Why Intermountain Residential is ‘worth fighting for,’ despite months of turmoil 

When Hope Dyson arrived at Intermountain Residential in 2012, she was struggling to find healthy ways to express her anger. At two years old, she had been adopted from Sierra Leone by a large Tennessee family, and she arrived at the Helena campus as an 11-year-old diagnosed with autism. Hope was trying to figure out who she was. Her parents and siblings were looking for any way to help her.

At Intermountain, she lived in one of the program’s “cottages” alongside other kids with severe emotional disturbances and traumatic histories. Hope and the other children went to school on campus and received round-the-clock care from on-site therapists and staff members. By the time she left the program 18 months later, Hope recalled, she had started to learn new skills for managing her feelings.

“They taught me there were other ways to cope with my anger,” the 22-year-old said in a recent phone interview. “Not just punch a hole in the wall.” 

Now, Hope uses other outlets for her emotions, like throwing shot put and discus in her free time. She lives independently in Nashville and describes herself as a passionate advocate for people with disabilities. 

Her mother, Darlene, said that at the time a residential group home seemed “really the only way” to help Hope regulate and allow her family to transition out of “crisis mode.” Unlike psychiatric facilities or programs that use reward-based systems to encourage better behavior, Intermountain’s therapeutic approach was fundamentally about building strong relationships and trust with adults, Darlene said, and required the rest of the family to develop new resources and skills, too. 

“It’s just a different style of therapy,” Darlene said. Other strategies, like behavioral incentives, had seemed irrelevant to her daughter. “She could be in the moment and I could offer her the moon and it didn’t matter. She was so dysregulated,” Darlene continued. Intermountain’s “model of trust was what worked best with Hope.”

Many current and former families share the assessment that Intermountain Residential’s approach helped troubled kids when nothing else did. They maintain that the changes many residents experienced were both deep and lasting, and were not the result of medications or reward-based behavior modification. Others noted that the program, which currently accepts children between the ages of 4 and 14, was willing to work with their young children when other residential options wouldn’t. 

Through personal testimony, word of mouth and industry recognition, Intermountain has developed a reputation in Montana and nationwide as a place where children with severe behavioral and emotional issues can begin to turn a corner. 

Now, many staff, families and alumni fear that the essence of the program will become a thing of the past. In early September, the nonprofit announced its intent to temporarily close the program because of short staffing and repeated warnings from its residential leaders about unsustainable rates of employee turnover. 

The news, including the announcement that Intermountain would be discharging the 16 children then in its care, sparked an emotional and logistical uproar. Parents and staff protested the closure, spoke out in local media and appealed to the organization’s board to reverse the decision. After weeks of turmoil, attorneys representing several staff members and parents negotiated an extension, agreeing that the campus would stay open at least until Nov. 30, and possibly later, giving parents more time to try to find other placements for their children. As recently as Oct. 3, the plan changed again. In a statement to staff shared with media outlets, Intermountain walked back the possibility of all-out closure, saying leadership had developed a plan aimed at keeping one cottage open while strategizing about how to “rebuild” the program.

The organization’s long-term future remains unclear. While the board and interim CEO Gary Larcenaire have promised to stabilize and eventually expand the program, some current and former staff and clients doubt that intention and question the current leadership’s commitment to Intermountain’s therapeutic DNA. The elements that define its residential services have been honed over decades, staff and families  say, and will need to be carefully tended to keep the program operating for years to come. 

For many, the disintegration of Intermountain’s particular model of care would be an almost incalculable loss.

“It would be devastating to so many to lose something so valuable,” Darlene Dyson said. “Some things are just worth fighting for. And Intermountain is one of them.” 

HEALING ‘THROUGH RELATIONSHIP’

The roots of Intermountain Residential can be traced back to 1909, when William Wesley Van Orsdel, a roaming Methodist preacher commonly known as Brother Van, and social worker Louise Stork opened the Montana Deaconess School at the site of the old Montana Wesleyan University campus in the Helena Valley. The new facility was a boarding and day school for students ages 5 to 14. Montana historian Ellen Baumler wrote that the program was especially geared to children whose parents “for a variety of reasons — illness, separation, death of a spouse — were unable to care for their children.”

The building was damaged by earthquakes decades later, forcing the Deaconness students and staff to move closer to Helena in 1935. The school’s program for youth and adolescents continued to evolve, eventually becoming the Intermountain Deaconess Home for Children. In 1971, the organization moved to its current south Helena location, near the foothills of Mount Ascension, with children spread across four residential cottages. Many children admitted to the program at that time came to Intermountain by way of Montana’s state-run foster care and adoption systems. 

But the program was not fully settled in its approach to serving children. In the 1980s, the program’s leaders sent a relatively new employee named Jim FitzGerald on a cross-country mission to find a clinical model of therapy that would work best for the children entering Intermountain’s care. 

One of FitzGerald’s stops was an old hunting lodge outside of Denver. There, a 23-bed facility called Forest Heights Lodge was treating adolescents with an emphasis on attachment theory and creating healthy connections between children and caregivers. FitzGerald was struck by the simplicity and promise of the approach: developing close, trusting relationships with children to soothe their rage, anxiety, reactivity or despondency. He brought the idea back to Intermountain, where, over the course of FitzGerald’s subsequent decades-long tenure as CEO, “developmental/relational” therapy became Intermountain’s primary tool for helping clients heal from trauma, abuse and neglect.

“What is harmed through relationship must be healed through relationship,” wrote Dr. Elizabeth Kohlstaedt, Intermountain’s former clinical director, in a 2010 article published in the Scottish Journal of Residential Child Care. In the 2016 book “Be Child Wise,” Kohlstaedt and other Intermountain staff expanded on the philosophy behind the model, urging adults to understand a child’s symptoms in light of instability or broken trust experienced at a young age.

“It is our job as adults to be the healing agent for children by understanding the need that the child is expressing,” the prologue reads. “In order to grow and thrive, a child must reside within a stable culture of caring and nurturing. The child’s relationships with adults in this setting must reflect the value of trust.”

In a September interview with Montana Free Press, Kohlstaedt emphasized that the therapeutic approach was only possible because of the skilled and attentive staff members who put it into place, day after difficult day. “When you’re dealing with a child who’s just bitten your face, it’s really difficult to control yourself. It’s very difficult to respond with something other than fury,” Kohlstaedt said. 

At full capacity, Intermountain worked with 32 children, divided among 8-bed cottages designed to mimic a home environment. Managing the ups and downs of that many patients 24 hours a day, seven days a week, Kohlstaedt said, required staff to be deeply perceptive and attentive to any personal emotional baggage that might undermine the trusting bond they’re required to develop with patients. Part of the strategy for creating a resilient staff, Kohlstaedt explained, was to help employees in each cottage regulate their own responses. If a staff member was feeling aggravated, Kohlstaedt said, another worker was expected to check in and give their colleague time to cool off. Such struggles were also processed in small employee groups with oversight from a clinical supervisor using a style of therapy Kohlstaedt called “Family Team Dynamics.”

Kohlstaedt and other Intermountain employees said this “layered approach” of support and training proved an effective antidote to burnout. Employees described developing reliable friendships and mentorships with their colleagues, often hanging out together in their free time and having dinners at one another’s homes. Some workers talked about becoming “Intermountain lifers” and wanting never to leave the organization.

“In the first six months to a year, I was in love with the place,” said Jager Kechely, a cottage supervisor who started working at Intermountain as a counselor more than 12 years ago, in a September interview. Watching patients grow and evolve was rewarding, he said, and tough days were made easier because of the “healthy, functioning team” working behind the scenes. 

“You go through fire,” Kechely said, about staff experiences with residents. “And it’s successful.”

Former patients and families of current patients say the staff’s dedication was foundational to their positive experiences. Elena Shain, a college student in California who attended the program when she was 11 years old, said in a recent interview that her unique connections with cottage counselors helped her grow over a year and a half of treatment.

“Something changed where I was able to handle my anxiety better. And I think I know what it is. A major thing was trust. I didn’t have trust for anybody,” Shain said in a September phone call. She’s remained in touch with some employees over the decade since she left, and now plans to pursue a career in social work, partly because of their influence on her life. The depth of her connection with Intermountain employees, which she later wrote about in a high school blog she shared with MTFP, was trust embodied. 

“The whole world is based off trust. You would have to do everything yourself if you could not trust a partner or even the grocer,” Shain wrote at the time. Reflecting on her time at Intermountain in the recent interview, she said, “I can honestly say that it saved my life.”

A ‘FRAGILE ECOSYSTEM’

In the years leading up to the pandemic, Intermountain expanded services beyond its Helena campus, beefing up programs in schools and other outpatient services. Meanwhile, Kechely said, the residential facility in Helena typically operated at or near capacity, with an ever-present wait list for patients from Montana and nationwide. The developmental/relational model continued to help set Intermountain apart from psychiatric and behavioral programs in Montana and nationwide. And few if any therapeutic group homes around the country worked with the same age group, often delaying admission to children younger than 13.

Though never flush with cash, the residential program was also financially stable. Some families had insurance programs that covered their child’s treatment, while others paid out-of-pocket. Private payers helped the program reserve some spots for children in the state’s foster care or adoption systems and patients insured by Medicaid, whose reimbursements didn’t cover the full cost of care. Much of Intermountain’s remaining operating expenses were funded by philanthropic donations. 

“When you are trying to be close and form a deep relationship with emotionally disturbed children, it takes time and it takes trust.”

Elizabeth Kohlstaedt, former clinical director, Intermountain Residential

Current and former Intermountain staff marvel at the campus’ lasting influence and efficacy, noting the unusual circumstance of talented employees staying for years and a funding model that kept the doors open 24/7. A few paraphrased an old saying attributed to FitzGerald, who stepped down from his role as CEO in 2022 and declined to be quoted for this article, citing his ongoing work in children’s mental health services in Montana. 

“[FitzGerald] used to call our campus a ‘fragile ecosystem.’ And it is. I think that is one of the hallmarks of it,” Kohlstaedt said. “When you are trying to be close and form a deep relationship with emotionally disturbed children, it takes time and it takes trust.”

That dynamic has become strained in recent months, staff say, making the highly specialized model harder and harder to execute. Even Kechely said he had neared the end of his rope with the program’s recent upheavals — multiple changes in the CEO seat and staff shortages on the residential side made him feel exhausted and unsupported by the organization’s higher-ups, he said. The tough job didn’t feel balanced like it used to, he said. He put in his notice of resignation with management on Sept. 1, but with an intentionally undefined end date. If the program seemed on a path to firmer footing, he said, he’d consider staying.

On Sept. 14, two weeks after announcing its impending closure, Intermountain paid tribute to Brother Van and the organization’s long history in a Facebook post celebrating “Founder’s Day,” an occasion, it said, “to honor our roots, celebrate our achievements, and anticipate the incredible journey ahead.” Parents and other Intermountain supporters blasted the post as out-of-touch and “crass” in the comments.

“Guy would be spinning in his grave if he knew what was going on with the residential program!” one person wrote.

‘WHAT I DO IS TURNAROUNDS’

Employees say Intermountain’s fragile ecosystem began to fracture for two primary reasons. The first, some say, is that the organization was simply spread too thin during its expansion of off-campus services, a growth spurt that coincided with state budget cuts to mental health services in 2017.

“I had concerns about the expansion,” said Crystal Amundson, an Intermountain board member from 2015 to 2021 who later took a clinical supervising role at the organization, a position she resigned from in August. “I understood the need to diversify funding and revenue sources, but on the other hand, I was concerned about the clinical integrity of the model. Did we have the staff to support the expansion?”

As with other mental health services in Montana, Intermountain’s staff and budget were also put through the wringer by the pandemic and its aftermath. Some staff said employee turnover and burnout began to seem more persistent than in previous eras. The residential campus, after downsizing to three cottages in response to staffing shortages, struggled to fill jobs and reopen the beds that had been closed. 

Money, as always, continued to be tight. While temporary pandemic funding helped ease the organization’s budget, outpatient services including home visitation and child and family therapy struggled to generate reliable revenue. Even so, as he prepared to leave his role as CEO in 2022, FitzGerald described Intermountain’s services as “thriving” and said the expansion of outpatient programs around the state would power the organization into the future. 

“When I started at Intermountain 43 years ago, we served 32 children a year. Now, we serve thousands in not just Helena, but Billings, the Flathead, Missoula, and Bozeman, as well as the surrounding areas of all these major hubs,” FitzGerald wrote in a donor newsletter in spring 2022. “I truly believe our footprint has expanded because of two exceptional factors: First, the tireless efforts of countless staff and Board members over the years, and second, the equally immeasurable generosity of our friends and donors like you. Without these two intangibles we would not be where we are today.”

Despite those optimistic words, the organization appeared to lose its footing after FitzGerald’s exit. The board’s next choice for CEO, Matt TeNyenhuis, rankled employees for a perceived lack of appreciation and understanding of the developmental/relational model, some recalled. Staff continued to leave, creating additional stubborn vacancies. Less than six months after he was hired, the board ended TeNyenhuis’ term as CEO following a vote of no confidence by a group of Intermountain staff from across the organization. The board soon began another tough search for a CEO.

In February 2023, the board hired health care executive Gary Larcenaire as interim CEO on an 18-month contract. Larcenaire’s resume includes past work in the mental health field in Texas and Utah, experiences marked by public scrutiny and sometimes dramatic business decisions. He’s also the founder of Project ItyÂ, a “healthcare concept company,” according to Larcenaire’s personal website. In a September interview, he said he was drawn to the position by his passion for bringing major change to strained health care settings. 

“What I do is turnarounds,” Larcenaire said. In his telling, Larcenaire has pulled organizations back from the brink of bankruptcy and helped them recover from “even the most desperate sets of circumstances.”

Soon after he came on board, Larcenaire said, he was told by Intermountain’s contracted accountants that the organization was financially strapped and might not be able to pay its employees later in the year unless it rectified a roughly $5 million shortfall between revenue and expenses, a figure that prompted confusion and doubt among some current employees. Asked by MTFP where the losses originated, Larcenaire said it wasn’t clear. Turnover in the accounting department and a change in software meant that “no one could make heads or tails of the financials” he had inherited, Larcenaire said. 

Still, he said, he began considering what might be done about retention and hiring. He implemented a pay raise for some staff, but heard employee feedback that the problems were bigger than that. Employees were feeling burned out by long hours, insufficient training and inadequate emotional support. Even before tensions with the residential team crescendoed in the fall, Larcenaire said, he was “alarmed” about how the loss of employees threatened the therapeutic model.

“When you have that degree of turnover, this very unique and valuable clinical orientation that they use there — it’s almost like an oral tradition. They pass it on to new employees orally and they display the behaviors that should be copied,” Larcenaire said. “But the problem is, when you have people who are constantly turning over, then that fundamentally erodes the very, very fundamental premise of the developmental relational model. Because in order to … intentionally build an intimate relationship with a child of trust, you have to be there.”

Even with that stated understanding, residential staff said they struggled to trust Larcenaire or feel like he was truly listening to their proposals to resolve the staffing shortages. Larcenaire’s communication, they said, also felt disconnected from the reality that residential staff was experiencing. Around the same time the residential program was considering downsizing from three cottages to two to accommodate diminished staffing, Kechely said, Larcenaire sent a July email announcing his ambition to rebound to a five-cottage operation by fixing up an additional housing unit on campus for patients.

“[T]he problem is, when you have people who are constantly turning over, then that fundamentally erodes the very, very fundamental premise of the developmental relational model … [Y]ou have to be there.”

Gary Larcenaire, interim CEO, Intermountain Residential 

“When I first read that, I was like, ‘What is he talking about?’” Kechely said. A handful of staff decided to leave after that communication, he said. “They were already so stressed … They were questioning their own emotional bandwidth to do the job, and not feeling supported or heard. And the disconnect was the cherry on top.”

After what both sides described as unsuccessful attempts to advance a plan for the residential team, staff from across the agency signed another no-confidence letter in mid-August about Larcenaire and the board’s leadership. The residential team said its effort to convey concerns seemed to have minimal effect, and the solutions they presented to the board were dismissed as nonstarters. 

Weeks later, the conflict came to a head. Residential leadership told Larcenaire and the board they could not sustain the operation of two cottages if they lost any more staff. The board subsequently decided to close the entire facility, attributing the decision to the status staff had communicated. Residential staff have since maintained they were not asking to close, but rather expressing the dire nature of the situation.

“If we lose so many more staff, it won’t be stable. And so what are we going to do about that?” recounted Ashley Browne, the current clinical director of the residential unit, in a September interview. “Here’s what we see as our data. Here’s the truth of our staffing situation. What are we going to do about it? We need immediate help.” 

Larcenaire said Intermountain had made efforts to move the needle on hiring — such as listing the recent pay raise on job postings — but admitted those tactics had not filled the vacancies. He reiterated that the closure decision was in response to the staff’s recommendation.

Based on the original closure timeline, families and the residential team had about a month to find new placements for the 16 children then living on the campus. Under the new agreement reached with lawyers for Intermountain and families and staff, the two cottages will maintain operations until the end of November with about 10-12 staff in each unit, Browne said in a recent text message. Some staff have already begun to transition to other jobs, she said, “given the instability.”

‘I JUST FEEL BAD FOR THOSE KIDS’

Throughout September, Larcenaire and the board continued to express a commitment to  rebuild the residential program in internal statements and comments to the media. Many current and former staff, and several families, told MTFP they have little faith in those pledges. Some suspected that, even if the campus were to reopen, it would be operated with a different model designed to make more money. One parent, whose child has been at Intermountain for less than a year, said the board’s actions and short timeline for discharging children make her wary of any future placement at Intermountain. Trust, one of the fundamental values at the core of Intermountain’s mission, appeared to have ruptured between the institution, clients and staff.

“They continue to use the word ‘closure,’ and then in the next breath want to know how many of us will be around to rebuild. And, of course, we still have no understanding as to what [a] rebuild will look like,” Browne said in a September phone call. A week later, when Intermountain released its statement about maintaing operations at one cottage, Browne said the change felt like “complete whiplash,” even as it reflected some of the desires of residential staff.

“I simply do not understand how or why we are now being allowed to stay open. When we have been asking and advocating for this all along!” Browne said in an October text message. She noted that her reaction may indicate she needs more time to recover from the recent tumult. “I feel so incredibly scarred up and burned from what we have been through.”

Amundson, who left the board before TeNyenhuis was hired and resigned from her clinical position during Larcenaire’s tenure, said in September that she’s grown increasingly doubtful about Intermountain’s fidelity to the developmental/relational model. Board turnover, including her own departure, has left Intermountain’s leadership without much expertise in the therapy that makes the program so noteworthy, Amundson said, or experience making sound financial decisions without compromising the therapeutic approach. 

“Currently, what I think is happening is leadership does not practice or understand the model, but claim that they do,” Amundson said. “So what decisions leadership are making is a blatant disregard and disvaluing of the model in the name of a viable business model.” 

Larcenaire disputed the suspicion expressed by some staff and families that he wants to change Intermountain’s developmental/relational model. In fact, he said, he wants to recommit to practicing it as Intermountain has done in decades past. If five cottages were up and running, Larcenaire said, Intermountain could sustain the cost of operating the residential program, leaning on donor philanthropy to fill in the gaps. 

“The developmental/relational model, for the demographic that we serve, is in many instances, the last hope. And it isn’t my desire to turn that into a psychiatric, heavily medicated facility,” Larcenaire said. If anything, he said, Intermountain’s future should align with FitzGerald and Kohlstaedt’s vision better than it has during the last few years of turmoil. “My goal has been to double down on the developmental/relational model, not to water it down one bit.”

How the program might restore that alignment is unclear, as Larcenaire admitted. In the late-September interview, he did not speculate about how long the campus might remain closed, saying it depends on how many staff decide to remain. 

Then, hours after Larcenaire spoke to MTFP, Intermountain’s communications director, Erin Benedict, announced another change. The board and Larcenaire, she said, had decided to begin a search for a permanent CEO, almost a year before Larcenaire’s contract is scheduled to expire. 

In an email to Intermountain employees shared that night with MTFP by Benedict and other staff, board chair Tim Lanham said Larcenaire declined to apply for the position, but will continue to lead the organization until a replacement is found.

“If we have a chance to do something again in the future, I’d like to influence that … But it all feels unknown. It feels like staring into a black hole.”

Ashley Browne, clinical director, Intermountain Residential 

“Mr. Larcenaire has worked tirelessly to understand and address the complex challenges that Intermountain faces. He has built a highly capable leadership team and data-driven design that will prove essential for us to move forward into our next chapters,” the email said. 

While the delay of the original closure date and the possibility of keeping one cottage open after November has allowed some parents and staff time to regroup, uncertainty continues to loom large. In September, Browne said she had no plans to resign, in part to provide stability to her patients. She also said she’s wary of trusting Intermountain’s leadership in the weeks and months ahead.

“It’s sort of like wait and see what happens. It’s a very important piece of the puzzle for these kids and families to not have people abandon them, for one. And if we have a chance to do something again in the future, I’d like to influence that,” Browne said. “But it all feels unknown. It feels like staring into a black hole.”

Shain, the former resident, tried to summarize the loss that would come with closure, or even the possibility of Intermountain reopening without the developmental/relational model intact. Her parents might have been able to find another placement for her when she needed it, she said, but many families don’t have those opportunities or resources.

“I just feel bad for those kids,” she said.

If Intermountain bounces back and eventually continues operations, Shain noted a potentially bitter irony born of the recent upheaval. 

“They’re trying to build trust in these kids,” Shain said. “But you just moved them again? I don’t think that builds trust.”

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