Current Mental Health Crisis in Child Welfare

Children involved in Child Protective Services (CPS) often have serious and chronic mental health needs due to the trauma they have endured both in and outside of the child welfare system. Further, unmet mental health and substance use needs remain a reason for some families’ involvement with the child welfare system despite ongoing efforts to change outcomes. Unfortunately, the lack of resources, safety net services, poverty, housing stability, and access to necessary mental health and substance use services can lead a family to be involved with CPS housed within the Department of Family and Protective Services (DFPS). Further, once a family is involved with CPS, the system itself can be a source of trauma for a child and their family, creating an additional need for intervention and support.

CPS continues to face chronic challenges including child fatalities, high numbers of children without placement (commonly referred to as CWOP), overburdened caseworkers, high staff turnover, and systemic issues in the treatment and care of foster youth. Several factors continue to impact the agency’s efforts, including transitioning the entire state into Community-Based Care (CBC), mental health needs of youth in crisis, the ongoing foster care federal lawsuit, LGBTQIA+ foster youth-related issues, and state-level implementation of the federal Family First Prevention Services Act (FFPSA).

The legislature and advocates remain committed to improving the child welfare system and reducing the number of families involved in the system, with numerous ambitious bills filed every session aimed to improve outcomes for families and foster youth aging out of the system.

Mental Health Needs of Foster Youth & Adverse Childhood Experiences (ACEs)

Child welfare experts say addressing mental and behavioral health needs is the largest unmet health need for foster youth.1 The majority of children and youth in foster care have ranging mental health needs, from minor to serious. While every situation is different, removal from a family alone is traumatic for children and youth.2 According to Casey Family Programs, “trauma experienced by children who come to the attention of a child protection agency is often complex and may have occurred over a long period of time.”3 Further, we know prolonged stress early in life can impact a child’s physical and mental health when they are older.4 Children in foster care often have other common experiences that impact their mental health including disruptions in routine, financial instability, food shortages, housing instability, and trauma.5

Children in the child welfare system often experience traumas before becoming involved with the system, defined as Adverse Childhood Experiences (ACEs). Experiences within the system can be an ACE itself, compounding the trauma prior to system-involvement. ACEs may include:

  • Experiencing violence, abuse, or neglect;
  • Witnessing violence in the home or community;
  • Having a family member attempt or die by suicide;
  • Not having enough food to eat;
  • Experiencing homelessness or unstable housing; and
  • Experiencing discrimination.6

For people who have experienced ACEs, their health and well-being later in life can be negatively affected. Toxic stress from ACEs can change brain development and impact how bodies respond to stress.7 Experts say:

  • One in 6 adults experienced four or more types of ACEs;
  • Five of the top 10 leading causes of death are associated with ACEs; and
  • Preventing ACEs could reduce the number of adults with depression by as much as 44 percent.8

Supporting the mental health needs of foster youth is paramount within both the child welfare and mental health systems. However, much more support is needed, as resources remain scarce throughout Texas.

Community-Based Care (CBC)

DFPS and the Office of Community-Based Care Transition (OCBCT) continue to guide CPS on the path to statewide implementation of community-based care (CBC), in an effort to keep children closer to home and connected with their families and communities. Created through SB 11 (Schwertner/Frank) in the 85th legislative session, CPS was directed to contract with a nonprofit or governmental entity as a single source continuum contractor (SSCC). The SSCC oversees the placement and services of children in DFPS conservatorship, including both foster care and kinship placements, while managing placements and adoptions. CBC offers regions the ability to create innovative solutions to local challenges by working with dedicated stakeholders.

The state has been slowly transitioning the entire child welfare system into CBC since 2017. CBC currently serves about one-half of Texas geographically, and about a quarter of the children who are in state custody. According to DFPS, all of Texas will be served by CBC in 2029.9 CBC is implemented at a regional basis with seven regions currently designated as of late 2023:

Regions as set by the DFPS and described in associated content.
  • Region 1 (41 counties in the Panhandle)
  • Region 2 (30 counties in Big Country and Texoma)
  • Region 3W (7 counties around Fort Worth)
  • Region 8b (27 counties in South Central and Hill Country)
  • Region 3E (9 counties in Metroplex East)
  • Region 4 (23 counties in Piney Woods)
  • Region 5 (15 counties in Deep East)

Lessons learned from each region have been crucial in planning for the future. The most up-to-date information is available on the DFPS Community-Based Care webpage.

Supporting Youth in Crisis: Child Relinquishment RTC Diversion Project

Child relinquishment to obtain mental health services refers to the process in which a parent or guardian terminates parental rights and relinquishes those rights to the state solely to get their child intensive mental health services they need. Legislation passed in previous sessions addressed the need to provide joint managing conservatorship (JMC) so families can stay connected to their children and prohibited placement of the parents’ name on the abuse/neglect registry if the child was relinquished solely to obtain mental health services.

To help prevent these relinquishments, the Texas Legislature created the Child Relinquishment RTC Diversion Project as an alternative way to access intensive services. The 87th Texas Legislature passed Senate Bill 642 (West/Hinojosa) to continue work done over previous sessions and implement a number of recommendations. This legislation included:

  • Eliminating the requirement for DFPS to conduct an abuse investigation before allowing a child to participate in the relinquishment avoidance program, unless there is an allegation of abuse/neglect;
  • Allowing Local Mental Health Authorities (LMHAs)/Local Behavioral Health Authorities (LBHA) to refer a child directly to the program without first contacting DFPS;
  • Requiring HHSC to develop an emergency eligibility process for admission into the program; and
  • Requiring HHSC and DFPS to develop and implement comprehensive guidance for providers and families and made available on HHSC’s website.

There is still work to be done around bolstering community supports to avoid the need for the program. Additionally, more attention and resources are needed to ensure that comprehensive, timely services are available after a child leaves the RTC Diversion Project in effort to promote stability at home.

LGBTQIA+ youth in foster care often need additional support. National research shows that more than 30 percent of youth in foster care identify as LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual), compared to 11.2 percent of youth outside of foster care.10 For many LGBTQIA+ youth, disclosing their identity to family members can lead to verbal and physical harassment, sometimes even resulting in out-of-home placement or periods of homelessness.11

In Texas, controversy surrounding gender-affirming care for transgender youth continues. In the 88th legislative session, legislators passed SB 14 (Campbell/Oliverson) which prohibits physicians from providing gender-affirming care for transgender youth, bans insurance companies from covering the treatments, and prohibits public funds from going towards gender-affirming care.12 While the legislation faced legal action to prevent it from becoming law, it ultimately took effect on September 1, 2023 and remains in place.13 The law does not impact mental health services nor prevent those services from being provided to LGBTQIA+ children and youth.

Concerns regarding investigations into families with transgender youth have waned since 2022. No bills were passed in the 88th legislative session related to redefining child abuse to include gender-affirming care or mandatory reporting laws. This comes after Attorney General Ken Paxton released a non-binding legal opinion on February 18, 2022 regarding “whether certain medical procedures performed on children constitute child abuse.”14 The opinion stated certain gender-affirming care for transgender youth “legally constitute child abuse under several provisions of chapter 261 of the Texas Family Code.”15 While the legal opinion was non-binding and did not change any DFPS policies or state laws regarding child abuse or mandatory reporting, several families were subsequently investigated by CPS.16 Swift legal action was taken to stop the investigations and there is a current injunction preventing investigation of families that belong to PFLAG, an LGBTQIA+ advocacy group.17 As of October 2024, the injuctions protecting PFLAG members from being investigated regarding gender affirming medical care remain in place. The Court of Appeals affirmed those injuctions in March 2024.18

Ongoing Federal Lawsuit

The state remains involved in an ongoing, thirteen-year long federal lawsuit regarding its treatment of youth in long-term foster care. Children’s Rights, a national advocacy group from New York City, filed suit against the Governor of Texas, the Texas Health and Human Services Commission (HHSC), and DFPS in federal court on March 29, 2011. The suit alleges constitutional violations of children in Permanent Managing Conservatorship (PMC), also known as long-term foster care.19 The lawsuit was filed on behalf of approximately 12,000 youth in the PMC of DFPS. There have been multiple hearings, court orders, and related opinions during the thirteen-year lawsuit.

At a hearing held in April 2024, the judge on the lawsuit ruled that Texas Health and Human Services was in contempt for regularly failing to investigate claims of abuse and neglect within the Texas foster care system.20 The ruling includes a daily fine of $100,000 until the state demonstrates progress in addressing this issue.21 The state has, however, appealed this decision.22 Furthermore, the state child welfare offices have expressed difficulty in meeting the demands placed upon them by the court, and they are requesting the presiding judge be removed from the case.23 The 5th Circuit Court heard oral arguments concerning this ruling and removal request on August 5th, 2024.

The court continues to meet periodically regarding the case. The most up-to-date information can be found on the DFPS Foster Care Litigation website.

Family First Prevention Services Act (FFPSA) Implementation

The federal Family First Prevention Services Act (FFPSA) passed in 2018 and restructured federal child welfare funding used to pay for services provided to children in foster care and their families.24 According to the Texas Children’s Commission, FFPSA seeks to “reduce entry into foster care, limit the use of congregate care, as well as improve services and outcomes for children placed in care.”25 FFPSA has central provisions aimed at increasing prevention services, providing support to kinship caregivers, addressing congregate care, and older youth.26 The FFPSA allows for a 50 percent federal match if the state invests in certain services considered well-supported, supported, or promising practices for families at risk of entering the foster care system. This includes children whose permanency is at risk of disruption or dissolution, as well as pregnant and parenting foster youth.27 The FFPSA Services Clearinghouse includes many well-supported or promising programs for mental health of youth and parents, substance use of youth and parents, and parenting skills and supports.28

Texas began state-level FFPSA implementation on October 1, 2021. DFPS has stated that Texas will delay implementation of certain provisions of FFPSA, including:

  • Limitations on certain foster care maintenance payments for payments that are not foster homes;
  • Limit on number of children in a foster family home;
  • Qualified Residential Treatment Programs (QRTPs); and
  • Certification preventing increases to the juvenile justice population.29

To support these efforts, the legislature included $20 million through DFPS Rider 43 in the 88th legislative session budget bill. Rider 43 will continue the FFPSA pilot programs created in the 2021 legislative session, requires DFPS to expand the availability of the programs to more eligible families, and continues funding the QRTPs to meet QRTP standards under FFPSA.30 Current updates on FFPSA’s implementation are on the DFPS FFPSA website.

To learn more about DFPS structure and funding, check out the DFPS section of the Guide!

References

  1. American Academy of Pediatrics. (2021). Mental and behavioral health needs of children in foster care. https://www.aap.org/en/patient-care/foster-care/mental-and-behavioral-health-needs-of-children-in-foster-care/ ↩︎
  2. Casey Family Programs. (2023). What impacts placement stability? https://www.casey.org/placement-stability-impacts/  ↩︎
  3. Casey Family Programs. (2018). How do investigation, removal and placement cause trauma for children? https://www.casey.org/investigation-removal-placement-causes-trauma/  ↩︎
  4. Ibid. ↩︎
  5. Children’s Bureau. (2022). Tip sheet on responding to youth and young adult mental health needs. https://cwlibrary.childwelfare.gov/discovery/delivery/01CWIG_INST:01CWIG/1219064650007651 ↩︎
  6. Centers for Disease Control and Prevention. (2023). Fast facts: Preventing adverse childhood experiences. U.S. Department of Health & Human Services. https://www.cdc.gov/violenceprevention/aces/fastfact.html  ↩︎
  7. Ibid. ↩︎
  8. Ibid. ↩︎
  9. Office of Community-Based Care Transition. (2023). Community-Based care. Department of Family and Protective Services.  https://www.dfps.texas.gov/CBC/default.asp ↩︎
  10. Baams, L., Wilson, B.D.M, & Russell, S.T. (2019). LGBTQ youth in unstable housing and foster care. Pediatrics March 2019; 143 (3): e20174211. 10.1542/peds.2017-4211 ↩︎
  11. Ibid. ↩︎
  12. Texas Legislature Online. (2023). Senate Bill 14, 88th Legislature. https://capitol.texas.gov/tlodocs/88R/billtext/pdf/SB00014F.pdf#navpanes=0 ↩︎
  13. Melhado, W. (2023, August 25). Texas ban on puberty blockers and hormone therapy for trans kids will go into effect despite legal fight. Texas Tribune. https://www.texastribune.org/2023/08/25/texas-transgender-kids-health-care-lawsuit/  ↩︎
  14. Attorney General of Texas. (2022, February 18). Opinion No. KP-0401 Re: Whether certain medical procedures performed on children constitute child abuse (RQ-0426-KP). https://texasattorneygeneral.gov/sites/default/files/global/KP-0401.pdf  ↩︎
  15. Ibid. ↩︎
  16. Klibanoff, E. (2022, September 16). Texas’ child welfare agency blocked from investigating many more parents of trans teens. Texas Tribune. https://www.texastribune.org/2022/09/16/texas-trans-teens-investigation-child-abuse/  ↩︎
  17. Ibid.  ↩︎
  18. PFLAG. PFLAG National Texas FAQ. Retrieved from https://pflag.org/resource/texas-faq/ ↩︎
  19. Department of Family and Protective Services. (2022). Foster care litigation. https://www.dfps.state.tx.us/Child_Protection/Foster_Care/Litigation.asp ↩︎
  20. Harper, K. B. (2024, July 8). State’s move to bump federal judge from longtime foster care lawsuit caps years of battles. The Texas Tribune. Retrieved from https://www.texastribune.org/2024/07/08/texas-foster-care-lawsuit-judge-janis-jack/ ↩︎
  21. Ibid. ↩︎
  22. Ibid. ↩︎
  23. Ibid. ↩︎
  24. Department of Family and Protective Services. (n.d.) Family First Prevention Services Act. Retrieved December 18, 2023 from https://www.dfps.texas.gov/Child_Protection/Family_First/default.asp ↩︎
  25. Texas Children’s Commission and Texas Department of Family Protective Services. (2022). Senate Bill 1575 (87th Regular session) report to the Legislature, October 1, 2022. Supreme Court of Texas Permanent Judicial Commission for Children, Youth, and Families. https://texaschildrenscommission.gov/media/al4bkm4h/sb-1575-report-online.pdf ↩︎
  26. Texas Children’s Commission. (n.d.) Bench Book: Family First Prevention Services Act – Introduction. Supreme Court of Texas Permanent Judicial Commission for Children, Youth, and Families. http://benchbook.texaschildrenscommission.gov/library_item/gov.texaschildrenscommission.benchbook/187  ↩︎
  27. Rasco, S. & Dryden, D. (2020, September 29). Family First Prevention Services Act: The changing landscape of Texas child welfare strategic plan [PowerPoint]. Department of Family and Protective Services. https://www.dfps.texas.gov/Child_Protection/Family_First/documents/DFPS_FFPSA_Update_Webinar_Presentation.pdf ↩︎
  28. Ibid.  ↩︎
  29. Department of Family and Protective Services. (n.d.). Family First Prevention Services Act. Retrieved December 19, 2023 from https://www.dfps.state.tx.us/Child_Protection/Family_First/default.asp  ↩︎
  30. Texas Legislative Budget Board. (2023). HB 1 General Appropriations Bill – Conference Committee Report 3rd Printing. https://www.lbb.texas.gov/Documents/Appropriations_Bills/88/Conference_Bills/Conf_CCR_GAB_88R.pdf  ↩︎

Updated on December 9th, 2024



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