Emelda Wani has seen a lot of change in the 15 years she’s worked for Spurwink Services, one of Maine’s largest behavioral health organizations.
In that time, she has worked her way up the nonprofit’s ranks from direct care worker to supervisor, including by taking night classes to earn her clinical license. Today, Wani, who emigrated from South Sudan, is the director of the Brook Child Residential Program in Westbrook, which serves children with such profound developmental disabilities that they require around-the-clock treatment and supervision.
Over the same period, however, the landscape for state-funded children’s residential services has deteriorated. Programs across Maine have closed or significantly reduced their capacity, in part because it has been so difficult to find staff to work such a demanding job when some retail jobs pay about the same. A decade ago, Spruwink had 200 beds for youth. Now it has 16.
As of July, those 16 are all at Brook, as it’s called for short.
That month, the program Wani oversees became one of only two residential services left in the state for children with severe developmental disabilities — and the only program that exclusively focuses on that population. (KidsPeace in Ellsworth also serves kids with developmental disabilities, but its residential program is not dedicated only to them.) Three similar programs, including two run by Spruwink, closed this summer, a contraction some in the behavioral health world described as “catastrophic.”
Now, Wani and her colleagues worry about what would happen if Brook should close, too, they said in interviews. Residential treatment, funded by MaineCare, the state’s Medicaid program, is often a last resort for families who would rather have their children receive treatment at home, access to which has also deteriorated in alarming ways. The kids at Brook would likely be living in hospitals or facilities out of state if they didn’t have the program, Spurwink staff said.
But Brook has stood out for other reasons, too. The program has managed to buck some of the trends that have afflicted its peers for reasons that may not solve the larger crisis facing children’s residential services but that have contributed to the individual program’s survival, said Misty Marston, senior vice president of residential and day treatment services for Spurwink.
The 16-bed program, located along a shady portion of Brook Street, has kept its beds full under the supervision of a remarkably stable workforce compared with its counterparts. When Spurwink made the decision to close two programs in Chelsea this summer, they had a staff turnover rate of about 75 percent in 2023. Brook’s was only 25 percent, Marston said.
It’s much easier to hire people in Cumberland County compared with more rural areas, Marston said. But Brook has also cultivated a workplace culture that makes staff feel supported and connected to their job, in part due to its largely immigrant workforce.
“We have a really fantastic, seasoned team there who have been doing this work for years,” Marston said. “It’s a very diverse place to work, and there is an excellent leadership team.”
Wani estimated that at least 90 percent of the program’s 60 or so employees come from the area’s African immigrant community, herself included. She and associate program director Patrice Cousineau, who has worked for Spurwink for 20 years, said that, while the program is not immune to the tough economic realities that have shuttered other programs, the culture at Brook underscores how developing strong leadership and a supportive culture are key to keeping similar programs afloat.
“The staff have a program director that looks like them,” Wani said. That signals to people who are new to Maine — or even to the English language — that they can advance professionally.
“I come to work, and it is like coming to see my family,” said Christian Irutingabo, a supervisor at the program, on Sept. 17. He had just helped usher a small group of residents into a van for a trip to the movie theater.
Most of the children and adolescents at Brook are nonverbal and autistic, and they may have accompanying psychiatric conditions. The program aims to teach the kids how to accomplish daily tasks while learning to cope with their conditions. The staff try to get kids out into the community as much as possible, they said.
Initially, the job with Spurwink was just a paycheck to Irutingabo, but he has stayed for seven years because of how rewarding it is to see kids progress over time, he said. He has watched himself make progress, too, learning how to adapt his body language or change a child’s environment to avoid outbursts.
“Not a lot rattles Christian,” Wani chimed in.
Janet Zahtila of Winslow noticed a huge difference in how the staff at Brook interacted with her son — and in her son’s improving condition — when he was admitted to the program two years ago, around his 13th birthday. Her son has autism with apraxia of speech, meaning he struggles to speak aloud what he is thinking. He also has bipolar disorder.
Initially, Zahtila worried about enrolling her son in a residential facility, nervous he might be mistreated. But the single mother could no longer meet his needs at home by herself while keeping them both safe. Her son is prone to aggressive outbursts that can come on suddenly. He has broken televisions and cut himself while smashing glass doors. He has punched his mother while putting her in a chokehold, Zahtila said. Before Brook, she often called the police for help.
The situation wouldn’t have gotten that bad if her son had more consistent access to in-home services, Zahtila and Wani said. He has qualified for them since he was 4, Zahtila said, but the agencies near her home in central Maine struggled to hire and retain staff, creating breaks in service that undermined her son’s progress. He kept having to restart with someone who wasn’t familiar with him, often leading to frustration, she said.
“I wish it didn’t have to come to this,” she said of placing her son in residential treatment. But he has improved at Brook, she said, something she attributes to the trusting relationships he has built with the people who look after him.
“That’s what they get right here,” she said. “I love them.”
Nearly all of Brook’s residents are eligible for more intensive staffing ratios than is typically required in a residential facility, which allows the program to receive a higher rate of reimbursement from MaineCare, Marston said.
But those rates are still not enough over the longterm to sustain a program like Brook. They have to cover both staff salaries and rising overhead costs, she said.
Without a change, Marston worries about the future of Brook and the families it serves, she said. Fortunately, the Maine Department of Health and Human Services recently said it is open to increasing those rates, Marston said, adding that Spurwink and other behavioral health organizations have been frequently discussing with state health officials how to keep what few programs for kids remain afloat.
“Brook has so much going for it,” Marston said, but “you can’t guarantee the longevity of any program that can’t pay its bills.”
Still, Wani has thought to herself, “They can’t close us,” she said. “We’re the last one.”
Reporter Callie Ferguson may be reached at [email protected].
