State’s Human Services Chief Answers Critics Of Juvenile Corrections Audit

Ryan Warner: This is Colorado Matters from CPR News. I'm Ryan Warner.  Violence at a youth correctional facility in Colorado Springs has been unusually high in recent years. Meanwhile in Pueblo, a home for people with severe disabilities has been under federal investigation for improper behavior by staff.  These are among the challenges Reggie Bicha faces, he leads the Colorado Department of Human Services. Bicha has also been praised for several initiatives, including new efforts to prevent child abuse. And Reggie, welcome back to the program.

Reggie Bicha: Thanks Ryan, it's great to be with you.

RW: And let's start with the troubles at youth correctional facilities. So there are about a dozen of them across the state. This is for kids awaiting a court hearing or who are serving sentences. A recent audit found that to discipline kids, staff are overusing what are called 'seclusions' to isolate them from the rest of the population. Lawyers have said that these can last for as long as a month. And state policy is that they're only to be used in rare circumstances. What are you doing to cut down on the number of seclusions at these facilities?

RB: Well Colorado's policy on seclusion for kids in youth corrections is one of the most progressive in the country. We're really proud of that. We changed it, our policy, in October of 2015. The audit you're referring to, the state auditors came in in December I believe it was, of last year, and evaluated how we were doing on these new policies that we had put in place. Imagine rolling out to ten facilities that serve some 500 kids across the state, over 1,000 staff, trying to do new ways of doing business. You're always going to have some bumps along the road and I think that's really what the audit identified was ways that we could better document, clarify our policies, advanced training and so forth. And we've already, I'm proud to say, have implemented the recommendations that came from the state audit. But back to seclusion, our use of seclusion is one of the most progressive in the entire country. We are not one of those states that places kids in administrative segregation or locked seclusion room and leaves them there for days at a time. We only use that type of isolation in an emergency situation and only have kids in isolation until the emergency is over. The average length of stay in a seclusion is an hour and a half.  The most frequent time period is about forty-five minutes. And so our use of seclusion is actually very very low. That compares to, I think the national average is about fifteen hours per seclusion episode.

RW: Fifteen hours. What is the longest you've seen lately in Colorado?

RB: Well we have a new law in place that was passed in this last session that if seclusion needs to last for more than four hours, there are a series of checks and balances, all the way up to having to go get a court order. Now we've only used that situation I think two times since this new law went into place where we've asked a judge to allow us to keep a youth in seclusion longer than eight hours.

RW: Could this be a question of vocabulary, that is if staff calls this a timeout or something like that, can you skirt the new rules?

RB: Yeah, it's a great question, Ryan. You know any of us who have raised teenagers, anytime a teenager gets unruly it's fairly common for us as parents to say hey, chill out, go to your room, right. In my world, in youth corrections, when we tell our teenagers to chill out and go to their room, it's called a seclusion. Particularly if the door closes, and all of our doors lock because it's a correctional facility, that's considered a seclusion.  And it's really challenged our staff and our leadership in the division of youth corrections to think about and develop new strategies of managing youth behaviors besides telling a kid to go to their room and chill out for awhile because that's a tool that is now very prescriptive and should be used in a very limited circumstance.

RW: Of course the safety and the mental health of the youth are a priority for you but so is the safety of staffers. 

RB: That's exactly right.

RW: And they too have to consider what to do if a youth is violent.  So without the tool that you had before the reforms related to seclusions, how can you guarantee the safety of staff and residents as well?

RB: So we're being, our staff are being very much more proactive. It's about developing relationships with kids. It's about…

RW: Shouldn't it have always been about that?

RB: Always was but we used to have practices before where we would like program in a youth who has violent behaviors, we might use seclusion, put them out of the unit, isolate them, as a preventative measure. Well we've taken that away because now the state statute says it has to only be used in an emergency. So we need to decrease. We have to add more staff so that we can have a lower staff to client ratio. It's about helping our staff to develop positive, constructive relationships with kids. It's about helping our staff to identify when things are beginning to escalate, how do we deescalate them verbally. And how do we help kids develop their own coping mechanisms. A youth can choose to go to their room and chill out on their own without being directed to do so. And other approaches that national experts have come in and given the division of youth corrections advice on how to develop these new strategies and I must say that they're being implemented across the division quite successfully. 

RW: That would include, I assume, the Spring Creek Juvenile Facility in Colorado Springs. There have been problems there. A whistleblower told the Denver Post that the facility is plagued by assaults on staff and kids. So again the violence that can go in both directions. The head of that place recently stepped down. There's been a lot of staff turnover but you've added staff there, as you’ve said, that that's a priority. Any evidence that conditions are improving at Spring Creek?

RB: So Spring Creek has been an outlier in terms of the amount of aggressive behaviors that we've been seeing from kids as you've outlined. We had done all of the early interventions that I just mentioned, bringing in national experts, additional training and so forth with little success. The number of rates of fights and assault had continued at Spring Creek, which was different than what we were seeing in other facilities in the division. So what we've done is we've changed the programming at Spring Creek. It used to serve both detention, which is like jail, if we were using an adult term.

RW: Okay.

RB: And commitment, which is like prison, if we use an adult term again.

RW: So shorter term stays versus maybe longer term stays. 

RB: And we've removed all of the longer term stay kids and placed them at other facilities. So now Spring Creek is only working on kids who are coming in, spend an average of about fifteen days, get settled and transition back, while they're awaiting court. That has allowed us…

RW: Why is that important? What does that make different?

RB: It's been really important because we've kept the staffing the same, with a fewer number of kids and only focusing on one type of program. So our staff now are having to work with one population of kids, they can spend more time with those kids. Also, here's the important piece, when I have a committed population and a detention population, we literally have a mix of the eleven-year-old kid, because I have kids from 10 to 21 age range, an eleven-year-old kid who's serving time because he's been skipping school, mixed in with a 19-year-old gang member who's in there for homicide.  That mix of kids does not work very effectively and by changing the programming and focusing just on the front-end detention, with lower staff ratios and new training, we think that we're going to see some positive results and quite frankly, Ryan, we already are.  We've more than cut in half the number of aggressive behaviors observed in just this past month compared to previous months.

RW: At that Spring Creek facility in Colorado Springs.

RB: At Spring Creek, hm-mmm.

RW: You're listening to Colorado Matters, I'm Ryan Warner. And we're speaking with Reggie Bicha, who is the head in Colorado of the Department of Human Services. Meanwhile the federal government has been looking into problems at a Pueblo facility for people with severe disabilities. There are three state run facilities for people who can't care for themselves essentially. There's been a lot of staff turnover in Pueblo as well and staff shortages. There was a highly questionable strip-search of residents a year and a half ago. Your agency says it was to check for signs of abuse. But families, including a state lawmaker who has a sister there were outraged that no one contacted them first. The federal government wants the state to give back Medicaid money that supported the center. What is being done to improve the situation in Pueblo? I know that there have been some steps taken already, including I think a new manager there. 

RB: Well let's go back to what happened in 2014 and 2015. February, Valentine's Day, February 2015 my deputy comes to me and shares with me an incident that was horrific to describe, where staff were scratching, using utensils to scratch into the skin of clients and creating this pretend séance thing that had happened the previous November, three months earlier. No one had reported this situation, no one had escalated it in my agency and that was disturbing to us so we started to ask questions about what was going on at the Regional Center. Between Valentine's Day and the end of March of 2015 we had uncovered a series of very disturbing incidents where some staff, a very few number of staff and I want to highlight that, were rough with clients, were failing to follow our procedures for physical interventions, were abusing clients. In one case we found someone who had sexually abused one of our clients and the director didn't terminate him. The list goes on and on of disturbing things. And by the end of March we realized that we were uncovering stuff that had never been elevated, it was either not reported to other authorities or marginally reported. And it got to the point where we literally didn't know, at the Regional Center, who we could trust and who was providing appropriate care to the residents there. So we brought  a team of registered nurses from one of our other Regional Center programs and asked them to do skin checks, these were not strip-search, I know that they've been categorized that way. These were trained medical professionals who were checking on the health and wellness of each of our residents at the Pueblo Regional Center. 

RW: We'll say that some families have a very different perception of what occurred and how traumatic it was.

RB: That is true. What I can tell you is that the folks who were there that day and performing these wellness checks, these medical procedures identified and what we found were ten more incidents of unexplained injuries and concerns that we then reported to all of the appropriate authorities and took appropriate action. We ended up putting eighteen people on administrative leave. The director of the facility retired. Of those eighteen, one of them came back, was cleared. The rest of them were either terminated, resigned, retired, moved on. And so we have since that time put a whole new host of new policies, new practices, new oversight mechanisms in place. We have brought in a new director. We've hired a number of new staff and recently I've announced that we're going to be adding an additional twenty to thirty FTE new employees to the Regional Center so that we can continue to improve the quality of care. 

RW: FTE, full time equivalent employees. 

RB: Yes, thank you.

RW: You know, a theme in this conversation is that you need more staff per resident, per ward. Is that easy, given like the budget situation?

RB: Well it's not easy but the governor's been very clear with me, we take care of our people first.

RW: Because he's looking at cuts in the coming budget you know.

RB: Absolutely. And he also has said in previous budgets that we don't cut to the last and the least. And folks who are dependent upon the Regional Centers have to ensure that they can get, that we can provide them the best care possible. So not only do we need enough staff, but they have to be highly trained staff, they have to be appropriately compensated and that's what we're working on. Not just at the Pueblo Regional Center but also in Wheatridge and at Grand Junction.

RW: So two years ago there were a number of lawmakers who signed a letter outlining problems in your department and calling for a change in leadership. This again was a letter to the governor about your department and you said, after that letter was sent, that you would meet with the lawmakers who signed it to talk about their concerns. Have you been able to do that with each of those lawmakers?

RB: I met with over 60 legislators, one-on-one meetings. If anything positive came out of that letter situation it was that it caused me to sit down and have these conversations, which by and large were very productive and constructive conversations. 

RW: Yeah, give me an example of something that came out of them.

RB: Well one of the things that I have done over the past year is each month I meet with the chair of our committees in both the House and the Senate, just to give them a briefing on what's going on, get their perspective on issues, give them heads up if something is coming down the pike. And those have been very, very positive conversations. We've met much more regularly with members of the joint budget committee, either myself or members of my team to improve communication.

RW: You're listening to Colorado Matters, I'm Ryan Warner. And we're speaking with Reggie Bicha who leads Human Services in Colorado. I'd like to turn to child welfare services. That division is charged with protecting abused and neglected children. There have been several high profile deaths involving abused children in recent years and you implemented a more centralized child-abuse hotline I think last year, so that people can report problems. Is that working?

RB: It's working fantastically. We did implement a statewide child abuse and neglect reporting hotline.

RW: Because they'd been what like decentralized and local before that?

RB: Colorado has what we call a State Supervised County Administered Human Services System which means the state is responsible for administering programs but it's the counties at the local level who are actually operating child welfare, child support public assistance and other programs every day. And so we have 64 child welfare systems if you will in our state. And prior to the hotline, we had 64 different ways to report. And a lot of times people will want to make a report but they don’t know which county a child lives in but that the incident happened in a different county and they're kind of confused. The worst scenario I had heard before we implemented the hotline was a psychologist who called Jefferson County because, and then they were told to call Denver County and then Denver County said no, they moved to Arapahoe County. We shouldn't have people who simply want to report about a child who's in harm's way having to call multiple counties. So now today we have one line that folks can call to report child abuse and neglect. And we've also added a whole new public awareness campaign because we know that in Colorado the vast majority of calls that come into our hotline are from mandatory reporters, professionals who have an obligation to report. But we know that there are neighbors, grandparents, aunt and uncles, friends of the family, who have concerns about a child and we need them to call us as well so that we can engage with that family and make certain that children are safe and families are healthy.

RW: So the call volume is up. The reports are up? Or what?

RB: Call volumes are up. We had 208,000 calls to the hotline last year that resulted in 91, nearly 91,000 reports of child abuse and neglect that the counties went out and investigated. And we think that the hotline is working very very well. We get good reports from counties. We get excellent reports from people who have reported to the child abuse system and we also now have tools in place where we can improve our training. We record all of the calls that come in. We can go back and listen to them to get further information. We can train people on how to improve their call taking ability and to get better information. It's a very strong system. One of the best in the country, quite honestly.

RW: Let's continue this discussion and specifically the topic of child abuse in just a moment. So back with Reggie Bicha, head of Human Services in Colorado after a break on CPR News.  It's Colorado Matters from CPR News. I'm Ryan Warner. And we're back with Reggie Bicha who leads Human Services in this state. He's the head of that department which oversees, is responsible for some of the most vulnerable Coloradans. One of the realities, as we talked about before the break, Reggie, of overseeing child protection services is that the counties run so many of the programs.  We reached out to Arapahoe County Commissioner Sallie Clark. Her county has the highest number of child abuse referrals in the state. 

RB: El Paso County Commissioner, Sallie Clark.

RW: I'm so sorry. El Paso County Commissioner. Fact-checking on the fly. Thank you, Reggie. Clark says during your tenure you have strengthened the partnerships between counties and states. 

Sallie Clark: I think that they have fought for more caseworkers for us to be able to answer calls and follow up to prevent kids from dying, prevent child fatalities. So from my standpoint it's been very collaborative in nature.

RW: So there she speaks to the collaboration. We also spoke with several people about the challenges of your job overseeing some of the most vulnerable Coloradans, and that included Dr. Richard Krugman, he's former dean of the CU School of Medicine. And he now researches child protection and he praised your leadership. He said, "One of the problems he sees though is these days in medicine for instance, doctors are taught to come forward with medical errors but that the same thing isn't encouraged in child protection or in other state agencies. "

Dr. Richard Krugman: It's not within the culture now and it is now within the culture of medical student and resident, physician and nurse and pharmacist training, to assiduously look at errors in systems.

RW: How could child protection workers be encouraged to come forward with the idea of improving the system?

RB: Well I'm so glad that Dr. Krugman made those comments and I think that I share with Dr. Krugman, a commitment that in order for us to have good government we have to be transparent about what's working and what's not working. And in human services, when things don't work the way that they should, people get hurt.

RW: Or die.

RB: Or die. And as Dr. Krugman was pointing out, in medicine it has become much more accepted that when there's an error, we want to identify the error so that we can correct it. It's a learning opportunity. It's a way to strengthen programs. And human services it hasn't, we haven't quite gotten there. We have attempted to create a very transparent administration. We created C-STAT, which is a performance management system that puts all of our performance data, makes it available to the public and asks them to help us to find ways to improve. When we identify problems like we talked about in Spring Creek or the issues at the Pueblo Regional Center, many administrations I suspect across the country would choose to keep that quiet, keep it under the rug and not deal with it. We took a much more dramatic approach and said we're going to share this information with the public. Be transparent. Be clear about what's not working and be aggressive about putting changes in place that are going to result in better care that we're responsible to serve.

RW: How, by the way, would you say things are going at the Pueblo Regional Center, which is for those with severe disabilities? Is the climate improved? Is there any sense of that?

RB: Absolutely the climate has improved. When I look back at some of the horrible circumstances that have been going on in 2014 and 2015, that is not the case today. As I look back at the number of people who had done some really horrific things to our clients who no longer are with us today and as I go to the Pueblo Regional Center, which I do with some frequency, and visit our homes and our day programming, and I watch our staff interact with the people that they're providing supports and services to, it is humbling. The nurturing that folks provide, the tenderness and the amount of care, the encouragement towards independence. We still have things to work on at the Pueblo Regional Center but it is a much better, much safer environment for the folks that we care for today than it was a year and a half ago. 

RW: You've come under fire. This has not been a smooth road as director. Why do you do this work?

RB: Well I came into this, gosh, 20-some years ago. I'm a social worker by training and I started out doing child abuse and neglect investigations we called them at that time. Was working in juvenile delinquency and every day I came into work and thought what can I do today to help make the lives of my kids and families that are on my caseload better.  And I still come to work every day thinking that. What can I do today that's going to make a difference for the people of Colorado whom we serve, who've been dealt a deck of cards that haven't been quite fair or just for them and need some extra supports to either get off drugs and alcohol, to overcome a serious and persistent mental illness, to cope with living with a severe developmental disability. Or growing up in a family with extreme poverty. Or the issues related to child abuse. How do we, what can I do to be open, transparent and bring the right tools and practices in place to help their lives get better.

RW: You mentioned addiction. Very quickly before we go, are you seeing the problem with opiates and heroin in younger people?

RB: We are. It's a significant issue across the country and certainly in Colorado. Another area that we've focused a fair amount of attention on is prescription drug abuse.  And the impact of both youngsters getting prescription drugs, oftentimes from their parents, the old pill bottles that nobody's paying attention to, as well as the over-prescription of those drugs that lead to addictive behaviors. 

RW: So affecting younger people as well. Reggie Bicha, thanks for being with us.

RB: My pleasure.  Thank you, Ryan.

RW: He leads the Colorado Department of Human Services. This is Colorado Matters from CPR News.