Many Colorado foster children 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 that lag in care and other issues raised in a Colorado Sun investigation about broken adoptions.
The recent report from the state Medicaid system reinforces the Sun’s findings that 13% of adoptions of foster children in this state have failed in the past decade in part due to a lack of behavioral health services that could help kids recover from trauma.
Fewer than a third of children in foster care across Colorado receive a behavioral health screening within a month of enrolling in the state’s Medicaid insurance program, according to 2020-21 figures from the Colorado Department of Health Care Policy and Financing. That’s despite well-documented concerns about the prevalence of trauma and mental health issues among foster kids and those adopted from the foster care system — issues that, in many cases, can follow former foster kids for years.
The data shows just 15.4% of foster children in Adams, Arapahoe, Douglas and Elbert counties received a behavioral health assessment within 30 days of signing up for the government 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, fared better. Thirty-three percent of children there received a behavioral health assessment on time in 2020 and 2021.
Former foster kids are eligible for Medicaid until they are 26 years old, regardless of their income. Children who are adopted from the foster care system in Colorado can remain on Medicaid, regardless of their adoptive family’s income.
Lawmakers on the powerful committee that writes the state budget raised concerns about the low assessment rates in a Nov. 18 hearing.
State Sen. Rachel Zenzinger connected the data to findings from the Sun investigation, which found former foster children and their adoptive parents are being failed by state and county systems ill-equipped to care for children with severe trauma.
“Some of these statistics… sort of bears that out,” said Zenzinger, an Arvada Democrat and chair of the Joint Budget Committee. “I’m concerned about that.”
The behavioral health screenings are important because of the trauma that foster kids experience, which can include abuse, being placed with multiple foster families or being adopted and relinquished back into the foster care system, she said.
If left unaddressed, mental health issues can “fester” and lead to other problems later on.
“Higher rates of substance abuse, higher rates of violence, higher rates of homelessness, the inability to pursue 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.”
Colorado’s Failed Adoptions
Hundreds of children in Colorado’s foster care system were failed twice — first when they suffered abuse and neglect and had to enter the system, and again when those adoptions failed and they reentered care. Through dozens of interviews with adoptive families, young adults who were sent back into the system, child advocates and child welfare officials, The Colorado Sun found a lack of support for both children and parents.
● Failed twice: An average of 100 children a year over the past 10 years were returned to foster care in Colorado after being adopted by their “forever family.” Read more
● Reforming subsidies: How are families supposed to handle adopting foster children with intense issues without enough financial support? Read more
● Raise the Future: The state is looking for ways to help and train adoptive parents, and there has been success with the nonprofit Raise the Future, but budget cuts could doom the programs. Read more
● Treating trauma: The top reason adoptions fail in Colorado is “child’s behavior problem.” What are reactive attachment disorder and adoption-related loss, and why is the mental health system failing to treat them? Read more
Zenzinger, who has sponsored past legislation to support foster kids in Colorado, said she wasn’t surprised by the low assessment rates. She intends to see what actions the legislature can take to address gaps in the system.
“It’s just really important that we are tracking this,” she added. “We want to make sure that all the needs of the children that are in the child welfare system have access to these kinds of — what I deem to be — 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 that we have done, it seems as if there’s still so much more to do,” she said.
Sybil Cummin, a behavioral health therapist in Arvada who sees foster children, said child protection caseworkers are often so overwhelmed by their caseloads that there is a delay in connecting with therapists.
And as children switch to new foster homes, they might also switch to a different region in Colorado’s Medicaid system, which has seven regional entities that license mental health and substance use therapists in their area. This means children might have to find a new therapist if they change homes.
On top of all that, there is a “significant lack of child providers in general and even fewer who specialize in working with child abuse, neglect and sexual abuse cases,” said Cummin, who runs Arvada Therapy Solutions.
Treating foster kids often means more work for therapists, not just because their mental health needs are more intense, but because therapists have to communicate with caseworkers, court-appointed guardians, foster parents and biological parents, she said.
Lauren Ferguson, a Conifer therapist who has worked with about 25 foster children in the last five years, said finding therapists who take Medicaid and don’t have long waiting lists is even more difficult in rural areas. And the timeline is crucial, she said, because children who have been through a “significant and traumatic life-changing event” often need someone to help them process it.
“The sooner they can have support for their emotional and mental health needs, the better,” she said.
Over the past decade, nearly 1,100 kids adopted from foster care in Colorado have ended up back in the system — an outcome that can be agonizing for adoptive parents and kids. Child welfare officials say behavioral problems are the primary reason those adoptions fail. And parents, who are often made to feel like monsters, say they dissolved adoptions after failing to find help.
“I am screaming to anyone that will listen. Teachers. Therapists. Somebody help me. Somebody help my kid, my family. We need help,” one mother said.
Some children adopted from the foster care system are diagnosed with reactive attachment disorder, which can show up in behaviors including stealing, lying, manipulation and resisting affection from parents while being affectionate with strangers. A shortage of therapists able to treat the disorder may be contributing to adoptions falling apart, parents told the Sun.
More broadly, a lack of health care providers who accept Medicaid is a common complaint of adoptive families, who have sometimes resorted to driving hours to get their kids to appointments. The Joint Budget Committee, as recently as this fall, had heard continued concerns about “inadequacy” of the Medicaid provider network.
Access to health care providers is a “huge problem, in rural areas especially,” Stephanie Holsinger, Montrose County’s adult and child protective services program manager, said earlier this month.
Providers who accept Medicaid frequently complain about the high administrative burden of participating in the government program, and the low rates at which they are reimbursed for providing care.