Foster Care Policy, Advocacy and Research
We're on a mission to promote the health and well-being of children and families involved in the child welfare system.
Children in foster care face persistent health care barriers and disparities that can create lifelong harm. The Rees-Jones Center for Foster Care Excellence has served thousands of children in the Texas child welfare system. We believe that these barriers and disparities can be overcome by adopting systemic reforms. To accomplish our goals, we partner with organizations across North Texas to:
- Identify structural issues and deficiencies in the child welfare system
- Develop and propose solutions
- Advocate for ways to reform and improve the child welfare system
We believe that the right reforms, implemented in the right way, can significantly improve the lives of the state’s most vulnerable children and make Texas foster care a model for the nation.
Policy priorities related to children in the child welfare system
Increase access to and funding for integrated care. Access to timely and effective pediatric and mental health care is particularly critical for children in foster care given the growing body of science documenting the short- and long-term effects of trauma and childhood maltreatment on the developing brain, immune system, disease potential and adult health and behavioral outcomes. Instigating more flexible payment models, such as bundled payments, is needed to advance integrated care.
Improve access to quality, evidence-based mental health screenings and treatments. Children coming into care should be screened, with the involvement and input of their caregivers when possible, to determine their mental health needs and related symptoms across developmental stages by licensed and trained professionals. A positive screen should result in a more comprehensive assessment conducted by a mental health provider using validated measures. Positive screens should result in the provision of evidence-based treatments.
Increase access to trauma-informed care. Trauma-informed care promotes physical and psychological safety through high-quality, collaborative care, and the promotion of recovery for a person, family and system. An organization that provides trauma-informed care is engaging, creates a safe environment, hires and trains a trauma-informed workforce, and engages in practices to prevent secondary traumatic stress in staff. In clinical settings, being a trauma-informed organization means involving patients in the treatment process, screening for trauma, training clinicians in trauma treatments, and engaging with community supports.
Ensure a sufficient provider network. Improving access to quality and easily accessible health providers will require streamlining the administrative requirements placed on providers and increasing reimbursement rates to be competitive. The provider directory should be screened regularly to ensure it is current and that network requirements are being met. Pilots using telehealth to deliver healthcare services should be conducted in an effort to increase accessibility, especially for families in rural areas. For example, the delivery of Parent-Child Interaction Therapy using telehealth has been tested and shown to be effective.
Ensure quality placements for children with complex medical and behavioral health conditions. Texas is experiencing a capacity crisis. Young people are sleeping in offices and hotels. The young people most affected tend to be older and to have highly specialized mental health and behavioral needs. They need high quality, intense, trauma-informed services and trauma treatments. Immediate and long-term investments by the State are needed.
Policy briefs and white papers
Telehealth TF-CBT with children in foster care: a pilot study
The effectiveness for trauma-focused cognitive behavioral therapy (TF-CBT) with young people in care is well established, but more research is needed regarding the use of the telehealth modality. The current investigation seeks to examine outcomes for patients who received TF-CBT via telehealth, along with factors that may have impacted successful completion.
Prevalence and characteristics of children with a behavioral health disorder diagnosis in foster care
Young people in foster care are at higher risk for behavioral health concerns. This study sought to provide prevalence data for behavioral health disorders and to increase understanding as to how various factors such as type of maltreatment and placement and physical health status may relate to the complexity of behavioral health concerns.
The impact of COVID-19 on child maltreatment encounters at two large pediatric health systems in Texas: prevalence, mechanisms of injury and sociodemographic shifts
Family stresses and strains of the COVID-19 pandemic has exacerbated the risk of violence in the home. This study evaluates child maltreatment prevalence change, and specifically change in the severity of injuries, during COVID-19 compared to pre-COVID-19 and evaluates possible sociodemographic shifts in child maltreatment injuries.
Long-term physical and mental health effects of neonatal abstinence syndrome
Every 15 minutes an infant is born with opioid withdrawal symptoms, also known as neonatal abstinence syndrome (NAS). This study will use a retrospective multilevel, matched case control design to answer questions about health outcomes and health care utilization for children born with NAS compared to children without NAS.
Supporting the uptake of long-acting reversible contraception (LARC) for adolescents in foster care
Texas has the fifth highest rate of teen births in the nation. LARC (intrauterine devices and contraceptive implants) is the first line contraceptive method for adolescents and is a possible solution for preventing teen pregnancy; yet, nationwide, uptake of LARC among adolescents is suboptimal. It is hoped that this research will provide the foundation necessary to design a future communication-focused intervention tool to support LARC uptake among adolescents in foster care.
Trauma-Informed Care training for medical and allied health students
Trauma-Informed Care (TIC) is an approach to care that is designed to address the needs of individuals that have experienced trauma by promoting safety and empowerment and by avoiding retraumatization. Currently, TIC training is not consistently integrated into the curriculum of medical and allied health students. This pilot study tests the feasibility and effectiveness of a brief, online training using pre-, post- and 3-month follow-up surveys.
Understanding suicidal behavior and brief assessment and intervention in primary care for children in the child welfare system
Children in foster care are at risk for higher rates of mental and behavioral health difficulties including dysregulated affect, depressed mood, anxiety, high-risk behaviors and suicidal behavior. This study seeks to identify risk indicators for suicidal behaviors among children in foster care; describe emergency department, residential treatment center, and inpatient treatment center use among those who have had safety planning interventions in a primary care setting; and describe suicidal behavior persistence and desistance and identify predictors of persistence/desistance.
Integrated care for pediatric populations: a scoping review
The literature lacks a comprehensive overview of how Pediatric Integrated Care (PIC) is being evaluated, distinction in measures and findings across the various levels of integration, and a focus on pediatric populations receiving integrated care. The implementation and evaluation of PIC is still developing, and this study should help inform future research and evaluation efforts.
Utility and validity of the PedsQLTM Family Impact Module for understanding foster and kinship caregiver functioning
There is a lack of understanding about the relationship between foster and kinship caregiver functioning and children’s health complexity. This study seeks to determine the utility of the PedsQLTM 2.0 Family Impact Module (PedsQLTM FIM) screener as a tool that could potentially meet this need.
Laboratory screening practices and results in a dedicated primary care clinic for children in foster care
This study addressed the lack of available data on routine laboratory screening in children in foster care to assess the rate at which a dedicated foster care clinic is completing recommended lab tests and to compare existing guidelines to current trends in this population. (Infectious disease screening in a dedicated primary care clinic for children in foster care)
Prevalence and risk factors for developmental concerns in children involved in the child welfare system
This study addressed the following questions: (1) What are the rates of developmental delay in children in foster care aged 0-5 years? (2) Are rates of delay in foster children different for motor, cognitive, communication and personal-social skills? (3) Are certain risk factors experienced by children in the foster care system more strongly associated with developmental delay? (Developmental status of young children in foster care)
Integrated care for substance-exposed infants: an innovative approach for providing care to children in the child welfare system
This study explored the rates of prenatal drug exposure in infants and young children in foster care seen at primary care clinics in North Texas. It describes barriers to care for this vulnerable population and offers an innovative approach to meeting their unique needs. (Trauma-informed, integrated primary care: A medical home model for children with prenatal drug exposure who enter foster care)
Caring for children in foster and kinship care during a pandemic
Through qualitative feedback from professionals in health care, mental health and child welfare, this study explored the impact of the COVID-19 pandemic on the health and well-being of children involved with the child welfare system. (Caring for children in foster and kinship care during a pandemic: lessons learned and recommendations)
Foster parent perceptions of feeding infants prenatally exposed to substance use
Research has shown that infants who are substance-exposed display feeding challenges, and foster parents struggle to meet the infant’s needs. This study examined foster parent perceptions of competence in feeding substance-exposed infants before and following an educational training.(Foster parent perceptions of feeding infants prenatally exposed to substance use)