Texas Child Protection Law Bench Book
2024 version: As effective October 1, 2024
E. Child and Family Assessments
Texas Health Steps: All children entering DFPS conservatorship must receive a comprehensive, preventive healthcare checkup within 30 days of entering DFPS conservatorship known as the “Texas Health Steps” medical checkup. The checkup helps identify the child's unique healthcare needs and helps DFPS make decisions that are in the child's best interest. This checkup is repeated annually or according to the Texas Health Steps periodicity schedule.
Medical Exam Within Three Business Days: Beginning September 1, 2023, a change to the “Three-Day Exam” policy means that not all children will automatically receive a Three-Day Exam. Only qualifying children who enter DFPS conservatorship will receive an initial medical examination from a physician or other healthcare provider authorized by state law to conduct a medical examination by the end of the third business day after the child is removed from the child's home. Tex. Fam. Code § 264.1076. Qualifying circumstances are if the child was removed for physical or sexual abuse, has an obvious physical injury, has a chronic medical condition, is medically complex, or has a diagnosed mental illness. Tex. Fam. Code § 264.1076. Each child is assessed individually for qualification. Exceptions include the youth being in an inpatient hospital setting or requiring urgent medical treatment at the time of removal.
Vaccinations Prohibited During Three-Day Exam: A physician or healthcare provider cannot administer a vaccination at this “Three-Day Exam” without parental consent except for an emergency tetanus vaccination, and only if the physician or other healthcare provider determines that an emergency requires a vaccination. The prohibition of vaccinations does not apply once DFPS is named the child's managing conservator. The restriction on vaccinations applies only to vaccinations (except for tetanus) administered under the medical exam required by Tex. Fam. Code § 264.1076. Thus, the prohibition is limited only to the population receiving the exam, and only restricts what can be done during the exam. This restriction is lifted once DFPS is granted conservatorship. Outside of these circumstances, the law neither expands nor restricts a parent's right to withhold consent for immunization either under Tex. Fam. Code § 32.101 or Tex. Health & Safety Code § 161.004. However, see Tex. Fam. Code § 266.002 and Tex. Fam. Code § 266.004 regarding a court's authorization to issue orders related to medical care for children in foster care. See In re Womack, 549 S.W.3d 760 (Tex. App.—Waco 2017) holding that to the extent Tex. Fam. Code § 266.004 and Tex. Fam. Code § 32.101(c) conflict, Tex. Fam. Code § 32.101(c) is more specific and is the controlling statute.
Texas Child and Adolescent Needs and Strengths (CANS) Assessment: Children and youth ages 3 to 17 years must receive a CANS Assessment completed by an in-network STAR Health clinician within 30 days of removal. Prior to conducting the CANS, the CPS caseworker will conduct the FSNA with the family, identify targeted interventions, and work with the family to prioritize goals and tasks.
DFPS uses the results of the CANS to evaluate each child's needs and strengths. This assessment assists in service planning, informs placement decisions, and reduces the number of assessments administered to children in DFPS conservatorship. An enhanced CANS Assessment (CANS 3.0) is anticipated to replace the current version in early 2025.
Family Strength and Needs Assessment (FSNA): DFPS administers the FSNA to assess how the family is functioning and to aid in developing a plan of service for the family. Although the FSNA and CANS will not be attached to court reports, judges may hear DFPS staff providing testimony or information regarding findings or recommendations that come from these assessments.
Special Issue: Many courts prefer to schedule a Status Hearing within a few days of the Adversary Hearing to jump-start services to families. However, this must be balanced with the need for both the STAR Health clinician and the CPS caseworker to have the time to utilize the CANS and FSNA tools with fidelity. The law requires that the CANS be administered within 45 days of removal, and DFPS policy sets the completion date at 30 days. The FSNA is conducted with the family within the first three weeks of removal and is used to inform the CANS. Allowing time for a thorough assessment and coordination of efforts should produce child and family service plans that set a path toward achieving permanency as quickly as possible for the child and family.
Developmental Disability Assessment: DFPS is also required to assess whether a child has a developmental disability as soon as possible after the child is placed in DFPS conservatorship, and if the assessment indicates an intellectual disability, to ensure that a referral for a determination of such is made as soon as possible. Tex. Fam. Code § 264.1075.