Foster children in Colorado are not receiving timely mental health screenings

Many foster children in Colorado are not being screened for mental health problems as quickly as they should be, according to data recently reviewed by state lawmakers, who said they are concerned about this backlog of care and other issues raised in the Colorado investigation Sun for failed adoptions.

A recent report from the state’s Medicaid system backs up the Sun’s findings that 13 percent of foster child adoptions in this state have failed over the past decade, in part because of a lack of behavioral health services that could help children recover from trauma.

Fewer than a third of children in foster care in Colorado receive a behavioral health screening within a month of enrolling in the state’s Medicaid insurance program, according to 2020-21 data from the Colorado Department of Health Care Policy and Financing. This is despite well-documented concerns about the prevalence of trauma and mental health issues among foster children and those adopted out of the foster care system—problems that in many cases can haunt former foster children for years.

The data show that only 15.4 percent of foster children in Adams, Arapahoe, Douglas and Elbert counties received a behavioral health evaluation within 30 days of enrolling in the state’s health insurance program. Just over 16% of children on the Western Slope did. Foster children in southern Colorado counties, including Las Animas, Mineral and Alamosa, fare better. Thirty-three percent of children there received a behavioral health evaluation on time in 2020 and 2021.

Former foster children are eligible for Medicaid until age 26, regardless of their income. Children who are adopted out of Colorado’s foster care system can remain on Medicaid regardless of their adoptive family’s income.

Lawmakers on the powerful committee that writes the state budget expressed concern about the low grade levels during a Nov. 18 hearing.

State Sen. Rachel Zenzinger linked the data to findings from a Sun investigation that found former foster children and their adoptive parents were being failed by state and county systems ill-equipped to care for children with severe trauma.

“Some of these statistics … kind of back that up,” said Zenzinger, an Arvada Democrat and chairman of the Joint Budget Committee. “I’m worried about that.”

Behavioral health screenings are important because of the trauma foster children experience, which can include abuse, multiple foster care placements, or adoption and return to the foster care system, she said.

If left untreated, mental health problems can fester and lead to other problems later.

“Higher rates of substance abuse, higher rates of violence, higher rates of homelessness, inability to pursue an education,” she said. “It just has such an impact on your ability to be successful that if you don’t address it, it’s going to hurt them.”

Zenzinger, who has sponsored past legislation to support foster children in Colorado, said she was not surprised by the low assessment rates. She intends to see what action the Legislature can take to fix the loopholes in the system.

“It’s really important that we follow this up,” she added. “We want to make sure that all the needs of children who are in the child welfare system have access to these kinds of — what I think of as — pretty basic supports.”

She also plans to work with the governor’s office on a bill that would create a voucher program for former foster children to help them find housing.

“As proud as I am of the work we’ve done, it seems like there’s so much more to do,” she said.

Sybil Kumin, a behavioral health therapist in Arvada who visits foster children, said child welfare workers are often so overwhelmed by their caseloads that there is a delay in connecting with therapists.

And as children transition to new foster homes, they may also transition to another region in Colorado’s Medicaid system, which has seven regional entities that license mental health and substance use therapists in their area. This means that children may need to find a new therapist if they change homes.

On top of that, there is a “significant lack of providers for children in general and even fewer specialists in dealing with cases of child abuse, neglect and sexual abuse,” said Kumin, who runs Arvada Therapy Solutions.

Treating foster children often means more work for therapists, not only because their mental health needs are more intense, but because therapists must interact with caseworkers, court-appointed guardians, foster parents and birth parents, she said.

Lauren Ferguson, a Conifer therapist who has worked with about 25 foster children over the past five years, said finding therapists who accept Medicaid and don’t have long waiting lists is even more difficult in rural areas. And timing is critical, she said, because children who have experienced a “significant and traumatic, life-changing event” often need someone to help them get through it.

“The sooner they can get support for their emotional and mental health needs, the better,” she said.

Over the past decade, nearly 1,100 children adopted from foster care in Colorado have ended up back in the system, an outcome that can be harrowing for adoptive parents and children. Child welfare officials say behavioral problems are the main reason these adoptions fail. And parents, who are often made to feel like monsters, say they have ended adoptions after failing to find help.

“I’m yelling at anyone who will listen. Teachers. Therapists. Somebody help me. Someone help my child, my family. We need help,” said one mother.

Some children adopted from the foster care system are diagnosed with reactive attachment disorder, which can manifest in behaviors including stealing, lying, manipulation, and resisting parental affection while being affectionate with strangers. A shortage of therapists capable of treating the disorder may be contributing to the breakdown of adoptions, parents told the Sun.

Michelle Schuld hugs Nico, 5, as Wesley, 7, looks on at Sunburst Park in Aurora. Schuldt and her husband have six adopted children in addition to two biological children. “I think there should be a branch at every post-adoption agency — to help adoptive parents find support groups, therapy or marriage counseling,” Schuldt said. (Olivia Sun, The Colorado Sun via Report for America)

More generally, the lack of health care providers who accept Medicaid is a common complaint of adoptive families, who sometimes resort to driving hours to take their children to appointments. The Joint Budget Committee, as recently as this fall, heard continuing concerns about the “inadequacy” of the Medicaid provider network.

Access to health care providers is “a huge issue, especially in rural areas,” Stephanie Holsinger, Montrose County’s adult and child protective services program manager, said earlier this month.

Providers who accept Medicaid often complain about the high administrative burden of participating in the government program and the low rates at which they are reimbursed for providing care.

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