D. DFPS Response to Substance Use Disorders

The Child Abuse Prevention and Treatment Act (CAPTA, P.L. 93-247) was originally enacted in 1974 and was amended by the Comprehensive Addiction and Recovery Act (CARA, P.L. 114-198) in 2016. Under these federal laws, states are required to have plans of safe care for infants born and identified as being affected by substance use or withdrawal symptoms of both legal and illegal substances. The plans of safe care are required to “ensure the safety and well-being of such infant following [the infant's] release from the care of health care providers to be achieved through addressing the health and substance use disorder treatment needs of the infant and affected family or caregiver. 42 U.S.C.S. § 5106a(b)(1)-(2).

To avoid confusion, DFPS does not utilize the unique federal term “plan of safe care” as set forth in CARA, as there are a number of DFPS tools and policies that reference “plans.” Using the structured decision-making tools for assessment of safety and risk and the service planning process used in different stages of service, the state meets the requirements under the CARA plans of safe care. Examples of types of plans that do not include removal include: use of Parental Child Safety Placements (PCSP) to assure safety as the mother initiates or becomes engaged in services; use of residential substance use disorder treatment programs that allow a mother (or father in a few programs) to live in a treatment setting with the child; use of Medication-Assisted Treatment (MAT) in combination with behavioral therapies, and the guidance of specialized drug courts in some areas. While access to treatment can be challenging, families referred by DFPS are considered a priority population for Health and Human Services substance use disorder services.

Doctors and nurses are required by mandatory reporting laws to report suspected abuse and neglect, and definitions of child abuse in Texas law include the use of controlled substances by an adult in a manner or to the extent that the use results in physical, mental, or emotional injury to a child. Tex. Fam. Code § 261.101(b); Tex. Fam. Code § 261.001(1)(I). DFPS Statewide Intake advances any reports of substance-exposed infants to the field for an investigation that assesses the child and family and assists in development of plans for the family for safety and services. In some cases, the mother has sufficient support and is engaged in treatment services, thereby eliminating the need for further DFPS involvement beyond investigation. Other parents may be assisted in plan development and service access during the investigation stage of services, or a Family Based Safety Services stage may be opened to provide ongoing services without removal. Where safety cannot be assured, DFPS will seek removal of the infant.

It is important to note that an infant born substance-exposed does not result in an automatic removal of that child, nor even an automatic disposition of abuse or neglect. Each family's specific circumstance is assessed. DFPS is working closely with Health and Human Services agency partners who provide substance use disorder treatment services to strengthen the State's response to children and parents with substance use disorder issues.

1. Behavioral Health Division at DFPS

In Fiscal Year 2019, the Behavioral Health Services Division with CPS was formed. This new division is fully staffed and includes a Behavioral Health Services Division Administrator who manages Substance Use Disorder, CANS, Trauma-Informed Care, and Mental Health subject matter experts. A Medical Services Division remains, covering medical and dental issues for Child Protective Services with Nurse Consultants and Well-Being Specialists. The Behavioral Health Services Division Administrator, Mental Health Program Specialist, Trauma Informed Care Program Specialist, and one CANS Program Specialist are housed at the State Office in Austin. Another CANS Program Specialist is housed in San Antonio. The division includes three Substance Use Program Specialists housed in San Antonio, Dallas, and Houston. These positions complement a fourth Substance Use Program Specialist, who is housed in Austin and reports to Child Protective Investigations. These staff work together to provide support, resources, and technical assistance to direct delivery staff in their work with families experiencing Substance Use Disorders through every stage of service.