We hear a lot of discussion around Child Protective Services reforms focused on agency capacity shortages, but there are significant gaps in frontline, community-based services for Texas' high-risk youth that also need to be part of these important policy conversations.
Before the 85th Legislative Session convenes in 2017, we hope policymakers will analyze this issue from the starting point of the child in need and seek to include strategies to prevent and divert young lives from being disrupted and traumatized by entry into the juvenile justice or foster care systems in the first place.
First, we have to be willing to talk openly about mental health and acknowledge the number of high-risk children in Texas experiencing very real mental health disturbances — children who will have the greatest chance for recovery and healthy, productive living if diagnosed and treated early.
We know that half of all mental health conditions begin by age 14. In a 12-month period, more than half a million Texas children and adolescents (ages 0-17) have severe emotional disturbances that impair function at school and home. It is estimated that more than:1
- 186,000 engage in self-injury/harming behaviors
- 160,000 have depression
- 100,000 have conduct disorders
- 76,000 suffer Post Traumatic Stress Disorder
Among these are about 30,000 children who are at high risk for suspension or expulsion from school or out-of-home placement. A six-year study of Texas students found that children with severe emotional disturbances were disproportionately suspended and expelled from school, including nearly three out of four children in special education. Though about 9 percent of public school children are identified as having emotional difficulties that affect learning ability, this population constitutes about 32 percent of youth in our juvenile detention centers.2
Most children who enter the foster care system do so because of traumatizing abuse or neglect. Approximately one in eight of the 47,000 children in Texas Department of Family Protective Services custody is considered a “high needs” child, with special medical, behavioral or emotional indicators or intellectual and developmental disabilities.3
It is clear: Texas children need effective programs to protect their emotional health and safety as soon as problems emerge in order to stem the influx of youth entering and getting trapped within our institutional systems.
1. Missing Component: Access to Community-Based and In-Home Services
Whether a child with severe emotional disturbances lives with their biological family or a foster family, when a child at high risk for placement out of home or school experiences an emotional crisis, parents and caregivers need better options than to call law enforcement, drive the child to the ER or try to handle it themselves.
“They need to be able to call someone with expertise in mental health to provide in-home services and support to that family until the child is more stable. Those services may include de-escalation, long-term needs assessment and an ongoing support plan,” says Anu Partap, MD, Assistant Professor of Pediatrics at UTSW Medical Center and Director of the Rees-Jones Center of Foster Care Excellence at Children's Health.
“Easy-to-access community-based and in-home services are especially crucial for children in foster care. We find that among our patients, the majority of foster parents who say, ‘I can’t do this any more,’ are loving and committed before that breaking point. They ask for more help in their homes to help parent children in foster care with high needs, but there is a gap in providing needed and critical support services,” says Dr. Partap.
Crisis, respite and intensive in-home services can help retain foster homes in the system and prevent the disruption and re-traumatization of changing placements, as well as the risk of extended, expensive, nonmedical hospital placements because a foster home is not available.
2. National Trend: Creating School-Based Partnerships
The Meadows Mental Health Policy Institute has reviewed efforts from around the country to identify school-based early prevention and intervention strategies aimed at keeping high-risk children in school and out of the courts. Following are some of the programs and approaches that work best:
- School-wide social and emotional support models to improve the culture within an entire school and replace more punitive measures with positive behavioral interventions and instructional strategies. Positive Behavioral Interventions and Support and Safe and Responsive Schools are two well-known programs.
- Developing educators’ skills in behavior management and student discipline. My Teaching Partner and Objective Threat Assessment are excellent program examples.
- Alternate disciplinary approaches that either replace suspension with another type of response or offer alternative activities to students during times of suspension. The Restorative Justice model is the most widely recognized of these strategies.
- Partnering schools with health care systems to ensure access to health and mental health care for students who need it through school-based and school-linked health care delivery.
3. Best Practice All Around: Integrated Health Care
The integration of primary and behavioral health care is a national medical best practice, a pediatric best practice and a mental health best practice. It allows joint medical and mental health assessments, joint treatment planning and effective intervention as children grow and develop.
With almost every medical condition, you treat the child. With mental conditions, evidence-based models show the most effective treatment plans involve the caregiver and child working together with mental health professionals, specifically around problematic or trauma behaviors.
“One issue that complicates the delivery of integrated care for high-needs children in foster care is that there is no mechanism to share a child’s CPS history with medical and behavioral health care treatment teams, making it difficult to provide adequate mental health assessment, diagnosis, and treatment plans,” says Dr. Partap.
The Rees-Jones Center developed a model that includes a CPS liaison as part of its practice to provide clinicians with accurate patient histories for health assessments and to collaborate and coordinate treatment plans between providers. It allows the center to more effectively work with child welfare agencies and look at the family support system a child will need.
We know Texas can do better, and we know it is better for Texas to protect high-risk children and adolescents before they enter institutionalized systems. Let’s start talking about early prevention and intervention now, before the next legislative session, to ensure the next policies and reforms enacted best serve our most vulnerable children.
1. Estimates of prevalence of mental health conditions among children and adolescents in Texas, Meadows Mental Health Policy Institute, March 2016.
2. Breaking school rules: A statewide study of how school discipline relates to students’ success and juvenile justice involvement, Justice Center of the Council of State Governments, 2011.
3. Addressing the health and safety of children in foster care, Rees-Jones Center for Foster Care Excellence at Children’s Medical Center, May 2016.