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Families say Texas failed to help after closing Fort Worth clinic, leaving teens in need

Fort Worth Star-Telegram - 2/25/2023

For a while, Elaine Harkey seemed okay.

In late January, the 16-year-old, who has autism, was abruptly discharged from her residential treatment program in Fort Worth. The state of Texas had shut down Fort Behavioral Health, citing safety risks to children and effectively kicking out 40 teens. When Elaine returned to her home in Oklahoma City, her parents did their best to replicate a strict schedule and keep their daughter on stable footing.

But the state had not provided Raymond Vail and Charity Harkey-Vail with any help to do that — no phone numbers to call, no clinics to stop by, no other ways to seek the support that had been taken away. Their daughter needed round-the-clock care to keep her from having what the family calls “meltdowns.”

“It’s like Bruce Banner going into the Hulk,” Harkey-Vail said.

The Hulk is Elaine’s favorite superhero, but she doesn’t always like how much she can relate to him. As Harkey-Vail described Elaine’s meltdowns to the Star-Telegram, Elaine gripped her parents’ hands and quietly apologized.

One of Elaine’s previous meltdowns left a hole in the wall of the family’s home, Harkey-Vail said, and left their TV broken. Another time, Harkey-Vail’s neck was sprained. (“Sorry, mama,” Elaine says.)

“We know she doesn’t mean to hurt. We know she’s not purposely coming after us for any reason,” Harkey-Vail said. “She’s in another frame of mind.”

It’s a frame of mind that Elaine’s parents try to keep their daughter away from. But, left suddenly and unexpectedly on their own, there was only so much they could do.

On Feb. 7 — 12 days after the state shut down Fort Behavioral Health — Elaine had a meltdown. It was triggered by her parents asking her to help clean up the house, but was set within the context of a week and a half of sudden changes that had disrupted her schedule and put her on edge.

After a violent episode and a struggle between Elaine and her dad, Elaine’s parents brought her to a children’s emergency room in Oklahoma City, where the family lives. She was admitted for more than a week, for treatment of her acute mental health crisis. And, after Vail and Harkey-Vail had gotten Elaine admitted, they realized that Vail’s hand was still swollen.

Vail checked into the hospital himself and learned that his hand had been broken while he tried to restrain Elaine — an attempt to keep her from hurting herself or him. He had a hospital stay of his own, followed by surgery.

The couple is confident that the domino effect that eventually led to two hospital stays was triggered by the sudden change to Elaine’s treatment.

The Texas Health and Human Services Commission issued an emergency 30-day suspension for Fort Behavioral Health’s adolescent programs on Jan. 26, citing immediate risk to children’s safety.

As of Friday, the state had not issued any public statements about what those risks were nor any details about its investigations, although some public documents indicate the state found evidence of aggressive restraints of children, among other violations.

Fort Behavioral Health, which operates several different programs for teens, has not responded to numerous requests for comment; in emails and documents obtained by the Star-Telegram, the facility has denied all allegations.

The state Health and Human Services Commission, through a spokesperson, answered some questions over email but refused to participate in an interview about Fort Behavioral Health or about its investigatory process.

After the suspension, Fort Behavioral submitted filings to a Tarrant County district court, urging the court to lift the suspension. In mid-February, Fort Behavioral and the state agreed that the facility could begin accepting children again as early as Saturday, Feb. 25, the Star-Telegram previously reported. The facility, however, will remain under probation for one year.

But even with the facility’s suspension lifted, the abruptness of the closure and the lack of resources provided has meant a month of chaos — and crisis — for the high-needs teens and their families caught in the middle.

“I feel like I was let down, my daughter was let down, everyone was let down,” Harkey-Vail said.

Four parents and caregivers, who had children at Fort Behavioral when the state shut it down, spoke with the Star-Telegram about their experiences. All of them described a disorganized, poorly communicated process, and all of them said they feel the state left them to fend for themselves.

“This has been catastrophic,” Harkey-Vail said. “It has caused total disruption.”

‘Everything is caving in on you’

Elaine’s parents started getting nervous on a Wednesday in late January.

Elaine had been at Fort Behavioral’s autism program — Camp Worth — for exactly two weeks, and she had finally begun settling in. She seemed happy when her parents talked to her on the phone, they said.

But then, Harkey-Vail got an email from a state Health and Human Services employee. There was an investigation, the employee told her, and asked if she knew anything about the staffing levels in her daughter’s program.

Harkey-Vail then called Fort Behavioral Health, she said. The staff’s response to her questions — What was going on? Was there an investigation? Was her daughter safe? — kept shifting, she said. It set Harkey-Vail on edge, and she told the staff that she wanted to withdraw Elaine from the program the next day.

“This is just not making sense,” Harkey-Vail remembers thinking.

A few minutes after she got off the phone with Fort Behavioral, another state employee called her, this one from the Department of Family and Protective Services. This time, they wanted to know if she’d heard about any abuse at the facility. Harkey-Vail told the state employee that she was actually withdrawing Elaine from the facility the next day.

“He goes, ‘Okay, good,’” Harkey-Vail recalled.

(The state Health and Human Services Commission oversees licensing and regulates childcare facilities; the Department of Family and Protective Services is responsible for investigations into child abuse and neglect.)

Vail and Harkey-Vail drove from Oklahoma City to Fort Worth to pick up their daughter on Thursday morning. When they checked her out, everything at the facility seemed normal, they said.

But only hours later, they got an email, at about the same time that families across the facility got the same notification — the state Health and Human Services Commission was shutting down Fort Behavioral’s adolescent programs, effective nearly immediately.

According to emails sent by state employees and obtained by the Star-Telegram, families were informed in the early afternoon on Thursday, Jan. 26, that they had to pick up their children by 8 p.m. that day. There was an “immediate risk” to the adolescent patients at the facility, the state said, without providing any specifics. The state ordered a 30-day closure of the facility’s adolescent programs. (Health and Human Services Commission spokesperson José Andrés Araiza said in an email that state staff remained at the facility until late that Thursday evening and returned the next morning when the last child was picked up.)

One parent, Alicia Glass Pulley, had dropped off her 16-year-old daughter Savannah at the facility about 24 hours before the state’s email and emergency shut-down order.

Her daughter — who has numerous diagnoses including mood disorder, anxiety and depression — had been in crisis, acting increasingly aggressive and eventually triggering the family to call the police. Pulley took her daughter to Fort Behavioral because she needed help, and she was admitted to the clinic’s Evergreen Path program.

When she dropped off Savannah, Pulley said, everything seemed fine at the facility.

“There was never any inclination that there was anything wrong or that there could’ve been anything wrong,” Pulley said.

But, one day later, while Savannah was still very much in crisis, the state called and said Pulley had to pick up her daughter immediately.

Pulley didn’t know what to do. On the phone alternately with state employees and Fort Behavioral, Pulley said she broke down, unsure of what to do next and how to help her daughter.

“I just started crying on the phone, I couldn’t even talk through the tears,” Pulley said. “It kind of just feels like everything is caving in on you.”

The state was of little help. With no clear place to turn, Pulley said, she ended up taking Savannah straight from Fort Behavioral to an emergency room. It was a challenge to get her admitted there, too, Pulley said, but there was nowhere else to go.

“Getting help in any capacity already is very difficult,” Pulley said. “The whole system is so broken and messed up.”

Back to ‘instability’

Another parent, who asked to use just his first name to protect his child’s identity, said his son had been at Fort Behavioral for 24 days when he was suddenly discharged because of the state shutdown.

Daniel’s 14-year-old son had just begun to really settle into Camp Worth, the same residential program for teens with autism that Elaine was in. “He had just started to be making some good improvement,” he said.

Daniel was worried about his son being forced to leave the program early. But because there had been some recent improvements, he was also optimistic when he first took his son home.

In those first days, Daniel said, he remembers his son walking into the kitchen and grabbing a bag of chips. Daniel told his son not to eat junk food right then — and, before going to Fort Behavioral, that kind of an instruction could’ve set off a loud fight. But that day, while clearly annoyed, the teen asked if they could instead get some other food.

“That’s alien to the way things have been working in my house for the last few years,” Daniel said. “So I was really, really encouraged for the first few days.”

Daniel was hopeful — maybe his son’s time at Fort Behavioral had already helped. But his optimism was short-lived. As the days passed, it became clear that his son’s new coping mechanisms hadn’t had time to solidify.

Two weeks after the state shut down Fort Behavioral, Daniel felt back to square one.

“We’re completely back to the level of instability we were the day we took him to the hospital,” Daniel said at the time.

Daniel was able to get his son into another treatment program that he can attend during the day. Because his son had been in that program previously, they were able to admit him quickly.

Still, the sudden shutdown has cost Daniel work time and caused an immense amount of stress. Daniel also worries about how his son perceives the rapid change, and what it makes him think about the reliability of the health care system as a whole.

“There’s been no consistency in his treatment because of things like this,” Daniel said. “It doesn’t encourage my son to have a lot of trust for people when his well-being is handled like this.”

‘Nobody reached out’

When Fort Behavioral was shut down, the families whose children had been admitted there were left scrambling to find care for kids who, as evidenced by their initial admission to the facility, are in need of immediate and intense treatment.

In an email, Araiza, the Health and Human Services Commission spokesperson, said the state worked “to coordinate outreach and support to parents and legally authorized representatives of children discharged from Fort Behavioral Health.”

The four families that spoke with the Star-Telegram reported slightly different experiences in dealing with the state — but they all said that the state did not actually help them in any substantive way. And the little outreach that some families did get from the state was either irrelevant or long-delayed, they said.

Yvonne — who asked to be identified only by her first name — is a caregiver for a now 16-year-old who was admitted to Fort Behavioral’s drug rehabilitation program in early January. After shutting down Fort Behavioral’s adolescent programs, Yvonne said, the state didn’t provide any resources for where the teenager might go to receive further treatment.

“Nobody reached out to offer any resources whatsoever,” Yvonne said. “I’m frustrated at the way it happened and the way we were left to resolve it.”

Vail and Harkey-Vail, Elaine’s parents, also said the state gave them no resources or references for stopgap care. Fort Behavioral did give them a list of psychiatrists that were covered by their insurance. It turned out that all of those psychiatrists worked with adults, not children, or didn’t treat children with Elaine’s diagnoses.

Pulley, the mother of Savannah, said she received one call from a group home. The caller indicated that the state had given them Pulley’s number, after she asked for help. But it was clear within the span of a short conversation that the group home wouldn’t be a good fit for Savannah’s treatment needs. Pulley received no other resources or references, she said.

And Daniel said that he received nothing from the state for a full week, despite numerous emails and calls asking for help. Five days after Fort Behavioral was shut down, Daniel received an email from a Health and Human Services Commission employee. In the email, which Daniel provided to the Star-Telegram, the employee wrote that “another HHSC department will be reaching out to provide possible avenues for obtaining resources in your area, should the need still exist.”

Daniel found the email insulting, particularly because of how delayed it was.

“Just a completely completely horrible, pointless message to send,” Daniel said. “If my kid was in good enough condition that he could wait a week to talk to a doctor, he wouldn’t have been there in the first place.”

He did receive a call from a local crisis resource coordinator later, Daniel said, but again that offer was far too delayed to be helpful.

“These people just don’t get what they did,” Daniel said, referring to the state’s handling of the shutdown. “In my opinion, the state is completely culpable for all the crap they’ve caused.”

‘We were begging for help’

After Elaine’s stay at the Oklahoma City hospital, her parents said she’s been assigned outpatient treatment and regular meetings with psychiatrists and therapists. They hadn’t wanted to take Elaine out of full residential care this early — “she hadn’t been there long enough to get what she needed,” Harkey-Vail said — but now that she’s in those programs, they’re going to give it a try.

Pulley’s daughter, Savannah, has now been admitted to a new residential care program in Texas. There were 13 days, plus an emergency room visit, between her discharge from Fort Behavioral and her admission to a new program.

And for Daniel’s son, the day treatment program has been just a stopgap. Daniel said he hasn’t found a place that really seems like a good fit for his son’s needs, outside of Fort Behavioral. But, with the state agreeing to allow Fort Behavioral to reopen, Daniel’s son could be readmitted there.

The families who spoke to the Star-Telegram all said one thing: Finding treatment for their kids has been a nightmare, both before and after Fort Behavioral’s shutdown.

They talked about long wait times, confusing admission criteria and large admission deposits. So, for each child, admission at Fort Behavioral had been a relief — and the sudden discharge meant stepping back into the world of endless phone calls and admission inquiries, this time with no support and sometimes with catastrophic outcomes.

“We were begging for help,” Harkey-Vail said. “We have been begging for help.”

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