The Community Health Needs Assessment (CHNA) provides valuable insights from parents, caregivers, and community leaders across our eight-county service region: Collin, Denton, Grayson, Hood, Johnson, Parker, Tarrant, and Wise Counties.

More than a hundred leaders from North Texas community organizations tuned in on May 6 for the first session of the two-part summit, during which Cook Children’s explained the methodology of the survey and outlined key findings. It is important to share these results because community organizations and leaders can use this data to inform their strategies for continuing to improve children’s health in their communities.

The key focuses of part one were overall health and well-being, asthma, and healthy lifestyles. The full assessment can be found here, and offers more detailed information on each data collection method used. See more tools for result breakdowns at the interactive data dashboard.

Additional findings specific to caregiver support, injury prevention, mental health, and oral health will be shared on June 3.

Main concerns

The assessment included 6,877 parents/caregivers' responses over the last three years and 239 survey responses from community leaders such as representatives from health departments, nonprofits, schools, and faith-based groups.

The most pressing concerns for many families in our area are related to financial stressors.

As costs have risen over the last few years, 45% of community leaders flagged inflation and poverty as a serious problem in their community.

These struggles directly impact kids’ and families’ physical and mental health. One caregiver said in a survey that they worry about paying for medical visits in addition to other household expenses. Community leaders noted that they help many working families with food, clothes, and other needs.

Housing affordability, food insecurity, and childcare costs are increasing problems for our communities. More than half of community leaders said access to affordable, nutritious food was a serious problem.

Overall health and well-being

Insurance coverage came up repeatedly in interviews with caregivers and parents. While the majority of children (88%) had continuous health insurance in the last year, 5% (about 54,700), had a coverage gap, and 7% (about 81,400) are currently uninsured. Children experiencing homelessness were three times more likely to be uninsured.

Caregivers shared that the lack of coverage was mostly due to affordability, respondents said. Families who did not speak English or Spanish said the language barrier was another obstacle to insurance coverage, and they did not always know how to renew or update their insurance.

Vaccination rates have decreased in our eight-county area - 89% of parents and caregivers reported their child had received all up-to-date vaccines, which is about an 8% decrease since the 2021 CHNA.

Asthma

One in ten children in the service area has asthma, and it is one of the most common health conditions in kids. While asthma is manageable, 19% of those children did not have an asthma action plan. This shows a need for more education, training, and support for caregivers of children with asthma, including daycare providers, schools, and aftercare programs.

Healthy lifestyles

A healthy lifestyle for children includes a healthy weight, physical activity, nutritious food, and adequate sleep. Only 35% of children in our area eat fresh fruits and veggies at the recommended amount, and the majority of children (94%) are spending more than two hours on entertainment screen time every day.

While living a healthy lifestyle benefits overall health, many children and families face obstacles to doing so. Not everyone can access nutritious food in their neighborhood, and 1 in 7 children do not live in an area that has sidewalks, parks, playgrounds, or recreation centers.

In the eight-county service area, approximately 34% of children (about 390,100) live in households that cannot always afford to eat good, nutritious meals and 21% of children (about 236,400) live in a household that reported receiving food stamps or SNAP benefits in the past year.

SNAP gives families financial help to buy nutritious food, but cuts in this program have made it harder for families to get those benefits. The reduction of SNAP emergency allotments also places additional strain on local food banks and community organizations to bridge the gap left by the reduced benefits.

Reduced benefits may lead to increased food insecurity, limiting access to nutritious meals and negatively affecting the health of families and children, ultimately exacerbating social and economic inequalities.

Calls to action

Based on the findings, Cook Children’s Center for Community Health identified crucial next steps to improving children’s health in our communities. One of those tactics is to foster more partnerships focused on non-medical drivers of health, such as food security, economic stability, and housing.

Cook Children’s also plans to strengthen collaborations to create more community outreach for families, advocate for strategies that benefit our communities, and improve access to community resources for children.

More detailed strategy plans can be found on Cook Children's community outreach page.

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Survey Highlights Health Concerns in the Community

Jamie Miller and her husband are foster parents who have worked closely with the clinic for three years. Since then, they have fostered 14 children. Most of their placements have been two or more children at a time.

“Jamie has the patience, flexibility and resilience that are crucial in her role as a foster parent,” said Elizabeth Popeck, a nurse practitioner in the Cook Children's Fostering Health program. “Her unwavering commitment for each child and their family is always astounding. Jamie has the capability to find joy and happiness in the care she provides these children every day even if it’s a small achievement for the child which makes her an exceptional foster parent.”

In celebration of National Foster Care Month, we spoke with Jamie about her experiences as a foster parent. Read her interview below!

What inspired you to become a foster parent?
We felt called to do this as a family ministry. God kept putting families in our path that had or were currently fostering.  We felt the need to help these children who had experienced trauma.  We believe that we could offer a loving and safe place to call home.

My husband and I truly believe that were called to stand in the “gap” and love children during the healing process. Through that belief system, that means that we are fully “rooting and reassuring” the biological parents as they work through their services. We send encouraging notes, pictures, text messages and sometimes even phone calls to show our support. We also believe that clothing and food should never be a hardship when families are reunited. It is hard enough finding a new rhythm and getting to know each other all over again. So, we send an abundance of clothing, diapers, and food home with each child that leaves our home.  If the parent doesn’t have our contact information, we share it with them to offer help, advice or whatever they might need. We want reunification to be as successful as possible!

What are some of the most rewarding moments you’ve had as a foster parent?
There are too many to count! Seeing children reunite with their family.  Being invited into the family of one of the children, as an actual family. Being able to help guide them to care for their child and the child being so supported by all involved. Seeing a child’s physical and mental well-being change in a nurturing environment. The way that it has impacted our family for the better and taught our biological son lessons in empathy and compassion that he wouldn’t have had otherwise. 

Can you tell us about your experience working with the Cook Children’s Fostering Health Program?
It has been wonderful! The Cook Children’s team is extremely knowledgeable and incredibly supportive of our family and so many others that we know. If any child needs a specialist, they make the appropriate referrals in a timely manner and continue to offer other services to benefit the foster families.

What message would you like to share with the community about the importance of fostering?
It’s hard. All of it is hard. However, we can all be a part of the solution in helping these families and especially these children. You can provide a meal to a foster family when they receive a new child into their home. You can donate gently used clothing to a foster closet.  You can become a babysitter or respite care provider.  There are lots of ways to love from afar, and even more ways to love from your home. It truly is the most rewarding and humbling job you will ever do!

Children entering the foster care system often have specialized health care needs. Through Cook Children's Fostering Health program, these children receive timely and thorough medical care. Learn more about the program here.

The parents don’t know the child’s social security number or even date a birth, but no one thinks twice because this is so normal to them.

This is part of the Cook Children’s Fostering Health program.

“Limited access to medical care is common among children entering the foster care system,” said Sharon Johnson, a nurse practitioner in the Fostering Health Program. “The goal of the Fostering Health program is to provide medical care using a trauma informed lens. We understand that removals are often due to a combination of trauma experiences and that even a visit to the doctor is unusual. Children in foster care are a very unique patient population that require unique care.”

The team follows the American Academy of Pediatrics’ health care recommendations to provide a health screening within three business days and a well-child checkup within 30 days of removal. During these visits, the team will assess behavioral, developmental and chronic health care needs. The staff also will partner with case managers to help coordinate care with required specialists and act as a continued resource for the children and biological parents.”

The Parents

On their very first date, they talked about adoption.

As Christians, the young couple felt their faith compelled them to take care of the orphaned, those who didn’t have a home or were less fortunate.

Time moved on and the couple married and they adopted their first child.

While their calling was to help children, they knew they could not afford another adoption.

“We looked into becoming foster parents,” “Janet” said. “There’s such a need and so many kids are in the foster care program. We both knew plenty of people aren’t called for it. We were.”

The couple have now been foster parents to three children. Their latest foster child is the first to have been seen by the Fostering Health program at Cook Children’s.

Raising foster children brings a new set of challenges, both logistically and emotionally. They have to:

• Be vetted legally through CPS and the foster care system.
• Be CPR and first-aid trained.
• Go through background checks and be finger printed.
• Make sure anyone who would baby sit or watch their children, also go through a similar process.

The husband and wife say they have seen children come out of very sad situations, where both the birth parents and sometimes even grandparents have a history with CPS. The children are often removed from the birth parents’ homes.

One or both of the birth parents sometimes are battling criminal charges, mental health issues or drug problems.

And then there’s always a chance, the birth family could get their life straightened out the child returns to them and leaves the foster parents.

The couple are currently fostering a daughter a little under a year old after the child’s mother was found to be unfit to care for her child because of psychiatric health care issues as well as the fact that she was homeless.

The child was brought to Cook Children’s Foster Care Program for an initial three-day evaluation. They found the concerns for the child included lack of prenatal care and possibly premature birth (estimated gestational age 36 weeks). The child was seen 10 days later for a weight check and a newborn screening and then two months later for another well-child exam.

The foster parents of the child say the experience at Cook Children’s Foster Care program was much different than previous visits to a pediatrician’s office. In the past, the staff in other pediatric offices didn’t always understand or appreciate the unique needs and concerns of the foster parents and their children. The family spoken to for this story said previous foster well-child visits might take as few as 20 minutes and the staff couldn’t understand that this child was new to the foster parents. They weren’t sure of common questions asked of birth parents such as if the child’s immunization record was updated or different behavioral aspects of the child.

“Previously, the doctor would take less than 20 minutes looking at our child,” “Janet” said. “At Cook Children’s Fostering Health program they spent well over an hour checking her. I just appreciated their understanding of our situation. We didn’t know the things most parents know. It’s not like the child came out me. We didn’t know the family history. We didn’t know anything about this baby.”

The foster mom said she vividly remembers crying on her way home following the first two placement, well-child visits.

“I tried to explain to them, I don’t know the children. I got them less than 24 hours ago,” Janet said. “There are so many elements that’s simply out of control of the foster care parents. We don’t even know the social security number, the birth mom’s name … sometimes they don’t tell you the basic things. I just appreciated the humility of the whole office. They were all walking around oohing and awing. It is a Foster care clinic. They get it like no one else does. I really loved going to Cook Children’s.”

Services provided from the Cook Children’s Fostering Health program include:

• Providing care coordination between foster and primary care physicians, specialists, therapists and behavioral health
• Helping establish a primary care medical home
• Providing sick and well-child visits
• Coordinating with Department of Family and Protective Services and child placement agencies

To schedule an appointment with Cook Children’s Fostering Health program, call 682-885-3953. The team can combine the three-day required visit and the appointment for hair follicle drug testing if the drug test is ordered by Child Protective Services.

The program provides a medical screening within three business days of removal to:

• Assess the child’s overall health and confirm that there is no evidence of abuse
• Find out if child should be taking routine medicines and help with refills if necessary
• Document behavior changes
• Provide a well-child checkup (Texas Health Steps) within 30 days of removal
• Reduce preventable hospitalizations and Emergency Department visits
• Connect children to services such as physical and occupational therapy, behavioral health and specialists visits
• Help foster parents access health care services

To Schedule an Appointment

Caregivers, Child Protective Services representatives and providers can call 682-885-3953 and ask for the fostering health care coordinator or email fosteringhealth@cookchildrens.org.