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Colorado’s foster children are not getting timely mental health screenings

Many Colorado foster children are not 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 the delay in care and other issues raised in a Colorado Sun – investigation into broken adoptions.

The recent report on the state’s Medicaid system reinforces the Sun’s findings that 13% of foster child adoptions in this state have failed in the past decade, in part because of a lack of behavioral health services that can help children 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 2020-2021 figures 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 from the foster care system — issues that, in many cases, can follow 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 signing up for the government’s health insurance program. Just over 16% of children on the Western Slope have. Foster children in southern Colorado counties, including Las Animas, Mineral and Alamosa, fared better. Thirty-three percent of children there received a timely behavioral health evaluation in 2020 and 2021.

Former foster children are eligible for Medicaid until they are 26 years old, regardless of income. Children 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.

The state Sen. Rachel Zenzinger linked 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 … kind of bear it out,” said Zenzinger, an Arvada Democrat and chairman of the Joint Budget Committee. “I’m worried about that.”

The behavioral health screenings are important because of the trauma foster children experience, which can include abuse, being placed with multiple foster families or being adopted and returned to the foster care system, she said.

If not addressed, mental health issues can “amplify” and lead to other problems later.

“Higher rates of drug 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.”

Zenzinger, who sponsored past legislation to support foster children in Colorado, said she was not surprised by the low assessment rates. She intends to see what steps the legislature can take to address gaps in the system.

“It’s just really important that we keep an eye on it,” she added. “We want to make sure that all the needs of the children who are in the child welfare system have access to these kinds of – what I consider 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 we’ve done, it seems like 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 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 children may need to find a new therapist if they change homes.

Additionally, there is a “significant lack of children’s providers in general and even fewer who specialize in working with child abuse, neglect and sexual abuse cases,” says Cummin, 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 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 past five years, said it’s even harder in rural areas to find therapists who take Medicaid and don’t have long waiting lists. 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 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 painful for adoptive parents and children. Child welfare officials say behavioral problems are the primary reason those adoptions fail. And parents, often made to feel like monsters, say they have dissolved adoptions after not getting help.

“I shout to anyone who will listen. Teachers. Therapists. Someone 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 resistance to affection from parents while being affectionate with strangers. A shortage of therapists who can treat the disease can contribute to adoptions falling apart, parents told the Sun.

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Michelle Schuldt hugs Niko, 5, as Wesley, 7, watches 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 in every agency for post-adoption — to help adoptive parents find support groups, therapy or marriage counseling,” Schuldt said. (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 had to drive hours to get their children to appointments. The Joint Appropriations Committee heard continued concerns about the “inadequacy” of the Medicaid provider network as recently as this fall.

Access to health care providers is a “huge problem, especially in rural areas,” 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.

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