Frontline For Children | JANUARY 2022

We pulled together this month’s most noteworthy child welfare research articles for you. Read them all here and take action today!

1. Equitable Supports for Basic Needs of Grandfamilies

“There are 2.6 million children in the U.S. who are living with extended family, inside or outside the child welfare system because their parents cannot care for them. These families are often called “kinship families” or “grandfamilies.” Strong evidence shows children in grandfamilies thrive, especially when they get the support they need. Yet, grandfamilies across the country are not equitably supported.” – Read more from a new report by Generations United.

TexProtects Takeaway: The annual State of Grandfamilies report by Generations United offers a wealth of information on the benefits of kinship care, the needs of kinship families, and available services and policies for these families. While there are known benefits to keeping children within their own families, this report finds that “for every 1 child being raised by kin in foster care, 18 children are being raised by kin outside of foster care.” One way to combat this inequity is to create parity among grandfamilies and promote financial equity by ensuring these families have access to income support, tangible goods/services, and physical and mental health resources. TexProtects has advocated to better support relative caregivers at every stage of the child welfare process and will continue to push for policy changes during the interim leading up to the Texas 88th Legislative Session.

2. FFPSA: Prevention Services

“True primary [child abuse] prevention, which proactively supports the formation and stability of healthy and thriving families, remains an area of much-needed investment.” – New report from the APHSA on Unlocking the Prevention Services in the FFPSA. 

TexProtects Takeaway: This new report by the American Public Human Services Association, Unlocking the “Prevention Services” in the Family First Prevention Services Act,  offers a series of recommendations on making the FFPSA roll-out effective, efficient, and transformational for the child welfare system. Currently, almost four years since the law was implemented, only 17 states have approved Prevention Plans and have started drawing down federal funding for prevention services (Texas is not included). This report offers recommendations such as amending the prevention services clearinghouse requirements to ensure those with lived experience are informing the services and extending the temporary enhanced federal matching of prevention services through 2023 instead of ending with the public health emergency.   In the 87th Texas legislative session, policymakers took steps to implement the FFPSA. HB 3041, by Representative Frank and Senator Kolkhorst, was passed and requires DFPS to create FFPSA pilot prevention programs in two areas of the state focused on children at imminent risk of being removed from their home and placed into conservatorship of the department. Families who participate in these pilot programs will be monitored, and parameters will be in place to ensure that CPS is not involved any longer than necessary. While the location of the pilots and the evidence-based prevention programs have not yet been announced, we are excited about this important step in the implementation of FFPSA in Texas.

3. Texas Department of Family and Protective Services – Disproportionality Report

TexProtects Takeaway: DFPS has taken steps to reduce disproportionalities and disparities in the Texas Child Welfare system, beginning with a 2005 mandate by the Texas Legislature to examine and address racial disproportionality in the state child welfare system and, if found, develop a plan to reduce disparities. The analysis indicated disproportionality existed with African American and Native American children in Texas disproportionately overrepresented in the child welfare system. 

Recognizing the importance of cross-system collaboration to address this issue, the state created the HHS Center for the Elimination of Disproportionality and Disparities, later named the Office of Minority Health, Statistics, and Engagement. Within DFPS specifically, they hired a disproportionality manager for CPS, regional specialists, and a state-level disproportionality specialist. In recent years most of these positions were repurposed to various state agencies, and in 2018, the Office of Minority Health, Statistics, and Engagement were defunded and closed in August 2018. Currently, according to the newly released DFPS Disproportionality Report for FY 2020, “all efforts to eliminate disproportionality and disparities in the Texas child welfare system are managed by the CPS state disproportionality manager,” the lone position that remains from the initial efforts, but it has been vacant since May 31, 2021. 

While we are disappointed in the defunding of the Office of Minority Health, Statistics, and Engagement, we are grateful for the continued efforts on the part of DFPS to reduce disparities and are excited for the latest announcement of the new disproportionality manager. 

The recently released DFPS Disproportionality Report for FY 2020 highlights these continued efforts by DFPS, but unfortunately, the data suggests we have not made large strides in addressing disparities and disproportionalities in the Texas child welfare system.  A few important takeaways from the report: 

  • African American children are overrepresented in at least one stage (if not multiple) of CPS involvement in each of the 11 DFPS State Regions. 
  • The racial and ethnic demographics of children removed has been consistent across FY16 to FY20, showing a higher proportion of African American children and a lower proportion of Asian children are entering, in, and exiting foster/kinship care. 
  • African American children are reported, investigated, and removed at a higher rate than children of Anglo, Asian, or Hispanic origin. 
  • African American children are most likely to be sent to investigations versus alternative response
  • Hispanic children are overrepresented in poverty yet are not overrepresented in child welfare at the state level – Hispanic families make up the largest percentage of children in poverty, yet they are reported and investigated by CPS at a slightly lower rate than their proportion in the Texas child population. 

We agree with and support DFPS’ plans for future analysis and recommendations contained in this report. Specifically, we are encouraged by the recommendation for DFPS to “collect better data on income due to the disproportionate number of families of color living in poverty and track these trends.” While we know that living in poverty can be a risk factor for neglect, poverty itself does not equal child neglect. We must work together across systems to ensure families have access to community-level prevention services and support when they need them the most. 

*Data and takeaways from the DFPS Disproportionality Report FY 2020.

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Children’s advocacy group discusses Texas foster care crisis

The Texas foster care system has too many problems to detail in just a short TV interview. But for a taste of how bad it is, Good Day talks to Kerrie Judice with the children’s advocacy group TexProtects. She said there are too many foster kids and not enough foster homes, which leaves children sleeping in hotels and CPS offices, as well as places that are called dangerous.

Frontline For Children | December 2021

We pulled together this month’s most noteworthy child welfare research articles for you. Read them all here and take action today!

  1. U.S. Chamber of Commerce Foundation Report

A new report released by the US Chamber of Commerce Foundation found that childcare issues in our state result in a loss of $9.39 billion on Texas’s economy annually!

TexProtects Takeaway: A new report released by the US Chamber of Commerce Foundation found that childcare issues in Texas result in an estimated annual loss of $9.39 billion annually to the Texas economy! For more data points on Texas and to read about the implications of barriers to accessing child care, check out the full report.  As more families move to Texas for job opportunities and Texans increasingly go back to work, access to high-quality child care will be a necessity.

2. Foster Youth and College Graduation Rates

A recent Chapin Hall study of CA foster youth found that rates of college enrollment and degree attainment among youth who have aged out are increasing. Go here to find out how Tx is supporting foster youth as they prepare to enter adulthood.  

TexProtects Takeaway: A recent Chapin Hall study of California foster youth found that a majority of youth were enrolled in college and almost 10% had attained a 2- or 4-year college degree by age 23. These rates of enrollment and degree attainment are generally higher than previous studies of transition-aged youth, and “maybe a result, at least in part, of the investments made in the past two decades in California aimed at increasing college access and persistence for foster youth (for example, extended foster care, ETVs, campus-based support programs, community college tuition fee waivers).” Texas has also made recent strides in supporting older foster youth and ensuring they are prepared to enter into adulthood.

An estimated 1,200 youth in Texas age out of foster care each year. Much older youth who age out are not adequately prepared for adulthood and often face challenges with obtaining a driver’s license, maintaining employment, securing consistent housing, following through on education and maintaining healthcare coverage. As a result, they are more likely to experience homelessness and have untreated mental or physical health issues. The passing of HB 700, passed during the Texas 87th Regular Session, will help to remove barriers and provide supports that can best ensure these young adults have every opportunity to succeed. HB 700, championed by Reps Jarvis Johnson, James Frank, Ray Lopez and Senator Judith Zaffirini, ensures foster youth who complete Preparation for Adult Living classes are eligible to receive college credit, helping them to lock in their tuition and fee waiver for state colleges. Hopefully, this policy change will support more transition-aged youth in continuing their education.

Department of Family Protective Services Resource Page.

3. Building Back Better

The passage of Build Back Better would mean increased access to preventive services for our youngest Texans, saving lives and dollars in downstream costs for the state. The Hunt Institute has created a helpful guide to understand the transformational policies included in BBB. Check it out!

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Four Recommendations to Start Transforming the CPS System

Guidance on how to measure outcomes for our child protection system and recommendations for improvement.

View the Report.

Frontline For Children | August + September 2021

We pulled together this month’s 8 most noteworthy child welfare research articles for you. Read them all here and take action today!

  1. 4 in 10 Latino and Black households with children lack confidence that they can make their next housing payment one year into COVID-19 (National Research Center on Hispanic Children & Families)

According to the National Research Center on Hispanic Children & Families, one year into the COVID-19 pandemic, roughly 40 percent of Latino and Black households with children who rent or have a mortgage reported housing insecurity. Roughly half of low-income Latino and Black households with children, and one third of low-income White households with children, reported little or no confidence in their ability to make their next mortgage or rent payment.

TexProtects Takeaway: The COVID-19 pandemic continues to disproportionately effect communities of color. This new data reveals that 40% of Latino and Black households with children are facing housing insecurity vs. 15% of comparable white households. With the recent expiration of the federal moratorium on evictions, many families may now be facing homelessness elevating the risk of child maltreatment. In order to ensure these families and children have secure housing, we must advocate for the American Rescue Plan Act funding (over $40 billion in housing assistance) to be released to the communities that need it most.

2. School-Based Strategies for Addressing the Mental Health and Well-Being of Youth in the Wake of COVID-19* (National Academies of Sciences, Engineering, and Medicine)

According to the National Academies of Sciences, Engineering and Medicine, there are evidence-based strategies for schools to address the mental health and well-being challenges among youth that arose or were exacerbated during the COVID-19 pandemic. *This PDF is free but does require creating an account with a valid e-mail address for access.

TexProtects Takeaway: The COVID-19 pandemic has been especially challenging for youth. From the loss of loved ones to loneliness and social isolation, these past 18 months have brought about a unique set of challenges. This new resource identifies strategies to address youth mental health and well-being in the school setting. A few examples include school-wide, mental health screenings and school-based health centers with mental health providers.

3. System Transformation to Support Child & Family Well-Being: The Central Role of Economic & Concrete Supports (Chapin Hall at University of Chicago)

Researchers at the University of Chicago have recently released this overview of policy, programmatic, analytic, and engagement strategies for leveraging economic supports to promote child and family well-being and prevent maltreatment.

TexProtects Takeaway: We know that financial supports reduce child abuse and neglect by enabling families to better access resources and address their own basic needs. The Centers for Disease Control identifies strengthening economic supports to families as one of their strategies to prevent child abuse and neglect. This brief highlights a similar advocacy strategy often championed by TexProtects – that it is best to intervene with a family before a crisis. The recent Child Tax Credit implemented through the American Rescue Plan Act has the potential to dramatically reduce child poverty by giving families access to economic supports on a monthly basis. It would be beneficial for families and children if this tax credit was made permanent.

4. Contact with Child Protective Services is pervasive but unequally distributed by race and ethnicity in large US counties (Edwards, F., Wakefield, S., Healy, K., & Wildeman, C.)

A new study provides county-level estimates of the prevalence of child abuse and neglect in Texas analyzing specifically by race and ethnicity and associated access to prevention and early intervention. A blog post from Duke University discusses the study results in further detail.

TexProtects Takeaway: This study examined CPS data at the county level, revealing the wide range of experiences families face when encountering the child welfare system. Across all counties examined, Black children had the highest risk of CPS investigation and higher rates of later-stage CPS contact (including foster care placements and termination of parental rights). Overall, this study revealed what we already know to be true of our current, often discriminatory child welfare system: risk of involvement in the CPS system is more common for children from historically and/or economically marginalized populations. We must confront these inequalities and continue to work to eliminate disparities at all levels of the child welfare system.

5. Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age (Goodman, W.B., Dodge, K., & Bai, Y.)

A recent study concluded that Family Connects, a universal newborn nurse home visiting program, resulted in a 33% decrease in reported cases to CPS and a 39% reduction in emergency medical care use through age 5.

TexProtects Takeaway: This new randomized control trial reveals exciting and promising outcomes for universal postpartum nurse home visiting programs, such as Family Connects. The Family Connects program is a universally offered nurse home visiting program offered to new caregivers. There are six counties in Texas currently operating Family Connects programs. These programs served more than 1,800 Texas families in 2020. To learn more about Family Connects and how TexProtects advocated to expand the program in the 87th legislative session, check out our newly released End of Session report.

6. GrandFacts State Fact Sheets (Casey Family Programs, American Bar Association, & Generations United)

These fact sheets provide data on public benefits, educational assistance, legal relationship options and state laws and Texas’s fact sheet can be found here.

TexProtects Takeaway: 266,337 grandparents are caring for their grandchildren in Texas. Children belong with their families, whenever safely possible. However, not all families have access to the necessary resources to care for additional children. This helpful fact sheet offers grand families a list of resources in Texas including parenting classes, counseling, and food/clothing assistance.

7. Evaluation of a statewide initiative to reduce expulsion of young children (Edge, N., Kyzer, A., Abney, A., Freshwater, A., Sutton, M., & Whitman, K.)

This program evaluation study describes 3 years of implementation of Arkansas’s BehaviorHelp (BH) system, a statewide expulsion prevention support system for early care and education (ECE). The study examined correlation of differences in characteristics including exposure to trauma for children by outcomes including expulsion.

TexProtects Takeaway: The state of Arkansas has launched a statewide effort to reduce suspension and expulsion of young children. Not surprisingly, this study identified children most at-risk for expulsion from school had a history of childhood trauma. We know a child’s reaction to trauma can greatly affect their ability to engage productively in the classroom. Trauma-informed training for all educators is essential to helping children with a history of trauma feel safe and secure in the school setting. Texas requires new teachers to receive trauma-informed care training as part of their orientation, however, a bill passed in the 87th legislative session removes the frequency requirements for trauma-informed care training of current teachers. Texas has a long way to go in ensuring children feel safe and secure in the classroom. A report by Texans Care for Children in 2019 revealed that although the legislature has banned out of school suspensions for pre-k through second graders, a high number of Texas’ youngest students continue to face in-school suspensions at disproportionate rates (highest among students in foster care, special education, and black students and boys).

8. Why aren’t kids a policy priority? The cultural mindsets and attitudes that keep kids off the public agenda (Frameworks Institute)

This report by Frameworks institute explores the cultural barriers to prioritizing children in policymaking, as well as the opportunity to develop a new narrative that is asset focused on child wellbeing instead of child need.

TexProtects Takeaway: When the public thinks about children and policy, they most often think about education and family settings. The public struggles to connect other policy areas (healthcare, housing, etc.) to children’s issues. The Prenatal to Three Collaborative (led in part by TexProtects) works to elevate all policy issues that affect our youngest children. Policies recently in the news such as Medicaid Expansion, the Child Tax Credit, and the federal moratorium on eviction, all have a profound impact on children of all ages and their safety and well-being. In order to help the public make this connection, advocates must be open to new ways of thinking and communicating to better serve our youngest Texans.

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The critical foster care reforms in Texas are having unintended consequences

Recently, we have been reading about foster children sleeping in Child Protective Services offices as if sleeping in offices is our child welfare crisis. Sleeping in CPS offices is a symptom of the real crisis, which is that today 524 children don’t have foster care placements. This shortage of placements is a symptom of even deeper and more complex challenges that put the entire foster care system, which cares for 30,000 children, at risk of cratering. Many factors have led us to these dire circumstances.

First, the Texas foster care system has been the subject of litigation since 2011, alleging violations of children’s rights. The case is before federal Judge Janice Graham Jack, who ruled that Texas was in fact violating children’s rights in foster care by subjecting them to abuse, overmedication and repeated placements.

The system needed reform, and although well-intentioned, there have been many unintended consequences resulting from Judge Jack’s orders.

For example, additional regulations ordered by the judge have resulted in increased citations for infractions, some minor, with little to no due process. While such citations are meant to improve safety, it has not been transparent as to how providers can remedy such infractions.

These regulations have driven up costs, with the expectation that the state will continue to pick up the ever-increasing tab. Meanwhile, the new regulations have shifted provider attention away from providing quality care, the intent of the lawsuit, to chasing the ever-changing and elusive paper tiger of compliance.

As a result, several providers of poorer quality have been rightfully shut down, but we also are losing much of the existing quality capacity that was insufficient to begin with.

Concurrently, the Texas Legislature is moving ahead with privatizing the foster care system, known as community-based care, in which the state pays regional private entities to administer foster care instead of the state. Given this new environment, entities that receive contracts may not receive sufficient reimbursement to care for children, cover costs and absorb the regulatory risk. We must be prepared in case of failure and question what the alternative will be if the privatization is not successful.

We cannot keep pointing fingers for the situation we are in because of our collective inability to solve the problem. Immediate action is needed.

Read the full article at the Dallas Morning News.

Frontline For Children | July 2021

We pulled together this month’s 9 most noteworthy child welfare research articles for you. Read them all here and take action today!

  1. 2021 Kids Count Data Book (Annie E. Casey Foundation)

“The Annie E. Casey Foundation has released the 2021 Kids Count Data Book. This annual report with state rankings presents a comprehensive picture of child well-being before and during the COVID-19 pandemic. It identifies multiyear trends — comparing statistics from 2010 to 2019. In addition, the report shares data on how families endured throughout the pandemic. The report is accompanied by state data profiles for all 50 states plus the District of Columbia and Puerto Rico.” Texas-specific data can be found here.

TexProtects Takeaway: Texas continues to rank near the bottom – number 46 among all states – in child health and well-being. We are number 49 when it comes to child health! With one in every ten American children living in Texas, we must do so much more to ensure that kids count when decisions are made regarding policy, investments, and strategies. A strong Texas tomorrow is dependent upon our investment in children today.

2. Number Story (ACE Resource Network)

This newly developed website by the ACE Resource Network offers a detailed explanation of Adverse Childhood Experiences – how they affect our lives, why we should care about them, the science behind their impact, and opportunities for prevention or healing, including those being piloted by leading healthcare providers and medical professionals in the field.

TexProtects Takeaway: Do you know your number? Positive and negative early childhood experiences affect our biology, behavior, and health and understanding why and how is critical! We LOVE this resource for the way it makes this robust and impactful science easy to understand and for its focus on how you can help create healing and resilience for yourself, your children, and your community. Check it out!

3. Moving Upstream: Confronting Racism to Open Up Children’s Potential (Center on the Developing Child at Harvard University)

“To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs)”, the authors of this article “linked vital records for California’s 1999 birth cohort (n = 519 248) to CPS records from 1999 to “The scientific evidence is clear and growing: racism imposes unique and substantial stressors on the daily lives of families raising young children of color. Understanding how these stressors affect child health and development provides a compelling framework for new ideas about how communities, policies, programs, and funding streams might confront and dismantle these inequities and build a stronger future for us all. This new brief discusses how racism creates conditions that harm the well-being of children and families, and the need to go “upstream” and create policy solutions to address the source of structural, cultural, and interpersonal forms of racism.”

TexProtects Takeaway: Once again, the answers are upstream! Reducing cultural racism, investing in place based interventions, and increasing economic supports are just a few of the recommendations included here that would provide meaningful focus and impact on reducing the impact of racism on our families of color.

4. Child Poverty Increased Nationally During COVID, Especially Among Latino and Black Children (Child Trends)

“Child poverty rates have increased during the COVID-19 pandemic, particularly among Latino and Black children and among children in female-headed families, according to a new Child Trends analysis of recently released national data from the Current Population Survey. These newly released data provide a first nationally representative look at how the pandemic has changed child poverty. We find that child poverty increased by an average of 1.8 percentage points—from 15.7 percent in 2019 to 17.5 percent in 2020—based on families’ reports in 2020 and 2021. This translates to roughly 12.5 million children living in poverty in 2020, or 1.2 million more than in 2019.”

TexProtects Takeaway: The pandemic has not only reversed what was a downward trend in child poverty but it has increased disparities based by race/ethnicity and family structure. However, the changes to the Child Tax Credit implemented through the Federal American Rescue Plan have the potential to dramatically decrease child poverty (45% reduction in Texas according to research at Columbia University) and minimize the disparities in poverty according to race/ethnicity.

5. Millions of Young People are Struggling to Meet Basic Needs during COVID-19, with Large Racial Disparities (Chapin Hall at University of Chicago)

This report — part of the first phase of the Expanding Evidence on Replicable Recovery and “Researchers at Chapin Hall at the University of Chicago and Howard University conducted a study to examine previously untold stories of the pandemic among young people. They focused particularly on food and housing insecurity, mental health, and the racial dimensions of those adversities. The researchers analyzed a large, nationally representative dataset available through the U.S. Census Bureau’s Household Pulse Survey, which has collected data over the course of the pandemic.” Findings show that young adults have experienced distressing levels of food and housing insecurity during the COVID-19 pandemic, with these challenges disproportionately affecting BIPOC youth. Given that these adversities have negative implications for young people’s healthy development and stable transitions to adulthood, the authors conclude with several recommendations for policymakers to ameliorate pandemic-related hardships.

TexProtects Takeaway: Study after study is demonstrating that not only are the effects of COVID challenges likely to outlast the physical pandemic but the impacts have been more severe and supports less accessible in populations and communities already disproportionately challenged. These adversities have important implications for young people’s healthy development and positive transitions to adulthood and demand holistic and innovative approaches to minimize barriers and increase access to resources.

6. Family-Centered Reunification in Child Welfare: A Review of Best Practices (National Quality Improvement Center on Family-Centered Reunification)

“The Quality Improvement Center on Family-Centered Reunification (QIC-R), led by The Institute for Innovation & Implementation at the University of Maryland School of Social Work in collaboration with the Children’s Bureau (CB), will work with five to seven sites to install, implement, and evaluate selected practices and interventions to support the timely, stable, and lasting reunification of families by preserving, nurturing, and strengthening parent-child relationships and supportive community connections and resources, including through meaningful engagement of birth parents, foster families, youth, alumni of foster care, and other stakeholders… The purpose of this scoping review is to provide applicants with relevant background information on the reunification interventions and best practices that could guide the design of the applicant’s intervention. This report offers an overview of the state of the research evidence about interventions designed to promote reunification and presents a catalogue of reunification programs that outlines each intervention’s: Programmatic approach, service population, level of research evidence, implementation considerations, and outcomes studied.”

TexProtects Takeaway: Children belong in families – their own, when it is safe However, in 2020, only 34% of the exits from conservatorship resulted in family reunification. Check out this evidence-based summary of interventions and programs that could improve the services we offer families and ultimately result in more families staying safely together. How many are offered in your community?

7. A Seat at the Table: Piloting Continuous Learning to Engage Fathers and Parental Relatives in Child Welfare (Office of Planning, Research & Evaluation – OPRE, University of Denver, Mathematic)

“The Fathers and Continuous Learning in Child Welfare (FCL) project used a methodology known as the Breakthrough Series Collaborative (BSC) to improve placement stability and permanency outcomes for children by engaging their fathers and paternal relatives. A BSC is a continuous learning methodology developed by the Institute for Healthcare Improvement that is used to test and spread promising practices to help organizations improve in a focused topic area (IHI 2003)… Six Improvement Teams representing five state or county child welfare agencies participated in the BSC. Throughout this BSC, each team identified, implemented, and studied a unique group of strategies to engage fathers and paternal relatives. Teams developed processes to collect, organize, and report data to gauge whether the engagement strategies were producing improvements on specified metrics. This pilot study report describes insights into the implementation of a BSC and potential strategies for increasing father and paternal relative engagement in child welfare.”

TexProtects Takeaway: Father involvement and extended family support both improve child wellbeing and increase protective factors, however many child welfare systems may be underinvesting in dads or inadvertently creating barriers to participation. Learn more about the great work around fatherhood engagement happening at the Child and Family Partnership at UT here.

8. Our Youngest Learners: Increasing Equity in Early Intervention (The Education Trust)

“Early intervention services are funded through a complex blend of federal, state, and local sources, and are part of the Individuals with Disabilities Education Act (IDEA). States have to make difficult decisions about how to fund critical IDEA services, including early intervention services, because Congress vastly underfunds IDEA. This often results in stricter eligibility requirements and other cost-saving measures that sometimes lead to a decrease in the number of children receiving services. There are several strategies states can use to address systemic racial inequities in the health and education systems in which early intervention services take place. In this report, we identify the strengths of state approaches and opportunities for increasing equity in providing early intervention services.”

TexProtects Takeaway: One significant win for Texas infants and toddlers this session, was the legislature’s increased investment in Early Childhood Intervention. Alongside this investment, promising practices include strengthening Child Find and including evidence-based comprehensive screening and referral services like Family Connects and Healthy Steps which ensure families get screened and get access to services early when the impact is greatest.

9. Our Young Too Many Babies Miss Out on Medicaid Infant Coverage, Promising Practices Point the Way for States (Georgetown University Health Policy Institute, Center for Children and Families)

For more than 25 years, federal law has guaranteed enrollment for babies born to Medicaid beneficiary mothers, known as deemed newborn coverage, which begins at birth and continues uninterrupted through the first year of life. Policy changes in the Children’s Health Insurance Program Reauthorization Act of 2009 removed some outstanding limitations to strengthen state application of this requirement. As described by the Centers for Medicare and Medicaid Services (CMS) in a letter to states, the changes ‘effectively… means that all newborns born to women covered by Medicaid for the child’s birth are now covered as mandatory categorically needy.’” However, various challenges to maintaining infant enrollment protection have resulted in a wide variation of states’ approaches to and success in implementing the policy. This report identifies gaps in Medicaid enrollment for eligible babies born 2010-2018 and makes recommendations for how states can better implement infant EPSDT coverage through effective administration and communication between the prenatal period and children’s first birthdays.

TexProtects Takeaway: Medicaid and CHIP provide coverage for approximately half of all births, and approximately 2/3 of Black, Native American and Hispanic infants nationwide. Having both maternal and infant coverage be continuous for one year following a birth is a major step to end disparities in maternal and infant mortality and give our children an equitable start. This legislative session, critical improvements were made by the passage of a bill to allow eligible children to remain enrolled in Medicaid insurance by reducing inaccurate mid-year eligibility reviews and extending postpartum coverage to 6 months.

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Frontline For Children | June 2021

We pulled together this month’s 8 most noteworthy child welfare research articles for you. Read them all here and take action today!

  1. Racism Creates Inequities in Maternal and Child Health, Even Before Birth

“The child welfare system is overdue for substantial transformation. Families and communities of color have experienced the brunt of the failings and limitations present in current policy and “To inform maternal and child health policy and practice, this brief applies a racial and ethnic equity lens to the review of data from the State of Babies Yearbook: 2021. Specifically, this brief aims to explore why there are disparities in maternal and child health; what disparities exist, and for whom; and how policymakers and practitioners can promote racial and ethnic equity to improve maternal and child health. We use racial and ethnic equity to refer to the process of involving those most impacted by institutional racism in the creation and implementation of policies and practices that impact their lives, and to outcomes in which race and ethnicity do not predict a person’s life course.5 This approach offers recommendations that are discussed in detail in the Recommendations section.” The brief also features multiple state-level data tables, which highlight where Texas has strengths and/or faces challenges.

TexProtects Takeaway: A baby’s future health and potential to thrive begins to take shape even before conception. This connection between maternal and child well-being is especially important among women of color, due to intergenerational trauma and the lived experience of institutional and interpersonal racism. Research has shown that racism can influence maternal health before and during pregnancy – ultimately having a negative impact on a baby from the beginning. The US also continues to struggle with extremely high rates of maternal mortality, in relation to all other high-income countries. In the 87th Texas legislature, TexProtects advocated for an expansion of voluntary nurse home visiting programs, such as Family Connects, to help combat maternal mortality and connect new moms and babies to the resources they need at the right time. Although legislation to expand these home visiting programs did not pass, HB 133 was signed into law, which expands Medicaid coverage for new moms post-partum from 2 months to 6 months. Texas still has a lot of work to do in protecting new moms and babies, but this is a huge step forward!

2. Parental Substance Use: A Primer for Child Welfare Professionals (U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau)

“Child welfare professionals can play a critical role in helping identify possible substance use disorders (SUDs) and supporting families in overcoming barriers to safety and permanency related to substance use. This factsheet reviews what SUDs are, how parental substance use affects families, and how child welfare professionals can support these families. It also considers how collaboration between child welfare professionals and SUD treatment providers, as well as others, is an essential component to assisting families. This factsheet is intended to serve as a brief primer on the intersection of parental SUDs and child welfare rather than a comprehensive guide. Additional information and resources are provided throughout to help readers explore the topic in more detail.”

TexProtects Takeaway: Almost 9 million children in the US live with at least one parent struggling with a substance-use disorder (SUD) – over 12% of all children in the US. Living with a caregiver suffering from an SUD is considered an adverse childhood experience (ACE), and increased exposure to ACEs can cause a host of negative outcomes for children later in life.  Substance abuse is a major factor in many child welfare cases and research has shown the existence of a parent with SUD is associated with an increased belief by child welfare workers that the children are experiencing severe risk and harm, regardless of actual risk or harm. This is troubling as a child welfare worker’s assessment of the severity of harm affects the type, intensity, and duration of services offered. Under the Family First Prevention Services Act (FFPSA), states may now use title IV-E funds for substance use and mental health services, that may ultimately prevent a child from being placed in foster care. TexProtects will continue to work with Texas DFPS Prevention and Early Intervention to ensure FFPSA funds are used in the most efficient and effective way possible – to intervene with these families to prevent child abuse and neglect before a crisis occurs.

3. Cumulative Rates of Child Protection Involvement and Terminations of Parental Rights in California Birth Cohort, 1999-2017 (Putnam-Hornstein, E., Ahn, E., Prindle, J., Magruder, J., Webster, D., & Wildeman, C.)

“To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs)”, the authors of this article “linked vital records for California’s 1999 birth cohort (n = 519 248) to CPS records from 1999 to 2017. We used sociodemographic information captured at birth to estimate differences in the cumulative percentage of children investigated, substantiated, placed in foster care, and with a TPR.” Results are as follows: “Overall, 26.3% of children were investigated for maltreatment, 10.5% were substantiated, 4.3% were placed in foster care, and 1.1% experienced a TPR. Roughly 1 in 2 Black and Native American children were investigated during childhood. Children receiving public insurance experienced CPS involvement at more than twice the rate of children with private insurance… Conservatively, CPS investigates more than a quarter of children born in California for abuse or neglect. These data reinforce policy questions about the current scope and reach of our modern CPS.”

TexProtects Takeaway: The authors of this groundbreaking article used records for California’s 1999 birth cohort and CPS records to show cumulative percentages of children investigated by CPS, placed in foster care, and those with parental rights terminated. This study found that while the number of children placed in foster care is small, the number of children investigated by CPS is substantial. Roughly half of all Black and Native American children in this California cohort were investigated by CPS for maltreatment at some point in their childhood. These groups also experienced all levels of CPS involvement at more than twice the rate of White children in the same cohort. Finally, this study also found children receiving public health insurance and missing paternity were strongly related to all levels of CPS involvement. We must continue to dig into the institutionalized and systemic racism that is present at all levels of the child welfare system and enact policies that are equitable and supportive of all families.

4. 2021/2022 Prevention Resource Guide (U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau; Child Welfare Information Gateway; FRIENDS National Center for Community-Based Child Abuse Prevention)

The authors created the first resource guide of this type over 15 years ago, “with the goal of raising awareness about emerging child abuse prevention concepts. It was created primarily to support community-based service providers who work to prevent child maltreatment and promote family well-being. However, over the years many others—including policymakers, health-care providers, program administrators, teachers, child care providers, parent leaders, mentors, and clergy—have found the resources useful… This guide has traditionally focused on primary and secondary prevention activities, which endeavor to stop maltreatment before it occurs.” In exploring prevention concepts, the guide uses a framework comprised of the following six protective factors: Nurturing and attachment; knowledge of parenting and of child and youth development; parental resilience; social connections; concrete supports for parents; and social and emotional competence of children.

TexProtects Takeaway: The Administration for Children and Families published this report to “support families all year long in ways that promote and build upon their strengths and enable them to care for their children safely before maltreatment is even a possibility.” This goal is directly in line with one of the top priorities for TexProtects – to prevent child abuse and keep families together. The 2021/2022 guide highlights many innovative ways communities across the US are engaging in purposeful prevention work to keep children safe and strengthen families.

5. Recovery Coaching Interventions for Families Involved with the Child Welfare System: Moving Toward Evidence-Based Practices (Office of Planning, Research & Evaluation – OPRE; Abt Associates; University of Michigan School of Social Work; Faces & Voices of Recovery)

“This report — part of the first phase of the Expanding Evidence on Replicable Recovery and Reunification Interventions for Families (R3) project — describes features of select interventions that use recovery coaches in the child welfare system, characterizes their current stage of readiness for replication and further evaluation, and informs a long-term effort by the Administration for Children and Families (ACF) within the U.S. Department of Health and Human Services (HHS) to build high-quality evidence on recovery coaching interventions for families involved with the child welfare system.”

TexProtects Takeaway: Parental substance abuse continues to be one of the most common risk factors for families involved in the child welfare system. Research has shown that parents who participate in and complete SUD treatment are more likely to be reunified with their children. Recovery coaching is one solution to increase the likelihood of family renunciation. Recovery coaches work with parents struggling with SUD who have or are at risk of having their children removed. Coaches increase engagement in treatment and other needed services to support the parent’s recovery, while also coordinating with child welfare agency staff. The 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatmentfor Patients and Communities (SUPPORT) Act required HHS to replicate a family SUD recovery and reunification intervention that used recovery coaches and conduct a three-part evaluation. As a first step, nine eligible interventions were considered for further study. Of these nine, three interventions showed some promise of efficacy. The most effective program with the greatest potential for replicability was the Oregon Parent Mentor Program and Sobriety Treatment and Recovery Teams (START). While more research needs to be done on the evidence of these programs and interventions, this is an excellent start and shows the importance of investing in innovative and evidence-based approaches.

6. Young Child Risk Calculator (National Center for Children in Poverty – NCCP, at the Bank Street Graduate School of Education)

This newly updated calculator serves as a tool for determining young children’s longer-term socioeconomic outcomes, given the number and types of risk factors to which they are currently exposed. Users are able to choose the state, a child’s age range (all below age nine), a family’s income level, and seven different risk factors related to parents’ education levels, housing stability, employment, etc. The creators of the calculator note that “Children with three or more risks are exceptionally vulnerable. Information about the prevalence of young children experiencing these risks can inform policies aimed at improving outcomes for vulnerable children and reducing the number of children experiencing early risks.”

TexProtects Takeaway: There are 1,149,024 children in Texas under the age of 3 and 47% of them are considered low-income (<200% FPT). This tool focuses on several risk factors a child might experience, such as: unemployed parents, low parent education, and residential mobility. Children with three or more risk factors identified are especially vulnerable to negative health, educational, and developmental outcomes. Of children under the age of 3 in Texas, 46% have experience at least 1-2 risk factors and 17% have experienced 3+ risk factors. The prenatal to three period for children is critical for brain development and future outcomes. TexProtects is proud to lead the Texas Prenatal to Three Collaborative with the goal of increasing the number of infants and toddlers in Texas who are healthy, supported, and arrive at school ready to learn. Click here to learn more about the PN3 Collaborative and how you can get involved.

7. Early Childhood Profiles (NCCP at the Bank Street Graduate School of Education)

“NCCP’s Early Childhood Profiles were produced as part of the Improving the Odds for Young Children project. These profiles highlight two-generation state policy choices that promote health, education, and strong families alongside other contextual data related to the well-being of young children.” Texas’s state profile can be found here.

TexProtects Takeaway: NCCP’s Early Childhood Profiles highlight policies that are two-generational in their approach, meaning the policies support the well-being and opportunities of young children as well as their parents. One example of two-generation policy supports is investment in Pre-K programs and high-quality childcare, along with state policies such as the Earned Income Tax credit and raising the minimum wage for low-income workers. Another example is increased access to mental health screenings, along with increased access to quality health care for children and their parents. One concerning Texas data point highlighted in this profile is the number of children under age 6 in Texas without health insurance. The national average is 8% while Texas sits at 15% of children under 6 with no health insurance. Children who do not have access to health insurance are less likely to attend preventive care appointments and wellness checks that could deter chronic conditions earlier. This legislative session, HB 290 (passed as a provision of HB 2658), will allow eligible children to remain continuously enrolled in Medicaid CHIP for 6 months before a mid-year eligibility review. The passage of this legislation will ensure less eligible children are inaccurately kicked-off of their health insurance. 

8. State of Babies Yearbook 2021 (ZERO TO THREE)

“The State of Babies Yearbook: 2021 compares national and state-by-state data on the well-being of infants and toddlers… We present this report after a year in which all of us, but especially families with young children, have faced unprecedented challenges from the pandemic, its economic fallout and social isolation, and nationally visible incidents of racial injustice that resonated in our study of babies’ lives in America… This year, we show how those inequities that pre-existed COVID-19 illuminate the disparate economic and social impacts of the pandemic on families of color and those with low income [as we supplement our usual data sources with data from the Rapid Assessment of Pandemic Impact on Development in Early Childhood survey].” Texas’s 2021 data can be found here.

TexProtects Takeaway: The State of Babies Yearbook is an excellent tool to see where Texas stands versus other states on many key indicators of healthy and safe babies and toddlers. One policy area where Texas is lagging is an area the Yearbook calls Strong Families. These are policies designed to address disparities by race, ethnicity, and income. A few examples include safe and stable housing, home visiting services, and tax credits for families with young children. Texas falls on the lowest tier in this category compared with all other states and Texas is doing worse than the national average on indicators such as the percentages of families who report being resilient and babies living in crowded housing. One solution to this problem is increasing access to voluntary home visiting services. These programs have a strong return on investment and have been shown to increase protective factors and strengthen families by connecting them with the resources they need most. Click here to learn more about home visiting in Texas.  

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Frontline For Children | May 2021

We pulled together this month’s 10 most noteworthy child welfare research articles for you. Read them all here and take action today!

  1. Transforming Child Welfare: Prioritizing Prevention, Racial Equity, and Advancing Child and Family Well-Being (National Council on Family Relations)

“The child welfare system is overdue for substantial transformation. Families and communities of color have experienced the brunt of the failings and limitations present in current policy and practice. A transformed approach is needed that prioritizes maltreatment prevention, racial equity, and child and family well-being. The Family First Prevention Services Act is an important step in this effort, although its scope falls short of the significant changes that are needed to effectively serve children and families. Transformation requires intentional efforts to disentangle poverty and child neglect, and investments in communities to build robust, accessible continua of prevention services.” With the goal of transforming the child welfare system in mind, the authors of this policy brief offer five recommendations for policymakers: reconceptualize the mandatory reporting system; expand primary prevention programs to families in their communities; address institutional racism within child welfare programs; invest in evidence-based interventions; and allocate more resources for kinship caregivers, equivalent to what is available for nonrelative foster parents.”

TexProtects Takeaway: Since the establishment of formalized state child protection systems, the majority of funding and resources have been directed to child abuse/neglect investigations and out-of-home placements. In 2016, only 15% of the $30 billion invested nationally was directed toward prevention services. This is also true in Texas, where prevention makes up only 5% of the DFPS budget.

2. Strategies to Build Evidence for Kinship Navigator Programs Under the Family First Act

“The 2018 Family First Prevention Services Act (Family First Act) provides funding for kinship navigator programs that demonstrate evidence of effectiveness. Many agencies believe their kinship navigator programs benefit kinship caregivers and their families; however, to qualify for Family First Act funding, stronger research evidence is needed to understand whether and how families benefit. This brief identifies common challenges agencies face in building this evidence and suggests ways to address these challenges, including defining the program model; selecting a comparison group; ensuring an adequate sample size; selecting appropriate outcomes and reliable and valid measures; and collecting data.”

TexProtects Takeaway: Kinship Navigator Programs can be a critical lifeline for kinship caregivers involved with the child welfare system. While it is always the goal for children to remain with family members, kinship caregivers are often unprepared for the financial burden of caring for another child and are unable to navigate the complicated web of resources available to them. Investing in Kinship Navigator programs will help to mitigate child trauma by ensuring more children are able to remain with their family members.  

3. State Child Abuse & Neglect (SCAN) Policies Database (Office of Planning, Research, and Evaluation – OPRE, Children’s Bureau in the Administration for Children and Families, Mathematica, and Child Trends)

“SCAN Policies Database includes data on select definitions and policies related to child maltreatment incidence for 50 states, the District of Columbia, and Puerto Rico. The data is organized into six variable domains: 1. Definitions of child abuse and neglect; 2. Reporting policies; 3. Screening policies; 4. Investigation policies; 5. Child welfare responses; 6. Child welfare system context.” Texas’ most recent profile, including data collected from May 2019 to July 2020, can be found here.

TexProtects Takeaway: Although federal law identifies certain acts or behaviors as child maltreatment, each state has their own legal definitions of child abuse and neglect. This leads to differing state policies and implementation in child maltreatment reporting and investigations. The SCAN database is able to be linked with other child welfare data sources, revealing important trends such as the incidence of child maltreatment, the child welfare system response, and ultimately child safety and well-being outcomes.  At a time when the Texas child welfare system is under extreme strain due to COVID-19 and the on-going federal lawsuit, we must take the time to identify what is working in Texas and what is not, in order to better support and protect our children.

4. Child Maltreatment Reporting in Rural vs. Urban Areas (Children’s Bureau Express)

“Most of the research on child maltreatment focuses on children in urban areas since they outnumber those in rural areas. A recent article in Children and Youth Services Review emphasizes child maltreatment statistics in rural areas, comparing maltreatment reports, report sources, and service outcomes with those in urban areas. The study examines three research questions: Do maltreatment reports differ between urban and rural areas during the study period (2003–2017)? Do report sources differ between urban and rural areas? Does the probability of substantiation and post response outcomes differ by report source and urban or rural area? This is the first major study in recent years to examine and compare national data for child maltreatment reports, report sources, and services outcomes for rural and urban areas. It is important to note that there are several limitations to the study, such as that it relied on official child maltreatment data and screened-in reports, which may undercount the actual occurrence of maltreatment.”

TexProtects Takeaway: Most research on child abuse/neglect reporting has historically focused on children in urban areas, exposing a gap in data pertaining to children in rural areas. This study revealed children in rural areas have higher rates of abuse/neglect reports and re-reports, a critical reminder that we must continue to work on investing in and expanding access to prevention services across the state of Texas. Your zip code should not determine if your family can access support services before a crisis occurs.

5. Distinguishing Racism, Not Race, as a Risk Factor for Child Welfare Involvement: Reclaiming the Familial and Cultural Strengths in the Lived Experiences of Child Welfare-Affected Parents of Color (Stephens, T.)

“Child welfare-affected parents of color (CW-PaoC) are often described using language that is deficit-focused, their families depicted as fragile and living in a near constant state of crisis and need. This commentary challenges the stereotypes created by hyper-attention to these parents’ struggles and situates them, and their families, within the broader context of the American appetite for family separation, wherein specific types of families are targeted for scrutiny, intervention and regulation. The concept of fragility within families is dissected to illustrate the ways in which racism and classism demarcate certain families for separation. Excerpts from two separate interviews conducted with Black mothers in 2014 and 2020 are used to illustrate how the appetite for family separation is currently fed. Familial and cultural strengths that counteract the prevailing deficit-focused narrative of CW-PaoC, particularly Black parents, are discussed. This commentary ends with a call for the dissolution of the CW system in its current regulatory form and the rebuilding of family-centered supports that center familial strengths.”

TexProtects Takeaway: Families of color continue to be grossly over-represented in the US child welfare system. It is time for the child welfare system to recognize and acknowledge the strengths within families of color and commit to a strengths-focused approach when interacting with  families, ensuring that each family receives fair, equal, and equitable treatment.

6. Maltreatment of Children with Disabilities (Legano, L., Desch, L., Messner, S., Idzerda, S. & Flaherty, E.)

“The purpose of this clinical report is to ensure that children with disabilities are recognized as a population at increased risk for maltreatment. This report updates the 2007 American Academy of Pediatrics clinical report “Maltreatment of Children With Disabilities.” Since 2007, new information has expanded our understanding of the incidence of abuse in this vulnerable population. There is now information about which children with disabilities are at greatest risk for maltreatment because not all disabling conditions confer the same risks of abuse or neglect. This updated report will serve as a resource for pediatricians and others who care for children with disabilities and offers guidance on risks for subpopulations of children with disabilities who are at particularly high risk of abuse and neglect. The report will also discuss ways in which the medical home can aid in early identification and intervene when abuse and neglect are suspected. It will also describe community resources and preventive strategies that may reduce the risk of abuse and neglect.”

TexProtects Takeaway: The rate of child abuse and neglect is at least 3x higher among children with disabilities than in the typically developing population. However, not all disabilities confer the same risks of child/abuse neglect. Researchers discovered children with milder forms of disabilities are at a higher risk of abuse/neglect than more profoundly affected children, and certain types of disabilities are associated with different forms of child abuse. For example, children with behavioral difficulties are at a greater risk for physical abuse and children who are nonverbal or hearing impaired are more likely to experience neglect or sexual abuse. In order to mitigate these risks, it is critical that children have a trusted Pediatrician and medical home. This is just one way families can receive the support and education they need.

7. Supporting School Stability for Children in Foster Care during COVID-19 and Beyond (American Bar Association Center on Children and the Law, National Council of Juvenile and Family Court Judges)

 “This alert highlights: Why prioritizing education is important for children in foster care; Critical education issues for children in foster care; Who is involved in advocating for the education of children in foster care; Judges’ roles in keeping children in care on track in school; And how courts can collaborate with schools and child welfare agencies to help children in care succeed in school.”

TexProtects Takeaway: We know that having a supportive relationship with a caregiver or adult can help to mitigate the devastating effects of childhood trauma and adverse childhood experiences (ACEs). Due to COVID-19, many children have lost access to their teachers and school counselors who offer safety and stability. For children involved in the child welfare system, the situation is even more dire, as they are at a high risk of school disruption leading to significant learning loss, increased behavior issues, and a higher drop-out rate. As we continue to navigate the ever-evolving COVID-19 crisis, it is imperative that we prioritize stability for children in every phase of the child welfare process.  

8. Interpretability of Machine Learning in Child Welfare (Chapin Hall at the University of Chicago)

“Despite the predictive power of machine learning (ML) models, they are difficult to apply and interpret. This has stymied translation of research into practice and policy in child welfare. As a proof of concept, we sought to bridge this gap in child welfare by testing a novel interpretation methodology in ML, Shapley Additive Explanation or SHAP (Lundberg et al., 2020). First, we developed a random forest ML model to predict the risk of youth running away from care within 90 days of entering a child welfare system. Second, we applied SHAP to the random forest ML model to identify and quantify the influence of important predictors and combination of predictors on the predicted risk of runaway. Demonstrating that SHAP can be used in child welfare research might facilitate end users of ML, such as child welfare administrators and caseworkers, in making relevant policy and practice changes.”

TexProtects Takeaway: This exciting new research tool, machine learning models, is able to mine data and “learn” underlying patterns, leading to more accurate predictions. As the child welfare field has become increasingly interested in using predictive analytics to better inform prevention strategies, these models can be used to predict which families would most benefit from prevention supports. These tools will allow for a more upstream approach and the ability to intervene with a family BEFORE a crisis occurs.  

9. CDC Resource Addresses Pandemic-Related Youth Mental Health Challenges (Children’s Bureau Express)

“While its impact has been quite visible through the news media and the restructuring of family, work, and school life across the globe, less visible are the mental health effects the pandemic has had on individuals, particularly children, youth, and young adults. Recognizing the social, emotional, and mental health challenges facing this young population, the Centers for Disease Control and Prevention (CDC) developed a resource kit for parents, caregivers, and other adults to support their efforts to identify and respond to these challenges and ensure the well-being of the young people in their lives. This toolkit is also beneficial for those caring for and working with families involved with child welfare, as these families are already experiencing increased stress and trauma made worse by the loss of face-to-face supports, meaningful family visits, and school and work adjustments.”

TexProtects Takeaway: Unfortunately, we are already beginning to see the devastating effects COVID-19 has had on young people in the US. Youth have faced isolation, loss of normalcy, and educational setbacks during the pandemic. Each one of us has a role to play in supporting the young people in our lives and our communities. This CDC resource can help and can be accessed here.

10. A Resource Guide for Developing Integrated Strategies to Support the Social and Emotional Wellness of Children (ACF)

This resource guide first emphasizes the importance of supporting young children’s social and emotional needs through an integrated early childhood system of care, which involves children, families, and providers. The guide goes on to discuss considerations for implementing social-emotional early childhood initiatives, including the use of theories of change and logic models, stage-based frameworks, prevention-based approaches, and professional development strategies for caregivers. Each initiative discussed is supported by both implementation strategies and implementation examples.

TexProtects Takeaway: As young children develop, their early emotional experiences literally become embedded in the architecture of their brains (National Scientific Council on the Developing Child, 2004, p.1). With this knowledge, “identifying strategies to support a child’s social and emotional well-being is just as important as his or her physical health.”