TexProtects

July 3, 2019

How Did Prevention and Early Intervention Fare in the 86th Texas Legislature?

DID YOU KNOW?

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.

For a PDF version of this blog post, click here.

Prevention and Early Intervention Background

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.

July 1, 2019

86th Texas Legislative Session Wrap Up

Smart solutions to child abuse and neglect were put forward by TexProtects during the legislative session, including accomplishments, missed opportunities.

View the Report.

April 16, 2019

86th Texas Legislature Update: Mid-April

The 86^th Texas Legislature is almost two-thirds complete. Here is the status of the major bills TexProtects is supporting:

The Fiscal Years 2020-21 Budget (House Bill 1)

Our major goal for the 86^th Legislature is to secure increased investments in family support home visiting programs – specifically an additional $12 million for Nurse-Family Partnership (NFP) and $18.5 for the HOPES (Healthy Outcomes through Prevention and Early Support) program. The majority of child maltreatment occurs in the most formative years for children and 75% of child abuse fatalities over the past five years were children under age 3. Texas needs these most proven and effective programs for reducing child maltreatment for children between the ages of 0-5. Currently both the House and Senate versions of the budget fall short of those goals.

Prevention

For Nurse Family Partnership, the Senate included an additional $2 million dollars. The House, thanks in large part to the efforts of Representatives Button and Meyer, added $5.8 million dollars to NFP. For Project HOPES, however, the House only included $1.5 million new dollars and the Senate didn’t appropriate any. The differences between the two versions will have to be ironed out in a conference committee between the two chambers. House conferees are Reps. John Zerwas, Greg Bonnen, Sarah Davis, Oscar Longoria and Armando Walle; Senate conferees will soon be appointed.

TexProtects will monitor negotiations between the House and Senate and will advocate for larger investments (thus reaching more families who would benefit) in the final budget.

Child Protective Services

Overall, the House version of the 2020-2021 biennial budget includes $3.9 billion (an increase of $311.8 million from 2018-2019) in Child Protective Services funding, while the Senate version includes $3.8 billion (an increase of $271.7 million from 2018-2019).

Included in these amounts is $2 billion in the House version and $1.9 billion in the Senate version for client services programs, including foster care, adoption subsidies, permanency care assistance payments, relative caregiver monetary assistance payments, and day care. The House appropriated funds for rate increases for certain foster care providers. Both the House and Senate included $1.6 billion for CPS direct-delivery staff, including services provided through Community-Based Care. This amount includes increased funding to maintain lower caseloads for most caseworkers – the House version would reduce caseloads for conservatorship caseworkers, and the Senate version would reduce caseloads for conservatorship, kinship, foster and adoptive developmental home (FAD) and residential child care investigators. The House version expands Community-Based Care into two new regions and into stage 2, which includes case management, in Region 3B. The Senate version expands Community-Based Care into two new regions and into stage 2 in Regions 3B, 2, and 8A.

Behavioral Health Services

The House appropriated $4.1 billion (an increase of $665.4 million) while the Senate included $3.1 billion (a decrease of $275.9 million) for behavioral health services at the three health and human services agencies, which includes funding for community mental health services; mental health services for veterans; inpatient mental health services at state-owned and community hospitals; and substance abuse prevention, intervention, and treatment services.

Early Childhood Intervention (ECI)

Finally, funding for Early Childhood Intervention services totals $372.8 million (an increase of $83.4 million) in the House version for the 2020–21 biennium. The Senate appropriated $313.1 million for ECI services, representing an increase of $23.7 million.

For additional details related to the funding amounts for the Department of Family and Protective Services throughout the legislative process, please review this table.

Non-Budget Bills

HB 3718 (Rep. Tan Parker with Reps. Zerwas, Huberty, Miller, and Senfronia Thompson): This bill would require school districts and open-enrollment charter schools to implement a trauma-informed care policy (including staff training) and incorporates trauma-informed training into the existing continuing education hours teachers complete each five years. This bill is part of TexProtects’ call for a statewide strategy to mitigate and prevent trauma from Adverse Childhood Experiences and other sources of trauma. On April 11, HB 3718 was reported favorably from the House Public Education Committee, and now, it should head to the full House for a vote.

HB 4183 (Rep. Tan Parker with Reps. Zerwas, Miller, Sanford and Senfronia Thompson): This bill is key to our Adverse Childhood Experiences campaign, requiring multiple state agencies across the child protection, justice, education and health care systems to create a statewide strategy for preventing and mitigating ACEs. Testimony on HB 4183 was heard in the House Public Health Committee on April 3 and was voted out favorably on April 15. We look forward to a House vote on the bill soon.

Senate Bill 355 (Sen. Royce West with Sens. Kolkhorst, Lucio and Menéndez): SB 355 tasks DFPS with creating a strategic plan to maximize prevention funds available through the Federal Family First Prevention Services Act. Family First marks a key shift in federal policy, allowing money that was previously reserved strictly for foster care (in other words, after a tragedy has occurred) to be directed toward programs designed to prevent children from ever needing foster care (before tragedy occurs). Funds can be used for evidence-based substance use prevention and treatment, mental health care, and in-home parenting programs to strengthen families so that children can remain safely at home. SB 355 passed the Senate on March 20 and is currently in the House Human Services Committee.

HB 12 (Rep. Sarah Davis): This bill strengthens the Early Childhood Intervention Program by streamlining processes to receive services, requiring health benefit plans to cover services, creating a tele-health pilot to increase access, and requiring the ombudsman office to collect data on complaints and make recommendations on how to improve the provision of services. HB 12 received a hearing in the House Human Services Committee on April 9 and was left pending in committee.

HB 18 (Rep. Four Price and others): In response to ongoing concerns with school safety as well as recommendations from the House Select Committee on Mental Health, HB 18 provides students and educators with training and resources on mental health and substance use. Included in this very comprehensive bill is language that would ensure that trauma-informed practices are integrated into school environments and included in teachers’ continuing education. HB 18 has made it through the House and is on its way to the Senate.

HB 474 (Rep. Donna Howard): HB 474 will expand the data that is available as part of the foster care needs assessment to better understand where there are service gaps affecting pregnant and parenting foster youth. In addition to collecting information on prenatal, postpartum, or parenting supports for youth, it also collects information on placements that will be reimbursable under the Family First Prevention Services Act, including: licensed residential family-specialized substance use treatment facilities; qualified residential treatment programs; supervised independent living; and settings specializing in serving survivors of human trafficking. HB 474 will be considered by the House Human Services committee this week.

HB 475 (Rep. Donna Howard): Ensures pregnant and parenting youth in care receive basic parenting education and services that will help strengthen and preserve their young families. HB 475 specifically will make available to these youth information on: safe sleeping arrangements; recommendations for safety childproofing their home; methods to manage crying infants; the selection of appropriate substitute caregivers; early brain development; the importance of meeting an infant’s developmental needs by providing positive experiences and avoiding adverse experiences; the importance of paternal involvement; the benefits of reading and talking to young children; and the impact of perinatal mood disorders. HB 475 will be considered by the House Human Services committee this week.

HB 1110 (Rep. Sarah Davis): This bill expands Medicaid coverage for pregnant women from 60 days after the birth of a child to 12 months after delivery. This ensures that new mothers have access to critical health care in the postpartum period to increase health outcomes for moms and children. HB 1110 received a hearing in the House Human Services Committee on April 9 and was left pending in committee.

HB 2030 (Rep. John Turner): This bill provides that if a child is eligible for pre-K at 3 years old, they remain eligible at 4 years old. The House Public Education Committee passed a committee substitute version of the bill and reported it favorably to the full House.

HB 2832 (Rep. Dade Phelan): This bill requires the Health and Human Services Commission to work with the Department of Family and Protective Services to promote and track referrals to Nurse-Family Partnership programs. HB 2832 received a hearing in the House Human Services Committee on April 2 and was left pending in committee.

SB 708 (Sen. Judith Zaffirini with Sen. Campbell): This bill ensures that HHSC and other stakeholders have access to critical data on child safety. This bill directs the commission to collect data on caregiver-child ratios and group size standards as well as serious violations and injuries. This information will allow leaders to better understand if state minimum standards are sufficient to ensure that enrolled children are being cared for in supportive and safe environments. HB 708 received a hearing on April 16 and was left pending.

March 25, 2019

The 86th Texas Legislature is heating up

The Texas Legislature has a rule: Bills may not be considered for floor debate in either the House or Senate during the first 60 days of the 140-day session unless designated an emergency by the Governor. This allows members to spend adequate time in committee meetings vetting them.

That 60 days is up! We have reached the second half of the session and we can expect things to start moving quickly now – in fact, some of bills are already rolling along, and we could use your help with a key budget request.

Our key budget request – $30.5 million to expand evidence-based home visiting programs to reach an additional 3,600 families – is thus far not reflected in the budget bill. At the moment, an expansion of only $5.2 million is included in the House version. Fortunately, it is still early in the budgeting process and we will continue advocating for a much larger investment. We encourage you to do so as well by reaching out to Senate Finance Committee members. Key senators working on health and human services budget decisions include: Chair Lois Kolkhorst, Kirk Watson, Donna Campbell and Pete Flores. (For a deeper look at our budget requests, read here.)

Senate Bill 355 by Sen. Royce West, another of our top-priority bills, was passed unanimously by the Senate last week! SB 355 would lay out a Texas plan for implementation of the federal Family First Prevention Services Act, a landmark bill that will direct more federal dollars toward keeping children out of foster care. When SB 355 was in committee, TexProtects Vice President of Public Affairs Pamela McPeters testified in favor of it. Now the bill goes to the House.

House Bill 3718 by Rep. Tan Parker, which would require public schools to develop and implement a trauma-informed care policy, is scheduled for a hearing on Tuesday (March 26) in the House Public Education Committee.

House Bill 123, by multiple authors, made it out of the House Human Services Committee and has been placed on the General State Calendar for Monday, March 25. This bill will make it easier for foster children to obtain forms of state identification that are crucial for youth aging out of care.

Our Public Policy Director Jennifer Lucy spoke in support of House Bill 18, which would ensure teachers, principals and counselors are equipped with evidence-informed training on how trauma affects our students and then how to respond in ways that will de-escalate stressed responses, avoid retraumatizing our students, and create an environment of safety. The trainings also help school staff understand which students may need opportunities to access resources outside of the school setting. This supports our efforts to highlight the role of Adverse Childhood Experiences in lifetime health.

Speaking of Adverse Childhood Experiences, the bill number for Rep. Tan Parker’s legislation to study a cross-systems plan to prevent and address such experiences has been updated. In our previous communications we identified it as House Bill 822. However, after making revisions, Rep. Parker decided to reintroduce it as a new bill: HB 4183. Passage of this bill is one of TexProtects’ major goals of the 86th Legislative Session.

To get status updates on the many bills we are following or supporting this session, bookmark our Bill Tracker.

January 23, 2019

The State Budget: Building Upon Success

By Pamela McPeters
TexProtects Vice President of Public Affairs

The budget is one of the most significant responsibilities of the Texas Legislature. The Senate Finance and House Appropriations Committees of the 86th Legislature will soon be underway crafting the fiscal years 2020-2021 General Appropriations Act. As these committees work on competing interests, including school finance, Hurricane Harvey obligations and many others, it is imperative they prioritize the safety and well-being of Texas children. The child protective services system is experiencing increased pressure which requires investments to continue and build upon the progress made in the 85^th Legislative Session. Pressure includes:

Abuse/neglect reports are projected to increase by 2.1% in FY 2020 over FY 2019 and 2.3% in FY 2021 over FY 2020.
Investigations are projected to increase by 2.5% in FY 2020 over FY 2019 and 2.6% in FY 2021 over FY 2020.
The number of confirmed findings of child abuse and neglect is projected to increase by 1.2% in FY 2020 over FY 2019 and 0.9% in FY 2021 over FY 2020.
Client Services Adoption Subsidies and Permanency Care Assistance caseloads are projected to grow 4.2% in FY 2020 and 8.6% in FY 2021 above FY 2019.
Day Care is projected to increase 7.1% children served in FY 2020 and a 13.5% in FY 2021 above the projected FY 2019 levels.
Purchased Client Services are projected to increase 5.0% in average monthly client caseloads in FY 2020 and 10.0% in FY 2021 above FY 2019.
Foster Care caseloads (FTEs) are projected to grow by 0.3% in FY 2020 and by 0.4% in FY 2021 relative to FY 2019 projected caseloads.

Below are some key priorities for funding:

#1 Expand Prevention Services (DFPS Exceptional Item 8)

Additional Details may be found on pages 534-536 of the Department of Family and Protective Services (DFPS) Legislative Appropriations Request (LAR).

$18.5 million to expand HOPES program into additional counties and increase families served from 4,660 families expected to be served in fiscal year 2019 to 7,060+ families served in fiscal years 20 and 21, an expansion of 26%.

Healthy Outcomes through Prevention and Early Support (HOPES) is a flexible, community-based approach to child abuse and neglect prevention in high-risk counties by increasing protective factors of families served. Currently serves families in 55 Texas counties with children ages 0-5 at risk for abuse and neglect. Families are commonly referred to HOPES by community organizations, clinics, school districts, or self-referral. Families generally participate in HOPES services for 3-12 months.

$12 million provide for a targeted expansion to increase the number of families served through Texas Nurse-Family Partnership from 2,725 families in fiscal year 2019 to 3,975+ families in fiscal years 2020 and 2021, a 20% increase.

Texas Nurse Family Partnership (TNFP) is a voluntary program in which registered nurses regularly visit the homes of low-income women pregnant with their first child. Families must start services with TNFP by their 28th week of pregnancy and can receive services until the child reaches two years of age. TNFP Serves expecting parents, new parents, and caregivers of children under the age of 2. Families are commonly referred by WIC, community clinics, school districts, and health plans. Families generally participate in TNFP services for two years.

In addition we have additional background on HOPES and TNFP here.

#2 Maintain Client Services (DFPS Exceptional Item 2)

Additional Details may be found on pages 516-518 of the DFPS LAR.

$79.3 million for Day Care Services to address growth for fiscal years 2020 and 2021.

Day care services for children while biological parents are receiving services to preserve the family and/or when a child is placed with a relative, along with while a child is in foster care, increase safety. These services may provide for immediate or short-term safety from abuse and neglect; prevent the child from being removed from the home; allow the child to be reunited with the family; address the developmental needs of a child whose physical, social, emotional, cognitive, or language developmental delay is a significant factor in the risk of abuse or neglect in the home; and help stabilize the family.

$52.3 million for Client Services for children and their families starting from intake, relative caregiver homes, foster and adoptive homes and post-adoption.

These services may include evaluation and treatment services, parent/caregiver training, and substance abuse assessments and treatment (individual, family and group counseling).

#3 CPS Initiatives and Operations (DFPS Exceptional Item 5)

Additional Details may be found on pages 525-530 of the DFPS LAR.

$17.8 million to support CPS initiatives including, preparation for adult living skills assessment for older youth, determine eligibility, improve permanency and other frontline staff, case management for certain youth in extended foster care, services for children post-adoption and post-permanency, and medical services staff.

In addition, funding will support case management for youth with complex needs in extended foster care, behavioral health services to promote permanency, and support medical wellbeing.

#4 Maintain Caseloads (Exceptional Item 1)

Additional Details may be found on pages 513-5515 of the DFPS LAR.

$106 million to maintain average daily caseloads at manageable levels for CPS Investigations (13.9 cases), Conservatorship (23.1 cases), Foster/Adopt (17.3 cases), and Kinship (31.4 cases) and reduce statewide intake hold times by about half.

Here is a side-by-side comparison of key Child Protective Services line items from the House and Senate proposed budgets. After each chamber passes its respective version of the budget, they will then have to agree on a final version to send to Governor Greg Abbott.

	House Bill 1	Senate Bill 1	Difference in SB1 from HB1	DFPS LAR Base Request	DFPS Exceptional Item Request
	2020-21	2020-21	2020-21	2020-21	2020-21
STATEWIDE INTAKE	45,903,260	45,903,260	0	45,903,260	16,868,045
A.1.1. Statewide Intake Services	45,903,260	45,903,260	0	45,903,260	16,868,045
CHILD PROTECTIVE SERVICES	3,702,740,868	3,698,484,378	(4,256,490)	3,629,796,180	323,927,022
B.1.1 CPS Direct Delivery Staff	1,478,091,278	1,536,903,280	58,812,002	1,517,333,763	143,204,700
B.1.2 CPS Program Support	89,541,930	90,159,264	617,334	90,508,294	12,444,948
B.1.3 TWC Contracted Day Care	197,539,038	197,539,038	0	140,245,446	84,278,580
B.1.4 Adoption Purchased Services	19,563,842	19,563,842	0	19,563,842	7,056,161
B.1.5 Post – Adoption/Post-Permanency	6,976,442	6,976,442	0	6,976,420	5,854,961
B.1.6 PAL Purchased Services	17,987,420	17,987,420	0	17,987,420	386,672
B.1.7 Substance Abuse Purchased Services	16,344,380	16,344,380	0	16,344,380	24,234,694
B.1.8 Other CPS Purchased Services	78,271,948	78,271,948	0	78,271,948	10,640,296
B.1.9 Foster Care Payments	779,127,440	1,041,748,299	262,620,859	1,049,176,063	29,108,240
B.1.10 Adoption/PCA Payments	612,413,881	612,413,881	0	615,753,103	–
B.1.11 Relative Caregiver Payments	80,576,584	80,576,584	0	77,635,479	6,717,770
B.1.12 Community-Based Care Payments	326,306,685	–		–	–
PREVENTION PROGRAMS	209,424,985	209,424,985	0	209,424,985	31,242,687
C.1.1 STAR Program	48,624,721	48,624,721	0	48,624,721	9,228,000
C.1.2 CYD Program	16,845,117	16,845,117	0	16,845,117	4,083,600
C.1.3 Child Abuse Prevention Grants	6,574,786	6,574,786	0	6,574,786	800,000
C.1.4 Other At-Risk Prevention	59,179,881	59,179,881	0	59,179,881	9,955,634
C.1.5 Home Visiting Programs	63,319,104	63,319,104	0	63,319,104	5,530,800
C.1.6 At-Risk Prevention Program	14,881,376	14,881,376	0	14,881,376	1,644,663

January 16, 2019

TexProtects report, lawmakers call for statewide strategy on Adverse Childhood Experiences

FOR IMMEDIATE RELEASE
January 16, 2019
Contact: Lee Nichols
512-796-9877
Lee@texprotects.org

Photos of the press conference available upon request. See video of the press conference here.

Science Meets Policy

ACEs Uncovered: Powerful preventative strategies to promote resilience and brain health for a better Texas tomorrow

Austin, Texas — Adverse experiences early in life, known as Adverse Childhood Experiences or ACEs, can result in trauma that potentially affects the brain architecture of developing children. In 2016, an estimated 3.4 million Texas children had one or more ACE. Child maltreatment in its many forms makes up half of the recognized ACEs. Advocacy group TexProtects, Champions for Safe Children, estimates child maltreatment cost Texas over $55 billion in 2017.

A coordinated, statewide strategy across the healthcare, child welfare, early childhood education and justice systems can prevent and mitigate the impact of trauma, and equip children, families and communities with the resilience to have healthy futures.

That’s the conclusion of ACEs Uncovered: Powerful preventative strategies to promote resilience and brain health for a better Texas tomorrow, a new report by TexProtects, unveiled Wednesday at the Texas State Capitol. Flanked by Texas lawmakers, TexProtects CEO Sophie Phillips said that building a statewide collaboration will take the support of the 86th Texas Legislature.

“Chronic health problems, criminal or risky behaviors, and poor academic and workforce performance can all result from ACEs – but with the right support structures and prevention strategies, it doesn’t have to be that way,” Phillips said. “With the help of our lawmakers, Texas can build a cross-systems, preventative approach that leads to self-sufficient families, healthier children and taxpayer savings.

“TexProtects will push for this coordinated system throughout the legislative session, especially on February 12, when we will bring child protection advocates, including 125 seventh-grade students from Dallas, from across the state to the Capitol for a day of action,” Phillips added.

Katherine Snyder, Child Abuse Pediatrician for the CARE Team at Dell Children’s Hospital, provided some expert perspective on ACEs: “Stress is a normal part of life, but exposure to chronic stress has important consequences on the short and long term physical and psychological health of the child and the adult they become. Intervening as early as possible to create safe environments, healthy and protective relationships and empower healthier coping mechanisms for the child and caregiver is paramount to the overall health of the community and society.”

Phillips and key lawmakers laid out three priorities for the session, which began on January 8:
• Develop and implement a statewide strategic plan to address causes and symptoms of adverse childhood experiences (ACEs).
• Strengthen investments in community-based, primary child abuse prevention programs like home visiting.
• Improve coordination and effectiveness of services for children at risk of entering foster care.

Rep. Tan Parker, R-Flower Mound, said that the emerging science of Adverse Childhood Experiences must be thoroughly ingrained into Texas’ care of children who have been abused and neglected. On Tuesday, he introduced House Bill 4183 which will facilitate coordination of agencies in developing a statewide strategic plan.

“In the past, when children or adults have engaged in high-risk or socially unacceptable behaviors, our reaction was to ask, ‘What’s wrong with you?’ Today, we realize the better question is, ‘What happened to you?’ If the adults in their life helping them on that journey don’t understand what they’ve endured and how it still affects them, then those children have higher odds of falling short in education, in health – including mental health – and in personal relationships,” Parker said.

State Rep. John Zerwas, R-Richmond and a physician who served as Chair of the House Appropriations Committee in the 85th Legislature, spoke of the value of making prevention programs available to families:

“Evidence-based, voluntary prevention programs such as home visiting produce stronger, more self-sufficient families, and save taxpayers money. But Texas is reaching only 5% of the 423,000 families with children under 6 who can benefit from prevention services. We can do better! Investments in proven programs, such as Nurse-Family Partnership (NFP) and Healthy Outcomes through Prevention and Early Support (HOPES) prevent negative outcomes and avert costs in the criminal justice, health care and educational systems,” Zerwas said.

In its legislative appropriations request, the Department of Family and Protective Services is asking for $5.5 million to help NFP reach an additional 550 families in each year of 2020 and 2021, in turn saving Texas taxpayers over $31 million by preventing negative outcomes. DFPS is also requesting to expand the community-driven HOPES program by $9.4 million to reach an additional 1,200 families.

Sen. Royce West, D-Dallas and a TexProtects Advisory Board member, emphasized the need for the Legislature to leverage new federal funds made available by the Family First Prevention Services Act. Tuesday, he introduced Senate Bill 355 to enable this.

“Family First provides flexibility for states to use money previously reserved only for foster care and channel it toward programs that prevent children from ever being removed from their homes. But the Legislature will need to strengthen the infrastructure and effectiveness of programs eligible for Family First funds,” West said.

“Last session, the Legislature and Governor identified child abuse and neglect as a key issue and took historic steps in changing how our state deals with it. But it is critically important that state leaders and the public realize: The efforts in 2017 did not mark an end point in Texas’ fight against child abuse and neglect – it marked a beginning,” Phillips said.

Advocates wishing to RSVP for TexProtects’ Child Abuse Prevention Day at the Texas Capitol on February 12 (including a free, round-trip bus ride between Dallas and Austin) may do so at http://bit.ly/2019PCATDay.

ACEs Uncovered: Powerful preventative strategies to promote resilience and brain health for a better Texas tomorrow may be accessed any time at http://bit.ly/acesuncovered

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TexProtects, Champions for Safe Children, was created to tackle issues of Child Protective Services (CPS) reform, prevention and public awareness to bring a collective, organized voice representing the needs of children at risk of abuse and survivors of child abuse and neglect. TexProtects is the Texas Chapter of Prevent Child Abuse America. TexProtects is autonomous, nonpartisan and nonpolitical, designed to educate decision makers, private funders and the public at large. To date, it is the only Texas organization that has a dedicated focus on the main issues of protection, prevention, and healing of abused and neglected children. For more information, please visit www.TexProtects.org.

September 10, 2018

DFPS Submits Legislative Appropriations Request for 2019 Session

The 86^th Legislative Session will begin January 8, 2019, and in preparation, the Department of Family and Protective Services released its Legislative Appropriations Request (LAR) for Fiscal Years 2020-2021 on August 31.

First, let’s review the previous session:

Before the 2017 Texas Legislative Session, Child Protective Services was plagued with problems. Governor Greg Abbott declared child protection an emergency, asking lawmakers to approve structural reforms and increase funding. The 85^th Legislature responded by providing additional investments for Fiscal Years 2018-2019. Some of these investments were for: 1) prevention and early intervention, including home visiting programs, 2) additional caseworkers and meaningful salary increases to better ensure manageable workloads and retain caseworkers, 3) new relative caregiver monthly financial payments to reduce reliance on the foster care system and help keep children with their extended family, and 4) foster care payments for the legacy system and to expand Community Based Care to help stabilize the foster care provider base.

Due to the investments and legislation passed by the 85^th legislature, DFPS has made significant advances:

Turnover in Investigations has dropped more than 14 percent, from 30.5 percent in July 2016 to 26.2 percent in July 2018. Similarly, investigative average daily caseloads have dropped more than 22.5 percent, from 16.4 in July 2016 to 12.7 in July 2018. Family-Based Safety Services (FBSS) and Conservatorship (CVS) have seen similar decreases and both are now below 20.0 percent.
More children are being seen by caseworkers in a timely manner with contacts for highest priority cases improving by almost 15 percent.
36 percent more youth are completing the Preparation for Adult Living training, and the average number of months for foster children to permanency has decreased by 6 percent.
More children are being placed with relatives, an increase from 44 percent to 46 percent. The national average for relative placements is 32 percent.
Expansion of prevention services to increase the level of evidence-based programs and community initiatives to support children before they are abused and neglected. In the FY 2018-19 biennium, PEI projects to serve 128,000 families and youth, more than 98% of whom it expects to defer from both child protection and juvenile justice.

Now, the legislative appropriations request for 2019:

In its baseline request of $4.2 billion for fiscal years 2020-2021, DFPS requests funds to continue essential agency operations and a minor increase of 1.64 percent for Child Protective Services due to growth. The agency also includes exceptional items as an additional funding request to maintain current services levels, continue legislative initiatives, and fill in gaps in its service system and critical agency operations.

The Legislative Budget Board and the Governor’s Budget Office will hold a hearing for the public to weigh in on the agency’s LAR at 11am on Friday, Sept. 14, at the Texas Capitol, in room E2.016.

The additional funding requests include:

Prevention

$30.8 million to expand prevention services. Investment in prevention reduces the increasing demand for costly foster care by devoting resources to preventing maltreatment before a child is traumatized by abuse or neglect or separated from their family. PEI services also provide cost avoidance in juvenile justice and high Medicaid costs in adulthood. Some specific programs included in the request:

- STAR – increased investment of $9,228,000 or 19% increase to expand its available programming across the state to serve an additional 6,000 families.
- CYD increased investment of $4,083,600 or 24% increase to serve an additional 4,100 families.
- HOPES – increased investment of $9,420,000 or 17% increase to serve an additional 1,200 families. HOPES could expand to serve contiguous counties of existing HOPES contracts. The Prevention and Early Intervention division of DFPS would also explore existing community need for increasing program capacity.
- Nurse-Family Partnership – increased investment of $5,530,800 or 18% increase to serve an additional 550 families. Expansion of this program would blend geographic and programmatic expansion. While some programs may be poised to expand their geographic coverage to serve contiguous counties of existing TNFP contracts, other communities may increase the number of individuals they can serve.

Child Protective Services

$116.7 million for additional caseworkers, intake specialists, and support staff to maintain the caseworker and statewide intake workload levels and to lower the average hold time at the statewide abuse call center to 8.5 minutes.
$1.9 million for Employee Support Services to create a team to address the impact of trauma on direct delivery staff. As required by HB 1549, 85R, the proposed team will focus on development of a secondary trauma program and supports for caseworkers, including incident stress debriefing.
$4.4 million for a salary increase of $500/month for Statewide Intake staff to improve retention, thereby enhancing tenure and enabling improved performance.
$9.7 million to strengthen Child Protective Investigations outcomes, provide key investigations support, and prevent human trafficking.

Family Preservation

$136.6 million to meet the increased demand for day care, CPS client services, and relative caregiver financial assistance.

Foster Care

$62.6 million to support the continued phased in expansion of the Community Based Care foster care model to a total of nine geographic catchment areas covering approximately 74% of children in paid foster care by the end of fiscal year 2021. This request would continue and expand four existing catchment areas and fund five new catchment areas over the course of the biennium.

Child Healing

Funding for Medical Services Well-Being Staff to support CPS caseworkers and caregivers through initiating appeals, monitoring fair hearings, and facilitating resolution as part of the STAR Health processes associated with denials. Staff will also monitor data to analyze issues and coordinate with HHSC to resolve.

Preparation for Adulthood

$19.7 million for key initiatives and client support, including: Preparation for Adult Living staff and Regional Youth Specialists, additional case management for youth who have complex needs in Supervised Independent Living, and behavioral health services for children in post-adoption and post permanency relative homes.

Family First Prevention Services Act

The request for additional investment also includes a placeholder to address the new requirements from the federal Family First Prevention Services Act (FFPSA).

In February 2018, the United States Congress passed the FFPSA. The purpose of the bill is to provide investment further upstream to strengthen and preserve families and prevent children from entering the foster care system. The bill also better ensures children in foster care receive the most appropriate care for their individual needs in the least restrictive environment.

Implementation of FFPSA will help Texas attain its goals by 1) investing in results-proven programs and reducing child neglect and abuse fatalities; 2) promoting healthy biological families and supporting children with their relative families; 3) improving foster care to provide children with nurturing and safe foster families; and 4) ensuring children receive services to address their emotional, behavioral, and medical needs and heal their trauma.

Implementation of the Family First Prevention Services Act will have a significant positive effect on the lives of children and families in Texas.