“Parental relinquishments” account for 6% of foster care entries in the state; critics say public investments in mental health care will curb the practice.
As a youth mental health crisis continues to strain families across the country, hundreds of Texas children are entering foster care every year not because of abuse or neglect, but because parents can’t meet their behavioral and mental health needs.
Overwhelmed and out of their depth, parents report being unable to handle increasingly aggressive children. They don’t know how to help teenagers struggling with suicidal thoughts or leaving psychiatric hospitals and juvenile detention centers. They fear they can’t keep them or siblings safe.
Now, two pieces of legislation calling for expanded mental health services in Texas offer lawmakers an opportunity to assist families early on — before desperation and thin hope push parents toward the drastic decision to relinquish custody just to get help.
The bills, which call for making services such as crisis intervention, outpatient programs and home-based help reimbursable through Medicaid, are just two of several budget considerations child welfare advocates are pushing Texas leaders to approve.
“If we could support children and families better earlier on, I think we could prevent a lot of this,” said Leela Rice, behavioral health policy chief with the Texas Council of Community Centers. The organization represents 39 centers that provide alternatives to institutional care for people living with mental illness, substance addictions and intellectual and developmental disabilities.
Last year, more than 500 children, nearly 6% of all foster care entries, came into the Texas system under circumstances related to mental health issues their parents couldn’t handle or a reported lack of access to services, according to state data. That number is slightly higher than the national average, according to a 2025 federal study.
Child welfare advocates say parents seek this route believing that Medicaid — a state and federally funded medical insurance that all youth in foster care are categorically eligible for — will allow their children access to treatments and resources they haven’t been able to obtain.
But professionals working with these families warn that this pathway rarely leads to children getting the help they need to heal. Local child welfare systems have long struggled to care for foster youth with intensive mental health needs.
“To get to that point of desperation with your child is devastating, and should not be happening,” said Sarah Crockett, director of public policy for Texas CASA, a national nonprofit that pairs trained volunteer advocates with children in child welfare cases. “Parents often think that if they work with CPS, their kiddo can get some help, and that just really hasn’t borne out.”
Child welfare officials agree that foster care should not be the solution in these cases.
Marta Talbert, associate commissioner for child protective investigations with Texas’ Department of Family and Protective Services, said her agency is primarily designed to address child safety for victims of abuse and neglect, and that these types of cases “are not what our agency was set up to do.”
“We’re their last resort, and we’re really not set up for that,” Talbert told The Imprint. “And we don’t have any other resources or services than anyone else has.” If parents were unable to find a treatment center for their child, it’s unlikely the department will be able to either, she continued.
As a result, struggling teens wind up spending weeks or months living in hotel rooms or other unlicensed settings because the state can’t find appropriate placements, Talbert said. In December 2024, relinquished youth comprised 40% of the state’s “children without placement” population.
Relinquishments can devastate families as well, Talbert said. Children already in the throes of crisis and trauma are wounded again when they learn that their parents are giving them up. They also rarely reunify with their families; reunification is sought in fewer than one-quarter of these cases, Commissioner Stephanie Muth testified to the Legislature in July.
“I think about the needs of these youth,’’ said Talbert, “and then you put that on top of it — all of a sudden they think they’re not loved, or no one wants them.”
Texas relinquishments explained
By the time parents find themselves in this position, the challenges confronting their families have become multi-layered and entrenched, child welfare advocates and mental health professionals say.
Roughly 20% of children and teens in Texas report struggling with a mental, emotional or behavioral health concern, and many receive no treatment, according to the public policy firm Every Texan.
Part of the problem in this sprawling state, advocates said, is that mental health providers can sometimes be hours away and acute mental health care can be cost-prohibitive and outside the coverage of private insurance. Mirroring costs elsewhere in the country, residential treatment centers in Texas often run close to $15,000 per month, and treatment plans often require stays of several months to a year or longer.
Additionally, many of these children are in a clinical in-between. They’ve been discharged from psychiatric hospitals because their symptoms are no longer considered acute, but they remain too unstable to be accepted into residential treatment centers — regardless of who is paying the bill — said Talbert with DFPS and Crockett with CASA.
“To get to that point of desperation with your child is devastating, and should not be happening. Parents often think that if they work with CPS, their kiddo can get some help, and that just really hasn’t borne out.”
— Sarah Crockett, director of public policy for Texas CASA
For years, experts have warned that insufficient access to lower levels of mental health care was driving children into foster care, and particularly into the “children without placement” population.
The issue was highlighted in a 2022 report produced for the state’s Department of Family and Protective Services that noted the lack of intensive home-based mental health services for Texas children.
“Because of this, children with high mental health needs who otherwise could live with family or in family-based settings, attend their neighborhood school, and lead a normal life are too often moved to distant placements where they have less contact with siblings and parents, live in a restrictive environment, change placements frequently, and sometimes find themselves without any placement at all,” wrote authors Ann Stanley, Paul Vincent, and Judith Meltzer, child welfare experts appointed by a federal judge to analyze the state’s child welfare system.
The process of relinquishing custody of a child in Texas typically requires the parents to first seek a court finding of “refusal to accept parental responsibility.’’ This action results in the parents then being entered into the state’s child abuse registry.
In some cases, parents seek an alternative to full custody relinquishment known as a “joint management conservatorship.’’ In August of last year, 224 children were in such arrangements, according to Department of Family and Protective Services spokesperson Marissa Gonzales.
Under this pathway, custody is shared and parents have a say in their child’s treatment. Parents often choose this option believing that it offers quicker passage back home for their child, but this isn’t always so, child welfare advocates say. A child’s release from state custody is dependent on successful treatment and being deemed “safe.’’
With limited mental health resources available to these children, that determination is sometimes hard to come by, said Crockett, the public policy director with Texas CASA.
“It gives both kids and parents a false sense of hope,” Crockett said.
States across the nation face similar challenges
What’s happening in Texas is a reflection of an extreme measure families are resorting to across the country. Government officials say mental health relinquishments can be found in every state.
According to a 2025 federal report that used foster care and Medicaid data, between 2017 and 2019 “as many as 25,000 foster care entries (or 5% of all foster care entries) might have been instances of custody relinquishment” in an effort to get needed healthcare or disability services.
The data, from the U.S. Department of Health and Human Services, showed that Maine had the lowest incidence, with just 1% of entries appearing to be relinquishments carried out in order to get mental health care. Wyoming had the highest, with nearly one in five youth entering foster care for this reason. In Texas, 3% of new foster care cases during that time frame appeared to be relinquishments.
Nationally, children involved were most likely to be white, male teenagers living with single parents in their 40s.“Trauma and stressor related disorders,” “behavior or conduct disorders,” and ADHD were the prevalent diagnoses, and the vast majority had multiple diagnoses, some living with physical disabilities as well as mental health conditions.
Solutions proposed in Texas
Texas child welfare advocates say part of the solution to reducing this reliance on foster care lies in filling gaps in mental health services funded by Medicaid. In Texas, one in three youth receive this publicly funded coverage.
One of the state bills now being considered would require Medicaid to cover intensive outpatient services. House Bill 2036, sponsored by Republican Rep. Tom Oliverson also calls for Medicaid funding for partial hospitalization programs that provide therapy and treatment to mental health patients who don’t need 24-hour supervision.
The other proposed legislation, House Bill 475, would add Medicaid coverage for “multisystemic therapy,’’ a specialized intervention for at-risk youth that sends therapists into homes, schools and communities to work with children and their guardians. The intensive treatment “targets the types of serious clinical problems that put adolescents at risk for out-of-home placements,” including violent behaviors. The bill is sponsored by Democratic Rep. Ann Johnson.
Neither Johnson nor Oliverson responded to requests for comment.
Multisystemic therapy is covered by Medicaid in several states including South Carolina, Louisiana and Nebraska. Texans Care for Children, a policy advocacy group pushing for these reforms, estimates that adding it to public coverage would cost the Lone Star state $8 million annually. But after five years, the state could expect to see a $1.4 million annual savings due to children kept out of foster care.
Advocates and a committee of child welfare, juvenile justice and mental health officials in the state want to see increased funding in two existing services: the Youth Empowerment Services Waiver program and the state’s respite centers.
Respite centers are small, home-like settings that families in crisis can use for a cooling-off period, which can range from a few hours to days or weeks. Eleven such centers in Texas currently serve children who can be referred by schools, child protective services, medical providers, parents or teens themselves. While there, youth get services and families get connected with a treatment plan moving forward.
“It’s not inpatient, it’s not anywhere near as intensive — it’s not anywhere near as scary for a kid,” Rice said. “But they can go and just kind of break that tension, be away from their family for a little bit, and be away from whatever triggers, and try to work on what’s going on.”
The waiver program — commonly called YES Waiver — offers tailored case management to families so kids in crisis can remain at home. It is only available to children at risk of out-of-home placement in foster care or a residential treatment center because of behavioral or mental health challenges. The program served 2,227 Texan children in 2023, but has a lengthy waiting list.
Treatment teams provide 24-7 care that includes art, music, or animal-assisted therapies, family counseling, transportation to treatment sessions and crisis support. Parents too, can receive help with substance abuse and mental health issues.
Quin Heston participated in the YES program in 2016. Diagnosed with ADHD, autism and bipolar disorder, the teenager had exhibited extreme suicidal ideations that had his mother Nidia on the brink of relinquishing custody so he could get acute treatment she couldn’t afford.
She slept on the couch to watch over him each night for a month while they waited to be approved for YES Waiver services, she told the Texas Tribune. After a year of consistent services and treatments, Quin reported feeling like a new person.
“I think plenty of families want this kind of support. They just don’t know where to start,” Quin told the Texas Tribune.
This story has been updated to clarify living arrangements for “children without placement” in Texas.
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