Thousands of children across Puget Sound travel through the doors of behavioral rehabilitation services center Ryther each year — a number that the organization’s director says is likely only about 30 percent of the total children in the state who need psychiatric help.

Children and adolescents are referred by parents, physicians, schools, state agencies and courts. Many of them come from the foster care system, and have failed on average in nine previous placements. They come with a complex array of behavioral issues.

“I used to run a psychiatrict hospital in the Midwest, and some of these kids are every bit as disturbed as those patients,” said Executive Director Lee Grogg. “In terms of the children coming from foster care, we think these children were not only traumatized initially, but going through placements that weren’t prepared for them traumatized them again.”

After their stay — nine months generally being the longest — 80 percent of these adolescents are able to move on to less restrictive placements. But, Ryther and other organizations like it continue to fight for survival.

Reimbursements for behavioral rehabilitation services have decreased more than 15 percent over the past decade, although demand continues to increase and adolescent patients served become more difficult, leading organizations like Ryther to seek other funding methods.

Ryther is one of just nine intensive inpatient youth treatment centers in Washington, and is the only one located in King County. They are all currently reimbursed by the state at the same level they were in 2004. But, that only covers about 60 percent of their costs.

“I think the reimbursements are the worst they’ve ever been,” said Grogg. “And what we’re asking for would only get us to 2011 levels.”

Legislation introduced into the House and Senate in February originally called for an increase of no less than 15.27 percent over the next two years.

In the latest version of the state budget introduced on Monday, June 21, the reimbursement increase for behavioral rehabilitation service programs stood at six percent.

“Is 6 percent adequate?… I mean, its better than it’s been,” said Sen. David Frockt, one of the sponsors of the Senate version of the bill. “But, I have a lot of frustration, because I feel like everything we say, there has been excuse after excuse.”

Once a small operation started in 1885 by “Mother” Ryther, the organization has grown to provide multiple programs, 84 different categories of enrichment therapy, and inpatient and outpatient services. Demand and a need for revenue from privately insured patients led Ryther to open outpatient service centers in Bellevue and Mukilteo in August 2012 and September 2013, respectively.

Between its inpatient and outpatient services, Ryther serves 2,600 children each year from 10 counties.

That number continues to grow, and the children are increasingly difficult and troubled.

Children being treated at Ryther have issues that include affective disorders, post-traumatic stress disorder, expressing themselves by starting fires and smearing feces, and homicidal and suicidal ideations.

In 2004, only half of the children in Ryther’s inpatient Hospital Alternative Care program fell in the most severe category (1-A). A decade later, all of the children are rated 1-A, correlating with an increase in staff injuries and assaults.

The staff at Ryther uses a variety of reatment and enrichment programs to treat these children. In addition to working with one of the three full-time therapists or handful of doctoral students, therapy dogs, art therapy, pysical fitness and outings,  children also attend school and work on building social skills. All of this is geared to producing students whocan reassimilate into life outside of a treatment center.

To compensate the shortcoming in state funding, Ryther has turned to expanding their outpatient services in addition to seeking private funding and donations.

“This private sector revenue is our path to survival,” said Grogg. “We can’t count on the state to ensure our existence.”

In 2010, the organization enrolled about 160 outpatient clients per month— that number jumped to 600 per month by 2014. In that same time, the number of private insurance patients tripled.

“Privately insured clients were once the exception for Ryther. Now, they account for more than half of outpatients served,” according to the 2013-2014 Stakeholders Report.

Ryther also relies on private donations. Their 60-year-old Seattle campus is currently undergoing renovations that Grogg hopes will, in part, encourage donations.

Still, Grogg said that Ryther will always treat children coming from the foster care system who need treatment.

“One of the great things about Ryther is the passion and commitment of the staff that work here,” said Grogg. “That’s harder to find than you’d think.”