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Colorado’s foster children don’t get timely psychiatric evaluations

Many foster children in Colorado are not being screened for mental health issues as quickly as they should, according to data recently reviewed by state lawmakers.

The latest report from the state’s Medicaid system reiterates the Sun’s findings that 13% of foster child adoptions in the state over the past decade have failed in part due to a lack of behavioral health services that could help children recover from trauma.

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

The data shows that only 15.4% of foster children in Adams, Arapahoe, Douglas and Elbert counties received a behavioral health assessment within 30 days of enrolling in the state health insurance program. Just over 16% of the children on the west slope did. Foster children in southern Colorado counties, including Las Animas, Mineral and Alamosa, fared better. There, 33 percent of children received a behavioral health assessment in a timely manner in 2020 and 2021.

Former foster children are eligible for Medicaid until they turn 26, regardless of their income. Children adopted from the Colorado foster care system can receive Medicaid regardless of the income of their adoptive family.

Lawmakers on the powerful committee that writes the state budget raised concerns about low tax rates in a hearing on November 18.

State Senator Rachel Zenzinger linked the data to findings from the Sun investigation, which found that former foster children and their adoptive parents are being abandoned by state and regional systems ill-equipped to care for children with severe trauma.

“Some of these statistics … kind of confirm that,” said Zenzinger, an Arvada Democrat and chairman of the joint budget committee. “That worries me.”

The behavioral assessments are important because of the trauma children experience, which can include abuse, placement in multiple foster families, or adoption and return to the foster system, she said.

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

“Higher rates of substance abuse, higher rates of violence, higher rates of homelessness, 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 will hurt you.”

Zenzinger, who sponsored previous legislation supporting foster children in Colorado, said she wasn’t surprised by the low ratings. She wants to see what measures the legislature can take to close loopholes in the system.

“It’s really important that we pursue that,” she added. “We want to make sure that all of the needs of the children who are in the child support system have access to this type of — which I think is pretty basic support.”

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 still so much more to do,” she said.

Sybil Cummin, a behavioral therapist in Arvada who treats foster children, said child protection cases are often so overwhelmed with their caseload that there are delays in connecting with therapists.

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

Additionally, there is a “significant shortage of child care providers in general, and even fewer who specialize in working with cases of child abuse, neglect and sexual abuse,” said Cummin, who leads 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 communicate 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 take Medicaid and don’t have long waiting lists is even more difficult in rural areas. And timing is crucial, she said, because children who have gone through a “significant and traumatic life-changing event” often need someone to help them process it.

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

In the past decade, nearly 1,100 children adopted by Colorado foster families have ended up back in the system — an outcome that can be distressing for adoptive parents and children. Child protection officials say behavior problems are the main reason these adoptions fail. And parents, who often feel like monsters, say they canceled adoptions after they couldn’t find help.

“I yell at anyone who will listen. Teacher. therapists. someone help me Someone will help my child, my family. We need help,” said one mother.

Some children adopted from the foster system are diagnosed with reactive attachment disorder, which can manifest itself in behaviors such as stealing, lying, manipulation, and resisting parental affection while being affectionate toward strangers. A lack of therapists able to treat the disorder could be helping adoptions fall apart, parents told the Sun.

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

More broadly, a lack of health care providers who accept Medicaid is a common complaint from adoptive families, who have sometimes resorted to driving lessons to take their children to appointments. As recently as this fall, the joint budget committee had heard lingering concerns about the “inadequacy” of the Medicaid provider network.

Access to health care providers is a “big problem, especially in rural areas,” Stephanie Holsinger, Montrose County’s adult and child protection 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 care.

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