2010-2012 Growing Up in Houston: Assessing the Quality of Life of Our Children by CHILDREN AT RISK

Edited by: Robert Sanborn, Ed.D. Mandi Sheridan Kimball, MSW Dawn Lew, Esq. Jennifer Michel Solak, Esq. Diana Zarzuelo with foreword by Mayor Annise Parker

We encourage utilization of the data included in this document, excluding the artwork. Please give credit to CHILDREN AT RISK if any statistics or information is used from this publication. We ask that the organizational name be printed in all capital letters. If the name needs to be abbreviated, please use C@R. Copies of the 2010-2012 edition of â&#x20AC;&#x153;Growing Up in Houston: Assessing the Quality of Life of Our Childrenâ&#x20AC;? can be obtained by writing or calling our office at 713-869-7740.

Growing Up In Houston 2010-2012

Assessing the Quality of Life of Our Children Research, Production Team, and Staff Robert Sanborn, Ed.D. President & CEO, Executive Editor

Mandi Sheridan Kimball, MSW Director of Public Policy and Government Affairs, Editor

Dawn Lew

Jaime Hanks

Staff Attorney, Editor

Jennifer Solak

Tanya Makany-Rivera Assistant Director of Public Policy

Ben Wells Assistant Director of Public Policy

Caroline Holcombe

Senior Staff Attorney

Karen Clark Harpold Staff Attorney/Writer

Sara Prentice Assistant Director

Research Analyst

Alexandra Montgomery

Director of Strategic Partnerships, Editor

Laura Nelson

Assistant Director, Development & Communications

Laila Nabi Development Coordinator

Richard Kerr Business Manager

Rashena Lindsay

Futurist/Researcher

Public Relations

Interns Meghan Binford Paul Brown Christina Castell Margot Danker SaraBeth Egle

Laura Evanoff Maureen Holcombe Teddy Holtz Cathryn Ibarra Allison Kolb

Carolyn Malicki Sunaina Mewara Elisa Moran Catherine Perry Nicole Phillips

Design & Layout Squidz Ink Design Special thanks go to former CHILDREN AT RISK staff Diana Zarzuelo and Olga Sinitsyn.

Published by CHILDREN AT RISK

Daniel Ramirez Nicole Royal Susan Shotland Brittany Taylor Megan Waterman

TA B L E O F CO N T E N T S INTRODUCTION Foreword by Mayor Annise Parker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Letter from CHILDREN AT RISK Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 About the Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Quality of Life Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

BASIC NEEDS Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hazardous Waste Sites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Parks and Green Space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Children Living in or Near Poverty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Temporary Assistance for Needy Families (TANF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Food Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Housing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Child Support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Youth Workforce. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agenda for Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 16 18 20 22 24 28 30 32 34

PHYSICAL AND MENTAL HEALTH Maternal Health and Infant Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pregnancy and Alcohol/Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Teen Births. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Early Childhood Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Coverage: CHIP and Medicaid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Supplemental Security Income (SSI) Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . School-Based Clinics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Texas Health Steps - EPSDT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WIC: Special Supplemental Food Program for Women, Infants, and Children. . . . . . . . . . . . . . . . . . . . . . . . . Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Childhood Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lead Poisoning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Childhood Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dental Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sexually Transmitted Diseases (STDs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Childrenâ&#x20AC;&#x2122;s Mental Health: Prevalence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Children Assessed and Served by MHMRA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mental Health Funding: MHMRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mental Health Services: Cost per child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Respite Bed Days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medicaid Mental Health Costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Parenting Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Forensic Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Systems of Hope. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Teen Suicide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pediatric AIDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agenda for Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHILDREN AT RISK 2010-2012

36 40 43 45 48 53 54 56 57 59 62 65 68 71 73 75 77 79 80 82 83 85 86 87 91 93 95 98

TA B L E O F CO N T E N T S SAFETY AND SECURITY Human Trafficking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Accidental Deaths of Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Runaways, Truancy, and Minor Offenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Child Abuse and Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Children Under Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Intervention and Treatment Services for Children and Parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Juvenile Gang Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Juvenile Probation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Juvenile Offenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Children Referred to Court Supervision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Juveniles Detained and Cost of Detention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Recidivism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Texas Youth Commission (TYC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Adult Certifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Child Homicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Corporal Punishment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Agenda for Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

EDUCATION Children in Child Care and Early Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pre-K and Head Start Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Economically Disadvantaged Students. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expenditure Per Student. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Average Class Size & Student-to-Teacher Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Charter Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Career and Technology Education Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alternative Education Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Limited English Proficiency and Bilingual Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Special Education Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Students at Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Graduation and Dropout Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . School Rankings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Advanced Placement and International Baccalaureate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gifted and Talented Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . College Admissions Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student Assessment: TAKS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Math and Science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agenda for Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

144 148 151 153 155 157 160 162 164 166 168 170 175 182 184 186 189 192 196

CONCLUSION About CHILDREN AT RISK & Data Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Honorary Board & Board of Directors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Public Policy and Law Center Advisory Boards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Our Supporters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230

CHILDREN AT RISK 2010-2012

M AYO R ’ S F O R E WO R D

CITY OF HOUSTON Office of the Mayor

Annise D. Parker Mayor P.O. Box 1562 Houston, Texas 77251-1562

September 13, 2010 As mayor of the City of Houston, I congratulate CHILDREN AT RISK on the publication of the eleventh edition of Growing Up in Houston: Assessing the Quality of Life of our Children. Since 1990, this biennial publication has tracked over 100 different data indicators that measure our progress on meeting children's needs in Harris County. It continues to be a crucial resource for all individuals who work to ensure that Houston’s children are given the opportunity to succeed. Our city’s future rests in the hands of its children. As a community, it is our duty to ensure that the basic needs of all children are met. While we have greatly improved the quality of life for Houston’s children over the past decade, we still have far to go in many aspects. Some of our most critical areas for improvement include increasing access to healthy foods year round in order to decrease childhood obesity, increasing access to health coverage, and improving the public education system in order to decrease dropout rates and increase graduation rates. With the help of CHILDREN AT RISK’s eleventh edition of Growing Up in Houston, Houston can implement new policy initiatives to better serve the needs of all children. Because Houston is continuously increasing in size and rapidly transforming in demographics, we must join together as a community to provide the necessary resources for our population. With the compassion and strength of the members of our city, we can create dramatic improvements to build a strong, successful, independent, and happy future for our city and for our children. Sincerely,

Annise D. Parker Mayor

CHILDREN AT RISK 2010-2012

LETTER FROM THE CHAIR

David Roylance As chairman of the Board of Directors for CHILDREN AT RISK, I welcome you to the eleventh edition of Growing Up in Houston: Assessing the Quality of Life of Our Children. First published in 1994, Growing Up in Houston, was the vision of a small group of child advocates responding to the lack of consistent documentation regarding the status of children in the Houston area. As we enter our 21st year and another legislative session in Texas, the publication of this edition parallels a time where actionable data and research about our children is crucial. CHILDREN AT RISK distills the extensive statistical data and research in order to analyze policy decisions and make effective legislative and actionable policy recommendations to public officials. We also communicate this information to the entire community through our collaborations with health, education, environmental, legal and media leaders, and with other charities who use the data to drive more effective policy debate and delivery of services to our children. This publication is the foundation of CHILDREN AT RISK’s mission as we continue to expand our efforts throughout the state of Texas. For the past 5 years, Dr. Robert Sanborn has served as the President and CEO of CHILDREN AT RISK, helping to transform the organization into the public policy and advocacy catalyst that it is today. Not only has our organization expanded its recognition within the city, it has started its conversion into a statewide child advocacy group. Going forward, our programs and initiatives will expand to captivate new audiences on the importance of direct change in policies and laws affecting our children’s needs. CHILDREN AT RISK’s Public Policy and Law Center (PPLC), established in 2006, successfully expanded our influence and kept us abreast of critical children’s issues. The PPLC was significantly involved with child advocates to raise greater awareness on many children’s issues across the state of Texas. For the past five years, the PPLC has evaluated the public high schools in Greater Houston to hold schools accountable for providing quality education to all of our students. This effort was recently extended to include all public schools across Texas. The Public School Rankings Report strives to serve as an accessible guide for parents, educators, and community members on the performance of local schools, and to spark important community dialogue on the quality of public education in Texas. The PPLC has also made important strides in driving awareness and policy changes to address the very real issue of human trafficking. Within the PPLC, The Human Trafficking Summer Law Institute was developed to educate law students about human trafficking. Through this program, the law fellows produced and published The State of Human Trafficking in Texas in 2009, a publication that is widely distributed, providing public officials, legal and other government professionals with actionable data, background information, and a policy analysis on human trafficking. This crucial compilation of data has provided the community with an evidence rich tool on human trafficking in our State. The PPLC also spearheaded a collaborative effort to establish a mental health docket, launched in January 2009, which will divert youths with mental health needs from incarceration to necessary, community-based treatment, when appropriate. This docket was unanimously approved by the commissioner’s court and is expected to result in more effective and comprehensive treatment, reduced recidivism rates, and ultimately lower costs to treat juvenile offenders. CHILDREN AT RISK has traveled throughout this great State to share the success of the mental health docket and to research and analyze other Juvenile Mental Health Dockets for best practices. CHILDREN AT RISK believes our society’s highest goal is to ensure that its children are safe and their basic needs are met - Children are our future. We are the only ones who can give hope for a future that is healthy, safe, and prosperous. The data found in Growing Up in Houston provides a sobering reminder that there is much work to be done. We can provide hope to our children that the future is bright, by coming together as a community to address the issues. We can and will reach our dream of making Texas a great place for children to live. The book and its actionable analysis you hold in your hand is an important catalyst of effective change. On behalf of the staff, Board Members and child advocates across Texas, I invite you to join us in driving effective policy and programs to secure our children’s future. We welcome your interest and support of our initiatives. Thank you.

CHILDREN AT RISK 2010-2012

E X E C U T I V E S U M M A RY

Robert Sanborn, Ed.D.

President and CEO of CHILDREN AT RISK CHILDREN AT RISK continues to expand on our assessment of the quality of life for children in Houston and across Texas with our 11th edition of Growing Up in Houston. Using our quality of life indicators, we are able to measure Texas’ progress in making children a priority. By focusing on critical issues facing our children, we are able to provide a wealth of information concerning youth in our community. The data in this volume illustrates that while some progress has been made there remains much room for improvement and growth. The following is a brief overview of the current state of the quality of life for Texas’ children.

Basic Needs Air Pollution Houston was ranked fifth out of the 25 most ozone-polluted cities by the American Lung Association in 2009. As with all pollution, the effects of air pollution are more severe in children than adults. Children suffering with asthma have a much greater risk of symptoms when they live in a highly polluted community.

Parks and Green Space Houston ranked 72nd out of 77 major cities for spending on parks with only $40 in park-related total expenditure per resident as compared to an average of $100 per resident among all cities ranked. In 2008, Houston had 23.9 acres of parkland per 1,000 residents, which is just slightly less than the suggested amount of 25 acres per 1,000 residents. Strong evidence suggests that people exercise more when they have access to parks, reducing the risk of various diseases.

Children Living in or Near Poverty Twenty-three percent of Texas’ children live below the federal poverty level in 2008, compared to 19% nationally. Poverty is especially debilitating for children, affecting nearly every aspect of their lives in key stages of development, and leaving lasting consequences. Children living in low-income families have a higher risk of dropping out of school, poor adolescent and adult health, poor employment outcomes, and experiencing poverty as adults.

Food Programs In 2009, 24.1% of households with children nationwide did not have enough money for food. In Harris County, only 44% of children eligible for free breakfast actually took advantage of the benefit. The number of Summer Food Service Program sites in Harris County has grown from 385 in 2008 to 430 in 2009, though participation in the Summer Food Service Program is only 14.7% of eligible children. Furthermore, Texas has the worst ranked food stamp program in the nation.

CHILDREN AT RISK 2010-2012

E X E C U T I V E S U M M A RY

Physical and Mental Health Maternal Health and Infant Mortality Harris County is below the national average for the number of women who receive early prenatal care during pregnancy. The national average is 69% while the average for Harris County is 58.4%. There were 411 deaths of infants under the age of one in Harris County in 2006, which equates to an infant mortality rate of 5.9%. Disparities by race and ethnicity exist in the receipt of prenatal care and the prevalence of infant mortality.

Teen Births Texas had the third highest teen birth rate in the nation in 2006 with 63.1 births per 1,000 women ages 15-19, comprising 14% of all births in the state. Of these teen births, 23% were repeat births, and 80% of the mothers were unmarried. In Harris County, 62% of births to teens in 2006 were among the Latino population, followed by African Americans at 25%, Anglo at 12%, and 1% among all other ethnic groups. Teen births are estimated to cost Texas taxpayers $1 billion a year.

Health Coverage: CHIP and Medicaid Texas had the second highest percentage of children under age 18 with no insurance coverage during any time in both 2008 and 2009. Medicaid and CHIP help cover medical costs of the uninsured. Medicaid is available to certain low-income individuals and families while CHIP targets uninsured children and pregnant women in families with incomes too high to qualify for most state Medicaid programs, but often too low to afford private coverage. Children represent the majority of Medicaid recipients.

Immunizations In 2008 in Texas, only 79% of children between 19 and 35 months of age had received all recommended immunizations. In 2004 Harris County Public Health and Environmental Services (HCPHES) created a task force dedicated to increasing immunization rates; their efforts have led to increased outreach and thus higher immunization rates in Harris County. The more persons immunized against disease, the lower the risk presented to the community in terms of any kind of outbreak.

Childhood Obesity Texas ranks 32nd in overall prevalence of childhood obesity, with 32.2% of children considered either overweight or obese. Over the past 20 years, the prevalence of overweight children and adolescents between the ages of 6 and 19 has nearly tripled. Poor nutrition and inadequate physical activity are the fundamental causes of childhood obesity. Childhood obesity affects not only the health of our population but also our economy.

Childrenâ&#x20AC;&#x2122;s Mental Health: Prevalence Among the states, Texas ranks 49th in mental health expenditures per capita. Studies show that at least 20% of children in the U.S. have a mental health disorder. One in ten of these children suffer from a serious emotional disturbance severe enough to disrupt daily functioning in the home, school, or community. Despite these statistics, it is estimated that only about half of all affected children receive specialty mental health services. When untreated, mental health disorders can lead to school failure, family conflicts, drug abuse, violence, and even suicide.

Safety and Security Human Trafficking Since 2006, the FBI has rescued 81 juvenile victims of domestic human trafficking in Houston. Houston is a major hub for international and domestic human trafficking and sexual exploitation. The 78th Texas Legislature first enacted a human trafficking bill in 2003 and the Legislature continued to pass human trafficking legislation in the 81st Legislative Session.

CHILDREN AT RISK 2010-2012

E X E C U T I V E S U M M A RY

Accidental Deaths of Children Motor vehicle crashes were responsible for 53% of all unintentional child deaths in the Houston/Harris County area in 2006-07. The majority of drowning deaths occurred in swimming pools. Lack of adequate supervision was the cause of most drowning cases in 2006-07. Lack of supervision is also cited as the main reason for child deaths from bathtub drowning.

Child Abuse and Neglect In 2008, 51% of the 193,254 reports of suspected child abuse in Texas were made by teachers or other school personnel, medical personnel, or law enforcement. The number of confirmed abuse allegations has dropped significantly in Harris County over the last two decades, from approximately 40% of all abuse allegations in Harris County confirmed in the early 1990s to approximately 20.4% in 2008.

Juvenile Probation The number of juveniles referred to the Harris County Juvenile Probation Department (HCJPD) decreased by almost 10% from 2007 to 2008, from 23,164 to 20,885. Juveniles referred to HCJPD often require intensive psychiatric evaluation and treatment. To address this, in 2008, the department integrated Operation Redirect in an effort to direct mentally ill youth from the juvenile justice system.

Recidivism HCJPD defines recidivism as adjudication of a second offense that is greater than or equal to the severity of the first adjudication. In 2008, one-year recidivism rates for juveniles on probation increased to 15.6% from 14.7% in 2007. In 2008, 15.6% of youth relapsed into criminal and antisocial behavior within one year of the original referral.

Juveniles Detained and Cost of Detention The Juvenile Detention Center received 6,405 youths in 2008. The average per-day cost to house a child in Harris County Juvenile Probation Department facilities rose 21% between FY 2007 and FY 2009. The Mental Health Court, begun in February 2009, is a voluntary, specialized, diversionary court program for families of youths with mental health problems who are involved in the juvenile justice system. The Harris County Juvenile Mental Health Court is instrumental in ensuring that the mental health needs of youthful offenders are met. As its successes in rehabilitating and diverting youths continue, the involvement of additional community service providers is needed to expand the courtâ&#x20AC;&#x2122;s services to allow more youths to participate in the program.

Adult Certification Evidence suggests that adult certification has little or no general deterrent effect, and research has shown that recidivism rates are higher among transferred youth. Transfer to the adult system often deprives juveniles of much-needed therapy and rehabilitative services that are offered in the juvenile system. Juveniles incarcerated in adult prison are eight times more likely to commit suicide, five times more likely to be sexually assaulted, and almost twice as likely to be attacked with a weapon by other inmates, compared to youth detained in juvenile facilities. An alternative to certification in Texas is the determinate sentence, which offers much-needed flexibility in deciding the most appropriate sentence for an individual juvenile.

Education Children in Child Care and Early Education Public school pre-K enrollment in Harris County has increased by over 50% in the last decade to 38,179 children in 2009, while local enrollment in Head Start has steadily declined since 2006. Pre-kindergarten programs have been shown to lead to important growth in childrenâ&#x20AC;&#x2122;s intellectual and social development, and the implementation of a universal pre-kindergarten program should be made a priority in Texas.

CHILDREN AT RISK 2010-2012

E X E C U T I V E S U M M A RY

Expenditure per Student in Public Education During the 2007-08 academic year, the national average for expenditure per student was $9,963. Texas ranked 45th out of the 50 states and the District of Columbia, with an average of $7,978 spent per student, while school districts in Harris County expended even less at an average of $7,157 per student. In 2009, the Texas Legislature did away with the 65% rule, which mandated that at least 65% of school funds be spent on “instruction,” the impact of which remains to be seen.

Alternative Education Programs In Greater Houston, the majority (68.3%) of removals to a Disciplinary Alternative Education Program in 2008-09 were discretionary, or not resulting from a violation of state code. Students placed in alternative education settings for disciplinary purposes are significantly more likely to drop out of school; Texas must work to decrease discretionary referrals to disciplinary programs and provide teachers with adequate training on student behavior management.

Graduation and Dropout Rates Texas ranks last in the nation in the percentage of adults with high school diplomas; only 79.6% of Texans have a high school diploma. For the class of 2008, Texas’ self-reported graduation rate (for federal accountability) was 79% and Houston ISD’s rate was reported as 68%. In contrast, CHILDREN AT RISK’s four-year graduation rate for firsttime freshmen entering ninth grade in 2004-05 was 66% for Texas and 54% for the Houston Independent School District (HISD), as the state’s removal of leavers and underreported students from their cohort results in a higher graduation rate.

School Rankings The purpose of CHILDREN AT RISK’s school rankings is not only to provide a tool to parents and students regarding the quality of local schools, but also to provide information to campuses and districts on how they perform relative to their peers and on successful models of high-performing public schools. To evaluate the performance of public schools across the state, CHILDREN AT RISK examines fourteen indicators at the high school level, ten at the middle school level, and twelve at the elementary level. Although Greater Houston boasted some of the best schools in the 2010 rankings, a disproportionate number of Greater Houston area high schools—more than a third of all area high schools—fell in the bottom quartile in the state. Although we have made tremendous strides over the past two decades, much work remains for a state that continually ranks in the bottom for many indicators of child well-being. It is our hope that these data will provide a basis for continued reform of local and state policies to better serve children, and as a spark for fellow child advocates to continue to demand that children’s needs be put first.

Very truly yours,

Robert Sanborn

CHILDREN AT RISK 2010-2012

A B O U T T H E AU T H O R S

Dr. Robert David Sanborn is a noted leader, advocate, and activist for education and children and the President and CEO of CHILDREN AT RISK. Dr. Sanborn earned his undergraduate degree at Florida State University and his doctorate at Columbia University in New York City. Before entering the non-profit sector, he had a distinguished career in higher education at institutions such as Rice University and Hampshire College. Under his leadership, CHILDREN AT RISK has expanded its influence considerably. Significant change has been achieved through CHILDREN AT RISK’s legislative victories to fight human trafficking in Texas, providing solutions to help child trafficking victims and raising awareness throughout the state. Dr. Sanborn also initiated and led the development of CHILDREN AT RISK’s highly visible annual School Rankings to provide accurate and honest data on the performance of schools in Texas, giving school districts and educators the incentive to strive for better quality education for Texas’ children. In recognition of the significant impact Dr. Sanborn has had within the community, he recently received the Houston Area Association for the Education of Young Children “Advocate of the Year Award” and the “Seeds of Hope” award for his work to end poverty at a systematic level through advocacy with community organizations and an increased awareness among public officials and the media. Mandi Sheridan Kimball has been advocating for Houston children since 2004. In January 2006, she became CHILDREN AT RISK’s Senior Public Policy Analyst and now serves as the Director of Public Policy and Government Affairs. She received her Masters in Social Work from the University of Houston and received her Bachelors degree in Social Work from St. Edwards in Austin. Health and human services are a priority on Mandi’s advocacy agenda. Her experience and knowledge of the Texas Legislature has assisted her efforts in achieving quality care and services to Houston’s most vulnerable youth. Dawn Lew received her undergraduate degree in Political Science from the University of California-Berkeley in 2002 and received her law degree from Boston College Law School in 2006. Through her course of study as well as her work and volunteer experiences in law school Dawn knew she wanted to dedicate her legal career to working on issues affecting the health, safety, and welfare of women and children. Dawn moved to Houston in 2007 and joined CHILDREN AT RISK as a staff attorney in 2009. She is licensed to practice law in both California and Texas.

Jennifer Michel Solak received her J.D. from Tulane Law School in 2005 and her B.A. from Louisiana State University in 2000. Since 2008, Jennifer has researched, published, and presented on various issues affecting children. During Texas’ 81st Legislative Session, she advocated at the Texas Capitol to strengthen existing human trafficking and juvenile justice legislation and pass new legislation. Prior to joining CHILDREN AT RISK, she clerked for the Honorable Mary Milloy on the United States District Court for the Southern District of Texas and worked as an associate with the Kullman Firm in New Orleans, Louisiana. She is licensed to practice law in both Texas and Louisiana. Caroline Holcombe serves as a Research Analyst for CHILDREN AT RISK where she focuses her research on K-12 education, including the organization’s annual Public School Rankings Report. Caroline graduated from Rice University in 2009 with a B.A. in Sociology and the Study of Women, Gender, and Sexuality. In January 2009, she came to CHILDREN AT RISK as an intern to assist with the school rankings and completed her senior research project on the gender gap in Greater Houston’s high school dropout rates. She joined the CHILDREN AT RISK staff as a Project Associate in May 2009. Caroline Holcombe serves as a Research Analyst for CHILDREN AT RISK where she focuses her research on K-12 education, including the organization’s annual Public School Rankings Report. Caroline graduated from Rice University in 2009 with a B.A. in Sociology and the Study of Women, Gender, and Sexuality. In January 2009, she came to CHILDREN AT RISK as an intern to assist with the school rankings and completed her senior research project on the gender gap in Greater Houston’s high school dropout rates. She joined the CHILDREN AT RISK staff as a Project Associate in May 2009. Diana Zarzuelo joined the CHILDREN AT RISK staff as a Public Policy Coordinator in January 2007 and served as Deputy Director from 2009 to August 2010. During her time at CHILDREN AT RISK, Diana served in a number of capacities including education policy analysis, advocacy, development, conference organizing, helping produce CHILDREN AT RISK's biennial publication, and data analysis for CHILDREN AT RISK's annual public school rankings report. In addition, she co-hosted with Dr. Bob Sanborn a weekly radio program called Growing Up in America. Diana graduated from the University of Pennsylvania with a B.A. in Psychology and Cultural Anthropology. Most recently she moved to Boston to pursue a Master in Public Policy from the Harvard Kennedy School.

CHILDREN AT RISK 2010-2012

Q UA L I T Y O F L I F E M E T H O D O LO GY

The Quality of Life Indicator Model has been amended from the original 1990-2000 structure to a simplified data and the format is still built upon four major issue areas: Basic Needs, Physical and Mental Health, Safety and Security, and Education. Indicators define the quality of life of our children in each of these areas. Data for each indicator will continue to be collected every two years. Indicators are compared to a 2010 goal when applicable. The comparison of statistics will illustrate how the community is progressing in meeting the needs of Houston/ Harris County children. It is hoped that this model will demonstrate progress in the well being of children as we analyze the data. The indicators in the Quality of Life Indicator Model concentrate on infants through 17 years old. In some instances data for ages 18 through 24 years of age is reported because that is how those statistics are collected by local, county, and state departments. Breakdown of children by race or origin is included where possible, although it is important to note that data still rarely covers more than major racial groups. All of the statistics, unless otherwise indicated, are for Harris County and include Houston and the other communities within the county. Some indicators are based on the number of cases reported at rates per 100,000 or per 1,000 children. Many goals are also written using rates per a certain number of population. Child population figures are based on the 2000 U.S. Census of Population and Housing as well as the 2008 U.S. Census Bureau American FactFinder. The poverty population was based on the percentage of children below the federal poverty income level in 2008, according to the 2008 American Community Survey, U.S. Census Bureau. Sometimes data requested for the indicators in the Quality of Life Indicator Model was not available (NA) because it had not been collected, was not able to be retrieved from computer systems or organizations were unwilling to honor CHILDREN AT RISKâ&#x20AC;&#x2122;s request for information. Data in the Quality of Life Indicator Model is from secondary research. Statistics used came directly from the staff of the agency or the program targeted, published agency materials such as annual reports, summary tables from agency computer files, websites, or electronic diskettes from agencies. In a few instances, reports or other documents from sources outside the primary agency providing information have been used, but only after the information was verified. Sources can be found in the endnotes after each indicator.

CHILDREN AT RISK 2010-2012

DEMOGRAPHICS

1996-2008 estimates of the child population for harris county Age

1996

1998

2000

2002

2004

2006

2008

57,600

59,332

58,000

63,603

66,148

69,082

70,980

56,573

60,010

56,059

62,108

64,655

68,049

69,661

57,027

57,640

55,645

57,508

62,900

66,346

68,312

58,154

56,643

55,966

55,537

61,253

64,520

66,994

58,446

57,101

55,691

55,082

57,414

62,740

65,251

58,025

58,232

55,354

55,365

54,772

60,992

63,409

53,975

58,518

56,280

55,153

53,971

57,120

61,663

52,034

58,099

56,968

54,853

54,120

54,569

59,861

50,693

54,045

56,275

55,721

54,025

53,770

55,945

49,070

52,113

56,550

56,500

53,838

54,006

53,525

48,953

50,795

55,961

56,480

54,972

54,521

53,337

48,129

49,189

53,587

57,201

56,308

54,963

54,181

46,869

49,066

52,912

56,662

56,677

56,393

54,952

47,085

48,238

51,785

54,404

57,301

57,921

55,559

45,620

46,983

51,929

53,666

57,027

58,303

56,996

47,256

47,245

51,111

52,601

55,241

58,987

58,563

46,813

45,809

51,682

52,920

54,264

58,833

59,124

43,921

47,420

52,801

52,321

53,485

57,197

60,010

Total

926,246

956,475

984,556

1,007,685

1,028,371

1,070,318

1,088,323

CHILD POPULATION FOR HARRIS COUNTY, 2008

6% Other

Latino

50% 19%

25% Anglo

African American

CHILDREN AT RISK 2010-2012

BASIC NEEDS

CHILDREN AT RISK 2010-2012

BASIC NEEDS

Air Pollution INDICATOR: The number of days that Houston’s air quality was designated unhealthy for sensitive groups, unhealthy, or very unhealthy by the EPA’s Air Quality Index (AQI) Year

2003

2004

2005

2006

2007

Indicator

Source: Air Quality Index Report, Environmental Protection Agency

• Houston’s air pollution stems not only from the high rate of standard vehicle emissions, but also from the many chemical manufacturing plants and refineries in the city’s immediate vicinity. • Children are at greater risk of developing asthma or life-threatening diseases such as leukemia as a result of repeated exposure to air pollution. • Houston’s task force plan has helped identify dangerous pollutants, although the sources of air pollution in high-risk areas are outside the realm of local government control.

The causes of air pollution are varied, and range from large, coal-burning power plants to more mundane activities like painting or filling up a gas tank.1 Any activity that causes the release of gases, particles, or chemicals into the air will contribute to air pollution. In Houston, sources of pollution include vehicle emissions, 400 chemical manufacturing plants, two of the four largest refineries in the United States, the Houston Ship Channel’s petrochemical complex, the Port of Houston, and many miscellaneous small sources like those from restaurants, gas stations, barbeques, and lawn and garden equipment.2 To control air pollution across the country, whatever the source, Congress passed the Clean Air Act, most recently amended in 1990.3 This law gives the Environmental Protection Agency (EPA) the power to set National Ambient Air Quality Standards (NAAQS) on air pollutants deemed to “cause or contribute to air pollution which may reasonably be anticipated to endanger public health or welfare.”4 NAAQS set a maximum limit on the level of pollution that can be released into the air in a given area. Currently, the EPA has set NAAQS for six common air pollutants: particle pollution (or particulate matter), ground-level ozone, carbon monoxide, sulfur dioxide, nitrogen oxides, and lead.5 Recently, in December 2009, the EPA Administrator identified six key greenhouse gases—carbon dioxide, methane, nitrous oxide, hydrofluorocarbons, perfluorocarbons, and sulfur hexafluoride—as being a cause of air pollution which threatens public health.6 This endangerment finding is the first step in creating new NAAQS to limit the output of each of these listed gases. To enforce air quality standards, the EPA measures and tracks output of all gases that have a NAAQS maximum

Houston was ranked fifth out of the 25 most ozonepolluted cities by the American Lung Association in 2009; California had the top four worst cities. limit. Most counties in the U.S. are within attainment of all NAAQS. However, most large urban areas are still unable to meet EPA standards on at least one harmful air pollutant, generally ozone. In December 2008, Harris County, as well as every surrounding county, was classified as being in nonattainment of the eight-hour ozone standard.7 Preliminary data for 2009, however, showed that, for the first time since ozone standards were set, Houston was in compliance with the eight-hour standard.8 This 1997 eight-hour ozone standard requires that an area have a three-year average of the fourth-highest daily maximum eight-hour concentration measure at each monitoring site as less than 84 parts per billion. If a county, like Harris County, exceeds 84 parts per billion four times in one year for three consecutive years the county is declared a nonattainment area. The 1997 standard will soon be abandoned for more stringent requirements. It will remain until the EPA completes revisions to a new standard set in 2008.9 Children are more susceptible to air pollution than adults for a variety of reasons. Children take in more air per unit body weight, they do not feel the same symptoms of air pollution, they spend more time outdoors, and their

CHILDREN AT RISK 2010-2012

Although Harris County and surrounding areas are improving overall air quality,15 there are still many communities that endure concentrated doses of dangerous pollutants, many of which are not regulated by the EPA. In 2005, Mayor Bill White commissioned a task force to study these problems. The report, completed in June 2006, enumerated twelve pollutants found to be at levels that present a definite risk to current and future residents of Houston, and seven of these pollutants posed a definite risk of increasing residents’ chances of developing cancer. These definite risk pollutants included ozone and particulate matter, two items already regulated by the EPA, as well as toxic chemicals like chromium VI, 1,3-butadiene, chlorine, ethylene dibromide, acrolein,

Texas, especially the Greater Houston area, must address ozone reduction caused by the most dangerous pollutants and air toxins that are discharged from industrial sources.

BASIC NEEDS

respiratory systems are still developing.10 Asthma makes air pollution riskier for children who suffer from the disease. These children have a much greater risk of increased symptoms when they live in a community like Houston, with high levels of ozone, and participate in sports.11 Indoor air pollution also creates a substantial risk of increased asthma symptoms, and in many cases the level of fine particle pollution indoors was twice as high as EPA standards for outdoor particulate matter.12 According to an 18-month epidemiological study by the University of Texas School of Public Health in 2007, preliminary findings indicated that living near the Ship Channel, with higher estimated 1,3-butadiene levels, may be associated with childhood leukemia.13 Children living within two miles of the Ship Channel, according to the study, had a 56 percent higher risk for childhood leukemia than those living more than 10 miles away.14

and others. Most areas of the city were exposed to three or fewer of these definite risk pollutants, but 28 areas studied by the task force in east Harris County had three or more pollutants at dangerous concentration levels. The study also identified nine other air pollutants with less, though still persuasive, evidence of unacceptable health risks and 179 air pollutants that might potentially affect the health of residents of Houston. This study is currently being used to develop air pollution plans for the city of Houston, though many of the sources of this pollution are coming from outside of Houston, limiting local government’s options.16

POLICY IMPLICATION Texas, especially the Greater Houston area, must address ozone reduction caused by the most dangerous pollutants and air toxins that are discharged from industrial sources, including coal-fired power plants, refineries, and chemical companies. Unfortunately, many of these large polluters are located outside of Houston city limits, preventing many local solutions. There are many ways to help in ozone reduction, and even the seemingly smallest solutions can make a difference in the aggregate. For example, schools can reduce air pollution through “no idling” policies, which require vehicles to be turned off around the schools, and parents should consider turning off their vehicles when waiting to pick up their children, even if not a school policy.

CHILDREN AT RISK 2010-2012

BASIC NEEDS

Hazardous Waste Sites INDICATOR: The number of uncontrolled and abandoned hazardous waste sites in Harris County designated by state law Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2009

2010 Goal

Indicator

Source: Texas Superfund Registry, Texas Commission on Environmental Quality

INDICATOR: The number of uncontrolled and abandoned waste sites in Harris County identified by the EPA which are eligible for clean up under the Superfund Act Year

1990

1994

1996

1998

2000

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

7.5

6.5

Source: National Priorities List Sites in Texas, U.S. Environmental Protection Agency

• Toxic compounds commonly found at waste sites include mercury, dioxin from herbicides, ethylene from car radiators, and even chromium. • Children are at greatest risk for exposure to toxic compounds because of several factors, including: their organs have not fully developed, they spend more time outside than adults, and they are closer to the ground. • Several thousand toxic sites in Texas still need to be investigated, although only 24 are listed on the Texas Superfund Registry. Superfund is the environmental program established to address abandoned hazardous waste sites. Superfund also refers to the fund established by the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), which was enacted by Congress on December 11, 1980. In the 1960s and 1970s, when the public was less aware of the hazards that dumping chemical wastes posed on public health and the environment, such practices were extensive—resulting in many hazardous waste sites such as abandoned warehouses and landfills. Citizen concern over the extent of this problem led Congress to enact CERCLA to locate, investigate, and clean up the worst sites nationwide. The law allows the Environmental Protection Agency (EPA) to clean up such sites and compel the responsible parties to perform cleanups or reimburse the government for EPA-lead cleanups.17 The EPA administers the Superfund program in cooperation with individual states and tribal governments. The cleanup process for hazardous waste sites is complex. It begins with site discovery or notification to the EPA of the possible release of hazardous substances. Sites can be reported to the EPA by citizens, state agencies or regional EPA staff. Texas belongs to the EPA’s Region 6 (one of 10 regional offices), together with Arkansas, Louisiana, New

Mexico, and Oklahoma. Region 6 also serves 66 Native American tribes. Once the site is discovered, it is entered into a computerized inventory of potential hazardous substance release sites. The most serious sites requiring long-term cleanup efforts are subsequently placed on the National Priorities List (NPL). The EPA then establishes and implements the appropriate cleanup plan. The EPA’s Office of Solid Waste and Emergency Response (OSWER) oversees the Superfund program. The Office of Emergency Management within OSWER is responsible for short-term responses conducted under the authority of Superfund. This is short-term removal, when action is required to address releases or threatened releases

As of February 2010, fortyseven out of 1,269 toxic waste sites on the EPA’s National Priority List are found in Texas. Twelve of the active Texas sites are located in Harris County.

CHILDREN AT RISK 2010-2012

As of February 2010, the EPA had determined that 1,269 sites are in need of immediate attention and placed them on the NPL. Forty-seven out of 1,269 toxic waste sites on the NPL are found in Texas. Twelve of the active Texas sites are located in Harris County.19 Since 2005, the number of sites added to the nationwide list has been consistently higher than the number of sites deleted from the list.20 The most commonly found toxic compounds at NPL sites are mercury, uranium, cyanide, arsenic, lead, chromium, creosote, commercial solvents such as benzene and toluene, dioxin from herbicides, ethylene glycol from car radiators, asbestos, and trichloroethane. Chromium is frequently found at Texas Superfund sites. Its effects, particularly on children, are often cancer, pulmonary problems, birth defects, DNA-chromosome changes, headaches, immune system problems, blood changes, nosebleeds, low birth weight in babies, and nervous system and kidney problems. Children are most vulnerable to exposure because they are undergoing physical development and take in significantly more pollutants per body weight than do adults. Children also spend more time outdoors. National data shows that children spend an average of 50% more time outdoors than adults. Children are closer to the ground, where pollutants, especially pesticides and lead, are generally most concentrated. Children are more vulnerable to toxic substances because their bodies are immature and rapidly growing. They do not have the fully developed immune system, liver, or kidneys required to protect them from the damaging effects of many chemicals. Immature lungs are unable to remove and neutralize contaminants adequately and

developing brains and neural pathways are particularly vulnerable to toxins. In addition, some chemicals affect the endocrine system, potentially disturbing healthy neural, reproductive, and immune system development.21 Children of parents exposed to toxic chemicals appear to have a higher incidence of cancer, possibly because they inherit damaged genetic material, and additional exposure may then precipitate malignancy in these genetically susceptible children. Fetuses are exposed during gestation to environmental pollutants stored in the mother’s body. Newborns are further exposed to environmental pollutants in human breast milk. In addition to these risk factors common to all children, some children, especially those who lack adequate medical care, who are undernourished or malnourished, or who live in crowded or unsanitary conditions, are at great risk. The Texas Commission on Environmental Quality maintains the State Superfund Program in addition to sites that are already listed on the NPL. If a site is ineligible for the national list and cannot be resolved through an agreed order with a responsible party, it can become a part of the Texas State Superfund Registry. The sites on this ranked list are not dangerous enough to be put on the NPL but are still determined by the State of Texas to be an “imminent and substantial endangerment” to Texans.22

BASIC NEEDS

of hazardous substances for sites that are particularly life-threatening. The Office of Superfund Remediation and Technology Innovation and the Federal Facilities Response and Reuse Office are responsible for managing the long-term Superfund response program. Long-term remedial response actions entail steps that permanently and significantly reduce the dangers associated with the release or threats of release of hazardous substances that are serious, but not immediately life-threatening.18

There are several thousand closed or abandoned sites in Texas that contain hazardous substances, most of which still need to be investigated and put onto the proper lists. Only 24 were listed on the Texas Superfund Registry as of September 18, 2009. Three of these active sites are located in Harris County: ArChem Thames/Chelsea at 13013 Conklin Lane in Houston, Federated Metals at 9200 Market Street in Houston, and Jensen Drive Scrap at 3603 Jensen in Houston. Some 26 other sites have been proposed to the State Superfund Registry in accordance with Texas Health and Safety Code requirements. The last site proposed to be added to the Registry is Camtraco Enterprise Site located at 18823 Amoco Drive in Pearland, Brazoria County.23

POLICY IMPLICATION Toxic wastes still plague Houston and other American communities 30 years after the federal government set up programs to identify and clean up the country’s worst sites. A large increase in the designation of sites in Harris County is cause for concern, given the disastrous effects hazardous pollutants can have on children. An even greater number of sites with hazardous materials remain idle, waiting for the proper Superfund designation. This problem is due in part to the Superfund being short on funds and, consequently, unable to begin cleanup efforts of these waste sites. This creates a backlog of sites that continue to menace the environment and, quite often, the health of nearby residents. The Texas Commission on Environmental Quality must be adequately funded to effectively clean up contaminated sites and the neighborhoods that surround them.

CHILDREN AT RISK 2010-2012

BASIC NEEDS

Parks and Green Space INDICATOR: The amount of park acreage in Harris County that is available for use by children Year

1998

1999

2000

2003

2005

2006

2007

2009

Indicator

21,593

21,655

21,724

21,630

23,169

24,352

24,664

26,556

Source: Harris County Parks Department

• Houston has had recent success in creating more parks and open space during the past few years, yet the city still falls behind the national average per capita. • Studies have indicated that parks provide extensive health benefits because they promote exercise, which in turn helps reduce the risk of many chronic illnesses and improves psychological well-being at the same time. • Children receive vast benefits from neighborhood parks because of the hands-on learning opportunities that parks present and the reduction in neighborhood crime that occurs with the implementation of parks.

City parks and open space improve physical and psychological health, strengthen communities, and make cities and neighborhoods more attractive places to live and work. Another important benefit of park space is a cleaner environment. Trees reduce air pollution and water pollution, help keep cities cooler, and provide a more effective way to manage storm water runoff than building systems of sewers made out of concrete.

However, many urban areas are challenged in having adequate and accessible park space. Eighty percent of Americans live in urban areas, many of which lack park space; few of them are able to enjoy park benefits. Government and civic groups have renewed their interest in city parks over the past two decades, but with the current economic situation, states and cities are often compelled to cut park spending, which threatens the

CHILDREN AT RISK 2010-2012

BASIC NEEDS

In 2007, Houston ranked 72nd on the list of 77 major cities in public spending for parks, with $40 in total park-related expenditure per resident, as compared to an average of $100 per resident among other cities ranked. well-being of existing parks and limits the creation of new parks. In 2007, Houston ranked 72nd on the list of 77 major cities, with $40 park-related total expenditure per resident, as compared to an average of $100 per resident among the cities ranked.24 Houston ranks above only Memphis, Toledo, El Paso, Stockton, and Buffalo.25 According to the Harris County Parks Department, park acreage has increased from 21,724 acres in 2000 to 26,556 in 2009. Harris County has approximately six acres of park and open space per 1,000 residents, compared to the twentyfive acres recommended by the Urban Land Institute.26 Lack of park space has many harmful implications. Strong evidence suggests that people exercise more when they have access to parks. Exercise helps reduce the risk of various diseases, including heart disease, hypertension, colon cancer, and diabetes, and helps relieve symptoms of depression and anxiety. According to the Centers for Disease Control and Prevention, only 25 percent of American adults engage in the recommended levels of physical activity.27 In addition, lack of park space in neighborhoods decreases the value of residential property. More evidence shows that commercial property values tend to fall for the same reason. Over the past several years, Houston has had more success in creating parks and open space overall. In 2008, Houston had 23.9 acres of parkland per 1,000 residents. Houston ranked sixth in the Intermediate-Low population density after San Diego, Raleigh, Phoenix, Portland, Ore., and Lincoln and was closely followed by Dallas with 23.2 acres of parkland per 1,000 residents.28 The average for cities with similar density was 15.6 acres of parkland. The national average for all cities ranked, however, was 40.2 acres.29 This shows that in large populous counties the acreage of parkland is not distributed evenly. Often neighborhoods that are short of park space are populated by low-income families, and lack of parkland has a profound effect on these communities. Parks offer recreational activities for at-risk youth and low-income children and help close educational achievement gaps by providing hands-on learning opportunities. In addition, studies show that access to

public parks and recreational facilities helps reduce crime and juvenile delinquency. Houston has four of the nation’s 100 largest city parks, including Cullen Park and George Bush Park, which are the seventh and ninth largest parks respectively.30 Houston’s Hermann Park and Memorial park occupy seventeenth and twenty-fourth places respectively on the list of The 40 Most Visited City Parks.31 Discovery Green, downtown Houston’s $93 million park which opened in 2008, is one of the most successful examples of the urban park. The 11.78 acres includes a jogging trail, amphitheater, fountain, and vast green spaces available for small events and children’s festivities.32

CHILDREN AT RISK 2010-2012

BASIC NEEDS

C H I LD R E N

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TO P

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P R I O R I T Y

Children Living in or Near Poverty INDICATOR: The number and percentage of Harris County children from 0-17 living below the federal guidelines for sufficient income Year

1998

1999

2000

2002

2003

2004

2006

2008

Indicator

190,778 (20.2%)

192,163 (19.6%)

191,074 (19.1%)

208,200 (19.9%)

228,966 (21.7%)

244,526 (22.9%)

259,986 (23.5%)

263,413 (23.0%)

Source: 2008 American Community Survey, U.S. Census Bureau

• Families living in poverty lack more than just the basic minimal necessities; they also lack access to “human and social capital” resources, such as education and employment experience. • Poverty has the profound effect of impeding a child’s future education and can add to chronic health problems. • Harris County has a much higher rate of poverty for children than for adults, with 27.1% of children under the age of five living below the federal poverty line. Poverty is one of the most far-reaching and wide-spread was based on the premise that an average family spends problems in the United States. It is especially debilitatabout one-third of their income on food.36 Yet food now comprises only one-seventh of an average family’s exing for children, as it affects nearly every aspect of their penses, while the cost of housing, child care, and translives in key stages of development, leaving lasting conseportation have grown significantly. Most analysts agree quences. American families are considered to be living that an average family needs an income of about twice the in poverty when they are unable to achieve a minimum, decent standard of living that allows them to engage mean- Federal Poverty Level (FPL) to meet their basic needs.37 The current Federal Poverty Guidelines do not take into ingfully in mainstream society.33 In the 21st century, the definition of basic material necessities includes more than account material hardship (such as living in substandard the essentials of food, clothing, and shelter. Indeed, havhousing) or debt of financial assets (such as property). Reing access to running water, electricity, indoor plumbing, search also indicates that economic inequality in America and telephone service are also considered essential. In has been on the rise since the 1970s and has reached a addition, to achieve not only a “minimum” standard of liv- historic level since 1929. Between 1979 ing, but one that is “decent,” and 2006, after-tax incomes rose modern-day families need by 256 percent for the top “human and social one percent of households, capital.” 34 Human and compared to 11 percent for social capital includes households in the bottom resources such as edufifth.38 cation, basic life skills, A family living on inemployment experience, In 2008, 23% of Texas’ come below the FPL is social networks, and acchildren lived below the referred to as “poor.” In cess to civic institutions. 2008, this was $21,200 These resources are said federal poverty level, for a family of four. It has to help families increase compared to 19% nationally. been raised to $22,050 for their earnings potential 2009.39 Families living with and accumulate assets; gain incomes below 200%, or two access to safe neighborhoods times the FPL, are considered and services such as medical care “low-income” and they face many of and schooling; and expand their netthe same material hardships and finanworks and social connections.35 cial pressures as poor families do. The U.S. government measures poverty by an antiquated standard established in the 1960s, which Of the 73.7 million children living within the

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

In Texas, there are a total of 3,472,355 families with 6,607,575 children.43 Twenty-three percent of children live below the Federal Poverty Level, compared to 19% nationally.44 Twenty-five percent of children in urban areas live in poor families and 18% of children in suburban areas live in poor families.45 In Texas, 37% of children from immigrant parents live in poor families.46 Thirtyeight percent of children in poor families have at least one parent who is employed full-time, year-round, and 33% of children in poor families have at least one parent who is employed either part-year or part-time. Further, 30% of children in poor families do not have an employed parent and 53% of children from poor families have parents who have never attained a high school degree. Finally, 58% of poor children live with a single parent, and 6% live in families with no parent present at all.47 The poverty rate increases when looking at the children of Harris County compared to adults. In 2008, Harris County had a poverty rate of 15.3% for individuals, but for

T E N

P R I O R IT Y

children, this rate was 23%.48 Moreover, children under five are disproportionately affected by poverty, with a rate of 27.1%.49 In Harris County, 38% of poor children were living in a household headed by a single woman.50 Forty-eight percent of children in Texas,51 or 3,180,754 children, and 45% in Harris County52 were living in lowincome familiesâ&#x20AC;&#x201D;income below 200% of FPL. This level compares to 41% of children nationally.53 Of low-income children in Texas, 53% were under 6 years old.54 Looking at what race and ethnicities are most affected, 64% of Latino children were from low-income families, 58% of African American children were from low-income families, 23% of Anglo children lived in low-income families, and 30% of Asian American children lived in low-income families.55 Of children in low-income families in Texas, 60% have at least one parent who is employed full-time, year round, compared to 51% nationally; 24% have at least one parent employed either part-year or part-time; and 16% do not have an employed parent.56 Of Texas children from immigrant parents, 70% live in low-income families, whereas 41% of Texas children from native-born parents live in low-income households.57 From an educational standpoint, data reveal that 86% of children who live in families with parents who have less than a high school education are low-income, while 63% of children whose parents have graduated from high school are low-income, and only 29% of children whose parents have attained some college education or more are considered low-income.58

BASIC NEEDS

U.S., 41% or 29.9 million live in low-income families40 and 19% or 14 million live in poor families.41 Economic hardship has a profound effect on childrenâ&#x20AC;&#x2122;s development and their prospects for the future. Living in poverty can impede childrenâ&#x20AC;&#x2122;s cognitive development and their ability to learn. It can contribute to behavioral, social, and emotional problems. It can cause and exacerbate poor child health as well. The children at greatest risk are those who experience economic hardship when they are young and adolescents who experience severe and chronic hardship. Children living in low-income families have a higher risk of dropping out of school, poor adolescent and adult health, poor employment outcomes and experiencing poverty as adults.42 Parents who are in need of financial resources find it difficult to provide experiences and services that are essential for children to grow and thrive into healthy, productive adults, such as high-quality health care, adequate housing, stimulating early childhood programs, good schools, money for books and other enriching activities.

TO P

High rates of child poverty and income inequality in the United States can be reduced through a dynamic shift in national policies that addresses the needs of children.

POLICY IMPLICATION Given its wealth, the United States has unusually high rates of child poverty and income inequality, even prior to the current economic situation. 59 Other industrialized nations have lower poverty rates because they seek to prevent hardship by providing services and assistance to all families. The support provided includes monetary supplements for those with children, child care assistance, health coverage, paid family leave, and other services that help offset the cost of raising children. The United States does little to assist low-income working families unless they hit rock bottom. Even then, those families are eligible for means-tested benefits that tend to be highly stigmatized. High rates of child poverty and income inequality in the United States can be reduced, but effective, widespread, and long-lasting change will require shifts in both national policy and the economy.60

CHILDREN AT RISK 2010-2012

BASIC NEEDS

Temporary Assistance for Needy Families (TANF) INDICATOR: The average amount of cash grants per child per month given under TANF program in Harris County Year

1990

1992

1994

1996

1997

1998

1999

2000

Indicator

$57.00

$58.12

$58.42

$54.87

$53.43

$54.39

Year

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

$67.00

$69.33

$71.00

$62.69

$61.87

$62.00

$60.00

$68.00

$70.00

Source: 2008 American Community Survey, U.S. Census Bureau

INDICATOR: The number of children receiving cash benefits under Temporary Assistance for Needy Families (TANF) in Harris County Year

1990

1992

1994

1996

1998

1999

2000

2002

Indicator

80,512

100,834

150,035

85,558

47,047

32,639

30,830

54,936

Year

2003

2004

2005

2006

2007

2008

2009

Indicator

62,707

32,837

27,259

18,706

15,140

12,131

7,795

Source: Texas Health and Human Services Commission

• TANF in Texas seeks to prevent increased poverty by assisting parents and caretakers in finding and securing jobs, as well as developing methods to better care for their children. • The number of families receiving TANF aid in Texas has dropped over the years, despite the fact that the poverty rate in the state remains higher than the national average. • Funds for TANF aid in Texas have been transferred in recent years into state programs that reduce the effects of poverty, instead of tackling the causes of poverty. Temporary Assistance for Needy Families (TANF) is a federal grant program designed to provide monetary assistance to families who are temporarily unable to support themselves and to help them cease dependence on aid programs. TANF was created by the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, supplanting both the Aid to Families with Dependent Children program and the Job Opportunities and Basic Skills Training program. It delivers block grants to states, territories, and tribes each year to be distributed through their own agencies for benefits, administrative expenses, and services. The Office of Family Assistance (OFA), within the U.S. Department of Health and Human Services, oversees the TANF Bureau.61 Texas residents can apply for TANF benefits through Texas Works, a part of the Texas Health and Human Services Commission,62 and participate in the TANF work program through the Texas Workforce Commission.63 There are four goals to which states must direct their TANF programs: to assist needy families so that children can be cared for in their own homes; to reduce the dependency of needy parents by promoting job preparation, work and marriage; to prevent out-of-wedlock pregnancies; and to encourage two-parent families.64 In Texas, these goals

are met by requiring parents and caretakers who receive TANF funds to agree to train for a job or look for employment if capable, pay child support obligations, not voluntarily quit a job, not abuse alcohol or drugs, take parenting skills classes, get medical screenings and immunizations for all of the children in their care, and ensure that their children are attending school. Monetary assistance through the TANF program in Texas is time-limited to one to three years, depending on the caretaker’s education, work experience, and situation.65 TANF assistance has a federal lifetime limit of five years.66 Congress reauthorized TANF in February 2006 until 2010 as part of the Deficit Reduction Act of 2005.67 As a part of the American Recovery and Reinvestment Act of 2009, signed into law on February 17, 2009, the Emergency Contingency Fund for State TANF Programs was created. This Emergency Fund provides up to $5 billion for TANF programs that have an increase in assistance expenditures, basic assistance expenditures, or expenditures related to short-term benefits or subsidized employment in 2009 and 2010.68 The Fund will expire at the end of 2010. Despite the Emergency Fund, the number of families receiving TANF aid in the state of Texas has continued to

CHILDREN AT RISK 2010-2012

In Region 6, which includes Harris County, TANF denial rates are approaching 90%. The Number of Children Receiving Cash Benefits Under Temporary Assistance for Needy Families (TANF) FY 2006

FY 2007

FY 2009

Harris County

18,706

15,140

7,795

Texas

141,153

120,149

95,900

Average Grant Amount for a Family of Three FY 2006

FY 2007

FY 2008

FY 2009

Harris County

$62

$66

$68

$70

Texas

$60

$64

$66

$67

Average Grant Amount per Child FY 2006

FY 2007

FY 2008

FY 2009

Harris County

$62

$66

$68

$70

Texas

$60

$64

$66

$67

Policy Implication The TANF program faces many difficulties. Even though the program is designed to help the impoverished, the federal government financially rewards states that are able to reduce their caseloads, even when there are rising numbers of poverty-stricken families. Texas spends $251 million of its state funds for maintenance of effort (MOE) to receive the federal TANF grant of $486 million plus the $53 million available in supplemental grants. The Texas Legislature, however, due to the budget crisis of 2004, has directed much of these funds to maintain services that were previously supported by other state and federal monies, such as child protective services (CPS), foster care, and state employee benefits. As a result, less money is distributed to employment and job training services, childcare, and cash assistance TANF was intended to provide for. While CPS and other social service programs must be financed, TANF funds are meager in comparison, and it remains to be seen whether the money provided through the Emergency Contingency Fund will have a significant effect. Rather than focusing on programs that tackle the causes of poverty, the funds are used to deal with its effects. This weakens the ability of TANF to focus on core poverty reduction efforts.

BASIC NEEDS

drop. In 2009, there were 95,900 children who received TANF benefits statewide, down from 105,794 children in 2008.69 These numbers follow a similar drop in 2006, in which 141,153 children received TANF aid, and in 2007, when 120,949 children received TANF aid.70 Unfortunately, despite these drops in TANF distributions, Texas poverty levels have remained higher than the national average. In 2008, the national poverty level was 13.2 percent, while Texasâ&#x20AC;&#x2122; poverty level was 15.8 percent. In 2007, Texasâ&#x20AC;&#x2122; poverty rate was at 16.3 percent, but the drop between 2007 and 2008 was not accompanied by a significant change in the total number of people in poverty.71 TANF application denials are also high. In Region 6, which includes Harris County, denial rates are approaching 90%.72 The average statewide amount of cash granted per child per month under TANF was $67, falling below the average federal amount of $70. The average amount in grant dollars distributed per month to a TANF family of three (one caretaker and two children) in Texas was $240, well below the national average of $390.73

Financial eligibility for TANF as determined by the state is incredibly restrictive: only the most desperately poor can receive benefits and the application process is so complex that many are excluded even if they are eligible. Since 2006, applicants are disqualified if they do not show proof that they are U.S. citizens, even though non-citizens are barred from applying. New federal requirements passed with the Deficit Reduction Act that went into effect in 2006-07 are even harsher. These requirements, which include increased work participation and new verification methods for work activities, cut off aid for children after parental time limits are reached, eliminate credit for vocational educational programs, and fail parents for work participation standards if they miss more than two days of work. It remains to be seen whether the TANF program will be extended past 2010, but, to become sustainable, drastic changes in its policies must be undertaken in order for needy Texas families to experience any positive, appreciable changes.

Source: Texas Health and Human Services Commission

CHILDREN AT RISK 2010-2012

BASIC NEEDS

C H I LD R E N

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T E N

P R I O R I T Y

Food Programs INDICATOR: The average monthly number of children receiving food through the Federal Food Stamp Program in Harris County Year

1990

1992

1994

1996

1998

2000

2001

Indicator

142,216

203,598

245,299

183,967

97,506

78,835

81,028

Year

2002

2003

2004

2005

2006

2007

2008

2010 Goal

Indicator

181,107

210,565

261,297

290,223

320,842

292,181

295,301

379,428

Source: Texas Health & Human Services Commission Goal Source: The Houston Hunger Fighters

INDICATOR: The average daily number of children receiving a free or reduced-priced breakfast at school Year

1990

1992

1994

1996

1998

1999

2000

2001

Indicator

59,156

73,033

85,476

109,004

110,526

111,053

116,770

120,153

Year

2002

2003

2004

2005

2006

2007

2008

2010 Goal

Indicator

123,796

141,570

134,252

152,702

153,849

162,839

173,544

191,542

Source: Texas Department of Agriculture Goal Source: Child Nutrition Programs Division, Texas Education Agency

INDICATOR: The average daily number of children receiving a free or reduced-priced lunch at school Year

1990

1992

1994

1996

1998

1999

2000

2001

Indicator

139,029

166,087

186,278

218,445

227,925

237,750

251,606

247,050

Year

2002

2003

2004

2005

2006

2007

2008

2010 Goal

Indicator

258,213

280,801

296,677

311,588

334,137

339,009

350,773

358,835

Source: Texas Department of Agriculture Goal Source: Food Research and Action Center

• The food insecurity rate of families in Texas has grown much higher since 2007, causing low-income families to rely more heavily on the Food Stamp Program, School Breakfast Program, National School Lunch Program, and the Summer Food Service Program. • Less than half the families who are eligible for food benefits in Harris County participate in the Food Stamp Program, largely due to the fact that Texas ranked last in the nation in processing food stamp applications. • Many children in Harris County do not participate in the School Breakfast Program and the National Lunch Program because of the stigma associated with receiving free meals, and because of the early morning hour breakfast is served. Between 2006 and 2008, 16.3 percent of Texans lived in households at risk of hunger, according to the United States Department of Agriculture. However, this is the number obtained during the period when the economic crisis was just beginning, unemployment was on the rise, and food prices were rapidly rising. In the last quarter of 2009, when asked, “Have there been times in the past twelve months when you did not have enough money to buy food that you or your family needed?” 18.5 percent of households nationally answered “yes.” The situation is

much worse for households with children. In 2009, respondents reported food hardship at a rate of 24.1 percent for such households versus 14.9 percent for households without children.74 Food insecurity is defined as limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.75 In the United States, more than 49.1 million people lived in “food insecure” households in 2008, up from 36.2 million in 2007 and the highest number on record.76 Of the 49.1 million, 16.7

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

TO P

T E N

P R I O R IT Y

Year

1990

1992

1994

1996

1998

1999

2000

2001

Indicator

137

243

487

437

270

492

607

565

Year

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

638

595

693

688

671

578

385

430

BASIC NEEDS

INDICATOR: The number of sites where sponsoring organizations are serving food under the Summer Food Service Program

Source: Summer Food Service Program, Houston Parks and Recreation Department

INDICATOR: The average daily number of children receiving a meal through the Summer Food Service Program Year

1990

1992

1994

1996

1998

1999

2000

2001

Indicator

27,330

36,666

42,727

55,461

59,429

81,296

43,811

54,076

Year

2002

2003

2004

2005

2006

2007

2008

2010 Goal

Indicator

56,507

67,388

61,326

60,262

64,086

71,017

67,855

105,837

Source: Texas Health and Human Services Commission Goal Source: Food Research and Action Center

million are children.77 This equates to 22.5 percent of the nationâ&#x20AC;&#x2122;s children.

and nutrition assistance program. Under this program, participants are provided with electronic debit cards that According to the latest can be used at accepted estimate, the Texas grocery and retail stores. In 2009, 24.1% of households population in 2008 Food stamps cannot be with children reported they was 23,904,380, with used for nonfood items, children accounting such as personal care did not have enough money for over 25 percent of products, cleaning supfor food within the last 12 this number. Texas has plies, alcohol, or cigaalways trailed the narettes. In 2008, the average months, versus 14.9% for tion in poverty and food number of participants in the households without children. Food insecurity rates. In 2007, Stamps Program in Texas the food insecurity rate in Texas was 2,605,532 per month, and was 16 percent as opposed to 11 in Harris County it was 351,182.79 However, the number of people percent nationally, but now that the potentially eligible for benefits in Texas food insecurity rate has reached 18.5% was 5,713,000; hence the participation rate as discussed earlier, the situation in Texas in Texas in 2008 was only 46 percent. The rate is even worse. Texasâ&#x20AC;&#x2122; poverty rate is the ninth was even smaller in Harris County, with participahighest among the states, and its child poverty rate is tion of only 38 percent, where the number of potenthe seventh highest. In 2008, 15.8% of persons in Texas tially eligible people was 923,000. In the same year, the lived below the Federal Poverty Level.78 The Food Stamp Program, School Breakfast Program, National School average gross monthly income for a family of three receivLunch Program and Summer Food Service Program are es- ing Food Stamp benefits was $839.80 sential to providing enormous help for these food-insecure Total Food Stamp value for Harris County in 2008 was families. $417,306,342. On average, a recipient of Food Stamp benefits receives $100 a month. It is important to keep The Food Stamp Program is administered by the U.S. the Food Stamp Program, as it puts money back into the Department of Agriculture (USDA) and the Food and struggling economy. However, in 2009, Texas had the Nutrition Service (FNS), and is the largest federal food CHILDREN AT RISK 2010-2012

BASIC NEEDS

C H I LD R E N

R I S K

TO P

T E N

Food Programs (cont.) Percent of Harris County Students Eligible for Free or Reduced-Price Lunch who Eat vs Not Eat (2008)

Percent of Harris County Students Eligible for Free or Reduced-Price Meals who Eat vs Not Eat in the Summer (2008)

Eating 15%

Non-Eating 24%

Eating 76%

Non-Eating 85%

worst performing program in the nation. Texas ranked last among all 50 states and U.S. territories in processing food stamp applications.81 In September 2009, only 36.1 percent of applications were processed on time in Houston.82 Also, Texas does a poor job of encouraging eligible potential participants to apply. Hence, grocery retailers in the state are missing out on nearly $1 billion a year in food sales.83 The School Breakfast Program and the National School Lunch Program (NSLP) are food nutrition programs funded by federal dollars which provide healthy and nutritious breakfasts and lunches for children. The money is provided to public schools, non-profit private schools, and residential child care institutions by the Food and Nutrition Service (FNS). School breakfast is not only effective in reducing hunger among needy children, it is also effective in improving nutrition; preventing obesity; improving studentsâ&#x20AC;&#x2122; attendance, attentiveness and achievement; and reducing discipline problems. In 2007, 10.1 million children participated in the School Breakfast Program and, of that number, 8.1 million were low-income students.84 However, in the same year, only 45 children ate breakfast for every 100 children who ate lunch. An increase in this ratio to 60 children eating breakfast per every 100 children eating lunch would equate to almost 2.6 million more children eating a healthy school breakfast every day. Eighty-five percent of schools who serve lunch, and could be serving breakfast, did so during the 2006 school year. In Texas, 99 percent of the schools serving lunch also served breakfast.85 In Harris County, the average daily number of children who received free breakfast was 173,544 during the 20082009 school year.86 The number of children who were

P R I O R I T Y

Percent of Harris County Students Eligible for Free or Reduced-Price Breakfast who Eat vs Not Eat (2008)

Eating 38% Non-Eating 62%

approved to receive free breakfast was 389,070 in 2008. Thus, only 44 percent of Harris County children eligible for free breakfast actually took advantage of the benefit. The percentage is even lower for Harris County children approved to receive a reduced-price breakfast and those who actually ate a school breakfast. In 2008, 20,369 out of these 72,493 students ate breakfast at school; thus only 28 percent participated in the program. Only about half (49.4%) of students that eat free or reduced-price lunch at school also take advantage of the breakfast option in Harris County.87 The stigma associated with poverty and receiving a free or reduced-price meal is only one of many contributors to such low participation. Early morning school bus schedules, long commutes to jobs, and nontraditional work hours make it challenging to find time for a healthy and nutritious breakfast. It is a proven fact that many children, es-

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

The National School Lunch Program (NSLP) is a federal school meal program that provides nutritious lunches to children during each school day.88 During the 20082009 school year, 31.2 million children participated in the National School Lunch Program through more than 101,000 schools and residential childcare institutions. On a typical school day, 19.4 million of these 31.2 million total participants were receiving free or reduced-price lunches.89 In Harris County, the number of children who were approved to receive free meals was 389,070 in 2008, while the average daily number of children who received free lunches was 300,513 (77% participation). The number was lower for Harris County children approved to receive a reduced-price lunch and those who actually ate lunch at the reduced-price (69% participation). Approximately 76 percent of Harris County children eligible for free or reduced-price meals received meals through the program in 2008.90 It is equally important for children to eat every day, and not just during the school year. While during the school year, many children receive free and reduced-price breakfast and lunch through the School Breakfast and National

Greater awareness and access are important in furthering the reach of food programs in Harris County.

T E N

P R I O R IT Y

School Lunch Programs, many of these children lack nutrition during the summer months. Such an outcome may set up a cycle for poor performance once school begins again. The Summer Food Service Program (SFSP) is designed to fill that nutrition gap and make sure children receive the nutritious meals they need. Many summer nutrition sites provide not just meals, but educational enrichment and recreational activities that help children continue to learn and stay safe during the summer. Meals provided through summer nutrition programs act as a magnet to draw children to these activities.

BASIC NEEDS

pecially teenagers, do not eat breakfast when they wake up due to lack of an appetite early in the morning. Moreover, some children who do eat breakfast at home often have to wait too long between an early breakfast at home and a late lunch at school. Nationally, only 35 percent of parents of children age six to eleven report eating breakfast each day with their children. This number is much lower for middle and high school students. Only 22 percent of parents eat breakfast with older children.

TO P

The SFSP for children has been simplified so that tracking and reporting are made easy and savings in administrative costs are invaluable. School districts, churches, food banks, and summer camps can utilize federal funds and become a feeding site for children.91 During the summer of 2007, federal funding for the SFSP totaled over $249 million dollars.92 Texas received over 10 percent of the SFSP federal funds, disbursing $26.9 million dollars to 1,694 program sites in 2007.93 Even so, participation in the summer program for eligible children in 2007 was only 8.2 percent in Texas. In Harris County, 4,123,099 meals were served during the summer of 2008.94 The number of Summer Food sites in Harris County has grown from 385 in 2008 to 430 in 2009; however, overall participation in the program continues to be low. In 2008, 456,299 students were eligible for free or reduced-price meals through the SFSP, and only 67,855 students participated.95 This equates to a participation rate of 14.7 percent for Harris County; some of these participating students, however, were not eligible under free or reduced-price meal programs, but participated via open sites. Thus, the participation rate is less than 14.7 percent for those eligible for the program. If participation reached 40 percent in our state, Texas would be eligible to receive an additional $38 million in federal money and feed more than 637,000 additional low-income children.

POLICY IMPLICATION During the summer of 2007, only 17.5% of low-income children nationwide participated in the Summer Food Service Program. In Texas, this percentage was even lower, with only 8.2% of low-income children participating, ranking the state 47th in low-income participation.96 This low rate of participation, taken into account with other rates of participation for Food Stamps and the National School Lunch Program and School Breakfast Program, illustrates that these important resources are being under-utilized in our community. These food programs provide nutritious meals to children. Schools are required to give children a balanced and healthy diet in their meals served. For many children, these are the only nutritious meals they will receive. Breakfast, especially, is critical to combating childhood obesity, because children who eat breakfast are less likely to eat larger amounts of food later in the day. Greater awareness and ease of access are important in furthering the progress of these initiatives in Harris County. Quality nutrition greatly contributes to success in school and healthier children year-round.

CHILDREN AT RISK 2010-2012

BASIC NEEDS

Housing Indicator: The number of transitional beds available for homeless youth Year

1995

1996

1998

2000

2001

2002

2003

2004

2005

2006

2007

2008

Indicator

113

Source: Covenant House, Texas

Indicator: The number of subsidized housing units and certificates for low and moderate-income families with children in Harris County Year

1990

1992

1994

1996

1998

2000

2003

2005

2006

2007

2010 Goal

Indicator

17,935

20,009

21,892

23,787

24,264

46,938

*63,955

1,471

1,485

670

Source: Texas Department of Housing, Houston Office, Region VI, U.S. Department of Housing and Urban Development

Indicator: The number of unaccompanied homeless children and youth in children-only emergency shelter facilities Year

1990

1992

1994

1996

1998

2000

2001

2002

Indicator

N/A

139

473

2003 2004 2005 2006 2007 623

724

987

787

748

2008 603

Source: Covenant House, Texas

• Currently there are no available shelters for homeless youth without adult accompaniment unless youth are in the custody of CPS or the juvenile justice system. • The minimum wage rate provides for less than half of the monthly rent necessary for a family to rent an apartment in Houston. • Houston provides enough low-rent public housing and subsidized units to serve 60,000 of its low-income residents, but many more families still need housing assistance, including 19,000 families who are on a wait list for the Housing Choice Voucher Program. Homelessness is defined in a variety of different ways. Federal law defines a homeless person as “one who lacks a fixed, regular, and adequate nighttime residence.”97 The U.S. Department of Housing and Urban Development’s Annual Homeless Assessment Report to Congress divides the scope of individuals who have residential instability into two broad categories: “literally homeless” and “precariously housed.” Those who are literally homeless live in emergency shelters, transitional housing, or on the streets. Precariously housed individuals live with friends and relatives, or pay a very high proportion of their income in rent, putting them in imminent danger of becoming literally homeless.98 Homelessness is caused by many different factors, notably, a lack of affordable housing, mental illness, substance abuse, and low-paying jobs.99 Large natural disasters, like Hurricanes Katrina and Ike, also have thrown large populations into temporary or extended homelessness.100

Services for the homeless in Houston are restricted to adults and children accompanied by their parents. Currently, there are no shelters in Houston that provide assistance to unaccompanied homeless minors. Houston-area Covenant House provided such services until mid-2009. However, disputes with state regulators have forced the program to stop services to minors. Covenant House’s Crisis Shelter is now available only to those between 18 and 21 years of age.101 Covenant House has enacted this

There are currently approximately 19,000 families on a waiting list for the Housing Choice Voucher Program.

CHILDREN AT RISK 2010-2012

BASIC NEEDS

age restriction because in order to provide for youth under age 18, criminal background checks on those 18 and over currently residing in the shelter would be required. These checks are costly and effectively limit the number of children who are able to receive housing and treatment. Each youth may stay in the shelter for up to thirty days and is assigned a Resident Advisor to help them reconnect with their families and obtain education and job skills.102 Children below the age of 18 without a home must seek assistance from Child Protective Services. Covenant House also provides a transitional housing program called the Rights of Passage program (ROP). The program is open to youth 18-21 years to provide them with a foundation to develop the skills necessary to live independently. The program is divided into two parts. The first part is a 12-month program at the Covenant House facility where school, vocational, and life skills training are provided. After six months, qualified youth can apply for the Rights of Passage Apartment Living program (ROPAL). Covenant House co-signs with the youth at the Covenant House ROPAL apartment and pays a decreasing portion of the rent over a nine-month period, after which the youth is fully responsible for the rent for the remainder of the lease period.103 These two programs combine to give youth without a stable foundation the opportunity to learn to live independently. Transitional living services are crucial for homeless persons who â&#x20AC;&#x153;age-outâ&#x20AC;? when they reach the age of 21, but there is an almost complete lack of these facilities in the Houston area. One of the few options available to these persons is religious-based organizations that, unlike Covenant House, largely do not provide round-the-clock

service nor have fully equipped facilities. The Houston Alumni and Youth Center (HAY) provides similar services to former foster-care children up until the age of 25, not only providing these individuals with basic care and a transitional living allowance but also with life skills training. Like many other programs of its kind, HAYâ&#x20AC;&#x2122;s funding was pulled in 2007, and it is currently operating on a short-term commitment funded in part by the Texas Workforce Commission.104 Subsidized housing programs through the federal government provide low-income individuals and families with rent assistance either through government run housing projects or vouchers for private housing. Such programs are designed to prevent those who are precariously housed because of the large proportion of their income going towards their rent from falling into homelessness. Current fair market rents in Houston range from $661 per month for a studio apartment to $1495 per month for a four bedroom.105 For an individual to pay the ideal rent-to-income ratio of 30 percent, he or she would need to make $26,440 annually for a studio apartment. With the current minimum wage of $7.25 an hour and a 40-hour work week, an individual would make $11,600 annually, less than half of the ideal rent ratio.106 Voucher recipients pay approximately 30 to 40 percent of their income for rent, and the voucher covers the rest of their monthly payment.107 These vouchers allow for excess money to be left over every month to pay for utility bills, childcare expenses, car payments, and food. Currently, the city of Houston provides approximately 4,000 low-rent public housing units108 and around 19,000 subsidized units total for its low-income residents.109 This amount is sufficient to serve approximately 60,000 low-

CHILDREN AT RISK 2010-2012

BASIC NEEDS

Housing (cont.) income residents in the Houston area. Unfortunately, there are still many families in need of affordable housing. There are currently approximately 19,000 families on a waiting list for the Housing Choice Voucher program. As a part of the relocation of Hurricanes Katrina and Rita victims into more permanent housing, even more families are being added to the wait list until the September 2010 deadline is reached. Although the Houston Housing Authority processes about 125 to 150 applications every month, the wait time for those currently on the wait list is very long, and even longer for those waiting to apply.

More homeless shelters, transitional beds, and subsidized housing units are greatly needed, especially for unaccompanied homeless minors.

POLICY IMPLICATION Research has clearly shown that children who live in poor urban neighborhoods are at greater risk for school failure: poor standardized test results, grade retention, and high dropout rates. Research has also shown that when low-income families are given the chance to move to better neighborhoods, school performance and family stability improves. More homeless shelters, transitional beds, and subsidized housing units are greatly needed, especially for unaccompanied homeless minors. However, many of the organizations that provide these resources have experienced significant cuts to their budgets. The federal government is aware of this need and is currently evaluating legislation designed to provide a dedicated source of funding to very low-income households for the production, preservation, rehabilitation, and operation of rental housing. However, for the most part the federal government is ill-equipped to provide aid to a growing number of low-income families.

Child Support Indicator: The percentage of parents paying court-ordered child support in Harris County Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2007

2008

2009

2012 Goal

Indicator

30%

38%

44%

47%

44%

50%

54%

58%

57%

54%

100%

Source: Office of the Attorney General of Texas Goal Source: Establshed by the Family Law Courts, Harris County

• The Office of the Attorney General of Texas enforces services related to child support and ensures that parents receiving TANF automatically qualify to receive child support. • The Legal Enforcement Division of Harris County provides parents with legal representation to establish and enforce child support. • While both Texas and Harris County provide services for parents to receive child support payments, hundreds of children in Houston still do not receive their monthly payment. • The percentage of parents who fulfill their child support obligations has dropped to only 54%. Two government agencies are responsible for collecting unpaid child support in Harris County: the Office of the Attorney General of Texas (OAG) and the Harris County Domestic Relations Office (DRO). These two offices use different methods to ensure enforcement of support obligations, including interception of federal income taxes, seizure of assets held in financial institutions, suspension

of driver’s, professional and recreational licenses, denial of passport applications, and jail time for delinquent parents. The best and most effective method, however, is direct withholding from the obligated parent’s wages, so long as the employer can be found. Despite an increase in effort, the percentage of parents paying court-ordered child support in Harris County has slightly decreased. From 2008

CHILDREN AT RISK 2010-2012

PERCENT OF OBLIGATED CASES PAYING CHILD SUPPORT IN HARRIS COUNTY

60% 50% 40% 30%

30%

38%

1990

1992

44%

47%

45%

44%

1996

1997

1998

54%

52%

54%

2001

2002

2003

50%

58%

57%

54%

2006

2007

2008

2009

20% 10% 0%

1994

2000

BASIC NEEDS

70%

Source: Office of the Attorney General

to 2009 the percentage of parents fulfilling their support obligations dropped from 57% to 54%.110

Office of the Attorney General of Texas This state agency is responsible for establishing and enforcing child support orders upon obligated parents. The child support division of the OAG provides services related to the enforcement of child support, including location of the absent parent, establishing paternity, establishing and enforcing medical support orders, reviewing and adjusting child support payments, and collecting and distributing child support payments.111 Payment of support obligations are made easier by providing an online system where obligated parents can change their address and employment information or make their monthly payments. Parents receiving Temporary Assistance for Needy Families (TANF) or certain forms of Medicaid automatically qualify to receive child support services from the OAG once they are certified for public assistance.

lish, enforce or terminate child support and visitation, as well as attorney consultation. To qualify for legal services from the Harris County DRO, interested parents must already have the address of the other parent and must submit an application to the DRO, who will evaluate each application after an interview.113 Other services available from the DRO include social studies investigations for adoptions and contested custody cases, parenting coordination services, family mediation services for the Family District Courts, and probation services for parents who have been found in contempt of court for nonpayment of child support or for denial of courtordered visitation. The DRO also runs the Friend of the Court and the Focus on Collections and Services (FOCAS) programs, both of which are designed to monitor child support obligors and enforce compliance with court orders.

The Harris County Domestic Relations Office The DRO serves families in Harris County by providing assistance with all aspects of complying with court orders and child support obligations. The DRO is divided into four divisions: Legal Enforcement, Family Court Services, Family Dispute Resolution, and Community Supervision.112 For a fee, the Legal Enforcement Division provides residents of Harris County with legal representation to estab-

POLICY IMPLICATION Because various agencies work to collect child support from delinquent parents, the figures presented do not represent the total number of child support cases in Harris County. However, these figures do indicate that hundreds of children in Harris County are being denied adequate funds. Children whose parents or guardians apply for child support services must often wait several months before any of this money is received. In 2004, the OAG and the DRO partnered with the Harris County District Clerk and the Family District Courts to create the FOCAS program that emphasizes early intervention and monitoring. All offices that have partnered together for the program monitor child support payments as soon as the support order is established. If a payment is missed, the office begins enforcement proceedings immediately. CHILDREN AT RISK 2010-2012

BASIC NEEDS

Youth Workforce Indicator: The number of youths participating in job readiness and training programs in Harris County Year

1990

1992

1994

1996

1998

1999

2000

Indicator

10,956

6,736

2,258

1,597

806

493

5,612

Year

2001

2002

2003

2004

2005

2007

2008

Indicator

3,816

4,791

4,459

682

7,453

Source: Workforce Solutions

Indicator: The number of youths participating in summer youth employment programs in Harris County Year

1990

1992

1994

1996

1998

1999

2000

Indicator

5,322

7,566

5,153

5,090

6,989

8,000

4,660

Year

2001

2002

2003

2005

2007

2008

Indicator

2,079

2,360

790

1,550

214

4,412

Source: Workforce Solutions

• The Workforce Investment Act created a job training program in 1998 and required all states to consolidate their previous training programs, and to focus on and improve youth programs. • Workforce Solutions in Houston offers a wide range of youth services for career planning and scholarship assistance. • The Summer Jobs Program has become very successful in Houston since the stimulus bill passed, and has placed over 4,000 youth into job placements, affording them valuable experience for the future.

The Workforce Investment Act (WIA), signed into law on August 7, 1998, supplanted and amended former job training legislation with the goal of creating a single, comprehensive, customer-focused federal job training program. The Act achieves this goal by requiring states to consolidate all job training programs and resources into a “one-stop service delivery” community center.114 In Texas, there are 28 local workforce boards, overseen by the Texas Workforce Commission.115 Houston, Harris County, and 12 other contiguous counties are served by the Gulf Coast Workforce Board using the name Workforce Solutions.116 One of the key principles of the WIA is to increase and improve youth programs offered and link them with local labor needs and existing youth programs within the community.117 At the 15 offices of Workforce Solutions within Houston and Harris County, a full range of youth services are offered.118 Programs and assistance available include job placement services, career planning, assessment, counseling, resume assistance, access to tools like the Internet and fax machines, and workshops on interviewing, resumes, and job search. Some youth may also qualify to receive assistance with finding scholarships and financial aid, tutoring assistance, and work/study assistance.119

As part of the American Recovery and Reinvestment Act of 2009, also known as the stimulus, Texas received a grant of $82 million, $14,761,027 of which was directly allocated by the Gulf Coast Workforce Board. The Summer Jobs program at Workforce Solutions is one of the more prominent youth services offered, and it is the primary way to engage youth in Workforce Solutions’ programs. The program targets youth ages 14-24 from low-income families and subsidizes their employment at worksites around the community.120 In the past, the Summer Jobs program existed on a small scale due to funding restrictions. Just 214 youth participated in subsidized summer employment in 2007.121 As part of the American

CHILDREN AT RISK 2010-2012

6,000 5,000 4,000 3,000 2,000 1,000 0

90-91

92-93

93-94

1996

Source: Office of the Attorney General

1997 Latino

1998

1999

2000

African American

Recovery and Reinvestment Act of 2009, also known as the stimulus, Texas received a grant of $82 million, $14,761,027 of which was directly allocated by the Gulf Coast Workforce Board. With this money, Workforce Solutions was able to recruit 4,412 youth122 for subsidized employment at over 600 worksites with over 400 employers.123 Workforce Solutions also helped many other youth find unsubsidized summer employment. Overall, the program has had an immense economic impact for Houston, and has provided thousands of low-income youth with valuable work skills and experience for their future. Workforce Solutions receives funding from a number of state and federal grants, including Temporary Assistance for Needy Families (TANF), the WIA, the Child Care and Development block grant, and in 2009 the American Recovery and Reinvestment Act. The Gulf Coast Regional Workforce Board, which receives a portion of these grants through state and federal contracts, contracts with other organizations to provide services in the community. From

2001 Anglo

2002

2005

2007

BASIC NEEDS

NUMBER OF YOUNG PEOPLE BY ETHNICITY SERVED THROUGH EMPLOYMENT AND TRAINING PROGRAMS IN HARRIS COUNTY AS FUNDED BY THE WORKFORCE INVESTMENT ACT

2008

Asian

January 1, 2008 to September 30, 2009 the Gulf Coast Regional Workforce Board spent $30.5 million on youth services, $20.6 million of which was used directly in Harris County. $19.3 million of the funds spent in Harris County were direct service costs, with only $1.3 million being spent on administrative costs.124 Workforce Solutions allows their customers access to many of their services without requiring registration or tracking their information. Some services require customers to meet an income eligibility requirement. As part of those requirements, detailed information on customers receiving those services is kept. Between January 1, 2008 and August 30, 2009, 7,453 youth registered with Workforce Solutions in Harris County.125 This number is significantly higher from previous years, in part because of the temporary expansion of the Summer Jobs program, and it does not even include all of the youth benefitted by the programs at Workforce Solutions, only those required to meet income tests.

CHILDREN AT RISK 2010-2012

BASIC NEEDS

Agenda for Change Air Pollution • Texas, especially the Greater Houston area, must address ozone reduction caused by the most dangerous pollutants and air toxins that are discharged from industrial sources including coal-fired power plants, refineries, and chemical companies. • Schools should implement “no idling” policies and encourage parents to turn off their vehicles whenever possible. Hazardous Waste Sights • The Texas Commission on Environmental Quality must be adequately funded in order to investigate and clean up the thousands of closed or abandoned hazardous waste sites. Parks and Green Space • Houston should create private/public partnerships to expand parks and green space in urban areas. Low-Income Families and Resources • To better assist children living in low-income families, eligibility and the application process for aid should be made less restrictive and more accessible. • Poverty and associated problems within low-income communities can be prevented by addressing related issues such as teen pregnancy, low graduation rates, and access to affordable early childhood education and healthcare.

Food Program • In order to increase participation rates for eligible children for Food Stamps programs, the National School Lunch Program, the School Breakfast Program, and the Summer Food Service Program, government entities and schools must promote awareness of these programs, implement proactive policies, and seek to maximize federal funding. Housing • Due to natural disasters and difficult economic times, there is a need to increase low-income housing assistance, homeless shelters, and transitional beds to meet the needs of families. • Housing and increased services should be available for unaccompanied homeless minors. Child Support • With only 54% of parents fulfilling their child support obligations, collection of child support must be a priority with a continued effort to strengthen partnerships, vigilant monitoring and enforcement. Youth Workforce • The Texas Workforce Board should maintain training and work programs for low-income youth that offer valuable work skills and experience.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Maternal & Infant Health Indicator: The percentage of women in Harris County receiving early prenatal care, which is defined as starting medical care in the first trimester of pregnancy and continuing care until delivery Year

1990

1992

1994

1996

1998

2000

2002

2003

2004

2005

2006

2010 Goal

Indicator

71.4

71.6

78.7

81.6

81.8

81.2

62.2

58.4

90%

Source: Texas Department of State Health Services, Vital Statistics Unit Goal Source: U.S. Department of Health and Human Services, Healthy People 2010 (2000)

Indicator: The percentage of infants born in Harris County weighing <2,500 grams, or approximately 5 lbs. 8 oz, and classified as low birth weight Year

1990

1992

1994

1996

1998

2000

2002

2003

2004

2005

2006

2010 Goal

Indicator

7.3%

7.5%

7.4%

7.9%

8.30%

8.50%

Source: Texas Department of State Health Services, Vital Statistics Unit Goal Source: U.S. Department of Health and Human Services, Healthy People 2010 (2000)

Indicator: The number of deaths of infants under 1 year per 1,000 live births in Harris County Year

1990

1992

1994

1996

1998

2000

2001

2002

2003

2004

2005

2006

2010 Goal

Indicator

8.8

8.3

8.1

6.5

6.2

4.9

5.6

6.3

6.5

6.8

5.9

4.5

Source: Texas Department of State Health Services, Vital Statistics Unit Goal Source: U.S. Department of Health and Human Services, Healthy People 2010 (2000)

• Mothers who do not receive prenatal care have an infant mortality rate six times the rate of mothers who receive early prenatal care. • The percentage of African American and Latino mothers who receive prenatal care continues to be lower than the percentage of Anglo mothers who receive prenatal care. • According to the CDC, preterm delivery is a major contributing factor to the high infant mortality rate in the U.S.

Prenatal care is important for both maternal and infant health. Early, ongoing prenatal care enhances pregnancy outcomes by assessing risks and providing early treatment of potential problems, while late or no prenatal care has been associated with premature birth, low birth weight, and infant mortality. Women who receive no prenatal care have pregnancy-related maternal mortality that is three to four times higher compared to those who do receive prenatal care.1 Furthermore, mothers who receive no prenatal care have an infant mortality rate more than six times that of mothers receiving early prenatal care.2

Women who receive no prenatal care have pregnancy-related maternal mortality that is three to four times higher compared to those who do receive prenatal care.

In 2006, there were 4,265,555 births nationwide; 3 399,309 births in Texas;4 and 70,175 births in Harris County.5 In 2003, the U.S. Standard Certificates of Birth, Death, and

Fetal Death were revised.6 Texas adopted the new U.S. Certificate of Live Birth in 2005, and the new U.S. Standard Certificates of Death and Fetal Death were implemented in 2006. It is important to note that due to the

CHILDREN AT RISK 2010-2012

2000

2001

2002

2003

2004

2005

2006

African American

12.2

1377

12.5

1398

12.6

1414

13.8

1583

13.7

1588

14.2

1665

14.8

1945

Anglo

6.5

1423

1469

7.4

1567

7.2

1277

7.8

1634

7.9

1615

8.1

1669

Latino

6.2

1858

1876

6.6

2178

6.4

2147

6.6

2291

6.9

2402

6.8

2473

Total*

8.3

4658

8.5

4743

8.8

5159

9.1

5306

8.2

5513

8.5

5682

8.7

6087

*For this chart only: Total counts and percentages include other ethnic groups Source: Texas Department of State Health Services, Vital Statistics Unit

Harris County Infant Mortality Rates per 1,000 by Race/Ethnicity Race/Ethnicity

2000

2002

2003

2004

2005

2006

African American

8.7

12.6

11.6

12.3

13.2

10.4

Anglo

4.4

4.9

5.4

4.7

4.8

5.2

Latino

4.1

5.3

5.5

5.7

5.9

4.6

Other

2.2

2.7

5.3

3.7

5.1

Average

4.9

6.3

6.5

6.8

5.9

Source: Texas Department of State Health Services, Vital Statistics Unit

implementation of the new Certificate of Live Birth, the percentage of women receiving early prenatal care in 2005 and beyond is not directly comparable to previous years. In Harris County, 58.4% of women received early prenatal care in 2006.7 This represents a decrease from 2005, in which 62.2% of women in Harris County received early prenatal care.8 Statewide, the numbers decreased in 2006 as well, with 61.0% of women in Texas receiving early prenatal care9 compared to 63.7% in 2005.10 Nationally, 69% of women received early prenatal care in 2006.11 Disparities by race and ethnicity in the receipt of prenatal care still persist in Texas and throughout the nation. The percentage of Anglo women who receive early prenatal care continues to be higher than the percentages for African American and Latino women. In Harris County, 71.5% of Anglo women12 received early prenatal care in 2006, compared to only 53.3% of African American women and 54.6% of Latino women.13 Nationwide, 76.2% of Anglo women received early prenatal care in 2006, while 58.4% of African American women and 57.7% of Latino women received early prenatal care.14 The American Congress of Obstetricians and Gynecologists recommends that pregnant women receive prenatal care as early as possible.15 There were 31,055 infants born in Harris County in 2006 to mothers who received late prenatal care (beginning after the first trimester) or no prenatal care.16 According to the Centers for Disease Con-

PHYSICAL & MENTAL HEALTH

Low Birth Weight Babies by Race/Ethnicity in Harris County

Harris County is below the national average for the number of women who receive early prenatal care during pregnancy. The national average is 69% while the average for Harris County is 58.4%. trol and Prevention (CDC), nearly one-third of American women will have some form of pregnancy complication, and one-fourth will have a serious complication.17 Early prenatal care helps to ensure that these complications are detected and treated early. Low birth weight is one of the complications that can result from the absence of early and adequate prenatal care. Infants born weighing less than 2,500 grams, or 5 lbs. 8 oz, are considered to be born at low birth weight.18 Infants born weighing less than 1,500 grams, or 3 lbs. 4 oz, are considered to be of very low birth weight.19 A newbornâ&#x20AC;&#x2122;s weight at birth is closely related to its risk of early death and long-term morbidity; infants born at the lowest weights are the most likely not to survive the first year.20 Long-term risks include disability and impaired development, including delayed motor and social development.21

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Maternal & Infant Health (cont.) In Harris County 8.7% of all infants born in 2006 were classified as low birth weight, which is slightly higher than the 8.5% for Texas and 8.3% nationwide. Latino women in Harris County had the lowest percentage of low birth weight infants in 2006 at 6.8%, followed by Anglo women at 8.1% and African American women at 14.8%.22 This is consistent with statewide statistics showing that African American women in Texas having the highest percentage of low birth weight infants in 2006 at 14.2%, followed by Anglo women at 7.8% and Latino women at 7.7%.23 Many low birth weight infants are also born preterm. Preterm infants are born at less than 37 completed weeks of gestation, and they often experience the same short and long-term complications as low birth weight infants.24 In 2006, 13.7% of infants in Texas were born preterm, and 12.8% of infants were born preterm nationwide.25 According to the CDC, preterm delivery is a major contributing factor to the high infant mortality rate in the U.S.26 Infant mortality is defined as the number of infant deaths less than one year of age per 1,000 live births. The infant mortality rate is used as an indicator for the health and well-being of a population. The national infant mortality rate for 2006 was 6.7, and the rate has remained fairly stagnant since 2000.27

exception of 2006, the rate among the Latino population in Harris County has been the second highest since 2001, but the disparities between the Anglo and Latino rates are much smaller.31 The same trend is found statewide, with African Americans having the highest mortality rate, followed by a fluctuation from year to year between the Anglo and Latino populations as having the second highest rate.32

Latino women in Harris County had the lowest percentage of low birth weight infants in 2006 at 6.8%, followed by Anglo women at 8.1% and African American women at 14.8%.

There were 411 deaths of infants under the age of one in Harris County in 2006, which equates to an infant mortal-

The infant mortality rate among African Americans in Harris County has consistently been more than double the next highest race/ ethnic group since 2001. ity rate of 5.9. This is the lowest rate for Harris County since 2001 when the rate was 5.4.28 Like the national rate, the rate for Texas continues to remain fairly constant with a rate of 6.2 in 2006, 6.5 in 2005, and 6.3 in 2004.29 Racial disparities are found in the infant mortality rate as well. The infant mortality rate among African Americans in Harris County has consistently been more than double the next highest race/ethnic group since 2001.30 With the

CHILDREN AT RISK 2010-2012

Race/Ethnicity

2000

2002

2003

2004

2005

2006

African American

11,338

11,225

17,795

11,580

11,760

13,111

Anglo

18,385

17,643

11,483

17,083

16,935

16,558

Latino

30,029

32,852

33,675

34,703

34,740

36,355

Other

3,573

3,690

3,754

3,765

3,535

4,151

Total

63,325

65,410

66,707

67,131

66,970

70,175

Source: Texas Department of State Health Services, Vital Statistics Unit

With a decrease in the number of women throughout Texas who are receiving early prenatal care, and with percentages of low birth weight and preterm infants born in Texas that are consistently higher than national percentages, it is important to identify and address the underlying causes of these trends.

TRIMESTER PRENATAL CARE BEGAN BY RACE/ETHNICITY IN TEXAS 2006 80 70 60 50 40 30 20 10 0 % Anglo 1st Trimester

% African American 2nd Trimester

% Latino

PHYSICAL & MENTAL HEALTH

Live Births in Harris County by Race/Ethnicity

% All Races

3rd Trimester

No Care

Policy Implication With a decrease in the number of women throughout Texas who are receiving early prenatal care, and with percentages of low birth weight and preterm infants born in Texas that are consistently higher than national percentages, it is important to identify and address the underlying causes of these trends. Access to healthcare is a significant factor, and health insurance coverage is a deciding factor in whether health care is accessible. The uninsured are less likely to have a usual source of medical care and are more likely to delay or forgo needed health care services. 33 On average in 2006-2008, about one in three women of childbearing age was uninsured in Texas.34 Thus, there is a need for increased access to affordable healthcare. The underlying causes of the disparities in early prenatal care, low birth weight, and infant mortality across racial and ethnic groups must also be addressed. Of particular concern are the significant disparities found in the population of African American women who continuously have the highest rates of infant mortality, low birth weight and preterm babies. In addition to increased access to affordable health care, there is also a need for more educational outreach that stresses the importance of prenatal health care. This will improve the health of both mothers and infants and help close the statistical gap among ethnic groups.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Pregnancy & Alcohol/Substance Abuse INDICATOR: The number of pregnant women in Harris County who sought treatment for alcohol/substance abuse Year

2003

2004

2005

2006

2007

2008

2009

Number

109

118

147

195

211

173

190

Source: Texas Department of State Health Services, Decision Support Unit, Mental Health & Substance Abuse

â&#x20AC;˘ Alcohol can damage a fetus at any time during pregnancy, and there is no amount of alcohol that is considered safe to consume during pregnancy. â&#x20AC;˘ Women who smoke during pregnancy are more likely to suffer from pregnancy complications, premature delivery, low birth weight infants, stillbirth, and sudden infant death syndrome. â&#x20AC;˘ Marijuana, crack and cocaine are the most abused substances by pregnant women.

Alcohol consumption, tobacco, and illicit drug use during pregnancy all can have short- and long-term harmful effects on prenatally exposed children, including early childhood behavioral and developmental problems. Despite increasing awareness about these detrimental effects, studies show that nearly 11% of pregnant women aged 15 to 44 in the U.S. drink alcohol, over 16% smoke cigarettes, and over 5% use illicit drugs.35 Among nonpregnant women aged 15 to 44, 54% drink alcohol, over 27% smoke cigarettes, and 10% use illicit drugs.36 The overall percentages are lower for pregnant women in comparison to their nonpregnant counterparts, which means that some women are abstaining from alcohol, cigarettes, and illicit drug use during pregnancy. However, in certain age groups, specifically younger age groups, the percentage of pregnant women who smoke cigarettes and use illicit drugs is actually higher in comparison to their nonpregnant counterparts.37

Women who drink during pregnancy risk the chance that their baby will be born with one or more Fetal Alcohol Spectrum Disorders (FASD). FASD includes fetal alcohol syndrome (FAS), fetal alcohol effects, alcohol-related birth defects, and alcohol-related neurodevelopmental disorder.39 The effects of FASD include physical, mental, behavioral, and learning disabilities with possible lifelong implications.40 FAS is among the more severe disorders and can cause abnormal facial features, growth problems, central nervous system problems, and even fetal death.41 While no amount of alcohol consumption during pregnancy can be considered safe, risk of harm to both the mother and the fetus increases with greater alcohol consumption. Among the 11% of pregnant women nationwide aged 15 to 44 who consume alcohol, 5% reported binge drinking (four or more drinks on one occasion) and 1% reported heavy drinking.42

Smoking during pregnancy not only affects the health of According to the U.S. Surgeon General, no amount of alco- the mother, but also can result in several harmful outcomes hol consumption can be considered safe during pregnancy, to the developing baby. Research shows that women and alcohol can damage a fetus at any stage of pregnancy.38 who smoke during pregnancy are at greater risk of pregThe number of pregnant women in texas who sought treatment for alcohol/substance abuse 1600 1400 1200 1000 800 600 400 200 0 2001

2004

2005

2006

2007

CHILDREN AT RISK 2010-2012

2006

2009

nancy complications, premature delivery, low birth weight infants, stillbirth, and sudden infant death syndrome.43 Like alcohol consumption, the risk of harm to the infant increases with increased use, as the risk of heart defects appears to increase with the number of cigarettes a woman smokes.44 While national statistics show that the overall percentage of pregnant women aged 15 to 44 who smoke (16%) was lower than those who were not pregnant (27%), cigarette smoking among younger women aged 15 to 17 was actually higher for pregnant women (21%) than nonpregnant women (15%).45 The use of illicit drugs such as Ecstasy, marijuana, cocaine, and amphetamines during pregnancy can have numerous harmful effects on the fetus as well as on a child long after birth, including miscarriage, premature birth, low birth weight, brain damage, and withdrawal. In addition, women who use illicit drugs may also engage in other behaviors which put themselves and their unborn child at risk, such as smoking or consuming alcohol during pregnancy, all which add further risk of harm to the fetus and the mother. Like smoking, although the overall percentage for illicit drug use among pregnant women in the U.S. aged 15 to 44 (5%) is lower than the rate among women who are not pregnant (10%), illicit drug use is higher among younger pregnant women aged 15 to 17 (22%) than those who are not pregnant (13%).46 Treatment for alcohol and substance abuse during pregnancy can significantly improve pregnancy outcomes for

In the same year in Harris County, 35% of pregnant substance abuse treatment clients reported marijuana as their primary substances at first admission, 19% reported cocaine, and 13% reported crack.

both mothers and infants, and pregnancy offers mothers the opportunity to seek help and change their own lives in order to ensure the health of their unborn child. However, given the stigma with smoking, alcohol consumption, and illicit drug use during pregnancy, lack of disclosure by the mother is common and may inhibit the mother from seeking treatment. Therefore, statistics regarding the total number of women who are abusing these substances are difficult to determine. While data is available regarding the number of pregnant women who seek treatment, it is important to note that the number of pregnant women who do not seek treatment may differ greatly in comparison. In Texas, the Department of State Health Services (DSHS) licenses and funds substance abuse treatment facilities and programs throughout the state which provide both residential and outpatient substance abuse treatment services for pregnant women. Residential treatment services provide 24-hour per day multidisciplinary professional clinical support to facilitate recovery from addic-

Among the 11% of pregnant women nationwide aged 15 to 44 who consume alcohol, 5% reported binge drinking (four or more drinks on one occasion) and 1% reported heavy drinking.

PHYSICAL & MENTAL HEALTH

The percentage of pregnant women aged 15 to 17 in the U.S. who smoke cigarettes and use illicit drugs is higher than their nonpregnant counterparts.

tion. Outpatient programs are designed for clients who do not require the more structured environment of residential treatment to maintain sobriety. There are a variety of different residential and outpatient treatment services. The most frequently used residential treatment services are the intensive residential services, specialized residential female services, and residential services for women with children.47 Among the most frequently used outpatient services are the outpatient individual and group counseling sessions and specialized outpatient female services.48 After steadily increasing from 2003 (832 clients) to 2007 (1,396 clients) the number of pregnant women in Texas who sought treatment for substance abuse through DSHS decreased in 2008 (1,303 clients).49 In 2009, the number increased to 1,310 clients.50 The number of pregnant women in Harris County who sought treatment for substance abuse also increased from 2003 (109 clients) to 2007 (211 clients).51 Like the state trend, the number of clients in Harris County decreased in 2008 (173 clients) and increased again in 2009 (190 clients).52

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Pregnancy & Alcohol/Substance Abuse (cont.) The number of pregnant women in Texas receiving residential treatment is fairly comparable to the number of pregnant women receiving outpatient treatment, and some women may receive both outpatient and residential treatment during the year. In 2009, there were 937 pregnant women statewide who received outpatient treatment and 808 pregnant women who received residential treatment.53 In 2008, there were 890 pregnant women statewide who received outpatient treatment and 808 women who received residential treatment.54 In 2007, a greater number of pregnant women statewide received residential treatment (968) than outpatient treatment (929).55 In Harris County, more pregnant women have received residential treatment than outpatient treatment each year since 2003. In 2009, there were 168 pregnant women who received residential treatment and 105 pregnant women who received outpatient treatment.56 In 2008, there were 121 pregnant women receiving residential treatment and 111 women receiving outpatient treatment.57 The most commonly reported substances used by pregnant women in Texas and Harris County include marijuana, crack, cocaine, amphetamines, heroin, and alcohol.58 Among these substances, marijuana, crack, and cocaine are the top three most frequently reported substances. Statewide, 26% of pregnant substance abuse treatment clients in 2009 reported marijuana as their primary substances at first admission, 17% reported heroin, and 15% reported cocaine.59 In the same year in Harris County, 35% of pregnant substance abuse treatment clients reported marijuana as their primary substances at first admission, 19% reported cocaine, and 13% reported crack.60 Pregnant substance abuse treatment clients with alcohol as their primary substance reported at first admission statewide comprised 9% of all treatment clients in 2009, 10%

in 2008, and 7% in 2007.61 In Harris County, clients with alcohol reported as their primary substance at first admission comprised 21% of all treatment clients in 2009, 11% in 2008, and 20% in 2007.62

Increased educational efforts are needed to raise awareness among the teenage population about preventing unintended pregnancies and the dangers of substance abuse.

Policy Implication While it is well-known that smoking, alcohol and substance abuse during pregnancy can harm an unborn child, the persistent use among pregnant women demonstrates the need for increased prevention and treatment efforts. Prenatal exposure to these substances can endanger the life of the unborn child or result in lifelong complications. Some outcomes, such as Fetal Alcohol Spectrum Disorders, are entirely preventable, further emphasizing the need for more prevention and treatment services. Of particular concern are the alcohol consumption, smoking, and substance abuse rates among the teenage pregnancy population. Increased educational efforts are needed to raise awareness among the teenage population about preventing unintended pregnancies and the dangers of substance abuse.

CHILDREN AT RISK 2010-2012

Indicator: The rate of births to teens ages 13 to 17 per 1,000 population in Harris County Year

1990

1991

1992

1993

1994

1995

1996

1997

1998

Indicator

15.5

16.3

15.4

16.2

15.4

15.1

15.0

13.9

Year

1999

2000

2001

2002

2003

2004

2005

2006

11.4

10.9

10.5

11.1

Indicator 13.7 12.2 11.4 Note: Texas Department of State Health Services

• The United States has the highest teen birth rate among developed countries. • The Latino population has the highest birth rate among 15 to 19 year olds nationwide. • Financial costs associated with teen pregnancy include lost tax revenue, public assistance, health care costs and child welfare.

Texas is ranked No. 3 in the nation for the highest number of teen births in 2006. Already having the highest teen birth rate among developed countries, the U.S. teen birth rate increased in 2006 from 40.5 in 2005 to 41.9 births per 1,000 population of 15 to 19 year old girls.63 After a steady decline, this was the first time in fifteen years that the U.S. teen birth rate rose. According to preliminary data, the birth rate rose again in 2007 by about 1 percent, to 42.5 births per 1,000.64 The majority of teen births are unintended, nearly two-thirds among mothers under age 18 and more than half among mothers aged 18 to 19 years, meaning they occurred sooner than desired or were not wanted at any time.65

Nationally, the highest birth rate among 15 to 19 year olds is among the Latino population.74 The second highest birth rates are among African Americans, followed by Native Americans, Anglos, and Asian or Pacific Islander populations.75 The same trend is found in Harris County, where 62% of births to girls under 20 years of age in 2006 were among the Latino population; followed by African Americans at 25%; Anglos at 12%; and 1% among all other ethnic groups.76 In Texas in 2006, Latinos comprised 62%; followed by Anglos at 22%; African Americans at 15%; and all other ethnic groups at 1%.77

PHYSICAL & MENTAL HEALTH

Teen Births

Texas had the third highest teen birth rate in the nation in 2006, with 63.1 births per 1,000 women aged 15-19, or 54,008 births, comprising 14% of all births in the state.66 Of these teen births, 23% were repeat births, and 80% of the mothers were unmarried.67 In Harris County, the rate of births to teens aged 13 to 17 per 1,000 population rose to 11.1 in 2006 from 10.5 in 2005.68 The rates for Texas for the same age group in 2005 and 2006 remained the same at 10.8.69 There were 8,596 births in Harris County in 2006 to girls under the age of 20.70 Of these births, 22% were repeat births, and 15% of the infants were born preterm.71 Preliminary data shows that there were 8,852 births in 2007 and 8,786 births in 2008 to girls in Harris County under the age of 20.72 Of the 2007 births, 22% were repeat births and 14% of the infants were born preterm; in 2008 21% were repeat births with 14% of the infants born preterm.73 CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Teen Births (cont.) The costs associated with teen pregnancy include lost tax revenue, public assistance, health care costs, and child welfare. Nationally, teen childbearing costs taxpayers at least $9.1 billion a year.78 Teen births are estimated to cost Texas taxpayers $1 billion a year.79 The costs of childbearing are greatest for younger teens; the average annual cost associated with a child born to a mother 17 and younger in Texas is $2,997.80 Overall, teenage mothers are less likely to receive adequate prenatal care, less likely to gain adequate weight during pregnancy, and more likely to smoke than older mothers.81 Therefore, infants born to teenage mothers are at greater risk of low birth weight, disability, and mortality during the first year of life.82

Recognizing the importance of reaching out to teen males for teen pregnancy prevention, the 81st Legislature passed HB 3076 which expands the p.a.p.a. health curriculum for high schools to junior high schools. Policy Implication Teenage pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children. 83 A significant portion of these costs stems from dropping out of school, as teenage parenting often diverts or postpones education for both girls and boys. 84 The Texas Education Code appropriately requires schools to emphasize abstinence when teaching human sexuality curriculum. However, in order to further help teens prevent unintended pregnancies and remain free of sexually transmitted diseases, it is also important to equip them with medically accurate, age-appropriate information about sexual health. Unfortunately, two bills, HB 741 and HB 1567, which would have required such information, did not pass during the 81st Texas Legislative Session. While teen mothers are often the focus of teen pregnancy and parenting, it is necessary to apply equal focus on teen fathers. Eight out of ten teen fathers do not marry the mothers of their first child. 85 Teen fathers are also more likely to drop out of school, have poor involvement with their children, and have decreased economic stability than their counterparts. In Texas, the Parenting and Paternity Awareness curriculum (p.a.p.a.) stresses the benefits of sequencing parenthood after a person has completed his/her education, started a career, and is in a stable, committed relationship. 86 Key themes in the curriculum focus on the importance of fatherhood and the financial and emotional challenges of single parenting. 87 Recognizing the importance of reaching out to teen males for teen pregnancy prevention, the 81st Legislature passed HB 3076 which expands the p.a.p.a. health curriculum for high schools to junior high schools.

CHILDREN AT RISK 2010-2012

Indicator: The number of children served comprehensively through the Early Childhood Intervention program in Harris County Year

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

5,263

5,946

6,395

6,581

6,852

7,372

7,948

8,771

Source: Texas Department of Assistive and Rehabilitative Services, Early Childhood Intervention

• The Early Childhood Intervention program (ECI) coordinates a statewide system of services for families with children from birth to age three who have disabilities and developmental delays. • ECI services include family counseling and education, nutrition services, nursing services, physical therapy and social work services. • The majority of children served through ECI in Harris County and across the state are eligible for services due to developmental delays.

The number of children served through ECI in Texas has steadily increased, from 33,649 children served in 2001 to 57,110 children served in 2009. The Early Childhood Intervention Program (ECI), created by the 67th Texas Legislature in 1981, is a division of the Texas Department of Assistive and Rehabilitative Services. With local programs in every county in Texas, ECI

coordinates a statewide system of services for families with children from birth to age three who have disabilities and developmental delays.88 ECI is state- and federally-funded through the Individuals with Disabilities Education Act (IDEA, P.L. 108-446), and also funded through local funds, Medicaid, and private insurance.

PHYSICAL & MENTAL HEALTH

Early Childhood Intervention

Research has shown that growth and development are most rapid in the early years of life, and early intervention is therefore important in minimizing the effects of developmental delays over time. Parents are included as participants in the ECI programs, and treatment is provided in the child’s natural environments, such as in the home or at a child care center. The result is treatment which helps maximize progress by promoting development and learning

Planned Services FY 2005 Developmental Services

FY 2008

FY 2009

Harris

Statewide

Harris

Statewide

Harris

Statewide

40%

74%

76%

83%

82%

86%

Occupational Therapy

15%

31%

27%

29%

26%

29%

Physical Therapy

14%

25%

22%

23%

21%

23%

Speech Language Therapy

20%

57%

34%

52%

32%

51%

Nutrition

10%

12%

13%

Audiology

Vision

Family Training / Counseling

N/A

Behavioral Intervention

N/A

Psychological / Social Work

N/A

Source: Texas Department of Assistive and Rehabilitative Services, Early Childhood Intervention

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Early Childhood Intervention (cont.) Race/Ethnicity of Population Served 2005 Harris

2008

Statewide

Harris

2009

Statewide

Harris

Statewide

Asian

African American

18%

12%

18%

12%

18%

12%

Latino

47%

45%

48%

52%

49%

American Indian

< 1%

Anglo

31%

41%

30%

38%

27%

36%

Source: Texas Department of Assistive and Rehabilitative Services Early Childhood Intervention

tion services, nursing services, physical therapy, and social work services.91 Some services, such as development of the Individual Family Service Plan, service coordination, and translation and interpretation services are provided at no cost regardless of income.92 Families with children enrolled in Medicaid or CHIP, or whose income is below 250% of the Federal Poverty Level, do not pay for any ECI services.93 Other families pay a cost share determined by a sliding fee scale based on family size and net income.94 The number of children served through ECI in Texas has steadily increased, from 33,649 children served in 2001 to 57,110 children served in 2009.95 The numbers for Harris County have also increased, from 5,263 children served in 2001 to 8,771 children served in 2009.96 Latino children represent the largest racial population served in 2009, at 49% of the children served statewide, followed by Anglo at 36%, African American at 12%, Asian at 2%, and Native American at less than 1%.97 The same trend exists for 2008 statewide percentages as well as Harris County percentages for 2008 and 2009. In 2009, 52% of the children served in Harris County were Latino, followed by Anglo at 27%, African American at 18%, Asian at 3%, and Native American at less than 1%.98 and by providing continuous support to families. ECI provides free evaluations and assessments to families to determine eligibility and need for services.89 Income is not a factor in determining eligibility. Children are eligible for services if they meet one of the following criteria: developmental delays in certain areas of development such as cognitive, motor, social-emotional, and self-help skills; atypical development (children who may perform within their appropriate age range on test instruments but whose patterns of development are different from their peers); and children with medically diagnosed conditions with a high probability of developmental delay.90 Services include family counseling and education, nutri-

The majority of children served through ECI both statewide and in Harris County are eligible for services due to developmental delay. In 2009, 73% of children served statewide were eligible due to developmental delay, followed by 16% due to atypical development, and 11% due to medical diagnosis.99 In Harris County in 2009, 71% were eligible due to developmental delay, 17% due to atypical development, and 12% due to medical diagnosis.100 The same trend is found in the 2008 percentages for both the state and Harris County.101 Statewide, 61.4% of children served were eligible for Medicaid in 2009, and 60.2% were eligible in 2008.102 In Harris County, 61.7% were eligible for Medicaid in 2009, and 60.4% were eligible in 2008.103

CHILDREN AT RISK 2010-2012

Receiving treatment at an earlier age will reduce the need for more intensive treatment in subsequent years, and the state may save in overall long-term costs of providing special education services when these children enter public school.

PHYSICAL & MENTAL HEALTH

Among the planned services, developmental services were the most utilized services both statewide and in Harris County in 2008 and 2009, followed by speech language therapy, occupational therapy, physical therapy, and nutrition.104 In Texas in 2009, 86% of eligible children received developmental services, 51% received speech language therapy, 29% received occupational therapy, 23% received physical therapy, and 13% received nutrition services.105 In Harris County in 2009, 82% of eligible children received developmental services, 32% received speech language therapy, 26% received occupational therapy, 21% received physical therapy, and 12% received nutrition services.106 Utilization percentages for audiology, vision, family training/counseling, behavioral intervention, and psychological/social work services for both Texas and Harris County in 2008 and 2009 ranged from 1% to 9%.107

Policy Implication The Early Childhood Intervention Program (ECI) plays an integral role in treating children throughout Texas who have developmental delays by providing them with necessary treatment during a very critical developmental period of their lives as well as invaluable continuous support for their families. Providing treatment early on may eliminate current developmental delays and also help to prevent further developmental delays that can compound over time if left untreated. Without ECI, many families are otherwise unable to bear the financial costs of treatment, and these children would not have access to treatment for developmental delays until they enter public school. Receiving treatment at an earlier age will reduce the need for more intensive treatment in subsequent years, and the state may save in overall long-term costs of providing special education services when these children enter public school. Therefore, it is of utmost importance to develop a sustainable service system and to ensure that funding and eligibility for these vital services are not decreased.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

C H I LD R E N

R I S K

TO P

T E N

P R I O R I T Y

Health Coverage: CHIP and Medicaid Indicator: The average number of children under the age of 21 in Harris County who were certified for health care services through the Medicaid program Year

1990

1992

1994

1996

1997

1998

1999

2000

Indicator

86,484

135,489

198,691

211,054

171,033

85,490

113,524

119,032

Year

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

127,103

209,947

266,499

328,907

349,407

351,912

364,463

382,762

409,744

Source: Texas Health and Human Services Commission

Indicator: The average number of Harris County children under the age of 18 who were certified for health care services through the Texas Children’s Health Insurance Program Year

2000

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

93,865

82,093

70,594

64,954

59,693

66,306

86,869

96,483

Source: Texas Health and Human Services Commission

INDICATOR: The average number of children enrolled in CHIP Perinatal coverage in Harris County Year

2007

2008

2009

Average Enrollment

5,915

15,222

16,689

Note: CHIP perinatal coverage began in January 2007. Enrollment numbers are in addition to the numbers of children enrolled in traditional CHIP and are not included in other CHIP enrollment reports. Individuals are enrolled retrospectively (coverage begins the month the person is certified).

• In 2008, Texas had the second highest percentage for children with no insurance coverage. • The majority of Medicaid enrollees in Texas are children. • The Harris County CHIP program has mirrored the enrollment trend of the state, as numbers have drastically fluctuated since its implementation in 2000.

In 2008, there were 7.3 million children (9.9%) in the U.S. under the age of 18 who were uninsured, the lowest rate and number of uninsured children since 1987.108 Texas had the second highest percentage of children under age 18 with no insurance coverage during any time in 2008 at 17.9%, 109 representing a decrease from the 21.4% in 2007 but still well above the national average.110 Furthermore, Texas continues to have the highest uninsured rate in the nation for people of all ages, with 25.1% of Texans living without insurance in 2008, significantly higher than the 15.4% for the nation.111 Despite the decrease in the number of uninsured children in Texas and the nation, it is important to note that children, like adults, continue to lose coverage through employer-sponsored insurance, but increased coverage through public programs like Medicaid and the Children’s Health Insurance Program (CHIP) help

Children in Harris County comprised 18% of all Texas children under age 19 enrolled in Medicaid in 2009. make up for the loss.112 Medicaid is a state-administered program available to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law.113 CHIP targets uninsured children and pregnant women in families with incomes too high to qualify for most state Medicaid programs, but often too low to afford private coverage.114

CHILDREN AT RISK 2010-2012

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In 1993, Frew v. Hawkins, a class action lawsuit, was filed against the state of Texas alleging that the state did not adequately provide Medicaid services through the Texas Health Steps Program. After several years of negotiations, in 2007 the 80th Legislature appropriated an estimated $1.8 billion in funds to increase availability of Medicaid services for children. Increased expenditures were required on strategic dental and medical initiatives, including those to enhance services in underserved areas, to improve medical transportation, and to simplify access to medically necessary areas. In 2009, the 81st Legislature approved an increase in general revenue funds to maintain the rate increases enacted in 2007 as part of the Frew lawsuit settlement. Medicaid is a jointly funded state-federal health care program, established in Texas in 1967 and administered by the Health and Human Services Commission (HHSC).115 Medicaid is an entitlement program, which means the federal government does not, and the state cannot, limit the number of eligible people who can enroll, and Medicaid must pay for any services covered under the program.116 In its initial implementation, Medicaid was available only to people who qualified for cash assistance. During the late 1980s and early 1990s, Congress expanded the Medicaid program to include the elderly, the disabled, children, and pregnant women.117 Eligibility for Texas Medicaid is based upon age, income, resources and assets, and disability status. People who are eligible for Temporary Assistance for Needy Families (TANF) or Supplemental Security Income are automatically eligible for Medicaid. In addition, pregnant women and infants under twelve months old in families with income up to 185% of the Federal Poverty Level (FPL); children ages 1-5 in families with income up to 133% of FPL; and children ages 6-18 in families with income up to 100% of FPL are covered.118 Also, the majority of children in foster care are categorically eligible for Medicaid until age 18.119 The annual income for a family of four at 100% of FPL is $22,050.120 The annual income for a family of four at 185% of FPL is $40,792.50; and $29,326.50 at 133% of FPL.121

PHYSICAL & MENTAL HEALTH

Frew v. Hawkins, 540 U.S. 431 (2004)

Children represent the majority of Medicaid enrollees in Texas. Newborns and children through age 5 represented 32% of all Medicaid enrollees in the state in 2009, and children aged 6-18 represented 31% of all enrollees.122 Children can be enrolled in traditional Medicaid or Children’s Medicaid. Children’s Medicaid includes children in the following categories: TANF children, foster care children, newborns, children ages 1-5, and children ages 6-14. The children in these categories qualify for Medicaid based on their age and family income. Children enrolled in traditional Medicaid include children who qualify based on age and family income, as well as children who qualify for other reasons, such as pregnancy or disability status. In 2009, an average of 2,263,482 children in Texas under age 19 were enrolled in Medicaid each month, and a monthly average of 2,134,775 of these children (94.3%) were enrolled in Children’s Medicaid.123 This represents an increase in enrollment from 2008 in which an average of 2,132,142 children in Texas under age 19 were enrolled in Medicaid each month, and a monthly average of 2,009,573 of these children (94.3%) were enrolled in Children’s Medicaid.124 Of the children enrolled in Children’s Medicaid in Texas in 2009 an average of 204,984 children (9.6%) were receiving TANF each month, which is a numerical increase but slight percentage decrease from the 2008 monthly average of 199,355 children (9.9%).125 The average number

CHILDREN AT RISK 2010-2012

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Health Coverage: CHIP and Medicaid (cont.) approved in 2009.132 The application approval rates for TANF were significantly lower, with 937 applications, or 19% of all applications processed approved, in 2008, and 783, or 21% of all processed applications, approved in Harris County in 2009.133

of children in foster care enrolled in Children’s Medicaid decreased in 2009, with 34,473 children (1.6%) enrolled each month, compared to an average of 35,771 children (1.8%) in foster care enrolled each month in 2008.126

A bill that could have made a significant improvement to the Children’s Medicaid program did not pass during the 81st Texas Legislative Session in 2009. Currently, Medicaid Children in Harris County comprised 18% of all Texas beneficiaries must be recertified every six months. House children under age 19 enrolled in Medicaid in 2009, with Bill 2962 would have provided for 12-month eligibility for an average monthly enrollment of 406,928 children, and 19% of all Texas children enrolled in Children’s Medicaid, Children’s Medicaid, thus providing children with a full with an average monthly enrollment of 384,765 children.127 year of continuous coverage. The average monthly Medicaid enrollment in Harris The 81st Legislature passed Senate Bill 187, which reCounty of children under age 21 has steadily increased quires the executive commissioner of the Health and over the past decade. In 1999, an average of 113,524 children under age 21 were enrolled each month. In 2009, Human Services Commission to implement a Medicaid an average of 409,744 children under age 21 were enrolled buy-in program for certain disabled children whose family in Harris County, and an average of 382,762 were enrolled incomes do not exceed 300% of FPL. This bill requires participants to pay monthly premiums on a sliding scale in 2008.128 An average of 20,317 children were receivbased on family income. Also passed during the 81st Sesing TANF each month in Harris County in 2009, and an average of 5,458 children in foster care were enrolled each sion was House Bill 1630, which will ensure that children are assessed and that eligible children are enrolled in month.129 Similar to the state data, newborns and children Medicaid and CHIP before they are released from the through age 5 represented 36% of all Medicaid enrollees Texas Youth Commission and the Texas Juvenile Probation in Harris County in 2009, and children ages 6-18 repre130 Commission. sented 31% of all enrollees. With respect to application approval for Medicaid in Harris County, a monthly average of 20,596 applications, or 72% of all processed applications, were approved in state fiscal year 2008, and 21,648 or 75% were approved in 2009.131 For Transitional Medicaid, a monthly average of 74 applications, or 92%, were approved in Harris County in 2008, and an average of 88 applications, or 94%, were

The Federal Balanced Budget Act of 1997 created the State Children’s Health Insurance Program (SCHIP) and appropriated nearly $40 billion for the program for federal fiscal years 1998-2007.135 Like Medicaid, CHIP is administered by the federal agency, Centers for Medicare and Medicaid Services, and is jointly funded by the federal government and the states.136 On February 4, 2009, the

CHILDREN AT RISK 2010-2012

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Childrenâ&#x20AC;&#x2122;s Health Insurance Program Reauthorization Act of 2009 was signed into law, financing CHIP through federal fiscal year 2013 and expanding coverage from 7 million children to 11 million children nationwide.137 With broad federal guidelines, each state determines the design of its program, eligibility groups, benefit packages, and payment levels for coverage.138 Initially in 1998, Texas used SCHIP funds to expand Medicaid eligibility. In 1999, a separate childrenâ&#x20AC;&#x2122;s health insurance program was established by the 76th Legislature.139 Coverage under Texas CHIP began in 2000; the Texas Health and Human Services Commission has administered CHIP since 2003. Texas CHIP is available to children under the age of 19 in families with low incomes and resources, but who earn too much to receive Medicaid and do not have private health insurance. These are families with incomes up to 200% of FPL.140 In 2009, FPL for a family of four equated to an annual income of $44,100.141 This translates to a monthly income of $3,675. Statewide, an average of 7% of CHIP enrollees in 2009 earned less than 101% of FPL; 55% earned between 101% to 150% of FPL; 32% earned between 151% to 185% of FPL; and 6% earned between 186% to 200% of FPL.142 Unlike Medicaid, CHIP is not an entitlement, so the state can require recipients to share in the cost of care, including enrollment fees and co-pays, based upon the relation of income to FPL.143 In addition, families whose income is above 150% FPL must pass an asset test which was implemented in September 2004. Since implementation of CHIP in 2000, enrollment has experienced somewhat of a rollercoaster effect. Enrollment increased steadily until state law was passed by the 78th Legislature in 2003 requiring enrollees to prove continued eligibility every six months, resulting in a significant decline from its peak in May 2002 with 529,211 enrolled, to its lowest point following the new law in September 2006 with only 291,530 enrolled.144 The issue of proving enrollment eligibility was addressed again in the 80th Legislature which extended eligibility to one full year, thus

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slowly increasing the numbers to their highest point since to 511,871 enrolled in May 2010.145 The benefits offered through CHIP also underwent a period of flux, with certain benefits including dental, vision, and mental health being cut in 2003, only to be restored in 2005 by the 79th Legislature. The enrollment trend for Harris County has mirrored that of the state, with average yearly enrollment numbers dropping beginning in 2003, reaching their lowest point in 2006 at 59,693, and rising again in 2007 with the highest average enrollment in 2009 at 96,483 enrolled.146 During the 81st Legislative Session, two bills which would have allowed families above the current income limit of 200% of FPL to purchase coverage on a sliding scale based on income were not passed. Both House Bill 2962 and Senate Bill 841 attempted to increase access to health coverage by proposing a CHIP buy-in option for families who cannot afford private health care premiums.

PHYSICAL & MENTAL HEALTH

Newborns and children through age 5 represented 32% of all Medicaid enrollees in Texas in 2009, and children aged 6-18 represented 31% of all enrollees.

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The 79th Legislature authorized the Health and Human Services Commission to expend funds to provide unborn children with health benefit coverage under CHIP, resulting in the CHIP Perinatal program which began in January 2007.147 The program allows pregnant women who are ineligible for Medicaid due to income (from families with income up to 200% of FPL) to receive prenatal care, and provides CHIP benefits to the child upon delivery for the remainder of the twelve-month coverage period.148 In addition, members receiving the CHIP Perinatal benefit are exempt from the 90-day waiting period, the asset test, and all cost-sharing for the duration of their coverage period.149

CHILDREN AT RISK 2010-2012

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Health Coverage: CHIP and Medicaid (cont.) Since its implementation in 2007, CHIP Perinatal enrollment has steadily increased. In state fiscal year 2009, the total monthly average state caseload was 63,001.150 Of these cases, 43% were mothers under 185% of FPL

and 55% were newborns in families under 185% of FPL; mothers and newborns in families over 185% of FPL represented 1% each.151 In Harris County, the average monthly enrollment for 2009 was 16,689, and 15,222 in 2008.152

Enrollment barriers must be eliminated by providing parents with clear instructions on how to enroll and also by ensuring adequate staffing of the eligibility system so that applications are processed in a timely manner. Policy Implication Medicaid and CHIP play an important role in the well being of children in Texas. Children who are insured are more likely to be up to date on immunizations, have a regular health care provider, have preventive care visits, fewer emergency room visits, and even miss fewer school days due to illness than uninsured children. Thus, it is essential that all eligible children receive program services. There are many children in Texas who are eligible for Medicaid or CHIP but are not enrolled. In 2008, 49.5% of all children in Texas under age 19 were eligible for Medicaid or CHIP, but only 68.1% of these eligible children were enrolled.153 This means that 1,126,944 eligible children in Texas were not enrolled in 2008.154 In Harris County, over 115,000 eligible children are not enrolled. Enrollment barriers must be eliminated by providing parents with clear instructions on how to enroll and also by ensuring adequate staffing of the eligibility system so that applications are processed in a timely manner. In addition, the implementation of 12-month eligibility for Medicaid is needed in order to ensure more eligible children are served, as evidenced by the increase in enrollment numbers with the implementation of 12-month eligibility for CHIP. Due to the current economic climate, the number of children without insurance is growing as poverty in the state and throughout the nation increases. Nationwide, over two-thirds of newly-uninsured children were in families above 200% FPL, the current limit for Texas CHIP, and the latest census reports indicate that the number of uninsured Texas children at 200 to 300% of FPL is growing. Thus, a CHIP buy-in option is needed for the growing number of children in families with income above the current limit but who cannot afford private health care. Medicaid and CHIP are both jointly funded state-federal health care programs. For every state dollar invested in Medicaid in 2009, $1.47 was federally matched, and for every state dollar invested in CHIP, $2.52 was federally matched. Unfortunately, Texas has forfeited nearly $1 billion of federal CHIP funding to other states over the past ten years. The state must maximize the utilization of these federally matched dollars to ensure that all eligible children are covered. On March 23, 2010, President Obama signed the Healthcare Reform Bill into law to extend coverage to 32 million uninsured people. Medicaid and CHIP serve as key building blocks for healthcare reform. Among the provisions that became effective on the date of enactment is the requirement that states must at least maintain the Medicaid and CHIP coverage and enrollment procedures in place on the enactment date, which means that states cannot scale back their income eligibility levels. Additional provisions beginning on September 23, 2010, will allow children to remain on their parentsâ&#x20AC;&#x2122; health plan until age 26; prohibit children with insurance from being denied coverage for pre-existing conditions; eliminate lifetime caps or restrictive annual limits on coverage; and provide free preventive services to enrollees in new plans.

CHILDREN AT RISK 2010-2012

Indicator: The number of Harris County children receiving Supplemental Security Income (SSI) benefits Year

2000

2002

2004

2006

2008

Indicator

8,834

10,320

13,335

17,781

19,961

Source: Social Security Administration

• SSI is a federal cash assistance program that provides monthly payments to low-income, aging, blind, and disabled persons in the 50 states and the District of Columbia. • Most children who qualify for SSI suffer from chronic rather than acute conditions. • In 2008, 112,875 children in Texas received SSI benefits, which equated to 9.8% of all children in the United States.

Texas leads the nation in the number of children under the age of 18 receiving SSI benefits. Supplemental Security Income (SSI) is a federal cashassistance program that provides monthly payments to low-income, aging, blind, and disabled persons in the 50 states and the District of Columbia. The program is based on nationally uniform eligibility standards and payment levels. SSI is means-tested and has relatively stringent medical eligibility criteria. Most children who qualify for SSI suffer from chronic rather than acute conditions. The federal SSI payment is calculated using the recipient’s

countable income, living arrangement, and marital status. Children on SSI are eligible for Medicaid, Temporary Assistance for Needy Families (TANF), and food stamps. In 2008, 1,153,844 children in the United States under the age of 18 received federally administered SSI payments, a monthly average of $561.25, in the United States.155 In determining the benefit amount for a child, the SSI program excludes one-third of child support payments from countable income.

PHYSICAL & MENTAL HEALTH

Supplemental Security Income Benefits (SSI)

In 2008, the Social Security Administration received just over 476,000 SSI applications for children. This number equated to 16.8% of the more than 2.8 million total SSI applications received during that year. The number of applications filed for children has been rising steadily since 1996.156 In 2008, 112,875 Texas children received SSI benefits, which equated to 9.8% of all children in the United States. This percentage increased from 2006, when it was 8.9%. Of Texas children receiving SSI, 19,961 lived in Harris County, 17.7% of all children receiving SSI benefits in Texas. While the number of children receiving SSI benefits in Harris County increased in 2008, the percentage slightly decreased from 2006, when it was 18.6%.157 States and other jurisdictions have the option of supplementing their residents’ SSI payments and may choose to have the additional payments administered by the federal government. When a state chooses federal administration, the Social Security Administration maintains the payment records and issues both the federal payment and the state supplement in one check. The data presented is for federally-administered state payments only.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

School-Based Clinics Indicator: The number of school-based or school-linked programs in Houston ISD that provide medical and mental health care to underserved children Year

1990

1992

1994

1996

1999

2000

2002

2003

2004

2005

2007

2009

Indicator

2010 22

Source: Director of Health and Medical Services, Houston Independent School District; Texas Association of SchoolBased Health Centers

• School-based health centers serve an important function as they offer collaborative health services as well as help to educate children and their families about preventive health measures and self-reliance in obtaining optimum medical care. • School-based health centers are primarily used for minor injuries, health-maintenance exams, immunizations, mental health concerns, ADD, asthma and obesity. • Although the clinics in Harris County currently serve 85,000 students, the number of clinics has dropped from a high of 33 clinics in 2003 to 22 school-based fixed and mobile clinics. School-based health centers serve a vital purpose for thousands of children in Harris County every day. These centers offer collaborative health services to students and help to educate children and their families about preventive health practices and self-reliance in obtaining optimum medical care. Besides improving health outcomes for students throughout the district, school-based clinics additionally help prevent extended absences from school due to health problems.158 Schools are a logical place to provide health care because of the convenience of the location and the comfort that many students feel due to familiarity with the staff. Fur-

thermore, teachers are able to observe any chronic health conditions and immediately refer them to an in-house health professional. This assists many families who may have difficulties providing transportation to outside health care centers and reflects the desire of the neighborhood to provide health care for its children.159 The most common uses of school-based health centers are for minor injuries, health-maintenance exams, immunizations, mental health concerns, ADD, asthma, and obesity. These clinics are typically prevention-oriented: children do not have to wait for their conditions to worsen before

There are approximately 85 school-based health centers in Texas as reported by the Texas Association of SchoolBased Health Centers (TASBHC). they are referred to a hospital, thereby cutting down on health care costs and increasing school attendance rates. While the majority of visits to the school-based clinics operated by the Harris County Hospital District (HCHD) are due to illness-related ailments, immunizations have become an integral function of the clinics, with 46,719 vaccines given during Fiscal Year 2010 (March ‘09 to Feb ‘10).160 These health centers are successful because the services are easily accessible, located in a familiar environment, and offered by teams of professionals who address a wide range of health care needs.161

CHILDREN AT RISK 2010-2012

2010, a drop in number from the peak of 33 in 2003, although the clinics currently serve over 85,000 students.163 HCHD expanded its program services in 2005 to include behavioral health care, including mental health services. Four school-based health centers in Texas received funding from the Texas Department of State Health Services in 2008. Unfortunately, none are within Houston ISD, but are located near Galveston (La Marque ISD), Brownwood (Bangs ISD), Lubbock (Frenship ISD), and Brownsville (Mathis ISD).164

PHYSICAL & MENTAL HEALTH

School-based clinics are typically funded through partnerships involving the state, school district, hospital district, community health centers, universities, and private fundraising efforts. Houston Independent School District (HISD) implemented its first school-based clinic 20 years ago, although the greatest growth has occurred during the past five years. There are approximately 85 school-based health centers in Texas as reported by the Texas Association of School-Based Health Centers (TASBHC).162 There are 22 school-based fixed and mobile clinics in HISD in

Increasing the amount of school-based clinics would decrease the number of days children miss from school and would lessen the burden on parents to find health care for their children. Policy Implication School-based health clinics are extremely valuable to children of all ages. The opportunity to receive care at school decreases the time a child would typically wait to receive health care and lessens the burden on parents who might otherwise have to miss work and other obligations to take their child to an alternate location. Health clinics in schools also reduce missed school time, as children are more likely to attend school knowing that there is a clinic where they can receive care. It is important to provide outreach to students and parents on the availability of these services to ensure that they are fully utilized.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Texas Health Steps: THSteps EPSDT Indicator: The percentage of eligible children and adolescents in Harris County who are receiving medical screening through the Texas Health Steps Program, formerly Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Year

1990

1992

1994

1996

1997

1998

1999

2000 2002

Indicator

15%

22%

39%

36%

40%

41%

30%

44%

36%

2004 47%

2005 2006 2007 2008

2010 Goal

48%

100%

46%

48%

42%

Source: Texas Health and Human Services Commission Goal source: Texas Department of State Health Services, Texas Health Steps (EPSDT)

Indicator: The percentage of eligible children and adolescents in Harris County who are receiving any dental service through the Texas Health Steps Program, formerly Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Year

1990

1992

1994

1996

1997

1998

1999 2000 2002 2004 2005

2006

2007 2008

2010 Goal

Indicator

21%

24%

37%

32%

37%

44%

38%

44%

46%

100%

40%

46%

48%

Source: Texas Health and Human Services Commission Goal source: Texas Department of State Health Services, Texas Health Steps (EPSDT)

• The THSteps program informs eligible Medicaid children of any preventive medical and dental services they may need. • Less than half of the children in Harris County who are eligible to receive Medicaid THSteps services are actually receiving services. • Frew vs. Hawkins increased the number of service providers willing to accept Medicaid clients and further allocated an additional $706.7 million in general revenue to increase eligible children’s access to Medicaid.

THSteps is a component of the federal Medicaid program that provides preventive medical and dental services to indigent children under age 21. Under federal law, the THSteps program must inform eligible Medicaid children of the availability of screening, diagnostic, and treatment services; arrange screening services when requested; and arrange any necessary corrective treatment.165 The program provides vision, dental, and health care as well as comprehensive and periodic evaluation of a child’s health, development, and nutritional status.166 Frew vs. Hawkins: The lawsuit originally was filed in 1993 by a group of mothers on behalf of their THSteps eligible children. The mothers alleged that Texas had failed to provide necessary and essential preventive health services under a federally mandated Medicaid program. As the numbers indicate, the need for services is great. The number of children eligible for Medicaid THSteps services has been steadily increasing over the past few years. In 2008, 545,411 children were eligible for medical and dental services in Harris County.167 Despite that fact,

the percentage of eligible children receiving services has hit a plateau around 47%. From 2007 to 2008, the number of eligible children receiving any dental service increased from 242,917 to 264,008, but the number of children receiving at least one medical check-up decreased from 252,274 to 230,797.168 In past years, the number of service providers willing to accept Medicaid clients was decreasing. With an increase in the number of eligible children and a decrease in service providers, children were not being screened in a timely manner. Grievances with the system, such as failure to conduct initial and periodic screening, the lack of adequate outreach and informing services, poor case management, and the failure to recruit a sufficient number of dentists, sparked the Frew vs. Hawkins class action lawsuit against the State of Texas. The lawsuit originally was filed in 1993 by a group of mothers on behalf of their THSteps eligible children. The mothers alleged that Texas had failed to provide necessary and essential preventive health services under a federally mandated Medicaid pro-

CHILDREN AT RISK 2010-2012

Because of the agreement, the number of providers accepting Medicaid clients saw a dramatic increase. By 2007, the number of THSteps dental providers in Harris County reached 1,363 and rose to 1,476 in 2008. The number of

THSteps medical providers in Harris County reached 893 in 2008, increasing from 865 in 2007, more than doubling the numbers from 2006.170 In 2008, Texas also saw its highest numbers of THSteps dental and medical providers, reaching 4,913 and 5,109 total respectively.171

The number of children receiving medical services has decreased dramatically, indicating a greater need to serve children who are eligible for Medicaid.

Policy Implication The 80th Texas Legislature appropriated $723.84 million for the 2008-2009 biennium for Early Periodic Screening, Diagnosis and Treatment (EPSDT) programs for children. Funding assumed 440,482 children would be covered each month under EPSDT in 2008 and 445,548 children per month in 2009. Throughout the implementation of the ruling, state and federal government entities as well as other advocates continue to monitor allocations, outreach efforts, and access to services.

PHYSICAL & MENTAL HEALTH

gram. Unlike similar class action suits pending throughout the country, Frew vs. Hawkins initially was resolved when the state entered into a consent decree with the plaintiffs. In 2007, an agreement in the Frew vs. Hawkins lawsuit allocated $706.7 million in general revenue ($1.78 billion in all funds) to increase eligible children’s access to Medicaid, including increasing physician and dental reimbursement rates.169

WIC: Special Supplemental Food Program for Women, Infants, and Children Indicator: The percentage of eligible infants, children, and women who are served in the local WIC programs in Harris County Year

1990

1992

1994

1996

1998

1999

2000 2002 2003 2004 2005 2006

2007 2008 2009

Indicator

22%

32%

64%

58%

62%

65%

70%

77%

72%

77%

80%

81%

84%

80%

86%

Source: Texas Department of State Health Services

• WIC strives to improve the nutritional status of low-income women, infant and children who are most vulnerable to the effects of malnutrition. • Services are free to those who meet the eligibility requirements. • The Harris County WIC projects continue to serve a diverse clientele.

Harris County makes up approximately 17% of estimated total eligibles in the Texas WIC program.

The Special Supplemental Food Program for Women, Infants, and Children (WIC) strives to improve the nutritional status of low-income women, infants, and children who are most vulnerable to the effects of malnutrition. WIC nutrition education, health foods, and access to medical and social programs promote better outcomes for at-

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

WIC: Special Supplemental Food Program for Women, Infants, and Children (cont.) Annual Average of Participating women, infants and children in all harris county wic projects 113,500 98,500 83,500 68,500 53,500 38,500 23,500 8,500

2000

2001

Breastfeading

2002

Children

2003

Infants

2004

Post Partum

2005

2006

2007

2008

2009

Pregnancy

risk pregnant women, breast-feeding mothers, infants, and children to age five. To be eligible, an applicant must be a pregnant, breast feeding, or postpartum woman; an infant or child under age five; have one or more nutritional health problems, such as iron deficiency, anemia, or under weight or height; and live at or below the federal income guidelines of 185% of poverty. In 2009, the eligibility guideline was an annual income of $40,793 for a family of four or a monthly income of $3,400, an increase from the 2008 income criteria of $39,220 and $3,269 respectively.172 Services are free to those who are eligible. The Harris County WIC projects continue to serve a diverse clientele. In 2009, the demographics of WIC enrollment by ethnicity across the state of Texas were estimated to be 72% Latino, 14% Anglo, 11% African American, 1% Asian, 1% mixed, and 0.15% Native American/Hawaiian/ Pacific Islander.173 In 2009, Texas received $607,910,272 in federal funding for the WIC program. The numbers of Harris County participants in 2009 were 45,649 infants, 92,070 children, 18,936 pregnant women, 9,259 postpartum women, and 19,659 breastfeeding women.174

Policy Implication Given the rising cost of foods with the highest nutritional value, eligible infants, children, and women must utilize the WIC program. While participating in the program, WIC-approved foods supply significant amounts of protein, iron, vitamin C, calcium, and other nutrients needed for proper growth and development. Each participating infant or child and their siblings receive immunizations at no cost, as well as other important referral services. Texas and Houston must continue outreach efforts to ensure that all children have the opportunity for healthy development.

CHILDREN AT RISK 2010-2012

Indicator: The percentage of Houston children between 19 and 35 months who have completed the 4:3:1:3:3:1 vaccination schedule Year

1988

1993

1994

1996

1998

2000

2002

2004

2005

2006

2007

2008

2009

2010 Goal

Indicator

11%

17%

52%

48%

60%

56%

62%

77%

70%

42%

37%

30%

90%

Source: National Immunization Survey Goal Source: Healthy People 2010, U.S. Department of Health and Human Services

Indicator: The percentage of Harris County children ages 0-35 months with at least one immunization entered into the Texas ImmTrac Immunization Registry Year

2000

2003

2004

2006

2007

2008

2009

2010 Goal

Indicator

18.56%

18.12%

55.27%

89.20%

93.00%

95.20%

80%

Source: City of Houston Health & Human Services Department; ImmTrac Statewide Immunization Registry Goal Source: Healthy People 2010, U.S. Department of Health and Human Services Note: Data beginning in 2007 reflects transition from the Houston-Harris County Immunization Registry to ImmTrac

â&#x20AC;˘ The recommended vaccination schedule now requires 19 vaccinations by 19 months of age. â&#x20AC;˘ The 2008 National Immunization Survey reported that only 80% of infants between 19 to 35 months of age in the U.S. had received the 4:3:1:3 series immunizations, the most basic of the immunization schedules in the U.S.

PHYSICAL & MENTAL HEALTH

Immunizations

In 2004 Harris County Public Health and Environmental Services (HCPHES) created a task force dedicated to increasing immunization rates; their efforts have led to increased outreach by providers in Harris County, which has resulted in higher immunization rates. Vaccinations serve as a barrier against physical illnesses and prevent more costly treatment in the event a person develops symptoms of a disease. Administering vaccinations for children on a timely schedule is of great importance, especially against diseases that may prove lethal to many in this population. A vaccinated child is not only protected against potentially deadly diseases, but is also one less person that can contribute to spreading disease in the event of a large-scale outbreak. Since vaccinations prevent many diseases, they are beneficial to both the adult and child populations. The more persons immunized against disease, the lower the risk presented to the community in terms of developing any kind of outbreak.

The ACIP regularly updates or modifies recommended combination schedules as more knowledge and research on disease prevention is acquired. In 2009 the pneumococcal conjugate vaccine (PCV7) was added to the 4:3:1:3:3:1 schedule, incorporating four doses of this vaccine in the current series.176 The recommended vaccination schedule now requires 19 vaccinations by 19 months of age in the updated immunization series. In February 2010, the ACIP voted to and eventually modified the PCV7 vaccine to PCV13, which added protection against 6 additional serotypes.177 Vaccination program series have dramatically reduced the prevalence of many serious diseases in the United States.178

The Advisory Committee on Immunization Practices (ACIP) recommended until recently, in 2009, that children receive approximately 15 vaccinations by 19 months of age, in accordance with the 4:3:1:3:3:1 childhood immunization schedule.175

The 4:3:1:3:3:1:4 schedule designates the appropriate ages for administering each of the 19 vaccine doses. Late immunizations can still be implemented if a person does not follow the recommended schedule, however it is more beneficial to follow the recommended ages for immunization in order to maximize protection as early as possible

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Immunizations (cont.) while minimizing potential risks.179 Administering vaccines on the recommended schedule is a critical factor during a child’s first two years of life because susceptibility levels to vaccine-preventable diseases are at their highest.180 However, if multiple and various doses are received too early, the vaccines may prove to be ineffective.181 Annually, the Centers for Disease Control and Prevention (CDC) conducts the National Immunization Survey (NIS), generating estimates of vaccination coverage rates for

In Texas, for every man, woman and child’s immunization record to be added to the ImmTrac registry the processing cost to the state would be $25 million. children between 19 and 35 months on national, state, and selected local levels, including the city of Houston. NIS data can be useful in highlighting groups at risk of contracting vaccine-preventable diseases and raising public awareness. Historically, immunization initiatives in Harris County dating back to 2002 were conceived as a result of these surveys, resulting in a jump in immunization rates between 2002-2006. The 2008 National Immunization Survey reported that 80% of infants between 19 to 35 months of age nationwide had received the 4:3:1:3 series immunizations, the most basic of the immunization schedules in the United States.182 This series includes four doses of diphtheria/ tetanus/pertussis vaccine, three doses of poliovirus vaccine, one dose of measles/mumps/rubella vaccine and three doses of haemophilus influenzae type b (Hib) vaccine. Concerning the recommended schedule, the 4:3:1:3:3:1:4 series, the NIS reported that 68% of infants 19 to 35 months nationally had received these immunizations.183 The recommended series combines the 4:3:1:3 series with three doses of hepatitis B vaccine, one dose of the varicella vaccine and four doses of PCV13 vaccine. In 2004 Harris County Public Health and Environmental Services (HCPHES) created a task force dedicated to increasing immunization rates; their efforts have led to increased outreach by providers in Harris County, which has resulted in higher immunization rates.184

Most public schools and childcare facilities in the state of Texas make it a prerequisite to have children immunized with at least the 4:3:1:3 series before admission. Texas requires a report of immunization status annually from public schools and accredited private schools.185 In Texas in 2008, only 79% of children between 19 to 35 months of age had received the 4:3:1:3 schedule186 and only 71% for the 4:3:1:3:3:1:4 schedule.187 The rate or percentage of children immunized on the 4:3:1:3 schedule has remained steady since 2006 in Texas; only slight growth has been observed in the 4:3:1:3:3:1:4 series each year since 2007, from 68% to 71% in 2008. After steadily increasing, the percentage of Houston children who have been immunized with the 4:3:1:3 schedule decreased slightly to 74% in 2008,188 one percent below the last reported data showing 75% in 2007.189 The 4:3:1:3:3:1:4 schedule for 2008 remained unchanged from 2007, with 64% of children aged 19-35 reported to have completed the series. Since ImmTrac utilizes an “opt-in” system an individual must consent to have their records recorded by ImmTrac. This fact and the fact that the Houston and Harris County registries were previously managed

Vaccine exemptions serve as barriers to increasing immunization rates; children with immunization exemptions are at higher risk for contracting vaccinepreventable diseases. by their own local registry program which auto-processed records leads to some question as to whether this data is representative of the area. Vaccine exemptions serve as barriers to increasing immunization rates. The state of Texas recognizes the right of parents or guardians to exempt their children from vaccination requirements for reasons of conscience, including a religious belief or for medical reasons. The rationale of some parents requesting exemptions stems from safety fears. Texas is one the leading states in expanding state exemptions.190 Children with immunization exemptions are at higher risk for contracting vaccine-preventable diseases.191 Likewise vaccination exemptions have contributed

CHILDREN AT RISK 2010-2012

Emerging in many statewide immunization registries is the use of Electronic Medical Record systems (EMR), which is becoming the preferred method by physicians in connecting and exchanging data between EMR and IT systems.194 Currently, ImmTrac’s “opt-in” system, which requires individuals to first consent to allowing their records into the registry, costs the state a processing fee of $1.13 per consented record.195 In Texas, for every man, woman and child’s record to be added to the ImmTrac registry the processing cost to the state would be $25 million.196 Some experts believe the cost is higher, suggesting $25 million is actually an underestimate.197 A lack of modernization within ImmTrac has led to problematic issues such as an inadequate interface to new or existing software, poor data quality and exchange, an outdated forecaster for reminder/ recall, inadequate rapid data entry for pandemic relief, and the incompatibility of the registry to accommodate the growing EMR supply.198

PHYSICAL & MENTAL HEALTH

to outbreaks across the nation of diseases such as measles, mumps and hepatitis B.192 Of Texas children surveyed during the 2007-2008 school year, 3% reported having vaccine exemptions.193

Immunization records from ImmTrac, the state registry, should be monitored to track the immunization coverage rate for childhood diseases and to ensure that children are receiving the appropriate immunizations during the recommended time frame. Policy Implication Childhood diseases can be prevented through timely immunizations. Health care officials continue to shed light on the importance of immunizations for children. Because of the importance of timely immunizations, most kids get vaccinated at the kindergarten level. One of the national health objectives set by the U.S. Department of Health and Human Services is to immunize 95% of children in kindergarten – 1st grade by 2010. Texas overall was above the national average at 78% whereas the nation was reported at 76% according to the NIS in 2008. Unfortunately, Houston is still behind on both the goal and national average as of the 2008 NIS data at 72%. The state registry, ImmTrac, has recently absorbed all data and elements of the Harris County Immunization Registry (HHCIR), which was dissolved in 2008, and tracks immunization records for children and makes them available to health professionals. It will be important to monitor ImmTrac in the future to track the immunization coverage rate for childhood diseases in the Houston and Harris County area and at the same time continue to work on educating parents as well as local public health leaders about the importance of appropriately immunizing children with a sense of urgency.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Childhood Diseases Indicator: The number of confirmed measles cases in children ages 0 to 19 in Houston/Harris County Year Indicator

2010 Goal

1990 1992 1994 1996 1998 2000 2002 2003 2004 2005 2006 2007 2008 2009 101

Source: Texas Department of Health and Human Services Goal Source: U.S. Department of Health and Human Services, Health People 2010 Note: Data for 2009 is provisional

Indicator: The number of confirmed cases of children under the age of seven with pertussis in Houston/Harris County Year

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010 Goal

Indicator

134*

Source: Texas Department of Health and Human Services Goal Source: U.S. Department of Health and Human Services, Health People 2010 Note: Data for 2009 is provisional

Indicator: The number of tuberculosis (TB) cases reported per 100,000 population of children and youth up to age 24 Year Indicator

1990 1992 1994 1996 1998 8.1

12.1

11.1

7.1

6.4

2000 4.6

2002 2003 2004 4.5

2.6

2005

2006

2007

2008

2010 Goal

2.4

5.2

5.5

5.7

Source: Texas Department of Health and Human Services Goal Source: U.S. Department of Health and Human Services, Health People 2010

• The majority of measles cases in 2008 consisted of unvaccinated children whose parents had either withheld immunization, had not received their own measles vaccine, or because children were not old enough to receive the MMR vaccination. • In Texas, cases of Pertussis increased significantly from 2007 to 2009. • In 2008, 11.6% of all TB cases were in Texas, of which 16.4% of those infected were persons under the age of 24. The bodies of infants and children are in a state of continuous growth. An immune system under development is an immune system that is more susceptible to contracting a disease that otherwise may be considered minor in nature for an adult. A disease that is otherwise minor in an adult can be much more serious in a child, sometimes proving fatal in the absence of proper treatment. Measles, pertussis and tuberculosis are some of the more serious diseases to threaten children’s health. Measles, identified also as rubeola, is a highly contagious disease that is passed through the air when people sneeze or cough. Measles is an infection of the respiratory system caused by a virus that normally grows in the cells that line the back of the throat and lungs.199 People who

The MMR vaccine is the safest protection against measles. The National Immunization Survey reported that, in 2008, 94% of children aged 19 to 35 months were vaccinated in Texas, a higher rate than the 92% the nation reported in 2008.

CHILDREN AT RISK 2010-2012

Although there were zero measles cases reported for children aged 0-19 in Harris County and Texas in 2008, in 2009, Texas reported two cases of measles and Harris County reported one case. There were no deaths attributed to this disease reported in 2009, which also has been the case for the past several years.204 Since complications from measles more commonly occur in children younger than 5 years of age,205 a timely vaccination is essential when infants are 12 to 15 months of age,

In Texas, pertussis cases have increased significantly, from 1051 cases in 2007 to 2205 cases in 2009. In the past three years approximately 23% of those cases were among children under the age of 19. who are considered to be at high risk of catching the disease because they have not been immunized or have not completed the recommended immunization series. In Texas, pertussis cases increased significantly from 1051 cases in 2007 to 2205 cases in 2009. Approximately 23% of those cases were among children under the age of 19 for the past three years.218

PHYSICAL & MENTAL HEALTH

become infected usually experience symptoms associated with rhinovirus, such as coughing or having a runny nose. Conjunctivitis, known as pink eye, is another symptom that can emerge. Days later, a flat, red rash develops on the body.200 Widespread immunization in the United States has led to gradual decline to where it is today, as generally non-occurring within the country.201 Between 2000 and 2007 an average of 50 cases were reported to the CDC per year.202 In 2008 there was a significant increase in cases, with a total of 140; however, in 2009, only 61 cases were reported.203

The last reported data on TB for Harris County was in 2007, which illustrated that it held 26.3% (397) of TB cases in Texas. as recommended by the CDC.206 Serious complications of measles include blindness, inflammation of the brain caused by infection (encephalitis), severe diarrhea that may lead to dehydration, ear infections, and severe respiratory infections.207 The most common cause of death associated with measles is pneumonia.208 The MMR vaccine is the safest protection against measles. The National Immunization Survey reported that, in 2008, 94% of children aged 19 to 35 months were vaccinated in Texas, a higher rate than the 92% the nation reported in 2008.209 Houston improved its timely vaccination coverage from 88% in 2006 to 91% in 2008.210 Pertussis, nicknamed â&#x20AC;&#x2DC;whooping cough,â&#x20AC;&#x2122; is a highly contagious bacterial infection that causes symptoms similar to the common cold.211 It is caused by the fastidious gramnegative coccobacillus, Bordetella pertussis.212 Infection is spread by person-to-person transmission via aerosolized respiratory droplets or by direct contact with respiratory secretions.213 Left untreated, the infection can develop into a serious cough, making it a severe burden for a person when they try to breathe, eat or sleep.214 In some instances it may result in cracked ribs, pneumonia or hospitalization.215 For infants, pertussis can be fatal.216 Because it is often misdiagnosed or undetected in children, pertussis presents a great health threat,217 especially for children CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Childhood Diseases (cont.) persons have been BCG vaccinated. However, in the United States, BCG is generally not recommended because of the low risk of infection.227 Further, clinical trials have revealed that the efficacy of the BCG vaccine varies widely, ranging from 80% to zero.228 Finally, the BCG vaccine is also known to cause a false positive TB skin test.229 Since 1998, the CDC has led a major research effort to develop new TB vaccines. With no new vaccines currently developed, researchers are striving to continue to improve their knowledge and understanding of the disease.230

Mycobacterium Tuberculosis or Tuberculosis (TB) is an airborne disease that usually affects the lungs but may also damage various parts of the body such as the brain, kidneys and spine.219 Since TB germs multiply and destroy tissues in the body, TB can be fatal if not treated.220 TB has two forms: active and latent. As the name latent suggests, this form of TB cannot be spread to other people; however, just like HIV/AIDS, it may transition eventually to an active status, causing the infected individual to fall ill.221 There is prescribed treatment available to both prevent and treat latent and active TB. People with weaker immune systems, infants and the elderly are generally at higher risk for contracting TB.222 The factors for high risk typically revolve around crowded and/or unsanitary living conditions, a poor nutritional diet or simply people who are in continuous or frequent contact with persons infected with TB.223 Since 1992 there has been a decline in TB cases nationally. The most recent data on deaths reported in the country shows 644 deaths in 2006, a 46% decrease compared to 1996, when there were 1202 deaths reported. 224 In the United States, there were a total of 12,904 TB cases reported in 2008.225 This equates to a rate of 4.2 cases per 100,000 persons. As of 2008, Asians accounted for 25.6 cases per 100,000 population in the United States, followed by African Americans at 8.8, Native Hawaiians and other Pacific Islanders at 15.9, Latinos at 8.1, Native Americans at 6.0 and Anglos at 1.1.226 The only existing vaccination for TB currently is the BCG, or bacilli Calmette-Guerin vaccine. Many foreign-born

Although there has been an overall decline in TB cases, there conversely has been an increase in cases concerning foreign-born persons in the United States. In 2008 the TB rate for foreign-born persons was nearly 10 times greater (20.3 cases per 100,000) than that of U.S.-born citizens (2.0 cases per 100,000).231 Fifty-nine percent of all TB cases in the United States occurred in foreign-born persons in 2008.232 Of the 7,563 total foreign-born cases reported in 2008 in the United States, 726 of those cases were in Texas.233 Mexican-born persons represented about 23% of all foreign TB cases nationwide in 2008, ranking number one within the top seven countries that account for 61% of foreign-born cases.234 Texas had a total of 1,510 TB cases in 2007 with a rate of 6.3 per 100,000 population, comprising 12.2% of all cases in the United States. The last reported data on TB for Harris County was in 2007, which illustrated that it held 26.3% (397) of TB cases in Texas, with a rate of 10.4 cases per 100,000 in population.235 Harris County has the largest number of TB cases within Texas because of its sizeable population. Harris County is designated a higher-risk county because the 3-year average rate of tuberculosis is 1.5 to 2 times higher than the average rate for Texas.236 In 2008, with a total of 1,501 cases and a rate of 6.2 per 100,000 population, Texas comprised 11.6% of all TB cases within the United States. Of those 1,501 cases, 246, or 16.4%, were in persons under the age of 24.237 These numbers represent a slight decrease from 286 cases in 2006. For age group 0-24 years of age, there were 42 cases in 2008 and 49 cases in 2009 in Harris County.238 In Houston/Harris County, the rate of TB in persons under the age of 24 continues to increase from 5.2 per 100,000 in 2006, to 5.5 in 2007 and 5.7 in 2008.239 Data clearly shows that Harris County and Texas are not following the national trend.

CHILDREN AT RISK 2010-2012

Indicator: The number of Harris County children ages 0 to 14 who were tested having blood lead levels of 10 micrograms per deciliter or greater Year

2000

2002

2003

2004

2005

2006

2007

2008

2010 Goal

Indicator

507

430

840

802

549

501

385

373

Source: Childhood Lead Poisoning Prevention Program, Texas Department of State Health Services Goal Source: U.S. Department of Health and Human Services, Healthy People 2010

• The number of children with elevated blood levels in Harris County has fluctuated over the past decade, but has steadily decreased over the past few years. • Children between the ages of nine months and six years are the most vulnerable to lead poisoning. • The American Academy of Pediatrics (AAP) has recommended that children, regardless of their perceived risk or exposure, should be tested for lead poisoning at age one or two. The number of children with elevated blood lead levels in Harris County has fluctuated over the past decade, but has steadily decreased over the past few years. Due to increased attention in Houston as well as in the rest of Texas, the reduced number of children with elevated blood lead levels is evidence that improvements made to lead poisoning prevention programs are working. In 2004, the large number of children with elevated blood lead levels was thought to be the result of the large number of children who received blood lead testing (64,177). However, with the number of children who have received blood lead test-

In 2008, 14.8% of Harris County children were tested for lead, just above the Texas average of 14.1%.

PHYSICAL & MENTAL HEALTH

Lead Poisoning

ing increasing steadily to 71,382 in 2008, and the number of children with elevated blood lead levels decreasing from 802 to 373, one can see that the supposed association was incorrect.240 In recent years, lead poisoning has gained increased attention in Texas and the Houston community. In 1995, the 74th Texas Legislature passed a law requiring reporting of elevated blood lead levels in children under the age of 15. On June 1, 2003, reporting became mandatory for all blood lead tests for persons under age 15 whether the report showed elevated lead levels or not. As part of the Bureau of Community & Children’s Environmental Health (BCCEH), the Texas Childhood Lead Poisoning Prevention Program provides appropriate follow-up and case management services to all children with elevated blood lead levels as part of their Healthy Homes vision.241 The BCCEH also performs a combination of lead inspections and risk assessments to every unit that meets the Housing & Urban Development’s (HUD) guidelines and qualifies to participate in the program as part of the HUD Lead Based Paint Hazard Control Grants. Since the inception of this program in 1992, lead hazard reduction has been provided to over 1,600 housing units, 170,000 children have been screened, and about 167 individuals have been trained as state-certified lead hazard reduction workers.242

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Lead Poisoning (cont.) Children are at higher risk of poisoning due to lead exposure than adults because they have more contact with household objects that are covered by lead dust. They risk exposure when putting their hands and toys in their mouths. According to the Texas Department of Health and Human Services, a minimum amount of lead can be found in water and soil. However, the lead-based paint in older houses and buildings is a primary source of lead toxins.243 Findings show that most children with elevated blood lead levels live in houses built before 1950. In Houston, inside the 610 Loop, 25% of the homes were built before 1950.244

Unduplicated Harris County children, ages 0-14, receiving blood lead testing 2008* by age and lead levels by sex, ethnicity, and age group (Texas Helath Steps) and lead status** Demographic

Not Elevated (<10 Qg/dL)

Elevated (>=10 Qg/dL)

Total

Percent Elevated

Sex Male

36,514

198

36,712

0.54%

Female

34,495

175

34,670

0.50%

Unknown

0.00%

Total

71,009

373

71,382

0.52%

21,657

0.99%

Race/Ethnicity Latino

21,442

215

Non-Latino

836

859

2.68%

Other/Unknown

48,731

135

48,866

0.28%

Anglo

6,208

168

6,376

2.63%

African American

5,476

5,534

1.05%

Asian/Pacific Islander

539

545

1.10%

Native American

0.00%

Other/Unknown

58,753

141

58,894

0.24%

Total

136,542

688

137,230

0.05%

Age Less than 1 year

8,572

8,606

0.40%

1 year

19,540

109

19,649

0.55%

2years

13,251

13,319

0.51%

3 years

6,466

6,507

0.63%

4 years

6,739

6,779

0.59%

5 years

4,148

4,177

0.69%

6 through 14 years

12,293

12,345

0.42%

Total

71,009

373

71,382

0.52%

*Based on age at time of test and the highest blood lead level test results for an individual child in given year. **Elevated results are lead levels greater than or equal to 10 micrograms per deciliter. % Elevated is percent within that age.

CHILDREN AT RISK 2010-2012

Through supporting the Texas Strategic Plan to Eliminate Child Lead Poisoning by 2010, we can reduce the number of children exposed to lead hazards.

Policy Implication: Childhood lead poisoning continues to be a significant and preventable environmental health problem for children. As a result of increased awareness about lead poisoning, the Texas Strategic Plan to Eliminate Child Lead Poisoning by 2010: Toward a Lead-Safe Texas was developed. The goal of the strategic plan is to decrease the number of children being exposed to lead hazards by increasing educational programs, informing stakeholders and medical societies, increasing the number of leadsafe housing units, increasing the number of at-risk children screened, increasing the percentage of children receiving appropriate case management services, and improving the reliability of the existing surveillance system. 245

PHYSICAL & MENTAL HEALTH

Children between the ages of nine months and six years are the most vulnerable to lead poisoning. The American Academy of Pediatrics (AAP) has recommended that children, regardless of their perceived risk or exposure, should be tested for lead poisoning at age one or two. In 2008, the number of Harris County Medicaid children identified as having high blood lead levels was four times higher than non-Medicaid children (296 Medicaid children compared to 77 non-Medicaid children). This difference can be attributed to the fact that blood level testing is mandatory for Medicaid children only.

In late 2009, the U.S. Department of Housing & Urban Development announced that $7.7 million in grants would be awarded to Texas to protect thousands of children from lead and other health hazards within the home; about $5 million went to the Houston Department of Health and Human Services (HDHHS). Both the Lead Hazard Reduction Demonstration Grant and the Lead Based Paint Hazard Control Grant work to maximize the number of children protected from lead-based paint hazards by evaluating and eliminating lead hazards in hundreds of homes in the Houston area, developing a public Environmental Safe Housing Registry in Houston, and providing training to hundreds of individuals on lead safety. 246

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

C H I LD R E N

R I S K

TO P

T E N

P R I O R I T Y

Childhood Obesity Indicator: The percentage of Harris County children in the fourth, eighth, and eleventh grades who are obese or overweight Year

1999

2001

2004

2006

2008

Indicator

13.5%*

12.6%*

21.6%

Source: Statewide Obesity Task Force Note: The percentage of Harris County children in the ninth through twelfth grades who are obese or overweight

• The increase of children who are overweight or at-risk of becoming overweight is an alarming public health epidemic of this generation. • Of all ethnic groups, Latino adolescents had the highest prevalence of obesity in Houston, with a 19.1% rate of obesity in 2007. • In 2001, the healthcare costs for obesity were estimated to be $10.5 billion. The increase in the number of children who are overweight or at risk of becoming overweight is an alarming public health epidemic of this generation.247 Over the past 20 years, the prevalence of overweight children and adolescents between the ages of 6 and 19 has nearly tripled, with one-third of children overweight or at risk of becoming overweight.248 Data from the National Health and Nutrition Examination Surveys (NHANES) (1976-1980 and 20072008) show that the prevalence of childhood obesity is also on a dramatic rise: for children aged 2–5 years, prevalence increased from 5.0% to 10.4%; for those aged 6–11 years, prevalence increased from 6.5% to 19.6%; and for those aged 12–19 years, prevalence increased from 5.0% to 18.1%.249

Minority populations, especially African Americans and Latinos, experience higher incidences of childhood obesity than Anglo or other populations. increase in the rate of obesity among adolescent African American girls (12.9% increase) compared to adolescent Anglo (5.6%) and Latino (4.0%) females.250

According to the 2007 Texas While the current national Youth Risk Behavioral prevalence of obesity Survey, 16% of Texas high is high for children school students were obese from all racial and and 16% were overweight; ethnic groups, obesity in Houston, the survey particularly impacts Texas ranks 32nd (50th indicated that 17% of adolescent Latino males being the worst) in overall high school students were (26.8%), adolescent obese and 18% were overprevalence of childhood African American males 251 Latino adolesweight. (19.8%), and adolescent obesity, with 32.2% of Texas cents were the ethnic group Anglo males (16.7%), with the highest prevalence children considered either with the largest increases of obesity in Houston, with in the rate of obesity overweight or obese. 19.1% in 2007.252 However, among adolescent Latino despite the rising incidence of (12.7% increase) and African childhood obesity at the national American (9.1% increase) males level, the rate in Texas of overweight compared to adolescent Anglo males and obese children has fallen since 2003. (5.1% increase). Obesity also particularly affects adolescent African American females Harris County is not excluded when it comes to (29.2%), adolescent Latino females (17.4%), and the childhood obesity public health epidemic. The adolescent Anglo females (14.5%), with the biggest

CHILDREN AT RISK 2010-2012

C H I L D R E N

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P R I O R IT Y

PHYSICAL & MENTAL HEALTH

UT School of Public Health 2004-2005 study, School Physical Activity and Nutrition (SPAN), indicated that 21.6% of Harris County students are obese and an additional 16.1% are at risk of becoming overweight. Elementary students in the fourth grade had the highest obesity rate at 30.5%, compared with 17.7% of eighth grade students, and 16.5% of eleventh grade students.253 The study provided evidence that minority populations, especially African Americans and Latinos, experience higher incidences of childhood obesity than Anglo or other populations. As an epidemic, childhood obesity affects not only the health of our population but also our economy. Poor nutrition and inadequate physical activity are the fundamental causes of childhood obesity. Obesity in children, similar to obesity in adults, increases a personâ&#x20AC;&#x2122;s risk for many diseases, including but not limited to, Type 2 diabetes, high blood pressure, heart disease, high cholesterol levels, some types of cancer, asthma, and sleep apnea.254 Approximately 60% of overweight children between 5 and 10 years of age already have one risk factor for heart disease.255 The economic costs of overweight and obesity in Texas during 2001 were an estimated $10.5 billion. These costs include direct healthcare costs, such as medicine and hospital stays, and indirect costs, such as lost productivity and wages due to illness and death. If the trend towards an

increase in the numbers of overweight and obese persists, the annual costs associated with excess weight in Texas is projected to reach $15.6 billion by the end of 2010 and could skyrocket to $39 billion by 2040.256 Recent estimates of the direct and indirect costs of Type 2 diabetes attributable to childhood overweight were $32.4 billion and $30.74 billion, respectively.257 Socioeconomic status also influences the rate of childhood obesity. Low-income families are often limited on the quality of food they are able to purchase, leaving many to defer to fast-food options over higher-priced healthy or organic choices. The Centers for Disease Control and Prevention (CDC) conducted a study on obesity prevalence among low-income preschool-aged children from 19982008, and found that one in seven low-income, preschoolaged children was obese. The prevalence of obesity in low-income children ages two to four increased from 12.4 percent in 1998 to 14.5 percent in 2003, but rose only to 14.6 percent in 2008.258 Studies like SPAN and new programs such as the Coordinated Approach to Child Health (CATCH) have been established by the UT School of Public Health to battle childhood obesity in Harris County and Texas, and the new SPAN study data will be released in late 2010.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

C H I LD R E N

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P R I O R I T Y

Childhood Obesity (cont.)

Policy Implication Since the 77th Legislature in 2001, Texas lawmakers have aimed to prevent and treat the public health epidemic of obesity through multiple avenues, including implementation of coordinated health and physical education programs and stricter nutritional standards in schools. In the 81st Legislature, several bills were introduced and passed in efforts to increase access to nutritious foods in school and out of school as well as increase awareness of nutrition and the importance of physical activity. In 2007, Texas chose the FitnessGram program as an educational assessment tool for data collection of fitness test results as part of the Physical Fitness Assessment Initiative (PFAI) program designed to gather data from Texas students for analysis to determine if there is any correlation between student academic achievement, attendance, obesity, and school meal programs. PFAI was created by the Texas Education Agency as part of a Texas Education Code mandate. FitnessGram assesses students in the areas of health-related fitness: cardiovascular fitness, muscle strength, muscular endurance, flexibility, and body composition. The program aims to provide individualized, educational reports for both students and parents. In the 81st Legislature in 2009, HB 1622 attempted to implement a program providing access to nutritious food for children at risk of hunger or obesity, through nonprofits and food banks. The program would have provided access to nutritious food outside the school day. Although HB 1622 passed, funding was not appropriated. Several other bills were passed that aimed to develop a strategic coordinated plan to improve early childhood nutrition and activity and to reward schools for their achievements in nutrition. SB 395 created a seven-member Early Childhood Health and Nutrition Interagency Council to develop an early childhood nutrition and physical activity plan with a recommended timeline for implementation over a six-year period. In efforts to increase access to fresh fruits and vegetables, the 81st Legislature passed SB 1027 to establish an interagency farm-to-school coordination task force. The bill expands and coordinates current systems and creates mechanisms to facilitate local food purchases by school districts, expand food-focused experiential education, and assist farms and schools in overcoming barriers to increasing the use of fresh fruits, vegetables, and good health practices in school diets.

CHILDREN AT RISK 2010-2012

Indicator: The number of children accessing public health dental services in Harris County Year

2000

2001

2002

2004

2006

2008

Indicator

122,012

142,934

197,921

Source: Bureau of Oral Health, Houston Department of Health and Human Services

• Programs in Harris County such as Texas Health Steps, CHIP, WIC, and the Harris County Public Health and Environmental Services offer emergency dental services and outreach and education on oral health care to children. • In 2008, Harris County had 1,476 providers that offered Texas Health Steps dental services, which reached 502,839 children between the ages of one to 20. • In the past few years, there have been significant increases in the number of children receiving checkups and dental services in Harris County through the Texas Health Steps program. total children in harris county who received any thsteps medicaid dental services 250,000

PHYSICAL & MENTAL HEALTH

Dental Care

200,000 150,000 100,000 50,000 0 FY 2001

FY 2002

FY 2003

The Oral Health Group (OHG) at the Department of State Health Services (DSHS) serves to encourage the residents of Texas to improve and maintain good oral health. The OHG works collaboratively with partners across the state to identify the oral health needs of Texans and to identify resources to meet those needs. With offices located throughout the state, dental public health professionals provide preventive dental services to low-income, underserved, pre-school, and school-aged children in Texas.259 In Harris County, through Texas Health Steps, the Children’s Health Insurance Program (CHIP), and WIC programs, the City of Houston Department of Health and Human Services (HDHHS) and the Harris County Public Health and Environmental Services (HCPHES) offer preventive and emergency dental services to children, in addition to providing outreach and education on oral health care. While HDHHS and HCPHES offer the majority of dental services, the University of Texas Dental School as well as a small handful of independent health clinics in the area also offer low cost dental care for children, all contributing to the number of children able to access public health dental services in Harris County.

FY 2004

FY 2005

FY 2006

In 2008, 30% of clinics providing dental care in Texas through the THSteps program were located in Harris County. The HCPHES Dental Program provides basic services to eligible children at two different locations within the county. The clinics offer services to CHIP- and Medicaideligible children free of charge. For children not qualified under those programs and for families with incomes less than 200% of the Federal Poverty Level, dental services are provided at $5.00 per visit.260 The HDHHS has four dental clinics in the greater Houston area. The City of Houston Dental Bureau, also known as the HDHHS Bureau of Oral Health (BOH), emphasizes primary preventive dentistry, such as optimal oral hygiene and nutrition, sealants, and fluoride treatment, for its program participants. It provides comprehensive dental services for single persons ages one through 20 years utilizing Title V funding; for children one through 20 years whose family is en-

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Dental Care (cont.) rolled in the Women Infants and Children (WIC) program; for CHIP recipients ages one through 18 years; and for Medicaid recipients ages one through 20 years. Preventive dental services are provided for enrolled prenatal patients and WIC enrolled mothers or legal guardians.261 As part of the Bureau of Oral Healthâ&#x20AC;&#x2122;s sealant program initiated in 2007, BOH staff travel to and from schools in the greater Houston area which have more than 95% participation in the Free/Reduced Lunch Program to provide sealant placement and oral health education to grade school students.262

children were eligible. Of the 502,839 eligible Harris County children in 2008, 263,951 children received some dental service (52.5%), and 245,854 children received at least one checkup (48.9%).266 In the past few years, there have been significant increases in the number of children receiving checkups and dental services in Harris County through the THSteps program.

Texas Health Steps is the name adopted in Texas for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), a federal Medicaid program for children. The primary objective of the THSteps dental screening examination is to detect dental problems early, allowing for diagnosis and treatment, before these problems become more complex and their treatment more costly.263 Within Harris County in 2008, Texas Health Steps listed 1,476 providers that offer THSteps dental services,264 with 502,839 children ages one to 20 that were eligible for dental services through the program.265 This is an increase from 2007, when only 480,393

At-risk children in Houston could greatly benefit from an increase in the populations that receive water fluoridation in residential water systems; every dollar spent on fluoridation saves $7 to $42 in dental costs. Policy Implication The Frew vs. Hawkins lawsuit resulted in increased community outreach and better reimbursement rates for dental providers. The settlement attempted to ensure that Texas children receive the medical/dental care they need, as required by federal law. In the settlement, the state agreed to increase the reimbursement rates for dental providers to 50% above SFY 2006-2007. The Frew agreement also resulted in the First Dental Home Initiative, a legislatively supported dental initiative aimed at improving the oral health of Medicaid-enrolled children from 6-35 months of age. Pediatric and general dentists served over 37,000 children as of December 2008. Community water fluoridation provides cost savings by reducing dental caries. Every dollar spent on fluoridation saves $7 to $42 dollars in dental costs. To help prevent dental caries and periodontitis and reduce chronic oral infections in children, Harris County needs to increase the total percentage of the population receiving the minimum requirement level of water fluoridation in the residential drinking water systems. The major public health entities providing dental care to low-income children across Harris County are lacking the capacity and resources to collect and track comprehensive data on service delivery. To make a difference in the health of children, and, in turn, their quality of life, data collection regarding oral health services must become a public policy priority.

CHILDREN AT RISK 2010-2012

Indicator: The rate of chlamydia cases reported for children ages 0 to 19 per 100,000 population in Houston Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2007

2008

2009

2010 Goal

Indicator

452

351

224

200

213

171

133

114

147

159

166

127

Source: City of Houston Department of Health and Human Services Goal Source: Healthy People 2010

Indicator: The rate of gonorrhea cases reported for children ages 0 to 19 per 100,000 population in Houston Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2007

2008

2009

2010 Goal

Indicator

99.0

81.1

43.6

30.0

17.0

7.2

7.0

5.5

9.5

13.0

17.5

14.5

3.2

Source: City of Houston Department of Health and Human Services Goal Source: Healthy People 2010

Indicator: The rate of syphilis cases reported for children ages 0 to 19 per 100,000 population in Houston Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2007

2008

2009

2010 Goal

Indicator

423

398

409

450

458

371

373

342

413

516

497

PHYSICAL & MENTAL HEALTH

Sexually Transmitted Diseases (STDs)

Source: City of Houston Department of Health and Human Services Goal Source: Healthy People 2010

• In 2008, gonorrhea and chlamydia were the two most commonly reported STDs, with the largest cases found in girls ranging from 15 to 19 years old. • The Chlamydia and Syphilis rate for African Americans is eight times higher than that of Anglos and 20 times higher than Anglos for Gonorrhea cases. • Of all sexually transmitted diseases in the U.S., chlamydia is the most frequent, with over one million cases reported in 2006.

Women infected with chlamydia are also five times more likely than men to contract HIV if exposed. Sexually transmitted diseases (STDs) affect millions of lives each year in the United States.267 Many teenage youth are often times involved in risky sexual behaviors. These behaviors heighten the risk of a youth becoming infected with an STD sometime in his or her life. Of the many known STDs, gonorrhea, chlamydia and syphilis are the top three in the nation reported.268 Findings in 2008 for the United States by the Centers for Disease Control and Prevention (CDC) show gonorrhea and chlamydia to be the two most commonly reported STDs; girls aged 15-19 constituted the largest number of these cases.269 Syphilis is the next most-reported disease in the national profile;

age groups 20-24 and 25-29 are found to be affected the most and males are found to carry this disease more than females.270 For all age groups, African Americans accounted for the majority of gonorrhea, chlamydia and syphilis cases; the chlamydia and syphilis rate for African Americans is eight times higher than that of Anglos and 20 times higher than Anglos for gonorrhea cases.271 Houston and Harris County’s statistics mirror these national trends. Of all sexually transmitted diseases in the United States, chlamydia is the most frequent, with over one million cases reported in 2006.272 According to the CDC, underreporting is substantial due to the fact that many people are unaware of their infections and consequently do not seek treatment. Teenagers in age group 15-19 along with young adults aged 20-24 have five times the reported rate of cases compared to the general population.273 Causing damage to a woman’s reproductive organs and on rare occasion sterility in men, chlamydia trachomatis is consid-

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Sexually Transmitted Diseases (STDs) (cont.) ered a “silent” disease, as half of infected men and 75% of infected women have no symptoms.274 In terms of risk, women infected with chlamydia are also five times more likely than men to contract HIV if exposed.275 From January 1 until June 30, 2009, there were 9,015 cases of chlamydia in Houston and Harris County.276 African Americans and women accounted for the majority of these cases: 43% in Harris County and 79% in Houston, respectively, and chlamydia was the most reported STD for age group 13-24.277 Continued technological expansion of diagnostic and screening tools and better reporting from improved information systems have lead to a larger pool of cases reported over the years.278 The overall improved STD surveillance resulted in a 25% increase in chlamydia cases for children aged 0-19 from 2007 to 2008 in Houston and Harris County. However, the possibility during these years that a general increase in the disease and sexual activity also occurred in Houston/Harris County should not be discounted. Reported by the CDC as the second highest STD infection in the United States, gonorrhea originates from bacteria found to commonly live and multiply within the reproductive tract of the human body.279 Like chlamydia, damage done by gonorrhea can cause pelvic inflammatory disease (PID) in women, leading to tubal infertility and chronic pelvic pain, and increase the risk of HIV transmission. If infected during pregnancy, mothers can directly infect their newborns via the birth canal during labor.280 Similar to chlamydia, the increased number of cases can be partially attributed to updated screening and diagnostic tools and techniques. However, a leading hypothesis for the increase in gonorrhea cases by the CDC suggests that increased drug-resistant strains and decreased treatment

options are having an impact on cases reported. There used to be several antibiotic options to choose from when treating gonococcal infections in the United States. Options since 2006 have been reduced to one class of drug, the cephalosporins.281 The rates of infection beginning in 2006 and over the next few years has shown an increase in Houston/Harris County, from 147 cases in 2006 to 166 in 2008 per 100,000 persons, ages 0-19.282 Fortunately, a significant decrease was observed in 2009, to 127.283 As of June 30, 2009, the Houston Department of Health and Human Services (HDHHS) reported that the number of gonorrhea cases in Houston/Harris County were highest in age group 13-24.284 Although thought to have been on the verge of being eradicated less than a decade ago, syphilis reemerged as a public health threat nationally in 2001 and cases have increased each year since that time.285 In the U.S., the CDC reported in 2008 that the rate of syphilis cases per 100,000 population had increased 18% from 2007.286 In 2007 and 2008, Houston/Harris County experienced an increase in the number of syphilis cases affecting all age groups.287 For children aged 0-19, there were 43 more cases in 2007 than 2006 and an additional 52 cases in 2008.288 Overall there has been an 85% increase in cases since 2006. The Syphilis Elimination Advisory Council (SEAC) and HDHHS Prevention Bureau, aware of the increase, took measures to address this issue and were able to decrease the number of cases reported from 207 in 2008 to 174 in 2009.289 The CDC requested states in 2005 to report the sex of an individual’s partner, revealing that the higher rate of syphilis attributed to men is linked to increases in cases among males having sex with males (MSM) characterized by high rates of HIV co-infection and high-risk sexual behavior.290

There is a greater need for outreach and education on prevention of STDs and safe sex, especially among youth and minorities. Policy Implication Although outreach and education on prevention of sexually transmitted diseases and safe sex has overall improved throughout the years, the data reflects a significant majority of STDs are occurring within the African American population, making it imperative that increased emphasis and collaboration is needed to meet the needs of this population of children in the coming years. There is still a need for greater outreach and education on prevention of STDs and safe sex, especially among youth and minorities.

CHILDREN AT RISK 2010-2012

Indicator: The estimated number of children in Harris County who have a diagnosable mental illness Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

Indicator

161,001

168,064

179,163

185,249

191,295

196,911

201,537

210,463

214,064

2007

2008

226,453 229,055

Source: U.S. Census Bureau; Substance Abuse and Mental Health Services Administration

• One in five children and adolescents in the U.S. has a mental health disorder. • The cost associated with children’s mental health issues are alarming, with an estimated $247 billion spent annually in the United States. • Among the states, Texas ranks 49th in mental health expenditures per capita.

Mental health is how people think, feel, and act as they face life’s situations.291 Mental health affects a person’s overall wellbeing; it affects how people view themselves, interact with each other, and deal with the normal stresses of life. Children and adolescents are especially susceptible to developing a mental illness, as research shows that half of all lifetime cases of mental illness begin by age 14.292 Studies show that at least one in five children and adolescents in the U.S. has a mental health disorder.293 One in ten of these children suffers from a serious emotional disturbance severe enough to disrupt daily functioning in the home, school, or community.294 Despite these statistics, it is estimated that only about one in five of all affected

Texas ranks 49th in the U.S. for mental health expenditures per capita. children receive specialized mental health services.295 When untreated, mental health disorders can lead to school failure, family conflicts, drug abuse, violence, and even suicide.296

PHYSICAL & MENTAL HEALTH

Children’s Mental Health: Prevalence

The costs associated with children’s mental health issues are alarming, with an estimated $247 billion spent annually in the U.S.297 This figure includes mental health services costs as well as costs associated with drug and

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Childrenâ&#x20AC;&#x2122;s Mental Health: Prevalence (cont.) alcohol abuse, crime, and decreased productivity. Much of these costs can be avoided by investing in more prevention programs that are designed to identify and treat mental health issues in children and adolescents before the damaging effects occur.298 Unfortunately, with the ongoing economic decline states are preparing to cut support for mental health programs. Among the states, Texas ranks 49th in mental health expenditures per capita.299 In 2008, an estimated 1,145,274 children under the age of 18 were living in Harris County.300 Since research indicates that one in five children and adolescents in the U.S. have a mental health disorder and one in ten children suffer from a serious emotional disturbance, approximately 229,055 children in Harris County in 2008 were living with a mental illness and approximately 22,906 were suffering emotional disturbances serious enough to disrupt daily life.301

It should be a national priority to take preventative measures for mental, emotional, and behavioral disorders; and promote access to mental health services in young people. Without proper treatment, the consequences of mental illness for the individual and society are staggering. Policy Implication The National Research Council and Institute of Medicine (NRCIM) states that the federal government should make preventing mental, emotional, and behavioral disorders, along with the promotion of mental health in young people, a national priority. According to NRCIM, research has shown that a number of programs are effective at preventing these problems and promoting mental health. With one in five adolescents in the United States suffering from a mental health disorder, public awareness of childrenâ&#x20AC;&#x2122;s mental health issues along with the reduction of the stigma associated must be promoted. The assessment and recognition of mental health needs also requires improvement. Currently, roughly only half of the child population suffering from mental illness is receiving care, largely due to socioeconomic hindrances. The socioeconomic disparities in access to mental health care services must be eliminated. Without proper treatment, the consequences of mental illness for the individual and society are staggering. In addition to an increased focus on crisis treatment, there is a need for a continuum of care to help avert crisis in the first place. The aversion of crisis can help society by improving graduation rates and also diverting involvement in the juvenile justice system.

CHILDREN AT RISK 2010-2012

Indicator: The number of children who have been assessed by Children and Adolescent Services (CAS) of Harris County in order to determine recommended treatment and related services Year

1990

1992

1994

1996

1998

2000

2002

2004

2005

2006

2007

2008

2009

Indicator

1,122

3,112

3,374

4,756

2,779

2,875

4,242

5,542

3,505

3,707

3,224

4,279

Source: Mental Health and Mental Retardation Authority (MHMRA) of Harris County

Indicator: Number of children served by Harris County MHMRA Year

1990

1992

1994

1996

1998

2000

2002

2004

2005

2006

2007

2008

2009

Indicator

2,157

4,279

5,188

4,887

6,493

5,974

5,927

4,184

4,485

5,369

5,421

5,293

5,002

Source: Mental Health and Mental Retardation Authority (MHMRA) of Harris County

• The Harris County MHMRA serves children who meet its priority population, including residential, mental, and financial requirements. • Around half of the children receiving services at the Harris County MHMRA are enrolled in Medicaid and CHIP. • Only a small number of children who do not meet MHMRA requirements are given referrals to other health providers.

In Harris County, the Children and Adolescent Services (CAS) department of the Harris County Mental Health and Mental Retardation Authority (MHMRA) provides mental health services for children and adolescents. MHMRA serves children and adolescents who meet its definition of priority population. The requirements for priority population include residential, mental/emotional, and financial criteria. A child must be a Harris County resident and be between the ages of 3 and 17. In addition the child must either have CHIP or Medicaid, have insurance that will cover MHMRA services, have resources to pay for services, or qualify for the reduced cost due to financial situation. Finally, the child must have a serious mental health or behavior disorder that affects him or her on a daily basis, or be in a special program at school for Serious Emotional Disturbance. Students who are 18 years of age may seek help through MHMRA Adult Mental Health Services or other local services.

PHYSICAL & MENTAL HEALTH

Children Assessed and Served by MHMRA

of children assessed by CAS has fluctuated greatly from year to year for various reasons. Severe program cuts and limited resources for therapeutic services have impacted the number of children able to be evaluated. However, in 2004 and 2005 the number of children assessed by CAS significantly increased. Yet in 2006, the number assessed decreased by approximately 2,000 children.302 In 2009, the number assessed increased by 1,000 children, returning to previous levels.

The Harris County MHMRA Children and Adolescent Services (CAS) department provides assessments to determine the extent of individual or family problems, the factors that contribute to those problems, and the resources available to families. Referral and aftercare services are then recommended for the treatment of mental illness and severe emotional disorder disturbances. Since 2000, the number CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Children Assessed and Served by MHMRA (cont.)

In 2008, 1,702 children (3.49%) who sought the services of MHMRA did not meet the eligibility criteria for the target population, with only 4 children being referred to an external provider.307 In 2009, 1,677 children (3.20%) were ineligible with only 1 child being referred to another provider. In 2008, 246 children (15.76%) were ineligible for MHMRAâ&#x20AC;&#x2122;s services because their diagnosis did not for services, or they were financially ineligible for services.308 Â In 2009, 178 children were ineligible.

MHMRA has the responsibility to serve all children who fall into the priority population and to assign them the appropriate level of services. However, the child must meet the financial criteria. The median annual income of the priority population in 2008 for a family of four was $16,056.303 In 2009 the median annual income for a family of four was $15,852.304 In 2008, 2,730 children (45.84%) were enrolled in Medicaid and 145 (2.94%) children were enrolled in CHIP; this is also comparative to 2009 when 2,794 (48.55%) children were enrolled in Medicaid and 145 (2.67%) were enrolled in CHIP.305 In 2008, 125 children met the qualifications for the priority population but were placed on a waitlist for services. The waitlist is usually very fluid with children being added or removed on a monthly basis. In 2009, 25 children waited for services. As of this writing, there are no children on the waitlist.306

Children and their families are helped with CAS mental health services in a variety of settings such as clinics, homes, schools, and community locations. Males were the majority served, making up 73% of the population compared to females at 27% in 2008 and 2009.309 In addition, the most frequently occurring primary diagnoses are Attention Deficit Hyperactivity Disorder and Disruptive Behavior Disorders.310 A triage assessment system created by the HCJPD revealed 50% of detained youth exhibited symptoms of mental illness and 22 to 55% displayed symptoms of severe emotional disturbance.311 The Harris County Juvenile Probation Department has developed a mental health court to address the issue of mentally ill children ending up in the juvenile justice system.312 MHMRA is currently contracted with the Texas Department of Mental Health Mental Retardation to provide services through the Choices Program, a joint effort of MHMRA, Child Protective Services, and Harris County Juvenile Probation. In 2008, 122 children and adolescents were served through the program and in 2009, the number served decreased to 76.

Policy Implication According to the statistics, there exists a significant population of children and adolescents in Harris County in need of the services provided by MHMRA. Barriers to access include diagnosis, income, knowledge of available resources, and funding. In addition, access to a provider after a referral and determination of need can prove difficult. Since 2003, MHMRA has been charged with connecting with local mental health providers in order to allow for more choice and competition in services delivered. Due to budgetary constraints and administrative requirements, that partnership has proven difficult to form. However, in 2008, MHMRA published a Network Development Plan as a step closer to making the requirement to collaborate with community providers a reality. Although the program is currently in existence, there have been no applicants willing to adhere to the application process or to accept the rates being offered, due to low reimbursement rates and an extensive application process. Finally, based on the statistics from the Harris County Juvenile Probation Department it is clear that there is a link between mental illness and commission of crime. Increased access to care could potentially weaken that link.

CHILDREN AT RISK 2010-2012

Indicator: Funding allocations to Child and Adolescent Mental Health Services that appear in the annual budget for the Mental Health Mental Retardation Authority of Harris County (MHMRA) Year

1990

1992

1994

1996

1998

2000

2002

2004

2005

2006

2007

2008

2009

Indicator

8.0%

10.0%

12.6%

12.3%

8.3%

5.3%

6.0%

7.9%

7.8%

8.5%

11.3%

11.5%

Source: Mental Health and Mental Retardation Authority (MHMRA) of Harris County Goal Source: Joint City/County Commission on Children (Houston and Harris County) Mental Health Needs Council Child and Adolescent Committee of Harris County, Public Policy Committee United Way of the Texas Gulf Coast

• The Child and Adolescent Services (CAS) division of the MHMRA budget has been steadily increasing over the past years, but it is not at a rate that allows for any significant change to be made regarding the number of children who are served. • The 81st Legislature increased the amount of funding for mental health, allocating $50 million to go toward community-based mental health centers. • Harris County currently has a greater rate of children who enter the mental health system than are discharged. The budget allocation for the Child and Adolescent Services (CAS) Division of the MHMRA budget was $15,495,629 in 2009, which is 11.5% of the $134,797,924 agency budget.313 CAS funding includes Texas Department of Mental Health and Mental Retardation allocations, federal block grant funds and other grants, Medicaid, and Children’s Mental Health Plan (CMHO) funds. While the CAS budget has been increasing since 2000, it is not at a rate that allows for the addition of any significant number of new children to be served. Texas ranks 49th nationally in per capita funding for mental health services.314 In FY 2008, the Texas Department of State Health Services (TDSHS) calculated that Harris County MHMRA is ranked 37th among the 38 Texas local mental health authorities.315 The overall per capita child mental health funding in Harris County was $12.69 in 2008, and $14.24 in 2009.316 TDSHS estimated that an additional $10.8 million would have been required in 2008 to lift Harris County MHMRA to the statewide center per capita average of $13.94.317

calls placed to the Harris County MHMRA is growing, and currently more children with severe mental illnesses reside in Harris County than any other Texas county.319 However, despite these numbers, funding is limited, and each month more children and adults enter the mental health system than are discharged.320

PHYSICAL & MENTAL HEALTH

Mental Health Funding: MHMRA

More children with severe mental illness reside in Harris County than any other county in Texas.

The 81st Legislature was shocked by the high rate of drop-outs for students with mental disabilities and subsequently increased the funding for mental health by $82 million, bringing the total funding to $164 million. Out of this figure, $50 million was appropriated for communitybased mental health centers, since statistics indicate that the cost is significantly lower to house children in these centers when compared to TYC.318 Many youths in the juvenile justice system have a mental illness, and often times, the juvenile justice system is the first time these youths encounter mental health treatment. The number of CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Mental Health Funding: MHMRA (cont.) It is imperative that MHMRA centers and services are sufficiently funded to meet the needs of children and families. Policy Implication Harris County MHMRA remains a valuable resource for sufferers of mental health disorders, with 217,413 calls received by their call center in 2008 and 212,643 calls in 2009. 321 However, children and adults who do not have health insurance are faced with higher costs and little or no care despite their illnesses. It is imperative that MHMRA centers and services are sufficiently funded to meet the needs of children and families. Treating mental disorders and substance abuse helps improve the quality of life for the sufferer and works to rehabilitate and reduce the severity of the disability. 322

Mental Health Services: Cost per Child INDICATORS Clinical Costs: The cost of clinical services or supportive counseling in which the focus is on treatment of a mental illness or emotional disturbance by Harris County MHMRA Year

1990

1992

1994

1996

1998

2000

Indicator

$280.65

$506.60

$1,416.89

Year

2002

2004

2006

2007

2008

2009

Indicator

$1,635.33

$1,511.12

$1,297.39

$1,338.99

$2,283.09

$2,746.90

Source: Mental Health and Mental Retardation Authority (MHMRA) of Harris County

Out-of-Home Costs: The average annual cost of residential treatment per child in Harris County Year

1990

1992

1994

1996

1998

2000

Indicator

$42,756

$54,750

$38,478

$18,563

$25,578

Year

2002

2004

2006

2007

2008

2009

Indicator

$73,481

$11,310

$11,347

$11,977

$12,373

Source: Mental Health and Mental Retardation Authority (MHMRA) of Harris County

Inpatient Costs: Average annual cost of inpatient hospitalization for mental health treatment per child in Harris County Year

1994

1996

1998

2000

2002

2004

2006

2008

2009

Indicator

$9,980

$6,161

$5,031

$3,943

$4,523

$5,000

$3,749

$3,899

Source: Mental Health and Mental Retardation Authority (MHMRA) of Harris County

In 2009, 470 children were hospitalized for mental illness at an average cost of $3,899.28. 80

CHILDREN AT RISK 2010-2012

The Harris County Mental Health Mental Retardation Authority budget for Child and Adolescent Services in Fiscal Year 2009 was $15,495,629.323 Administrative overhead is limited by the Department of State Health Services policy not to exceed 12% of the annual budget. In Fiscal Year 2009, administrative costs were 11.33% of the overall budget. The remaining 88.67% funds were dedicated to clinical/support services.324 Clinical services include therapy for individuals, families, or groups that are provided by licensed/certified professionals. The clinical services cost per child has fluctuated throughout the years from $1,511.12 in 2004, to $1,297.39 in 2006,325 to $1,338.99 in 2007. In 2009, the amount spent on clinical services or supportive counseling per child for mental illness or emotional disturbance treatment was $2,746.90.326 Some children receive treatment for their mental illness which requires hospitalization. In 2009, 470 children were hospitalized for mental illness at an average cost of $3,899.28.327 These figures were similar to 2008 figures in which 442 children were hospitalized for mental illness at an average cost of $3,749.43 per stay. Residential programs for children and adolescents with mental health disorders are designed to improve their ability to participate in normal activities and environments. These programs provide living and sleeping facilities and can either be highly structured or semi-independent, depending on the level of care required for each patient. Diagnosis, treatment, and/or training services are also often available with these programs. Local residential services are coordinated and funded through the TRIAD Prevention Program, a consortium made up of three county agencies, Child Protective Services, Juvenile Probation Department, and MHMRA, to serve at-risk youth. TRIAD does not provide residential services directly. Instead, those services are provided through the Alliance for Children and Families (“The Alliance”). The Alliance is in charge of the administration and staff for this program.328

The Alliance for Children and Families, formerly known as the CRCG, is a local interagency group comprised of public and private agencies. Together, they develop service plans for individuals and families whose needs can only be met through interagency coordination and cooperation. For many children, The Alliance is the place of last resort; these children cannot stay at home or go to school and typically have exhausted all other state and federal resources. The Waco Center for Youth (WCY) is a psychiatric residential treatment facility under the Texas Department of Mental Health and Mental Retardation that serves youth ages 13 through 17 with emotional difficulties and/or behavioral problems.329 In FY 2008, the average length of stay at the Waco Center for Youth was 182 days, and 222 days in 2009.330

PHYSICAL & MENTAL HEALTH

• The majority of funds allocated for Child and Adolescent Services are dedicated to clinical/ support services. • The clinical services and therapy costs per child doubled from $1,338.99 in 2007 to $2,746.90 in 2009. • The Alliance for Children and Families, a local interagency group of public and private agencies, develops service plans typically for children who have exhausted other state and federal resources.

Texas needs to invest greater funding for outpatient mental health services in order to effectively treat children’s mental disorders. Policy Implication Texas ranks 49th nationally in funding for children’s outpatient mental health services. 331 Without sufficient funding, children do not have access to the quality care they need nor the sufficient time in residential placements to effectively treat their mental disorders. Texas must invest in community-based treatment or the burden of care will be placed on emergency rooms, juvenile justice systems, and other costly programs.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Respite Bed Days Indicator: The number of beds that Harris County MHMRA contracted out to provide care for a brief period at another location to relieve families of their child’s difficult care Year

1990

1992

1994

1996

1998

2000

2001

2003

2004

2006

2007

2008

2009

Indicator

Source: Mental Health and Mental Retardation Authority (MHMRA) of Harris County

• Respite care provides temporary relief for family caregivers taking care of children with mental illnesses and offers them the chance to address their own needs so they can continue to provide care for the child. • Respite care can be provided in the home or at a temporary residential placement. • The Harris County MHMRA has increased their number of beds available for respite care over the past years. Respite care is the provision of short-term, temporary relief for family caregivers who are taking care of a child with mental illness. Families may experience stress due to the economic, emotional, and physical consequences associated with caring for a child with mental illness. Respite care provides them with the time to address their own needs so that they can continue to provide care for their child. Furthermore, respite care is seen as providing benefits to all members of the family: Parents receive a break from caregiving, siblings of the child with a mental illness may have opportunities for more activities and interaction with parents, and the child with a disability receives a positive social experience.332 Trained respite staff care for the child for a brief period of time to provide

the families relief from the stresses of caring for the child. Respite care can be provided in the home by respite staff, known as community-based respite care, or it can be provided at a temporary residential placement outside the home, known as program-based respite care.333 In FY 2009, the Harris County Mental Health and Mental Retardation Authority (MHMRA) contracted out a total of 23 beds to provide respite care at an average contracted rate of $250 per day.334 The respite services were provided under contract between MHMRA and the DePelchin Children’s Center, and the contract is no longer active. Thus, although 23 beds in 2009 represents a significant increase since 2003 when only 2 beds were available, there still exists the need for an increase in the number of beds available.

Additional funding is needed to provide more respite care beds for children in order to provide temporary relief to families. Policy Implication Respite care is an important service to the health and welfare of children with mental health disabilities as well as to their families. Respite care offers an essential relief to families and provides a social benefit to children with mental disabilities. Public officials must recognize the need for this necessary service in order to allocate appropriate funding. Respite care is frequently identified as one of the most needed and least available services for families with children with mental disabilities - a conflict that is in desperate need of progressive attention.

CHILDREN AT RISK 2010-2012

Indicator: The average cost per client under age 21 in Harris County who received funding for inpatient hospitalization care for mental illness Year

1990

1992

1994

1996

1998

2000

2002

Indicator

$8,446

$5,541

$6,495

$7,786

$6,349

$5,706

Year

2003

2004

2005

2006

2007

2008

2009

Indicator

$6,820

$4,130

$4,889

$5,032

$4,400

$5,217

$4,936

Source: Texas Health and Human Services Commission

Indicator: The average annual Medicaid cost per client under age 21 for outpatient intervention treatment services provided in the Fee For Services (FFS) and Primary Care Case Management (PCCM) models Year

1990

1992

1994

1996

1998

2000

2002

Indicator

$167.64

$246.98

$679.20

Year

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

$679.20

$818.80

$895

$787

$950

$700

$689

Source: Texas Health and Human Services Commission

PHYSICAL & MENTAL HEALTH

Medicaid Mental Health Costs

• Medicaid provides basic medical care to people who would otherwise go without health care for themselves and their children. • Most of Texas provides Medicaid managed care to the majority of Medicaid clients. • Texas Medicaid also funds behavioral health services in addition to basic care, treating children who suffer from disorders before the disorders become unmanageable.

In 2007, children made up 70% of clients receiving Medicaid. Medicaid is a jointly funded state-federal health care program administered by the Health and Human Services Commission. The purpose of Medicaid in Texas is to improve the health of people who might otherwise go without medical care for themselves and their children.335 The program must pay for any services covered, and the program itself is available to low-income individuals and families who fit into an eligibility bracket that is recognized by federal and state law.336 There are a number of groups who are eligible for Medicaid coverage; eligibility requirements include age, income resources, health conditions, citizenship, and more. Eligibility for the child is based on the child’s status, not the parents’ or caretakers’. In 2007, children made up 70% of clients receiving Medicaid.337

The program covers inpatient hospitalization treatment for mental illness in both private and public facilities. In Harris County, the average cost per child who received Medicaid funding for inpatient hospitalization for mental illness was $4,936 in 2009. This cost has decreased since 2008 when the average cost per child was $5,217, although the cost increased since 2007 when the average cost per child was $4,400. Fluctuation in the cost per client reflects the variation of the number and length of stays, different services being utilized, variation in diagnoses, and provider billing methodologies. Medicaid operates on several different models. Under Medicaid, states may deliver health care services through unrestricted fee-for-service (FFS) arrangements, which includes the Primary Care Case Management (PCCM) model or through managed care.338 The percentage of Medicaid clients receiving services through Medicaid managed care has gradually increased throughout Texas, and this number seems set to expand further as the Legislature ropes in the last region of Texas that does not offer managed care – the Rio Grande Valley.339 In August 2008, Medicaid managed care enrollees alone increased to 2.1 million of the state’s

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Medicaid Mental Health Costs (cont.) that provides medical and dental prevention and treatment services for low income families from birth to age 20. Mental health coverage is among the preventive care provided through THSteps.

2.9 million Medicaid clients. Texas Medicaid currently operates managed care throughout the state including STAR and STAR+PLUS. The State of Texas Access Reform (STAR) program is administered through health maintenance organizations (HMOs) in 9 urban areas, and the Primary Care Case Management (PCCM) model provides for the rest of the state.340 HMOs account for the majority of managed health care coverage under Medicaid in Harris County, though PCCM and FFS arrangements are still available, particularly for children in foster care, and also mentally ill clients. Everyone receiving Medicaid through STAR in Texas is required to select an HMO and a primary care physician who has signed up with an HMO. The state pays the premium to HMOs to provide services to Medicaid clients, and HMOs pay for the services rendered.341 The primary care physician serves as the doctor for all Medicaid covered medical treatment, unless he or she refers the patient to a specialist. However, individuals receiving Medicaid must first go through their primary care physician before gaining access to psychiatric or chemical dependency treatment. Texas Health Steps (THSteps) is an Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT)

Texas Medicaid also funds behavioral health services used to treat a mental, emotional, or chemical dependency disorder. The services include, but are not limited to, psychiatric therapy, inpatient care in a general acute hospital or a psychiatric hospital, and outpatient care which is counseling by state licensed facilities. Services are provided by therapists in private practice, physicians, private and public psychiatric hospitals, and by community mental health centers. For outpatient services, individuals suffering from a mental illness can be treated through therapy either individually or in groups. Outpatient services are often coordinated through service providers such as schools, courts or the Department of Health and Human Services, as well as programs that provide parent training and consultation. These services are part of Texas managed care programs such as STAR and STAR+PLUS. For each child who used the Medicaid Fee For Services/ Primary Case Management Model (FFS/PCCM) for outpatient mental health services in 2009, the average cost Medicaid paid was $689. This amount has fluctuated since 2002 at $679.20, rising to $895 in 2004, dropping to $787 in 2005, and rising again to $950 in 2007. These fluctuations are possibly due to changes in FFS/PCCM and STAR/ STAR+PLUS policy.

Additional funding is needed to provide preventative mental health services for children.

Policy Implication Children suffering from mental and physical disabilities are helped through Medicaid funding, although many children who qualify are still not receiving the services they need. Preventative health services early on can help detect serious illnesses in children before they become more costly and life-threatening. Expanding the number of children who participate in Medicaid, as well as expanding the umbrella costs will help ensure that each child receives the physical and mental health necessary to continue a healthy lifestyle.

CHILDREN AT RISK 2010-2012

Indicator: The number of parents receiving training through the Harris County MHMRA to help attain positive mental health prevention outcomes Year

1990

1994

1996

1998

2000

2002

2004

2005

2006

2007

2008

2009

Indicator

450

533

524

845

1,734

2,042

3,062

2,747

Source: Mental Health and Mental Retardation Authority (MHMRA) of Harris County

• Appropriate parental control has positive outcomes on child development and family life and is crucial to early stages of child development. • Parenting education provides parents with the means to better inform them of societal changes that their children may face on a daily basis. • Parenting classes allow parents to learn from one another and provides tools for parents to understand their child’s behavior.

Since 2007, there has been a 35% increase in the number of parents receiving training. Parenting plays a crucial role in child development, and effective parenting provides children with the support they need to grow into healthy adults. While there is no specific definition for effective parenting, providing guidance, appropriate parental control, and being involved in a child’s life can all have positive outcomes on both child development and family life as a whole.

There are several organizations throughout Harris County which offer parenting classes. These organizations include: Communities in Schools, Collaborative for Children, ESCAPE Family Resource Center, Family Outreach Center, Family Services of Greater Houston, ToughLove, and the Mental Health and Mental Retardation Authority of Harris County (MHMRA). For fiscal year 2008, 3,062 parents received parenting training in Harris County, and for fiscal year 2009, 2,747 parents received parenting education.342 Since 2007, there has been a 35% increase in the number of parents receiving training.343

PHYSICAL & MENTAL HEALTH

Parenting Education

Societal changes result in children facing different challenges today than were faced by previous generations. As a result, parents may find themselves ill-equipped or unable to understand their child’s behavior. Parenting education provides parents with the support they need to help face the challenges they encounter in raising their children. Parents are provided with the tools and techniques to help them understand and address their child’s behavior, and the classes also allow parents to share their experiences and learn from one another in a supportive environment.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Forensic Evaluations Indicator: The number of referrals of children received from the Harris County Juvenile Probation Department (HCJPD) in which requested or court ordered psychiatric or family evaluations or consultations are conducted Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2007

2008

Indicator

948

1,136

1,289

1,809

1,409

1,474

1,989

2,167

3,314

2,948

Source: Mental Health and Mental Retardation Authority of Harris County

â&#x20AC;˘ The Mental Health and Mental Retardation Authority (MHMRA) Forensic Assessment Unit (FAU) provides psychological evaluations for pre-adjudicated and post-adjudicated youth in the detention centers. â&#x20AC;˘ As a result of the implementation of Operation Redirect, 98% of children entering into the juvenile justice system are now screened prior to their court date. From 2000 through 2007, the FAU has seen a steady increase in the number of juveniles passing through its doors, from 1,409 juveniles assessed in 2000 to 3,314 juveniles assessed in 2007. However, there was a decrease in 2008 with 2,948 juveniles assessed, representing an 11% decrease from 2007. This may be due to a significant decline in the number of juveniles referred.346 Operation Redirect is another important juvenile justice initiative in Harris County designed to address the high number of children with mental illness at risk of involvement in the juvenile justice system. The two-phase program was implemented in 2007 and serves as an assessment instrument to screen juveniles for diagnosable mental health disorders upon entry into the juvenile justice system, as well as focuses on the expansion of communitybased mental health services.

The Mental Health and Mental Retardation Authority (MHMRA) Forensic Assessment Unit (FAU) provides psychological evaluations for pre-adjudicated and post-adjudicated youth in the detention centers.344 The Deputy Director of Mental Health Services of the Harris County Juvenile Probation Department (HCJPD) supervises the FAU, which is staffed by mental health professionals under the supervision of licensed psychologists and psychiatrists.345 The FAU was formed out of concern, as well as the costs associated with, the increasing number of youth asked to be assessed by the court system. The Forensic Assessment Unit was originally part of the mental health system but was transferred to the Juvenile Probation Department under the administrator for mental health services within probation.

Prior to Operation Redirect, 90% of children entering the juvenile justice system were brought in without a comprehensive needs assessment, leaving many children in inappropriate placement with inadequate service recommendations. As a result of the implementation of Operation Redirect, 98% of children entering into the juvenile justice system are now screened prior to their court date. In the 18 months following the implementation of the program, Operation Redirect served over 3,500 youth, and found that over half of the youths identified with emotional disturbance or severe emotional disturbance reported no prior mental health assessment or intervention, and that the juvenile justice system was the sole mental health service provider.347 The assessment results show that the most common mental health disorders include emotional disturbance, substance abuse or dependence, and behavioral disorder.

CHILDREN AT RISK 2010-2012

Policy Implication With the increasing number of children in the juvenile justice system being assessed by the court system, continued funding for the FAU as well as Operation Redirect must be provided. Programs such as Multi-Systemic Therapy (MST), a form of treatment approved through Operation Redirect, are cost-effective and produce positive and dynamic results. In 2008 MST cost approximately $101.33 per day per participant, whereas the Juvenile Detention Center cost approximately $213.52 per day per participant. 348

PHYSICAL & MENTAL HEALTH

With the increasing number of children in the juvenile justice system being assessed by the court system, continued funding for the FAU and Operation Redirect must be provided.

These cost-effective programs must be supported as well as maintained to ensure that continued attention is given to the many youths involved in the juvenile justice system who suffer with mental illness. Assessment is essential in providing better placement and more effective treatment for these juveniles, and also in guaranteeing a safer community.

Systems of Hope Indicator: The number of children served by the Harris County Systems of Hope program Year

2006

2007

2008

2009

Indicator

177

175

Source: Harris County Systems of Hope Note: The program began accepting referrals in October 2006.

• Systems of Hope started its fifth year of operation in 2010, as it serves Harris County youths who have a mental health diagnosis and an IQ of 70 or above. • Utilizing a wraparound planning process, the care teams meet with children and their families to create a plan of care that is family-driven, youth-guided, culturally and linguistically competent, and coordinated with community supports. • In February 2009, Systems of Hope became one of the services providers for the new Harris County Juvenile Mental Health Court.

2010 marks Systems of Hope’s fifth year of operation, serving Harris County youths ages 6 to 15 (at the time of referral) who have a mental health diagnosis and an IQ of 70 and above. CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Systems of Hope (cont.) In 2009, 29% of youths served were diagnosed with ADHD, 15% were bipolar, 15% had adjustment disorder, 10% were suffering from depression, and 10% were diagnosed with oppositional defiant disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) is a federal agency established by Congress in 1992 to target effective substance abuse and mental health services to the people most in need.349 Through the administration of block grant programs and data collection activities, SAMHSA’s mental health programs are carried out by its federal agency, the Center for Mental Health Services, which focuses on the prevention and treatment of mental disorders.350 The Harris County Alliance for Children and Families (the “Alliance”) is a collaborative of public and private local interagency groups who come together to develop individual service plans for children, youth, and adults.351 The Alliance encourages collaboration and coordination among agencies, prevention of duplicate services, and serves as a vital resource in addressing the needs of children and

youth who require interagency coordination. In 2005, the Alliance was awarded a six-year grant totaling $9,500,000 by SAMHSA.352 With Harris County Protective Services serving as the fiduciary agent for the grant, the funds were used to create a system of care, called Systems of Hope, to address the mental health needs of children and their families. 2010 marks Systems of Hope’s fifth year of operation, serving Harris County youths ages 6 to 15 (at the time of referral) who have a mental health diagnosis and an IQ of 70 and above. The program consists of a network of services through which families and youth work in partnership with public and private organizations to design mental health services and supports.353 Care teams are assigned to one of eight geographic areas of Harris County. Utilizing a wraparound planning process, the care teams meet with children and their families to create a plan of care that is family-driven, youth-guided, culturally and linguistically competent, and coordinated with community supports.354 Community sites are located throughout Harris County and additional partners are located throughout Texas. ComRacial Breakdown of children served by harris county systems of hope 60% 50% 40% 30% 20% 10% 0%

Anglo

2006

2007

African American

2008 Latino

2009 Asian

Biracial

munity sites include the Harris County Juvenile Probation Department, Harris County Protective Services, Mental Health Mental Retardation Authority of Harris County, DePelchin Children’s Center, and the City of Houston Department of Health and Human Services.355 Harris County Systems of Hope began accepting referrals in October 2006 and served 7 youths that year.356 The number of children served increased greatly in 2007 with 98 youths served, and 177 and 175 youths served in 2008 and 2009 respectively.357 The average age of children served in 2006 was 13.2 years, 12.7 years in 2007, and 12.6 years in both 2008 and 2009.358 African American

CHILDREN AT RISK 2010-2012

children represented the largest racial category from 2006 through 2009 with a range of 42% to 57%; followed by Latinos ranging from 28% to 36%; and Anglos ranging from 14% to 21%.359 No Asian children were served in 2006, and they represented less than 1% of children served in 2007 through 2009.360 With the exception of 2006 in which the male to female ratio was 3:4, more males were served than females in 2007, 2008, and 2009, with the percentage of males served ranging from 63% to 79%, and the percentage of females served ranging from 21% to 37%.361 There is a wide range of disorders represented by the youths served by Systems of Hope, and some youths are diagnosed with more than one disorder. The more prevalent disorders include attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, depression, adjustment disorder, and oppositional defiant disorder.362 In 2009, 29% of youths served were diagnosed with ADHD, 15% were bipolar, 15% had adjustment disorder, 10% were suffering from depression, and 10% were diagnosed with oppositional defiant disorder.363 In 2008, 32% of the youths served had ADHD, 20% were bipolar, 11% had adjustment disorder, 10% were suffering from depression, and 10% were diagnosed with oppositional defiant disorder.364 In addition, 11% of youths in 2009 and 8% of youths in 2008 had co-occurring substance abuse problems.365 Other disorders represented by youths served include mood disorder NOS (not otherwise specified), posttraumatic stress disorder, disruptive behavior disorder NOS, and conduct disorder.366 In February 2009, Systems of Hope became one of the ser-

The Juvenile Mental Health Court emphasizes the importance of family involvement in supporting the rehabilitation of the youth. The youth and his/her parents meet with the judge and the mental health team to discuss their progress during regularly scheduled review hearings.369 The hearings are held around a conference table, with the judge, prosecutor, probation officer, psychologist, counselors, and the child and his/her family working together to find solutions.370 Youth who successfully complete the program are placed in a deferred prosecution status, and if the youth completes the deferred prosecution term without engaging in delinquent conduct the original charge is dismissed.371

PHYSICAL & MENTAL HEALTH

vice providers for the new Harris County Juvenile Mental Health Court, which is a voluntary, specialized, diversionary court program for families of youth with mental health problems who are involved in the juvenile justice system.367 Approximately 70% of youth in the juvenile justice system suffer from mental disorders, with 25% experiencing disorders so severe that their ability to function is significantly impaired.368 The program focuses on rehabilitation over punishment, and the target juvenile population includes youth ages 10-17 with a mental health diagnosis who are referred for misdemeanor or felony offenses.

Systems of Hope served 8 youths in the Harris County Juvenile Mental Health Court in 2009.372 The average age of the youths served was 14 years.373 African American youths represented 50% of youths served, followed by Anglo at 25%, and Latino and biracial youths at 12.5% each.374 The male-to-female ratio among these youths was 7:1.375 Number of males/females served by harris county systems of hope 150 Male

100 50

Female

0 2006

2007

2008

2009

Like the children served through standard Systems of Hope services, the children served by Systems of Hope through the Juvenile Mental Health Court are diagnosed with a variety of disorders, and some youths are diagnosed with more than one disorder. In 2009, 62.5% of the youths served were diagnosed with ADHD; 50% had adjustment disorder; 25% were suffering from depression; 25% had oppositional defiant disorder; 12.5% were bipolar; and 12.5% had posttraumatic disorder.376 In addition, 75% of the youths served had co-occurring educational problems.377

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Systems of Hope (cont.) The cost-effectiveness of Systems of Hope services is proof that successful program models exist, and it also demonstrates the need for additional funding to expand community-based services to provide more children and families with access to these services. Policy Implication Harris County Systems of Hope provides much-needed services to children with mental health issues and their families. Through community-based and family-oriented support, children and their families are able to receive help that they might not otherwise have been able to access. A 2009 report from a federal site visit conducted by the Center for Mental Health Services commended Systems of Hope for its involvement in the development of collaborative and innovative programs that demonstrate the efficacy of interagency involvement and for the programâ&#x20AC;&#x2122;s significant expansion of services within Harris County. The role of Systems of Hope in the juvenile mental health court is an important one. With a focus on rehabilitation, juveniles are treated for their mental health issues through a treatment plan that is catered to each individual. Upon successful completion of the mental health court program, youths are placed in a deferred prosecution status, and upon completion of the deferred prosecution term without further delinquent conduct, the original charge is dismissed. Thus, in addition to helping these youth and their families by providing them with needed services, the mental health court also results in a more cost-efficient alternative through diversion from the juvenile justice system when youths successfully complete the program. With 2011 marking the final year of the six-year SAMHSA grant, remaining challenges include the need to develop a strategic sustainability plan to continue the work of Systems of Hope as federal funding winds down. The cost-effectiveness of Systems of Hope services is proof that successful program models exist, and it also demonstrates the need for additional funding to expand community-based services to provide more children and families with access to these services.

CHILDREN AT RISK 2010-2012

Indicator: The percentage of HISD students in grades 7 through 12 who have consumed beer, wine, and/or liquor in the past month Year

1990

1992

1994

1996

1998

2000

2002

2003

2004

2006

2008

2010 Goal

Indicator

41%

31.8%

39%

34%

36.5%

33%

34%

33%

30%

32%

11%

Source: Texas School Survey, Texas Department of State Health Services Goal Source: Healthy People 2010

Indicator: The percentage of HISD students in grades 7 through 12 who used tobacco in the past month Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

Indicator

16%

12.5%

21%

20.5%

22.6%

18%

15%

14%

11.7%

9.8%

Source: Texas School Survey, Texas Department of State Health Services

Indicator: The percentage of HISD students in grades 7 through 12 who used marijuana in the past month Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

Indicator

0.70%

3.10%

1.90%

2.40%

2.90%

2.00%

PHYSICAL & MENTAL HEALTH

Substance Abuse

Source: Texas School Survey, Texas Department of State Health Services

Indicator: The percentage of HISD students in grades 7 through 12 who reported having used cocaine/crack in the past month Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010 Goal

Indicator

5.9%

5.1%

14%

13.4%

12.4%

14%

13%

11.4%

11.9%

Source: Texas School Survey, Texas Department of State Health Services Goal Source: Healthy People 2010

Indicator: The number of Harris County youth served as clients for inpatient substance abuse programs funded by the Texas Commission on Alcohol and Drug Abuse Year

1990

1992

1994

1996

1998

2000

2002

2004

2005

2006

2007

2008

2009

Indicator

718

746

836

398

754

680

791

1049

1257

423

466

237

260

Source: Texas School Survey, Texas Department of State Health Services

• In Texas, alcohol, tobacco, and marijuana ranked as the top three substances to be used by youth in 2008. • In 2008, 20.6% of students in grades 7-12 admitted to binge drinking. • Although alcohol remains the most-used substance among students in grades 7-12 in Harris County, the majority of students are admitted into county-funded youth substance abuse programs for marijuana use.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Substance Abuse (cont.) In 2008 the percentage of eighth graders in Houston ISD who reported consuming marijuana in their lifetime was 27.2% compared to 25% statewide; marijuana remains the most commonly used illegal drug by students. For more than 20 years, substance abuse has remained a constant in negatively affecting the lives of youth and their families in the United States. In Texas, according to the Department of State Health Services (DSHS), alcohol, tobacco and marijuana ranked as the top three drugs to be used by youth in 2008, with a substantial first-time usage rate before 13 years of age at 42.1%.378 Among the top three, alcohol usage continues to dominate youth substance abuse in Texas, with a 63% reported lifetime usage rate by students in grades 7-12 in 2008.379 Past-month drinkers reported beer as the most popular alcoholic beverage consumed, with liquor as the next pre-

in Texas report that they received alcohol from family and friends.384 Alcohol impairs rational judgment and bodily senses like vision, making things such as operating a motor vehicle a hazard to all. The consequences of impairment can be seen in the percentage of youth deaths caused by alcohol consumption. Reports published by the National Highway Traffic Safety Administration (NHTSA) show that among 15-20 year old drivers involved in fatal crashes in 2006, 31% of the drivers who were killed had been drinking and 77% of these drivers were not wearing their seat belt.385 Following alcohol, tobacco and marijuana use ranked 2nd and 3rd among students respectively, in 2008 in Texas. Usage of inhalants ranked 4th showing a trend of younger students, generally grade 7, reporting a higher utilization of inhalants than older students.386 Inhalants superseded cocaine and crack usage in 2008387

Alcohol continues to be the most widely-used substance among secondary school students in Texas, with 63 percent reporting in 2008 they had consumed alcohol at some point in their lives.

ferred choice.380 In 2008, 20.6% of students in grades 7-12 admitted to binge drinking.381 Binge drinking is defined as consuming five or more alcoholic drinks at one time, in the past month.382 Of the 20.6% reported, over one-fifth of this number, nearing almost 1 in 20 students, were identified as frequent binge drinkers, meaning they binged six or more days in the past month.383 Research shows that alcohol kills more than 6.5 times more youth than other illicit drugs combined, and that 65% of youth who drink alcohol

Alcohol and marijuana usage in the Houston Independent School District (HISD) saw slight increases in 2008, while tobacco, cocaine and crack continued to decline. Comprehensive tobacco control laws debuting in 1997 for both Texas and the U.S. resulted in the overall decline in sale of tobacco to minors in Texas to 11.3% of all sales from 56% in 1997.388 These declines mirror the reduction in HISDâ&#x20AC;&#x2122;s use of tobacco, which fell from 22.6% in 1998 to 9.8% in 2008, according to the Texas School Survey in spring, 2008.389

CHILDREN AT RISK 2010-2012

The Harris County Mental Health and Substance Abuse Division reported 237 inpatient admissions in 2008.390 Regardless of a slight increase in inpatient admissions

observed in 2009 at 260, the number of admissions is still a near 50% decrease from both 2006 and 2007. The decrease can be traced to past policy decisions that emphasized the utilization of an outpatient model by DSHS, beginning in 2005. Since then outpatient admissions have retained a much more substantial enrollment than inpatient admissions, and represents the majority of admissions cases to date. In 2008 the number of outpatient admissions was 720 and was 570 in 2009.

More research and assessment is needed to determine the effectiveness of the outpatient model on county-funded youth substance abuse programs. Policy Implication More research and assessment is needed to determine the efficiency of the outpatient model on county-funded youth substance abuse program admissions as the inpatient numbers continue to decline. Reduction in inpatient youth numbers may not necessarily be the result of fewer cases through effective prevention measures but rather more or less the result of a huge shifting of these cases being reclassified as outpatient cases. Some youth may not be adequately served because an outpatient program may not be as appropriate to their needs as an inpatient setting.

PHYSICAL & MENTAL HEALTH

Although in Harris County alcohol remains the most-used substance among students in grades 7-12, it ranks second to marijuana in the majority of county-funded youth substance abuse program admissions. Only a total of 40 admissions were attributed to alcohol abuse, compared to 832 total admissions attributed to marijuana abuse in 2008. The average age for these admissions was 16 years.

Teen Suicide Indicator: Intentional deaths by suicide of youth ages 15 through 19 as shown by the death rate per 100,000 Year

1990

1992

1994

1996

1998

2000

2002

Indicator

15.95

17.91

12.3

11.7

13.3

11.1

Year

2004

2005

2006

2007

2008

2010 Goal

Indicator

8.6

11.2

7.6

8.33

9.02

Source: Texas Department of State Health Services; Harris County Medical Examiner’s Office Goal Source: Healthy People 2010, U.S. Department of Health and Human Services (2000)

• Nationally, the suicide rate for youth between the ages of 15-19 has significantly increased between 1980 and 1994. • Suicide is the third leading cause of death for youths between the ages of 15-24. • In Harris County, the rate of death by suicide within the ages of 15-19 has significantly dropped from 1990 to 2007. Nationwide the suicide rate for youth aged 15-19 increased between 1980 and 1994.391 Since the peak in 1994 with 11.0 suicides per 100,000 youth, there has been a 34% decrease.392 However, suicide is still the third leading cause of death for youths between the ages of 15-24,393

accounting for 12.0% of all deaths among this group annually.394 Males between the ages of 20-24 are more than five times more likely than females to commit suicide and males 15-19 are more than four times more likely than females to commit suicide.395 Of all U.S. suicides in 2009,

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Teen Suicide (cont.) Texas Ranks 14th among the 50 states for overall suicide rate.

Teen suicide by cause in harris county 2009 9%

males represented 79% of the total.396 However, research shows that females attempt more suicides, but they are not as successful as their male counterparts. For adolescents, this is particularly true. “Nonfatal suicide attempters,” as classified by the Centers for Disease Control and Prevention (CDC), typically are females who ingest pills, whereas the profile of a male is usually that of being a suicide completer who dies of a gunshot wound.397 Firearms are the most commonly-used method among youth, especially males, accounting for 46% of all completed suicides.398 However, there has been a gradual increase in suffocation and hanging from 1992 to 2006 for youth in general.399 In Harris County, the rate of youth suicides between the ages of 15-19 has significantly dropped from 15.95 per 100,000 in 1990 to 8.33 in 2007.400 However, the rate of males completing suicide is still higher compared to females. In 2008, the rate of death by suicide for 15-19 year DEATHS BY SUICIDE BY RACE HARRIS COUNTY/AGES 15-19 14 12

4 1

0 2006

Anglo

Hanging/Strangulation/Suffocation Toxicity

Other

0 2007

0 2008

African American

2009

Research shows that most adolescent suicides occur after school hours and in the teen’s home.403 The leading cause in most cases is interpersonal conflict. The most common indicators of teens at risk for suicide are: presence of a mental illness, increased use of alcohol or drugs, recent severe life stressor, family instability, and thoughts and idealization of dying and life after death.404 Among these indicators, substance abuse is highly suspected to be the instigator of over half of all suicide cases.405

Latino

olds was 9.02 per 100,000, 5% of which were males.401 This trend has been consistent since 2005, with males committing suicide at a disproportionately higher rate. In Harris County, the tendency to commit suicide is much greater for Anglo and Latino youths. Since 2005, Anglo youths have had the highest number of fatalities by suicide, followed by Latinos. Of all fatal suicides, Anglos constituted approximately 48% in 2009. In the same

Firearms

year Latinos constituted 39% of completed suicides, and African Americans and other non-Anglo youths constituted 13%.402

48%

35%

CHILDREN AT RISK 2010-2012

Policy Implication Suicide among youth is preventable. As suicide sometimes occurs during the pinnacle of a mental illness, careful attention and treatment is a must. Monitoring adolescents who exhibit serious depression and abnormal negative changes in behavior can help identify those at risk and in need of help. Discussion about suicide, even in jest, can also be a red flag that an adolescent may be considering suicide. Reassurance from loved ones and compassionate listening are key to dissuading an adolescent from suicide, as they may confuse ending their pain with ending their life. Additional factors such as removing firearms and other deadly weapons within an adolescent’s household also remain important. Seeking professional intervention and care for suicidal adolescents is the best way to get them the help they need. Preventive mental health care should be emphasized as a tool to counteract suicidal thoughts or attempts and be strongly considered and incorporated in public schools and universities.

PHYSICAL & MENTAL HEALTH

Increased awareness of the suicide prevention among atrisk youth is the first key to reducing unnecessary deaths. Preventative mental health care should be emphasized as a tool to counteract suicidal thoughts or attempts and should be incorporated in public schools and universities.

Pediatric AIDS Indicator: The number of Acquired Immunodeficiency Syndrome (AIDS) cases that have been diagnosed in children ages 0 to 19 Year

1990

1992

1994

1995

1996

1998

2000

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

Source: City of Houston Department of Health and Human Services

• Different levels of AIDS emerge in infected children and infants, causing ailments such as tuberculosis, pneumonia and other infections. • In 2007, of all recorded cases of AIDS, 9,209 cases were children under the age of 13. • Harris County has a higher number of AIDS/HIV cases than any other region in the state of Texas.

Acquired Human Immunodeficiency Virus or AIDS which is spawned from the catalyst Human Immunodeficiency Virus (HIV) has for decades plagued the world with millions of deaths since its discovery by scientists in 1981. Since then, almost 60 million people worldwide have been infected with HIV.406 As of December 1, 2009 AIDS had killed 25 million people across the globe.407 Developing a vaccine exists as a potential medical form of prevention but progress in this area has been slow. Current approaches to reducing HIV/AIDS such as highly active antiretro-

viral therapy (HAART) and social approaches such as safe sex exist as limited ways of treating and preventing this disease. To this day, no cure has been found. Different levels of AIDS emerge in infected children and infants, causing ailments such as tuberculosis, pneumonia and other infections. Not only does the number of HIV/AIDS cases rise at each age level, the risk is further increased in minority races and ethnicities.408 HIV is commonly spread through sexual activity; many teen youth do

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Pediatric AIDS (cont.) Hiv cases regardless of aids status in houston/harris county, 0-19 years of age 60 50 40 30 20 10 0 1992

1994

African American

1996 Anglo

1998 Latino

2000

200102

2004

2005

2006

2007

2008

2009

Other

In 2007 Texas had the 4th highest number of AIDS cases in the nation. not consider the danger of engaging in risky sexual activity due to feelings of invincibility. These decisions may have life-long consequences, including death at a young age.409 By the end of 2006, an estimated total of 1,106,400 persons in the U.S. were infected with HIV.410 The cumulative estimated number of AIDS cases through 2007 was 1,018,428. Males constituted 74% of these diagnoses.411

2003

With children included, little more than half of the cases, 51%, were African Americans, followed by Anglos at 29% and Latinos at 18%.412 Male to male sexual contact (MSM) was cited as the highest category of transmission, 53%, followed by high-risk heterosexual contact at 32%.413 Of all AIDS cases cumulatively in 2007, 9209 cases were children under 13.414 By that yearâ&#x20AC;&#x2122;s end, AIDS claimed the lives of an estimated 4,891 children under 13 in the U.S.415

CHILDREN AT RISK 2010-2012

Region six, to which Harris County belongs, has a higher number of AIDS/HIV cases than any other region in the state. There were 48 cases of AIDS in 2008 and 24 cases in 2009.418 In 2007 Harris County had 60 HIV cases, and 68 in 2008.419 However, in 2009, the number of HIV cases decreased significantly, to 44.420 Past data from 2007-2008 show that 90% of HIV/AIDS cases in Harris

County originated in Houston.421 To date, Harris County remains the largest area of people living with HIV/AIDS in Texas.422 Despite fluctuating rates for HIV/AIDS cases for ages 0-19 in Harris County as seen in previous years, the number of cases reported in 2009 shows promise. The current data suggests that awareness of the HIV/AIDS issue has increased nominally in the county. The question now becomes whether or not this is another fluctuation or the dawn of a new trend toward a decline in cases for Harris County.423

PHYSICAL & MENTAL HEALTH

In 2007, Texas was ranked fourth nationwide in the number of AIDS cases, having a total of 2,964 that year. In 2007, Texas also claimed 7.5% of the 563 AIDS cases in children and adolescents aged 19 and under in the United States.416 New York State, based upon current census data from the CDC still retains the highest state cumulative total of AIDS cases.417

At-risk populations need easier access to prenatal and other healthcare services that are particularly important to the wellbeing of individuals with HIV/AIDS. Policy Implication With the recent drop in pediatric HIV cases, it will be paramount that the Houston Department of Health and Human Services (HDHHS), Harris County officials and state and local academic institutions and governments continue to provide easy access to information and services on HIV/AIDS and prevention through quality comprehensive sex and disease prevention education geared toward an emphasis on our youth. Regardless of the current progress, other areas need to be closely monitored. National, state and local data show that males comprise the majority of HIV/AIDS cases. African American men make up over half of these cases and African American women represent the majority of women affected by HIV/AIDS. The children of this population ages 0-19 represent the majority of youth affected as well. A pressing concern continues to exist for more attention toward this population in order to effectively address the current data trend.

CHILDREN AT RISK 2010-2012

PHYSICAL & MENTAL HEALTH

Agenda for Change Childhood DiseaseS and Immunizations Substance Abuse • Healthcare providers and government entities • Efforts to monitor child and teen substance abuse must increase education efforts regarding pertussis should be continued. vaccinations for adults to prevent disease in infants. • Substance abuse treatment should be made available • Healthcare providers and government entities through outpatient care and inpatient care to ensure must continue to stress the importance of timely that youths are receiving the treatment they need. vaccinations. • Schools and communities should make efforts to • The “opt-in” registration for immunizations should be educate teenagers on the consequences of the use of eliminated and an “opt-out” registration implemented. controlled substances during pregnancy. Childhood Obesity Sexually Transmitted Diseases • Families, communities, and individuals can fight • Harris County must intensify STD prevention outreach the obesity epidemic by adopting a healthy diet and and education, especially with at-risk populations good exercise habits. such as youth and minority communities. • Access to fresh fruits and vegetables in at-risk • Harris County must continue to provide education communities should be increased. and outreach on HIV prevention and offer treatment to individuals with HIV/AIDS. Children’s Mental Health • Texas and Harris County must make a financial Teen Births commitment to preventing and combating mental • Sexual health education should be both medically health disorders with special focus on children whose accurate and an age-appropriate curriculum that economic situation prevents them from receiving focuses on abstinence-plus, including protection of treatment. STD’s. • Texas must better fund outpatient mental health care • Programs like the Parenting and Paternity Awareness to reduce more costly strains on residential programs curriculum that reach out to teen males and the juvenile justice system. and females should be expanded. • The Texas Department of State Health Services must direct recently-received funding to cost-effective services such as MHMRA centers and crisis intervention. Health Care • Harris County should promote CHIP and Medicaid for children and pregnant women who qualify but are not enrolled, by publicizing the program and expanding application assistance outreach. • Texas should maximize federal matching dollars by increasing its own investment in CHIP and Medicaid. • Oral health services should be actively promoted and funded, especially in communities where basic dental care is cost-prohibitive.

CHILDREN AT RISK 2010-2012

SAFETY & SECURITY

CHILDREN AT RISK 2010-2012

SAFETY & SECURITY

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Human Trafficking Indicator: The number of certified victims of human trafficking that are under the age of 18 in Harris County Year

2005

2006

2007

2008

2009

Indicator

Source: Human Trafficking Rescue Alliance

• More than half of human trafficking victims are children and women. • Houston is a major hub for human trafficking because of its proximity to a major interstate highway, the large number of homeless youth, and the underground nature of trafficking. • Vulnerable youth – homeless and runaway children – are specifically targeted by pimps and are at risk of being lured into sex trafficking. • The number of child victims involved in forced labor and forced organ transplant are often underestimated because they are less visible than victims of sexual exploitation. Most people assume that slavery in the modern world ended with Lincoln and the 13th Amendment. This could not be further from the truth. Nearly a century and a half after abolition, slavery persists inside and outside of our country’s borders in the form of human trafficking. Trafficking of persons is one of the largest criminal industries existing today, tied with arms dealing and superseded only by drug dealing.1 It is the fastest growing criminal industry in the world, and generates billions of dollars in profits for its perpetrators every year.

underground crime, for several reasons. Many, if not most, victims will not seek help. Victims often fear imprisonment or deportation by law enforcement. They may also fear retaliation by the trafficker if they report the crimes they suffer. Moreover, victims may experience difficulty communicating in the language of the country in which they are enslaved. Lack of awareness among the general public, law enforcement and other professionals who may unknowingly serve trafficked persons also contribute to the persistence of human trafficking.

There are two types of human trafficking: domestic and Trafficked persons often suffer torture tactics including international. Victims of domestic human trafficking sexual abuse, imprisonment, and starvation. Trafficking include both U.S. citizens and legal residents who are often involves elements of other crimes, including forctrafficked within the United States’ borders without ever ible rape, kidnapping, false imprisonment, and violations leaving the country. Victims of international of labor and immigration codes.3 The global demand for sex and labor trafficking include foreign services provides a lucranationals who are traftive business for individuficked into the country als as well as organized from abroad. Despite crime units. Women and the general belief that children remain the most victims of traffickvulnerable victims.4 ing are mainly foreign Trafficking of persons is one of citizens, the internal or the largest criminal industries The International Labor “domestic” component existing today, tied with arms Organization (ILO) estiof human trafficking is mates that there are at least much larger than the indealing and superseded only 12.3 million adults and chilternational one. Accordby drug dealing. dren in forced labor, bonded ing to the Polaris Project, labor, and commercial sexual more than 200,000 American servitude at any given time.5 Of children are at risk for being 2 these victims, the ILO estimates lured into sex trafficking each year. that at least 1.39 million are victims of The criminal industry of human trafficking commercial sexual servitude, both transis driven by high demand, the enormous profit national and within countries. According to available due to that demand, and a negligible-tothe ILO, 56 percent of all forced labor victims low risk of prosecution. Trafficking in persons is an are women and girls.6 However, because sexual

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exploitation is often more visible than other forms of forced labor, it is likely that the number of victims of forced labor, debt servitude, and forced organ transplantation are underestimated. In January 2009, the Bureau of Justice Statistics issued a report that was the first in a series that will describe the number and characteristics of suspected human trafficking investigations and their outcomes. This report represents a snapshot of the investigations opened by 38 federally funded human trafficking task forces.7 However, because “these task forces were not selected to be statistically representative, the data do not represent all incidents of human trafficking nationwide.”8 Nevertheless, from the data collected, the first report found that sex trafficking accounted for 83% of the 1,229 alleged incidents of human trafficking reported by task forces.9 It also found that forced prostitution and child sex trafficking totaled 76% of all confirmed human trafficking incidents. Moreover, the report noted that 23% of human trafficking victims were either age 17 or younger and 34% were age 18 to 24.10

An estimated one out of every three children that run away is lured into sex trafficking within 48 hours of leaving home. One of the most common ways that young American girls become victims of human trafficking is by being lured into the sex trade while staying on the street. Vulnerable youth, particularly runaway and homeless children who are often as young as twelve years old, are particularly at risk for being targeted by pimps.11 According to the National Incidence Studies of Missing, Abducted, Runaway, and Throwaway Children, an estimated one out of every three children that run away is lured into sex trafficking within 48 hours of leaving home.12 Children who run away from home can often be found at bus stations, which have become a major recruiting ground for prostitution. Unfortunately, Houston, as well as other large Texas cities, possesses all of the factors that make a community susceptible to human trafficking. Not only is Houston the closest major city to the border with an I-10 corridor passing right through it, it is also home to a large number of sexually oriented businesses including strip clubs, massage parlors, and modeling studios, most of which can be found along inter- and intra-state highways. In addition, Houston, Dal-

las, Austin, and San Antonio, are homes to universities and professional sporting events that attract many visitors. Each of these cities also hosts major conventions that create even greater demand for the commercial sex industry. Because of the underground nature of human trafficking, the number of reported victims does not reflect the true scope of the problem. The FBI tracks domestic minor sex trafficking victims in Harris County through the FBI Innocence Lost Task Force. Since 2006, the FBI has rescued 81 juvenile victims of domestic human trafficking in Houston.13 Further, since the inception of Houston’s local law enforcement task force, the Human Trafficking Rescue Alliance (HTRA), the Harris County Sheriff’s Office has rescued 11 international undocumented minor victims since 2005.14 As a whole, the HTRA in Houston has investigated 63 incidences of human trafficking, 28 of which were confirmed human trafficking cases.15 They have arrested 31 suspects and rescued 161 victims.16 An important tool for law enforcement to combat trafficking is the National Human Trafficking Hotline, supported by the Polaris Project. By calling 1-888-3737-888 any time of day or night, people can seek help or report suspicious activity. Information from the Hotline data report indicates that in 2009, 12% of calls to the National Hotline came from Texas and 33% of the calls from Texas were from Houston.17 Of the calls received from Texas, most were from community members, with the second most calls from

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Human Trafficking (cont.) potential victims of labor exploitation.18 In addition, of the calls received from Texas, 12% learned about the Hotline number from a poster and 7% learned about it from a billboard.19

to attain a higher level of licensing, on or after January 1, 2011.24 An advanced four-hour training course will also be included in officers’ continuing education curriculum, on a voluntary basis.

In 2003, Texas was one of the first states to pass legislation criminalizing human trafficking.20 In Texas, a person commits the offense of human trafficking if the person “knowingly traffics another person with the intent or knowledge that the trafficked person will engage in forced labor or services.”21 Under the Texas human trafficking law, a minor is defined as a person under 18, and the term “traffic” is not dependent on the element of “transport.” In addition, Texas law imposes greater penalties on the offender when the victim is less than 18 years old. Trafficking of a minor is a first-degree felony, but trafficking of an adult is a second-degree felony.22

In 2009, 12% of calls to the National Hotline came from Texas and 33% of the calls from Texas were from Houston.

The Texas Legislature has continued its leading role in enacting laws to fight this crime. In 2009, Texas’ 81st Legislature increased the body of anti-trafficking legislation in the state by establishing a statewide task force, mandating training for police officers, and expanding victims’ rights, the state’s ability to prosecute traffickers, and the ability of counties to regulate illegitimate massage parlors.

The Legislature also introduced several changes for the courtroom. Defendants may now raise, as a defense to a charge of prostitution, that they were a victim of human trafficking.25 Further, prosecutors are no longer required to prove that the trafficker knew his victim was a minor; if a defendant is convicted of trafficking and the victim is a minor, the harsher penalty automatically attaches.26 Victims also can now pursue monetary damages in civil court against their trafficker for the physical and emotional harm they suffered at the trafficker’s hands.27

The statewide task force, established in the Office of Attorney General, will increase awareness and communication among the multiple state agencies charged with dealing with the complex issues surrounding human trafficking.23 The legislation requires training of police officers and mandates that they receive a four-hour training course on human trafficking. The training course specifically impacts newly-licensed officers or officers who want

Texas’ 81st Legislature gave individual counties more authority to fight human trafficking locally. Counties may now regulate massage parlors located in the unincorporated area of the county. The purpose behind this bill was to provide an avenue to regulate the illegitimate businesses attempting to escape city ordinances by moving to unincorporated parts of the county.28 Once the commissioners’ court passes the regulation, liability for operating an ille-

CHILDREN AT RISK 2010-2012

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As a further result of new legislation passed in 2009, sexually oriented businesses will have to maintain identification records on their employees or independent contractors for up to two years past the last date of employment. This law will allow for easier discovery and prosecution of business owners who exploit child sex workers.29 The 81st Legislature also passed a law that will allow municipalities to access the National Crime Identification Center when a sexually oriented business applies for a license.30 According to the FBI, authority to access this national database must come from the state. Without such authority, municipalities can check only an applicantâ&#x20AC;&#x2122;s

Texas needs to amend its laws and policies to treat children as victims and provide them with a safe place where they can recover from their exploitation.

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criminal background within the state when they apply for a sexually oriented business license. Now, as a result of this legislation, if an applicant is convicted of a crime in another state that would prohibit the applicant from obtaining a license for a sexually oriented business in Texas, the municipality will have access to that information. Also during the 81st Session, the Legislature recognized for the first time the particular plight of domestic human trafficking victims in the United States. It required the Texas Juvenile Probation Commission to conduct a study on alternatives to the juvenile justice system for minors who are accused of engaging in prostitution. As previously mentioned, it is estimated that nearly 200,000 American children are at risk for being lured into sex trafficking each year.31

SAFETY & SECURITY

gitimate massage parlor will exist, and a district or county attorney may then bring suit to shut down such a business and the owner may be fined up to $1,000 per violation per day.

TO P

It is particularly important to give trafficking victims strong support and tools to rebuild their lives once they have been rescued. The TRIAD Prevention Program currently serves at-risk youth in Houston, including runaway children. In 2008, TRIAD provided services to 1,600 children each month. However, while Houston is a known hub for human trafficking, it does not currently have a safe house for rescued victims. CHILDREN AT RISK is working with officials in Harris County to find locations in which young victims can be protected from their abusers, and successfully recover and grow.

Policy Implication Although important progress has been made in regards to human trafficking legislation, there is much more that needs to be accomplished. Survivors of human trafficking have had years of their lives taken away from them. While their rescue from traffickers has ensured their liberty, they are lacking in resources. One policy solution includes increasing revenue for victim services such as requiring that assets forfeited in trafficking cases be paid to trafficking victims. During the 81st Texas Legislative Session, House Bill 533 made progress in ensuring that victims are able to recover financially by allowing trafficking victims to bring civil claims against their traffickers. This is important legislation since civil litigation can be brought in addition to a criminal case or when a criminal case will not be possible. In addition to increasing revenue for victim services, there needs to be an increase in revenue for police officers who are investigating the cases and rescuing victims, as human trafficking cases can be resource intensive. While increasing revenue helps to ensure that survivors of trafficking have financial resources to move on with their lives, the current law in Texas still continues to criminalize large segments of trafficking victims. Texas continues to criminalize children who are found to be prostituting. Children who are arrested for prostitution are usually runaway or throwaway youth who have been lured or coerced into prostitution and are victims who are being sexually exploited. Many of these children have a pimp who is exploiting them, but all of these children are being exploited by purchasers of sex. Texas needs to amend its laws and policies to treat children as victims and provide them with a safe place where they can recover from their exploitation.

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SAFETY & SECURITY

Accidental Deaths of Children INDICATORS Motor Vehicle: The rate per 100,000 children ages 15 through 17* killed in motor vehicle collisions in Harris County Year

1990

1992

1994

1996

1997

1998

1999

2000

Indicator

30.5

27.6

16.1

11.6

14.3

11.4

15.0

15.4

Year

2001

2002

2003

2004

2005

2006

2007

Indicator

12.8

17.1

13.1

11.0

15.0

9.1

14.7

Source: Houston/Harris County Child Fatality Review Team * Data collected from the Texas Department of State from 1990-94 included children up to 19 years of age.

Firearm: The number of children 19 years and younger that died from an accident caused by a firearm in Harris County Year

1990

1992

1994

1996

1998

2000

2002

2004

2005

2006

Indicator

Source: Center for Health Statistics, Texas Department of State Health Services

• Over half of unintentional child deaths in Houston and Harris County are the result of motor vehicle accidents, and these crashes are the leading cause of death for teens nationwide. • Lack of adequate supervision is the main cause of both bathtub and swimming pool drowning deaths in Harris County. • Accidental child deaths from firearm discharge have dramatically decreased over the past decades because of heightened awareness and better safety precautions.

Motor vehicle crashes were responsible for 53% of all unintentional child deaths in the Houston/Harris County area in 2006-07. Nearly every parent or caregiver intends to do everything possible to keep his or her child safe. This involves preventative measures and close supervision to ensure that accidents do not end a child’s life prematurely. Some of these unfortunate accidents include death by motor vehicle accident, drowning and accidental firearm discharge. Although public awareness campaigns and child safety requirements such as safety seats have led to progress in protecting children from deadly accidents, a sizeable number of children under the age of 18 continue to die accidentally every year. Advances in child safety seats and other programs have led to better protection for the youngest children from deaths in motor vehicles; however a large number of children still die each year in collisions. In fact, motor vehicle crashes were responsible for 53% of all unintentional child deaths in the Houston/Harris County area in 2006-07.32 During that

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time period, 99 children died from motor vehicle collisions, with the majority of those deaths occurring in the 15 to 17 year-old age group.33 Indeed, the motor vehicle death rate generally rises in children as they age, peaking in the teen years.34 Motor vehicle crashes are the leading cause of death for U.S. teens, and they account for more than one in three deaths in this age group.35 In 2008, nine teens aged 16 to 19 died every day in the United States as the result of motor vehicle injuries.36 Since 1996, Harris County data shows that the motor vehicle death rate among 15 to 17 year olds has fluctuated between 9.1 and 15.4 deaths per 100,000, except that in 2002, the rate was 17.1 deaths per 100,000.37 Major factors contributing to child deaths in motor vehicle collisions included: poor weather conditions, traffic law disobedience, driver’s inexperience, inattentiveness, and substance abuse.38 However, the most frequent contributing factor was excessive speed.39 Some of the factors that contributed to the 15 to 17 year-old age group being the highest at risk for death from a motor vehicle collision are the facts that they are more likely to be distracted, inexperienced, and receive peer pressure to remain unrestrained.40 More than half of the motor vehicle deaths among teens occurred during the weekend.41

CHILDREN AT RISK 2010-2012

Lack of adequate supervision was the cause of most of the drowning cases in 2006-07.47 Lack of supervision is also cited as the main reason for child deaths from bathtub drowning.48 In some cases, caregivers mistakenly believed a bath seat or ring would keep the child safe.49 Nationwide, about 100 children under the age of five drown each year in bathtubs.50 In 2006-07, five Harris County children died in bathtub drownings.51

16 4

< 1 Year

< 1-4 Years

< 10-14 Years

ming pools, with 61% of swimming pool deaths being in a private residential pool.44 Interestingly, while drowning deaths at apartment and community pools were concentrated between May and August, those at residential pools were dispersed throughout the year.45 Such data underscores the importance of four-sided fencing around backyard pools.46 However, nothing can substitute for careful supervision.

< 5-9 Years

< 15-17 Years

Source: Houston/Harris County Child Fatality Review Team

It is important to continue building awareness about the dangers of passive supervision of children.

A dip in the pool, lake, or a trip to the beach may be a welcome escape from the Houston heat, but these can be fatal places for unsupervised children. Despite public awareness campaigns, heightened during the summer months, a number of children continue to fatally drown each year. According to data from 2006-07, thirty children under age 18 died by accidental drowning and submersion in the Houston/Harris County area.42 Of these deaths, males were more likely to drown than females, and the age group with the highest mortality rate was 1 to 4 year olds.43 The majority of these drowning deaths occurred in swim-

SAFETY & SECURITY

NUMBER OF ACCIDENTAL DROWNING DEATHS BY AGE, 2006-2007

In 2006, data for Harris County showed one death of a child under age 19 in which the underlying cause was an accidental firearm discharge.52 Nationwide, accidental youth deaths by firearm have decreased 90% since 1975.53 Possible reasons for this decline include: a better economy, safer gun storage methods, and increased safety awareness.54

Policy Implication It is important to continue building awareness about the dangers of passive supervision of children, especially near a body of water and during the summer months when children are more likely to be near a pool, lake, or beach. Similarly, a child must never be unattended within the vicinity of a firearm or neglectfully secured in a motor vehicle. Research suggests that Graduated Driver Licensing (GDL) programs reduce the likelihood of a teen being involved in a fatal accident by nearly 40%. 55 This program addresses the high risks faced by new drivers by first granting learners permits, followed by a provisional license that, for example, temporarily restricts unsupervised driving during the night and limits the number of passengers. 56 GDL programs should be implemented by all states in order to increase the safe driving of young drivers.

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Runaways, Truancy, and Minor Offenses INDICATOR: The number of children in Harris County referred to CPS for services who left home without consent and intent to return, were truant from school, or committed other minor offenses (Class C misdemeanors such as alcohol violations, theft, and disorderly conduct) Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2007

2008

Indicator

5,218

3,879

3,446

3,204

9,764

3,854

3,373

2,769

2,696

2,214

1,968

Source: Success: One Puzzle Piece at a Time, Harris County Juvenile Probation Department, 2008 Annual Report

• Harris County’s Youth Services Center has helped address many needs of at-risk youth before they develop any further delinquent behavior, through Community Youth Services (CYS) and the TRIAD Prevention Program. • CYS works to prevent youths from running away or dropping out of school, and additionally assists runaway/homeless youth. • TRIAD intervenes early on with juveniles who have committed minor offenses and are in need of supervision.

In addition to servicing 6,213 referred youth cases in 2008, Harris County CYS staff provided an additional 48,736 Student Support Services to students at school and in the community that were unrelated to open cases. In recent years, Harris County has successfully implemented the Youth Services Center (YSC) to deal with minors who skip school, are consistently truant, run away from home, and commit minor offenses. YSC is a “hub” of support services for children and youth who need help. Community Youth Services (CYS) and The TRIAD Prevention Program are two of the YSC’s “spokes” and are programs that help address the needs of at-risk youth before the problems become very serious. CYS is a crisis intervention and case management program with 92 staff members that offers free, voluntary assistance to at-risk youth and their families. The goal of this program, which is the result of a collaboration between Harris County Protective Services (HCPS), 16 contracting school districts, the Pasadena Police Department, the Educational Services Division of the Harris County Juvenile Probation Department, and the Community Education Partners Charter School, is to prevent youth from running away, dropping out of school, entering into delinquent behavior, or

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suffering from child abuse.57 Additionally, CYS provides support services to runaway/homeless youth through the Safety Net program, and conflict resolution/mediation to youth and their parents through the Parent/Teen Survival program. During 2008, 454 parents and teens completed the program. In addition to servicing 6,213 referred youth cases in 2008, CYS staff provided an additional 48,736 Student Support Services to students at school and in the community that were unrelated to open cases. In 2008, CYS received 27% of new youth referrals as a result of schoolrelated issues such as truancy, classroom behavior, and skipping class.58 The TRIAD Prevention Program is a three-pronged alliance between HCPS, Juvenile Probation, and the Mental Health and Mental Retardation Authority to deliver countywide prevention and early intervention services to divert youth and families from involvement with CPS, as well as the mental health and/or juvenile justice systems. The TRIAD program serves at-risk-youth (ages 10-17) who are apprehended by law enforcement and are in need of supervision; have committed status offenses such as running away, truancy, or curfew violations; or have committed Class C misdemeanors such as theft, assault, disorderly conduct, or public intoxication.59 TRIAD operates as a 24hour intake center and in 2008, 1,968 juveniles received services at the YSC.60 The probation staff also assisted another 1,250 juveniles and received 847 non-custody status offense and Class C misdemeanor referrals and provided services to these youth. Many parents consult the TRIAD staff to find ways to prevent their children from breaking the law.

CHILDREN AT RISK 2010-2012

cause detention hearing conducted by an associate judge. In 2008, there were 6,405 youth received at the Juvenile Detention Center.61

REASONS FOR REFERRALS TO CYS 8,000 Runaway

7,000 6,000

School Related

5,000 Minor Offenses

4,000 3,000 2,000

SAFETY & SECURITY

In addition to these services, Harris County operates a Juvenile Detention Center, also a 24-hour intake unit. If a youth is thought to present a threat to him or herself or the community, or is likely to run away and not return for a court appearance, he or she will be detained for a probable

1,000 0

2000

2001

2002

2004

2006

2007

2008

TOTAL REFERRALS TO CYS 30,000 25,000 20,000 15,000

18,694

21,686

21,562

26,127

10,000

14,187

5,000 0

2000

2001

2002

2004

2006

7,018

6,213

2007

2008

Accurate attendance monitoring, well-known consequences of excessive absences, and rewarding class attendance and participation are ways to begin addressing issues of schools engagement. Policy Implication With respect to truancy and school misbehavior, the responsibility of families, communities, and students in keeping children engaged and attending school regularly is crucial. Accurate attendance monitoring, well-known consequences of excessive absences, and rewarding class attendance and participation are ways to begin addressing issues of schools engagement. School personnel should also consider what motivates students to attend classes and school functions. Many schools suspend or expel students for excessive unexcused absences. This, however, does little to re-engage youth in school, or prevent further truancies. Other responses to excessive truancy can include meaningful community service and catch-up classes to re-engage students in learning.62

CHILDREN AT RISK 2010-2012

107

SAFETY & SECURITY

Child Abuse and Neglect INDICATORS Projected Abuse/Neglect: The number per 1,000 children in Harris County projected to be abused or neglected Year

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010 Goal

Indicator

68.2

85.3

87.4

86.3

84.5

81.8

137.1

150.6

143.3

25.0

Source: Administration for Children and Families, U.S. Department of Health and Human Services; 2006 American Community Survey, U.S. Census Bureau Goal Source: Healthy People 2010, U.S. Department of Health and Human Services

Cases Reported: The number of child abuse and neglect cases reported in Harris County Year

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

23,452

23,925

23,827

26,545

30,235

30,621

30,972

32,038

30,794

Source: Data Book 2007; 2008; 2009, Texas Department of Family and Protective Services

Investigations: The percentage of investigations carried out by Child Protective Services of reports alleging child abuse and/or neglect in Harris County where there was reason to believe abuse or neglect had occurred Year

1996

1998

2000

2002

2004

2006

2007

2008

2009

Indicator

33%

29.4%

27.9%

27.8%

22.8%

21.6%

20.3%

19.3%

20.4%

Source: Data Book 2007; 2008; 2009, Texas Department of Family and Protective Services

Average Caseload: The average caseload per caseworker by fiscal year for the Houston Region (Region 6) Year

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010 Goal

Indicator

31.3

32.3

26.8

28.7

25.7

29.4

32.9

29.8

30.8

32.0

14.4

Source: 2008-2009 Annual Report, Harris County Child Protective Services

• Children who are victims of neglect make up a little less than half of the total children in Harris County who are investigated by CPS. • Despite in-depth investigations into allegations of abuse, only a small fraction of children were removed from their homes in Texas and Harris County due to concerns over the child’s safety. • While the number of confirmed abuse accusations in Harris County dropped between 2008 to 2009, the number of abuse-related child deaths has risen drastically, indicating a need for a reduction in caseworker daily caseloads to enable caseworkers to spot abuse more efficiently.

An estimated 794,000 children were victims of maltreatment during FY 2007 based on the child populations of the 50 states, District of Columbia and the Commonwealth of Puerto Rico.63 Maltreatment has immense effects on a child’s life including physical, psychological, and behavioral consequences. 64 The Texas Family Code defines abuse as an act or omission that endangers or impairs a child’s physical, mental or emotional health and development. Neglect, the most prevalent form of maltreatment

108

to children, is defined as deliberately failing to provide a child with the necessary resources for survival, such as food, clothing, and medical care. Neglect is further defined as placing a child in or failing to remove a child from a situation that is inappropriate for the child’s maturity level and results in bodily injury or substantial risk of immediate harm to a child.65 As required by Texas state law, the Department of Family

CHILDREN AT RISK 2010-2012

11%

11% 42%

In Harris County, there were 30,794 reports of child abuse and neglect made in FY 2009 and 32,038 reports in FY 2008.70 However, only about 82% of intakes were assigned for investigation: 25,428 in 2009 and 26,225 in 2008.71 In 2008, 41.6% of the 35,388 children involved in completed investigations were alleged victims of neglectful supervision.72 Another 28.6%, or 10,121 children, were involved in cases that implicated physical abuse.

29%

Neglectful Supervision

Medical Neglect

Physical Abuse

Emotional/Verbal Abuse

Sexual Abuse

Refusal to Assume Parental Responsibility

Physical Neglect

Abandonment

Source: CPS in Harris County Annual Report, 2008

and Protective Services (DFPS) or law enforcement is to receive a report immediately from any person who has cause to believe that child abuse and/or neglect has occurred or has cause to be concerned about the welfare of a child. Professionals who have this same knowledge are required by law to report their concerns within 48 hours of their first suspicion.66 In 2008, 51% of the 193,254 reports made in Texas were made by teachers or other school personnel, medical personnel, or law enforcement.67 Child Protective Services

SAFETY & SECURITY

(CPS), the entity within DFPS that investigates reports of child abuse and neglect, must classify each received report as Priority I or Priority II depending on the seriousness of the allegations. Priority I reports include all those where there appears to be an immediate risk of abuse and/or neglect that could result in death or serious harm. Priority I investigations must be initiated with face-to-face contact within 24 hours of the report. All other reports of abuse and neglect receive a Priority II classification.68 The 79th Texas Legislature, through Senate Bill 6 in 2005, changed the timeframe that Priority II investigations must be initiated to 72 hours from the previously allotted 10 days.69

Types of Abuse/Neglect of Alleged Victims in Completed Investigations

A report may contain multiple allegations of different types of abuse/neglect. Once a report is assigned for investigation a CPS caseworker is required to interview all persons residing in the home where the abuse occurred and may interview other family members, as well as other collateral sources to determine whether abuse or neglect has occurred. At the end of the investigation, a disposition is assigned to each allegation. Dispositions include: “reason to believe” child abuse has occurred; “ruled-out” or reason to conclude that no abuse or neglect has occurred; “unable to complete” due to inability to locate the family; “unable to determine” or not enough information exists to determine whether abuse/neglect did or did not occur; and “administrative closing.”73 Of the 21,547 total investigations completed in FY 2008 in Harris County,74 62.9% were “ruled out” because the investigator found it unreasonable to conclude that abuse

TOTAL NUMBER OF CASES REPORTED-HARRIS COUNTY Intakes/ Investigations Families Alleged Victims Total Number of Children 0

10K

20K

30K 2008

CHILDREN AT RISK 2010-2012

40K 2007

2006

50K 2005

2004

109

SAFETY & SECURITY

Child Abuse and Neglect (cont.) or neglect occurred.75 While 19.3% of cases were confirmed to have “reason to believe” abuse or neglect has occurred, another 11.4%, or approximately 2,521, investigations were classified as “unable to determine.” Another 6.3% were classified as “unable to complete.”76 Risk assessments completed during investigation concluded that 14.5% of the families were at risk of further abuse or neglect. Over 60% of the families’ risk assessments showed that the risk factors for further abuse or neglect were controlled.77 In FY 2009, a total of 20,671 investigations were completed in Harris County with 20.4% of the cases confirmed as “reason to believe” abuse or neglect has occurred.78 Of the 35,388 alleged victims of child abuse or neglect in FY 2008,79 6,365 children were confirmed to be victims of maltreatment.80 This is approximately 6 per 1,000 children in Harris County who are confirmed victims of child abuse/ neglect, compared to 11 per 1,000 children across Texas.81 In 2008, a total of 11,597 children were removed from their homes in Texas82 and 1,980 children were removed in Harris County because of concerns over the child’s safety in the home after an investigation was completed.83 Across Texas, the most common confirmed perpetrators of child abuse or neglect were married women between the ages of 26-35, and the parent of the victim. The data clearly shows that there are gaps between cases reported, investigated, and completed. As with any resource, the number of available caseworkers to complete investigations accurately and in a timely manner is limited. In FY 2009, the daily caseload per CPS caseworker in the Houston region was 32.84 This is a slight increase from FY 2008 and FY 2007 where the average caseload was 30.8 and 29.8, respectively.85 However, these levels are well above the recommended monthly caseload of 12 active cases per worker for investigators.86

The National Incidence Study of Abuse and Neglect (NIS), a Congressionally-mandated comprehensive study of child abuse and neglect, is completed every ten years. The fourth completed study, NIS-4, was completed in January 2010. This latest study found that only 32% of child abuse and neglect is being investigated by CPS. When applied to Harris County, with 48,683 children in completed CPS investigations in 2008,87 this percentage would indicate that there were 152,134 children who were abused and neglected in Harris County but not brought to the attention of CPS. The number of confirmed abuse allegations has dropped significantly in Texas and in Harris County over the last two decades, from approximately 40% of all abuse allegations in Harris County confirmed in the early 1990’s to approximately 20.4% in 2008.88 In FY 2009, 280 Texas children died in abuse and neglect-related deaths and 67 died in Harris County.89 This is a significant increase over the 35 children who died in Harris County due to abuse and neglect in FY 2008. The state’s total in the same year was 213 child abuse and neglect related deaths.90

DFPS continues to struggle to maintain workable caseloads, and efforts must be taken to address this problem.

Policy Implication Despite its plans to reduce caseworker daily caseloads, DFPS continues to struggle to maintain workable caseloads, and efforts must be taken to address this problem. DFPS continues its reform efforts by employing tools to aid caseworkers in providing increased productivity in case management, especially while in the field. The agency began rolling out its Mobile Technology Project on August 7, 2006. Caseworkers were given Tablet PCs to essentially become their mobile office.91 The units provide remote wireless Internet access, case documentation, checks into client history, and even a route mapping for caseworkers on the go.92 Despite these efforts, caseworkers continue to carry caseloads above the recommended limits. This continues to inhibit the ability of caseworkers to spend the amount of time needed to provide in-depth case management.

110

CHILDREN AT RISK 2010-2012

INDICATORS CPS at Home: The number of children confirmed to have been abused who are determined to be safe and living at home while the child and family receive counseling and direct services to enhance the safety of the child Year

1994

1996

1998

2000

2002

2004

2006

2007

2008

Indicator

3,865

4,001

3,183

3,092

3,962

3,654

5,180

5,219

5,108

Source: Data Book 2007; 2008; 2009, Texas Department of Family and Protective Services

Temporary Custody: The number of children taken into protective custody by Child Protective Services until decisions are made about the safety of returning the child to his/her home or placing the child in a permanent out-of-home facility Year

1996

1998

1999

2000

2002

2004

2006

2007

2008

2009

Indicator

1,139

1,085

1,213

1,343

1,951

1,732

2,456

2,135

1,980

1,866

SAFETY & SECURITY

Children Under Supervision

Source: 2008-2009 Annual Report, Harris County Child Protective Services

KINDER SHELTER: The number of children in Harris County placed in the Kinder Emergency Shelter for temporary placement because of threatening home situations Year

1994

1996

1998

2000

2002

2004

2005

2006

2007

2008

2009

Indicator

403

315

465

501

300

355

395

313

270

985*

774

Source: 2008-2009 Annual Report, Harris County Child Protective Services *Prior to 2008, the number of children served included unduplicated data. This data is included in CPS in Harris County Annual Reports. In 2008 and 2009, the data is duplicated and includes CPS children sheltered on a temporary basis to avoid overnight stays in hotels and CPS offices.

FOSTER CARE: The number of Harris County children placed in foster care Year

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

3,460

3,761

4,151

4,217

4,040

4,356

4,799

4,714

4,368

4,122

Source: Data Book 2007; 2008; 2009, Texas Department of Family and Protective Services

CONSERVATORSHIP: The number of children in Harris County in the custody of Child Protective Services by a civil court under the Texas Family Code Year

1994

1996

1998

2000

2002

2004

2006

2007

2008

Indicator

3,865

4,001

3,183

3,092

3,962

3,654

5,180

5,219

5,108

Source: 2008-2009 Annual Report, Harris County Child Protective Services

adoption: The number of children adopted from Child Protective Services in Harris County after termination of parental rights Year

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

310

315

361

414

493

515

542

623

687

702

Source: Data Book 2007; 2008; 2009, Texas Department of Family and Protective Services

CHILDREN AT RISK 2010-2012

111

SAFETY & SECURITY

Child Under Supervision (cont.) • When a child cannot safely return home, CPS must petition the court to remove the child from the home and place he or she in protective custody, either in a foster home or with relatives. • The Nancy and Rich Kinder Emergency Shelter in Harris County operates on a 24-hour basis to give children temporary residence while caseworkers work to reunify the family and resolve any harmful situations. • In the Texas CPS system, a higher percentage of minority children are removed from their homes, a lower percentage are successfully reunited with their families, and a higher percentage age out of foster care.

FAMILY UNIFICATION SERVICES

2000

Returned to Family

Relatives

Adoptive Homes

Long-Term Sub-Care

Other

Total

35.20%

21.10%

24.50%

11.10%

8.10%

3,160

2001

33.10%

25.80%

22.50%

11.10%

7.60%

3,497

2002

33.90%

20.80%

26.10%

11.30%

7.90%

3,962

2004

35.60%

23.00%

24.80%

9.50%

7.10%

3,654

2006

27.70%

21.80%

31.40%

13.40%

5.70%

1,726

2007

29.50%

26.10%

29.40%

10.60%

4.40%

2,100

2008

28.00%

25.80%

31.80%

10.70%

3.70%

2,118

Source: CPS in Harris County, 2008 Annual Report (2007 Statistics) & 2009 Annual Report (2008 Statistics)

At the end of FY 2008, a total of 5,108 children from Harris County were in protective custody. When a Child Protective Services (CPS) investigative worker determines the disposition of each case, an assessment of the reasonable likelihood that abuse or neglect may occur again is mandatory. Based on this assessment, several determinations can be made. When the child’s safety can be reasonably assured, CPS provides Family Based Safety Services (FBSS) to help stabilize the family and reduce the risk of future abuse and neglect.93 In these cases, CPS through its contract agencies offers the family a variety of services including family counseling, crisis intervention, mental health services, parenting classes, childcare and substance abuse treatment.94 Based on the degree of risk to the child, the family may receive regular, moderate or more intensive FBSS services.95 In FY 2008, 11,807 Harris County children received FBSS services. Most FBSS services are provided to

112

children who continue to live at home, while in some cases, children receive services while living temporarily with relatives or friends until the home becomes safe enough for them to return.96 In 2008, CPS implemented a substance abuse protocol for use by FBSS staff working with families dealing with this issue.97 When children cannot safely return home and there are no known relatives or kinship caregivers to care for the child, CPS must petition the courts to remove the child and any sibling from their home.98 Following court approval, arrangements are made and the children may be placed temporarily with relatives, a foster family or in an emergency shelter. Children with special needs who require more specialized attention may be placed in specialized group homes, residential treatment centers or other facilities.99 In FY 2009, CPS and the courts in Harris County determined that 1,866 children could not remain with their families.100 This is a 6% decrease from the number of children in the Temporary Managing Conservatorship of the state in FY 2008. At the end of FY 2008, a total of 5,108 children from Harris County were in protective custody.101 This is a 2%

CHILDREN AT RISK 2010-2012

The Nancy and Rich Kinder Emergency Shelter, located at the Harris County Youth Services Center, admits youth ages 12 to 17 that need to be separated from harmful home situations. They are given temporary residence in the 24-bed facility, while a caseworker helps them to resolve their immediate crisis and counsels the family so that the youth may return home.109 Ninety-seven percent of children referred to the Kinder Emergency Shelter in calendar year 2008 were in the custody of the Department of Family and Protective Services (DFPS). The remaining 3% of children had placements requested by parents/legal guardians with sponsorship from the Community Youth Services and TRIAD Prevention Programs and Systems of Hope.110 These youth were experiencing severe family conflict, were on the verge of homelessness, and/or were actively engaging in runaway behavior.111 On average, slightly more girls (57%) are admitted than boys (43%) each year. In 2008 and 2009, 985 girls and 774 boys were admitted to the Kinder Emergency Shelter.112 In 2007 only 270 youth were sheltered at Kinder Emergency Shelter,113 marking a sharp increase in years 2008 and 2009. decrease from the 5,219 children in custody at the end of 2007. Of the 5,108 children in the stateâ&#x20AC;&#x2122;s custody, the vast majority of children, 51.6%, were living in foster care.102 Of these children, 24.5% had been in foster care for more than 2 years. Children placed in foster care live in foster homes, group homes, residential treatment facilities or a facility under the authority of another state agency.103

SAFETY & SECURITY

children the benefit of more stability when they cannot live with their birth parents.107 The CPS kinship program supports relative caregivers by assisting with initial costs of accepting a child and also with ongoing case management. In 2008, over 1,800 children were in a kinship placement in Harris County each month.108

During temporary custody, CPS works with the child and the family toward a goal of family reunification. This goal is secondary to the safety and well-being of the child, but is considered crucial to the childâ&#x20AC;&#x2122;s future.114 Within 12 months, the court must approve a permanent placement for the child by either dismissing the case; appointing a parent, relative or CPS as permanent managing conservator; or returning the child to his or her home of origin. If the

Minority children make up over 79% of the children waiting for adoption in Harris County and 75% are between the ages of zero to ten. Before placing children in foster care, CPS certifies foster homes and foster parents for child safety. Some foster parents are reimbursed for their expenses on behalf of their foster child. Harris County spent over $53 million in foster and institutional care payments in FY 2009.104 Depending on the service level, foster parents are paid between $22.15 and $88.62 daily.105 Of children in protective custody in 2008, another 36.9% of children were living with relatives.106 Referred to as kinship care or relative care in CPS, these caregivers provide

final decision of the court removes all of the rights of the parent(s), the child may then be considered for adoption.115 Once parental rights are severed and a child is eligible for adoption, CPS begins searching for a permanent adoptive home for that child. In the state of Texas, 4,859 children were adopted in FY 2009 through the Texas Department of Family and Protective Services.116 This is a general increase of 7% above the 4,517 children adopted in the state during FY 2008.117

CHILDREN AT RISK 2010-2012

113

SAFETY & SECURITY

Child Under Supervision (cont.) In 2009, Harris County CPS found adoptive homes, placed, and consummated the adoption of 702 children.118 In Region 6, which includes Harris and 12 surrounding counties, there were 932 completed adoptions.119 The county and region represented 15% and 19%, respectively, of the total finalized adoptions in the state of Texas for 2009. The increase in adoptions in Harris County is in contrast with the decrease in the number of children taken into protective custody within the county. Despite the rise in the number of children being adopted, there continue to be hundreds of children who are eligible for adoption but do not have adoptive families. In 2008, 1,772 children were awaiting adoption.120 Minority children make up over 79% of the children waiting for adoption in Harris County and 75% are between the ages of zero to ten.121 In order to help facilitate more adoptions, CPS contracts with licensed child placing agencies to increase the number of homes available to adopt foster children. In April 2007, CPS launched the “Why Not Me” public awareness campaign to increase the likelihood older children awaiting adoption would find permanent homes. The campaign sought to increase awareness among and the number of prospective adoptive parents. The campaign was funded by a federal grant which was awarded to the state of Texas due to increasing adoptions more than any other state in 2005.122 During FY 2008, 2,118 Harris County children in CPS custody were placed in a permanent living arrangement.123 The average length of time children were in temporary custody prior to placement in a permanent living situation was 20.8 months.124 Of the 1,726 children permanently placed, 31.8% of these children were in adoptive homes, 28% were returned to his/her family, 25.8% were living with relatives, another 10.7% were living in long-term substitute care and 3.7% were living in other arrangements.125 In 2008, the Intensive Permanency Placement Initiative (IPPI) pilot program began in Harris County. The program is designed to support CPS youth ages 14 and older who have had multiple placements and have been in the custody of CPS more than two years.126 Experienced caseworkers are assigned to only seven cases so they can provide intensive case management services by having more frequent contacts with the youth and developing closer relationships.127 Disproportionality is the over-representation of a particular race or cultural group in a particular program or system.128 In the Texas CPS system, a higher percentage of minority children are removed from their homes, a lower percentage

114

are successfully reunited with their families, and a higher percentage age out of foster care.129 This past year, some of the efforts in addressing the disproportionality issue in the Houston area have included a partnership between CPS, Casey Family Services, and the Houston Area Urban League to provide wrap-around services for identified youth.130 CPS also collaborated with the City of Houston and Systems of Hope in the development of the Kids Village Model.131 The Disproportionality Advisory Group developed an outreach and networking team and the group is providing education to various housing complexes within the disproportionality zip codes on how the CPS system works.132 On October 7, 2008, the Fostering Connections to Success and Increasing Adoptions Act of 2008 became law. This federal act provides a significant overhaul of the child welfare structure. The Act seeks to create a fundamental shift in child welfare that recognizes that: “Foster care is not a viable long-term solution; Adoption is not an option for everyone; There should be an increased focus on relatives; and Older children in foster care need help.”133 Texas must meet several requirements under the Act that include providing written notification to maternal and paternal grandparents, as well as other adult relatives, of a child’s removal and placement in the state’s custody and options on how they can provide support for the child.134 The Act will be beneficial to kinship caregivers and CPS youth who turn age 18 while in the state’s custody.135

CHILDREN AT RISK 2010-2012

INDICATORS cases opened: The number of family cases opened in Harris County for services as a result of a completed investigation Year

1996

1998

2000

2002

2004

2005

2006

2007

2008

2009

Indicator

988

2,079

3,267

3,470

4,947

4,755

4,265

4,725

5,450

Source: 2008-2009 Annual Report, Harris County Child Protective Services

TRIAD: The number of children and families served through the Harris County TRIAD Program Year

2002

2003

2004

2005

2006

2007

2008

Indicator

20,900

21,564

42,573

49,133

45,400

20,479

19,944

SAFETY & SECURITY

Intervention and Treatment Services for Children and Parents

Source: TRIAD Prevention Program, Harris County Child Protective Services

CYS: The number of youth served through Harris County’s Community Youth Services (CYS) Program Year

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

18,694

21,686

21,562

28,543

28,784

26,140

19,741

21,588

22,137

23,039

Source: TRIAD Prevention Program, Harris County Child Protective Services

STAR: The number of children and families served through Harris County’s TRIAD Services to At-Risk Youth (STAR) Program Year

2002

2003

2004

2005

2006

2007

2008

Indicator

952

777

245

559

357

293

348

Source: TRIAD Prevention Program, Harris County Child Protective Services

• After abuse has been documented in a home, CPS develops a service plan for the child and family involved in the abuse, in order to ensure a safe environment for the child. • CYS serves to prevent instances of abuse in Harris County and also successfully intervenes with at-risk youth to prevent youth homelessness. • The TRIAD county programs provide resources for at-risk youth through various counseling and mentoring programs.

When a completed investigation of child abuse and neglect determines that there is abuse in the home, a Child Protective Services (CPS) case is opened in Family Based Safety Services (FBSS) or a child is legally removed and placed in conservatorship. A service plan is developed for the child and the family within 21 days. The service plan provides information and actions that are necessary for the parents to take in order to achieve the plan’s goals. If the child has been removed from the home, the plan also contains information about legal deadlines, permanency goals, and steps that are necessary to return the child to the family

home. If the child has been removed from the home and the goal is to return the child to the parents, the plan must ensure that reasonable efforts are made to enable a child’s parent(s) to provide a safe environment for the child. CPS enables parents to receive services, which may include referrals to crisis intervention, parenting classes, substance abuse treatment, and counseling. CPS may also provide these services in a preventive manner to parents whose children have not been removed from the home, to reduce the risk of future abuse or neglect.

CHILDREN AT RISK 2010-2012

115

SAFETY & SECURITY

Intervention and Treatment Services for Children and Parents (cont.) FAMILY CASES OPENED FOR SERVICES AS A RESULT OF A COMPLETED INVESTIGATION - FISCAL YEAR 2009 Region

In Home Direct Delivery

In Home Purchased

Family Substitute Care

Total

Lubbock

3143

782

3,925

Abilene

2555

436

2,993

Arlington

12,305

1076

2,774

16,155

Tyler

2406

902

3,319

Beaumont

1056

370

1,427

Houston

11,611

3,108

14,728

Austin

3,873

1,908

5,783

San Antonio

9,236

356

1923

11,515

Midland

2282

611

2,897

El Paso

2355

154

2,512

Edinburg

11,866

1223

13,095

Other

State Total

62,698

1,470

14,192

78,360

Source: Texas Department of Family & Protective Services, Data Book 2009 Note: Family Substitute Care includes all children in the case regardless of victimization.

Reasons For New Referrals To CPS136 • School Related - 1,677 (27%) • Adolescent Development Issues - 1,302 (21%) • Financial Problems - 1,228 (20%) • Family Problems/Violence - 600 (10%) • Mental Health Problems - 442 (7%) • Grief Counseling - 278 (4%) • Health Problems - 262 (4%) • Child Abuse/Neglect - 182 (3%) • Substance Abuse - 117 (2%) • Gang, Crime Victim, Police, Misc. Offense, Assault - 79 (1%) • Running Away - 46 (1%)

Community Youth Services (CYS) CYS is the largest county-funded program of Harris County Protective Services for Children and Adults, with ninetyfour staff members who provide prevention and early intervention services to children, youth and their families. There are three components of the CYS program. The first component is the unique shared funding partnership with 16 school districts, as well as the Community Education Partners Charter School, the Educational Services Division of the Harris County Juvenile Probation Department and the Pasadena Police Department. Under these contracts, seventy-six CYS staff provide free, voluntary, crisis intervention, counseling, and generic case management

116

services to families with school age youth who are at risk of running away, dropping out of school, or have family problems that are affecting their behavior or school success. By networking and coordinating with existing non-profit, church-sponsored and public agencies, clients are assisted in resolving their problems without the loss of parental authority and the more costly intervention of the court system. The mobility of the staff permits them to take services directly to families in their own homes. Sometimes these families are so overwhelmed by their crisis or economic condition that they are unable to arrange transportation, make and keep appointments, and seek beneficial services or activities for themselves. The goal of CYS is to prevent at-risk youth from becoming victims of child abuse, running away, dropping out of school or entering into delinquent behavior.137 During 2008 CYS staff served 22,137 youth and, of the total youth served, 6,213 were new youth referrals. CYS staff provided Student Support Services to an additional 48,736 students at school or in the community not related to open cases. Students may participate in multiple outreach event services. The second component, the Safety Net Program, is designed to prevent runaway episodes in adolescents and to successfully intervene in the lives of adolescents who do

CHILDREN AT RISK 2010-2012

SAFETY & SECURITY

run in an effort to prevent youth homelessness. This is accomplished through flexible support and intervention services, to include the coordination of services available through agency, school and community collaborations; assistance with shelter placements or other safe housing alternatives; and the provision of contract services for family therapy and psychological screenings. The Safety Net program is grounded in Positive Youth Development that promotes youth leadership and service through its Youth Advisory Council which engages in various community projects and outreach activities geared toward youth ages 12 to 21. During 2008, the Safety Net program served 300 youth and their families.138 The third component, the Parent/Teen Survival Program, is an early intervention program offered to at-risk youth and their families. The program is a five-week, ten-hour curriculum-based program that demonstrates and teaches conflict resolution, anger management and mediation skills to youth ages 10 to 17 and their parent(s) simultaneously, thereby improving behavior at home and in school. The goal is for parents and youth to work out their differences in a respectful and productive way. The training empowers all family members to communicate and understand others, and helps reduce tensions in the home, school and community that could lead to violence. During 2008, 454 parents and teens completed the course.

TRIAD Harris County Protective Services offers and provides support programs for children. The most comprehensive of these services, the TRIAD Prevention Program, comprises a group of three county agencies that work together to provide resources for at-risk youth. The three public agencies that compose TRIAD include Child Protective Services, the Juvenile Probation Department, and the Mental Health/Mental Retardation Authority.139 The TRIAD Program consists of eight different countywide prevention and early intervention services. Descriptions of each of these programs follows.

Justice of the Peace Court Liaison

Truancy Learning Camp (TLC)

The liaisons in the Justice of the Peace Court Liaison program work with families appearing in JP Court for Class C misdemeanor offenses such as truancy, disorderly conduct, and disruption of school classes.140 During the courtâ&#x20AC;&#x2122;s dockets, the liaisons provide crisis intervention services and sentence recommendations. To assist them in their duties, the liaisons collaborate with community and faith-based organizations, local school districts, and other branches of the judicial system.

The TLC is a truancy-prevention and early-intervention program, and serves students and their guardians who are referred by the Justice of the Peace Court.142 The program focuses on issues that may contribute to excessive absences in school. It is structured into two eight-hour sessions, which occur on consecutive Saturdays. The training includes components covering life skills, anger management, substance-abuse prevention, parenting skills, communication skills, and truancy laws.

Justice of the Peace Court Case Management

Intake/Diversion Program

The Justice of the Peace Court Case Management program employs case managers who provide intensive follow-up services for families for which the JP Court has recommended or ordered certain conditions or programs.141 Among the services that the case managers provide are home and school visits, development of case plans, and referrals that meet clientsâ&#x20AC;&#x2122; needs.

TRIADâ&#x20AC;&#x2122;s Intake/Diversion program results from collaborations between CPS and the Juvenile Probation Department. The staff works side-by-side, 24 hours a day, seven days a week to provide screenings/assessments, crisis intervention, short-term counseling, information/referral, and follow-up services. Youth and families access services through law enforcement or on a walk-in basis. As of December 1999, intake staff

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Intervention and Treatment Services for Children and Parents (cont.) began a program in which they responded to calls on a special hotline that was set up to address the issue of infant abandonment in the Houston community (The Baby Abandonment Prevention Hotline).143 In 2008 and 2009, The Baby Abandonment Prevention Hotline received 225 calls.144

Services to At-Risk Youth (STAR) The STAR program serves those at-risk youth who do not meet the criteria to receive CPS services or the services of county juvenile probation programs. Since its beginning in 1983, the STAR program has grown to provide services in all 254 Texas counties. In Harris County, services are provided by TRIAD as well as the DePelchin Children’s Center. Harris County STAR provides crisis intervention, emergency shelter placement, curriculum-based groups and family therapy services at the Youth Services Center, schools and in the community or in-home. The STAR program focuses on families presenting with issues of runaway, truancy, or family conflict. STAR serves families with children/youth from ages zero to 17. Therapeutic intervention services are short-term and solution-focused. The STAR program also works in conjunction with area child abuse prevention agencies to provide universal prevention services in the Harris County community. 145 All services are free. The Texas Department of Family and Protective Services provides funding for the program.

Community Youth Development (CYD) The CYD attempts to decrease juvenile crime in the communities of Gulfton and Pasadena. These areas were chosen because of their specific needs for juvenile delinquency prevention. To achieve this goal, the services provided include after-school programs, mentoring, self-esteem and leadership courses, sports, counseling, and support groups.146

Parenting With Love and Limits (PLL) The PLL is a parenting education program that integrates principles of a structural family therapy approach into a comprehensive six-week program. The program is designed to provide parents with specific tools and techniques (e.g., contracting, troubleshooting, anti–button pushing tactics, using creative consequences) to reestablish the parents’ abilities to determine rules and restore nurturance to the parentchild relationship. Parenting skills are taught in a group setting and individual coaching is provided to show each family how to use the skills in day-to-day interactions.147

TRIAD Mental Health Mental Health/Mental Retardation Authority counselors provide free in-home, family-based counseling and therapy to youth and families identified with serious mental health issues. The TRIAD Mental Health program utilizes a family-centered approach based on the needs of the family. The goal of the program is to maintain children and youth who are at risk for outof-home placement in a family setting by providing a broad range of individual and family services.148

The parents’ issues must first be accurately identified and then matched with providers that can provide the quality care and treatment in order for these services to be successful and for reunification to occur.

Policy Implication Once CPS removes a child from their home due to abuse or neglect, it is important that the parent receive services to alleviate the problems and issues that originally brought the child into care. The parents’ issues must first be accurately identified and then matched with providers that can provide the quality care and treatment in order for these services to be successful and for reunification to occur. It is essential that the parents receive these services and learn skills and acquire knowledge to ensure that their home is safe. If this does not occur, children may not be able to return home and will remain in foster care, or they may return home only to be re-abused.

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INDICATOR: The number of youths who fit the gang member criteria in Houston Year

1990

1992

1994

1996

1998

2000

2001

Indicator

1,098

2,645

2,640

2,125

1,556

306

Year

2002

2004

2005

2006

2007

2008

2009

Indicator

300

230

222

363

566

607

Source: Houston Police Department

• Street gang membership was on the decline from 1998 to 2001, but has maintained steady growth in Harris County over the past five years. • One third of jurisdictions in the National Youth Gang Survey experienced gang problems in 2007. • Houston has taken steps toward decreasing gang membership through the collaboration of different groups to share information about gang members, as well as help reverse the appearance of gang members and gang activity.

Section 71.01 of the Texas Penal Code defines a criminal street gang as three or more people who have a common identifying sign or symbol, or an identifiable leadership regime, who regularly commit criminal activities. While gang membership saw a sharp decrease from 1,556 in 1998 to 306 in 2001, gangs maintained steady growth for the past five years in Harris County.149

SAFETY & SECURITY

Juvenile Gang Members

orative effort with the Mayor’s Anti-Gang Office and the Association for the Advancement of Mexican Americans, 323 youth were monitored in 2008. In an effort to reverse the appearance of gang activity, tattoo removal is available through a partnership with the City of Houston and graffiti abatement projects are conducted on a regular basis.151

The Houston Police Department’s Gang Division documents annual gang statistics, and reports that as of December 2009, there were approximately 607 juvenile gang members – a forty percent increase since 2007. Of known gang members in Harris County, 589 are male, 18 are female; 443 are Latino, 147 are African American, 16 are Anglo, and 1 is Indian. Harris County is not the only place with increased gang membership; more than one third of the jurisdictions in the National Youth Gang Survey study population experienced gang problems in 2007, the highest annual estimate since before 2000.150 The Harris County Juvenile Probation Department offers the Gang Supervision Caseload program, focusing on the sharing of information about gang members. In a collab-

Policy Implication Harris County has been viewed as a model for fighting gang membership in the past. With the recent increase in gang membership, it may be time for Harris County to renew and increase its antigang efforts.

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Juvenile Probation INDICATORS INTAKE REFERRALS: The number of referrals of Harris County children to intake units for assessment Year

1990

1992

1994

1996

1998

1999

2000

Indicator

20,296

29,221

34,027

30,422

27,046

24,641

24,335

Year

2002

2003

2004

2005

2006

2007

2008

Indicator

20,812

22,738

26,072

23,488

24,877

23,164

20,885

Source: Harris County Juvenile Probation Department

AVERAGE CASELOAD: The average number of caseloads per juvenile probation officer in Harris County Year

1990

1992

1994

1996

1998

1999

2000

Indicator

3,089

3,298

3,503

3,760

3,650

Year

2002

2004

2005

2006

2007

2008

Indicator

4,756

5,140

5,235

5,429

5,208

Source: Harris County Juvenile Probation Department

FIELD SERVICES: The number of children on probation receiving field services in Harris County Year

1990

1992

1994

1996

1998

1999

2000

Indicator

3,089

3,298

3,503

3,760

3,650

Year

2002

2004

2005

2006

2007

2008

Indicator

4,756

5,140

5,235

5,429

5,208

Source: Harris County Juvenile Probation Department

• While the number of juveniles referred to the Harris County Juvenile Probation Department decreased by ten percent in 2008, the number of severe crimes nearly doubled. • HCJPD implemented Operation Redirect to direct mentally ill youth away from the juvenile justice system in order to get them the treatment they need. • The average caseload per juvenile probation officer decreased dramatically over the course of the past four years.

In 2007, Harris County referred approximately 23% of all juveniles referred to probation in Texas.

The Harris County Juvenile Probation Department (HCJPD) handles referrals made by individuals, schools or police officers alleging illegal acts committed by juveniles. Cases resolve through counseling, social service agencies, or by charging the juvenile with a crime. After completing the court process, the juvenile receives either mandatory probation or can voluntarily comply with a period of informal probation. Juveniles referred to HCJPD often require intensive psychiatric evaluation and treatment. To address this, in The number of juveniles referred to HCJPD decreased 2008, the department integrated Operation Redirect in an by almost ten percent in 2008, from 23,164 to 20,885.152 effort to direct mentally ill youth from the juvenile justice Major decreases occurred in administrative action and system. Operation Redirect clinicians assessed 1,514 probation violations. However, the most severe crimes, youths with court cases pending. HCJPD data indicates homicide and arson, both nearly doubled.

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that 50% of the youths screened had symptoms of a mental disorder, with 20% evidencing symptoms of a severe emotional disturbance.153 When intake screening determines a youth needs psychiatric services, he or she is sent to the Ben Taub NeuroPsychiatric Center. Youth with severe psychiatric needs receive treatment at the Harris County Psychiatric Center Sub Care Unit. Between January and October 2009, 139 youths were admitted to the Harris County Psychiatric Center, a decrease from 160 in 2008, and 164 in 2007.154 Juvenile probation officers serve in a variety of capacities. Probation officers intake cases referred to juvenile and family courts, oversee predisposition or pre-sentence investigation of juveniles, and oversee court-ordered supervision of juvenile offenders. The total number of juveniles on probation may be divided by type of services received: field supervision, deferred adjudication, intensive supervision, intensive after-care, and special programs. In 2008, an average of 5,208 juveniles were under supervision by the Field Services Division while they remained at their homes each month; an average of 1,531 juveniles participated in deferred adjudication each month; an average of 683 juveniles received services in Intensive Supervision each month; and an average of 357 juveniles received services in the aftercare program each month.

Average caseload per officer in the community supervision program decreased dramatically – from 67 cases per officer in 2006 to only 40 in 2009. Furthermore, in intensive supervision each officer had only 16 cases.155 While on probation, youth often participate in HCJPD field services voluntarily, or by court mandate. HCJPD offers field services programs, addressing the broad range of problems children on probation experience.

Services include: • Baby Think It Over - Computerized infants are used to educate and deter teen pregnancy in a realistic, hands-on experience about motherhood and responsible parenting. • Drug Free Youth Program - Certified alcohol and drug abuse counselors are available to all community unit probation services offices by the Houston Council on Alcohol and Drugs to intervene with those who have substance abuse problems. • Educational Workshops - Workshops for youth and families on various topics. • Early Termination - A voluntary program that may shorten probationary periods. • Equine Therapy - A program combining traditional therapeutic intervention with a more innovative component involving relationships and activities with horses. • Juvenile Consequences - Monthly meetings with representatives of court, law enforcement and juvenile probation to explain the system.

• MADD Victim Impact Panel - Workshops for probationers and families intended to show the tragic consequences of drinking and driving, presented by the Bureau of Alcohol, Tobacco and Firearms and Mothers Against Drunk Driving. • Peer Pressure Workshops - Workshops presented by the Houston Police Department on positive and negative effects of peer pressure. • Prohibited Weapons Workshops - Houston Police Department workshops which teach consequences of possession of illegal weapons. • ROPES - (Reality Orientation through Physical Experience) A two-day program with low and high element challenges to build confidence and promote teamwork. • WINGS - Educational specialists advocate for juveniles to keep them in school, to reinstate them if expelled, or to arrange completion of GED requirements and career planning.

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Juvenile Offenses INDICATORS HOMICIDE: The number of homicides referred to the Harris County Juvenile Probation Department Year

1990

1992

1994

1996

1998

1999

2000

Indicator

Year

2002

2004

2005

2006

2007

2008

Indicator

Source: Harris County Juvenile Probation Department

Assault: The number of felony assaults referred to the Harris County Juvenile Probation Department Year

1990

1992

1994

1996

1998

1999

2000

Indicator

336

560

666

363

286

282

273

Year

2002

2004

2005

2006

2007

2008

Indicator

298

360

382

383

315

309

Source: Harris County Juvenile Probation Department

SEXUAL ASSAULT: The number of sexual assault offenses referred to the Harris County Juvenile Probation Department Year

1990

1992

1994

1996

1998

1999

2000

Indicator

152

211

181

147

109

Year

2002

2004

2005

2006

2007

2008

Indicator

124

146

189

186

121

119

Source: Harris County Juvenile Probation Department

• The rate of the juvenile crimes of forcible rape, theft, drug offenses, assault, and several property crimes are decreasing in Harris County although juvenile homicide and arson rates are rising. • Harris County juvenile crime rates for homicide and arson are significantly higher than national crime rates. • In 2007, the Juvenile Consequences Partnership was established to teach first-time offenders about the consequences of their behavior.

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Crimes committed by juveniles in Harris County saw major changes in 2008, both positive and negative. While drug offenses were at an approximately 18 year low, with an almost 50% decrease, homicide referrals hit a ten year high, with an almost 50% increase. Furthermore, while assaults, sexual assaults, and thefts slightly decreased, arson cases almost doubled.

While the nation saw its lowest juvenile arrest rate for arson in 2008, Harris County saw a 49% increase.

The FBI assesses trends in violent crime by monitoring four offenses that law enforcement agencies nationwide consistently report. These four crimes—murder, forcible

rape, robbery, and aggravated assault— form the Violent Crime Index. The United States Juvenile Violent Crime Index in 2008 was lower than in any year in the 1990s. In

CHILDREN AT RISK 2010-2012

Year

1990

1992

1994

1996

1998

1999

2000

Indicator

159

213

215

124

Year

2002

2004

2005

2006

2007

2008

Indicator

110

106

Source: Harris County Juvenile Probation Department

DRUGS: The number of felony drug offenses referred to the Harris County Juvenile Probation Department Year

1990

1992

1994

1996

1998

1999

2000

Indicator

584

647

675

566

679

599

550

Year

2001

2002

2004

2005

2006

2007

2008

Indicator

644

630

758

689

762

409

SAFETY & SECURITY

THEFT: The number of felony theft offenses referred to the Harris County Juvenile Probation Department

Source: Harris County Juvenile Probation Department

In Harris County, drug offenses were at an 18 year low, with an almost 50% decrease in 2008, while homicide referrals hit a ten year high, with an almost 50% increase in 2008. 2008, in Texas, 181 out of every 100,000 juveniles were arrested for a crime monitored by the Violent Crime Index. Nationwide, the juvenile murder arrest rate in 2008 was 3.8 arrests per 100,000 juveniles ages 10 through 17. This was 17% more than the 2004 low of 3.3, but 74% less than the 1993 peak of 14.4.156 In Harris County, juvenile homicide referrals increased from 14 in 2007 to 27 in 2008.157 Nationwide, forcible rape reached its lowest level since 1990; aggravated assault decreased by 8%; and burglary increased â&#x20AC;&#x201C; up 44% since its 2004 low. In Harris County, felony assaults and sexual assaults both decreased by 2%, and robberies decreased by 6%. As with violent crime, the FBI assesses trends in the volume of property crimes by monitoring four offenses that law enforcement agencies nationwide consistently report. These four crimes, which form the Property Crime Index, are burglary, larceny-theft, motor vehicle theft, and arson.

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Juvenile Offenses (cont.) Nationwide, between 1994 and 2006, the number of juvenile Property Crime Index arrests fell by half to their lowest level since the 1970s. However, the number of juvenile arrests for property crimes increased in each of the past two years for the first time since 1993–1994. In 2008 in Texas, 1,182 out of every 100,000 juveniles committed a crime monitored by the Property Crime Index. In Harris County, three of the four crimes in the Property Crime Index have also been on a decline. Burglary saw a 7% decline from 2007 to 2008; auto theft saw a 15% decline; and felony theft saw a 20% decline, a 60% decline since its peak in 1994.158 While the nation saw its lowest juvenile arrest rate for arson in 2008, Harris county saw a 49% increase. 180,100 juveniles were arrested in the U.S. for drug abuse offenses in 2008. That same year, 566 out of every 100,000 juveniles in Texas were arrested for drug offenses,

and Harris County saw a 46% decrease in drug referrals from 2007 to 2008.

Local outreach centers should work with the District Attorney’s office to determine the best strategies for educating teens about the consequences of violent crimes and how to prevent them. Policy Implication Violent crimes committed by juveniles in Harris County, especially murder, have increased at an alarming rate. To help alleviate this trend, local outreach centers should work with the District Attorney’s office to determine the best strategies for educating teens about the consequences of violent crimes and how to prevent them. Fortunately, in September 2007, the Harris County District Attorney’s Office established this kind of a program, the Juvenile Consequences Partnership, in collaboration with the Houston Bar Association, the Juvenile Probation Department, and the Houston Police Department. The Juvenile Consequences Partnership is aimed at informing young offenders and their families about the consequences of their involvement in the juvenile justice system and keeping them from returning to it. Most of the children attending the new program are first-time misdemeanor offenders charged with possession of marijuana or small quantities of drugs, theft offenses such as stealing a bicycle or shoplifting, evading arrest, assault, criminal mischief, or burglary of a motor vehicle. The group also includes some first-time, non-violent felony offenders. All of these juveniles have one thing in common: they are all on Deferred Prosecution, a diversion program offered through the Harris County juvenile courts. Juveniles and their parents voluntarily enter this rehabilitative program for not more than six months, and they are supervised by a probation officer. No guilty plea is required, and successful completion allows the juvenile to avoid being adjudicated delinquent in the juvenile court.

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CHILDREN AT RISK 2010-2012

Indicator: The number of referrals of children in Harris County determined by the court to be in need of supervision because of status offenses Year

1990

1992

1994

1996

1998

1999

2000

2002

2004

2005

2006

2007

2008

Indicator

4,288

6,700

7,292

5,338

5,319

4,824

4,520

2,451

3,566

2,115

2,801

1,755

1,620

Source: Harris County Juvenile Probation Department

• The number of status offenders and status offender referrals are declining in Harris County. • Status offenders are referred to TRIAD programs in order to address the issues that led to these offenses. • Status offenders rely heavily on programs throughout Harris County that intervene early on in an effort to reduce the number of repeat juvenile offenders.

Children in Need of Supervision (CHINS) refers to “status offenders,” juveniles whose crimes are illegal only because of their age. Truant students, juveniles breaking curfew, and runaway teenagers are all status offenders.

SAFETY & SECURITY

Children Referred to Court Supervision

In 2008, Harris County had the lowest number of CHINS referrals in 18 years.

Status offenders are reported to various programs such as TRIAD, Services to At-Risk Youth (STAR), Truancy Learning Camp (TLC), or Parenting with Love & Limits (PLL). The TRIAD Prevention Program is a consortium of three county agencies (Protective Services for Children and Adults, Juvenile Probation, and the Mental Health/Mental Retardation Authority) working together to coordinate their resources to serve at-risk youth. TRIAD provides county-wide prevention and early intervention services to divert youth and families through involvement with child protective services and the mental health and juvenile justice systems. TLC is a truancy prevention and early intervention program specifically designed to address the issues that may contribute to excessive absences in school. STAR offers 24 hour crisis intervention on a walk-in basis, at no cost. Finally, PLL is a six week program designed to help a parent reestablish the ability to determine rules and nurture the parent-child relationship. CHINS referrals continue to decline, with 1,620 referrals in 2008, down from 1,755 referrals in 2007.159 CHINS offenses also continued to decline statewide, down by 888 between 2006 and 2007.160

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SAFETY & SECURITY

C H I LD R E N

R I S K

TO P

T E N

P R I O R I T Y

Juveniles Detained and Cost of Detention INDICATORS children detained: The number of children placed in detention by the courts in Harris County Year

1990

1992

1994

1996

1998

2000

Indicator

6,598

7,052

6,144

8,113

6,605

6,411

Year

2002

2004

2005

2006

2007

2008

Indicator

6,215

6,616

6,098

6,935

7,021

6,405

Source: Harris County Juvenile Probation Department

MENTAL HEALTH COURT: The number of children placed in detention by the courts in Harris County Year

2009

2010

Indicator

Source: Health Services Division, Harris County Juvenile Probation Department Note: The Mental Health Court began serving youths in 2009

AVERAGE COST: The average cost of a child per day in Harris County Juvenile Detention facilities Year

1990

1992

1994

1996

1998

2000

2002

2004

Ind

$88.00

$99.66

$96.25

$98.36

$88.09

$127.02

$117.34

$132.18

2005

2006

2007

2008

$125.69 $133.40 $126.44 $160.00

Source: Harris County Juvenile Probation Department

• At intake, some youths are diverted to the Harris County Juvenile Mental Health Court, which focuses on community-based treatment rather than incarceration. • While Burnett-Bayland Reception Center and Burnett-Bayland Home continue to serve boys adjudicated to residential facilities, girls are now housed at the Harris County Youth Village. Both communities offer education, therapy, and substance abuse programs. • The cost of detaining a juvenile in a Harris County facility ranges from $139.72 per day to $359.59 per day, depending on the level of services provided.

The Juvenile Detention Center received 6,405 youths in 2008. When a youth arrives an intake screening is completed, diverting approximately ten percent of all youth received at the detention center each year. Intake screening prevents youths that are not a flight risk, or that need special mental or physical treatment, from inappropriate detainment. When a youth is thought to present a threat to themselves or to the community, he or she will be detained for a probable cause detention hearing conducted by an associate judge. Post-adjudication facilities include the Burnett-Bayland Reception Center, the Burnett-Bayland Home, the Harris County Leadership Academy (formerly Delta Boot Camp), and the Harris County Youth Village. The division continues to use the DART system of structured supervision

126

and programming from campus to campus. DART stresses personal accountability through Discipline, Accountability, Redirection, and Transition. Male juvenile offenders adjudicated to a county residential facility first visit the Burnett Bayland Reception Center (BBRC). BBRC is a secure placement with a capacity of 144 boys. 1,547 youth completed assessments at BBRC in 2008. After assessment, the Harris County Juvenile Probation Department (HCJPD) places youth in another county campus, private placement, the Texas Youth Commission (TYC), at home on regular probation, or at BBRC. In addition to the general population programming, BBRC offers specialized treatment components: Sex Offender Program, Psychiatric Stabilization Unit, and a drug dependent treatment program.

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

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P R I O R IT Y

A male offender sent to the Harris County Youth Village and personal accountability. This is accomplished in a (HCYV) receives educational, medical, and therapeutic safe, secure environment with zero tolerance for abuse of services, as well as drug education therapy. HCYV serves any kind while maximizing opportunities for development males ages 10 to 17, and can accommodate 170. Six of body, mind and spirit. The boot camp facility in west hundred forty-four young men resided there in 2008. The Harris County opened in 1999 and has a capacity behavioral program of the HCYV of 144 residents. During 2008, 592 targets personal responyoung men participated in the sibility, appropriate program. expression of anger, positive decisionFemales were formerly sent making, leadership to the Burnett-Bayland and, ultimately, selfHome Girls Program (BBH), The average per-day cost management of one’s a non-secure residential to house a child in one of own behavior. In Janplacement for delinquent uary 2010, the Girls females ages 10 to 17. BBH the Harris County Juvenile Program at HCYV was had a capacity of 60 resiProbation Department facilities dents and required a four to started after accepting the girls that were six month stay. During 2008, rose 21% between FY 2007 previously housed at 119 females participated in the and FY 2009. the Burnett-Bayland Home program where they were ensured which closed in December 2009. an emotionally safe and secure liv ing environment. Many services were The Harris County Leadership Acaddirected at the unique needs of females emy provides a residential correctional in order to decrease or eliminate their fuprogram for adjudicated males, ages 13 to 16, ture involvement in the criminal justice system. who have been determined by the court to need a Services were designed to provide gender specific discipline-oriented program. The focus of the proprograms that promote positive self-esteem, personal gram is to redirect the thinking and behavior patterns of accountability, self-discipline, and improve family relajuveniles by instilling in them a sound foundation embrac- tionships. As noted above, BBH closed in December 2009 ing a healthy self-concept, respect for others, authority and the Girls Program was transferred to HCYV.

SAFETY & SECURITY

JUVENILES DETAINED PER RESIDENTIAL FACILITY 8,000

Juvenile Detention Center

7,000 6,000

Burnett-Bayland Reception Center

5,000 4,000

Burnett-Bayland Home

3,000 2,000

Youth Village

1,000 0

1998

2000

2002

2004

2005

2006

2007

CHILDREN AT RISK 2010-2012

2008

Harris County Leadership Academy

127

SAFETY & SECURITY

C H I LD R E N

R I S K

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P R I O R I T Y

Juveniles Detained and Cost of Detention (cont.)

Â The Harris County Advocate Program (H-CAP) offers a community-based alternative to placement. The program serves adjudicated offenders whose behavior and social circumstances put them at risk of placement in residential treatment facilities. It offers a range of individualized, non-traditional, wrap-around and advocacy services for the youth and the entire family. Referrals are received from Field Services and institutions, saving placement funds and allowing youths to remain in their own homes. In 2008, 491 youths received services from the H-CAP program.161 Some of the youths diverted from detention upon completion of the intake screening at the Juvenile Detention Center are eligible to participate in the Harris County Juvenile Mental Health Court. Started on February 3, 2009, the Mental Health Court is a voluntary, specialized, diversionary court program for families of youths with mental health problems who are involved in the juvenile justice system.162 According to a study conducted by the National Center for Mental Health and Juvenile Justice, approximately 70% of youth in the juvenile justice system nationwide have at least one mental health disorder, and over 20% of these youths have a mental disorder severe enough to require significant and immediate treatment.163 Despite these statistics, many of these youth do not receive the mental health treatment they need, and some families rely on the juvenile justice system to provide treatment for their children, which may result in the criminalization of these youth for offenses committed due to mental illness. The Mental Health Court serves youth 10 to 17 years of age who have a mental health diagnosis and have been referred to the Juvenile Detention Center for misdemeanor or felony offenses.164 In addition, family willingness to participate in an intensive in-home program is required, and the youth and family must participate in the Mental Health Court for a minimum of six months. Once an appropriate case is identified, a comprehensive psychological assessment is conducted by the Mental Health Court Psychologist to create an individualized treatment plan.165 The case is then reviewed by the Mental Health Court team, consisting of the Judge, Court Case Manager, Psychologist, District Attorney, and Defense Attorney.166 Upon acceptance by the team, the case is transferred from the originating court into the Mental Health Court. During the initial court hearing, the youth and family discuss the treatment plan with the Mental Health Court team and a pre-determined treatment provider.167 The treat-

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ment providers include Systems of Hope, TRIAD Prevention Program, the Mental Health and Mental Retardation Authority, the Texas Juvenile Probation Commission, and the Texas Correctional Office on Offenders with Medical and Mental Impairments. At least once each month, a review hearing is held to monitor the progress made by the youth. Youth who successfully complete the Mental Health Court program are placed in a Deferred Prosecution status. Upon completion of the Deferred Prosecution term without engaging in delinquent conduct the original charge is dismissed. As of March 30, 2010 a total of fifty youths had been served since the Mental Health Court began operating in 2009, serving thirty-five youths in 2009, of which nine youths continue to be served in 2010.168 The majority of youth served are male, with thirty-five males and fifteen females served.169 Fifteen of these youth were 15 years old, the largest age group, followed by ten youths age 16 and

Approximately 70% of youth in the juvenile justice system nationwide have at least one mental health disorder, and over 20% of these youths have a mental disorder severe enough to require significant and immediate treatment.

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

TO P

T E N

P R I O R IT Y

The average cost to detain children in HCJPD facilities continues to rise. The average per-day cost to house a child in one of the HCJPD facilities rose 21% between FY 2007 and FY 2009, where daily costs are based on the total number of youths that each facility can accommodate and the length of time they remain.179

Most of the youth served have more than one mental health diagnosis. The most prevalent diagnosis is Attention Deficit/Hyperactivity Disorder Not Otherwise Specified (NOS), with thirty of the fifty youths served diagnosed.174 Twenty youths were diagnosed with Adjustment Disorder – Mixed Emotions and Conduct, and thirteen youths were diagnosed with Mood Disorder NOS.175 Other prevalent diagnoses include: Oppositional Defiant Disorder, Disruptive Behavior Disorder, Depressive Disorder NOS, and Bipolar Disorder NOS.176

For FY 2009, HCJPD reported the following per-day costs for each detention center: Burnett-Bayland Home: $188.90, a 5.4% increase from FY 2008; Burnett-Bayland Reception Center: $158.86, an 11.6% increase from FY 2008; Harris County Youth Village: $148.38, an 11.6% increase from FY 2008; Harris County Leadership Academy (Delta Boot Camp): $139.72, a 4.6% increase from FY 2008; Juvenile Detention Center: $270.31, a 27% increase from FY 2008; and Harris County Psychiatric Center: $359.59.180 The addition of the Harris County Psychiatric Center introduced a facility that costs, on average, $89 more per day than any other detention center. However, this diversion may enable Harris County to save long-term by rehabilitating youths and preventing repeat offenses and detentions.

Eighteen youths have completed the Mental Health Court program and were placed in a Deferred Prosecution status, and an additional eighteen youths successfully completed the Deferred Prosecution term and had the original charge dismissed.177 Five youths did not complete the program due to noncompliance, moving out of state, or residential placement by parents.178

SAFETY & SECURITY

seven youths age 14.170 Six youths age 12 and six youths age 13 were served, and there were two youths each ages 10, 11 and 17.171 The racial majority of the youths served are African American, with twenty-three youths served.172 There were fourteen Anglo and thirteen Latino youths served.173

There is a need for increased awareness about juvenile mental health issues as well as a great need for more community-based prevention efforts so that youths with mental health issues receive the treatment and care they need. Policy Implication The intake screening at the Juvenile Detention Center is an important step in diverting youths who do not need to be detained, resulting in cost efficiency as well benefiting youths through the prevention of unnecessary detainment. In addition, by identifying youths who require special treatment for issues such as mental health and substance abuse, youths are given the opportunity to rehabilitate through detention or community-based services. Without this process, youths may not otherwise receive the treatment they need. The Harris County Juvenile Mental Health Court is instrumental in ensuring that the mental health needs of youthful offenders are met. As its successes in rehabilitating and diverting youths continue, the involvement of additional community service providers is needed to expand the Court’s services to allow more youths to participate in the program. The prevalence of mental illness among youth is alarming, and for many youths, the juvenile justice system is unfortunately their first opportunity to receive treatment. There is a need for increased awareness about juvenile mental health issues as well as a great need for more community-based prevention efforts so that youths with mental health issues receive the treatment and care they need without having to resort to the juvenile justice system for treatment.

CHILDREN AT RISK 2010-2012

129

SAFETY & SECURITY

Recidivism Indicator: The percentage of children on probation in Harris County who relapsed into criminal and antisocial behavior within one year of the original referral Year

1994

1996

1998

2000

2002

2004

2005

2006

2007

2008

Indicator

19%

13.3%

16.1%

14.4%

13.4%

13.9%

14.7%

15.6%

Source: Harris County Juvenile Probation Department

• One-year recidivism rates for juveniles on probation in Harris County have risen since 2007. • In 2008, 22.3% of Harris County’s adjudicated first-time juvenile offenders were re-referred to the Harris County Juvenile Probation Department for committing an equal or greater offense. • Rising recidivism rates in Harris County indicate a need to expand rehabilitative programs.

Once youth are referred to the Harris County Juvenile Probation Department (HCJPD), one of two things can happen: adjudication, meaning the case goes to court, or no adjudication, meaning the case is dismissed. HCJPD defines recidivism as adjudication of a second offense that is greater than or equal to the severity of the first adjudication. In 2008, one-year recidivism rates for juveniles on probation increased to 15.6% from 14.7% in 2007.181 In 2008, 7,603 first-time juvenile offenders received referrals to HCJPD.182 Of total first-time offenders, 1,875 (24.7%) were adjudicated on the referral.183 Of those adjudicated, 1,120 (59.7%) were referred again for committing another offense within one year of the original referral:

In 2008, 15.6% of youth relapsed into criminal and antisocial behavior within one year. 318 (17.0%) were re-referred for a less severe offense; 419 (22.3%) for an equal or greater offense; and 383 (20.4%) for a technical violation.184 Of first-time offenders who were not adjudicated, 820 youths (14.3%) were re-referred within one year of the original referral: 209 (3.6%) were re-referred for a less severe offense, and 611 (10.7%) were re-referred for an offense of equal or greater severity.

Recidivism rates have increased since 2005, indicating the continued need for prevention and support programs to keep adjudicated youths from re-committing additional offenses. Policy Implication Recidivism rates have increased since 2005, indicating the continued need for prevention and support programs to keep adjudicated youths from re-committing additional offenses. In addition to the significant impact on the juvenile, juvenile offenders who become chronic offenders impose substantial lifetime costs on taxpayers and victims. Thus, it is of great importance to ensure that juvenile offenders receive the rehabilitative treatment they need to prevent them from further involvement with the justice system. In March of 2009, the Office of the Harris County District Attorney implemented a Juvenile NonPetition Deferred Prosecution Program, with the goal to ensure that first-time juvenile offenders who commit non-violent misdemeanor offenses are not charged with a crime, but are instead diverted to community supervision.185 This program is designed to deter youth from participation in criminal or antisocial behavior in the future through parent training and workshops on AIDS education, anger management, and peer pressure programs designed to teach kids to act responsibly. In 2009, approximately 1,466 juveniles participated in program.186

130

CHILDREN AT RISK 2010-2012

Indicator: The number of new youths from Harris County who were ruled judicially to be delinquent for violation of a penal law punishable by imprisonment or confinement in jail and subsequently committed to the Texas Youth Commission Year

1990

1992

1994

1996

1998

1999

2000

2002

2004

2005

2006

2007

2008

Indicator

572

428

405

469

591

619

404

401

527

580

630

533

300

Source: Texas Youth Commission

Indicator: The average cost per day to house a juvenile committed to the Texas Youth Commission Year

1990

1992

1994

1996

1998

2000

Indicator

$76.03

$81.33

$86.00

$85.39

$110.11

$129.36

Year

2002

2004

2005

2006

2007

2008

Indicator

$151.28

$155.02

$153.20

$162.88

$190.07

$270.49

SAFETY & SECURITY

Texas Youth Commission (TYC)

Source: Texas Youth Commission

• Texas Senate Bill 103 in 2007 has sparked significant reforms in the Texas Youth Commission’s facilities, conditions, treatment programs, and policies. • SB 103, the Juvenile Detention Alternatives Initiative, and the Juvenile Non-Petition Deferred Prosecution Program have dramatically decreased the population of TYC’s detention facilities. • While aftercare is available to youths being released from TYC custody, there is room for improvement.

The Texas Youth Commission (TYC) is the state’s juvenile corrections agency. TYC provides for the care, custody, rehabilitation, and reestablishment into society of Texas’ most chronically delinquent and serious juvenile offenders. Commitments to TYC are made for felony-level offenses committed when children are between the ages of 10 and 17; however, TYC can maintain jurisdiction over these offenders until age 19. In 2007, sweeping changes were made to the TYC system following the resignation of the TYC Board and the passing of Texas Senate Bill 103. Senate Bill 103 arose as a result of state investigations into allegations of sexual abuse against TYC youth at the West Texas State School in Pyote. The changes to TYC included creating an independent ombudsman office to monitor the agency; lowering the age of youths responsible to TYC from 21 to19; no longer committing youths with only misdemeanors to TYC; increasing training of TYC guards to 300 hours; and maintaining a ratio of at least one guard for every 12 youth in TYC.187 As a result of the changes, the number of new commitments to TYC dropped 36.4% from 2007 to 2009. Additionally, the average length of stay has declined from 20.5 months in 2006 to 16.7 months in 2009.188

There are two types of commitments to TYC: determinate and indeterminate. With a determinate sentence, youths receive a minimum period of confinement at a TYC facility as well as a total sentence for a number of years. If these youth fail to participate in treatment programs or have not sufficiently rehabilitated while at TYC, they may be transferred to adult prison on or before their 19th birthday, with a total sentence of up to 40 years. However, if a determinate sentenced youth successfully completes his or her minimum period of confinement and satisfactorily completes treatment programs while in TYC, she or he may be permitted to transfer to adult parole rather than to prison.189 Youth with an indeterminate sentence are given a minimum length of stay upon entering into TYC custody that ranges from nine months for the least serious offenses to twenty-four for the most serious.190 However, a youth is not automatically eligible for release upon completion of the minimum length of stay and can only be held until his or her 19th birthday. A TYC review panel examines each child’s progress in treatment and educational programs to determine whether or not that child should remain under TYC custody for further rehabilitation.191

CHILDREN AT RISK 2010-2012

131

SAFETY & SECURITY

Texas Youth Commission (TYC) (cont.) HARRIS COUNTY RECIDIVISM RATES TYC Fiscal Year 2001

On-Year Re-arrest Rate 718

48.7%

One-Year Re-incarceration Rate 718

29.8%

Two-Year Re-incarceration Rate 759

Three-Year Re-incarceration Rate

44.9%

669

51.7%

2002

575

47.7%

575

32.0%

722

48.6%

748

52.5%

2003

534

51.5%

534

28.3%

583

46.0%

718

57.7%

2004

530

51.5%

530

31.5%

534

44.0%

575

54.8%

2005

N/A

2006

549

53.2%

549

29.1%

522

46.9%

527

56.4%

2007

672

55.5%

672

24.7%

549

42.6%

522

52.7%

2008

977

51.0%

977

20.1%

672

35.3%

549

47.5%

2009

720

54.7%

720

20.8%

977

32.9%

672

43.2%

In 2009, Harris County accounted for 13.6% of all new TYC commitments in Texas. TYC calculates the minimum length of stay for indeterminate commitment youth by conducting an offense severity rating in conjunction with an assessment rating of the individual youth. The offense severity is determined by the felony level of the offense and whether the youth used a weapon, committed a felony sex offense, or committed a felony against a person. If the assessment rating and the offense severity rating are both “high,” the youth will be sentenced to 24 months. Lower ratings can get a sentence ranging from 9 to 18 months.192

Commitments from Harris County The percentage of commitments to TYC from Harris County has dropped from 25.5% in 2007 to 13.6% in 2009, an

approximate decrease of 50%.193 This dramatic change is due in part to the reforms brought about by SB 103, as well as to the implementation in 2007 of the Harris County Juvenile Detention Alternatives Initiative (JDAI), a program funded by the Annie E. Casey Foundation that implements reform strategies to reduce reliance on secure detention facilities while also reducing juvenile crime. Since the JDAI was instituted in Harris County in 2007, 42% fewer youth were placed in residential juvenile justice facilities, 31% fewer youth were certified as adults, and 24% fewer petitions were filed by the District Attorney’s office.194 Also contributing to the decline in Harris County commitments is the piloting of a new initiative by the Harris County District Attorney called the Juvenile Non-Petition Deferred Prosecution Program. Youths who have committed class A or B misdemeanors not involving a weapon, violence against a person, intoxication, or the burglary of a motor vehicle are eligible for the program, which allows youth to avoid serving time in a TYC or juvenile detention facility if they successfully complete a period of proba-

Overall New Commitments to TYC vs. New Commitments from Harris County 3500 3000 2500 2000 1500 1000

Overall Total

Harris County

500 0

132

1999

2000

2001

2002

2003

2004

2005

CHILDREN AT RISK 2010-2012

2006

2007

2008

2009

ALL TEXAS COMMITTED YOUTHS

YOUTHS COMMITTED FROM HARRIS COUNTY

FY 2006

FY 2007

FY 2008

FY 2009

FY 2006

FY 2007

FY 2008

FY 2009

TOTAL NEW COMMITMENTS

2738

2327

1582

1481

630

593

300

201

% OF NEW COMMITMENTS WITH MENTAL ILLNESS DIAGNOSES

33.4%

32.2%

37.9%

29.8%

28.2%

27.3%

29.9%

NEW COMMITMENTS DISCHARGED FROM TYC AS OF 30 JUNE 2010

2433

1667

316

562

424

% OF DISCHARGED YOUTH WITH MENTAL ILLNESS DIAGNOSES

32.3%

31.7%

32.6%

44.4%

29.7%

28.8%

28.6%

50.0%

SAFETY & SECURITY

MENTAL ILLNESS AND RESIDENTIAL TREATMENT OF NEW COMMITMENTS PRIOR TO DISCHARGE

Notes: TYC reports numbers of youths receiving mental health treatment as the number who received residential treatment, either in TYC treatment facilities or in psychiatric hospitals. Many youths found to have mental disorders are treated with medications or psychotherapy while in the general population, without ever being transferred to residential treatment facilities. All youth with diagnoses of mental disorders receive psychiatric care, whether or not they need to be placed in residential treatment centers.

In 2009, TYC expanded specialized treatment programs to accommodate youth with varying needs, made outpatient aftercare treatment available for at-risk youth after their release, and instituted several facility improvements. tion.195 This new program aligns with the juvenile justice protocol set by the Annie E. Casey Foundation.196 TYC reports the number of youth receiving mental health treatment on the basis of those who have been treated either in TYC treatment facilities or in psychiatric hospitals. Of the 201 youth committed to TYC from Harris County, 60 were diagnosed with mental-health illnesses. Many youths found to have mental disorders are treated with medications or psychotherapy while in the general population, without ever being transferred to residential treatment facilities. All youth with diagnoses of mental disorders receive psychiatric care, whether or not they need to be placed in residential treatment centers.197

Facility Changes and Improvements TYC facilities have undergone dramatic changes since 2007. Dorms are being reconfigured to provide additional

HARRIS COUNTY NEW COMMITMENTS NEEDING TREATMENT FOR CHEMICAL DEPENDENCY 50 45 40 35 30 25

The average cost per day for a child varies depending on the type of facility or service to which the child is assigned. In 2008, the cost per day at a TYC institutional facility was $270.49, a 66% increase from 2006. The costs in 2008 for residential contract facilities and half way houses increased as well, to $147.41 and $184.26 up from $128.66 and $147.13 respectively.198

20 15 10 0

2007

Females Needing Treatment

CHILDREN AT RISK 2010-2012

2008

2009

Males Needing Treatment

133

SAFETY & SECURITY

Texas Youth Commission (TYC) (cont.) security and privacy for youth and staff in order to enhance treatment and rehabilitation efforts. Three facilities were closed in FY 2008 â&#x20AC;&#x201C; San Saba, Marlin, and Sheffield, and two additional facilities, the West Texas State School in Pyote and the Victory Field Correctional Academy in Vernon will be closed by August 31, 2010 in accordance with Rider 23, General Appropriations Act, 81st Legislative Session.199 The agency also ended its contract with the GEO Group to operate the Coke County Juvenile Detention Center. The more than 50% decline in TYCâ&#x20AC;&#x2122;s youth population eliminated the need for those facilities as the agency moves toward a regionalized, community-based approach to providing services. In an effort to encourage communication with youth and involvement in their treatment programs, TYC provides free phone calls to families through resources made available during reform. Currently, youth receive 75 minutes each per month to call their families, with additional minutes (100 each per month) provided in November and again in December because of the Thanksgiving and Christmas holidays.200

New Programs CoNEXTions is the agencyâ&#x20AC;&#x2122;s new core treatment program, recently piloted at the Al Price facility and currently being implemented statewide. CoNEXTions is an integrated system-wide rehabilitative program that uses a variety of evidence-based therapeutic tools and techniques allowing individualized treatment for TYC youth. The program

includes specialized educational plans for youth as well as an increased focus on completion of a high school diploma or GED. In addition, TYC has put an enhanced emphasis on trade certification for youth. Industry- recognized certifications are earned in skill areas such as computer cabling, construction trades, food preparation, management, and Microsoft office systems. In FY 2008, TYC youth earned 648 certifications, an increase of approximately 140% from FY 2007.201 The Pairing Achievement with Service (PAWS) program is another new initiative within the TYC system aimed at providing therapeutic relationship building skills with leadership training by pairing select youth with rescued dogs for twelve weeks. During the course of the program, the youth learn about the mutual respect and responsibilities that come with caring for another living being.202

TYC should be able to extend custody for those youth for the period of time after their 19th birthdays required to complete necessary counseling and programming.

Policy Implication Since 2007, significant strides have been made to ensure that the youth incarcerated in TYC have adequate treatment resources and that those youth from Harris County who might benefit more from non-residential services are kept out of institutions. However, much work remains to be done. One primary concern is that youth in need of critical counseling services who age out of the system currently do not have the ability to complete those programs before release to the public or to an adult facility. TYC should be able to extend custody for those youth for the period of time after their 19th birthdays required to complete necessary counseling and programming. Stakeholders, community partners and policy makers also need to continue pushing for a reduction in the number of youth certified as adults. Children need specially tailored counseling and educational services to treat their specific needs, and time in adult prison makes a child more likely to recidivate. While the Texas Department of Criminal Justice Youthful Offender Program is working to address these needs, youth are ultimately better served in a grouping of their peers in juvenile facilities that specialize in serving their unique needs. In addition, TYC needs to further expand aftercare and community based services for youth preand post-trial. Pre-trial and aftercare services can make a significant difference for children who have been institutionalized and need assistance reintegrating into their communities. These nonresidential programs can also reduce recidivism and improve family reunification.

134

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

TO P

T E N

P R I O R IT Y

Indicator: The number of juveniles certified as adults in Harris County Year

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

170

155

105

Source: Harris County Juvenile Probation Department

• In Texas, juveniles as young as 14 can be certified as adults in the criminal justice system. • Certified youths are tried as adults, receive adult sentences, and are housed in adult facilities, significantly increasing the length of their sentences and their risk of committing suicide or being physically or sexually assaulted in prison. • While the Texas Department of Criminal Justice’s Youthful Offenders Program offers ageappropriate treatment and houses certified youths separately from adults, programming is not the same as in TYC facilities and capacity limitations prevent some youths from participating.

SAFETY & SECURITY

Adult Certifications

All 50 states and the District of Columbia have legal adult, always an adult” provisions which require criminal mechanisms to try juveniles in adult court. Although the prosecution of all qualifying offenses subsequently comnumber of juveniles tried as adults represents a small permitted by the juvenile.206 In Texas, certification and the “once an adult, always an adult” provision are the two centage of all juvenile referrals, the severe consequences methods used to try juveniles in adult of being processed in the adult criminal system court. warrant an evaluation of the practice. Transfer to Juvenile court jurisdiction the adult system often in Texas covers youth ages deprives juveniles of 10 to 16, and also youth much-needed therapy age 17 who were under and rehabilitative serage 17 at the time of the vices that are offered In 2009 the number of offense. Juveniles can in the juvenile sysjuvenile certifications in be certified as young as tem. Juveniles placed Harris County decreased age 14 for capital felonies, among adult jail and aggravated controlled subprison populations are significantly with a total of 56 stance felonies, and first deat greater risk of physicertifications for the year. gree felonies, and age 15 and cal and sexual assault older for all other felonies.207 and suicide. Furthermore, evidence suggests that transfer Once a juvenile is certified as an laws have little or no general deteradult in Texas he or she is treated as rent effect, and research has shown a fully functioning adult for purposes of that recidivism rates are higher among the criminal law. Juvenile cases are civil in transferred youth.204 nature and governed by the Texas Family Code. There are several methods which enable a juvenile Upon certification, however, the juvenile’s case will to be tried in adult court. Judicial waiver, known as no longer be governed by the Family Code but will certification, is the most common method of transfer, giving be governed by the Code of Criminal Procedure.208 This means that, unlike adjudicated juveniles who are placed the juvenile court judge the discretion to waive certain in the Texas Youth Commission, upon adjudication, most juveniles to criminal court.205 Upon prosecutorial recommendation for certification of a juvenile, a transfer hearing convicted certified juveniles will be placed in the Texas is held in which the juvenile court judge may grant or deny Department of Criminal Justice (TDCJ) to serve his or her the certification. In addition, some states have “once an sentence.209 Certified youths who are convicted of state CHILDREN AT RISK 2010-2012

135

SAFETY & SECURITY

C H I LD R E N

R I S K

T E N

P R I O R I T Y

Adult Certifications (cont.) certifications for the year.214 This decrease may be attributed to a variety of factors which include a shift in prosecutorial philosophy away from the justice system towards more community-based rehabilitative services, and also the fact that juvenile crime itself decreased in 2009. An alternative to certification in Texas is the determinate sentence. 215 Also known as blended sentencing, when a juvenile between the ages of 10 and 17 commits a qualifying crime, the prosecutor may seek, and the judge may impose, a determinate sentence.216 This sentence provides for a minimum period of confinement at a TYC facility. If completion of the minimum period of confinement occurs before the juvenileâ&#x20AC;&#x2122;s 19th birthday, TYC may, in its sole discretion, parole the child.217 Since TYC jurisdiction ends when the juvenile turns 19, if the juvenile has not

jail felonies are held in state jails to serve their sentences. Also, unlike their counterparts who are held in juvenile detention facilities while awaiting their hearing, certified juveniles are held in county jails while awaiting trial.210 Many of these juveniles are placed in isolation in the county jails in order to protect them from the older inmates and from each other. The majority, roughly two-thirds, of certified juveniles in TDCJ are placed in the Youthful Offender Program, which is a program for 14 to 17 year olds created to provide education, therapeutic programming, and housing that is separate from the general adult inmate population.211 Due to capacity limitations, not all eligible juveniles are placed in the Youthful Offender Program, and the remaining juveniles are placed among the general adult population. However, if it is believed that a youth may be harmed by older inmates, he or she is placed in isolation for their protection. In Texas, 245 juveniles were certified to stand trial as adults in 2008 and 227 were certified in 2009.212 Harris County has historically certified more juveniles than any other county in Texas. In 2008, Harris County had the largest number of certifications in the state with 83 juveniles certified, more than the next five largest counties combined.213 In 2009 the number of juvenile certifications in Harris County decreased significantly with a total of 56

136

TO P

Juveniles incarcerated in adult prison are eight times more likely to commit suicide, five times more likely to be sexually assaulted, and almost twice as likely to be attacked with a weapon by other inmates, compared to youth detained in juvenile facilities. 203 completed the minimum period of confinement before his or her 19th birthday, a hearing may be held in juvenile court to determine whether the juvenile should be paroled, released, or transferred to TDCJ to complete the sentence. Determinate sentencing offers much-needed flexibility in deciding the most appropriate sentence for an individual juvenile. Juveniles are held in the rehabilitative environment of TYC but still face the possibility of transfer to TDCJ, thus incentivizing the juvenile to reform. In Texas, certification has historically been used more prevalently than the determinate sentence. While there is significant overlap between qualifying offenses for adult certification and determinate sentencing, there are more qualifying offenses for certification.218 With the exception of 2009, the trend in Harris County shows more youth

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

The 81st Legislature made an important improvement to the certification process. Through Senate Bill 518, the juvenile court is now required to provide both the attorney for the child and the prosecuting attorney with access to all

T E N

P R I O R IT Y

written material to be considered by the court in making the transfer decision at least five days prior to the transfer hearing. Previously, the court was required only to provide these materials to the attorney for the juvenile at least one day prior to the transfer hearing. Another significant change made by the 81st Legislature with the passage of Senate Bill 839 was the elimination of life without parole as a sentencing option for certified juveniles. These changes are indicative of the seriousness of certifying a juvenile to stand trial as an adult and the importance of making sure the interests of juvenile offenders are not dismissed.

SAFETY & SECURITY

being certified than receiving a determinate sentence: in 2008, 83 youths were certified and 43 received a determinate sentence; in 2007, 81 youths were certified and 54 received a determinate sentence; and in 2006, 90 youths were certified and 52 received a determinate sentence. In 2009, 56 youths were certified and 83 youths received a determinate sentence.219

TO P

Youths should be placed in juvenile facilities where they can benefit from treatment and the overall rehabilitative nature of the juvenile system. Policy Implication The impact of certifying juveniles to stand trial as adults gives us cause to ensure that the practice is limited only to the most warranted circumstances. The U.S. Department of Justice, Bureau of Justice Assistance states that juveniles in adult facilities have a higher recidivism rate and are at greater risk of physical abuse and sexual assault than youth housed in juvenile facilities. 220 Also, the suicide rate for juveniles held in jails is eight times the rate for youths in juvenile detention facilities. 221 Thus, there are significant concerns for youth who are certified as adults, and additional measures should be taken to help prevent victimization of these youth. Policy considerations include limiting the qualifying offenses for certification. Currently, there are more qualifying offenses for a juvenile to be certified as an adult in Texas than there are to receive a determinate sentence. Of the two, certification is the harsher option, as youth who receive a determinate sentence may be paroled or discharged from TYC upon completion of their minimum period of confinement. Another policy consideration concerns the placement of youth who have been certified as adults and the use of isolation in jails and prisons. Youths should be placed in juvenile facilities where they can benefit from treatment and the overall rehabilitative nature of the juvenile system. With no alternative placement options within adult facilities, youth are placed in isolation to protect them from other certified youths and adult inmates. However, research shows that the placement of youth in solitary confinement may cause severe emotional and psychological trauma and increases the risk of suicide; therefore other placement options must be explored.

CHILDREN AT RISK 2010-2012

137

SAFETY & SECURITY

Child Homicide Indicator: The number of children ages 0 through 17 who died from injuries purposely inflicted by another person Year

1990

1992

1994

1996

1997

1998

1999

2000

2001

Indicator

111

102

2002 2003 2004 2005 2006 2007 53

Source: Houston/Harris County Child Fatality Review Team Report 2006-07 Note: Data collected from the Texas Department of State, from 1990-94, included children up to 19 years of age

• Harris County has seen a significant increase in child homicide deaths since 2004-2005. • Firearms are the most common means of child homicide. • Older youths, minorities, and males have an increased risk of falling victim to child homicide.

During 2006 and 2007, 114 Harris County children died due to intentional injuries inflicted by another.222 Unfortunately, this number represents a 33% increase in the number of homicide deaths since 2004-2005.223 In 2006 alone, Harris County saw 68 child homicide victims, the highest number recorded since the Houston/Harris County Child Fatality Review team was established and began reporting in 1996.224 The means by which these homicides were accomplished include: firearms, striking that resulted in blunt force trauma, drowning, strangulation, scalding, being left in a hot car, malnourishment/neglect, and the caregiver’s failure to seek necessary medical care.225 Firearm-related homicides were responsible for the majority of these deaths, and usually involved a handgun.226 Homicide affected gender, racial, and age groups differently. More than half of the intentional killings affected children ages 15 to 17 years and data shows that homicides in this age group have grown by 32% since 200203.227 In addition, the rate of male homicide victims is 7.5 per 100,000, more than double that of female victims, at 3.0 per 100,000.228 Finally, African American children in Harris County are three times more likely than Latinos to become the victim of homicide, and six times more likely than their Anglo counterparts.229

More than half of intentional child killings affected children ages 15 to 17 and data show that homicides in this age group have grown by 32% since 2002-03.

138

CHILDREN AT RISK 2010-2012

70 60 50

1-4

5-9 10-14

15-17

10 0

1996-97

1998-99

2000-01

2002-03

2004-05

2006-07

Source: Office of the Attorney General

In order to prevent these deaths, CPS needs more case officers to oversee these families for longer periods of time to ensure that the child is living in a safe environment.

SAFETY & SECURITY

NUMBER OF CHILD HOMICIDES BY AGE GROUP

Policy Implication Child homicides are a disturbing part of reality, but one of the most concerning factors of such homicides is that an overwhelming majority of child homicides occur in the home and at the hands of a parent. Child Protective Services case officers are on the frontline confronting this problem every day. Their purpose is to protect children from dangerous parents; however, child homicides are still occurring even after CPS investigations are conducted. In order to prevent these deaths, CPS needs more case officers to oversee these families for longer periods of time to ensure that the child is living in a safe environment.

CHILDREN AT RISK 2010-2012

139

SAFETY & SECURITY

Corporal Punishment Indicator: Number of children subjected to corporal punishment in schools Year

2004

2006

Indicator

1285

665

Source: Civil Rights Data Collection, U.S. Department of Education

• Nationally, corporal punishment in schools is steadily declining. • While corporal punishment remains popular in Texas, it is becoming less common in Harris County. • Corporal punishment by schools disproportionately affects minority and low-income students. Texas is one of twenty states that have laws allowing corporal punishment, often referred to as “paddling,” in public schools to discipline students.230 The American Academy of Pediatrics defines corporal punishment as the willful and deliberate infliction of physical pain on the person of another to modify undesirable behavior.231 During the 2006-2007 school year, 223,190 school children in the United States were physically punished in schools.232 Of these children, 49,197 were paddled in Texas.233 This number comprises about 1.1 percent of all Texas school children.234

During the 2006-2007 school year, of 223,190 school children subjected to physical punishment across the nation, 49,197 were in Texas.

Although the total number of children hit in schools has been steadily dropping in the last decade, twenty states still allow corporal punishment. Almost 40% of all cases of corporal punishment occur in two states: Texas and Mississippi. Together with Arkansas, Alabama and Georgia, the five states account for almost three quarters of all the nation’s school punishments. In Texas, school districts may include corporal punishment in their charters. During the 2004-2005 school year, seven Harris County school districts reported that children were subjected to physical punishment in schools. However, in 2006-2007, all of these districts showed either a significant drop in numbers or reported that no children were paddled at all.235 Overall, in 2006-2007 six out of 26 school districts in Harris County reported that their students were subjected to corporal punishment in schools. The total number of children paddled in Harris County during this period was 665, with one district not submitting the data to the Department of Education. Children subjected to corporal punishment are often from less-educated and lower-income families in which physical punishment and spanking at home are customary. Often, the students paddled are minority students. Overall, in the United States African American students comprise 17% of all public school students, but comprise 36% of those who have corporal punishment inflicted on them.236 In Harris County, 280 out of 665 children punished during the 20062007 school year were Latino and African American.

140

CHILDREN AT RISK 2010-2012

NUMBER OF CHILDREN SUBJECTED TO PHYSICAL PUNISHMENT School District

2004

2006

Aldine

715

Alief

Channelview

Clear Creek

N/A

Crosby

110

Cypress-Fairbanks

Dayton

N/A

445

Deer Park

N/A

Fort Bend

N/A

Friendswood

N/A

Galena Park

Goose Creek

N/A

Houston

Huffman

N/A

Humble

N/A

Katy

Klein

La Porte

N/A

North Forest

180

Pasadena

160

140

Pearland

N/A

Sheldon

N/A

Spring

N/A

Spring Branch

N/A

Tomball

N/A

Waller

N/A

TOTAL

1285

665

Source: Department of Education Office of Civil Rights

SAFETY & SECURITY

Almost 40% of all cases of corporal punishment occur in two states: Texas and Mississippi. Together with Arkansas, Alabama and Georgia, these five states account for almost three quarters of all school physical punishment in the nation.

Policy Implication Although Harris County has made significant progress in numbers in the recent years, Texas still allows school districts to use corporal punishment in schools. Extensive social research is available to show that corporal punishment is both inefficient and can result in serious social harm. Research shows that many of the social problems present in the United States, such as violence, substance abuse, and unsuccessful interpersonal relationships, result from and are aggravated by violence directed at children, including corporal punishment. As a consequence, professional child welfare and health organizations unanimously oppose the use of corporal punishment in schools. Texas, however, has yet to abolish corporal punishment by law.

CHILDREN AT RISK 2010-2012

141

SAFETY & SECURITY 142

Agenda for Change Human Trafficking • Safe houses must be created to provide domestic human trafficking victims with a place to go to receive services and rehabilitation when they are rescued. • The Legislature should remove the requirement for prosecutors to prove that a trafficker caused a minor victim to enter into prostitution through the use of force, fraud, or coercion. • School personnel and community members should be trained to be aware of victim risk factors so they might intervene early to prevent at-risk youth, such as runaways and victims of sexual abuse, from entering into the world of trafficking.

Children Under Supervision • Houston and Texas must strive to meet the requirements of the Fostering Connections to Success and Increasing Adoptions Act of 2008. • CPS should continue to increase its focus on kinship caregivers, family reunification, and promoting the adoption of older children. Juvenile Probation • HCJPD must maintain recent decreases in probation officer caseloads. • HCJPD should continue to expand services to youth son probation.

Runaways, Truancy, and Minor Offenses • Funding must be appropriated for important preventive programs that can address the root causes of delinquent behavior. • Educators, families, and communities should provide positive motivation for students to attend school.

Juvenile Offenses • The availability of crime prevention programs, such as the Juvenile Consequences Project, should be increased to all Harris County youth. • Schools, communities, and law enforcement should involve themselves in juvenile crime prevention by educating and reaching out to at-risk youth.

Child Abuse and Neglect • DFPS must reduce caseworkers’ workloads to recommended levels so that each child receives the attention he or she deserves. • DFPS should continue to increase efficiency through the strategic use of technology.

Adult Certifications • Laws should be amended to limit adult certification to older juveniles who commit the most serious offenses. • Alternatives to solitary confinement as a way of protecting certified youth from adult inmates should be explored.

CHILDREN AT RISK 2010-2012

EDUCATION

CHILDREN AT RISK 2010-2012

143

EDUCATION

C H I LD R E N

R I S K

TO P

T E N

P R I O R I T Y

Children in Child Care and Early Education INDICATORS Subsidized Care: The percentage of all children under the age of 14 in Harris County receiving subsidized child care through the Workforce Commission and its Gulf Coast Workforce Development Board Year

2001

2002

2003

2004

2006

2007

2008

2009

Indicator

3.5%

3.8%

3.9%

4.3%

4.9%

4.8%

4.9%

Source: The WorkSource – Gulf Coast Workforce Board; U.S. Census Bureau

Licensed Facilities: The number of facilities that meet standards and are licensed under the Child Care Licensing Program within the Texas Department of Family and Protective Services in Harris County Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2007

2008

2009

Indicator

1,095

1,236

1,382

1,322

1503

1566

1588

1596

1,618

1,622

1,648

1548

Source: Texas Department of Family and Protective Services, Child Care Licensing

Children in Child Care: The capacity/number of children receiving care in state licensed or registered child care facilities in Harris County Year

1990

1992

1994

1996

1998

2000

Indicator

111,617

122,811

134,849

139,195

145,625

148,605

Year

2002

2004

2006

2007

2008

2009

Indicator

158,053

182,650

184,511

188,238

191,277

192,150

Source: Texas Department of Family and Protective Services, Child Care Licensing

National Standards: The number of child care providers in Harris County that are accredited by the National Association for the Education of Young Children Year

1990

1992

1994

1996

1998

2000

2002

Indicator

Year

2004

2005

2006

2007

2008

2009

2010

Indicator

124

149

158

107

47*

Source: The National Association for the Education of Young Children (NAEYC); Collaborative for Children Note: Information reflects data available as of June 2010

School Age Child Care: The number of formal programs providing care for children before school, after school, and in some cases during the holidays in Harris County Year

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2009

Indicator

287

250

283

385

413

478

352

329

356

Source: Harris County Department of Education; Collaborative for Children Note: This indicator excludes licensed child care facilities, licensed family homes, and listed homes that provide afterschool child care

• Quality child care is related to achievement later in life, but it can be prohibitively expensive to many Harris County families. • The Texas Workforce Commission provides childcare subsidies to low-income families and childcare providers who serve them through Workforce Solutions, but funding limitations affect the quality of this care. • Fewer childcare providers are eligible to participate in Workforce Solutions because accreditation standards have recently risen.

144

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

TO P

T E N

P R I O R IT Y

EDUCATION

Early childhood experia 13-county region in the ences have been proven Houston-Galveston Gulf to shape long-term Coast area through Worklife outcomes for force Solutions.9 every child. Research The annual average In 2009, Workforce indicates that a child’s child care cost for a child Solutions provided child health development care subsidies to 41,327 depends on positive under four years of age is children in Harris County and stimulating experi$6,054, a price comparable under the age of 14.10 This ences, especially during number decreased from the first six years of life.1 to a public Texas University Studies have shown that 2007, when 46,291 children semester tuition. quality child care can benin Harris County received efit a child’s cognitive, socialsubsidized child care.11 The current family income guidelines emotional, and language developset the gross monthly eligibility ment, which is particularly beneficial income for a family of three at $3,052 to low-income children.2 The positive correlation between high-quality child care for the first month and then $3,710 for and child development extends to graduation subsequent months;12 approximately $43,852 annually, and averages at 75.8% of the state’s rates, college attendance, math and reading scores, median family income for a family of three.13 As of and fewer teen pregnancies. early 2010, there were no Texas children eligible for subsidized child care waitlisted and not receiving assisIn 2009, there were 404,607 children under the age of six tance.14 After having exhausted the waitlist, a large number in Harris County3 and approximately 45% of children in Harris County lived in or near poverty. 4 Finding affordable of eligible children still were not receiving assistance. In child care is a daunting task for parents when the average 2010, Workforce Solutions received $33 million in Ameriannual child care cost for a child under four years of age can Recovery and Reinvestment Act funds for child care to is $6,054, a price comparable to a public Texas university provide these remaining eligible children with subsidies.15 semester tuition.5 Once a child reaches school age, the Texas law requires that the Texas Department of Family average cost for before- and after-school care is $3,040.6 and Protective Services (DFPS) regulate all child care Child care subsidies for Texas’ low-income children are operations to protect the health, safety, and well-being provided through the Texas Workforce Commission, which of children in care. Services include daycare facilities, manages federal funds received through a Child Care and registered family homes, and listed family homes.16 DFPS regulates the number of children per caregiver, the numDevelopment Block Grant. The Workforce Commission’s services offer parents the opportunity to gain and maintain ber of hours that can be worked, and minimum hours of training and age of caregivers. To qualify for payment by employment or to participate in workforce training activiWorkforce Solutions under the child care subsidy program, ties.7 Although the federal government sets maximum family eligibility standards for subsidies at 85% of the a child care provider must be licensed or registered by the state’s median income, the state’s local workforce develop- DFPS.17 In 2009, there were 1,548 licensed or registered child care providers in Harris County, with a capacity of ment boards can set local eligibility criteria.8 The Gulf Coast Workforce Board, Harris County’s local develop170,358 children.18 ment board, provides direct services to the residents of SCHOOL AGE CHILD CARE SITES IN HARRIS COUNTY 250 200 150 100 50 0

2002

2003

ASAP (City of Houston)

2004

2006

ASE (County Wide Initiative)

2007

2008

2009

2010

Non-Profit Providers

CHILDREN AT RISK 2010-2012

145

EDUCATION

C H I LD R E N

R I S K

TO P

T E N

P R I O R I T Y

Children in Child Care and Early Education (cont.) In 2009, 1,167,862 of Texas’ K-12 children, roughly 26%, were responsible for caring for themselves after school. The National Association for the Education of Young Children (NAEYC) sets standards for accreditation with the goal of improving the well-being of all young children.19 The NAEYC developed the Accreditation of Programs for Young Children to raise the standards for accreditation and also to monitor standards.20 The NAEYC uses 10 standards to evaluate child care institutions. As of July 2010, there were 6,983 accredited programs serving 610,761 children in the United States.21 Texas houses 264 accredited child care providers, 3.8% of all accredited facilities.22 As of June 2010, there were 47 accredited providers in Harris County, compared to 50 in 2009, 60 in 2008, and 107 in 2007.23 Increased NAEYC child care standards have caused some providers to default on maintaining their accreditation. However, these higher standards are meant to provide a safe and healthy physical environment and maintain polices that ensure high-quality experiences for children, families, and staff.24 In 2009, 1,167,862 of Texas’ K-12 children, roughly 26%, were responsible for caring for themselves after school.25 Studies show that lack of adult supervision and resulting self-care for children and adolescents leads to increased likelihood of accidents, injuries, lower social competence, lower GPAs, lower achievement test scores, and greater likelihood of participation in delinquent or high-risk activities.26 School-aged children show significant benefits from

before- and after-school programs, as they provide services that assist with schoolwork, test preparation, life skills, physical activity, social experiences, attitudes, and relationships.27 Harris County offers such programs through individual school districts and non-profits, but programs are also available through churches, community centers, apartment complexes, and learning centers. In 2009, there were 356 formal programs providing before- and afterschool care for school-age children. The 21st Century Community Learning Centers (CCLC) is a national program that provides funds to public schools to plan, implement, or expand projects that benefit the educational health or social service needs of the community.28 Through the Harris County Department of Education, the CCLC endorsed the Cooperative for After-School Enrichment Program (CASE) which provided after-school enrichment services to over 16,000 students at 110 sites in 2009.29 The City of Houston also funds after-school programs through the Mayor’s After-School Achievement Program (ASAP). In 2009, ASAP provided services to 3,105 students at 44 different sites.30 The number of children served by the ASAP program has decreased significantly over the past years due to guidelines set to encourage regular attendance, from over 4,000 children in 2007; 8,000 children in 2004; and over 11,000 in 2002.

Number of children receiving subsidized child care in harris county 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0

2000

2001

Infants (0-17 months)

146

2002

2003

Toddlers (18-35 months)

2004

2006

Preschool (3-5 years)

CHILDREN AT RISK 2010-2012

2007

2008

2009

School Age (Kindergarten - 14 years)

C H I L D R E N

R I S K

TO P

T E N

P R I O R IT Y

EDUCATION Child care providers should receive higher payments that are at market rate and be provided with reimbursements in a more efficient and effective manner. Policy Implication Texas child care providers who participate in the child care subsidy program often receive payment based upon rates that are 30-40% below the market rate. 31 The result of this is often higher childto-staff ratios, under-trained staff, and lack of equipment, resources, and materials. Families in Texas utilizing the child care subsidy program usually pay a 9-11% co-payment; however, child care providers report that insufficient reimbursement rates have caused them to discontinue serving low-income children. 32 Despite the significant amount of stimulus funds allocated to Texas, little progress was made in response to the urgent need to change the system of reimbursements for child care providers to find a more efficient and effective method for providing reimbursements. There is a desperate need for quality, affordable before- and after-school programs. In 2009, only 15% of school-age children were enrolled in after-school care, while 26% of Texasâ&#x20AC;&#x2122; children care for themselves after school, and yet 51% of all Texas children not involved in after-school programs would likely take part if programs were available in their community. Research indicates that beyond the lack of need, the predominant barriers to after-school program enrollment include cost, preference for alternative activities, and concerns about program quality. 33 Because school-age child care programs fill the gaps in communities by offering resources and experiences that families and schools are sometimes unable to provide, the continued need for quality care before- and afterschool remains an important issue that requires attention. An essential component of quality early child care is the knowledge and skills of a childâ&#x20AC;&#x2122;s caregiver. Legislation proposing increased development of early childhood professionals was proposed during the 81st Legislative Session, and while it did not pass, its proposal offers promising ideas for early child care standards. 34 Currently, early childhood professionals are required only 8 hours of preservice training, and 15 hours of in-service training for teachers and staff. 35 With so many children in need of early child care, higher standards requiring more extensive training for the child care provider must be considered.

CHILDREN AT RISK 2010-2012

147

EDUCATION

Pre-K and Head Start Enrollment INDICATORS Pre-K: The number of children enrolled in the pre-kindergarten public school program designed for the improvement of the social, intellectual, language, aesthetic, and physical development of children in Harris County Year

1990

1992

1994

1998

2000

2001

2002

Indicator

14,551

17,897

20,475

22,958

24,563

25,254

28,743

Year

2003

2004

2006

2007

2008

2009

Indicator

30,731

32,683

35,381

34,965

36,022

38,179

Source: Harris County Head Start/Early Head Start Collaborative Community Assessment

Head Start: The number of children enrolled in the federal Head Start Program in Harris County Year

1990

1992

1994

1996

1999

2000

2002

Indicator

3,424

3,806

4,149

5,512

5,178

5,670

7,215

Year

2003

2004

2005

2006

2007

2008

Indicator

7,568

7,760

8,589

7,679

7,328

7,386

Source: Harris County Head Start/Early Head Start Collaborative Community Assessment

• Pre-kindergarten programs have been shown to increase success later in life. • The Harris County Head Start program and the Public School Pre-kindergarten initiative provide pre-k education and care to needy children. • Texas would benefit from universal pre-k programs, which have proven successful in other states. A strong learning background is essential for the preparation of a child entering kindergarten and can impact his/her education experience throughout life. School district-led pre-school and the national Head Start program play vital roles in providing toddlers with the skills necessary to succeed in kindergarten. In 1984 Texas established the Public School Pre-kindergarten initiative to provide a half-day pre-kindergarten program for children who are unable to speak or comprehend the English language, are economically disadvantaged, or are homeless.36 The State defines “economically disadvantaged” as being eligible to participate in the National Free or Reduced-Price Lunch Program (family income at or below 185% of the Federal Poverty Level). In 2006 and 2007 the program was expanded to include children of active military personnel or the children of someone killed or injured during active duty, and all children who have ever been in the foster care system.37 School districts with 15 or more eligible children are mandated to offer the program.38 Following a decline between 2006 and 2007, enrollment in school district-led pre-kindergarten programs in Harris County has continued its previous trend of increasing

148

each school year. Since the year 2000, when the programs served 24,563 children, enrollment has increased by over 50%, to 38,179 children in 2009.39 Enrollment increased by more than 2,000 children between the years of 2008 and 2009 alone. Half-day pre-k, however, can often be impracticable for working parents. School districts that choose to offer a full-day pre-k program either pay half the difference or must compete for state grants. Research confirms the value of early education for young children. Pre-kindergarten programs that support effective teaching practices have been shown to lead to important growth in children’s intellectual and social development, which is crucial to their future academic success. A Georgetown University study that assessed Oklahoma’s universal pre-k program by focusing on Tulsa, the state’s largest school district, showed strong positive effects of the pre-k program on children’s language and cognitive test scores.40 The study found positive and statistically significant impacts on students in both half- and full-day pre-k programs. The evaluation showed that Latino children benefited most from the program and African American children also showed sharp gains, especially when they attended the full-day programs.41

CHILDREN AT RISK 2010-2012

19992000

20002001

20022003

20032004

20042005

20052006

20062007

20072008

20082009

Area I:

927

1,483

1,544

1,973

1,328

1,432

1,350

1,311

Area II:

1,303

1,485

1,915

1,946

2,364

2,059

1,713

Area III:

1,300

1,545

1,853

2,214

1,365

2,696

2,203

2,098

Area IV:

1,648

1,713

1,864

2,058

2,506

2,431

2,167

2,064

Total:

5,178

5,670

7,215

7,568

7,760

8,589

7,779

7,328

7,186

Source: Harris County Department of Education; Avance; Neighborhood Centers, Inc.; Gulf Coast Community Services Association

Since the year 2000, when the programs served 24,563 children, Harris County district-led pre-k program enrollment has increased by over 50%, to 38,179 children in 2009.

EDUCATION

Head Start Enrollment in Harris County

In the Tulsa pre-k program, teachers must hold bachelorâ&#x20AC;&#x2122;s degrees and child care certificates, and they must receive compensation at the same level as elementary and secondary school teachers. During the 81st Legislative Session the Texas Legislature passed a landmark bill to increase pre-k quality standards; this legislation would have enabled districts to mandate bachelorâ&#x20AC;&#x2122;s degrees for pre-k teachers, while placing necessary limits on teacher-tochild ratios and class size. The bill was, however, vetoed by Governor Perry. A $25 million pre-k budget increase remained intact.42

Pre-K Enrollment in Harris County by District District

2003

2004

2006

2007

2008

2009

Aldine

2,684

2,863

2,997

3,083

3,048

3,526

Alief

1,852

1,924

2,306

2,135

2,136

2,139

Channelview

311

320

367

390

459

463

Crosby

114

127

105

144

120

117

Cypress-Fairbanks

1,494

1,732

2,270

2,565

2,892

3,089

Deer Park

203

213

230

252

235

261

North Forest

979

986

992

890

901

926

Galena Park

916

1,010

970

989

954

968

Goose Creek

768

792

813

753

726

738

Houston

14,034

14,823

15,814

15,023

15,354

16,352

Humble

622

632

667

745

900

947

Katy

544

709

892

974

1,118

1,158

Klein

666

732

961

1,016

1,028

1,044

La Porte

202

211

227

175

228

219

Pasadena

1,902

1,968

2,085

2,098

2,176

2,219

Spring

895

966

1,260

1,283

1,312

1,470

Spring Branch

2,233

2,298

1,957

1,925

1,902

1,935

Tomball

129

166

174

181

182

203

Sheldon

140

172

222

283

273

321

Huffman

Total

30,731

32,683

35,381

34,965

36,022

38,179

Source: Texas Education Agency

CHILDREN AT RISK 2010-2012

149

EDUCATION

Pre-K and Head Start Enrollment (cont.) Head Start enrollment dropped sharply in 2006 (from 8,589 to 7,779 children) and has continued to steadily decline throughout the last two years to 7,186 children in the 2008-2009 school year. The Head Start program first emerged in 1965 as part of a solution to end systemic poverty in the United States.43 Directed mainly towards children ages three to five, the program provides comprehensive education, health, nutrition, and parental involvement services to low-income families.44 As an addition to the Head Start Program, Early Head Start (EHS) was created to promote healthy prenatal outcomes, to enhance the development of very young children, and to promote healthy family functioning.45 In 2007 the federal government reauthorized the Head Start program with new requirements, including more stringent teacher credentials and extension of the program to children living within 130% of the Federal Poverty Level.46 Harris County Head Start has divided its services into four geographic areas, each directed by different agencies: Area I – Harris County Department of Education; Area II – Avance; Area III – Neighborhood Centers, Inc.; and Area IV – Gulf Coast Community Services Association. In 2008 Harris County Head Start operated 81 locations within schools, community centers, and independent sites.47 Children who attend Head Start participate in a variety of

educational activities. They also receive free medical and dental care, have healthy meals and snacks, and enjoy playing indoors and outdoors in a healthy setting. Services are offered to meet the special needs of children with disabilities. Head Start enrollment dropped sharply in 2006 (from 8,589 to 7,779 children) and has continued to steadily decline throughout the last two years to 7,186 children in the 2008-2009 school year.48 While the number of children benefiting from Head Start has remained unsteady, a recent increase in funding may facilitate growth. In February, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA), which included a funding increase of $2.1 billion for Head Start, $1.1 billion of which was designated for Early Head Start expansion.49 In addition, as part of the FY 2009 appropriations process, Congress provided a $234.8 million funding increase for Head Start. More recently, in December 2009, President Obama signed the Consolidated Appropriations Act, 2010, which included an approximate increase in funding of $122 million over the FY 2009 appropriation level for Head Start.50

Implementation of universal pre-kindergarten programming should be made a priority in Texas.

Policy Implication Both Head Start and district pre-k programs are important in giving low-income children learning opportunities that they would not otherwise have access to. The availability of these programs also positively impacts parents’ ability to work and to provide for their families while their children are enrolled at school during the day. The implementation of a universal pre-kindergarten program should be made a priority in Texas. Universal pre-kindergarten, already implemented in such states as Georgia, Florida, and Oklahoma, provides equality of access to all families, and would significantly impact those families who are ineligible under the current guidelines and struggling with private-sector child care costs. Emphasis should be placed on high-quality teaching rather than child supervision. Continuing federal support of Head Start is also essential in supporting families with children living in and near poverty. The pay levels for both pre-kindergarten and Head Start teachers should be increased to better match pay levels of other teachers.

150

CHILDREN AT RISK 2010-2012

Indicator: The percentage of students enrolled in Harris County public schools who are economically disadvantaged Year

1990-91

1994-95

1998-99

2000-01

2001-02

2002-03

2003-04

Indicator

33.8

42.5

49.8

52.5

54.0

55.6

56.9

Source: Texas Education Agency

EDUCATION

Economically Disadvantaged Students

â&#x20AC;˘ Economically disadvantaged students experience chronic and severe economic challenges which hinder their academic success. â&#x20AC;˘ Latino children (65.3% of all low-income children) make up a majority of the economically disadvantaged students in Harris County, followed by African American children (24.9% of all low-income children). â&#x20AC;˘ Several federal initiatives target economically disadvantaged schools and districts by providing funding for instructional and program improvements, counseling, and parental involvement.

Before October of every school year, Texas school districts identify those students who fall into the category of economically disadvantaged. A status of economically disadvantaged is given if the student is eligible for free or reduced-priced meals under the National School Lunch and Child Nutrition Program or if he/she meets one of the following criteria: having a family income at or below the federal poverty line, being eligible for Temporary Assistance for Needy Families (TANF) or other public assistance, receiving a Pell Grant or comparable state grant of need-based financial assistance, being eligible for programs assisted under Title II of the Job Training Partnership Act (JTPA), or for benefits under the Food Stamp Act of 1977.51

In 2009-2010, there were 512,473 economically disadvantaged students in Harris County, which comprises 63.2% of the student population.

In 2009-2010, there were 512,473 economically disadvantaged students in Harris County public schools, comprising 63.2% of the student population.52 These figures rose in comparison to 2007-2008, when there were 461,344 economically disadvantaged students in Harris County, which was 59.6% of all students. In North Forest ISD, 100% of the students fell under the definition of economically disadvantaged. Other districts with a high percentage of economically disadvantaged students were Aldine ISD with 85% and Houston ISD with 81%. Most school districts in Harris County have a rate of economically disadvantaged students above 50%. Tomball ISD remains the district with the lowest rate of economically disadvantaged students, 23.1%, although this rate has increased 3.5% since 2007.53 The demographics of economically disadvantaged students in Harris County have changed considerably over the past CHILDREN AT RISK 2010-2012

151

EDUCATION

Economically Disadvantaged Students (cont.) two decades. Latino children make up a majority of the 2009-2010 economically disadvantaged students at 65.3%, followed by African American children (24.9% of all lowincome students), Anglo children (6.4% of all low-income students), Asian American children (3.2% of all lowincome students), and Native American children (0.2% of all low-income students). The most visible difference in racial/ethnic composition of economically disadvantaged students from 1989-1990 to present is a significant increase in the percentage of low-income students who are Latino (from 50.2% in 1989-1990 to 65.3% in 2009-2010) alongside a moderate decrease of low-income students identified as African American (from 35.5% to 24.9%) and Anglo (from 11.0% to 6.4%).54 Economically disadvantaged students face particularly difficult challenges in succeeding academically.55 Research shows that socioeconomic factors such as family income, neighborhood poverty, parental education levels, and parental occupation are even more significant in explaining differences in educational achievement than traditional factors such as race, ethnicity, and immigration status.56 Experience of chronic and severe economic hardship limits childrenâ&#x20AC;&#x2122;s potential and hinders a nationâ&#x20AC;&#x2122;s ability to sustain itself in the future. American students, on average, already rank behind students in other industrialized nations, particularly in their understanding of math and science.

HARRIS COUNTY STUDENTS BY ECONOMIC DISADVANTAGE AND RACE/ETHNICITY 2009-2010 SCHOOL YEAR 90%

80.80%

73.40%

80% 70% 60%

48.40%

50%

38.30%

40% 30%

18.40%

20% 10% 0% African American

Asian

Latino

Native American

Anglo

Several federal initiatives, such as the Elementary and Secondary Education Act, are designed to alleviate the burden on economically disadvantaged families to provide their children with a quality education.57 Under this Act, federal funds can be used for instructional and program improvements, counseling, and parental involvement. In return, Title I schools and districts must meet accountability requirements for raising student performance.58

Training programs should be provided to teachers so that they may better understand the issues low-income children face, and outreach should be made to economically disadvantaged students in order to change their perceptions of education. Policy Implication It is imperative to invest time and effort in educating students who are economically disadvantaged. More than half of the students in Harris County are economically disadvantaged, and schools need more programs to reach these children. Training programs that help teachers understand the issues low-income children face are important in providing quality education. Reaching out to economically disadvantaged students and changing their perception of education will increase the quality of life for the students and the community as a whole.

152

CHILDREN AT RISK 2010-2012

Indicator: The average expenditure per student in Harris County based on the total current operating expenses of the school districts divided by the number of students for that year Year

1990

1992

1994

1996

1998

1999

2000

Indicator

3,850

4,304

4,552

5,347

5,702

6,498

6,724

Year

2002

2003

2004

2005

2006

2007

2008

Indicator

7,045

7,283

6,936

6,151

6,249

6,679

7,157

EDUCATION

Expenditure Per Student

Source: Academic Excellence Indicator System, Texas Education Agency Note: Charter schools are excluded from this calculation

• Texas is currently one of the lowest in the country in regards to amount spent per student, and has continued to drop in the national rankings. • It remains to be seen whether data will show an increase in expenditure per student as a result of the repeal of the “65 Percent Rule.”

A school district’s total operating expenses include such items as salaries for school personnel, fixed charges, student transportation, school books and materials, and energy costs. Each district quantifies a value of total expenditures from the general funds allocated per pupil, the average of which is reported with the indicator. The general fund excludes special revenue funds, debt service funds, and capital project funds.59 During the 2007-2008 school year, the national average for current expenditure per student was $9,963. 60 Texas ranked 45th out of the 50 states and the District of Columbia, with an average of $7,978 spent per student.61 Just three years ago, Texas ranked 41st nationally in the amount spent per student. Unfortunately, Texas continues to drop in the national rankings and is currently one of the lowest in the country. A district’s general fund is typically used for operations of on-going organizations and activities.62 School districts in Harris County expended an average of $6,679 per student from their general funds in 2007. In 2008, the average rose to $7,157 per student. During this school year, Sheldon ISD reported expending $8,090 per student, the highest of all districts in Harris County.63 North Forest ISD and Deer Park ISD reported the second and third highest expenditures per student with $7,808 and $7,583, respectively.64 Cypress-Fairbanks ISD, expending $6,332 per pupil, and Klein ISD, expending $6,607 per pupil, reported the lowest expenditures per student in 2008. From 2005 to 2009, a possible reason for Texas’ overall low expenditure per student was the “65 Percent Rule.” CHILDREN AT RISK 2010-2012

153

EDUCATION

Expenditure Per Student (cont.) Governor Perry issued this rule under an executive order in 2005, and it mandated that 65% of school district funds be expended for “instruction.”65 “Instruction” was based on the definition issued by the National Center for Education Statistics and included costs such as salaries and benefits for teachers, instructional aides, general instructional supplies, athletics, field trips, music, and art.66 The remaining 35% of school district spending was considered to be for “support services,” even though it included costs such as expenses for librarians, teacher training, nurses, counselors, food services, transportation, operations, and maintenance.67 During Texas’ 81st Legislative Session, Governor Perry came to recognize that it would be best to abandon the rule if Texas found a better way to measure school efficiency.68 Therefore, the Legislature passed a measure that did away with the 65% rule.69 The specific language stated:

The [financial accountability] system may not include an indicator under Subsection (b) or any other performance measure that: (1) requires a school district to spend at least 65 percent or any other specified percentage of district operating funds for instructional purposes; or (2) lowers the financial management performance rating of a school district for failure to spend at least 65 percent or any other specified percentage of district operating funds for instructional purposes.70 This act took effect in 2009. It remains to be seen whether data will show an increase in expenditure per student as a result of its repeal.

Both instructional services and support services such as buses to school, counselors, and breakfast and lunch programs should be made priorities in Texas classrooms. Policy Implication The idea behind Governor Perry’s “65 Percent Rule,” was to increase funds for classroom use; however, critics argued that the rigid breakdown of funding impaired public schools’ abilities to serve the needs of their students. While direct instructional services are the obvious priorities for public schools and the students they serve, money spent on these services is not always related to student achievement. For many schools, especially those in low-income areas, support services, such as buses to school, counselors, and breakfast and lunch programs, often provide students with missing resources that give them the potential to attain academic success from the instruction provided in the classroom. 71 By ensuring that the money is spent where needed, Texas will be investing in the future of its children and strengthening its national position in the public school system.

154

CHILDREN AT RISK 2010-2012

INDICATORS Student-to-Teacher Ratio: The average student-to-teacher ratio in the Greater Houston Area (Region 4) Year

1999-00

2000-01

2001-02

Indicator

16.2

15.9

2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 15.8

15.9

15.6

15.4

EDUCATION

Average Class Size and Student-to-Teacher Ratio

15.3

Source: Academic Excellence Indicator System, Texas Education Agency

First Grade: The average class size for first grade students in the Greater Houston Area (Region 4) Year

1999-00

2000-01

2001-02

Indicator

19.3

19.4

19.3

2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 18.5

19.5

20.1

19.5

19.9

19.8

Source: Academic Excellence Indicator System, Texas Education Agency

Secondary English: The average class size for secondary English/Language Arts in the Greater Houston Area (Region 4) Year

1999-00

2000-01

2001-02

Indicator

23.2

22.9

22.7

2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 23

22.9

22.6

22.5

22.1

Source: Academic Excellence Indicator System, Texas Education Agency

Secondary Math: The average class size for secondary mathematics in the Greater Houston Area (Region 4) Year

1999-00

2000-01

2001-02

Indicator

23.7

23.2

22.7

2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 23.2

22.7

22.8

22.1

22.3

21.9

Source: Academic Excellence Indicator System, Texas Education Agency

• Between 2000 and 2009, the average class size of Greater Houston Area classrooms has remained fairly steady. • Class size, or the number of students in a classroom, is a more accurate tool of measurement rather than the standard student-to-teacher ratios. • Studies indicate that students in smaller classes are more successful, made better grades, and took more advanced courses in high school.

Student-to-teacher ratio is most commonly calculated by dividing the number of students enrolled by the number of all educators, including administrators, counselors, and other employees.72 Therefore, student-to-teacher ratios measure only the number of students relative to the number of instructional staff in the school. Counselors, administrators, and other staff are considered part of the instructional staff in the school, even though many of these positions do not involve actual curriculum instruction. Student-to-teacher ratios also do not consider unique circumstances, such as special education classes, which

are generally smaller than traditional instructional classes and often have more than one teacher. Lower student-toteacher ratios reveal higher availability of teacher services to students.73 Since 2000, the student-to-teacher ratios in Harris County schools as well as nationwide have undergone a slow but steady decline. The average student-to-teacher ratio for districts in the Greater Houston Area in 2009 was 15.3,74 slightly below the national student-to-teacher ratio in 2009 of 15.4 students to one teacher.75 However, this is above

CHILDREN AT RISK 2010-2012

155

EDUCATION

Average Class Size and Student-to-Teacher Ratio (cont.) Texas law requires that class sizes from kindergarten through fourth grade should not exceed 22 students; however, the National Education Association recommends 15 students per classroom. the average student-to-teacher ratio for Texas which stands at 14.4.76 Crosby ISD, North Forest ISD, and Houston ISD had the highest student-to-teacher ratios in 2009. Together these three districts averaged a student-to-teacher ratio of 17. Galena Park ISD and Spring Branch ISD had the lowest ratios, with approximately 14 students for every fulltime teacher.77 Class size, or the number of students in a classroom, is a more accurate tool of measurement.78 It is calculated by taking the number of students served in a certain grade on a school campus and dividing that number by the number of full-time teachers for those students.79 When calculating an average class size the Texas Education Agency includes: • Classes identified as serving regular, compensatory/ remedial, gifted and talented, career and technical, and honor students; • Subjects including English language arts, mathematics, science, social studies, foreign language, computer science, business education, vocational, and self-contained;

• Teachers labeled as “special duty teacher,” “teacher,” and “substitute teacher”; and • Only classes coded as “regular class.” • Finally, if a teacher teaches more than one class at the same time, the records are combined into a single class.80 Because class size measures the approximate number of students actually in the classroom, this measure will generally be higher than student-to-teacher ratios. Between 2000 and 2009, the average class size of Greater Houston Area classrooms has remained fairly steady.81 The biggest shifts have occurred in mixed elementary grades—usually a subject that is taught by a teacher with students from varied grade levels—and sixth grade, both showing a significant decline. However, kindergarten, first, second and third grade classes have shown a slight increase in average size. In 2000, first grade classes averaged 19.3 and in 2009 these classes averaged 19.8.82 Studies have found that students in smaller classes generally were more successful, made better grades, and took more advanced courses in high school.83 According to a four-year longitudinal class-size study, known as the Student Teacher Achievement Ratio (STAR), students in smaller classes demonstrated better high school graduation rates and were more inclined to pursue higher education.84 The STAR experiment also revealed that “attendance in small classes appears to have cut the African American Anglo gap in the probability of taking a college entrance exam by more than half.”85 Texas law requires that class sizes from kindergarten through fourth grade should not exceed 22:1.86

Policy Implication:

NATIONAL AND STATE STUDENT-TO-TEACHER RATIO 16.5 16 15.5 15 14.5 14 13.5

2001 National

156

2002

2003

2004

2005

2006

Texas

CHILDREN AT RISK 2010-2012

2007

2008

2009

EDUCATION

Harris County should strive to achieve an average class size that matchers the National Education Association’s recommendation of 15 students per classroom for kindergarten and first grade. Policy Implication Student-to-teacher ratio and class size have been measured in relation to student achievement to ascertain how these can affect the quality of education. For younger children specifically, smaller classes allow teachers to dedicate more individualized attention to students, which produces an increase in student achievement, particularly for disadvantaged students. A widening disproportionate racial and economic achievement gap and alarming high school dropout rates indicate that Harris County would benefit from a reduced average class size that matches the National Education Association’s recommendation of 15 students per classroom for kindergarten and first grade. 87

Charter Schools Indicator: The number of charter operators in Harris County Year

1996-97

1997-98

1998-99

1999-2000

2000-01

2001-02

2002-03

Indicator

Year

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

Indicator

Source: Academic Excellence Indicator System, Texas Education Agency Note: Each charter school/system with a unique district number is counted as one charter operator.

• When compared to public schools, charter schools are subject to fewer state laws. • When compared to the state average, charter schools tend to serve more minority students and students designated as economically disadvantaged.

CHILDREN AT RISK 2010-2012

157

EDUCATION

Charter Schools (cont.) Only two states, Arizona and California, have more charter schools than Texas. Texas has 427 of the nation’s 4,364 active charter schools.

A charter school is a type of public school providing education through a contract, or charter, granted by the State Board of Education, or the board of trustees of an independent school district. These schools are subject to fewer state laws than other public schools, with the goal of being fiscally and academically accountable without undue regulation of pedagogical methods. Charter schools, like independent school districts, are monitored by the state and accredited under the state’s testing and accountability system.88 The Texas Education Code defines the purpose of charter schools: (1) to improve student learning; (2) to increase the choice of learning opportunities within the public school system; (3) to create professional opportunities that will attract new teachers to the public school system; (4) to establish a new form of accountability for public schools; and (5) to encourage different learning methods.89 Four classes of charters are authorized by the Texas Education Code: (1) home-rule school district charters; (2) campus or campus program charters; (3) open-enrollment charters; and (4) college or university charters.90 Currently, there are no home-rule school district charters operating in Texas. Historically most charter schools have operated under open-enrollment charters granted by the State Board of Education. Similar to independent school districts, open-enrollment charter schools receive state funds based on the average daily attendance of students. They may also receive funds from private funding sources. Unlike independent school districts, however, open-enrollment charter schools do not receive funds from local tax revenue and do not have access to state facility allotments.91

158

A growing number of new charter schools are campus charter schools.92 During the 2008-2009 academic year, 48 charter operators served 27,767 students in Harris County.93 Charter schools have increased their presence in Harris County since 2007, when 46 charter operators were serving 22,605 students.94 Compared to traditional public schools, charter schools tend to serve more minority students and students designated as economically disadvantaged. In Harris County, 75.8% of the student body in open-enrollment charters is economically disadvantaged, compared to 61.8% of students enrolled in traditional public school districts. In addition, 48.4% of charter school students in Harris County are considered to be at risk of dropping out. Harris County open-enrollment charters also serve proportionately more African American students and fewer Anglo students than traditional public schools, as 36% of charter students in 2008-2009 were African American, 50.1% were Latino, and 9.5% were Anglo. This compares to the 2008-2009 student demographics of Harris County’s traditional public schools where 21.3% of students are African American, 50.3% are Latino, and 23% are Anglo.95 Student Demographics in Charter and Non-Charter School Districts in Harris County (2008-09) Charter

Non-Charter

Asian/Pacific Islander

4.2%

5.2%

African American

36.0%

21.3%

Latino

50.1%

50.3%

Native American

0.2%

Anglo

9.5%

23.0%

Economically Disadvantaged

75.8%

61.8%

At-Risk

48.4%

54.1%

Total Students

100.0%

Source: Academic Excellence Indicator System, Texas Education Agency

CHILDREN AT RISK 2010-2012

In the 2008-2009 academic year, there were 48 charter operators in Harris County:100 Academy of Accelerated Learning Inc. Accelerated Intermediate Academy Alief Montessori Community School Alphonso Crutch’s Life Support Center Amigos por Vida (Friends for Life) Bay Area Charter Inc. Beatrice Mayes Institute Charter School Benji’s Special Educational Academy Calvin Nelms Charter Schools Children First Academy of Houston Comquest Academy Draw Academy Excel Academy

George I. Sanchez Charter Girls & Boys Prep Academy Gulf Shores Academy* Harmony School Of Excellence Harmony School Of Innovation Harmony School Of Science - Houston Harmony Science Academy Houston Alternative Preparatory Charter Houston Can Academy Charter School Houston Gateway Academy Inc. Houston Heights High School Houston Heights Learning Academy Jamie’s House Charter School Jesse Jackson Academy Juan B. Galaviz Charter School KIPP Inc. Charter KIPP Southeast Houston La Amistad Love & Learning Academy Medical Center Charter School Meyerpark Elementary North Houston High School for Business Northwest Preparatory Raul Yzaguirre School For Success Rhodes School Richard Milburn Academy Ripley House Charter School Ser-Niños Charter School Southwest School Stepping Stones Charter Two Dimensions Preparatory Academy University of Houston Charter School Varnett Public School West Houston Charter School Yes Preparatory Public Schools Zoe Learning Academy

EDUCATION

Many teachers who work in charter schools have fewer years of experience, and earn less on average, when compared to teachers in traditional public schools across the state.96 Of charter schools founded after 2005, the average years of teaching experience was 4.5 years prior to their current position, and about half of these years were spent in traditional public schools.97 According to a survey conducted by the Texas Center for Educational Research for the Texas Education Agency, parents and students revealed deciding factors to enroll in a charter included teacher quality, specialized courses, smaller class sizes, and reduced student conflict.98 The majority of students in Texas (78% of respondents) also reported receiving less than an hour of homework per day, and a small percentage of students stated their grades had dropped since enrolling. Finally, while many charters require that parents sign agreements expressing they will be actively engaged in their child’s education, overall levels of parental involvement did not increase.99

*Note: Gulf Shores Academy was denied a charter renewal shortly after the 2008-2009 academic year.101

It is imperative that Texas continue to work to ensure that high-quality schools proliferate and that low-performing charters do not. Policy Implication Interest in expanding high quality charters has grown amongst policy makers in Texas. As a result, there has been increased focus on identifying and providing support to new charter programs that have the potential to meet the unique needs of students and improve educational outcomes. The U.S. Department of Education has provided funding for new charter schools since 1994, and the current administration continues to seek ways to provide support for charter school expansion across the country, including competitive grants for states to establish or enhance facilities for charter schools102 and requiring states wanting to compete for Race to the Top funds to adopt policies that support the expansion of high-performing charter schools.103 However, as charter schools vary dramatically in the quality of education they provide, it is imperative that Texas work to ensure that high-quality schools proliferate and that low-performing charters do not.

CHILDREN AT RISK 2010-2012

159

EDUCATION

Career and Technology Education Programs Indicator: The percentage of students enrolled in career and technical education in Harris County public schools Year

1990-91

1994-95

1998-99

2000-01

2002-03

2004-05

Indicator

10.1%

14.8%

14.2%

16.8%

17.3%

18.4%

Year

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

18.2%

18.1%

18.0%

18.8%

18.4%

Source: Texas Education Agency

• The U.S. Bureau of Labor Statistic’s 2008-2018 occupational projections state that of the 30 most rapidly growing occupations, 16 require on the job training, a postsecondary vocational award, or an Associate degree. • There are an increasing number of students from higher academic achievement who are completing occupational concentrations.

Changes in the labor market and economy, such as advancements in technology, global competition, and increasingly service-oriented industries, have altered the face of the workforce and the occupational skills needed to succeed in America.104 Since the 1970s, Career and Technical Education (CTE) has gained significant attention as a way to broaden the academic focus and career preparation of students in Texas.

Fewer Houston ISD students (17.1%) are enrolled in Career and Technical Education programs compared to 21.4% statewide. Most high schools in Texas have adopted CTE to provide a foundation of skills with the aim of enabling students to attain high-skill, high-wage jobs after graduation and/ or to continue their education. With employers reporting that approximately 45% of high school graduates with no additional education are unprepared for the expectations that they face in entry-level jobs,105 more career and technical courses, as well as “innovative courses,” are being considered as viable alternatives for preparing students with more specified knowledge and skills than traditional high school courses. According to 2008-2018 occupational projections conducted by the U.S. Bureau of Labor Statistics, of the 30 most rapidly growing occupations 16 require

160

on-the-job training, a postsecondary vocational award, or an associate degree.106 Of these 16 occupations, including home health aides, physical therapist assistants, and environmental engineering technicians, 6 were considered high or very high paying professions, while the rest were low or very low paying professions.107 The majority of high schools nationwide offer career and technical education, and the vast majority of graduating students, over 90% of the class of 2005, have taken at least one CTE course.108 Although historically high school students who participate in CTE are more likely to come from lower educational backgrounds, often taking a lowerlevel 9th grade mathematics course, an increasing number of students of higher academic achievement have been completing occupational concentrations since the 1990s.109 The most common CTE credits remain computer technology and business services.110 Examining the class of 1992 and their status eight years later, a high school graduates’ occupational course-taking correlated with a lack of postsecondary aspirations: the more occupational credits that graduates earned in high school the less likely they were to pursue any postsecondary education; attend a vocational, technical, or business school; or complete a postsecondary certificate or associate degree.111 However, examining the class of 2000 and their status five years later, it appears that this correlation has shifted: students who earn more occupational credits in high school are more likely to attain a subbaccalaureate credential (most likely an associate’s degree).112 Although it remains unclear whether CTE is correlated to higher earnings later in life, because CTE

CHILDREN AT RISK 2010-2012

While specific course offerings vary among schools, the Texas Education Agency recognizes CTE programs in agriculture, business, health, marketing, home economics, and technological education, with courses ranging from entrepreneurship to applied entomology. Many Texas schools offer licensing and certificate opportunities to CTE students, but there is no state requirement to offer such programs.114 However, in 2007, the 80th Texas Legislature passed HB 3485 which required the State Board of Education to revise previous standards for knowledge and skills for CTE programs.115 Tech-Prep is a national program funded by the Carl D. Perkins Vocational and Technical Education Act, which allows students to begin a college technical major while still in high school. In 2008, 860 Texas public school districts with high schools had TechPrep program agreements with one or more Texas colleges, up from 821 in 2007.116 Tech-Prep high school students in grades 9-12 have had lower annual dropout rates for thirteen years (‘94-‘95 to ‘06-‘07) than those students who did not participate in Tech Prep programs.117

Harris County public schools spent more than $130 million on career and technical education, or approximately 1.6% of total expenditure from all funds, in 2007-08.

HARRIS COUNTY CAREER & TECHNICAL EDUCATION (CTE) ENROLLMENT BY RACE/ ETHNICITY, 2009-2010 SCHOOL YEAR 25% 20% 15% 10% 5%

EDUCATION

classes relate directly to career goals, such programs engage students otherwise disinterested in strictly academic coursework.113

0% African American

Asian

Latino

Native American

Anglo

was a considerable obstacle to implementing quality CTE programs.120 Seventy-five percent of respondents agreed or strongly agreed that the misperception of CTE programs as “old vocational” programs that do not prepare students for college was also a considerable barrier.121 In addition, the majority of respondents also expressed significant difficulty in creating effective partnerships with businesses and industries for hands-on experience—citing factors such as liability, transportation costs, and inadequate supervision.122 Finally, 78% of respondents expressed that not all Texas colleges accepting the statewide articulated course credit for career and technical education was a significant barrier to offering quality CTE programming.123

Harris County public schools spent more than $130 million on career and technical education, or approximately 1.6% of total expenditure from all funds, in 2007-2008.118 During the 2009-2010 school year, 148,976 students in Harris County public schools were enrolled in CTE programs, or 18.4% of the total student population. This figure has nearly doubled in the past two decades, from 10.5% of students in the 1989-1990 school year. Today in Harris County, Anglo and African American students are most likely to be enrolled in CTE programs, participating at rates of 20.1 and 20.0%, respectively. They are followed, in descending order, by Latino (17.2%), Asian (16.6%), and Native American (15.6%) students.119 According to a 2008 survey conducted by the Texas Education Agency, 85% of respondents, comprised mainly of CTE teachers and administrators, reported that the need for flexibility to offer advanced/college level CTE courses in lieu of existing requirements for graduation CHILDREN AT RISK 2010-2012

161

EDUCATION

Alternative Education Programs Indicator: The percentage of students in Region 4 (Houston) with disciplinary placements Year

1998-99

1999-00

2000-01

2001-02

Indicator

1.70%

2.20%

2.80%

3.10%

2002-03 2003-04 2004-05 2005-06 2006-07 2.70%

2.50%

2.20%

2.30%

2.20%

2007-08 1.80%

Source: Academic Excellence Indicator System, Texas Education Agency

• Alternative Education Campuses (AECs) available in Texas provide a non-traditional academic environment for students who might otherwise struggle in typical instructional settings. • All Texas public school districts operate mandatory Disciplinary Alternative Education Programs to serve students who have been removed from regular instruction. • During the 2007-2008 school year, over 100,000 Texas public school students were transferred from regular instructional settings to a disciplinary alternative education setting.

Alternative Education Campuses (AECs) are designed to serve students who struggle to succeed in a traditional academic environment. In Texas, AECs include Alternative Education Campuses of Choice, Residential Facilities, Disciplinary Alternative Education Programs (DAEPs), Juvenile Justice Alternative Education Programs (JJAEPs), and stand-alone General Educational Development (GED) programs. An AEC of Choice provides accelerated instruction to students at risk of dropping out (see “Students At Risk” in this volume), allowing students to accelerate their academic progress toward performing on grade level and completing high school. Residential Facilities include residential educational programs operated under contract with the Texas Youth Commission (TYC), detention centers and correctional facilities registered with the Texas Juvenile Probation Commission (TJPC), and private residential treatment centers.124 DAEPs serve students who have been temporarily removed from their regular educational setting due to disciplinary actions,125 while JJAEPs serve students who were expelled from their home school for engaging in delinquent conduct.126 Beginning in 1994, Texas developed a set of alternative performance measures to provide accountability for schools serving students at risk of dropping out, recovered dropouts, pregnant or parenting students, adjudicated students, students with severe discipline problems, and/ or expelled students. Currently, only AECs of Choice and Residential Facilities are eligible to register for evaluation under Alternative Education Accountability (AEA) procedures, whereas performance data from DAEPs, JJAEPs, and stand-alone GED programs are attributed to the student’s home campus. Schools rated under Alterna-

162

tive Education Accountability procedures may receive the following ratings, based on performance on the Texas Assessment of Knowledge and Skills (TAKS), completion rate, and dropout rates: AEA-Academically Acceptable, AEA-Academically Unacceptable, AEA-Not Rated-Other, or AEA-Not Rated-Data Integrity Issues. 127 As of June 2010, there were a total of 460 registered AECs in Texas which were eligible for alternative accountability.128 Beginning with the adoption of the Texas Safe Schools Act in 1995, all Texas public school districts are required to operate DAEPs to serve students who have been removed from regular instruction for disciplinary purposes. In contrast to AECs of Choice, attendance and length of stay at a DAEP is compulsory for sentenced students. A student’s assignment to a DAEP may be either mandatory, resulting

CHILDREN AT RISK 2010-2012

Disciplinary Action

Mandatory

Discretionary

Number

Percent

Number

Percent

Expelled to JJAEP

456

39.8

689

60.2

Expelled

491

26.9

1332

73.1

Removed to a DAEP

6648

31.7

14334

68.3

In-School Suspension

1213

0.3

395994

99.7

Out-of-School Suspension

5779

3.6

156181

96.4

Total - All Disciplinary Actions

14587

2.5

568530

97.5

EDUCATION

Mandatory vs. Discretionary Disciplinary Actions in Region 4 (Houston), 2008-09

Source: Texas Education Agency

The majority (68.3%) of removals to a Disciplinary Alternative Education Program in the Greater Houston Area (Region 4) in 2008-09 were discretionary, or not resulting from a violation of state code. from a violation specified under Chapter 37 of the Texas Education Code, or discretionary, based upon locallyadopted codes of student conduct.129 During the 20082009 school year, there were 20,982 removals to DAEPs in Region 4 (Houston), 68.3% of which were discretionary. Similarly, 60.2% of expulsions to JJAEPs were discretionary. 130 During the 2007-2008 school year, 103,727 Texas public school students were removed from their regular instructional setting to a disciplinary alternative education setting, including DAEPs and JJAEPs. Nearly one in five Texas students with a disciplinary placement in 20072008, or a total of 19,831 students, came from Region 4

(Houston). However, the percentage of students with a disciplinary placement is in fact lower in Region 4 (1.8%) than the state figure (2.1%) for the 2007-2008 school year. Houstonâ&#x20AC;&#x2122;s rate of 1.8% is on par with its rate of 1.7% a decade prior, though follows a trend of modest decline since a peak of 3.1% during the 2001-2002 school year. Among Harris County non-charter school districts, Channelview Independent School District had the highest rate of removals to a disciplinary setting during the 2007-2008 school year at 5.0%, followed closely by Goose Creek Consolidated Independent School District at a rate of 4.9%. At 0.5%, Katy Independent School District had the lowest rate of disciplinary placements of any Harris County school district.131

While ensuring that public schools are a safe place for learning, it is equally important that the programs in place to deal with disruptive students are not merely punitive, but also preventative and rehabilitative. Policy Implication Students placed in alternative education settings for disciplinary purposes are significantly more likely to drop out of school, thereby placing a burden on society by increasing the probability that the dropout will require government assistance or be incarcerated.132 While ensuring that public schools are a safe place for learning is of paramount importance, it is equally important that the programs in place to deal with disruptive students are not merely punitive, but also preventative and rehabilitative. If Texas is going to keep its promise to its youth that bright futures are in store for them, disciplinary alternative education settings should be reserved for the most seriously disruptive students to get back on track. By providing training for teachers on student behavior management, the number of discretionary referrals to disciplinary programs can be decreased.

CHILDREN AT RISK 2010-2012

163

EDUCATION

Limited English Proficiency and Bilingual Education Indicator: The percentage of students in the Greater Houston Area (Region 4) who are identified as limited English proficient based on criteria defined in the Texas Administrative Code Year

1994-95

1996-97

1998-99

2000-01

2001-02

2002-03

Indicator

14.4%

15.5%

15.2%

16.2%

16.8%

17.2%

Year

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

Indicator

17.9%

18.2%

18.1%

18.4%

19.6%

20.2%

Source: Academic Excellence Indicator System, Texas Education Agency

Indicator: The percentage of students enrolled in bilingual education or English as a second language programs at schools in the Greater Houston Area (Region 4) Year

1994-95

1996-97

1998-99

2000-01

2001-02

2002-03

Indicator

12.3%

13.5%

14.0%

14.6%

15.4%

15.9%

Year

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

Indicator

16.7%

17.0%

16.9%

17.2%

18.4%

19.1%

Source: Academic Excellence Indicator System, Texas Education Agency

• If twenty or more LEP students of the same grade level are enrolled on a campus Texas law requires the campus to provide a bilingual or special language program. • Dual immersion programs have been shown to be relatively successful, while English as a Second Language education programs do not prepare students for school success. • During the 2008-2009 school year 20.2% of students in the Greater Houston Area were identified as LEP and 19.1% of those students were enrolled in bilingual or ESL programs.

Texas law requires that every student must be assessed within the first four weeks of school to determine the student’s language of “primary proficiency.”133 If it is determined that a student is a limited English proficient (LEP) student, the parent must agree to the student’s entry into, exit from, or placement in the special language program.134 A parent may decide to disagree with his or her child’s entry into the program, and this decision is referred to as “parental denial.” After the initial determination, the language proficiency assessment committee of a district shall report the number of the LEP students on each campus to the district’s board of trustees. Each district that has twenty or more LEP students in the same grade level must “offer bilingual education or a special language program.”135 For any district that is required to offer these programs, the district is required to offer “bilingual education in kindergarten through the elementary grades,” “bilingual education, instruction in English as a second language (ESL), or other transitional language instruction in post-elementary grades through eight,” and “instruction in English as a second language in grades nine through twelve.”136 In

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practice, LEP students receive bilingual education in kindergarten through the sixth grade and ESL instruction in seventh through twelfth grade, unless these students are enrolled in special education classes. Dual immersion programs, referred to as ‘bilingual education’ programs, are programs in which students are taught in English for half the school day and the other half of the school day in the second language. The goal is to help students become bilingual in a second language. These programs have been relatively successful in helping non-English speakers learn English. In contrast, research shows that English as a Second Language education programs, which are used in Texas in grades seven to twelve, do not teach students the English language and literacy they need for school success. Segregation by language and ethnicity does not lead to higher academic performance, does not raise students’ self-esteem, and often results in social isolation and high dropout rates. During the 2008-2009 academic year, 20.2% of enrolled

CHILDREN AT RISK 2010-2012

as a Second Language (88.7% in grades 6-8 and 100% in grades 9-12).138 The most common language spoken among Limited English Proficient students in 2009-2010 was Spanish, with 170,742 speakers. Vietnamese was the next most common language, with 5,594 speakers. Other common languages include Urdu, Arabic, Chinese (Mandarin and Cantonese), Korean, Tagalog, and French.139

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students in the Greater Houston Area were identified as Limited English Proficient, while 19.1% of students were enrolled in bilingual or English as a Second Language programs.137 The majority of early education and elementary school students are enrolled in bilingual education programs (78.7% in early education through Kindergarten and 75.1% in first through fifth), compared to the majority of students in middle and high school enrolled in English

Policy Implication Texas has the following stated policy regarding education of its language minority students: “Experience has shown that public school classes in which instruction is given only in English are often inadequate for the education of those students” whose primary language is not English.140 ESL courses provide a program of “intensive instruction in English.” 141 It is unclear then why Texas has chosen the blanket policy of providing ESL courses for grades nine through twelve, when “experience has shown” that a more individualized assessment of each student’s needs is required, regardless of their grade level. The individual needs of each student should be assessed. According to the Texas Education Agency, strategies for teaching English as a second language may involve the use of the student’s home language. The Agency has also stated that this strategy and others may be used in any of the courses or electives required for promotion or graduation to assist the limited English proficient students to master the Texas Essential Knowledge and Skills (TEKS) test for the required subject(s).142 However, because Texas policy also states that ESL courses provide a program of “intensive instruction in English,” the extent to which a student’s native language is used in ESL courses is questionable. One argument for a true dual-language program is that while the student is learning English, he or she is also keeping up with his or her peers in other nonlanguage subjects, such as science, math and social studies, because they are taught in his or her native language.143

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Special Education Students Indicator: The percentage of students enrolled in special education in Harris County public schools Year

1990-91

1992-93

1994-95

1996-97

1998-99

2000-01

2001-02

2002-03

Indicator

8.6%

9.2%

9.9%

10.2%

10.6%

10.2%

10.1%

10.0%

Year

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

10.0%

9.7%

9.5%

8.9%

8.3%

8.0%

Source: Texas Education Agency

• The Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act and No Child Left Behind Act of 2001 mandates services for children with disabilities. • Harris County’s public school districts spend nearly 10% of all funds on special education; during the 2007-2008 school year a total of $775,328 was spent.

The Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act and No Child Left Behind Act of 2001 mandate services for children with disabilities. IDEA provides a free, appropriate public education in the least restrictive environment to these students. IDEA covers students with educational dis-

In the 2009-2010 school year, 64,696 students were receiving special education services in Harris County, which equates to 8.0% of all students in the county. abilities ages 3-21 or until graduation that require special education services. The disabilities referenced under IDEA include: mental retardation, hearing loss, speech or language impairments, visual impairments, serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments or specific learning disabilities.144 Section 504 of the Rehabilitation Act of 1973 is the “umbrella” civil rights law covering persons who have a “physical or mental impairment that substantially limits one or more major life activity.”145 All students who qualify for special education and related services under IDEA are also covered by the provisions of Section 504. The law prohibits recipients of federal funding from discriminating against individuals with disabilities. As it relates to public education, the law states that a school cannot place a student in segregated classes or facilities “solely by reason of her or his disability.” Students

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with disabilities must be given the same opportunities to participate in academic, non-academic and extracurricular activities as their non-disabled peers. The No Child Left Behind (NCLB) of 2001 was enacted to hold schools accountable for performance of students who are struggling to learn. Federal funds are provided to states and local independent school districts so that they may accomplish the goals of NCLB through NCLB’s Title I grant program. Title I is the law that supports students who are considered “disadvantaged.” NCLB holds states and schools that accept Title I funds accountable for “providing a fair, equal, and significant opportunity to obtain a high quality education for all students.”146 When a child needs special education or related services, a parent, teacher, counselor, principal, social worker, therapist or another individual involved in the education or care of the student can make a request for evaluation.147 This need can arise when the student is not developing at SPECIAL EDUCATION STUDENTS IN HARRIS COUNTY PUBLIC SCHOOLS BY RACE/ ETHNICITY, 2009-2120 SCHOOL YEAR 12%

10.7%

10% 8%

7.0%

7.7%

8.6%

Latino

Native American

Anglo

6% 3.7%

4% 2% 0% African American

CHILDREN AT RISK 2010-2012

Asian

ing the 2007-2008 school year.150 In Harris County public schools, there were a total of 64,696 students enrolled in special education during the 2009-2010 school year, representing a decline from three years prior (2006-2007) when 72,455 students were enrolled.151 Currently, African American students are most likely to be enrolled in special education (10.7% enrolled), followed by Anglo (8.6%), Native American (7.7%), Latino (7.0%), and Asian (3.7%). Over the past two decades, African American students have consistently been more likely than Anglo, Latino, or Asian students to be enrolled in special education. During the 2009-2010 school year, 8.0% of all students in Harris County public schools received special education services.152

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the same rate as other children or the student is experiencing unusual or prolonged difficulties with the general education curriculum, and varied rates of intervention have not helped. The school district must then give parents notice of the proposed evaluation and ensure the notice is understood. The parent must give his informed consent before the child is evaluated for the first time. Once consent is received, the student is then assessed in all areas related to the suspected disability, including health, vision, hearing, and motor abilities, language dominance and communicative status, sociological and emotional status, academic performance, and general intelligence. The school district is required to conduct the full individual evaluation within sixty calendar days of receiving parental consent, and a reevaluation shall occur at least once every three years. IDEA 2004 made changes in the request process for students with a suspected learning disability. Prior to the request process, the school must assure “the student has been provided appropriate, high-quality, researchbased instruction in a regular classroom, delivered by qualified personnel.”148 After the evaluation, the school typically conducts an ARD/IEP planning conference at which school personnel and the student’s family come together to discuss results obtained from the evaluation, placement options, and other general information. Shortly after the planning meetings, Texas schools conduct an Admission, Review, and Dismissal (ARD) meeting. At this meeting, specific services and goals are discussed, and members of the ARD committee set annual measurable goals for the student, known as the IEP, or Individualized Education Program. This committee reconvenes at least once a year to review and revise the IEPs as necessary.149 Harris County public school districts spend nearly 10% of all funds on special education, or a total of $775,328 dur-

Schools must provide sufficient staff to adequately meet the needs of special education students. Policy Implication Special education programs are designed to give students with disabilities the tools to learn in ways that best meet their needs. These students are placed in small groups outside of the general classroom so that they can receive more individualized attention. However, schools are not providing sufficient staff to adequately meet these students’ needs, even though the numbers of students in special education are increasing. Furthermore, because many students receiving special education services do not take the same assessment tests as students in general education,153 teachers and administrators often overlook them. When placed in the right setting, these students can thrive, and many of them are even able to overcome their disabilities. Schools must ensure that students are given that opportunity.

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Students at Risk Indicator: The percentage of students identified as at risk of dropping out of school in Harris County based on criteria defined in the Texas Education Code Year

1990-91

1994-95

1998-99

2000-01

2001-02

2002-03

2003-04

Indicator

20.0%

42.1%

40.5%

44.3%

44.4%

44.7%

48.5%

Year

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

51.4%

55.1%

53.6%

53.9%

52.0%

Source: Texas Education Agency

• Risk factors contributing to the likelihood of a student not completing high school include poor performance in school, low socioeconomic status, limited English proficiency, and living in a single-parent home. • In 2009, over half of the general student population in Harris County was considered to be at risk of dropping out. • In 2007, the 80th Texas Legislature authorized additional funding for dropout prevention for at-risk students.

Many factors contribute to a child’s risk of dropping out of school before graduating. Some risk factors include low socioeconomic status, limited English proficiency, and living in a single-parent home. A student’s performance in school also contributes to his or her risk of dropping out. Failing classes, poor attendance, low grade point average (GPA), and behavioral problems are warning indicators of a student at risk of dropping out.154 Texas developed specific criteria for designating a student’s at-risk status.155 A student under the age of 21 meeting any of the following criteria is considered at risk of dropping out of school in the state of Texas: • Has not advanced from one grade level to the next for one or more school years; • Is in grades 7-12 and did not maintain at least a 70% average in two or more subjects in the current or prior semester; • Did not perform satisfactorily on an assessment instrument (TAKS) administered to the student, and did not perform at least 110% of the level of satisfactory performance on that instrument the year before; • Is in Pre-Kindergarten, Kindergarten, or grades 1-3 and has not passed a readiness test or assessment instrument administered during the current school year; • Is pregnant or a parent; • Has been placed in an alternative education program during the preceding or current school year; • Has been expelled during the preceding or current

168

CHILDREN AT RISK 2010-2012

In 2009, there were 424,595 students in Harris County that were considered at risk of dropping out—over half (53.9%) of the general student population.156 In Texas, 2,285,954 students were considered at risk of dropping out, or 48.3% of the student population.157 Of all school districts in Harris County, Humble ISD had the smallest percentage of at-risk students (31.8%), while Aldine ISD had the most at-risk students with 70.1% of its students identified as at-risk.158 At-risk students are most likely to be minority and from economically disadvantaged backgrounds. In 2010, 47.8% of African American and 67.3% of Latino students were considered at-risk compared to only 23.2% of Anglo students.159

In 2009, 53.9% of students in Harris County public schools, compared to 48.3% of students in Texas, were considered at risk of dropping out.

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school year; • Is currently on parole, probation, deferred prosecution, or other conditional release; • Has a previous report of dropping out of school; • Is of limited English proficiency; • Is in the custody or care of the Department of Protective and Regulatory Services or has, during the current school year, been referred to the department by a school official, officer of the juvenile court, or law enforcement official; • Is homeless; or, • Has resided in the preceding school year or resides in the current school year in a residential placement facility in the district – including a detention facility, substance abuse treatment facility, emergency shelter, psychiatric hospital, halfway house, or foster group home.

In 2007, the 80th Texas Legislature passed House Bill 2237, which authorized additional funding for dropout prevention for at-risk students.160 The Texas Education Agency (TEA) and school districts have implemented programs designed to keep students in school. One program uses an early warning system to let districts know when a student is becoming disengaged or falling behind in school. The Texas Ninth Grade Transition and Intervention Program (TNGTI) was developed to identify at-risk students and allow schools to intervene before they drop out. This program includes a summer transition program to develop the academic, social, and study skills of incoming freshman students, an early warning tool to monitor the progress of program participants throughout the ninth grade year, and targeted intervention for students who exhibit early warning signs of being off-track for graduation.161

Recognizing the off-track, at-risk students is the first step in keeping students in school. Policy Implication An effective early warning system that uses indicators based on accessible data can predict during one semester whether a student is on-track towards graduation.162 Recognizing the off-track, at-risk students is the first step in keeping students in school. However, as the number of students identified as at-risk increases, Texas must also proactively implement new systems and policies that support the academic, emotional, and social needs of these students. Some of these strategies include lengthening the school day/year, intensive summer catch-up programs, restructuring schools to provide personalized learning, individualized education plans, mentoring, service learning, afterschool programming, early literacy development, and quality early childhood education.

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Graduation and Dropout Rates Indicator: The average freshman-to-senior graduation rate in the Greater Houston Area (26 independent school districts) Year

2004

2005

2006

2008

Indicator

63*

Source: CHILDREN AT RISK using data from the Texas Education Agency *Note: The 2008 graduation rate employs a new methodology, and is thus not directly comparable to previous years. The new calculation represents the percentage of first-time freshmen entering in 2004-2005 who graduated from any Texas public school within four years.

Indicator: The percentage of students from a class of ninth graders who drop out and do not return by the fall of their fourth school year and do not meet other completion requirements in the Greater Houston Area (26 independent school districts) Graduating Year

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Indicator

11.4

8.4

6.9

5.7

6.8

5.4

6.2

10.4

14.3

13.6

11.9

Source: Secondary School Completion and Dropouts in Texas Public Schools Report-County Supplement, Texas Education Agency

• The median income for high school dropouts aged 25 and older in Harris County is significantly lower when compared to the median income of those of the same age who finished high school or attained a GED. • While there are various means of tracking students, calculations from a number of independent research organizations indicate that more than one in three students never finish high school in Texas. • For the class of 2008, TEA reported the percentage of students who graduated or were continuing their education after their expected graduation date was 10.5% in Texas and 18.7% in HISD.

older lived below the poverty Students drop out of line.164 The median income school for a variety of for high school dropouts aged reasons: poor grades, 25 and older in Harris County low attendance, grade was $19,993,165 compared to retention, or behava median income of $27,318 ioral problems. These Texas ranks last in the nation in for those 25 and older in problems stem from the percentage of adults with Harris County who finished circumstances occurhigh school or attained a ring in the student’s high school diplomas; only GED.166 Additionally, droplife, such as: difficult 79.6% of Texans have a high outs account for half of all pristransitions to high school diploma. oners in Texas prisons,167 and school, deficient basic more than two-thirds of inmates skills, disengagement from on death row never completed high one’s school or home, and/or school.168 In Texas, a single cohort of lack of guidance and encouragedropouts has been estimated to result in a ment from a caring adult.163 Dropping out of high school correlates with a loss of up to $9.6 billion for the state.169 According to a number of independent research number of negative outcomes, both for the organizations, more than one in three students individual and for the state. For example, in never finishes high school in Texas.170 However, the 2008, 24.3% of the dropout population aged 25 and

170

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GRADUATION AND COMPLETION RATES Texas is widely recognized for its student-level reporting system, allowing the TEA to track students on an individual basis. TEA assigns each student a unique ID number and tracks students throughout the public school system to see if they graduate, continue high school after their expected graduation date, drop out, earn a GED, or leave the school system for another reason. TEA calculates multiple

T E N

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data to measure and report on the number of students who complete high school, including completion and graduation rates. The first is the longitudinal completion rate (“Completion Rate I”), which is used for standard accountability purposes. This rate is utilized in part to determine whether schools and districts receive the state ratings of Exemplary, Recognized, Academically Acceptable, or Academically Unacceptable. The longitudinal completion rate shows the percentage of students in the cohort who have graduated or are continuing their education after their expected graduation date. To count as a completer, the student must have received a high school diploma within four years or have reenrolled in school for a fifth year. Because this rate accounts for both graduates and continuers, it creates a

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Texas Education Agency (TEA) reports that for the class of 2008, only 10.5% of Texas students who started ninth grade dropped out.171 The difference in these figures arises because there are various methods to calculate rates and various means of tracking and classifying students.

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CHILDREN AT RISK vs. TEA Dropout Rates by Schools for class of 2008* (Region 4) Campus

District

TEA Four-Year Graduation Rate

C@R Four-Year Graduation Rate

Graduation Rate Difference

TOP 10 CHILDREN AT RISK FOUR-YEAR GRADUATION RATES Debakey High School For Health Professions

Houston ISD

Eastwood Academy

Houston ISD

100

Performing & Visual Arts High School

Houston ISD

Kerr High School

Alief ISD

Carnegie Vanguard High School

Houston ISD

Clements High School

Fort Bend ISD

Harmony Science Academy

100

Taylor High School

Katy ISD

Stephen F Austin High School

Fort Bend ISD

Law Enfcmt-Criminal Justice High School

Houston ISD

LOWEST CHILDREN AT RISK FOUR-YEAR GRADUATION RATES Clear View Education Center

Clear Creek ISD

Challenge Early College High School

Houston ISD

-3

Wheatley High School

Houston ISD

Worthing High School

Houston ISD

Furr High School

Houston ISD

Girls & Boys Prep Academy

Sam Houston High School

Houston ISD

North Forest High School

North Forest ISD

Sharpstown High School

Houston ISD

Lee High School

Houston ISD

Source: Academic Excellence Indicator System, Texas Education Agency; CHILDREN AT RISK calculation using Texas Education Agency data *Note: Schools with missing or insufficient data as well as alternative or disciplinary campuses were exluded from this list.

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Graduation and Dropout Rates (cont.) Graduation and Dropout Rates by School District, Class of 2008 District

TEA Longitudinal Dropout Rate

TEA Completion Rate I

TEA Graduation Rate

CHILDREN AT RISK Four-Year Graduation Rate*

Aldine ISD

Alief ISD

Channelview ISD

Clear Creek ISD

Crosby ISD

Cypress-Fairbanks ISD

Dayton ISD

Deer Park ISD

Fort Bend ISD

Friendswood ISD

Galena Park ISD

Goose Creek CISD

Houston ISD

Huffman ISD

Humble ISD

Katy ISD

Klein ISD

La Porte ISD

North Forest ISD

Pasadena ISD

Pearland ISD

Sheldon ISD

Spring Branch ISD

Spring ISD

Tomball ISD

Waller ISD

Source: Academic Excellence Indicator System, Texas Education Agency; Information Request, Texas Education Agency *Note: CHILDREN AT RISK calculations based on data provided by the Texas Education Agency. This graduation rate represents the percentage of first-time freshmen entering in 2004-2005 who graduated from any Texas public school within four years.

high depiction of the students who finish high school, and does not account for whether the continuers will drop out or eventually graduate.172 Under federal guidelines, TEA also calculates a graduation rate, which is reported to the Department of Education. To calculate this completion rate, TEA tracks a cohort or class of students, meaning the group of students who start ninth grade for the first time and the students who leave

172

and enter that class over a four year period, to calculate a graduation rate. The graduation rate represents only the percentage of students who graduated high school within four years with a high school diploma. Since this number does not account for continuers who may or may not finish, it does not reflect the fact that some students take longer than four years to graduate. While this rate reflects the common public understanding of what it means to finish high school, graduating, it is not used for state accountabil-

CHILDREN AT RISK 2010-2012

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ity purposes.173 In Texas, the completion rate for the class of 2008 was 88%, while the graduation rate was only 79%, according to the Texas Education Agency.174 For both calculations, some students, based on ‘leaver codes,’ are removed entirely from the cohort and not included in the graduation or completion calculation because they left the public school system. Students removed from the cohort include those who have left the public school system to enroll elsewhere: those who leave to attend private school, a school outside Texas, or to be homeschooled. Students who leave to return to their home country, who are expelled, or who die are also removed. In addition to leavers, TEA also removes students from the calculations for whom TEA cannot find records in their system. Since TEA is unable to tell how many underreported students are dropouts, TEA reports them separately from graduation, completion or dropout rates.175 Removing leavers and underreported students from their cohort results in a higher graduation or completion rate. In past years, CHILDREN AT RISK has calculated its own graduation rate utilizing data from the Texas Education Agency, employing a methodology similar to that of the Manhattan Institute. This methodology compares the entering freshman class size with the number of graduating seniors four years later. The rate is adjusted for school growth or decline in the freshman class over the four years. Based on this calculation, CHILDREN AT RISK found that 68% of students graduated in the class of 2006,176 compared to TEA’s graduation rate of 80.4%.177 In 2009, CHILDREN AT RISK developed a new methodology to calculate graduation rates across the state. This methodology is unique in that it tracks first-time freshmen (those enrolled in ninth grade for the first time) to determine whether the cohort of students graduated from any Texas public school within a specified time frame (typically four or six years). Utilizing data from the Texas Education Agency, this measure relies on the state’s ability to track individual students anywhere in the Texas public school system, but does not remove students from the cohort who leave school regardless of the reason. A benefit of this method is that students who have not been well-documented to have left for home schooling or left the country, for example, are not preemptively removed from the calculation. Furthermore, this calculation does not penalize schools for transferring students to other schools in the state by including students who graduated from the same campus or a different campus, as graduates. For the class of 2008, Texas’ self-reported graduation rate (for federal accountability) was 79%178 and Houston ISD’s rate was reported as 68%.179 In contrast, CHILDREN AT RISK’s

four-year graduation rate for first-time freshmen entering ninth grade in 2004-2005 was 66% for Texas and 54% for Houston Independent School District (HISD).180

DROPOUT RATE TEA calculates and reports annual dropout rates in addition to a four-year, longitudinal dropout rate to determine the percentage of students from a cohort who dropped out before completing their high school education. TEA changed part of its methodology to comply with the passage of Senate Bill 186, passed by the 78th Texas Legislature in 2003. The passage of the bill required Texas to comply with the No Child Left Behind Act by changing the way Texas reports dropouts to conform to the definitions developed by the U.S. Department of Education’s National Center for Education Statistics (NCES). NCES defines a dropout as a student who is enrolled in public school in grades 7-12, does not return to public school the following fall, is not expelled, and does not graduate, receive a GED, continue school outside the public school system, begin college, or die. Students who are not considered dropouts include those who are expelled, return to their home country, or move to another educational setting, such as a private school or home school. TEA reported a longitudinal dropout rate for the class of 2008 of 10.5% in Texas and 18.7% in HISD.181 In the cohort, more than 20% of Latinos and African Americans dropped out of HISD while less than 9% of Anglo students dropped out.182

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Graduation and Dropout Rates (cont.) It is essential to catch students as soon as they begin to fall behind or become disengaged in order to make a successful early intervention to get the student back on track to graduation. Policy Implication Dropouts cost the state in a number of ways: through higher rates of crime and incarceration, increased use of welfare and social services, a higher dependence on public health care systems, and most significantly, the loss of future economic activity that a high school diploma holder brings into the state. The current demand for a highly-educated labor market has created many barriers for those who lack high school diplomas to secure employment. Given the shifting forces at work in the 21st century economy, a high school diploma is the lowest baseline level of education necessary for a livable wage. The current education system will determine the quality of our future workforce, social service systems, and economy. The undeniable link between a quality education and prosperity necessitates that public officials address this dropout crisis with all due urgency. A thorough and accurate understanding of why children drop out and an understanding of the magnitude of the dropout problem will allow schools, districts, and policymakers to develop effective programs to increase high school completion and success. Texas, considered a leader in creating and maintaining longitudinal data on its students, must take the lead in this arena as well. Public officials must implement an accurate and transparent system of monitoring dropout and graduation rates, especially where these rates are attached to accountability. Officials must also work to enhance graduation rates through focused school reform, and identifying districts and schools that are failing their students. Substantial work has been done to identify some of the essential components of high school reforms that relate to keeping students in school. It is time for us to take this knowledge and put it to use, or face the economic and societal consequences. Texas must realize that a failure to look to the future in addressing today’s education challenges will result in disastrous economic consequences for our state in the present and well into the future. TEA plans to make the early warning system available to all school districts across Texas. The early warning system will begin tracking students in middle school based on four indicators: attendance, grades, GPA, and behavior. The system will flag students who are not on-track to graduate, allowing the school and district time to intervene and attempt to keep the student in school. The system will flag students who miss more than 10% of class, fail a core class, have a low GPA, or have multiple behavioral referrals. While many students do not drop out until high school, students’ disengagement may begin long before. It is essential to catch students as soon as they begin to fall behind or become disengaged in order to make a successful early intervention to get the student back on track to graduation.183

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• CHILDREN AT RISK expanded the school ranking system to include eligible high schools statewide in addition to eligible elementary and middle school campuses. • By using various indicators to evaluate campuses, CHILDREN AT RISK encourages a comprehensive examination of school quality and seeks to hold schools accountable for student performance. • Even though the Greater Houston Area has several schools in the top rankings, a disproportionate number of Greater Houston Area high schools fall in the bottom quartile of the state.

In an effort to raise community awareness of the “dropout crisis” facing Houston and the need for school reform, CHILDREN AT RISK designed a school ranking system in 2006 to publicly evaluate and rank high schools in the Greater Houston Area. In 2009, CHILDREN AT RISK began to include all eligible high schools in the state of Texas as well as extend the ranking system to include eligible elementary and middle school campuses. For the fifth Public School Rankings report released in 2010, CHILDREN AT RISK evaluated and ranked 5,864 public school campuses across Texas. The purpose of the school rankings is not only to provide a tool to parents and students regarding the quality of local schools, but also to provide information to campuses and districts on how they perform relative to their peers and on successful models of highperforming public schools. The school rankings aim to:

EDUCATION

School Rankings

data collected by the Texas Education Agency through the Academic Excellence Indicator System, the Student Assessment Division (TAKS™ data), and through direct requests to the Agency. CHILDREN AT RISK emphasizes utilizing a diverse array of indicators to evaluate campuses to encourage a holistic examination of school quality. CHILDREN AT RISK seeks to hold schools accountable for students’ performance on standardized testing in addition to numerous other measures such as performance on college entrance exams, participation in advanced coursework, student retention, and graduation rates. CHILDREN AT RISK examines fourteen indicators at the high school level, ten at the middle school level, and twelve at the elementary level.

At the high school level, CHILDREN AT RISK constructs a weighted index comprised of fourteen variables to measure student preparedness for post-secondary education. • Serve as an accessible guide for parents, educators, These measures include: the percentage and community members of students achieving TAKS regarding the Commended Performance performance of local standards in Mathematics, schools; English/Language Arts, • Generate Social Studies and Science; conversation the percentage of ACT/SAT about how schools test-takers; mean SAT and More than a third (36%) and districts are ACT test scores; enrollment of Greater Houston Area performing overall in advanced courses; comin creating college pletion of the Recommended high schools rank in ready students; High School Program; Texas’ bottom • Encourage the use of participation in AP/IB exams; quartile. data in public school performance on AP/IB exams; reform; and graduation rate; and attendance • Be transparent, accessible rate. Similarly, CHILDREN AT to the public, and open to RISK constructs a weighted index scrutiny. based on ten indicators at the middle school level, evaluating the performance To rank public schools across Texas, CHILof schools in preparing students for secondDREN AT RISK compiles and analyzes universal ary and post-secondary success. Middle schools CHILDREN AT RISK 2010-2012

175

EDUCATION

C H I LD R E N

176

R I S K

TO P

T E N

P R I O R I T Y

School Rankings (cont.) Houston Rank

Texas Rank

School Name

District

TEXAS TIER 1 1

Debakey High School For Health Professions

Houston ISD

Carnegie Vanguard High School

Houston ISD

Kerr High School

Alief ISD

KIPP Houston High School

KIPP Inc Charter

Harmony Science Academy

YES Prep - Southeast Campus

YES Preparatory Public Schools

Eastwood Academy

Houston ISD

Perfor & Vis Arts High School

Houston ISD

Clements High School

Fort Bend ISD

Memorial High School

Spring Branch ISD

Westchester Academy For International

Spring Branch ISD

Cinco Ranch High School

Katy ISD

Taylor High School

Katy ISD

Stephen F Austin High School

Fort Bend ISD

Law Enfcmt-Crim Just High School

Houston ISD

Friendswood High School

Friendswood ISD

The Woodlands High School

Conroe ISD

Bellaire High School

Houston ISD

Stratford High School

Spring Branch ISD

Dulles High School

Fort Bend ISD

Clear Lake High School

Clear Creek ISD

Kingwood High School

Humble ISD

Carver High School For Applied Tech/Engin

Aldine ISD

Lamar High School

Houston ISD

Cy-Fair High School

Cypress-Fairbanks ISD

Cypress Creek High School

Cypress-Fairbanks ISD

Langham Creek High School

Cypress-Fairbanks ISD

102

Klein High School

Klein ISD

112

Kempner High School

Fort Bend ISD

130

Cypress Falls High School

Cypress-Fairbanks ISD

136

Westside High School

Houston ISD

146

Lawrence E Elkins High School

Fort Bend ISD

163

Jersey Village High School

Cypress-Fairbanks ISD

195

Katy High School

Katy ISD

201

Morton Ranch High School

Katy ISD

217

Clear Brook High School

Clear Creek ISD

235

Raul Yzaguirre School For Success

237

Hightower High School

Fort Bend ISD

239

Foster High School

Lamar CISD

252

Pearland High School

Pearland ISD

CHILDREN AT RISK 2010-2012

C H I L D R E N Texas Rank

R I S K

TO P

T E N

School Name

P R I O R IT Y District

TEXAS TIER 2 41

264

Danbury High School

Danbury ISD

271

Brazoswood High School

Brazosport ISD

284

George Bush High School

Fort Bend ISD

285

Klein Collins High School

Klein ISD

330

Clear Creek High School

Clear Creek ISD

347

Tomball High School

Tomball ISD

349

Mayde Creek High School

Katy ISD

363

Needville High School

Needville ISD

375

Stafford High School

Stafford Msd

383

Cypress Springs High School

Cypress-Fairbanks ISD

387

Challenge Early College High School

Houston ISD

399

Barbers Hill High School

Barbers Hill ISD

402

Hargrave High School

Huffman ISD

450

Oak Ridge High School

Conroe ISD

458

Montgomery High School

Montgomery ISD

483

Cypress Ridge High School

Cypress-Fairbanks ISD

495

Klein Oak High School

Klein ISD

507

Barbara Jordan High School

Houston ISD

are evaluated based on the following variables: Commended Performance rates for TAKS Reading, Mathematics, Writing, Science, Social Studies, and all tests taken; attendance rate; and retention rates in 7th and 8th grades. Finally, elementary campuses are evaluated based on a twelve-measure weighted index. Indicators for elementary campuses are as follows: Commended Performance rates for TAKS Reading, Mathematics, Writing, Science, and all tests taken; attendance rate; retention rates in 4th and 5th grades; and average class size in grades one through three. One adjustment variable is included for all campuses: the percentage of students who are economically disadvantaged (i.e. students who qualify for free or reduced-price meals or other public assistance), as research has consistently shown that poverty is a predictor of whether or not a student will graduate and achieve postsecondary academic success.

DREN AT RISK ranking are examined in conjunction with each other, they provide a more accurate assessment of how well a campus has prepared students for the next level of their education. To calculate the school rankings, CHILDREN AT RISK first computes a standardized score, or z-score, for each of the measures, comparing a campus’ performance against schools across the state. CHILDREN AT RISK then applies predetermined weights to each measure and aggregates the weighted values to produce a composite score. CHILDREN AT RISK assigns a rank order to each campus, which is determined as the order in which campuses are listed when the weighted composite z-scores are sorted from highest to lowest. Finally, elementary, middle, and high schools across the state are assigned ‘Tiers’ which represent quartiles, with ‘Tier 1’ schools in the top quartile and ‘Tier 4’ schools in the bottom quartile in the state.

The CHILDREN AT RISK ranking methodology employs a statistically straightforward method for ranking schools across various measures. Much like the methodology used by other institutions to rank higher education programs, CHILDREN AT RISK’s method uses the z-score statistic to standardize the data and compute a ranking among campuses included in the analysis. The z-score, sometimes called a normal deviate, indicates presence above and below the population mean for a raw score. The standardization of scores makes it possible to compare scores from different distributions where measurement is based on different scales, such as graduation rates and mean SAT scores. When the variables used in the CHIL-

CHILDREN AT RISK’s rankings are computed at the elementary, middle, and high school levels across the state of Texas. The School Rankings’ analysis is conducted at the state level before campuses are extracted to rank schools in smaller geographic areas (i.e. Houston, Dallas, Austin, and San Antonio). For the purpose of school rankings, the Greater Houston Area is defined as the following eight counties: Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller. In the Greater Houston Area, CHILDREN AT RISK rated 140 high schools, 253 middle schools, and 557 elementary schools in 2010.

CHILDREN AT RISK 2010-2012

EDUCATION

Houston Rank

177

EDUCATION

C H I LD R E N

R I S K

TO P

T E N

P R I O R I T Y

High School Rankings (cont.) Houston Rank

Texas Rank

School Name

District

TEXAS TIER 3 59

518

Sweeny High School

Sweeny ISD

526

East Chambers High School

East Chambers ISD

557

Pasadena Memorial High School

Pasadena ISD

559

Hempstead High School

Hempstead ISD

561

Magnolia High School

Magnolia ISD

575

Royal High School

Royal ISD

580

B F Terry High School

Lamar CISD

581

Crosby High School

Crosby ISD

584

Angleton High School

Angleton ISD

601

Macarthur High School

Aldine ISD

613

Deer Park High School

Deer Park ISD

617

Hull-Daisetta High School

Hull-Daisetta ISD

618

Spring Woods High School

Spring Branch ISD

619

La Porte High School

La Porte ISD

621

Columbia High School

Columbia-Brazoria ISD

644

Willis High School

Willis ISD

645

Waltrip High School

Houston ISD

650

Tarkington High School

Tarkington ISD

656

Milby High School

Houston ISD

660

Thurgood Marshall High School

Fort Bend ISD

666

North Shore Senior High

Galena Park ISD

671

Sterling High School

Goose Creek CISD

686

Liberty High School

Liberty ISD

697

Westfield High School

Spring ISD

706

Lamar Cons High School

Lamar CISD

710

Waller High School

Waller ISD

714

Dobie High School

Pasadena ISD

732

Galena Park High School

Galena Park ISD

733

Conroe High School

Conroe ISD

735

Austin High School

Houston ISD

747

Spring High School

Spring ISD

755

Anahuac High School

Anahuac ISD

Houston Rank

Texas Rank

School Name

District

TEXAS TIER 4

178

766

Reagan High School

Houston ISD

801

Taylor High School

Alief ISD

803

Chavez High School

Houston ISD

829

New Caney High School

New Caney ISD

830

Lee High School

Goose Creek CISD

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

TO P

T E N

P R I O R IT Y

834

Alvin High School

Alvin ISD

835

Hardin High School

Hardin ISD

837

Aldine High School

Aldine ISD

839

Caney Creek High School

Conroe ISD

100

843

Hastings High School

Alief ISD

101

852

Ball High School

Galveston ISD

102

869

Klein Forest High School

Klein ISD

103

875

Sam Rayburn High School

Pasadena ISD

104

876

Brazosport High School

Brazosport ISD

105

878

C E King High School

Sheldon ISD

106

879

Dayton High School

Dayton ISD

107

881

Scarborough High School

Houston ISD

108

891

Channelview High School

Channelview ISD

109

894

Nimitz High School

Aldine ISD

110

895

Splendora High School

Splendora ISD

111

916

Elsik High School

Alief ISD

112

918

Santa Fe High School

Santa Fe ISD

113

920

Eisenhower High School

Aldine ISD

114

924

Quest High School

Humble ISD

115

927

Texas City High School

Texas City ISD

116

931

Madison High School

Houston ISD

117

940

South Houston High School

Pasadena ISD

118

941

Worthing High School

Houston ISD

119

946

Dickinson High School

Dickinson ISD

120

950

Cleveland High School

Cleveland ISD

121

952

Washington B T High School

Houston ISD

122

958

Davis High School

Houston ISD

123

962

Humble High School

Humble ISD

124

966

Northbrook High School

Spring Branch ISD

125

968

Pasadena High School

Pasadena ISD

126

973

Westbury High School

Houston ISD

127

975

Willowridge High School

Fort Bend ISD

128

983

Sharpstown High School

Houston ISD

129

987

North Forest High School

North Forest ISD

130

988

Hitchcock High School

Hitchcock ISD

131

991

Furr High School

Houston ISD

132

998

Sterling High School

Houston ISD

133

999

Lee High School

Houston ISD

134

1004

La Marque High School

La Marque ISD

135

1005

Wheatley High School

Houston ISD

136

1007

Girls & Boys Prep Academy

137

1008

Kashmere High School

Houston ISD

138

1009

Yates High School

Houston ISD

139

1010

Clear View Education Center

Clear Creek ISD

140

1013

Jones High School

Houston ISD

CHILDREN AT RISK 2010-2012

EDUCATION

179

EDUCATION

C H I LD R E N

R I S K

TO P

T E N

High School Rankings (cont.) Top 10 Elementary Schools in the Greater Houston Area 2010 1. T H Rogers Elementary (Houston ISD) 2. Barbara Bush Elementary (Houston ISD) 3. Walker Station Elementary (Fort Bend ISD) 4. Henderson J Elementary (Houston ISD) 5. Hamilton Elementary (Houston ISD) 6. Two Dimensions Preparatory Academy (Two Dimensions Preparatory Academy) 7. Commonwealth Elementary (Fort Bend ISD) 8. Tough Elementary (Conroe ISD) 9. West University Elementary (Houston ISD) 10. River Oaks Elementary (Houston ISD)

Top 10 Middle Schools in the Greater Houston Area 2010 1. TH Rogers Sec (Houston ISD) 2. Energized For Excellence Middle School (Houston ISD) 3. Lanier Middle (Houston ISD) 4. Fort Settlement Middle (Ford Bend ISD) 5. Sartartia Middle (Fort Bend ISD) 6. Project Chrysalis Middle (Houston ISD) 7. KIPP Academy Middle School (KIPP Inc. Charter) 8. Westbrook Intermediate (Clear Creek ISD) 9. Briarmeadow Middle School (Houston ISD) 10. Garland Mcmeans Jr High (Katy ISD)

Top 10 Most Improved High Schools in the Greater Houston Area 2010 1. Westbury High School (Houston ISD) 2. Lee High School (Houston ISD) 3. Wheatley High School (Houston ISD) 4. Conroe High School (Conroe ISD) 5. La Marque High School (La Marque ISD) 6. Elsik High School (Alief ISD) 7. Austin High School (Houston ISD) 8. Westside High School (Houston ISD) 9. Willowridge High School (Fort Bend ISD) 10. Kerr High School (Alief ISD) Note: This list represents area high schools that have shown the greatest improvement across the fourteen measures used in the rankings over the past three academic years â&#x20AC;&#x201C; 2006-07, 2007-08, and 2008-09. Campuses with missing data points are excluded. CHILDREN AT RISK used weighted total aggregate zscore values for each campus for each academic year and computed the positive difference across years for total positive change over the last three years.

Top 10 Urban Comprehensive High Schools in the Greater Houston Area 2010 1. Springs High School (Cypress-Fairbanks ISD) 2. Macarthur High School (Aldine ISD) 3. Spring Woods High School (Spring Branch ISD) 4. Waltrip High School (Houston ISD) 5. Milby High School (Houston ISD) 6. North Shore Senior High (Galena Park ISD) 7. Westfield High School (Spring ISD) 8. Galena Park High School (Galena Park ISD) 9. Austin High School (Houston ISD) 10. Reagan High School (Houston ISD) Note: This list represents the top area comprehensive high schools that are located in urban districts and house majority (at least 50%) economically disadvantaged student populations.

180

P R I O R I T Y

CHILDREN AT RISK 2010-2012

C H I L D R E N

R I S K

T E N

P R I O R IT Y

Preparatory Public Schools, were each represented in Greater Houston’s top ten high school list: KIPP Houston High School (#4), Harmony Science Academy-Houston (#5), and YES Prep-Southeast Campus (#6). However, a disproportionate number of Greater Houston Area high schools (around 36%) fall in the bottom quartile, or fourth tier, in the state. This disparity increases when looking at economically disadvantaged high school students, nearly half of whom are enrolled in ‘Tier 4’ high schools.

EDUCATION

In the Greater Houston Area, small, theme-based schools were found at the top of the rankings alongside more traditional, comprehensive schools with high affluence. The top-rated area high schools in 2010 included three HISD magnets: DeBakey High School for Health Professions (#1), Carnegie Vanguard (#2), and High School for the Performing and Visual Arts (#8), and an internal charter, Eastwood Academy (#7). Three highly-regarded open-enrollment charter school systems originating in Houston, Knowledge Is Power Program (KIPP) Inc. Charter, Harmony Science Academy, and YES

TO P

CHILDREN AT RISK encourages parents to utilize the school rankings as an advocacy tool to better understand the performance of their local schools and demand improvement. Policy Implication The CHILDREN AT RISK Public School Rankings are designed to serve as a resource for parents, service providers, educators, policymakers, and other community members on the performance of schools in the Greater Houston Area and across Texas. Thus far, school and district administrators have utilized the school rankings to spur further data analysis, inform teacher and staff professional development, and target school interventions. The school rankings have also encouraged parents to contact their school or district; have conversations with neighbors, the Parent-Teacher Organization, and school board candidates on the quality of public schools; and informed decisions of where to send their children to school. CHILDREN AT RISK encourages parents to utilize the school rankings as an advocacy tool to better understand the performance of their local schools and demand improvement. Furthermore, by examining the characteristics of the high performing schools in the school rankings, particularly those serving diverse or disadvantaged student populations, we may uncover and learn from what works in our public education system. Among the high performing schools in the 2010 school rankings, common themes include small theme-based learning communities, more time on task, effective teachers, and high expectations for all students.

CHILDREN AT RISK 2010-2012

181

EDUCATION

Advanced Placement and International Baccalaureate Indicator: The percentage of 11th and 12th grade Houston ISD students who scored at or above the criterion for passing an AP or IB exam Year

1995

1996

1997

1998

1999

2000

2001

Indicator

68.6%

71.0%

71.6%

73.1%

70.6%

70.5%

66.5%

Year

2002

2003

2004

2005

2006

2007

2008

Indicator

64.0%

66.8%

59.1%

54.7%

54.1%

50.5%

51.2%

Source: Academic Excellence Indicator System, Texas Education Agency

Indicator: The percentage of 11th and 12th grade students in the Greater Houston Area (Region 4) who scored at or above the criterion for passing an AP or IB exam Year

1995

1996

1997

1998

1999

2000

2001

Indicator

68.6%

71.0%

71.6%

73.1%

70.6%

70.5%

66.5%

Year

2002

2003

2004

2005

2006

2007

2008

Indicator

68.4%

67.1%

64.5%

62.1%

61.0%

59.5%

58.3%

Source: Academic Excellence Indicator System, Texas Education Agency

• Advanced Placement (AP) exams allow high school students the opportunity to receive credit or advanced placement at over 90% of the universities in the country. • The AP and IB examinations allow high school students to get a head start on college-level coursework and to improve their writing skills and problem-solving techniques. • The percentage of students passing the AP and IB examinations has decreased over the past few years in the state of Texas.

Advanced Placement (AP) exams allow high school students the opportunity to receive credit or advanced placement at over 90% of the universities in the country. There are more than 30 AP courses and exams across multiple subject areas. Different high schools offer varying AP classes in literature, languages, history, and math.184 The International Baccalaureate Organization is a nonprofit educational foundation established in Geneva, Switzerland in 1968.185 The purpose of the organization is to promote quality education to children around the world.186 Students aged 16-19 are allowed to take Diploma Programme courses and in some cases receive International Baccalaureate (IB) diplomas.187 At the end of the course examinations or two-year course study, students can take IB examinations; the IB diploma is awarded to students who gain at least 24 points on these examinations.188 College recognition of the IB diploma may be in the form of recruitment, admission, placement, credit and/or scholarships, depending on the institution’s policies.189 Currently there are six public high schools in Harris County that of-

182

fer IB courses and diplomas: Bellaire High School, Dwight D. Eisenhower High School, Humble High School, Klein Oak High School, Mirabeau B. Lamar Senior High School, and Westchester Academy for International Studies.190 The AP and IB examinations allow high school students to get a head start on college-level coursework and to improve their writing skills and problem-solving techniques. Research has established a strong relationship between student participation in AP and IB programs and future college success. A 2008 study found that AP students had better four-year college graduation rates than those students who did not take AP.191 Completion of college within four years represents a significant cost savings to students. Similarly, the Educational Policy Improvement Center reported in 2009 that IB standards are highly aligned with the Knowledge and Skills for University Success (KSUS) college-ready standards, indicating that “…students who learn IB curriculum in high school enter college with the type of knowledge and skills not only expected by college faculty but also with skills known to promote academic

CHILDREN AT RISK 2010-2012

The indicator percentages tracked come from the Texas Education Agency (TEA) and are calculated by the number of AP and IB examinees scoring at or above the criterion, on at least one exam, out of the total number of AP and IB examinees.193 The percentage of students passing the AP and IB examinations has decreased over the past few years in the state of Texas. In 1997, 71.2% of students in HISD taking AP or IB exams passed at least one exam. Over the years, there has been a steady decline in the number of students passing exams, although more students are taking the test on a yearly basis than when the test was first offered. In 2008, just slightly more than half (50.1%) of students who took an AP or IB exam passed at least one exam.194 Students in the Greater Houston Area

passed these exams at a rate slightly higher than the state average, but these numbers have also decreased over the past three years. In 2008, 58.3% of students in the Greater Houston Area who took an AP or IB exam passed at least one, compared to 50.1% of students in Texas.195 When considering these numbers, it is important to take into account how the numbers of students taking the AP and IB exams changes each year. The number of examinees has been increasing in Texas due to the additional state funding appropriated by the 79th Texas Legislature in 2005 to the TEA for the AP/IB Incentive Program. In 2008, 24.1% of all HISD students took the AP and IB exams; this is more than double the percentage of students who took exams in 2000 (11.2%).196

EDUCATION

success in entry-level courses.”192

GREATER HOUSTON AREA AP/IB TEST TAKERS VS. PASSING RATES, 1995-2008 80% 70% 60% 50%

Test Takers

40% 30% 20%

Passing Rate

10% 0%

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

The state legislature should continue to fund the AP/IB Incentive Program to encourage continued participation in the AP and IB exams. Policy Implication The pressure to improve high school students’ academic results has led many schools and districts to encourage the enrollment of more students in advanced courses; business and state policy leaders have supported this practice.197 However, schools must be careful to ensure that students actually learn the advanced content implied by the course labels. Lack of student academic preparation and teacher capacity has led many schools and districts to relax standards so that students can pass the course and graduate.198 This practice appears to be most prevalent with low-income and minority students. This is especially disturbing in light of research indicating that the percent of a school’s students who take and pass AP exams is the best AP-related indicator of whether the school is preparing its students to graduate from college.199

CHILDREN AT RISK 2010-2012

183

EDUCATION

Gifted and Talented Students Indicator: The percentage of students enrolled in Gifted and Talented programs in Harris County public schools Year

1990-91

1994-95

1998-99

2000-01

2001-02

2002-03

2003-04

Indicator

7.3%

7.1%

8.1%

8.2%

7.2%

7.0%

7.1%

Year

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

7.2%

7.3%

7.4%

7.3%

7.4%

7.7%

Source: Texas Education Agency

• Gifted and Talented programs are required in all Texas public school districts. • The largest groups of students who participate in the Gifted and Talented program in Harris County are Asian and Anglo students. • During the last two decades figures of participation in Gifted and Talented programming has not increased significantly for minority students.

In Texas, Gifted and Talented programs are required in all public school districts. The state defines a “gifted and talented student” as a child or youth who performs at or shows the potential for performing at a remarkably high level of accomplishment when compared to others of the same age, experience, or environment and who: (a) exhibits high performance capability in an intellectual, creative, or artistic area; (b) possesses an unusual capacity for leadership; (c) excels in a specific academic field.200

184

can be included in the regular school day may include a combination of following: (a) interdisciplinary curriculum; (b) special units from the each of the areas; (c) differentiation of each of the core areas in regular classes; (d) acceleration in a discipline that is a particular area of strength; (e) Advanced Placement (AP) and International Baccalaureate (IB) classes with appropriate modification for Gifted/ Talented students; (f) Independent Study courses; (g) dual/ concurrent enrollment; and (h) and Education Service Center (ESC) seminars.203

The Texas Legislature passed legislation for the first time regarding the education of gifted students in 1977. In 1979, state funds for providing services to gifted children were made available, but providing such services was optional for school districts. In 1987, The Texas Legislature mandated that all school districts identify and serve gifted students at all grade levels. In 1990, The Texas State Plan for the Education of Gifted/Talented Students was adopted, and in 1999 the Texas Performance Standards Project for Gifted/Talented Students was created. The identification process for recognizing gifted and talented students consists of teacher recommendations and evaluations, achievement and aptitude tests, and/or good grades.201 School districts are not required to reassess students once they are identified for services in the Gifted/Talented program. The students remain in the program unless they choose to exit.202

Gifted and talented students may be served in a regular classroom if the classroom teacher has 30 hours of professional development in gifted education and an additional six hours of professional development annually in gifted education. But the key issue is whether or not the teacher has time and/or resources to provide instructions and guidance for gifted and talented students at an appropriately challenging level. Administrators and counselors who are responsible for programming decisions for gifted and talented students are required to receive six hours of professional development that includes nature and needs of gifted and talented students and program options for those students. Any campus or district level administrator (including the superintendent) or counselor who has authority to make scheduling, hiring, and/or program decisions should also have the six hours of training.

Students may be identified by one or more of four core areas of language arts, mathematics, science, and social studies. There are many ways to allow students to do advanced work reflecting depth and complexity within the general school curriculum. Examples of learning opportunities that emphasize content from the four areas and that

According to the National Association for Gifted Children, gifted children spend 80% of their time in the regular classroom, yet only 61% of classroom teachers have had any training in meeting their needs.204 As a result, and also as a result of achievement tests that can leave their talents undetected, many potentially gifted students go un-

CHILDREN AT RISK 2010-2012

GIFTED AND TALENTED STUDENTS IN HARRIS COUNTY PUBLIC SCHOOLS BY RACE/ETHNICITY, 2009-2010 SCHOOL YEAR 20% 17.5%

18% 16% 14%

12.3%

12%

EDUCATION

Students in Houston ISD are nearly twice as likely to be enrolled in Gifted and Talented programs as are students statewide (12.5% versus 7.5% in 2009).

10%

recognized. Currently, the largest groups of students who participate in the Gifted and Talented program in Harris County are Asian and Anglo students at rates of 17.5% and 12.3%, respectively, compared with relatively low rates of participation among Latino (5.9%), African American (4.7%), and Native American (6.7%) students. During the last two decades, these figures have not increased significantly for minority students.205 In 2008, Congress allocated $7.5 million for the Jacob K. Javits Gifted and Talented Students Education Act, which funds the National Research Center on the Gifted and Talented and funds grants that focus on identifying and serving students who are traditionally under-represented in gifted and talented programsâ&#x20AC;&#x201D;students from culturally, linguistically, and ethnically diverse backgroundsâ&#x20AC;&#x201D;to help reduce gaps in achievement and to encourage the establishment of equal educational opportunities for all U.S. students.

8% 6%

4.7%

5.9%

6.1%

Latino

Native American

4% 2% 0% African American

Asian

Anglo

In Harris County, 7.7%, or 62,159 students, students were enrolled in the Gifted and Talented program during the 2009-2010 school year.206 During the 2007-2008 school year, Harris County school districts spent a total of $64,119,067 on the Gifted and Talented program, 0.8% of total expenditures.207

CHILDREN AT RISK 2010-2012

185

EDUCATION

College Admissions Testing Indicator: The mean ACT score for graduates in the Greater Houston Area (Region 4) Year

1992

1994

1996

1998

2000

2001

2002

2003

2004

2005

2006

2007

2008

Indicator

20.5

20.8

20.7

20.8

20.7

20.3

20.6

20.5

20.8

21.2

Source: Academic Excellence Indicator System, Texas Education Agency

Indicator: The mean SAT score for graduates in the Greater Houston Area (Region 4) Year

1992

1994

1996

1998

2000

2001

2002

2003

2004

2005

2006

2007

2008

Indicator

882

897

1006

1003

1001

1000

1004

1000

1004

1003

1002

994

Source: Academic Excellence Indicator System, Texas Education Agency

• Texas continues to rank in the lowest quartile for average SAT scores, in 2009 ranking 45th in mean SAT scores. • In 2009 Texas ranked 35th in mean ACT scores. • While minorities continue to be underrepresented in higher education, an impressive 54% of 2009 college-bound SAT takers in Texas were from minority backgrounds, indicating the potential of college-bound minority students.

The SAT is a nationally recognized college admission test that examines a prospective student’s ability in math, reading and writing. Almost all colleges and universities in the United States accept SAT scores to use as a variable in the selection of incoming students.208 Similar to the SAT, the ACT test assesses a prospective college student’s knowledge and readiness for higher learning. The multiple choice section of the ACT examines skills based on four educational areas: reading, math, science, and English. The test also includes an optional short essay section.209 In March of 2005, The College Board fully implemented a new 800 point writing section of the SAT to better reflect a student’s written understanding and expression. The addition of the writing section increased the maximum test score from 1600 to 2400.210 Also in 2005, the math and reading components were altered to cover current high school curriculum. Within the math section, quantitative comparisons were removed and new questions were created to cover areas typically taught during junior high school math classes. Analogies were also removed from the reading component of the exam, which now includes short and long reading passages.211 Through two comprehensive studies performed by the College Board and the University of California (Validity of the SAT for Predicting First-Year College Grade Point Average and Differential Validity and Prediction of the SAT), the adjustments to the

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SAT exam were found to improve its validity and prediction of a college-ready student.212 Over the past three years, the average verbal, math, and writing scores for Texas students have dropped slightly. For example, the average verbal score has dropped from 492 in 2007 to 486 in 2009, while the average math score has only dropped one point over the past three years (502 in 2007 to 501 in 2009). The Texas student test scores for the relatively new writing section have also experienced a decline, dropping from 482 in 2007 to 475 in 2009. All three average test scores for Texas students consistently fall below test scores of students nationally. In 2009, Texas students’ verbal, math and writing scores stood 15, 9 and 18 points below the national average, respectively.213 Furthermore, the overall mean SAT score for the class of 2009 in Texas was 1467, 42 points below the national average score of 1509. Texas reports a state average for combined reading and math scores of 992, while the national average in reading and math was 1016 for the class of 2009. 214 With a mean score of 994 for the class of 2008, the Greater Houston Area also falls below the national average.215 When comparing mean SAT scores of the graduating class of 2009 for all 50 states, Texas continues to rank in the lowest quartile. In fact, the state was ranked the lowest it has been in 4 years at 45th in the nation.216

CHILDREN AT RISK 2010-2012

EDUCATION

Unlike the SAT, the ACT tests a student’s educational development through four curriculum-based skill areas: English, mathematics, reading, and science, along with an optional writing section. 217 The ACT was first administered in 1959 and currently stands as the entrance exam preferred by most four-year colleges. Many students feel more comfortable taking the ACT over other entrance exams because of its similarity to content taught in high school. 218 In 2009, the national average ACT composite score was 21.1 out of 36 possible points.219 The ACT reports “College Readiness Benchmark Scores” that signify the “minimum score needed on an ACT subject-area test to indicate a 50% chance of obtaining a B or higher or about a 75% chance of obtaining a C or higher in the corresponding credit-bearing college courses, which include English Composition, Algebra, Social Science and Biology.”220 Twenty-three percent of Texas high school graduates in 2009 who took the ACT met all four of the College Readiness Benchmarks.221 Texas ranks as one of the top five states in numbers of ACT-tested high school graduates.222 Both the national and Texas average ACT scores have remained steady over the past three years, and Texas ranks similarly to national

Mean SAT Score by Race/Ethnicity for Greater Houston area (Region 4) and Texas Class of 2003

Class of 2004

Class of 2005

Class of 2006

Class of 2007

Class of 2008

Region 4

Texas

Region 4

Texas

Region 4

Texas

Region 4

Texas

Region 4

Texas

Region 4

Texas

Asian American

1091

1074

1071

1070

1098

1095

1097

1096

1091

1095

1093

1100

Anglo

1070

1054

1066

1050

1079

1059

1074

1059

1074

1056

1075

1060

Latino

907

911

905

913

916

902

921

903

927

914

918

897

African American

854

841

850

843

858

855

862

860

866

867

853

855

Source: Academic Excellence Indicator System, Texas Education Agency

Comparison of Verbal, Math, and Writing SAT Scores Class of

Verbal

Math

Writing

Texas

National

Texas

National

Texas

National

2003

493

507

500

519

2004

493

508

499

518

2005

493

508

502

520

2006

491

503

506

518

487

497

2007

492

502

507

515

482

494

2008

488

502

505

515

480

494

2009

486

501

506

515

475

493

Source: Texas and College Bound Seniors, 2006, 2007, 2008, 2009, College Board

CHILDREN AT RISK 2010-2012

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EDUCATION

College Admissions Testing (cont.) ACT Comparison Class of

Texas

National

2003

20.1

20.8

2004

20.2

20.8

2005

20.2

20.9

2006

20.3

21.1

2007

20.5

21.2

2008

20.7

21.1

2009

20.8

21.1

Source: ACT High School Profile Report, The Graduating Class of 2007: Texas. ACT, Inc.

standings. Compared to all 50 states, Texas is ranked 35th in the average ACT score for the class of 2009, a slight improvement from the SAT state rankings mentioned earlier.223 In 2009, Texas students scored an average of 20.8 on the ACT, while nationally students scored a 21.1 average. Only 22% of Texas students from the graduating class of 2009 taking the ACT met all four benchmarks, compared to 23% of students nationally.224 Furthermore, only 63% of test-takers in Texas were considered prepared for college-level English Composition, 44% were ready for Mathematics, 49% prepared in Reading, and 26% in Science.225 High school graduates from the class of 2008 in the Greater Houston Area achieved an average ACT

score of 21.2, comparable to the Texas and national score averages.226 Minority and low-income students continue to be underrepresented in higher education. In particular, AfricanAmerican and Hispanic minorities continue to fall behind their peers in test scores. For the class of 2008, AfricanAmerican students in Texas scored, on average, over 200 points less on the SAT than white students, while Hispanic students scored an average of 163 points less than white students.227 For the past five years (2005-2009), the ACT average test scores have shown a similar pattern with African-American and Hispanic students scoring approximately 5 and 4 points lower, respectively, than white students.228 However, minority SAT testing participation has gradually increased nationally and in Texas. In the United States, 39% of 2009 college-bound seniors who took the SAT were minority students.229 Fifty-four percent of 2009 college-bound seniors taking the SAT in Texas were of minority backgrounds.230 While this large percentage may partly be a factor of Texasâ&#x20AC;&#x2122; demographics, it does indicate the potential of college-bound minority students. Texas must focus on improving college readiness and ensure preparation to raise its lagging SAT and ACT scores in addition to combating the continued underrepresentation of minorities in higher education.

In 2009, Texas ranked 35th in mean ACT scores and 45th in mean SAT scores out of 50 states and the District of Columbia. Policy Implication The SAT and ACT scores of Texas students continue to fall within the bottom half of the nation. In addition, minority students continue to suffer from underrepresentation in higher education. In order to increase the quantity of students on the college track and to ensure that they are fully prepared, Texas must focus particular attention to the improvement of college admission testing attendance and scores. With college readiness in mind, Texas must strive to challenge high school students to a new level, leaving them with the skills necessary for success throughout college and into their professional lives.

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Indicator: The percentage of students in Harris County meeting the panel recommendation standard on the Texas Assessment of Knowledge and Skills (TAKS) in all subjects and in all grades Year

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

46%

55%

59%

62%

66%

70%

72%

76%

Source: Texas Education Agency

EDUCATION

Student Assessment: TAKS

• All students must pass the TAKS for English Language Arts, Mathematics, Science, and Social Studies in the 11th grade to be eligible to graduate. • Asian students are consistently more likely to meet the Panel Recommendation and Commended Performance benchmarks at rates of 92% and 37% respectively. • End of Course Assessments are currently voluntary, but will be required of students taking these courses starting with the freshman class of 2011-2012.

In 1999, the 76th Texas Legislature established the Texas Assessment of Knowledge and Skills (TAKS) to test the Texas Essential Knowledge and Skills (TEKS). TEKS is the state-mandated basic curriculum that determines the objectives and guidelines of the TAKS. The TAKS was first administered in the 2002-2003 school year, replacing and improving upon the Texas Assessment of Academic Skills (TAAS) exams.231 Pearson Educational Measurement, the Texas Education Agency, and Texas Educators collaborated to create the TAKS. The TAKS is administered to students in grades 3 through 11 each year. Reading is given in grades 3 through 9, Mathematics in grades 3 through 10, Writing in grades 4 and 7, and Science in grades 5 and 8. Spanish versions were previously available for grades 3 through 6, but are

now only available through grade 5.232 Students must pass their reading and mathematics TAKS in fifth and eighth grade to advance to the next grade. 233 Students in third grade no longer need to pass their reading TAKS to advance as was previously required.234 All students must pass the TAKS for English Language Arts, Mathematics, Science, and Social Studies in eleventh grade to be eligible to graduate. Various retesting opportunities are available to those who fail on their initial attempt.235 Modified versions are available for students receiving special education services.236 In 2010, 76% of students in Harris County met the Panel Recommendation standard on the Texas Assessment of Knowledge and Skills across all grades and subjects, as did 76% of students statewide. The Harris County figure

Percentage of Students Meeting ‘Panel Recommendation’ and ‘Commended Performance’ Standards on TAKS in Harris County by Grade 3rd Grade

Year

Panel Rec.

Commended

5th Grade

Panel Rec.

8th Grade

Commended

Panel Rec.

Commended

11th Grade

Panel Rec.

Commended

2002-03

67%

11%

33%

47%

37%

2003-04

77%

16%

47%

52%

54%

2004-05

79%

17%

59%

10%

56%

58%

2005-06

79%

20%

68%

10%

44%

63%

2006-07

80%

20%

72%

13%

52%

67%

2007-08

82%

21%

76%

16%

65%

12%

72%

2008-09

83%

27%

78%

19%

68%

13%

76%

11%

2009-10

84%

26%

83%

20%

75%

14%

83%

10%

Source: Texas Education Agency

CHILDREN AT RISK 2010-2012

189

EDUCATION

Student Assessment: TAKS (cont.) marks of the TAKS across racial groups. Asian students are consistently more likely to meet the Panel Recommendation and Commended Performance benchmarks at rates of 92% and 37%, respectively, followed by Anglo students, 88% of whom met Panel Recommendation and 25% of whom met Commended Performance in the 2010 administration of the TAKS. They are followed by Latino students (73% Panel Recommendation and 10% Commended), Native American students (74% Panel Recommendation and 14% Commended), and African American Students (66% Panel Recommendation and 8% Commended). Although the gap between Asian and African American student pass rates (at Panel Recommendation) shrank from 39% in 2003 to 26% in 2010, the gap between these groups actually increased when looking at the more stringent Com-

In 2010, 76% of students in Harris County and 76% statewide met the Panel Recommendation standard on the TAKS test. represents an increase from the previous year (72%) and follows an upward trend of students meeting the Panel Recommendation standard on the TAKS since its first implementation in 2003 (46%). However, as in 2003, significant disparities currently exist in meeting the Panel Recommendation and Commended Performance bench-

Students Meeting â&#x20AC;&#x2DC;Panel Recommendationâ&#x20AC;&#x2122; Standard on TAKS All Grades, All Tests, by District District

2003

2004

2005

2006

2007

2008

2009

Aldine

Alief

Channelview

Crosby

Cypress-Fairbanks

Deer Park

Galena Park

Goose Creek

Houston

Huffman

Humble

Katy

Klein

La Porte

North Forest

Pasadena

Sheldon

Spring

Spring Branch

Tomball

Average Score:

Source: Academic Excellence Indicator System, Multi-Year History, Texas Education Agency

190

CHILDREN AT RISK 2010-2012

100% 80% 60% 40% 20% 0%

African American

2002 - 03

Anglo

Latino

Asian

mended Performance benchmark, growing from 10 to 29 percentage points.237 Senate Bill 1031 of the 2007 Legislature added End of Course Assessments to the graduation requirements, including tests in Algebra I, Algebra II, Geometry, Biology, Chemistry, Physics, English I, English II, English III, World Geography, World History and United States History. By the spring of 2010, seven tests were in place and two were being field-tested. End of Course Assessments are currently voluntary, but will be required of students taking these courses starting with the freshman class of 2011-2012.238

EDUCATION

Percentage of students in Harris county meeting the â&#x20AC;&#x153;panel recommendationâ&#x20AC;? standard on taks in all grades and all subjects by race/ethnicity

Native American

2009 - 10

Texas must continue to improve its public education for its students and should shift the focus from testing to actual learning. Policy Implication Attaining Panel Recommendation on the Texas Assessment of Knowledge and Skills test is not a true indication of the quality of education that our children receive. Texas must continue to improve its public education evaluation system if its students are to be competitive with those from other states and countries in the global marketplace. By shifting the focus of curriculum in Texas from a yearly test to actual learning could result in significant overall improvement in the school system, as administrators, teachers, and students would not be under the pressure inherent in such a highstakes test.

CHILDREN AT RISK 2010-2012

191

EDUCATION

Math and Science IndicatorS 5th Grade Math: Percentage of Harris County students who met Panel Recommendation on 5th Grade math TAKS Year

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

64%

71%

87%

89%

91%

90%

91%

93%

Source: Texas Education Agency

8th Grade Math: Percentage of Harris County Students who met Panel Recommendation on 8th Grade math TAKS Year

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

51%

56%

60%

67%

72%

82%

85%

88%

Source: Texas Education Agency

11th Grade Math: Percentage of Harris County Students who met Panel Recommendation on 11th Grade math TAKS Year

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

50%

69%

71%

76%

79%

80%

82%

89%

Source: Texas Education Agency

5th Grade Science: Percentage of Harris County Students who met Panel Recommendation on 5th Grade science TAKS Year

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

37%

53%

61%

72%

76%

82%

84%

88%

Source: Texas Education Agency

8th Grade Science: Percentage of Harris County Students who met Panel Recommendation on 8th Grade science TAKS Year

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

49%

57%

70%

73%

79%

Source: Texas Education Agency

11th Grade Science: Percentage of Harris County Students who met Panel Recommendation on 11th Grade science TAKS Year

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

Indicator

53%

64%

70%

74%

76%

81%

86%

92%

Source: Texas Education Agency

• U.S. students score significantly lower than their peers in Asian and European countries in mathematics and science. • In Harris County, 93% of fifth grade and 88% of eighth grade students performed at the ‘Panel Recommendation’ benchmark on the math section of the TAKS in 2010, compared with 92% of fifth graders and 87% of eighth graders statewide.

192

CHILDREN AT RISK 2010-2012

Debakey High School for Health Professionals was identified as the top high school for math and science in the Greater Houston Area. ministration of this study in 2007, U.S. fourth-graders were significantly outperformed by eight European and Asian nations in mathematics and four Asian nations in science. By eighth grade, U.S. students scored significantly lower than their peers in five Asian nations in mathematics and nine Asian and European nations in science. Nations that consistently outperformed U.S. students in math and science include Singapore, Chinese Taipei, and Japan.239 In Texas, performance in mathematics and science in public schools is primarily measured for accountability purposes through the Texas Assessment of Knowledge and Skills (TAKS). This examination is administered in grades three through eleven in Mathematics and in grades five, eight, ten, and eleven in Science. In third through eighth grades, Texas students’ mathematics skills were tested in the following areas in 2010: numbers, operations, and quantitative reasoning; patterns, relationships, and algebraic reasoning; geometry and spatial reasoning; concepts and use of measurement; probability and statistics; and mathematical processes and tools.240 In Harris County, 93% of fifth grade and 88% of eighth grade student performed at the ‘Panel Recommendation’ benchmark on the math section of the TAKS in 2010, compared with 92% of fifth graders and 87% of eighth graders statewide. In secondary grades (nine through eleven), the following objectives were covered in the mathematics section of the 2010 TAKS: functional relationships; properties and attributes of functions; linear functions; linear equations and inequalities; quadratic and other nonlinear functions; geometric relationships and spatial reasoning; two- and three-dimensional representations; measurement and similarity; percents, proportions, probability, and/or statistics; and, mathematical processes and tools.241 For the exit-level TAKS examination (Grade 11), 89% of Texas

students met the panel recommendation in Mathematics (the lowest passing rate for any subject area) as well as 89% of Harris County eleventh-graders. Harris County students’ performance on the Mathematics section of the TAKS has increased over time as passage rates were in the 50-60% range in the 2002-2003 school year and now hover around 90%. In fifth grade, science subjects covered on the Texas Assessment of Knowledge and Skills include nature of science, life sciences, physical sciences, and earth sciences.242 In 2010, 88% of Harris County fifth grade students and fifth graders statewide met panel recommendation. In eighth grade, students are tested on the following items: nature of science; living systems and the environment; structures and properties of matter; motion, forces, and energy; and earth and space systems.243 In 2010, 78% of Texas eighth-graders met the panel recommendation standard in TAKS Science, compared to 79% of Harris County eighth grade students. For the exit-level science exam, eleventh-graders in Texas are tested on their knowledge and skills in the following areas of scientific inquiry: nature of science; organization of living systems, interdependence of organisms and the environment; structures and properties of matter; and, motion, forces, and

EDUCATION

Considering the demands of the global economy of the 21st century, the importance of exceptional math and science education in primary and secondary grades cannot be understated. The Trends in International Mathematics and Science Study (TIMSS) has measured the math and science knowledge and skills of fourth and eighth graders around the world since 1995. According to the most recent ad-

Top 10 High Schools for Math & Science in the Greater Houston Area, 2010 Houston Rank

Campus

District

Debakey High School For Health Professions

Houston ISD

Clements High School

Fort Bend ISD

Carnegie Vanguard High School

Houston ISD

Kerr High School

Alief ISD

Cinco Ranch High School

Katy ISD

Memorial High School

Spring Branch ISD

Taylor High School

Katy ISD

Stephen F Austin High School

Fort Bend ISD

Bellaire High School

Houston ISD

Dulles High School

Fort Bend ISD

Note: This list represents the top area high schools in math and science. This ranking examined math and science specific college readiness indicators, including advanced course offerings, AP math/science participation and success rates, and performance on the math and science sections of college entrance exams.

CHILDREN AT RISK 2010-2012

193

EDUCATION

Math and Science (cont.)

energy.244 Ninety-one percent of eleventh grade students statewide ‘Met Standard’ on the exit-level science portion of the TAKS as compared to 92% of Harris County eleventh graders. For the first time, CHILDREN AT RISK produced a list of the “Top 10 High Schools in Math and Science” for the Greater Houston Area in 2010 as part of its annual “School Rankings.” To gauge excellence in secondary math and science education, CHILDREN AT RISK developed a weighted index comprised of thirteen measures: ‘Commended Performance’ rate on the exit-level TAKS Mathematics; ‘Commended Performance’ rate on the exit-level TAKS Science; advanced course offerings in mathematics and science; percentage of students (grades 11-12) taking an AP examination in a math subject; passing rate of AP mathematics test-takers; percentage of students (grades 11-12) taking an AP examination in a science subject; passing rate of AP science test-takers; graduation rate;

194

percentage of graduates taking the SAT or ACT college entrance examination; mean score on the Mathematics section of the SAT; mean score on the Mathematics section of the ACT; mean score on the Science section of the ACT; and the percentage of students who are economically disadvantaged. All data used in this analysis was reported by the Texas Education Agency, and campuses with missing data were excluded. Based on these measures, the ‘Top 10’ area high schools in math and science were identified as follows: (1) Debakey High School For Health Professions, Houston ISD; (2) Clements High School, Fort Bend ISD; (3) Carnegie Vanguard High School, Houston ISD; (4) Kerr High School, Alief ISD; (5) Cinco Ranch High School, Katy ISD; (6) Memorial High School, Spring Branch ISD; (7) Taylor High School, Katy ISD; (8) Stephen F Austin High School, Fort Bend ISD; (9) Bellaire High School, Houston ISD; and, (10) Dulles High School, Fort Bend ISD.

CHILDREN AT RISK 2010-2012

Policy Implication

EDUCATION

Curriculum for math and science needs to be expanded to include hands-on experiential learning techniques and more time on task.

Trends in Harris County show that the percentages of students who are meeting panel recommendation on TAKS are increasing, but the standards need to be reexamined to ensure that students are truly learning the necessary knowledge and skills in math and science. Although students are performing well on standardized tests, curriculum for math and science needs to be expanded to include hands-on experiential learning techniques and more time on task. In addition, the global economy demands students with exceptional abilities in math and science. Young students who have a strong foundation in math and science have numerous opportunities in both higher levels of education as well as the job market, as long as these subjects are being adequately taught and tested at the secondary school level.

CHILDREN AT RISK 2010-2012

195

EDUCATION 196

Agenda for Change Early Childhood Education Teacher Preparation • Increase payment made under the child care • Provide incentives to exceptional teachers to work in subsidy program to the market rate so that child high needs schools and/or subjects, such as those in care facilities are better equipped to have appropri- high poverty neighborhoods, bilingual classrooms, ate child-to-staff ratios, qualified staff, and necessary and science and mathematics courses. equipment. • Mandate behavior management training for teachers • Implement universal pre-kindergarten to provide to help decrease disciplinary problems in the equality of access to parents that do not meet income classroom, and encourage school districts to limit guidelines or are unable to pay the costs of private the number of discretionary referrals to Alternative child care. Increase access to full day programs to Education Programs (AEPs). In Greater Houston, allow parents to continue to work during the day and 68% of the 20,982 removals to alternative disciplinary provide financial flexibility for their family. sites were discretionary. • Continue to push for federal support of the Head College Readiness Start program so that parents with children living • Continue to provide an array of opportunities and at or near the poverty line can have access to child encouragement for students to pursue college-level care. Increase salaries of Head Start and pre- course Placement examinations and Dual Credit kindergarten teachers to be comparable with the pay programs. levels of other teachers. • Encourage all students to prepare for college Dropout Prevention admissions, including taking college entrance • Continue to support the state and school districts as examinations, completing college-level coursework, they develop early warning systems to identify visiting college campuses, and completing college students who are at risk of dropping out of school. admittance and financial aid applications. • Support evidence-based strategies for improving the • Measure and monitor ‘college-ready’ benchmarks, graduation rates of disadvantaged students to improve rather than minimum standards, on student the academic progress of the rising number evaluations and assessments, including the Texas of students at risk of dropping out of school. Assessment of Knowledge and Skills (TAKS). • Encourage the Texas Education Agency to reexamine Support of Educational Programs its graduation rate calculation in Texas and the • Continue supporting the development of Career and method in which it removes “leavers” from the Technical Education programs that align with college cohort. By removing students from the cohort and career expectations of the 21st century workforce. without adequate documentation, graduation rates • Monitor the enrollment of economically disadvantaged for school districts are improperly increased. and minority youth in educational programs, such Expanded Learning Time as Gifted and Talented and Career and Technical • Extend learning time (i.e. longer day or longer year) Education, to ensure that they are equally represented for Houston’s students to foster higher achievement and have full access to the benefits of these programs. in five key ways: increasing time on task, broadening • Encourage the implementation of dual language and deepening coverage of curriculum, providing bilingual programs to support the academic growth of more opportunities for experiential learning, Limited English Proficient students across core strengthening ability to work with diverse ability subject areas. levels simultaneously, and deepening adult-child relationships. • Ensure funding for extended learning opportunities, especially for low-income and at-risk students, to lessen the summer learning loss, provide enrichment opportunities, and increase student achievement.

CHILDREN AT RISK 2010-2012

CONCLUSION

A B O U T

C H I L D R E N

For more than twenty years CHILDREN AT RISK has been speaking out and driving change for children in Texas. With the release of this eleventh edition of Growing Up in Houston: Assessing the Quality of Life of Our Children, CHILDREN AT RISK continues to highlight the critical issues facing our children. Indeed, it is only once we know where the problems lie, that we can properly work to improve them. Our intention is for this publication to continue to be the most accurate and comprehensive source of information concerning local youth for service providers, policymakers, and advocates. Over time, this book has also provided CHILDREN AT RISK with the data needed to support and expand its own efforts to improve the lives of children across Texas. Among the ways in which CHILDREN AT RISK has increased its influence is through the creation of the Public Policy and Law Center, the CHILDREN AT RISK Institute, the Latino Children’s Health Initiative, the Center to End the Trafficking and Exploitation of Children, extensive outreach through the media, and community education events. The most notable development in the last few years has been the establishment of CHILDREN AT RISK’s Public Policy and Law Center (PPLC). The PPLC has allowed CHILDREN AT RISK to address some of the most pressing issues facing children through legislation and other legal advocacy measures. In the Houston area, there are more than forty lawyers from major law firms and corporations in the community who serve on CHILDREN AT RISK’s Law Advisory Board. With their guidance, in 2010 the PPLC submitted an amicus brief in a Texas Supreme Court case on behalf of a minor domestic trafficking victim. The Court ruled in favor of the victim and specifically held that minors under the age of 14 cannot be convicted of prostitution. This decision was a major victory for minor trafficking victims and a step forward in the campaign to recognize all children of commercial sexual exploitation as victims, as opposed to criminals. The organization’s Public Policy Advisory Board, comprised of more than twenty-five leaders from Houston’s public policy and non-profit community, has also provided invaluable guidance to the organization on the needs of the community and opportunities for policy change. Under their direction, the organization triumphed in leading a collaborative effort in 2008 to establish a juvenile mental health docket in Harris County to divert youth with mental health needs to wraparound services outside of the juvenile justice system. In 2007, the PPLC instituted its Legislative Fellows Program, which recruits lawyers from across Texas every two years to commit over one hundred pro bono hours each to draft policy briefs and legislation in preparation

198

A T

R I S K

for the legislative session. Collectively, these Legislative Fellows, in conjunction with the CHILDREN AT RISK staff, have prepared nearly twenty proposed bills aimed at improving the lives of children in Houston and Texas. Of these proposed pieces of legislation, five were passed in the 80th Texas Legislative Session in 2007 and another three were passed in the 81st Session in 2009. Some of these new laws have helped to establish a statewide human trafficking task force in the Office of the Attorney General, mandate human trafficking training for all newly licensed law enforcement officers, and create an independent Ombudsman in the Texas Youth Commission to serve as a liaison between juvenile offenders and the Legislature. Among some of the legislation that CHILDREN AT RISK plans to draft for the 82nd Legislative Session are laws that will increase protections and services to minor victims of human trafficking; allow minors to stand trial as adults for only the most serious criminal offenses; increase the availability and utilization of free breakfast programs in public schools; and create more transparency in the high school dropout rate. With the implementation of child-focused legislation, countless youth across Texas will benefit for decades to come. Another major initiative is the recent launching of the CHILDREN AT RISK Institute, an academically-oriented policy and research collaborative focused on bringing the research and problem-solving powers of the Texas higher education community to facilitate new and innovative solutions to the challenges faced by our children. The CHILDREN AT RISK Institute is comprised of senior-level academics from over seventeen academic institutions. The Institute has recently released the first edition of its openaccess, online, peer-reviewed Journal of Applied Research on Children: Informing Policy for Children at Risk, in fall of 2010. The Journal of Applied Research on Children (JARC) focuses on research that is linked to practical, evidenced-based policy solutions for children’s issues and serves to inform legislative and policy decisions, as well as influence existing and innovative practice models. JARC aims to serve as a resource to child advocates and community stakeholders by providing case studies on how innovative research and data have been used effectively to influence local, state, or national policies. JARC is published by The Houston Academy of Medicine. The Latino Children’s Health Initiative, launched in collaboration with Univision, is another program that CHILDREN AT RISK has introduced in an effort to increase awareness of the most critical issues impacting Latino children. The Initiative aims to educate Texas’ growing Latino community on the importance of continuous healthcare and

CHILDREN AT RISK 2010-2012

healthy living. As part of this initiative, CHILDREN AT RISK organizes an annual community health fair to provide Latino families with important information on health resources, as well as free health screenings and immunizations. In addition, the awareness campaign includes the dissemination of information and resources to Houston’s Latino community through Public Service Announcements, public affairs shows, and news stories on Univision’s two television and six radio stations. In 2010, CHILDREN AT RISK significantly expanded this initiative with the release of an in-depth report on Latino children’s health, hosting neighborhood action forums to further engage the community, and extending its successful awareness campaign year round. CHILDREN AT RISK is also currently promoting legislation that will enable community health workers to more easily bring awareness of available medical resources to Latino communities that may be uninformed or overwhelmed about how to navigate the medical system.

Further, the media has allowed CHILDREN AT RISK to dramatically increase its presence in Houston and Texas. Such visibility is attained through the use of print media coverage, radio broadcasts, and television appearances. In the Houston area, President and CEO Dr. Bob Sanborn, along with CHILDREN AT RISK staff, host a weekly radio show on KPFT Pacifica Radio called “Growing Up in America” to inform the public on pressing issues facing our children. Through this increased community presence CHILDREN AT RISK continues to strengthen its voice and role as an advocate and catalyst for change concerning the needs of all children in Houston and across Texas. In the future, CHILDREN AT RISK hopes to continue to expand its efforts with new and innovative programs that improve the lives of Texas’ children. While much progress has been made over the past twenty-one years, much work remains. Almost half of all children in Harris County continue to live at or near the poverty line, dropout rates remain high, and many children are not getting the health care they need. As we move forward, it is crucial to continue to uncover, evaluate, and focus on the most pressing needs of our children. In doing so, CHILDREN AT RISK can hopefully change the root causes of these problems. Through the efforts of its supporters, volunteers, and staff, CHILDREN AT RISK will continue to drive for change in areas affecting the whole child, such as education, juvenile justice, child welfare, health, and human trafficking. We look forward to seeing continued and sustained change in these areas and eagerly anticipate the day when our services are no longer needed.

CHILDREN AT RISK, through its Center to End the Trafficking and Exploitation of Children, works to raise awareness on the human trafficking crisis that plagues our city. As part of this effort, the Center holds annual human trafficking summits throughout the state to raise awareness and educate local communities about human trafficking. Training for CPS workers, law enforcement officers, lawyers, the medical community, counselors, social workers, juvenile probation officers, and other community members on what human trafficking is and how to identify it is also provided through the Center. A major endeavor of the Center is the establishment of a safe house to rehabilitate domestic minor victims of human trafficking. To accomplish this goal, CHILDREN AT RISK has convened the Safe House Now task force, which is a multi-county public/ private partnership that is working together to create this much-needed resource for the Greater Houston area.

Disclaimer

CHILDREN AT RISK recognizes that the media is one of its most valuable partners in disseminating important information about children. One of the major ways in which CHILDREN AT RISK collaborates with the media is with the release of our Public School Rankings in the major newspapers of Houston, Dallas, San Antonio, and Austin. Ranking public schools in these major cities is a critical tool in advocating for change in Texas’ public education system. Moreover, it allows schools with lower rankings to reevaluate the way they educate students. Overall, CHILDREN AT RISK hopes that initiating this conversation will ultimately lead to improved education and a higher graduation rate for all Texas students.

A majority of the information, data and statistics found in Growing Up in Houston: Assessing the Quality of Life of Our Children 2010 has been obtained from external sources. CHILDREN AT RISK has made every reasonable effort to verify the accuracy of all such information contained herein. Responsibility for actual content rests with the organization providing the information, and accordingly CHILDREN AT RISK makes no representations, guarantees or warranties as to the accuracy, completeness, or currency of such outside information. CHILDREN AT RISK disclaims any and all liability from claims or damages that may result from information, data or statistics provided by external sources and contained within this publication.

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This eleventh edition of Growing Up in Houston would not have been possible without the true dedication of those individuals involved in making Texas a better place for children to live. This team of individuals represents a collaborative effort between CHILDREN AT RISK and the Houston community; CHILDREN AT RISK is sincerely grateful to all those whose time and hard work have gone into the creation of this publication. First and foremost, our staff was instrumental in putting together the book, from obtaining data to writing and editing, especially Mandi Sheridan Kimball, Diana Zarzuelo, Dawn Lew, and Jaime Hanks. Our staff members: Jennifer Solak, Caroline Holcombe, Karen Harpold, Tanya Makany-Rivera, Laura Nelson, Ben Wells, Laila Nabi, and Sara Prentice are also owed a big thank you. This publication could not exist without the helpful assistance of the agencies and organizations that supplied the raw data for the 2010 edition of Growing Up in Houston; CHILDREN AT RISK is very appreciative of the support provided by these groups. Once again we owe a huge debt of gratitude to Cole Schweikhardt of Squidz Ink Design, who is responsible for the layout and design of the book. Through each successive edition of Growing Up in Houston he has continued to amaze us with his creativity and endless originality in communicating our message. He has given us a design that is new and innovative while building upon the solid foundation of past editions. Looking beyond the visual aspect, we are equally grateful to the number of talented writers who put together the text for this latest publication. These include a diverse and well-qualified group of student interns working towards undergraduate, graduate, and law degrees who devoted many semester and summer hours to completing the research and writing for this edition. It is our hope that these internships were instrumental in preparing them for their future professions and that their work on children’s issues allowed them to grow personally as well. Each student’s contribution was important; CHILDREN AT RISK is extremely thankful to the following individuals:

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Meghan Binford, Paul Brown, Christina Castell, Margot Danker, SaraBeth Egle, Laura Evanoff, Maureen Holcombe, Teddy Holtz, Cathryn Ibarra, Allison Kolb, Carolyn Malicki, Sunaina Mewara, Elisa Moran, Catherine Perry, Nicole Phillips, Daniel Ramirez, Nicole Royal, Susan Shotland, Brittany Taylor, and Megan Waterman. The recent establishment of the CHILDREN AT RISK Institute and their involvement in Growing Up in Houston has added great depth and insight to the book. The Institute’s oversight of the process and wise counsel have been invaluable in refining the publication so that it is the most useful to groups and individuals working to improve the lives of children. The Institute members’ honest critiques of the presentation and vigor of the data presented are respected and valued for their significant contribution to the quality of this publication. Finally, we must mention those without whose support CHILDREN AT RISK would not be able to speak for Texas’ children and effectively drive the change that is needed. CHILDREN AT RISK’s staff, consultants, Board of Directors, and Honorary Board are an indispensable part of the work that we do, and their commitment is especially evident in the quality of this publication. These are people who truly care about Texas’ children. Each and every person who worked on this edition of Growing Up in Houston made an important contribution. Further, the publication of this book would be impossible without the generous contributions of our financial supporters, whose hope for and commitment to the future sustains Texas’ children. The individuals, corporations, and foundations that have donated funds are responsible for CHILDREN AT RISK’s ongoing presence. A very special thanks to the United Way of Greater Houston for the generous financial support they provided to ensure publication of this book. On behalf of CHILDREN AT RISK, and the children of Texas, thank you all.

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We are grateful for the input of the CHILDREN AT RISK Institute: CHAIR: Angelo Giardino, M.D., Ph.D., M.P.H.

Susan Landry, Ph.D.

Medical Director, Texas Children's Health Plan and Clinical Professor, Baylor College of Medicine

Ira Colby DSW, LCSW-ACP Dean and Professor, Graduate College of Social Work, University of Houston

Frances P. Deviney, Ph.D. Texas KIDS COUNT Director, Center for Public Policy Priorities

Catherine M. Flaitz, DDS, MS William N. Ginnegan III Professorship in the Dental Sciences, Professor and Maxillofacial Pathology and Pediatric Dentistry, Department of Diagnostic Sciences, Dental Branch at Houston, University of Texas

J. Greg Getz, Ph.D. Professor of Social Sciences, University of Houston – Downtown

Chris Greeley, M.D. Associate Professor of Pediatrics, Center for Clinical Research and Evidence-Based Medicine Department of Pediatrics, University of Texas, Health Sciences Center at Houston

Deanna Hoelscher, Ph.D.

Director and Founder of the Children’s Learning Institute, University of Texas, Health Science Center at Houston

Linda Lloyd, Ph.D., MBA, MSW Associate Professor of Community Health and Associate Dean for Public Health Practice, School of Public Health, University of Texas

Jay Mendoza, M.D., M.P.H. Assistant Professor, Department of Pediatrics and USDA/ARS Children’s Nutritional Research Center and Academic General Pediatrics, Baylor College of Medicine

Beth Pelz, Ph.D. Dean, College of Public Service, University of Houston - Downtown

Adolfo Santos, Ph.D. Associate Professor and Department Chair of Social Science, University of Houston - Downtown

Steve Schnee, Ph.D. Executive Director, Mental Health and Mental Retardation Authority of Harris County

Keely G. Smith, M.D. Pediatric Residency Program Director and Assistant Professor of Pediatric Pulmonary Medicine, The University of Texas, Health Science Center at Houston

Director and Professor, Michael & Susan Dell Center for Advancement of Healthy Living, School of Public Health, University of Texas

Ruth SoRelle, M.P.H.

W. Robert Houston, Ed.D.

Jeff Starke, M.D., FAAP

Chief Science Editor, Baylor College of Medicine

Moores Professor and Executive Director, Institute for Urban Education, University of Houston

Chief of Pediatric Medicine, Ben Taub Hospital

Stephen L. Klineberg, Ph.D.

Director, Center for Health Promotion and Prevention Research, School of Public Health, University of Texas

Professor, Urban Research Center, Rice University

Susan Tortelero, Ph.D.

Artwork The artwork in this edition was created by students at KIPP SHINE Prep and YES Prep in Houston. KIPP SHINE Prep was the first primary school in the KIPP network in Houston and the United States. Now fully grown, SHINE serves children in PreK-3 through fourth grades. At KIPP SHINE Prep, art is an integral part of the children’s learning experience. The values of SHINE, Seek, Honor, Imagine, Never Give Up, Every Day, encourage expression and participation and are reflected in the SHINEsters’ work. “Imagination” is at the core of the young artists’ creative expression. As they create, students are taught to “never give up” and to keep trying “every day.” The children’s artwork is celebrated and exhibited at SHINE, and some of the students have also shown their work at Photo Fest and at the “Smartest Artist” Gallery Show at Gallery M Squared.

YES Prep Public Schools is a free, open-enrollment public school system that serves 4,200 students across eight campuses in the Houston area. YES Prep has been continuously ranked among the top 100 public high schools in the nation. YES Prep Fine Arts is within the campus system to educate the young minds of Houston in the area of visual and performing arts. Each student in the program gains knowledge of different art forms, art movements, performance pieces, and real world experiences within the arts.

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H O N O R A RY B OA R D & B OA R D O F D I R E C TO R S

Honorary Board of Directors Maconda Brown O’ Connor, Ph.D. Dr. Carolyn Farb, h.c. Rev. William Lawson Diana Davila Martinez Virginia McFarland James S. Mickelson Richard W. Mithoff Rev. Joe Samuel Ratliff Jack Segal, Rabbi Emeritus Melissa Wilson Board of Directors Jason Bailey The Downtown Club Philamena Baird Community Volunteer Bob Baker El Paso Corporation Christopher Borreca Thompson Horton Andy Buttacavoli Sara Lee Foodservice Will Denham Abrams Scott & Bickley, L.L.P Angelo Giardino, MD, PhD Texas Children’s Health Plan & Baylor College of Medicine Christopher Greeley, MD UT Health Sciences Center Lauren Harrison Conner & Winters Regay M. Hildreth RMH Marketing & Media James Holtz Holtz & Wright Pam Humphrey ACE USA Toby Hynes Gulf States Toyota, Inc.

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George Jordan III Fulbright & Jaworski Shelda Keith Logix Communications Susan Kellner Spring Branch ISD Board Member Jane Lehman Attorney Susan Lindberg Attorney Michael Maher Presenture Susan Mullins Brisbane Gifts with Heart Anne Nemer Strategic Marketing Services Larry Payne Educational Excellence Resource Group, LLC Joe Perillo Locke Lord Bissell & Liddell, LLP Megan Sutton Reed Community Volunteer

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Alyssa Rodriguez UBS Financial Services David Roylance Prism Energy Solutions Lynn Sessions Texas Children’s Hospital Jeffrey Starke, M.D. Ben Taub General Hospital & Texas Children’s Hospital Myron F. Steves, Jr. Myron Steves Mark Troth Bank of River Oaks Sibila Vargas Fox 26 News Lisa Wallace Community Volunteer Robert Westendarp Griffin Americas Drew Wilson Thomson Reuters Frazier Wilson, Ed.D. Shell Oil Company Robert Zincke Former President, Kroger Robert Sanborn, Ed.D. President & CEO

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Law Advisory Board (LAB) Chair: Susan Lindberg, Eni Petroleum Co., Inc. Sally Green Thurgood Marshall School of Law, Texas Southern University Lauren Harrison Conner & Winters LLP James Holtz Holtz & Wright Inc. Bruce Hurley King & Spalding LLP George Jordan Fulbright & Jaworski LLP James Jordan Macquarie Bank Limited Ellyn Josef Vinson & Elkins LLP Karyl McCurdy Lawson Phillips & Reiter PLLC Mark D. Lee American General Life Insurance Company Jane Lehman Attorney Michael Maher Presenture Karen Maston Sedgwick, Detert, Moran & Arnold LLP John Meredith Greenberg Traurig LLP

Bob Baker El Paso Corporation Sherie Beckman Mithoff Law Firm Erma Bonadero University of Houston Law Center Chris Borreca Thompson and Horton LLP Melanie Bragg Legal Insight Inc. Shelly Buchman NRG Texas LLC Katherine Cabaniss Crime Stoppers Rachel Clingman Sutherland Asbill & Brennan LLP Judie Cross Fulbright & Jaworski LLP Will Denham Abrams Scott & Bickley LLP Dennis Duffy Baker Botts LLP Linda Dunson NAACP Mike Falick Rothfelder & Falick LLP Joshua Farkas Dynegy Inc. Kat Gallagher Beck Redden & Secrest LLP

Silvia Mintz Plake and Mintz PLLC Shelby Moore South Texas College of Law Katharine Newman ConocoPhillips Company Susan Pennebaker, Esq. Pennebaker Fifth Ring Daniel Plake Plake and Mintz PLLC Jill Schaar Locke Liddell & Sapp LLP Lynn Sessions Texas Children’s Hospital Lisa Sherrill Attorney Ann Stephens Shell Oil Company Katrina Stilwell Shell Oil Company Andrew Strong Texas A&M University System Deborah Thompson Deborah L. Thompson Attorney at Law Veronica Vasquez Perdue Brandon Fielder Collins & Mott LLP

Public Policy Advisory Board (PPAB) Chair: Larry Payne, CHILDREN AT RISK Wafa Abdin Catholic Charities Mitzi Bartlett Search/House of Tiny Treasures Alex Byrd RICE University Rep. Ellen Cohen State Representative Laurie Glaze One Voice Texas Brian Greene Houston Food Bank Angela Hodson Boys & Girls Club of Greater Houston Council Member Jarvis Johnson Council Member Joseph Lee Joint City/County Commission on Children

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Joel Levine Children and Adults Dr. Kim Lopez Consultant Rosie Valdez-McStay Texas Children’s Hospital Christina Mintner Harris County Hospital District Michelle Mitchell Catholic Charities Janet Pozmantier CHILDBUILDERS Carroll Robinson Texas Southern University Betin Santos Environmental Policy Expert Ann Stiles Project Grad Houston

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Elaine Stolte Texas Southern University Betin Santos Environmental Policy Expert Ann Stiles Project Grad Houston Elaine Stolte Children’s Assessment Center Dr. Steve Schnee MHMRA of Harris County Betsy Schwartz Mental Health Association Maria Trujillo Houston Rescue & Restore Coalition Dr. Jonita Wallace Gulf Coast Community Services Association

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Foundations Anonymous Arch and Stella Rowan Foundation Baylor Methodist Community Health Fund Boone Family Foundation Brown Foundation Ed Rachal Foundation Embrey Family Foundation Enrico and Sandra DiPortanova Foundation George Foundation, The Holthouse Foundation for Kids Houston Rescue and Restore Coalition Jack H. and William M. Light Charitable Trust Keating Family Foundation

Kiwanis Foundation of Houston McCune Charitable Trust Meadows Foundation Memorial Drive Presbyterian Church Mithoff Family Charitable Foundation Ray C. Fish Foundation Salners Family Foundation Scurlock Foundation Sequor Foundation Simmons Foundation St. Luke’s Episcopal Health Charities United Way of Greater Houston Volunteer Houston

Corporations Academy Sports + Outdoors ACE USA Administaff Aetna American General Life Companies Anadarko Petroleum Astros in Action Foundation Baker Botts LLP Bank Of River Oaks, The Barclays Beck Redden Secrest BNP Paribas Bracewell & Giuliani, LLP CenterPoint Energy Children’s Assessment Center Foundation, The Don McGill Toyota Of Katy El Paso Corporation ENI Petroleum Corporation, Inc. ExxonMobil Foundation Future Surgical Griffin Americas Gulf Coast Ford Nissan Toyota Gulf States Toyota Gullo Dealerships Harrison, Bettis, Staff, McFarland & Weems, L.L.P H-E-B Houston A+ Challenge Houston Chronicle Hunting PLC

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Kinder Morgan Lockwood International, Inc. Lone Star RV Memorial Hermann Mercedes-Benz Mike Calvert Toyota Mir Fox & Rodriguez (MFR) Morgan Stanley Pillsbury Winthrop Presenture LLC Prism Energy Solutions Randalls Food Markets Reliant Energy Roth Käse, USA Ltd RSL Funding Sara Lee SaveOnEnergy.com Scotia Capital Sedgwick Detert Moran & Arnold LLP Shell Oil Company Susman Godfrey LLP Sysco Corporation Texas Children’s Hospital Thompson & Horton LLP Thompson Reuters TR Moore & Company Tradition Energy UBS Giving Programs Vinson & Elkins LLP Wells Fargo Energy Group

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Individuals Jan and Clint Ables Marcia and Joe Alexander Arthur and Philamena Baird Kathryn and Robert Baker Alan Bentz and Sallymoon Benz John Blaisdell Mary and Ron Botkin City of Houston Municipal Employees Jeff Connelly Bob Cress Rania and Jamal Daniel Ernie and Jacquelyn Danner Nancy and Paul Darst Will and Elizabeth Denham Sedwick Detert Jo Lynn and Gregg Falgout Eileen and Angelo Giardino Mark Grayson Tony Gullo Lauren and Geoffrey Harrison Regay and Shane Hildreth

Bill Prentice Michael Rhodes Alyssa Rodriguez Roland Rodriguez David and Deborah Roylance Robert and Ellen Sanborn Lynn Sessions Debra Shniderson Chris and Robert Snyder Jason Spencer Joan Shook and Jeffrey Starke Rowena Young and Buddy Steves Elaine Stolte Lisa and Barron Wallace Robert and Heather Westendarp John D. White Sheridan Williams Melissa Wilson and David Cook Isabel Brown Wilson Janet and Robert Zincke

Ron and Natasha Holley Kay and Ned Holmes Michael Holthouse James Holtz Pam Humphrey George Jordan Steve and Sandie Jordan Susan and Larry Kellner John Leggitt Donald R. Lehman Jane Lehman and Matt Winter Richard and Alisha Loftin Mike and Denise Maher Alex Matturro Ann Miller Virginia and Richard Mithoff Marsha and Carlos Montemayor Mary and Tyler Moore Rachel Ann Palmer Mehul Parikh John Phillips

*These lists include gifts and donations above $1000 given between August 2009 and August 2010. CHILDREN AT RISK apologizes in the event that there is an inadvertent omission of a corporation, foundation, or individual. We greatly appreciate all who support our work!

Friends of Our Children Adkins International Marcia Alexander Leslie Amann Terry G. Aven Bob Baker Katy Barth Roger Barth Mary Baugher Julie Boom Chris Borreca Mary Botkin Tim Broussard Cecily Burleson Karen Cambell Ronald Cookston Andrea Cruz Will Denham Trea Drake Richard and Elaine Field John and Phyllis Freeman Al Gallo

Angelo Giardino George Jordan Angelo Giardino Elizabeth Whyburn and Stuart Goldstein Christopher Greely Brian Greene Jaime Hanks Michele Hanks FJ Harberg Susan Harris Lauren Harrison Wesley Hart Linda Hester Regay Hildreth Caroline Holcombe Janet Holcombe James Holtz Pam Humphrey Connie Hunker Scott Hyder

Toby Hynes George Jordan Shelda Keith Richard Kerr Susan Kossler Karyl Lawson Jane Lehman Jane Leverett Joel Levine Gloria Luna Michael Maher Michelle Maidenburg David Marold Michael Marx Jeff McGee John Meredith David Miclette Rita and Paul Morico Laila Nabi Joaquin Negreros, Jr Luis Negreros

Laura Nelson Anne Nemer Trish O Grady Laura Palmer Larry Payne Nicole Perdue Muriel Phillips Michael Phillipus Charlotte Prentice Sara Prentice William Prentice Maria Reyna Tanya Makany-Rivera Alyssa Rodriguez Ronald Rodriguez David Roylance Robert Sanborn Zack Schultz Lynn Sessions Joni Shereda Hannah Sibiski

Paul Sirbaugh Jennifer Solak Ann Stiles Andrew Strong Deborah Thompson Virginia Tomlinson Lise Valbert Rosie Valdez-McStay Nelson Waite Lisa Wallace Mark Ward Ben Wells Jim Wells Pam Wells Jordan Witherspoon Diana Zarzuelo Tricia Zucker

Friends of Our Children members provide CHILDREN AT RISK with critical annual support, through a gift of $100 or more a year, to ensure the strength of our ongoing programs. Their support is essential to maintaining and strengthening our ability to speak out and drive change for our children! This list includes Friends from October 2009 to August 2010. CHILDREN AT RISK apologizes in the event that there is an inadvertent omission of a member.

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Basic Needs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

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Basic Information, 20 Feb. 2009, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/air/basic.html. A Closer Look at Air Pollution in Houston: Identifying Priority Health Risks, no date, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/ttn/chief/conference/ei16/session6/bethel.pdf. Clean Air Act, 5 Jan. 2010, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/air/caa/. 42 U.S.C. 7408 Six Common Air Pollutants, 17 Nov. 2009, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/air/urbanair/. Endangerment and Cause or Contribute Findings for Greenhouse Gases under the Clean Air Act, 18 Dec. 2009, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/climatechange/endangerment.html. Nonattainment Areas Map, no date, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/ Matthew Tresaugue, “Houston may finally meet smog standard,” Houston Chronicle, 2 Nov. 2009, 18 Feb. 2010 www.chron.com/disp/story. mpl/metropolitan/6699807.html. Ozone Air Quality Standards, 8 Jan. 2010, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/air/ozonepollution/standards.html. Michael T. Kleinman, Ph.D., “The Health Effects of Air Pollutions on Children,” South Coast Air Quality Management District, 14 Sept. 2005, 18 Jul. 2010 www.aqmd.gov/forstudents/health_effects_on_children.html#WhyChildren. Ibid. “Indoor Air Pollution Increases Asthma Symptoms, Study Suggests,” Science Daily, 27 Feb. 2009, 18 Jul. 2010 www.sciencedaily.com/releases/2009/02/090219101700.htm. “Possible Link Between Ship Channel Air Pollutants, Cancer Risks,” University of Texas School of Public Health, May 2007, 15 Jul. 2010 www.uthouston.edu/distinctions/archive/2007/may/archive.htm?id=795285. Ibid. Matthew Tresaugue, “Houston may finally meet smog standard,” Houston Chronicle, 2 Nov. 2009. A Closer Look at Air Pollution in Houston: Identifying Priority Health Risks, Jun. 2006, City of Houston, 18 Jul. 2010 www.greenhoustontx.gov/reports/UTreport.pdf; Dina Cappiello, “Pollutant study gives the county a cleanup `to-do’ list, mayor says,” Houston Chronicle, 13 Jun 2006, 18 Feb. 2010 www.chron.com/CDA/archives/archive.mpl?id=2006_4134290. CERCLA Overview, no date, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/superfund/policy/cercla.htm. Ibid. National Priorities List Sites in Texas, no date, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/superfund/sites/npl/tx.htm. Number of National Priorities List Site Actions and Milestones by Fiscal Year, no date, Environmental Protection Agency, 18 Jul. 2010 www.epa.gov/superfund/sites/query/queryhtm/nplfy.htm. The Cement Kiln Portal, 15 Jul. 2008, Ground Work, 18 Jul. 2010 www.groundwork.org.za/Cement.html. Abandoned Hazardous Waste Sites, no date, Texas Environmental Profiles, 15 Jul. 2010 www.texasep.org/html/wst/wst_5iab.html. Texas Superfund Registry, 18 Sept. 2009, Texas Commission on Environmental Quality, 18 Jul. 2010 www.tceq.state.tx.us/remediation/superfund/registry.html. Park-Related Total Expenditure per Resident, by City, 17 Aug. 2009, Trust for Public Land, 15 Jul. 2010 www.tpl.org/content_documents/citypark_facts/ccpe_TotalSpendingbyCity_09.pdf. Ibid. Harris County Park Planner, e-mail to Harris County Parks Department. The Benefits of Parks, Trust for Public Land; see also CDC, Increasing Physical Activity: A Report of the Task Force on Community Preventive Services (Atlanta: Centers of Disease Control and Prevention, October 26, 2001) at 1, 15 Jul. 2010 www.cdc.gov/mmwr/preview/ mmwrhtml/rr5018al.htm. Acres of Parkland per 1,000 Residents, by City, 22 May 2009, Trust for Public Land, 15 Jul. 2010 www.tpl.org/content_documents/citypark_facts/ccpe_TotalAcresperResident_09.pdf. This data should be viewed in light of the fact that an average for the low density cities was 102.4 acres per 1,000 residents. The 150 Largest City Parks, 13 Apr. 2010, Trust for Public Land, 15 Jul. 2010 www.tpl.org/content_documents/citypark_facts/ccpe_150_ LargestParks_4_2010.pdf. The Most Visited Parks in the U.S., 18 Sept. 2009, Trust for Public Land, 15 Jul. 2010 www.tpl.org/content_documents/citypark_facts/ ccpe_Most_Visited_Parks_09.pdf. Discovery Green Debuts at Groundbreaking Ceremony, 17 Oct. 2006, Discovery Green, 15 Jul. 2010 www.discoverygreen.com/en/ cms/150/. Nancy K. Cauthen and Sarah Fass, Ten Important Questions About Child Poverty and Family Economic Hardship, Dec. 2009, National Center for Children in Poverty, 15 Jul. 2010 www.nccp.org/publications/pub_829.html. Ibid. Ibid. Ibid. Ibid. Income Gaps Hit Record Levels In 2006, New Data Show Rich-Poor Gap Tripled Between 1979 and 2006, Center on Budget and Policy Priorities, 15 Jul. 2010 www.cbpp.org/cms/index.cfm?fa=view&id=2789. Nancy K. Cauthen and Sarah Fass. United States: Demographics of Low-Income Children, no date, National Center for Children in Poverty, 15 Jul. 2010 www.nccp.org/ profiles/US_profile_6.html. United States: Demographics of Poor Children, no date, National Center for Children in Poverty, 15 Jul. 2010 www.nccp.org/profiles/

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US_profile_7.html. 42 Nancy K. Cauthen and Sarah Fass. 43 Texas: Demographics of Poor Children, no date, National Center for Children in Poverty, 15 Jul. 2010 www.nccp.org/profiles/TX_profile_7. html. 44 Ibid. 45 Ibid. 46 Ibid. 47 Ibid. 48 U.S. Census Bureau, 2008 American Community Survey, “Harris County, Texas – Selected Economic Characteristics: 2008.” 49 Ibid. 50 Ibid. 51 Texas: Demographics of Low-Income Children, 29 Sept. 2009, National Center for Children in Poverty, 15 Jul. 2010 www.nccp.org/profiles/TX_profile_6.html. 52 U.S. Census Bureau, 2008 American Community Survey, “Harris County, Texas – Selected Economic Characteristics: 2008.” 53 Texas: Demographics of Low-Income Children, National Center for Children in Poverty. 54 Ibid. 55 Ibid. 56 Ibid.; United States: Demographics of Low-Income Children, National Center for Children in Poverty. 57 Ibid. 58 Ibid. 59 Nancy K. Cauthen and Sarah Fass. 60 Ibid. 61 About TANF, 20 Nov. 2008, U.S. Department of Health and Human Services, 21 Jul. 2010 www.acf.hhs.gov/programs/ofa/tanf/about.html. 62 State TANF Program Names, 6 Oct. 2009, U.S. Department of Health and Human Services, 21 Jul. 2010 www.acf.hhs.gov/programs/ofa/ states/tnfnames.htm. 63 Temporary Assistance for Needy Families, no date, Texas Health and Human Services Commission, 21 Jul. 2010 www.hhsc.state.tx.us/ Help/Financial/Temporary_Assistance.html. 64 About TANF, U.S. Department of Health and Human Services. 65 Temporary Assistance for Needy Families, Texas Health and Human Services Commission. 66 Fact Sheet – Office of Family Assistance, 1 Apr. 2009, U.S. Department of Health and Human Services, 21 Jul. 2010 www.acf.hhs.gov/opa/ fact_sheets/tanf_factsheet.html. 67 About TANF, U.S. Department of Health and Human Services. 68 Fact Sheet – Office of Family Assistance, 1 Apr. 2009, U.S. Department of Health and Human Services, 21 Jul. 2010 www.acf.hhs.gov/opa/ fact_sheets/tanf_factsheet.html. 69 Lisa Belli, public information request to Texas Health and Human Services, 20 Oct. 2009. 70 Lisa Belli, public information request to Texas Health and Human Services, 8 Nov. 2007. 71 Poverty: 2007 and 2008 American Community Surveys, Sept. 2009, U.S. Census Bureau, 21 Jul. 2010 www.census.gov/prod/2009pubs/ acsbr08-1.pdf. 72 Lisa Belli, public information request to Texas Health and Human Services, 20 Oct. 2009. 73 Characteristics and Financial Circumstances of TANF Recipients, 21 May 2010, U.S. Department of Health and Human Services, 21 Jul. 2010 www.acf.hhs.gov/programs/ofa/data-reports/annualreport8/chapter10/chap10.htm. 74 Food Hardship: A Closer Look at Hunger, Jan. 2010, Food Research and Action Center, 21 Jul. 2010, www.frac.org/pdf/food_hardship_report_2010.pdf. 75 Life Sciences Research Office, S.A. Andersen, ed., “Core Indicators of Nutritional State for Difficult to Sample Populations,” The Journal of Nutrition 120:1557S-1600S, 1990. 76 Texas Food Bank Network, “New USDA Data: 16.3 Percent of Texas Households Face Hunger,” released 16 Nov. 2009. 77 Heather Hartline-Grafton, DrPH, RD, “How Improving Federal Nutrition Program Access and Quality Work Together to Reduce Hunger and Promote Healthy Eating,” Feb. 2010, Food Research Action Center, 21 Jul. 2010 frac.org/pdf/CNR01_qualityandaccess.pdf. 78 Texas QuickFacts from the U.S. Census Bureau, 22 Apr. 2010, U.S. Census Bureau, 21 July 2010, quickfacts.census.gov/qfd/ states/48000.html. 79 Texas TANF and SNAP Enrollment Statistics, no date, Texas Health and Human Services Commission, 21 Jul. 2010 www.hhsc.state.tx.us/ research/TANF_FS.asp. 80 Characteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2008, Table 3.4 – Average Values of Selected Characteristics by Household Composition, Sept. 2009, U.S. Department of Agriculture, 21 Jul. 2010 www.fns.usda.gov/ora/MENU/published/ snap/FILES/Participation/2008Characteristics.pdf 81 Gary Scharrer, “Official: Texas has worst-ranked food stamp program,” Houston Chronicle, 12 Jan. 2010, 21 Jul. 2010 www.chron.com/disp/ story.mpl/metropolitan/6811169.html. 82 Corrie MacLaggan, “Federal officials: Texas needs food stamp czar,” Statesman.com, 6 Oct. 2009, 21 Jul. 2010 www.statesman.com/news/ content/region/legislature/stories/2009/10/06/1006foodstamps.html. 83 Gary Scharrer, “Official: Texas has worst-ranked food stamp program,” citing U.S. Department of Agriculture’s undersecretary Kevin Concannon. 84 Rachel Cooper and Madeleine Levin, School Breakfast Scorecard 2007, Dec. 2007, Food Research and Action Center, 21 Jul. 2010 www. frac.org/pdf/SBP_2007.pdf.

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Basic Needs 85 86 87 88

Ibid. L. Hoyt, public information request to Texas Department of Agriculture, 15 Oct. 2009. Ibid. National School Lunch Program, Aug. 2009, Food and Nutrition Service, U.S. Department of Agriculture, 21 Jul. 2010 www.fns.usda.gov/ cnd/lunch/AboutLunch/NSLPFactSheet.pdf. 89 Federal Food Programs, no date, Food Research and Action Center, 21 Jul. 2010 www.frac.org/html/federal_food_programs/programs/nslp. html. 90 L. Hoyt, public information request to Texas Department of Agriculture, 15 Oct. 2009. 91 Summer Food Service Program, no date, Food and Nutrition Service, U.S. Department of Agriculture, 21 Jul. 2010 www.fns.usda.gov/cnd/ Summer/. 92 Rachel Cooper and Jim Weill, State of the States: 2008, FRAC’s Profile of Food & Nutrition Programs Across the Nation¸ Nov. 2008, Food Research and Action Center, 21 Jul. 2010 www.frac.org/pdf/SOS_2008_withcover_nov08.pdf. 93 Ibid. at 1. 94 L. Hoyt, public information request to Texas Department of Agriculture, 23 Oct. 2009. 95 Ibid. 96 Rachel Cooper and Jim Weill, State of the States: 2008, FRAC’s Profile of Food & Nutrition Programs Across the Nation. 97 Federal Definition of Homelessness, no date, Department of Housing and Urban Development, 21 Jul. 2010 portal.hud.gov/portal/page/portal/HUD/topics/homelessness/definition; 42 U.S.C. 119 § 11302. 98 The Annual Homeless Assessment Report to Congress, Feb. 2007, U.S. Department of Housing and Urban Development Office of Community Planning and Development, 25 Mar. 2010 www.huduser.org/Publications/pdf/ahar.pdf. 99 Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America’s Cities, A 25-City Survey, Dec. 2008, The United States Conference of Mayors, 25 Mar. 2010 www.usmayors.org/pressreleases/documents/hungerhomelessnessreport_121208.pdf. 100 Shaila Dewan, “Resources Scarce, Homelessness Persists in New Orleans,” New York Times Online, 28 May 2008, 25 Mar. 2010 www. nytimes.com/2008/05/28/us/28tent.html; “Thousands remain homeless weeks after Hurricane Ike hit Texas coast,” Dallas Morning News, 20 Oct. 2008, 21 Jul. 2010 www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-ikehousing_20tex.ART.State. Edition1.4a8c9ec.html. 101 Eva Thibadeaux, telephone interview, 16 Feb. 2010. 102 2008 Annual Report, Covenant House Texas < http://www.covenanthouse.org/about/financials. 103 Programs & Services, no date, Covenant House Texas, 25 Mar. 2010 www.covenanthousetx.org/default.asp?id=99. 104 Child Welfare: Aging out of Foster Care, 11 Nov. 2008, OneVoice, 21 Jul. 2010 www.adoptation.org/onevoicehouston/pdfs/81PolicyPriority/ Child%20Welfare%20Aging%20Out%20of%20Foster%20Care.pdf. 105 2010 Fair Market Rents, 26 Oct. 2009, Texas Department of Housing and Community Affairs, 21 Jul. 2010 www.tdhca.state.tx.us/ pmcdocs/10-FMR-TBRA.pdf. 106 Minimum Wage Laws in the States, 1 Jan. 2010, United States Department of Labor, 25 Mar. 2010 www.dol.gov/whd/minwage/america. htm#Texas. 107 Housing Choice Voucher, no date, Houston Housing Authority, 25 Mar. 2010 www.housingforhouston.com/housing-programs/housing-choicevoucher.aspx. 108 Public Housing, no date, Houston Housing Authority, 25 Mar. 2010 www.housingforhouston.com/housing-programs/public-housing.aspx. 109 Housing Programs, no date, Houston Housing Authority, 25 Mar. 2010 www.housingforhouston.com/housing-programs.aspx. 110 Carol Campbell, public information request to the Texas Attorney General, Child Support Division, 29 Oct. 2009. 111 Texas Attorney General, 6 Jan. 2010, Office of the Attorney General, 2 Feb. 2010, www.oag.state.tx.us/cs/about/index.shtml. 112 Harris County Domestic Relations Office – Home, no date, Harris County Domestic Relations Office, 2 Feb. 2010, < http://www.dro.hctx. net/default.aspx. 113 Harris County Domestic Relations Office – FAQs, no date, Harris County Domestic Relations Office, 2 Feb. 2010, www.dro.hctx.net/legal_faqs.aspx. 114 WIA Final Regulations 8/11/2000, 30 Dec. 2009, U.S. Department of Labor, 4 Feb. 2010, www.doleta.gov/usworkforce/wia/finalrule.txt. 115 What is the Texas Workforce Commission, 19 Jun. 2003, Texas Workforce Commission, 4 Feb. 2010, www.twc.state.tx.us/twcinfo/whatis. html. 116 Rebecca Leppala, public information request to Workforce Solutions, 11 Nov. 2009. 117 WIA Final Regulations 8/11/2000, U.S. Department of Labor. 118 Rebecca Leppala, public information request to Workforce Solutions, 11 Nov. 2009. 119 Workforce Solutions – Jobs & Careers – Youth, no date, Workforce Solutions, 4 Feb. 2010 www.wrksolutions.com/jobs/youth.html. 120 Summer Jobs for Youth Report 2009, no date, Gulf Coast Workforce Board Houston-Galveston Region, 21, Jul. 2010 www.wrksolutions. com/jobs/summerjobs2009/WFS-SummerJobs_final.pdf. 121 Rebecca Leppala, public information request to Workforce Solutions, 4 Aug. 2008. 122 Rebecca Leppala, public information request to Workforce Solutions, 11 Nov. 2009. 123 Summer Jobs for Youth Report 2009, Gulf Coast Workforce Board Houston-Galveston Region. 124 Rebecca Leppala, public information request to Workforce Solutions, 11 Nov. 2009. 125 Ibid.

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Physical & Mental Health 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41

Special Edition: April 27-May 3 is Cover the Uninsured Week, Apr. 2008, The American Congress of Obstetricians and Gynecologists, 8 Sept. 2010 www.acog.org/acog_districts/dist_notice.cfm?recno=1&bulletin=2612. Ibid. Joyce A. Martin, M.P.H., Brady E. Hamilton, Ph.D., Paul D. Sutton, Ph.D., et al. National Vital Statistics Reports, Births: Final Data for 2006, Vol. 57, No. 7, 7 Jan. 2009, Centers for Disease Control and Prevention, 8 Sept. 2010 www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07. pdf. 2006 Natality, 13 Jul. 2010, Texas Department of State Health Services, 8 Sept. 2010 www.dshs.state.tx.us/chs/vstat/vs06/nnatal.shtm. Table 9: Births by Public Health Region, County and City of Residence, Texas , 2006, Texas Department of State Health Services, 8 Sept. 2010 < http://www.dshs.state.tx.us/chs/vstat/vs06/t09t.shtm. 2003 Revisions of the U.S. Standard Certificates of Live Birth and Death and the Fetal Death Report, 2 Jul. 2010, Centers for Disease Control and Prevention, 8 Sept. 2010 www.cdc.gov/nchs/nvss/vital_certificate_revisions.htm. Table 12: Onset of Prenatal Care Within First Trimester, Texas, 2006, Texas Department of State Health Services, 8 Sept. 2010 www. dshs.state.tx.us/chs/vstat/vs06/t12.shtm. Table 12: Onset of Prenatal Care Within First Trimester, Texas, 2005, Texas Department of State Health Services, 8 Sept. 2010 www. dshs.state.tx.us/CHS/VSTAT/vs05/t12.shtm. Table 12: Onset of Prenatal Care Within First Trimester, Texas, 2006, Texas Department of State Health Services. Table 12: Onset of Prenatal Care Within First Trimester, Texas, 2005, Texas Department of State Health Services. Martin, Hamilton, Sutton, National Vital Statistics Reports, Births: Final Data for 2006, Centers for Disease Control and Prevention. The Texas Department of State Health Services includes women of other and unknown race/ethnicity in the category of “Anglo.” 2006 Natality, Texas Dept. of State Health Services. Martin, Hamilton, Sutton, National Vital Statistics Reports, Births: Final Data for 2006, Centers for Disease Control and Prevention at 65. You and Your Baby: Prenatal Care, Labor and Delivery, and Postpartum Care, Jan. 2007, The American Congress of Obstetricians and Gynecologists, 8 Sept. 2010 www.acog.org/publications/patient_education/ab005.cfm. Texas Health Data: Births to Texas Residents, Texas Department of State Health Services, 8 Sept. 2010 soupfin.tdh.state.tx.us/birth05.htm. What We Know: Maternal, Infant, and Child Health, Centers for Disease Control and Prevention, Office of Women’s Health, 24 Feb. 2010 www.cdc.gov/Women/owh/motherchild/know.htm. Martin, Hamilton, Sutton, National Vital Statistics Reports, Births: Final Data for 2006, Centers for Disease Control and Prevention at 18. Ibid. Ibid. D’Vera Cohn, Is Low Birth Weight a Cause of Problems, or a Symptom of Them? Jun. 2007, Population Reference Bureau, 8 Sept. 2010 www.prb.org/Journalists/Webcasts/2007/LowBirthWeight.aspx. Table 10: Low Birth Weight Infants, Texas, 2006, Texas Department of State Health Services, 8 Sept. 2010 www.dshs.state.tx.us/chs/vstat/ vs06/t10.shtm. 2006 Natality, Texas Department of State Health Services. Martin, Hamilton, Sutton, National Vital Statistics Reports, Births: Final Data for 2006, Centers for Disease Control and Prevention at 2. Ibid at 2, 77. Marian F. MacDorman, Ph.D., and T.J. Mathews, M.S., Behind International Rankings of Infant Mortality: How the United States Compares with Europe, Nov. 2009, Centers for Disease Control and Prevention, National Center for Health Statistics Data Brief No. 23, 8 Sept. 2010 www.cdc.gov/nchs/data/databriefs/db23.pdf. Ibid. Infant Mortality Rate Analyzer – Texas, Texas Department of State Health Services, 8 Sept. 2010 www.dshs.state.tx.us/CHS/VSTAT/imr/ imr.shtm. Ibid. Ibid. Ibid. Ibid. Texas Quick Facts: Health Insurance Overview, no date, March of Dimes PeriStats, 8 Sept. 2010 www.marchofdimes.com/peristats/tlanding.aspx?dv=lt&reg=48&top=11&lev=0&slev=4. Ibid. Results from the 2008 National Survey on Drug Use and Health: National Findings, Sept. 2009, Office of Applied Studies, SAMHSA, U.S. Department of Health & Human Services, 8 Sept. 2010 www.oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.cfm. Ibid. Ibid. News Release: U.S. Surgeon General Releases Advisory on Alcohol Use in Pregnancy, 21 Feb. 2005, Office of the Surgeon General, U.S. Department of Health & Human Services, 8 Sept. 2010 www.surgeongeneral.gov/pressreleases/sg02222005.html. The FASD Center, 12 Aug. 2010, SAMHSA, U.S. Department of Health and Human Services, 8 Sept. 2010 www.fasdcenter.samhsa.gov/. Ibid. Fetal Alcohol Spectrum Disorders (FASDs), no date, Centers for Disease Control and Prevention, 8 Sept. 2010 www.cdc.gov/ncbddd/fasd/ facts.html.

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Physical & Mental Health 42 Results from the 2008 National Survey on Drug Use and Health: National Findings, U.S. Dept. of Health and Human Services. 43 Smoking & Tobacco Use, Highlights: Impact on Unborn Babies, Infants, Children, and Adolescents, 27 May 2004, Centers for Disease Control and Prevention, 8 Sept. 2010 www.cdc.gov/tobacco/data_statistics/sgr/2004/highlights/children/index.htm. 44 Quick Reference: Fact Sheets, Smoking During Pregnancy, no date, March of Dimes, 8 Sept. 2010 www.marchofdimes.com/professionals/14332_1171.asp. 45 Results from the 2008 National Survey on Drug Use and Health: National Findings, U.S. Dept. of Health and Human Services. 46 Ibid. 47 Alan Shafer, Ph.D., public information request to Decision Support Unit, Mental Health and Substance Abuse Division, Texas Department of State Health Services, 25 Mar. 2010. 48 Ibid. 49 Ibid. 50 Ibid. 51 Ibid. 52 Ibid. 53 Ibid 54 Ibid. 55 Ibid. 56 Ibid. 57 Ibid. 58 Ibid. 59 Ibid. 60 Ibid. 61 Ibid. 62 Ibid. 63 Joyce A. Martin, M.P.H., Brady E. Hamilton, Ph.D., Paul D. Sutton, Ph.D., et al. National Vital Statistics Reports, Births: Final Data for 2006, Vol. 57, No. 7 at 7, 7 Jan. 2009, Centers for Disease Control and Prevention, 8 Sept. 2010 www.cdc.gov/nchs/data/nvsr/nvsr57/ nvsr57_07.pdf. 64 Brady E. Hamilton, Ph.D., Joyce A. Martin, M.P.H., and Stephanie J. Venutra, M.A., National Vital Statistics Reports, Births: Preliminary Data for 2007, Vol. 57, No. 12 at 2, 18 Mar. 2009, Centers for Disease Control and Prevention, 8 Sept. 2010 www.cdc.gov/nchs/data/ nvsr/nvsr57/nvsr57_12.pdf. 65 Adolescent and Reproductive Health: Home, 13 Jul. 2010, Centers for Disease Control and Prevention, 8 Sept. 2010 www.cdc.gov/reproductivehealth/AdolescentReproHealth/index.htm. 66 Facts at a Glance: A Fact Sheet Reporting National, State, and City Trends in Teen Childbearing at 3, Sept. 2009, Child Trends, 8 Sept. 2010 www.childtrends.org/Files//Child_Trends-2009_08_31_FG_Edition.pdf. 67 Ibid. 68 Janice Jackson, M.P.H., public information request to Center for Health Statistics, Texas Department of State Health Services, 18 Mar. 2010. 69 Ibid. 70 Ibid. 71 Ibid. 72 Ibid. Data for 2007 and 2008 is provisional and subject to errors/changes. 73 Ibid. 74 Martin, Hamilton, Sutton, National Vital Statistics Reports, Births: Final Data for 2006, Centers for Disease Control and Prevention at 5. 75 Ibid. 76 Janice Jackson, M.P.H., public information request to Center for Health Statistics, Texas Department of State Health Services. 77 Ibid. 78 By the Numbers: The Public Costs of Teen Childbearing in Texas, Nov. 2006, The National Campaign to Prevent Teen Pregnancy, 8 Sept. 2010 www.thenationalcampaign.org/costs/pdf/states/texas/onepager.pdf. 79 Ibid. 80 Ibid. 81 2008 Annual Report at 38, no date, Harris County Public Health & Environmental Services, 9 Sept. 2010 www.hcphes.org/2008annual.pdf. 82 Ibid. 83 Preventing Teen Pregnancy: An Update in 2009, 10 Aug. 2009, Centers for Disease Control and Prevention, 9 Sept. 2010 www.cdc.gov/ reproductivehealth/AdolescentReproHealth/AboutTP.htm. 84 Teen Pregnancy Prevention, 18 Mar. 2009, Texas Department of State Health Services, 9 Sept. 2010 www.dshs.state.tx.us/famplan/tpp.shtm. 85 Why It Matters: Teen Pregnancy and Responsible Fatherhood at 2, no date, The National Campaign to Prevent Teen Pregnancy, 9 Sept. 2010 www.thenationalcampaign.org/why-it-matters/pdf/fatherhood.pdf. 86 Family Initiatives, 2 Sept. 2010, The Attorney General of Texas Greg Abbott, 9 Sept. 2010 www.oag.state.tx.us/cs/ofi/index.shtml#papa. 87 Ibid. 88 Early Childhood Intervention Services, no date, Texas Department of Assistive and Rehabilitative Services, 9 Sept. 2010 www.dars.state. tx.us/ecis/index.shtml. 89 Ibid.

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90 Services and Eligibility, no date, Texas Department of Assistive and Rehabilitative Services, 9 Sept. 2010 www.dars.state.tx.us/ecis/eligibility.shtml. 91 Ibid. 92 Ibid. 93 Ibid. 94 Ibid. 95 Christina Newmann, public information request to Texas Department of Assistive and Rehabilitative Services, 12 Mar. 2010. 96 Ibid. 97 Ibid. 98 Ibid. 99 Ibid. 100 Ibid. 101 Ibid. 102 Ibid. 103 Ibid. 104 Ibid. 105 Ibid. 106 Ibid. 107 Ibid. 108 Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, Income, Poverty, and Health Insurance Coverage in the United States: 2008 at 22, Sept. 2009, U.S. Census Bureau, 9 Sept. 2010 www.census.gov/prod/2009pubs/p60-236.pdf. 1987 was the first year that comparable health insurance data was collected. 109 Current Population Survey (CPS): 2009 Annual Social and Economic (ASEC) Supplement, Table HI05, no date, U.S. Census Bureau, 9 Sept. 2010 www.census.gov/hhes/www/cpstables/032009/health/h05_000.htm. 110 Current Population Survey (CPS): 2008 Annual Social and Economic (ASEC) Supplement, Table HI05, no date, U.S. Census Bureau, 9 Sept. 2010 www.census.gov/hhes/www/macro/032008/health/h05_000.htm. 111 Population Survey (CPS): 2009 Annual Social and Economic (ASEC) Supplement, U.S. Census Bureau. 112 Derrick Crowe, News Release: Census Data Show Texas Stands to Gain Most from Health Reform, 10 Sept. 2009, Center for Public Policy Priorities, 9 Sept. 2010 www.cppp.org/files/3/CPS_Data_Release_final.pdf. 113 Medicaid: Overview, 29 Mar. 2010, Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services, 9 Sept. 2010 www.cms.hhs.gov/MedicaidGenInfo/. 114 The Children’s Health Insurance Program (CHIP): Overview, 30 Jun. 2010, Medicare & Medicaid Services, U.S. Department of Health & Human Services, 9 Sept. 2010 www.cms.hhs.gov/LowCostHealthInsFamChild/. 115 Texas Medicaid and CHIP in Perspective: Chapter 1: Texas Medicaid in Perspective at 1, Jan. 2009, Texas Health and Human Services Commission, 9 Sept. 2010 www.hhsc.state.tx.us/medicaid/reports/PB7/BookFiles/Chapter%201.pdf. 116 Ibid. 117 Ibid. 118 Texas Medicaid and CHIP in Perspective: Chapter 4: Medicaid Clients and Benefits at 5 www.hhsc.state.tx.us/Medicaid/reports/PB7/ BookFiles/Chapter%204.pdf. 119 Ibid. at 2. 120 The 2009 HHS Poverty Guidelines, 3 Aug. 2010, U.S. Department of Health & Human Services, 9 Sept. 2010 aspe.hhs.gov/ poverty/09poverty.shtml. 121 Ibid. 122 Final Count – Medical Enrollment by Month, no date, Texas Health and Human Services Commission, 9 Sept. 2010 www.hhsc.state.tx.us/ research/MedicaidEnrollment/meByMonthCompletedCount.html. 123 Ibid. The 2009 average monthly enrollment includes data for January 2009 through July 2009, the most current month for which data is available as of 4 Feb. 2010. 124 Ibid. 125 Ibid. 126 Ibid. 127 Medicaid Enrollment by County, no date, Texas Health and Human Services Commission, 9 Sept. 2010 www.hhsc.state.tx.us/research/MedicaidEnrollment/me_results.asp. The 2009 average monthly enrollment includes data for January 2009 through July 2009, the most current month for which data is available as of 02/04/2010. 128 Lisa Belli, information request to Texas Health and Human Services Commission, 19 Mar. 2010. 129 Medicaid Enrollment by County, Texas Health and Human Services Commission. 130 Final Count – Medical Enrollment by Month, Texas Health and Human Services Commission. 131 Lisa Belli, public information request to Texas Health and Human Services Commission. 132 Ibid. 133 Ibid. 134 Texas Budget Highlights Fiscal 2010-11 at 8-9, 13 Jul. 2009, House Research Organization, Texas House of Representatives, 9 Sept. 2010 www.hro.house.state.tx.us/focus/highlights81.pdf. 135 Texas Medicaid and CHIP in Perspective: Chapter 7: Medicaid Clients and Benefits at 1 www.hhsc.state.tx.us/medicaid/reports/PB7/ BookFiles/Chapter%207.pdf.

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Physical & Mental Health 136 Ibid. 137 Ibid. 138 National CHIP Policy: Overview, no date, Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services, 9 Sept. 2010 www.cms.hhs.gov/NationalCHIPPolicy/. 139 Texas Medicaid and CHIP in Perspective: Chapter 7: Medicaid Clients and Benefits at 1-2. 140 Ibid. at 2. In order to qualify for CHIP, the child must also be: a U.S. citizen or legal permanent resident; a Texas resident; uninsured for at least 90 days; and living in a family that passes an asset test if family income is above 150 percent of the FPL. 141 The 2009 HHS Poverty Guidelines, U.S. Department of Health & Human Services. Guideline is for the 48 contiguous states and the District of Columbia in 2009. 142 CHIP Enrollment by Income Group: Number and Percent by Federal Poverty Level, no date, Texas Health and Human Services Commission, 9 Sept. 2010 www.hhsc.state.tx.us/research/CHIP/CHIPEnrollIncomeGroup.html. 143 Texas Medicaid and CHIP in Perspective: Chapter 7: Medicaid Clients and Benefits, Table 7.2 at 10. 144 CHIP Enrollment, Renewal and Disenrollment by Month, no date, Texas Health and Human Services Commission, 9 Sept. 2010 www. hhsc.state.tx.us/research/CHIP/ChipRenewStatewide.html. 145 Ibid. Data as of January 22, 2010. 146 Chip Enrollment Statistics, Chip Enrollment by County and Month, no date, Texas Health and Human Services Commission, 9 Sept. 2010 www.hhsc.state.tx.us/research/CHIP/ChipDataTables.asp. 147 Texas Medicaid and CHIP in Perspective: Chapter 7: Medicaid Clients and Benefits at 14. 148 Ibid. 149 Ibid. 150 Ibid. at 15. 151 Ibid. at 15. 152 Chip Enrollment Statistics, Texas CHIP Perinatal Coverage Enrollment by County, Texas Health and Human Services Commission. 153 Children’s Health Insurance Status and Medicaid/CHIP Eligibility and Enrollment, 2008, Sept. 2009, American Academy of Pediatrics, 9 Sept. 2010 www.aap.org/research/cps.pdf. 154 Ibid. 155 SSI Annual Statistical Report, 2008, Sept. 2009, Social Security Administration, 13 Sept. 2010 www.ssa.gov/policy/docs/statcomps/ssi_ asr/2008/ssi_asr08.pdf p. 21. 156 Ibid. 157 SSI Recipients by State and County, 2008, May 2009, Social Security Administration, 13 Sept. 2010 www.ssa.gov/policy/docs/statcomps/ ssi_sc/2008/index.html. 158 School-Based Health Centers, no date, 22 Mar. 2010, Texas Department of State Heath Services, 9 Sept. 2010 www.dshs.state.tx.us/schoolhealth/healctr.shtm. 159 Ibid. 160 Public information request to Harris County Hospital District 2010. 161 School-Based Health Centers, Texas Department of State Heath Services. 162 Ibid. 163 List of Addresses of School Based Clinics 2010-2011, no date, HISD Connect, Student Support Services, 9 Sept. 2010 www.houstonisd.org 164 David L. Lakey, M.D., Annual Report on School-Based Health Centers Fiscal Year 2008, no date, Texas Department of State Health Services, 9 Sept. 2010 www.dshs.state.tx.us/schoolhealth/pdf/SchoolBasedHealthCtrsRptFY08.pdf. 165 About Texas Health Steps, last updated 1 Sept. 2010, Texas Department of State Health Services, 16 Sept. 2010 www.dshs.state.tx.us/ thsteps/about.shtm. 166 Ibid. 167 Public information request to Strategic Decision Support, Texas Health and Human Services Commission, Feb. 2010. 168 Ibid. 169 Texas Medicaid and CHIP in Perspective, Chapter 1: Texas Medicaid in Perspective at 6, Jan. 2009 Texas Health and Human Services Commission, 16 Sept. 2010 www.hhsc.state.tx.us/medicaid/reports/PB7/BookFiles/Chapter%201.pdf. 170 Public information request to Strategic Decision Support, Texas Health and Human Services Commission, Dec. 2009. 171 Ibid. 172 Texas WIC Income Guidelines, Nutrition Services, Texas Department of State Health Services, 9 Sept. 2010 < http://www.dshs.state.tx.us/ wichd/policy/pdf_files/CS_12-0.pdf. 173 Public information request to Women, Infants and Children (WIC) Program, Texas Department of State Health Services, 2009. 174 Ibid. 175 General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices and the American Academy of Family Physician, 8 February 2002, Washington, DC: Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Reports, 51(RR02); 1 – 36, 13 Sept. 2010 www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm. 176 Public information request to Immunization Division, Texas Department of State Health Services, 8 Mar 2010. 177 Dragsbaek, Anna C., Moore, Maureen, Nakra, Nidhi M. The Houston Area Immunization Partnership Stakeholder Meeting at the United Way building, March 3, 2010, www.immunizeusa.org. 178 Nelson, Zakia Coriaty, Jeannine S. Schiller, Gulnur Scott. National Center for Health Statistics “Rates of 4:3:1 vaccination among U.S. children aged 19–35 months, National Health Interview Surveys, 2002 – 2003”, 20 Aug 2010 www.cdc.gov/nchs/data/hestat/vaccination.htm.

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179 General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices and the American Academy of Family Physician, 8 February 2002, Washington, DC: Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Reports, / 51(RR02); 1 – 36, 13 Sept. 2010 www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm. 180 Luman, Elizabeth T., Lawrence E. Barker, Mary Mason McCauley, Carolyn Drews-Botsch. Timeliness of Childhood Immunizations: A State-Specific Analysis, American Journal of Public Health, August 2005, Volume 95, Number 8. 13 Sept. 2010 www.ajph.org/cgi/reprint/95/8/1367. 181 Ibid. 182 Centers for Disease Control, National Immunization Survey 2008, Estimated Vaccination Coverage with 4:3:1:3 Among children 19 to 35 months of age by state and local area, 13 Sept. 2010 www2a.cdc.gov/nip/coverage/nis/nis_iap2.asp?fmt=r&rpt=tab28_4313_race_ iap&qtr=Q1/2008-Q4/2008. See also, www.cdc.gov/vaccines/stats-surv/nis/nis-2008-released.htm for main data page. 183 Centers for Disease Control, National Immunization Survey 2008. Estimated Vaccination Coverage with 4:3:1:3:3:1:4 Among children 19 to 35 months of age by state and local area, 13 Sept. 2010 www2a.cdc.gov/nip/coverage/nis/nis_iap2. asp?fmt=r&rpt=tab27_4313314_race_iap&qtr=Q1/2008-Q4/2008. 184 Harris County Public Health and Environmental Services, Immunization Action Plan. (May 2004), 13 Sept. 2010 www.hcphes.org/ITFReport518311.pdf. 185 Public Information Request. Immunization Division, Texas Department of State Health Services. March 30, 2010. 186 Centers for Disease Control, National Immunization Survey 2008, Estimated Vaccination Coverage with 4:3:1:3 Among children 19 to 35 months of age by state and local area. 187 Centers for Disease Control, National Immunization Survey 2008. Estimated Vaccination Coverage with 4:3:1:3:3:1:4 Among children 19 to 35 months of age by state and local area. 188 Centers for Disease Control, National Immunization Survey 2008, Estimated Vaccination Coverage with 4:3:1:3 Among children 19 to 35 months of age by state and local area. 189 Centers for Disease Control, National Immunization Survey 2007, Estimated Vaccination Coverage with 4:3:1:3 Among children 19 to 35 months of age by state and local area. 190 The Houston Area Immunization Partnership Stakeholder Meeting at the United Way building, March 3, 2010. 191 Ibid. 192 Ibid. 193 Ibid. 194 Ibid. 195 Ibid. 196 Ibid. 197 Ibid. 198 Ibid. 199 Centers for Disease Control, Overview of Measles Disease, (Atlanta) www.cdc.gov/measles/index.html. 200 Ibid. 201 Ibid. 202 Ibid. 203 Public information request to Immunization Division, Texas Department of Health, 28 Oct. 2009. 204 Ibid. 205 Skinsight, Measles (Rubeola) – Overview, 15 Sept. 2010 < http://www.skinsight.com/child/rubeolaMeasles.htm. 206 CDC, Recommended Immunization Schedule for Persons Aged 0 Through 6 Years—United States • 2010, www.cdc.gov/vaccines/recs/ schedules/downloads/child/2010/10_0-6yrs-schedule-pr.pdf. 207 Skinsight, Measles (Rubeola) – Overview. 208 Ibid. 209 Centers for Disease Control and Prevention, National Immunization Survey 2008, Estimated Vaccination Coverage with 4:3:1:3 Among children 19 to 35 months of age by state and local area, 13 Sept. 2010. 210 Ibid. 211 Centers for Disease Control and Prevention, Pertussis (Whooping Cough) – What You Need To Know, 15 Sept. 2010 www.cdc.gov/Features/Pertussis/. 212 ClinLabNavigator.com, Bordetella Pertussis PCR, 15 Sept. 2010 www.clinlabnavigator.com/Test-Interpretations/bordetella-pertussis-pcr. html. 213 Medscape, Pertussis: eMedicine Pediatric, 15 Sept. 2010 emedicine.medscape.com/article/967268-overview. 214 National Foundation for Infectious Diseases, Pertussis, Tetanus & Diphtheria, 15 Sept. 2010 <http:www.nfid.org/pertussis. 215 Ibid. 216 Pertussis (Whooping Cough), no date, Centers for Disease Control, 15 Sept. 2010 www.cdc.gov/pertussis/. 217 The Sounds of Pertussis, no date, Parents of Kids with Infectious Diseases, 15 Sept. 2010 www.pkids.org/dis_pert_about-pertussis.php. 218 Public information request to Immunization Division, Texas Department of Health. 219 Tuberculosis, last update 10 Sept. 2010, Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov./tb. 220 Ibid. 221 Ibid. 222 Ibid. 223 Tuberculosis: Risk Factors, 28 Jan. 2009, Mayo Clinic, 15 Sept. 2010 www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=riskfactors.

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Physical & Mental Health 224 Fact Sheet: Trends in Tuberculosis, 2008, Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/tb/publications/factsheets/statistics/TBTrends.htm. 225 Ibid. 226 Ibid. 227 TB: Fact Sheet, BCG Vaccine, no date, Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/tb/publications/factsheets/ vaccine/BCG.htm. 228 Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Development of New Vaccines for Tuberculosis: Recommendations for the Advisory Council for the Elimination of Tuberculosis (June 1998), 15 Sept. 2010 www.cdc.gov/mmwr/preview/ mmwrhtml/00054407.htm. 229 TB: Fact Sheet, BCG Vaccine, Centers for Disease Control and Prevention. 230 Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Development of New Vaccines for Tuberculosis: Recommendations for the Advisory Council for the Elimination of Tuberculosis. 231 Fact Sheet: Trends in Tuberculosis, 2008, Centers for Disease Control and Prevention. 232 Ibid. 233 Reported Tuberculosis in the United States 2008 at 59, Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/tb/statistics/reports/2008/pdf/2008report.pdf. 234 National Tuberculosis Surveillance System Highlights from 2008, Centers for Disease Control and Prevention,15 Sept. 2010 www.cdc. gov/tb/statistics/surv/surv2008/default.htm. 235 Tuberculosis Statistics, Texas Department of State Health Services: Infectious Disease Control Unit, 15 Sept. 2010 www.dshs.state.tx.us/idcu/ disease/tb/statistics/. 236 Ibid. 237 Reported Tuberculosis in the United States 2008 at 53, Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/tb/statistics/reports/2008/pdf/2008report.pdf. 238 Public information request to Harris County Public Health and Environmental Services, 2 Nov. 2009. 239 Ibid. 240 Reported Tuberculosis in the United States 2008at 56, Centers for Disease Control and Prevention. 241 Texas Childhood Lead Poisoning Prevention Program. Toward a Lead-Safe Texas. Texas Strategic Plan to Eliminate Child Lead Poisoning by 2010. July 2007-June 2008. 242 Road to Healthy Housing, Bureau of Community & Children’s Environmental Health,16 Sept. 2010, www.healthyhomestraining.org/Transitions/Houston_Road%20to%20Healthy%20Housing_11-24-08.pdf. 243 City of Houston, Health and Human Services: Childhood Lead Poisoning Prevention Project, Elimination of Childhood Lead Poisoning in Houston by 2010, 16 Sept. 2010 www.houstontx.gov/health/Environmental/Elimination%20Plan%20Childhood%20Lead%20Poisoning%20 in%20Houston%202010.pdf. 244 Ibid. 245 Ibid. 246 U.S. Department of Housing & Urban Development, 5 Oct. 2009, HUD Announces $7.7 Million in Grants to Texas to Protect Thousands of Children From Lead and Other Health Hazards, 16 Sept. 2010 www.hud.gov/local/tx/news/pr2009-10-05.cfm. 247 Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. “Prevalence of Overweight and Obesity in the United States, 19992004.” JAMA. 295, 13, 5 Apr. 2006, 16 Sept. 2010 jama.ama-assn.org/cgi/reprint/295/13/1549. 248 Ogden CL, Flegal KM, Carroll MD, Johnson CL. “Prevalence and Trends in Overweight among US Children and Adolescents, 1999-2000.” JAMA. 288, 13, 9 Oct. 2002, 16 Sept. 2010 www.biostat.mcg.edu/Seminars/Year2007/Handout4.pdf. 249 Ogden CL, Carroll MD, Flegal KM, Centers for Disease Control and Prevention, National Center for Helath Statistics, Prevelance of Obesity Among Children and Adolescents: United States, Trends 1963 – 1965 Through 2007 – 2008, 16 Sept. 2010 www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf. 250 Ibid. 251 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Healthy Youth: Childhood Obesity Fact Sheets, 2010, 16 Sept. 2010 www.cdc.gov/healthyYouth/obesity/facts.htm. 252 Ibid. 253 Kelly Reed, public information request to School Health Program Manager of HCPHES, 2 Aug. 2006. 254 Office of the Surgeon General, Overweight and Obesity: Health Consequences. (Washington, DC: 2007), 16 Sept. 2010 www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences. 255 Office of the Governor Rick Perry, Texas Governor’s Commission for Women Newsletter, Spring 2007, 16 Sept. 2010 governor.state.tx.us/files/ women/Spring-2007.doc. 256 Texas Department of State Health Services, Texas! Bringing Healthy Back: Obesity, 16 Sept. 2010 www.dshs.state.tx.us/obesity/default.shtm. 257 Houston Department of Health and Human Services, The State of Health in Houston/Harris County Texas 2009: Overweight/Obesity in Youth, houstonstateofhealth.org/soh_doc.php, (25). 258 AJ Sharma, PhD, LM Grummer-Strawn, PhD, K Dalenius, MPH, D Galuska, PhD, M Anandappa, MS, E Borland, H Mackintosh, MSPH, R Smith, MS, Div of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Obesity Prevalence Among Low-Income, Preschool-Aged Children – United States, 1998-2008, 24 July 2009, 16 Sept 2010 www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm. 259 Texas Department of State Health Services, Texas Health Step Services: Oral Health Group, 16 Sept 2010 www.dshs.tx.us/thsteps/default.

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260 Harris County Public Health & Environmental Services, Dental Health and Prevention Services, Dental Public Health Clinics, 16 Sept. 2010 www.hcphes.org/dccp/dental/DentAccess/English%20Dental%20Referral%20Sheet.pdf. 261 Dental Services, no date, City of Houston Health and Human Services, 16 Sept. 2010 www.houstontx.gov/health/Dental/index.html. 262 Ibid. 263 Texas Department of State Health Services, Texas Health Steps Dental Statewide Report for Service Utilization for SFY 2006, May 2007, 16 Sept. 2010 www.dshs.state.tx.us/dental/pdf/dent_statewide_2006.pdf. 264 Public information request to Strategic Decision Support, Texas Health and Human Services Commission, Dec. 2009. 265 Ibid. 266 Ibid. 267 Sexually Transmitted Diseases in the United States, 2008, 16 Nov. 2009, United States Department of Health and Human Services- Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/std/stats08/trends.htm. 268 Ibid. 269 Ibid. 270 Ibid. 271 Ibid. 272 Chlamydia- CDC Fact Sheet, 12 May 2010, United States Department of Health and Human Services- Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm. 273 STD Health Disparities, 11 May 2010, United States Department of Health and Human Services - Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/std/health-disparities/age.htm. 274 Chlamydia- CDC Fact Sheet, United States Department of Health and Human Services- Centers for Disease Control and Prevention. 275 Ibid. 276 HDHHS Gonorrhea & Chlamydia in Houston/Harris County, no date, Houston Department of Health and Human Services, 15 Sept. 2010 www.houstontx.gov/health/HIV-STD/GC%202009.pdf. 277 Ibid. 278 Sexually Transmitted Diseases in the United States, 2008, United States Department of Health and Human Services - Centers for Disease Control and Prevention. 279 Gonorrhea- CDC Fact Sheet, 28 Feb. 2008, United States Department of Health and Human Services- Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/std/gonorrhea/STDFact-gonorrhea.htm. 280 Ibid. 281 Sexually Transmitted Diseases in the United States, 2008, United States Department of Health and Human Services - Centers for Disease Control and Prevention. 282 Public information request to Houston Department of State Health Services, 2010. 283 Ibid. 284 HDHHS Gonorrhea & Chlamydia in Houston/Harris County, Houston Department of Health and Human Services. 285 Sexually Transmitted Diseases in the United States, 2008, United States Department of Health and Human Services - Centers for Disease Control and Prevention. 286 Ibid. 287 Public information request to Houston Department of Health and Human Services, 2010. 288 Ibid. 289 Ibid. 290 Sexually Transmitted Diseases in the United States, 2008, United States Department of Health and Human Services - Centers for Disease Control and Prevention. 291 SAMHSA’S National Mental Health Information Center, 1 Nov. 2003, United States Department of Health and Human Services – Substance Abuse and Mental Health Services Administration, 13 Sept. 2010 mentalhealth.samhsa.gov/publications/allpubs/CA-0004/default.asp. 292 National Institute of Mental Health, 2009, National Institute of Health, 13 Sept. 2010 www.nimh.nih.gov/health/publications/treatment-ofchildren-with-mental-illness-fact-sheet/index.shtml. 293 SAMHSA’S National Mental Health Information Center, United States Department of Health and Human Services – Substance Abuse and Mental Health Services Administration. 294 Ibid. 295 Office of the Surgeon General, no date, United States Department of Health and Human Services, 13 Sept. 2010 www.surgeongeneral.gov/ topics/cmh/childreport.html. 296 SAMHSA’S National Mental Health Information Center, United States Department of Health and Human Services – Substance Abuse and Mental Health Services Administration. 297 Office of News and Public Information, 13 Feb. 2009, National Academies, 13 Sept. 2010 www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12480. 298 Ibid. 299 National Alliance on Mental Illness - Texas Report, no date, National Alliance on Mental Illness, 13 Sept. 2010 www.nami.org/gtsTemplate09.cfm?Section=Grading_the_States_2009&Template=/contentmanagement/contentdisplay.cfm&ContentID=74934. 300 U.S. Census Bureau, no date, U.S. Census Bureau, 13 Sept. 2010 www.factfinder.census.gov/ 301 Ibid.; SAMHSA’S National Mental Health Information Center, United States Department of Health and Human Services – Substance Abuse and Mental Health Services Administration. 302 Scott Hickey, public information request to the Mental Health and Mental Retardation Authority of Harris County, 14 Sept. 2010. 303 Ibid.

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Physical & Mental Health 304 Ibid. 305 Ibid. 306 Ibid. 307 Ibid. 308 Ibid. 309 Ibid. 310 Ibid. 311 Ibid. 312 About the Mental Health Court, Judge John F. Phillips, 13 Sept. 2010 www.judgejohnfphillips.com/mental-health-court/. 313 Ibid. 314 Aron L., Honberg, R., Duckworth, K., et. al., Grading the States 2009: A Report on America’s Health Care System for Adults with Serious Mental Illness, Mar. 2009, National Alliance on Mental Illness, 16 Sept. 2010 www.nami.org/Content/NavigationMenu/NAMILand/ POLgts2009.pdf. 315 Scott Hickey, public information request to MHMRA of Harris County, 14 Sept. 2010. 316 Ibid. 317 Ibid. 318 Cost to house a child in the TYC is $270 per day, while the cost to house a child in a community-based mental health center is $175 per day. 319 Mental Illness in Harris County: A Report of the Mental Health Needs Council, Inc. 2009, no date, The Mental Health Needs Council, 16 Sept. 2010 mhnchc.org/mhnc2009report.html. 320 Ibid. 321 Ibid. 322 Ibid. 323 Scott Hickey, public information request to MHMRA of Harris County, 23 Jun. 2010. 324 Ibid. 325 Public information request to MHMRA of Harris County, 2007. 326 Ibid. 327 Scott Hickey, public information request to MHMRA of Harris County, Sept. 10, 2010 328 Public information request to TRIAD, 2006. 329 Waco Center for Youth, no date, Texas Department of State Health Services, 16 Sept. 2010 www.dshs.state.tx.us/mhhospitals/wacocenterforyouth/default.shtm. 330 Scott Hickey, public information request to MHMRA of Harris County, 2010. 331 Ibid. 332 Respite Care for Children with Serious Emotional Disorders and Their Families: A Way to Enrich Family Life, Vol. 15 No. 2, Fall 2001, Regional Research Institute for Human Services, 16 Sept. 2010 www.rtc.pdx.edu/PDF/fpF0106.pdf. 333 Children’s Mental Health Services, last modified 19 Dec. 2007, Texas Department of State Health Services, 16 Sept. 2010 www.dshs.state. tx.us/mhservices/mhchildrensservices.shtm. 334 Scott Hickey, public information request to MHMRA of Harris County, 23 Jun. 2010. 335 Texas Medicaid Program, no date, Texas Health and Human Services Commission, 16 Sept. 2010 www.hhsc.state.tx.us/medicaid/. 336 Medicaid Program Overview, last modified 9 Sept. 2010, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, 16 Sept. 2010 www.cms.gov/MedicaidGenInfo/. 337 Texas Medicaid and CHIP in Perspective, Chapter 1: Texas Medicaid in Perspective, Jan. 2009 Texas Health and Human Services Commission, 16 Sept. 2010 www.hhsc.state.tx.us/medicaid/reports/PB7/BookFiles/Chapter%201.pdf. 338 Impact of Primary Care Case Management (OCCM) Implementation on Medicaid and SCHIP, Mar. 2009, The Child Health Insurance Research Institute, 16 Sept. 2010 www.ahrq.gov/chiri/chiribrf8/chiribrf8.pdf. 339 Texas May Expand Medicaid Managed Care to Valley, 15 Jun. 2010, The Texas Tribune, 16 Sept. 2010 www.texastribune.org/texas-stateagencies/health-and-human-services-commission/texas-may-expand-medicaid-managed-care-to-valley/. 340 Texas Medicaid and CHIP in Perspective, Chapter 1: Texas Medicaid in Perspective, Texas Health and Human Services Commission. 341 Lisa Belli, public information request to the Office of the General Counsel, Texas Department of Health and Human Services Commission, 16 Jul. 2006. 342 Scott Hickey, public information request to MHMRA of Harris County, 2010. 343 Ibid. 344 Harris County Juvenile Probation Department, no date, Harris County Juvenile Probation Department, 13 Sept. 2010 www.hcjpd.org/ mental_health_services.asp. 345 Ibid. 346 Survey of youths in custody finds half have mental health problems, 8 May 2008, Houston Chronicle Online, 16 Sept. 2010 www.chron. com/disp/story.mpl/metropolitan/5766286.html. 347 Ibid. 348 Houston Chronicle, 8 May 2010, Houston Chronicle, 13 Sept. 2010 www.chron.com/disp/story.mpl/metropolitan/5766286.html. 349 Agency Overview, no date, Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, 9 Sept. 2010 www.samhsa.gov/About/background.aspx. 350 The Center for Mental Health Services, no date, SAMHSA’s National Mental Health Information Center, U.S. Department of Health and

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Human Services, 9 Sept. 2010 mentalhealth.samhsa.gov/cmhs/. 351 Community Resource Coordination Group, no date, Harris County Systems of Hope, 9 Sept. 2010 www.systemsofhope.org/CRCG.aspx. 352 About Us, no date, Harris County Systems of Hope, 9 Sept. 2010 www.systemsofhope.org/Aboutus.aspx. 353 Welcome, no date, Systems of Care, U.S. Department of Health and Human Services, 9 Sept. 2010 systemsofcare.samhsa.gov/index.aspx. Additional partners include: Baylor College of Medicine; The Council on Alcohol and Drugs Houston; Harris County Department of Education; Texas Department of Family and Protective Services; Texas Health and Human Services Commission; and Texas Department of State Health Services. 354 Welcome to the Systems of Hope, no date, Harris County Systems of Hope, 9 Sept. 2010 www.systemsofhope.org/default.aspx. 355 Ibid. 356 Pam Schaffer, information request to Program Services Manager, Harris County Systems of Hope, 18 Feb. 2010. 357 Ibid. 358 Ibid. 359 Ibid. 360 Ibid. 361 Ibid. 362 Ibid. 363 Ibid. 364 Ibid. 365 Ibid. 366 Ibid. 367 Welcome!, no date, Juvenile Mental Health Court of Harris County, 9 Sept. 2010 www.hcjpd.org/MentalHealthCourt/index.html. 368 Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System, no date, National Center for Mental Health and Juvenile Justice, 9 Sept. 2010 www.ncmhjj.com/Blueprint/ default.shtml. 369 Newsletter at 3, June 2009, Harris County JDAI, 9 Sept. 2010 www.hcjpd.org/JDAINewsletter/Newsletter%20-%20June%202009%20Final. pdf. 370 Ibid. 371 Court Design, no date, Juvenile Mental Health Court of Harris County, 9 Sept. 2010 www.hcjpd.org/MentalHealthCourt/court_design.html. 372 Pam Schaffer, information request to Harris County Systems of Hope. 373 Ibid. 374 Ibid. 375 Ibid. 376 Ibid. 377 Ibid. 378 Liu, Liang Y., Substance Use in Texas, 01 Jan. 2009, Decision Support Unit Mental Health and Substance Abuse Services Division Department of State Health Services, 13 Sept. 2010 www.dshs.state.tx.us/sa/Research/PDF/Adolescent%20Sub%20Use%20in%20Texas%20 01_2009%20%28revised%29.pdf. 379 Ibid. 380 Ibid. 381 Ibid. 382 Ibid. 383 Ibid. 384 Red Ribbon Week 2009, 02 Jun. 2010, Prevention Resource Center – Region 3, 13 Sept. 2010 www.prc3.org/redribbon/facts.htm. 385 Traffic Safety Facts – 2006 Data, Mar. 2008, National Highway Traffic Safety Administration National Center for Statistics and Analysis. 13 Sept. 2010 www-nrd.nhtsa.dot.gov/pubs/810817.pdf. 386 Liu, Substance Use in Texas. 387 Ibid. 388 2009 Tobacco and Marijuana Market Impact Index Volume I: Texas Trends, no date, ProtectYouth.org, 15 Sept. 2010 www.scribd.com/ doc/17339513/ProtectYouthorg-Tobacco-Marijuana-Market-Impact-Index-Texas-Trends. 389 Houston ISD Texas School Survey of Drug and Alcohol Use, Spring 2008, Houston ISD, 15 Sept. 2010 www.scribd.com/doc/19483124/ Houston-ISD-2008-Texas-School-Survey-of-Drug-and-Alcohol-Use. 390 Public information request to Harris County Mental Health and Substance Abuse Division, 2009. 391 Youth Suicide Fact Sheet, no date, American Association of Suicidology, 15 Sept. 2010 www.suicidology.org/c/document_library/get_ file?folderId=232&name=DLFE-245.pdf. 392 Ibid. 393 Ibid. 394 Suicide Facts at a Glance, Summer 2009, Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/violenceprevention/pdf/ Suicide-DataSheet-a.pdf. 395 Youth Suicide Fact Sheet, American Association of Suicidology. 396 Suicide Facts at a Glance, Centers for Disease Control and Prevention. 397 Youth Suicide Fact Sheet, American Association of Suicidology. 398 Ibid.

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Physical & Mental Health 399 Ibid. 400 Public information request to Harris County Medical Examiner’s office, 2009. 401 Ibid. 402 Ibid. 403 Youth Suicide Fact Sheet, American Association of Suicidology. 404 Ibid. 405 Factsheet: Suicide, no date, Mental Health America, 15 Sept. 2010, www.mentalhealthamerica.net/go/suicide. 406 HIV and AIDs- Questions and Answers, no date, American Social Health Association, 15 Sept. 2010 www.ashastd.org/learn/learn_hiv_aids. cfm. 407 D’Arcy Dora, “AIDS deaths top 25 mln but infections slow,” Google News, 24 Nov. 2009, 15 Sept. 2010 www.google.com/hostednews/afp/ article/ALeqM5hxc-xJF5Wv4ROHi6TPUcqiuqVrmA. 408 HIV/AIDS among Youth, Aug. 2008, United States Department of Health and Human Services- Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/hiv/resources/factsheets/print/youth.htm. 409 Ibid. 410 HIV in the United States, Jul. 2010, United States Department of Health and Human Services - Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/hiv/resources/factsheets/PDF/us.pdf. 411 Ibid. 412 Ibid. 413 Ibid. 414 Basic Statistics, 27 Jul. 2010, United States Department of Health and Human Services- Centers for Disease Control and Prevention, 15 Sept. 2010 www.cdc.gov/hiv/topics/surveillance/print/basic.htm. 415 Ibid. 416 2008 Annual Report, Texas HIV/STD Surveillance Report, 31 Dec. 2008, Texas Department of State Health Services, 15 Sept. 2010 www. dshs.state.tx.us/hivstd/stats/pdf/surv_2008.pdf. 417 Basic Statistics, United States Department of Health and Human Services - Centers for Disease Control and Prevention. 418 Public information request, AIDS cases with residency at time of AIDS diagnosis in Houston/Harris Co. in Children 0-19 Years Old, 2009. 419 Ibid. 420 Ibid. 421 2008 Annual Report, Texas HIV/STD Surveillance Report, Texas Department of State Health Services. 422 Ibid. 423 Public Information Request, AIDS cases with residency at time of AIDS diagnosis in Houston/Harris County in Children 0-19 Years Old.

Safety & Security About Human Trafficking, no date, Administration for Children & Families, U.S. Department of Health and Human Services, 9 Aug. 2010 http://www.acf.hhs.gov/trafficking/about/index.html. 2 What is Human Trafficking?, no date, Polaris Project, 18 Jul. 2010 www.polarisproject.org/content/view/26/47/. 3 Look Beneath the Surface: Human Trafficking is Modern-Day Slavery, no date, Administration for Children & Families, U.S. Department of Health and Human Services, 18 Jul. 2010 www.acf.hhs.gov/trafficking/index.html. 4 Ibid. 5 Trafficking in Persons Report, Jun. 2009, U.S. Department of State, 18 Jul. 2010 www.state.gov/documents/organization/123357.pdf. 6 Ibid. 7 Tracey Kyckelhahn, Allen J. Beck, Ph.D., and Thomas H. Cohen, Ph.D., Characteristics of Suspected Human Trafficking Incidents, 2007-08, Jan. 2009, Bureau of Justice Statistics, 18 Jul. 2010 bjs.ojp.usdoj.gov/content/pub/pdf/cshti08.pdf. 8 Ibid. 9 Ibid. 10 Ibid. at 2, 3, 7. 11 Domestic Trafficking Within the U.S., no date, Polaris Project, 18 Jul. 2010 www.polarisproject.org/content/view/60/81/. 12 Human Trafficking Statistics, no date, Make Way Partners, 18 Jul. 2010 www.makewaypartners.org/effects.html. 1

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13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63

Caren Thomas, public information request to U.S. Department of Justice, 20 Nov. 2009. Ibid. Bruce Carr, public information request to Special Investigation Division – Human Trafficking Rescue Alliance. Ibid. Erin Meyer, public information request to Polaris Project, 9 Jun. 2010. The data displayed in this report was generated based on limited criteria from calls received by the National Human Trafficking Resource Center Hotline. This is not a comprehensive report on the scale or scope of human trafficking within the state or the U.S. These statistics may be subject to change. Ibid. Ibid. Tex. Pen. Code. §20A.02(a) (2007) Ibid. Tex. Pen. Code. §20A.02(b) (2007). Tex. Gov’t Code. §402.35(b) (2009). Ibid. Tex. Pen. Code. §43.02(d) (2009). Tex. Pen. Code. §43.05(a) (2009). Tex. Civ. Prac. & Rem. Code. §98.002(a) (2009). Tex. Loc. Gov’t Code. §234(D) (2009). Tex. Labor Code. §51.016 (2009). Tex. Gov’t Code. §411.122(a) (2009). What is Human Trafficking? Polaris Project. Jaennie Yoon, MPH, 2006-2007 Child Fatality Report, Mar. 2010, Houston/Harris County Child Fatality Review Team, 18 Jul. 2010 www. hcphes.org/dccp/epidemiology/child_fatalit_review_team/0607ChildFatalityReport_Final.pdf. Ibid. at 16. Teen Drivers: Fact Sheet, no date, Centers for Disease Control and Prevention, 18 Jul. 2010 www.cdc.gov/MotorVehicleSafety/Teen_Drivers/teendrivers_factsheet.html. Ibid. Ibid. 1996-2007 Child Fatality Reports, no date, Houston/Harris County Child Fatality Review Team, 18 Jul. 2010 www.hcphes.org/dccp/epidemiology/child_fatalit_review_team/child.htm#report. Yoon, 2006-2007 Child Fatality Report, Houston/Harris County Child Fatality Review Team. Ibid. Ibid. at 16. Ibid. Ibid. at 19. Ibid. Ibid. at 20. Ibid. Ibid. Ibid. Prevent bathtub drowning, no date, Texas Children’s Hospital, 18 Jul. 2010 texaschildrenshospital.org/Parents/TipsArticles/ArticleDisplay. aspx?aid=1062. Ibid. Ibid. Yoon, 2006-2007 Child Fatality Report, Houston/Harris County Child Fatality Review Team at 20. Lyudmila Baskin, public information request to Center for Health Statistics, Texas Department of State Health Services, 19 Nov. 2009. Firearm Safety In America 2009, no date, National Rifle Association Institute for Legislative Action, 18 Jul. 2010 www.nraila.org/issues/factsheets/read.aspx?id=120. Lois A. Fingerhut and Katherine Kaufer Christoffel, Children, Youth, and Gun Violence, Fall 2002, The Future of Children, 18 Jul. 2010 futureofchildren.org/futureofchildren/publications/journals/article/index.xml?journalid=42&articleid=163&sectionid=1044&submit. Teen Drivers: Fact Sheet, Centers for Disease Control and Prevention. Graduated Driver Licensing, no date, Centers for Disease Control and Prevention, 18 Jul. 2010 www.cdc.gov/MotorVehicleSafety/Teen_Drivers/ GradDrvLic.html. CPS in Harris County Annual Report, 2008 Statistics, 2009 Program Information, Harris County Protective Services, 18 Jul. 2010 www. hc-ps.org/CPSAnnRepOct09.pdf . Ibid. Success: One Puzzle Piece at a Time: 2008 Annual Report, Harris County Juvenile Probation Department, 18 Jul. 2010 www.hcjpd.org/annual_reports/2008.pdf. Ibid. Ibid. School Policies that Engage Students and Families, 28 Jul. 2006, National Center for School Engagement, 18 Jul. 2010 www.schoolengagement.org/TruancypreventionRegistry/Admin/Resources/Resources/SchoolPoliciesthatEngageStudentsandFamilies.pdf. Child Maltreatment 2007, 2 Feb. 2009, The Administration for Children and Families, U.S. Department of Health and Human Services, 18 Jul. 2010 www.acf.hhs.gov/programs/cb/pubs/cm07/chapter3.htm#child.

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Safety & Security 64 Long-Term Consequences of Child Abuse and Neglect 2008 Factsheet, no date, Child Welfare Information Gateway, 18 Jul. 2010 www. childwelfare.gov/pubs/factsheets/long_term_consequences.cfm . 65 Tex. Fam. Code. ยง261.001(4)(B)(i) (2005). 66 Tex. Fam. Code. ยง261.101(b) (2007) 67 Annual Report 2008, Texas Department of Family and Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/documents/about/Data_Books_ and_Annual_Reports/2008/annual_report/2008DFPSAnnualReport.pdf . 68 Child Protective Services Handbook, Texas Department of Family and Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/handbooks/ CPS/Files/CPS_pg_2223.jsp#CPS_2223_2. 69 Ibid 70 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 71 Calls, Reports, Intake or Investigation Workers, and Response Time, Data Book, 2009, Texas Department of Family and Protective Services at 130, 18 Jul. 2010 www.dfps.state.tx.us/documents/about/Data_Books_and_Annual_Reports/2009/2009databook.pdf. 72 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 73 Annual Report and Data Book 2009, Texas Department of Family and Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/documents/ about/Data_Books_and_Annual_Reports/2009/2009databook.pdf. 74 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 75 Ibid. 76 Ibid. 77 Ibid. 78 Annual Report and Data Book 2009, Texas Department of Family and Protective Services. 79 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 80 Ibid. 81 Ibid. 82 Annual Report and Data Book 2009, Texas Department of Family and Protective Services. 83 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 84 Annual Report and Data Book 2009, Texas Department of Family and Protective Services. 85 Annual Report 2008, Texas Department of Family and Protective Services. 86 Shay Bilchik, CPS Needs Support, and We Must Find It, 17 Nov. 2003, Child Welfare League of America, 18 Jul. 2010 www.cwla.org/ execdir/edremarks031117.htm. 87 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 88 Ibid. 89 Annual Report and Data Book 2009, Texas Department of Family and Protective Services. 90 Annual Report 2008, Texas Department of Family and Protective Services. 91 Child Protective Services Caseworkers Get Mobile Technology: Tablet PC Training for 3,000 Employees Kicks Off, 7 Aug. 2006, Texas Department of Family & Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/About/News/2006/2006-08-07_tabletpc.asp. 92 Ibid. 93 Ibid. 94 Ibid. 95 Child Protective Services Handbook, no date, Texas Department of Family and Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/handbooks/CPS/Files/CPS_pg_3000.jsp#CPS_3130. 96 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 97 Ibid. 98 Ibid. 99 Ibid. 100 Ibid. 101 Ibid. 102 Ibid. 103 Ibid. 104 Ibid. 105 Ibid. 106 Ibid. 107 Ibid 108 Ibid. 109 Ibid. 110 Ibid. 111 Ibid. 112 Ibid. 113 Ibid 114 Foster Care, no date, Texas Department of Family and Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/Child_Protection/Foster_Care/. 115 Requirements for Foster/Adopt Families, no date, Texas Department of Family and Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/ Adoption_and_Foster_Care/Get_Started/requirements.asp.

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116 Annual Report and Data Book 2009, Texas Department of Family and Protective Services. 117 Annual Report and Data Book 2008, Texas Department of Family and Protective Services. 118 Annual Report and Data Book 2009, Texas Department of Family and Protective Services. 119 Ibid 120 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 121 Ibid 122 Children Never Outgrow the Need for Parents. Why Not You?, no date, Texas Department of Family and Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/About/News/2007/2007-04-01_adoption.asp . 123 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 124 Ibid. 125 Ibid. 126 Ibid. 127 Ibid. 128 The Disproportionate Representation of Ethnic or Racial Groups in the CPS System (Disproportionality), no date, Texas Department of Family and Protective Services, 18 Jul. 2010 www.dfps.state.tx.us/about/Renewal/CPS/disproportionality.asp. 129 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 130 Ibid. 131 Ibid. 132 Ibid. 133 Fostering Connections, 31 Mar. 2010, Texas Department of Family and Protective Services, 18 Jul. 2010, www.dfps.state.tx.us/Child_Protection/About_Child_Protective_Services/fostering_connections.asp. 134 Ibid. 135 Ibid. 136 CPS in Harris County Annual Report 2009, 2008 Statistics, Harris County Protective Services For Children & Adults. 137 Ginger Harper, public information request to Community Youth Services Director, 3 May 2010. 138 Ibid. 139 Deborah Colby, TRIAD Prevention Program Director, public information request to TRIAD Prevention Program, 17 March 2010; TRIAD Prevention Program, 17 Mar. 2010, Harris County Protective Services, 18 Jul. 2010 www.hc-ps.org/triad_prevention.htm. 140 Ibid. 141 Ibid. 142 Ibid 143 Ibid. 144 Ibid. 145 Ibid. 146 Ibid. 147 Ibid. 148 Ibid. 149 Public information request to Houston Police Department Public Affairs, Nov. 19, 2009. 150 Fact Sheet: Highlights of the 2007 National Youth Gang Survey, Apr. 2009, U.S. Department of Justice, 18 Jul. 2010 www.ncjrs.gov/pdffiles1/ojjdp/225185.pdf. 151 Success: One Puzzle Piece at a Time: 2008 Annual Report, Harris County Juvenile Probation Department, 18 Jul. 2010 www.hcjpd.org/ annual_reports/2008.pdf. 152 Ibid. 153 Ibid. 154 John Sukols, public information request to Harris County Juvenile Probation Department, 3 Dec. 2009. 155 Ibid. 156 Juvenile Arrests 2008, December 2009, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, 18 Jul. 2010 www.ncjrs.gov/pdffiles1/ojjdp/228479.pdf. 157 Success: One Puzzle Piece at a Time: 2008 Annual Report, Harris County Juvenile Probation Department. 158 Ibid. 159 Ibid. 160 The State of Juvenile Probation Activity in Texas, Calendar Year 2007, June 2009, Texas Juvenile Probation Department, 18 Jul. 2010 www.tjpc.state.tx.us/publications/reports/RPTSTAT2007.pdf. 161 Success: One Puzzle Piece at a Time: 2008 Annual Report, Harris County Juvenile Probation Department. 162 Juvenile Mental Health Court of Harris County, no date, Harris County Juvenile Mental Health Court, 18 Jul. 2010 www.hcjpd.org/MentalHealthCourt/index.html. 163 Youth with Mental Health Disorders in the Juvenile Justice System: Results from a Multi-State Prevalence Study, June 2006, National Center for Mental Health and Juvenile Justice, 18 Jul. 2010 www.ncmhjj.com/pdfs/publications/PrevalenceRPB.pdf. 164 Court Design, no date, Harris County Juvenile Mental Health Court, 18 Jul. 2010 www.hcjpd.org/MentalHealthCourt/court_design.html. 165 Ibid. 166 Ibid. 167 Ibid. 168 Rebecca deCamara, public information request to Harris County Juvenile Probation Department, 16 Apr. 2010.

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Safety & Security 169 Ibid. 170 Ibid. 171 Ibid. 172 Ibid. 173 Ibid. 174 Ibid. 175 Ibid. 176 Ibid. 177 Ibid. 178 Ibid. 179 John Sukols, public information request to Harris County Juvenile Probation Department, 3 Dec. 2009. 180 Ibid. 181 Ibid. 182 Kendall Mayfield information request to Harris County Juvenile Probation Department, 16 Jun, 2010. 183 Ibid. 184 Ibid. 185 DA Announces Juvenile Diversion Program, 26 Feb. 2009, Office of the District Attorney, Harris County, 18 Jul. 2010 app.dao.hctx.net/ Article/64/DA_Announces_Juvenile_Diversion_Program.aspx. 186 Collaboration: A Role and a Responsibility: 2009 Annual Report, Harris County Juvenile Probation, 18 Jul. 2010 www.hcjpd.org/annual_reports/2009.pdf. 187 Senate Bill 103, Bill Analysis (Enrolled Version). Austin, TX: Senate Research Center. www.legis.state.tx.us/tlodocs/80R/analysis/html/ SB00103F.htm. 188 TYC Population Trends, no date, Texas Youth Commission, 10 Jun. 2010 www.tyc.state.tx.us/research/growth_charts.html. 189 Ibid. 190 Ibid. 191 Ibid. 192 Ibid. 193 Public information request to Texas Youth Commission. 194 “Harris County Leading the Way.” Harris County JDAI 2:2 (July 2010): 1. 195 DA Announces Juvenile Diversion Program, 26 Feb. 2009, Office of District Attorney Patricia Lykos, 9 Aug. 2010 app.dao.hctx.net/Article/64/DA_Announces_Juvenile_Diversion_Program.aspx. 196 Ibid. 197 Public information request to Texas Youth Commission. 198 Average Cost per Day per Youth, no date, Texas Youth Commission, 2 Aug. 2010, www.tyc.state.tx.us/research/cost_per_day.html. 199 West Texas State School, no date, Texas Youth Commission, 2 Aug. 2010, www.tyc.state.tx.us/programs/westtexas/index.html. 200 Townsend, Cheryln K., Final Report on the Progress and Impact of Senate Bill 103. Rep. Austin: Texas Youth Commission, 2008. 201 Ibid. 202 Pairing Achievement with Service, no date, Texas Youth Commission, 2 Aug. 2010 www.tyc.state.tx.us/programs/paws.html. 203 Juvenile Transfer Laws: An Effective Deterrent to Delinquency? Jun. 2010, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, 18 Jul. 2010 www.ncjrs.gov/pdffiles1/ojjdp/220595.pdf. 204 Ibid. 205 Juvenile Justice Reform Initiatives in the States 1994-1996, no date, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, 18 Jul. 2010 www.ojjdp.ncjrs.gov/pubs/reform/ch2_j.html#235. The other methods are statutory exclusion, which requires the automatic transfer of certain cases mandated by statute; and direct file, also known as prosecutorial discretion, which gives prosecutors the discretion to transfer juvenile cases to adult court. 206 Once and Adult/Always an Adult, no date, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, 18 Jul. 2010 www.ojjdp.ncjrs.gov/pubs/tryingjuvasadult/transfer5.html. 207 Tex. Fam. Code. §54.02 (2009). 208 Tex. Fam. Code. §54.02(h) (2009). 209 Tex. Code of Crim. Proc. 42.09. 210 There is no state statute which requires the removal of certified juveniles from juvenile detention facilities to county jails to await trial. 211 Courage Program for Youthful Offenders, no date, Rehabilitation Programs Division, Texas Department of Criminal Justice, 18 Jul. 2010 www.tdcj.state.tx.us/pgm&svcs/pgms&svcs-yop.htm. 212 Nancy Arrigona, public information request to Texas Juvenile Probation Commission, 18 May 2010. 213 Success: One Puzzle Piece at a Time: 2008 Annual Report, Harris County Juvenile Probation Department; OIO Special Report: SB 103 and Rising Adult Certification Rates in Texas Juvenile Courts, 12 Jan. 2009, Office of the Independent Ombudsman for the Texas Youth Commission, 18 Jul. 2010 www.tyc.state.tx.us/ombudsman/SB103_AdultCert_SpecialReport.pdf. 214 Collaboration: A Role and a Responsibility: 2009 Annual Report, Harris County Juvenile Probation. 215 Tex. Fam. Code. §54.04(d)(3) (2009). 216 Special Report: SB 103 and Rising Adult Certification Rates in Texas Juvenile Courts, Office of the Independent Ombudsman for the Texas Youth Commission.

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217 Ibid. 218 Ibid. 219 Collaboration: A Role and a Responsibility: 2009 Annual Report, Harris County Juvenile Probation. 220 Juveniles in Adult Prisons and Jails: A National Assessment, Oct. 2000, Office of Justice Programs, U.S. Department of Justice, 18 Jul. 2010 www.ncjrs.gov/pdffiles1/bja/182503.pdf. 221 Ibid. 222 Child Fatality Report: 2006-2007, Mar. 2010, Houston/Harris County Child Fatality Review Team, 18 Jul. 2010 www.hcphes.org/dccp/epidemiology/child_fatalit_review_team/0607ChildFatalityReport_Final.pdf. 223 Ibid. 224 Ibid. 225 Ibid. 226 Ibid. 227 Ibid. at 6. 228 Ibid. at 5-6. 229 Ibid. 230 Texas Education Agency does not collect information on how many children are punished in schools. Department of Education collects this data by surveying school districts directly. 231 Guidance for Effective Discipline, 4 Apr. 1998, American Academy of Pediatrics, 18 Jul. 2010 aappolicy.aappublications.org/cgi/reprint/ pediatrics;101/4/723.pdf. 232 Discipline at School: U.S. Corporal Punishment and Paddling Statistics by State and Race, no date, The Center for Effective Discipline, 18 Jul. 2010 http://www.stophitting.com/index.php?page=statesbanning. 233 Ibid. 234 Ibid. 235 Fifteen out of 26 districts did not report any data at all in 2004-2005. However, in 2006-2007 only one district failed to submit the data. 236 Discipline at School: U.S. Corporal Punishment and Paddling Statistics by State and Race, The Center for Effective Discipline.

Education 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

You Shape Your Childâ&#x20AC;&#x2122;s Future, no date, Collaborative for Children, 8 Sept. 2010 www.collabforchildren.org/finding_child_care/find_child_ care_online_28. Ibid. Estimates of the Population by Age, Sex, and Race/Ethnicity for July 1, 2008 for State of Texas, no date, Texas State Data Center and Office of the State Demographer, 8 Sept. 2010 txsdc.utsa.edu/tpepp/2008ASREstimates/alldata.pdf. Public information request to Texas State Data Center. Most Recent Child Care Data by State, Mar. 2010, The National Association of Child Care and Referral Resource Agencies (NACCRRA), 8 Sept. 2010 www.naccrra.org/randd/state_by_state_facts.php. Public information request to Collaborative for Children, May 2010. The annual cost for before and after school child care is based off of information requested from Collaborative for Children, and the weekly average rate for the 40 week school year. Child Care, no date, Workforce Solutions, 8 Sept. 2010 childcare.wrksolutions.com/cc/childcare1.asp. Child Care and Development Fund (CCDF) Subsidies, Sept. 2007, National Center for Children in Poverty (NCCP), 8 Sept. 2010 www. nccp.org/profiles/TX_profile_14.html. Child Care, Workforce Solutions. Public information request to the Gulf Coast Workforce Board, Nov. 2009. Ibid. Child Care Financial Aid, no date, Workforce Solutions, 10 Sept. 2010 childcare.wrksolutions.com/cc/Childcare_financialaid.asp. Median Family Income in the Past 12 Months (in 2008 Inflation-Adjusted Dollars) by Family Size, no date, 2008 American Community Survey, U.S. Census Bureau, 13 Sept. 2010 census.gov/hhes/www/income/statemedfaminc.html. Public information request to the Gulf Coast Workforce Board, Nov. 2009. Ibid. About Child Care Licensing, no date, Texas Department of Family and Protective Services, 10 Sept. 2010 www.dfps.state.tx.us/Child_Care/ About_Child_Care_Licensing. Childcare Vendor Handbook at 4, no date, Workforce Solutions 10 Sept. 2010 childcare.wrksolutions.com/download/Child%20Care%20 Vendor%20Handbook%20-%20Version%2010-8-2009.pdf . Annual Report and Data Book 2009, no date, Texas Department of Family and Protective Services, 10 Sept. 2010 www.dfps.state.tx.us/ documents/about/Data_Books_and_Annual_Reports/2009/2009Databook.pdf .

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19 About NAEYC, no date, National Association for the Education for Young Children, 14 Sept. 2010 www.naeyc.org/content/about-naeyc. 20 NAEYC Annual Report: September 1, 2008 — August 31, 2009, 2009, National Association for the Education for Young Children, 10 Sept. 2010 www.naeyc.org/files/naeyc/file/about/AnnualReport.pdf. 21 Summary of Accredited Programs, no date, National Association for the Education of Young Children, 10 Sept. 2010 www.naeyc.org/academy/accreditation/summary. 22 Ibid. 23 K. Butler, public information request to the Collaborative for Children, Jun. 2010. 24 Summary of Accredited Programs, National Association for the Education of Young Children. 25 Texas After 3pm, no date, America After 3pm, Afterschool Alliance, 10 Sept. 2010 www.afterschoolalliance.org/documents/AA3PM_2009/ AA3_Factsheet_TX_2009.pdf. 26 Making the Case: A 2009 Fact Sheet on Children and Youth in Out-of-School Time, 2009, National Institute on Out-of-School Time, 10 Sept. 2010 www.niost.org/pdf/factsheet2009.pdf. 27 Ibid. 28 21st Century Community Learning Centers, no date, U.S. Department of Education, 10 Sept. 2010 www2.ed.gov/programs/21stcclc/index. html. 29 D. Driver, public information request to the Harris County Department of Education, Apr. 2010. 30 S. Caldwell, public information request to the City of Houston, Oct. 2009. 31 The Child Care Crisis in Texas: 2007 Statewide Survey Results, no date, Collaborative for Children and Texas Association of Child Care Resource and Referral Agencies (TACCRRA), 10 Sept. 2010 www.tecec.org/files/SurveyResults.pdf. 32 Ibid. 33 Texas After 3pm, America After 3pm, Afterschool Alliance. 34 81st Legislative Session, no date, Texas Early Childhood Education Coalition, 10 Sept. 2010 www.tecec.org/pages.php/New_81st_Legislative_Session.html. 35 Ibid. 36 State Profiles, no date, Pre[k]now, 10 Sept. 2010 www.preknow.org/resource/profiles/texas.cfm. 37 Ibid. 38 Texas Education Code, §29.153. 39 Five Years at a Glance Reports, no date, Texas Education Agency; LONESTAR, 10 Sept. 2010 loving1.tea.state.tx.us/lonestar/selectdist. aspx?level=district. 40 William T. Gormley, Jr., Ted Gayer, Deborah Phillips, and Brittany Dawson, The Effects of Universal Pre-K on Cognitive Development, 2005, Georgetown University, 10 Sept. 2010 www.crocus.georgetown.edu/reports/oklahoma9z.pdf. 41 Ibid. 42 State Profiles, Pre[k]now. 43 About NHSA, no date, National Head Start Association, 10 Sept. 2010 www.nhsa.org/about_nhsa. 44 Ibid. 45 The Early Head Start National Resource Center, no date, Administration for Children & Families, U.S Department of Health and Human Services, 10 Sept. 2010 www.ehsnrc.org/AboutUs/ehs.htm. 46 Helping All Children Succeed in School and in Life: The Improving Head Start for School Readiness Act of 2007, Nov. 2007, Committee on Education and Labor, 10 sept. 2010 edlabor.house.gov/publications/20071108HeadStartSummary.pdf. 47 Carla Danbury, e-mail communication to Avance Houston, 15 Jul. 2010; Venetia Peacock, e-mail communication to Harris County Department of Education, 19 Nov. 2009; Kathy Johnson, e-mail communication to Gulf Coast Community Services Association, 13 Nov. 2009 Tywannia Thompson, e-mail communication to Neighborhood Centers Inc., 19 Jul. 2010. 48 Ibid. 49 Head Start Funding Increase, 12 May 2009, Early Childhood Learning & Knowledge Center, 10 Sept. 2010 eclkc.ohs.acf.hhs.gov/hslc/Program%20Design%20and%20Management/Head%20Start%20Requirements/PIs/2009/resour_pri_006_040209.html. 50 Program Instructions, 17 Feb. 2010, Office of HeadStart, Administration for Children & Families, U.S. Department of Health & Human Services, 10 Sept. 2010 www.acf.hhs.gov/programs/ohs/policy/pi2010/acfpihs_10_01.html. 51 2008-2009 Economically Disadvantaged Students Report Criteria, 4 Feb. 2009, Texas Education Agency, 10 Sept. 2010 www.tea.state.tx.us/ adhocrpt/abteco09.html. 52 Fernando Garcia, public information request to Texas Education Agency, 5 Aug. 2010. 53 2008-2009 Academic Excellence Indicator System, no date, Texas Education Agency, 10 Sept. 2010 ritter.tea.state.tx.us/perfreport/ aeis/2009/index.html. 54 Fernando Garcia, public information request to Texas Education Agency, 5 Aug. 2010 and 9 Aug. 2010. 55 Economically Disadvantaged Students, no date, Dallas Indicators, 10 Sept. 2010 www.dallasindicators.org/Education/EquityinEducation/ Economicallydisadvantagedstudents/tabid/546/language/en-US/Default.aspx. 56 Ibid. 57 Title I—Improving the Academic Achievement of the Disadvantaged, no date, U.S. Department of Education, 10 Sept. 2010 www.ed.gov/ policy/elsec/leg/esea02/pg1.html. 58 Title I- Helping Disadvantaged Children Meet High Standards, no date, National Association for the Education of Young Children, 10 Sept. 2010 www.naeyc.org/policy/federal/title1. 59 Academic Excellence Indicator System, 2006-2007, no date, Texas Education Agency, 10 Sept. 2010 www.tea.state.tx.us/perfreport/ aeis/2009/glossary.html.

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60 Rankings & Estimates; Rankings of the States 2008 and Estimates of School Statistics 2009 at 83, 2008, National Education Association, 10 Sept. 2010 www.nea.org/assets/docs/09rankings.pdf. 61 Ibid. 62 Academic Excellence Indicator System Glossary, 2008-2009, no date, Texas Education Agency 10 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2009/glossary.html. 63 Academic Excellence Indicator System, Download All Data, Financial Information, 2007-2007 and 2008-2009, no date, Texas Education Agency, 10 Sept. 2010 www.tea.state.tx.us/prefreport/aeis. 64 Ibid. 65 Mike Falick’s Blog, 17 Feb. 2009, 10 Sept. 2010 mikefalick.blogs.com/my_blog/2009/02/the-end-of-the-65-rule-in-texas-the-death-of-avery-poorly-thought-out-idea.html. 66 Analysis of 65% Rule in School Spending at 3, 27 Sept. 2005, Center for Public Policy Priorities, 10 Sept. 2010 www.cppp.org/files/2/ POP%20254%20final%20version.pdf. 67 Ibid. 68 Mike Falick’s Blog, 17 Feb. 2009, 10 Sept. 2010. 69 HB 3 (81st Legislative Session); Mike Falick, email communication received 3 Mar. 2010. 70 Ibid. 71 Analysis of 65% Rule in School Spending, Center for Public Policy Priorities. 72 Project STAR: The Tennessee Student/Teacher Achievement Ratio Study: Background & 1999 Update, no date, HEROS, 10 Sept. 2010 www.heros-inc.org/star99.pdf. 73 Educational Indicators: An International Perspective, no date, Institute of Education Sciences, National Center for Education Statistics, U.S. Department of Education, 12 Sept. 2010 nces.ed.gov/Pubs/eiip/eiipid39.asp. 74 Academic Excellence Indicator System, Download of Selected Data, 1999-2000 through 2008-2008, Texas Education Agency 12 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/. 75 Rankings & Estimates: Rankings of the States 2009 and Estimates of School Statistics 2010, Dec. 2009, National Educational Association, 12 Sept. 2010 www.nea.org/assets/docs/010rankings.pdf. 76 Ibid. 77 Academic Excellence Indicator System Report, Download of Selected Data, 1999-2000 through 2008-2008, Texas Education Agency. 78 Charles M. Achilles, Ed.D., The Difference between Class Size and Pupil/Teacher Ratio, no date, Health & Education Research Operative Services, Inc., 12 Sept. 2010 < http://www.heros-inc.org/pupil-teacher%20ratio.pdf . 79 Glossary for the Academic Excellence Indicator System 2008-09, no date, Texas Education Agency, 12 Sept. 2010 ritter.tea.state.tx.us/ perfreport/aeis/2009/glossary.html. 80 Ibid. 81 Academic Excellence Indicator System Report, Download of Selected Data, 1999-2000 through 2008-2008, Texas Education Agency. 82 Ibid. 83 Project STAR: Tennessee’s K-3 Class Size Study, no date, Health & Education Research Operative Services, Inc., 12 Sept. 2010 www. heros-inc.org/star.htm. 84 Ibid. 85 Project STAR: The Tennessee Students Teacher Achievement Ratio Study: Background & 1999 Update, no date, Health & Education Research Operative Services, Inc., 12 Sept. 2010 www.heros-inc.org/star99.pdf. 86 Texas Education Code (TEC) §25.112, 12 Sept. 2010 www.statutes.legis.state.tx.us/Docs/ED/htm/ED.25.htm#25.112. 87 Class Size, no date, National Education Association, 12 Sept. 2010 www.nea.org/home/13120.htm. 88 Texas Charter Schools, no date, Texas Education Agency, 16 Sept. 2010 www.tea.state.tx.us/charter/index.html/. 89 Ibid. 90 Texas Charter Schools: Frequently Asked Questions, no date, Texas Education Agency, 16 Sept. 2010 www.tea.state.tx.us/index2. aspx?id=2990#5/. 91 Texas Charter Schools: Funding Frequently Asked Questions, no date, Texas Education Agency 16 Sept. 2010 www.tea.state.tx.us/index2.aspx?id=2988/. 92 Evaluation of New Texas Charter Schools (2007-10): Interim Report Executive Summary, June 2009, Texas Center for Educational Research, 16 Sept. 2010 www.tcer.org/research/charter_schools/new_charters/documents/nwchrt_execsum_inter.pdf/. 93 Academic Excellence Indicator System 2008-2009, State Report, no date, Texas Education Agency download of all data, 16 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2009/index.html/. 94 Academic Excellence Indicator System 2006-2007, State Report, no date, Texas Education Agency download of all data, 16 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2007/index.html/. 95 Academic Excellence Indicator System 2008-2009, Texas Education Agency. 96 Evaluation of New Texas Charter Schools (2007-10): Interim Report Executive Summary, Texas Center for Educational Research. 97 Ibid. 98 Ibid. 99 Ibid. 100 Academic Excellence Indicator System 2008-2009, Texas Education Agency. 101 Summary of Charter Award and Closures, 19 Feb. 2010, Division of Charter Schools, Texas Education Agency, 16 Sept. 2010 ritter.tea. state.tx.us/charter/reports/closed.pdf/. 102 State Charter School Facilities Incentive Grants Program, no date, U.S. Department of Education, 16 Sept. 2010 www2.ed.gov/programs/ statecharter/index.html/.

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Education 103 Race to the Top Program Guidance and Frequently Asked Questions, 27 May 2010, U.S. Department of Education, 16 Sept. 2010 www2. ed.gov/programs/racetothetop/faq.pdf/. 104 Vocational Education in the United States Toward the Year 2000, at iii-iv, Feb. 2000, National Center for Education Statistics, 12 Sept. 2010 nces.ed.gov/pubs2000/2000029.pdf. 105 Rising to the Challenge: Are High School Graduates Prepared for College and Work? at 4, Feb. 2005, Achieve, Inc., 12 Sept. 2010 www.achieve.org/files/pollreport_0.pdf . 106 Fastest Growing Occupations, Occupational Employment Projections to 2018, Nov. 2009, Employment Projections Program, U.S. Department of Labor, U.S. Bureau of Labor Statistics, 12 Sept. 2010 stats.bls.gov/emp/ep_table_103.htm. 107 Ibid. 108 Career and Technical Education in the United States: 1990 to 2005, Statistical Analysis Report at v, Jul. 2008, National Center for Education Statistics, 12 Sept. 2010 nces.ed.gov/pubs2008/2008035.pdf. 109 Ibid. at vi-vii. 110 Ibid. at 26. 111 Ibid. at 53. 112 Ibid. 113 Ibid. at 68-70. 114 CTE Industry Certification, no date, Texas Education Agency, 12 Sept. 2010 www.tea.state.tx.us/cte. 115 Career and Technology Education – Texas Essential Knowledge and Skills, Course Crosswalks and Coherent Sequences, no date, Texas Education Agency, 12 Sept. 2010 www.tea.state.tx.us/index2.aspx?id=5415. 116 Quick Facts – Statewide Statistics, no date, College Tech-Prep Texas, 12 Sept. 2010 www.techpreptexas.org/facts.html. 117 Ibid. 118 2008-09 Academic Excellence Indicator System, 2009, Texas Education Agency, 12 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2009/ index.html. 119 Public information request to the Texas Education Agency. 120 Career and Technical Education 2008 Survey at 6, Jan. 2008, Texas Education Agency, 12 Sept. 2010 ritter.tea.state.tx.us/cte/ctesurvey_092908.pdf January 2008. 121 Ibid. at 10. 122 Ibid. at 12-14. 123 Ibid. at 17. 124 2010 Accountability Manual, Part 2 – AEA Procedures at 3, no date, Texas Education Agency, 14 Sept. 2010 ritter.tea.state.tx.us/ aea/2010/manual/entirepart2.pdf. 125 Disciplinary Alternative Education Program Practices, Policy Research Report No. 17 at 1, Aug. 2007, Texas Education Agency, 15 Sept. 2010 ritter.tea.state.tx.us/research/pdfs/prr17.pdf. 126 Texas’ School-to-Prison Pipeline: Dropout to Incarceration at 20, Oct. 2007, Texas Appleseed, 14 Sept. 2010 www.texasappleseed.net/ pdf/Pipeline%20Report.pdf. 127 2010 Accountability Manual, Part 2 – AEA Procedures at 4, no date, Texas Education Agency, 14 Sept. 2010 ritter.tea.state.tx.us/ aea/2010/manual/entirepart2.pdf. 128 Final 2010 Registered Alternative Education Campuses (AECs), 01 Oct. 2009, Texas Education Agency, 14 Sept. 2010 tea.state.tx.us/ aea/. 129 Disciplinary Alternative Education Program Practices at 5, Texas Education Agency. 130 Region Level Annual Discipline Summary: PEIMS Discipline Data for 2008-2009, no date, Texas Education Agency, 15 Sept. 2010 ritter.tea.state.tx.us/adhocrpt/Disciplinary_Data_Products/Download_Region.html. 131 Academic Excellence Indicator System: 2008-09 Katy ISD Performance, State Report, no date, Texas Education Agency, 15 Sept. 2010 http://ritter.tea.state.tx.us/perfreport/aeis/2009/district.srch.html. 132 Texas’ School-to-Prison Pipeline: Dropout to Incarceration, Texas Appleseed; The High Cost of High School Dropouts: What the Nation Pays for Inadequate High Schools, Jan. 2007, Alliance for Excellent Education, 15 Sept. 2010 www.all4ed.org/files/archive/publications/HighCost.pdf. 133 Tex. Educ. Code. Ann. § 29.053(b). 134 Tex. Educ. Code. Ann. § 29.056(a). 135 Tex. Educ. Code. Ann. § 29.053(c). 136 Tex. Educ. Code. Ann. § 29.053(d). 137 Academic Excellence Indicator System 2008-09, 2010, Texas Education Agency. 16 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2009/ index.html. 138 PEIMS Standard Reports, 2010, Texas Education Agency, 16 Sept. 2010 ritter.tea.state.tx.us/adhocrpt/adleplg.html. 139 Ibid. 140 Tex. Educ. Code Ann. § 29.051 (Vernon 2006). 141 Ibid.; United States v. Texas, 572 F. Supp. 2d 726, 736 (E.D. Tex. 2008). 142 Division of Curriculum, Frequently Asked Questions, Bilingual/ESL Education, 4 March 2005, Texas Education Agency, 14 May 2010 ritter.tea.state.tx.us/curriculum/biling/bilingualfaq.pdf. 143 Margaret M. Williams, “U.S. Bilingual Education Controversy Continues,” Suite101.com, 19 Sept. 2009, 14 May 2010 esllanguageschools. suite101.com/article.cfm/us_bilingual_education_controversy_continues.

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144 Building the Legacy: IDEA 2004, no date, U.S. Department of Education, 12 Sept. 2010 idea.ed.gov. 145 Fact Sheet: Your Rights under Section 504 of the Rehabilitation Act at 1, no date, U.S. Department of Health and Human Services, 12 Sept. 2010 www.hhs.gov/ocr/civilrights/resources/factsheets/504.pdf. 146 No Child Left Behind Act of 2001. 20 USC 6301. 147 The Special Education Process Step-by-Step, no date, Texas Project FIRST—Families, Information, Resources, Support & Training, 12 Sept. 2010 www.texasprojectfirst.org/SEProcessStep1.html. 148 Ibid. 149 Ibid. 150 Public information request to the Texas Education Agency, 9 Aug. 2010. 151 Public information request to the Texas Education Agency, 5 Aug. 2010. 152 Academic Excellence Indicator System, no date, Texas Education Agency, 12 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/. 153 Frequently Asked Questions and Answers about the Texas Assessment Program at 20-28, no date, Texas Education Agency, 12 Sept. 2010 ritter.tea.state.tx.us/student.assessment/FAQ.pdf. 154 Jessica B. Heppen and Susan Bowles Therriault, Developing Early Warning System to Identify Potential High School Dropouts, July 2008, National High School Center, 14 Sept. 2010 www.betterhighschools.org/docs/IssueBrief_EarlyWarningSystemsGuide_081408.pdf. 155 Tex. Educ. Code § 29.081. 156 Academic Excellence Indicator System 2008-2009, State Report, no date, Texas Education Agency, 14 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2009/state.html. 157 Ibid. 158 Ibid. 159 Public information request to the Texas Education Agency, Aug. 2010. 160 Texas Education Agency, Report on Implementation of House Bill 2237, 1 Sept. 2009. 161 9th Grade Transition and Intervention Program, no date, Texas Education Agency, 15 Sept. 2010 www.tea.state.tx.us/index3. aspx?id=3629#Applicant%20Info. 162 Jessica B. Heppen and Susan Bowles Therriault, Developing Early Warning System to Identify Potential High School Dropouts, July 2008, National High School Center, 14 Sept. 2010 www.betterhighschools.org/docs/IssueBrief_EarlyWarningSystemsGuide_081408.pdf. 163 High School Dropouts in America: Fact Sheet at 2, Feb. 2009, Alliance for Excellent Education, 14 Sept. 2010 www.all4ed.org/files/GraduationRates_FactSheet.pdf. 164 Ibid.. 165 Harris County, Texas - Educational Attainment: 2006-2008 American Community Survey 3-Year Estimates, no date, U.S. Census Bureau, 15 Sept. 2010 factfinder.census.gov/servlet/STTable?_bm=y&-geo_id=05000US48201&-qr_name=ACS_2008_3YR_G00_S1501&ds_name=ACS_2008_3YR_G00_&-_lang=en&-redoLog=false. 166 Ibid. 167 Statistical Report: Fiscal Year 2009 at 12, no date, Texas Department of Criminal Justice, 14 Sept. 2010 www.tdcj.state.tx.us/publications/ executive/Statistical_Report_FY09.pdf. 168 Offenders on Death Row, 18 Aug. 2010, Texas Department of Criminal Justice, 14 Sept 2010 www.tdcj.state.tx.us/stat/offendersondrow.htm. 169 Taylor, Lori et al., The ABCDs of Texas Education: Assessing the Benefits and Costs of Reducing the Dropout Rate, May 2009, The Bush School of Government and Public Service, 15 Sept. 2010 bush.tamu.edu/research/capstones/mpsa/projects/2009/TheABCDs.pdf. 170 Statewide Graduation Rate – cumulative promotion index (CPI) Texas Class of 2007, no date, Education Counts, 15 Sept. 2010 www. edcounts.org/; Education Week, High School Graduation in Texas: Independent Research to Understand and Combat the Graduation Crisis, Oct. 2006, Editorial Projects in Education Research Center, 15 Sept. 2010 www.edweek.org/media/texas_eperc.pdf. 171 Academic Excellence Indicator System 2008-2009, State Report, no date, Texas Education Agency, 14 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2009/state.html. 172 Secondary School Completion and Dropouts in Texas Public Schools, 2008-09, July 2010, Texas Education Agency, 15 Sept. 2010 ritter. tea.state.tx.us/research/pdfs/dropcomp_2007-08.pdf. 173 Ibid. 174 Academic Excellence Indicator System 2008-2009, State Report, no date, Texas Education Agency, 14 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2009/state.html. 175 Secondary School Completion and Dropouts in Texas Public Schools, 2008-09, Jul. 2010, Texas Education Agency, 15 Sept. 2010 ritter.tea.state.tx.us/research/pdfs/dropcomp_2007-08.pdf. 176 CHILDREN AT RISK calculation based on Texas Education Agency data reported in the Academic Excellence Indicator System. 177 Academic Excellence Indicatory System: 2006-2007, State Report, no date, Texas Education Agency, 14 Sept. 2010 ritter.tea.state.tx.us/ perfreport/aeis/2007/state.html. 178 Academic Excellence Indicator System: 2008-2009, State Report, no date, Texas Education Agency, 14 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/2009/state.html. 179 Academic Excellence Indicator System: 2008-09 Houston ISD Performance, State Report, no date, Texas Education Agency, 15 Sept. 2010 < http://ritter.tea.state.tx.us/perfreport/aeis/2009/district.srch.html. 180 CHILDREN AT RISK calculation based on Texas Education Agency data. 181 Secondary School Completion and Dropouts in Texas Public Schools 2007-2008, District Supplement, Jul. 2009, Texas Education Agency, 15 Sept. 2010 ritter.tea.state.tx.us/research/pdfs/dropcomp_district_supp_2007-08.pdf. 182 Ibid. at 157. 183 Early Warning System Tool, no date, Texas Comprehensive Center, 15 Sept. 2010 txcc.sedl.org/resources/ewst/. 184 About AP, 2010, College Board, 17 Sept. 2010 www.collegeboard.com/student/testing/ap/about.html.

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Education 185 History of the International Baccalaureate, no date, International Baccalaureate Organization, 17 Sept. 2010, www.ibo.org/history/index. cfm. 186 Ibid. 187 The IB Diploma Programme, no date, International Baccalaureate Organization, 17 Sept. 2010, www.ibo.org/diploma/index.cfm. 188 Diploma Program Assessment, no date, International Baccalaureate Organization, 17 Sept. 2010, www.ibo.org/diploma/assessment/results/. 189 How the IB Diploma is Recognized, no date, International Baccalaureate Organization, 17 Sept. 2010, www.ibo.org/diploma/recognition/ guide/slidec.cfm. 190 Find an IB World School, no date, International Baccalaureate Organization, 17 Sept. 2010, www.ibo.org/school/search/index.cfm?programm es=DIPLOMA&country=US&region=TX&find_schools=Find. 191 Linda Hargrove, Donn Godin, and Barbara Dodd, “College Outcomes Comparisons by AP and Non-AP High School Experiences,” The College Board, 2008, 17 Sept. 2010, professionals.collegeboard.com/profdownload/pdf/08-1574_CollegeOutcomes.pdf. 192 David T. Conley and Terri Ward, “Summary Brief: International Baccalaureate Standards Development and Alignment Project,” Educational Policy Improvement Center, May 2009, 17 Sept. 2010, www.ibo.org/informationfor/mediaandresearchers/researchers/documents/EPICSummaryBrief.pdf 193 Glossary for the Academic Excellence Indicator System 2008-2009, February 2010, Texas Education Agency, 17 Sept. 2010, ritter.tea. state.tx.us/perfreport/aeis/2009/glossary.html. 194 Academic Excellence Indicator System 2008-09 State Performance Report, 2008-2009, Texas Education Agency, 17 Sept. 2010, ritter. tea.state.tx.us/perfreport/aeis/2009/state.html. 195 Ibid. 196 Ibid. 197 Chrys Dougherty, Lynn Mellor, and Shuling Jian, “Orange Juice or Orange Drink? Ensuring that “Advanced Courses” Live Up to Their Labels,” National Center for Educational Accountability, February 2006, 17 Sept. 2010, www.nc4ea.org/files/orange_juice_or_orangedrink_02-13-06.pdf. 198 Ibid. 199 Chrys Dougherty, Lynn Mellor, and Shuling Jian, “The Relationship between Advanced Placement and College Graduation,” National Center for Educational Accountability, February 2006, www.just4kids.org/en/files/Publication_The_Relationship_between_Advanced_Placement_ and_College_Graduation-02-09-06.pdf. 200 Gifted and Talented, no date, Texas Education Service Center, 12 Sept. 2010 portal.esc20.net/portal/page/portal/esc20public/GiftedAndTalented. 201 Gifted Education in Texas: A Story of Growth and Understanding, 2008, Texas Education Agency, 12 Sept. 2010 www.tea.state.tx.us/ gted/GifTal.html. 202 19 Tex. Admin. Code § 89.1(5). 203 Advanced Programs & Gifted and Talented Education: Questions and Answers on the State Plan, 2004, Texas Education Agency, 12 Sept. 2010 ritter.tea.state.tx.us/gted/QAStaPla.html. 204 Why Gifted and Talented Education is Important, no date, National Association for Gifted Children, 12 Sept. 2010 www.nagc.org/index. aspx?id=533. 205 Public information request to the Texas Education Agency, 9 Aug. 2010. 206 Academic Excellence Indicator System, no date, Texas Education Agency, 12 Sept. 2010 ritter.tea.state.tx.us/perfreport/aeis/. 207 Public information request to the Texas Education Agency, 9 Aug. 2010. 208 Why Take the SAT, 2010, The College Board, 17 Sept. 2010, sat.collegeboard.com/about-tests/sat/why-take-the-test. 209 The ACT Test, 2010, ACT Inc., 17 Sept. 2010 act.org/aap/. 210 SAT Validity Studies, 2010, The College Board, 17 Sept. 2010, professionals.collegeboard.com/data-reports-research/sat/validity-studies. 211 Critical Reading Section, 2010, The College Board, 17 Sept. 2010, professionals.collegeboard.com/testing/sat-reasoning/about/sections/ critical-reading. 212 SAT Validity Studies, 2010, The College Board, 17 Sept. 2010, professionals.collegeboard.com/data-reports-research/sat/validity-studies. 213 State Profile Report: Texas, 2009, The College Board, 17 Sept. 17, 2010, professionals.collegeboard.com/profdownload/TX_09_03_03_01. pdf. 214 Ibid. 215 Academic Excellence Indicator System 2008-2009 Region Performance Report, Texas Education Agency, 17 Sept. 2010, ritter.tea.state. tx.us/cgi/sas/broker. 216 2009 College-Bound Seniors-Total Group Profile Report, 2009, The College Board, 17 Sept. 2010, professionals.collegeboard.com/profdownload/cbs-2009-national-TOTAL-GROUP.pdf. 217 The ACT Test, 2010, ACT, Inc., 17 Sept. 2010, www.act.org/aap/. 218 Facts about the ACT, 2010, ACT Inc., 17 Sept. 2010, www.act.org/news/aapfacts.html. 219 ACT National and State Scores for 2009, no date, ACT, Inc., 17 Sept. 2010, www.act.org/news/data/09/charts/text.html#two. 220 College Readiness: Benchmarks Met, no date, ACT, Inc., 17 Sept. 2010. www.act.org/news/data/07/benchmarks.html. 221 ACT National and State Scores for 2009, no date, ACT Inc., www.act.org/news/data/09/benchmarks.html. 222 Facts about the ACT, 2010, ACT Inc., 17 Sept. 2010, www.act.org/news/aapfacts.html. 223 ACT National and State Scores for 2009, no date, ACT Inc., 17 Sept. 2010, www.act.org/news/data/09/states.html. 224 ACT Profile Report-State, 2009, ACT, Inc., 17 Sept. 2010, www.act.org/news/data/09/pdf/states/Texas.pdf. 225 Ibid.

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226 Academic Excellence Indicator System 2008-2009 Region Performance Report, Texas Education Agency, 17 Sept. 2010, ritter.tea.state. tx.us/cgi/sas/broker. 227 Academic Excellence Indicator System 2007-2008 Region Performance Report, Texas Education Agency, 17 Sept. 2010, ritter.tea.state. tx.us/cgi/sas/broker. 228 ACT Profile Report-State, 2009, ACT, Inc., 17 Sept. 2010, www.act.org/news/data/09/pdf/states/Texas.pdf. 229 2009 College-Bound Seniors-Total Group Profile Report, 2009, The College Board, 17 Sept. 2010, professionals.collegeboard.com/profdownload/cbs-2009-national-TOTAL-GROUP.pdf. 230 2009 College-Bound Seniors-State Profile Report-Texas, 2009, The College Board, 17 Sept. 2010, professionals.collegeboard.com/profdownload/TX_09_03_03_01.pdf. 231 Texas Assessment of Knowledge and Skills (TAKS), no date, Texas Education Agency, 16 Sept. 2010 www.tea.state.tx.us/index3. aspx?id=948&menu_id=793/. 232 Interpreting Assessment Reports: Texas Student Assessment Program, Spring 2010, Texas Education Agency at 1.1-1.2, 16 Sept. 2010 ritter.tea.state.tx.us/student.assessment/resources/guides/interpretive/2010General.pdf/. 233 Ibid. at 1.2. 234 TAKS/TAKS-M, Spring 2010, Texas Education Agency at 2.4, 16 Sept. 2010 ritter.tea.state.tx.us/student.assessment/resources/guides/ interpretive/2010TAKS.pdf/. 235 Ibid. 236 Interpreting Assessment Reports: Texas Student Assessment Program, Texas Education Agency at 1.2. 237 Information Request to the Texas Education Agency, Sept. 2010. 238 End of Course (EOC) Assessments, Spring 2010, Texas Education Agency at 5.1, 16 Sept. 2010 ritter.tea.state.tx.us/student.assessment/ resources/guides/interpretive/2010EOC.pdf/. 239 Patrick Gonzalez et al., Highlights from TIMSS 2007: Mathematics and Science Achievement of U.S. Fourth- and Eighth-Grade Students in an International Context, Sept. 2009, National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education, 16 Sept. 2010 nces.ed.gov/pubs2009/2009001.pdf/. 240 Texas Assessment of Knowledge and Skills: Spring 2010 Performance Standardsâ&#x20AC;&#x201C;Panel Rec., Spring 2010, Texas Education Agency, 16 Sept. 2010 ritter.tea.state.tx.us/student.assessment/scoring/pstandards/perfst10.pdf/. 241 Ibid. 242 Ibid. 243 Ibid. 244 Ibid.

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I N D E X A Accidental Deaths of Children 8, 104 ACT 175, 186, 187, 188 Adoption 114, 142 Adult Certification 8, 135, 136, 142 Advanced Placement 182, 184 AIDS 64, 95, 96, 97, 98 Air Pollution 6, 14, 34 Air Quality 14 Alcohol Abuse 40, 42, 91, 92, 121 Aldine ISD 151, 169, 172, 176, 178, 179, 180 Alliance for Children and Families (“The Alliance”) 81, 88 Alternative Education 9, 162, 163, 196 American Recovery and Reinvestment Act (ARRA) 22, 32, 33, 145, 150 Assault 8, 106, 116, 122, 123, 124, 135, 136, 137 Average Caseload 108, 110, 120, 121

B Bilingual 164, 196 Birth Defects 17, 40 Burnett-Bayland 126, 127

C Career and Technical Education 160, 196 Centers for Disease Control and Prevention (CDC) 37, 60, 69, 73, 94 Charter School 106, 116, 157, 158, 159 Chemical 14, 15, 16, 17, 34, 84 Child Abuse and Neglect 8, 108, 110, 142 Child Care 8, 33, 144, 145, 146 Child Homicide 138 Childhood Diseases 62, 64 Childhood Obesity 7, 68, 70, 98 Child Protective Services (CPS) 29, 78, 81, 108, 109, 111, 112, 115, 117, 139 Children and Adolescent Services (CAS) 77 Children in Need of Supervision (CHINS) 125 Children Referred to Court Supervision 125 Children’s Health Insurance Program (CHIP) 48, 71 Children’s Medicaid 49, 50 Children Under Supervision 111, 142 Child Support 30, 34 Child Welfare 43, 44, 114, 141, 199 City Parks 18, 19 Class Size 155, 156 Clean Air Act 14 College Board 186, 187 College Readiness 175, 188, 193 Commended Performance 175, 177, 189, 190, 194 Community Youth Development (CYD) 118 Community Youth Services (CYS) 106, 113, 115, 116 Completion Rate 162, 171, 172, 173 Conservatorship 112 Corporal Punishment 140, 141 Covenant House 28, 29

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D Dental Care 71, 72, 98, 150 Department of State Health Services (DSHS) 41, 71, 92 Determinate Sentence 8, 131, 136, 137 Developmental Delay 45, 46, 47 Diagnosis and Treatment (EPSDT) 57 Disciplinary Alternative Education Program 9, 162 Disease 6, 7, 15, 19, 37, 44, 59, 60, 61, 62, 63, 64, 69, 73, 74, 94, 95, 97, 98 Dropout 157, 161, 162, 163, 164, 168, 169, 196 Dropout Rate 9, 170, 172, 174 Drowning 8, 104, 105, 138 Drugs 22, 40, 41, 92, 94, 121, 124

E Early Childhood Intervention (ECI) 45, 46, 47 Early Periodic Screening 57 Economically Disadvantaged 148, 151, 152 Elementary and Secondary Education Act 152 Emergency Contingency Fund 22, 23 English as a Second Language (ESL) 164 English Language Arts 156, 189 Environmental Protection Agency (EPA) 14, 16 Expel 121, 162, 163, 168, 173 Expenditure Per Student 9, 153, 154

F Family Based Safety Services 112, 115 FBI Innocence Lost Task Force 101 Federal Poverty Level (FPL) 20, 49 Fetal Alcohol Spectrum Disorders (FASD) 40 Field Services 120, 121, 128 Firearm 94, 95, 104, 105, 121, 138 Food Insecurity 24, 25 Food Programs 6, 24, 26, 27 Food Stamp Program 6, 24, 25 Forensic Evaluations 86 Foster Care 23, 49, 50, 84, 111, 112, 113, 114, 118, 148 Fostering Connections to Success and Increasing Adoptions Act 114, 142

G Galena Park ISD 156, 172, 178, 180 GED 121, 134, 162, 170, 171, 173 Gifted and Talented 156, 184, 185, 196 Grade Point Average (GPA) 168 Graduation 9, 34, 76, 145, 156, 160, 161, 165, 166, 169, 170, 171, 172, 173, 174, 175, 182, 191, 194, 196, 199

H Harris County Advocate Program 128 Harris County Juvenile Mental Health Court 8, 87, 89, 126, 128, 129 Harris County Leadership Academy 126, 127, 129 Harris County Youth Services Center 113 Hazardous Waste Sites 16, 34 Head Start 8, 148, 149, 150, 196 Health and Human Services Commission 22, 23, 25, 48, 49, 50, 51, 56, 83

CHILDREN AT RISK 2010-2012

231

Homeless 28, 29, 30, 34, 100, 101, 106, 113, 115, 117, 148, 169 Home Schooling 173 Homicide 120, 122, 123, 138, 139 Housing 11, 20, 21, 28, 29, 30, 34, 65, 67, 114, 117, 136 Houston ISD 9, 54, 55, 92, 151, 156, 160, 171, 172, 173, 176, 177, 178, 179, 180, 182, 185, 193, 194 Human Trafficking 5, 7, 10, 100, 101, 102, 103, 142, 198, 199 Human Trafficking Rescue Alliance 100, 101 Humble ISD 169, 172, 176, 179

I ImmTrac 59, 60, 61 Immunizations 7, 22, 52, 54, 58, 59, 60, 61, 98, 199 Individuals with Disabilities Education Act 45, 166 Infant Mortality 7, 37 Infants 36, 38, 39, 57 Intake/Diversion Program 117 Intake Referrals 120 International Baccalaureate 182, 184 Intervention and Treatment Services 115

J Job Training 23, 32, 151, 160 Judicial waiver 135 Juvenile Gang Members 119 Justice of the Peace Court Liaison 117 Juvenile Consequences Partnership 122, 124 Juvenile Detention Center 8, 87, 107, 126, 127, 128, 129, 134 Juvenile Gang Members 119 Juvenile Justice Alternative Education Program 162 Juvenile Mental Health Court 8, 87, 89, 90, 126, 128, 129 Juvenile Non-Petition Deferred Prosecution Program 130, 131, 132 Juvenile Offenses 122, 124, 142 Juvenile Probation 8, 50, 78, 81, 86, 103, 106, 116, 117, 118, 119, 120, 121, 122, 123, 125, 126, 127, 128, 130, 135, 142, 162, 199 Juveniles Detained 8, 126, 127, 128

K Kinder Shelter 111

L Lead Poisoning 65, 66, 67 Leaver Codes 173 Legislation 7, 10, 30, 32, 102, 103, 147, 149, 184, 198, 199 Limited English Proficient (LEP) 164 Low Birth Weight 17, 36, 37, 38, 39, 40, 41, 44 Low-Income 6, 7, 19, 20, 21, 24, 26, 27, 28, 29, 32, 33, 34, 48, 53, 57, 69, 71, 72, 83, 140, 144, 145, 147, 150, 151, 152, 154, 183, 188, 196

M Maternal Health 7 Maternal and Infant Health 36, 38 Math 55, 145, 152, 155, 156, 160, 165, 175, 177, 182, 184, 186, 187, 188, 189, 192, 193, 194, 196 Measles 60, 61, 62, 63 Medicaid 7, 31, 45, 46, 48, 49, 50, 51, 52, 56, 57, 67, 71, 72, 77, 78, 79, 83, 84, 98 Mental Health 51, 54, 55, 67, 76

232

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Mental Health and Mental Retardation Authority (MHMRA) 77, 78, 79, 80, 82, 85, 86 Mentally Ill Youth 8, 12 Motor Vehicle 8, 92, 104, 105, 124, 132

N National Center for Education Statistics 154, 173 National Human Trafficking Hotline 101 National School Lunch Program (NSLP) 26, 27 No Child Left Behind 166, 173 North Forest ISD 151, 153, 156, 171, 172, 179 Nutrition 7, 24, 25, 26, 27, 45, 46, 47, 56, 57, 58, 64, 68, 69, 70, 71, 150, 151

O Office of the Attorney General 30, 31, 139, 198 Operation Redirect 8, 86, 87, 120 Ozone 6, 14, 15, 34

P Parenting Education 85, 118 Parenting With Love and Limits 118 Parent/Teen Survival Program 106, 117 Parks and Green Space 6, 18, 34 Pertussis 60, 62, 63, 98 Physical Fitness Assessment Initiative (PFAI) 70 Pollution 6, 14, 15, 18, 34 Poverty 6, 10, 11, 20, 21, 22, 23, 25, 34, 46, 49, 52, 58, 71, 145, 148, 150, 151, 152, 170, 177, 196, 199 Pregnancy 7, 34, 36, 37, 40, 41, 42, 43, 44, 49, 58, 74, 98, 121 Pre-K 8, 148, 149, 150, 168, 196 Prenatal Care 7, 36, 37, 39, 44, 51 Private School 26, 60, 173 Property Crime Index 123, 124 Protective Custody 111, 112, 114

R Recidivism 5, 8, 130, 132, 134, 135, 137 Recommended High School Program 175 Region 4 155, 162, 163, 182, 186, 187 Rent Assistance 29 Respite Care 82 Rights of Passage Program (ROP) 29 Runaway 100, 101, 103, 106, 107, 113, 116, 118, 125, 142

S Safety Net Program 106, 116, 117 SAT 175, 177, 186, 187, 188, 194 School-Based Health Centers 54, 55 School Breakfast Program 24, 25, 26, 27 School Rankings 5, 9, 10, 175, 176, 177, 180, 181, 194, 199 Science 10, 159, 171, 175, 176, 177, 181, 187, 188, 192, 193, 194 Service Plan 46 Services to At-Risk Youth (STAR) 115, 118, 125 Sexual Abuse 109 Sexually Transmitted Diseases (STDs) 73, 74 Social Studies 175, 177, 189 Special Education 159, 166

CHILDREN AT RISK 2010-2012

233

Special Supplemental Food Program for Women 57 Spring Branch ISD 156, 172, 176, 179, 180, 193, 194 STAR 84, 115, 118, 125, 156 State Board of Education 158, 161 State of Texas Access Reform (STAR) 84 Status Offenders 125 Student-to-Teacher Ratio 155, 156 Subsidies 145, 147, 196 Substance Abuse 40, 75, 88, 91, 92, 93, 98, 116 Summer Food Service Program (SFSP) 27 Superfund 16, 17 Supplemental Security Income (SSI) 53 Systems of Hope 87, 88, 89, 90, 113, 114, 128

T Teen Births 7, 43, 44, 98 Teen Suicide 93, 94 Temporary Assistance for Needy Families (TANF) 22, 23, 33, 49, 53, 113, 114, 151 Temporary Custody 111 Texas Assessment of Knowledge and Skills (TAKS) 162, 189, 196 Texas Department of Family and Protective Services 108, 111, 113, 118, 144, 145 Texas Education Agency (TEA) 169, 171, 183 Texas Essential Knowledge and Skills (TEKS) 165, 189 Texas Health Steps (THSteps) 84, 56, 57, 71 Texas Youth Commission (TYC) 126, 131, 134, 162 Toxic Waste 16, 17 TRIAD Prevention Program 81, 103, 106, 115, 117, 128 Truancy Learning Camp 117, 125 Tuberculosis (TB) 62, 64

U Uninsured 7, 39, 48, 52

V Vaccination 59, 60, 63, 64, 98 Violent Crime Index 122, 123

Y Youthful Offender Program 134, 136 Youth Workforce 32, 34

234

CHILDREN AT RISK 2010-2012

NOTES:

CHILDREN AT RISK 2010-2012

235

NOTES:

236

CHILDREN AT RISK 2010-2012

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CHILDREN AT RISK was established in 1989 as an action focused think-tank/research group dedicated to improving the quality of life of Texas’ children through strategic research, public policy analysis, innovation, legal action, community education, and collaboration. Our focus is on childhood health, public schools, safety, and children’s poverty issues. We are the leading source of accurate information through our biennial Growing Up in Houston publication and an advocate and a catalyst for change concerning the needs of all children in Texas.

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