Welcome to the training on Recognizing, Reporting, and Preventing Child Abuse provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and other health-care professionals who care for pediatric and adolescent patients to recognize, report, and prevent child abuse and neglect.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Distinguish the risk factors, symptoms, and consequences of physical, emotional, and sexual child abuse and neglect.
- Apply ethical principles and legal requirements related to reporting suspected abuse or neglect.
- Integrate routine screening and guidance practices that promote protective factors and reduce the likelihood of child abuse and neglect.
Please note this module expires on 8/2/2022.
This module was released on 8/2/2019.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.75 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.75 contact hour(s) of Continuing Social Work Education.
Licensed Professional Counselors
The Texas Department of State Health Services, Continuing Education Service is an approved provider (#690) by the Texas State Board of Examiners of Professional Counselors to offer continuing education contact hours to Licensed Professional Counselors. The Texas Department of State Health Services, Continuing Education Service has awarded 1.75 contact hour(s) for Licensed Professional Counselors.
The Texas Department of State Health Services is authorized by the Texas State Board of Examiners of Psychologists as a (c)(2)(A) provider of professional development hours for licensed psychologists. Per the Texas State Board of Examiners of Psychologists Act and Rules, at least half (10) of the required 20 hours of professional development must be obtained by a provider listed in section (c)(2)(A). The Texas Department of State Health Services, Continuing Education Service has awarded 1.75 contact hour(s) for Licensed Psychologists.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.75 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.75 hour(s) for attendance.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
- American Academy of Pediatrics. (2019). Practicing Safety.
- American Academy of Pediatrics, healthychildren.org. (2016). Childhood Exposure to Violence.
- American Academy of Pediatrics. (2016). Textbook of Pediatric Care, 2nd Edition. Chapter 42, Safety and Injury Prevention. Chapter 44, Violence Prevention.
- American Academy of Pediatrics, healthychildren.org. (2016). Childhood Exposure to Violence.
- American Academy of Pediatrics, Committee on Child Abuse and Neglect. (2010). Child Abuse, Confidentiality, and the Health Insurance Portability and Accountability Act. Pediatrics, 125(1), 197-201.
- American Academy of Pediatrics. (2008). Policy Statement: The Medical Home. Pediatrics, 110:184–186.
- American Academy of Pediatrics. (n.d.). Medical Home for Children Exposed to Violence.
- Brown, J. L. (2012). Physicians have ethical, legal obligation to report child abuse. AAP News, 33(3), 20.
- Centers for Disease Control and Prevention. (2018). Child Abuse and Neglect: Consequences.
- Centers for Disease Control and Prevention. (2013). Adverse Childhood Experiences (ACE) Study.
- Centers for Disease Control and Prevention. (2012). Child Maltreatment: Risk and Protective Factors.
- Centers for Disease Control and Prevention. (n.d.). Adverse Childhood Experiences, looking at how ACEs affect our lives & society. (Graphics).
- Centers for Disease Control and Prevention. (n.d.). Preventing Child Maltreatment Through Promotion of Safe, Stable, and Nurturing Relationships Between Children and Caregivers.
- Children’s Advocacy Centers of Texas.
- Christian, C. W. (2015). The Evaluation of Suspected Child Physical Abuse. Pediatrics, 135(5), 0031-4005.
- Christian, C. W., Levin, A. V., American Academy of Pediatrics, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, & American Academy of Ophthalmology. (2018). The Eye Examination in the Evaluation of Child Abuse. Pediatrics, 142(2): e20181411.
- Cole, S. J., & Lanham, J. S. (2011). Failure to Thrive: An Update. American Family Physician, 83(7), 829-34.
- Dubowitz, H., Lane, W., Semiatin, J., Magder, L., Venepally, M., & Jans, M. (2011). The Safe Environment for Every Kid Model: Impact on Pediatric Primary Care Professionals. Pediatrics, 127(4):e962-70.
- Dubowitz, H., Feigelman, S., Lane, W., & Kim, J. (2009). Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model. Pediatrics, 123(3) 858-864.
- Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., & Kracke, K. (2009). Children's Exposure to Violence: A Comprehensive National Survey. U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, Juvenile Justice Bulletin.
- Fisher-Owens, S. A., Lukefahr, J. L., Tate, A. R., American Academy of Pediatrics, & American Academy of Pediatric Dentistry. (2017). Oral and Dental Aspects of Child Abuse and Neglect. Pediatrics,140(2): e20171487
- Flaherty, E. G., Stirling, J. & American Academy of Pediatrics. (2010). The Pediatrician’s Role in Child Maltreatment Prevention. Pediatrics, 126(4), 833-841.
- Flaherty, E. G., & Sege, R. (2005). Barriers to physician identification and reporting of child abuse. [Abstract]. Pediatric Annals, 34(5), 349-56.
- Greeley, C. S. (2009). The Future of Child Maltreatment Prevention. Pediatrics, 123(3), 904-905.
- Hillis, S., Mercy, J., Amobi, A., & Kress, H. (2016). Global Prevalence of Past-year Violence Against Children: A Systematic Review and Minimum Estimates. Pediatrics, 137(3).
- Hibbard, R. A., Desch, L. W., & American Academy of Pediatrics. (2007). Maltreatment of Children With Disabilities. Pediatrics, 119(5), 1018 -1025.
- Horner, G. (2013). Child maltreatment: screening and anticipatory guidance. Journal of Pediatric Health Care, 27(4):242-50.
- Jenny, C. & Crawford-Jakubiak, J. E. (2013). The Evaluation of Children in the Primary Care Setting When Sexual Abuse is Suspected, Pediatrics, 132(2), e558–e567.
- Jones, R., Flaherty, E. G., Binns, H. J., Price, L. L., Slora, E., Abney, D., & Sege, R. D. (2008). Clinicians’ Description of Factors Influencing Their Reporting of Suspected Child Abuse: Report of the Child Abuse Reporting Experience Study Research Group. [Abstract]. Pediatrics, 122(2), 259-266.
- Kellogg, N. D., & the American Academy of Pediatrics. (2013). Clinical Report—The Evaluation of Sexual Behaviors in Children. Pediatrics, 124(3), 992-998.
- Jenny, C., Crawford-Jakubiak, J. E., and the American Academy of Pediatrics. (2018). The Evaluation of Children in the Primary Care Setting When Sexual Abuse is Suspected. Pediatrics, 132(2).
- Lane, W. G. (2014). Prevention of Child Maltreatment. Pediatrics Clinics of North America, 61(5): 873-888.
- Lindberg, D. M., Beaty, B., Juarez-Colunga, E., Wood, J. N., & Runyan, D. K. (2015). Testing for Abuse in Children With Sentinel Injuries. Pediatrics, 136(5), 0031-4005.
- Lowell, D. I., Carter, A. S., Godoy, L., Paulicin, B., & Briggs-Gowan, M. J. (2011). A Randomized Controlled Trial of Child FIRST: A Comprehensive Home-Based Intervention Translating Research Into Early Childhood Practice. Child Development, 82(1), 193–208.
- National Center for Biotechnology Information (2010). Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision, Sexual Maturity Rating (Tanner Staging) In Adolescents.
- Ness, C. D. (2009). The Adverse Childhood Experiences (ACE) Study. Schuyler Center for Analysis and Advocacy, Research Briefing.
- Oregon Children’s Justice Act Taskforce, Oregon Department of Justice, Child Abuse Multidisciplinary Intervention (CAMI) Program, & Oregon Network of Child Abuse Intervention. (2017). Project Ability: A Reference Guide for Interviewing Children with Disabilities.
- Orue, I., Bushman, B., Calvete, E., Thomaes, S., de Castro, B. O., & Hutteman, R. (2011). Monkey See, Monkey Do, Monkey Hurt: Longitudinal Effects of Exposure to Violence on Children’s Aggressive Behavior. Social Psychological and Personality Science, 2(4), 432–437. [Abstract].
- Pierce, M. C., Magana, J. N., Kaczor, K., Lorenz, D. J., Meyers, G., Bennett, B. L., & Kanegaye, J. T. (2016). The Prevalence of Bruising Among Infants in Pediatric Emergency Departments. Annals of Emergency Medicine, 67(1), 1-8.
- Putnam-Hornstein, E., Cederbaum, J. A., King, B., Eastman, A. L., & Trickett, P. K. (2015).
- A Population-Level and Longitudinal Study of Adolescent Mothers and Intergenerational Maltreatment. American Journal of Epidemiology, 181(7), 496–503.
- Seay, D. M., Jahromi, L. B., Umaña-Taylor, A. J., & Updegraff, K. A. (2016). Intergenerational Transmission of Maladaptive Parenting Strategies in Families of Adolescent Mothers: Effects from Grandmothers to Young Children. Journal of Abnormal Child Psychology, 44(6), 1097-1109.
- Selph, S. S., Bougatsos, C., Blazina, I., & Nelson, H. D. (2013). Behavioral Interventions and Counseling to Prevent Child Abuse and Neglect: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Annals of Internal Medicine, 158(3), 179-190.
- Sege, R. D; Amaya-Jackson L.; American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, & National Center for Child Traumatic Stress. (2017). Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment. Pediatrics, 139(4): e20170100
- Shanley, J. R., Shropshire, D., & Bonner, B. L. (2009). To Report or Not Report: A Physician’s Dilemma. Virtual Mentor, 11(2): 141-145.
- Shonkoff, J. P., & Garner, A. S. (2012). The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 129(1), e232-e246.
- Spies, E. L. & Klevens, J. (2016). Fatal Abusive Head Trauma Among Children Aged <5 Years — United States, 1999–2014. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR), 65(20): 505–509.
- Stalker, K., & McArthur, K. (2010). Child abuse, child protection and disabled children: a review of recent research. Child Abuse Review, 21(1), 24-40. [Abstract].
- State of Texas. (2015). Protect Our Kids Commission Report.
- Texas Administrative Code, Title 40, Chapter 700, Subchapter E, Division I, RULE §700.517, Investigation of Lack of Medical Care Because of Religious Beliefs. (2019).
- Texas Department of Family and Protective Services. (2019). Fiscal Year 2018 Child Maltreatment Fatalities and Near Fatalities Annual Report.
- Texas Department of Family and Protective Services. (n.d.). Home Visiting.
- Texas Department of Family and Protective Services. (n.d.). Recognize the Signs of Child Abuse.
- Texas Department of Family and Protective Services. (n.d.). Reporting Abuse, Neglect, or Exploitation.
- Texas Department of State Health Services. (2010). Child Abuse Screening, Documenting, and Reporting Policy For Contractors (and) Providers. Child Abuse Reporting.
- Texas State Legislature. Texas Family Code. Title 5. The parent-child relationship and the suit affecting the parent-child relationship Subtitle E. Protection of the child. Chapter 261. Investigation of report of child abuse or neglect.
- Texas State Legislature. Texas Penal Code § 21.11. Title 5. Offenses against the person
- Chapter 21. Sexual offenses
- The Nemours Foundation, KidsHealth. (2016). When Your Teen Is Having a Baby.
- U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2019). Child Maltreatment 2017.
- U.S. Department of Health and Human Services, Children's Bureau. (2019). The Child Abuse Prevention and Treatment Act (CAPTA).
- U.S. Department of Health and Human Services. (2016). Building Community, Building Hope: 2016/2017 Prevention Resource Guide.
- U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2013). Long-Term Consequences of Child Abuse and Neglect. Fact sheets.
- U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2013). What Is Child Abuse and Neglect? Recognizing the Signs and Symptoms. Factsheets. In Spanish.
- U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2013). Chapter 2: Working With Families: The Six Protective Factors. Preventing Child Maltreatment and Promoting Well-Being: A Network for Action (pp. 9-20).
- U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2012). The Risk and Prevention of Maltreatment of Children with Disabilities.
- U.S. Department of Health and Human Services, Child Welfare Information Gateway. (n.d.). Protective Factors.
- U.S. Department of Health and Human Services, Office on Child Abuse and Neglect, Children's Bureau. (2003). A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice.
- U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention. (2009). 2008 National Survey of Children’s Exposure to Violence.
- Vachon, D. D., Krueger, R. F., Rogosch, F. A., & Cicchetti, D. (2015). Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment. JAMA Psychiatry, 72(11):1135-1142.
- Van Horne, B. S., Moffitt, K. B., Canfield, M. A., Case, A. P., Greeley, C. S., Morgan, R., & Mitchel, L. E. (2015). Maltreatment of Children Under Age 2 With Specific Birth Defects: A Population-Based Study. Pediatrics, 136(6):e1504-12. [Abstract].
The medical definitions provided in this module were obtained or adapted from the Centers for Disease Control and Prevention, Developmental Science, Emergency Medicine Clinics of North America quarterly, the Mayo Clinic, Mosby's Medical Dictionary 8th edition, the National Institute on Alcohol Abuse and Alcoholism, Psychology Dictionary, Stanford University, the U.S. Department of Health and Human Services, and the U.S. National Library of Medicine.
- Adverse Childhood Experiences. A series of graphics from the CDC that portray how adverse childhood experiences (ACES) affect individual lives and society, with resources and references.
- Building Community, Building Hope 2016 Prevention Resource Guide, U.S. Department of Health and Human Services. Information, strategies, and resources to help communities support and strengthen families and promote the well-being of children and youth.
- Centers for Disease Control and Prevention. Sex Trafficking. Information on the risks, signs and consequences of sex trafficking, and a list of resources.
- The Child Abuse Prevention and Treatment Act (CAPTA). U.S. Department of Health and Human Services.
- Child Welfare Information Gateway. A federal clearinghouse of information promoting child and family well-being; public awareness and creative, supportive communities; prevention programs; and evidence-based practice.
- Children’s Advocacy Centers of Texas. A membership association representing all local children’s advocacy centers in the state.
- Children’s Safety Network. A National Resource Center for Injury and Violence Prevention that provides technical assistance on injury prevention planning, programs, and best practices; analyzes and interprets injury data; disseminates the latest injury prevention research; conducts trainings and presentations; and produces publications.
- Darkness to Light, a national nonprofit dedicated to ending child sexual abuse, offers “Stewards of Children,” a sexual abuse training program focused on increasing knowledge, improving attitudes, and changing child-protective behaviors. It addresses sexual abuse signs and situations in which abuse is most likely to occur, as well as prevention and protection strategies.
- Docs for Tots. Nonprofit, nonpartisan, advocacy organization to encourage doctors to fulfill their important role as active advocates for infants, toddlers, and preschoolers on the national, state, and local levels.
- Effective Discipline to Raise Healthy Children. This policy statement from the American Academy of Pediatrics (AAP) provides guidance for pediatricians and other child health-care providers on educating parents about positive and effective parenting strategies of discipline for children at each stage of development as well as references to educational materials.
- Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments. This document from the Centers for Disease Control and Prevention’s Division of Violence Prevention proposes strategies that communities, including professional groups, can consider to promote the types of relationships and environments that help children grow up to be healthy and productive citizens that can, in turn, build stronger and safer families and communities for their children.
- The Evaluation of Suspected Child Physical Abuse, AAP Committee on Child Abuse and Neglect. Outlines the role of the physician, which may include identifying and reporting child abuse, supporting families who are affected by child abuse, coordinating with other professionals to provide treatment to children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.
- Eco-Bio-Developmental Model of Human Health and Disease from the AAP. The Adverse Childhood Experiences (ACE) Study and others demonstrate strong associations between early childhood adversity, including abuse and neglect, and a wide array of sub-optimal adult outcomes in physical and mental health and prosperity. Early childhood has lifelong effects on development of adaptive behaviors, learning capacity, physical and mental health, and economic productivity. An integrated approach to health care is referred to as the “ecobiodevelopmental” framework. The AAP provides resources on applying this model to patient care.
- Literacy Promotion. Participation in Reach Out and Read is associated with improved parent-child interactions and many other benefits. The AAP recommends that pediatric providers promote early literacy development for children beginning in infancy and continuing at least until kindergarten. Recommendations include counseling parents about developmentally appropriate shared-reading activities, providing developmentally appropriate books at medical checkups for high-risk and low-income young children, and using a robust spectrum of options to support and promote these efforts.
- Maltreatment of Children With Disabilities. An AAP policy statement about the need for early recognition and intervention of child abuse and neglect of children with disabilities, as well as the ways that a medical home can facilitate the prevention and early detection of child maltreatment.
- Maltreatment Risk in Communities. A series of maps from the University of Texas System intended to provide communities in Texas with information about their maltreatment risk and insight into factors associated with that risk.
- National Alliance of Children’s Trust and Prevention Funds. Free online training courses to support implementation of the Strengthening Families™ Protective Factors Framework in multiple settings.
- National Human Trafficking Hotline website. Resources and information about safety planning and other topics for victims and survivors of human trafficking.
- Preventing Child Maltreatment and Promoting Well-Being. This resource guide from the Parent Child Center of Tulsa focuses on the protective factors proven to reduce the risk of abuse and neglect, and provides tools and strategies to integrate the protective factors into existing programs and systems.
- The Resilience Project. A project of the AAP, providing information on creating a medical home, types of violence and their prevalence, clinical assessment tools, and other resources.
- Prevention is Possible. Part of a video gallery provided by the Centers for Disease Control and Prevention, this three-minute video shows Shairi Turner, MD, MPH, and former Deputy Secretary for Health, Florida Department of Health, discussing child abuse and neglect prevention.
- Recognizing, Reporting, and Preventing Child Abuse and Neglect. A Texas Health Steps video overview of the extent of child neglect and abuse in Texas, signs and symptoms that can be identified during a primary care medical checkup, and the health-care provider’s role in prevention of abuse and neglect. Share this video with staff members who have contact with patients.
- Tanner Staging for Adolescents. Sexual Maturity Rating. A World Health Organization tool to help providers place adolescents in the appropriate stage of sexual maturity.
- Technical Assistance Center on Positive Behavioral Interventions and Supports. Information from the U.S. Department of Education about positive school-based behavioral interventions and support for advocacy efforts.
- Texas A&M AgriLife Extension Child Care Courses. Free training for child-care providers and educators, with most courses developed in cooperation with the Texas Department of Family and Protective Services (DFPS). Topics include guidance and discipline; developmentally appropriate activities; safety in the child-care setting; and preventing, recognizing, and reporting child abuse and neglect, among others. (Some courses require a fee to obtain a certificate of completion.)
- Texas Department of Family and Protective Services. Child Protective Services web page provides a variety of services to strengthen families so children can stay safe at home with their parents. Find a Regional Office near you.
- Texas Department of State Health Services. (2010). Child Abuse Screening, Documenting, and Reporting Policy For Contractors/Providers.
- Texas Family Code “TITLE 5. The Parent-Child Relationship And The Suit Affecting The Parent-Child Relationship, Subtitle E. Protection Of The Child, Chapter 261, Investigation Of Report Of Child Abuse Or Neglect, Subchapter A. General Provisions.”
- Texas Health Steps Periodicity Schedule. Download copies in a large color format, pocket-size, or laminated.
- Texas Home Visiting (THV). This Texas Department of Family and Protective Services includes two primary components: 1) provision of evidence-based home visiting services for at-risk pregnant women and parents/caregivers of children birth to through age 6 years, and 2) development/enhancement of early childhood coalitions that coordinate services and address broad, community-level issues that impact young children and families. For direct service delivery, THV uses three evidence-based home visiting programs: Nurse-Family Partnership (NFP), Parents as Teachers (PAT), and Home Instruction for Parents of Preschool Youngsters (HIPPY).
- Texas Medical Child Abuse Resources and Education System. Find a list of child abuse pediatricians (CAPs) and specialist contacts in Texas on this Texas Department of State Health Services web page.
- Texas Protect our Kids Commission report includes a summary of the national and state work currently underway; an inventory of evidenced-based and promising practices to reduce child abuse fatalities in Texas; specific recommendations about abuse and neglect prevention, data collection, the state and local child fatality review team processes; and sustainability of the work already begun in Texas. Appendix A, a comprehensive chart of prevention programs in Texas, may be of particular interest to health-care providers.
- Triple P - Positive Parenting Program. Multi-level system of family intervention developed through more than 30 years of clinical research trials. It aims to prevent severe emotional and behavioral disturbances in children by promoting positive and nurturing relationships between parent and child. It also offers training for organizations and practitioners as well as self-help and parent resources.
- United Against Human Trafficking. This Houston-based nonprofit provides professional education and youth and direct outreach programs to combat human trafficking. Victims of human trafficking are subjected to force, fraud, or coercion for the purpose of sexual exploitation or forced labor.
- U.S. Department of Health and Human Services, Child Welfare Information Gateway. About CAPTA: A Legislative History. This fact sheet summarizes the legislative history and purpose of the Child Abuse Prevention and Treatment Act (CAPTA), the key federal legislation addressing child abuse and neglect.
- U.S. Department of Health and Human Services, Administration for Children and Families. The Office on Trafficking in Persons provides victim assistance and resources and training to combat human trafficking.
- U.S. Department of Justice, Office for Victims of Crime. Through Our Eyes: Children, Violence, and Trauma. This web page includes videos and other resources to help anyone who plays a role in identifying, protecting, and treating children exposed to violence.
Resources for Parents and Caregivers
(The following resources can be printed out for or emailed to parents).
- Child Welfare Information Gateway. “Find Help with a Personal Situation” includes a list of resources to help parents deal with child abuse, domestic violence, parenting, and more.
- Darkness to Light, a national nonprofit dedicated to ending child sexual abuse. It offers resources and “Five Steps to Protecting Our Children”—Learn the Facts, Minimize the Opportunity, Talk About It, Recognize the Signs, and React Responsibly.
- Help for Parents, Hope for Kids. A website from the Texas Department of Family and Protective Services that offers local resources to help parents, caregivers, child-care providers, community members, companies, and organizations give children hope for a brighter future.
- Little Texans, Big Futures. Learning guide for infants, toddlers, and 3-year-olds, created by the Texas Early Learning Council to help Texans understand what very young children should know and be able to do at different points in their development. Discusses “Responsive Caregiving,” a style of interaction between caregiver and child that builds a solid foundation for future relationships and learning. It can play an important role in the prevention of child abuse and neglect.
- Stop Abuse for Everyone (Safe). A national nonprofit alliance to stop child abuse and neglect through an array of programs including housing, counseling, education, and advocacy.
- Supplemental Nutrition Assistance Program (SNAP). U.S. Department of Agriculture program that provides food-buying assistance to individuals and families in need.
- Take Time Texas. A Texas Health and Human Services Commission project offering resources to find short-term relief, or “respite” services, for families and primary caregivers to restore and strengthen their ability to continue providing care for a child. Such services contribute to ensuring the safety of children by giving caregivers the opportunity to rest, recharge, and come back refreshed.
- Texas Council on Family Violence. Works to end family violence through partnerships, advocacy, and direct services for women, children, and men, including support of domestic violence shelters, and intervention and prevention programs; domestic violence-related resources library; and public awareness efforts about domestic violence in Texas and beyond.
- Report Child Abuse, Neglect, or Exploitation. The Texas Department of Family and Protective Services (DFPS) provides a central place to report child abuse and neglect. A person who reports abuse in good faith is immune from civil or criminal liability and DFPS keeps the name of the person making the report confidential. Anyone who does not report suspected abuse can be held liable for a misdemeanor or felony.
- Texas Parent to Parent (TXP2P). A nonprofit parent-to-parent peer support model to improve the lives of Texas children who have disabilities, chronic illness, and/or special health-care needs. Includes resource referral and education.
- The Period of PURPLE Crying. An informative website sponsored by the National Center on Shaken Baby Syndrome. The letters stand for Peak crying, Unexpected, Resists soothing, Pain-like face, Long-lasting, and Evening—characteristics of infant crying from about 2 weeks through 4 months of age. The program helps parents understand this early period in their baby’s life and includes practical, research-based strategies to guide how to soothe their infants and to cope.
- Texas Poison Center Network. A 24/7 toll-free poison information help line at 800-222-1222 for health-care providers and the public. If you think someone has been poisoned or exposed to toxins, call immediately. Do not wait for the victim to look or feel sick. Callers can access a network of nurses, pharmacists, paramedics, and physicians with extensive education, training, and expertise in toxicology. If necessary, the poison network staff may refer callers to the nearest hospital and may assist in the caller's initial treatment and follow-up care.
- Women, Infants, and Children (WIC), a nutrition program for pregnant women, breastfeeding women, and families with children 4 years of age or younger.
- 2-1-1 Texas. A website and phone number with information to help Texans find the services they need from more than 60,000 state and local programs, including information to help parents and caregivers find a parenting class, someone who knows about parenting to come to the home, short-term child care in an emergency, and services for a child with special health-care needs.
Preventing Unintentional Injury
Equip Texas Health Steps providers and others to identify risk factors for unintentional injury from birth through 20 years, provide age-appropriate anticipatory guidance, and apply state law and best practices to prevent unintentional injury and death.
Building a Comprehensive and Effective Medical Home
Learn how and why to create and sustain a medical home in your primary care practice.
Interpersonal Youth Violence
Implement strategies to identify, intervene in, and prevent behaviors such as bullying, self-injury and suicide, dating violence, and sexting. Includes guidelines for ethically responding when an adolescent patient perpetrates violence.
Concussion: Diagnosis, Treatment, and Prevention
Learn to diagnose, treat, and prevent concussion in children and adolescents.
Texas Health Steps Guidance
Texas Health Steps Guidance
Anticipatory guidance—age-appropriate education and counseling—is a required component of every Texas Health Steps preventive medical and dental checkup. Texas Health Steps offers age-appropriate education and counseling topics so providers can assist patients, families, and caregivers to understand growth, development, and healthy practices. Texas Health Steps recommends that health-care providers personalize anticipatory guidance depending on the needs of their patients. Anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the child or adolescent and their parent or guardian. Specific guidance should also be based on findings obtained during the health history and physical exam.
Texas Health Steps offers Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years. It mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.
Families and caregivers of children with chronic medical conditions face complex challenges and extended stress. Providing long-term care for a child with a disability or chronic illness can take a physical, emotional, and financial toll. It also requires a time commitment that can be difficult to achieve.
As a pediatric health-care provider, you “have a responsibility to recognize caregiver burden (Adelman, Tmanova, Delgado, Dion & Lachs, 2014). Research has shown that caregivers are at increased risk for depression, anxiety, and other negative health effects of what can be a crushing responsibility. At each pediatric checkup, make it part of your routine to inquire whether family or caregivers have questions or concerns about their roles, their own health, or navigating the health-care system.
The health of your young patients and the health of their caregivers are interwoven.
Caregivers who feel overwhelmed may not be able to provide appropriate care for a child in need. You must be alert to outcries for help or signs of health problems related to caregiving, including loss of sleep and diet imbalance. Open communication allows you to be a sounding board for caregivers who are struggling with their duties. At the same time, be on the watch for signs of fatigue or stress in caregivers who try to project an “all’s well” attitude even when they are having problems.
Your role includes providing practical counseling about stress and offering resources designed to help families and caregivers cope.
Top 10 Caregiver Coping Skills
Sharing this Top Ten list of coping skills can help caregivers learn strategies that may reduce stress:
- Understand your feelings.
- Express your emotions.
- Educate yourself about your child’s illness or condition.
- Keep communications open.
- Talk to other parents.
- Focus on the strengths and goals that are achievable.
- Believe in your child.
- Establish routines.
- Maintain your sense of humor! There is no co-pay for laughter!!
- Remember that taking care of yourself is caring for your family.
Source: Parent to Parent of New York State
Resources to share with families and caregivers
Aging and Disability Resource Centers (ADRCs) operated by Texas Health and Human Services (Texas HHS). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support, and housing. Visit the ADRC website for a list of resource center locations in Texas.
Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program, a branch of the Texas Department of State Health Services.
Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This unique site offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
Take Time Texas, a website offered by Texas HHS that includes a state inventory of respite services.
Texas Parent to Parent offers peer support for parents of children with special health-care needs.
All Medicaid managed care organizations (MCOs) provide case management services (called service management for STAR members with special health-care needs). In the other Medicaid managed care programs, everyone gets some level of case management. Patients should first be referred to the plan’s service coordinator and then referred to Case Management for Children and Pregnant Women if patient needs cannot be met by the plan’s services. Health plans are also required to make appropriate referrals to case management services.
For patients enrolled in STAR Medicaid, STAR Health, or Fee-For-Service (FFS) Medicaid, providers can make a referral by one of these methods:
- Calling 877-847-8377 (877-THSteps).
- Contacting a case manager (“Find a Case Manager” web page accessed from the Resources for this module).
- Submitting the Case Management Referral Form (the form is also accessed from Resources).
For patients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the STAR Kids Case Management Request Form (the form is also accessed from Resources).
Early Childhood Intervention (ECI) is a statewide program for families with children birth through 35 months who have disabilities and developmental delays. All health-care providers are required by federal and state regulations to refer children 35 months and younger to the local ECI program as soon as possible but no later than seven days after the suspicion or identification of a developmental delay.
To qualify for ECI services, a child must have:
- A qualifying medically diagnosed condition that has a high probability of resulting in a developmental delay. For more information, visit the ECI Qualifying Diagnosis Search web page.
- An auditory or visual impairment as defined by the Texas Education Agency (TEA) rule at 10 TAC Section 89.1040.
- A documented delay of at least 25 percent in one or more of the following areas of skills and development: gross motor, communication, cognition, fine motor, social, emotional, or self-help. Or, a documented delay of at least 33 percent when the delay occurs only in expressive language.
- A qualitative determination of delay, as indicated by responses or patterns that are disordered or qualitatively different from what is expected for the child’s age.
To refer a child, providers should use the ECI Provider Referral and Feedback form. The form, which requires a parent or guardian signature, helps ensure that ECI’s evaluation results and service plan are shared with the referring provider.
To refer families for services, providers can call the local ECI program.
Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record in order for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component that is not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results, and referrals. Texas Health Steps child health clinical record forms are optional but are recommended to assist providers with documentation of all required checkup components. Providers should be aware that Texas Health Steps checkups are subject to retrospective review and recoupment if the medical record does not include all required documentation.
A medical home is the patient’s primary point of contact when accessing health care. The medical home concept was developed by the American Academy of Pediatrics (AAP) and is promoted by Texas Health Steps. A medical home is defined as one in which care is accessible, family-centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. It is a partnership between a child, the family or caregiver, and the child’s primary health-care setting. The primary health-care setting can be a physician’s office, a hospital outpatient clinic, a school health center, a community health center, or a health department clinic.
Providers who need assistance finding a specialist or subspecialist who accepts patients enrolled in Medicaid can find a specialist or subspecialist by using the Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup or by calling the Texas Health Steps toll-free help line for providers at 800-964-2777 Monday through Friday from 8 a.m. to 6 p.m. Central Time. Select option 3 to speak with a representative.
Providers can access a set of child health clinical record forms to document Texas Health Steps preventive medical checkups. The set includes a form for each checkup under the Texas Health Steps Periodicity Schedule, for patients from up to 5 days old through 20 years. Providers can save or print the forms.
Each form includes the required components for that age’s checkup, along with space for documenting routine, non-required components of a medical checkup. The backside of the form includes a helpful list of suggested anticipatory guidance topics and checklists such as the Hearing Checklist for Parents and Lead Risk Factors.
Texas Health Steps is the preventive care services program for children birth through 20 years who are enrolled in Medicaid. Texas Health Steps provides regular checkups and screenings as part of the Early and Periodic Screening, Diagnosis, and Treatment program, also known as EPSDT.
In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components—or Early and Periodic Screening (EPS)—of the total EPSDT service. Required medical checkups and preventive care services are provided in accordance with the latest Texas Health Steps Periodicity Schedule, which is modeled after the one developed by the American Academy of Pediatrics (AAP). Additional checkup components are required in Texas to meet federal and state guidelines, and checkups are encouraged as part of the medical home. The Periodicity Schedule specifies when each of the checkup components is due. Providers should always refer to the latest schedule available. To download a PDF of the Periodicity Schedule online, visit the Texas Health Steps Provider Information web page.
The Texas Medicaid & Healthcare Partnership (TMHP) updates the TMPPM monthly. The policy updates are published on the TMHP website and in banner messages, which appear weekly on a provider’s Remittance and Status Report as well as on the website. Providers can find updates on the web page in two ways:
Release Notes—Changes to the TMPPM arranged by date, with most recent at the top of the list.
Change History—Changes to the TMPPM arranged by chapter. (If a chapter has not changed, it will not appear on the list).
NOTE: Providers should always check the TMHP website for the current TMPPM, banner messages, and policy and procedures updates. Archived versions of the TMPPM will remain online for reference purposes.