Colorado’s mental health system ill-equipped to handle adopted children with severe trauma

Colorado’s child welfare system has stepped up efforts in recent years to either keep kids with their relatives or more quickly get them adopted, policies motivated by research that children are better off in permanent homes. 

But where the system is failing, parents and child advocates say, is in getting kids the mental health help they need to heal — not just from the original abuse and trauma, but from the grief that comes with losing their biological parents. 

“Our child welfare system is really far behind in understanding the effects of early trauma,” said Amy VanTine, who relinquished parental rights to her daughter two years after adopting her. “They are still stuck in that thinking that love will fix it. Unfortunately, that is not quite it. Colorado is a hot mess right now and it’s scary to watch.”

A growing community of Colorado parents who have adopted children diagnosed with reactive attachment disorder, or the more generic term “developmental trauma,” are finding each other through word of mouth and social media. They now believe that what they were told is an extremely rare diagnosis is far more common than they thought — and that a shortage of therapists who know how to treat it is likely contributing to a 13% failure rate of adoptions from the state foster care system. 

The behaviors associated with the disorder are intense: stealing, lying, manipulation, avoiding eye contact, resisting affection from parents yet indiscriminately being affectionate with strangers, food hoarding, destruction, obsession with fire and gore. 

The child welfare system in Colorado does not know how many of the 1,094 kids who returned to foster care after they were adopted in the past decade were diagnosed with reactive attachment disorder. The primary reason adoptions “disrupt” in Colorado, however, is “child’s behavior problem.” 

The diagnosis of reactive attachment disorder is controversial. Some experts question whether the extreme behaviors — which can include dangerous aggression toward family members and animals — are the result of the neglect and abuse the child suffered with their biological parents, or whether they are caused by the adoption itself. 

The distress and confusion of missing biological parents who are “physically absent but psychologically present” is called “adoption-related loss,” and Colorado adoptive parents are ill-prepared to handle it, child advocates say. 

Colorado law does not require adoptive parents to receive training about reactive attachment disorder or adoption loss. Families are required to complete 40 hours of training that includes first aid and “trauma-informed” care, but the curriculum is left up to the adoption agency or the county where the child is adopted. 

A lack of training for parents about what to expect and a lack of understanding in the mental health system about how to treat childhood trauma is causing adoptions to fail, said Katherine Noto, an adoptive mom who created a nonprofit called Attach Families Inc.

“Kids are not going to 27 different foster homes because they are just so darn cute,” Noto said. “Kids are not aging out of the system because they were fabulous and adults just suck. They are aging out of the system because there is literally no support for the adults in their lives to help them and their behaviors are so severe.”

Chapter Two: Few options for parents dealing with attachment disorder

VanTine and her husband signed the papers dissolving their adoption of a 13-year-old girl after realizing the years of therapy they had gotten her were actually making their relationship worse. The more VanTine tried to show unconditional love, the more violent the girl became. 

When VanTine discovered the girl had used a knife to stab her mattress, leaving deep slashes on her side of the bed, she decided it was time to give in.

“She didn’t come to our home homicidal,” VanTine said. “It was years of trying to force her to attach that caused her to become homicidal toward me.  She didn’t feel safe. Without her feeling safe, we couldn’t get her to attach.” 

The girl came to their Adams County home as a foster child when she was 7. By age 11, her behaviors — headbutting and spitting and trying to jump off the roof and out of a moving car  — pushed VanTine to the point of forcing the county to intervene. Child protective officials opened a case after VanTine asked the school psychologist, the girl’s therapist, the family’s therapist and anyone else she knew who was required by law to report child abuse or neglect to call the county child welfare department. 

County officials threatened at first to open an abuse and neglect case against VanTine, she said, then began harassing her about paperwork about her adoption subsidy and respite care that the county had previously approved. It seemed, she said, that caseworkers were retaliating against her for asking for help post adoption. Adams County did not respond to a request for comment from The Sun.

She hired an attorney, and county officials agreed to send the girl to Shiloh House, a Littleton-based youth residential treatment center that offers intensive therapy. The girl seemed to think of the facility as camp and did not show signs of reactive attachment disorder while she lived there. VanTine believes it was because the girl felt safer in a chaotic environment rather than a peaceful home, and because she was not with VanTine. 

VanTine was able to move her to the only residential facility specifically for children with reactive attachment disorder in Colorado, The Institute for Attachment. The nonprofit center recently closed after its long-time director retired. 

While the girl was living there, VanTine found the stab marks in her mattress at home and learned from the child’s therapists that their relationship was likely beyond repair. “We relinquished our rights,” VanTine said. “She was relieved when she found out we were no longer going to be her parents.” 

Thanks to living in a small town and social media, VanTine found eight other families in the Brighton area who had been through a similar experience after adopting from foster care. Three of them joined VanTine to create a nonprofit, RAD Advocates, which stands for reactive attachment disorder, that helps families across the country navigate the systems of Medicaid and child welfare when their adoptive children are beyond their control. 

The group’s four volunteer advocates, each with a caseload of 15 or 20 families, will help parents search for therapists and treatment centers that take Medicaid (there are only a few nationwide that specialize in reactive attachment disorder) and, as a last resort, get their children back into foster care. 

The child welfare and behavioral health systems are not set up to help kids with such severe developmental trauma, VanTine said. Instead, kids with reactive attachment disorder cycle from home to home, everything going fine until they are expected to reciprocate some level of closeness. And then the placement blows up. 

“Our foster care system accommodates this disorder,” she said. 

Chapter Three: Parents, adoption agencies underestimate “adoption-related loss”

It doesn’t matter at what age they were adopted, kids go on a “lifelong search for a sense of self,” said Jessica Handelman, a licensed clinical social worker who has testified as an expert witness about “adoption-related loss” in about 100 court cases in Colorado.

While most experts are testifying about how the loss of a trusted caregiver will cause irreparable damage, Handelman is one of the few who is adamant that the adoption itself is causing the trauma. She often testifies on behalf of biological relatives who are fighting to adopt a child, opposing the narrative that the child would be better off being adopted by their foster family. 

“Courthouses celebrate adoption day with balloons and parties, showing excitement for the ‘forever family’ that the child is gaining,” she said, “but no one considers what the child also loses on that day.”

Adopted children, at some point, will grieve the loss of family and culture, especially if they are adopted by a family of a different race or ethnicity, she said. They will wonder if any of their biological relatives fought to keep them. And, if they were adopted from foster care and their biological parents fought to keep them and lost that fight, they will question why their adoptive parents were considered “better” by the system, Handelman said. 

Whether it’s spoken aloud or not, she said, children will hear the message from their adoptive parents: “We felt that we were better suited to care for you than your own family.” 

Research from Rutgers University found that 100% of people who are adopted from foster care will search for biological family members. “It’s because of this innate human drive to want to know who we are and where we come from,” Handelman said. “There is a piece of them that’s always gone.” 

What’s sometimes misdiagnosed as reactive attachment disorder is actually adoption-related loss, she said. But “no one is talking about the adoption-related loss because it’s that whole savior complex — we saved this child from what was a terrible situation,” she said. 

The answer isn’t to avoid all adoptions, she said. But kids more often should remain or reunite with family. 

Colorado law says that if children are removed from their biological parents, they should go to a relative if possible rather than into foster care. And if a relative comes forward after a child has been living with a foster family that wants to adopt them, “deference needs to be given to that family,” Handelman said. 

To ease the move from foster family back to biological relatives, she created a “therapeutic transition” protocol to minimize the traumatic effects. “The idea is to hold the child’s emotional safety at the forefront of the transition,” and go only at the pace the child can handle, she said. 

Handelman has been contracted by several county child welfare divisions, including Adams County, to provide the therapeutic transitions, and is sometimes hired by biological families’ attorneys after families get their children back. 

There is a “huge unmet need” for the therapy statewide, she said, and many professionals who work on child welfare cases are unaware that therapeutic transfer exists. More children should have access to the therapy, she said. 

In cases when foster parents adopt, Handelman said, they should receive training on adoption-related loss and how to find therapy for their children. 

Colorado is moving in the wrong direction and allowing foster parents greater leeway to battle against biological parents in court, according to the Office of Respondent Parents’ Counsel, which represents needy parents in cases where the government has removed their kids because of abuse and neglect. 

It’s because of this innate human drive to want to know who we are and where we come from. There is a piece of them that’s always gone.

— Jessica Handelman, a licensed clinical social worker

A 1997 state law allowed foster parents to intervene in adoption cases but many courts limited their participation to input on the child’s treatment plan. Then a 2013 state Supreme Court decision opened that up to full participation, meaning foster parents could file motions to suspend visitation with biological parents, cross examine parents and, in effect, turn proceedings into custody battles. 

The change motivated foster parents who wanted to adopt their foster children to hire lawyers and intervene early in abuse and neglect cases against the biological parents. The percentage of cases in which an “intervenor” has jumped into an abuse and neglect case in Colorado jumped to 11% in 2019 from 3% in 2012. 

However, more children are staying with their biological parents and not entering foster care in the first place. The rate of removal of children from their homes after allegations of abuse and neglect was 2.4 per 1,000 children this year, down from 3.8 per 1,000 in 2018, according to the state child welfare division. 

Last month, 199 kids entered the foster care system. That compares to 336 children in December 2018. 

The goal is to return foster children to their biological parents, said Korey Elger, who is in charge of permanency, or finding kids permanent homes, at the Colorado Department of Human Services. But that isn’t always an option. Foster kids who are adopted are most often adopted by their foster parents. 

“Children and youth are resilient,” Elger said. “Even when they’ve experienced adverse childhood experiences, such as abuse or neglect, they can overcome and reach their full potential with support from a dedicated foster parent.” 

And Colorado is perpetually short on foster parents, especially for teenagers. “You’re never too old to need a family,” she said. 

Chapter Four: Mental health system isn’t set up to treat severe trauma

Colorado’s behavioral health system is equipped to handle chidren who are anxious, depressed and suicidal, although even services for those mental health issues are severely lacking across the state. Kids are spending days and even weeks in hospital emergency rooms as their parents search for open beds at treatment centers or even therapists who have openings for new patients. 

But when it comes to treating kids with severe developmental trauma, there are even fewer options. Only a handful of specialists who know how to treat reactive attachment disorder and adoption-related loss take Medicaid, the government insurance program for which all foster kids and kids adopted from the system are eligible.

Intimacy is the core problem for children with reactive attachment disorder. Emotional bonding with an adoptive parent, often the mother, triggers a feeling of loss or abandonment that stems from the absence of the biological mother, said Carrie O’Toole, who counsels families dealing with the disorder. The Castle Rock mom adopted a boy from Vietnam, and eight years later, gave him to another family so they could adopt him. 

The adoptive mother can become the “nurturing enemy,” said O’Toole, who offers Christian counseling through Carrie O’Toole Ministries. 

After her family’s broken adoption, O’Toole went to graduate school to study reactive attachment disorder but quickly realized it was hardly even mentioned in the curriculum. The disorder is extremely hard to treat because children with it will act charming and well-behaved during therapy sessions, but break their parents’ noses and terrorize family pets at home, she said. 

O’Toole, who started her practice in 2012, now employs two other life coaches and holds retreats twice each year for families who have relinquished their rights or lost contact with children with reactive attachment disorder. 

Noto, whose nonprofit Attach Families is based in North Carolina, said she asked for help multiple times from caseworkers after adopting her three boys from foster care. “The caseworker would say, ‘You just need to make them feel loved and safe. They’re just testing you,’” Noto recalled. 

But the boys were so aggressive at home that she feared for their lives and hers. “They raged for days,” she said. “They threw vases at my head. If anyone else had gotten my children they would have pushed them onto another house.”

Noto started her organization about five years ago and now helps parents across the country advocate for services at schools, hospitals and child welfare departments. The group has a 24/7 crisis line. And it holds multiple support groups — for parents falsely accused of abuse, for parents whose adoptive children are sexually abusing other children, for siblings of children with trauma disorders. The largest support group has 2,000 members. 

Noto blames the child welfare system for not preparing adoptive parents and not being honest about children’s issues, but it’s the mental health system that is failing to help children with severe trauma disorders, she said. 

“The truth of the matter is that our behavioral and mental health system in this country right now is not set up to handle children with complex trauma disorder or reactive attachment disorder,” said Noto, whose sons are now teenagers. “We need to envelop these children as soon as they come into care. Some children will never heal. Some children can heal to a point where they can exist in the world without forming relationships. Some can find healing.” 

Noto once refused to pick up her youngest son from a psychiatric hospital because she knew he wasn’t ready to come home. The hospital reported her to child protective services, which threatened her with an abandonment charge. 

“He was there for 88 days. And for 88 days, I waited to be arrested,” she said. But she won the battle, and after those 88 days, her son was sent to a residential treatment facility for more than two years. 

Her boys are stable now, not nearly as aggressive after years of treatment. Noto’s mission is to help others through the journey she endured mostly on her own. 

“Parents should be completely and totally told about this,” she said. “They should be advised of the truth about the child’s background and behaviors and then thoroughly supported and believed and helped while that child is in their home.” 

Chapter Five: Unknown number of international adoptions fail

The Colorado Department of Human Services, which includes the child welfare division, released data to The Colorado Sun under public records laws revealing for the first time how many children end up back in foster care after they are adopted. The data does not include children who were placed through private adoptions, from other countries or from child welfare systems in other states before ending up in foster care in Colorado. 

But those cases exist, too. 

Liz Clark joined a group of adoptive mothers with her “torch and pitchfork” on the Dr. Phil show to call out a Tennessee woman who in 2010 sent her 7-year-old son alone on a one-way flight back to Russia. The woman sent the boy with a note saying she was misled about his behavior problems and she could not keep him.

At the time, Clark had just adopted a boy and girl, both 3, from a Russian orphanage and was appalled that anyone could renege on a promise to love and care for a child forever. 

The Fort Collins mom understood a few years later. Her adoptive son had pulled a knife on her and sexually assaulted one of her biological children. In one year, Clark and her husband spent more than $200,000 on therapies for their adopted children, who were both diagnosed by psychiatrists with reactive attachment disorder. 

They are now 18 and have not lived with Clark and her husband for years. They spent most of their teenage years in residential treatment centers, and for the son, rehab and a Utah wilderness treatment program.

The family paid for the residential treatment out of pocket after failing to get help from child protection caseworkers, even when the family reported that Clark feared for her life. 

The experience nearly broke her. The stares from classmates’ parents after her son threw a chair across a classroom and swept off the contents of the teacher’s desk. The shame she felt when she told the high school principal to check her son’s locker for weapons after she noticed a knife missing at home. 

“The judgment and the loneliness is incredibly painful,” Clark said. “I truly have a broken heart because of these kids.” 

Clark wishes there were government-funded therapeutic boarding schools for children with reactive attachment disorder who cannot live safely at home. Children with the disorder would function better outside the family unit, seeing their adoptive parents only during visits. 

She also wishes all adoptive families — including those who adopt from other countries — had access to Medicaid and subsidies to pay for therapies “before the bottom falls out.” And she says adoptive families should have access to legal protection in case they are falsely accused by their children of abuse. 

Clark had always wanted to adopt because she was adopted from foster care as a baby. “We chose those kids over everything,” Clark said, breaking down in tears in an interview. “No one ever tells you about the level of sacrifice.”