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Time arrives for decisions

This is the fourth and final story in a series about a severely emotionally disturbed 6-year-old named Marcus. Today his therapy makes a breakthrough, and for a brief, tantalizing moment, hope blooms.

On the cinderblock wall of Spofford Home’s Kiva dorm, nine children’s names are scrawled on a white board. Next to the names are single words: “Green” means good. “Yellow” means OK. “Red” means danger.

Next to one name, Marcus, is a single word that declares his deteriorating status, repeated day after day.

Red.

Red.

Red.

But in child therapy, every now and then a tiny breakthrough occurs and a window into a disturbed child’s mind slides open. When these small miracles happen sometimes you can reach in, grab the child and pull him out.

Maybe, Spofford therapist Sarah Thibault hopes, she’s found the window in Marcus.

The date is Sept. 1, nearly four months since the 6-year-old arrived at the residential treatment center. In recent weeks his behavior has grown frightening. For his own safety he’s being stripped of his sneakers and carefully watched. He’s begun urinating in bed, biting himself and, once again, punching himself in the temple with his knuckles.

“I’m gonna kill myself!” he shouts.

Home is a tempest. Marcus’ younger brother, Ricky, has a disintegrative disorder, a rare autism, that is almost assured now. Rosalyn, the 6-month-old sister, has lymphangiomas, benign masses in her lymph glands that surgeons cut out. Other masses are growing on her back.

Kym Barrera, Marcus’ mom, is missing his therapy sessions to rush back and forth to the hospital with her other children. On top of this, two weeks ago, while Marcus was home on a weekend pass, his pet rabbit escaped from its cage. The family cat mauled it to death before Marcus’ eyes.

“I got it for my birthday. My brother opened the cage,” he says, in a lost, vague voice.

It’s almost as if Marcus is absorbing and exuding all the confusion around him, his therapist says.

Now, this: Ivan Hough, an 8-year-old boy whom Marcus knew inside Spofford, died suddenly and inexplicably. He was rushed to the hospital one week after returning home. The death has shaken Spofford’s staff.

“He was my friend,” Marcus says.

Marcus thinks Ivan died because he went to the hospital. He’s scared the same thing will happen to Rosalyn.

Against this tapestry of ruin, Marcus’ therapy pushes on and Sarah, eager for a breakthrough, is ready to play her hunch. The two are in therapy again, and this time she places a line of toy dinosaurs in front of him.

“I want you to organize the dinosaurs, place them in order, from biggest to smallest,” she says.

Most kids do it easily. Marcus tries, but stalls, hesitates, putting the little before the big, then switching again. Watching him, something in Sarah’s mind clicks.

•••

In many ways, Marcus’ case has stymied Sarah. Each day she works with other children who make progress. Diamond, 10, is one.

Bipolar with attention deficit hyperactivity disorder, she came in about the same time as Marcus. She’d been cutting herself, tried to run away and threatened to kill herself.

Four months later she is doing better on every level: expressing her feelings openly to her mother, and chasing away nightmares about ghosts and menacing figures that kept her sleepless.

Spofford survives on and derives hope from such stories: kids who leave and return years later to visit, kids with stable jobs and lives, having graduated high school, even college, raising kids of their own. Seventy to 90 percent of children who leave Spofford have made modest to significant gains in their behavior, according to outside audits.

Still, one of the difficulties of dealing with children with severe disorders, said Joe Beck, Spofford’s director of therapy services, is helping some parents understand what their children “may never be.”

“May never be the child who leaves early for school and gets to the bus on time,” he said. “May never be the child you can leave with the baby sitter, come home, and know they have done their homework. Not going to be ‘perfect.’ ”

At Spofford they talk about achieving “enough,” of doing “enough” for a child so that he or she can leave and “be successful” at home or school or in the community.

“Enough” is a soft term, defined differently for every disturbed child. For some kids, “enough” is being able to exist at home or school without exploding, to rein in their tempestuous emotions or self-hatred, to move through the world without hurting others or falling apart.

For others, it could be “how to be healthy and safe when they meet the dad who used to beat their brains in,” Beck said. “Or how not to cut themselves when they get angry. You can achieve ‘enough’ to the point where the family says (to Spofford), ‘I don’t need you anymore.’ ”

“Enough” is when they’re stable and in control “enough to go home” and, once there, to get services that continue to help them and their families progress.

With Marcus, Sarah may have found a way to get “enough.”

It takes minutes, but Marcus finally gets his dinosaurs in order, from the big two-headed red crazy T-rex to the tiny, pink and green pteranodon.

“Good job! High-five,” Sarah says.

She has him do the same with a collection of seven balls. He has trouble. She asks him to count them.“One, two, four, 15, 18, 95, 96,” he says.

Finally, Sarah asks him to place a group of plastic animals in groups based on color: brown, black, white, yellow, gray.

He can’t. He arranges the blacks with the grays, the yellows with the browns. He picks up a white bunny.

“I have a baby bunny,” Marcus says. “It died.”

Sarah’s hunch seems right. Marcus is poor at “sequencing.” Putting things in order or into categories is hard for him, probably because of his pervasive developmental disorder.

“That’s huge for us,” Beck would say. It gives them a key into care, an approach to help Marcus and may explain why progress has been slow.

The notion of cause-and-effect is hard for him. Because he’s slow to sequence he doesn’t quite understand the idea of action and consequences. Because he doesn’t sequence well, he doesn’t understand that by hurting and threatening to kill himself, it moves him further from going home.

Now they know that with Marcus, everything will need to be slowed down, explained, put in order for him. It also makes creating more order at home all the more vital.

As Marcus leaves on pass before the Labor Day weekend, Sarah is, at last, hopeful. She’s made progress.

Two days later, hope cracks.

•••

Kym is livid. Her son’s hurt. She’s the one who’s had “enough.”

It happened Sunday. Marcus had been wild at home; Kym sent him back to Spofford. He climbed the monkey bars there — and fell. It’s the second time in his five-month stay that he’s fallen from the same jungle gym.

Now, on Labor Day, he and Kym are in Children’s Mercy Hospital awaiting surgery for a left elbow so severely cracked it will need pins and, the doctor guesses, months of rehabilitation.

Marcus climbs around the hospital bed like a lemur, kicks its bars, pushes buttons on the I.V. unit, pulls his tubing.

“Marcus! Get the hell off that!” Kym snaps. “They’ll tie your hands to the bed.”

A nurse sweeps into the room every 30 seconds to turn off another alarm. She asks Marcus to stop.

“I’m gonna die!” Marcus shouts, his face contorted with rage.

“You’re not,” the nurse says. She’s nice, reassuring.

“Yes I am, you bitch!” he yells. “Get the f*** out! Everybody hates me!”

They roll Marcus toward the operating room. Double doors swing open and a security guard is on the other side. He smiles. Marcus sits up and gives him the finger.

At Spofford, the staff briefly wonders if Marcus hurt himself just to go home.

“If he did,” Kym says, “he got what he wanted.”

She’s pulling Marcus out of Spofford.

•••

Four days pass. Kym and Spofford’s Miss Sarah and Joe Beck gather in a meeting room. State and county mental-health workers, all involved in Marcus’ welfare, listen in on a conference call.

“Had this incident not occurred, we would have recommended continued treatment here,” Joe says.

The Spofford staff hopes Kym will keep Marcus at Spofford. They think she’s been rash and are worried that Kym, with all she’s facing, will be overwhelmed. But they would never go against her or any parents who want to care for their children.

Their philosophy is concrete: Kids need to be with their parents. Spofford’s role is to support, not to undermine.

“He’s made some good progress here, I don’t doubt that,” Kym tells the group. “The way he’s wired, I don’t think Spofford can do much for him. I’m ready to take him home.”

Joe suggests that perhaps Marcus go home with mom for a little while, but then come back.

Kym is adamant. She wants her son. Together, the group sets up a plan of care: individual and family therapy, youth support, case management, group therapy through the Wyandot Center, the community mental-health center where Marcus has been treated for years. The saga has come full circle. It was a Wyandot Center caseworker who originally recommended that Marcus be put in Spofford.

“Sounds like we’ve come to the point where you don’t feel like we can provide anything you can’t provide at home,” Joe says.

Kym agrees. Sarah, feeling half-defeated, but also knowing she did the best she could, stays silent.

“One last thing I want to discuss,” Kym says. “Who placed Marcus on the monkey bars? I’m angry.”

The answer — Marcus was playing, it was an accident — isn’t enough for Kym.

Marcus waits in a nearby office.

“You ready to blow this joint?” Kym says. Marcus hops off his chair and hurries to his mom’s side.

Minutes later, she and Marcus and his sister Rosalyn, in her stroller, stop their van at an A&W fast-food place for a snack.

“Now that I know we’re on our own, I’m thinking, ‘What have I gotten myself into?’ ” she says.

Still, she believes that after four months Marcus has improved somewhat. He hits his brother and sisters less, heeds Kym more and controls himself a bit better — at least for now, which, for the moment, is better than it was.

“I’ll also be the first one to admit that that broken arm ain’t gonna keep me from giving that boy a whoopin’ if he needs it,” she says. The world is tough for kids with emotional problems, she wants her son steeled. “No breaks in life. No breaks with me.”

“Mama, you gonna whoop my butt?” Marcus asks, sipping a chocolate shake.

Kym smiles at her son. Maybe with more time, more love, more attention, more therapy, the miracle will happen and one day her son will walk into the world on his own.

Meanwhile, she has called Marcus’ school, the one she envisioned in flames.

“I left a message,” Kym says. “ ‘Get off your butts; the easy life is over. Marcus is back.’ ”

•••

Back at Spofford, Sarah walks to her cramped office and her desk heaped with files and reports.

Later, she’ll give herself the luxury of thinking about Marcus and what she might have done better to help him and Kym. She knows that coming to Spofford doesn’t mark the beginning of a child’s troubles, and leaving rarely marks the end.

Besides, right now there’s no time to think. From the moment Marcus arrived in May until now, 30 children left Spofford. And 30 more arrived.

Sarah takes a deep breath and flips open her day planner. In three minutes, she’s got therapy with a 12-year-old girl with bipolar disorder. Tomorrow, among her nine clients, will be a depressed 11-year-old whose father was shot over the weekend.

She steps from her office. As she walks down the gleaming hallway to the girls’ dorm, a small prayer courses through her mind: “Lord, help me do the best I can, and be who I need to be, to help this family.”

Day four of four

One family, after years of searching for answers, finally finds care that works. | A15

@ Go to Kansas City.com to read the entire series, view an audio photo gallery and find where to go for help in your area.

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