The State of Texas
2016 Annual Progress and Services Report
Title IV-B Child and Family Services Plan
Fiscal Years 2015-2019
Section XII. Targeted Plans
i. Foster and Adoptive Parent Diligent Recruitment Plan
ii. Health Care Oversight and Coordination Plan
iii. Disaster Plan
Texas Department of Family and Protective Services
ACYF-CB-PI-15-03
2016 Title IV-B APSR
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The State of Texas
2016 Annual Progress and Services Report
Title IV-B Child and Family Services Plan
Fiscal Years 2015-2019
Section XII. Targeted Plans
i. Foster and Adoptive Parent Diligent Recruitment Plan
Texas Department of Family and Protective Services
ACYF-CB-PI-15-03
2016 Title IV-B APSR
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2016 Child and Family Services Plan
XII. Targeted Plans
i. Foster and Adoptive Parent Diligent Recruitment Plan
►Description of the activities to be conducted over the next five years to ensure that
there are foster and adoptive homes that meet the needs of the infants, children, youth,
and young adults served by the child welfare agency.
A description of the characteristics of children for whom foster and adoptive homes are
needed.
DFPS continues to recognize that diligent recruitment of foster and adoptive homes
must generate foster and adoptive families that meet the demographic characteristics of
children in care. Demographic data of the characteristics of the children needing foster
and adoptive homes is available to all staff through the Data Warehouse reports that are
updated monthly. Current demographic information on children and families is being
used to establish recruitment targets and track progress.
Of the 17,378 youth in foster care as of August 2015.
•
•
•
•
•
•
Age
•
37% age 02
20% age 35
19% age 69
12% age
10-13
9.8 % age
14-17
•
48%
Female
•
51% Male
Gender
•
Race/Ethnicity
•
Characteristics
•
17% African
American
•
42% Hispanic
•
33% Anglo
•
.1%
American Indian
•
.02% Asian
•
4.5% Multiple
•
1.3 UTD
•
•
•
•
•
•
•
.54% Physical
2.2% medical
6.7%Drug/Alcohol
4.6% Emotional
6.6 Learning
11% Sibling
.27% Teen Parent
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Foster and Adoptive Homes by Race/Ethnicity
as of August 31, 2014
Anglo
African American Hispanic
Native American Asian
Other
#
#
#
Home Category
#
%
%
#
%
%
# %
%
Adoptive
220 36.2% 102
16.8%
263 43.3% 0
0.0%
1 0.2% 21 3.5%
Foster
46
45.6%
23
16.9% 2
1.5%
0 0.0% 3
22.1%
216 20.4% 2
0.2%
7 0.7% 37 3.5%
33.8% 62
Foster/Adoptive 561 53.1% 234
Progress: In FY15 DFPS implemented the revised Annual Recruitment Plan form that
better assists staff in reviewing local data reports to determine the characteristics of
children needing foster and adoptive homes. Emphasis has been placed on working
collaboratively with internal and external partners including residential providers to build
capacity and develop a culture of positive permanency.
Specific strategies to reach out to all parts of the community.
DFPS is committed to reaching out to all parts of a community and will work to increase
collaboration with faith-based and community based organizations to accomplish this
goal. DFPS will also collaborate with partner child placing agencies on information
meetings. DFPS will collaborate with the Advisory Committee on Promoting Adoption of
Minority Children to target areas of need in a community. DFPS will continue to ensure
that information is shared with stakeholders (SEC. 86 of SB 206 repeals the Advisory
Committee on Promoting Adoption of Minority Children, TFC §162.309, effective
9/1/15).
Progress: In FY15 DFPS participated in Regional Provider Meetings. These meetings
were held at least quarterly. The meetings facilitated open communication between
providers and DFPS, training and education, and provided information on placement
needs of the local region. DFPS and private CPAs also held foster/adopt inquiry
meetings in multiple locations within each region to generate interest in fostering and/or
adopting. DFPS regional staff continued to work with local media outlets to provide
recruitment information to local communities. Campaigns included such activities as "A
Forever Family," "Wednesday's Child," "The Gift of Love," "Children are a Gift," Heart
Gallery displays across the state, and pen/magnet giveaways to community businesses
when resources were available. DFPS also participated in many different individual
provider and trade organization meetings across the state when invited. Information of
placement needs was shared with many of these coalitions/organizations. 2011 began
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2.2%
a reinvigorated collaboration between the faith-based community and the child welfare
system in Texas. Representatives from both systems pledged to work jointly and
differently than before in service to children, youth and families. The approach
developed for collaboration is unprecedented and reflects both the faith-based
community's mission and the state's commitment to safely reduce the need for foster
care through a clearly articulated prevention to permanency model. Over a hundred
churches are actively involved in the range from active ministries to beginning to build a
ministry with over one thousand churches expressing a desire to understand more
about this work. Another notable recruitment effort are the Adoption Forums facilitated
by the Advisory Committee on Promoting Adoption of Minority Children. These Forums
are held 3 to 4 times a year in different locations of the state. The Department
participates in these Forums by sharing data of the local needs including placement
needs (Please see above comment noting that the Advisory Committee on Promoting
Adoption of Minority children will be repealed on 9/1/15. This committee will cease to
exist effective 9/1/2015).
Diverse methods of disseminating both general information about being a
foster/adoptive parent and child specific information.
DFPS strives to use diverse information sharing methods to communicate the need for
foster and adoptive parents and provide general information to the public. DFPS will
work to increase collaboration with faith-based and community based organizations to
share general information. DFPS will collaborate with partner child placing agencies for
information meetings. DFPS will maximize the use of internet sites such as the DFPS
public website, Facebook, the DFPS YouTube channel, TARE, AdoptUSKids, and
Adoption.com. DFPS staff will participate in recruitment activities during existing
national recognition months, such as Foster Care Month in May and National Adoption
Month in November. Various community recruitment activities during the year will be
conducted including information meetings, adoption fairs and expositions, match
parties, and print and electronic media stories on television and radio.
Progress: In FY2015 DFPS has continued to conduct collaborative information meetings
with partner child placing agencies. Information continues to be placed on the DFPS
public website and the TARE website. A video depicting what foster and adoptive
children wish for was developed to encourage families to consider fostering and
adopting and was placed on the TARE website home page and the DFPS You Tube
channel. TARE continues to be a utilized recruitment avenue and the goal is to have all
children on TARE also placed on partner websites AdoptUSKids.org, Adoption.com,
Adoption.net, and A Family For Every Child. DFPS social media policy has been
revised to provide staff with additional guidance on the use of social media sites such as
Facebook. DFPS staff participated in FY14's National Adoption Day and National
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Adoption Month. Events were published on the TARE website. Staff also participated
in recognizing Child Abuse Awareness Month in April 2015 in ways such as participating
in Go Blue Day and notifying area faith communities about Blue Sunday. Data is also
posted on the public website to share demographic data of children in local areas and
educate regarding placement needs for recruitment. DFPS has also participated in
provider meetings which facilitated open communication between providers and DFPS,
training and education, and shared information on placement needs of the local region.
These efforts align with the culture of positive permanency being cultivated in the
agency and the sense of urgency to achieve positive permanency for children and
families.
Strategies for assuring that all prospective foster/ adoptive parents have access to
agencies that license/approve foster/adoptive parents, including location and hours of
services so that the agencies can be accessed by all members of the community.
DFPS continues to ensure that all prospective foster and adoptive parents have access
to agencies they can work through to become verified and approved. Contact
information by region for partner Child Placing Agencies and for CPS recruitment staff is
shared on the TARE website and accessible by the general public. Prospective families
who contact the 1-800 Foster and Adoption Inquiry line are also informed that they can
locate CPA information on the website. Information packets provided to prospective
foster and adoptive families also include a list of partner Child Placing Agencies in the
area. DFPS staff continue to work with partner Child Placing Agencies to hold
collaborative information meetings.
Strategies for training staff to work with diverse communities including cultural, racial,
ethnic, and socio-economic variations.
CPS increases the cultural competence of staff through multiple training opportunities.
All new caseworkers are required to participate in "Knowing Who You Are: Racial and
Ethnic Identity Training" during basic skills development training. In addition, a new
version of "Knowing Who You Are" for supervisors and managers was also
implemented and delivered upon request. CPS is aware that there is a need for greater
exposure to information regarding socio-economic variations in cultures through
training. This awareness has led to CPS collaborating with DFPS Center for Learning
and Organizational Excellence (CLOE) to develop courses on working with African
American and Latino families as well as a course on "Working with families Who Are
Impoverished" for child welfare caseworkers. The Missouri Community Action Poverty
Simulation is delivered to internal and external stakeholders. CPS has also partnered
with Lambda Legal to deliver a training related to working with LGBTQ youth in care.
CPS also developed and implemented a course for caseworkers to enhance knowledge
of the Indian Child Welfare Act. Future projects include development and
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implementation of courses related to working with African American and Latino families.
These trainings will continue to be offered to all staff to increase the cultural
competence of staff.
Strategies for dealing with linguistic barriers.
DFPS continues to recognize that prospective foster and adoptive parents may
encounter some linguistic barriers and connects families as needed with an interpreter
by phone or in person or a staff who speaks the family's primary language. Information
has also been shared with staff on how to request sign language interpreters as needed
and a message has been placed on the TARE website to ensure that prospective
families know that they can contact Recruitment staff to request a sign language
interpreter. When possible, DFPS seeks to employ staff and contract agencies who
have the skills to communicate with families in diverse ways.
Non-discriminatory fee structures.
DFPS does not charge a fee to prospective families and only contracts with agencies
that are governed by strict minimum standards requirements related to fees.
Procedures for a timely search for prospective parents for a child needing an adoptive
placement, including the use of exchanges and other interagency efforts, provided that
such procedures ensure that placement of a child in an appropriate household is not
delayed by the search for a same race or ethnic placement.
To ensure that searches for prospective parents for children who need an adoptive
placement are done in a timely manner DFPS continues to utilize recruitment activities
such as broadcasting a request for home screenings to child placing agencies in the
region local to the child(ren), holding selection staffing meetings to review home
screenings submitted, broadcasting a child(ren)'s profile to potential families registered
with the TARE website, and placing a profile of the child(ren) if other efforts have not
resulted in a potential adoptive family on adoption exchange websites such as TARE,
AdoptUSKids, and Adoption.com. DFPS staff also utilize match parties that bring
together potential families with waiting children, and print and electronic media stories
on television and radio to increase the exposure to potential adoptive placements a
child receives.
Progress: In FY2015, a culture of positive permanency and sense of urgency is being
developed in the agency. The new positive permanency culture will set goals and
establish strategies to ensure timely searches and matches for waiting children. DFPS
is using several child specific recruitment tools to work toward moving waiting children
to a forever family. Regional Broadcasts of children waiting for adoptive families
continued to be utilized. Regional video tapings of waiting children also occurred in
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partnership with TV and News stations. Selection Staffings assisted staff in selecting
forever families, and broadcasts to families registered in TARE were emailed for child
specific recruitment. Regional staff also created new profiles for children and updated
existing profiles as needed so that children could be seen on TARE, AdoptUSKids,
Adoption.com, Adoption.net and A Family for Every Child and hopefully be matched
with a forever family.
Adoptive families in Texas and throughout the United States continued to register their
family with the TARE website which allows them to inquire about children and sibling
groups online and be considered for adoption of children who may or may not yet be
photo-listed on the website. The Texas Heart Gallery project involving community
volunteers taking professional portraits of children also continued. The photographs
taken were displayed in a public forum so the community at large is made aware of the
children in their community who need permanent homes as well as online through the
Heart Galleries websites. There are currently eight active Heart Galleries throughout
Texas. Several match parties also occurred across the state that resulted in positive
matches between a waiting child and an adoptive family. In addition, Staff also have a
training available to them to review how to use the family registries in TARE and
AdoptUSKids to proactively search for a potential adoptive family for a child in their
workload.
Permanency is not delayed during the search as regional staff continue to explore
options such as reverse TARE searches in which the regional staff searches for families
meeting certain criteria rather than waiting for families to inquiry. In addition, regional
staff are seeking permanency though past and current connections in the child's life.
2016 Title IV-B APSR
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The State of Texas
2016 Annual Progress and Services Report
Title IV-B Child and Family Services Plan
Fiscal Years 2015-2019
Section XII. Targeted Plans
ii. Health Care Oversight and Coordination Plan
Texas Department of Family and Protective Services
ACYF-CB-PI-14-03
2016 Title IV-B APSR
709
2016 Title IV-B APSR
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2016 Child and Family Services Plan
XII. Targeted Plans
ii. Health Care Oversight and Coordination Plan
►Description of the plan for providing ongoing oversight and coordination of health care
services for children in foster care.
The Department of Family and Protective Services (DFPS) has a number of systems in
place to oversee and coordinate the health care provided to children in DFPS
conservatorship and to involve medical professionals in assessing the health and wellbeing of children. These systems include a single managed care organization for all
children, the designation of a medical consenter for each child, DFPS policy, Residential
Child Care Contract requirements, Residential Child Care Licensing Minimum
Standards, judicial review of medical care, and specialized staff designated to DFPS
medical services, trauma informed-care and Medicaid eligibility.
Development of Plan to Coordinate Health Care
Single Managed Care Organization
Effective September 2005, Texas Family Code Chapter 266 required the Texas Health
and Human Services Commission (HHSC), which is the Texas Medicaid agency, to
coordinate with DFPS to develop a comprehensive health care delivery system for
children in DFPS conservatorship. In response, DFPS and HHSC collaborated between
2005 and 2008 to design a model tailored to the unique needs of these children, in
consultation with pediatricians, health care experts, child welfare experts and recipients
of child welfare services. HHSC entered into a contract with Superior Health Plan
Network in 2007 to administer the health plan, called STAR Health.
STAR Health was implemented in April 2008 and provides medical, behavioral health,
dental, vision, and pharmacy (added in 2011) services. DFPS continues to collaborate
on a day-to-day basis with HHSC and STAR Health, to ensure oversight and
coordination of health care services for children. Joint Team meetings with HHSC,
STAR Health and DFPS staff are held monthly to resolve problems and plan
innovations.
The STAR Health system includes features such as:
•
•
Expedited enrollment for immediate access to Medicaid benefits.
An initial Texas Health Steps checkup - Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) 4 - for children within 30 days of entering foster care.
4
The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) service is Medicaid's comprehensive preventive child
health service (medical, dental, and case management) for individuals from birth through 20 years of age. In Texas EPSDT is known
2016 Title IV-B APSR
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•
•
•
•
•
•
•
•
•
•
•
•
Integrated physical and behavioral health care.
Health care coordination through medical homes, dental homes, service
coordination and service management.
Telephonic health screenings when children enter care or change placements,
with questions about medical needs, behavioral health needs and psychotropic
medications.
Enhanced access to services through a network of providers and service
coordination.
A Health Passport, which is a web-based electronic health record for each child;
A process for oversight and review of psychotropic medications.
Location of STAR Health Liaisons in CPS regional offices to work closely with
CPS Well Being Specialists to address health care needs of children.
Monthly mini-webinars for CPS staff related to various STAR Health services and
relevant topics.
The provision of training to children's caregivers and residential providers about
STAR Health services, Trauma-Informed Care, and related topics.
Participation, as needed, in family group conferences and other case staffings
conducted by CPS related to children's health care needs.
An electronic interface to allow the transmission of key data from the DFPS
IMPACT system to the Medicaid and STAR Health systems.
Seven-day, 24-hour nurse and behavioral health hotlines for members,
caregivers and medical consenters.
DFPS Policy, Contract and Standards
DFPS policy, the Residential Child Care contract, and Residential Child Care Licensing
Minimum Standards have a number of provisions in place to ensure that children's
health care needs are met and that health care is coordinated. DFPS licensed and
contracted residential operations are required to have policies and procedures in place
to address routine and emergency diagnosis and treatment of medical and dental
problems, routine health care relating to pregnancy and childbirth for pregnant youth,
and the provision of health care services to children with primary medical needs.
Residential contracts and licensing staff monitor a random sample of cases to ensure
compliance with these requirements. CPS caseworkers must also follow up with
children's caregivers regarding the provision of preventive and medically necessary
health care and complete a summary of medical care for court reports.
as Texas Health Steps (THSteps). EPSDT was defined by federal law as part of the Omnibus Budget Reconciliation Act (OBRA) of
1989 legislation and includes periodic screening, vision, hearing, and dental preventive and treatment services. In addition, Section
1905(r)(5) of the Social Security Act requires that any medically necessary health care service listed in the Act be provided to Texas
Health Steps (EPSDT) recipients even if the service is not available under the State's Medicaid plan to the rest of the Medicaid
population. These additional services are available through the Comprehensive Care Program.
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Medical Consenter
Texas Family Code and DFPS policy require a court authorized or DFPS designated
medical consenter for each child in DFPS conservatorship. Typically, DFPS designates
emergency shelter staff or live-in caregivers when children are placed in community
settings and CPS staff when children are placed in facilities, such as residential
treatment centers. The medical consenter must complete training on informed consent,
be knowledgeable of the child’s health care needs, participate in each medical
appointment, keep CPS updated about children's medical care and ensure that the
child's health needs are met.
DFPS provides training on medical consent to all CPS staff and caregivers who are
medical consenters through online training and handouts. It is now required as part of
pre-service and annual training for all medical consenters. In response to enactment of
House Bill 915 of the 83rd Texas Legislature, effective September 1, 2013, this training
was revised to incorporate information about trauma informed care, informed consent
for psychotropic medications and the appropriate use of non-pharmacological
interventions prior to or concurrently with psychotropic medications. Medical
consenters must acknowledge that they have completed the training on informed
consent for psychotropic medications and non-pharmacological interventions, in
addition to acknowledging that they understand informed consent and nonpharmacological interventions. The acknowledgment form must be presented as
evidence of completion of the training before DFPS staff designates them as medical
consenters. DFPS ensures that CPS staff complete the training and contracted
residential childcare providers ensure that their staff and foster parents complete the
training. DFPS also created a Medical Consenter email address to receive questions
about medical consent from staff, caregivers, residential contractors, and other
stakeholders. The online Medical Consent training is located at
http://www.dfps.state.tx.us/Child_Protection/Medical_Services/medical-consenttraining.asp.
Youth receive training on informed consent as part of the health section of the Life Skills
training offered through the Preparation for Adult Living program after a youth turns 16.
DFPS has processes in place to inform 16 and 17 year old youth of their right to request
the court to authorize them to consent to their own medical care according to the Texas
Family Code. DFPS policy and Medical Consent Training address the requirement for
medical consenters to involve youth in decisions about their health care in
developmentally appropriate ways. Youth who have been authorized by the court to
consent to some or all of their own medical care or who are aging out of DFPS
conservatorship are now required to complete the online Medical Consent training. If
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these youth take psychotropic medications, they must also complete the online
Psychotropic Medication training.
Judicial Review of Medical Care
CPS caseworkers include a summary of medical care in each court report. The court is
required to review the child’s medical care at each hearing, under Texas Family Code
Chapter 263. Ch. 263 also requires the court at each permanency hearing to ensure
that the child has been provided the opportunity, in a developmentally appropriate
manner, to express the child's opinion on the medical care provided.
Courts sometimes issue orders addressing children's health care needs. In response to
House Bill 915 of the 83rd Texas Legislature, DFPS amended court reports for
permanency and placement hearings to also address:
•
Behavior strategies and psychosocial therapies considered before or used
concurrently with psychotropic medications;
• The expected timeframe the child will need to take the medications and other
medications tried;
• The expected benefits of the any psychotropic medication the child is taking;
• Dates of appointments; and
• That the youth 16 and older was notified about their right to request the court to
authorize them to consent to some or all of their own medical care and the
youth’s response.
Specialized Staff
DFPS has multiple specialized staff dedicated to the coordination and oversight of
health care services for children in DFPS conservatorship and who are eligible for
Medicaid. Dedicated staff includes the following:
•
•
•
DFPS Medical Director, who is a child and adolescent psychiatrist, interfaces
with other state agencies, health care providers, the judicial system, legislators
and other external stakeholders; coordinates with HHSC and STAR Health in
efforts to improve medical services and ensure the appropriate prescribing of
psychotropic medications; and provides consultation to DFPS staff related to
health care policies, the behavioral health needs of children served by DFPS and
psychotropic medications.
CPS Director of Services who is responsible for DFPS oversight and
management of Medicaid eligibility, medical services and quality assurance.
Division Administrator of Medical Services who coordinates CPS medical
services, medical policy, and psychotropic medication activities, works closely
with HHSC and STAR Health staff, supervises Medical Services Program
Specialists and Well Being Specialists, and serves as a liaison to the Forensic
Assessment Center Network and the regional nurse consultants.
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•
•
•
•
•
•
Medical Services Program Specialists who manage medical services initiatives,
develop medical policies/processes, liaison with other DFPS programs, health
and human services agencies and STAR Health on Medicaid benefits/services,
children's mental health, ensure DFPS compliance with decree orders resulting
from the Frew lawsuit and Alberto N. settlements, and provide leadership and
coordination for the Department's Trauma Informed Care Initiative.
Seven Well Being Specialists who are located in the regions and serve as
liaisons between frontline CPS staff and STAR Health. They are subject matter
experts on CPS medical services and work closely with STAR Health Liaisons
located in CPS offices to facilitate access to health care for children.
CPS regional nurse consultants provide consultation to CPS staff regarding
children’s health care needs, educate staff about disease processes,
medications and treatment plans, assist with the DFPS psychotropic oversight
activities, and attend various CPS staffings as requested, such as removal
staffings, child fatality reviews and family group conferences.
Division Administrator for Federal and State Support, who is responsible for
ensuring that eligibility issues are resolved in a timely manner, supervises staff
responsible for resolving issues that contribute to barriers that prevent smooth
enrollment in or transition out of the automated systems supporting eligibility for
STAR Health;
Exceptions Lead, who helps resolve problems that prevent Medicaid eligibility
from being established; and
Division Administrator for Accountability, who is responsible for quality assurance
reviews including the Child and Family Services Review (CFSR), Investigations
and Title IV-E. The CFSR specifically has a domain for review of child wellbeing, including medical, dental, behavioral and mental health.
Collaboration to Ensure the Appropriate Use of Psychotropic Medications
The Supreme Court of Texas Permanent Judicial Commission for Children, Youth and
Families (Children's Commission) formed a multi-disciplinary workgroup in 2011 led by
the DFPS Medical Director and a former Texas State Judge to study the psychotropic
medication oversight process in Texas, the information-sharing process between the
court and the state's many child welfare professionals, and the consent process for
psychotropic medications. After meeting for approximately a year, the Children's
Commission held a Psychotropic Medication Roundtable on July 6, 2012 to facilitate a
discussion among a larger group of stakeholders. The Children's Commission produced
a report that contains twelve recommendations that impact courts, DFPS and others.
Some of the recommendations were incorporated into proposed legislation for
strengthening informed consent for psychotropic medications, which later passed into
law by the 83rd Texas Legislature as House Bill 915, effective September 1, 2013.
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With the passage of House Bill 915, the Children's Commission and DFPS assembled a
60-member stakeholder workgroup to oversee an implementation plan addressing
DFPS, court, attorney and guardian ad litem requirements in the bill. The workgroup
met four times over the course of the implementation of House Bill 915 and concluded
on March 7, 2014. The membership of the group consisted of approximately 60
participants and included judges, representatives of advocacy groups, legislative
staffers, medical professionals, youth and parent representatives, DFPS staff, and
HHSC staff. Participants also include representatives from the STAR Health
contractors: Superior Health Plan Network and Cenpatico (the behavioral health care
provider). As part of implementation of HB 915, DFPS also developed a family friendly
brochure, "Making Decisions About Psychotropic Medications" in August 2013 that was
widely disseminated.
DFPS collaborated with the Texas Department of State Health Services (DSHS) and the
Texas Department of Aging and Disability Services (DADS) to present a Grand Rounds
training on April 22, 2015, titled: Monitoring of Psychotropic Medications: Initiatives in
Texas Foster Care, State Supported Living Centers, and Nursing Facilities. The
presentations were by the Medical Directors for DFPS and DADS to describe the
impetus for psychotropic monitoring initiatives; identify the risks and benefits for the use
of psychotropic medications in each population; and discuss the methodology,
successes and challenges of each initiative.
Schedule for Initial and Follow-up Health Screenings
CPS policy requires that children in DFPS conservatorship receive preventive and
medically necessary health care through Texas Medicaid's Texas Health Steps
program, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), including:
•
•
•
•
An initial Texas Health Steps medical checkup within 30 days of entering foster
care and subsequent Texas Health Steps medical checkups annually for children
36 months of age and older;
More frequent medical checkups are required for children under 36 months of
age as outlined in the Texas Health Steps Periodicity Schedule.
An initial Texas Health Steps dental checkup within 60 days of entering foster
care beginning at age six months and subsequently every six months; and
Expanded Medicaid benefits through Texas Medicaid's Health Steps
Comprehensive Care Program.
The CPS Medical Service team developed and delivered required training addressing
Texas Health Steps requirements to front line staff who work with conservatorship
cases. Texas Health Steps requirements are also included in the general Medical
Consent training which is required for all medical consenters. Additionally, STAR Health
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offers a similar training for foster parents and residential providers. STAR Health
developed a Kinship Outreach Team who contacts kinship caregivers to explain STAR
Health services, Texas Health Steps requirements, and helps them set Texas Health
Steps appointments.
How Health Needs Will Be Monitored and Treated
CPS policy, DFPS Residential Child Care Licensing Minimum Standards and the
Residential Child Care Contract require foster parents and residential providers to
ensure that health needs identified through Texas Health Steps screenings are followed
up and treated. DFPS licensed and contracted residential operations are required to
have policies and procedures in place to address routine and emergency diagnosis and
treatment of medical and dental problems, routine health care relating to pregnancy and
childbirth for pregnant youth, and the provision of health care services to children with
primary medical needs. DFPS Contract and Licensing staff monitors residential
operations for compliance with these requirements.
Children have medical and dental homes to help ensure health care needs are identified
and treated and STAR Health is required to provide all medically necessary
preventative screenings and Medicaid covered health services. Per contract, STAR
Health provides telephonic health screenings upon entry into conservatorship and at
placement changes in order to ensure that every child’s needs are known by the
caregiver and are fully met. STAR Health follows up with caregivers about such needs
through their Service Management and Service Coordination programs. STAR Health
develops a Health Care Service Plan for any youth that requires Service Management
assistance. HHSC’s Health Plan Management staff monitors the health plan to ensure
that all telephonic screenings and Service Plans are occurring within contractually
required timeframes. CPS caseworkers must also follow up with children's caregivers
regarding the provision of preventive and medically necessary health care and complete
a summary of medical care for court reports.
One of the lessons DFPS learned is that caseworkers and supervisors needed
additional guidance on assessing for safety and well-being and meeting the health care
needs of children with primary medical needs. DFPS developed more detailed policy,
tools to guide staff when making home visits, and computer based training addressing
all stages of CPS service. These materials provide practical supports for caseworkers
and supervisors, such as:
•
•
Provision of a reference guide with questions to ask children, caregivers and
healthcare providers
Instruction on assessing and using the child's communication method in the
interview
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•
•
•
•
Education on observing the child, his or her medical equipment and supplies, and
physical environment
Provision of educational materials on medical equipment, supplies and
terminology including visual aids
Identification of regional experts, such as well-being specialists, nurses and
development disability specialists who can assist caseworkers
Other supporting resource and reference materials
DFPS continues to produce and monitor monthly reports on compliance with Texas
Health Steps and is working with the Health and Human Services Commission on
reporting regarding the compliance with Texas Health Steps periodicity requirements for
medical and dental checkups for children in DFPS conservatorship through age 17,
including children enrolled in STAR Health. DFPS learned that changes were needed in
reporting data in order to outreach to Child Placing Agencies to improve compliance
with 30 day check-ups for children entering DFPS conservatorship. In FY 2015 DFPS,
the Human Services Commission and STAR Health plan to collaborate to develop
processes designed to improve compliance with Texas Health Steps among Child
Placing Agencies.
How Medical Information Will Be Updated and Shared
The Texas Family Code requires HHSC to provide a Health Passport record for each
child in conservatorship. The Health Passport electronic health record application is a
tool provided as part of STAR Health. The Health Passport is populated with two years
of health care history for children who were enrolled in Medicaid or Children's Health
Insurance Program (CHIP) prior to entering DFPS conservatorship (about 52% of
children entering care). The system then continues to populate with present day data
through claims submission and information transmitted from the DFPS IMPACT system
(medical consenters, demographics, etc.) STAR Health updated the Health Passport in
October of 2014 to improve organization and access to information.
Information in the Health Passport includes the name and address of each of the child's
health care providers, the child's medical consenters, a record of each visit to a health
care provider, a record of immunizations, identification of the child's known health
problems and information on all prescriptions. Medical consenters, Court Appointed
Special Advocate staff, certain authorized users for each residential operation, health
care providers and CPS staff have access to children's Health Passport records for the
specific children they serve. DFPS plans a pilot project with judges to determine the
most effective process for providing Health Passport access to judges. DFPS is also
required by the Texas Family Code to provide a copy of the Health Passport record to
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caregivers when DFPS conservatorship is dismissed and to young adults who leave
foster care after age eighteen.
CPS staff is required to provide a detailed Summary of Medical Care in each court
report, including physical health care, behavioral health care, and details about all
medications, and other related information. Court reports are provided to the Court
Appointed Special Advocates, attorneys and guardians ad litem and judges. Residential
child care providers keep records of children's medical and behavioral health visits
which are provided to CPS. CPS caseworkers also share medical information with the
individuals involved in children's cases, such as biological parents, caregivers, medical
consenters, residential childcare staff, Court Appointed Special Advocates and
attorneys ad litem. Specific to psychotropic medications, DFPS has revised policy to
require caseworkers to notify parents of the initial prescription of psychotropic
medications and any dosage changes at the next scheduled meeting with the
caseworker after the prescription in order to comply with TFC 266.005, as amended by
HB 915.
Although the medical consenters have the legal authority to consent to medical care,
other individuals involved in the case are offered opportunities to provide input into
some medical decisions and express concerns about medical care provided.
Steps to Ensure Continuity of Care and Consultation with Physicians and other
Professionals to Determine Appropriate Medical Treatment
HHSC and DFPS developed STAR Health as the primary means to ensure ongoing
consultation with health care providers and continuity of health care for children in
DFPS conservatorship. DFPS follows the requirements of Texas Health Steps for
assessing the health, and well-being and for determining appropriate medical care for
children. STAR Health functions that help ensure continuity of care include the Health
Passport, the establishment of medical and dental homes for children, integration of
medical and behavioral health care, and medical and behavioral health service
management and service coordination.
When children enter DFPS conservatorship, change placements or their medical needs
change, STAR Health is contractually required to conduct telephonic general health
screenings with caregivers to address children's medical and behavioral health needs
and any psychotropic or other medications they take. Children with complex behavioral
health, medical or intellectual and developmental disabilities are assigned service
managers who are either registered nurses or master's level behavioral health
clinicians, depending on the child's primary need.
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Service managers develop a health care service plan, provide medical case
management, outreach to caregivers regularly and may make home visits. STAR Health
has a number of specialized service management programs to address certain complex
needs, such as diabetes, transplants, and Start Smart program to follow pregnant teens
and their newborns. Children with less complex needs are provided with service
coordination. Service coordinators must facilitate access to primary, dental and
specialty care and support services, including providing assistance with locating
providers and scheduling appointments as necessary. Finally, STAR Health has a
discharge planning team to provide planning and coordination for children who are
being discharged from an in-patient setting.
To ensure a smooth transition and coordination/continuity of medical care for children
with complex medical conditions, DFPS holds multi-disciplinary, primary medical needs
case staffings at removal, and placement changes and transitions to adoption or
reunification. The purpose is to plan the transition of medical care, such as specialized
training for the new caregiver, transportation of the child and durable medical
equipment, or services needed in the home such as private duty nurses, specialists, or
others. Well-being Specialists facilitate the staffings and those in attendance may
include STAR Health service managers or coordinators, DFPS direct delivery staff,
placement staff, CPS regional nurse consultants and sometimes the DFPS medical
director, the STAR Health medical director, health care providers, residential providers,
caregivers, biological parents, Court Appointed Special Advocates (CASA), and
attorneys ad litem. CPS placement staff conducts similar staffings that include some of
the same representatives to plan the discharge of children from psychiatric hospitals.
The Superior Health Plan Network contract for Star Health, DFPS policy, the Residential
Child Care Contract and Residential Child Care Licensing Minimum Standards contain
requirements to ensure children receive appropriate follow-up for health care needs.
Beginning March 1, 2014, children and young adults who are in DFPS conservatorship
and who are dually eligible for Medicare and fee-for-service Medicaid began receiving
care management services through the Texas Medicaid Wellness Program operated by
McKesson Corporation. The program is a whole-person care management service that
supports Medicaid clients’ individual health needs and challenges. Dually eligible
children are not enrolled in STAR Health.
Steps to Ensure That Transition Plans Include Required Elements Relating to
Health Care Needs
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Transition Plan
During the development of a youth's transition plan, DFPS policy requires staff to inform
youth about the importance of designating a health care or medical power of attorney to
make health treatment decisions on behalf of the youth if he or she becomes unable
make these decisions. DFPS discusses information about the medical power of attorney
and health care options with youth during their Transition Plan Meeting, Circle of
Support, Preparation for Adult Living training, and other meetings between the youth
and caseworkers.
In response to House Bill 915, DFPS revised the youth Transition Plan to address
physical/mental health care needs and resources. The purpose is to ensure that youth
transitioning out of foster care have improved ability to exercise informed consent,
understand their own health care needs, know how to safely manage any psychotropic
medications prescribed and know how to access health care resources.
Medicaid for Former Foster Care Youth
Effective January 1, 2014, the Affordable Care Act extends the period of Medicaid
eligibility for former foster care youth until age 26, known in Texas as the Former Foster
Care Children program. The extended health care coverage is available to young adults
who leave Texas foster care after age 18 and are receiving Medicaid. This population
will receive services in two separate programs based on age: Young adults aged 18
through 20 will be enrolled in STAR Health but can switch to STAR, the program
through which most people in Texas get their Medicaid coverage. People in STAR
Medicaid get their services through medical plans, also known as managed care plans,
which they choose. Young adults aged 21 through 25 will receive Medicaid through the
STAR Medicaid managed care plan of their choice through the end of the month of their
26th birthday.
HHSC provides health care coverage for individuals living in Texas who aged out of
foster care under an Interstate Compact for the Placement of Children (ICPC)
agreement. This includes both individuals placed by the Texas Department of Family
and Protective Services (DFPS) in foster care in other states and individuals placed in
foster care in Texas from other states.
The current program, known in Texas as Medicaid for Transitioning Foster Care Youth,
will continue to be available for former foster youth who are younger than 21 and are not
eligible for the Former Foster Care Children program because they were not receiving
Medicaid at the time they aged out.
Young adults who age out of foster care from a state other than Texas and were not
placed in Texas through the ICPC, are not eligible for Texas Medicaid. Those currently
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receiving Medicaid for Transitioning Foster Care Youth who aged out of foster care from
another state will continue to receive Medicaid for Transitioning Foster Care Youth until
they turn 21 or no longer meet the eligibility requirements, whichever occurs first.
Individuals receiving Former Foster Care Higher Education Medicaid (a previous
Medicaid program that provided Medicaid for former foster care youth in higher
education) through STAR Health who were eligible for the Former Foster Care Children
program were automatically transitioned to the Former Foster Care Children program on
January 1, 2014 when the Affordable Care Act was implemented. Individuals receiving
Former Foster Care In Higher Education but not eligible for Former Foster Care
Children will continue to receive Former Foster Care In Higher Education through STAR
Health until their 23rd birthday or until they no longer meet the eligibility requirements,
whichever comes first.
CPS caseworkers, Preparation for Adult Living (PAL) staff, and youth specialists have
been instructed to inform youth about these changes to Medicaid programs during
Circles of Support or Transition Plan Meetings (before leaving care), PAL Life Skills
classes, in Aging out Seminars, and upon request. CPS caseworkers, PAL staff and
youth specialists are also required to tell Transition Centers, PAL contractors,
caregivers, and community partners about the changes. Information on Medicaid
programs for transitioning foster care youth is also available on the STAR Health
Member Handbook online and the DFPS Texas Youth Connection web site.
Training of Staff and Providers to Support the Treatment of Emotional
Trauma/Trauma-Informed Care Initiative
DFPS recognizes the long-term effects of adverse childhood experiences such as child
abuse and neglect and the need to address trauma as an important component of
effective service delivery. DFPS anticipates that the transition of the Texas child welfare
system into a trauma-informed system of care will promote child emotional and wellbeing, reduce the use of psychotropic medications, increase placement stability, and
support more timely permanency.
DFPS launched a Trauma-Informed Care initiative in October 2011. The goal of the
initiative, which is currently underway, is to build capacity to use trauma-informed
practice strategies across the child welfare system.
Four subgroups were established to focus on specific sectors of this work:
1. Trauma-informed assessments/screening tools. The charge of this workgroup
was to review the evidence-based and evidence-informed assessment
protocols that incorporate trauma history as part of optimal mental and behavioral
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health care that would best serve children and families and make
recommendations to DFPS leadership.
• This subgroup made recommendations for trauma screenings and
assessments and has concluded. DFPS is working with key
stakeholders, including HHSC, to incorporate trauma screening and
assessment processes for children in DFPS substitute care.
2. Trauma-informed training. Develop trauma-informed training for staff,
caregivers, and external stakeholders, including classroom as well as computerbased applications.
• This subgroup has developed a cross-walk comparing traumainformed care competencies identified in the National Child Traumatic
Stress Network Child Welfare Toolkit with the current DFPS training
curriculum. Currently new DFPS staff participates in classroom based
training on trauma-informed care provided through Cenpatico during
CPS Professional Development (formerly called Basic Skills
Development). Following the initial training every employee is required
to complete an annual refresher training that is computer based. In
addition, completion of the Trauma Informed Care Training is required
for caseworker advancement.
3. Trauma-informed caregiver support. Develop recommendations and protocols for
supporting kinship caregivers.
• This subgroup has shifted their focus to kinship caregivers and their
needs regarding parenting children who have experienced
trauma. They have surveyed kinship caregivers and will make
recommendations for this specific population of caregivers. The
subgroup will focus their work to provide kinship development workers
with trauma-informed care resources to support placements.
• October 2014: a Kinship Newsletter dedicated to trauma-informed care
was released. The newsletter provides educational information related
to trauma and provides resources for kinship caregivers.
4. Secondary Traumatic Stress. Develop recommendations and protocols for
supporting staff affected by secondary traumatic stress, direct trauma,
compassion fatigue burnout, and compassion success.
• This subgroup has presented its recommendations to CPS direct
delivery management and formed a charter group to implement them.
Recommendations include building awareness by managers of the
effects of secondary traumatic stress, and developing peer support for
staff and managing coverage when staff is on leave.
• This subgroup has implemented a plan that allows staff to take leave
with appropriate coverage in place. There is an understanding that
staff on leave should not be required to check their phones or emails
while on leave.
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•
This subgroup worked with the DFPS Employees Assistance Program
to provide staff with support related to secondary trauma. Regions 8
and 1 participated in the support groups.
Currently this subgroup is working with Dr. Karen Purvis and Dr. David Cross from
Texas Christian University to create a Secondary Traumatic Stress curriculum unique to
CPS needs. DFPS hopes to implement the training by the end of 2015.
All four subgroups are co-led by DFPS staff and external stakeholders and include
representatives across the child welfare system. DFPS developed a governance plan to
support the Trauma-Informed Care Strategic Plan that was approved by DFPS
leadership in May 2012 and amended in December 2013. The core group first met in
October 2011 and continues to provide direction for this TIC Initiative.
Statewide training to date includes:
•
•
•
•
•
•
•
Cenpatico (STAR Health's behavioral health provider) developed and initially
provided Trauma-Informed Care training to all levels of regional staff and some
State Office staff (about 8,000 CPS staff) during FY 2010-2011, which met the
requirement in the Texas Family Code. Cenpatico provides this training to
residential providers, foster parents and kinship caregivers upon request.
Cenpatico also provides Trauma-Informed Care training to all new DFPS staff
during CPS Professional development. Since March of 2013, Cenpatico has
completed 155 trainings with a total of 3,431 staff in attendance.
The Center for Learning and Organizational Excellence has incorporated
Trauma-Informed Care training provided by Cenpatico into CPS Professional
Development and a two-hour online refresher course. Completion of the
refresher course is required for CPS program and contract staff annually. From
April 1, 2012 through April 6, 2015, 2,823 staff received credit for completing the
online refresher course.
DFPS posted a two-hour online training on Trauma-Informed Care on the DFPS
public website at
http://www.dfps.state.tx.us/Training/Trauma_Informed_Care/default.asp.
The DFPS Residential Contract requires contractors to ensure that foster parents
and direct caregivers complete the online Trauma Informed Care Training during
pre-service training and annually thereafter. Resources include training offered
by Cenpatico and materials on the National Child Traumatic Stress Network.
DFPS requires Trauma-Informed Care training for DFPS foster homes.
Cenpatico offers training on Trauma-Informed Care to health care providers in
the network upon request. They also seek Trauma-Focused Cognitive Behavioral
Therapy qualified therapists as part of their network, known as the TraumaInformed Care Specialty Provider Network. They also offer training to certify
behavioral health therapists as Trauma-Informed Care therapists.
In FY 2014, CPS has joined other stakeholders in collaborating with the Texas
Department of State Health Services initiative to certify qualified therapists in
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•
•
•
Parent Child Interaction Therapy (PCIT). Among the 12 therapists selected for
training, two are part of the Cenpatico network. Four others, already certified in
PCIT, were selected for Level 1 training to become "train the trainers" to expand
the base of certified PCIT therapists in Texas.
In FY 2014, the Department of State Health Services consulted with CPS on the
development of an online provider education module on Trauma Informed Care
for EPSDT/Texas Health Steps providers, which was launched on the DSHS
website in September 2014.
A number of other child welfare stakeholders, such as Court Appointed Special
Advocates (CASA), judges, and attorneys ad litem, have an interest in TraumaInformed Care and include workshops on the topic in their various conferences.
In addition to Trauma-Informed Care training, DFPS is also focused on
Secondary Traumatic Stress. DFPS is currently working with Dr. Karen Purvis
and Dr. David Cross from Texas Christian University on creating a curriculum
specifically for DFPS staff. This training will address the unique needs of CPS
caseworkers and supervisors. In the future DFPS would like to create a similar
training for Kinship caregivers.
DFPS is collaborating with experts and exploring ways to enhance caregiver practices
that address the impact of trauma and how caregivers can help children recover and
attain social and emotional well-being.
Comprehensive Coordinated Screening, Assessment and Treatment Planning to
Identify Mental Health Needs and Trauma-Treatment Needs
Current Practice for Identifying and Treating Mental Health Needs
DFPS identifies the mental health needs of children through mental health or
developmental screenings during EPSDT (Texas Health Steps) within 30 days of
entering conservatorship. Texas Health Steps now has a Trauma-Informed Care
training module for providers. Additionally, DFPS may identify mental health needs as
caseworkers gather information for the child's and the family service plans and
Residential Operations receives information for an Admission Assessment required by
Residential Child Care Licensing Minimum Standards. Psychological evaluations and
psychiatric examinations are conducted on children when indicated. Psychological
evaluations are required before children are admitted for treatment services for mental
health disorders or intellectual and developmental disabilities and for placement of
children for adoption. The evaluations also assist in case planning, service coordination,
and in determining recommendations to the court.
Although DFPS does not currently have a standardized process to screen all children
for trauma, many child welfare stakeholders identify children's trauma and refer them for
evidence-based, trauma-informed treatment. Cenpatico has developed a network of
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behavioral health therapists trained in Trauma-Focused Cognitive Behavioral Therapy.
Cenpatico has also hired a director to promote evidence-based and other promising
trauma-focused practices in the Texas child welfare system. DFPS continues to
coordinate with Cenpatico and HHSC to implement evidence-based treatment practices,
such as Parent Child Interaction Therapy within the network. The Texas Child
Advocacy Center clinicians also use TF-CBT and PCIT as part of their therapy services
to the children and families they serve who are receiving services through DFPS.
In response to House Bill 915, Texas created numerous strategies to ensure the
appropriate use of psychotropic medications by strengthening informed consent
processes, training, the judicial review of medical care, notification of parents, and
transition planning. DFPS now requires medical consenters (CPS staff and caregivers)
to attend all psychotropic medication appointments for children in person. Previously,
medical consenters were allowed to participate by phone. The medical consenter and
health care provider must also complete and sign the "Psychotropic Medication
Treatment Consent form" for each new psychotropic medication. This form was
developed in response to House Bill 915 and covers the elements of informed consent
for psychotropic medication for children in foster care.
As part of the consent process for psychotropic medications, the health care provider
and medical consenter must consider any non-pharmacological interventions that
should be tried before or concurrently with psychotropic medications. The medical
consenter must also ensure that the child receives the recommended interventions.
DFPS defined non-pharmacological interventions as any psychosocial therapies and
behavior strategies provided to the child or youth. These interventions can help the child
heal from trauma, cope with traumatic stress, learn to self-regulate, and achieve social
and emotional wellbeing. STAR Health continues to develop and expand the health
plan's clinical capacity to provide, trauma-informed, evidence-based psychosocial
therapies.
All medical consenters are required to ensure that children taking psychotropic
medications have an appointment with the health care provider at least every 90 days
to:
•
•
•
Appropriately monitor the side effects of the medication.
Decide whether the medication is helping the child achieve the treatment goals.
Decide whether continued use of the medication is appropriate.
With stakeholder input, DFPS developed a family friendly brochure, “Making Decisions
About Psychotropic Medications,” which includes expectations regarding psychotropic
medication by children in conservatorship. The brochure addresses nonpharmacological interventions, informed consent, how to talk to health care providers
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about children’s behavioral health needs and psychotropic medications, requirements
for follow-up appointments with health care providers, involving youth in decisions, side
effects and other concerns. Caseworkers are required to give the brochure to all
medical consenters and it is also available on the DFPS website.
Development of a Psychosocial Assessment with Trauma Screening
DFPS recognizes the need to streamline the assessment process and is working with
Texas Health and Human Services Commission to develop a comprehensive
assessment process. With input from stakeholders and experts in assessment, CPS
has recommended the Texas Child and Adolescent Needs and Strengths (CANS),
which includes a trauma module, to provide an assessment for all children over age
three who enter foster care. The goal of the assessment would be to ensure that parties
responsible for the child have a comprehensive, trauma-informed assessment on which
to base behavioral health treatment, placement, intervention strategies and caseplanning decisions.
This assessment would help identify trauma and the need for ongoing behavioral health
treatment or referral for further evaluation. Children with certain psychiatric disorders or
intellectual and developmental disabilities would still receive psychological evaluations,
as appropriate. Streamlining the process would also prevent duplicative assessments
by multiple parties.
The Texas Legislature recently passed legislation that would require such an
assessment. An implementation plan will follow the directives of the law as passed by
the Texas Legislature.
Protocols to Monitor the Use of Psychotropic Medications
Texas implemented a comprehensive protocol to monitor, track and address the
prescribing of psychotropic medications to children in DFPS conservatorship. It was
implemented after DFPS coordinated with Health and Human Services Commission,
STAR Health, and the Texas Department of State Health Services. The protocol
consists of the following components:
Psychotropic Medication Utilization Parameters for Children and Youth in Foster
Care
The parameters are best practice guidelines for use of psychotropic medication for
children and youth in foster care. They include general principles, reference material, a
listing of commonly used psychotropic medications with dosage ranges and indications
for use in children, and nine criteria for indicating need for further review of a child's
clinical status. The parameters were first released in February 2005 and updated in
January 2007, December 2010, and September 2013. The fourth edition is at:
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http://www.dfps.state.tx.us/documents/Child_Protection/pdf/TxFosterCareParametersSeptember2013.pdf. This edition also includes updated information on evidenced-based
assessment/treatment, medication tables, and FDA/literature based dosage ranges.
Psychotropic Medication Utilization Review
STAR Health is contractually required to conduct ongoing oversight of the psychotropic
medication regimens of children to ensure compliance with the parameters. If the child's
psychotropic medication regimen appears non-compliant, the case is referred for a
Psychotropic Medication Utilization Review. The need for a review is triggered by one of
the following:
•
•
•
•
A Telephonic General Health Screening (calls to caregivers of the child)
conducted by STAR Health service managers when a child enters care,
changes placement or status changes indicate a need for a Psychotropic
Medication Utilization Review.
An automated review of Medicaid pharmacy claims data indicates a need
for a Psychotropic Medication Utilization Review.
An outside request from CPS nurse consultants, caseworkers, court
appointed special advocates, foster parents, attorneys, residential child
care providers or others.
A court requests a Psychotropic Medication Utilization Review.
STAR Health Behavioral Health Service Managers (Masters level clinicians) conduct a
preliminary screening of identified cases in which psychotropic medication regimens
appear to be outside parameters. The information gathered during the preliminary
screening is reviewed by a child psychiatrist and, if indicated, forwarded to a child
psychiatry consultant for a formal review and peer-to-peer consultation to the
prescribing physician. The child's case is then tracked by STAR Health to ensure that
the child's psychotropic medication regimen complies with the parameters.
Quarterly Psychotropic Medication Monitoring Workgroup meetings
This task force (chaired by the DFPS Medical Director) includes representatives from
DFPS, Health and Human Services Commission, Department of State Health Services,
STAR Health and the University of Texas at Austin School of Pharmacy. STAR Health
manages the overall psychotropic medication monitoring program. Activities include
quarterly reports from HHSC pharmacy claims data regarding medication usage, STAR
Health reports on the PMUR outcomes, Quality of Care activities and any issues
surrounding Health Passport functioning and usage. The group is updated as to any
ongoing research activities regarding Texas foster care and the general Medicaid
population. The group also oversees the biennial updates of the parameters.
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Quality of Care Reviews
STAR Health reviews physicians identified as having concerning practice patterns
through the Psychotropic Medication Utilization Review process. Physicians that
consistently prescribe, “outside parameters" are referred to the STAR Health
Credentialing Committee for further investigation and action. A Quality of Care review
includes a review of any additional medical records requested and a peer-to-peer
interview with the prescriber. The credentialing committee determines if a physician
should be placed on a corrective action plan, which could include disciplinary action up
to and including termination from the network.
In response to House Bill 915 passed by the Texas Legislature in 2013, processes are
now in place:
•
•
For quarterly psychotropic medication monitoring by the HHSC Medicaid Vendor
Drug Program Pharmacy Utilization Review contractor for:
o Children placed in Texas under the Interstate Compact for the Placement of
Children (ICPC) not enrolled in STAR Health.
o Children in conservatorship, who are dually eligible for Medicare and
Medicaid, typically have end-stage renal disease, and are not enrolled in
STAR Health.
To notify the home state of any child placed in Texas under ICPC when the
medication regimen is outside the parameters.
CPS well-being specialists and regional nurse consultants monitor the medication of
dually eligible children and will continue to assist their caregivers in accessing
reimbursement for medication co-pays.
How the Child Welfare Workforce and Residential Providers Are Trained on the
Appropriate Use of Psychotropic Medications
DFPS created an online Psychotropic Medication Training for CPS Staff, Foster Parents
and Residential Providers, which is available internally and at
http://www.dfps.state.tx.us/Training/Psychotropic_Medication/. The training includes
topics such as:
•
•
•
•
•
•
Appropriate use of non-pharmacological interventions before consenting to
psychotropic medications.
Informed consent.
How to talk to doctors.
The Psychotropic Medications Utilization Parameters for Foster Children.
Administering and monitoring psychotropic medications.
How to report concerns to STAR Health and children's health care providers.
DFPS updated the training based on House Bill 915 to include:
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•
•
•
•
•
Online Medical Consent and Psychotropic Medication trainings were revised to
add requirements for informed consent for psychotropic medications, information
about trauma-informed care and use of non-pharmacological interventions.
New and existing medical consenters are now required to complete the new
Medical Consent training initially and annually sign the Acknowledgement and
Certificate of Completion of Medical Consent Training form, and provide a copy
to CPS caseworkers at time of placement.
All CPS staff, and any caregivers who serve children taking psychotropic
medications, must complete the online Psychotropic Medication training preservice and annually.
DFPS has provided classroom training, in addition to the online training, for CPS
staff attending psychotropic medication appointments at residential operations.
After classroom training was completed around the state, DFPS held a series of
monthly calls with CPS medical consenters to allow them to ask questions.
CPS program and contract staff must complete the online training annually. Other child
welfare stakeholders may access the training on the DFPS website.
Residential Child Care Licensing Minimum Standards require foster parents and
caregivers who administer psychotropic medications to receive pre-service and annual
training on psychotropic medications. Residential operations must use the DFPS online
training and may in addition use the STAR Health training on informed consent for
psychotropic medication developed specifically to meet the needs of caregivers. The
DFPS Residential Child Care Contract requires residential operations to follow the
principles of the Psychotropic Medication Utilization Parameters for Foster Children and
to report concerns to STAR Health.
DFPS finalized a simple, family friendly brochure to help medical consenters when they
talk to doctors about psychotropic medications. The brochure addresses topics such as
involving youth in discussions and decisions, trying non-pharmacological interventions
as appropriate before consenting, questions to ask doctors and follow-up requirements.
It was widely disseminated and is on the DFPS website.
Finally, DFPS updated the general Medical Consent training to make it more userfriendly and included information on consenting to psychotropic medications,
considering non-pharmacological interventions appropriately and Trauma-Informed
care.
Informed and Shared Decision-making (Consent and Assent) and Methods for
Ongoing Communication between the Prescriber, Child, Caregivers, Health Care
Providers, Caseworker, and Other Key Stakeholders
Texas has numerous systems to share decision-making and information about
children's psychotropic medications. Children's medical consenters, who are typically
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children's live-in foster or relative caregivers, emergency shelter staff or CPS staff, have
the legal authority and duty to provide informed consent for psychotropic medications
for children in conservatorship. Medical consenters are required to involve youth in
decisions about their medical care.
Medical consenters who are not DFPS staff are required to notify DFPS of a new
prescription for a psychotropic medication by the next business day. Residential
operations ensure that foster parents and staff who administer psychotropic medications
follow DFPS requirements, monitor for side effects, the child's response to psychotropic
medications, and follow-up with the prescriber at least quarterly and immediately when
the child experiences significant side effects or adverse reactions. DFPS monitors the
overall medical care of children and the performance of medical consenters and acts to
change the medical consenter when needed. The court reviews court reports provided
by DFPS at each court hearing, which includes detailed information about children's
psychotropic medications. The court hearing provides one of several venues for
interested parties to raise any concerns about children's psychotropic medication
regimens.
CPS caseworkers also share medical information with the individuals involved in
children's cases, such as biological parents, caregivers, medical consenter, residential
childcare staff, court appointed special advocates and attorneys ad litem. Although the
medical consenters have the legal authority to consent to medical care, other individuals
involved in the case can provide input into some medical decisions and express
concerns about medical care provided.
Effective Medication Monitoring at Both the Client and Agency Level
DFPS requires that children prescribed psychotropic medications receive follow-up with
their health care providers at least quarterly and metabolic monitoring for children as
indicated in the parameters. Caregivers who administer medications are required to
monitor children's progress and report side effects to physicians. Courts review
children's psychotropic regimens and STAR Health's behavioral health contractor,
Cenpatico, tracks children's prescriptions and conducts Psychotropic Medication
Utilization Reviews when indicated. A Psychotropic Medication Monitoring Group
quarterly reviews data, trends and plans innovations to improve the process.
Availability of Mental Health Expertise and Consultation Regarding Consent and
Monitoring Issues by a Child and Adolescent Psychiatrist
The majority of children in DFPS conservatorship who take psychotropic medications
are under the care of either a general psychiatrist or a child and adolescent psychiatrist.
STAR Health child and adolescent psychiatrists provide consultation to prescribers who
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are outside the parameters during the Psychotropic Medication Utilization Review
process.
The DFPS Medical Director, who is a child and adolescent psychiatrist, consults with
CPS regarding policies and practices addressing the consent to and monitoring of
psychotropic medications. He also periodically participates in case staffings to address
the behavioral health needs and psychotropic medication regimens of children with
complex needs.
Mechanisms for Sharing Accurate and Up-to-Date Information Related to
Psychotropic Medications to Clinicians, Child Welfare Staff and Consumers
The Psychotropic Medication Utilization Parameters for Foster Children provide a listing
of commonly used psychotropic medications with dosage ranges, indications for use in
children and common side effects/adverse reactions. This information is updated
periodically by the University of Texas School Of Pharmacy. The Health Passport also
provides detailed information on each psychotropic medication that is typically included
in pharmacy inserts. STAR Health offers training and information to clinicians.
Psychotropic medication training is often included in various conferences offered to
DFPS staff, external stakeholders and clinicians.
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The State of Texas
Title IV-B Child and Family Services Plan
2015 Annual Progress and Services Report
Fiscal Years 2015-2019
Section XII. Targeted Plans
iii. Disaster Plan
Texas Department of Family and Protective Services
ACYF-CB-PI-15-03
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2016 Child and Family Services Plan
XII. Targeted Plans
iii. Disaster Plan
DFPS recognizes that unexpected disruptive events may bring significant risks to
essential public health service delivery and business processes. The DFPS Continuity
of Operations Plan (COOP) provides a framework for building organizational resilience
to mitigate, minimize, or recover business processes essential to restore mission
essential functions within targeted time frames. Strategies include leveraging of shared
HHS Enterprise resources and working cooperatively and collaboratively with the HHS
Enterprise Emergency Management Council.
Introduction
The Comprehensive Preparedness Guide 101, "Developing and Maintaining State,
Territorial, Tribal, and Local Government Emergency Plans" defines the purpose of the
planning as:
"Planning has a proven ability to influence events before they occur and is an
indispensable contribution to unity of effort…Accomplished properly, planning provides
a methodical way to think through the entire life cycle of a potential crisis, determine
required capabilities, and help stakeholders learn and practice their roles. It directs how
a community envisions and shares a desired outcome, selects effective ways to achieve
it, and communicates expected results."
The DFPS plan describes the processes required to continue or restore the function of
DFPS Mission-Essential Functions (MEFs). The desired outcome is to enable
preparation processes that lead to continuation or rapid return of vital services provided
to our vulnerable stakeholders. Planning for the business continuity of DFPS in the
aftermath of a disaster is a complex task. Preparation for, response to, and recovery
from a disaster affecting the administrative functions of the agency requires the
cooperative efforts and partnership of other functional areas supporting the "business"
of DFPS.
Purpose
The primary purpose of this document is to ensure that DFPS continues or restores
normal business operations under emergency and/or disaster conditions and within
targeted timeframes. Throughout the recovery effort, this plan establishes clear lines of
authority and prioritizes work efforts.
•
Mitigate future injury and property damage through planning and prevention.
2016 Title IV-B APSR
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•
•
•
•
•
•
•
•
•
Ensure that the DFPS can deliver mission-essential services to its
clients/customers.
Provide for the safety of people on the premises at the time of a disaster.
Continue or restore essential support functions (ESFs) and critical support
systems (CSSs) for business operations.
Designate an appropriate incident management structure.
Minimize the duration of a serious disruption to operations and resources (both
information processing and other resources).
Minimize immediate damage and losses.
Establish management succession and emergency powers.
Facilitate effective coordination of recovery tasks.
Identify strategies for preparedness for, response to, and recovery from
emergency incidents and disasters.
Applicability and Scope
This document describes the actions and processes required to maintain essential
functions. The DFPS COOP is developed to ensure that the capabilities exists to
continue mission critical activities a wide range of potential emergencies, including
localized acts of nature, accidents, and technological or attack-related emergencies.
Elements of a standardized continuity plan include:
1. Identification of Mission Essential Functions (MEFs);
2. Orders of Succession;
3. Delegations of Authority;
4. Continuity Facilities;
5. Continuity Communications;
6. Mission-Essential (Vital) Resource Management,
7. Human Capital;
8. Testing Training and Exercising;
9. Devolution of Control and Operations; and,
10. Reconstitution.
This Plan contains these elements as well as describing prioritized mission essential
functions (MEFs); personnel and resources; incident management organizational
structure and procedures; strategic partnerships, relationships and dependencies;
system failure alternatives; continuity risk factors; mitigation strategies; and, concepts of
operations.
Mission-Essential Functions/Personnel/Resources
The focus of the DFPS Business Continuity Program and Plan are mission-driven; that
is, each of the elements of the Plan support accomplishment of our mission and
clientele. The mission of the Texas Department of Family and Protective Services
(DFPS) is “To protect children, the elderly, and people with disabilities from abuse,
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neglect, and exploitation by involving clients, families and communities.” Besides being
mission-based, the DFPS Continuity Program has established the following criteria:
•
A multi-hazard plan that anticipates response requirements of a variety of
possible incident types;
• A plan that addresses each of the 10 recognized components of a
comprehensive COOP program;
• A realistic plan enabling business activities to be reinstated w/in target times
frames;
• Department-wide participation to ensure gap coverage and accounts for the
contribution of all programs;
• Tested/Trained/Exercised annually;
• AARs conducted, and implement improvement plans w/in 90 days;
• Plan that is National Incident Management System (NIMS) compliant and ICSbased.
The Department’s functions are divided into four main programs: Child Protective
Initiate the
COOP Process
Distribute, Maintain
& Update the Plan
COOP
Determine MissionEssential Functions
Planning
Test, Train &
Exercise the Plan
Process
Conduct Risk &
Vulnerability
Design and Build
the Plan
Services, Adult Protective Services, Child Care Licensing, and Prevention and Early
Intervention. The programs serve different populations, but share many administrative
functions. DFPS MEFs are prioritized according to a tiered system that provides the
ability for the Department to restore critical services within targeted timeframes. The
prioritization system also identifies where Department resources must be committed
should circumstances or lack of resources necessitate hard choices.
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DEFINITIONS AND ACRONYMS
• Mission-Essential Functions (MEFs) (Programs): Those activities for which
the Department exists or was created; Functions that are required by statute,
standardized practice, and/or recognized authority. (Example: Child/Adult
abuse investigations, licensing childcare facilities, etc.)
• Essential Support Functions (ESFs) (Support Services): Tasks (and
personnel performing them) and knowledge bases that do not constitute a
MEF, but materially contribute to DFPS’ ability to perform them. (Example:
SWI, IT personnel)
• Critical Support Systems (CSSs) (Tools): Technology, procedures and/or
data sets that enable and/or facilitate the efficient and timely performance of
the DFPS MEFs. (Example: IMPACT, CLASS)
• Other Associated Activities (OAA): Activities and tasks that contribute to
efficiency and effectiveness of the Department, but are not part of the
mission-essential core. (Example: CLOE, CPI)
Mission-Essential Functions Performance Target Timelines
• Tier 1 MEFs/ESFs shall be uninterrupted as much as practical, and in all
cases shall be restored to function within 8 hours of the passing of the
immediate emergency.
• Tier 2 MEFs/ESFs/CSSs shall be uninterrupted as much as practical, and in
all cases shall be restored to function within 24 hours of the passing of the
immediate emergency.
• Tier 3 Support and Systems shall be uninterrupted as much as practical, and
shall be restored to function within 10 days of the passing of the immediate
emergency when possible.
• Other Associated Activities shall be restored as time and resources permit.
Priority of Mission Essential Functions
• Tier 1 MEFs (Core Services & Support)
o Receive APS, CPS, CCL and RCCL Priority 1 referrals and transmit to the
appropriate local office for screening (ESF);
o Investigate/take appropriate action where there is immediate danger
regarding abuse or neglect of children (MEF);
o Investigate/take appropriate action where there is immediate danger
regarding abuse or neglect of older adults and persons with disabilities
(MEF);
o Initiate a welfare check of children in DFPS Conservatorship and FBSS
following an emergency (MEF);
o Investigate/take appropriate action where there is immediate danger
regarding child or adult facility-based complaints (MEF);
o Provide financial resources to support Tier 1 MEFs (ESF).
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•
Tier 2 MEFs (Semi-Core Services & Support)
o Ensure SWI referral and subsequent investigation for all other (non-Priority 1)
activities for all programs (ESF);
o Ensure activation of the Public Communication for Disasters Plan, and initiate
follow-up communication with caregivers of children in DFPS Conservatorship
(ESF);
o Follow-up and track facility evacuation sites and emergency contact numbers
for facilities with open MHMR investigations (MEF);
o Initiate after-event Childcare Licensing Inspection functions to ensure the
safety of childcare facilities (MEF);
o Ensure the availability of information technology in support of normal
operations, with priority to IMPACT and CLASS systems (ESF);
o Ensure DFPS compliance with Strategic National Stockpile agreement (ESF).
•
Tier 3 MEFs (Important Support, Not Urgent)
o Restore routine inspection child care licensing facilities for hazards and
compliance with agency requirements (MEF);
o Ensure Runaway Hotline/Youth Hotline operation & referrals (MEF);
o Restore/Perform purchasing and procurement and accounting functions
except as urgently needed to support Tier 1 MEFs (ESF);
o Perform other administrative and support functions that enable routine
operations (ESF);
o Restore Other Associated Activities as time/resources permit (ESF).
Mission-Essential Personnel/Non-Essential Personnel Defined
• Tier 1 Essential personnel
o All personnel whose responsibilities include supervision and delivery of Tier 1
MEFs/ESFs to clients/customers;
o All personnel whose responsibilities include receiving and routing initial
reports for delivery of Tier 1 MEFs/ESFs to clients/customers;
o All personnel with designated duties in the Incident Management Structure of
the Department, when activated.
o All personnel providing ESF or CSS maintenance of Tiers 1 and 2 MEFs
when/as designated by their supervisor;
Note: All personnel that have been issued State-owned equipment or software
license(s) to enable off-site working (e.g., laptop, tablet, GoToMyPC) must comply with
the DFPS “Work from Home” policy regardless of Essential/Non-Essential Status.
Note: Standard delivery of services may be modified at any time by the Commissioner
through the Chief Operating Officer and Assistant Commissioners.
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•
•
Tier 2 Essential Personnel
o All personnel whose responsibilities include only delivery of Tier 2
MEFs/ESFs/CSSs;
o All personnel whose responsibilities include routine administrative support
when/as designated by management personnel;
o All personnel must remain available for immediate call-back during regular
business hours, their regular work shift hours, and/or as designated by his/her
immediate supervisor during emergencies or other extraordinary
circumstances.
Non-Essential Personnel
o All personnel so designated by management and not involved in delivery or
indirect support of Tiers 1 and 2 MEFs/ESFs; and,
o Personnel whose routine job functions may be suspended for a period of time
without loss of mission-essential services;
o All N/E personnel must remain available for call-back during regular business
hours, their regular work shift hours, and/or as designated by management
personnel during emergencies or extraordinary circumstances.
Note: Any employee's essential status designation may be changed at any time upon
notification. Duties may also be modified to perform tasks not routinely part of his/her
job description, according to the needs of the Department.
Mission-Essential Resources
Mission-Essential Resources are divided into four broad categories (people,
circumstances, tools and performance factors) that define what inputs and
considerations are needed for DFPS to perform its mission. The value of this exercise is
that it assists Incident Commanders to identify missing resources and prioritize efforts to
restore essential services. The following provides details for considerations in each
category:
•
•
•
People
o Number sufficiency to meet performance requirements
o Appropriate certifications/licenses/authority to accomplish mission
o Appropriate training to accomplish mission
Circumstances
o Safety of DFPS personnel
o Mobility/Transportation Availability/Access safety
o Functioning communications
o Administrative support available
o Task volume/number of calls for service within the disaster area
Tools
o Computer/Internet/Paper records
o Communication equipment
2016 Title IV-B APSR
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•
o Vehicle appropriate for the circumstances
o Appropriate safety shields/barriers
o Facilities/Office space
o Records systems access
o Stocked resources (diapers, formula, car seats, walking canes, etc.)
Performance factors ("How well?" or "To what degree?")
o Federal and State statutory mandate
o MEF/BCP performance objectives
o Necessary to "safeguard life and health"
o Necessary to maintain a favorable public opinion
PLANNING ASSUMPTIONS
• The DFPS Mission remains the central value that drives plans and actions
even during extraordinary circumstances as often occur during emergency
incidents and disasters.
• Many DFPS clients meet the FEMA definition of a "Special Needs"
population:
• Populations whose members may have additional needs before, during, and
after an incident in functional areas, including but not limited to:
o Maintaining independence
o Communication
o Transportation
o Supervision
o Medical care
• Individuals in need of additional response assistance may include those that
have disabilities; who live in institutionalized settings; who are elderly; who are
children; who are from diverse cultures; who have limited English proficiency; or
who are non-English speaking; or who are transportation disadvantaged.
• This Plan details the DFPS mission-essential portion of the State's primary goal
and its recovery efforts following a disaster. DFPS is responsible for a missionspecific piece of the State of Texas disaster response, but may be called upon
under extraordinary circumstances to exceed its traditional role.
• DFPS plans are based on industry standards and best practices, where
applicable, and include (at least) the ten elements of continuity planning. Not all
extraordinary circumstances can be anticipated in advance, but preparation for
those that can be anticipated is the responsibility of all personnel.
• "Risk" is the juxtaposition of the three factors of hazard, impact and vulnerability.
Once risk is determined, senior leadership decides to what degree it must be
accepted or mitigated, and what resource commitment is appropriate to the risk.
• Emergency incidents and disasters can be either/both narrowly local, widely
diffuse, or any range in between the two in their impact; the incident impact will
determine the nature and size of the incident management structure.
• Preparedness, in the context of all-hazards homeland security, entails:
o Understanding the Department's business processes and prioritizing client
services.
2016 Title IV-B APSR
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o
o
o
o
o
o
Planning for “all hazards” events.
Organizing prevention, protection, response, and recovery assets.
Equipping with tools and technology for those assets.
Training the organization.
Exercising the Department’s ability to prevent, protect, respond, and recover.
Assessing preparedness throughout the process to adjust the plan as
required.
RESPONSIBILITIES AND ACCOUNTABILITY
Jurisdictional/Organizational Responsibilities
• The Continuity Planning Guide for State, Local, Territorial, Tribal and Private
Sector Organizations defines the scope of jurisdictional/organizational
responsibilities as
"[The] development of strategic COOP vision and overarching policy, the appointment of
key COOP personnel, and the development of a program budget that provides for
adequate facilities, equipment and training."
•
The Continuity Guidance Circular 1, published by the Federal
government delineates the following responsibilities for state, local and
tribal government organizations:
"Continuity requirements must be incorporated into the daily operations of all agencies
to ensure seamless and immediate continuation of Mission Essential Function
(MEF)/Primary Mission Essential Function (PMEF) capabilities so that critical
government functions and services remain available to the Nation’s citizens…
Responsibility for continuity planning resides with the highest level of management of
the organization involved. The senior Elected Official or the administrative head of a
State or local organization is ultimately responsible for the continuation of essential
services during an emergency and for the related planning…Effective implementation of
continuity plans and programs requires the support of senior leaders and decision
makers who have the authority to commit the organization and the necessary resources
to support the programs."
The Commissioner of the DFPS (or his/her designee) shall:
• Maintain overall responsibility for Plan preparation, approval and oversight.
• Activate the Plan (or any portion thereof) and the Departmental Operations
Center (DOC) at his/her discretion.
The DFPS Chief Operating Officer (COO) shall:
• Serve as the DOC Area Commander for supervision of Regional
Command structures;
2016 Title IV-B APSR
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•
•
•
•
•
•
Designate a scalable incident management structure (consistent with
the National Incident Management System [NIMS]) according to the
incident requirements to ensure continuity/restoration of MEFs;
Declare when the immediate hazard is past for the purpose of
beginning of the restoration period for interrupted MEFs (for
performance objective purposes);
Define the operational period length for the incident/event, and define a
personnel relief strategy as needed;
Determine the Department's strategic objectives for each operational
period and cause an Incident Action Plan (IAP) to be prepared for
large/major incidents;
Cause all incidents/events to be fully documented;
Modify the organizational structure as required by the incident, and
determine when the Department shall stand down to resume normal or
reconstituted operations.
The Business Continuity Planner shall:
• Be the primary action officer responsible for updating and
training this plan;
• Act as advisor and subject matter expert (SME) for
business continuity and incident management matters;
• Coordinate and lead the development of the
Department’s homeland security and all-hazards
implementation strategies and preparedness;
• Ensure that the DFPS Plan is consistent and in
compliance with Federal and State mandates;
• Maintain the COOP Plan annually, or as appropriate;
• Maintain a program of After Action Reporting and track
progress on improvement recommendations;
• Coordinate with other agency's activities and plans.
Regional Incident Commanders shall:
• Report to the DOC Area Commander;
• Designate an appropriate and responsive incident management team for
each incident;
• Be responsible for results in restoring normal operations within their region;
• Establish Incident Objectives for each operational period;
• Cause their portion of the incident activities to be documented;
• Integrate strategic partners into the DFPS response to facilitate return to
normal operations.
Other Personnel Responsibilities
2016 Title IV-B APSR
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•
•
All personnel are expected to be responsible to assist as needed to respond
to recovery and program continuity operations;
Personnel are expected to remain flexible in extraordinary circumstances to
perform, as needed, other-than-usual duties, work non-standard hours, or
report to a different work location when called upon to do so.
Continuity Risk Factors
Risk Assessment and Mitigation Planning
This Plan adopts and incorporates by reference the State of Texas Mitigation Plan
(2010-2013) that details specific events/incidents to which the various geographic
regions of the state are vulnerable. Additionally, this plan incorporates by reference the
Texas Health and Human Services Commission Hazard Mitigation Plan.
Risk and Impact Analysis
In addition to the State and HHSC Mitigation Plans, DFPS supplements with a nontraditional Risk and Impact Analysis for All Hazards directed at key functional
vulnerabilities of the Department. DFPS defines risk in terms of threats to certain factors
essential for business continuity. Thus, the planning object is not any event in particular,
but the effects of any incident, event or condition on mission-essential resources:
•
•
•
•
•
•
•
•
•
Facility damage
Power/Other utility loss
Hazardous environment
Loss of staff
Communication/IT Outage
Destruction of/damage to Records
Mobility/Transportation impairments
Mandatory evacuations of citizens and workers
System over-stress due to large client influx
MITIGATION STRATEGIES
Introduction
In support of the State's overall recovery strategy to "reduce vulnerability…and quickly
recover," the Department employs a four-fold approach to reducing risk in the foregoing
areas of functional vulnerability:
• Organize incident management efforts according to accepted and
standard Incident Command System principles and practices;
• Prepare and maintain comprehensive plans to ensure continuity of
business operations and/or the return to delivery of the Department's
MEFs as quickly as practical to meet performance objectives;
• Train and exercise DFPS employees (in accordance with the Federal
Homeland Security Exercise and Evaluation Program [HSEEP]) in
2016 Title IV-B APSR
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•
potential homeland security and all-hazard disaster scenarios to ensure
preparedness;
Support statewide efforts toward response, mitigation and recovery
through participation as a cooperating/assisting agency in the State
Operations Center (SOC) and the State Multi-Agency Coordination Center
(MACC).
Pre-Incident Preparation Strategies
• Define mission-essential functions (MEFs) and produce plans to ensure
their continuation/restoration within targeted restoration time and level
objectives.
• Identify critical service nodes and single points of failure, and build
redundancy into systems and processes where they are cost-effective and
make sense.
• Identify facility needs (number of persons and workstations, square
footage requirements, computer drops/connections required, etc.) for each
office prior to an emergency to facilitate selection of devolution facilities as
quickly as practical.
• Train Department personnel to an appropriate level of specialty in NIMS
structure and practices.
• Ensure event/incident organizational structures and practices are NIMS
compliant.
• Implement a Family Support Planning process to encourage employees to
make pre-incident preparations to arrange for the needs of their personal
family.
• Test plans through a regimen of formal exercises in all regions at least
annually;
• Ensure clear lines of authority and communication for Plan
implementation.
• Define a Departmental incident management organizational structure
appropriate for ensuring MEF continuation/restoration and supporting
state-wide efforts through the SOC and SMOC.
• Designate positional roles for personnel within the incident management
organizational structure, and provide training on role responsibilities.
• Anticipate needs and engage in prudent precautionary activities for those
incidents and emergencies where advance notice can be obtained (e.g.,
hurricanes, rising flood waters, raised terrorism threat level).
• Formalize strategic partnerships and mutual aid relationships prior to the
need for their activation.
• Conduct periodic and formal Business Analysis and Environmental Scans
to ensure the appropriateness of plans with respect to MEFs, and
determine gaps in Plan coverage.
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Post-Incident Continuity Strategies
• Program Operations shall maintain or reestablish conditions necessary for
MEF accomplishment;
• Enable MEFs to continue even when facilities are damaged or destroyed
by activating work from home or mobile workplace methods (laptops,
tablets, GoToMyPC);
• Activate interim facilities plans to maintain staff contact with temporary
facilities;
• Activate strategic relationships, partnerships for internal mutual aid, and/or
external mutual aid with law enforcement for temporary devolution of
responsibilities as needed;
• Activate redundant communication systems, including the ability to
connect intakes with investigators and caseworkers in the field.
Post-Incident Recovery Strategies
Recovery Operations shall initiate tactics to solve incident problems. Branch operations
could include facilities repair/relocation, information technology, records, and/or
security, as appropriate;
• Work closely with Regional Administrative Services/Texas Facilities
Commission for facilities and records issues;
• Identify the need continuity facilities (temporary, long-term,
"synchronization bases");
• Communicate to mobile staff times and places for regular
supervisor/worker contact and check-in;
• Safeguard/secure State-owned equipment;
Post-Incident Command Considerations
• Establish contact with staff and obtain a report of their safety and status.
(Program Ops)
• Consider the major problems, and devise an appropriate command
structure using a standard ICS structure. (Command)
• Initiate reinstatement of Tier 1 Mission Essential Functions within eight
hours. (Program Ops)
• Ensure a communications link with State Office; communicate with all
local offices affected by the incident. (Command, Program & Recovery
Ops)
• Work with Regional Administrative Services (RAS) to initiate a damage
assessment of all local offices and obtain an "all-clear" before entering a
damaged structure. (Recovery Ops)
• Initiate telephone or other contact of DFPS clients in state
Conservatorship to verify their safety. (Program Ops)
• Evaluate damage to computer network equipment. (Recovery Ops)
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•
•
Provide for means of securing buildings if possible; if a building cannot be
secured, provide for the removal of state property to a secure location.
(Recovery Ops)
Secure all electronic and paper records; begin the records recovery
process within 72 hours for damaged records. (Recovery Ops)
Concept of Operations
Incident Management and Planning Philosophy
The incident management philosophy of DFPS is mission-based; that is, all postincident activities and appropriate resources should be directed toward the goal of
restoring mission essential functions within targeted timeframes, and reconstituting
normal operations, subsequently. Toward this end, "local and regional management
with state office support" best describes the strategic structure of incident management
teams. DFPS leadership recognizes that most emergency incidents are best managed
locally, with local response resources and local/regional incident command structures.
State Office personnel empowers local and regional incident command teams, working
within resource constraints and in the context of strategic partnerships, to restore
normal functions and enable the resumption of services as quickly as practical.
DFPS leadership also recognizes that emergency response and operations constitute a
very fluid environment requiring a high tolerance of ambiguity. The appropriate decision
environment for staff is well-stated in the Federal Comprehensive Preparedness Guide
101:
"Planning helps [an organization] know the means it has at its disposal to achieve
desired outcomes by performing critical tasks, under specified conditions, to target
levels of performance. Rather than concentrate on every detail of how to achieve the
objective, an effective plan structures thinking that supports insight, creativity and
initiative in the face of an uncertain and fluid environment."
Bifurcated Mission
The DFPS efforts during disaster response are divided along two parallel-yetinterrelated paths: 1) Continuity of mission essential functions; and, 2) Recovery
operations that deal with the effects of the incident. This distinction is a major one in
contrast to a first responder mission. Social services agencies with vulnerable clientele
cannot statutorily or ethically/morally abandon its safety net role, and must take
affirmative steps to restore services when they are interrupted by urgent circumstances.
Recovery operations refer to those activities that enable reconstitution of normal
operations. In DFPS context, these most frequently will involve facilities, information
technology, records recovery and management, devolution of facilities, and security
issues (including access and safeguarding state-owned assets).
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To support parallel missions, DFPS has designed a flexible management structure that
addresses both strategic needs at the Operations Section Chief (SC) level. The
structure designates a Program Operations SC to lead continuity activities for clientele,
and a Recovery Operations SC to lead efforts to deal with the physical effects of an
incident.
Incident Management Teams: Qualifications and Training
Each DFPS Region has appointed members to a Regional Incident Management Team.
These teams are led by one or more of the Regional/District Directors from the DFPS
Programs (CPS, APS, CCL). In order to qualify to serve in a regular capacity on an IMT,
personnel must be trained to the advanced ICS level (through ICS 300/400 for Social
Services). Prior to enrolling in ICS 300/400, Team members must have taken
appropriate introductory independent study courses through FEMA/Emergency
Management institute Web site (IS 100, 200, 700, 800). The BCP has conducted initial
training of all personnel; additional offerings of ICS 300/400 for SS will be made as
needed as team member turnover occurs. Additionally, as part of the Training, Testing,
Exercising and Maintenance program (TTE&M), IMT members will receive semi-annual
refresher training and exercises. Additionally, DFPS will track and follow all
recommended training requirements through the National Incident Management
System: Five Year Training Plan.
Activation of Incident Management Teams
The National Response Framework (NRF) states that “Incidents must be managed at
the lowest possible jurisdictional level and supported by additional capabilities when
needed.” Within DFPS the lowest practical jurisdictional level is within a region.
Activation of IMTs may also be a local decision by the Regional Incident Commander or
Unified Command Team. There may also be times when a team or multiple teams are
activated from State Office. Teams are said to be “stood up” when activated.
Incident Commanders should keep in mind that it may be appropriate to activate the
team in advance of the emergency if it can be reasonably anticipated (e.g., in advance
of a hurricane, or a planned event).
Area Command Structure and Organization
In terms of recognized National Incident Management System (NIMS) structure and
doctrine, DFPS will, for major incidents, employ an Area Command (AC) centralized
oversight with Regional Command structures and Branch Tactical Planning. Incident
management structures may be further subdivided (at Regional Unified Command level)
into geographic or functional branches.
Regional ICs/UCs are empowered to activate the incident management structure within
their region as necessary; during major incidents, Area Command may designate
specified regions for activation of teams. The Chief Operations Officer (COO) is
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designated as DFPS Area Commander, and will coordinate state-wide emergency
response efforts from the Department Operations Center (DOC).
Unified Command
While Incident Command structure within regional offices remains discretionary, State
Office recommends that regional leadership consider a unified command approach that
incorporates multiple program interests in the formulation of operational period strategic
objectives.
Management by Objectives (MBO)/ICS 202
Management by Objectives is an established model of business and incident
management, and shall be the management approach by which efforts to recover and
restore services will be coordinated.
•
The Incident Commander/Unified Command Team shall be
responsible for determining and approving objectives for each
operational period. Command may be assisted by the General and
Command Staffs in formulating objectives.
• The Plans Section Chief shall be responsible to draft an Incident
Action Plan for Incident Commander approval.
• Objectives should be drafted according to the “SMART” format:
Specific, Measurable, Action-oriented, Realistic, and Timely/timesensitive.
• Operational period objectives shall form the basis of strategies and
tactics developed and employed by the Operations Section
Chief(s). The Ops Section chiefs shall work with the logistics
section chief to order resources to accomplish the objectives.
Incident Documentation
Each incident requiring the activation of an incident management team shall be
documented as follows:
• The RC/UC shall ensure that incident objectives are recorded on an ICS
Form for every operational period. The forms shall be the responsibility of
the Plans Section Chief.
• The Plans Section shall also keep a historical log documenting major
events, such as completion of milestones/objectives, news inputs,
Command and General Staff decisions, staff meetings, etc. The Historical
Log shall be e-mailed or faxed to the Assistant Area Commander for Plans
at State Office at the end of each operational period.
• Other documentation may be required due to the nature of the incident.
The Plans Section Chief is responsible for all documentation efforts on the
regional level.
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Strategic Relationships and Dependencies
Strategic relationships, partnerships and dependencies are those that are vital to
continuity of mission for DFPS, and typically involve interaction to supply material, tools
or expertise not contained within the Department; and, cooperation with agencies that
have essential responsibilities on which DFPS has an affirmative dependence (e.g.,
facilities repair, generator supply, etc.). Some examples of strategic relationships and
partnerships are:
• Local law enforcement for temporary devolution of investigation responsibilities;
• Regional Administrative Services and Texas Facilities Commission for repair of
facilities or relocation to temporary or new permanent facilities for damaged or
destroyed offices;
• "Sister Regions" as designated for internal mutual aid;
• Texas Department of Emergency Management for resource allocation and
coordination;
• Other Enterprise Departments, particularly those sharing facilities;
• Conservatorship families.
Unplanned Outage of Call Receipt/Routing Processes
The pre-investigation phase of DFPS call processing can be divided into the subphases of call-receipt, information recording, and transmission to the appropriate office.
Each of these three sub-phases has an important technology component that expedites
our delivery of service. Two of the three phases occur primarily within the State Wide
Intake (SWI) section, and the third involves the "handshake" between SWI and field
offices.
Unplanned outages of information technology equipment can potentially delay service
delivery to DFPS clients. For this reason, DFPS strives to maintain redundancy in
systems and procedures. A matrix describing the call receipt/transcribing/transmitting
process is contained in Appendix D, as well as procedures in the event of unplanned
loss of any important component.
SCAN (Statewide Communication Access Network) Calls Content and Structure
During major events and incidents, a SCAN call will typically be scheduled daily at
12:00 noon, unless otherwise designated. Other calls may be added as necessary,
particularly for complex incidents, incidents requiring 24-hour staffing attention, or
incidents developing rapidly. SCAN calls will be hosted by the Assistant AC for
Planning, and will typically include the following information:
•
•
•
•
•
Updated weather and other information from the SOC
Concise incident briefings (including IAPs and other documentation)
Area Command roles and responsibilities
Policy, direction, and priorities
Conflict resolution procedures
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•
•
•
Communication procedures, meeting schedules, etc.
Resource ordering process
Critical resource needs
After Action Reporting (AAR)
DFPS has initiated an After-Action Review process with a view toward organizational
learning from incidents, as well as recognizing and reinforcing best practices in the
aftermath of incidents and events. The Business Continuity and Emergency
Management Coordinator will be responsible for the After Action Reporting program.
Scope
The following event/incident types will trigger an After-Action Review
•
•
•
•
•
•
•
•
Significant damage or destruction of DFPS-managed facilities, or where DFPS is an
occupant (any mechanism);
Significant denial of service or closing of facilities due to unforeseeable
circumstances;
Significant events/incidents affecting a group of staff or clients;
Any interruption of Tier 1 & 2 Mission-Essential Functions;
Incidents requiring the activation of one or more Incident Management Teams;
Planned tests of critical Support Systems when unexpected problems occur;
Unplanned downtime of more than one hour for Critical Support Systems;
Any other event/incident where an AAR in desirable.
Format
All AARs shall address at least the following topics:
•
•
•
•
•
Incident time, date and type;
Narrative of significant events/chronology;
What went well;
Opportunities for improvement;
Recommendations.
Follow-up
• The BCP will maintain a folder on the Share Drive that tracks progress on
implementation of all improvements that arise out of the AAR.
• An AAR Improvement Matrix will contain the improvement proposed/accepted, the
responsible party, and a due date for completion.
• The BCP will gather an appropriate group of SMEs to write the AAR and to
implement follow-up improvement recommendations.
CONTINUITY OF OPERATIONS PLAN ELEMENTS
Mission-Essential Functions
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Mission-Essential Functions are identified and discussed in section “Mission Essential
Functions/Personnel/Resources.”
Order of Succession Authority
Succession to office is critical in the event DFPS leadership is debilitated or incapable of
performing their legal authorized duties, roles, and responsibilities. The following predetermined orders of succession are designed to allow for an orderly, and pre-defined,
transition of leadership within DFPS. Successors to the DFPS Commissioner will serve
only until the Executive Commissioner of the HHSC designates a replacement.
Successors of Authority
1. Commissioner, DFPS
2. Chief Operating Officer
3. Chief Financial Officer
4. Assistant Commissioner, Child Protective Services
5. Assistant Commissioner, Adult Protective Services
6. Assistant Commissioner, Child Care Licensing
7. CPS Regional Director, Region 8
Successors to positions other than the Commissioner will be made by the
Commissioner or his/her designee.
Delegations of Authority
• The pre-determined delegations of authority specify the positions that will
have the authority for making policy determinations and key decisions in an
emergency within the areas of responsibility. Delegations of authority take
effect when normal channels of direction are disrupted and end when these
channels have resumed. The following table identifies, by position, the
authorities for making policy determinations and decisions at DFPS state
office and other locations. These delegations of authority address specific
competency requirements in program and administrative areas needed for
effective operations in the event or aftermath of a disaster.
•
The successor identified in the table below has the authority to assume
responsibility for the assumption of the area of responsibility in the event of
the absence or incapacitation of the lead position title until a permanent
successor is named.
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•
DFPS personnel, commensurate with their positional and incident
management responsibilities, maintain discretion when discharging their
duties under this plan.
•
Lead Position Title
•
Area of Responsibility
•
Commissioner
•
Administration
•
Chief Operating Officer
•
Operations
•
Chief Financial Officer
•
•
Assistant
Commissioner
Assistant
Commissioner
•
•
•
•
•
Successor
•
•
Chief Operating
Officer
Director of
Program Support
Budget and Finance
•
Budget Director
•
•
Child Protective
Services
Adult Protective
Services
Assistant
Commissioner
•
Child Care Licensing
Division Director
•
Statewide Intake
Regional Director,
Region 8
Regional Director,
Region 8
District Director,
South Texas
District
SWI Operations
Manager
•
•
•
Devolution
Devolution planning addresses DFPS' capability to transfer statutory authority and
responsibility for essential functions from primary operating staff and/or facilities to other
employees or facilities. It also identifies external dependencies for making the transfer
of location or responsibility. Devolution typically embraces four potential scenarios:
•
•
•
•
Allows the agency to transfer all of its essential functions and responsibilities
to personnel at a different location.
Provides for devolving statutory authority temporarily to an outside agency
(e.g., law enforcement).
Allows for decentralization of Department authority to 11 regional offices
under extreme conditions.
Anticipates relocation of offices following damage to or destruction of
facilities.
The following procedures apply to devolution in major incidents:
•
There may be circumstances where, in association with an emergency,
personnel are evacuated from one area of the state to another to avoid
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danger (e.g., hurricanes with mandatory evacuations). In these instances,
alternative arrangements for coverage of Priority 1 and Priority 2 calls may be
made by cooperating regional offices until workers are able to return. This
application of internal mutual aid by "sister regions" is an example of when
responsibilities for coverage are devolved from one group of personnel to
another in a different location. Typically, this arrangement would be made
necessary only when workers suffer personal damage to their homes and are
not able to timely return from evacuation.
• In the event it is necessary to evacuate workers from one part of the state to
another and conditions are such that internal mutual aid is impractical or will
be substantially delayed, DFPS may devolve its responsibilities to investigate
high priority calls where there are reports of neglect or abuse to law
enforcement for initial investigation.
o The Regional Directors/District Director acting as the Unified Command Team
shall be responsible for ensuring that the law enforcement jurisdiction(s) in
the evacuated county are made aware through official notification that DFPS
is devolving call response/investigation, including the time and date of the
beginning of devolution of responsibilities.
o The Unified Command Team shall notify the on-duty supervisor at Statewide
Intake of the devolution of responsibilities and the counties affected. The onduty supervisor shall ensure notification of the Director of Statewide Intake
and the Chief Operations Officer.
o DFPS shall reinstate normal response when sufficient personnel have
returned, or emergency conditions improve to the degree that personnel may
respond in safety.
• Under extreme conditions and the loss of State Office, State Office authority
may be decentralized and devolved to the Regional and District Directors
statewide. Regional Directors will be responsible for continuing or reestablishing mission-essential functions in coordination with other regions
until such time as reconstitution of State Office can occur.
• The most common form of devolution occurs when a local office suffers major
damage or destruction. Devolution to new facilities may be temporary or
permanent. Devolving facilities will typically involve cooperation with
Regional Administrative Services and/or the Texas Facilities Commission. It
may involve moving to a newly acquired facility, or temporarily sharing a
facility with another location until repairs can be effected.
Continuity Facilities/Alternate Facility Operations
When/If a need arises to devolve operations from one location to another due to
damage or destruction of a facility, DFPS Regional Command and State Office will
coordinate with the office of the Director of Program Logistics, the Texas Facilities
Commission, and HHSC Regional Administrative Services to develop alternatives
temporarily and long-term.
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Vital Files, Records, and Databases
DFPS will maintain vital files, records, and databases necessary to perform essential
functions and activities and to reconstitute normal operations after the emergency
ceases. Vital records have been identified on the agency approved Records Retention
Schedule. There are three categories of records to be reviewed and prioritized, then
transferred (either hard copy or electronic media) to an alternate location:
•
•
•
Client's case files;
Legal/financial records; and,
Any other vital files, records, and databases deemed to be necessary to be
used to perform mission critical activities.
Procedures for caring for wet/damaged paper records may be found at on the Records
Management Web site.
Note: It is important to remember that restoration of wet paper records MUST begin
within 72 hours if at all possible. Also, paper records, including case files, should
NEVER be left on the floor; and, in the event of a foreseeable emergency (e.g.,
approaching hurricane or strong storm) records stored in individual offices/cubicles
should be kept in a manner that best protects them from damage and exposure.
Human Capital
There are many emergency incidents that may affect the availability of DFPS to
maintain MEFs due to the shortage of personnel, including:
•
•
•
•
•
Multiple incidents or a single incident with multiple sites requiring many
resources;
An incident that affects local personnel so that extra-local personnel must be
brought in to backfill or assist with the workload (e.g., a weather event that
damages local workers’ personal property);
A major incident that necessitates mandatory evacuation of a county or other
political jurisdiction (e.g., major hurricane);
A diffuse incident that affects personnel regionally or state-wide to cause
wide-spread shortages (e.g., pandemic flu);
A complex single site incident requiring many resources (e.g., mass child
removal operation).
Human capital shortages are generally handled on a case-by-case basis, and often with
the activation of internal mutual aid. Some potential DFPS actions to meet human
capital shortages are:
•
•
“Sister region” coverage
Temporary reassignment
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• Temporary transfer
• Permanent transfer
Inter-regional coverage of human capital shortages—including travel logistics—will
generally be coordinated by/through the Area Command Team at State Office.
When personnel are ordered to evacuate by the County Judge, or other official having
jurisdiction, the Regional Commander/Unified Command (RC/UC) shall designate postincident contact procedures. The RC/UC shall designate when, where, and/or how staff
should check in following the passing of the emergency to receive further instructions. If
possible, the RC/UC should compile a roster of personnel evacuating, their planned
evacuation destination, and a contact phone number(s).
Interoperable Communications
The success of DFPS operations at an alternate facility is dependent upon the available
and redundancy of critical communication systems to support connectivity to internal
organizations, other state and federal entities, critical stakeholders and the public.
DFPS’ interoperable communication objectives are to provide:
•
•
•
•
Capability commensurate with DFPS’ mission critical activities;
Ability to communicate with essential agency personnel, obtain critical
data, and access other organizational components;
Ability to communicate with other agencies and emergency personnel;
and,
Access to other data and systems necessary to conduct mission critical
activities.
The following communication options have been identified and developed to allow
DFPS to take maximum advantage of the spectrum of communications media likely to
be available in any emergency situation. These services may include, but are not limited
to the following:
•
•
•
•
•
•
GotoMyPC services
Blackberries
Cellular phone communications
Message One Capability
Laptops, with or without soft phones
Internet and intranet webpages
Test, Training, and Exercises
The objectives for the tests are to undertake a thorough and rigorous testing of the
business recovery process, including the simulation of a disruptive event, which
produces results which can be measured and evaluated together with feedback to allow
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the COOP to be enhanced and streamlined. The scope of the tests is to be carried out
in a comprehensive and exhaustive manner so that all aspects of the plan may be
tested. The tests should be contributed to, in a significant manner, by all business and
support units within the organization. The tests will include recovery of all aspects of the
Business Recovery Activities section of the COOP including IT systems recovery.
In order to ensure consistency of the testing process throughout the organization,
members of the Continuity of Operations Team should assist in coordinating the testing
process within each business unit across the agency. Each business process should be
thoroughly tested and the coordinator should ensure that each business unit observes
the necessary rules associated with ensuring that the testing process is carried out
within a realistic environment. At the completion of each test feedback will be provided
to each participating business unit.
All persons serving on regional or state office incident management teams will have
complete Incident Command System Training through (at least) the ICS 300/400 level.
The BCP will be responsible for conducting periodic refresher training for teams, as well
as ensuring training when new members are appointed.
Training and exercises in Incident Command procedures will be provided semi-annually
to regional teams. Generally, training and exercises will be conducted in early spring
(prior to hurricane season) and again in the fall. The Business Continuity Planner will
design and lead training and exercise sessions for regional teams.
Reconstitution
Reconstitution procedures will commence when the Incident Commander or other
authorized person ascertains that the emergency situation has ended and is unlikely to
recur. Once the appropriate person has made this determination in coordination with
other authorities, one or a combination of the following options may be implemented,
depending on the situation.
•
•
Continue to operate from the alternate site location with support, if necessary.
Begin an orderly return to the Headquarters and reconstitute from remaining
or other resources.
• Begin to establish a reconstituted office in some other facility as identified with
assistance from the Director of Program Support and coordinated efforts with
HHSC Facilities and Leasing.
Upon the decision of the Commissioner or other authorized person that the
Headquarters can be re-occupied or that a different facility will be established as a new
location. Working in partnership with Regional Administrative Services:
•
The facility manager, will oversee the orderly transition of all functions,
personnel, equipment, and records from the alternate site location to a new or
restored facility.
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•
•
Prior to relocating to the current Headquarters or another building, Facility
Management will conduct appropriate security, safety, and health
assessments for suitability.
When the necessary equipment and documents are in place at the new or
restored headquarters facility, the staff remaining at the alternate site location
will transfer mission critical activities and resume normal operations.
Multi-Year Strategy and Program Management Plan
The continuity of operations plan is dynamic and only part of an overall DFPS Business
Continuity Program. The plan should be modified as significant changes occur to our
ability to respond, our facilities or organizational structure. As part of the review cycle,
the COOP plans, policies, and procedures will be reviewed at least annually. Additional
reviews should be undertaken following each exercise and the testing of major systems.
Any issues identified in training may trigger a plan review.
Most major issues affecting the COOP plan will result from lessons learned from
exercises. Other sources of information for identifying major issues could come from:
•
Presidential Directive, and state and local ordinances or directives, as
appropriate.
• Direction from agency leadership.
• Policy or mission changes.
• Changes in technology or office systems.
• Changing customer needs.
Long-term plan maintenance will be undertaken carefully, planned for in advance, and
completed according to an established schedule.
Disaster Plan Update
DFPS completed its annual review of its emergency planning practices in October,
2014; and, for this iteration the former Business Continuity Plan has been expanded into
four industry-standard divisions:
• Emergency Operations Plan
• Functional Annexes
• Hazard-Specific Annexes
• Appendices
DFPS' current initial strategy in any disaster/emergency includes the following for
locating staff and conservator shop clients in disasters. These strategies are
documented in the following location in the new revision of the DFPS Emergency
Operation Plan.
Current practice calls for DFPS to initiate a series of telephone contacts with
conservatorship families. Caseworkers are responsible to make contact with their
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assigned clients and report their welfare to their supervisors. The result of these
contacts is included in the DFPS common operating picture report submitted to
DFPS/HHS Executive Leadership.
DFPS tracking of client welfare begins well before the incident for those for which notice
can be given. For example, a hurricane headed for the Texas Coast would trigger prelandfall telephone contact between caseworkers and clients to ensure awareness and
urge foster families to review their required emergency evacuation plans. Once a
mandatory evacuation notice is issued, the calls are repeated and clients are tracked
through the evacuation process until they return home post-incident. For example, in
one recent minor hurricane that made landfall in northern Mexico (but impacted DFPS
Region 11--South Texas), DFPS caseworkers documented over 100 hours of telephone
tracking activities.
As a postscript, DSFPS is currently in the bid process for a mass notification system to
improve the efficiency of the contact process. The proposed system will initiate two-way
contact between the Department and families through multiple media, such as cellular
phone, landline phone, e-mail, and text messaging. The objective is to improve
efficiency and facilitate the communication process between caseworker and clients. A
second objective is to improve the two-way communication process with employees in
disasters. DFPS hopes to have the Request for Proposal (RFP) process completed and
the mass communication system installed and operational in FY2015.
The DFPS emergency management system recognizes a bifurcated mission in disaster
circumstances (for expanded explanation, see EOP, XI.B. Concept of
Operations/Bifurcated Mission, pg. 26):
1. Deal with the effects of the disaster on facilities, processes, information
technology, safety and security, vital records, etc.
2. Continue to respond and manage the business of protecting the unprotected; that
is, both initiating new investigations and managing current cases.
DFPS has established the following Tier 1 Mission-Essential Functions with a targeted
timeline goal of NO GREATER than 8 hours of service interruption:
Tier 1 MEFs (Core Services & Support)
• Receive APS, CPS, CCL and RCCL Priority 1 referrals and transmit to the
appropriate local office for screening (ESF);
• Investigate/take appropriate action where there is immediate danger
regarding abuse or neglect of children (MEF);
• Investigate/take appropriate action where there is immediate danger
regarding abuse or neglect of older adults and persons with disabilities
(MEF);
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•
•
•
Initiate a welfare check of children in DFPS Conservatorship and FBSS
following an emergency (MEF);
Investigate/take appropriate action where there is immediate danger
regarding child or adult facility-based complaints (MEF);
Provide financial resources to support Tier 1 MEFs (ESF).
Though not explicitly stated, DFPS does not differentiate between initial investigation
and on-going casework for the purposes of emergency and disaster circumstances.
Toward this end, DFPS has adapted standard incident management organizational
structures (Incident Command System) to include a Program Operations Section
Chief whose responsibility it is to manage the continued day-to-day caseloads while the
Regional Director and the balance of the Incident Management Team (IMT) dedicate
focused attention to incident recovery and restoration of normalcy. The regional
Program Operations Section Chief leadership is supplemented by an Assistant Area
Commander for Program Operations (AACPO) for each of the Client Programs plus
Statewide Intake. The AACPO's responsibility is to facilitate and routine continuity of
mission activities, and balance mission-essential resources (e.g., personnel) through an
internal mutual aid system should a critical shortage occur anywhere in the state.
DFPS recognizes (in agreement with the National Incident Management System, or
NIMS) that incidents are best managed locally; therefore, the DFPS Incident
Management System establishes, trains, and exercises 10 Regional Incident
Management Teams led by either single command or a unified command arrangement
with all programs participating.
For a "with-notice incident", Regional Incident Commanders are urged to communicate
with the personnel in their region prior to an evacuation and communicate two pieces of
information:
•
The location and contact information for the regional Incident Command Post;
and,
• Their expectations concerning when and how to establish contact and report
their availability following an incident.
In addition to this region-specific information, and for "no-notice incidents," personnel
are given instruction to call the State of Texas 888-TEXRING (1-888-839-7464) phone
number for general information concerning office closings. Failing these contacts,
regional personnel may check in with state office in Austin to get or report disaster
information.
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The Vital Records Section has been expanded in the recently-completed annual
revision (and in this case, general re-write and formatting) of the DFPS Emergency
Operations Plan.
The DFPS Incident Management System was activated in April, 2013 for the West,
Texas Fertilizer Plant Explosion. DFPS Region 7 activated its Incident Management
Team in Waco, TX to provide assistance and information to local residents. One child
placed with grandparents suffered a severe eye injury from flying glass, as did both
grandparents. All three were transported to Dallas Parkland Hospital for treatment. The
Incident Management Team remained activated for three days, and then for an
additional two days on decreased capability. DFPS participated in the Health and
Human Service Commission After Action Report (the DFPS Business Continuity
Planner/Emergency Manager [BC/EM] authored the report). Based on the experience in
West, improvements were made to incident command team training and requirements.
DFPS continues an annual program of team and policy group exercising. For example,
the CY2014 exercise was a mass shooting/death in the line of duty scenario. The CY
2015 exercise is underway, and involves a tabletop discussion of a high-mortality
infections disease scenario led by the BC/EM (who is certified as a Master Exercise
Practitioner by FEMA's National Emergency Training Center, Emergency Management
Institute).
Program leadership determined to leave Runaway Hotline re-instatement at the Tier 3
level; however, every effort will be made to exceed the 10-day target timeline for Tier 3
incidents. Statewide Intake has four FTEs on-staff full time for this service,
supplemented by volunteers. Leadership's rationale was that the full-time staff persons
can most likely be used to initially reestablish the hotlines (at least part-time) and
resume full service as volunteers become available.
DFPS is actively engaged with the current efforts in unaccompanied children and adult
issues in disasters. DFPS has been appointed as the lead agency for Family
Reunification (FR) by the Texas Department of Emergency Management (TDEM). The
DFPS Business Continuity/Emergency Manager is in process of drafting a multi-agency
Family Reunification Guide for inclusion in the Mass Care Annex of the Texas State
Emergency Operations Plan. The focal point of operations for the FR process in
disasters will be DFPS' seat at the State Operations Center (SOC) in conjunction with
the Area and Regional Command structures within DFPS.
DFPS has recently (May, 2015) activated its Area Command and Regional Incident
Management Command Structures to facilitate the Department's response to a statewide severe weather incident that lasted over several weeks. As of this writing (June,
2015) DFPS has received 105 calls for assistance (mostly Adult Protective Services
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cases) through the Abuse and Neglect Hotline as a result of very heavy rain and widespread flooding. The multi-week incident resulted in both State of Texas and
Presidential Disaster Declarations for multiple Texas counties. DFPS is in process of
working these cases as standard agency business process response through APS. An
After-Action Report process is planned to review agency response and improvement
opportunities.
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