LIVE VIDEO: 9NEWS Morning News    Watch
 

Failed to Death Denver Post

2:32 PM, Nov 19, 2012   |    comments
  • Inner turmoil. Grant Oakes displays his grandson's brain scan. Oakes became the legal guardian of the boy when he was 10 months old after the child's mother used drugs and was abused by her partner in front of the child. When he reached his teens, the child began using pot, skipping school and threatening suicide. A donation from a friend allowed Oakes to pay for the brain scans that he said helped diagnose the child as struggling with a bipolar disorder. (Craig F. Walker, The Denver Post)
  • BRIGHTER DAYS. Dominique Mallard, 21, of Aurora says she felt that nobody understood her emotional challenges through much of her time in Colorado's child protection system. At 16, she and her 4-year-old brother were removed from her home because of unsafe conditions. She ended up cycling from foster home to foster home and in and out of treatment centers — 13 placements in all. "I feel that the system, they twist things up to where they don t make sense," she said. In one treatment center, she
    
  • Share
  • Print
  • - A A A +
  • FILED UNDER

By Christopher N. Osher, Jennifer Brown and Karen Auge
The Denver Post
But in Colorado, specific treatment for such emotional distress is rare, leaving these children vulnerable to being misdiagnosed as mentally ill or hyperactive when, in reality, they are exhibiting post-traumatic stress disorders, experts say.

As a result, these children are more likely to develop long-term depression and even illnesses such as cancer and heart disease. Some are given drugs they may not need.

"What has really emerged out of the science of the last 15 years is the evidence that when you abuse and neglect a child, it actually changes the way their brain is organized," said Bryan Samuels, who oversees the U.S. Department of Health and Human Service's programs for at-risk kids.

"It actually shapes the architecture of the brain."

Dominique Mallard, 21, of Aurora says she felt that nobody understood her emotional challenges through much of her time in Colorado's child protection system.

At 16, she and her 4-year-old brother were removed from her home because of unsafe conditions. She ended up cycling from foster home to foster home and in and out of treatment centers - 13 placements in all.

"I feel that the system, they twist things up to where they don t make sense," she said. In one treatment center, she was prescribed five mood-stablizing medications, which she believes weren't needed. It wasn't until her last placement that a therapist finally worked to understand her and the pain she had been through.

 It has much to do with hormone levels that can rise dangerously during abuse.

High levels of the hormone cortisol, for example, affect impulse control and memory. Heightened stress also can damage the prefrontal cortex, the region of the brain that regulates focus, self-control and decisionmaking.

Unfortunately, hormone levels can remain high even after abuse victims are removed from bad situations.

That means fixing these broken children often requires more than putting them into a stable environment.

Doctors need to evaluate their physical development while counselors review the patterns and severity of past abuse to develop a long-term combination of psychological and medical care. Instead, many simply are treated as bad kids.

Dominique Mallard, 21, of Aurora said she felt that nobody understood her emotional challenges through much of her time in Colorado's child protection system.

At 16, she and her 4-year-old brother were removed from her home because of unsafe conditions. She ended up cycling from foster home to foster home and in and out of treatment centers - 13 placements in all.

Along the way, she was separated from her brother, complicating her issues. She has since seen him just once, and only briefly, in a chance encounter in a discount department store. He waved at her from afar, too timid to approach.

"I feel that the system, they twist things up to where they don't make sense," she said.

In one treatment center, she was prescribed five mood-stablizing medications, which she believes weren't needed and which she has stopped taking now that she is an adult.

It wasn't until her last placement that a therapist finally worked to understand her and the pain she had been through.

"It wasn't until then that they actually looked at the problem instead of focusing on the behavior," Mallard said. "In foster care, they label you as a horrible child. They never look at why you do what you do."

Looking at the why - including the type of abuse, and when and how it occurred - is crucial because different kinds of abuse can have different impacts, experts say. The child's age and the frequency of abuse can also play roles.

Children in the worst situations grow up more likely than their peers to abuse drugs and alcohol; contract sexually transmitted diseases; suffer from obesity, and heart and lung disease; and even commit suicide.

The more complex the abuse, the more likely the negative impact will follow a child into adulthood, according to an ongoing study by Kaiser Permanente and the Centers for Disease Control and Prevention that has been tracking the mental and physical health of more than 9,000 survivors since 1995.

Abused and neglected kids are 11 times more likely than their peers to get arrested for criminal activity as juveniles, according to another study by the U.S. Department of Health and Human Services.

And the problems persist: As adults, they are nearly three times more likely to get arrested for violent and criminal activity.
The cycle of abuse is hard to break. Nearly one-third of the victims will abuse their own children, statistics show.
Several of the children who died of abuse and neglect in Colorado since 2007 had parents who grew up in the child welfare system.

Anthony Angel and Brandi Strawn - whose 5-month-old baby, Antonio Angel, was shaken to death - had troubled childhoods and spent time in foster homes, state records show.

Anthony Angel now faces criminal charges in Pueblo County for allegedly killing Antonio while in a rage. His trial is pending.

That cycle and the sobering statistics have prompted Colorado officials to look to other states, such as Illinois, that have more robust systems in place for determining the traumatic impact children suffer.

In Illinois, minors entering the protective system get an initial survey and within 45 days receive a comprehensive assessment conducted with a licensed clinician that determines the level and frequency of their abuse.

Caseworkers use the information to create detailed treatment plans that differ from child to child. The plans are rigorously reviewed for effectiveness.

"The screenings and assessments allowed us to get to the children sooner," said Samuels, who overhauled the Illinois system more than 10 years ago when he was its director. "They ended up having less problems in the long run. They had reduced level of trauma. They functioned better."

Colorado wants to see similar success stories, but it has a way to go.

"The directive I have is to get trauma-informed care implemented systemwide and departmentwide," said Dr. Lisa Clements, director of behavioral health in the Colorado Department of Human Services.

This year the state received a grant from the federal Substance Abuse & Mental Health Services Administration that will help eight counties test and craft assessment tools for abused and neglected children.

Colorado, along with the rest of the states in the nation, will have to meet new federal mandates enacted by Congress in 2011 requiring them to come up with plans for screening and treating trauma-related symptoms.

Some areas in Colorado are starting to forge ahead. The federal agency that Samuels heads provided a $3.2 million grant for the Kempe Center, which treats abused kids, to work with Denver child protective officials to develop a program similar to Illinois'.

"We are going to be putting trauma front and center in everything we do, creating an understanding of trauma so that when we work with families and children, we are working with the underlying causes of what's going on with them," said Nachshon Zohari, the administrator for mental health for Denver's Department of Child Welfare.

Children who are misdiagnosed with behavior problems are often prescribed psychotropic drugs that do more harm than good, said Dr. Gary McClelland, a leading behavior specialist and professor at Northwestern University.

"You do a great disservice to children if what you are treating is a manifestation of trauma but you are treating it as a mental disorder," he said. "The treatment is quite different for trauma than what you would do for a mental disorder. You want to develop skills for that child that got interrupted when they got traumatized."

Lately, scientists have expanded their focus on treatment into the brain itself.

Dr. Bruce Perry, a senior fellow at the ChildTrauma Academy in Houston, has used brain-scanning technology, including imaging produced by the Denver clinic CereScan, as part of a broad treatment designed to determine not just what's wrong with a traumatized child in complex cases but also how best to try to repair the damage.

He said research shows that the neurological abnormalities that abused children develop, if left unchecked, will turn into health concerns as the child ages through adulthood.

In the 1990s, Perry and his team conducted a pilot study that assessed both the emotional and neural development of 400 children as soon as they entered the child welfare system.

The two-year pilot cost $1.5 million, but, Perry said, it ultimately saved money because children who got the upfront assessment were in care for a shorter amount of time.

And because they were able to identify which children had the most intractable emotional problems, "We were able to place higher-risk kids in a higher level of care," which meant fewer moves and placements for those children.

Research showed the potential savings would have amounted to $25 million annually if the program had been spread throughout Texas, where Perry works, but no money was made available for implementation.

Mount Saint Vincent Home in Denver is one of the first treatment centers in Colorado to put some of Perry's work into practice.

"What we used to do as a treatment center, we assigned every kid a therapist and every kid got the same package of therapy, which, most of the time, was talk or play therapy," said Kirk Ward, Mount Saint Vincent Home's clinical director. "Now, we conduct an assessment on all kids who come in, based on their history and the observation of the child and interviewing caretakers."

Instead of trying to get kids to talk about what has happened to them - an approach many therapists now agree doesn't make sense at an age when verbalizing anything can be challenging - Ward's staff emphasizes repetitive tasks, along with music, art and dance, which "activate the brain."

Some of those who end up caring for children from abusive homes are pushing for brain scans to craft treatments even though such scans are controversial. The cost is also high, about $3,450 per child, and Medicaid, which insures foster children, typically won't cover that.

Inner turmoil. Grant Oakes displays his grandson's brain scan. Oakes became the legal guardian of the boy when he was 10 months old after the child's mother used drugs and was abused by her partner in front of the child. When he reached his teens, the child began using pot, skipping school and threatening suicide.

Grant Oakes became the legal guardian of his 10-month-old grandson after the child's mother used drugs and was abused by her partner in front of the child. When he reached his teens, the child began using marijuana, skipping school and eventually threatening suicide.

A donation from a friend allowed Oakes to pay for the brain scans that he said helped diagnose the child as struggling with a bipolar disorder. Now on mood-stabilizing medication, the child has improved, though challenges remain, including issues of substance abuse, Oakes said.

"I love this kid, but we went through hell and back," Oakes said. "If we would do these scans and get people help much earlier, then there would be so much money saved in the court system and in doctor visits, not to mention avoiding the grief that people go through."

Christopher N. Osher: 303-954-1747, cosher@denverpost.com or twitter.com/chrisosher and Jennifer Brown: 303-954-1593, jenbrown@denverpost.com or twitter.com/jbrowndpost

 

Most Watched Videos