Texas Health Steps Services for Children in Foster Care

“3 in 30” – A Comprehensive Care Approach

The State of Texas provides coordinated health services for children in DFPS conservatorship with a “3 in 30” series of services.

“3 in 30” Services

  • 3-Day Exam

    By law, an initial health exam must be provided within three business days of the child being removed from his or her home. A physician performs a physical exam; evaluates medical, developmental, and behavioral needs; identifies existing injuries or illnesses, including those that may be related to child abuse and neglect; and provides treatment or makes appropriate referrals.

    Note: By law, the 3-Day Exam does not include administration of immunizations.

  • Texas Health Steps Checkup

    Within 30 days, the child must receive a Texas Health Steps preventive medical checkup with all required components on the Texas Health Steps Periodicity Schedule. This checkup is required even if the child is up to date on checkups according to the Periodicity Schedule, even if a checkup was completed a month, a week, or even a day before the child entered DFPS conservatorship. Additional checkup components may be required; these components are discussed in detail in the next section.

    Note: This checkup should be billed as an exception-to-periodicity checkup if the child is up to date on his or her Texas Health Steps preventive medical checkups.

  • CANS Assessment

    Children 3 through 17 years must receive a Texas Child and Adolescent Needs and Strengths (CANS) assessment. CANS 2.0 was developed for DFPS to assist in service planning and assessment. The comprehensive trauma-informed behavioral health assessment must be performed in the first 30 days of DFPS conservatorship and every 12 months thereafter.  The CANS 2.0 must be performed by a licensed clinician enrolled with STAR Health and certified to administer the tool.

Ongoing Coordinated Care

Children in DFPS conservatorship continue to receive Texas Health Steps preventive medical checkups in a medical home. In addition, STAR Health provides specialty referrals, oral health services, vision services, behavioral health services, prescription drugs and medical supplies, and other health services.

By providing a medical home, Texas Health Steps providers coordinate care with other health-care service providers to address the full range of health needs of children in DFPS conservatorship.

Best Practices

The AAP recommends that, when possible, children in foster care continue to receive health care in their original medical home. This promotes continuity of care for the child. It also provides a more complete health history, immunization records, and results of previous screenings.

Texas Health Steps promotes the medical home model and encourages providers to adopt trauma-informed practices to better serve all patients, including children in DFPS conservatorship.


Texas Law

Reporting Suspected Abuse or Neglect

Children removed from their home may have experienced abuse or neglect that has not been reported. Health-care providers are required by Texas law to report suspected abuse or neglect immediately to state or local law enforcement or DFPS. If you detect signs of child abuse or neglect while examining a child in DFPS conservatorship, file a report by:

  • Calling the 24-hour toll-free DFPS abuse hotline at 800-252-5400
  • Or making a report online on the DFPS reporting website.