CPS and the Forensic Assessment Center Network

Sometimes, medical professionals become concerned about child abuse or neglect if a parent cannot explain how a child was injured or why a child is sick. Signs of abuse may include broken bones, burns, or internal bleeding. Signs of neglect might be untreated medical or dental issues, weight or growth issues, or ignoring a doctor’s medical advice.

Texas is a mandatory reporting state. This means that Texas law requires any person who reasonably suspects a child has experienced abuse or neglect to immediately make a report to CPS. Licensed professionals, including doctors and nurses, must contact CPS within 48 hours of first having concerns of abuse or neglect.

Note: Well-meaning people can reasonably believe that abuse or neglect took place even if no such abuse or neglect exists. A CPS report or investigation does not mean a child was abused or neglected. Parents in this situation need to know their rights and understand how CPS investigators and medical professionals assess abuse and neglect.

FACN, or the Forensic Assessment Center Network, is a group of medical facilities, doctors, nurses, and social workers in contract with DFPS (“CPS”). This network provides medical expertise, record review, and consultations in child abuse and neglect cases.

The doctors, known as “CAPs” or Child-Abuse Pediatricians, are trained in pediatric trauma and forensics involving child abuse.

CPS caseworkers can contact the FACN 24 hours a day for guidance on how to handle child abuse and neglect cases. CPS caseworkers rely heavily on FACN’s medical evaluations when deciding if abuse or neglect occurred and whether to legally remove a child from their home or take other protective steps.

FACN providers may be asked to testify as expert witnesses for CPS in court.

You can read more about the FACN.

In general, parents have the right to make medical decisions for their children. But this right can change if a court says that another person or CPS should make medical decisions for the children instead of the parent. Read all parental rights and duties in Texas Family Code 153.132 and 153.173(8).

If a court finds that a child has experienced abuse or medical neglect, the court may decide that the parent should not continue to make medical decisions. In that case, the court may allow another person or CPS to make medical decisions instead.

FACN keeps a list of current network partners.

Not all parts of Texas have an FACN partner facility. Because of this, some children (especially those living in more rural areas) may not be physically examined by a CAP. Instead, the child’s pediatrician or other doctors send the child’s medical records to a CAP for review. In some cases, CPS may ask the family to travel to an appointment with a CAP.

CPS can refer a case to FACN at any stage of CPS involvement, though this typically happens during the investigation. Parental consent is not required for this referral.

Other medical professionals, such as a child’s pediatrician, an ER doctor, or a nurse, may also make referrals.

Common reasons that cases are referred to FACN professionals are:

• There is not a "reasonable explanation” for an injury to a child.
• The child’s injury does not seem to match the explanation given by their caretaker.
• A medical professional or caseworker believes that a child requires an in-person assessment for possible abuse or neglect.
• A CPS investigator needs help determining if abuse or neglect has occurred, or if they need clarity about the seriousness of the injury or condition.
• There is evidence of medical abuse or medical neglect of a child.
• A child under 11 has a sexually transmitted disease and there is concern about whether sexual abuse caused the disease.
• A child almost died (known as a “near-fatality”).

Once a case is referred, a CAP from the FACN begins evaluating whether the abuse or neglect likely caused the medical issue.

If the child is already at a medical facility—usually an emergency room—a CAP may do a physical examination there. If the child is at home, the parent or caretaker may be asked to bring the child to an examination.

An FACN social worker may also want to interview the parents or caretakers about the child’s history, caretakers’ history, and the family’s living situation. These factors are often connected to a child’s health and stability.

Not all FACN review involves a physical examination of the child. A CAP might only review documents, such as:

• photographs
• lab reports
• the child’s medical history
• statements from the parents or witnesses
• statements from the child
• CPS intake information

Once the consultation is finished, the CAP provides a written evaluation to CPS.

If a lawyer represents you, the lawyer can request a copy of your CPS records through a discovery request.

Alternatively, you or your attorney can ask the medical facility for a copy using a special form called a “business record affidavit.” However, each hospital has different policies, forms, and language used for releasing records. Getting these records can often be difficult. Plus, medical records can be expensive.

If you need records quickly, you should speak with an attorney.

No, a healthcare provider who reports suspected abuse or neglect may not provide the FACN evaluation for the investigation. This applies even if the doctor is a member of the FACN.

Unfortunately, the FACN is not clearly defined. Sometimes a nurse or social worker who works for a doctor may make the report instead of the doctor. Also, you do not have the right to know who made the original report of abuse or neglect against you, although sometimes this information is listed in the medical records.

If the evaluation results are used against you and it is unclear whether the doctor who did the assessment also made the report to CPS, you should consult with a child welfare attorney.

Yes. CPS cases involving medical treatment are often complicated and take longer to investigate. In general, CPS should finish an investigation within 45 days. However, a caseworker can request an extension if they are waiting on an FACN assessment or medical records. Read more in the DFPS Policy Handbook at 2232.4 and the DFPS Forensic Assessment Center Network Resource Guide.

CPS must consider the CAP’s assessment when determining whether a child was abused or neglected, and in deciding what steps are necessary to protect a child.

However, Texas law says that CPS cannot remove a child based solely on the opinion of a CAP who did not physically examine the child. If the doctor who physically examined the child and the CAP both agree that abuse or neglect occurred, both opinions can be used for an emergency removal.

Parents can get second medical opinions for their child unless a court order limits this right. If CPS removes your child, the law requires the judge to consider any medical opinions you get. Read Child Protective Services: The Removal Process to learn more about removal.

A parent or caretaker has the right to:

1. Request information. You have a right to information about any planned treatments for your child so that you can give informed consent.

   For example, if an FACN medical professional says that your child needs more X-rays, you can ask how these X-rays relate to your child’s treatment plan.

2. Refuse certain medical procedures. You have a right to refuse medical treatment for your child unless doing so would harm the child.

   Some parents may be uncomfortable with certain treatments, such as psychiatric medication or procedures that violate religious beliefs. Even doctors may disagree on treatment options. You have the right to explore your options if your child is not harmed by you doing so. However, refusing medical treatment against a doctor’s advice may result in a report to CPS.

3. Request a second opinion. You may get a second opinion from any doctor you choose unless your right has been restricted by a court order. You must make your own appointment and pay for the examination yourself. It is important to keep a record of any medical opinions you get.
4. Request your child’s medical records. You may get a copy of your child's medical records unless a court order has restricted this right. You can also share these records with your attorney. Initial medical records may be incomplete, so you might have to make additional follow-up requests.
5. Know who the CAP is. You have the right to know who the Child-Abuse Pediatrician is. You can ask any doctor their name, their role or title, and how they are going to assist in your child’s treatment plan. In some cases, the CAP may make useful recommendations to help uncover rare medical conditions.
6. Refuse to speak to the CAP. You do not have to speak to the CAP if you do not want to do so.

Specialty consultations are performed by board-certified doctors who specialize in diagnosing unique medical conditions that often mimic signs of abuse, such as  

• Rickets 
• Ehlers-Danlos Syndrome 
• Osteogenesis Imperfecta (OI) 
• Vitamin D deficiency 
• Other medical conditions that mimic child maltreatment or an increased risk of a misdiagnosis (for example, certain types of fractures).

Texas law says that CPS must refer a child’s case for a specialty consultation if:

• Policy requires it.
• The child’s parent or legal guardian or their attorney requests it.
• The child‘s healthcare provider recommends it.

An FACN medical professional can recommend that a child be referred for a specialty consultation. However, the FACN professional cannot choose which doctor to refer the case to. The doctor who conducts the specialty consultation cannot be the original reporter of abuse or neglect. 

Before making the referral, CPS must give the parent (and the child's attorney, if there is one) written notice of the recommended specialist's name, credentials, and contact information.   

The parent can object to the referral and request a different specialist.  CPS must collaborate in good faith to choose an alternate specialist.  However, if CPS and the parent cannot agree upon an alternate specialist, CPS can refer the case over the parent's objection.

Unless a court order says otherwise, a parent always has the right to take the child to another specialist for a second opinion. The parent must make the appointment themselves and pay for it.   

For children with complex medical needs, it may be helpful to keep a folder of all relevant medical information, including: 

• Names and contact information for all doctors who have been involved in the child’s treatment
• Dates of past and upcoming appointments 
• Documents that clearly show the medical diagnosis and treatment plan 
• All of the child's medications and their medication schedule
• Any specialized medical equipment the child uses, such as a GI tube or oxygen tank 

Keep this folder handy in case any questions about your child’s medical care arise. 

You can also consider giving a written birth and medical history to the hospital, any doctors or CAPs, and any Child Protective Investigation caseworkers. Be sure to note any hereditary or genetic conditions that could mimic child abuse or neglect.   

It is important to seek regular medical care for your child. Follow through on any appointments or other treatments recommended by your child’s doctor and seek a second medical opinion if you do not agree with the recommended treatment plan.  Failure to do so could be considered medical neglect. 

If you are delaying necessary medical care because your child does not have health insurance, it is important to apply for assistance as quickly as you can.   

You can apply for Children's Medicaid or the Children's Health Insurance Program (CHIP) at Your Texas Benefits. Children's Medicaid is a healthcare program for children in low-income families. CHIP is for families who earn too much for Medicaid but cannot afford private health insurance.  

Another option is to see if you can obtain private health insurance through your employer or the employer of the other parent or conservator. 

You can apply for private insurance at HealthCare.gov. Depending on your income, you may qualify for a "premium tax credit" that lowers your premium (the amount you pay each month for your insurance plan).