In this special edition of Frontline for Children, we take a deep dive into the latest research and resources on home visiting as part of our #HomeVisitingIsEssential campaign.

TexProtects Takeaway: Home visiting saves dollars and makes sense. Investments in home visiting programs demonstrate positive impacts and cost savings across two generations and multiple domains including child abuse prevention, maternal mental health, child health, economic stability, and school readiness. However less than 4% of Texas families that could most benefit from these programs currently have access. Now more than ever, it is critical that we do more of what works and less of what doesn’t. Home visiting works, and Texas needs to do more to support families so that they can ensure healthy beginnings and successful futures for their children.


Home Visiting in Texas 4.0

The fourth release of TexProtects’ Home Visiting in Texas report. In it, we overview the landscape of home visiting, including history, families and communities served, funding, return on investment and demonstrated outcomes, and program descriptions. We hope it will serve as a useful resource for those new to home visiting and advocates in need of tools to communicate about its footprint and impact.

Home Visiting Advocacy Toolkit

Resources, templates, and talking points for supporting home visiting during the 87th Texas Legislative Session – all in six steps. Join us as we spread the message that #HomeVisitingIsEssential.

Future Directions for Home Visiting in Texas (with Child Trends)

This report looks to the future of home visiting in Texas by outlining 5 innovative strategies to help increase quality and expand access including partnering with multiple state agencies, leveraging technology, addressing workforce challenges, expanding connections with other systems, and using precision research.


During the COVID-19 pandemic, telehealth can help connect home visiting services to families (Child Trends)

“Two fields—medicine and behavioral health—have explored the use of telehealth, defined as the use of electronic platforms such as video, texting, or online content to support long-distance health services. Studies comparing in-person and telehealth models have generally found similar outcomes across the two modes of service. Because of the overlap between the kinds of services that both telehealth services and home visiting programs provide—including assessment, information sharing, and support—lessons learned from telehealth can be valuable to home visiting.”This blog applies telehealth research to the HV field.

Advancing Home Based Parenting Programs Through the Use of Telehealth Technology (Traube, D., Hsiao, H., Rau, A., Hunt-O’Brien, D., Lu, L., & Islam, N.)

“Home-based parenting programs have demonstrated impact on the prevention of child maltreatment, promotion of child screening and health care, and increased school readiness. However, cost and time resources make access to home-based parenting programs limited. Telehealth delivery systems may help to fill this gap, reducing barriers and expanding the reach of home-based parenting programs. This manuscript describes a pilot feasibility study focusing on model fidelity for delivering a home-based parenting program (Parents as Teachers) via a university-based telehealth interactive video conferencing technology. Results indicate that the program was able to meet all fidelity measures related to supervision, training, and curriculum delivery.”

Implementation of a telehealth-enhanced home visiting programme for families of young children (Jetelina, K., Oke, O., Rodriguez, P., Weerakoon, S., & Barlow, S.)

“A large pediatric healthcare system implemented a telehealth-enhanced home visiting program as an extension of primary care services.” Results of this evaluation suggest that “Once families were enrolled, the program was fairly successful in addressing patient outcomes. The program and visit process was highly regarded by families and the unlicensed healthcare professionals. Future program recommendations, such as small programmatic changes and major improvements in the clinic, should be implemented before widespread dissemination.”

COVID-19’s Early Impact on Home Visiting: First Report of Results from a National HARC-Beat Survey of Local Home Visiting Programs (Home Visiting Applies Research Collaborative – HARC)

“This HARC-Beat survey “took the pulse” of local programs nationally in their early efforts to adapt to disruptions arising from the pandemic. It included all local programs regardless of model or funding sources. It aimed to provide useful information to advance the field overall in helping individual programs adapt to the pandemic, for example through efforts such as the Rapid Response Initiative.” Among other things, the survey asked about social distancing policies, changes to the HV workforce, and challenges in shifting to virtual formats. 


Reflective parenting home visiting program: A longitudinal study on the effects upon depression, anxiety, and parenting stress in first-time mothers (Vismara, L, Sechi, C., & Lucarelli, L.)

“Our study aimed to investigate the effects of a reflective parenting home visiting program in first time-mothers at risk for depression, anxiety, and parenting stress, from three to 12 months after their child’s birth… Our findings confirm the benefits of reflective parenting home visiting programs and underline the need to constantly evaluate the levels of depression, anxiety and parenting stress throughout the perinatal period to target effective prevention programs to foster early mother-child attachment bond.”

Addressing maternal mental health to increase participation in home visiting (Molina, A., Traube, D., & Kemner, A.)

“This study aimed to examine rates of depression among mothers in the national Parent as Teachers (PAT) home-visiting program, whether various high needs characteristics were associated with elevated depressive symptoms, and whether depressive symptomology and initiation of outside mental health treatment were associated with attendance and retention in services, particularly after considering important family risk factors… Results demonstrate that mothers with higher depressive symptoms, including those in the subclinical range, have a harder time participating in home-visiting services, even though they may need the support the most. However, when PAT home-visitors address maternal mental health and mothers initiate treatment, mothers appear to be better equipped to participate in home visiting.”

Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network (Tandon, D., Mackrain, M., Beeber, L., Topping-Tailby, N., Raska, M., & Arbour, M.)

“Maternal depression is common among low-income women enrolled in home visiting programs, yet there is considerable variability in the extent to which it is identified and addressed. This study examines outcomes related to postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients of home visiting programs in the Health Resources and Services Administration’s Maternal, Infant, and Early Childhood Home Visiting Program Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN)…” Findings suggest that “Home visiting programs can play an important role in closing gaps in maternal depression identification, referrals, service access, and symptom alleviation.”


Home Visiting Career Trajectories (Office of Planning, Research & Evaluation, Urban Institute)

“A stable and qualified workforce is crucial for the effective delivery of early childhood home visiting services, yet little information exists on this workforce nationally and across home visiting models… The Home Visiting Career Trajectories project launched in fall 2016 to fill this knowledge gap. Using multiple methods, the study examined the characteristics, qualifications, and career trajectories of home visiting staff in local implementing agencies (LIAs) that receive funding through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. The findings provide nationally representative descriptive information on the home visiting workforce in MIECHV-funded agencies across the US.”


Parent Involvement in Maternal, Infant, and Early Childhood Home Visiting Programs: an Integrative Review (Bower, K., Nimer, M., West, A., & Gross, D.)

“Despite the evidence and investment in evidence-based federally funded maternal, infant, and early childhood home visiting, substantial challenges persist with parent involvement: enrolling, engaging, and retaining participants. We present an integrative review and synthesis of recent evidence regarding the influence of multi-level factors on parent involvement in evidence-based home visiting programs.” Findings suggest that “Future research should move beyond the study of parent- and family-level characteristics and focus on program- and home visitor–level characteristics which, although still limited, have demonstrated some consistent association with parent involvement. Neighborhood characteristics have not been well studied and warrant future research.”

Intention to Engage in Maternal and Child Health Home Visiting (Turner, M., Cabello-De la Garza, A., Kazouh, A, Zolotor, A., Kilka, J., Wolfe, C., & Lanier, P.)

“This qualitative study used a Reasoned Action Model (RAM) and a cultural lens to explore factors influencing the engagement of women with low-income in HV programs… The constructs most salient for participants were emotions and affect, behavioral beliefs, and self-efficacy. In the context of an urban public health prenatal clinic, HV marketing and outreach should highlight convenience and social support, as well as clearly communicate program content and intent. In practice, HV programs must be flexible to work around work and home schedules; marketing and outreach should emphasize that flexibility.”

Strengthening Family Retention and Relationships in Home Visiting Programs through Early Screening and Assessment Practices (Barton, J., Jimenez, P., Biggs, J., Garstka, T., & Ball, T.)

“Evidence-based home visiting (EBHV) programs for pregnant women and families of young children prevent child maltreatment and improve maternal and child health outcomes. However, home visiting programs often struggle to retain families long enough to achieve positive outcomes. The current study sought to understand how home visitor relationship building skills and screening practices predict families’ duration in EBHV…  Results suggest that screening practices may help build relationships with families which then enhances retention in services and increases the likelihood of achieving positive maternal and child outcomes.”


National Home Visiting Resource Center

“The NHVRC Reference Catalog features home visiting research and evaluation, including evaluation plans, research briefs, conference and poster presentations, cost studies, and fact sheets.” Resources can be sorted by specific topic, data collection methods, home visiting model type, and date of publication.

Rapid Response Virtual Home Visiting Collaborative (Institute for the Advancement of Family Support Professionals)

“The Rapid Response-Virtual Home Visiting collaborative (RR-VHV) will provide best practice principles and strategies to support all home visiting professionals in maintaining meaningful connection with families during this time of increased anxiety and need. Through collaboration, the RR-VHV will leverage the extensive resources and expertise that exists across home visiting organizations to support the development and distribution of cross-model, cross system approaches and guidance. Providing immediate support for our front-line home visiting staff and the families they serve is our highest priority.”The website houses a host of resources for HV professionals on topics such as family engagement, supervision, technology, and screening, as well as a bank of RR-VHV Webinar Recordings.

Important Home Visiting Information During COVID-19 (U.S. Health Resources & Services Administration, Maternal & Child Health – HRSA)

This page features guidance from HRSA, encouraging “family support programs to offer prevention and family strengthening strategies virtually and through other safe means during the COVID-19 pandemic.” The site also has informational sections covering The Role of Home Visiting During a Public Health Emergency; Identifying Risks (for face-to-face home visits); Precautions for Home Visitors; Self-Care and Managing Stress; FAQs for Home Visiting Grantees; and Additional Resources for women and families, social service providers, and health care professionals.

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


  • Four children die from abuse/neglect each week, and 80 percent of victims are 3 years of age and younger.
  • 181 children are confirmed as abused/neglected every day, and the highest rates occur in children under age 5.
  • Evidence-based home visiting programs can reduce child maltreatment by up to 48 percent and have a positive return for each dollar invested.
  • Currently, only 3.5% of families with the highest need have access to proven prevention programs.

Welcome to the second part of our look at how child protection legislation fared in the 86th Texas Legislature. We began this series in May with our top-priority bills. This begins the first of three deeper dives into specific subject areas. This post is about Prevention and Early Intervention legislation; it will be followed by Child Protection Systems and will conclude with Mental Health and Trauma.

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

Prevention and Early Intervention Background

The Adverse Childhood Experiences (ACEs) Study – as well as decades of subsequent, validated research – has made clear that the impact of severe childhood adversities, including child maltreatment, is a public health crisis.

In the absence of supportive relationships and environments, chronic and compound ACEs increase the likelihood of negative behavioral, educational, health and economic outcomes. Prevention strategies can reduce the prevalence and impact of ACEs and increase a child’s opportunity for cognitive and emotional development, productivity, health, and economic wellbeing.

Prevention efforts fall across a spectrum that includes:

Primary prevention focuses on reaching families before the first occurrence of child maltreatment.
Secondary prevention focuses on efforts to prevent maltreatment among families considered to be at high risk.
Tertiary prevention focuses on mitigating the negative effects and prevent re-occurance in families where maltreatment has already occurred.

Evidence-based in-home parenting programs (known as home visiting) have proven to be the most effective and efficient model for prevention. These programs connect expectant and new parents who enroll voluntarily with a trained nurse, social worker, or early childhood specialist who promotes health, child development, parenting skills, education, and employment. By intervening to prevent adversity and build resilience during a child’s most critical years of neurodevelopment, in-home parenting programs impact outcomes across multiple domains and generations.

Evidence-based programs currently operating in Texas include AVANCE, Early Head Start, Family Connects, Healthy Families America, Home Instruction Program for Preschool Youngsters, Nurse-Family Partnership, Nurturing Parenting, Parents as Teachers, SafeCare, Systematic Training for Effective Parenting, and Triple P- Positive Parenting Program.

While some communities have been able to initiate programs with private and/or local funds, most in-home parenting programs implemented in Texas are funded through the Prevention and Early Intervention Division at the Department of Family and Protective Services. In 2018, funding was available to provide approximately 16,000 families with evidence-based in-home parenting support; however, 423,000 families in Texas have young children and three or more risk factors. Our goal is to continue working until many more of those families can access these beneficial programs.

ACEs and trauma do not dictate the future of a child. Children with protective factors (e.g. healthy attachment to parents, access to community resources, and supportive school and home environments) can build the resilience needed to thrive despite adversity. Evidence-based and effective solutions can strengthen families and help ensure that children start with a secure foundation of health and safety.

prevention in the 86th texas legislature

Top-Priority Bills passed

House Bill 1 – The General Appropriations Act

Champions – Sen. Jane Nelson and Rep. John Zerwas

In response to research, federal initiatives, and best practices, the landscape around prevention funding has changed within the past couple decades. The ACEs research makes clear the public health ramifications of severe adversities in childhood. Emerging brain science continues to demonstrate the importance of the development that happens in the first five years of a child’s life. This has created new urgency and a growing and diverse group of stakeholders who are invested in improving access to proven programs. The federal Family First Prevention Services Act demonstrates an increasing prioritization by the federal government in programs that provide evidence-based services to ensure that, when possible, children can remain safely at home. Protecting a child’s development by strengthening families to increase resilience and protective factors, and empowering communities to offer needed supports before a crisis occurs, have become the clear path forward.

Each session, TexProtects prioritizes increased investments in primary, evidence-based in-home parenting programs. Despite cuts to the Health and Human Services budget overall, the Legislature included funding to maintain Project HOPES (Healthy Outcomes through Prevention and Early Support) and the Nurse-Family Partnership (NFP) Programs and appropriated an additional $4.3 million to expand those programs.

Evidence-Based Prevention2020-21 Base BudgetAdditional Investment
HOPES$39.9 million General Revenue/All Funds$1.5 million
NFP$30.2 million All Funds ($5.6 million General Revenue)$2.9 million
Total$70.1 million All Funds$4.3 million

Healthy Outcomes Through Prevention and Early Support (HOPES) is a prevention approach developed to be a flexible and community-based solution to child abuse and neglect in high-risk counties by increasing protective factors of families served. It is currently serving families in 55 counties with children ages 0-5 at risk for child abuse and neglect. The evidence-based programs chosen by the communities each have proven positive outcomes across multiple domains and returns on investment that range from $1.26 to $8.08.

The Nurse-Family Partnership Program is an evidence-based, community health approach with over 40 years of evidence currently serving families in 43 counties. NFP works by having specially trained nurses regularly visit young, first-time expectant moms and fathers, starting early in the pregnancy, continuing through the child’s second birthday. For every dollar invested, there is a return on investment of $5.70 including savings on medical care, child welfare, special education, and criminal justice.

Senate Bill 355


SB 355 directs the Department of Family and Protective Services to develop a strategic plan to leverage federal funds made available through the Family First Prevention Services Act to increase access to mental health care, substance use treatment and in-home parenting programs that can prevent child maltreatment and keep children with their families. This will result in cost savings to the state and better outcomes for Texas children. For the first time, federal dollars previously only available for children in the foster care system will be made available to fund evidence-informed and community-based early interventions so that children can remain safely at home when possible rather than placing them in foster care. These prevention strategies address key drivers of child abuse and neglect: substance use, mental health issues, and parenting skills. Such services build on the knowledge that most children can be safely protected and remain within their own homes when parents are equipped with appropriate support and opportunities to care for their children.

SB 708

Champions – Sen. judith zaffirini and rep. john Raney

SB 708 requires the Health and Human Services Commission to use existing procedures to collect, make publicly available, and report to the Legislature data on child safety in licensed child-care centers. Data must include violations that impact the health, safety, and well-being of children as well as information on the number of children and caregivers in each classroom. This data will allow lawmakers, providers, and parents to make better decisions to ensure the safety of children in care.

TexProtects Goal – Provide training to promote prevention and early intervention

HB 111 – Rep. mary Gonzáles / sen. pat fallon

HB 111 requires that existing child abuse training for school staff must also include information on students with significant cognitive disabilities. Persons with disabilities are victimized at much higher rates than those without disabilities and are much less likely to report abuse.

HB 403 – rep. senfronia thompson / sen. joan huffman
HB 403 requires that the board of trustees and superintendent of a public school district complete one hour of training on identifying and reporting potential victims of sexual abuse, human trafficking, and other maltreatment of children every two years.
HB 2059 – Rep. Cesar Blanco / Sen. Larry Taylor
HB2059 equips health care practitioners who provide direct patient care with the training needed to help detect potential victims of human trafficking and provide them with adequate care, including referring them to additional support services. Ensuring that health care providers are knowledgeable and adequately prepared is vital in combating human trafficking in Texas. Approximately 80 percent of human trafficking victims are women, and health care providers are often the first professionals to have contact with trafficked women and girls.

TexProtects Goal – Improve Maternal and Newborn Healthcare

HB 25 – Rep. Mary Gonzáles / Sen. Judith Zaffirini

HB25 creates a pilot program to allow pregnant and postpartum women utilizing the Medicaid medical transportation program to travel with their children to pregnancy-related appointments. Women enrolled in the STAR Medicaid managed care program during pregnancy or after delivery often miss prenatal or postpartum appointments because the medical transportation service program does not provide an option for women to bring their children along with them to appointments. This pilot could increase access to health care during this critical time for mom and baby.

HB 253 – Rep. Jessica Farrar / Sen. Lois Kolkhorst
HB253 requires the Health and Human Services Commission (HHSC) to develop and implement a recurring five-year strategic plan to improve access to postpartum depression screening, referral, treatment, and support services. Postpartum depression (PPD) affects 1 in 9 mothers nationally, according to the Centers for Disease Control. PPD can affect a mother’s capacity to attach and interact with her child. This can disrupt healthy development and family functioning. Depression is treatable and most mothers improve with access to adequate support.
HB 405 – Rep. Ina Minjarez / Sen. Lois Kolkhorst
HB405 designates June as Neonatal Abstinence Syndrome (NAS) Awareness Month.Neonatal Abstinence Syndrome (NAS) is a group of conditions caused when babies withdraw from certain drugs that they have been exposed to before birth. Rates of NAS in Texas increased by more than half between 2010 and 2015. This bill would increase public awareness and access to information and resources to decrease stigma and encourage mothers to seek help.
HB 1576 – Rep. Dade Phelan / Sen. Dawn Buckingham
HB1576 allows the Health and Human Services Commission (HHSC) and Medicaid managed care organizations to contract with transportation network companies (TNCs) and transportation vendors such as Uber and Lyft for the delivery of nonemergency medical transportation. The medical transportation program currently provides non-emergency transportation services to and from covered health care services — based on medical necessity — to recipients under Medicaid, the children with special health care needs program, and indigent cancer patients program who have no other means of transportation. This would increase options and flexibility and decrease the use of emergency medical transportation resources for non-emergency transport.
HB 1651 – REP. MARY GONZÁLES / Sen. Carol Alvarado
HB1651 requires the Commission on Jail Standards to prohibit the use of restraints for women who are incarcerated during pregnancy and 12 weeks postpartum unless clearly required for the health and safety of the mother or staff. Shackling pregnant inmates is banned in Texas state prisons and was recently outlawed at the federal level. This bill extends the same protection to the inmates of our state’s county jails. The bill also requires an annual report on any use of restraints on pregnant and post-partum women.
SB 436 – Sen. Jane Nelson / Rep. Four Price

SB436 requires the Department of State Health Services (DSHS) to collaborate with the Maternal Mortality and Morbidity Task Force to develop and implement initiatives to improve screening and continuity of care for women with opioid use disorder, as well as newborns with neonatal abstinence syndrome, while increasing access to medication-assisted treatment and decreasing the number of opioids prescribed before, during, and following delivery. A report on these initiatives is due to the legislature by December 2020.

SB 748 – Sen. Lois Kolkhorst / Rep. Sarah Davis
SB748 would create a general revenue dedicated account to fund newborn screenings conducted by the Department of State Health Services (DSHS). The public health laboratory at DSHS tests 400,000 infants per year for 53 disorders or medical conditions. Dedicated funds could be used to maintain the lab and add additional screenings to the panel to meet federal requirements.
SB 750 – Sen. Lois Kolkhorst / Rep. Eddie Lucio III
SB 750 seeks to maximize Texas’ efforts to address maternal mortality as detailed by the Health and Human Services Commission’s report, State Efforts to Address Materna Mortality and Morbidity in Texas, by improving access to healthcare during the prenatal and postpartum period for women enrolled in the Healthy Texas Women Program. This bill also renames the Maternal Mortality and Morbidity Task Force as the Texas Maternal Mortality and Morbidity Review Committee and extends its work until 2027.

TexProtects Goal – Increase Access to High-Quality Early Care and Education

HB 3 – Rep. Dan Huberty / Sen. larry Taylor
HB 3 creates an early education allotment to fund full-day Pre-k for eligible students, provides additional funding for districts with high concentrations of poverty, increases funding per student, and provides funding for extended summer instruction.
HB 680 – Rep. Joe Deshotel / Sen. Kirk Watson
HB 680 requires the Texas Workforce Commission to assess and report the information on the quality and types of childcare being used by families receiving childcare subsidies. This information will include the average cost of childcare and the total number of providers and children participating in the state’s quality rating system, Texas Rising Star. The Texas Workforce Commission (TWC) administers a federal program that provides childcare subsidies to low-income families so their parents can work or attend workforce training. The data collected can help decision makers better improve access to high quality care.
SB 1679 – Sen. Royce West / Rep. John Turner
SB 1679 authorizes children at the age of three who were eligible for enrollment in a free Pre-k class to remain eligible for enrollment for the following school year. This will eliminate confusion and the burden on families that can result in children not being enrolled.

TexProtects Goal – Increase Safety for Children in Childcare

SB 568 – Sen. Joan Huffman / Rep. Greg Bonnen
SB568 transfers certain regulatory authority over childcare facilities and family homes from the Department of Family and Protective Services (DFPS) to the Health and Human Services Commission (HHSC). The bill creates a safety training account of dedicated funds, requires liability insurance unless it is cost-prohibitive, and establishes safe sleeping standards. A family home is a caregiver who provides regular care in their own residence for six or fewer children who are younger than 14, excluding children who are related to the caretakers.
SB 569 – Sen. Joan Huffman / Rep. Greg Bonnen
SB569 transfers regulatory authority for listed family homes from the Department of Family and Protective Services (DFPS) to the Health and Human Services Commission (HHSC). The bill requires HHSC to adopt minimum standards for listed family homes, requires liability insurance unless it is cost-prohibitive, and requires certain training like safe sleep training. The bill requires the HHSC to inspect listed family homes whenever the commission receives a complaint. Listed family homes are adult caregivers that provide care in their own home for compensation for up to three children unrelated to the caregiver.
SB 706 – Sen. Kirk Watson / Rep. Bobby Guerra
SB706 requires there be an investigative unit within the childcare licensing division at the Health and Human Services Commission to identify childcare facilities operating without a license, certification, registration, or listing and initiate appropriate enforcement actions against those facilities.

Missed opportunities for prevention and early intervention

Cross Sector Collaboration to Prevent Adverse Childhood Experiences

Research conducted by the Centers for Disease Control, the National Institutes of Health, the American Academy of Pediatrics, and others has made clear that ACEs are prevalent and can have lifelong consequences on health and behavior. Currently, prevention efforts in Texas are spread across multiple agencies. Communities do not have access to the informaiton and resources they need to make strategic decisions toward safer and healthier families. HB 4183 would have facilitated a cross-agency strategic planning process to better coordinate statewide data and initiatives and give communities a better toolkit for providing services that can strengthen families and prevent trauma. The bill passed in the House but not in the Senate.

Strengthen ECI

Early Childhood Intervention (ECI) is a statewide program within the Texas Health and Human Services Commission for families with children from birth up to age 3 who have developmental delays, disabilities, or certain medical diagnoses that may impact development. ECI services recipients can access needed therapies and be school-ready. The agency made a $72 million request for the funds needed to keep ECI sustainable; however, the budget appropriated only $31 million. HB 12 would have strengthened the ECI program by addressing prior authorizations, requiring health benefit plans to cover services, and creating a tele-health pilot and  ombudsman office. The bill passed the House but did not move in the Senate.

Extend Medicaid Coverage for Women Postpartum

Texas has the nation’s worst uninsured rate for kids AND the nation’s worst uninsured rate for women of childbearing age — with often devastating consequences for moms and babies. Extending Medicaid coverage for women postpartum up to 12 months post-child birth would have addressed the first recommendation from the state’s Maternal Mortality and Morbidity Taskforce; however, the issue faced significant challenges prior to House passage and was not referred to committee in the Senate.

Strategically Expand Proven Prevention Programs

While we are relieved to see continued investment in evidence-based child abuse prevention programs, we still have a long way to go. HB 1549 in the 85th legislative session directed the department to develop a plan to take these programs to scale in order to impact statewide outcomes. Current investments are only providing services to 3.5% of those families in highest need. In order to move the needle, Texas needs to make strategic investments that outpace population growth and inflation and can move us toward a reality in which at least 30% of families in need have access to services.

Home Visiting Works: Surviving Hurricane Harvey

One of the main purposes of the “Champions” blog is to highlight success stories from family support home visiting programs that illustrate how vital they are in building family resiliency. TexProtects advocated for the legislative funding that helped bring Nurse-Family Partnership to Texas, and has been a strong supporter of NFP ever since. This story first appeared on NFP’s website at

When Hurricane Harvey hit the Gulf Coast and greater Houston area, 28-year-old Mirna was among thousands of people forced to leave their homes for safer grounds. Though she graduated from Nurse-Family Partnership more than a year ago, she says her nurse Savannah reached out during the ordeal to offer support for her situation. “She is someone I can trust with things I don’t tell others, even if I don’t talk to her every day,” she says. “If I need any help I know I can ask her.”

Now parenting an active preschool aged daughter, Mirna was 19 weeks pregnant when she agreed to try the Nurse-Family Partnership program provided by Texas Children’s Health Plans in Houston, Texas. What convinced her to make that first appointment was the assurance that she could leave if she didn’t like it. The idea that a nurse would come to their “humble” home made her feel self-conscious. The first time her nurse, Savannah, came to see her, she realized her expressions were welcoming and not judgmental. After their first meeting, Mirna says, “some worries were put to rest.” Her partner Angel also brought questions to some of their meetings.

Her curious, active preschool aged daughter has thrived since they graduated from NFP. Mirna recalls that her nurse would bring her books and toys, always helping her learn to connect with her daughter. NFP nurses also help new mothers set personal goals to build a foundation for their new family. Mirna is a part-time student taking prerequisite courses for nursing school. She perseveres at both being a student and a mother. Every day they play, go to the park, and Mirna answers a lot of questions. Every answer, she says, “constantly are followed by three ‘why’s?’”In fact, Mirna felt her nurse was a perfect match for their family. “I am reserved and quiet, she never pushed to where I would feel uncomfortable.” Savannah provided her with “so much information to assure a healthy pregnancy and a healthy child,” she says. After her daughter was born, Mirna says she had even more questions, which Savannah answered honestly and kindly. “Any questions I had, regardless of how naive it sounded, she would answer with patience.”

“She asks a lot of questions, some are easy to answer, and some are harder,” Mirna says. “For example, how do babies come out from their mom?” Mirna delights in her daughter’s confidence, and the way she likes to introduce herself to new people.

Mirna felt like her nurse was more than a source of information. “She has been my rock,” she says. “Thanks to her guidance I was able to feel some hold on the entirely new, scary experience.”