When Angelina Burke entered the Platte Valley Youth Services Center in Greeley last month, she had been steadily taking a litany of psychiatric medications.
Those medications — including Suboxone to treat opioid addiction — helped the 16-year-old Longmont native sleep better, manage her cravings and stabilize her mood.
But when Burke came to the juvenile detention center, the staff took her off most of her meds entirely, she said, causing the teen to go through serious withdrawal, her mental health plummeting.
“I was so emotional,” Burke said. “I cried so much, and I don’t even know why… I was really suicidal. It was terrible.”
Burke’s case exemplifies what juvenile justice workers say has been a consistent problem over the years in Colorado’s Division of Youth Services. Teens will enter detention facilities and sometimes be yanked off their meds abruptly as they wait to see a state psychiatrist, they say. Meanwhile, courts have been reluctant — or unable — to force the state’s hand.
“This is a statewide problem,” said Chris Henderson, executive director of the Colorado Office of the Child’s Representative. “Starting and stopping children’s meds — it’s just common sense that it’s not good for kids.”
Dr. Renee Marquardt, the Colorado Department of Human Services’ chief medical officer, said in an interview that each case is different and that “there is no one answer for psychiatric medications.”
“A lot of the misconceptions… seem to be reflecting that there are these automatic decisions made that are arbitrary,” she said. “Whereas… the decisions made are after careful consideration of each youth’s individual circumstances and needs.”
Waiting for medication
After being picked up by police in January on a probation violation, Burke was sent to the Boulder County Juvenile Assessment Center.
There she was put on an M1 hold — a 72-hour involuntary psychiatric hold when someone is deemed at risk of hurting themselves or others.
Burke spent a week in an Aurora hospital, where doctors prescribed a variety of psychiatric medications.
When she was arrested in June for missing a court hearing, Burke again went to Boulder’s juvenile center, where staff gave her the medications she was prescribed.
But after being transferred to Platte Valley, staff there took Burke off most of her medications.
Without her Suboxone, Burke went through withdrawal in the Greeley facility, shaking and throwing up. Staff also took her off Trazadone, which made it difficult for the teen to sleep.
“It’s been really, really hard,” Burke said. “I’ve just been suffering.”
It took eight days to see a psychiatrist in Platte Valley, Burke said.
This was the teen’s third time in Platte Valley, and “every time she goes there, they mess with her medications,” Burke’s mother Erin Gosney said. “It sends me through the roof.”
Juvenile justice advocates say Burke’s case is hardly a one-off exception in the state’s 12 detention facilities, which, as of Friday, housed 126 kids in pre-trial detention and another 284 youth who have been committed by a court to DYS.
One teen, who last month entered the Mount View Youth Services Center in Lakewood, had been taking Abilify — an antipsychotic — for over a year, in addition to other medications.
When the teen was arrested and taken into DYS custody, however, staff cut off the medications, said April Murtha, a guardian ad litem appointed by the court to represent the child’s interests.
“He wasn’t sleeping, he was stressed and he felt caged,” Murtha said about how the teen coped without his medications. “He had two fairly major incident reports for inappropriate behavior toward staff.”
The teen never saw a DYS doctor, Murtha said — only a nurse. That individual, the guardian ad litem said, never contacted the teen’s prescribing doctor, despite repeated attempts by the youth’s caseworker to get the two in touch.
“It was just baffling,” Murtha said.
It took three weeks before the teen was able to get back on his meds.
Dr. Teresa Mayer, the DYS psychiatric medical director, said “we always reach out” to get information from previous prescribers — though she couldn’t comment on specific cases.
“A concern for child safety”
Dr. Steven Berkowitz, a professor in the University of Colorado Department of Psychiatry and Pediatrics, helped start mental health programs in detention centers in Connecticut and Philadelphia. He acknowledged that when it comes to prescribing psychotropic medications, there’s not an obvious “good idea, bad idea.”
Berkowitz’s general practice, though, was not to change medications unless it was clear the teen was not going to be discharged.
“In my experience, we never just stopped a medication when kids were admitted to a detention facility,” Berkowitz said. “That doesn’t make any sense. We’d only do any of that with a good evaluation.”
Pulling medications abruptly “is not good practice,” he said, noting that it’s better to wean kids off to see how they do.
When a child enters a DYS facility and they report that they are taking medications, an independent assessment is done by an on-site medical provider to determine whether or not there’s anything concerning with the medicine, to verify that the child has been taking it, and to make sure are there no current health concerns that need to immediately be addressed, Mayer said.
“There’s a common misperception… that medications are stopped,” she said. “They are certainly checked for safety and appropriateness.”
There are many psychiatric medications where there is “no risk specifically from stopping medications cold turkey,” Marquardt said, adding that any decision to stop medication factors in how necessary it is for the individual to function, how quickly they may decompensate without it, and whether or not the youth was actually taking it regularly.
The office of the Child Protection Ombudsman of Colorado has received complaints from advocates and youth guardians indicating children are not getting meds in a timely manner, said Stephanie Villafuerte, the ombudsman.
“Of course, if that’s true, that is a concern for child safety,” she said, calling the issue a “balancing act” for juvenile corrections’ staff.
“DYS has to evaluate children and give meds safely, according to best practice,” she said. “They have to be cautious.”
At the same time, “we know it takes months, if not years, to get the proper medication they need for their diagnosis,” Villafuerte said. “To not continue that level of care could cause them great setbacks.”
Henderson, whose office represents and advocates for children in Colorado’s court system, said the issue is not confined to one particular detention center.
“This is not an isolated concern whatsoever,” he said.
“Knee-jerk reaction”
Part of that thinking stems from a 2014 probe by the state auditor, which found the Division of Youth Corrections — the previous name for DYS — gave numerous youth psychiatric medications without consent and without evidence of a mental health diagnosis.
A 2014 FOX31 investigation found one facility — the now-shuttered Betty K. Marler Youth Service Center in Lakewood — prescribed serious antipsychotic medications at a pace far exceeding other youth corrections facilities.
In 22 of the 60 cases reviewed by the auditor, youth medical records “did not indicate what diagnosis or symptoms prescribed medications were intended to treat.”
Other instances described staff providing medication solely based on the kid saying he or she had asthma, and nurses improperly preparing medication for youth at discharge.
The department agreed to implement a more robust oversight system, ensure prescribers are consistently informing youth and their families about the risks and benefits of medication being prescribed, and requiring all juvenile facilitates to institute better procedures.
“The current policies are consistent with national standards on best practice for psychiatric medication treatment of youth in juvenile justice settings,” Madlynn Ruble, a Department of Humans Services spokesperson, said in an email.
Murtha, the guardian ad litem, said the department clearly overcorrected after the 2014 audit, calling it a “knee-jerk reaction.”
“We can’t overmedicate so now it’s no meds for you,” she said. “It went from one end of the spectrum to the other. There’s a way to do a happy medium.”
The juvenile justice system in general, Berkowitz said, “isn’t quite set up yet to evaluate kids effectively for medications and psychiatric needs.”
If DYS isn’t going to continue kids on their medication, the least they could do is taper them off, Gosney said.
“It’s inhumane,” she said. “I would wish my daughter to never go back there again. That place needs to be shut down.”
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