THE HISTORY AND PROGRESS OF
HOME VISITING
IN TEXAS
Madeline McClure, LCSW | Executive Director
November 14, 2014 | Austin, TX | Toxic Stress & Early Childhood
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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.
2.
3.
Investments in proven Child Abuse Prevention programs
Improvements to Child Protective Services and systems that impact abused children
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
Texas Ranks…
3
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
8,000,000
7,000,000
Child Population
6,000,000
5,000,000
4,000,000
3,000,000
103
300
250
200
150
Fatalities
The Texas child population grew by 1.5% on average each
year between 1997 and 2013. Meanwhile, child abuse and
280
neglect fatalities increased by an average of 4.8% each year –
more than 3x child population growth.
227 223
227 231
213
212
204 201
203
195
184
171
156
156
135
100
2,000,000
50
1,000,000
0
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
CA/N Fatalities
Child Population
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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.”
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.
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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.”
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.
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Lifetime Costs of Maltreatment: CDC
$140
$120
Billions
$100
U.S. lifetime cost from one year of child
maltreatment
Fatal victims' medical
$124 Billion
costs
Fatal victims'
productivity losses
Survivor' special
education costs
$80
Survivors' criminal
justice costs
$60
Survivors' child welfare
costs
$40
Survivors' long-term
healthcare costs
$20
$0
Average lifetime cost per
survivor: $210,012
.
4%
4%3%
5%
15%
69%
Average lifetime cost per
fatal victim: $1,272,900
1%
Survivors' short-term
healthcare costs
Survivors' productivity
losses
99%
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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, 156-1
Lifetime Costs of Maltreatment: The Perryman Group
Key Results: Lifetime Social Costs and Lost Earnings Due to Child Maltreatment in 2014
Social Costs of Non-Fatal Child
Maltreatment
Lost Earnings Stemming from
Non-Fatal Child Maltreatment
Total Expenditures*
Gross Product*
Personal Income*
Retail Sales*
Person-Years of Employment
Total Expenditures*
Gross Product*
Personal Income*
Retail Sales*
Person-Years of Employment
Total Expenditures*
Total Economic Cost of NonFatal Child Maltreatment
Total Economic Cost of Fatal
Child Maltreatment
Gross Product*
Personal Income*
Retail Sales*
Person-Years of Employment
Total Expenditures*
Gross Product*
Personal Income*
Retail Sales*
Person-Years of Employment
$1,051,754,556,308
$506,935,982,252
$335,180,266,736
$129,345,107,948
5,712,406
$4,790,521,167,140
$2,165,310,794,660
$1,322,482,760,975
$594,309,864,183
22,050,950
$5,842,275,723,447
$2,672,246,776,912
$1,657,663,027,711
$723,654,972,131
27,763,357
$25,475,161,062
$11,521,315,782
$7,042,421,367
$3,160,181,043
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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
$7
$6.25 Billion
TX 2007 Total Cost
Spent on Consequences
of Abuse
Cost in Billions
$6
$5
Total Annual Cost of
CPS-FY14 budgeted
$4
$3
$2
$1
$1.25 Billion
$56.8 Million
Total Annual Prevention
Investment*-FY14
budgeted
$0
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* Prevention Investment Includes FY14-15 Allocation for Prevention and Early Intervention Division (PEI), Texas Home Visiting
Program and the Texas Nurse-Family Partnership Program
NFP=Nurse Family Partnership
THVP=Texas Home Visiting Program
MIECHV=Maternal, Infant, and Early
Childhood Home Visiting
Texas’ Prevention Investment
Prevention Early Intervention
NFP & THVP
$140
$130.7
$120
MILLIONS
$100
MIECHV
$21.1*
$91.8
$83.9
$80
$96.1
$8.90
$17.80
$111.35
$31.7*
$17.1*
$25.65
$17.75
$60.0
$60
$131.55
$87.1
$40
$91.8
$88.8
$61.9
$20
$0
2002-2003
2004-2005
2006-2007
2008-2009
BIENNIUM
2010-2011
2012-2013
2014-2015
* MIECHV award dates; Do not necessarily reflect budget cycles
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Home Visiting = Most Effective Defense
Outcomes Among Multiple Evidence-Based Home Visiting Programs
35%
Reduction in ER Visits
44%
Reduction in Out-of-Home Placements
20%
Reduction in months on welfare
32%
Fewer subsequent pregnancies
28-48%
48-50%
Reduction in child abuse and neglect
Reduction in low birth weight babies
50%
Reduction in language delays at 21 months
59%
Reduction in child arrests at age 15
79%
83%
Reduction in premature delivery
Mom's labor force participation by child's fourth birthday
0%
20%
40%
60%
80%
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100%
Home Visiting: A Return On Investment*
$45,000
$40,000
$41,419
Cost
Increased Participant Income
$35,000
$30,000
Reduction in Crime Losses
$25,000
Savings to Government
$20,000
$15,000
$10,000
$7,271
$9,151
$7,271
$5,000
$0
Higher-risk families
Higher-risk families Cost
Lower-risk families
Lower-risk families Cost 12
Savings
Savings
Source: RAND Corporation Analyses of the Nurse-Family Partnership Program (2008)
Progress of Home Visiting in Texas: Recent Timeline
2014
2013
2011
2007
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
Nurse-Family
Partnership to
Texas
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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 session
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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
http://mchb.hrsa.gov/programs/homevisiting/
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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
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Program Model
AVANCE Parent-Child
Education Program
Early Head Start
Texas Counties Served
Bexar, Dallas, El Paso, Harris, Hidalgo, McLennan, Travis
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
Dallas
HOME VISITING PROGRAMS IN TEXAS
Exchange Parent Aide
Family Connections
Healthy Families America
Healthy Start
Home Instruction for Parents
of Preschool Youngsters
Nurse-Family Partnership
Brazos, Burleson, Grimes, Leon, Madison, Robertson, Washington
Concho, Dallas, Runnels, Tom Green, Travis
Bexar, Cameron, Dallas, Harris, Tarrant, Webb
Cherokee, Dallas, Ector, Gregg, Harris, Hidalgo, Nueces, Potter, San Patricio
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
Positive Parenting Program
SafeCare
Systematic Training for
Effective Parenting
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
Galveston, Tarrant (Dallas and Houston beginning)
Beginning in Cameron, Tarrant and Webb
Bexar
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Now: Texas Serving Few of those in Highest Need
Currently, Texas has the capacity
to serve only 21,217 of our
highest-need families with home
visiting services.
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Map of Home Visiting Services & Child Abuse County Risk
Highest
Risk
Counties
(Bottom
25%)
Moderate
Risk
El Paso
Counties
(Top 26% 50%)
High Risk
Counties
Lubbock
(Bottom
51% 75%)
Number of Families Served by HV Represents
** Percentage of Highest Need Families:
Lubbock
Lowest
Risk
Counties
(Top 25%)
Number of Families Served by
HV Represents ** Percentage of
Highest Need Families:
40.1 - 50%
Dallas
Waco
30.1 - 40%
20.1 – 30%
Houston
10 – 20%
Less than 10%
Laredo
Corpus Christi
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Corpus Christi
Brownsville
Brownsville
2023 Goal for Texas
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Path to Success: Investments from All Sources
$200
$150
Federal Funding Needed
25% /
Year
State Funding Needed
Millions
Private (Non-Governmental) Funding Needed
$100
Local Government Funding Needed
$50
$0
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
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A Vision for Prevention in Texas
Universal Child
Development & Trauma
Impact Education
Universal Prevention
Messaging
(e.g. Triple P Stage 1)
Universal OBGYN Education
(Basic Child Development Stages)
Junior
High-High
School
Prenatal
Targeted High-Risk
Home Visiting
Targeted High-Risk
Home Visiting
Prenatal
(e.g. Nurse-Family Partnership, Parents as
Teachers, Healthy Families)
Toddler/Early Childhood
(e.g. HIPPY, Parents as Teachers,
EHS, AVANCE)
Universal Prevention at
Birth
Universal Hotline/Classes
for New Parents
(e.g. Triple P stages 2-4)
(Period of Purple Crying)
Toddler
Birth
Targeted High-Risk
Home Visiting
Universal Medical
Professional Training on
Recognizing Maltreatment
Birth/Postnatal
(e.g. AVANCE, Early Head Start,
Healthy Start, NFP)
Postnatal
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QUESTIONS?
Madeline McClure, LCSW
Executive Director
madeline@texprotects.org
Sophie Phillips, LMSW
Director of Research
sophie@texprotects.org
TexProtects | The Texas Association for the Protection of Children
214.442.1672
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