TexProtects Stands Up | Disproportionality in Maternal and Child Health Care

TexProtects’ vision is one where every child is safe, nurtured, and resilient — no matter the color of their skin. This vision cannot be realized while families of color continue to be wounded by systemic racism and injustice. As part of our effort to speak out and stand up against injustice, this blog is part of a series to highlight existing inequalities in our child protection systems. A deepened understanding of these issues can help us know better and do better so that Texas is a safe place to be born – where families can thrive and where every individual is seen and valued equally.

TexProtects takes a comprehensive approach to the prevention of child abuse and neglect and recognizes the Center for Disease Control’s Essential for Childhood framework which includes the following strategies: strengthening economic supports for families, changing social norms to support parents and positive parenting practices, providing quality care and education early in life, enhance parenting skills to promote healthy child development and intervening to lessen harm and prevent future risk and occurrence.

As our communities have been challenged by COVID-19, Texas families of all kinds have had to find enormous strength and resilience. This moment is an opportunity to reflect upon how our own wellbeing is related to the health of everyone in our community.

Evidence shows that children and mothers of color have long faced stark health disparities, which now may be worsened by the effects of COVID-19. Black and Native American babies have a much higher risk of birth complications, low birthweight, and death within their first year of life in comparison to white babies. Black mothers face even more pronounced health disparities: maternal mortality among Black mothers is more than three times higher than among their white peers. These disparities are driven in part by the fact that families of color often have less access to healthcare. According to Zero to Three’s 2020 State of Babies, 7.7% of Latinx/Hispanic women and 9.9% of Black women in the United States receive late or no prenatal care whatsoever compared to 4.5% of white women. In Texas, these disparities are particularly pronounced: 15.1% of Black women and 10.5% of Latinx/Hispanic women receive insufficient prenatal care compared to 6.3% of white women.

Racial discrimination is a distinct factor that drives both low healthcare access and poor health outcomes for families of color. Researchers from Zero to Three affirm that racism accounts for huge differences which cannot be explained by other contributing factors such as poverty, lack of local resources, or low education levels. As a result, mistrust of medical systems is common among people of color. According to Zero to Three’s State of Babies, nearly 1/3 of Black Americans report that they have personally experienced racial discrimination during a healthcare visit and 22% report sometimes avoiding care because they fear discrimination. These fears are warranted. Rates of maternal mortality and delivery complications demonstrate that minority women and children often receive lower-quality hospital care. Racial health disparities have persisted over multiple decades and are not improving over time. In fact, the racial health divide may actually be deepening because of COVID-19.

New mothers often rely upon a trusted network of family and friends. Robust social supports such as these are a crucial protective factor for families of color. Unfortunately, due to social distancing, mothers of color currently have less access to social support. Black women in particular have an elevated risk of postpartum depression and more severe postpartum conditions including postpartum post-traumatic stress disorder (PTSD), which can develop if childbirth is especially traumatic. Low social support is a significant risk factor for such conditions and isolation has negative impacts on overall health. These facts suggest that pregnant women and mothers of color have a heightened risk of serious physical and mental health complications during this pandemic.

As communities come together to take care of each other, we must ensure that Black, Latinx/Hispanic, and Native American families are not left behind. To achieve the strongest possible outcomes for all, we must meaningfully address health disparities in our communities, beginning with the earliest days of each child’s life. TexProtects is proud to be a part of the Prenatal to Three (PN-3) Collaborative which works to ensure more young Texas children benefit from effective and well- funded programs that promote healthy beginnings, supported families, and quality early care (learn more).

COVID-19 has forced us all to reimagine what normal looks like on an individual level. Our health systems are also reimagining how they will protect us through and beyond this health crisis. Although that process will be challenging, it has the potential to foster new innovations. Now is the time to overturn the status quo of a system which has failed to provide equal care to all children. TexProtects is committed to a future where equality in child and maternal healthcare is the new normal. 

TexProtects Stands Up | Disproportionality in the Child Welfare System

 TexProtects’ vision is one where every child is safe, nurtured, and resilient — no matter the color of their skin. This vision cannot be realized while families of color continue to be wounded by systemic racism and injustice. As part of our effort to speak out and stand up against injustice, this blog is part of a series to highlight existing inequalities in our child protection systems. A deepened understanding of these issues can help us know better and do better so that Texas is a safe place to be born – where families can thrive and where every individual is seen and valued equally.

TexProtects’ mission and vision are to prevent children from the trauma of abuse and neglect and to keep families together when children can be kept safe. However, due to various circumstances impacting child safety and risk, some children and families come into contact with the child protection system. Unfortunately, data shows that from intake (recognizing and reporting abuse) to permanency, Black families and children are disproportionately represented and disparities in outcomes are present in the child protection system in Texas.

Black children are 1.8 times more likely to be reported as abuse victims, 2 times more likely be investigated, and 1.7 times more likely to be removed from their home than their White counterparts due to biases and racism at personal, community, and systemic levels. The stakes are higher the further Black children move through the system. They experience more placements, wait longer to be adopted, and are more likely to age out of care.

Tackling disproportionality in the child protection system cannot be done in isolation. Families often interact with so many other systems: healthcare, education, juvenile justice, criminal justice, and more. Therefore, it is crucial we collaborate across systems when addressing disproportionality. Unfortunately, targeted efforts to do this in a thoughtful, systematic way were defunded in Texas in 2018.

The Office of Minority Health Statistics and Engagement was initially created in 2010 to work in the context of Child Protective Services (CPS) but later recognized the value of working across systems so it expanded to include other state agencies. Housed within the Texas Health and Human Services Commission (HHSC), the office was tasked with studying and solving the issue of racial inequities and providing context to the issue of disproportionality. After it was disbanded, CPS subsequently created the role to continue the work within their own agency (Department of Family and Protective Services). Tanya Rollins, the State Disproportionality Manager, now leads the agency’s efforts to address institutional racism. CPS continues to provide its workforce with training on racial and ethnic identity and cultural awareness, as well as poverty simulations.

Despite these activities, the system clearly continues to produce more negative outcomes for Black families and their children. To do better, to create long term change, there must be increased dedication, support, and resources toward both describing and solving the problem. 

We all have a part to play and plenty of areas for growth and change: on an individual level, on a policy and practice level, and on a systems level. TexProtects will continue to speak up and stand up against injustice and inequality, and we commit to addressing inequities through our policy and programmatic work to help ensure that the child welfare system no longer disproportionately produces outcomes that negatively impact Black children. We call on you to participate in and support this work too. 

TexProtects Stands Up | The Disproportionate Impact of COVID-19

TexProtects’ vision is one where every child is safe, nurtured, and resilient — no matter the color of their skin. This vision cannot be realized while families of color continue to be wounded by systemic racism and injustice. As part of our effort to speak out and stand up against injustice, this blog is part of a series to highlight existing inequalities in our child protection systems. A deepened understanding of these issues can help us know better and do better so that Texas is a safe place to be born – where families can thrive and where every individual is seen and valued equally.

We will only be able to grasp the full negative effects of COVID-19 once the pandemic is behind us, but the disproportionate affect the virus is having on children and families of color is already apparent. The onset of this health crisis has further exposed how systemic racism is creating harmful disparities between white communities and communities of color. The ways in which Black and Latinx or Hispanic communities are negatively affected by the fallout from COVID-19 translate into potentially negative outcomes for their children.

Instances of COVID-19 cases and deaths are disproportionately affecting Black and Latinx/Hispanic communities. Based on the COVID Racial Data Tracker by the COVID Tracking Project, the nation has lost at least 25,932 Black lives to COVID-19 to date. Deaths of Black people from COVID-19 are nearly two times greater than what would be expected based on their population percentage. Latinx/Hispanic people also make up a greater share of confirmed cases than their share of the population. In Texas, 15% of all COVID-19 cases and 16% of all deaths were Black people, when Black people make up just 12% of the total state population. For Latinx/Hispanic people, cases are also disproportionately higher, making up 47% of all COVID cases, when Texas is 39% Latinx/Hispanic.

But these are just the tested and reported numbers available in Texas. Of all tested cases and instances of deaths, Texas has only reported race data for 11% of positive cases and 23% of deaths. This means that the percentages of Black and Latinx/Hispanic deaths could be much greater than what is reported.

But it is systemic racism, not race, that is the risk factor for these communities.

Racism is playing out during the pandemic through examples like a disproportionate number of COVID-19 testing sites in predominantly white communities compared to Black and Latinx/Hispanic communities, and yet they are still disproportionately impacted. One data analysis found, for example, that Dallas had 15 more testing sites in whiter areas and Austin had 7 more. Experts are saying these testing disparities are problematic – if we aren’t testing our most marginalized people, we could miss pockets of infection and have new large areas of virus outbreak. 

Given that there is a higher prevalence of chronic health conditions like hypertension and diabetes in communities of color, Black and Latinx/Hispanic communities are especially vulnerable to COVID-19. These chronic health conditions are a result of centuries of intergenerational trauma and a lack of resources inflicted on these communities. A lack of health insurance, poor access to medical care, and other systemic inequalities also undermine virus prevention efforts in these communities.

Living conditions (e.g. food deserts, minimal nearby medical facilities) in predominantly Black and Latinx/Hispanic areas may also contribute to underlying health conditions. These underlying health conditions may complicate people’s ability to follow health guidelines to prevent getting sick with COVID-19.

The likelihood that a person will test positive for COVID-19 increases in areas where the population of Black residents is higher.  This may be attributable to higher concentrations of Black people living in densely populated areas, which are due to institutional racism in the form of residential housing segregation and fewer access to services. This is also known as redlining — a racist practice denying or putting up barriers to services like for residents of certain areas based on their race. These circumstances make guidelines for social distancing almost impossible to follow safely.

Black and Latinx/Hispanic individuals are also more likely to hold jobs that are deemed “essential”. Essential workers are continuing to work outside the home, putting themselves and their families at risk. According to the CDC, nearly a quarter of Latinx/Hispanic and Black workers are employed in service industry jobs compared to just 16% of non-Hispanic whites nationally. Latinx/Hispanic workers make up 17% of total employment in the U.S. but constitute 53% of agricultural workers. Black workers account for 12% of all employed workers nationally but make up 30% of licensed practical and licensed vocational nurses. Both sectors are areas of work that have continued outside the home during the pandemic.  

These barriers not only make people of color more vulnerable to COVID-19, they also impact how families are able to care for their children during this crisis. This systemic racism apparent in our healthcare and housing systems trickles down to Black and Latinx/Hispanic children. Placing more stressors on parents and caregivers in turn places stressors on children, who are then less able to cultivate protective factors that build resilience.

Protective factors — including social connections, concrete supports for basic needs, knowledge of parenting and child development, social and emotional development of children, nurturing and attachment, and resilience — provide the key to ensuring that risk and adversity in childhood are not predictive of negative outcomes later in life.

We have a lot of work to do to ensure all children and families stay healthy through this pandemic and into the future. The state of Texas is making a small start:  the Texas Health and Human Services Commission has recently announced that it is seeking to remedy the lack of information about how Black and Latinx/Hispanic communities are being affected by the virus  and will work to study this. But answers must also come from communities themselves so that those of us working toward child protection can learn how to best empower community work and strengthen families to ensure they have access to the right supports at the right time. We must use a holistic approach to ensure that their access to resources is distributed equitably.

Another way we can help is through supporting the Texas Prenatal to Three (PN-3) Collaborative (learn more). Through PN-3, TexProtects, Children At Risk, and Texans Care for Children – along with many other organizations across the state – have come together to urge policymakers to ensure all Texas children have equitable access to healthy beginnings, family supports, and high quality early care and education.



State of Babies Yearbook 2020 (Zero to Three & Think Babies)

“The State of Babies Yearbook: 2020 compares national and state-by-state data on the well-being of infants and toddlers. The current state of babies tells an important story about what it is like to be a very young child in this country, and where we are headed as a nation. By nearly every measure, children living in poverty and children of color face the biggest obstacles, such as low birthweight, unstable housing, and limited access to quality child care.”

TexProtects’ Takeaway: Texas state ranked 43rd on the list for child wellbeing and our ranking for economic wellbeing, family & community, health, and education were not much higher on the list. With one in ten American children living here in Texas, we MUST do better. Our Prenatal to Three (PN-3) Collaborative has an ambitious policy agenda to improve services for 300,000 low income infants and toddlers in Texas.

Integrated data can help states better respond to and recover from crises like COVID-19 (Child Trends)

“State policymakers and program administrators need access to reliable and continuous data about early childhood services to understand what services have been disrupted, where services are most urgently needed, and how to deploy resources during and after the crisis to best support children and families.” Early childhood integrated data systems afford states access to comprehensive data, which may assist them in more efficiently responding to and recovering from crises like the global pandemic.

TexProtects’ Takeaway: The early childhood work in Texas is fragmented across multiple state agencies including TEA, HHSC, TWC, DSHS, and DFPS. To understand the way forward will require integrated data systems in order to better identify gaps and needs and coordinate and deliver services efficiently and effectively.

States Are Using the CARES Act to Improve Child Care Access during COVID-19 (Child Trends)

“The Coronavirus Aid, Relief, and Economic Security (CARES) Act included $3.5 billion in emergency funds for the Child Care and Development Block Grant, and the federal Administration for Children and Families issued guidance to allow states more flexibility in meeting Child Care and Development Fund (CCDF) requirements to mitigate the effects of the pandemic.… A new policy scan from Child Trends shows that states are using these emergency funds to improve the affordability of care and increase provider compensation.”

TexProtects’ Takeaway: As the nation continues to struggle with the COVID-19 pandemic, child care plays an even more vital role for working parents and caregivers needing respite. Texas is one of the states continuing to pay child care providers who accept subsidies, which is especially crucial due to closures of care centers and low attendance and enrollment in programs. Texas is also providing additional funding to providers who are taking care of the children of essential workers so that they will continue to serve families in need.


Addressing Racial Disparity in Foster Care Placement (National Child Welfare Workforce Institute – NCWWI )

This resource summary examines a recent case study in county-level public child welfare practices that attempt to address racial disparity in foster care placement. NCWWI concludes: “Child welfare systems need case-level strategies and community-supported interventions to reduce racial disparities in removal decisions and disproportionality in foster care systems. Child welfare administrators should consider development and training on case-practice and decision-making processes that reduce racial bias and increase racial equity. Additionally, it is critical to create collaborative community partnerships to develop systems of care that impact racial disparity within the larger community.”

TexProtects Takeaway: Tackling disproportionality in the child protection system cannot be done in isolation. It is crucial we collaborate across systems when addressing this disproportionality. There must be increased dedication, support, and resources toward both describing and solving the problem. Stay tuned for an upcoming blog series on disproportionality in our child protection systems.

A Review of the Literature on Access to High-Quality Care for Infants and Toddlers (Child Trends)

“While we know that high-quality early learning experiences that begin early in life can promote young children’s development and help reduce achievement gaps, much of the literature has focused on child outcomes related to attendance in early care and education programs for preschool-age children; less is known about how quality child care contributes to the development of infants and toddlers.” This literature review examines the existing research on access to high-quality care, specifically for infants and toddlers.

TexProtects’ Takeaway: Quality matters and access and affordability are continued challenges. COVID-19 has made the problems clearer than ever. If we want to do better and do something different, the time is now.

Resident Hispanic Fathers Report Frequent Involvement in the Lives of Their Children (Child Trends)

“To date, limited research has examined father involvement among Latinos — the largest racial/ethnic minority group in the United States today. Documenting levels of father involvement for Latino fathers, as we do in this brief, provides one important piece of the story needed to understand contemporary patterns of Hispanic fathering…. This brief uses data from the 2013-2017 NSFG [National Survey of Family Growth] to look more closely at levels of involvement for Hispanic fathers who live with their children.”

TexProtects’ Takeaway: Information on how fathers of color are involved in their children’s lives is important to providing community resources to further support families in caring for their children. Protecting kids mean supporting their families (and that means mothers AND fathers AND other caregivers)

Home Visiting Career Trajectories: Snapshot of Home Visitor’s Qualifications, Job Experiences, and Career Pathways (Office of Planning, Research & Evaluation – Administration for Children & Families)

Research on home visiting staff and the opportunities available for their professional development is relatively scarce. The study highlighted in this report sought to assess “the home visiting workforce in MIECHV Program-funded local implementing agencies (LIAs) to gather needed information about home visitors’ backgrounds and career paths. This snapshot highlights findings on home visitors’ qualifications, job experiences, and career pathways.”

TexProtects’ Takeaway:  Home visiting is a critical community service and proven prevention strategy for families with young children. Home visitors in MIECHV Program-funded agencies have strong educational backgrounds and job-related experience and the majority of home visitors are likely to continue their jobs for the next two years. This is good news for communities who have access to these programs!

Not in the Same Boat – The Pandemic Is Reducing Childcare Availability for Lower-income Families (University of Oregon Center for Translational Neuroscience – UOregon CTN)

As part of their Rapid Assessment of Pandemic Impact on Development Early Childhood Household Survey Project (RAPID-EC Project), UOregon CTN is updating this site weekly with new reports on survey findings that assess how COVID-19 is impacting young children and their families across the US. In addition to this report, the project has recently published findings on the decline of well-child visits and young children’s mental health difficulties during COVID-19.

The full list of RAPID-EC Project reports can be found here.

TexProtects’ Takeaway: We must do more to ensure lower-income families get the child care resources they need during the COVID-19 crisis. We must take action through policy change in order to prevent child care providers who serve lower-income families from shuttering. Stay connected with our PN-3 Collaborative to be part of the solution.


Resources to Support Children’s Emotional Well-Being Amid Anti-Black Racism, Racial Violence, and Trauma (Child Trends)

In this resource, Child Trends offers “… several steps that caregivers can take to support all children, and especially those who have experienced direct or secondary racial trauma. While the evidence strongly suggests that caregivers need a holistic understanding of how, and in what ways, racial trauma impacts children and youth of all races and ethnicities, our recommendations focus primarily on anti-Black racism and the racial trauma experienced by Black children and families. These recommendations can provide caregivers with a foundation for speaking with children about racism and racial trauma.”

TexProtects’ Takeaway: Learning to be anti-racist and unlearning systemic oppression of Black individuals must start at an early age. Parents and children can use these resources to learn together what it means to move past changing beliefs into taking action to ensure a safer and more just world for people of color.

Healing and Supporting Fathers: Principles, Practices, and Resources for Fatherhood Programs to Help Address and Prevent Domestic Violence (Child Trends)

“Domestic violence (DV) is a widespread problem in the United States. Experiencing and/or witnessing violence in relationships can negatively affect the health of parents and their children. Therefore, any program that works with families should play a part in preventing and addressing domestic violence. Fatherhood programs provide an opportunity to engage fathers in these efforts. This document includes: Background information to help fatherhood programs better understand DV; Foundational principles fatherhood programs can adopt to address and prevent DV; Descriptions of promising practices already being used by some fatherhood programs; Recommended future directions for fatherhood programs, based on current challenges in the field.”

TexProtects’ Takeaway:  Family violence is correlated with poor outcomes for children. Fathers who may be perpetrators and/or survivors of violence need a safe space to educate themselves and unlearn these behaviors. Families and children are stronger when fathers are engaged and healthy.