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- Effects of COVID-19 on the agency’s operations and on children in state conservatorship, also known as foster care.
- Maintaining quality, accessible mental health treatment and support services for both children and their families during the agency’s transition to community-based care.
- Tracking the usage and effectiveness of the Alternative Response (AR) system in the Child Protective Investigations (CPI) process.
- Increased focus on housing, employment, and normalcy as crucial parts of recovery for foster youth, including those aging out of foster care.
- Continued monitoring and prevention of child fatalities within the Child Protective Services (CPS) system.
- Addressing disproportionality of minority and LGBTQIA+ youth in the CPS system and providing adequate services to meet the needs of these children and youth.
- More individualized interventions and treatment plans for youth with dual diagnoses (i.e., mental health and substance use or intellectual/developmental disabilities).
- System-wide integration of trauma-informed practices into all levels of care, including accessible trainings for all mental health professionals, caregivers, and staff working within the system.
- Improving support for youth transitioning from child to adult services (ages 17-24).
- Ongoing review of the barriers to implementation for the Foster Care Redesign/ Community Based Care Project and outcomes of regions already in Community Based Care.
- Implementation of the Family First Prevention Services Act in Texas in effort to draw down funding for additional mental health and substance use treatment, support, and prevention efforts.
- Combatting human trafficking and child exploitation for children within the foster care system and young adults who have aged out.
- Continuing innovative practices for families in effort to prevent the need for child relinquishment to obtain mental health services
- Preparing for a potential increase in family violence and child abuse cases during the COVID-19 pandemic and the need for robust prevention services to meet families’ needs.
- Continuing to focus on supporting and providing treatment for parents at risk of engagement with CPS due to mental health and substance use issues.
- In FY 2019, a record 6,107 children in state care found permanent homes, an increase from 5,678 in FY 2018. More than half of these adoptions were by relatives.
- In FY 2019, more children left foster care (20,343) than entered it (18,615) for the
- first time in the state’s history.
- In FY 2019, the Statewide Intake (SWI) division of DFPS received over 449,000 reports related to allegations of abuse and neglect.
- In FY 2019, there were 67,313 confirmed and 199,298 unconfirmed victims in abuse/neglect investigations.
- In FY 2019, there were 18,615 children removed from their homes by CPS, or 2.51 per 1,000 children.
- In FY 2019, there were 153,260 children and adults served by CPI’s AR system.
- Adult Protective Services (APS) completed 84,439 in-home investigations, with 49,284 of those investigations validated and 37,346 completed in-home service delivery stages.
- An estimated 234,000 people in Texas are victims of labor trafficking, and an estimated 79,000 youth are victims of sex trafficking in the state at any given time.
- Of the 51,417 children and youth in DFPS conservatorship in FY 2019, 2,122 children and youth were reported missing at some point.
- Texas had 235 confirmed child abuse and neglect-related fatalities in FY 2019, an increase from 211 in FY 2018.
- Experts predict that the COVID-19 pandemic may stimulate family violence and child abuse in families where it has not occurred before and worsen situations where violence and mistreatment is already an issue.
- 17,500 children were in DFPS Substitute Care as of August 31, 2018. Of those in foster care, 11,906 were in Child Placing Agency (CPA) foster homes, 1,516 in DFPS foster homes, 845 in basic child care, 1,747 in residential treatment centers (RTCs), 731 in emergency shelters, and 754 in other types of foster care.
- ACA – Affordable Care Act
- ACH – All church home
- APS – Adult Protective Services
- APS PI – Adult Protective Services provider investigations
- AR – Alternative response system
- CAC – Children’s Advocacy Center
- CANS – Child and Adolescent Needs and Strengths assessment
- CASA – Court appointed special advocate
- CBCAP – Community-based child abuse prevention
- CCL – Child Care Licensing
- CFE – collaborative family engagement
- COVID-19 – Coronavirus disease of 2019
- CPD – CPS professional development
- CPS – Child Protective Services
- CYD – Community youth development
- DFPS – Department of Family and Protective Services
- DSHS – Department of State Health Services
- FFCC – Former Foster Care Children
- FFPSA – Family First Prevention Services Act
- FGCM – Family group decision making
- GAO – Government Accounting Office
- GRO – general residential operations
- HHSC – Health and Human Services Commission
- HIP – Help through intervention and prevention
- HOPES – Health outcomes through prevention and early support
- HTCE – Human Trafficking and Child Exploitation
- IDD – Intellectual and other Developmental Disabilities
- JMC – joint managing conservatorship
- LGBTQIA+ – Lesbian, gay, bisexual, transgender, queer, intersex, and asexual
- LMHA – Local mental health authority
- MCO – Managed care organization
- MTFCY – Medicaid For Transitioning Foster Care youth
- NPP – Nurturing Parent Program
- OCOK – Our Community Our Kids
- PAL – Preparation for adult living
- PEI – Prevention and early intervention
- PMC – Permanent managing conservatorship
- QRTP – Qualified residential treatment program
- RCCL – Residential child care licensing
- RTC – Residential treatment center
- SNAP – Supplemental Nutrition Assistance Program
- SSCC – Single source continuum contractor
- STAR – Services to at risk youth
- SWI – Statewide intake
- SUD – Substance use disorder
- TANF – Temporary Assistance for Needy Families
- TEA – Texas Education Agency
- TFFC – Treatment Foster Family Care
- TFTS – Texas families together and safe
- YES – Youth Empowerment Services waiver
Source: Department of Family and Protective Services. (2020, May 10). DFPS Org Chart. Retrieved from https://www.dfps.state.tx.us/About_DFPS/Executives/DFPS_Org_Chart.pdf
The Department of Family and Protective Services (DFPS) is the state agency responsible for ensuring the safety of children, older adults, and adults with disabilities. DFPS is an independent agency that provides services and supports to these vulnerable populations to reduce the likelihood of abuse, neglect, and exploitation. Its headquarters are in Austin and included more than 12,000 employees that work in 328 local offices in 11 geographic regions as of August 31, 2019. DFPS geographic regions are shown in Figure 70.
Data obtained from: Texas Department of Family and Protective Services . “Agency Strategic Plan Fiscal Years 2021-2025,” June 1, 2020. https://www.dfps.state.tx.us/About_DFPS/Strategic_Plans/documents/2021-2025-DFPS_Strategic_Plan.pdf.
As Figure 71 below illustrates, Texas is also divided into several regional networks of child protection courts.
Data obtained from: Child Protection Courts. (2019, December). Retrieved from https://www.txcourts.gov/media/1445466/childprotectioncourts_december2019-11×17.pdf
As Table 52 shows, DFPS is comprised of five separate divisions. In 2017, Child Care Licensing (CCL) was transferred to Health and Human Services (HHS). During that transition, DFPS created an Investigations division.
Sources: Texas Department of Family and Protective Services. Learn about DFPS. Retrieved from http://www.dfps.state.tx.us/About_DFPS/default.asp
Texas Department of Family and Protective Services. DFPS Annual Report 2019. (2020). Retrieved from https://www.dfps.state.tx.us/About_DFPS/Annual_Report/2019/DFPS_2019_Annual_Report.pdf
The mental health needs of children and their parents involved with the child welfare system are far-reaching. CPS has been plagued for years with serious issues including child fatalities, overburdened caseworkers, and systemic issues in the treatment and care of foster youth. This was bolstered by a 2015 Supreme Court ruling that stated the system had “violated the constitutional rights of children living in foster care.” The most significant system-wide change occurred during the 85th legislative session when the Texas Legislature voted to shift the child welfare system to embrace community-based care in order to keep children closer to home and connected with their communities and families. Due to critical issues within the child welfare session. The state has also spent significant time focused on preparing for the implementation of the Family First Prevention Services Act (FFPSA), which was passed by Congress in 2018. Certain provisions will not go into effect in Texas until 2021. Due to the COVID-19 outbreak within Texas in 2020, the 87th Texas legislative session will likely be focused on aiding the families and children served by DFPS whom have been affected by the pandemic.
In June 2020, DFPS released their Agency Strategic Plan for FY 2021-2025, which listed the following goals:
- Goal 1: Client Services – Improve direct delivery services to meet client, family, and community needs
- Goal 2: Workforce Stability and Development – Increase workforce stability and retention of institutional knowledge by focusing on attracting, retaining, and developing highly qualified staff
- Goal 3: Process Improvement – Strengthen internal processes by better analyzing agency operations and identifying and correcting areas for more efficient and effective operations
- Goal 4: Teamwork – Enhance internal communications to ensure cohesion among divisions
- Goal 5: Community Relations – Improve external communications and outreach to better inform the public and assist with protecting clients, families, and communities
CHILD WELFARE LEGISLATION PASSED BY THE 86TH TEXAS LEGISLATURE
Various bills passed in the 86th legislative session that directly affected children involved in the DFPS system. The General Appropriations Bill, HB 1 (Zerwas/ Nelson), includes several budget riders affecting the agency. Article II, Rider 52 directs the Health and Human Services Commission (HHSC) and DFPS to enter into a memorandum of understanding for the provision of outpatient substance use treatment services by HHSC to referred DFPS clients.
Rider 66 mandates an annual legislative report on all opioid abuse and misuse-related programs at HHSC, DFPS, and the Department of State Health Services (DSHS) to be submitted by HHSC.
Rider 24 requires DFPS to submit quarterly reports on whether foster children are being placed in appropriate service levels. The April 2020 report stated that two residential treatment centers (RTCs) were contracted to provide Intense Plus services, with three providers in the process of becoming certified providers. Intense Plus services are intended to address chronically serious to severe emotional and/or behavioral management problems that interfere with a child’s ability to function in a family, school, or community setting outside of a therapeutic environment. Additionally, between September 1, 2018 and April 17, 2020, 133 children received placement through Treatment Foster Family Care services. These services hold providers accountable for decreasing the acuity of need and administering placements into less restrictive, more family-like settings. More detailed information on the April 2020 report can be found here https://www.dfps.state.tx.us/About_DFPS/Reports_and_Presentations/Rider_Reports/documents/2020/2020-04-30_Rider_24_Report.pdf.
SB 195 (86th, Perry/Parker) requires DFPS to publicly report state-level data related to parental substance use, prenatal substance exposure, and postnatal treatment.
HB 72 (86th, White/Paxton) directs HHSC and DFPS to develop and implement a program that allows the adoptive parent or permanent managing conservator of a former foster child to receive or continue receiving Medicaid benefits under the STAR Health program or the STAR Kids managed care program.
HB 2764 (86th, Frank/Hughes) mandates that DFPS and single source continuum contractors (SSCCs) limit trainings for potential caregivers to a maximum of 35 hours, and requires SSCCs to meet the training requirements of the FFPSA.
Amongst many other provisions, SB 781 (86th, Kolkhorst/Leman) directs DFPS to develop a strategy for trauma-informed protocols aimed at reducing runaway incidents from RTCs, as well as a plan for foster care placement facilities eligible for funding under the FFPSA.
HB 1709 (86th, Gonzalez/Menendez) requires school districts to notify DFPS if a surrogate parent has been appointed to a child with disabilities and is in the conservatorship of the state. It also clarifies that if a school district determines that a court-appointed surrogate parent is not properly performing their required duties, then the district shall consult with DFPS. If the agency agrees with the school district that the court-appointed surrogate parent is unable or unwilling to act in the surrogate parent capacity, then DFPS must request that the court review the appointment of the individual.
HB 811 (86th, White/West) requires schools to consider students’ status in the conservatorship of DFPS, as well as if they may be experiencing homelessness, before issuing suspensions, removals, expulsions, or placements in alternative education programs.
LEGISLATION THAT FAILED TO PASS IN THE 86TH TEXAS LEGISLATURE
Several bills failed to pass that would have reformed child welfare or DFPS policies and procedures.
HB 517/SB 1251 (Israel/Menendez) would have defined unprofessional conduct by a mental health professional to include attempts to change a child’s sexual orientation, gender identity, and attractions or feelings towards the same sex.
HB 2926/SB 951 (Hinojosa/Watson) would have created the Family First Prevention Services Task Force in order to assess the readiness of Texas to implement the FFPSA and make recommendations to support the state in its transition and reformations.
HB 1536/SB 2419 (Miller/Fallon) would have required DFPS to implement and expand trauma-informed care across the child welfare system, including staff and caregiver training requirements. It included the establishment of a task force consisting of nine DFPS-appointed members that work in the trauma-informed care field, a House Member appointed by the Speaker, and a Senator appointed by the Lieutenant Governor, to improve trauma-informed practices and policies throughout DFPS.
CHILD RELINQUISHMENT TO OBTAIN MENTAL HEALTH SERVICES
Child relinquishment to obtain mental health services refers to the process in which a parent or guardian terminates parental rights of their child and relinquishes those right to the state, solely to help their child get the intensive mental health services he/she needs. Legislation passed in the 83rd, 84th, and 85th sessions addressed the need to provide joint managing conservatorship (JMC) so that a family can stay connected to their child, and disallowed placement of the parents’ name on the abuse/neglect registry if the child was relinquished solely to obtain mental health services. Recent experiences of families indicate that significantly more work still needs to be done to support the children who need these services and their families.
To help prevent these relinquishments, the Texas Legislature created the Child Relinquishment RTC Diversion Project as an alternative way to access intensive services. In January 2020, a group of HHSC and DFPS staff, provider organizations, parents, and children’s mental health and child welfare stakeholders conducted a process mapping exercise of the Diversion Project to identify areas needing improvement. This program was originally developed as a way to prevent parents from relinquishing custody of their child to the state when less restrictive mental health services were unsuccessful in meeting the intensive needs of the child. The results of the process mapping and a letter with recommendations to improve the system were sent to the executive commissioner of HHSC in May 2020, and again in September 2020 after the appointment of a new executive commissioner.
The group collectively identified potential bottlenecks in the current processes, discussed both positive and unintended outcomes that result from some of the program policies, and developed preliminary recommendations that are listed below:
- Enhance intensive community-based services and supports that families need in order to prevent the difficult decision to relinquish custody
- Allow children who are post-adoption to have access to the diversion project services to enable adoptive families to access a broader range of state-funded behavioral health services needed to support the family and prevent custody relinquishment
- Shorten the wait-time to obtain diversion project placement
- Reform the process so that a CPI investigation is no longer needed to obtain services
- Create a centralized point-of-contact for CPS caseworkers handling mental health relinquishment cases
- Evaluate JMC standards across the state
- Increase the awareness of CPS workers, local mental health authority (LMHA) staff, and families of the diversion project
- Enhance data collection of programs to ensure that gaps and barriers can be identified and addressed
LAWSUIT AGAINST DFPS/CPS
In 2011, the DFPS foster care system came under increased public scrutiny after a class-action lawsuit was filed against DFPS on behalf of all Texas children in foster care on a long-term basis. The case was originally brought forth by two advocacy groups — Children’s Rights and A Better Childhood. Over a dozen other advocacy organizations joined as plaintiffs in the case. The lawsuit focused on how CPS treats children in the state’s Permanent Managing Conservatorship (PMC) program, specifically children who have been unable to find a permanent placement within a year of their initial removal from their home.38 In 2011, when the lawsuit was first brought against CPS, there were approximately:
- 12,000 children in PMC, of which there were:
- 6,400 children in PMC for three or more years;
- 500 children in PMC for more than 10 years; and
- More than one-third of children in PMC experiencing five or more placements.
In December 2015, U.S. Federal District Judge Janis Graham Jack of Corpus Christi issued a ruling on the case, finding that the state had systematically violated the constitutional rights of children in PMC foster care. Judge Jack described the foster care system run by DFPS as one “where rape, abuse, psychotropic medication and instability are the norm,” where children “often age out of care more damaged than when they entered.” Several of the ruling’s reforms to improve the PMC program were implemented in the beginning of 2016. These changes include:
- Addressing caseworker turnover and caseload size issues by directing DFPS to hire enough caseworkers to “ensure that caseloads are manageable” across the state
- Addressing concerns of child safety in foster care placements by prohibiting placement of children in foster group homes without 24-hour awake supervision and addressing regulatory lapses in the state’s “broken” residential licensing division
Judge Jack appointed two special masters in March 2016 to help guide and oversee the changes to DFPS’ foster care system. The two transition masters, mediator and specialist attorney Francis McGovern and Kevin Ryan, former Commissioner of Children and Families for New Jersey, began their new roles working with DFPS on April 1, 2016. The co-transition masters created a plan to address the capacity issues, defining “manageable” caseload sizes, and resolving other problems with the PMC program identified in the lawsuit. Their plan guided Judge Jack’s ruling in January 2018, which required DFPS to implement nearly 100 changes to the CPS system. According to Texas CASA, some of the most important were a reduction in caseloads for conservatorship caseworkers, creation of a new comprehensive data system, expansion of placement capacity to meet regional needs, and payment of attorneys ad litem by DFPS while children are in PMC. After the final ruling was issued, the 5th U.S. Circuit Court of Appeals upheld Attorney General Ken Paxton’s request for a temporary halt on Judge Jack’s order.
In November 2019, Judge Jack found the state of Texas in contempt of court, ruling that they had failed to comply with prior orders. The judge’s ruling resulted in $150,000 in paid fines for the state’s failure to require large foster homes and institutions to have 24-hour awake supervisions. From July 2019 to February 2020, the special masters billed the state for about $3.2 million.
In June 2020, a report was released by independent federal monitors appointed by Judge Jack to look into Texas’ child welfare system. The report included several violations and stories of children being exposed to harm because: the state frequently moved too slowly to investigate abuse and neglect allegations, inappropriately downgraded allegations against staff, and failed to investigate certain workers accused of harming youth. As of June 2020, state attorneys had not responded to the report. Judge Jack can potentially hold the state in contempt of court again for continuing to be in violations of her orders. According to the Texas Tribune, the report also found that:
- Texas did not adequately inform children in the system about their rights for reporting abuse allegations. A majority of the youths interviewed for the report were unaware of the foster care ombudsman.
- A fragmented system of managing state data makes it difficult to track investigation histories about children and facilities and identify patterns of maltreatment.
- Dozens of new case workers were assigned more children than they should have been responsible for, under a court order designed to limit caseloads to manageable levels.
- Awake-night staff, who are required to monitor homes that house more than six children, were often suspected to be sleeping or drowsy when inspectors arrived. Often, inspectors found that the census sheet of children at the facility did not accurately reflect the children who were there.
- The state failed to comply with the judge’s orders about preventing sexual abuse, leaving children at risk. “The State may be prioritizing identification of victims and aggressors, but not prevention of sexual abuse,” the monitors wrote.
FOSTER CARE REDESIGN/COMMUNITY-BASED CARE
Foster care and mental health delivery systems overlap because the youth entering into foster care have suffered traumatic experiences. Trauma inflicted by experiencing physical, psychological, or sexual abuse or chronic neglect has a profound effect on children. The effects of trauma can last a lifetime and can play out differently depending on each person’s individual experiences. Individuals who experience significant childhood abuse and family discord in their youth have a higher incidence of physical and behavioral health problems as adults. A youth who has experienced trauma is at higher risk of having issues with substance use, mental health (such as depression and suicide), promiscuity, and criminal behavior. Children in foster care often experience abuse and neglect, and as a result experience different degrees of traumatization. Mental health conditions are one of the consequences that typically result from traumatic experiences. However, children’s symptoms of trauma may sometimes be misinterpreted as deliberate problematic behavior or indicative of a condition unrelated to trauma. It is important to know that children and youth who experience traumatic events can and do heal with proper mental health supports and treatment. Further, providers and caregivers who work from a trauma-informed lens can help children and youth health in a supportive space.
Disconnected and uncoordinated foster care with multiple placements is likely to aggravate childhood trauma and any other mental health conditions, especially if mental health needs are not properly addressed with timely and appropriate care. Lack of permanency and consistency in childcare placements, including receiving a high number of placements, is traumatic and exacerbates mental health conditions for children in foster care. These symptoms are worsened by placements outside a child’s home community. In order to best serve the needs of children and youth in the foster care system, CPS practices need to be embedded with trauma-informed care principles.
In an effort to reduce negative outcomes for children in the foster care system, DFPS embarked on a Foster Care Redesign project in 2010. Now known as Community- Based Care, the initiative was launched in effort to improve outcomes for youth in the areas of safety, permanency, and overall well-being. This community-focused approach involves contracting out to select nonprofits and government agencies, who are then responsible for finding services such as living arrangements or foster homes for children under the care of the state.
One of the biggest changes resulting from Community-Based Care has been the switch from service-based funding to performance-based funding. Under the previous system, payment was linked to a child’s service level (basic, moderate, specialized, or intensive) and placement type (Child Placement Agency, Emergency Shelter, General Residential Operation, or RTC). This reimbursement structure did not create incentives for a child to be moved to a lower service level. Through the redesign effort, payments are now tied to positive outcomes in the child’s care instead of their current service level, thereby encouraging children’s transition to lower service levels and corresponding overall reductions in the average cost-per-child.
Community-Based Care also restructures service delivery so that care is coordinated from an SSCC rather than a compilation of DFPS contracts with over 300 private service providers. Texas law requires SSCCs to be either government entities or nonprofits focused on child welfare. The goal of streamlining the delivery of care is to better coordinate services for families so that services are more consistent across the state and readily accessible close to a child’s home and community, regardless of what part of the state they live in. Under the new system, an SSCC is required to provide a range of services for foster care youth in specific geographic catchment areas. As of October 2019, Texas had 17 catchment areas established by DFPS. Areas where community-based care has not yet been implemented are referred to as being part of the “legacy system,” meaning DFPS still dictates both placement and case management over these areas. In 2017, the Texas Legislature passed SB 11 (85th, Schwertner/Thompson, Senfronia) to expand the Community-Based Care model to include both foster care and relative or kinship care and services, and give the SSCC sole responsibility for case management.
A recent partnership between CPS and Texas CASA has been formed to provide collaborative family engagement (CFE) in the child welfare process. CFEs are made up of a CPS caseworker, a CPS supervisor, a Court-Appointed Special Advocate aka “CASA” volunteer, and a CASA supervisor. They work with SSCCs to enhance the well-being of children by maintaining their relationships with biological family members to prioritize a kinship placement. In Phase 1 of CFE, the family is invited into the planning and decision-making process for the children in foster care. Phase 2 involves the shift of case management from CPS to a SSCC caseworker, who will search for permanent placements for the child.
In 2019, SB 355 (86th, West/Click) directed DFPS to identify a network of service providers to provide mental health, substance use, and in-home parenting support for children at risk of entering foster care, the parents and caregivers of children at risk of entering foster care, and pregnant or parenting youth in foster care. SB 355 also required a strategic plan to identify optimal methods for: 1) statewide implementation of foster care prevention services, 2) identification of necessary resources for the department to implement community-based care, and 3) coordinating community-based care implementation with foster care prevention services.
In new regions, the Community-Based Care program will be implemented in two stages:
- In Stage I, the SSCC will develop a network of services and provide foster care placement services. The focus in Stage I is on improving the overall well-being of children in foster care by keeping them closer to home and connected to their communities and families.
- In Stage II, the SSCC will provide case management, kinship, and reunification services. The focus of Stage II is on expanding the continuum of services to include services for families and to increase permanency outcomes for children.66 By the end of FY 2018, Community-Based Care was active in Bexar County, all counties in Region 2, and seven North Texas counties. DFPS grew Community-Based Care in FY 2019 by awarding Saint Francis Ministries in Region 1 a contract to expand the initiative into 41 counties around the Texas Panhandle.
The first SSCC was awarded to All Church Home (ACH) Child Services in Region 3b in 2013. ACH’s Our Community Our Kids (OCOK) program serves as the SSCC foster care provider for a seven-county region that includes Erath, Hood, Johnson, Palo Pinto, Parker, Somervell, and Tarrant counties. The results of the implementation of Stage 1 of the Community-Based Care program in Region 3b have been positive, as DFPS found an improvement in outcomes for children in Community-Based Care in that region, compared to children in the legacy system outside the region. In 2019, 81 percent of days in the Community-Based Care area were in foster homes, rather than treatment centers or shelters. Additionally, 74 percent of youth were placed close to their home communities, compared to 62 percent in non-Community-Based Care areas. OCOK took responsibility for Stage II services in March 2020, where they have provided case management services following a transition with DFPS. OCOK has developed more placements for youth with complex needs in foster homes by increasing placements in foster homes within 50 miles and keeping siblings together. For more information, see the DFPS Rider 15 report provided at the bottom of this section.
Using data from the Region 3b service area (including Fort Worth and Dallas County), one study from the Perryman Group estimates that every dollar invested in the state’s Community-Based Care program will return $3.44 in state revenue and $1.66 in local revenue.
As of December 2019, DFPS had contracted to enter Stage II in Region 2, which includes 30 Texas counties. The 2INgage partnership between the New Horizons Ranch & Center and the Texas Family Initiative has been responsible for providing services to this area since December 2018. 2INgage began providing case management services as Stage II commenced, and assumed responsibility for Stage II in June 2020. As of March 2020, services were provided through 2INgage to about 750 youth.
A contract for Region 8a, which includes all of Bexar County, was awarded in August 2018 to the Children’s Shelter in San Antonio to serve as the catchment area’s SSCC. As of March 2020, services were provided through Family Tapestry to about 1,720 youth. The Children’s Shelter dealt with fiscal management concerns in 2019, which delayed the implementation of Stage II. This was planned to be corrected and verified by DFPS in May 2020, allowing for Stage II negotiations to take place.
A contract for Region 1 was awarded to St. Francis Community Services in Texas, Inc. which served as the SSCC for the catchment area since July 1, 2019. After a six-month start up period, St. Francis’s readiness was certified by DFPS, and on January 6, 2020 they started accepting placement referrals. As of March 2020, St. Francis was serving about 740 youth through their continuum of care.
Region 8b, which includes all counties in Region 8 except Bexar County, had a procurement closed on August 2, 2019 for the catchment area. As of September 2020, a Request for Application was set to close on December 1, 2020.
View the April 2020 DFPS Rider 29 Report on Community-Based Care Implementation Status here: http://www.dfps.state.tx.us/About_DFPS/Reports_and_Presentations/Rider_Reports/documents/2020/2020-04-01_Rider_29- CBC_Implementation_Status_Report.pdf.
View DFPS’s March 2020 Rider 15 report on Community-Based Care here: http://www.dfps.state.tx.us/About_DFPS/Reports_and_Presentations/Rider_Reports/documents/2020/2020-03-31_Rider_15_Community_Based_Care_Report.pdf.
DFPS’s December 2019 Implementation Plan for the Texas Community-Based Care System, which reports on high-level accomplishments from FY 2018 – FY 2020, can be viewed here: https://www.dfps.state.tx.us/Child_Protection/Foster_Care/Community-Based_Care/documents/2019-12-20_Community-Based_Care_Implementation_Plan.pdf.
FAMILY FIRST PREVENTION SERVICES ACT
In February 2018, Congress passed the FFPSA, which restructured how the federal government funds child welfare services. The legislation aims to help families in crisis safely stay together and reduce the foster care population by prioritizing prevention of entry into foster care, and increasing the number of children successfully exiting foster care by reducing reliance on congregate care in favor of more family-like settings.
Although intended to go into effect October 1, 2019, Texas has an alternative timeline for the law’s implementation to allow time to prepare. The FFPSA was delayed two years and will not go into effect state-wide until October 1, 2021. SB 355 required DFPS to submit a strategic implementation plan to the legislature by September 1, 2020. Most funding changes from the 87th Texas Legislative Session will go into effect by September 1, 2021, followed by full implementation of the law one month later. Under FFPSA, many of Texas’ congregate care placements are ineligible for funding. States such as Texas that chose to delay implementation cannot draw down any of the newly available prevention dollars until they are in full compliance with the law.
The largest federal source of child welfare funding comes from Title IV-E of the Social Security Act, which provides states with funds to support foster care, adoption assistance, guardianship assistance, and the Chafee Foster Care Independence Program, a grant program that helps foster youth gain self-sufficiency. With the exception of Chafee, children must meet Texas’s eligibility requirements for guardians to be reimbursed for IV-E funded programs. On October 1, 2019 the FFPSA changed Title IV-E funding to provide more flexibility to invest in prevention programs, as well as to remove funding from certain congregate care placements.
The FFPSA will provide states with additional funding to invest in prevention programs aimed to keep children at imminent risk of foster care placement out of the system, assist pregnant and parenting youth already in foster care, and better support kinship caregivers. Trauma-informed and evidence-based programs are required and the law allows mental health and substance use prevention services to qualify for funds.
Additionally, the FFPSA precludes states from using Title IV-E funding to support children in foster care who spend more than two weeks in “child care institutions,” a broad term that encapsulates settings like group homes and RTCs. Under the FFPSA, states can only use Title IV-E funding for services provided to children in the following congregate care settings beyond two weeks:
- Facilities for pregnant and parenting youth
- Supervised independent living for youth 18 and older
- Specialized placements for youth who are victims of or at risk of becoming victims of sex trafficking
- Family-based residential treatment facilities for substance use conditions
- Qualified residential treatment programs (QRTP)
A QRTP is a new standard for congregate care settings. The term refers to a program that has a trauma-informed treatment model designed to address the needs, including clinical needs, of children with serious emotional or behavioral disorders or disturbances. Appropriately, licensed clinical staff must be available to provide care 24 hours a day under this standard.
DFPS is jointly funded by both state and federal dollars. The agency’s budget was roughly $4.185 billion for FY 2018-19 and $4.428 billion for FY 2020-21— an almost 5.8 percent increase in two years. In FY 2018-19, 42 percent of DFPS funding came from federal sources while the other 58 percent came from state sources (e.g., general revenue funds, GR-dedicated funds and other funding sources such as child support payments). In FY 2020-2021, the federal share of funding for DFPS slightly decreased to 41 percent and state funding increased to 59 percent. As Figure 72 shows, the vast majority of the DFPS budget (85.53 percent) goes towards the department’s CPS-related mission of protecting children by operating an integrated service delivery system.
Source: Zerwas & Nelson. (2019). H.B. No. 1 General Appropriations Act Eighty-Sixth Legislature. Retrieved from https://capitol.texas.gov/BillLookup/History.aspx?LegSess=86R&Bill=HB1
Source: Zerwas & Nelson. (2019). H.B. No. 1 General Appropriations Act Eighty-Sixth Legislature. Retrieved from https://capitol.texas.gov/BillLookup/History.aspx?LegSess=86R&Bill=HB1
Child Protective Investigations (CPI) Division
CPI is responsible for investigating allegations of child abuse and neglect, which are reported to the CPS division if they meet certain criteria. Feeling unsafe in a household can harm the mental health of children, and state intervention is sometimes used to further trauma. In addition to investigating allegations of child abuse and neglect, CPI works with law enforcement on joint investigations, taking custody of children who are in unsafe environments, referring children to community resources that promote their safety and well-being, and assisting in the fight against human trafficking. Investigators typically attempt to complete investigations within 30 days of the agency receiving a report, but extensions can be provided.
After conducting interviews and inquiring into the details of a case, including whether there is a reasonable likelihood that a child will be abused or neglected in the foreseeable future, DFPS makes a ruling on each allegation. This ruling is called a disposition, which according to DFPS’s CPI webpage, can result in any of the following verdicts:
- Reason to believe: Abuse or neglect occurred based on a preponderance of the evidence. This means when all evidence is weighed, it is more likely than not that abuse or neglect occurred.
- Ruled out: Staff determines that it is reasonable to conclude that the abuse or neglect has not occurred based on the information that is available.
- Unable to Complete: The investigation cannot be concluded. Often this verdict is This is usually because the family could not be located to begin the investigation or the family was contacted but later moved and could not be located to complete the investigation or the family refused to cooperate with the investigation. DFPS policy outlines several actions that the investigator must complete to make this disposition.
- Unable to determine: DFPS concludes that none of the dispositions above is appropriate.
- Administrative closure: DFPS intervention is unwarranted based on information that comes to light after the case is assigned for investigation.
CHILD ABUSE/NEGLECT AND CPI INVESTIGATIONS
CPI investigates abuse and neglect allegations to decide whether there is a threat to the safety of the children in their home environment. During child abuse and neglect investigations, an agency caseworker screens the child’s behavioral health, basic physical condition, and the safety and livability of their living environment. Based upon in-person interviews with alleged victims, photographs of injuries (if present) and documented conversations with other adults in the child’s life (e.g., teachers and siblings), the worker will assess the mental health and psychosocial functioning of each child and make referrals for additional behavioral health services and assessments as necessary. If the caseworker determines that a child is not safe, then the caseworker initiates protective services. Next steps could include family-based protective services such as outpatient engagement while the child remains in the home, a court petition to remove the child from the home, and/or legal action to terminate parental rights.
A child is placed in foster care after other parent engagement services and outpatient treatment options have been exhausted. In FY 2019, more than 49,525 children were in DFPS custody at some point. According to DFPS language, FY 2019 data showed that Hispanic (about 40 percent) and Anglo children (nearly 29 percent) make up the majority of children in foster care, with African-American children (about 21 percent) as the third most prevalent racial/ethnic group. However, when you take into account the racial demographics of Texas children as a whole, African-American children (who made up 12 percent of the Texas child population in 2018) are overrepresented in the foster care system — see the Disproportionality and Racial/Ethnic Diversity of Children and Youth section in this chapter for further information.
In FY 2019, the total number of cases/intakes was 294,739, with 266,611 children suspected victims of abuse or neglect statewide. Of those cases, 67,313 were confirmed (defined as “based on a preponderance of evidence, staff concluded that abuse or neglect occurred”). Confirmed victims of child abuse/neglect in FY 2019 was up about 1.62 percent from FY 2018, and about 4.06 percent higher than in FY 2016.
As of August 31, 2019, 37.71 percent of children in DFPS conservatorship were in kinship placements (family or fictive kin such as family friends). When it is unsafe for a child to remain in his or her home and there are no appropriate kin or fictive kin who can provide shelter and care for that child, CPS will petition the court for temporary legal conservatorship. When family and kinship placements are unavailable, CPS may place a youth in a variety of different settings, including:
- Emergency children’s shelters;
- Foster group homes;
- Foster family homes;
- Residential group care facilities; and
- Facilities overseen by another state agency.
Parental substance use can be a contributing factor in CPI cases. A report from Texas CASA showed that 94 percent of removals in substance use-related cases were due to neglectful supervision, 14 percent to physical abuse, two percent to medical neglect, and less than one percent to emotional abuse (more than one reason could be listed). The report also indicated that substance use alone rarely leads to removals. Rather, there are typically multiple risk factors, co-occurring problems, or socioeconomic factors that raise the probability of a removal. These include: housing instability, poverty, social networking gaps, mental health conditions, and structural racism that affect investigative and judicial decision-making. Interviews also found that parental substance use of marijuana often led to what the agency defined as child abuse or neglect, even if the child was not endangered.
A report from Texans Care for Children concluded that Texas is a “low-removal state,” removing a smaller percentage of children from their families compared to the national average. However, the rate of removals in the state is increasing, and parental substance use is a contributing factor in most removals. The report also shared barriers present for parents seeking substance use treatments. In 2017, there were over 100 mothers on a waitlist for a spot at a women and children residential treatment center, waiting an average of 18 days before a spot became available. This has a direct effect on removals, as access to community services is critical to family preservation. When DFPS determines whether a child is in danger, the agency weighs possible safety interventions that could alleviate the danger, including community services. However, DFPS is not allowed to consider long-term therapy, treatment, or placement on a waiting list for services as a “safety intervention” since these would not immediately resolve the safety concern.
Because there are often significant barriers to receiving substance use services, in 2019 the Texas Legislature passed HB 1780 (86th, Miller/Kolkhorst). This bill requires courts to consider a parent’s good faith attempt to complete substance use services or treatment 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, the bill allows parents a chance to seek the services they need and keep families together when appropriate.
ALTERNATIVE RESPONSE (AR) SYSTEM
The CPI AR system aims to ameliorate the stress of a CPI investigation and provide prevention services to more families in need by adapting the typical investigation process when workers identify a lower-risk allegation. In doing so, the agency provides a non-adversarial means of dealing with less serious cases of abuse and neglect in a more client-centered and less intrusive manner. When considering if AR is appropriate for a case, staff reviews the type and severity of the allegation, any history of previous reports, and the willingness of the family to participate and be involved with support services. AR, also known at the national level as “differential response,” places an emphasis on reinforcing family strengths, fostering parental involvement, and the development of support systems.
AR interventions do not name the parent or guardian as a perpetrator of abuse or neglect, which avoids negative impacts on future employment. This approach differs from typical investigations, where they are named. The AR approach builds upon a family’s strengths and supports already in existence in order to ensure child safety. During AR interventions, CPI runs rigorous screening of lower priority cases to single out families that could potentially benefit from this method.
National research has found that differential response systems have demonstrated generally positive outcomes related to child safety, parent satisfaction, service delivery, and improved worker satisfaction. Despite higher initial investments, this approach is more cost-effective in the long run due to lower costs for case management and prevention services. AR engages parents, prompts them to identify their strengths, and connects them to providers to help address behaviors that may be harming a child’s cognitive, social, emotional, or physical development.
In FY 2018, Texas expanded AR into the San Antonio and southeast areas of the state. In FY 2019, CPI expanded AR in Region 2, which includes 30 North Texas counties. By the end of FY 2020, Harris County is expected to receive AR services, making AR available statewide.109,110,111 More information on AR in Texas can be found at: https://www.dfps.state.tx.us/Investigations/alternative_response.asp.
CHILD FATALITIES IN TEXAS DUE TO ABUSE/NEGLECT
Child fatalities continue to occur in Texas. DFPS reports that a total of 235 children in Texas died as a result of child abuse or neglect in FY 2019, up from 211 in FY 2018 and 172 in FY 2017. The increase was largely due to neglectful supervision, which led to a significant increase in drownings, vehicle related deaths, and ongoing concerns of unsafe sleep practices combined with substance use. CPS had no contact with the child or perpetrator in over 91 percent of abuse/neglect fatalities in FY 2019. The number of child fatality investigations continued its trend of decreasing since 2010, as the 785 reported in FY 2018 went down to 772 in FY 2019.
It is important to look at trends in past child deaths in order to understand the risk factors that can be used by DFPS to prevent child abuse and neglect-related fatalities in the future. Some of the most salient risk factors for child abuse or neglect-related fatalities can be drawn from the following pieces of information:
- According to DFPS language, the highest number of the child abuse/neglect deaths involved Hispanic children. Of the 235 child fatalities in FY 2019, 82 were Hispanic, 69 were African American, and 69 were Anglo. However, African American youth were disproportionately represented in child abuse and neglect-related death statistics, with a 7.85 per capita fatality rate compared to 2.23 for Hispanic children and 2.98 for Anglo youth.
- A history of child maltreatment and domestic abuse increases child fatality risks; 45.5 percent of families who had a confirmed child abuse or neglect-related fatality in FY 2019 had a history of prior involvement with CPS.
- 21 abuse and neglect-related fatalities involved families and/or perpetrators with an open and active CPS case at the time of death.
- Children three years and younger have accounted for roughly 80 percent of all confirmed child abuse and neglect-related deaths in the past ten fiscal years.
Figure 74 provides data on the child fatalities in Texas in FY 2019:
MISSING CHILDREN, HUMAN TRAFFICKING, AND CHILD EXPLOITATION
The Texas Attorney General’s office estimates that there are around 234,000 victims of labor trafficking and 79,000 youth in sex trafficking in Texas at any given time. Global research indicates that victims of human trafficking commonly report suffering from the following mental health conditions: depression, anxiety, post-traumatic stress disorder, self-harm, and attempted suicide. When combined with physical health problems, researchers have concluded that services and interventions are urgently needed to support this population, especially regarding mental health.
MISSING CHILDREN AND YOUTH TRAFFICKED IN STATE CONSERVATORSHIP
In May 2020, DFPS published their FY 2019 annual report on Children and Youth Missing from DFPS Conservatorship & Human Trafficking Initiatives. The report found that of the 51,417 children and youth in DFPS conservatorship, 2,122 children and youth were reported missing at some point during FY 2019. Of these 2,122 individuals:
- 1837 (87 percent) were located as of August 31, 2019.
- 175 (8 percent) were still missing on August 31, 2019. Of these, 75 (43 percent) had gone missing during August 2019.
- 110 (5 percent) children and youth exited conservatorship while missing. Of these:
- 63 youth turned 18 while on missing status; and
- 47 had legal responsibility terminated while on missing status before they turned 18.
The percent of children and youth in conservatorship who were missing at some point has slightly increased over the past three fiscal years, from 3.4 percent in FY 2017 to 3.8 percent in FY 2019. According to survey results, the top reasons individuals went missing in FY 2019 were: anger at CPS or the system (19 percent); desire to be on one’s own (18 percent); desire to see family/relatives (15 percent); frustration/anger with caregivers (15 percent); desire new placement (13 percent); and desire to be with boyfriend or girlfriend (11 percent). Youth between the ages of 15 and 17 made up 66 percent of first-time missing incidents in FY 2019. Of all children missing in this time period, 53 percent were classified as female and 47 percent as male. In terms of race/ethnicity, DFPS reported that 42 percent of those missing were Hispanic, 30 percent were Anglo, and 21 percent were African American. With regards to living arrangements, 19 percent of youth and children missing were living in RTCs, 19 percent in emergency shelters, 18 percent in therapeutic foster homes, and 12 percent in kinship care. Harris County had the highest number of children and youth in placements during the individual’s first missing event, with 439 children missing from care in FY 2019. This was followed by Bexar County with 169 missing children, Dallas County with 149, Travis County with 95, and Fort Bend with 81.
Of the 1,837 children and youth who were recovered in FY 2019, Figure 75 shows that 109 (5.9 percent) were victimized while missing. Of these individuals, 72 were sexually abused, 46 were sex trafficked (44 females and 2 males), and 19 were physically abused.
Source: Texas Department of Family and Protective Services. “Children and Youth Missing from DFPS Conservatorship & Human Trafficking Initiatives Fiscal Year 2019 Annual Report,” May 2020. https://www.dfps.state.tx.us/About_DFPS/Reports_and_Presentations/Agencywide/documents/2020/2020-05-29_Children_Youth_Missing_from_DFPS_Conservatorship_and_Human_Trafficking_Data_FY2019.pdf.
STATEWIDE REPORTS AND INVESTIGATIONS OF SEX AND LABOR TRAFFICKING
Allegations of sex trafficking and labor trafficking are investigated by DFPS when the alleged perpetrator is responsible for a child or youth’s care, custody, or welfare. In FY 2019, there were 732 reports of sex trafficking and 102 of labor trafficking, 859 alleged victims of sex trafficking and 125 of labor trafficking, and 549 reports of sex trafficking investigated and 64 of labor trafficking.
Upon investigation, DFPS confirmed 29 victims of sex trafficking and 11 cases of labor trafficking in FY 2019. While 59 percent of confirmed victims of sex trafficking investigations were between 15 and 17 years old, 21 percent were under the age of 12. For labor trafficking, 63 percent were between the ages of 15 and 17. The agency reported that Hispanic youth and children were confirmed victims in 48 percent of sex trafficking investigations, followed by African Americans at 28 percent and Anglos at 24 percent. With labor trafficking investigations, 55 percent of confirmed victims were Anglo and 27 percent Hispanic. 93 percent of confirmed sex trafficking victims were females, and 73 percent of confirmed labor trafficking victims were males.
More information on DFPS’s May 2020 report on Children and Youth Missing from DFPS Conservatorship & Human Trafficking Initiatives can be found at: https://www.dfps.state.tx.us/About_DFPS/Reports_and_Presentations/Agencywide/documents/2020/2020-05-29_Children_Youth_Missing_from_DFPS_Conservatorship_and_Human_Trafficking_Data_FY2019.pdf
In June 2020 Texas HHSC published a Provider Guidebook on Services for Victims of Human Trafficking in Texas, which can be viewed here: https://hhs.texas.gov/sites/default/files/documents/services/safety/human-trafficking/provider-guidebook-services-victims-human-trafficking-texas.pdf
The Human Trafficking and Child Exploitation (HTCE) team was established in Texas by DFPS in June 2017. The team was tasked with building relationships between law enforcement and community leaders to develop services for children who have experienced sex trafficking. Additionally, HTCE aims to identify and increase reporting of human trafficking, support children with lived experience, and educate children on how to avoid trafficking. Located under the CPI division of DFPS, an additional 7,159 staff completed human trafficking awareness training, increasing the total number of staff trained to over 14,000.
DFPS also established the Light the Way to Freedom to End Human Trafficking: Sunday Prayers. This is an awareness campaign intended to bring together communities of faith annually during Human Trafficking Awareness Month. The Light the Way to Freedom to End Human Trafficking 2019 Summit was launched by the agency to serve as a statewide conference for anti-human trafficking advocates and stakeholders, as well as DFPS staff. Over 850 people attended the 2019 summit, where they discussed awareness, identification, and prevention of human trafficking. The conference also focused on restoration and support for survivors of trafficking.
DFPS established the Commercial Sexual Exploitation-Identification Tool and the Human Trafficking Response Protocol in March 2019. This program, which launched in Bexar, Dallas, Harris, Tarrant, and Travis counties, provides caseworkers with information needed to detect risks of sexual exploitation.
Child Protective Services (CPS) Division
CPS is responsible for: responding to CPI’s inquiries of child abuse and neglect allegations, providing at-home services for families and youth in need, removing children from unsafe environments when deemed necessary for child safety, helping identify and coordinate with family members to provide kinship placements, managing the foster care system, and assisting youth to successfully transition out of the CPS system and into safe and permanent living situations. Thus, CPS interacts with children at three stages: reviewing investigations of abuse allegations, placing youth in emergency custody or inpatient treatment, and transitioning youth back into normalcy and a healthy environment.
CPS Handbook Policies on Behavioral & Mental HealthSection 11600 of DFPS’ CPS Handbook states the agency’s policies for youth in need of mental health services. Subsection 11611.1 states that youth in DFPS’s conservatorship can be placed in an inpatient psychiatric facility if a physician states both of the following are true: 1) the child has a mental illness or shows symptoms of a serious emotional disturbance; and 2) the child risks serious harm to self or others if not immediately restrained or hospitalized. Youth may also be admitted if one of the following occurs: 1) DFPS applies for court-ordered mental health services for the child; 2) DFPS requests emergency detention; or 3) a court grants a protective custody order.
Under subsection 11611.2, youth aged 16 or older may request to be voluntarily admitted to an inpatient psychiatric facility or to receive outpatient mental health treatment services. This can be done by filing a request directly with a facility’s administrator. Admission can occur without the consent of a parent/managing conservator/guardian, and a facility is not required to accept the youth.
Subsection 11611.4 states that in order for youth to receive mental health treatment, a caseworker must provide a mental health facility with the name and contact information for the child’s medical consenter, who must approve of treatments (unless the youth is authorized to consent themselves).
In subsection 11612, it’s noted that law enforcement can be called if a caseworker or residential child care provider believes that a child needs a temporary involuntary mental health commitment and the child will not willingly be evaluated by mental health professionals.
Finally, subsection 11613 states that DFPS staff or a residential childcare provider may contact an LMHA for assistance with involuntary inpatient mental health services.
More information on DFPS’s CPS guidelines can be found in their Mental Health Resource Guide at https://www.dfps.state.tx.us/handbooks/CPS/Resource_Guides/Mental_Health_Resource_Guide.pdf.
TREATMENT FOSTER FAMILY CARE(TFFC) PROGRAM
CPS established the TFFC program to grow the state’s foster care capacity, reduce the number of youths under the age of 10 in RTCs, and have youth in a family environment. By the end of July 2019, there were 39 youths placed in 53 TFFC homes across the state. CPS also created the Nurturing Parent Program (NPP) in Lubbock, Potter, Val Verde, Burnet, and Smith Counties. This trauma-informed, evidence-based program intended to prevent, intervene in, and treat child abuse and neglect. Faith-based initiatives were supported and expanded by CPS. Congregations participated in the CarePortal, an online platform that allows churches to provide goods and services to children and families in need. As of August 31, 2019, 1,929 congregations were partnering with DFPS, 535 faith partners were enrolled in the CarePortal, and the CarePortal had given aid to 7,645 children with an estimated economic impact of $2,381,487.
Accessing Mental Health Services
STAR HEALTH (SUPERIOR HEALTH SYSTEM)
In 2008, the STAR Health program was created to provide children in foster care with primary care and behavioral health services using a managed care delivery model (intended to reduce healthcare costs and improve access to services). Superior Health Plan contracted with the state to run the STAR Health program and has been operating the program since its inception. The statewide program was designed to improve the continuity and coordination of care by improving data sharing and access to health services for children in the foster care system.
Children who reach adulthood in foster care can be covered by STAR Health until their 26th birthday. Youth in Extended Foster Care can be covered by STAR Health until their 22nd birthday, and those in the Former Foster Care Children (FFCC) and Medicaid for Transitioning Foster Care Youth (MTFCY) programs can be covered until age 21. Those eligible for Medicaid for FFCC can choose which managed care plan under STAR Medicaid that they want to continue coverage with from age 21-26. In addition to medical and development strengths tests, youth entering DFPS custody must take the Child and Adolescent Needs Assessment (CANS) to evaluate any behavioral health needs and if there are any impacts from past trauma. This assessment helps guide recommendations for youths’ services, living arrangements, and supports under STAR Health.
In FY 2017 (the soonest year data was available), the STAR Health average monthly enrollment was 32,091. The state provides immediate STAR Health eligibility for children in DFPS conservatorship and for former foster care children up to age 21. Youth aged 18 to 22 who sign extended foster care agreements are also eligible. In FY 2017, 53 percent of children in STAR Health had a diagnosis of a mental health condition or a substance use condition. Texas spent $174 million on those children and youth, which accounted for 68 percent of STAR Health total expenditures in FY 2017.
STAR Health requires that each foster care child has access to primary care physicians, behavioral health clinicians, specialists, dentists, vision services, and more. Behavioral health services offered by Superior include:
- Education, planning, and coordination of behavioral health services;
- Outpatient mental health and substance abuse services;
- Psychiatric partial and inpatient hospital services (for members 21 and under);
- Non-hospital and inpatient residential detoxification, rehabilitation and half-way house (for members 21 and under);
- Crisis services 24 hours a day, 7 days a week;
- Residential care (for members 21 and under);
- Medications for mental health and substance abuse care;
- Lab services;
- Referrals to other community resources; and
- Transitional health care services.
Historically, the lack of a central medical records system for children in DFPS care created serious problems, including the over-prescribing of medications or the sudden discontinuation of medications when a child’s placement changed. To help solve this continuity of care issue, DFPS began using a computer-based system called the Health Passport to track and monitor the medical information of every child enrolled in the STAR Health program.143 The Health Passport follows children to each placement so that every caregiver, DFPS staff member, and medical professional working with a child has a full understanding of his or her past and current treatments. The Health Passport allows access to that information in one central, easy-to-find location. Each child’s Health Passport is available online through a password-protected website and can be accessed by DFPS staff and medical consenters. While the Health Passport is not a full and complete medical record, it provides claims data on pharmacy, dental, vision, physical, and behavioral health services provided to each child. Information on a child’s drug allergies can also be directly uploaded to the Health Passport website and the system can alert medical professionals and caregivers if there is a potentially unsafe drug interaction or allergy.
FORMER FOSTER CARE CHILDREN’S (FFCC) PROGRAM AND MEDICAID FOR TRANSITIONING FOSTER CARE YOUTH (MTFCY)
Many children lose health insurance coverage when they age out of the foster care system. Many children in foster care experience trauma or other mental health conditions that impact them even after they have left the child welfare system. Foster care alumni are more likely than young adults in the general population to rely on public assistance, experience difficulties in finding and keeping a stable home, and have a high risk for physical and mental health concerns. Thus, retaining health insurance for former foster care children for a longer period of time may lead to better outcomes by ensuring that they have more consistent and reliable access to the mental health care services and supports needed for recovery and long-term well-being.
As a component of the Affordable Care Act (ACA), the FFCC program provides extended health insurance coverage to former foster care children under the age of 26 who were on Medicaid while in foster care. With the implementation of the FFCC plan, more adults formerly in the foster care system will have health insurance coverage up until their 26th birthday, as is discussed in the preceding STAR Health section. Effective January 2014, former foster youth receiving healthcare services transitioned to FFCC or, for those ineligible for FFCC because they were not enrolled in Medicaid while in care, to MTFCY.
Unlike Medicaid or other foster care insurance plans, FFCC has no asset, income, or educational requirements for coverage. There are two FFCC insurance plans based on the age of the applicant: STAR and STAR Health. The services provided by each of these plans vary — see the HHSC section for more information on STAR and STAR Health services and eligibility.
There are some groups of young adults who will not qualify for either program, including young adults who aged out of the Texas foster care system and moved to another state, and young adults who were not in foster care when they turned 18. Young adults who do not qualify for FFCC may purchase health insurance through the Health Insurance Exchange if they have sufficient resources and/or federal marketplace subsidies, or they may still qualify for Medicaid. See Table 53 for an overview of existing health insurance programs for former foster care children.
Source: Texas Department of Family Protective Services. Medical Benefits. Retrieved from https://www.dfps.state.tx.us/Child_Protection/Youth_and_Young_Adults/Transitional_Living/medical_benefits.asp
Texas Health and Human Services. TWH, M-1500, Income. Retrieved from https://hhs.texas.gov/laws-regulations/handbooks/twh/part-m-medicaid-transitioning-foster-care-youth-mtfcy/section-1500-income
INSTITUTIONAL RESIDENTIAL SERVICES
While the state recognizes that it is preferred that children grow up in family, home-based environments, some children in the custody of the state are placed in congregate care facilities. Prior to placing a child in foster care, the court is required to consider temporary placement with a relative if possible (kinship placement). If kinship placement is not available or appropriate, the child may be placed in a foster home with foster parents, a foster family group home, or a general residential operations (GRO) facility. A GRO is a congregate care facility that provides residential services for 13 or more children up to the age of 18 years. GROs are licensed by DFPS and include short-term residential facilities that provide basic childcare, emergency shelters in which children are typically placed for less than 30 days, and RTCs. An RTC provides care and treatment services exclusively for children with complex emotional and psychological needs. DFPS provides an online search tool that lists childcare facilities in the state, which can be found at: www.dfps.state.tx.us/Child_Care/Search_Texas_Child_Care/ppFacilitySearchResidential.asp
In addition to child fatalities detailed in the CPI section, CPS has several continuing issues that need to be addressed. Two primary issues are the disproportionality and diversity of children and youth in CPS (which encompasses the racial/ethnic/sexual/ gender identities of foster youth), as well as the ongoing need for comprehensive trauma-informed care within the system and for those who work with children and youth.
DISPROPORTIONALITY AND DIVERSITY OF CHILDREN AND YOUTH IN CPS
Racial and Ethnic Disparities
There has historically been a disproportionate number of African American and Native American children, youth, and families involved in the Texas CPS system according to DFPS. This is consistent within the national child welfare landscape. A higher percentage of African American and Native American children are removed from their homes due to abuse or neglect. These groups also spend more time in foster care, and face longer waits to be adopted and to find other permanent placements.
A number of theories have been offered as to why there is disproportionate representation of certain racial and ethnic groups in the child welfare system, including:
- Increased parent and family risks;
- Increased rates of poverty and exposure to neighborhood risks and harms;
- Societal disparities that make it difficult for parents to obtain mental health and substance use treatment, stable housing, and employment;
- Racial biases among CPS workers and individuals who report abuse and neglect; and/or
- Lack of comprehensive cultural competence and cultural humility among CPS investigators and caseworkers.
According to 2019 DFPS data, African American children were less likely to be adopted than Hispanic or Anglo children. While African American children made up 22 percent of those waiting to be adopted as of August 31, 2019, they made up only 18 percent of children adopted in 2019. The 44 percent of Hispanic children waiting to be adopted roughly matched the percent adopted (45 percent) and the percent of Anglo children waiting to be adopted (27 percent) was less than the percent adopted (31 percent). As of August 31, 2019, there were a total of 6,806 children waiting to be adopted in Texas. Figure 76 shows the ethnic and racial profiles of children successfully adopted in Texas.
Sources: Texas Department of Family and Protective Services (DFPS). (2019). CPS Permanent Managing Conservatorship (PMC): Children Waiting for Adoption on August 31. Retrieved from https://www.dfps.state.tx.us/About_DFPS/Data_Book/Child_Protective_Services/Adoption/Children_Waiting_Adoption.asp
Texas Department of Family and Protective Services (DFPS). Child Protective Services (CPS): Adoption Placements. Retrieved from https://www.dfps.state.tx.us/About_DFPS/Data_Book/Child_Protective_Services/Adoption/Adoption_Placements.asp
Texas Department of Family and Protective Services (DFPS). Child Protective Services (CPS): Adoptions Consummated. Retrieved from https://www.dfps.state.tx.us/About_DFPS/Data_Book/Child_Protective_Services/Adoption/Adoptions_Consummated.asp
While DFPS’ main method to address disproportionality is through providing comprehensive and quality services through its regular programming and service delivery for all children, CPS has made some attempts in recent years to reduce racial and ethnic disparities in the child welfare system. DFPS developed courses on working with African American, Latinx, and impoverished families. In FY 2013, CPS established Poverty Simulations trainings for staff and external stakeholders. These exercises are meant to enhance participants’ understanding of impoverished families by showing how racial oppression and poverty are interconnected.
Another key component to addressing racial and ethnic disproportionality is CPS increasing support for kinship care — placing the child with a relative or someone close to the family so that children maintain connections to their community, family, support network and culture. Unfortunately, individuals who take on this kinship responsibility are not eligible to receive many supports available to foster and adoptive parents. For example, social services like Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) benefits are not available for kinship caregivers. CPS provides limited financial help to encourage kinship placements. Once kinship placements begin, programs like the Family Group Decision Making (FGCM) model are essential support services that can help strengthen bonds and support a successful transition to the kinship placement so that the child does not have to deal with the trauma and instability associated with having to move multiple times. In 2019, the Texas Legislature passed SB 355 (86th, West/Klick), which directed DFPS to develop a strategic plan that would identify a network of service providers to inform parents and caregivers of children at risk of entering foster care with mental health, substance abuse, and in-home parenting support. Additional information on kinship care can be found at https://texascasa.org/casa-deep-dive-kinship-care/.
Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual Youth
With the increasing national focus on the rights of same-sex couples following the Supreme Court’s ruling in Obergefell v. Hodges, the conversation over disproportionality has expanded to include lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) youth who are also overrepresented in the child welfare system. The stigma associated with LGBTQIA+ identity makes this community more vulnerable to both trauma and mental health conditions such as depression, substance use, and heightened risk of suicide. Stigma can also lead to an under-utilization of social supports (e.g., family or church clergy) and services (e.g., school-based counseling) if the child feels discriminated against or not accepted. Due to a lack of reporting and the fact that sexual orientation is self-identified and gender identity is fluid, it is difficult to determine the actual number of LGBTQIA+ youth in the foster care system. However, the National Resource Center for Youth Development reports that LGBTQ youth (those identifying as intersex or asexual were not included in this study) are overrepresented in foster care, accounting for between 5 and 15 percent of all youth in foster care.
Research shows that LGBTQIA+ youth have an increased risk of experiencing several negative situations and outcomes compared to their heteronormative peers. A 2017 study by the University of Connecticut and Human Rights Campaign Foundation found the following statistics (youth identifying as intersex or asexual were not included in this study):
- 78 percent of youth not out to their parents as LGBTQ hear their families make negative comments about LGBTQ people.
- 73 percent of LGBTQ youth have experienced verbal threats because of their actual or perceived LGBTQ identity.
- Trans youth are over twice more likely to be taunted or mocked by family for their LGBTQ identity than cisgender LGBQ youth.
- LGBTQ youth of color report hearing family express negativity about LGBTQ people more frequently than their white peers.
- 85 percent of LGBTQ youth rate their average stress level as ‘5’ or higher on a 1-10 scale.
- 77 percent of LGBTQ youth report receiving unwanted sexual comments, jokes, and gestures in the past year.
- 11 percent of LGBTQ youth report that they have been sexually attacked or raped because of their actual or assumed LGBTQ identity.169
- Additional research from various sources shows (certain identities are excluded from studies):
- LGBTQ youth are at least twice as likely as non-LGBTQ youth to attempt suicide, and gay and bisexual young men face substance abuse issues at a rate 15 times that of the youth population as a whole.
- LGBT youth who experience family rejection have a greater chance of having mental health issues in adulthood and are significantly more at risk for suicide attempts (8.4 times more likely), depression (5.9 times higher), and substance use (3.4 times more likely).
- LGBTQ youth report a more negative experience with the child welfare system, are more likely to be moved or hospitalized for emotional reasons, and are more likely to live in group settings.
- Disparities for LGB foster care youth continue into adulthood, as studies show that LGB former foster care youth are less financially stable as adults than their heterosexual peers.
The National Survey of Child and Adolescent Well-Being – II (NSCAW-II) showed that LGBT youth (those identifying as queer, intersex, or asexual were not included in this study) in the foster care system suffer from placement instability at higher rates than the rest of the population. While 19.6 percent of LGB youth in out-of-home care were moved from their first placement at the request of their caregiver or foster family, this rate was 8.6 percent for heterosexual youth. Additionally, 44.8 percent of LGB youth were moved from their first placement because of perceived needs for lower levels of care, compared to 65.5 percent of heterosexual youth. Alternatively, 12.6 percent of LGB youth were moved from their first placement to higher levels of care, while 9.8 percent of heterosexual youth were moved for the same reason.
There are currently no policies in Texas specifically addressing the needs of LGBTQIA+ youth in the state’s foster care system, and there is no required data reporting on the number of LGBTQIA+ youth awaiting adoption in comparison to their heteronormative peers. Increasing family and caregiver support services to encourage acceptance will likely support the well-being of LGBTQIA+ children in Texas and reduce both their safety risks and likelihood of entering into the foster care system.
There are mixed efforts to improve the system for LGBTQIA+ youth. DFPS established a workgroup made up of external advocates to focus on the needs of LGBTQIA+ youth in foster care. The agency also offers staff trainings on best practices for serving LGBTQIA+ youth. However, a rule prohibiting discrimination based on a person’s sexual orientation, gender identity, and other characteristics was challenged by DFPS, Archdiocese of Galveston-Houston, and the Texas Attorney General’s office. Per the unsettled 2019 lawsuit, the archdiocese would like to serve as a foster care provider, but only if they can be exempt to anti-LGBTQIA+ discrimination. Advocates remain concerned that the lawsuit could have negative impacts on LGBTQIA+ youth, foster and adoptive parents within the state.
In the 85th session, Texas passed HB 3859 (Frank/Perry), which protects child welfare providers from retaliation if they assert their “sincerely-held religious beliefs.” Among other things, the bill allows child welfare organizations to preclude certain people from participating in programs and to refuse to enter into contracts with providers that do not share their religious beliefs.
Youth who are in child welfare systems nationally and in Texas are at greater risk for trauma-related mental health and substance use conditions than children in the general population. The overwhelming majority of children who enter the foster care system experience trauma as a result of neglect or abuse. Further, being removed from your family of origin is a trauma in and of itself, so every child or youth within the foster care system is living with the trauma of removal. Many children in foster care also experience additional trauma as a result of multiple removals and placements in different foster homes and shelters. Reports show that nearly half of youth aged 2-14 with completed child welfare investigations have clinically significant emotional or behavioral problems. Rates of behavioral problems, developmental delays, and need for psychiatric intervention for foster care youth reach up to 80 percent. Professionals who interact and work with foster and adoptive children must therefore be cognizant of youths’ trauma-related needs and how they impact mental wellness.
Trauma-informed care recognizes the effects of trauma on the individual and provides care that is evidence-based and tailored to an individual’s needs and unique experiences. It therefore provides a non-pharmacological approach to healing that decreases reliance on psychotropic medications and increases placement stability. Trauma-informed care is not a discrete intervention, but rather a treatment framework that strengthens service delivery at all levels of care. In a trauma-informed system, every component of the service system is evaluated and reframed with an understanding of the role that trauma and violence play in the lives of people seeking behavioral health services.
Awareness of an individual’s trauma-inducing experiences can help CPS staff, mental health professionals, and caregivers to avoid any re-traumatization that may occur during the delivery of traditional services or daily living. Understanding the effects of trauma can provide better insight into a child’s trauma reminders, stress signals, coping mechanisms, behavioral tendencies and cognitive development. As a result, trauma-informed care can provide communities, parents, schools, and caseworkers with a better set of skills for understanding how to approach traumatized children and provide them the services and supports needed.
The push for trauma-informed care in Texas gained traction in 2013 with bills that expanded education and training. In 2015, SB 125 (84th, West/Naishtat) mandated that children entering into DFPS care receive a comprehensive assessment. This evaluation would include a screening for trauma within 45 days of the child’s entry into services in an effort to learn more about their trauma history. The assessment is used by substitute caregivers, case managers, clinicians, care coordinators, and conservatorship workers to gather information needed to make decisions about the best course of action to take to address a child’s needs.
DFPS continues to promote trauma-informed practices by operating and maintaining its own trauma-informed care training program for a number of different groups, including:
- Court-appointed special advocates (CASA workers),
- Child advocacy centers (CACs),
- Foster parents and kinship caregivers,
- Adoptive parents, and
- DFPS caseworkers and supervisors.
The 2018 shooting at a high school in Santa Fe, TX brought trauma-informed practices into the forefront during the 86th Legislative session, and several bills impacted DFPS. SB 11 (86th, Taylor/Bonnen) required schools to have a trauma-informed policy to integrate trauma-informed practices into schools. Under the bill, DFPS must be consulted for development of a rubric and a list used by regional education service centers to identify resources related to student mental health that are available to schools in their respective regions.187 SB 781 (86th, Kolkhorst/ Leman) directed DFPS to develop a strategy for trauma-informed protocols aimed at reducing runaway incidents from residential treatment centers. HB 1536 (86th, Miller/Raymond/Parker/Davis) would have required DFPS to develop trauma-informed care across the child welfare system. Foster parents, adoptive parents, and kinship caregivers would receive specialized, tailored training in trauma-informed care that could vary depending on what best suits the child. However this bill failed to pass. Had SB 488 (86th, Watson) passed, it would have created policies and procedures for a trauma-informed juvenile justice system.
Prevention and Early Intervention (PEI) Division
The PEI division of DFPS partners with community providers and families to prevent abuse, neglect, truancy, runaway youth, and involvement with law enforcement. Community-based early intervention strategies and programs can address mental health conditions by providing timely access to services and reducing disparities for low-income and minority populations who may not have access to private providers or specialists (including parents at risk of engagement with DFPS). Additionally, these programs may identify youth at risk of developing mental health and behavioral health conditions and link them to treatment to prevent negative outcomes such as homelessness, family separation, poverty, removal from the home, incarceration, gaps in school enrollment and attendance, or complete dropout from school. Programs and outreach efforts coordinated through this division address negative outcomes and try to provide services for youth before they are in crisis.
Due to the COVID-19 pandemic, PEI program specialists also spent 2020 compiling family/caregiver resources and public health information for mental healthcare providers, stakeholders and advocates. These resources can be found here: https://www.dfps.state.tx.us/About_DFPS/Coronavirus/pei.asp
In FY 2019, 48,391 youth and 10,356 families were served by PEI programs. This represents an increase from the 47,013 youth and 9,369 families served in FY 2018, but a decrease from FY 2017 totals, when over 64,000 youth and 15,964 families received PEI services.192,193 Table 54 lists the various programs and services provided through the PEI division of DFPS.
Sources: Texas Department of Family and Protective Services. DFPS Annual Report 2019. (2020). Retrieved from https://www.dfps.state.tx.us/About_DFPS/Annual_Report/2019/DFPS_2019_Annual_Report.pdf
Texas Department of Family and Protective Services. Prevention and Early Intervention (PEI) Programs. Retrieved from https://www.dfps.state.tx.us/Prevention_and_Early_Intervention/About_Prevention_and_Early_Intervention/programs.asp
Adult Protective Services (APS) Division
The APS division of DFPS investigates allegations of abuse, neglect, and exploitation for individuals age 65 or older and adults with a mental, physical and/ or intellectual/developmental disability. Investigations by APS involve both in-home investigations and facility investigations. Reported allegations can include self-neglect, abuse of parents by their adult children, physical and emotional abuse by caregivers, financial exploitation (e.g., taking social security checks or misusing a joint bank account), sexual assault, and any other forms of abuse, neglect or exploitation. These investigative and support services help to protect the mental health and wellness of persons with disabilities and aging Texans.
The primary APS program is the In-Home Investigations and Services Program. The In-Home program investigates allegations of abuse, neglect, and financial exploitation of adults age 65 and older and adults age 18-64 who have a substantial physical or mental disability and live in their own homes or other community settings. This program also investigates allegations of financial exploitation of adults living in nursing homes, assisted living facilities, or adult foster care homes who may be financially exploited by someone from outside the facility.
The state also conducts investigations into allegations of adult abuse within facilities called the Adult Protective Services Provider Investigations (APS PI) program. APS PI investigates allegations of abuse, neglect, and exploitation of people served by certain providers in a facility setting. As of September 1, 2017, the APS PI program transferred to the Regulatory Division in HHSC.
The incidence of validated adult abuse, neglect and exploitation per 1,000 Texans aged 65 or older was 1.6 in 2019, which is consistent with past years’ rates dating back to 2010. There were 118,717 reports made of in-home abuse/neglect of adults in FY 2019, with the majority of reports initiated by medical personnel (23 percent), relatives (14 percent), community agencies (14 percent) and the victims themselves (10 percent). In addition to the investigations of abuse and neglect conducted by APS, this division also educates the general public about elder abuse via public outreach campaigns; Elder Abuse is Everyone’s Business is one such public awareness campaign. APS also distributes literature about health risks for the elderly, including dangers related to excessive summer heat.
In FY 2019, APS established a mentor program as part of their employee retention efforts. The program allowed experienced APS staff to connect with and support new caseworkers, meeting biweekly. From October 2018 – August 2019, the mentor program had 138 new APS caseworkers participating, with the turnover rate declining from 50.2 percent to 44.3 percent.
A February 2020 DFPS report showed projected turnover rates for APS, however these estimations were made before the widespread outbreak of COVID-19 in Texas. The report showed that APS caseworker turnover fell from 25.2 percent in FY 2018 to 20.7 percent in FY 2019. Based on first-quarter data (September, October, November), FY 2020 turnover was projected to be below 17 percent. The turnover rate for new APS caseworkers was 50.8 percent. In 2020, first-year turnover was expected to be about 31 percent. The 86th legislative session led to APS caseworkers and front-line supervisors receiving a $750 per month raise, as well as 40 additional caseworkers being added to the workforce.