Welcome to the training on Trauma-Informed Care for Children in Foster Care provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
The goal of this course is to equip Texas Health Steps providers and other health-care professionals with strategies to implement trauma-informed practices when providing services for children and adolescents in foster care.
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:
- Describe the prevalence and impact of trauma on children in foster care.
- Summarize the characteristics of trauma-informed care within the medical home.
- Review unique considerations in the care provided to children and adolescents in Texas Department of Family Protective Service conservatorship as part of the “3 in 30” requirements.
- Specify how to provide trauma-informed care when providing services for children and adolescents in foster care.
Note: In this module, the term “children” refers to children and adolescents and the term “parent” includes guardians and caregivers, except when differentiation is needed. In addition, the term “foster care” is used as an umbrella to cover a variety of custodial arrangements. The term “DFPS conservatorship” denotes that the State of Texas has custody and requires that specific services be provided.
Please note this module expires on 12/10/2022.
This module was released on 12/10/2019.
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 1.00 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 1.00 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 1.00 contact hour(s) of Continuing Social Work Education.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.00 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).
Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.
Abuse and neglect reporting in Texas:
- Call the 24-hour toll-free DFPS abuse hotline at 800-252-5400.
- Or make a report online on the DFPS reporting website.
American Academy of Pediatrics. (2014). Toolkit: The Medical Home Approach to Identifying and Responding to Exposure to Trauma.
American Academy of Pediatrics. (2015). Immigrant Child Health Toolkit.
Centers for Disease Control and Prevention. (2014). Guidelines for the U.S. Domestic Medical Examination for Newly Arriving Refugees.
Early Childhood Intervention (ECI) Services. Referral form for health-care providers.
PCIT International [Parent-Child Interactive Therapy]. (2019). Find a Therapist.
Texas Department of Family and Protective Services:
- Family-Based Safety Services (FBSS)
- Family Group Decision Making
- Parent Collaboration Group
- Preparation for Adult Living
- Responsible Fathering
- Transitional Living Services.
Texas Department of State Health Services, Texas Health Steps. Mental Health Screening Tools.
Texas Education Agency. (2019). Services for Texas Students with Disabilities Ages 3 through 5 years. Preschool Programs for Children with Disabilities (PPCD).
Trauma Informed Parent: ACEs. Includes an ACE test to get a score.
- Texas Department of Family and Protective Services. Child and Adolescent Needs and Strengths (CANS) Assessment. A Guide to Medical Services at Child and Protective Services (CPS). What is CANS?
- Texas Department of Family and Protective Services. Texas Child and Adolescent Needs and Strengths Assessment (Texas CANS 2.0). Comprehensive Assessment Manual, Texas CANS 2.0.
- Praed Foundation. Texas CANS 2.0 Child Welfare PDF.
- Texas Health and Human Services Commission. Child and Adolescent Needs and Strengths Assessment.
- TFCBT.org, the national therapist certification program for trauma-focused cognitive behavioral therapy. Provider look-up.
- STAR Health Behavioral Health web page, with information for finding behavioral health services for foster children and their families.
- American Academy of Pediatrics. (2012/2016). Technical Report: The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1):e232–e246.
- American Academy of Pediatrics, Healthy Foster Care America. (2016). Helping Foster and Adoptive Families Cope with Trauma.
- American Academy of Pediatrics. (2016). Poverty and Child Health in the United States. Pediatrics 137:4, e20160339.
- American Academy of Pediatrics. (2012/2016). Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. Pediatrics, 129(1):e224e231.
- American Academy of Pediatrics. (2015). Health Care Issues for Children and Adolescents in Foster Care and Kinship Care. Pediatrics, 136(4), e1131-e1140.
- American Academy of Pediatrics. (2014). Adverse Childhood Experiences and the Lifelong Consequences of Trauma. A Guide for Pediatricians.
- American Academy of Pediatrics. (2014). The Medical Home Approach to Identifying and Responding to Exposure to Trauma. A Toolkit for Pediatricians.
- Center on the Developing Child, Harvard University. (2019). Key Concepts: Toxic Stress.
- Centers for Disease Control and Prevention. (2019). Adverse Childhood Experiences (ACEs).
- Cronholm, P. F., Forke, C. M., Wade, R., Bair-Merritt, M. H., Davis, M., Harkins-Schwarz, M., Pachter, L. M., & Fein, J. A. (2015). Adverse Childhood Experiences: Expanding the Concept of Adversity. American Journal of Preventive Medicine, 49(3):354-61.
- Easterlin, M. C., Chung, P. J., Leng, M., & Dudovitz, R. (2019). Association of Team Sports Participation with Long-term Mental Health Outcomes among Individuals Exposed to Adverse Childhood Experiences. JAMA Pediatrics. Published online May 28, 2019.
- Garcia, A. R., Gupta, M., Greeson, J. K., Thompson, A., & DeNard, C. (2017). Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing. Child Abuse & Neglect, 70, 292-302.
- Mental Health Connection of Tarrant County. (n.d.). Recognize Trauma: Change a child’s future.
- Murphy, K. (2019). Support Pregnant and Parenting Youth in Foster Care. Texans Care for Children; Child Protection, Reports and Briefs.
- National Child Traumatic Stress Network. (2016). Children with Traumatic Separation: Information for Professionals.
- Robert Wood Johnson Foundation. (2017). Traumatic Experiences Widespread Among U.S. Youth, New Data Show.
- Sacks, V., & Murphey, D. (2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. Child Trends.
- Schulman, M., & Menschner, C. (2018). Laying the Groundwork for Trauma-Informed Care. Center for Health Care Strategies.
- Stambaugh, L. F., Ringeisen, H., Casanueva, C. C., Tueller, S., Smith, K. E., & Dolan, M. (2013). Adverse childhood experiences in NSCAW. OPRE Report #2013-26, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
- Substance Abuse and Mental Health Administration. (2017). Understanding Child Trauma.
- Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.
- Supreme Court of Texas Children’s Commission. (2019). Building a Trauma-Informed Child Welfare System: A Blueprint.
- Tennant, P. (n.d.). How to Administer a Trauma Screening Using the ACEs Questionnaire. Texas Institute for Child and Family Well-Being, Steve Hicks School of Social Work, University of Texas at Austin.
- Texas Department of Family and Protective Services. (n.d.). Transitional Living Services.
- Texas Health and Human Services Commission. (n.d.). Child and Adolescent Needs and Strengths Assessment.
- Texas Supreme Court, Children’s Commission. (n.d.). Texas Child Protection Law Bench Book.
- Trauma-Informed Care Implementation Resource Center. (n.d.). 10 Key Ingredients for Trauma-Informed Care.
- Trauma Institute & Child Trauma Institute. (2019). Trauma Therapies.
- Trauma Survivors Network. (2019). Risk and Protective Factors.
- Williams, M. T., Metzger, I. W., Leins, C., & DeLapp, C. (2018). Assessing racial trauma within a DSM–5 framework: The UConn Racial/Ethnic Stress & Trauma Survey. Practice Innovations, 3(4), 242–260.
The medical definitions in this module were adapted or obtained from the American Heart Association, Centers for Disease Control and Prevention, Dictionary.com, Lexico, Mayo Clinic, National Library of Medicine, National Child Traumatic Stress Network, National Institute on Drug Abuse, and the University of Michigan.
Recognizing, Reporting and Preventing Child Abuse
Implement best practices to effectively screen for child abuse, comply with legal reporting requirements and promote protective factors that prevent child abuse.
Adolescent Health Checkups
Learn how a morning huddle can set the stage for a successful day of appointments with adolescent patients.