It is estimated that 40-60% of children in state care have behavioral health problems, which are often accompanied by physical health concerns as well. (1)

In 2012, approximately 4,800 children in Harris County were placed into protective custody programs. These children come from a variety of backgrounds and experiences, and are placed in the care of foster parents, kinship placements or other caretaking scenarios. Harris County Protective Services (HCPS) has provided children in state custody with physical health checks, full dental exams, x-rays and pharmaceutical services since the 1970s. However, 100 percent of mental health and behavioral health cases were referred out. The majority of children in kinship care in Harris County (56 percent) did not receive behavioral health treatment (2). “Kids weren’t being screened. They often went without assessment and treatment for mental health issues, and conditions worsened,” says Jacquelyn M. McMillon, Children’s Services Administrator at HCPS.

Since Medicaid became available to children in state custody, use of the HCPS medical clinics began dwindling. It was clear that their current model needed re-evaluating and they sought a better health care approach for children.

Laying the Groundwork for Success

HCPS received funding from the Hogg Foundation to implement an integrated health care program for children ages birth through 17 in state care. The program attempted to address gaps in services for children in foster care, who tend to have much higher rates of mental health concerns, physical health concerns, and developmental delays than children from similar socioeconomic circumstances.

The grant included a planning phase during which HCPS put together a steering committee to discuss the clinic and its services, and gather information from a broad stakeholder group including kinship caregivers, foster parents, alumni of the CPS system, parent partners, parent representatives, and organizations related to child abuse and neglect.

Three Services Under One Roof

McMillon and her team began to identify exactly how they wanted the clinic to look. Over that first year, they were able to develop a plan that became an integrated health care model for children in the child welfare system. They began by hiring a care manager and a child psychiatrist, and adding a psychiatric and behavioral health component to the existing model of medical and dental care. By putting all three services under one roof, HCPS created vital communication flows between medical, dental and behavioral health. They were able to make referrals within one setting, while also working with caregivers and children for specialty care and referrals outside of the system.

Family-Centered Support

HCPS understood that families needed very basic support and were stressed by the system. In response, HCPS created a Family Support Navigator position funded by a grant from the Harris County Hospital District Foundation. The Family Support Navigator has personal, lived experience, having been involved with child protective services, worked through the system, or had a child with behavioral health issues.

Initial Success

Results from the pilot program point to an extremely promising approach with clear, early results. Following the initial planning phase, HCPS successfully launched their integrated health care initiative in June 2014, creating a program in which:

  • Care management and psychiatric services are provided on-site and in collaboration with primary care,
  • 194 unique clients were served as of September 2015,
  • There has been an increase in patient satisfaction and number of visits, and
  • Caregivers and stakeholders report that the program fills important service gaps (e.g. care management and psychiatric services).

The integrated health care project provides comprehensive health care to children in kinship and foster care, allows caregivers to focus on prevention and wellness, and results in better health outcomes.

Learn more about Harris County Protective Services’ work on this initiative. For more information on the foundation’s projects in this area, contact Rick Ybarra.

(1) Burns, B. J., Phillips, S. D., Wagner, H., Barth, R. P., Kolko, D. J., & Campbell, Y. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry, 43 (8), 960–970.

(2) Watt, Toni, Professor Sociology Department Texas State University. (2015). Harris County Protective Services Integrated Health Care Implementation Grant: Evaluation Report. (2015).