Resource Letter:
For Judges and Attorneys Handling Child Protective Services Cases
June 13, 2018
Updated "3 in 30" Program Information
Please Note:  Our original communication on the DFPS “3 in 30” program dated June 13, 2018, omitted one of the roll-out dates, specifically the date of implementation of the “3 in 30” program in Region 2. Implementation in Region 2, along with Regions 3E and 3W, was begun on June 1, 2018. This has been corrected in the updated version below.
DFPS "3 in 30" Program Information and Implementation Schedule
According to the American Academy of Pediatrics , children and youth in foster care have significant medical needs. For example,
  • Up to 80% of children enter foster care with at least one medical problem.
  • 30% of children come into foster care with a chronic medical condition.
  • Up to 80% of children and adolescents enter foster care with a significant mental health need.

Effective December 31, 2018, DFPS will be legally required to implement statewide an initial medical screening within three business days of children and youth coming into foster care. This “3-Day Medical Exam” is an additional medical screening beyond what was previously required. 

The new 3-day Medical Exam is being combined with the existing Texas Health Steps and the ongoing CANS Assessment currently required and together they will be known as the “3 in 30” Program. This comprehensive approach to assessing a child’s medical health, behavioral health, and developmental needs will provide DFPS with a greater understanding of the needs and strengths of children in its care and chart the path for service planning from the very beginning.
Q: What is “3 in 30”?

A: “3 in 30” is a new assessment program that is required for each child placed in the conservatorship of DFPS. The program includes three exams or assessments:
  • 3-day Medical Exam (within 3 business days of removal)
  • Texas Health Steps Medical Checkup (within 30 days of removal)
  • Child and Adolescent Needs and Strengths Assessment (CANS) (within 30 days of removal)
Q: What does the 3-Day Medical Exam encompass?

A: The 3-Day Medical Exam is a medical screening that is intended to provide a baseline of a child’s physical health upon entering foster care. It is designed to identify existing needs or conditions, including previously unknown chronic medical conditions such as asthma or diabetes. It is also an opportunity for the caregiver to obtain necessary medications for a child which may not have been obtained at the time of removal, such as an asthma inhaler or eczema cream. Children and youth may not be administered vaccinations at the 3-day Medical Exam unless medical consent from the biological parent is given. The only exception is if there is an emergent need for a tetanus vaccination.
Q: Who provides the 3-Day Medical Exam?

A: The 3-Day Medical Exam must be completed by a credentialed STAR Health medical provider such as a Nurse Practitioner, Clinical Nurse Specialist or Physician’s Assistant. In addition, youth can be seen for their 3-Day Medical Exam at a Federally Qualified Health Center or Rural Health Clinic. The 3-Day Medical Exam cannot be completed remotely via telemedicine.
Q: What is the Texas Health Steps Exam?

A: The Texas Health Steps exam is an age-appropriate medical checkup which includes medical screenings, vaccinations, and lab tests recommended by the American Academy of Pediatrics.  Children in DFPS conservatorship, including children in foster care and kinship care, must get Texas Health Steps medical and dental checkups, which are comprehensive head-to-toe checks that allow the doctor to treat problems early, and ensure a child is growing and developing as expected. The  Texas Health program, known in federal law as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, is Medicaid’s preventive healthcare program for children, teens, and young adults age 20 and younger.
Q: Who provides the Texas Health Steps Exam?

A: Only STAR Health credentialed, licensed medical practitioners who are enrolled as Texas Health Steps providers may do Texas Health Steps checkups.
Q: What is the CANS Assessment?

A: The Child and Adolescent Needs and Strengths Assessment (CANS) is a developmentally appropriate, comprehensive assessment of each child which is conducted by a STAR Health clinician within 30 days of the child entering DFPS conservatorship. Since September 1, 2016, DFPS has used the Child and Adolescent Needs and Strengths Assessment (CANS) to ensure uniformity and consistency in evaluating each child's needs and strengths, assist in service planning, inform placement decisions, and reduce the number of assessments administered to children in DFPS conservatorship. For more information about the CANS Assessment, please link to the Children’s Commission’s JIR letter: Child Adolescent Needs and Strengths Assessment and Family Strength and Needs Assessment
Q: Who provides the CANS Assessment?

A: The CANS is also administered by a credentialed STAR Health provider.
Q: Who is responsible for ensuring the "3 in 30" occurs?

A: The removal caseworker is responsible for ensuring that the 3-Day Medical Exam is scheduled and completed. The child’s caregiver could assist in scheduling and it is ideal for the caregiver to transport the youth and to be present to hear recommendations for care from the medical provider. STAR Health can help connect the worker or caregiver with a medical provider in their area. The ongoing caseworker is responsible for Texas Health Steps and CANS. In most cases, the ongoing worker will be the Conservatorship worker. 
Q: What is the 3 in 30 implementation schedule for the State?

A: The 3 in 30 Program is being introduced with the implementation of the 3-Day Medical Exam. The roll out schedule is as follows: 
Implementation Date : DFPS Region
April 1 st : 1, 7, 9, 10*
June 1 st : 2, 3E, 3W
August 1 st : 4, 5, 6A, 6B
October 1 st : 8, 11
*Note: Lubbock County is already implemented.
Q: How can judges help?

A: Judges can help ensure that children in foster care have received a 3-Day Medical Exam, Texas Health Steps medical checkup, and CANS by inquiring at the Adversary and Status Hearings about the status of each assessment.
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For a complete list of Jurist in Residence Letters, please visit the Children's Commission webpage . Information provided by the Children’s Commission should not be read as a commentary by the Supreme Court of Texas or any other court. The Children’s Commission website is not equipped to facilitate dialogue or conversation about matters related to the information in this communique. For more information about the Children’s Commission, please visit our website .