Presentation to the Senate Finance Committee August 18, 2010 Audrey Deckinga, DFPS Assistant Commissioner for Child Protective Services

CPS Overview Big Picture Fiscal Year 2009 Removals 100,762 Children in Confirmed Investigations 283,922 Alleged Victims in Investigations 12,107 Removals 6,510,210 Total Child Population Big Picture Fiscal Year 2009

CPS Services Foster Care If the Court determines that the child cannot remain safely in the home, they are either placed in the home of a relative, a foster home, or residential facility. Foster homes and residential facilities are reimbursed for child care-related costs. Foster Care Reimbursement rates are based on the service needs of the child. DFPS staff and the family develop a service plan to resolve barriers to safety. Children in foster care are eligible for STAR Health. DFPS is required to arrange all medical, dental and therapeutic services needed by the child, in addition to basic needs.

Foster Care Population 142 Children/youth in four facilities 882 Children/youth in foster care with Intellectual Disabilities 101 with ID 27,311 Total children/youth in foster care Where are we now? As of June 30, 2010

Children in Foster Care with Designation of Intellectual Disability CPS policy requires caseworkers to ensure that children with disabilities are placed on all appropriate Medicaid-waiver interest lists as soon as the disability is identified. Assessments may have been conducted prior to the child coming into care. Psychological and/or psychiatric evaluations may contribute to the assessment of the child’s needs. Children may also have behavioral issues due to the trauma of abuse and neglect. Placements are needed with services to address behavioral health and intellectual disability needs.

Placement for Children with Intellectual Disability Needs Four facilities provide care for children, addressing both Intellectual Disability needs and child abuse/neglect related behavioral health needs: Daystar RTC, Casa Esperanza, Shared Vision, and Mission Road. Treatment models typically include behavior modification models with level systems. When behavioral health needs are addressed, children may be placed in a less restrictive setting to meet Intellectual Disability needs that remain. While in one of these four facilities, their CPS caseworker is a CPS Regional Developmental Disability Specialist.

Child Profile David, age 16, is currently placed at Casa Esperanza in Liberty Hill, Texas.  David was removed from his mother’s care due to his mother’s drug use and because he was being left at home alone. David is diagnosed with Oppositional Defiant Disorder, Downs Syndrome, moderate intellectual disability, he has an IQ of 40 and a Specialized Service Level David exhibits antisocial behavior including stealing from others and making homicidal threats. David exhibits negative-contrary behavior. He loses his temper and has poor boundaries. David's adaptive living skills are delayed. Although he is toilet trained, David continues to soil his pants. He needs assistance brushing his teeth, bathing and dressing himself.  Casa Esperanza has the training and skills required to address David's needs - a child who is dually diagnosed with intellectual disability and mental health

HCS Waiver Slots HCS Waiver slots Priority: DFPS receives 120 priority slots per biennium, specifically for youth aging out of foster care Non-priority: Children in foster care access HCS waiver and services in the same manner as the general population Without HCS Waiver slots, youth with intellectual disability needs who are aging out of foster care may be at risk for placement in a more restrictive setting.

Goal Ensure that the special needs of children with Intellectual Disabilities in the care of DFPS are met through: Placement in the least restrictive setting available that can meet the child’s needs Access to comprehensive, coordinated healthcare and services Children who are in HCS waivers receive acute health care through STAR Health, remainder services through traditional Medicaid Children in ICF/MRs receive traditional Medicaid Access to appropriate educational services including transition services for children moving from secondary school to post-school activities Transition to adult living

Goal Texas needs sufficient foster home capacity to meet the needs of children within the foster care system. DADS and DFPS are working together to develop a plan for how Medicaid waiver HCS could be used to appropriately care for CPS children/youth who meet the eligibility criteria. Goal: To provide joint services in one setting. To achieve the goal, HCS slots are needed for youth in care and for youth who age out of care.