A teenage boy follows Stuart Marcus from one end of the hallway to the other. He bounces around the doctor like a large puppy and eventually maneuvers in front of him, walks backward and gets the face-to-face that he wants.
"When can we talk?" the boy asks, allowing Marcus no more than two strides' worth of space. "I need to talk to you about something. When can we talk? Can we talk now? When can we talk?"
There's an edge of urgency to the boy's voice, only slightly dulled by the medication he takes that keeps things like hallucinations at bay. Marcus smiles and walks calmly past posters of Mother Teresa, Martin Luther King Jr. and Albert Einstein taped to the walls. These are the people he wants the 12 boys who live here to think about, even though he allows them pictures of rock stars in the privacy of their own rooms.
"We'll talk when I'm through here," Marcus tells the boy, who has strategically shortened the distance between the tips of their shoes.
"I need to talk to you now. Can we talk now? When can we talk?"
Other boys pour out of their rooms when they hear Marcus' voice, and he's soon buffeted by urgent requests. Here at the Juvenile Transitional Center in East St. Louis, an acute-care psychiatric facility for teenage boys, Marcus is the alpha adult, an important man in these hallways.
He -- like his business partner, Tim Carl -- has imagined this scene a million times during the past two years. But since the facility opened last summer, they've had little time to revel in the reality. There's not much time to do what they need to do.
Marcus and Carl's agreement with the Illinois Department of Children and Family Services (DCFS) stipulates that the facility will take the state's most emotionally disturbed teenage boys and in six short months try to make them psychologically fit to "transition down" to a less restrictive environment or, once they turn 18, to walk out the doors on their own. The center gets $1 million a year from the state to try, but all the money on earth can't change what some of the boys have been through.
Most are orphans, born in Illinois but shipped off to locked juvenile facilities in other states when their problems got the better of them. Though years of neglect, abuse and abandonment have played a part in shaping the boys' clamorous need to talk to Marcus, the loneliness of institutionalization drives much of their current momentum.
Marcus, therefore, must choreograph an exit from the main hallway that won't squash the fragile psychological gains he's made with the boys over the past several months. He doesn't want the boys to feel he is pushing them away. They've seen enough of that already. On the other hand, he must instill respect for authority. The boys need to understand that when he says no he means no, but they also need to trust that he'll come back and talk with them.
The cluster around him seems tense. Questions come at Marcus from all sides, but he remains smiling, stays focused, keeps walking.
It's been hard sometimes, thinking about what he gave up to get here -- his career, his reputation, his credibility with family and friends -- but harder still to think about how close this came to not happening. If it hadn't been for Carl, Marcus wouldn't be here right now. Neither would the boys. To make this real, Carl lost almost everything.
But that's all behind them now, even though the memories still cling like sweat from a bad dream. Right now, he has to think about the future instead, about how he's going to get these kids back home, wherever that might be.
"I'll be back," Marcus promises the boys over and over again. "I'll be back."
But as he slides out the door of the facility's main hallway, pleading silhouettes haunt the door's glazed window, which separates them from the rest of the world.
In 1997, Tim Carl was working as the director of outpatient services at a St. Charles facility for troubled youth. It was a good time in Carl's life -- he was young, financially successful and relatively content with his life. But he was also ambitious, so when he noticed that the St. Charles facility housed dozens of kids from across the river in Illinois, he decided to find out why.
Carl learned that Illinois law banned locked juvenile residential facilities, which meant that teenagers who were too violent or too emotionally disturbed for foster care or group homes were sent to locked psychiatric centers instead. But secured psychiatric units for teenagers in Illinois were operating at full capacity, so hundreds of teens were being sent off to locked juvenile facilities in other states.
In 1997, almost 800 Illinois kids were living in institutions as far away as Texas.
Then Carl discovered that one year earlier, in 1996, the Child Care Association of Illinois, in conjunction with DCFS, had decided to try to reduce the total number of children in Illinois residential care and bring the children placed out of state back to Illinois.
Ron Moorman, CEO of the Child Care Association, says the trouble was that psychiatric units in Illinois were 95 percent full and unlocked residential facilities -- housing 4,300 youth at the time -- couldn't handle the needs of the state's most disturbed kids. What Moorman's group and DCFS wanted to find out was whether all of the kids in residential care really needed to be there. If it was determined that some would do better in a foster home or some other form of placement, their being moved would open up desperately needed space.
"We just felt that where at all possible, those children ought to be placed in state as close to their families and communities as possible," Moorman says.
But there would still be a lack of secured psychiatric units, and a plot started unfolding in Carl's mind. Sending kids out of state was not an alternative anyone, including DCFS, lauded as healthy. These were kids who would someday come of age and be returned to the communities they came from -- communities that neither knew nor wanted these institutionalized, mentally vexed, severely screwed-up young adults.
"It was clear to me that there wasn't an acute residential facility in Southern Illinois, a long-term place to treat these kids," Carl says. "So, being a businessman, I thought, "This is a no-brainer.'"
Meanwhile, Marcus was operating a private counseling service in Belleville, Ill. He was a well-respected child psychotherapist, known for his ability to get kids to open up and talk. But most of his clients lived at home, and for years Marcus worried about the number of children the state was sending to locked institutions. "For 20 years I knew there was a need, but I had no idea how to go about fixing it," Marcus says.
When Marcus and Carl met, after Marcus took a clinical position at the St. Charles facility, they found that their philosophies melded like a hand of aces. Both men were well educated, well paid and well endowed with professional skill. Both were parents of teenagers themselves, and both understood the short time it took for kids to grow up. If they could bring the out-of-state kids back home before it was too late, they might be able to salvage what time was left.
What was needed, they decided, was an acute-care psychiatric residential facility that would take in 12- to 18-year-old boys. The treatment would home in on preparing the kids for independent living when they turned 18 or, at the very least, prepare them for the transition down to foster or group homes.
To sell the idea to the state, Carl knew, it would have to be cost-effective, would have to be pitched as an alternative to expensive, long-term care. To do that, he and Marcus would work on intensive treatment programs incorporating everything from psychotherapy to art and music lessons. The boys would learn how to cook, wash their clothes and fill out job applications. Just buying a pair of shoes in a store was something most of these kids never experienced.
It was a simple plan -- a desperately needed, easily accomplished project. All they had to do was secure a contract with DCFS. And the state, at first, seemed supportive.
"When we had the initial discussions with Dr. Marcus and Tim Carl regarding the opening of this, the population we were looking at were some of the most seriously emotionally disturbed children that we were placing outside of the state of Illinois," says Jerry Slomka, deputy director of the Division of Operations for DCFS. "At that time, we had goals of first reducing our reliance on out-of-state placements; secondly, to place those children closer to the areas where they lived; and thirdly, to reduce our population overall in residential care."
Marcus and Carl decided that in order to get the project moving, they would have to devote more time to it than they currently had to spare. Because both had saved enough money to live on for a few months, they left their positions at the St. Charles facility, and Marcus drastically reduced the number of clients he was seeing in Belleville.
"I was petrified," Carl says, "but I knew the opportunity was there and I knew the need was there. It was just a matter of having the belief and the courage to take a chance and do it."
But, as Carl and Marcus would find out, belief and courage were warm and fuzzy concepts. Reality was more like electrified barbed wire.
The scant weeks Marcus and Carl thought it would take to get the initial approval turned into months -- five of them. There were meetings, proposal revamps, more meetings and long periods of nothing at all. It was December 1997 before the southern region of DCFS set a tentative opening date of April 1998.
After that, the two men thought, it was just a matter of submitting a budget and getting final approval at the state level. The project consumed them. Every resource, every weekend, every ounce of energy went hurtling toward it.
They felt they were in a race with time. Every day that the out-of-state kids were away was one fewer day Marcus and Carl had to help them. Considering the kids' backgrounds, every day counted.
Most of the kids in out-of-state placements were orphans who somewhere along the way skipped being children and became residents or case numbers or wards of the state instead. Most had been the victims of extreme sexual or physical abuse by their parents or guardians at very young ages. Then they were moved around like checkers from one facility to the next, many enduring continued abuse from other residents and staff members every step of the way. By the time they reached puberty, their normal cognitive processes were lost somewhere in outer space.
Many of the kids had learned to create their own realities, because the ones they lived in didn't offer much breathing room. They made up pictures in their heads, which eventually turned into full-blown hallucinations. The lack of any long-term parental or societal guides meant they never learned right from wrong, so by the time they reached an age where they should have been experiencing first dates, they were downing anti-psychotic medications and fending off sexual predators instead.
From there it got worse. It was a variety show of trouble, and because the kids jumped around so much, no one ever got a firm handle on their diagnoses. Eventually, after attacking a staff member or another resident in an unrefined rage, some ended up in juvenile-detention facilities, where fending off violence and encroaching mental deterioration were the posted activities of each day. After that it was more medications and more abuse and more placements, one right after the other, until the teens got to the point -- in Illinois, anyway -- of no return.
So after the December meeting with DCFS, Marcus immediately approached St. Mary's Hospital in East St. Louis about leasing space for the center. His idea met with a round of applause. "When they brought the idea to us," says Richard Mark, CEO of the hospital, "we realized it was a service that was needed. It has always been our goal not to ship patients outside of their community, and this project met that goal."
Carl and Marcus had jumped into the project with few doubts that it would succeed. They brainstormed daily. Ideas flowed like water. They solicited professional advice from friends and colleagues, and they soon had a medical director, a board president, a senior child-care worker, a caseworker and a director of human resources.
One of the people Marcus invited on board as an employee was Dan, a 20-year-old former client who was studying for his bachelor's degree in psychology at Southern Illinois University-Edwardsville (SIUE). Dan, who asks that his last name not be used, was drawn to the idea of becoming a child-care worker at the facility. Having spent time in psychiatric hospitals and behavioral residential facilities himself, he understood how effective proper treatment could be.
"My parents got divorced when I was 8 years old, and I guess I didn't handle it very well," Dan says. "I took my anger out in very aggressive ways."
At the time, Dan lived in Belleville. After the divorce, he moved with his mother to Chicago, where Dan's aggressive behavior escalated to the point that he couldn't stay in school or at home. His mother sent him to a psychiatric hospital, where he stayed for three months, and then he moved to a residential facility, where he spent the next year.
Dan says he left the facility with a better grasp of how to handle his rage, but for the next six years he lived with his father in Belleville in a constant state of anxiety instead. He became extremely introverted and developed a paralyzing fear of social situations. He never developed friendships, never went to school functions and never, ever talked to girls. That's when he started seeing Marcus.
"He became sort of a role model for me, a kind of big brother in my life," Dan says. "He was, like, the nicest man I ever met. He had so much patience. I never once saw him get angry."
Eventually Dan worked his way through the anxieties and residual rage, and Dan stopped seeing Marcus on a regular basis, though they called each other occasionally just to keep up. After graduating from high school, Dan worked odd jobs for a few years and then decided to mold his life after his mentor's. He enrolled at SIUE so that he could become a child psychologist himself.
"I wanted to help people in the same way I had been helped," Dan says. "I wanted to help prevent other kids from having to go through what I went through."
When Marcus called him in 1998, told him about his plan to open up an acute-care psychiatric center and asked whether he'd be interested in a part-time position as a child-care worker, Dan jumped at the offer. It was a dream come true.
But the project's expected opening date of April came and went without the southern region's final approval. It had now been almost a year since Carl and Marcus left their full-time jobs, and they began, for the first time, to question whether the center was going to happen at all.
"We had potential staff calling us, asking us when we were going to open up," Marcus says. "I think the hardships we were starting to face -- in addition to the financial hardship -- was our loss of credibility. People were starting to say things like 'This isn't really going to happen, is it?'"
Karen O'Reilly, a school social worker and personal friend of Marcus, says she started worrying about her friend about that time. "At first, I didn't realize what this would entail," O'Reilly says. "I was just so pleased that he had such a good idea and the gumption to do something about it. But this was a huge undertaking. There were trips to the lawyers, to Chicago and to Springfield. He had a well-established practice in Belleville, but he was taking a financial hit. I was fearful for him, and I would talk to him and ask him if he was sure he wanted to do this."
Even Dan began to wonder.
It wasn't until May 1998 that the director of the southern region handed down his official approval. It was Carl and Marcus' first victory in almost a year, and now it was just a matter of waiting for the state director to approve. That, both men thought, would come quickly.
But months went by with no word from Springfield. Then a letter came late in the summer stating that the director's office wanted more information about the project. Until then, it would officially be considered "on hold."
DCFS's Slomka says the state had its reasons.
"They were a brand-new entity that we hadn't done business with before," he says. "Understandably, and this is the business side of the child-welfare system, we had to be very careful about the process -- and, I think, rightfully so, because the goal here is that they will be serving our children, and we have to make sure this is an entity that can provide us with that service."
By this time, the money had run out. Marcus had already dropped most of his private clients, and Carl, who had already turned down several other job offers, began selling off his personal belongings.
"I was pretty beat-up by this time," Carl says. "I was at my wits' end. Going through it was hell, basically. I mean, by this time, I had gone through my life's savings. I took a waiter's job to live. A waiter's job. I'd run into a lot of people I knew and they'd ask me why the hell I was waiting tables, and I'd say, 'Well, see, there's this project....' Two months later they'd come back in, and I'd say, 'I'm still working on this project, see....'"
Rommie Martinez, a friend of Carl's who owns the CD ROM hair salon on the Hill, remembers the time well.
"He just stuck with it," Martinez says. "I mean, this was a person who used to make a very decent living, and I watched him take a job as a waiter. He sold his car at one point, and, I mean, he was used to driving Jaguars. He gave up all of his personal possessions just to stick with this thing."
For Carl and Marcus, there was little choice. They had swum out into the middle of an ocean, and the only decision to be made was whether to go forward or back. At that point, it didn't make much difference.
Says Carl: "Our close friends looked at us and said, 'Are you crazy?' And we'd say that this thing is going to happen, and they'd say, 'Sure it is. Sure it is.' Even when my own kids would want something and I'd say, "Dad doesn't have the money right now,' they'd say, 'Oh, when the deal comes through?' Then they'd roll their eyes at me."
The pair watched Field of Dreams and The Big Lebowski daily.
"People were starting to look at me like I was crazy," Marcus says.
Looking back, he thinks maybe he was.
It was a bad time for Marcus and Carl, the worst they'd ever been through. In a little more than a year, they had pawned their careers and sacrificed their reputations. Because he devoted so much time to the project, Marcus' large private counseling practice had been cut down to just nine clients, and Carl, a business administrator by profession, now waited tables full-time.
Urgency overtook all common sense. The money was gone, and every better business practice known by the men had been violated. When they ran into smirking former colleagues eager for gossip, all either of the men could say was "Well, see, there's this project...."
For both men, the project was everything, and for both men, the project was going nowhere. It was now October 1998, 13 months since they'd first approached DCFS with the idea of opening a private facility for the state's most emotionally troubled teenagers, and it still hovered in the future like a mirage.
"Almost everyone who supported the project in the beginning had dropped out," Marcus says, "and understandably so. It wasn't going anywhere."
Everyone, that is, except Marcus' former client Dan. Though he questioned whether the state would ever allow the center to open, he never doubted Marcus' vision. "I just kept waiting," Dan says.
Marcus, prodded by the thought of starvation and Carl's insistent persuasion, decided to go where his common sense told him never, ever to go -- the political arena. He called state Sen. James Clayborne (D-Belleville) and state Rep. Thomas Holbrook (D-Belleville) and told them about the project: It would help take heat off DCFS for having so many out-of-state placements; it would help the kids transition back to their communities; it would save the state money and create jobs in East St Louis.
The state lawmakers were supportive and called DCFS on behalf of Marcus and Carl. By late November 1998, the agency called back to announce that a contract would be signed in January. "We were elated," Carl says. "We were flying high. We felt like we had finally done it."
But the men's elation ended abruptly when January came and went without a signed contract. Two months later, in March 1999, they received notice from DCFS informing them that even though the state wanted to contract with the center, it couldn't until a center actually existed.
What that meant, Marcus and Carl soon learned, was that they would have to hire, train and do background checks on a staff and appoint a board of directors. The facility itself would also have to have every sheet, every towel, every fire extinguisher in place and would have to pass inspection.
From the state's point of view, the delays were necessary. "All of those things take time," Slomka, of DCFS, says. "New programs are first developed; then they're implemented. They don't just fall from the sky."
From Marcus and Carl's point of view, the sky had already taken its nosedive. "We started laughing about it at this point," Carl says. "It was truly a matter of 'Build it and they will come.'"
Says Marcus' colleague O'Reilly: "It was like they were running a marathon, only the finish line kept being moved farther away. It seemed cruel how the state was dangling these things in front them -- you know, 'Just do this and everything will be OK' -- and then something would happen, and it wasn't OK, and then they had to do something else."
Then early one morning, Marcus' phone rang. It was Rep. Holbrook's office, and the director of DCFS was on an intercom call. They were calling, they said, to tell Marcus the contract would finally be signed.
"He apologized to me up and down about how long it took," Marcus says, adding that he was so surprised by the call, he couldn't think of anything to say. "All I could say after two years of hell was 'Oh, no problem.'"
He called Carl immediately: "You're not going to believe who just called me...."
Carl and Marcus take the boys to a local department store to shop for clothes. In just a short time, the state will want to know whether the kids are ready to transition down to foster care or a group home or, if they're 18, to live on their own. In addition to teaching the boys how to cope with reality, control ingrained anger and learn to trust other people, Carl and Marcus have to teach them how to shop.
One of the kids eyes a pair of shoes he wants as the two men look on. Then the boy sees a second pair of shoes, but Carl realizes the boy is afraid, can't even imagine how, to ask for both.
Carl goes over and picks up the two pairs of shoes.
"Do you really want them?"
The boy just looks at Carl.
"Let's get them."
Carl knows this is probably the only time in the boy's life that he's ever gone into a store and walked out with two pairs of shoes.
Afterward, Carl says, "I went home that night and said to myself that if this thing were to fold tomorrow, it was almost all worth it just to buy that kid two pairs of shoes. It really was."
Since the opening of the facility in July, Carl finds himself dealing with more than just the top and bottom lines of the center's $1 million annual contract with DCFS. He's also learning how to acclimate the boys to the communities they will someday return to and to squeeze as much intensive treatment into six months as he can. So he takes the kids shopping. He takes them to ball games and to the movies and to the circus. They attend classes during the day at space rented from the hospital, and they take part in art therapy, music therapy, learning how to fill out a job application and read a bus pass. They spend their days learning what it will take to survive out there.
"It's similar to what happened to the behavioral-medicine field 10 or 12 years ago with inpatient and outpatient stays," Carl says. "We're trying to cut down on the length of the stay, thereby cutting down on costs. A six-month stay here, wrapped by the community agencies, is going to be a lot more effective than putting them down in Texas and letting them sit there for three years and then trying to bring them back."
Once a boy's six months at the facility is up, he is re-evaluated and a decision is made as to whether he's ready to transition down or needs to continue at the facility for another six months. So far, one boy whose parents live in the area has gone home. Another is applying for college.
Marcus' former client Dan is now one of the center's child-care workers, helping oversee the boys' outings, their chores and their schoolwork. "Already I've seen a change in a couple of the kids," Dan says. "I just knew this would be a good thing to do."
At the state level, the change in philosophy seems to be working as well. The number of out-of-state placements has dropped by 83 percent, and the in-state residential population has decreased from 4,300 to 2,560 since 1997.
But realistically, Marcus and Carl know that total independence for some of the boys will never be accomplished. They're simply too damaged; Marcus and Carl got to them too late.
John (not his real name), for example, came to the Juvenile Transitional Facility soon after it opened. He was sexually abused by his father when he was 4 and was sent to a foster home, where he lost contact with his parents. He called his mother, but she didn't call back. He became angry, started acting out and soon found himself labeled as having a "behavior disorder" because he couldn't sit still like the other kids in class.
Soon he was sent to another foster home, then another, until he ended up in a residential facility when he was 9 years old. There, he was sexually abused by some of the older residents. He started fixating on his anger and resentment at being abused, and by the time he turned 13, he was abusing younger residents himself. Then he turned his anger toward the staff and ended up in a juvenile-detention center, where he was sexually abused again. Once John left there, it was one placement after another, until he ended up in a locked juvenile facility in another state.
Most of the boys come to Marcus and Carl after having been in 15-20 different placements. All of them, except for one, is on medication. As Cheryle Chaney, the center's case manager, explains, they have a long way to go.
"They've been abused their whole lives," Chaney says. "They learn that they cannot trust anybody, that everybody wants to hurt them, and that's their reality."
"And if they got out of here too soon, they wouldn't make it," Carl adds. "They don't function anywhere near what they need to survive on the streets."
They are kids, Marcus says, on survival mode, with most still depending on medication to get them through each day.
"They're on anti-psychotic medication, anti-depressants, Ritalin and anti-convulsants to offset some of the other medication," Marcus says.
"Picture living in a facility since you were a young child, never living at home. In order for this child to survive, what he will do is make up a world that is real to him. He creates pictures in his head. He starts hallucinating, either auditory or visually. It's his defense mechanism that kicks in, so they don't even know how awful their situation has been.
"You know when you look at him he's not there. But," Marcus says, pointing to his head, "he is surviving up here."
Chaney jumps in: "So we have to deal with them where they are. We have to outlast them, basically, outlast their temper bursts, outlast them trying to hurt the staff, outlast the anger. You just have to last longer than they do."
"It's like riding a bronco," Carl says.
But Carl and Marcus have ridden plenty in the past two years.
"After working with these kids, the fact that I sacrificed two years doesn't matter at all -- I'd do it again. If it started all over tomorrow, I'd do it again."