Using federal funding could prevent entries into the foster care system.
Topic: Foster Care
TexProtects Public Testimony on Article II Budget for FY 2022-2023
The best way to get policymakers to make the changes we need to protect children and families is to provide them with evidence that proves investing in prevention works. Not only will our state finances see the benefits but so will Texas children at risk of abuse and neglect. Jennifer Lucy, our Managing Director of Policy, submitted the public testimony below to the House Appropriations and Senate Finance Committees proving that investing upstream works; it saves dollars and makes sense!
By Jennifer Lucy, Managing Director of Policy for TexProtects, on Article II budget for FY 2022-2023.
TexProtects is the only statewide organization singularly focused on the prevention of child abuse and neglect, and we serve as the Texas Chapter for Prevent Child Abuse America and as a steering committee member for the Texas Child Protection Roundtable and Prenatal to Three Collaborative. We applaud the maintenance of prevention funding in the base budget and appreciate the work of this committee in ensuring that the health and well-being of the next generation remain primary in our approach to COVID-19 response and recovery.
Texas has an opportunity to use what we learned during COVID-19 to transform systems in ways that support families, rather than removing children, and roll out proven prevention strategies BEFORE a crisis. Like any smart investor, it’s critical that we pay for the outcomes we do want rather than those we don’t. This requires a shift upstream and will result in downstream cost savings across multiple systems for decades to come as today’s children grow up to be the strong Texas of tomorrow.
The cost of the status quo and inaction is clear. Adverse Childhood Experiences (ACEs) like child abuse and neglect are associated with negative outcomes for individuals across the lifespan including poorer health, lower educational attainment, and higher likelihood of experiencing unemployment. Individuals and governments incur significant costs as a result. Bellis et al. (2019) estimate that annual costs attributable to ACEs across North America are approximately $748 billion with 82% of the costs resulting from individuals who had two or more ACEs.[i] With one in 10 American children living in Texas, we can expect to incur a significant percent of those costs if we are not better able to prevent ACEs.
Healthcare costs are the most well-documented, but there are also criminal justice, child welfare, and education costs, among others. Each case of child abuse or neglect results in $830,000 in costs across the victim’s lifetime.[ii] This translates to over $55 billion in costs as a result of confirmed abuse and neglect in Texas in 2019 alone. We can continue to pay for the effects of childhood adversity, or we can work to prevent it.
TexProtects worked with Child Trends to look specifically at the potential impact of COVID-19 on child abuse and neglect risks and found reason to believe that increases in unemployment, mental health struggles, family violence, substance use issues, and parental stress may result in increased abuse and neglect. Research during the last recession found that for each point the unemployment rate rises, physical and emotional abuse increase by 12-15%.[iii]
However, with the large majority of Child Protective Services (CPS) cases addressing neglect rather than abuse and much abuse/neglect going unreported, we know families need support more often than they need protection. The most cost-efficient and effective approaches offer supports BEFORE A CRISIS occurs and during the first years of life when a stable, safe, nurturing caregiver is THE KEY to healthy child development.
The 87th legislature can increase access to proven support strategies that protect children by implementing the following recommendations in the 2022/2023 budget for Texas.
- Fully fund the Prevention and Early Intervention Exceptional Item Request for $10 million to strengthen community based, primary child abuse prevention programs for children prenatal to age 5 through Healthy Outcomes Through Prevention and Early Support (Project HOPES) and other prevention strategies.
Proven prevention programs administered through the Prevention and Early Intervention (PEI) division at the Department of Family Protective Services (DFPS) have been critical lifelines for families during COVID-19 and depend on an infrastructure of community providers who work together to support families. Over the past decade, state and federal investments have helped build community-driven prevention infrastructure that accelerates the work of local nonprofits to deliver parenting support, information on local resources, and health screenings to children and their families. These voluntary programs have a proven return on investment of between $1.26 and $8.08 and have impacts across multiple domains and two generations. [iv]
Only 4% of the families in highest need currently have access, therefore, expansion is critical if Texas desires the statewide impact and cost savings that could result from widespread access to these programs. The current PEI strategic plan indicates that to adequately protect families, a 20% increase in prevention funds is needed every biennium. Currently, DFPS only spends 5% on early prevention efforts compared to CPS costs.
- Prevent early childhood trauma and entries into foster care by leveraging the opportunities in the federal Family First Prevention Services Act to offer families at imminent risk of removal access to evidence-based mental health, substance use, and parenting supports.
Texas must be proactive and innovative in determining how to maximize the opportunity of the Family First Prevention Services Act (FFPSA) to access federal matching funds for prevention funding that can be used to directly address the key drivers of child abuse/neglect: substance use, mental health, and parenting skills. With the large majority of CPS cases addressing neglect rather than abuse, we know families need support more often than they need protection. As noted by the DFPS 2018 Prevention Task Force Report, “Preventing 3% of removals (593) would save upwards of $20.3 million.”
Use of these funds should be prioritized for evidence-based programs that will prevent entry into the foster care system as this is the primary way to ensure better outcomes for children, family preservation, and long-term cost savings for the state.
The current plan provided by the agency proposes that $33.9 million of the $50.4 federal transition funds go toward prevention. All prevention strategies recommended here rely on community contracts rather than staff who work for DFPS.
Option 2D (A pilot for prevention services carried out by DFPS’ PEI division): PEI offers services to families to prevent child abuse and neglect. Their efforts focus mainly on primary prevention, which aims to reach families before the first occurrence of child maltreatment. However, some of their programs also focus on secondary prevention, which targets families who are at high risk of child maltreatment, such as families participating in Family-Based Safety Services (FBSS). Grants would be awarded to up to six regions. One community contractor would receive the grant in each region and then decide which programs to fund and deliver either through their own services or those of local subcontractors.
Option 2E (Expand HIP [Helping through Intervention and Prevention] for all pregnant and parenting foster youth):HIP is an effective program through PEI that serves current and former foster youth who are pregnant or parenting a child under the age of 3 by providing in-home parent education services. Additional funds would allow expansion of these voluntary support services.
These options focus on strategies that are evidence-based and have shown that they can keep children safe and reduce child maltreatment. They also already have an established and successful infrastructure. Some of the programs also have experience serving families participating in FBSS, who fit the eligibility definition and have already been approved by the Clearinghouse, including Healthy Families America, Nurse-Family Partnership, and Parents as Teachers.
The other options presented by DFPS would require a great length of time before they could be implemented (i.e. carrying out prevention services through Community-Based Care) or would be relying on FBSS caseworkers to deliver programming that is outside their area of expertise and/or credentialing requirements. Both would require significant deviation for systems and staff and potential conflicts of interest or complexities that do not make it feasible.
- Fully restore MedCARES (Medical Child Abuse Resources & Education System) funding of $5.96 million which was completely cut from the Department of State Health Services budget.
In 2009, the Texas Legislature passed Senate Bill 2080 to establish the MedCARES grant program as part of a strategic response to growing numbers of child abuse and neglect-related fatalities. The bill was championed by Senator Jane Nelson with the help of now Lieutenant Governor Dan Patrick; Representatives Garnet Coleman, Tan Parker, Toni Rose, Rafael Anchia, and Abel Herrero; and now Senator Jose Menéndez.
MedCARES provides grant funding to hospitals, academic health centers, and facilities with expertise in pediatric health to prevent, assess, diagnose, and treat child abuse and neglect. MedCARES grant recipients give communities easy access to medical providers who support education for the general public, case reviews for other physicians, trainings, and expert courtroom testimony by child abuse specialists. MedCARES providers include general pediatricians, child abuse pediatricians (CAPs), nurse practitioners, social workers, and sexual assault nurse examiners.
COVID-19 has exacerbated child abuse risks due to increased family stress, increased substance use, and heightened economic insecurity. Cutting MedCARES compromises critical infrastructure we have in place to protect children in Texas. Last year alone, almost 22,000 professionals attended child abuse prevention trainings through MedCARES and more than 2 million individuals participated in prevention program activities.
Thank you for your attention to these critical investments that not only support families and protect children today–but ensure a brighter Texas tomorrow.
We look forward to working with you. Please contact us anytime if we can provide support or resources as you address these and other child protection issues.
Jennifer Lucy
Managing Director of Policy
512-971-9347
Members of our Advisory Board include:
The Hon. Darlene Byrne, J.D. | Rebel Calhoun | Leslie Carpenter | John Castle, Jr., J.D. | Leslie DeCillis Debra Decker | The Hon. Maurine Dickey | Catherine Estrada | Robert Estrada | Kathleen Fletcher, Ph.D. Laura Gardiner | Tammy Cotton Hartnett | The Hon. Lee Jackson | Scott Murray | Len Musgrove
Janet Pozmantier, MS, LPC | Dick Rogoff | The Hon. Peter Sakai, J.D. | The Hon. Florence Shapiro
Lisa K. Simmons | The Hon. Mark Strama | The Hon. Royce West, J.D.
About TexProtects
TexProtects’ mission is to protect Texas children from the trauma of abuse and neglect and empowers families to thrive through education, research, and advocacy. Our vision is that all children are safe, nurtured, and resilient. To achieve our mission, TexProtects engages in research, advocacy and education. We advocate for better policies, reforms and appropriate increases in federal, state and local funding for three priority areas: 1) Prevention: Increasing investment in proven child abuse prevention programs, 2) Protection: Strengthening and reforming the CPS system, and 3) Healing: Ensuring victims receive adequate and accessible treatment.
[i] Bellis et al (2019)
[ii] Peterson et al (2018)
[iii] Schneider, W., Waldfogel, J., & Brooks-Gunn, J. (2017).
[iv] : Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009); Chaffin, M., Hecht, D., Bard, D., Silovsky, J. F., & Beasley, W. H. (2012). DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., Rodriguez, M., & Dorabawila, V. (2008); Olds, D. L., Kitzman, H. J., Cole, R. E., Hanks, C. A., Arcoleo, K. J., Anson, E. A., . . . Stevenson, A. J. (2010); Olds, D. L., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K., et al. (2007); Olds, D. L., Robinson, J., Pettitt, L. M., Luckey, D. W., Holmberg, J., Ng, R. K., . . . Henerson, C. R. (2004)
Frontline For Children | February 2021
- More than One in Four Latino and Black Household with Children Are Experiencing Three or More Hardship during COVID-19 (Child Trends)
“During the COVID-19 pandemic, the number of families experiencing hardships across the country has risen dramatically, with a disproportionate impact on Latino and Black communities.… For the analysis presented in this brief, we used nationally representative data from the Census Bureau’s Household Pulse Survey, which has tracked the well-being of U.S. households during the pandemic, to examine seven types of hardships: unemployment, difficulty paying expenses, not being caught up on rent or mortgage, food insecurity, physical health problems, symptoms of anxiety or depression, and lack of health insurance.”
TexProtects Takeaway: The hardships brought on by COVID-19 affecting Black, brown, and indigenous families trickle down to their children. Issues like economic distress, food insecurity, and mental health challenges, exacerbated by the pandemic, impact how families can care for their children during this crisis and in the future. This places more stressors on caregivers, who are less able to help children cultivate the protective factors and resilience that help mitigate adverse experiences in childhood. To read more from TexProtects about the disproportionate impact on these families during COVID-19, click here.
2. Strategies to Virtually Support and Engage Families of Young Children during COVID-19 (Child Trends)
“As preschools and schools continue to reopen, caregivers (e.g., childcare providers and teachers) are quickly pivoting to using virtual platforms to support and engage families in children’s learning. This rapid transition has left little time to assess what we know (and do not know) about family engagement best practices within the virtual space. This brief offers an overview of four best practices and lessons learned from research and practice to assist caregivers and teachers with the transition to engaging families virtually during the COVID-19 pandemic, and beyond.”
TexProtects Takeaway: Virtual learning can be a strain on parents and children’s mental health and time. It is imperative that caregivers and teachers use all the tools necessary to ensure education and resources are provided in the least intrusive, most beneficial ways possible to ensure children, especially those at the critical ages of 0-5, are getting what they need out of virtual learning and early childhood experiences.
3. Buffing Child Maltreatment: School Connectedness as a Protective Factor in a Community Sample of Young Adults(Goldstine-Cole, K.)
“Identified or not, maltreatment increases the risk for substance use disorder, depression, anxiety and post-traumatic stress disorder across the lifespan. This study examines whether school connectedness (SC), the sense of belonging at school derived from affective relationships in the school context and commitment to learning, protects against such effects. Specifically, in paper one, data from 349 young adults who completed the Protective Factor Questionnaire is used to develop a retrospective five-indicator, measurement model of school connectedness for K-12 and elementary, middle, and high school.… Paper two evaluates SC as a moderator in the relationship between childhood maltreatment and mental well-being during early adulthood, ages 18-25. Results indicate that SC buffers against intrafamilial maltreatment as well as five individual forms of abuse and neglect.… These results suggest that schools have roles beyond that of mandatory reporter in supporting the wellbeing of maltreated children.”
TexProtects Takeaway: Child abuse and neglect numbers may have risen during the pandemic and schools’ closures, despite fewer reports. Teachers and school staff are one of the main reporters of abuse and neglect, and with the move to virtual learning for many, picking up on the signs is more difficult. TexProtects is working to spread awareness in schools about staff intervening in abuse or neglect, not just as mandatory reporters. See our resources on recognizing abuse on our website.
4. Trauma-Informed Care in Child Welfare: An Imperative for Residential Childcare Workers (Brend, D. & Sprang, G.)
“Rates of traumatization among residential child welfare professionals are alarmingly high. The well-being of these professionals is associated both with their intention to stay in their jobs and outcomes of children in their care.… This manuscript details experiences empirically shown to have potential negative impacts on professional well-being, discusses why these impacts are of particular concern for residential childcare workers, and describes the types of organizational cultures and climates that appear to mitigate these negative impacts. Trauma-informed care at the organizational level is proposed both as a means to reduce harm to child welfare professionals and promote the rehabilitation of children within the child welfare system.”
TexProtects Takeaway: Organizations and agencies working with children from hard places need to implement trauma-informed care training for all staff. Not only does training help mitigate secondary trauma of professionals, but it also helps professionals best serve the children they are working with. TexProtects worked on HB18 last session to ensure school staff receive trauma training; however, Texas has more work to do to ensure high quality training and implementation are consistent across all sectors that impact children and families.
5. AGED OUT: How We’re Failing Youth Transitioning Out of Foster Care (Cancel, S., Fathallah, S., Nitze, M., Sullivan, S., & Wright-Moore, E)
“To understand the aging out experiences of foster youth, Think Of Us and Bloom conducted in-field discovery sprints using proven human-centered design and participatory research methodologies in five participating locations” (Santa Clara, Solano, San Francisco, and San José counties in California, Hennepin County in Minnesota, and New York City). “During these sprints, we spoke to a total of 206 people in 92 research sessions. The research team conducted in-depth interviews and participatory design workshops with a wide range of foster youth, former foster youth, child welfare staff and leadership, supportive adults, foster parents, and more…Over the course of the project, three key themes began to emerge. To us, these themes represent where the child welfare system is most failing transition-age youth, and where we must urgently focus our attention. These themes are: 1. Healing and dealing with trauma; 2. Centering youth in their preparedness; and 3. Helping youth build a supportive network.”
TexProtects Takeaway: The state must not forget the needs of youth transitioning out of the foster care system. TexProtects is supporting our partners’ work this legislative session to support improved services for transitioning youth. Check out our bill tracker to learn more.
6. Why Do We Focus on the Prenatal-to-3 Age Period? Understanding the Importance of the Earliest Years (Prenatal-to-3 Policy Impact Center at LBJ School of Public Affairs, University of Texas at Austin)
This research brief discusses why researchers and practitioners in early childhood consistently describe the first few years of life as being the most critical period for children’s development. The authors highlight that investing in families during a child’s earliest years can have a lasting impact on children’s lifelong health and well-being. They point to key practices that can strengthen families, and therefore, promote the healthy development of children. Some of these factors include access to quality health care for mothers, safe and supportive childcare settings, and other social services, such as early intervention programs for children with developmental delays or disabilities.
TexProtects Takeaway: TexProtects is part of the Prenatal to Three initiative alongside our partners Children at Risk and Texans Care for Children. We support investment in increasing the following for low-income mothers and infants and toddlers: access to prenatal and postpartum health services; health screening and successful connection to necessary services; and access to high-quality childcare programs. Read more about the initiative.
7. Three Trimesters to Three Years: Promoting Early Development (Princeton University and the Brookings Institution)
“The period from pregnancy through age three is the one in which the most rapid growth of the brain and behavior occurs. Yet most researchers and policy makers have treated the nine months of development during pregnancy separately from the first three years of life. Prenatal experiences are part and parcel of the postnatal experience of mothers and their babies; the postnatal period is sometimes referred to as the fourth trimester, a way to highlight the fact that after a child’s birth, mothers themselves need continuing services and screening. Indeed, children’s wellbeing very much depends on their mothers’ health and wellbeing. The title of this issue of the Future of Children, “Three Trimesters to Three Years,” highlights continuity in development, the continuing intersection of mother and baby, and the rapid growth that occurs from conception to three years of age.”
The prenatal and postnatal periods are critical to a child’s health and development. We advocate for investment in home visiting programs that support families in nurturing their children’s development and resilience from an early age, such as Family Connects and Nurse-Family Partnership. Read more on home visiting programs.
Gov. Abbott’s New Commitment: An Update on the Foster Care Lawsuit
TexProtects continues to follow the latest developments on the foster care lawsuit. For the first time since the lawsuit began, Governor Greg Abbott publicly stated at the beginning of this month that the state would cooperate and that he would work with legislators this session to get the funding necessary to be in compliance with Judge Janis Jack’s orders.
Both the Department of Family and Protective Services (DFPS) and the Health and Human Services Commission (HHSC) included Exceptional Items for a total of almost $75 million above their base budgets to cover the expenses of the lawsuit. A supplemental request now increases that number to more than $126 million for the 2022-2023 biennium. In a session where state agencies have had to scale back spending and are trying to maintain service levels without cutting supports to children and families, finding $126 million in the Article II Health and Human Services budget will be no easy task.
For the sake of child safety, we are glad to see this shift in Governor Abbott’s approach to the lawsuit. It is also critical that Texas comply with the remedial orders ongoing from a financial perspective. Every possible fine and every dollar spent on this lawsuit, while necessary to keep kids in the system safe, is costing the state a lot of money. This has the potential of taking away necessary services for children and families from other areas of the agencies’ budgets and hinders opportunities to make smarter investments in new, innovative, and effective strategies.
Read the complete Dallas Morning News article here and check out TexProtects’ full statement on Governor Abbott’s public response.
In our last update in July 2020, we brought you up to speed on the findings in the Special Monitors report to Judge Jack, which showed how practices by both DFPS and HHSC were still placing the children in state custody at an unreasonable risk of harm. Since this time, the state has been held in contempt and threatened with hefty daily fines for not complying with more than a dozen of the Judge’s remedial orders, including the failure to comply with:
- Caseload sizes to ensure workers aren’t overwhelmed and can do optimal work;
- Timeliness of investigations;
- Communication both internally and externally with placements about safety issues; and
- Ensuring a system is in place to review a licensed provider’s history so that children are not placed in or remain in placements with significant histories of deficiencies that subject children to risk of harm.
Governor Abbott spoke out in December 2020 soon after these findings and directed both state agencies to comply.
TexProtects on Gov. Abbott’s Pledge to Comply with Foster Care Lawsuit
Austin – Yesterday, Gov. Greg Abbott pledged to comply with orders by U.S. District Judge Janis Graham Jack in a nearly 10-year-old class-action lawsuit over long-term foster care conditions.
Sophie Phillips, CEO, TexProtects:
“We applaud Governor Abbott in his vow to bring the state of Texas into compliance with the longstanding lawsuit against the Texas Foster Care system, recognizing that it is fundamental to ensuring the immediate safety and protection of the nearly 50,000 children who are survivors of child abuse and neglect and come through the state’s foster care doors every year. The CPS system was built to protect. However, for thousands of children, it caused trauma on par, if not more significant than what launched them into foster care initially.
The Governor’s vow is a substantial promise and will require from our Legislature this session an investment to the tune of $126 million – significant, yet worth every penny to protect the safety of our children. It will also require leaders within our child protection agency to positively disrupt the challenges that have plagued the system for so long – coming up with innovative solutions and significant overhauls to infrastructure and systems. The reality is that while compliance with the lawsuit is necessary to solve many grave problems, it will not bring about transformational change – it is just the foundation and floor upon which we must build.
An investment of $126 million to address the many issues in the lawsuit will not erase the trauma those kids suffered.
We must consider what additional actions can be taken to prevent children from experiencing the trauma of abuse in the first place. The proven, most effective way to prevent abuse and neglect is to invest in community-driven prevention programs that get to root causes.
In addition to the $126 million investment needed, the state will spend more than $2 billion on the “back end” of the child protection system this year (i.e., foster care, abuse investigations, case management). Less than 5% – will be spent on programs and strategies that prevent abuse – which has demonstrated upwards of a 50% reduction in CPS involvement.
There should not be an “either” “or” when it comes to protecting our state’s most vulnerable. We urge Gov. Abbott and our lawmakers to fulfill the promise to comply with the lawsuit and further commit to fewer children in foster care, which is no permanent place for a child to grow up. Together we can build and restore the foundations of childhood and build healthy families – securing the future of Texas.”
TexProtects is the only nonprofit and nonpartisan advocacy organization with a singular focus: smart solutions to child abuse and neglect for the state of Texas. Visit texprotects.org for more resources.
The Opportunity of the 87th Legislative Session (Meet the Team)
The 87th Legislative Session is underway, and with it comes the opportunity to fight for smart solutions to child abuse and neglect. Now more than ever, the TexProtects policy team is laser-focused on strategies that strengthen families, prevent child abuse, and promote healing during these times of exponential need.
The Plan
COVID-19 has dramatically impacted our already vulnerable child protection system, put unimaginable strain on families with young children, and exacerbated root causes of child maltreatment like substance use and behavioral health concerns. 5,300 more children may be at risk of entering the Texas foster care system as a result and many more will be impacted. Texas cannot afford that additional $4.4 billion price tag nor can our children. Texas must invest in proven programs that prevent abuse and save $1.26-$8.08 per $1 invested by supporting community and family efforts to create safe and nurturing environments for the 7.5 million children who call Texas home. Together, it is time to do more of what works and less of what doesn’t for Texas children and their families across party lines. [link full agenda]
Meet the Team Behind the Plan
Sophie Phillips, TexProtects CEO, has a background in social work. Her passion and interest are in addressing the root causes of child abuse and neglect and creating partnerships to advance state policies and practices.
Jennifer Lucy, Managing Director of Programs, provides leadership, strategy, and coordination for TexProtects policy, research, education activities, and staff. She partners with legislators, staff, and community partners to execute a policy agenda that prevents child abuse and neglect and helps families thrive.
Kerrie Judice, CPS Researcher and Analyst, monitors key CPS and Foster Care issues for the team. Her prior experience as a worker in the CPS system and connections to other child protection partners provides invaluable insight as she advocates for improvements to the Texas child protection system.
Michelle Wittenburg is an external lobbyist whose strategic consultation and connections to the movers and shakers in the Capitol are an invaluable resource to TexProtects.
Jess Trudeau serves as the Director for the Texas Prenatal to Three Collaborative while providing coordination and direction for policy, advocacy, and funding efforts to support Family Connects.
Beth Cortez-Neavel provides organizational and administrative support for the policy team. She uses her journalism background to communicate the most important issues for child protection advocates.
Gloria manages communications strategies for TexProtects and the Texas Prenatal to Three Collaborative. Her goal is to connect the community to our policy recommendations and educational resources.
Why We Do What We Do
Safeguarding today’s children from abuse and neglect is essential to protecting tomorrow’s Texas. If you want to get involved in the process, we put together the six ways you can take action today. Visit [link https://www.texprotects.org/legetoolkit/ ] to view the list. The TexProtects team is committed to resourcing you well to use your voice to be a champion for children. Please don’t hesitate to contact our team with questions. We are here for you!
Frontline For Children | January 2021
“In this brief, Child Trends examines the prevalence of children and youth with special health care needs (CYSHCN) in the foster care system. CYSHCN have—or are at increased risk for—chronic physical, developmental, or behavioral/emotional conditions. This brief provides an overview of the literature on CYSHCN and their experiences in the foster care system, a detailed explanation of the methodology used for the current brief, an explanation of our findings, and a brief discussion of practice and policy implications.” A key finding of this research suggests that “children and youth’s reasons for entering foster care, their experiences while in care, and their reasons for leaving care vary depending on whether they have an SHCN.”
TexProtects Takeaway: 18% of children in Texas foster care have special health care needs with older youth and Black or Hispanic children having a higher likelihood of having an identified special health care need. These children come into foster care for different reasons than their peers and have different experiences and needs. More must be done to identify which placements and strategies are available and needed to best ensure their safety and success in care.
This feature of the MMWR features research on national child maltreatment reports during eight months of the global pandemic. Findings suggest that during COVID-19, “the total number of emergency department visits related to child abuse and neglect decreased, but the percentage of such visits resulting in hospitalization increased, compared with 2019. The pandemic has affected health care–seeking patterns for child abuse and neglect, raising concerns that victims might not have received care and that severity of injuries remained stable or worsened. Implementation of strategies to prevent child abuse and neglect is important, particularly during public health emergencies.”
3. The Neglected Ones: Time at Home During COVID-19 and Child Maltreatment (Bullinger, L., Raissian, K., Feely, M., & Schneider, W.)
“We combine early release child maltreatment reports in Indiana with unique and newly available mobile phone movement data to better understand the relationship between staying at home intensively during the COVID-19 pandemic and child maltreatment. Our findings indicate that the prolonged stays at home promoted by the public health response to COVID-19 resulted in reductions in child maltreatment reports overall and in substantiated reports of maltreatment. However, relative to areas that stayed home less, children in areas that stayed home more were more likely to be both reported for and a confirmed victim of maltreatment, particularly neglect. These areas have historically been socioeconomically advantaged and experienced lower rates of maltreatment. We only observe increases in confirmed child maltreatment in metropolitan counties, suggesting that the effects of staying home on child maltreatment may reflect both the differential risk of leaving home and access to services in metropolitan–rather than non-metropolitan–counties.”
TexProtects Takeaway: Despite the decreases in reports during the earlier months of COVID-19, research supports an assumption that the stresses of COVID-19 on families is likely increasing the risk of child maltreatment. TexProtects wrote a brief summarizing relevant research that points to the ways in which economic recessions, unemployment, increases in family violence, mental health, substance use, and parental stress have been correlated to increases in child abuse and neglect.
4. Child Well-Being Spotlight: Children Living in Kinship Care and Nonrelative Foster Care Are Unlikely to Receive Needed Early Intervention or Special Education Services (OPRE & RTI International)
“The purpose of the spotlight is to examine the degree to which early intervention and special education services are being received by children who may have developmental delays and/or compromised cognitive or academic functioning, and the difference in unmet needs between children in voluntary kinship care, formal kinship care, and nonrelative foster care.” Findings indicate that young children (ages 0-2) in nonrelative foster care are significantly likelier than those in formal kinship care or voluntary kinship care to have a developmental delay. Further, among children ages 3-17 in foster care, those in nonrelative foster care and formal kinship care are likelier to have developmental delays than those in voluntary kinship care. Authors state: “it is especially important to note that across all types of placements, most children involved with the CWS who potentially need these critical services do not receive them.”
TexProtects Takeaway: Kinship care can be a safer and more effective placement for children involved with the child protection system. TexProtects is a big proponent of putting policies in place to provide more support and access to resources to kinship caregivers, whether formal or voluntary, so that they may provide the best care for children.
5. Supporting Social-Emotional and Mental Health Needs of Young Children Through Part C Early Intervention: Results of a 50-State Survey (National Center for Children in Poverty & Georgetown University Health Policy Institute, Center for Children and Families)
“This report examines features of states’ Part C Early Intervention programs that help them identify and serve infants and toddlers with social-emotional (SE) delays and mental health conditions. A 50-state survey conducted by the National Center for Children in Poverty and Georgetown University Center for Children and Families asked state Part C Coordinators about their programs’ policies and procedures related to screening, evaluation, eligibility, services, and financing that affect the program’s capacity to meet the SE needs of infants and toddlers. The survey results are shared in this report, along with information from follow-up interviews with state Part C Coordinators. Overall, the findings point to both critical gaps in the capacity of Part C programs to meet infant-toddler SE and mental health needs and promising strategies some states are using to support children in this domain.”
TexProtects Takeaway: Increasing access and quality in Early Childhood Intervention (ECI) is a policy agenda item for the Prenatal to Three Collaborative and an unexpected but effective part of a robust system to prevent child abuse and neglect. ECI providers in Texas face numerous obstacles and this session, the legislature must increase investments so that the rates per child are adequate to meet demand and deliver quality.
6. COVID-19 Job and Income Loss Jeopardize Child Well-Being: Income Support Policies Can Help (Gennetian, L., Gassman-Pines, A., & Society for Research in Child Development)
“The burdens of job loss and continued economic uncertainty are felt by a wide range of families, though they are especially elevated among lower-income households and families of color. COVID-19-driven increases in job loss, income instability, and resulting strains on housing and food security are impairing child and family wellbeing. Temporary policy supports – such as stimulus checks, expanded Unemployment Insurance (UI) benefits, rent moratoriums, and expanded food programs – helped stem these losses and protect children.” Given the demonstrated ability of income support policies to mitigate harm among children and families experiencing unemployment and insufficient access to basic needs during the global pandemic, these researchers recommend that policymakers renew and reinstate economic supports.
TexProtects Takeaway: A healthy child comes from a healthy family. Especially during this pandemic, children and their families need economic support to stay safe, nurtured, and resilient. Policymakers can ease one aspect of childhood adversity – income instability — by making sure families who are struggling get the support they need.
7. 50-State Comparison: Early Care and Education Governance (Education Commission of the States)
“This 50-State Comparison provides data on states’ early care and education governance systems, with a focus on the agencies that oversee these programs, the level of alignment of these programs and the advisory entities for early care and education in the state.” The individual profile for Texas can be found here.
TexProtects Takeaway: Texas has an increasingly fragmented system of care for young children and their families that includes the Texas Workforce Commission, Texas Education Agency, Department of Family and Protective Services, Head Start Collaboration Office, and Health and Human Services among others. which makes collaboration, strategy, and coordination critical elements. The Texas Early Learning Council and PN3 Collaborative are a few of the groups working on improving collaboration and alignment to better ensure access and effectiveness of early childhood supports and services.
8. How Racism Can Affect Child Development (Harvard University: Center On the Developing Child)
“Advances in science are presenting an increasingly clear picture of how significant adversity in the lives of young children can disrupt the development of the brain and other biological systems. These early disruptions can undermine young children’s opportunities to achieve their full potential. And, while they may be invisible to those who do not experience them, there is no doubt that both systemic racism and interpersonal discrimination can lead to chronic stress activation that imposes significant hardships on families raising young children.”
TexProtects Takeaway: Childhood adversity and racism are some of the greatest public health crises in the U.S. We are working hard this legislative session with policymakers to create a Texas framework to address and prevent childhood adversity in our state. Stay tuned for ways you can advocate for this framework by signing up for our advocacy alerts on our home page.
“The federal Family First Prevention Services Act of 2018 (Family First Act) seeks to keep children safely with their families through the provision of evidence-based services to prevent foster care entry… In this brief, we present two evidence-based models (EBMs), implemented in NYC, as case studies: Brief Strategic Family Therapy (BSFT) and Child Parent Psychotherapy (CPP). Drawing on interviews with the purveyors of the two EBMs, as well as community-based provider agencies, we identify four key factors that influence the scale-up of EBMs in child welfare.
In addition to the brief above, the authors developed a fact sheet on program purveyors. “Program purveyors, who disseminate their program models through activities such as training staff and providing technical assistance, play an essential role in successfully implementing evidence-based models and scaling services. This fact sheet provides an overview of the role of purveyors in implementation and identifies four factors that may impact purveyors’ capacity to scale services under the Family First Act.”
TexProtects Takeaway: It is important to continue assessing various strongly-backed evidence-based models that could be included under FFPSA as promising, supported, or well-supported. States must begin scaling up their use of these models under FFPSA to better serve vulnerable and at-risk children and families.
10. Using Operations Research & Analytics to Increase the Effectiveness of Service Allocation to Families with Infants Out of Home Care Due to Substance Abuse in the Texas Child Welfare System (Barrameda, C., Clemente, J., Conroy, J., & Calnan, M.)
“This project is an extension of a 2018-2019 academic year MQP that conducted an initial investigation improving service allocation in the United States child welfare system. Our team narrowed the scope of the project by improving service allocation to infants from urban areas of Texas who were placed into foster care as a result of parental substance abuse. Through predictive analytics, we determined the impact services and other factors had on a child’s length of stay in the system. Then using prescriptive analytics, we developed a mechanism that reallocates services to minimize a child’s length of stay in the system. Our results demonstrate an opportunity to improve service allocation by examining both a child’s case details and the environmental factors surrounding their case.”
TexProtects Takeaway: Child involvement with the child welfare system due to parental substance use is a subject that needs more attention. TexProtects advocates for these children to receive the best care possible, including minimizing their continued involvement in the system. Texas can take note from this study to better improve service allocation to these vulnerable children and families.
How TexProtects Is Advocating for Children and Families in the State Budget
The work of the 87th Legislature is already well underway, and TexProtects’ staff is hard at work alongside agency and legislative leaders in ensuring that Texas keeps child safety and family wellbeing at the top of the priority list this session.
Late last month, TexProtects provided recommendations in response to the Department of Family and Protective Services’ (DFPS) Legislative Budget Request (LAR). The agency’s LAR will serve as the foundation for the appropriations bill and state budget for 2022 – 2023. With the ongoing challenges of COVID-19 and the prospect of a session much more limited in scope, now more than ever, public participation and feedback on the budgetary process is critical to ensuring that communities and families can benefit from strategic investments and proven programs that ensure every child has a bright tomorrow.
You can read our comments and recommendations here, and stay tuned for more opportunities to let lawmakers know that now is the time for us all to step up and be champions for children.
TexProtects’ Stakeholder Input Department of Family and Protective Services Legislative Appropriations Request 2022-2023
Submitted November 24, 2020
TexProtects appreciates the opportunity to offer comment on the Department of Family and Protective Services’ Legislative Appropriations Request for 2022-2023. As the only statewide organization singularly focused on child protection and preventing abuse and neglect, we applaud the Department’s investments in prevention and family preservation approaches that are proven to keep children safe and keep families together.
Investments by the 85th and 86th Legislatures and innovative approaches by DFPS leadership have resulted in substantial shifts in approach that have the potential to change the landscape of child welfare in Texas in a way that is beneficial for children and families. The rollout of Community Based Care and the potential funding available through the Family First Prevention Services Act offer Texas the opportunity to invest in proven strategies, leverage community strengths, and keep kids safe.
However, despite these significant improvements, the DFPS budget still reflects a prioritization of reaction to abuse and neglect rather than prevention and family preservation. Only 5% of the 2021 budget is spent on prevention with 87% spent on Child Protective Services. The investments in CPS have increased much faster than investments in prevention without any accompanying decreases in reports, investigations, or confirmed victims.
Texas has not created a system that is effectively rolling out evidence-based practices to prevent removals and address risk before a crisis.
- Despite increasing child fatalities resulting from child abuse and neglect (specifically in children under age 5), only 3.8% of families in highest need have access to voluntary evidence-based programs through the Prevention and Early Intervention Division that could help prevent such tragedy.
- The vast majority of investigations are for neglect rather than abuse, demonstrating that most families are need of support rather than protection.
- 78% of removals from the home (and entry intro foster care) are occurring straight from investigations without the family receiving family preservation services.
- 42% of families who have received services in Family-Based Safety Services (FBSS), which are intended to prevent removals, are re-reported for abuse or neglect within five years of completing services.
- 44% of children are subsequently alleged as a victim in a new investigation within five years of exiting CPS custody.
- Disparities by race persist with African-American families 1.9 times as likely to be investigated and African-American children 1.6 times as likely to be removed than Anglo children.
Impact of the COVID-19 Pandemic on Child Abuse and Neglect
Now more than ever, it is critical that the state respond correctly and provide families with proven strategies to meet their needs and to stay together safely, otherwise there is a risk of putting more stress on the system. The COVID-19 pandemic has not only negatively impacted Texas’ budget, it has caused families to face an unprecedented amount of stress, financial difficulties, and social isolation. Research during the Great Recession found significant correlations between unemployment and physical and emotional abuse. If those correlations hold in the current crisis, Texas could see a 15% increase in physical abuse cases and 12% increase in emotional abuse cases for every one-point increase in the unemployment rate.
For many families experiencing unemployment, untreated substance use and mental health challenges can increase the risks to child safety and family well-being. According to the Meadows Mental Health Policy Institute, a 5% increase in the unemployment rate could result in 300 additional lives lost to suicide, 425 additional lives lost to drug overdoses, and an additional 50,000 cases of Substance Use Disorder each year. With more than 70% of CPS cases involving mental health and substance abuse challenges prior to COVID-19, we expect to see an even more substantial impact.
Now more than ever, protecting children requires better support for families who are facing unprecedented challenges that can impact child safety and well-being.
DFPS’ Legislative Appropriations Request (LAR)
DFPS is entering into the next biennium with a $4.5 billion baseline request, which reflects growth forecasts but is impacted by the previous 5% reductions. According to DFPS, this required making some additional funding asks just to get back to a maintenance level of operations. In a typical legislative budget cycle, one would expect numerous exceptional items above DFPS’ baseline request. However, with the current economic climate amid a pandemic and a costly ongoing federal lawsuit, DFPS’ approach to the budget is narrow in scope and only aimed at initiatives they consider to be most necessary. DFPS’ LAR includes requests for an additional $192 million to carry these out.
It is promising to see two opportunities for additional prevention investments to keeping families safely together and preventing removals reflected in the Exceptional Item Requests.
- $10 million is requested for investment in Prevention and Early Intervention (PEI) services, specifically Project HOPES (Healthy Outcomes through Prevention and Early Support), the Family and Youth Success Program (formerly known as STAR), and the Military Families Program. Citing the costs of each program in comparison to the cost of foster care services, DFPS acknowledged these services as a “cost-effective alternative to foster care.”
- DFPS also included a placeholder to discuss how to leverage the funding opportunities in the Family First Prevention Services Act (FFPSA).
These initiatives and associated dollars are focused on keeping children safe and supporting families to ensure that reports, investigations, and child abuse/neglect rates decrease. The only path toward a better Texas tomorrow and decreasing costs spent on CPS is to shift the paradigm by investing in cost-effective and proven programs BEFORE crisis. Prevention saves dollars and make sense. It’s the right approach for children and the smart approach for taxpayers.
TexProtects’ Recommendations
1 Exceptional Item Request #4 – Fully fund Prevention and Early Intervention toward Strategic Growth
While the CPS system plays a vital role for children who have endured abuse and/or neglect, the Department of Family and Protective Services (DFPS)also plays a critical role in the prevention of abuse and neglect and the strengthening of families through effective prevention programs. The Prevention and Early Intervention Division at DFPS has established innovative and effective community-based strategies for delivering proven programs to families who choose to enroll.
The immense research done on the health implications of Adverse Childhood Experiences (ACEs)[i]—including abuse, neglect, family violence, or growing up with a caregiver who is incarcerated, mentally ill, or engaging in substance use—makes clear that what happens in early childhood literally lasts a lifetime. The prevention of ACEs holds incredible potential for ensuring healthy development and impacting societal challenges and taxpayer costs across multiple domains.
The cost of inaction is clear. ACEs like child abuse and neglect are associated with negative outcomes for individuals across the lifespan including poorer health, lower educational attainment, and higher likelihood of experiencing unemployment. Individuals and governments incur significant costs as a result. Bellis et al. (2019) estimate that annual healthcare costs attributable to ACEs across North America are approximately $748 billion with 82% of costs resulting from individuals who had two or more ACEs.[ii] With one in 10 American children living in Texas, we can expect to incur a significant percent of those costs if we aren’t better able to prevent child abuse, neglect, and other severe childhood trauma.
To create the most effective and efficient systemic change, interventions should occur in early childhood and should rely on evidence-based approaches that decrease risk and increase protective factors within family and community systems.
- We fully support the DFPS request in exceptional item #4 to increase investments in prevention initiatives including Project HOPES (Healthy Outcomes through Prevention and Early Support), the Family and Youth Success Program (formerly known as STAR), and the Military Families Program.
Specifically, we applaud the increase in Project HOPES and the Military Families Program which have implemented evidence-based home visiting strategies for families with young children. These programs are proven to have significant impacts on maternal and child health, school readiness, and child safety during the most critical years for development and have been a lifeline for families during the COVID-19 pandemic.
HB1549 (85R) directed the agency to create a strategic plan to scale prevention programming. The current PEI strategic plan indicates that to adequately protect families, a 20% increase in prevention funds is needed every biennium.
While this exceptional item does reflect a 6% increase for PEI budget and an 11% increase in the number of families who could be served by PEI, it still offers less than 4% of families with young children and 3 or more risk factors access to proven evidence-based home visiting.
- In order to maximize impact, ensure access for families in need, and realize savings across our state systems in this budget cycle and the many yet to come, our investment must demonstrate a true commitment to strategic expansion.
$18 million additional dollars (on top of the request) would allow Project HOPES to expand so that they could reach at least 5% of families most likely to benefit, would be more in line with the growth goals in the PEI strategic plan, and would create a meaningful path toward statewide scale of proven prevention programs.
2 Exceptional Item Request #5 – Prioritize Prevention in Appropriating Funds for Family First Prevention Services Act (FFPSA)
FFPSA provides Texas with a tremendous opportunity to transform the system from one that primarily responds after a crisis has occurred to one that invests in prevention to ensure families can remain together when safe and appropriate, have the supports they need, and avoid the trauma of a removal. In fact, FFPSA is the greatest investment and shift in the child welfare system from the Feds in the past five decades and if Texas doesn’t act, we will miss out on the opportunity to shrink our foster care system. FFPSA creates a funding mechanism for prevention services so that states can now be reimbursed at a rate of 50% for trauma-informed and evidence-based substance use, mental health, and in-home parenting services that have been approved by the Title IV-E Prevention Services Clearinghouse. Federal eligibility criteria broadly include children at imminent risk of entering foster care and their caregivers, as well as pregnant or parenting foster youth. The goal is to keep children out of the Child Protective Services (CPS) system by utilizing providers in the community who specialize in prevention.
DFPS released their strategic plan on September 1, 2020 which includes an overview of existing prevention services and agency activities that align with FFPSA, as well as implementation considerations and options for the prevention services and congregate care components of the bill using federal dollars already in hand from the Family First Transition Funds Act (FFTA). The plan does not require additional appropriations from the 87th Legislature and does not propose investment of any state dollars to receive the federal match that FFPSA affords. It does little to set up a framework for how to take advantage of this potentially transformational federal funding on an ongoing basis; therefore, there will still need to be planning in the 88th Legislature if this is not addressed now. Much can be done now to ensure Texas leverages this federal legislation and funding opportunities. The Department is awaiting direction from the 87th legislature on how to spend the recommended $33.9 million on prevention services for families whose children are at imminent risk of entering foster care.
- Support the Department’s plan to leverage $33.9 million in FFTA funds toward prevention efforts.
The prevention provisions of FFPSA are ultimately optional, so the Department’s plan to use $33.9 of the $50.3 million in FFTA funds on prevention efforts shows great promise. Prior to FFPSA, states focused dollars on measures that are expensive and reactive rather than proactive, protective, and cost-efficient. The further into the system a case flows, the more expensive it is. In 2019, there were 18,615 children who entered foster care. Preventing 3% of those removals would save the state $20 million. By investing earlier, Texas can prevent removals, save money, and keep children safe.
- Prioritize effectiveness and be strategic about which prevention options to pursue.
DFPS laid out a wide range of options in their strategic plan. In partnership with lawmakers during this session as well as future sessions, it is essential to identify which strategies are most effective and can be replicated well in diverse communities around the state.
The most promising options leverage the expertise that has been developed within DFPS’ PEI division. These services are not staffed or carried out by employees of DFPS. Instead, PEI contracts with community providers who are highly-skilled in prevention work to provide voluntary services. Similar approaches can be utilized to fund community block grants and targeted approaches to reach families at higher risk while still empowering community leadership, strengths, and choice.
Options 2D, 2E, and 2F in the FFPSA plan are most poised to deliver proven programs to the FFPSA defined population in the coming biennium and as written could offer pilot programming to over 3,000 families at risk of removal including pregnant and parenting foster youth.
These options leverage established and successful infrastructure and programs with experience, serving FBSS families, who fit the eligibility definition. Additionally, several of the programs already implemented by PEI are approved by the Clearinghouse, including Healthy Families America, Nurse-Family Partnership, and Parents as Teachers and could be used to draw down the federal match.
Increased investment in those three options from available FFTA funds could empower pilots in more communities as well as exapnsion into rural communiites through tele-health and in-person modalities. A more focused investment in pilot approaches most likely to succeeed would result in closer to 5,000 families served before the next legislatative session. This would provide the next legislature more information to decide how and where state general revenue investments could be most impactful to communities and the budget by maximizing the federal match.
- Strengthen family preservation services.
Family-Based Safety Services (FBSS) is the stage of service within DFPS that is tasked with providing services to families who have experienced child abuse and neglect but that has not risen to the level of requiring a removal. This stage of service is meant to keep families together and strengthen their ability to be healthy without further CPS intervention.
DFPS has proposed that families participating in FBSS are one of the primary targets for FFPSA prevention services. Unfortunately, DFPS does not publicly report which supports and services are provided to these families. Anecdotally, DFPS has shared that these services are primarily not evidence-based. FFPSA provides an opportunity to do something different by providing these families with evidence-based, trauma-informed services.The state spent $94 million on FBSS to serve 18,000 families in 2019. That money should be spent more wisely. Taking advantage of the opportunities in FFPSA could allow Texas to ensure that families are receiving evidence-based services proven to keep children safe. By doing so, we could finally decrease the recurrance rate among FBSS families. Diverting 5% of families from FBSS could save approximately $9.4 million.
- Better align across systems to increase access to substance use and behavioral health programs.
The match available through FFPSA is for mental health, substance use, and in-home parenting supports; however, the strategic plan does not provide a meaningful pathway toward increasing access to behavioral health services which are both severely lacking in our state and clearly identified as root causes of abuse and neglect.
Texas should ensure that the budget of each state agency who provides these services to families has been considered to see if there are any missed opportunities to draw down federal funds. Cross-agency work should be mandated to ensure that future funds can be invested in ways that capitalize on the federal match.
- Ensure there is state investment now in order to draw down the federal match in this biennium.
We know families are in need of services now, so the state should consider investing its own dollars, not just the federal dollars it already has, to ensure more families can be served and to provide a meaningful and sustainable path forward for these critical prevention services.
Carrying out the opportunities provided by FFPSA requires a drastic perspective shift. The intent of FFPSA is to transform the current system, not keep it the same. FFPSA aims to invest early in effective measures that will keep families together and out of the CPS system. Every dollar Texas invests should be spent with this in mind. With their current plan, DFPS has taken strides in the right direction for the children and families of Texas. However, it is essential that the Texas Legislature supports these efforts, makes a plan beyond this legislative session, and ensures the focus remains on child abuse and neglect prevention and family preservation.
TexProtects looks forward to serving as a resource and partner as you continue your work. Thank you for your commitment to these issues and to the families and children of Texas.
[i] Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998).
[ii] Bellis et al (2019)
FRONTLINE FOR CHILDREN | HOME VISITING SPECIAL EDITION
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 RESOURCES FROM TEXPROTECTS
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.
HOME VISITING AND TELEHEALTH
“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.
HOME VISITING AND MATERNAL HEALTH
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 WORKFORCE
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.”
HOME VISITING AND PARENTAL ENGAGEMENT
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.”
HOME VISITING COMPREHENSIVE RESOURCES
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.