Casa de Corazón suspended operations at its residential treatment centers, both in Taos and Española on Friday (Nov. 23).
The closing is expected to last at least six months while administrators determine if there is still a viable need for the centers, called RTCs, or if their resources could be better utilized elsewhere.
A shift in therapeutic emphasis, both nationally and in the state, has more youths with mental disabilities and substance abuse problems getting outpatient services within communities rather than live-in facilities. This change has seriously reduced the number of clients living at Casa de Corazón facilities, which draws youths from around the state.
John De Paula, president of Casa de Corazón’s board of directors, said administrators decided to suspend operations because fewer youths were being referred. “The referrals dried up and without the referrals we couldn't operate,” De Paula said. “We have significant increases in referrals for treatment foster care but not for the RTC and we don't understand that. We're putting things on hold for a while until we can figure it out, but I'm not considering the closing permanent.”
Mark Nash, clinical director of the Taos center, said the center used to receive three to five referrals a month, but in the last four months there has only been one. The referrals come from a variety of sources, including juvenile probation officers, families, teachers and psychiatrists.
As a result, the center could no longer cover its costs.
Casa de Corazón still offers behavioral management therapy and treatment foster care services. De Paula said it will be expanding its intensive outpatient services, the foster care, and the behavior management.
Change to community-based intervention
Nash said the current national trend is for less emphasis on residential treatment and more on community-based intervention.
The clinical director for the Española center, Mike Wallington, echoed that trend. “A lot of this came out of a behavioral gap analysis done several years ago, he said. “The state identified that in New Mexico in particular, RTCs were being over-utilized. The state recommended services transfer to a more community-based treatment.”
This trend was the subject of a Supreme Court decision in 1999. The Olmstead Act, which was placed under Title II of the federal Americans with Disabilities Act, required states to place persons with mental disabilities in community settings rather than institutions.
At the time of the Olmstead decision, three quarters of the states had already reorganized their behavioral health systems to provide most services for people with mental disabilities within their community — at less than half the cost of institutional care and with more productive results.
According to the testimonies, mental health care practitioners across the country said people placed in therapeutic community settings experienced more independence, a sense of competence and dignity, improved relations with family and friends, and a fuller integration into ordinary community life.
In 2004, the New Mexico Legislature established the Interagency Behavioral Health Purchasing Collaborative to streamline the network of behavioral health agencies in the state. Agencies such as Human Services, Health Corrections, and Child, Youth, and Families fell under this new umbrella.
In 2005, Value Options, a privately owned managed behavioral health care company, was chosen to oversee New Mexico public funding and the delivery of behavioral health care in the state.
“When Value Options came in two years ago,” said Wallington, “they started working on that emphasis away from RTCs. They've been denying a lot of requests for RTC placement, insisting kids need to be served in the community.”
Option for treatment
According to Wallington, when a child is recommended to an RTC, the facility will make an assessment based upon his or her situation and condition and then send a request to Value Options, which funnels Medicaid money. Value Options will deny a request for RTC placement if it seems the child can remain within the community and still receive necessary treatment.
“If a kid was having problems in the home, breaking curfews, creating conflicts within the family, then the idea was in the past to bring them into an RTC,” said Wallington. “Now we have a multi-systemic therapy with therapists in the home with the families, right in the middle of the conflict. If they can be maintained in the community, that's what they're (Value Options) going with. That's what should be done.”
“But sometimes,” Wallington continued, “kids need to be taken out of the home and put into intensive, 24-hour treatment centers. I believe we should keep kids in the community and in the homes as much as possible but at times taking them out of the home for short periods of time can be very beneficial. The trend is going too much in the other route. It must balance out at some point.”
Wallington said several RTCs in the state had recently closed. “As far as I know, there is no other residential center for kids north of Albuquerque now.”
Nash said it's a healthy trend to keep youth in their own communities and homes, if those community supports are available, but feels that RTCs should not be abandoned. “They have an important niche with kids who have long standing mental health issues such as bipolar condition or serious substance abuse and don't have a viable family support,” he said. “It's harder to address those needs through community-based support when there is no family.”
In the meantime, De Paula said the organization will study the needs of the community and whether there is still a need for the RTC. De Paula plans on spending the next 180 days contacting referral sources, looking at the demographics of youth referral, and spend time working with other coalition agencies in the hope a picture emerges.
Nash said the hardest thing about the closure is the number of devoted staff and dedicated professionals who have worked for the organization for 15 years. “They've given their lives to these girls and boys,” Nash said. “They've given their heart and soul to the program. We've been trying to bring them into the other programs.”
De Paula said they've been able to offer jobs in behavioral management to the direct-care people. Some have chosen to take those jobs.
“People see it as sad,” said De Paula, “because we've run that program for a very long time. I don't see it as hugely emotional, just as a necessity. Sometimes change doesn't feel real good.”
But De Paula affirms that Casa de Corazón is strong: “We're a strong organization that is committed to the kids in the area. We're not going anywhere. We have as much heart as our name implies.”
In the meantime, what happens to the youth who could benefit from an RTC in Northern New Mexico?
“I think a lot of kids in the area are spending time in jail,” said Wallington. “They're just waiting for various things, finding placement, getting approval, not coming back into the community. At least until a balance comes back in to meet everyone's needs.”