood close by. The Director said that sometimes children take comfort just standing inside the room. (In most instances physical force is used to “escort” the child to the seclusion room.) The walls of the room had once been painted; however, the paint, child height down had been scratched off the walls- the top of the room was sky blue, the bottom was brown/bare wood. We walked away for a moment and when we returned the door for the 1st seclusion room was closed, the door handle was pushed down in a locked position, and an adult stood by the door peered down at the child through wire vent (adult height) we could hear the faint cries of a child pleading for the adult to open the door… The Director asserted that seclusion is a better safer way to address behavior.
Starting in 2012 and continuing up until today AdvocacyDenver and other like disability rights agencies met with DPS to discuss concerns in relation to the District run facility program pipeline; the disproportionate number of minority males sentenced to the program, the use of physical restraint, and DPS Safety and Security/Campus Resource Officers (Denver Police Department) handcuffing children. In spring 2019 Denver Public Schools Board of Education and Superintendent publically put a ban on handcuffing young children. The Board directed the District to review and modify policy in relation to Student Restraint. The policy then and now bans the use of prone restraints, mechanical and chemical restraints as well as seclusion. However, just as the policy was being drafted, the district moved forward constructing the seclusion rooms at Barret; for the moment the doors have not been placed on rooms (“recovery bays”). There is no evidence that seclusion has therapeutic or educational value. Nineteen states prohibit secluding children in locked rooms; four of them ban any type of seclusion. Colorado’s law is well defined, but it does not demand meaningful oversight and monitoring, in relation to restraint (physical, mechanical, chemical) and/or seclusion.
Since 2012 AdvocacyDenver and other like disability rights agencies have met with a long list of public agencies, leaders, representatives to discuss and forward systemic change in relation to mental health crisis. Restraint, seclusion, removal does not address or replace behavior. The Mental health crisis is not an issue that can be addressed in isolation by the public school system. Instead the state, each city, must develop a blueprint to address the mental health crisis, hospitals, public and private providers must roll up their sleeves and make a commitment to serve all children in need.
Part I discussed FRAMING THE ISSUES
Part II discussed LONG TERM COMPETENCY