DALLAS — When Drew Dutton approached the microphone to testify before the Texas Health and Human Services Commission last September, his talking points included both a reminder of what had happened the month before and a warning of what was to come.
Dutton, the president and CEO of Phoenix House Texas, explained that the organization had closed its residential treatment facility in Austin the month prior because Phoenix House could not afford to continue providing services to the teens in their care, most of whom could not afford to pay for that care.
Dutton warned that the funding rates HHSC was considering, which was the topic of the public hearing, would not be enough for Phoenix House to continue offering treatment at its other residential center in Dallas or its other outpatient centers in other parts of the state.
"The current proposal for youth residential care would cover less than half of our daily costs for treatment and is a decrease from the proposal that we received last year that was ultimately never instated," Dutton testified.
Less than two weeks after he gave his testimony, Phoenix House Texas announced it would suspend operations at its other residential treatment center in Dallas as well as outpatient treatment at all of its centers. Instead of offering treatment, Phoenix House Texas fully pivoted its resources to prevention and education services.
"We've really had to shift with what the needs have been, and we've had to shift with what the current challenges are," Dutton said in an interview with WFAA a few months after the announcement.
Phoenix House Texas, which has been offering services in Texas for more than 28 years, is headquartered in Dallas and offers treatment programs in Dallas, Austin, Houston, San Antonio, and Round Rock.
The closures of the residential centers in Dallas and Austin left no other state-funded residential centers for youth substance use treatment in Central Texas and only one in North Texas. The location in North Texas, MHMR of Tarrant County, is in Ft. Worth and only serves boys.
According to Texas HHSC, there are only seven state-funded centers for youth substance use treatment in the entire state, and only two of them accept both boys and girls. The rest of them only serve boys.
"I think the pure scarcity of adolescent residential providers really highlights that there's a really unique and alarming issue going on with this specific population," Dutton said.
Texas HHSC receives federal block grants from the Substance Abuse and Mental Health Services Administration, which is an agency within the U.S. Department of Health and Human Services. Texas HHSC decides how best to distribute those funds to providers in the state that offer prevention and treatment services.
For residential providers, Texas HHSC offers a rate per child, per day to reimburse the provider for the cost of care. Dutton said the rates offered by the state haven't come close to meeting their needs in the 10 years he has been with Phoenix House Texas.
"When I started, they were around $161 and some change a night," Dutton said. "I believe our costs were around $250. Right before the announcement to suspend services in Dallas, we were around $400 or so a day. The rate was around $168."
According to data from Texas HHSC, the state was offering a rate of $168.49 per day and proposing a rate of $197.04 at the time that Dutton testified in September, which is an almost 17% increase.
Dutton said that increase still would not have been enough.
The state adopted the rate increase at the end of October, just more than a month after PHT suspended treatment service.
WFAA reached out to HHSC to ask about the state's funding model and the impact it had on such a large provider of treatment services in the state.
In response, a spokesperson for HHSC said, "Please contact the facility for information about their own business practices."
“There’s a reason that there are no resources," Dutton said, "There’s a reason that there’s not people doing this. There’s something that’s inherently broken with this system that’s preventing people from being able to give youth these services not only in Dallas but everywhere.”
The most recent data from the United States Census Bureau shows that Texas has a higher percentage of families and children without insurance than any other state. While Mental Health America ranks Texas dead last of all the states when it comes to access to mental health care for youth.
Dutton said the impact of the pandemic and the newest wave of the opioid crisis brought a surge in the demand for services, without any additional funding.
"All of these challenges are coming at a time when fatal youth overdoses more than doubled in the last few years," Dutton said while addressing Texas HHSC.
While Dutton said PHT was able to find placements and create recovery plans for the nearly 30 patients who were in their care when they made the decision to suspend treatment, the impact of the decision and the gap it's created in care for the low-income families in need of the service has had a ripple effect.
"The largest metropolitan city in Texas does not have a residential treatment center for adolescents who are either on Medicaid or do not have any insurance," Keri Stitt, the president and CEO of Youth180, said.
Youth180 offers prevention services and curriculum to community entities in North Texas as well as outpatient services out of its office in Dallas, meaning teens come to the center during the week for treatment services and counseling. Stitt said her staff typically refers patients who need more hands-on, round-the-clock care for their recovery journey to Phoenix House Texas.
“About 30 percent of our clients need that, and we didn’t have it and we still don’t have it right now," Stitt said.
Stitt said Youth180 has had to take more outpatient patients who were being served by Phoenix House Texas, which has impacted the patients they were already serving because they have had to stretch their resources to serve more teens.
"It's like a balancing act," Stitt said. "If you're trying to fix this hole right here, this one is just gaping open. Someone is losing out either way if we don't these inpatient services back online."
Heather Ormand, the president and CEO of Nexus Recovery Center, said not having state-funded inpatient services available locally is dangerous.
"There's only a small percentage of our population that can afford it," Ormand said.
Nexus Recovery offers residential drug treatment to adult women and their children. Ormand said Nexus offered services to teen girls until 2020 when they began referring them to Phoenix House and focusing fully on serving adults.
"The earlier you're able to intervene and prevent things, the better the long-term outcomes are," Ormand said. "At worst, death. At best, hopefully they can get access somewhere but we're trying to also prevent them from entering other systems like juvenile justice and child protective services."
Dutton, Ormand, and Stitt have all been pushing for changes in the state's funding model for years.
"Substance use disorder treatment is a game of inches and minutes, so we don't like for someone to have to wait 24 hours to hear back from us because we have such a small window of desperation and hope," Ormand said. "A day is too long. Months feels like forever."
In the nearly five months since Phoenix House Texas paused treatment options, the shift has been to ramp up prevention and public awareness programs for kids with the hopes of fueling a generation that doesn't need residential substance use treatment.
“There isn’t enough support in place to treat the amount of individuals that need these resources," Dutton said. "So, what can we do to reduce the number of individual adolescents from the start because odds are they are not going to be able to access these resources should they require them."
Dutton said Phoenix House Texas has transformed its Dallas facility into an administrative office with space dedicated to its new programming.
“We have every intention of being back in treatment, and that is a high priority and focus of our board to be back in residential and outpatient programming back in our facility," Dutton said.
But he said they need a sustainable funding model to make that possible.
"I don't feel comfortable speaking to a date," Dutton said. "If people really, understand the importance of this and take action and get legislators involved, it could happen much sooner. I don't think there's a particular date in mind because there's change that needs to happen."