Child welfare and early childhood media to watch, read, and listen to during this time of social distancing.*
Help us keep our mission moving by staying informed about how to keep all children safe, nurtured, and resilient. Here is a short list, curated by our team, of the most compelling educational documentaries, shows, podcasts and books related to our mission to protect children from the trauma of abuse and neglect. With the practice of social distancing and more time at home in the days and weeks ahead, we encourage you to fill some extra down time you may have with mission-driven media that helps you stay engaged and connected to our work.
Available on Netflix:
The Beginning of Life – This series uses breakthroughs in technology and neuroscience to show the importance of adult-child interaction, a child’s stages of learning, and the challenges of becoming a parent.
Babies – The producers of this series followed 15 infants and spoke to 36 scientists over one year to explore the groundbreaking science behind how infants develop.
Note: The following two suggestions have content warnings for graphic depictions of child maltreatment.
I Am Jane Doe — A documentary about child sex trafficking that highlights real cases, including a recent case that involved Congress.
The Trials of Gabriel Fernandez – This documentary peels back the curtain on a young child’s brutal murder and the public trials of his guardians and the social workers tasked with checking in on him.
Available on Hulu:
Foster – A documentary that follows stories of foster children and teens, their foster parents, and former foster youth in the L.A. County child welfare system.
Available on Amazon Video:
Instant Family – This feel-good movie is on the lighter side and based on a true story about foster care parents and the three siblings they took in from the foster system. It also highlights the process and case management aspects of foster care.
Books and Audiobooks Available on Amazon:
Note: Amazon is limiting all deliveries to essential items but their e-books and audiobook offerings are still available for purchase!
Cradle to Kindergarten: A New Plan to Combat Inequality – This book presents a blueprint for fulfilling the promise of reducing educational and economic inequalities for children by expanding access to education and financial resources at a critical stage of child development.
Note: The following suggestions also have content warnings for graphic depictions of child maltreatment and other trauma.
Spilled Milk: Based On A True Story – This is an easy but powerful read. It’s a real story that highlights the cracks in Child Protective Services reporting and investigating, politics, and the impact of Adverse Childhood Experiences on a child throughout their lifespan. (Also available as an audiobook.)
Child Welfare information Gateway Podcast Series – This podcasts series provides interviews and panel conversations for child welfare and social work professional. It covers a wide range of topics like implementing evidence-based programs, tribal courts and child welfare, reunifications, and other issues surrounding casework.
The Brain Architects – This new podcast from the Center on the Developing Child at Harvard University focuses on topics that surround the developing child’s brain from brain architecture to toxic stress to serve and return.
*On March 19, Governor Greg Abbott and Dr. John Hellerstadt, Commissioner of the Department of State Health Services, declared a state of public health disaster for Texas. Apart from encouraging hygiene and cleanliness practices, limiting gatherings to no more than 10 people, and shuttering dine-in options at restaurants, we are being asked to do our part for the community by staying socially isolated except for essential trips. Spending a lot of time stuck inside during the COVID-19 health crisis is important to “flatten the curve” to slow the virus’s infection rate.
A study released last week shows that 63% of pediatricians reported utilizing standardized developmental screening tools in 2016. That’s up 21% since 2002, but well short of the American Academy of Pediatrics recommendation that ALL children be screened at 9, 18, and 30 months.
TexProtects’ Takeaway: As part of our Prenatal to Three Policy Agenda, TexProtects will be working throughout the interim and into next session on ways to increase the rates and quality of developmental screenings, as well as ensuring that appropriate referrals are provided in response to those screenings. It’s about getting families to the right community resources at the right time!
A randomized control trial of 742 pregnant, low-income women with no previous live births found that children whose mothers had participated in nurse home visiting demonstrated better receptive language, math achievement, and a number of other secondary cognitive-related outcomes.
An 18-year follow-up of 618 out of 742 low-income, primarily African-American mothers with no previous live births enrolled in an randomized clinical trial of a prenatal and infancy nurse home visiting program concluded that nurse-visited women incurred $17,310 less in public benefit costs compared with program costs of $12,578.
TexProtects’ Takeaway: Since its inception, TexProtects has advocated for the expansion of evidence-based home visiting programs like Nurse-Family Partnership: they have an amazing return on investment and positive outcomes across multiple domains and two generations. Despite significant progress, less than 4% of families who could benefit from these programs have access to them. Expanding home visiting programs through the Prevention and Intervention Division, the Family First Prevention Services Act, and other funders is a critical part of our Prenatal to Three policy agenda.
Child Trends fielded the 2019 Survey of Child Welfare Agency Policies and Practices for Infants and Toddlers in–or who are candidates for–Foster Care to understand what policies and services are already in place for infants and toddlers involved in and at risk of entering foster care, as well as to understand where the child welfare field can leverage the opportunities provided by the Family First Prevention Services Act (FFPSA).
TexProtects’ Takeaway: With FFPSA, states have a new opportunity to use federal funds to support the children and families who are at risk of becoming involved with the foster care system. Texas will likely need to increase its capacity to provide a robust array of services for infants and toddlers who are candidates for foster care, as well as their families. FFPSA is included in interim charges to multiple committees that will hold hearings in the coming months to monitor the Department of Family and Protective Service’s (DFPS) planning and implementation. Stay tuned for ways you can participate and speak up for Texas children.
Child Trends’ Lauren Supplee recently appeared on the Freakonomics podcast to discuss evidence-based policy and implementation science, the study of what factors make it possible to scale up research-tested programs to serve larger populations in different communities.
TexProtects’ Takeaway: Evidence-based policy ensures that children and families benefit from proven programs. However, implementation matters! Investments in continued evaluation, adaptations for unique populations, and model fidelity are critical components in taking what works in one place to a larger scale. Thankfully, innovators at Child Trends as well as the Child and Family Research Partnership (CFRP) at the University of Texas are leading the way in designing solutions for these challenges.
New America makes eight recommendations to further policy actions that will help “America’s children become lifelong learners who are able to think critically and inventively, manage their emotions and impulses, and make smart decisions.”
TexProtects’ Takeaway: There is much that can be done to support the healthy development of a child’s brain in the early years, both inside and outside the home. TexProtects appreciates the recommendations to support two-generation programs (like home visiting) and ensure that they are integrated with other early childhood systems, as well as the recommendation to identify stable funding sources for early education and care so that parents can plan ahead, knowing they will have access to high quality and affordable care while they are at work.
“Unsurprisingly, it is mothers’ employment that suffers most when families are unable to find a child care program that suits their needs. The child care crisis not only affects families’ bottom lines; it also costs the economy $57 billion in annual lost revenue, wages, and productivity.”
TexProtects’ Takeaway: Texas policymakers must do more in the upcoming legislative session to ensure low-income families are able to receive child care assistance, which is critical for the parents’ ability to support their families. High-quality child care is also critical for children’s safety and brain development. 16,379 children on wait lists for child care assistance (as of February 2019) is too many.
TexProtects is pleased to launch our latest monthly feature, Frontline for Children. In it, we will share the newest and most noteworthy child protection research and resources to keep you in the know and inform your work. Our new partnership with Child Trends–the nation’s leading nonprofit research organization focused exclusively on improving the lives and prospects of children, youth, and their families–has expanded our ability to ensure that we are able to keep you connected to innovations and data that will inform policy and program to ensure that every child is safe, nurtured, and resilient.
“’Ideally, pediatricians work closely with therapists and psychiatrists when treating children who have been maltreated, but we know this is not always possible,’ Dr. Keeshin said. ‘This report offers pediatricians some tools to help children and families address mental health problems that stem from maltreatment.”
TexProtects’ Takeaway: To ensure the most effective interventions for healing and to minimize the use of psychotropic medications, medical, social, and trauma histories should be integrated when working with children who have experienced maltreatment.
Features an interactive map of infant health outcomes by race and ethnicity, across states. In Texas, the state average infant mortality rate is 5.8 per 1000; however, for African American/black infants the rate is 9.8 per 1000. Similarly, 8.4% of Texas infants are born low birth weight; however, that rate jumps to 12.4% for African American/black infants.
TexProtects’ Takeaway: Infant health outcomes are closely tied to a mother’s health during pregnancy. Texas must do more to ensure equitable access to maternal care and home visiting programs to ensure healthy beginnings for our children, particularly in our rural communities where there are the greatest disparities.
Child Trends analyzed data from the 2016-2017 National Survey of Children’s Health (NSCH), which asks parents or guardians to report whether their child has experienced any of nine out of the 10 ACEs. We found that the prevalence of ACEs is higher among children with special health care needs than among their peers.
TexProtects’ Takeaway: Trauma-informed practices should be incorporated into programs and services for these children and their caregivers to mitigate the long term-impacts associated with adverse childhood experiences. Children with SHCN are three to four times more likely to experience abuse and neglect which make up five of the ACEs.
“The U.S. is already pouring billions of dollars into the current system through government expenditures and parental contributions. And yet the current system is failing parents by stretching family budgets and keeping millions out of the labor force.”
TexProtects’ Takeaway: High quality early childhood education has a positive return on investment in terms of societal benefits as well as increases in revenue and savings for government. Our Prenatal to Three Initiative with Texans Care for Children and Children at Risk has set a policy agenda to further improve this system in Texas.
Offers an estimated distribution of the $550 million increase in CCDBG funds across states in 2020. Texas is estimated to receive $56,939,000 in additional funding.
TexProtects’ Takeaway: CCBDG is the largest source of federal funding for childcare; however, even with this increase, only a fraction of eligible children will have access.
New legislation bolsters support for the foster care system by establishing funds to help states implement prevention pieces of the 2018 Family First Act.
TexProtects’ Takeaway: These funds will allow Texas to invest in family preservation by offering high risk families evidence-based mental health, substance use, and parenting programs. The Family First Prevention Services Act is an unprecedented opportunity that should be a top priority for agencies and lawmakers involved in child protection.
The 86th Interim Committee Charges and Child Protection
The Texas Legislative Session takes place for 140 days every two years; but it may be a misconception to call it a part-time legislature. The laws passed during the session are the result of work that starts during the interim – the more than one-and-a-half years between the end of one session and the beginning of another.
Although the legislative session gets the majority of the attention, it’s important to understand the significance and opportunities of the interim. During this time, advocates strengthen relationships with legislators and their staff and educate them on issues that will inform their work and the bills they support the following session.
The Governor and the Lieutenant Governor kick off the interim with charges that instruct committees in the House and Senate on what to monitor and examine before the next session. The committees engage in discussions, research and hold public hearings to produce an interim report, inclusive of recommendations forthe next legislature. Charges typically include directions to monitor the implementation of bills passed by the previous legislature as well as directives toward emerging priorities and issues.
Lt. Governor Dan Patrick released Senate charges on Oct. 30, 2019. Most of the charges that affect child protection went to the Senate Health and Human Services committee chaired by Sen. Lois Kolkhorst (R-Brenham). Child protection related charges in the Senate include the following:
Rural Health:
Examine and determine ways to improve health care delivery in rural and medically underserved areas of the state.
Determine whether additional funding provided during the 86th Legislative Session has helped to ensure more accessible and quality health care in rural areas.
Strengthening Families:
Examine Department of Family Protective Services (DFPS) procedures and grounds for placing a child into the child welfare system and the termination of parental rights.
Make recommendations on ways to protect children who are involved with the child welfare system while preserving families under state law.
Identify ways faith-based and other community organizations can assist in preserving or reunifying families involved with the child welfare system.
Monitoring:
The continued implementation of Senate Bill 11 (85th Legislature) and Community-Based Care by DFPS,
Child Care Quality and Safety, and
Maternal mortality and infant health initiatives, including the women’s health programs administered by the Health and Human Services Commission (HHSC).
On the House side, this interim has presented some unique challenges. The first few months of the interim were disrupted by a political scandal involving Rep. Dennis Bonnen (R-Angleton) that resulted in his decision to resign his seat, which he has held since 1997. This also means he is leaving his position as Speaker of the House for the next session. This creates some challenges; there is less clarity about leadership and priorities for next session. But there also is an opportunity for the House Committees to pursue their work during the interim given more autonomy.
Adding to challenges in the House is the absence of Rep. John Zerwas (R-Richmond), a longtime House member and chair of the Appropriations Committee – and a dear champion for child protection issues. He will not be seeking reelection – leaving a vacancy on that committee that only the Speaker of the House can fill. With new leadership, every week counts. The Appropriations Committee typically spends the 18 months between sessions to prepare the budget. This year’s budget exceeded $200 billion and the budget is the only bill that every Legislature is required to pass. The appointment of the Appropriations chair will be critical to the political dynamics and the efficiency of the House during this interim.
Challenges aside, Speaker Bonnen released his full list of more than 200 interim charges on Nov. 25 of 2019.
House Charges related to child protection spread across several committees including Appropriations, Human Services, Public Education, Public Health and others. In addition to monitoring charges related to many of the child protection bills from last session, TexProtects is particularly excited that the House is studying the following topics over this interim.
Early Childhood Brain Health:
Examine state investments in the health and brain development of babies and toddlers including Early Childhood Intervention and other early childhood programs for children in the first three years.
Evaluate opportunities to boost child outcomes and achieve longer term savings (Appropriations Article II subcommittee).
Family First Prevention Services Act:
Review how Texas is preparing for state and federal budgetary changes that impact the state health programs including the Family First Prevention Services Act (joint charge for Appropriations Article II and Human Services Committee).
Community Based Care:
Monitor the implementation and expansion of Community Based Care by DFPS (joint charge for Appropriations Article II and the Human Services Committee).
Monitoring:
Former Foster Youth and Post-Permanency Care (HB53, HB72, HB123, HB1702),
Child Care Quality and Safety (SB568, SB569, SB706, HB680),
Behavioral Health in Schools (HB18, HB19, HB906),
Maternal and Child Health (HB253, SB436, SB748, SB749), and
Rural Health (SB633, SB670).
As lawmakers return from the holiday break, the committees will begin posting notices for hearings on these charges. Stay tuned for our next blog in this series which will outline ways that you can get involved and work alongside TexProtects to ensure that every child (and their family) is safe, nurtured, and resilient.
Today’s post looks at bills affecting behavioral health and trauma. For a PDF version of this post, click here.
Behavioral Health and Trauma Background
Challenges with mental health can be both a cause and a consequence of early childhood adversity. Therefore, both prevention and healing require adequate systems of care to ensure children and their parents have access to mental health care and services that incorporate trauma-informed approaches that can be both healing and protective.
In the 86th Legislative Session and in the wake of the shooting at Santa Fe High School and Hurricane Harvey, the momentum around school safety and trauma offered an opportunity to take a meaningful look at the capacity issues in our communities and the ways in which our schools might better facilitate access to care and incorporate strategies that allow children with a trauma history to engage productively and thrive.
Schools are often the first point of contact for students with behavioral health issues, and undiagnosed mental health conditions can negatively impact the academic performance, behavior, and school attendance of students.
Like all diseases, care works best with early intervention when symptoms are less severe and there is less need for more intense treatments, specialists, and medications. However, most schools lack adequate training or staff to address student needs, and most communities in Texas have a shortage of mental health and substance use providers to which families and children might be referred for treatment.
Stress and trauma, both acute (e.g. Hurricane Harvey) and chronic (e.g. abuse/neglect), can place children in “fight or flight” mode. This course overwhelms the brain, including its stress hormone cortisol, and impairs a child’s ability to self-regulate and engage in higher-order thinking. These adverse childhood experiences can disrupt normal development and lead to a higher risk of both mental challenges (e.g. depression and suicidality) and physical challenges (e.g. heart disease and stroke) throughout the lifespan. However, the negative impacts can be mitigated if students are equipped with protective factors through healthy relationships, safe environments and access to care, when needed.
Behavioral health care investments and programs are spread across state agencies including:
Health and Human Services Commission
Department of State Health Services
Department of Family and Protective Services
Texas Department of Criminal Justice
Texas Juvenile Justice Department
Texas Education Agency
Texas Department of Housing and Community Affairs
Texas Veterans Commission
Texas Workforce Commission
In addition to state entities, behavioral health services are provided at the local level in jails, hospital emergency departments, schools, local mental health authorities, various nonprofit agencies, public health clinics and other settings, with people frequently moving between service systems.
The goal of behavioral health policies is recovery. Recovery is an ongoing process that enables individuals to mitigate the negative effects of their challenges and trauma and become empowered to make beneficial choices, engage in healthy relationships and create a successful life.
Behavioral Health in the 86th texas legislature
Top-Priority Bills Passed
House Bill 1 – The General Appropriations Act
Champions: Sen. Jane Nelson and Rep. John Zerwas
HB 1 funding for behavioral health includes programs or services directly or indirectly related to the research, prevention, or detection of mental disorders and disabilities, and all services necessary to treat, care for, supervise, and rehabilitate persons who have a mental disorder or disability, including persons whose mental disorders or disabilities result from alcoholism or drug addiction. Funding for behavioral healthcare to support programs at 23 state agencies and associated costs within Medicaid and the Children’s Health Insurance Program total $7.8 billion for 2020-2021. Some of these services include:
funding for inpatient client services at state hospitals and community hospitals;
deferred maintenance projects at state mental health hospitals;
outpatient services provided through local mental health authorities and local behavioral health authorities;
substance abuse prevention, intervention, and treatment services for adults and children;
mental healthcare and substance abuse treatment for incarcerated offenders;
mental healthcare services for veterans; and
Mental Health Care Consortium.
Some notable increases in investment are found in the table below:
Behavioral Health
2020-21 Base Budget
Additional Investment and House Bill 1 FINAL
% Difference
Department of Family and Protective Services for Purchased Client Services
$52.8 million
$24.4 million; $77.3 million total
46.2% +
Health and Human Services Commission
$3 billion
$303.7 million; $3.3 billion total
10.3% +
University of Texas Health Science Center at Tyler
$8 million
$5.5 million; $13.5 million total
68.3% +
* Higher Education Coordinating Board
$0
$100 million total
100% +
Department of Criminal Justice
$515.8 million
$9.8 million; $525.6 million total
1.9% +
Juvenile Justice Department
$175.5 million
$3.6 million; $179.1 million
2.0% +
*Funds available to the newly created Texas Mental Health Consortium to be distributed to health-related institutions of higher education for expanding the mental health workforce and for psychiatric fellowships. The Consortium is created through SB 11.
Safe and Healthy Schools Initiatives
Funding for school safety programs includes an additional $343.5 million to expand children’s community mental health, grants to mental health professionals at local mental health authorities provided by HB 19, school safety infrastructure enhancements, a new school safety allotment provided by SB 11; school district reimbursement of post-disaster expenditures, and customized school safety programming and other services.
HB 18 – Trauma Informed Schools
Champions – Rep. Four Price & Sen. Kirk Watson
HB 18 will increase awareness of mental health among public school students and educators, reduce the stigma of mental health issues, and provide more resources on mental health and substance abuse for educators. Through integration in district policy, staff training and continuing education requirements, HB 18 ensures that school staff are adequately trained to understand the impact of trauma on students, implement strategies to minimize the negative impacts, and maximize academic opportunities in an environment of safety and connection, making referrals when needed and with parental consent.
Other Priority Bills Passed
TexProtects Goal – Address students’ mental health needs by increasing access to care and implementing trauma-informed approaches in school environments
House Bill 19 – Rep. Four Price / Sen. Kirk Watson
HB 19 requires local mental health authorities to employ a nonphysician mental health professional to serve as a mental health and substance use resource for school districts. These professionals will act as a resource for school district personnel by helping increase awareness of mental health and co-occurring mental health and substance use disorders, assisting with the implementation of mental health or substance use initiatives under state law or agency rules, and ensuring awareness of certain recommended programs and practices and treatment programs available in the district. The bill will also require the professionals to help personnel facilitate on a monthly basis training regarding mental health first aid, the effects of grief and trauma, and prevention and intervention programs that will help students cope with pressure to use illicit substances.
HB 811 – Rep. James White / Sen. royce West
HB 811 requires that school districts take into consideration whether a child is in the conservatorship of the state or is homeless when making decisions concerning disciplinary actions including suspension, removal to a disciplinary alternative education program, expulsion or placement in a juvenile justice alternative education program, regardless of whether the decision concerned a mandatory or discretionary action.
HB 906 – Rep. Senfronia Thompson / Sen. Beverly Powell
HB 906 establishes the Collaborative Task Force on Public School Mental Health Services to study and evaluate state-funded mental health services provided at school districts or open-enrollment charter schools. The task force will also evaluate mental health services training provided to educators and the impact of the provided mental health services. The task force will share its findings and recommendations with the governor, lieutenant governor, House speaker, and the TEA by Nov. 1 in each even numbered year until 2025.
SB 11 – Sen. Larry Taylor / Rep. Greg Bonnen
SB 11 is the 86th Legislature’s answer to increasing school safety. It includes many provisions related to safety, security, and emergency preparedness and response. In addition, the bill requires a trauma-informed care policy to address methods for increasing staff and parent awareness of trauma-informed care and the implementation of trauma-informed practices and care by district and campus staff. The policy will also address available counseling options for students affected by trauma and grief. In addition, SB 11, amended with language from Sen. Nelson’s SB 10, creates the Texas Child Mental Health Care Consortium to leverage the expertise and capacity of the health-related institutions of higher education in order to address urgent mental health challenges and improve the mental health care system in this state in relation to children and adolescents.
SB 712 – Sen. Eddie Lucio Jr. / Rep. Morgan Meyer
SB 712 provides guidance by naming extreme aversive interventions that may not be used on any student, under any circumstances. By clarifying what behavior modification techniques are prohibited and providing direction on positive alternatives. SB 712 will improve the safety and wellbeing of students, especially those with special needs. The companion to this bill is HB 3630.
TexProtects Goal – Improve access to mental health care, substance use prevention and treatment, and evidence-based treatments and approaches for survivors of childhood adversity
HB 2813 – Rep. Four Price / Sen. Jane Nelson
HB 2813 ensures the continued existence of the Texas Statewide Behavioral Health Council by codifying it in statute. The council is charged with developing and monitoring the implementation of a five-year statewide behavioral health strategic plan and developing a biennial coordinated statewide behavioral health expenditure proposal. This work helps state agencies coordinate and reduces duplication of services, improves the quality and accessibility of services, and saves taxpayer dollars.
SB 429 – Sen. Eddie Lucio, Jr. / Rep. Eddie Lucio III
SB 429 requires the Statewide Behavioral Health Coordinating Council, under the direction of the Health and Human Services Commission (HHSC), to develop a comprehensive plan to increase and improve the workforce in Texas to serve individuals with mental health and substance use issues. By Sept 1, 2020, HHSC will need to start implementing the plan.
SB 633 – Sen. Lois Kolkhorst / Rep. William Lambert
SB 633 requires HHSC to form local mental health authority (LMHA) groups in rural areas and develop a mental health services development plan for each group. Public mental health services are primarily provided through HHSC contracts with LMHAs. These entities provide or arrange crisis, community mental health, and substance use services; jail assessments; and services for individuals with intellectual and developmental disabilities. This bill increases service access, especially in rural counties, by requiring regional coordination and planning to reduce government costs and negative impacts to individuals in crisis.
SB 821 – Sen. Jane Nelson / Rep. Four Price
SB 821 amends a children’s advocacy center’s duties and a multidisciplinary team’s membership and response. These centers assess victims of child abuse and their families to determine their need for services related to the investigation of child abuse and provide those services. This bill updates the Family Code to more clearly align statute with current practices, standards, services, and operations of children’s advocacy centers, increase accountability, and strengthen access to services.
SB 1177 – Sen. JosÉ Menéndez / Rep. toni Rose
SB 1177 permits a Medicaid Managed Care Organization to offer medically appropriate, cost-effective, and evidence-based services from a list approved by the state Medicaid managed care advisory committee and included in the contract in lieu of mental health or substance use disorder services specified in the state Medicaid plan. This will provide flexibility to providers and access to evidence-based and cost-effective services without additional cost to the state.
SB 1564 – Sen. Royce West / Rep. Stephanie Klick
SB1564 aligns Texas Medicaid policy with federal law by using the federal definition of a “qualifying practitioner.” This will allow more practitioners to prescribe and be reimbursed for buprenorphine, a common medication-assisted treatment for substance use disorders. Currently, a large number of Texans who have a substance use disorder do not have access to providers who are able to prescribe them the common opioid antagonist buprenorphine.
Missed Opportunities for Behavioral Health and Trauma
Creating the Texas Mental and Behavioral Health Research Institute
Through HB 10, this research institute would have been able to lead the charge on child and adolescent mental health by funding research, increasing awareness of best practices, and fostering statewide collaborations. This institute would coordinate with the Mental Health Care Consortium to accelerate community access to information, treatments, and training related to behavioral health and substance use. The related HJR 5 would have created a revenue source for this research and increased access to care.
Online reprints must link back to this blog post; paper reprints must mention our websites (texprotects.org and texprotects.blog)
It may not be reprinted on any website or other forum that is contrary to TexProtects’ mission of child protection or that promotes illegal activity.
Photo from dallasnews.com
By Sophie Phillips, CEO, TexProtects
In the past 12 months, despite an executive order to end the policy allowing the separation of migrant children from their parents, followed by a judicial order to reunify those families, our government has continued to separate and traumatize children.
One might ask how this tragedy continues to occur – you could be forgiven for thinking both orders would have ended the matter. However, that is not the situation we find ourselves in, and certainly not the situation the 5,700 children in Texas shelters are in.
There were loopholes in the court’s decision: children could still be separated from parents with criminal histories, or considered dangerous to the child, or if they suffered communicable diseases.
All seemingly reasonable stipulations, except that advocacy groups who are face to face with these families are reporting the government is inappropriately exploiting those loopholes – reducing the orders to ineffective words on paper. Examples include children taken away from a parent for violations such as driving with an expired license or experiencing a brief hospitalization. They can also be separated from other relatives such as siblings or grandparents. We would never tolerate such flimsy pretenses for taking away children from U.S. citizens.
This result has been more than 700 immigrant families separated after the policy supposedly ended.
The organization I lead – TexProtects, the Texas chapter of Prevent Child Abuse America – makes no claim to immigration policy expertise. We’ll leave the crafting of immigration solutions to those who do.
Instead, our expertise is in children and policy that impacts them – specifically, how to keep children safe from trauma. And make no mistake – being separated from a parent, regardless of the situation, is itself an extreme trauma.
TexProtects fights tirelessly to make families stronger and more resilient, helping prevent crises that lead to child removal. Putting children in foster care must be the measure of last resort – all options for keeping a child safely with his or her parents must be explored before taking the extreme measure of separation.
We’ve worked to embed this philosophy within our government, gaining lawmakers’ support for prevention programs and strengthening family preservation services.
That’s why the current policy is unthinkable. We are witnessing the government, rather than protecting children from harm, actually inflicting trauma upon children as an instrument of policy.
The trauma goes beyond taking children away from parents, which is painful enough. Recent news reports have exposed children, including toddlers, being warehoused in horrific and dangerously unsanitary conditions.
This will not be a minor event in these children’s lives. During the Texas Legislative Session, TexProtects educated lawmakers across the state on the consequences of “adverse childhood experiences” (ACEs) – severe events such as mental illness, violence or substance use within the home, an incarcerated caregiver, or abuse or neglect.
In our ACEs Uncovered report earlier this year (http://bit.ly/acesuncovered), we outlined long-term consequences that can result from such experiences.
Research has shown that left untreated, people who suffered multiple adverse childhood experiences had, in adulthood, higher rates of disease, disabilities, social and mental health problems including suicides and suicide attempts, depression, a high number of sexual partners, sexually transmitted diseases, obesity, smoking, substance abuse, and early death.
Now, we – through our government – are creating more children who, assuming they survive this ordeal, could grow up with such health consequences.
As said, TexProtects will “stay in our lane” on immigration and refugee policy and refrain from suggesting what actions should be taken.
However, we have a moral imperative to rule out what action should not be taken: willfully traumatizing children absolutely cannot be an option.
Even if the policy produced the president’s desired result of fewer border crossings (it has not, as detentions and migrant deaths have surged again), hurting children would still be unacceptable.
Americans are outraged when parents abuse or neglect children. We must be equally outraged when our government does the same.
In 2018, there were 280,874 reports of suspected child abuse/neglect to Statewide Intake. 66,370 or 24% of those reports were confirmed.
Child maltreatment will cost Texas an estimated $1.75 billion in CPS expenditures in FY 2019 and over $55 billion in total costs across the victims’ lifetimes.
43% of children who complete Family Based Safety Services programming with their families are reconfirmed as victims of abuse within 5 years.
Today’s post looks at bills affecting Child Protection Systems, and next we will conclude with Mental Health and Trauma. For a PDF version of this post, click here.
Child Protection Systems Background
In the 85th Texas Legislative Session (2017), Governor Greg Abbott declared child protection to be an emergency item. That session resulted in unprecedented child protective services (CPS) reforms and investments including:
Increases in kinship care through enhanced financial assistance;
Expansion of community-based foster care;
Treatment-based foster family care in most regions;
Salary increases; and
Additional hires that lowered caseloads
While those reforms made real progress for the safety of Texas children, there was significant work left to do in the 86th Legislative Session (2019) and much less political will to do it. However, opportunities for continued investment in best practice and improvements to child safety were plentiful. Opportunities presented to the 86th Legislature included:
Maintenance – In order to maintain the salary increases, caseloads, and investments in community-based care despite a growing child population and increasing number of child abuse reports and victims, lawmakers had to invest additional dollars or risk losing ground on the changes made last session.
Pressure from the federal class action lawsuit – In 2015, Judge Janis Jack proposed significant changes to the CPS system to ensure the constitutional rights and due process of children in the care of the state in response to a class action lawsuit filed on behalf of 12,000 children in long-term foster care. While some of the proposals were overturned by the 5th Circuit Court of Appeals as overreach, the findings have consistently made clear that the state has work to do to ensure the safety, health, and constitutional rights of children in the conservatorship of the state.
Family First Prevention Services Act – This session presented a new opportunity to leverage federal funds made available through the federal Family First Prevention Services Act in two significant ways. First, it makes available new prevention funding to help strengthen families before a crisis by investing in mental health, substance use prevention and treatment, and in-home parenting programs. Second, it requires that federal dollars for children in care be spent on family-like settings and treatment centers that are offering accredited and high-quality care. In order to leverage those dollars most effectively, the Legislature had the opportunity to invest in planning and improved quality that would ready the state for implementation.
Child Protection in the 86th texas legislature
Top-Priority Bills Passed
House Bill 1 – The General Appropriations Act
Champions: Sen. Jane Nelson, Sen. Lois Kolkhorst, Rep. John Zerwas, REp. Sarah DAvis
General Overview – Although we did not see the urgent and comprehensive focus on child welfare this session that we did in the 85th, there was continued attention on child protection issues. Lawmakers viewed their role this session as one of a gatekeeper – ensuring that the large-scale changes of last session continued to move forward and that implementation was monitored closely. Despite a cut in state funds, when federal funds were included, the Department of Family and Protective Services (DFPS) budget grew by 6.1%. In their budget, lawmakers showed continued support for community-based care, increasing the use of kinship care, and the needs of older foster youth.
Area of Budget
2020-21 Base Budget
House Bill 1 FINAL
% Difference
Child Protective Services
$3.7 billion
$3.8 billion
2.2% +
Statewide Intake – At DFPS, statewide intake is the front door for the public to report suspected abuse. Additional investments will improve child safety by minimizing hold times on the statewide intake line. Long wait times can result in dropped calls and increase the risk of abuse going unreported. Investments in this biennium will support salary increases of $6,000, resulting in lower turnover and subsequently, a higher level of experience in the workforce.
Area of Budget
2020-21 Base Budget
Additional Investment & House Bill 1 Final
% Difference
Statewide Intake
$45.9 million
$4.3 million $50.2 million total
8.5% +
Caseloads – The maintenance of manageable caseloads is paramount to ensuring the safety of children who are interacting with the child protection system. Investments for CPS direct delivery staff will help to maintain lower caseloads per worker for most caseworkers.
Area of Budget
2021 Base Budget & Average Daily Caseload
Additional Investment, House Bill 1 Final, & Projected Average Daily Caseload
% Difference
CPS Direct Delivery Staff
$1.4 billion
$148 million $1.6 billion total
9.1%
CPS Investigations
13.6 cases
13.6 billion
CPS Family Based Safety Services
10.2 cases
9.3 cases
CPS Conservatorship
25 cases
23.5 cases
Projected caseloads are included in HB 1 and are estimates from the Legislative Budget Board; DFPS will prepare its own analysis.
Community-Based Care – The Legislature provided funding to continue rolling out Community-Based Care (CBC), formerly named “Foster Care Redesign,” which changes the way the state delivers foster care services. Under CBC, a private contractor (called a “Single Source Continuum Contractor [SSCC]”) is responsible for building and managing foster care capacity and placements for a specific service region in the state. CBC has been rolled out in Region 3B (seven-county area including Tarrant County), Region 2 (30-county area in North and North-central Texas that includes Wichita Falls and Abilene) and Region 8A (Bexar County). Additional investments this session will provide resources to expand into Region 8B (16 counties surrounding Bexar), and Region 1 (41 counties in Panhandle), as well as add case management work to the existing contracts.
2020-21 Base Budget
Additional Investment and House Bill 1 Final
% Difference
Community-Based Care
$434.5 million
$66.9 million $501.4 million total
15.4% +0
Foster Care Provider Payments – Foster care families and other providers are essential to building capacity in the foster care system so it meets the current demand, as well as ensuring positive outcomes for children and youth in conservatorship of the state. The Legislature provided additional investment of $12 million in foster family support, certain residential providers and emergency shelters.
Supervised Independent Living (SIL) and Preparation for Adult Living (PAL) – DFPS provides both SIL and PAL programs to assist older youth in their transition toward a successful and self-sufficient adulthood. Without supportive housing and access to training and resources, youth are more likely to be involved in the criminal justice system, are at higher risk of teen pregnancy, have lower high school graduation rates and are more likely to experience homelessness and unemployment. SIL increases of $1.8 million will support case management services for children with more complex needs and increase the rates paid to providers for services. PAL increases of $1.5 million will support 10 additional specialist positions.
HB 475
Champions – Rep. Donna Howard and SEn. Kirk Watson
HB 475 will ensure that pregnant and parenting foster youth receive basic information about ways to keep their child safe and promote healthy attachment, child development, and maternal health if they cannot or choose not to participate in Project Helping through Intervention and Prevention (HIP). Project HIP makes available evidence-based, in-home parenting programs to pregnant and parenting foster youth; however, it is voluntary and not currently available statewide.
Other Priority Bills Passed
TexProtects Goal – Efficiency and Best Practices in CPS and Foster Care
Senate Bill 195 – Sen. Charles Perry / Rep. Tan Parker
SB 195 requires DFPS to update their case tracking system to allow DFPS to keep statistics regarding alcohol and controlled substances when funds are available. This detailed information will allow the department to better understand the correlations between substance use and child abuse/neglect as well as the impacts of prenatal exposure to alcohol and controlled substances on children.
SB 781 – Sen. Lois Kolkhorst / Rep. Ben Leman
SB 781 will establish regulations for child safety, runaway prevention, quality contracting, and strategic planning for facilities that provide 24-hour care to children such as residential treatment centers and emergency shelters. The strategic plan outlined in the bill will help ensure that state agencies are prepared for the implementation of the federal Family First Prevention Services Act.
TexProtects Goal – Increased Use of Kinship Care
HB 1884 – Rep. Ina Minjarez / Sen. Carol Alvarado
HB 1884 requires that when a child is placed with a relative or other designated caregiver, the caregiver is informed, by the court, of the option to become verified by a licensed child-placing agency and of the permanency care assistance program. This opportunity can make available additional resources to the caregiver and as a result, increase stability for children.
HB 3390 – Rep. Scott Sanford / Sen. Angela Paxton
HB 3390 ensures that adequate steps are taken to identify any potential caregiver for a child before that child is placed in foster care. The bill also expands the definition of a designated caregiver to include a person who had a longstanding and significant relationship with the family of the child and requires that the child and parent both be asked to share any relatives or potential caregivers.
TexProtects Goal – Improved Services to Foster Youth Aging Out of Care
HB 53 – Rep. Ina Minjarez / Sen. Beverly Powell
HB 53 will require DFPS to collaborate with the Office of Consumer Credit Commissioner and the State Securities Board to develop an expanded financial literacy education program for foster youth. Experiential training will include filing taxes, using insurance, identity and credit theft, budgeting and civic engagement.
HB 123 – Rep. James White / Sen. Kirk Watson
HB 123 eases the burden of obtaining personal identification documents for foster children by waiving the fee, exempting the requirement for a parent signature and allowing the use of the DFPS regional office in lieu of a permanent address.
HB 1702 – Rep. Donna Howard / Sen. Kelly Hancock
HB 1702 requires institutions of higher education to make publicly available the contact information for their foster care liaison officer and information regarding support services available to students who were formerly in conservatorship. In addition, the name of any student who was formerly in conservatorship will be provided to the foster care liaison officer by their institution at the beginning of each semester.
TexProtects Goal – Cross-Sector Collaboration and Child Protection Systems
HB 72 – Rep. James White / Sen. Angela Paxton
HB 72 allows adopted children with chronic health conditions to continue to have access to the healthcare they would have had if they had remained in conservatorship if the adoptive parents opt-in. Foster children who transition into adoptive placement often experience gaps in medical care, and these gaps can have serious negative health consequences for children with severe disabilities.
HB 621 – Rep. Victoria Neave / Sen. Judith Zaffirini
HB 621 expands existing statutory protections against employer retaliation for a professional’s good faith reporting of child abuse or neglect by defining “adverse employment action” to mean any action that affected an employee’s compensation, promotion, transfer, work assignment, or performance evaluation, or any other employment action that would dissuade a reasonable employee from making or supporting a report of abuse or neglect.
HB 1709 – Rep. Mary González / Sen. José Menéndez
HB 1709 requires school districts to work closely with DFPS to notify when a surrogate parent has been appointed to a child with disabilities who is in conservatorship. Surrogate parents are appointed by school districts when children with disabilities who are under the managing conservatorship of DFPS do not have an available parent or foster parent who is willing or able to serve as the educational decision maker for the child. When a court-appointed surrogate parent is not properly performing their required duties, the district must consult with DFPS to review the appointment and, if appropriate, find a replacement. This bill expands the definitions of who can serve as a surrogate parent and helps ensure transparency and accountability in the system.
HB 1780 – Rep. Rick Miller / Sen. Lois Kolkhorst
HB 1780 requires the court to consider a parent’s good faith attempt to complete a drug rehab program when deciding whether to grant a 6-month extension before terminating parental rights. In light of the overwhelming majority of neglectful supervision cases that involve substance use and the complexity of treatment and recovery, this bill will give parents a chance to break the cycle of drug addiction and keep families together.
HB 2229 – Rep. Jarvis Johnson / Sen. Kirk Watson
HB 2229 adds specific information to a report the Texas Juvenile Justice Department (TJJD) must submit to the Governor, Lt. Governor, and Legislature every even numbered year regarding foster children in the juvenile justice system. This bill requires the report to break down the number of foster children in TJJD custody by age, sex, race, conduct, and first-time offenders. This data will enable advocates and policymakers to better implement programs and practices that can prevent foster youth from entering the justice system.
HB 2737 – Rep. Gene Wu / Sen. Nathan Johnson
HB 2737 will require the Texas Supreme Court to provide annual guidance to judges who preside over juvenile or child protective services cases to establish greater uniformity across the state in how those cases are handled. The issues addressed could include the placement of children with severe mental health issues; changes in placement; final termination of parental rights; release of children detained in
juvenile detention facilities; certification of juveniles to stand trial as adults; and commitment of children to the Texas Juvenile Justice Department.
HB 3809 – Rep. Craig Goldman / Sen. Kirk Watson
HB 3809 will allow suits for personal injury to be brought up to 30 years after the day the cause of action accrued if the injury arose from conduct involving offenses against children including sexual assault of a child, aggravated sexual assault of a child, continuous sexual abuse of a young child, trafficking a child and causing the child to be involved in certain sex crimes, compelling prostitution of a child, and indecency with a child. Currently, the statute of limitations is 15 years. This bill allows more time for child victims to come to terms with their trauma enough to talk about it and bring a civil lawsuit.
Missed Opportunities for Improving Child Protection Systems
Rate Increases
Children who cannot remain safely at home with their parents are removed by CPS. CPS places children in foster care placements when a suitable kinship option is not available. Foster care services may be provided through placement with foster families or through emergency shelters, residential treatment centers, and other programs. Foster care providers are reimbursed by the state at a daily rate based on the type of care that is required to meet the needs of each child. In Texas, these rates do not fully cover the cost of providing foster care services, and providers must secure philanthropic donations that subsidize the rates in order to provide quality foster care. While lawmakers did make some investments in rate increases, in most cases these increases did not keep pace with inflation and actual purchasing power decreased. Insufficient rates contribute to continuing problems in building sufficient capacity to serve children in need.
Trauma-Informed Care
Children who are interacting with the Child Protection System experience trauma at higher rates than their peers and often in patterns that are complex and chronic. Although DFPS currently includes trauma-informed training in programs made available to DFPS employees as well as foster, adoptive, and kinship caregivers, the comprehensiveness and accessibilty of that training may not be sufficient to ensure staff and caregivers have the skills they need to recognize and address the ways that trauma may be affecting a child’s behavior. Unfortunately, the Legislature failed to take action to ensure that the adults who are charged with decision making on behalf of traumatized children, have adequate training to understand the ways trauma can impact biology and behavior or strategies to increase resilience and healing.
Funding for Increased Quality in Foster Care
The Family First Prevention Services Act, which will go into effect in 2021, targets federal funding to evidencebased foster care prevention services and improved foster care that provides the best environment for each child’s
unique needs. For children with therapeutic needs, Family First dollars are available for providers who have thirdparty assessment, access to medical staff, and follow-up after transition to assure successful placement. Many
Texas providers are not currenly meeting the standards laid out by the bill. This session offered an opportuntiy to
invest in programs and services that are being prioritized by Family First so that implementation will be efficient,
federal dollars can be maximized, and children will have access to higher quality care.
Four children die from abuse/neglect each week, and 80 percent of victims are 3 years of age and younger.
181 children are confirmed as abused/neglected every day, and the highest rates occur in children under age 5.
Evidence-based home visiting programs can reduce child maltreatment by up to 48 percent and have a positive return for each dollar invested.
Currently, only 3.5% of families with the highest need have access to proven prevention programs.
Welcome to the second part of our look at how child protection legislation fared in the 86th Texas Legislature. We began this series in May with our top-priority bills. This begins the first of three deeper dives into specific subject areas. This post is about Prevention and Early Intervention legislation; it will be followed by Child Protection Systems and will conclude with Mental Health and Trauma.
The Adverse Childhood Experiences (ACEs) Study – as well as decades of subsequent, validated research – has made clear that the impact of severe childhood adversities, including child maltreatment, is a public health crisis.
In the absence of supportive relationships and environments, chronic and compound ACEs increase the likelihood of negative behavioral, educational, health and economic outcomes. Prevention strategies can reduce the prevalence and impact of ACEs and increase a child’s opportunity for cognitive and emotional development, productivity, health, and economic wellbeing.
Prevention efforts
fall across a spectrum that includes:
Primary Primary prevention focuses on reaching families before the first occurrence of child maltreatment.
Secondary Secondary prevention focuses on efforts to prevent maltreatment among families considered to be at high risk.
Tertiary Tertiary prevention focuses on mitigating the negative effects and prevent re-occurance in families where maltreatment has already occurred.
Evidence-based in-home parenting programs (known as home visiting) have proven to be the most effective and efficient model for prevention. These programs connect expectant and new parents who enroll voluntarily with a trained nurse, social worker, or early childhood specialist who promotes health, child development, parenting skills, education, and employment. By intervening to prevent adversity and build resilience during a child’s most critical years of neurodevelopment, in-home parenting programs impact outcomes across multiple domains and generations.
Evidence-based programs currently operating in Texas include AVANCE, Early Head Start, Family Connects, Healthy Families America, Home Instruction Program for Preschool Youngsters, Nurse-Family Partnership, Nurturing Parenting, Parents as Teachers, SafeCare, Systematic Training for Effective Parenting, and Triple P- Positive Parenting Program.
While some communities have been able
to initiate programs with private and/or local funds, most in-home parenting
programs implemented in Texas are funded through the Prevention and Early
Intervention Division at the Department of Family and Protective Services. In
2018, funding was available to provide approximately 16,000 families with evidence-based
in-home parenting support; however, 423,000 families in Texas have young
children and three or more risk factors. Our goal is to continue working until
many more of those families can access these beneficial programs.
ACEs and trauma do not dictate the future of a child. Children with protective factors (e.g. healthy attachment to parents, access to community resources, and supportive school and home environments) can build the resilience needed to thrive despite adversity. Evidence-based and effective solutions can strengthen families and help ensure that children start with a secure foundation of health and safety.
prevention in the 86th texas legislature
Top-Priority Bills passed
House Bill 1 – The General Appropriations Act
Champions – Sen. Jane Nelson and Rep. John Zerwas
In response to research, federal initiatives, and best practices, the landscape around prevention funding has changed within the past couple decades. The ACEs research makes clear the public health ramifications of severe adversities in childhood. Emerging brain science continues to demonstrate the importance of the development that happens in the first five years of a child’s life. This has created new urgency and a growing and diverse group of stakeholders who are invested in improving access to proven programs. The federal Family First Prevention Services Act demonstrates an increasing prioritization by the federal government in programs that provide evidence-based services to ensure that, when possible, children can remain safely at home. Protecting a child’s development by strengthening families to increase resilience and protective factors, and empowering communities to offer needed supports before a crisis occurs, have become the clear path forward.
Each session, TexProtects prioritizes increased investments in primary, evidence-based in-home parenting programs. Despite cuts to the Health and Human Services budget overall, the Legislature included funding to maintain Project HOPES (Healthy Outcomes through Prevention and Early Support) and the Nurse-Family Partnership (NFP) Programs and appropriated an additional $4.3 million to expand those programs.
Evidence-Based Prevention
2020-21 Base Budget
Additional Investment
HOPES
$39.9 million General Revenue/All Funds
$1.5 million
NFP
$30.2 million All Funds ($5.6 million General Revenue)
$2.9 million
Total
$70.1 million All Funds
$4.3 million
Healthy Outcomes Through Prevention and Early Support (HOPES) is a prevention approach developed to be a flexible and community-based solution to child abuse and neglect in high-risk counties by increasing protective factors of families served. It is currently serving families in 55 counties with children ages 0-5 at risk for child abuse and neglect. The evidence-based programs chosen by the communities each have proven positive outcomes across multiple domains and returns on investment that range from $1.26 to $8.08.
The Nurse-Family Partnership Program is an evidence-based, community health approach with over 40 years of evidence currently serving families in 43 counties. NFP works by having specially trained nurses regularly visit young, first-time expectant moms and fathers, starting early in the pregnancy, continuing through the child’s second birthday. For every dollar invested, there is a return on investment of $5.70 including savings on medical care, child welfare, special education, and criminal justice.
Senate Bill 355
Champions – SEN. ROYCE WEST AND REP. STEPHANIE KLICK
SB 355 directs the Department of Family and Protective Services to develop a strategic plan to leverage federal funds made available through the Family First Prevention Services Act to increase access to mental health care, substance use treatment and in-home parenting programs that can prevent child maltreatment and keep children with their families. This will result in cost savings to the state and better outcomes for Texas children. For the first time, federal dollars previously only available for children in the foster care system will be made available to fund evidence-informed and community-based early interventions so that children can remain safely at home when possible rather than placing them in foster care. These prevention strategies address key drivers of child abuse and neglect: substance use, mental health issues, and parenting skills. Such services build on the knowledge that most children can be safely protected and remain within their own homes when parents are equipped with appropriate support and opportunities to care for their children.
SB 708
Champions – Sen. judith zaffirini and rep. john Raney
SB 708 requires the Health and Human Services Commission to use existing procedures to collect, make publicly available, and report to the Legislature data on child safety in licensed child-care centers. Data must include violations that impact the health, safety, and well-being of children as well as information on the number of children and caregivers in each classroom. This data will allow lawmakers, providers, and parents to make better decisions to ensure the safety of children in care.
TexProtects Goal – Provide training to promote prevention and early intervention
HB 111 – Rep. mary Gonzáles / sen. pat fallon
HB 111 requires that existing child abuse training for school staff must also include information on students with significant cognitive disabilities. Persons with disabilities are victimized at much higher rates than those without disabilities and are much less likely to report abuse.
HB 403– rep. senfronia thompson / sen. joan huffman
HB 403 requires that the board of trustees and superintendent of a public school district complete one hour of training on identifying and reporting potential victims of sexual abuse, human trafficking, and other maltreatment of children every two years.
HB 2059 – Rep. Cesar Blanco / Sen. Larry Taylor
HB2059 equips health care practitioners who provide direct patient care with the training needed to help detect potential victims of human trafficking and provide them with adequate care, including referring them to additional support services. Ensuring that health care providers are knowledgeable and adequately prepared is vital in combating human trafficking in Texas. Approximately 80 percent of human trafficking victims are women, and health care providers are often the first professionals to have contact with trafficked women and girls.
TexProtects Goal – Improve Maternal and Newborn Healthcare
HB 25 – Rep. Mary Gonzáles / Sen. Judith Zaffirini
HB25 creates a pilot program to allow pregnant and postpartum women utilizing the Medicaid medical transportation program to travel with their children to pregnancy-related appointments. Women enrolled in the STAR Medicaid managed care program during pregnancy or after delivery often miss prenatal or postpartum appointments because the medical transportation service program does not provide an option for women to bring their children along with them to appointments. This pilot could increase access to health care during this critical time for mom and baby.
HB 253 – Rep. Jessica Farrar / Sen. Lois Kolkhorst
HB253 requires the Health and Human Services Commission (HHSC) to develop and implement a recurring five-year strategic plan to improve access to postpartum depression screening, referral, treatment, and support services. Postpartum depression (PPD) affects 1 in 9 mothers nationally, according to the Centers for Disease Control. PPD can affect a mother’s capacity to attach and interact with her child. This can disrupt healthy development and family functioning. Depression is treatable and most mothers improve with access to adequate support.
HB 405 – Rep. Ina Minjarez / Sen. Lois Kolkhorst
HB405 designates June as Neonatal Abstinence Syndrome (NAS) Awareness Month.Neonatal Abstinence Syndrome (NAS) is a group of conditions caused when babies withdraw from certain drugs that they have been exposed to before birth. Rates of NAS in Texas increased by more than half between 2010 and 2015. This bill would increase public awareness and access to information and resources to decrease stigma and encourage mothers to seek help.
HB 1576 – Rep. Dade Phelan / Sen. Dawn Buckingham
HB1576 allows the Health and Human Services Commission (HHSC) and Medicaid managed care organizations to contract with transportation network companies (TNCs) and transportation vendors such as Uber and Lyft for the delivery of nonemergency medical transportation. The medical transportation program currently provides non-emergency transportation services to and from covered health care services — based on medical necessity — to recipients under Medicaid, the children with special health care needs program, and indigent cancer patients program who have no other means of transportation. This would increase options and flexibility and decrease the use of emergency medical transportation resources for non-emergency transport.
HB 1651 – REP. MARY GONZÁLES / Sen. Carol Alvarado
HB1651 requires the Commission on Jail Standards to prohibit the use of restraints for women who are incarcerated during pregnancy and 12 weeks postpartum unless clearly required for the health and safety of the mother or staff. Shackling pregnant inmates is banned in Texas state prisons and was recently outlawed at the federal level. This bill extends the same protection to the inmates of our state’s county jails. The bill also requires an annual report on any use of restraints on pregnant and post-partum women.
SB 436 – Sen. Jane Nelson / Rep. Four Price
SB436 requires the Department of State
Health Services (DSHS) to collaborate with the Maternal Mortality and Morbidity
Task Force to develop and implement initiatives to improve screening and
continuity of care for women with opioid use disorder, as well as newborns with
neonatal abstinence syndrome, while increasing access to medication-assisted
treatment and decreasing the number of opioids prescribed before, during, and
following delivery. A report on these initiatives is due to the legislature by
December 2020.
SB 748 – Sen. Lois Kolkhorst / Rep. Sarah Davis
SB748 would create a general revenue dedicated account to fund newborn screenings conducted by the Department of State Health Services (DSHS). The public health laboratory at DSHS tests 400,000 infants per year for 53 disorders or medical conditions. Dedicated funds could be used to maintain the lab and add additional screenings to the panel to meet federal requirements.
SB 750 – Sen. Lois Kolkhorst / Rep. Eddie Lucio III
SB 750 seeks to maximize Texas’ efforts to address maternal mortality as detailed by the Health and Human Services Commission’s report, State Efforts to Address Materna Mortality and Morbidity in Texas, by improving access to healthcare during the prenatal and postpartum period for women enrolled in the Healthy Texas Women Program. This bill also renames the Maternal Mortality and Morbidity Task Force as the Texas Maternal Mortality and Morbidity Review Committee and extends its work until 2027.
TexProtects Goal – Increase Access to High-Quality Early Care and Education
HB 3 – Rep. Dan Huberty / Sen. larry Taylor
HB 3 creates an early education allotment to fund full-day Pre-k for eligible students, provides additional funding for districts with high concentrations of poverty, increases funding per student, and provides funding for extended summer instruction.
HB 680 – Rep. Joe Deshotel / Sen. Kirk Watson
HB 680 requires the Texas Workforce Commission to assess and report the information on the quality and types of childcare being used by families receiving childcare subsidies. This information will include the average cost of childcare and the total number of providers and children participating in the state’s quality rating system, Texas Rising Star. The Texas Workforce Commission (TWC) administers a federal program that provides childcare subsidies to low-income families so their parents can work or attend workforce training. The data collected can help decision makers better improve access to high quality care.
SB 1679 – Sen. Royce West / Rep. John Turner
SB 1679 authorizes children at the age of three who were eligible for enrollment in a free Pre-k class to remain eligible for enrollment for the following school year. This will eliminate confusion and the burden on families that can result in children not being enrolled.
TexProtects Goal – Increase Safety for Children in Childcare
SB 568 – Sen. Joan Huffman / Rep. Greg Bonnen
SB568 transfers certain regulatory authority over childcare facilities and family homes from the Department of Family and Protective Services (DFPS) to the Health and Human Services Commission (HHSC). The bill creates a safety training account of dedicated funds, requires liability insurance unless it is cost-prohibitive, and establishes safe sleeping standards. A family home is a caregiver who provides regular care in their own residence for six or fewer children who are younger than 14, excluding children who are related to the caretakers.
SB 569 – Sen. Joan Huffman / Rep. Greg Bonnen
SB569 transfers regulatory authority for listed family homes from the Department of Family and Protective Services (DFPS) to the Health and Human Services Commission (HHSC). The bill requires HHSC to adopt minimum standards for listed family homes, requires liability insurance unless it is cost-prohibitive, and requires certain training like safe sleep training. The bill requires the HHSC to inspect listed family homes whenever the commission receives a complaint. Listed family homes are adult caregivers that provide care in their own home for compensation for up to three children unrelated to the caregiver.
SB 706 – Sen. Kirk Watson / Rep. Bobby Guerra
SB706 requires there be an investigative unit within the childcare licensing division at the Health and Human Services Commission to identify childcare facilities operating without a license, certification, registration, or listing and initiate appropriate enforcement actions against those facilities.
Missed opportunities for prevention and early intervention
Cross Sector Collaboration to Prevent Adverse Childhood Experiences
Research conducted by the Centers for Disease Control, the National Institutes of Health, the American Academy of Pediatrics, and others has made clear that ACEs are prevalent and can have lifelong consequences on health and behavior. Currently, prevention efforts in Texas are spread across multiple agencies. Communities do not have access to the informaiton and resources they need to make strategic decisions toward safer and healthier families. HB 4183 would have facilitated a cross-agency strategic planning process to better coordinate statewide data and initiatives and give communities a better toolkit for providing services that can strengthen families and prevent trauma. The bill passed in the House but not in the Senate.
Strengthen ECI
Early Childhood Intervention (ECI) is a statewide program within the Texas Health and Human Services Commission for families with children from birth up to age 3 who have developmental delays, disabilities, or certain medical diagnoses that may impact development. ECI services recipients can access needed therapies and be school-ready. The agency made a $72 million request for the funds needed to keep ECI sustainable; however, the budget appropriated only $31 million. HB 12 would have strengthened the ECI program by addressing prior authorizations, requiring health benefit plans to cover services, and creating a tele-health pilot and ombudsman office. The bill passed the House but did not move in the Senate.
Extend Medicaid Coverage for Women Postpartum
Texas has the nation’s worst uninsured rate for kids AND the nation’s worst uninsured rate for women of childbearing age — with often devastating consequences for moms and babies. Extending Medicaid coverage for women postpartum up to 12 months post-child birth would have addressed the first recommendation from the state’s Maternal Mortality and Morbidity Taskforce; however, the issue faced significant challenges prior to House passage and was not referred to committee in the Senate.
Strategically Expand Proven Prevention Programs
While we are relieved to see continued investment in evidence-based child abuse prevention programs, we still have a long way to go. HB 1549 in the 85th legislative session directed the department to develop a plan to take these programs to scale in order to impact statewide outcomes. Current investments are only providing services to 3.5% of those families in highest need. In order to move the needle, Texas needs to make strategic investments that outpace population growth and inflation and can move us toward a reality in which at least 30% of families in need have access to services.
Today is that day when all over the nation, we salute the men who guided and nurtured us – and perhaps are still doing so.
We salute all the dads. Maybe he’s the one who has been with you since birth; maybe he’s a stepdad, uncle or grandfather who has stepped into the dad role; maybe he’s a foster or adopted father.
In that spirit, we sat down for chat with a state leader who has been through joys and trials of two of those forms of fatherhood.
Texas State Representative James Frank of Wichita Falls has put in a lot of time as a father – to six sons! The first four are his biological offspring, now grown, with his wife Alisha. But four years ago, the couple made the decision to foster-to-adopt two more.
Becoming adoptive parents was a huge step for the Franks, regardless of prior parenting experience, and one they did not rush into lightly. But once they did it, Rep. Frank says, it was a rewarding experience that made a huge difference in two boys’ lives … and in James and Alisha’s.
Ultimately, because of Rep. Frank’s position as Chair of the House Committee on Human Services, it could also be an experience that has an impact on public policy. It already has – among many other pieces of legislation, he sponsored a bill in 2017 that changed foster care to a more community-based model.
TexProtects: Tell us about your history with fostering and adopting – what led you to that?
My wife and I have worked with at-risk kids in various capacities in Wichita Falls for 25 years, primarily through church. We led what we called the bus ministry. We used to have 100, 150 kids, and I drove a bus for probably 12 or 13 of those years. That was always an important part of our life and ministry.
Getting into the foster care system itself, that came about because of some really good friends of ours. We had looked at adopting two different times earlier in our marriage, but not through the foster care system. One time Alisha wasn’t ready, one time I wasn’t ready.
This last time, our kids were getting older and we knew if we were going to adopt, we had to do it now. So we started thinking about what’s the right mechanism, and we had some good friends who had started a ministry at our church called Orphans to Grace, working with foster kids.
Be there. You’re not going to be perfect. Apologize when you mess up – sometimes that’s a thing dads forget to do. Be humble enough to admit when you mess up.
– Rep. James Frank
At the age we were at, 46, 47, we had to work with 8 to 10 to 12-year-old kids, not newborns. There’s a reason God gives kids to young people [laughs]. And our youngest at the time was 15, and we wanted kids younger than him.
It was always intended to be straight-up adoption. I had just entered the Legislature, and it seemed adoption would work better than foster, but we had to get trained to foster.
TexProtects: Most people, once they have their own kids, feel that their family is complete. What made you want to expand that?
I think really it’s just recognizing that there are a lot of people that don’t have that. My wife and I felt like we had a little more to give – a little more tread on the tires, so to speak. We had seen so many kids that didn’t have that.
TexProtects: So it was what you saw in your bus ministry that motivated you?
Following Christ is what drove us to work with at-risk kids, but the bus ministry was the thing that really trained us how to do it.
TexProtects: Tell us how that changed your life, bringing in two children that weren’t your biological children.
With us it wasn’t a huge change, we’d had four boys at once. The huge change is just when you bring in a 9 and 11-year-old and you don’t have their backgrounds. You know their backgrounds on paper, but you don’t know where their soft spots are – their hurts. We knew what the challenges in our [older] boys were because we had seen them.
Just having to deal with stuff you didn’t know. Something would happen and they’d react a lot differently than you’d expect, and you didn’t have the background to know why they’d react that way. It’s like getting an MBA in parenting and you think you’re a good parent, and now you don’t get to know their background, and you have a child who is still has attachment to their parents – their parents are still alive, one’s in jail and one’s on meth – and they have mostly fond memories of them. It’s almost amazing how kids don’t remember the bad stuff. Most kids in the foster care system are not from what you’d call abusive situations – most are from neglectful situations, and kids don’t recognize the bad, they just see the good.
TexProtects: What would you say is the joy of fatherhood, and particularly the joy of these two boys in particular?
To me the joy is when you see them “get it.” When you see them get life, when you see them grow, when you see them do things they couldn’t do before. Because your goal is not to grow children, your goal is to grow an adult. You’re trying to get them to adulthood where they can be independent and productive and hopefully love other people. That to me is the joy.
TexProtects: That joy, does it take a different form with adopted children or is it the same thing?
It’s the same thing. Once we committed to it, I feel as responsible with these boys as I ever did with my own. Certainly, there’s been less time to develop the knowledge that I need of them, but the joy and the satisfaction and sometimes the frustration are very similar.
TexProtects: What tips do you have for first-time fathers?
Be there. You’re not going to be perfect. Apologize when you mess up – sometimes that’s a thing dads forget to do. Be humble enough to admit when you mess up.
Also, enjoy them. Not everything about fatherhood is enjoyable, because a lot of it is sacrifice and tiring, but remember to enjoy them as well, as you’re leading and training and disciplining.
TexProtects: What have you tried to do in your role as a legislator to promote fatherhood involvement?
Most of my work has been around Child Protective Services. It’s very difficult to govern and make people be good fathers. But I do want to make sure we don’t do things to make it harder for fathers to be around.
I think we’ve done things to make it easier to foster – some of the foster care training requirements are over-the-top. We’ve tried to reduce some of the excess training requirements, so people spend time with kids instead of with paperwork.
We need to recognize the positive attributes of encouraging fatherhood and the consequences of not having fathers. There was a bill to study that last session that didn’t get passed, and hopefully gets passed next session. Anything we can do to keep families intact is something we should do.
