Texas Department of Family and Protective Services
Advisory Council Meeting
April 18, 2008
The Texas Department of Family and Protective Services (DFPS) Advisory Council met in Public Hearing Room 125-E of the John H. Winters Building, 701 West 51st Street, Austin, Texas. Council Members present were Chair Ommy Strauch, Vice Chair Imogen Papadopoulos, Gigi Edwards Bryant, Debbie Epperson, Paul Furukawa, Richard Hoffman, Faith Johnson, Linda Bell Robinson and Mamie Salazar-Harper.
Also present were Deputy Commissioner Sue Milam and Department staff.
Agenda Item 1 – Call to Order
Call to order at 9:00 am by Chair Strauch.
Agenda Item 2 – Reading, Correction and Approval of Minutes of January 18, 2008 Regular meeting*
Ms. Papadopoulos moved adoption of the minutes, and Judge Johnson seconded. Upon correction of spelling of a council member’s name, minutes were approved.
Agenda Item 3 – Public Testimony
Dr. Valerie Bauhofer, Association Executive, Texas Association of Child Care Resource and Referral Agencies (TACCRRA), provided handouts for Council members and mentioned that her agency represents seven agencies throughout Texas. Dr. Bauhofer discussed early child care licensing standards and suggested two major issues to be addressed by the Council: a full, comprehensive review of licensing standards for revision in 2009, and ongoing work with the state legislature in order to increase funding for licensing and regulatory activities.
Dr. Bauhofer discussed establishment of career paths for child care workers, as well as increasing the required amount of pre-service and in-service hours for providers; she also suggested making training requirements specific to the ages served, such as for infants and toddlers, and improving the staff-to-child ratio. Dr. Bauhofer declared that TACCRRA is quite anxious to work with the Council and said her agency is receptive to supplying statistics, data and input so as to ensure the health and welfare of children.
LaShonda Brown, Executive Director, Texas Association for the Education of Young Children (TAEYC), declared her agency’s support of full renewal of child care licensing standards in 2009. Ms. Brown informed the Council that TAEYC is a state affiliate of the National Association for the Education of Young Children, which enjoys a nationwide membership of nearly 100,000; her agency is comprised of approximately 3,000 members across 18 local affiliate chapters.
Ms. Brown stated TAEYC is committed to promoting excellence in early child care and education and that the mission of TAEYC is to provide opportunities for professional development and to increase the public’s awareness of issues affecting children, families and professionals in the state. TAEYC supports its members and the general public in various ways, one of which is through education on best practices in early care and education, including developmentally appropriate practice for young children and health and safety in out-of-home childcare settings.
Ms. Brown discussed a recent survey of TAEYC members, noting that more than half reported they were passionate and concerned about the issues affecting children in licensed child care facilities; these issues include child-to-staff ratios in child care settings and training requirements for early care and educational professionals. Ms. Brown noted that her agency supports the general public by serving as a resource in an advisory capacity to several partner organizations, such as the HHSC’s Raising Texas Initiative, Texas Early Childhood Education Coalition and Texans Care for Children.
Ms. Brown stated TAEYC applauds the Department’s work and effort in child care licensing and the last revision of the minimum standards; she noted while many improvements were made regarding the standards for children in out-of-home care, there are still opportunities for improvement. Ms. Brown urged the Council to support a full and comprehensive review of the child care licensing standards that will be up for review in 2009 and to provide an opportunity for broad public stakeholder input. Ms. Brown declared that TAEYC offers to serve as a resource for any of the Department’s efforts in ensuring the health and safety of children; she thanked the Council and Department for their commitment to the children, families and professionals in the state.
Josette Saxton, Early Childhood Policy Coordinator, Texans Care for Children, spoke regarding day care licensing rules and standards review. Ms. Saxton informed the Council that Texans Care, a children’s advocacy organization, seeks to improve the policies and programs serving Texas’ children to improve their outcomes so they’ll be successful adults. Ms. Saxton noted her agency works in partnership with over 100 different organizations in Texas that share the mission of improving the policies and programs for serving Texas’ children.
Ms. Saxton noted that although Texans Care is known for work in child welfare and within CPS reform, the organization also deals with other issues in child well-being, including family poverty and economic security, child and maternal health, child mental health, early care and education, juvenile justice and at-risk youth programs and services. Ms. Saxton said Texans Care values the partnership enjoyed with the Department during the recent CPS reform, as well as the involvement and active engagement of community stakeholders through CPS reform and, also, last year’s revision of residential child care standards; she expressed her hope for and encouragement of continued collaboration with community stakeholders as the Department undergoes the review of day care licensing for 2009.
Ms. Saxton noted that more than half the mothers in Texas with children under the age of six are working, which means someone else is caring for their children, and she reminded the Council that the Department has oversight of facilities providing care for over 1 million of Texas’ children, many of whom are under the age of six, and that this is a critical time period in child development. Ms. Saxton stated that research over the past two decades shows that nearly every aspect of child development is associated with or can be impacted by early environments, experiences and relationships in a child’s life, and she believes the Department and the state recognize this, as evidenced by its recent investments to ensure that each child coming into contact with CPS is screened for developmental delays and disabilities through the ECI program.
Ms. Saxton reminded the Council that the state legislature has mandated that every child in conservatorship of the state also be eligible for public pre-kindergarten programs, and that mandate signifies a recognition that by providing services and supports during these early formative years, we will have effective outcomes not only in terms of child well-being, academic success and later economic success, but, also, cost-effectiveness for the state.
Ms. Saxton stated that Texans Care looks forward to the opportunity that next year’s child care licensing and standards review will allow us to look at what science and best practices tell us will most support optimal child development compared to what we’re currently doing in the state and where we can somehow meet in the middle to best support the well-being of our children. In conclusion, Ms. Saxton declared her organization’s commitment to working with the Department in the coming year.
Connie Barker, Director of Government Affairs, DePelchin Children’s Center of Houston, spoke about proposed regulations regarding background checks and educational exemptions for child care workers. Ms. Barker noted that in the arena of licensing, a constant balance exists between children’s safety and having them in a normal home environment; she noted her organization’s concern that these efforts have gone too far toward safety, making foster homes feel more like institutions than homes. She noted that one foster father who testified before the House Human Services Committee said that under new rules, he feels less like a dad and more like a warden.
Ms. Barker stated that one of DePelchin’s concerns is that frequent visitors to foster homes, even those who have supervised access to the children, are required to have background checks; she noted the requirement could apply to such things as Bible studies in homes and family get-togethers. Ms. Barker said DePelchin suggests that the Department carefully evaluate how far the rules should go, because we don’t want to lose foster parents. She said we don’t yet know whether these rules would pose problems in the recruitment of foster families, but that is something her group plans to track in the future.
Ms. Barker noted that keeping children’s lives as normal as possible is paramount, and she urged the Council to delay passage of these particular regulations until the Department has a better sense of how they will affect foster families and children.
William Cox, Executive Director, Lighthouse Family Network, addressed the Council on child care licensing rules and standards and noted his support of their review; he encouraged the Council, however, to ensure there is again a complete revision of the standards. Mr. Cox stressed the importance of utilizing respected child care professionals as equal partners in the development of the standards. Mr. Cox provided the Council with a written copy of testimony.
Chair Strauch announced that the Council has received written comments from the Center for Children, Law & Policy, University of Houston. The Department encourages those who wish to testify before the Council to provide written testimony if they are unable to attend; the Council will read and consider all such comments.
4. Agency Briefings
4.a. STAR Health – Dr. Sue Milam, Deputy Commissioner
Dr. Sue Milam, DFPS Deputy Commissioner, discussed the STAR Health program and reminded the Council that one of her roles this past year has been as the Agency coordinator for the implementation of the program. The Department has begun its third week of the program, and she is pleased with operations thus far. Dr. Milam explained that, as mandated by the 79th Legislature, STAR Health was created in conjunction with HHSC to provide healthcare services for children in foster care, kinship care and state conservatorship; enrollment began in March, and the program is provided under contract with Superior HealthPlan Network, which coordinates all services for physical, dental, vision and behavioral healthcare.
Dr. Milam said those eligible for STAR Health include all children in foster care and kinship care. Eligibility extends to young adults up to 22 years of age who are in a voluntary foster care placement agreement and young adults up to 21 years old who were previously in foster care but are still receiving Medicaid services. A child’s eligibility takes effect immediately following the state taking conservatorship of the child; this is an important component of the program because children new to foster care, kinship care and state conservatorship often are in dire need of medical attention.
Dr. Milam noted many children in our care have special needs, in either behavioral or physical health or both, so service management teams have been created to help coordinate care; these teams work with the families, doctors and specialists to ensure children are receiving necessary attention. This system identifies and secures services from various providers as needed, and we will also be able to follow their progress very carefully to be sure children are receiving the necessary care on a continuing basis.
Dr. Milam discussed various features of STAR Health, including the Nurse Help Line, which provides a 7-day, 24-hour phone access to nurses who can provide advice on care and access to care. Another key feature is the Medical Home component, similar to other managed care products, the idea being that a child has a primary care provider who helps to coordinate all healthcare for the child. A big issue for foster children is behavioral health. Dr. Milam explained the Behavioral Health Help Line, also with 7-day, 24-hour availability, is community based, rehabilitative, and also provides in-patient behavioral health services.
Dr. Milam discussed the Health Passport; it has been demonstrated that this is a good tool for providers and case workers. She explained that the Health Passport is a web-based repository for medical and administrative information, not an electronic medical record, yet it has much more information than has previously been available for our children.
Dr. Milam said the national average is one primary care provider for about 1,500 or 2,000 children; in STAR Health, for the Texas program, that ratio is one primary care provider to 20 children. In many areas of the state, mostly rural, however, medical coverage isn’t as plentiful, simply due to the remoteness of these areas; we will continue to work with those communities to ensure that children in those areas are able to obtain healthcare quickly.
Ms. Papadopoulos thanked Dr. Milam for her efforts and congratulated her on the success of STAR Health thus far. Ms. Papadopoulos asked if the program is specifically for high-risk children in state care. Dr. Milam said STAR Health is for all children in state care; she reiterated that once the state takes conservatorship of a child, he or she is immediately enrolled in the program. Ms. Papadopoulos asked for clarification regarding interfacing with Medicaid. Dr. Milam replied that a child’s healthcare data are transferred from the DFPS IMPACT system to the HHSC TIERS system and a Health Passport is created; within 30 days of a child leaving state care, the passport information is downloaded and provided, either on CD or in printed form, to the family and/or the child.
4.b. Legislative Appropriations Request – Cindy Brown, CFO
Cindy Brown, Chief Financial Officer, presented a timeline regarding the Legislative Appropriations Request (LAR) for the next biennium, and she explained that beginning in February, an inventory of needs was gathered and organized for discussion purposes. Ms. Brown provided a list of identified needs and said the list will be presented at the April 25, 2008 meeting of stakeholders in order to receive their comments and input.
Throughout May and June 2008, the baseline request will be developed and generally limited to general revenue expended in the first year of the biennium plus the general revenue amount budgeted for the second year; during this time period, DFPS will continue to develop a listing of exceptional items and will acquire input from the Council regarding prioritizing the final list. Ms. Brown said the LAR should be close to completion and presented to the Council by July; HHSC will be briefed on the LAR and all documents will be completed for submittal in August.
The list of potential exceptional items under consideration has been organized into three main broad categories: maintaining current services, retention and recruitment, and enhancement of services. Ms. Brown discussed the exceptional items within each category. Under a fourth category, or placeholder items, are two new items: strengthening of capacity, and a 5-percent outsourcing of case Management. She noted these items will be developed during the remainder of 2008, with a target completion date of January 2009 to be presented to the legislature.
Council member Salazar-Harper and Ms. Brown briefly discussed the items in the “retention and recruitment” category.
4.c. Commissioner’s Report – Dr. Sue Milam
DFPS Deputy Commissioner Dr. Sue’ Milam presented the report on behalf of Commissioner Cockerell, who, due to active involvement in the ongoing investigation into the Fundamentalist Latter-Day Saints (FLDS) group in Eldorado, was unable to attend today’s meeting. Dr. Milam discussed the chronology of events regarding the FLDS situation, which are also posted on the DFPS website, noting this situation represents the largest removal of children in both Texas and U.S. history by Child Protective Services; this has been a unique situation for the Department.
Dr. Milam gave an update on Round Two of the Child and Family Services Review (CFSR), reminding the Council this is a federal/state collaborative effort to ensure that state child welfare systems provide quality services to children and families. Agencies involved in the review include the Children’s Bureau; Administration on Children, Youth and Families; the Administration for Children and Families, also known as ACF, and; the U.S. Department of Health and Human Services.
The intention of the CFSR is to identify strengths and deficiencies in state programs and systems, focusing on outcomes for children and families in the areas of safety, permanency and child and family well-being; following the review, states develop and implement Program Improvement Plans (PIPs) as needed. Dr. Milam noted that the Texas onsite review was conducted March 24 through 28 and the three counties reviewed were Dallas, Harris and El Paso.
Texas’ onsite review process culminated in a state exit meeting at the DFPS state office on March 28; preliminary review results are available and identify both strengths and areas that require further work in the Texas welfare system. The Council will be updated as this process continues; copies of the PowerPoint presentation on the CFSR were provided for each Council member.
Dr. Milam reminded the Council that after completing the PIP for Round One of the CFSR, Texas faced a $4 million penalty for not meeting one of the fourteen outcome measures, which was Well Being I. This outcome measure assesses whether families have enhanced capacity to provide for their children’s needs and is comprised of four individual items, two of which were met and two of which were not met. The two outstanding items for this outcome are case worker visits with the child and case worker visits with the parents; accordingly, on March 14, DFPS remitted the $4 million penalty to ACF. Dr. Milam noted that state is pursuing an appeal of the decision but elected to pay the penalty in order to avoid assessment of interest.
Dr. Milam provided the Council with documentation regarding Rider 13, which includes the required mid-year update. This update provides an overview of our workforce support and retention initiative, as well as status reports on the FY 2008 human resources management plan and the 2008 second quarter turnover results. Dr. Milam reminded the Council that this initiative was a direct result of the 2008 Human Resources Management Plan released in October 2007; the intent is to bring together all retention and recruitment efforts into one cohesive project; she noted there is much in the way of regional and state office recruitment and retention activities and that DFPS needs to do a better job of coordinating with and learning from each other in these efforts.
Dr. Milam said that because retention of employees is dependent on a variety of factors, we are taking a multi-faceted approach and looking at implementation of proactive strategies, policies, procedures and practices that manage work loads; also looking at additional ways to value employees, promote employee communication and input, strengthen supervision, improve hiring practices and enhance the work environment. This will be an ongoing challenge and all HHSC agencies are undergoing this process, and Dr. Milam noted the initiative will have a serious impact on our ability to provide quality services.
Dr. Milam briefly discussed DFPS’s planning efforts, reminding the Council that we do a consolidated HHSC agency strategic plan. She thanked Council members Debbie Epperson and Linda Bell Robinson for their help in the review of DFPS planning Materials. Two public hearings on the plan have already been held, one in Mesquite and one in Plainview, and there are additional hearings scheduled in Harlingen, El Paso, Baytown and Corpus Christi. Dr. Milam thanked the Council for its interest and efforts in attending these hearings for public comment.
Dr. Milam provided an update regarding capacity building; the goal is to work with our stakeholders and contracted providers in order to build a better system with the capability to fully meet the needs of all our children and families. She mentioned that this project grew out of concerns for children without placements who were sleeping in CPS offices; however, the current thinking is that this capacity challenge extends beyond that small percentage of children who ended up in CPS offices and includes our ability to place all children we serve either with their siblings or in their home communities and in settings that best meet their needs.
Several objectives have been formulated for the capacity project, one of which is to work with communities to develop strategies and solutions at their levels; another objective is to do a better job within DFPS to promote internal coordination, find program efficiencies and better communication processes that will result in better arrangements and relationships with our providers. An additional objective is to promote the best practices and innovations for purchased services, to do a better job in contracting and make it less onerous for our partners.
Dr. Milam said a statewide needs analysis will be conducted to assess the needs and what should be developed in each region; this analysis will explore innovative contracting processes, internal business practices and ways to provide better technical assistance to providers.
The CPS Adoption Conference will be July 14 through 16; the conference is for private providers who have adoption contracts with CPS, as well as for supervisors, administrators and direct-delivery adoption staff, and will address issues such as disproportionality, preparing African-American foster children for permanent placements, obtaining community support for identifying permanent homes, and improving efforts in the recruitment of adoptive families.
4.d. Chair’s Report – Ommy Strauch
DFPS Council Chair Ommy Strauch reported attending a meeting of chairpersons of the advisory councils of the five agencies under the HHSC umbrella, which was hosted by HHSC Executive Commissioner Albert Hawkins. A result of that meeting was a suggestion to hold another such meeting, to include all council members of all five agencies, this autumn, to allow for discussion of and solutions to issues that are common to some or all five of the agencies.
Chair Strauch announced that she attended the executive portion of the CFSR review on April 15 and was impressed by the amount of knowledge, confidence and pride exhibited by the DFPS executive team; she expressed how proud she is to be part of the Agency. Ms. Strauch also highlighted upcoming events and discussed future strategic planning meetings.
Agenda Item 5 – New Business
5.a. Recommendation to propose rule changes in 40 TAC, Chapter 700, Subchapter M, Special Issues, relating to travel outside the United States or Texas by a child in foster care* – Beth Engelking, CPS
Beth Engelking, CPS Support Manager, presented the proposed changes, which resulted when House Bill 1938 changed the process for obtaining court approval when a child in state conservatorship travels outside the U. S. She explained the new statute requires DFPS submit a motion which has been completed by the caregiver and outlines the itinerary and includes the Department’s recommendation for approval of the out-of-country travel; once the travel has been approved by the court, it is the responsibility of DFPS to notify the foster family.
Ms. Engelking requested the Council consider the rule proposal for travel for children in DFPS foster care and recommend to Commissioner Cockerell and Executive Commissioner Hawkins that these rules be proposed and published in the Texas Register for formal public comment.
Ms. Epperson moved that the Council recommend for proposal by the HHSC the amendment to 700.1340 concerning travel outside the United States or Texas by a child in foster care, as reflected in the Council’s April 18, 2008 Agenda Item 5.a.. Ms. Bryant seconded. Following brief discussion regarding the Hague Convention on International Child Abduction, the vote was taken and the motion carried.
5.b. Recommendation to propose rule changes in 40 TAC, Chapter 748, General Residential Operations and Residential Treatment Centers, and Chapter 749, Child-Placing Agencies, relating to consistency with legislation and language clarification* – Diana Spiser, CCL
Diana Spiser, Assistant Commissioner of Child Care Licensing, presented the proposed rule changes which are intended to implement House Bill 397 and to clarify and add flexibility to existing rules. Ms. Spiser asked the Council to recommend to Deputy Commissioner Milam and Executive Commissioner Hawkins that these rules be proposed and published in the Texas Register for public comment.
Ms. Papadopoulos moved that the Council recommend for proposal by the HHSC the amendments concerning consistency with legislation and language clarification, as reflected in the Council’s April 18, 2008 Agenda Item 5.b., and Mr. Hoffman seconded.
Vice Chair Papadopoulos queried how location of a child’s biological father would be handled under these rules. DFPS General Counsel Doug Barnes said options would be either to receive public comment and any concerns of the Council and, if necessary, retract the proposed rule changes until they can be further clarified or to go ahead and pull and modify the language in the rules now and bring them back before the Council for recommendation at a later date. After further discussion, it was decided that CCL staff and Department General Counsel will further research the intricacies of the rules, but publication in the interim is acceptable. The vote was taken, and the motion carried.
Agenda Item 6 – Old Business
6.a. Recommendation to adopt rule changes in 40 TAC, Chapter 745, Licensing, relating to background checks and educational exemptions* – Diana Spiser, CCL
Ms. Spiser presented the recommended rule changes and explained that they are intended to support statutory changes to background checks and to implement statutory changes to educational exemptions. All public comment received has been addressed, and several changes have been made based on those comments. Ms. Spiser asked that the Council recommend to Deputy Commissioner Milam and Executive Commissioner Hawkins adoption of these rules with the minor changes as reflected and to be effective June 1, 2008.
Ms. Bryant moved that the Council recommend to the HHSC adoption of the amendments, repeal and new section concerning background checks and educational exemptions, as reflected in the Council’s April 18, 2008 Agenda Item 6.a., and Judge Johnson seconded.
Ms. Bryant echoed concerns expressed today by Ms. Barker regarding frequent visitors to a foster family’s home and suggested that if the term “frequent” could be defined, that might address the issue. Ms. Spiser replied that the terms “frequent” and “regular” are defined in the rule language and that Ms. Barker had not the opportunity to see the modified language.
Ms. Papadopoulos expressed concern that who is or is not allowed in the home without a prior background check may still be unclear. Her understanding is if someone unrelated to the foster family or parents comes to the home and has no unsupervised time with any of the children, they won’t need a background check. Ms. Spiser replied in the affirmative.
Dr. Furukawa noted that in the camp industry, background checks are run on volunteers, and his understanding is that those checks are not as extensive as the ones mandated by legislation. He asked whether the statute requires these background checks to be of the caliber of an FBI- or DPS-run background check. Ms. Spiser said last session’s legislation requires all day care center directors and staff to have fingerprint checks.
Judge Johnson said that she has been trying to identify special funding sources to help with costs of background checks. Ms. Spiser replied staff is still investigating that possibility, because the background checks represent a $5.5-million yearly cost industry wide.
Judge Johnson recalled that during public comment at the last Council meetingrtion, there was testimony concerning too few locations easily accessible for child care providers to obtain background checks. Ms. Spiser noted this has been an ongoing concern and the DPS, who conducts the background checks for the Department, has contracted with Integrated Biometric Technology (IBT) to do the hand and fingerprint scans for them. The Department meets weekly with DPS in order to solve the dilemma regarding facilities providing fingerprint scans and turnaround times of background checks.
Dr. Furukawa asked whether CCL plans to request the legislature to review and possibly reconsider this particular level in the standard regarding background checks. Ms. Spiser stated it would be the responsibility of the provider community to work with legislators to make changes to the law; she noted that the Department is following the direction of legislation to require background checks.
Ms. Robinson suggested including local law enforcement agencies, such as sheriff’s departments, when meeting with DPS regarding this situation; she noted these agencies do FBI background checks and it might be possible to coordinate with them in order to schedule background checks for providers. Ms. Spiser said part of the ongoing discussion with DPS has been the possibility of engaging other law enforcement agencies to assist. She noted that along with the legal requirement for day care staff to be fingerprinted, school teachers, realtors and hundreds of thousands of other people in the state are now also required to do so. Ms. Spiser stated DPS is quite adamant that only IBT sites may be utilized, because they are the most reliable and have the quickest turnaround, and the best way for DPS to handle such a large volume is through their automated system with IBT.
A vote was taken, and the motion carried.
6.b. Recommendation to adopt rule changes in 40 TAC, Chapter 749, Child-Placing Agencies, relating to fire inspections in foster homes* – Diana Spiser, CCL
Ms. Spiser presented recommended rule changes and said Commissioner Cockerell has worked with the commissioner of the Department of Insurance during the amendment process. All public comments have been addressed by CCL. Ms. Spiser thanked the state fire marshal’s office for their assistance in composing the language of the rule and ensuring the safety of children in foster care facilities. Ms. Spiser requested the Council to recommend these proposed rule changes be adopted, to be effective June 1, 2008.
Judge Johnson moved that the Council recommend for adoption by HHSC the amendments concerning fire inspections in foster homes, as reflected in the Council’s April 18, 2008 Agenda Item 6.b. Ms. Salazar-Harper seconded.
Council member Epperson queried whether her understanding that these inspections can be performed by qualified inspectors other than fire marshals is correct; Ms. Spiser responded in the affirmative. Judge Johnson wondered whether there might be some way to help foster facilities allay the costs of fire inspections, because such items as sprinkler systems or fire alarms may be determined to be necessary by inspectors. Ms. Spiser said CCL has been researching that possibility and will continue to do so and will keep the Council updated.
A vote was taken, and the motion carried.
Chair Strauch adjourned the meeting at 10:45 am.
* Denotes Action Item