The 15-year-old boy sits cross-legged on the couch in red flannel pajama bottoms, his hair looking like it just rolled off the bed.
Because he just got out of bed about three minutes ago.
He is now seated across from his therapist, who had to knock on the door for several minutes before the teenager’s mom answered via the grocery store bell. It’s open, he told Bobby Tyman, a family therapist and clinical program coordinator with Paragon Behavioral Health Connections.
It’s not the first time Tyman has had to wake the sleepy boy for his 10am therapy appointment.
Sometimes he forgets about me and sleeps when I get here, Tyman said, standing on the porch of the small brick house in the Denver suburb of Sheridan. Part of my job is waiting on the doorstep.
This is what in-home mental health treatment for adolescents looks like. The teenager, who recently stole and crashed his mother’s car and has been using drugs to cope with depression, is groggy and shy, but tells Tyman he’s applied for three summer jobs and is choosing a new high school for the fall.
I love it for you, Tyman says after he grabs a stool from the kitchen so he can face the boy on the couch. Next, they sit on the floor around the coffee table and draw how they feel with colored pencils on construction paper. The teenager, who agreed to let The Colorado Sun participate in part of the therapy session but didn’t want his name published, draws a large head with tired eyes attached to a slim body.
They then make coffee and Tyman teaches the boy how to boil sugar and water for simple syrup while they talk in the kitchen.
The new home therapy program, which has served 200 children and their parents since it began in January, is an extension of the Colorado Boys Ranch. The ranch opened in 1959 as an orphanage in La Junta, then closed its residential program about ten years ago. But his Colorado Boys Ranch Youth Connect foundation has continued, pouring its resources into behavioral health care for children in their homes.
The evolution of the program reflects what has changed in the child care system over the past decade, Colorado is sending fewer children to home-based institutions and has increased efforts to provide home mental health care to reduce the number of children removed from their homes and placed in foster care in the first place. Several youth care centers, including the Tennyson Center for Children in Denver, have moved from residential care to day treatment and home therapy in recent years.
The ranch, which provided in-home counseling to children after finishing its residential program, has since partnered with Paragon Behavioral Health Connections to offer in-home intensive care, intervention services, and help with logistics like childcare or education for children in foster care or at risk of ending up there. Other children are referred to the juvenile justice system as part of pretrial rehabilitation programs and the Medicaid program. Parents can also seek help directly, without a referral from a government program.
A staff of 40 works in 20 counties, including the entire Denver metro area, plus Weld, Montezuma, La Plata, Garfield, Pitkin, Elbert, Summit, and Eastern Plains counties closest to the former Boys Ranch Crowley, Otero and Bent.
It is expanding near El Paso, Moffat and Routt counties.
Geolocation of personnel links them to reinforcement
The point is to help children and adolescents improve on their condition and provide an abatement program for adolescents who have visited a hospital emergency room in crisis or been admitted to mental health waiting, said Camille Harding, CEO of Paragons . The program aims to schedule the first appointment within 24 hours of receiving a help request.
Kids who are looking to have their own personality and have a say in who they are can do this best at home, not in an unfamiliar office with a therapist staring at them, Harding said.
Having it on their terms is much more powerful, he said. You decide what we do. We can go for a walk. We can go to the park down the street. From a development standpoint, it just makes more sense.
Some children in the program have such intense needs that someone from Paragon is at their home 10 hours a week. A therapist helps work on their mental health. A care manager can help enroll in school or enroll in a GED or help the family find housing or food assistance. A specialist can teach specific interventions for children with intellectual disabilities along with behavioral health issues.
The team approach means children get better help and staff are less likely to burn out, Harding said. The technology of the programs is also unique. Paragon is installing geolocations on its staff, many of whom are graduate social workers or case managers, and can quickly dispatch reinforcements. This means that if a teen threatens suicide or has a violent outburst, a more experienced counselor can assist them in person or virtually.
There’s such a huge variety of things you encounter, Harding said. There is nothing ordinary about going to someone’s house.
Without the additional support, staff are forced into a reckless approach, he said. They get stuck and things get tough. This is a quick way to burn staff.
A $1.7 million grant, part of Colorado’s federal pandemic relief, is helping the program develop the technology and hire a psychiatrist.
Therapy next to someone’s bed or in a Costco aisle
Tyman would rather stand on a client’s doorstep than sit in an office waiting for a client who doesn’t show up.
He did therapy on the floor next to someone’s bed because the person was too depressed to get up.
And one mom is so overwhelmed with her life that the only time she finds Tyman for therapy is when she’s at the park with her kids or walking around Costco. Tyman tells her that she can tell she’s a neighbor or friend if they meet someone she knows.
It’s okay if we start 15 minutes late because you had to get up and make coffee and get dressed, or whatever you had to do to deal with, she said. If your mental capacity is not very high, and you are not functioning well, and you do not get out of bed on time, and you are not able to manage your appointments, you will never get to therapy.
But therapy is what you need to fix these problems.
Plus, visiting people’s homes helps Tyman figure out what they need more quickly. Therapy is ingrained in their lives because it takes place in their space. Virtual therapy, which has become so popular during the pandemic, has its place, but this is the other way around.
Virtual therapy is beautiful and I’m glad it exists, Tyman said. But there’s so much I could never see looking through an iPad. There’s so much insight into being able to walk into a house and see how you live and what your world is like and who you are.
Tyman has eight clients he sees several times a week, driving from Green Valley Ranch to Evergreen. His Subaru Forester was filled with toys on a recent morning of water guns, sand art, and dolls that were headed to a playroom at Paragons Lakewood office.
Tailor his approach to each child. The 15-year-old loves to draw, but she bluntly told Tyman that he hated his markers. Tyman stopped by to buy colored pencils before his next visit.
He also learned that the boy plays The Sims, a video game in which user-created characters make friends, get jobs, and have families. The teen won’t talk much about the relationship with his friends, but the drama has been unfolding between his Sims.
His friends are like frenzied enemies. Classic 15-year-old stuff, Tyman said. When I asked him about this, he said, Oh, I don’t care. I am fine.
But when Tyman asked how one of the video game kids got shut out and got into fights with the others, the teen revealed that the character was angry, sad and lonely, Tyman said. It’s 100% about him, she said.
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