Learn how we can support strong Texas families in the 89th Legislative Session.
Category: Health
Post-Partum Depression and Early Childhood Development
The bond between a mother and child is special. Because that connection is so profound, wellbeing for an infant is largely determined by the physical and mental health of their mother. According to the American College of Obstetricians and Gynecologists (ACOG), Post-Partum Depression (PPD) is one of the most common threats to maternal mental health, affecting approximately 600,000 women a year. It is estimated that 14% to 23% of mothers will experience depression at some point during pregnancy and 5%-25% experience PPD. All women who give birth are potentially at risk. Despite that fact, many mothers with PPD struggle with guilt or shame. While PPD is highly treatable, fear of being labeled a bad mother can make it hard for women to discuss the issue or reach out for the help they need.
Symptoms of PPD include feelings of anger, crying more often than usual, withdrawing from loved ones, feeling distant from the baby, worrying or feeling overtly anxious, thinking about hurting yourself or the baby, and doubting one’s ability to care for the baby. These feelings of being unable to connect to the baby can be particularly unsettling for new mothers and particularly disruptive to the attachment and responsiveness which underlies health child development. Because the first three years of life are so foundational, untreated PPD can have lifelong consequences for children.
Simple acts of care such as hugs, smiles, and lullabies create new brain pathways for infants which develop their capacity to form memories, relationships, and logic. Post-partum depression can weaken the mother-child bond, stunting cognitive and linguistic development. A number of other negative outcomes have been linked to PPD, such as higher rates of behavioral problems and lower grades. If essential neural pathways are not formed during early childhood, they may never develop. This means that treatment is especially time sensitive; early treatment allows moms to fully bond with their children as soon as possible and to optimize their child’s early developmental period. TexProtects advocates for improving post-partum mental health and other issues which impact a child’s crucial development period through our Prenatal to Three Policy Agenda.
Destigmatizing PPD and supporting mothers with mental healthcare will help ensure every child in Texas has a strong start. Last legislative session, HB 253 mandated the creation of a five-year strategic plan to raise public awareness around PPD and to improve access to mental health screening, referral, treatment, and support services. The Texas Health and Human Services Commission (HHSC) recently released their initial draft of the Post-Partum Depression Strategic Plan for public comment. TexProtects submitted comments on that draft plan that included the following key recommendations:
- Texas should continue strong investments in programs overseen by the Department of Family and Protective Services’ (DFPS) Prevention and Early Intervention (PEI) Division – such as Texas Home Visiting, Project HOPES, Project HIP, and Texas Nurse-Family Partnership – to reach more families. These voluntary programs are proven to improve maternal and infant health, strengthen referrals and connections, and promote positive parenting.
- Texas should increase investments in Texas Family Connects, a short-term evidence-based nurse home visiting program that links nurses to moms with newborns. To encourage scale-up into more Texas regions, Texas should explore additional financing strategies, including Medicaid coverage for maternal mental health screenings, case management, and nurse visits delivered through Family Connects.
- Texas should expand Help Me Grow, a referral line and centralized access point that helps parents with young kids to get connected to community-based resources. Department of State Health Services (DSHS) Title V has recently become a statewide hub for Help Me Grow, a national model that works to create a “Centralized Access Point” for parents with young children. Included in this work is strategic integration with statewide 2-1-1 so that families have both an effective “front door” when looking to access services and a warm handoff to regional hubs where parent navigation can ensure families get access to the right program and supports at the right time.
Increasing healthy beginnings and supporting young families are critical components of our Prenatal to Three Policy Agenda. Learn more about our work to ensure infants and toddlers (and their families) have what they need to be safe and well and maximize the potential of the early years of development.
Partnering to Bring Family Connects to North Texas
The time around birth—whether it’s your first or fifth, you’re adopting or fostering a baby, you’ve just given a baby up for adoption, or you’ve lost your baby—is an immensely vulnerable time for all families. Parenting, however it looks for you, doesn’t come with an instruction manual. But what if it came with a study buddy? Someone who could check in on you, answer your questions, point you in the right direction, and share this moment with you?
This is Family Connects, a short-term evidence-based program in which registered nurses visit families in the first few weeks after a birth, adoption or foster care placement of a newborn, or pregnancy loss, to check in and see how families are adjusting, and connect families to community resources they need. Family Connects comes at no cost to the family and is available to all —it sets the expectation for how a community cares for its families, regardless of their personal circumstances. It is also short-term—Family Connects aims to connect families to the right services for them at the right time, rather than duplicate or replace those services. Most families only need one visit, but nurses can provide up to three visits, if necessary. All families receive a follow-up call one month after their last visit to confirm that they have connected with their referrals and had their needs met or are receiving services.
During the home visit, a Family Connects nurse assesses the family to identify their needs. Overwhelmingly, families do need information and resources: Family Connects has found that 95% of families have at least one nurse-identified risk or need. Some parents may need help finding a pediatrician, managing postpartum depression or anxiety, or getting connected to housing or food resources. Others may need referrals to programs and services for family members or a link to support groups for parents in similar situations.
Nurses are not case managers and Family Connects does not duplicate existing services. Based on the individual family’s needs, the nurse uses a searchable database to identify a community resource or service provider, such as a diaper bank, home visiting program, or early childhood intervention, that addresses the family’s need, makes a warm handoff to a local service provider, and follows up with the family to close the loop and make sure the family was connected to the resource or service. In so doing, Family Connects strengthens the web of community resources and referrals. The data collected by Family Connects helps inform community leaders and stakeholders of emerging trends, gaps in resources, and successful connections, which can be used to make decisions about community priorities and resource allocation.
Much like Family Connects brings the community together around families, the program itself is strengthened by the partners who make it up. As TexProtects began looking for partners to support the program in Dallas, we learned that MHMR of Tarrant County and the Early Learning Alliance were also looking at bringing the program to Fort Worth.
At this moment, we realized two critical things:
- Our programs may start and end at Highway 360, but our families don’t. North Texas is one community made up of not only Dallas and Fort Worth, but also Arlington, Plano, Cleburne, Forney, Frisco, Mansfield, and other cities and towns. We need to be forward thinking about how we can structure our programs to meet families where they are and how they live, rather than to easily fit our administrative structures.
- We are stronger when we work together. It didn’t make sense to have two separate Family Connects programs in North Texas when we could go through the process together, learn from one another, leverage each other’s strengths, and build one infrastructure that could support both counties and the region as a whole.
Since May of 2019, our Family Connects North Texas team has set itself up to provide one North Texas structure with two parallel branches—east (Dallas) and west (Tarrant). Based on a community needs assessment of North Texas, implementation began first in Arlington and Cleburne (west) in November 2019. During COVID-19, Family Connects has transitioned to providing virtual services. Isolated from their families, friends, and traditional support networks, parents are more eager than ever to receive these virtual connections.
As we all navigate this period of reopening our state and rebuilding our economy, we know there are so many competing needs, but our families must come first. We believe Family Connects can play an important role by helping new families get connected to the resources and services they need, so that parents and their newborns can get off to a strong start. As parents quickly find out, none of us can do it alone and we can all benefit from connections. Similarly, our organizations can’t do this alone. As we continue with our planning in the east (Dallas), we are grateful for the many partners who are working with us on funding and implementation planning to make a Dallas Family Connects pilot a reality.
COVID-19 Survival Kit
A handy guide for parents and families to thrive during the current health crisis
Parenting is HARD work, and it’s work that can be even more difficult when we are facing stress and adversity. However, we know that there is nothing more important than the parent/child relationship in terms of future learning, behavior, and health. As the unprecedented challenges of COVID-19 continue to unfold, TexProtects wants you all to know we are in this together, Texas! We too are moms, dads and have families – whether we are tending to kiddos out of school and needing guidance, searching for jobs, or finding ways to destress and reduce anxiety, we have put together a Family Survival Kit with some great tips, tools and resources that can help you and your family better weather the storm during these trying times – a parents’ survival guide to ensure your family can thrive.
There are actions each one of us can take to reduce the stress and burden on ourselves and parents we know during this time. Offer to provide childcare so parents and caregivers are not in difficult situations and potentially leaving children unsupervised or in neglectful environments. Deliver a meal. Take a break or ask your spouse or partner to step in and help. Check in on your neighbor to ensure they have what they need, and most of all, remember, there is no way to be a perfect parent but millions of ways to be a good one–so give yourself and your children an extra dose of compassion and care during these challenging days.
General Parenting Support
Help And Hope offers parenting tips (by age and topic), a parent resource library, family activity ideas, videos, and connections to programs in your county. They remind us that focusing on your child for just 15 minutes a day can make a big difference!
Sign up for Bright by Text for free games, tips, and resources sent right to your cell phone. Messages are targeted to your child’s age (ages 0 through 8) and include information on child development, language and early literacy, health and safety, behavioral tips, games, and more! It’s free and available in English or Spanish.
The American Academy of Pediatrics has a parent resource with tips to help families work and learn during the health crisis. Healthy Children breaks the resources out by prenatal, baby, toddler, preschool, gradeschool, teen, and young adult.
The Centers for Disease Control offers free tools and additional resources to help you understand and track your child’s developmental milestones. They remind us that talking is teaching!! Reading, singing, and talking to your child is easy and dramatically increases their language and social development. If your child has not had a developmental screening, you can complete one online for free here.
Support for Fathers
Having an involved father with positive parenting experience can be an important part of a child’s development. The National Center for Fathering has general information on fathering as well as resources on fathering during the COVID-19 health crisis, like how social distancing can mean more father involvement.
The National Responsible Fatherhood Clearinghouse also has tips, hints, and programs about fatherhood for you to peruse, including their dadtalk blog and library of resources related to research and issues impacting responsible fatherhood.
Families Learning Together
Babies are born ready to learn, and they love to learn with their parents. The time you spend together helps their brain grow strong and creates a safe attachment that will encourage them to explore the world and thrive. While every day is rich with opportunities to engage and learn together, the increased time at home and out of school resulting from the COVID-19 may mean that you are looking for new ways to keep your child (and yourself) active and learning. The resources below will provide you numerous ways to take advantage of this time together and have some fun.
KERA Education out of Dallas has put together an At-Home Education Toolkit to help parents and caregivers with kids and teens PreK-12 who are at home, as well as educators who are teaching children remotely. There are more than 60,000 videos, lesson plans, games, activities and other resources in all subject areas–most are aligned to the TEKS and TX PK Guidelines.
Zero to Three offers a library of activities for playing and learning with your child based on their age.
The Kennedy Center offers short tutorials on fun ways to learn together with your child. Take a creative lunch break and draw with your child with the guidance of a fabulous teacher.
Check out a printable list from the National Child Traumatic Stress Network that offers simple activities for your family. Most do not require a screen or any supplies but all of them can create opportunities to make good memories during this difficult time.
Coping with COVID-19
Information and details regarding COVID-19 are changing rapidly. Staying informed about the outbreak and learning how to be prepared can reduce your stress. In addition, managing your own anxiety and emotions is critical to ensuring that your child can cope with their own feelings and worries during this time of uncertainty.
For the latest updates on the COIVD-19 outbreak, visit the CDC site. Included on the site is information to help prepare as a family as well as tips for self-care. While everyone experiences stress differently, the unprecedented challenges resulting from this pandemic will likely create new anxiety for all of us. Remember to take care of your body, take breaks when you feel stressed, stay informed (but limit news exposure), stay connected, and get help if needed.
This resource from the National Child Traumatic Stress Network Parent/Caregiver Guide to Helping Families Cope with the Coronavirus Disease 2019 (PDF; en español) will help you think about how an infectious disease outbreak might affect your family—both physically and emotionally—and what you can do to help your family cope. You can support your child by encouraging their questions, keeping them informed, maintaining routines when possible, and make time for fun and meaningful activities that can help everyone connect and relax.
Prevent Child Abuse America has assembled a great list of activities and resources to help parents and children. They remind us to stay connected and offer ideas for connecting to family, friends, our culture, and ourselves even when we have to be physically apart.
Talking About COVID-19 With Your Children
With news and conversations about COVID-19 everywhere, it’s important to talk to children about what they are seeing and hearing in a way that is developmentally appropriate and reassuring. Children worry more when they are kept in the dark. The resources below can help if you are wondering how to start.
The Child Mind Institute’s article Talking to Your Children about the Coronavirus has a great short video from Dr. Jamie Howard, Director of Trauma and Resilience Services, who goes over quick tips on how to discuss the pandemic with your kids. The most important thing? Be developmentally appropriate.
Last but not least, other organizations also have tips for families to talk with children about the current health crisis. Check out these tips from Zero To Three, and videos, games and activities from PBS Kids and BrainPOP.
What resources did we miss?
Let us know in the comments what has been helping you and your family to stay safe and connected. What has helped your family have fun and learn during this health crisis? How are you and your loved ones growing your resilience together? We want to hear from you!
*Find more resources from TexProtects here.
Texas’ Child Maltreatment Fatality Data Shows There is Still Work to Do
Every week, more than four Texas children die because of child abuse and neglect.
The Texas Department of Family and Protective Services (DFPS) recently released their Child Maltreatment Fatalities and Near Fatalities Annual Report for Fiscal Year 2019. The report collects and provides context for the number of child deaths that occurred throughout the state, a troubling reminder that we have much more work to do in preventing child abuse and neglect. This year, there were a reported 235 confirmed abuse or neglect-related child fatalities in Texas, the highest number of fatalities we have seen in the last decade since it peaked in 2009 at 280 deaths, and on the rise from a low of 151 in 2014. Texas’s number of child fatalities is well above the national average with a 2.70 per capita rate for child abuse and neglect fatalities over the national average of 2.39.
Overall Takeaways:
- The top causes of child abuse and neglect related fatalities included:
- Neglectful Supervision (total of 141 cases)
- Drowning (48 cases)
- Unsafe Sleep (30 cases)
- Vehicle Related (19 cases)
- Physical Abuse (total of 94 cases)
- Blunt Force Trauma (56 cases)
- Neglectful Supervision (total of 141 cases)
- In 91% of the child fatalities, there was no open Child Protective Services (CPS) investigation or case at the time of the child’s death.
- There was no prior CPS history with either the child or the perpetrator in approximately 55% of the child abuse or neglect fatalities. This percentage remained steady from Fiscal Year 2018.
These percentages still reveal that several families had previous or active involvement with CPS. Therefore, families who experienced a child death were not receiving the support they needed or something about the services these families received did not work.
Victim Characteristics:
- 72% of child deaths were between the ages of 0 and 3
- There was an increase involving children age 4 through 6.
- 56% of the child fatalities were due to neglectful supervision, which is specified as physical/medical neglect, and unsafe sleep practices accompanied by substance abuse.
This concerning information illustrates the importance of prevention and early intervention efforts like Project HOPES and home visiting programs that support families in the early years when brain development is at its peak and families may not be connected to other resources that could help them create safe and nurturing environments for their children before a crisis occurs. As the Prevent Child Abuse Chapter for Texas, TexProtects is on the front lines to increase access to evidence-based prevention programs so that children can be safe, and their families can get the support they need.
Another concern about what the data shows is that we are still seeing some populations disproportionately represented in child deaths across the state:
- Hispanic children made up the largest percentage of deaths (35%).
- African American children were the highest rate per capita (7.85 vs 3.14).
- 29% of the fatalities were children with special medical needs.
- Approximately 57% of all child deaths were male (133).
It is worth noting that Texas defunded the Office of Minority Health Statistics and Engagement in 2018, leaving one person at DFPS leading the efforts to address racial inequities. In the report, DFPS mentions their cross-sectional work with other agencies and stakeholders, but it is worth considering how that work can be more targeted and effective specifically as it relates to equity issues.
Underlying Issues Faced by the Perpetrators of Abuse/Neglect:
- 48% of the child fatalities involved substance use of a caregiver.
- A parent/caregiver in the child’s household reported active mental health concerns in 32% of the child fatalities.
This is where we can leverage federal dollars for prevention services eligible through the Family First Prevention Services Act (FFPSA) for families. These federal dollars intend to address the key drivers of child abuse and neglect: substance use, mental health, and lack of parenting skills. Key policymakers and state agencies are making decisions now about how to implement FFPSA in Texas. TexProtects believes that making high quality, evidence-based prevention services available to families that address these issues will provide parents and caregivers with the tools they need to meet their children’s needs and safely keep their families together.
The Child Maltreatment Fatalities Report makes clear to advocates and policymakers alike why it is so necessary that Texas invests in child abuse and neglect prevention efforts. Every week, more than four children die because of child abuse and neglect. At TexProtects, we believe these deaths can be prevented. Join us as we work to ensure that they are.