A nonprofit agency in Juneau that served severely emotionally disturbed children closed suddenly this week, leaving parents, schools and state and private agencies scrambling to find replacement services.
Robin Brenner's 13-year-old son, Christopher, is developmentally disabled and autistic and has attention deficit hyperactivity disorder, she said.
Dreams TFC Inc. monitored Christopher at school, and provided individual therapy and a doctor's prescriptions for medications. Robin, a single mother, received family therapy and a break some evenings from caring for her son.
"He needs constant supervision," Brenner said Tuesday. "He can't be left alone for any time at all. He was continually with staff who knew how to work with him. Now we have absolutely nothing."
Dreams, which employed 56 people and served 38 children and young adults up to the age of 19, shut down Monday night, officials said. TFC stands for therapeutic foster care.
It served children who, because of their condition, can get frustrated easily and can act out and disrupt classrooms.
The agency laid off part of its staff Friday and the rest Monday, workers said. They have not been paid for February, they said. Employees said Tuesday night some parents hadn't been told of the closure. Brenner said this morning she still hadn't been notified.
The board of directors said in a prepared statement that Dreams must close because its "costs significantly exceed its income. There are no reserve funds to allow the agency to reorganize in a manner that would allow for more efficient delivery of clinically indicated services."
The agency was funded by Medicaid payments and some state money through the Alaska Youth Initiative, said Brita Bishop, the AYI state coordinator.
For the past 18 months, Dreams has been the vendor in Juneau for AYI, a state interdepartmental program that serves emotionally disturbed children. Before that, the city and then the nonprofit Juneau Youth Services provided the services. Dreams also served children who weren't in AYI.
In late November, Dreams received a very poor rating, 57 percent, from state officials who reviewed its compliance with Medicaid regulations. Most agencies score at about 90 percent, said Dan Weigman of the Division of Mental Health and Developmental Disabilities.
"That's significantly low and very alarming to us," he said.
Reviewers faulted some of the documentation for Medicaid billings, said some treatment plans prescribed more services than were recommended in assessments of children, and said many of Dreams' periodic reviews of treatment plans weren't documented.
Any time an agency gets a "severe audit," its billings drop because it can't continue billing at that rate without changing its documentation, Richard Nault, who stepped in as executive director of Dreams last week, said at a board meeting Tuesday night.
"There's a period of adjustment until the paperwork can support the billing and we get a more realistic handle on the billing," he said.
But time ran out, and the board decided Monday it couldn't continue to operate.
State and private agency officials met Tuesday and today to find a temporary way to provide and fund the services Dreams had been offering.
Juneau Youth Services will serve as many of the children as possible for the next 60 days, Executive Director Walter Majoros said this morning.
After that it will consider whether to continue the services or whether another agency will do so. State mental health officials couldn't be reached this morning.
Dreams' services included aides working with children in school, individual and family therapy, psychiatric care, help in crises, and respite for parents who need time off from caring for their children.
"We had one-to-one aides that would walk with those kids every step of the way and they would have support," said Gail Perez, a clinician at Dreams. "It was a great service to the school. I know that was why these kids were in the schools - because we had services for them."
Ron DeLay, director of student services for the Juneau School District, said he first heard of Dreams' closure at 7 a.m. Tuesday. About 31 children served by Dreams are enrolled in the school district, he said.
The district patched together coverage Tuesday with teachers, instructional assistants and laid-off Dreams employees who volunteered their time, DeLay said.
"We're scrambling right now, adjusting schedules for folks who are on our staff now," said Floyd Dryden Middle School Principal Tom Milliron on Tuesday.
Brenner, the parent of a former Dreams client, said she is concerned the children won't be able to handle the sudden change in their care.
"He's very slow," she said of her son. "He's not aware of what's happening right now, but the impact on him's going to be very hard because he doesn't do well with change."
At the Dreams board meeting Tuesday night, upset laid-off employees asked when they would be paid for their February work.
Alan Phillips, who had worked as a "tracker" of several high school students, said in an interview that he would get only $70 a week in unemployment benefits. He shares custody of his two children.
Other workers told board members they had no savings and needed their February pay to cover rent and car payments.
Jason Ralston, the former network systems administrator, said workers who were laid off Friday and are owed their pay today were told this morning they would get a check for 35 percent of what they're owed.
Board President Richard Silverly said Tuesday the board has contacted the state for help and is looking at liquidating its assets. But the board also has to pay payroll taxes, or it would incur penalties and interest, and board members could be liable for the taxes themselves, they said.
Eric Fry can be reached at firstname.lastname@example.org.