THE HISTORY AND PROGRESS OF HOME VISITING

IN TEXASMadeline McClure, LCSW | Executive Director

November 14, 2014 | Austin, TX | Toxic Stress & Early Childhood 1

About TexProtects

Our mission is to reduce and prevent child abuse and neglect through research, education and advocacy. We effect change by organizing and educating our members to advocate for increased

investments in three core areas:1. Investments in proven Child Abuse Prevention programs2. Improvements to Child Protective Services and systems that impact abused

children3. Improvements to programs that heal victims

Membership-based Statewide Advocacy Organization 7,000+ members statewide

Over the past 10 years, TexProtects has led and/or assisted the passage of 37 bills, including 2 omnibus bills, and has secured nearly $70 million in state funds for evidence-based home visiting services.

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Why Texas Needs to Invest in Prevention

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Texas Ranks…

Sources: The Annie E. Casey Foundation. (2014). The 2014 Kids Count Data Book. Retrieved from http://www.aecf.org/resources/the-2014-kids-count-data-book/.Guttmacher Institute. (2014). U.S. Teenage Pregnancies, Births and Abortions, 2010: National and State Trends by Age, Race and Ethnicity. Retrieved from http://www.guttmacher.org/pubs/USTPtrends10.pdf

Texas Child Abuse & Neglect Fatalities

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The Texas child population grew by 1.5% on average each year between 1997 and 2013. Meanwhile, child abuse and neglect fatalities increased by an average of 4.8% each year – more than 3x child population growth.

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

0

50

100

150

200

250

300

103

171

135156

195 203184

204 201

227 223213

280

227 231212

156

CA/N Fatalities Linear (CA/N Fatalities)Child Population Linear (Child Population)

Ch

ild

Po

pu

lati

on

Fa

taliti

es

Child Maltreatment: Economist View “Reliable survey evidence suggests that more than 13% of US

children are subject to abuse or neglect by a caregiver each year.”

Impacts children irrespective of age, gender, ethnicity, or socioeconomic status.

The physical and emotional consequences to the victims often persist throughout their lives and represent a truly incalculable and often irreparable harm.

This fact alone should be sufficient justification for a massive national effort to both address the underlying causes and minimize the impacts on the victims.”

5Source: Perryman, Bruce. (November 2014). The Perryman Group. Suffer the Little Children: An Assessment of the Economic Cost of Child Maltreatment. Retrieved from file:///C:/Users/TexProtects%201/Downloads/Perryman_Child_Maltreatment_Report.pdf.

Child Maltreatment: Economist View

“Child maltreatment also imposes substantial economic costs which can be quantified in a comprehensive manner.

Every year that the situation is allowed to persist at current levels drains literally trillions of dollars in long-term business activity.

Viewed from this perspective, there is a compelling case for the investment of public, private, and philanthropic resources into a multi-faceted attack on child maltreatment for pecuniary reasons that go beyond the obvious affront to human dignity and opportunity.”

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Source: Perryman, Bruce. (November 2014). The Perryman Group. Suffer the Little Children: An Assessment of the Economic Cost of Child Maltreatment. Retrieved from file:///C:/Users/TexProtects%201/Downloads/Perryman_Child_Maltreatment_Report.pdf.

Lifetime Costs of Maltreatment: CDC

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1%

99%

Average lifetime cost per fatal victim:

$1,272,900

$60

$20,000,000,060

$40,000,000,060

$60,000,000,060

$80,000,000,060

$100,000,000,060

$120,000,000,060

$140,000,000,060 U.S. lifetime cost from one year

of child maltreatmentFatal victims' med-ical costs

Fatal victims' productivity lossesSurvivor' special education costs

Survivors' criminal justice costs

Survivors' child wel-fare costs

Survivors' long-term healthcare costs

Survivors' short-term healthcare costs

Survivors' pro-ductivity losses

$124 Billion

Average lifetime cost per survivor: $210,012

 

 

 

 

 

69%

16%

5%4%

3% 4%.

Sources: Fang, X., Brown, D.S., Florence, C.S., & Mercy, J.A. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse and Neglect, 36, 156-165.

Lifetime Costs of Maltreatment: The Perryman Group

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Key Results: Lifetime Social Costs and Lost Earnings Due to Child Maltreatment in 2014

Social Costs of Non-Fatal Child Maltreatment

Total Expenditures* $1,051,754,556,308Gross Product* $506,935,982,252Personal Income* $335,180,266,736Retail Sales* $129,345,107,948Person-Years of Employment 5,712,406

Lost Earnings Stemming from Non-Fatal Child

Maltreatment

Total Expenditures* $4,790,521,167,140Gross Product* $2,165,310,794,660Personal Income* $1,322,482,760,975Retail Sales* $594,309,864,183Person-Years of Employment 22,050,950

Total Economic Cost of Non-Fatal Child Maltreatment

Total Expenditures* $5,842,275,723,447Gross Product* $2,672,246,776,912Personal Income* $1,657,663,027,711Retail Sales* $723,654,972,131Person-Years of Employment 27,763,357

Total Economic Cost of Fatal Child Maltreatment

Total Expenditures* $25,475,161,062Gross Product* $11,521,315,782Personal Income* $7,042,421,367Retail Sales* $3,160,181,043Person-Years of Employment 117,452

*Monetary values are given in constant (2014) dollars and discounted at a real (inflation-adjusted) rate of 3%. For definitions of these measures of business activity and terms, as well as an overview of methods used, see page 14 and the Appendices of this report. Source: The Perryman Group

Inverse Ratio – CPS System Cost vs. Prevention Investment

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Series1

$0

$1

$2

$3

$4

$5

$6

$7TX 2007 Total Cost Spent on Conse-quences of Abuse

Total Annual Cost of CPS-FY14 budgeted

Total Annual Preven-tion Investment*-FY14 budgetedC

ost

in B

illio

ns

$56.8 Million

* Prevention Investment Includes FY14-15 Allocation for Prevention and Early Intervention Division (PEI), Texas Home Vis-iting Program and the Texas Nurse-Family Partnership Program

$6.25 Billion

$1.25 Billion

Texas’ Prevention Investment

2002-2003 2004-2005 2006-2007 2008-2009 2010-2011 2012-2013 2014-2015$0

$20

$40

$60

$80

$100

$120

$140

$91.8

$60.0

$83.9

$87.1 $91.8

$61.9

$88.8

8.917.8

17.75

25.65

$21.1*

$31.7*

$17.1*

Prevention Early Intervention NFP & THVP MIECHV

Biennium

Million

s

$96.1

$130.7

$111.35

$131.55

* MIECHV award dates; Do not necessarily reflect budget cy-cles

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NFP=Nurse Family PartnershipTHVP=Texas Home Visiting ProgramMIECHV=Maternal, Infant, and Early Childhood Home Visiting

Mom's labor force participation by child's fourth birthday

Reduction in premature delivery

Reduction in child arrests at age 15

Reduction in language delays at 21 months

Reduction in low birth weight babies

Reduction in child abuse and neglect

Fewer subsequent pregnancies

Reduction in months on welfare

Reduction in Out-of-Home Placements

Reduction in ER Visits

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

83%

79%

59%50%

32%

20%

44%

35%

28-48%

48-50%

Outcomes Among Multiple Evidence-Based Home Visiting Programs

Home Visiting = Most Effective Defense

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Home Visiting: A Return On Investment*

Higher-risk families Savings

Higher-risk families Cost

Lower-risk families Savings

Lower-risk families Cost

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000 Cost

Increased Participant Income

Reduction in Crime Losses

Savings to Government

$41,419

$7,271$9,151

$7,271

Source: RAND Corporation Analyses of the Nurse-Family Partnership Program (2008)

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Progress of Home Visiting in Texas: Recent Timeline

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Nurse-Family Partnership to Texas

State major Investment in Home Visiting

Texas Receives First Federal MIECHV Funding

Senate Bill 426 - Home Visiting Accountability & Expansion Act & new Investment of $7.9 million

Comprehensive Home Visiting System under Texas Health and Human Services Commission

2006

2007

2011

2013

2014

The Start: Nurse-Family Partnership Pilot in Texas In 2006, the Nurse-Family Partnership model was

established in Dallas as a pilot project TexProtects, Dallas Foundation and Parkland Hospital’s

Injury Prevention Center

Funding was secured to serve 100 Families - Foundations, County and State Implementing Site: YWCA of Metropolitan Dallas

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Next Step: State Home Visiting Legislation and Investment

2007 80th Legislative Session, the Legislature made its first commitment to investing in home visiting

Senate Bill 156 -The Nurse Family Partnership Act - by Senator Florence Shapiro and Rep. Jerry Madden Unanimous passage in both Sen HHS and House PH committees and unanimous floor votes in each

chamber

Secured funding for the program: $7.9 million to serve 900 families across the State Added 10 new sites across Texas

2009 81st Session: Investment more than doubled to $17.8 million

2011 82nd $17.75 million renewed and again in 2013 83rd legislative session15

2011 Federal Funding: Texas Awarded MIECHV Funding

Maternal Infant Early Childhood Home Visiting Act (MIECHV): Federally funded program for home visiting: Est. by Congress in 2010 with $1.5 billion The U.S. Health Resources and Services Administration (HRSA) funds states to

administer funding to the models that best meet needs of own at-risk communities. Supports funded agencies (HHSC in Texas) in providing the services to families.

Features of the Federal MIECHV Home Visiting Program: Serve pregnant women and families with children from birth to age 5.

Focus on families at risk: Parents < 21 y/o, low income, live in at-risk communities, history of CA/N, other factors that places healthy child development in jeopardy.

Help to prevent child abuse and neglect.

Are proven by scientific research to improve the lives of children and families.

Texas MIECHV funded programs: HIPPY, Parents as Teachers, Early Head Start, Nurse-Family Partnership

Texas received nearly $70 million in MIECHV formula and competitive awards since 2011

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http://mchb.hrsa.gov/programs/homevisiting/

2012: Texas Home Visitation Consortium

Mission: To bring together home visiting programs to increase awareness of HV legislation in Texas and to coordinate education

and legislative efforts

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2013 Texas’ Home Visiting Accountability and Expansion Act

Senate Bill 426 (83-R): Senator Nelson, Senator Deuell, Senator West and Representative Zerwas Established the Texas Home Visiting Program

Ensures HV programs set clear standards and are: Accountable for outcomes Implemented with fidelity to the research model Evaluated for quality assurance and quality improvement

Creates a framework guaranteeing how state money invested in home visiting is allocated: At least 75% is directed toward evidence-based programs Up to 25% may be invested in “Promising Practices”

Unanimously passed Senate committee, Senate Chamber 31-0; passed House committee, House Chamber 139-4-2

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2013: Texas Home Visiting Trust Fund

Senate Bill 1836 (83-R): Senator Deuell/ Representative Zerwas Creates a Texas Home Visiting Trust Fund-controlled by the Office of Early

Childhood Coordination under HHSC Seeks funding for the Texas Home Visiting Program Provides citizens the opportunity to make a voluntary $5 donation at time

of purchase: Copy of a birth certificate, marriage license, or divorce decree Marriage license (pending County Commissioners approval and 10% fee) “To promote healthy early childhood for the Texas Home Visiting

program administered by the HHS Commission office 19

HOME VISITING PROGRAMS IN TEXAS

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Program Model Texas Counties Served

AVANCE Parent-Child Education Program

Bexar, Dallas, El Paso, Harris, Hidalgo, McLennan, Travis

Early Head Start Bastrop, Bell, Bexar, Bowie, Brazoria, Brazos, Brown, Collin, Dallas, Dawson, Deaf Smith, Gray, Grayson, Gregg, Harris, Harrison, Hidalgo, Hockley, Hutchinson, Lubbock, McLennan, Montgomery, Nueces, Potter, Rockwall, Shelby, Tarrant, Travis, Uvalde, Val Verde, Webb, Wichita, Zavala

Exchange Parent Aide Dallas

Family Connections Brazos, Burleson, Grimes, Leon, Madison, Robertson, Washington

Healthy Families AmericaConcho, Dallas, Runnels, Tom Green, Travis

Healthy Start Bexar, Cameron, Dallas, Harris, Tarrant, Webb

Home Instruction for Parents of Preschool Youngsters

Cherokee, Dallas, Ector, Gregg, Harris, Hidalgo, Nueces, Potter, San Patricio

Nurse-Family Partnership

Bexar, Chambers, Crosby, Dallas, Ector, El Paso, Floyd, Fort Bend, Gregg, Hale, Hardin, Harris, Hidalgo, Hockley, Jefferson, Lamb, Lubbock, Lynn, Montgomery, Nueces, Orange, Potter, Tarrant, Terry, Travis, Webb, Willacy, Williamson

Nurturing Parenting Program

Bexar, Concho, Crockett, Runnels, Tom Green

Parents and Children Together

Collin, Fort Bend, Travis

Parents As Teachers Bexar, Cherokee, Comal, Crosby, Dallas, Denton, Ector, Fayette, Fort Bend, Gregg, Guadalupe, Hale, Harris, Hidalgo, Hockley, Lubbock, Lynn, McLennan, Nueces, Potter, Tarrant, Terry, Travis, Willacy, Williamson, Wise, Young

Positive Parenting Program

Galveston, Tarrant (Dallas and Houston beginning)

SafeCare Beginning in Cameron, Tarrant and Webb

Systematic Training for Effective Parenting

Bexar

68 Countieswith Capacity of 21,000+ Families

Now: Texas Serving Few of those in Highest Need

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Currently, Texas has the capacity to serve only 21,217 of our highest-need families with home visiting services.

Map of Home Visiting Services & Child Abuse County Risk

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Number of Families Served by HV Represents ** Percentage of Highest Need Families:

Dallas

Lubbock

El Paso

Brownsville

Houston

Waco

Laredo Corpus Christi

Lubbock

Corpus Christi

Brownsville

Highest Risk Counties (Bottom 25%)

High Risk Counties (Bottom 51% - 75%)

Moderate Risk Counties (Top 26% - 50%)

Lowest Risk Counties (Top 25%)

 Number of Families Served by HV Represents ** Percentage of Highest Need Families:          40.1 - 50%           30.1 - 40%           20.1 – 30%

          10 – 20%

          Less than 10%

2023 Goal for Texas

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Path to Success: Investments from All Sources

2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

$160,000,000

$180,000,000

$200,000,000Federal Funding NeededState Funding NeededPrivate (Non-Governmental) Funding NeededLocal Government Funding Needed

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25% / Year

Birth

Prenatal

Postnatal

Junior High-High School

Toddler

Universal Medical Professional Training on 

Recognizing Maltreatment

Universal Prevention at Birth

(Period of Purple Crying)

Targeted High-RiskHome Visiting

Prenatal(e.g. Nurse-Family Partnership, Parents as 

Teachers, Healthy Families)

Universal OBGYN Education(Basic Child Development Stages)

Universal Hotline/Classes for New Parents

(e.g. Triple P stages 2-4)

Universal Prevention Messaging

 (e.g. Triple P Stage 1)

Universal Child Development & Trauma 

Impact Education 

Targeted High-RiskHome VisitingBirth/Postnatal

(e.g. AVANCE, Early Head Start, Healthy Start, NFP)

Targeted High-RiskHome Visiting

Toddler/Early Childhood(e.g. HIPPY, Parents as Teachers, 

EHS, AVANCE)

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A Vision for Prevention in Texas

QUESTIONS?

Madeline McClure, LCSWExecutive Director

madeline@texprotects.org

Sophie Phillips, LMSWDirector of Research

sophie@texprotects.org

TexProtects | The Texas Association for the Protection of Children

214.442.1672 26