A father and his son pull into the parking lot at UCHealth Longs Peak Hospital in Longmont in mid-June.
They don’t have an appointment scheduled. In fact, they don’t see a doctor. The father’s goal is to leave the boy at the hospital.
The child, who has autism, is reportedly still living there. He turned 14 a few weeks ago at the medical center.
The adolescent is in a precarious situation. His mother is dead. The majority of his relatives live in Florida. He has shuffled between a few foster homes over the years. The boy’s father isn’t willing to take care of him. His grandfather told CBS News no one else in the family will take the teenager, including him because of his own health concerns.
“[Keeping the boy in the hospital is] cruel and highly inefficient and it’s going to have a long-term impact on this young person,” says Rep. Judy Amabile, who received information about the boy’s circumstances from an anonymous hospital employee. “It’s just massive trauma; your parent drops you off and never comes back, then nobody else helps you.”
Details about the situation are sparse because of staunch privacy rights that protect the boy’s identity, and laws that keep hospital and county officials from sharing information about people receiving care. But incidents like the one at Longs Peak Hospital are becoming more common in Colorado’s overburdened and under-resourced child welfare and behavioral health system.
Hospitals and other stopgap measures can’t provide the acute behavioral treatment from specialized clinicians and staff that many of these children require.
“In our 41 years, we have never seen a crisis like the one we’re in right now,” says Dr. Becky Miller Updike, executive director of the Colorado Association of Family and Children’s Agencies (CAFCA), who oversees a collection of more than 40 agencies that take care of juveniles with mental and behavioral health issues across the state.
The 14-year-old boy is being held at Longs Peak Hospital because there’s nowhere else for him to go. There isn’t enough capacity in residential treatment centers for him and a rising number of other youth with complex medical and behavioral needs who require focused treatment outside of a home setting, including those with intellectual and developmental disorders (IDD).
That means dozens of adolescents find themselves boarding in hospitals, county human services offices and detention centers across the state each month. Some are sent to out-of-state facilities to get the support they need.
The Children’s Hospital Colorado frequently holds young people in its inpatient units.
“This type of story is all too common in Colorado,” said Megan Cook, director of clinical social work at Children’s Hospital Colorado, in an email to Boulder Weekly.
According to the Colorado Human Services Directors Association (CHSDA), there were at least 69 children or youth held without a future placement in county offices, hospitals or detention centers in June in Colorado.
These consequences can’t be traced back to one crack in the system, rather myriad fissures including an increase in minors with high-acuity needs post-pandemic, limited beds in residential treatment facilities and chronic underfunding to child welfare.
“There’s concern that Colorado is failing these kids and these families,” Amabile says.
Donovan Holligan is a social worker at Boulder County. He’s been reaching out to more families recently to find ways to support them.
“These are kids and they need help,” he says. “They don’t understand that they need help. And I think we’re doing them a disservice by making them wait six months to a year sometimes just to see a counselor.”
One of those families is Jennifer Beidler and her son Conor Gruber, who turned 15 this year. Beidler calls her son “a great kid” who is funny and finds joy in life.
After years of failing to get a psychological profile, Gruber was recently diagnosed with ADHD, disruptive mood disorder and is on the autism spectrum.
Beidler says her son is very smart, but was challenging to manage growing up. He has physically hurt family members, including his three little sisters and Beidler, and caused thousands of dollars of property damage at his school.
All the while, Beidler was trying to find a residential treatment center that could provide care for her son’s needs per the recommendation of hospitals. But because she couldn’t find one to take her son, even after pursuing out-of-state options, Gruber was forced in and out of hospitals that only held him temporarily.
“For a while we stopped going to the hospital because I had given up,” Beidler says. “Conor would have some months where he would do really good and we’d have some months that were just terrible. It was scary having him at home.”
On Nov. 13 last year, as Gruber’s behavior started to escalate to destroying property at home, Beidler dropped her son off at Longmont United. He stayed there for the next six months. Holligan, the family’s caseworker, told Beidler not to pick up her son, as they were working to find a permanent place for him.
“There aren’t places out there for kids,” Holligan says, adding that half of the hospitals and adolescent treatment centers Gruber went to either closed or wouldn’t take the teen because of aggressive behavior.
Kids with needs like Gruber’s are also held in county offices when they don’t have anywhere else to go.
When Mollie Warren, director of Family & Children Services at Boulder County, was a caseworker 10 years ago, stopgaps weren’t in the conversation. She says she was shocked when she took over as director and her team was discussing purchasing cots for the office.
At the time, Warren didn’t think the organization needed temporary beds because “kids shouldn’t sleep in offices,” and should instead be in systems meant to support them, like a foster care setting, residential treatment or at home with intensive care. But reality changed Warren’s perception.
“[Youth staying in our office] has become an inevitability today,” she says.
Generally, the minors who need care from human services have had a tough go at life. Many have experienced some form of trauma stemming from neglect, abuse, or adult substance abuse, resulting in aggression, depression and other behavioral health issues.
Experts call this “high-acuity needs.” Kids with autism, who can have complex care requirements because of dual mental health struggles and IDD, are a niche within this demographic and are often placed in separate programs.
“It’s really the kids who we know can’t safely be in the community or in a family’s home for now, because they need more intensive treatment,” Warren says.
The most common stopgap facilities for children with high-acuity needs in Boulder County are at county offices and in hospitals.
Five youths spent 16 total nights in the Boulder County Family & Human Services office so far this year, according to officials. Three kids spent 15 nights in the office in 2022. While stays are typically a few days, the longest stretched to 10 days. The youngest child was eight years old.
About the same amount of children are boarded in hospitals, Warren says. These hospital stays are longer, usually a minimum of 6 to 8 weeks, because these kids typically have the highest acuity needs, making them the hardest to find placement for.
Hospital stays are problematic, but Warren says it’s better than a child staying in county offices without trained medical staff or security.
“Being in a hospital is actually safer than sleeping in a conference room in our building,” she says. “Because of this crisis, those are the types of decisions we’re being forced to make.”
It’s easy to imagine how a hospital stay can be damaging to any child.
Holligan, the social worker, says children who wait for placement in a hospital are treated like any other patient and are typically held in a quiet section of the facility to avoid impacting anyone else’s care.
Conor Gruber stayed in an emergency room bed at Longmont United.
“Sometimes [staff] would take him on a walk outside,” Beidler says. “They brought him games and things like that, but he was stagnant. He wasn’t receiving any treatment therapy. So he just sat there in limbo while we tried finding him somewhere else to go.”
Beidler was optimistic a hospital in Florida would take her son, but was disheartened after it stopped returning her calls and emails.
“He was my first kid. He’s my boy. I love him very much,” she says. “I fought very hard for him to have a future, between calling hospitals and driving all over the state, and just fighting for him. And it’s been hard because there’s a lot of places that just don’t care.”
Boulder County partners with hospitals to make sure these kids have online school. But the children spend most of their time watching TV or talking to nursing staff.
Hospital staff try their best to accommodate — one even made a basketball court for a kid — but these medical centers aren’t built to serve the needs of these youngsters.
“While boarding keeps vulnerable patients physically safe from injury, waiting in an emergency department does not provide the specialized mental health treatment kids need to help them recover,” says Cook at Children’s Hospital. “In addition to delaying treatment and recovery, prolonged boarding in emergency departments can also mean extended absences from school, and puts stress on both kids and their caregivers.”
It also impacts the hospitals. In a statement, UCHealth says the children’s presence can take away medical staff and hospital beds from other patients who need care.
Updike at CAFCA says it’s the “worst-case scenario” when high-acuity needs youth lack therapy or stimulation.
“That kid’s not going to be better when the door opens for them,” she says.
A perfect storm
While it’s the county’s goal to find permanent placements for these youth, it can be more challenging when they have higher needs.
It’s common for treatment providers to deny adolescents with high acuity because the child may negatively impact development in their peers or may not meet specific admission requirements, or the treatment facility may not have necessary resources, like multiple clinicians and specialists. These days, Updike says it’s common for these types of children to move to 15 or more facilities before landing in a permanent setting.
Simultaneously, as need is at its highest, there are fewer facilities equipped to support this demographic.
Since 2007, nearly 50 residential treatment programs in Colorado have closed — amounting to about 2,000 less beds, according to CAFCA. Centers that care for kids with autism are also closing around the state after a 2021 Joint Budget Committee decision lowered the amount of money distributed to centers starting July 1 of this year. Nearly 10 agencies serving children with autism have closed since 2021, according to The Colorado Sun.
Part of the reason for the closures is a shift in the philosophy of how to provide care for children with high-acuity needs. The Family First Prevention Services Act of 2018 was championed as “the most significant reform to federal child welfare policy in decades” by the Children’s Defense Fund. It aims to keep children with their relatives and emphasizes the importance of growing up in family-like settings, which is proven to provide positive outcomes for young people.
Miller says the paradigm has shifted over the last decade to community-focused care that often doesn’t offer the expertise, preparation or tools to manage these kids safely.
“Providers are pretty offended at how, for years, there’s been this urgency to close residential [facilities]” she says. “And then, suddenly, there’s this crisis. [Maybe] we shouldn’t have been shutting down so aggressively the past decade, but here we are.”
There’s also a workforce issue. Updike says it’s hard to attract healthcare workers and staff to a job that doesn’t pay very well (starting around $20 an hour) and can be subject to abuse from the person they are supporting.
“It takes pretty special people to go do graduate school in social work, take out a bunch of loans and then get punched in the nose by a kid,” she says.
‘Not fast enough’
Warren is one of those people who has dedicated her life to helping people as a social worker. Nowadays, she says it can be “isolating” to support the needs of the community when “[people and families needing care] are fending for themselves,” and it feels like there aren’t solutions.
“At no point did I think anyone got into this field thinking their day-to-day work [would be] focused on getting kids out of a hospital, where they’ve been for months on end,” she says. “It’s just so far from what we believe we’re meant to be doing that it can feel incredibly difficult.”
She’s not alone. After nearly two years of fruitless efforts, multiple organizations, including CAFCA, sent a letter to Gov. Jared Polis on July 18 outlining the desperate need to ensure high-quality and individualized residential care for high-acuity needs children.
Their cries come as momentum builds to find solutions via a child welfare system interim committee organized in the General Assembly, and a working group composed of government agencies, providers and hospitals seeking immediate and short-term fixes.
Residential treatment beds have been added in the last year around the state through bills like HB22-1303, but some say it hasn’t been enough.
“[The Legislature is] trying to help, so that’s cool,” Updike says. “But it’s not fast enough for the kids that are in hotel rooms and in county offices sleeping.”
While experts say solutions to the crisis are complex, it boils down to a need for more money and resources directed to increasing the capacity of specialized care facilities and staff.
“To do what we need to do is going to be very expensive,” Warren says.
Despite the long road ahead, social workers like Holligan remain dedicated to their work.
“Even if it doesn’t go anywhere, even if I hit a wall, I’m going to try to climb over that wall,” he says. “Because [the children] deserve that. They deserve a voice, they deserve someone who’s gonna advocate for them, and they deserve to get help so they can be kids, and they can enjoy their life and not struggle.”
Earlier this summer, thanks to the persistent help from Holligan, Gruber was accepted into Third Way Center, a residential treatment center for high-risk adolescents with complex mental health issues. Gruber lives in a small pod of boys with constant attention from staff and medical specialists. He attends school there and goes to a family session once a week with his mom.
While their relationship is “rocky,” Beidler says her son is doing a lot better at Third Way: He made A’s and B’s on his latest report card and is becoming more involved in his care.
But Beidler is concerned that her son could be removed from his new center if he becomes aggressive again.
“He’s kind of running out of time,” she says as her son comes closer to becoming an adult. “That’s the way I see it. I feel like he’s running out of time to be able to fix this and learn from it.”
Conor’s goal is to get home. He’s motivated by getting a job and his three cats, Sir Handsom, Oreo and Cocoa bean.
“He wants to make his money and he wants to have his cats,” Beidler says. “Those are the things that are important to him. So as long as he can maintain that, I feel like it’s a success.”