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By Sophie Phillips, CEO, TexProtects
In the past 12 months, despite an executive order to end the policy allowing the separation of migrant children from their parents, followed by a judicial order to reunify those families, our government has continued to separate and traumatize children.
One might ask how this tragedy continues to occur – you could be forgiven for thinking both orders would have ended the matter. However, that is not the situation we find ourselves in, and certainly not the situation the 5,700 children in Texas shelters are in.
There were loopholes in the court’s decision: children could still be separated from parents with criminal histories, or considered dangerous to the child, or if they suffered communicable diseases.
All seemingly reasonable stipulations, except that advocacy groups who are face to face with these families are reporting the government is inappropriately exploiting those loopholes – reducing the orders to ineffective words on paper. Examples include children taken away from a parent for violations such as driving with an expired license or experiencing a brief hospitalization. They can also be separated from other relatives such as siblings or grandparents. We would never tolerate such flimsy pretenses for taking away children from U.S. citizens.
This result has been more than 700 immigrant families separated after the policy supposedly ended.
The organization I lead – TexProtects, the Texas chapter of Prevent Child Abuse America – makes no claim to immigration policy expertise. We’ll leave the crafting of immigration solutions to those who do.
Instead, our expertise is in children and policy that impacts them – specifically, how to keep children safe from trauma. And make no mistake – being separated from a parent, regardless of the situation, is itself an extreme trauma.
TexProtects fights tirelessly to make families stronger and more resilient, helping prevent crises that lead to child removal. Putting children in foster care must be the measure of last resort – all options for keeping a child safely with his or her parents must be explored before taking the extreme measure of separation.
We’ve worked to embed this philosophy within our government, gaining lawmakers’ support for prevention programs and strengthening family preservation services.
That’s why the current policy is unthinkable. We are witnessing the government, rather than protecting children from harm, actually inflicting trauma upon children as an instrument of policy.
The trauma goes beyond taking children away from parents, which is painful enough. Recent news reports have exposed children, including toddlers, being warehoused in horrific and dangerously unsanitary conditions.
This will not be a minor event in these children’s lives. During the Texas Legislative Session, TexProtects educated lawmakers across the state on the consequences of “adverse childhood experiences” (ACEs) – severe events such as mental illness, violence or substance use within the home, an incarcerated caregiver, or abuse or neglect.
In our ACEs Uncovered report earlier this year (http://bit.ly/acesuncovered), we outlined long-term consequences that can result from such experiences.
Research has shown that left untreated, people who suffered multiple adverse childhood experiences had, in adulthood, higher rates of disease, disabilities, social and mental health problems including suicides and suicide attempts, depression, a high number of sexual partners, sexually transmitted diseases, obesity, smoking, substance abuse, and early death.
Now, we – through our government – are creating more children who, assuming they survive this ordeal, could grow up with such health consequences.
As said, TexProtects will “stay in our lane” on immigration and refugee policy and refrain from suggesting what actions should be taken.
However, we have a moral imperative to rule out what action should not be taken: willfully traumatizing children absolutely cannot be an option.
Even if the policy produced the president’s desired result of fewer border crossings (it has not, as detentions and migrant deaths have surged again), hurting children would still be unacceptable.
Americans are outraged when parents abuse or neglect children. We must be equally outraged when our government does the same.
Today’s post looks at bills affecting Child Protection Systems, and next we will conclude with Mental Health and Trauma. For a PDF version of this post, click here.
Child Protection Systems Background
In the 85th Texas Legislative Session (2017), Governor Greg Abbott declared child protection to be an emergency item. That session resulted in unprecedented child protective services (CPS) reforms and investments including:
Increases in kinship care through enhanced financial assistance;
Expansion of community-based foster care;
Treatment-based foster family care in most regions;
Salary increases; and
Additional hires that lowered caseloads
While those reforms made real progress for the safety of Texas children, there was significant work left to do in the 86th Legislative Session (2019) and much less political will to do it. However, opportunities for continued investment in best practice and improvements to child safety were plentiful. Opportunities presented to the 86th Legislature included:
Maintenance – In order to maintain the salary increases, caseloads, and investments in community-based care despite a growing child population and increasing number of child abuse reports and victims, lawmakers had to invest additional dollars or risk losing ground on the changes made last session.
Pressure from the federal class action lawsuit – In 2015, Judge Janis Jack proposed significant changes to the CPS system to ensure the constitutional rights and due process of children in the care of the state in response to a class action lawsuit filed on behalf of 12,000 children in long-term foster care. While some of the proposals were overturned by the 5th Circuit Court of Appeals as overreach, the findings have consistently made clear that the state has work to do to ensure the safety, health, and constitutional rights of children in the conservatorship of the state.
Family First Prevention Services Act – This session presented a new opportunity to leverage federal funds made available through the federal Family First Prevention Services Act in two significant ways. First, it makes available new prevention funding to help strengthen families before a crisis by investing in mental health, substance use prevention and treatment, and in-home parenting programs. Second, it requires that federal dollars for children in care be spent on family-like settings and treatment centers that are offering accredited and high-quality care. In order to leverage those dollars most effectively, the Legislature had the opportunity to invest in planning and improved quality that would ready the state for implementation.
Child Protection in the 86th texas legislature
Top-Priority Bills Passed
House Bill 1 – The General Appropriations Act
Champions: Sen. Jane Nelson, Sen. Lois Kolkhorst, Rep. John Zerwas, REp. Sarah DAvis
General Overview – Although we did not see the urgent and comprehensive focus on child welfare this session that we did in the 85th, there was continued attention on child protection issues. Lawmakers viewed their role this session as one of a gatekeeper – ensuring that the large-scale changes of last session continued to move forward and that implementation was monitored closely. Despite a cut in state funds, when federal funds were included, the Department of Family and Protective Services (DFPS) budget grew by 6.1%. In their budget, lawmakers showed continued support for community-based care, increasing the use of kinship care, and the needs of older foster youth.
Area of Budget
2020-21 Base Budget
House Bill 1 FINAL
Child Protective Services
Statewide Intake – At DFPS, statewide intake is the front door for the public to report suspected abuse. Additional investments will improve child safety by minimizing hold times on the statewide intake line. Long wait times can result in dropped calls and increase the risk of abuse going unreported. Investments in this biennium will support salary increases of $6,000, resulting in lower turnover and subsequently, a higher level of experience in the workforce.
Area of Budget
2020-21 Base Budget
Additional Investment & House Bill 1 Final
$4.3 million $50.2 million total
Caseloads – The maintenance of manageable caseloads is paramount to ensuring the safety of children who are interacting with the child protection system. Investments for CPS direct delivery staff will help to maintain lower caseloads per worker for most caseworkers.
Area of Budget
2021 Base Budget & Average Daily Caseload
Additional Investment, House Bill 1 Final, & Projected Average Daily Caseload
CPS Direct Delivery Staff
$148 million $1.6 billion total
CPS Family Based Safety Services
Projected caseloads are included in HB 1 and are estimates from the Legislative Budget Board; DFPS will prepare its own analysis.
Community-Based Care – The Legislature provided funding to continue rolling out Community-Based Care (CBC), formerly named “Foster Care Redesign,” which changes the way the state delivers foster care services. Under CBC, a private contractor (called a “Single Source Continuum Contractor [SSCC]”) is responsible for building and managing foster care capacity and placements for a specific service region in the state. CBC has been rolled out in Region 3B (seven-county area including Tarrant County), Region 2 (30-county area in North and North-central Texas that includes Wichita Falls and Abilene) and Region 8A (Bexar County). Additional investments this session will provide resources to expand into Region 8B (16 counties surrounding Bexar), and Region 1 (41 counties in Panhandle), as well as add case management work to the existing contracts.
2020-21 Base Budget
Additional Investment and House Bill 1 Final
$66.9 million $501.4 million total
Foster Care Provider Payments – Foster care families and other providers are essential to building capacity in the foster care system so it meets the current demand, as well as ensuring positive outcomes for children and youth in conservatorship of the state. The Legislature provided additional investment of $12 million in foster family support, certain residential providers and emergency shelters.
Supervised Independent Living (SIL) and Preparation for Adult Living (PAL) – DFPS provides both SIL and PAL programs to assist older youth in their transition toward a successful and self-sufficient adulthood. Without supportive housing and access to training and resources, youth are more likely to be involved in the criminal justice system, are at higher risk of teen pregnancy, have lower high school graduation rates and are more likely to experience homelessness and unemployment. SIL increases of $1.8 million will support case management services for children with more complex needs and increase the rates paid to providers for services. PAL increases of $1.5 million will support 10 additional specialist positions.
Champions – Rep. Donna Howard and SEn. Kirk Watson
HB 475 will ensure that pregnant and parenting foster youth receive basic information about ways to keep their child safe and promote healthy attachment, child development, and maternal health if they cannot or choose not to participate in Project Helping through Intervention and Prevention (HIP). Project HIP makes available evidence-based, in-home parenting programs to pregnant and parenting foster youth; however, it is voluntary and not currently available statewide.
Other Priority Bills Passed
TexProtects Goal – Efficiency and Best Practices in CPS and Foster Care
Senate Bill 195 – Sen. Charles Perry / Rep. Tan Parker
SB 195 requires DFPS to update their case tracking system to allow DFPS to keep statistics regarding alcohol and controlled substances when funds are available. This detailed information will allow the department to better understand the correlations between substance use and child abuse/neglect as well as the impacts of prenatal exposure to alcohol and controlled substances on children.
SB 781 – Sen. Lois Kolkhorst / Rep. Ben Leman
SB 781 will establish regulations for child safety, runaway prevention, quality contracting, and strategic planning for facilities that provide 24-hour care to children such as residential treatment centers and emergency shelters. The strategic plan outlined in the bill will help ensure that state agencies are prepared for the implementation of the federal Family First Prevention Services Act.
TexProtects Goal – Increased Use of Kinship Care
HB 1884 – Rep. Ina Minjarez / Sen. Carol Alvarado
HB 1884 requires that when a child is placed with a relative or other designated caregiver, the caregiver is informed, by the court, of the option to become verified by a licensed child-placing agency and of the permanency care assistance program. This opportunity can make available additional resources to the caregiver and as a result, increase stability for children.
HB 3390 – Rep. Scott Sanford / Sen. Angela Paxton
HB 3390 ensures that adequate steps are taken to identify any potential caregiver for a child before that child is placed in foster care. The bill also expands the definition of a designated caregiver to include a person who had a longstanding and significant relationship with the family of the child and requires that the child and parent both be asked to share any relatives or potential caregivers.
TexProtects Goal – Improved Services to Foster Youth Aging Out of Care
HB 53 – Rep. Ina Minjarez / Sen. Beverly Powell
HB 53 will require DFPS to collaborate with the Office of Consumer Credit Commissioner and the State Securities Board to develop an expanded financial literacy education program for foster youth. Experiential training will include filing taxes, using insurance, identity and credit theft, budgeting and civic engagement.
HB 123 – Rep. James White / Sen. Kirk Watson
HB 123 eases the burden of obtaining personal identification documents for foster children by waiving the fee, exempting the requirement for a parent signature and allowing the use of the DFPS regional office in lieu of a permanent address.
HB 1702 – Rep. Donna Howard / Sen. Kelly Hancock
HB 1702 requires institutions of higher education to make publicly available the contact information for their foster care liaison officer and information regarding support services available to students who were formerly in conservatorship. In addition, the name of any student who was formerly in conservatorship will be provided to the foster care liaison officer by their institution at the beginning of each semester.
TexProtects Goal – Cross-Sector Collaboration and Child Protection Systems
HB 72 – Rep. James White / Sen. Angela Paxton
HB 72 allows adopted children with chronic health conditions to continue to have access to the healthcare they would have had if they had remained in conservatorship if the adoptive parents opt-in. Foster children who transition into adoptive placement often experience gaps in medical care, and these gaps can have serious negative health consequences for children with severe disabilities.
HB 621 – Rep. Victoria Neave / Sen. Judith Zaffirini
HB 621 expands existing statutory protections against employer retaliation for a professional’s good faith reporting of child abuse or neglect by defining “adverse employment action” to mean any action that affected an employee’s compensation, promotion, transfer, work assignment, or performance evaluation, or any other employment action that would dissuade a reasonable employee from making or supporting a report of abuse or neglect.
HB 1709 – Rep. Mary González / Sen. José Menéndez
HB 1709 requires school districts to work closely with DFPS to notify when a surrogate parent has been appointed to a child with disabilities who is in conservatorship. Surrogate parents are appointed by school districts when children with disabilities who are under the managing conservatorship of DFPS do not have an available parent or foster parent who is willing or able to serve as the educational decision maker for the child. When a court-appointed surrogate parent is not properly performing their required duties, the district must consult with DFPS to review the appointment and, if appropriate, find a replacement. This bill expands the definitions of who can serve as a surrogate parent and helps ensure transparency and accountability in the system.
HB 1780 – Rep. Rick Miller / Sen. Lois Kolkhorst
HB 1780 requires the court to consider a parent’s good faith attempt to complete a drug rehab program when deciding whether to grant a 6-month extension before terminating parental rights. In light of the overwhelming majority of neglectful supervision cases that involve substance use and the complexity of treatment and recovery, this bill will give parents a chance to break the cycle of drug addiction and keep families together.
HB 2229 – Rep. Jarvis Johnson / Sen. Kirk Watson
HB 2229 adds specific information to a report the Texas Juvenile Justice Department (TJJD) must submit to the Governor, Lt. Governor, and Legislature every even numbered year regarding foster children in the juvenile justice system. This bill requires the report to break down the number of foster children in TJJD custody by age, sex, race, conduct, and first-time offenders. This data will enable advocates and policymakers to better implement programs and practices that can prevent foster youth from entering the justice system.
HB 2737 – Rep. Gene Wu / Sen. Nathan Johnson
HB 2737 will require the Texas Supreme Court to provide annual guidance to judges who preside over juvenile or child protective services cases to establish greater uniformity across the state in how those cases are handled. The issues addressed could include the placement of children with severe mental health issues; changes in placement; final termination of parental rights; release of children detained in
juvenile detention facilities; certification of juveniles to stand trial as adults; and commitment of children to the Texas Juvenile Justice Department.
HB 3809 – Rep. Craig Goldman / Sen. Kirk Watson
HB 3809 will allow suits for personal injury to be brought up to 30 years after the day the cause of action accrued if the injury arose from conduct involving offenses against children including sexual assault of a child, aggravated sexual assault of a child, continuous sexual abuse of a young child, trafficking a child and causing the child to be involved in certain sex crimes, compelling prostitution of a child, and indecency with a child. Currently, the statute of limitations is 15 years. This bill allows more time for child victims to come to terms with their trauma enough to talk about it and bring a civil lawsuit.
Missed Opportunities for Improving Child Protection Systems
Children who cannot remain safely at home with their parents are removed by CPS. CPS places children in foster care placements when a suitable kinship option is not available. Foster care services may be provided through placement with foster families or through emergency shelters, residential treatment centers, and other programs. Foster care providers are reimbursed by the state at a daily rate based on the type of care that is required to meet the needs of each child. In Texas, these rates do not fully cover the cost of providing foster care services, and providers must secure philanthropic donations that subsidize the rates in order to provide quality foster care. While lawmakers did make some investments in rate increases, in most cases these increases did not keep pace with inflation and actual purchasing power decreased. Insufficient rates contribute to continuing problems in building sufficient capacity to serve children in need.
Children who are interacting with the Child Protection System experience trauma at higher rates than their peers and often in patterns that are complex and chronic. Although DFPS currently includes trauma-informed training in programs made available to DFPS employees as well as foster, adoptive, and kinship caregivers, the comprehensiveness and accessibilty of that training may not be sufficient to ensure staff and caregivers have the skills they need to recognize and address the ways that trauma may be affecting a child’s behavior. Unfortunately, the Legislature failed to take action to ensure that the adults who are charged with decision making on behalf of traumatized children, have adequate training to understand the ways trauma can impact biology and behavior or strategies to increase resilience and healing.
Funding for Increased Quality in Foster Care
The Family First Prevention Services Act, which will go into effect in 2021, targets federal funding to evidencebased foster care prevention services and improved foster care that provides the best environment for each child’s
unique needs. For children with therapeutic needs, Family First dollars are available for providers who have thirdparty assessment, access to medical staff, and follow-up after transition to assure successful placement. Many
Texas providers are not currenly meeting the standards laid out by the bill. This session offered an opportuntiy to
invest in programs and services that are being prioritized by Family First so that implementation will be efficient,
federal dollars can be maximized, and children will have access to higher quality care.
Austin – Today, 37 organizations dedicated to supporting Texas children and families wrote to state leaders and the state’s congressional delegation to express “deep concern over the reported treatment of parents and children held in immigration detention facilities on Texas soil.”
The letter follows numerous accounts of children and adults held for prolonged periods of time in overcrowded Texas-based immigration facilities with inadequate care as well as continued accounts of young children separated from their parents or other family members by U.S. immigration officials.
The letter urges the Texas officials to “support additional measures to ensure that all children and parents who are now in the care of the federal government, no matter their country of origin, receive compassionate, humane, and fair treatment.”
The organizations highlighted their concern about the long-term impact of the trauma experienced by children in immigration facilities, including those separated from their parents, noting, “Furthermore, early childhood trauma undermines a child’s healthy brain development and ability to form healthy attachments, resulting in lifelong, negative consequences, such as chronic physical and/or mental illness and less likelihood of succeeding in school or becoming productive workers.”
“We are very concerned that the inhumane treatment of migrant children, stays in detention facilities, and separation from their families or other nurturing caregivers may all have lasting, harmful effects on the health and development of these children,” said Sophie Phillips, CEO of TexProtects. “We should be protecting these children, not subjecting them to further traumatic events that can have dire, lifelong consequences.”
“Each and every child in our state, no matter where she was born or how she got here, should be treated with the kind of care and compassion that children deserve,” said Stephanie Rubin, CEO of Texans Care for Children and one of the nonprofit leaders who signed the letter. “We urge our elected officials from across the political spectrum to work together improve the way these children and families are being treated.”
The 37 Texas organizations sent the letter to Governor Greg Abbott, Lt. Governor Dan Patrick, Senator John Cornyn, Senator Ted Cruz, the 36 members of the Texas delegation in the U.S. House of Representatives, and the 181 members of the Texas Legislature.
Four children die from abuse/neglect each week, and 80 percent of victims are 3 years of age and younger.
181 children are confirmed as abused/neglected every day, and the highest rates occur in children under age 5.
Evidence-based home visiting programs can reduce child maltreatment by up to 48 percent and have a positive return for each dollar invested.
Currently, only 3.5% of families with the highest need have access to proven prevention programs.
Welcome to the second part of our look at how child protection legislation fared in the 86th Texas Legislature. We began this series in May with our top-priority bills. This begins the first of three deeper dives into specific subject areas. This post is about Prevention and Early Intervention legislation; it will be followed by Child Protection Systems and will conclude with Mental Health and Trauma.
The Adverse Childhood Experiences (ACEs) Study – as well as decades of subsequent, validated research – has made clear that the impact of severe childhood adversities, including child maltreatment, is a public health crisis.
In the absence of supportive relationships and environments, chronic and compound ACEs increase the likelihood of negative behavioral, educational, health and economic outcomes. Prevention strategies can reduce the prevalence and impact of ACEs and increase a child’s opportunity for cognitive and emotional development, productivity, health, and economic wellbeing.
fall across a spectrum that includes:
Primary Primary prevention focuses on reaching families before the first occurrence of child maltreatment.
Secondary Secondary prevention focuses on efforts to prevent maltreatment among families considered to be at high risk.
Tertiary Tertiary prevention focuses on mitigating the negative effects and prevent re-occurance in families where maltreatment has already occurred.
Evidence-based in-home parenting programs (known as home visiting) have proven to be the most effective and efficient model for prevention. These programs connect expectant and new parents who enroll voluntarily with a trained nurse, social worker, or early childhood specialist who promotes health, child development, parenting skills, education, and employment. By intervening to prevent adversity and build resilience during a child’s most critical years of neurodevelopment, in-home parenting programs impact outcomes across multiple domains and generations.
Evidence-based programs currently operating in Texas include AVANCE, Early Head Start, Family Connects, Healthy Families America, Home Instruction Program for Preschool Youngsters, Nurse-Family Partnership, Nurturing Parenting, Parents as Teachers, SafeCare, Systematic Training for Effective Parenting, and Triple P- Positive Parenting Program.
While some communities have been able
to initiate programs with private and/or local funds, most in-home parenting
programs implemented in Texas are funded through the Prevention and Early
Intervention Division at the Department of Family and Protective Services. In
2018, funding was available to provide approximately 16,000 families with evidence-based
in-home parenting support; however, 423,000 families in Texas have young
children and three or more risk factors. Our goal is to continue working until
many more of those families can access these beneficial programs.
ACEs and trauma do not dictate the future of a child. Children with protective factors (e.g. healthy attachment to parents, access to community resources, and supportive school and home environments) can build the resilience needed to thrive despite adversity. Evidence-based and effective solutions can strengthen families and help ensure that children start with a secure foundation of health and safety.
prevention in the 86th texas legislature
Top-Priority Bills passed
House Bill 1 – The General Appropriations Act
Champions – Sen. Jane Nelson and Rep. John Zerwas
In response to research, federal initiatives, and best practices, the landscape around prevention funding has changed within the past couple decades. The ACEs research makes clear the public health ramifications of severe adversities in childhood. Emerging brain science continues to demonstrate the importance of the development that happens in the first five years of a child’s life. This has created new urgency and a growing and diverse group of stakeholders who are invested in improving access to proven programs. The federal Family First Prevention Services Act demonstrates an increasing prioritization by the federal government in programs that provide evidence-based services to ensure that, when possible, children can remain safely at home. Protecting a child’s development by strengthening families to increase resilience and protective factors, and empowering communities to offer needed supports before a crisis occurs, have become the clear path forward.
Each session, TexProtects prioritizes increased investments in primary, evidence-based in-home parenting programs. Despite cuts to the Health and Human Services budget overall, the Legislature included funding to maintain Project HOPES (Healthy Outcomes through Prevention and Early Support) and the Nurse-Family Partnership (NFP) Programs and appropriated an additional $4.3 million to expand those programs.
2020-21 Base Budget
$39.9 million General Revenue/All Funds
$30.2 million All Funds ($5.6 million General Revenue)
$70.1 million All Funds
Healthy Outcomes Through Prevention and Early Support (HOPES) is a prevention approach developed to be a flexible and community-based solution to child abuse and neglect in high-risk counties by increasing protective factors of families served. It is currently serving families in 55 counties with children ages 0-5 at risk for child abuse and neglect. The evidence-based programs chosen by the communities each have proven positive outcomes across multiple domains and returns on investment that range from $1.26 to $8.08.
The Nurse-Family Partnership Program is an evidence-based, community health approach with over 40 years of evidence currently serving families in 43 counties. NFP works by having specially trained nurses regularly visit young, first-time expectant moms and fathers, starting early in the pregnancy, continuing through the child’s second birthday. For every dollar invested, there is a return on investment of $5.70 including savings on medical care, child welfare, special education, and criminal justice.
Senate Bill 355
Champions – SEN. ROYCE WEST AND REP. STEPHANIE KLICK
SB 355 directs the Department of Family and Protective Services to develop a strategic plan to leverage federal funds made available through the Family First Prevention Services Act to increase access to mental health care, substance use treatment and in-home parenting programs that can prevent child maltreatment and keep children with their families. This will result in cost savings to the state and better outcomes for Texas children. For the first time, federal dollars previously only available for children in the foster care system will be made available to fund evidence-informed and community-based early interventions so that children can remain safely at home when possible rather than placing them in foster care. These prevention strategies address key drivers of child abuse and neglect: substance use, mental health issues, and parenting skills. Such services build on the knowledge that most children can be safely protected and remain within their own homes when parents are equipped with appropriate support and opportunities to care for their children.
Champions – Sen. judith zaffirini and rep. john Raney
SB 708 requires the Health and Human Services Commission to use existing procedures to collect, make publicly available, and report to the Legislature data on child safety in licensed child-care centers. Data must include violations that impact the health, safety, and well-being of children as well as information on the number of children and caregivers in each classroom. This data will allow lawmakers, providers, and parents to make better decisions to ensure the safety of children in care.
TexProtects Goal – Provide training to promote prevention and early intervention
HB 111 – Rep. mary Gonzáles / sen. pat fallon
HB 111 requires that existing child abuse training for school staff must also include information on students with significant cognitive disabilities. Persons with disabilities are victimized at much higher rates than those without disabilities and are much less likely to report abuse.
HB 403– rep. senfronia thompson / sen. joan huffman
HB 403 requires that the board of trustees and superintendent of a public school district complete one hour of training on identifying and reporting potential victims of sexual abuse, human trafficking, and other maltreatment of children every two years.
HB 2059 – Rep. Cesar Blanco / Sen. Larry Taylor
HB2059 equips health care practitioners who provide direct patient care with the training needed to help detect potential victims of human trafficking and provide them with adequate care, including referring them to additional support services. Ensuring that health care providers are knowledgeable and adequately prepared is vital in combating human trafficking in Texas. Approximately 80 percent of human trafficking victims are women, and health care providers are often the first professionals to have contact with trafficked women and girls.
TexProtects Goal – Improve Maternal and Newborn Healthcare
HB 25 – Rep. Mary Gonzáles / Sen. Judith Zaffirini
HB25 creates a pilot program to allow pregnant and postpartum women utilizing the Medicaid medical transportation program to travel with their children to pregnancy-related appointments. Women enrolled in the STAR Medicaid managed care program during pregnancy or after delivery often miss prenatal or postpartum appointments because the medical transportation service program does not provide an option for women to bring their children along with them to appointments. This pilot could increase access to health care during this critical time for mom and baby.
HB 253 – Rep. Jessica Farrar / Sen. Lois Kolkhorst
HB253 requires the Health and Human Services Commission (HHSC) to develop and implement a recurring five-year strategic plan to improve access to postpartum depression screening, referral, treatment, and support services. Postpartum depression (PPD) affects 1 in 9 mothers nationally, according to the Centers for Disease Control. PPD can affect a mother’s capacity to attach and interact with her child. This can disrupt healthy development and family functioning. Depression is treatable and most mothers improve with access to adequate support.
HB 405 – Rep. Ina Minjarez / Sen. Lois Kolkhorst
HB405 designates June as Neonatal Abstinence Syndrome (NAS) Awareness Month.Neonatal Abstinence Syndrome (NAS) is a group of conditions caused when babies withdraw from certain drugs that they have been exposed to before birth. Rates of NAS in Texas increased by more than half between 2010 and 2015. This bill would increase public awareness and access to information and resources to decrease stigma and encourage mothers to seek help.
HB 1576 – Rep. Dade Phelan / Sen. Dawn Buckingham
HB1576 allows the Health and Human Services Commission (HHSC) and Medicaid managed care organizations to contract with transportation network companies (TNCs) and transportation vendors such as Uber and Lyft for the delivery of nonemergency medical transportation. The medical transportation program currently provides non-emergency transportation services to and from covered health care services — based on medical necessity — to recipients under Medicaid, the children with special health care needs program, and indigent cancer patients program who have no other means of transportation. This would increase options and flexibility and decrease the use of emergency medical transportation resources for non-emergency transport.
HB 1651 – REP. MARY GONZÁLES / Sen. Carol Alvarado
HB1651 requires the Commission on Jail Standards to prohibit the use of restraints for women who are incarcerated during pregnancy and 12 weeks postpartum unless clearly required for the health and safety of the mother or staff. Shackling pregnant inmates is banned in Texas state prisons and was recently outlawed at the federal level. This bill extends the same protection to the inmates of our state’s county jails. The bill also requires an annual report on any use of restraints on pregnant and post-partum women.
SB 436 – Sen. Jane Nelson / Rep. Four Price
SB436 requires the Department of State
Health Services (DSHS) to collaborate with the Maternal Mortality and Morbidity
Task Force to develop and implement initiatives to improve screening and
continuity of care for women with opioid use disorder, as well as newborns with
neonatal abstinence syndrome, while increasing access to medication-assisted
treatment and decreasing the number of opioids prescribed before, during, and
following delivery. A report on these initiatives is due to the legislature by
SB 748 – Sen. Lois Kolkhorst / Rep. Sarah Davis
SB748 would create a general revenue dedicated account to fund newborn screenings conducted by the Department of State Health Services (DSHS). The public health laboratory at DSHS tests 400,000 infants per year for 53 disorders or medical conditions. Dedicated funds could be used to maintain the lab and add additional screenings to the panel to meet federal requirements.
SB 750 – Sen. Lois Kolkhorst / Rep. Eddie Lucio III
SB 750 seeks to maximize Texas’ efforts to address maternal mortality as detailed by the Health and Human Services Commission’s report, State Efforts to Address Materna Mortality and Morbidity in Texas, by improving access to healthcare during the prenatal and postpartum period for women enrolled in the Healthy Texas Women Program. This bill also renames the Maternal Mortality and Morbidity Task Force as the Texas Maternal Mortality and Morbidity Review Committee and extends its work until 2027.
TexProtects Goal – Increase Access to High-Quality Early Care and Education
HB 3 – Rep. Dan Huberty / Sen. larry Taylor
HB 3 creates an early education allotment to fund full-day Pre-k for eligible students, provides additional funding for districts with high concentrations of poverty, increases funding per student, and provides funding for extended summer instruction.
HB 680 – Rep. Joe Deshotel / Sen. Kirk Watson
HB 680 requires the Texas Workforce Commission to assess and report the information on the quality and types of childcare being used by families receiving childcare subsidies. This information will include the average cost of childcare and the total number of providers and children participating in the state’s quality rating system, Texas Rising Star. The Texas Workforce Commission (TWC) administers a federal program that provides childcare subsidies to low-income families so their parents can work or attend workforce training. The data collected can help decision makers better improve access to high quality care.
SB 1679 – Sen. Royce West / Rep. John Turner
SB 1679 authorizes children at the age of three who were eligible for enrollment in a free Pre-k class to remain eligible for enrollment for the following school year. This will eliminate confusion and the burden on families that can result in children not being enrolled.
TexProtects Goal – Increase Safety for Children in Childcare
SB 568 – Sen. Joan Huffman / Rep. Greg Bonnen
SB568 transfers certain regulatory authority over childcare facilities and family homes from the Department of Family and Protective Services (DFPS) to the Health and Human Services Commission (HHSC). The bill creates a safety training account of dedicated funds, requires liability insurance unless it is cost-prohibitive, and establishes safe sleeping standards. A family home is a caregiver who provides regular care in their own residence for six or fewer children who are younger than 14, excluding children who are related to the caretakers.
SB 569 – Sen. Joan Huffman / Rep. Greg Bonnen
SB569 transfers regulatory authority for listed family homes from the Department of Family and Protective Services (DFPS) to the Health and Human Services Commission (HHSC). The bill requires HHSC to adopt minimum standards for listed family homes, requires liability insurance unless it is cost-prohibitive, and requires certain training like safe sleep training. The bill requires the HHSC to inspect listed family homes whenever the commission receives a complaint. Listed family homes are adult caregivers that provide care in their own home for compensation for up to three children unrelated to the caregiver.
SB 706 – Sen. Kirk Watson / Rep. Bobby Guerra
SB706 requires there be an investigative unit within the childcare licensing division at the Health and Human Services Commission to identify childcare facilities operating without a license, certification, registration, or listing and initiate appropriate enforcement actions against those facilities.
Missed opportunities for prevention and early intervention
Cross Sector Collaboration to Prevent Adverse Childhood Experiences
Research conducted by the Centers for Disease Control, the National Institutes of Health, the American Academy of Pediatrics, and others has made clear that ACEs are prevalent and can have lifelong consequences on health and behavior. Currently, prevention efforts in Texas are spread across multiple agencies. Communities do not have access to the informaiton and resources they need to make strategic decisions toward safer and healthier families. HB 4183 would have facilitated a cross-agency strategic planning process to better coordinate statewide data and initiatives and give communities a better toolkit for providing services that can strengthen families and prevent trauma. The bill passed in the House but not in the Senate.
Early Childhood Intervention (ECI) is a statewide program within the Texas Health and Human Services Commission for families with children from birth up to age 3 who have developmental delays, disabilities, or certain medical diagnoses that may impact development. ECI services recipients can access needed therapies and be school-ready. The agency made a $72 million request for the funds needed to keep ECI sustainable; however, the budget appropriated only $31 million. HB 12 would have strengthened the ECI program by addressing prior authorizations, requiring health benefit plans to cover services, and creating a tele-health pilot and ombudsman office. The bill passed the House but did not move in the Senate.
Extend Medicaid Coverage for Women Postpartum
Texas has the nation’s worst uninsured rate for kids AND the nation’s worst uninsured rate for women of childbearing age — with often devastating consequences for moms and babies. Extending Medicaid coverage for women postpartum up to 12 months post-child birth would have addressed the first recommendation from the state’s Maternal Mortality and Morbidity Taskforce; however, the issue faced significant challenges prior to House passage and was not referred to committee in the Senate.
Strategically Expand Proven Prevention Programs
While we are relieved to see continued investment in evidence-based child abuse prevention programs, we still have a long way to go. HB 1549 in the 85th legislative session directed the department to develop a plan to take these programs to scale in order to impact statewide outcomes. Current investments are only providing services to 3.5% of those families in highest need. In order to move the needle, Texas needs to make strategic investments that outpace population growth and inflation and can move us toward a reality in which at least 30% of families in need have access to services.