The 15-year-old boy is sitting cross-legged on his couch in red flannel pajama pants, his hair looking like he just rolled out of bed.
Because he did just get out of bed about three minutes ago.
Now, he’s sitting across from his therapist, who had to knock on the door for several minutes before the teenager’s mom answered via Ring doorbell from the grocery store. “It’s open,” she 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 rouse the boy from sleep for his 10 a.m. therapy appointment.
“Sometimes he forgets about me and is asleep when I get here,” Tyman said, standing on the front stoop of the small brick home in the Denver suburb of Sheridan. “Part of my job is waiting on doorsteps.”
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 that he applied for three summer jobs and is choosing a new high school for the fall.
“I love that for you,” Tyman says after pulling a stool from the kitchen so he can face the boy on the couch. Later, they sit on the floor around the coffee table and draw how they are feeling with colored pencils on construction paper. The teenager, who agreed to let The Colorado Sun attend part of the therapy session but did not want his name published, sketches a large head with tired eyes attached to a slender body.
Then they make coffee and Tyman teaches the boy how to boil sugar and water for simple syrup as they talk in the kitchen.
The new in-home therapy program, which has served 200 kids 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 a decade ago. But its foundation — Colorado Boys Ranch Youth Connect — has continued, pouring its resources into behavioral health care for kids in their homes.
The evolution of the program is a reflection of what’s changed in the child welfare system in the past decade — Colorado is sending fewer kids to institutions in favor of homes, and has increased efforts to provide in-home mental health care to cut down on the number of children removed from their homes and placed in foster care in the first place. Several youth treatment centers, including Tennyson Center for Children in Denver, have shifted in recent years from residential care to day treatment and in-home therapy.
The ranch, which provided in-home counseling to kids after ending its residential program, has since partnered with Paragon Behavioral Health Connections to offer intensive in-home therapy, intervention services and help with logistics like child care or education for kids who are in foster care or at risk of ending up there. Other children are referred by the juvenile justice system as part of pretrial rehabilitation programs, and by the Medicaid program. Parents also can call for 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 the Eastern Plains counties closest to the former Boys Ranch — Crowley, Otero and Bent.
It’s expanding next to El Paso, Moffat and Routt counties.
Geo location of staff connects them to reinforcement
The point is to help kids and teens get better “on their terms,” and to provide a step-down program for adolescents who have visited a hospital emergency room in crisis or been admitted on a mental health hold, said Camille Harding, Paragon’s CEO. The program aims to schedule the first appointment within 24 hours of receiving a call for help.
Kids who are “trying to have their own personality and a say in who they are” can accomplish that better at home, not in an unfamiliar office with a therapist staring at them, Harding said.
“Having it on their own terms is so much more empowering,” she said. “You get to decide what we do. We can go for a walk. We can go to the park down the street. Developmentally, it just makes more sense.”
Some kids in the program have such intense needs that someone from Paragon is in their home 10 hours a week. A therapist helps work on their mental health. A care manager can help enroll in school or sign up for a GED or help the family find housing or food assistance. A specialist can teach interventions specifically for kids who have intellectual disabilities along with behavioral health issues.
The team approach means kids get better help and staff are less likely to burn out, Harding said. The program’s technology is unique, too. Paragon is installing geo locations on its staff, many of whom are social workers or case managers with bachelor’s degrees, and can send reinforcements quickly. That means that if a teenager is threatening suicide or having a violent outburst, a more experienced counselor can assist in person or virtually.
“There are just such a wide variety of things you encounter,” Harding said. “Nothing is routine about going into someone’s home.”
Without the added support, staff are forced into a “white-knuckle approach,” she said. “They get stuck and things get hard. That’s a quick way to burn out staff.”
A $1.7 million grant, part of Colorado’s federal pandemic relief aid, is helping the program build the technology and hire a psychiatrist.
Therapy beside someone’s bed or in a Costco aisle
Tyman prefers standing on a client’s doorstep to sitting in an office waiting for a client who doesn’t show up.
He’s done therapy on the floor next to someone’s bed because the person was too depressed to get up.
And one mom is so overwhelmed by her life that the only time she finds for therapy with Tyman is when she’s at the park with her kids or walking through Costco. Tyman tells her she can say he’s a neighbor or a friend if they run into someone she knows.
“It’s OK if we start 15 minutes late because you had to get up and make coffee and put on clothes, or whatever it is you had to do to deal,” he said. “If your mental capacity isn’t super high, and you’re not functioning well, and you’re not getting out of bed on time, and you’re not able to manage your appointments, you’re never going to make it to therapy.
“But therapy is the thing you need to fix those problems.”
Plus, visiting people’s homes helps Tyman work out what they need more quickly. The therapy is rooted in their lives because it happens in their own space. Virtual therapy, which became so popular during the pandemic, has its place, but this is the opposite of that.
“Virtual therapy is beautiful, and I’m glad it exists,” Tyman said. “But there’s so much that I could never see looking through an iPad. There’s so much insight by being able to walk into a house and see how you live and what your world looks like and who you are.”
Tyman has eight clients he sees multiple times per week, driving from Green Valley Ranch to Evergreen. His Subaru Forester was stuffed with toys on a recent morning — squirt guns and sand art and dolls that were headed to a playroom at Paragon’s office in Lakewood.
He tailors his approach to each kid. The 15-year-old boy loves to draw, but bluntly told Tyman he hated his markers. Tyman stopped to buy colored pencils before his next visit.
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He also learned the boy plays Sims, a video game in which user-created characters make friends, get jobs and have families. The teenager won’t talk much about the relationship with his own friends, but the drama has played out among his Sims.
“His friends are like frenemies. Classic 15-year-old stuff,” Tyman said. “When I asked him about that, he’s like, ‘Oh, I don’t care. I’m fine.’”
But when Tyman asked about how one of the video game kids was excluded and fighting with the other ones, the teen revealed that the character was angry, sad and lonely, Tyman said. “It’s 100% about him,” he said.
