Many foster kids in Colorado aren’t being screened for mental health issues as quickly as they should be, according to data recently reviewed by state lawmakerswho said they were concerned about that backlog in care and other issues that were discussed in a Colorado Sun Research about broken adoptions.
The recent report from the state’s Medicaid system confirms the Sun’s findings that 13% of foster child adoptions in this state over the past decade have failed, in part due to a lack of behavioral health services that could help children recover from trauma.
Fewer than one-third of children in foster care in Colorado receive 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 problems among foster children and those adopted from the foster care system — problems 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 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 children are eligible for Medicaid until they are 26 years old, regardless of income. Children adopted from the Colorado 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 over low review rates in a November 18 hearing.
State senator Rachel Zenzinger connected the data to findings from the Sun inquiry, which found that former foster children and their adoptive parents are being abandoned by state and county systems ill-equipped to care for children with severe trauma.
“Some of these statistics… more or less confirm that,” said Zenzinger, an Arvada Democrat and chairman of the Joint Budget Committee. “That worries me.”
The behavioral health screenings are important because of the trauma foster children experience, including abuse, placement with multiple foster homes or adoption and relinquishment of the foster care system, she said.
Left unchecked, mental health problems can “worsen” and lead to other problems later on.
“Higher rates of substance abuse, higher rates of violence, higher rates of homelessness, the inability to get an 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 them.”
Zenzinger, who has sponsored past legislation in support of foster children in Colorado, said she was not surprised by the low assessment rates. She plans to see what action the legislature can take to address gaps in the system.
“It’s just really important that we follow this,” she added. “We want to make sure that all children who are in the child welfare system have access to this kind of – what I consider to be – 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 so much more to do,” she said.
Sybil Cummin, a behavioral therapist in Arvada who sees foster children, said child protection officers are often so overwhelmed with their workload that there is a delay in reaching out to therapists.
And as kids transfer to new foster homes, they can also transfer to another region in Colorado’s Medicaid system, which has seven regional entities licensed for mental health and substance use therapists in their area. This means that children may need to find a new therapist if they change homes.
In addition, there is a “significant lack of health 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 also because therapists must interact with social workers, court-appointed guardians, foster parents and biological parents, she said.
Lauren Ferguson, a Conifer therapist who has worked with about 25 foster children over the past five years, said it’s even harder to find therapists who use Medicaid and don’t have long waiting lists in rural areas. And the timeline is crucial, she said, because children who have experienced a “major 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.
In the past decade, nearly 1,100 children adopted from foster homes in Colorado have reentered the system — an outcome that can be painful for adoptive parents and children alike. Child welfare officials say behavioral problems are the number one reason adoptions fail. And parents, who often feel like monsters, say they canceled adoptions after failing to find help.
“I shout to anyone who will listen. Teachers. Therapists. Can someone help me. Someone help my child, my family. We need help,” said a mother.
Some children adopted from the foster care system are diagnosed with reactive attachment disorder, which can manifest in behaviors such as stealing, lying, manipulation, and resisting parental affection while being affectionate with strangers. A shortage of therapists who can treat the condition could contribute to adoptions falling apart, parents told the Sun.
More generally, a lack of providers accepting Medicaid is a common complaint from adoptive families, who have sometimes resorted to driving for hours to get their children to appointments. The As late as this fall, the Joint Committee on Budgets had heard continuing concerns about “inadequacy” of the Medicaid provider network.
Access to health care providers is a “huge problem, especially in rural areas,” Stephanie Holsinger, the program manager for Montrose County’s adult and child protection services, said earlier this month.
Providers that accept Medicaid often complain about the high administrative burdens when participating in the government programmeand the low rates at which they are reimbursed for the care provided.