E. Child and Family Assessments

Texas Health Steps: All children entering DFPS conservatorship must receive a comprehensive, preventive health care checkup within 30 days of entering DFPS conservatorship known as the Texas Health Steps medical checkup, which includes preventive care components. The checkup helps identify the child’s unique healthcare needs and helps DFPS make placement decisions that are in the child’s best interest.

Medical Exam within Three Business Days: As of December 31, 2018, for children removed because of sexual abuse, physical abuse or another obvious physical injury to the child, or if the child has a chronic medical condition, is medically fragile or has a diagnosed mental illness, DFPS must ensure that the child receives an initial medical examination from a physician or other health care provider authorized by state law to conduct a medical examination by the end of the third business day after the child is removed from the child’s home. Tex. Fam. Code § 264.1076.

•   Vaccinations Prohibited During Exam: A physician or health care provider cannot administer a vaccination without parental consent except for a tetanus vaccination, and only if the physician or other health care provider determines that an emergency requires a vaccination. The prohibition of vaccinations does not apply once DFPS is named the child’s managing conservator. The restriction on vaccinations applies only to vaccinations (except for tetanus) administered under the medical exam required by new subsection 264.1076. Thus the prohibition is limited only to the population receiving the exam, and only restricts what can be done during the exam. Likewise, the lifting of the restriction on vaccinations once DFPS receives managing conservatorship. Outside these circumstances, the law neither expands nor restricts a parent’s right to withhold consent for immunization either under Tex. Fam. Code § 32.101 or Health and Safety Code § 161.004. However, see Tex. Fam. Code §§ 266.002 and 266.004 regarding a court’s authorization to issue orders related to medical care for children in foster care.

Child and Adolescent Needs and Strengths (CANS): DFPS also uses the CANS to evaluate each child's needs and strengths to assist in service planning, inform placement decisions, and reduce the number of assessments administered to children in DFPS conservatorship.

Family Strength and Needs Assessment (FSNA) is also in use by DFPS to assess and utilize family strengths to hone in on necessary services customized to address the Department’s specific concerns. Although the FSNA and CANS will not be attached to court reports, judges may hear DFPS staff providing testimony or information regarding findings or recommendations that come from these assessments.

Children and youth, ages 3 to 17, will receive a CANS Assessment, completed by a STAR Health clinician, within 30 days of removal. During the same time period, the CPS caseworker will conduct the FSNA of the family, identify targeted interventions, and work with the family to prioritize goals and tasks. In the state’s Foster Care Redesign area, near Fort Worth, the Single Source Continuum Contractor (SSCC), Our Community Our Kids, is utilizing a combination of STAR Health providers and CANS certified staff, employed by residential providers within the SSCC network, to administer the CANS.

Special Issue: Many courts like to schedule a Status Hearing within a few days of the Adversary Hearing to jump start services to families. To maximize the effectiveness of the new assessment tools, it is recommended that courts conduct Status Hearings at around 60 days into the case. The law requires that the CANS be administered within 45 days of removal, and DFPS policy sets the completion date at 30 days. The FSNA is conducted with the family within the first three weeks of removal and is used to inform the CANS. Both the STAR Health clinician and the CPS caseworker need time to utilize the CANS and FSNA tools with fidelity. Allowing time for a thorough assessment and coordination of efforts should produce child and family service plans that set a path toward achieving permanency as quickly as possible for the child and family.

Developmental Disability Assessment: During the 85th Legislative Session, the Legislature also added a requirement that DFPS assess whether a child has a developmental disability as soon as possible after the child is placed in DFPS conservatorship, and if the assessment indicates an intellectual disability, to ensure that a referral for a determination of such is made as soon as possible. Tex. Fam. Code § 264.1075.