 We are going to have an overview of, unfortunately, child abuse statistics, fatality statistics for our state. And presenting this is one of the best people I know to do this. This is Madeline McClure, who is the founder and executive director of Text Protects, a research, policy, and advocacy organization dedicated to preventing child abuse in our state. Madeline? OK. Am I on? Well, if I knew what the agenda looked like in advance, I would say, let me come before William, because nobody is going to follow that act, OK? So I just want to manage your expectations down a little. Sorry, I'm just not that good. But I will do my best. So yes, Text Protects is a statewide organization and we're driven by about 7,300 members. And we work on data-driven research and work at the legislative level to pass laws to not only prevent child abuse, but to help reform the CPS system so children that are abused are treated better and to William's point to heal children the best way possible so that we can break the intergenerational cycle of violence. We also work with collaborations around the state and we run the Child Protection Roundtable. About 40 organizations are part of that. And we chaired the Home Visiting Consortium, one of the only true prevention programs out there. And it was started actually at Pew Charitable Trust by our very own Libby Dogget, who is in the audience. Wave Libby, there she is. And her wonderful husband, Congressman Lloyd Dogget. I think he's speaking of Lloyd Dogget. Lloyd is responsible for some federal legislation that does really address child abuse fatalities in our nation. And as he said so eloquently, you know, before we can solve a problem, we now have to know what the problem is and count it right. And so he created the federal commission on the elimination of child abuse and neglect. And that legislation was just passed and he's got it rolling. In fact, one of the very first hearings on that was here in San Antonio. So the results of that are going to be reported and hopefully that will morph into legislation that will reduce nationwide fatalities. And then in the last legislative session here in Texas, Representative Dukes passed a bill that's also the Texas Protect Our Kids Act that will also be coming up with recommendations to address child abuse fatalities in Texas through evidence-based strategies. And the list of commission members here next is really a who's who of the best researchers and doctors and judges in the state. Some of these folks are from right here. We have the UT Health Science Center, Nancy Dr. Nancy Kellogg, and also the Peter Sakai, Judge Sakai, and other Lady Mary and so-called. So we've got some really good folks. Oops, and there I am too. Okay, so like I said, some of the best people, really modest, you know, in any event. I think it's going to be a great coalition. I'm just honored to be part of it and we'll be back next year at the same time giving you the results of our report. So speaking of data, I thought we'd start off with the incidence of child fatalities in Texas as reported by the Department of Family and Protective Services. So as you can see, this orange bar, the bar's going across our child abuse neglect fatalities across our state from 97 to 2013. The top line, that dark orange line, is the child population. So you can see that's been growing at about 1.5% on average per year over this time frame, but look at the change in child abuse fatalities. Even including this precipitous drop, it has increased 4.8% each year on average, which is three times the growth of the child population. Fatalities are growing three times the rate of our child population in Texas. That is unforgivable. Now, the reason I have this little arrow here is that there is some controversy as to whether this is truly a drop-off or if we're just defining child abuse fatalities in Texas differently. One of the things that we do know is that how we count child abuse fatalities is not necessarily a realistic picture of these deaths. In DFPS, many of you here at DFPS, who's here from CPS? I think there's a table. Okay. Well, as you all know, RTB are reason to believe dispositions when a caseworker goes out and says that this is definitely not a rule out or an undetermined. This is a reason to believe substantiated case. They can mark that as a moderate, serious, severe, near-fatal, or fatal. But there's also a possibility that you can rank child abuse as a reason to believe, but the fatality is undetermined. So right now, we're not getting all of the CPS cases that are substantiated where a fatality actually occurred. What we should be doing is counting any reason to believe fatality case in which a fatality occurred. That's all. We have to see the data to know whether it's decreasing, increasing, staying flat, so we know where to put prevention resources. If a disposition is near-fatal, and this is a really tricky part, some of our shaken babies are now surviving because of the great medical care we provide. So while they don't die, it's a near-fatal, but if they die later, we don't go back into the system and change the disposition to fatal unless that case is still open. So if, in other words, a child's abusive head trauma survives and is in foster care, but then is reunited with a family or goes into a relative home, that case is closed and that child later dies due to that shaken or that abusive head trauma, that's not counted as a fatality. So we're really not getting accurate data. Any DFPS people want to argue with me? Oh, not yet? Well, I like arguments. You come up later. So this is one of the studies that we've been doing. Here are some of our obstacles to reducing child abuse fatality, and I'll go through each. The current impact system that DFPS works with doesn't have mandatory fields that these workers have to input data in. In other words, a lot of the details of a case are in the narrative form or the notes on the case. So that's a big obstacle for researchers like us to try to figure out what are the trends, what are the characteristics of these fatalities, which parents continually come back to the system? Is there a pattern of a certain family that is more likely to have a child die? What other kinds of things determine a child fatality? We don't know. Many of the screens and many of the fields are optional. And the biggest problem is that our reports of abuse and neglect are not recorded. But we know through the research that even a report of abuse and neglect is the number one strongest predictor of a return to the system and injury-related fatalities. Here's the problem with our retention policy. We've tried to pass some legislation to increase the length of time that we hold onto these records. But we've gotten a lot of obstacles from the department saying that they don't have the room for the files. Well, last I heard there's a thing called cloud. So I think they could find some room. Now, one of the things they might want to do if they really can't find the room is to reduce the records that we keep for 99 years and make that 50 years. Those are the reason to believe with a removal. But some of these other kinds of cases are removed within five years. So if a family is determined to be reason to believe and there's no removal, but that child is in a risk, it's a risk-controlled situation, but that child's been abused, that case gets wiped out after five years. So when a case worker is going back into the history of the family, when they get a report to see if there's any previous abuse, if it's five years later, let's say the grandmother takes one of the babies from the daughter that was abused, there's not going to be any record in there. How will she know what the history, how much will she know what the risk is? The really scariest one is this, when a family has moved. Look at Carlton or Charlton Turner. Now, that family was homeless. Many of you know about this little kiddo who was reported to CPS over four times, but the mom moved, they couldn't find the baby, and then he was killed, buried under what, two feet? I mean, it is just horrible, and so many people knew about this. Even the father of the child posted photos of that child bruised and welts on him and cuts all over him, and people have, even the family reported and reported, but because that mom was homeless or moved, we couldn't find it. That case should have been immediately moved up to the Department of Families, to our Texas Rangers. The Department of Safety should be the ones looking for those kiddos, and I hope that we can pass some legislation to make sure that we can get the police on those kinds of cases. So this is one of the big obstacles. Again, record retention is critical. The other obstacle to child abuse fatalities is that so many of our kids where we investigate but don't remove, we keep that child in the home of Arjen. Family preservation is also called Family-Based Safety Services, FBSS, and these cases in the old days used to be a maximum of eight cases per worker. Why? Because they were in there working with the family to get mom recovered from her depression and dad into anger management classes or reduced substance abuse and reduced risk, but that case worker had to be there on a weekly basis to check in, to kind of do real social work, to do therapy in the kitchen. But now, look at our cases. Again, we have decreased from 2005, 20 instead of eight, and we're down to 15, but there should never be more than 12 cases of worker for FBSS workers. There's limited amounts of slots. We can't increase those slots. We do need more workers. We do need these because so many of our deaths have occurred in Family-Based Safety Services and we need more workers and even able to be there more than once a month. And then these, you know, the case workers that can open cases will refer families to services, but we don't even know if they get, they access those services or not. So the fourth obstacle is leveraging prevention dollars at the federal level. We have the Community-Based Child Abuse Prevention federal grant program that has dollars. It's a state grant program for the states to invest in prevention. It's based on a formula, 70% of the funds Texas gets, it's based on population, so we should do well there, but the other 30% is based on how much we as a state currently invest in prevention. However, yeah, we get a leveraged match for that, but there's a lead agency that has to put up that match and the lead agency is the Department of Family Protective Services that has this much prevention in it, but there's prevention funding in the health and human services, there's prevention dollars in the Department of State Health Services, in the Texas Education Agency, but we're not leveraging any of those. We need to pull all those funds and make one agency, the lead agency, and then collect everything and leverage the highest match possible from the feds. That would move our dollars up quite a bit. And the other major area where we are, which is a big obstacle to child abuse fatalities is the fact that we have negligible investment in evidence-based, targeted and universal prevention period. So we're spending one and a quarter billion dollars a year, one and a quarter billion dollars a year on an agency that protects children from their parents, but we're only spending 58 million a year max on prevention. So do the math. It's four and a half percent of the entire Department of Family Protective Services CPS budget only is only going to prevention, four and a half percent. That's what we're expecting as a result. Some of the services that are working are specialized units. I know Region 3 has some and there's a couple across the state where the best skilled workers that are really good at detecting deception of families work together with medical professionals, law enforcement. These are not just the CACs, the Children's Advocacy Centers. These are special investigation units to reduce fatalities where there is near fatality and injuries. But the main way to get in front of all this is truly prevention through these programs and I'm going to go through each of those. So one of these programs is the Nurse Family Partnership Home Visiting Program. Who here has ever heard of Nurse Family Partnership? Okay, well pretty fair amount. For those that have not, it's an... Oh, NFPs here? Yes! Essentially this program is one where a nurse is matched with a very vulnerable family, a low income first time mother, and this nurse works with the mom in her home. Really a better way, the research shows that working with her in her home environment is where you're going to get the bigger bang for your buck and she starts working with her during pregnancy all the way through the birth of the child and up to child age two. And she's starting to work on her maternal behaviors, getting off the drug abuse away from drug abusing boyfriend and cigarettes and making sure the baby is healthy which is a great outcome for everybody and reduces abuse in and of itself but then really teaching her well baby behaviors. Really just basic care, feeding, rapping, walking, talking all those things that you think she takes for granted but a lot of these moms have been abused, neglected or abandoned themselves and we know through the research not just cognitively do we learn how we were raised through learned behavior but we know through last year's speaker epigenetics, the way you are nurtured is actually going to have an impact on the chromosomes in your DNA and you are programmed to be a nurturer or not based on how you were raised without awareness and active undoing and intervention. So the beauty of this program is it really gets in there for a period of time and change that we have some programs that match nurses when moms leave the hospital but it's a couple three visits. This is an intensive program and it's got some great outcomes. So just to summarize the fields we have here the mother after the 15 year period after the child has been through the program with the moms so when the child's age is now 15 or 17 those moms that had the nurses during pregnancy and infancy had 48% less verifiable child abuse than your control families. That's outstanding, that's unbelievable and the low socioeconomic status unmarried sample had even better outcomes. This also resulted in a lot of reduced hospital injuries so ingestions of kids they eat coins, they eat anything but all those things are reduced as well because mom is more tuned to these children and more concerned about their safety. Another great evidence based program is the Triple P which stands for the positive parenting program and this is a little different. It's a public health model so essentially what Triple P does is it has five stages. The first stage is that everybody in the community gets messaging on how to best raise a child or how to not shake a child through billboards or brochures or there's a big publicity campaign just to make sure people are more aware of how to raise kids. The second level is for parents that need a little more specific work maybe a phone call during the baby's toddlerhood a hotline where they can say help me with this child, they're acting out etc. The third level is big classes of parenting classes that folks can go to and the fourth and fifth stage are more specific and some of them involve home visiting but it's basically tailored to what parents need not every parent needs intensive services in their home for two and a half years but almost everybody needs some kind of parenting help especially if they don't have a mother-in-law or their own mother or some other kind of kin helping them raise children. Who will hear has ever raised children? The hardest job in the world, hello. They don't come with instructions when I last checked. This is a critical program and the results are outstanding a 35% reduction in hospitalizations in emergency room visits for child injuries and a 28% reduction in substantiated cases of child abuse in this particular trial in the Carolina, in the control counties versus the triple P counties. Another cool home visiting program that works with families after abuse has taken place is Safe Care. It's a home visiting program that's found that the families that received this intervention were 26% less likely to have less frequency of re-abusing their child compared to the service as usual group and the SAU services usual group did have services. The effect sizes would have been even larger if they didn't have any services. So basically if you treat 1,000 families with this program you could prevent 64 to 104 estimated first year recurrences of child abuse. And then finally another home visiting program, Healthy Families. Who has ever heard of Healthy Families in here? Okay, just about the same. Is there any healthy family group we should clap for here? But this is also a very effective program that works early with families and had found that after the child's second year of life the moms that were the participants in this Healthy Families New York model reported significantly fewer acts of physical aggression and harsh parenting. So where's the picture of where Texas is right now? Well, we've grown to serving about 21,217 families across our state with home visiting. That's pretty impressive. Don't you think? Well how many families do you think Texas has that qualify for the programs, home visiting? You want to guess? A million? I'm not going to call on you Adam. Now, don't you think that 570,000 is enough? Basically, what we have is about 500,000 families with kids under the age of six that are living at the current poverty level which is a whopping 22,300 for a family of four. So even though poverty doesn't mean you're going to abuse your children, it's the best proxy as to your risk of abusing children. So we are currently serving back to that 4.5%, another 4.5% of those families. Now, what our goal is is to at least serve the highest need families and those would be those making 50% of the federal poverty level. $11,525 for a family of four living with kids under the age of six. So there's 25,000 of those families. If we hit a half of them 112,000 or so, that's going to be the tipping point where we see a huge trajectory in the way our parents raise kids. And in these negative outcomes that we avert, whether it's child abuse or poor outcomes in terms of substance abuse, mental illness, low employment, lack of education, special ed, all those things. So our goal is to ultimately get to that number and we are getting there. We just had a meeting yesterday with Lieutenant Governor David Doherst and I don't know if it's public but he said he's going to add to our home visiting dollars before he leaves office. So we're going to hold them to it and I'll give you his personal phone number when we leave here so you can all call him and bother him about it. Another really oppressive child abuse fatality prevention program is the period of purple crying. Who here has heard of this program? Okay. I love that name purple because that's what the babies face looks like when they're crying incessantly. But the period of purple crying stands for the peak of crying that's unexpected, resists soothing pain like faced, long lasting and usually occurring in the evening and we've all seen babies at this stage, they're impossible to soothe. There's no matter what you do and change the temperature, their clothing or feeding or rocking or whatever you do with them, they're just going to cry. And of course, this is the biggest reason for shaken baby syndrome and abusive head trauma is this period of crying. So this particular program is dispensed in the hospital before mom checks out after having the baby and hopefully with the bow or father or child watching a video with the nurse instructing them on the things to do when a child is inconsolable. And it's had some really great outcomes. The most important thing on this slide is we understand that on average 191 kids in Texas are confirmed for abusive head trauma every year. Now my colleagues here were just telling me how that is such an underestimate 18 of those die of their injuries annually, but that's only what's counted. We know that there's probably many more and each case costs about a million dollars. So forget the financial cost but that is real. The real cost is the lives lost. And here are some of the outcomes. And our period of purple crying is making its way across the country and you can see that in the dark kind of purpley colors that's a jurisdiction wide. In other words there's 10 states that have 80% or more births are receiving this program. And the jurisdiction wide in process is the lighter lavender colors and the red dots are where the period of purple crying exist. So I'm going to just summarize with my little vision of how we're going to save children. And this is my little pinwheel circle of protection. And I think really what we need to do is think about this in terms of there's no wrong door. So however we reach families it can come in a myriad of places or all through this. So start at 12 o'clock universal prevention messaging. That's what our society needs. Triple P does that on teaching people not to abuse their kids. Also moving right to the right prenatal period universal obstetricians gynecologists educating their moms on child development stages. So they understand that crying is normal or potty training is not generally accepted or normal for a one-year-old that usually happens around age two that using a switch and leaving welts and breaking skin soiling a diaper is not a reason to kill a child. So this is some basic stuff where we can really reach a lot of families if we intervene here. My universal interventions are the solid lines and the targeted are the dotted lines. And you can see the color coded from prenatal birth, postnatal toddler to junior high. Moving down to three o'clock targeted high risk home visiting for prenatal moms, the ones that need it the most. So these are your higher risk families. Moving down here universal prevention of birth, the period of purple crying. So all mothers would get that at birth. Targeted high risk home visiting at birth and postnatal. There's several programs including right here in town, Avonce, Early Head Start and Healthy Families, Healthy Start and NFP. And then postnatal, universal medical professional training for all universal, all doctors pediatricians of course, but those that deal with children should be trained in recognizing the symptoms of child abuse. They've got to be able to know that also we need that triple P universal hotline for new parents. So they can call and get some information as we just described. And then as you're moving toward toddlerhood there are some other home visiting programs that focus just on older kids like the home instruction for parents of preschool youth and some others. And then finally this is kind of the real dream and we really need to work on this is universal child development, parenting training and trauma impact for students in junior high and high school before they graduate to become in parents. So that's why we need to start in junior high and really teach them about what happens when you abuse a child, neglect the child, sexually abuse a child or God forbid shake them. So with that I will conclude by saying I am just delighted to be here. Thank you so much for inviting me and I'm happy to take any questions.