The Purpose of the Family First Prevention Services of 2018

Public Health Rep. 2020 Mar-Apr; 135(ii): 282–286.

The Family unit Offset Prevention Services Act: A New Era of Child Welfare Reform

Karen U. Lindell

ⁱJuvenile Law Center, Philadelphia, PA, USA

Christina K. Sorenson

¹Juvenile Law Center, Philadelphia, PA, USA

Susan V. Mangold

^aneJuvenile Law Center, Philadelphia, PA, USA

Keywords: law, legal bug, child welfare, advocacy, boyish health, public policy

Passed past Congress in early 2018, the Family Commencement Prevention Services Human activity (Family First)^¹ is a major step forward in federal child welfare reform and has the potential to transform the way states provide services to children who are abused or neglected. This installment of Law and the Public's Health offers an overview of the major provisions of Family First. As states and counties reply to the new incentives and restrictions imposed by the statute, collaboration amid researchers, advocates, and policy makers will be needed to ensure that the promise of these reforms translates into meaningful alter for children and families. Quality evaluations of new preventive services and changes to institutional care will be of import, particularly in the early years of these reforms.

Groundwork

Family Get-go combines 2 policy goals long championed past child welfare stakeholders and advocates: (1) reforming child welfare financing to let federal dollars to exist used for prevention services and (ii) limiting federal fiscal support for placement of children and adolescents in group care.^²,ⁱⁱⁱ With the need for child welfare reform condign fifty-fifty more urgent amongst the growing opioid epidemic, there was a potent push to laissez passer the statute in 2016, only it ultimately failed.^⁴ Then, in early on 2018, the beak was added to the Bipartisan Budget Deed of 2018—the emergency spending agreement needed to continue the government open up among a budget impasse—and it was signed into law by President Trump on February 9, 2018.^{^one}

Under Family Outset, federal entitlement funding can—for the first time—be used for services to forestall a child'southward entry into the child welfare system. Previously, federal entitlement funding for child welfare services could be used only to fund costs incurred later placement. Family First also imposes substantial limits on federal funding for group care, reflecting the growing consensus amid child welfare advocates, researchers, and policy makers that family-based placements provide meliorate back up for children and adolescents than grouping intendance (eg, group homes, child-serving institutions, and residential handling facilities).^{^v -^viii} The statute includes many other provisions designed to support families and meliorate family-based placements, including development of model licensing standards, boosted data collection requirements for children and adolescents placed in group intendance, and support for adolescents and young adults transitioning out of intendance.^⁹

Although some Family First provisions went into effect immediately, the funding for prevention services and the restrictions on group care went into effect on October 1, 2019, and states accept the pick to delay implementation for up to 2 years.^¹⁰ If states delay adoption of the group care restrictions, they must also delay receipt of the new funding for prevention services. States are currently deciding whether to be early adopters of the statute or to opt for additional time.

Overview of Federal Child Welfare Financing

Family First implements its reforms largely past irresolute the ways states can use federal funds to finance their child welfare programs. Federal funds comprise fewer than half of the more than than $29 billion spent annually on child welfare programs in the United States.^¹¹ The biggest source of federal funds—comprising more than than half of all federal child welfare expenditures—is Title IV-E of the Social Security Act, which was created in 1980 to split federal foster care funding from funding for Aid to Families With Dependent Children (AFDC), the full general federal welfare program at the fourth dimension.^¹¹,¹² Title Four-East includes several kid welfare programs, including the foster care plan, adoption and guardianship aid, and programs to support older adolescents and young adults.^¹³ The foster care program is the largest category of Title Four-Eastward spending, and it entitles states to uncapped federal reimbursement for a set percentage of the costs expended for the intendance of "eligible children."^{^fourteen}

To be considered eligible under the Championship Iv-E foster care plan, children must be removed from their homes, come up from families considered to exist "needy" according to the 1997 public assistance guidelines, and be placed in an approved foster home or childcare institution, amidst other requirements.^{^xiv} Thus, before Family Kickoff, a state could not receive federal Four-East reimbursement if the child remained in the home, with the family receiving in-habitation preventive services. These services, as well as services for children who did not meet income requirements or who were placed in nonapproved settings, could be paid for just by using state or local dollars or capped federal dollars. A "needy" kid placed in a group intendance or a foster home, on the other paw, could keep to generate federal reimbursement for the total duration of the placement. By opening federal funding for prevention services, while limiting funding for placement in group care, Family Outset alters this funding landscape, creating new incentives for states and counties.

Major Provisions of the Act

Because of the numerous provisions in the statute, a total clarification of all Family First'due south provisions is across the scope of this commodity. We focus on the 2 fundamental provisions of the statute for public health: (1) new prevention services funding and (2) restrictions on group care. Nosotros also talk over the expansion of supports for adolescents and young adults transitioning out of care.

Prevention Services

Foster care statistics from the US Children's Agency show that the number of children in foster care has been increasing since 2012, and the provisions in Family First on prevention services are a federal endeavor to combat this trend.^¹⁵ Every bit of October ane, 2019, states, territories, and tribes tin access federal Championship Iv-E funding for eligible prevention services for eligible children, young adults, and families.^¹⁰ Notably, these federal contributions are not linked to the AFDC income eligibility requirements, although placement services remain linked to the income eligibility restrictions.

Eligible services and programs include (i) mental health and substance abuse prevention and handling services by qualified clinicians and (2) in-home parent skill-based programs, including parenting skills preparation, parent education, and individual and family counseling. Services and programs must exist trauma informed and testify based.^{^ix}

The evidence-based criteria for services and programs are modeled subsequently the criteria used in the California Bear witness-Based Clearinghouse for Kid Welfare (www.cebc4cw.org), but they differ in several means. For example, the requirement that a program be evaluated using a control requires only the use of a command group rather than a randomized controlled trial.^⁹ The statute defines 3 categories of testify-based programs—"promising," "supported," and "well-supported" practices—and at least 50% of expenditures must exist for prevention services and programs that meet the requirements for "well-supported" practices. Nether the statute, to encounter any of these categories of evidence-based practices, all of the following must be truthful:

There is documentation on what the practice consists of and how it is administered.
There is no empirical basis or case data suggesting or showing chance of greater harm than benefit to those served.
The overall weight of show supports the benefits of the practice.
Issue measures are reliable, valid, and consistently administered.^¹⁶

The programme or service must also take been "found superior to an advisable comparing practice in achieving improvements on important kid and parent outcomes (eg, child safety and well-being, mental health)."^¹⁶ On November 30, 2018, the U.s. Department of Health and Human being Services released its first guidance on prevention services that come across the evidence-based standards. That guidance reinforced the statute's requirement that prevention services be provided "in accord with recognized principles of a trauma-informed approach" merely did non further define that term.^¹⁷

Eligible recipients for these prevention services include (1) children who are candidates for foster care and/or their parents or kin caregivers and (2) adolescents and young adults in care who are meaning or parenting.^{^nine} These provisions have the potential to provide enhanced support services to parents in foster care, who ofttimes face up multiple challenges accessing resources.

States must ascertain for themselves who is a candidate for foster care, and the federal government provides limited guidance on how that term should exist interpreted, clarifying only that a child cannot simultaneously exist in a foster care placement and be considered a candidate for foster intendance.^¹⁷ Nether the language of the statute, a candidate for foster care must be at imminent adventure of inbound care simply, if provided services that preclude entry into foster care, may safely remain at dwelling or with family.^⁹ A child who is reunified, adopted, or placed with a legal guardian or relative may exist considered a candidate if the services or supports provided can exist considered efforts to prevent the kid's removal from the domicile and reentry into foster care.

For each candidate child, the state must certificate the services or aid needed, the permanency goal for the child, and how the services existence provided are tied to the child's placement and permanency goal and are trauma informed. Although no maximum is prescribed for the length of time a child may be considered a candidate, a state must document its reason for keeping a child in candidate status for longer than six months. Services may be provided for upwards to 12 months, per candidate episode. These services accept no lifetime limit, so children and families are able to access these services more than once.^⁹

Restrictions on Group Intendance

For many years, researchers, kid advocates, and an increasing number of land and local policy makers take focused on reducing the number of children in group care and expanding access to family unit-based placements.^{⁵ -⁸} Family First is the commencement major contribution to this effort at the federal level, restricting federal funding to most group care settings and imposing robust requirements on the grouping care settings that can proceed to receive federal dollars.

Both before and after passage of Family First, Title 4-E funds tin be used to fund placements in a "family foster dwelling," defined as a home with 24-hour care for ≤vi children (with some exceptions) or a "child care institution," defined as an institution for up to 25 children that is not a detention center.^{^xviii} Facilities that house more than 25 children are non eligible for federal Title 4-E reimbursement. Under Family unit Start, a kid's Title IV-E eligibility ends after two weeks of placement in a childcare institution.^{^nine} Thus, placements in settings with more than than 6 children lasting longer than 2 weeks generally will be ineligible for federal funding one time these provisions go into issue.

Family Commencement has several exceptions to this funding brake to meet the needs of adolescents, young adults, and young persons with special needs. First, Family unit First permits federal reimbursement for supervised contained living placements for immature adults aged ≥eighteen, allowing states that have extended their foster care programs to age 21 to continue to offering developmentally advisable placements. Family unit First also exempts group care settings that provide "high-quality residential care and supportive services" to children, adolescents, and young adults who accept been or are at risk of being victims of sexual practice trafficking. Specialized settings for meaning and parenting adolescents and immature adults also retain Championship IV-E eligibility after the ii-week cutoff.^⁹

Family Offset also creates a new placement type—the Qualified Residential Treatment Program (QRTP)—that is not discipline to the 2-week cap.^⁹ QRTPs must be designed to conform children with serious emotional or behavioral disorders, use a trauma-informed treatment model, comprise family members proactively, and provide belch planning and aftercare, among other requirements. The statute also provides that, earlier placement in a QRTP, a kid must receive an individualized cess to place the child'south strengths and needs and to determine whether placement is consequent with the kid's short- and long-term goals. The assessment process must include the child's family and permanency team, and the placement decision is subject to court approving. In improver, Family Outset requires ongoing oversight of the child'due south placement in a QRTP, with increasing levels of scrutiny the longer a QRTP placement continues.^{^nine}

In addition to the two-yr delay option, federal guidance allows states to continue to receive federal money for all children currently placed in eligible grouping care settings for the duration of that placement, potentially disincentivizing states from shifting children to family unit-based alternatives.^{^xix} Some advocates who originally opposed the legislation are concerned that important settings in their state'southward continuum of intendance may lose Championship 4-East funding under the new restrictions. And unintended consequences, such equally pushing more than children into the juvenile justice arrangement or encouraging overdiagnosis of behavioral health conditions, are possible. The statute attempts to avoid these potential pitfalls by requiring states to provide an "assurance of nonimpact on the juvenile justice system" and by imposing protocols to prevent inappropriate diagnosis.^{^nine} But policy makers, researchers, and advocates must continue to work together equally states implement the statute to ensure these provisions have their intended effect: expanding and strengthening the family-based placements bachelor to children, adolescents, and young adults in foster care.

Support for Adolescents and Young Adults Transitioning Out of Care

Family Kickoff also directly affects older adolescents and young adults, who are overrepresented in group care, by increasing the capacity of systems to support the successful transition to adulthood through modifications to the Chafee Foster Care Independence Plan. Intended to assist immature persons who are likely to age out of foster intendance, the Chafee Program allows states to employ for flexible funding grants to help these young persons with education, employment, financial management, housing, emotional back up, and building connections to supportive adults. It also includes an Education and Training Vouchers Program to back up the education needs of adolescents and young adults who are aging out of foster care.

Family First modifies these programs in several ways. First, the statute changes the plan name to "Chafee Successful Transition to Adulthood," in recognition that support should exist provided to aid adolescents transition to machismo rather than overemphasizing "independence."^{^ix} Research on adolescent brain evolution shows that a major developmental window begins in adolescence and continues through young adulthood.^{^twenty} This period of growth provides one of the greatest opportunities for the brain to heal from past trauma. Gradual independence and increasing autonomy in a safe, nurturing environs are keys to success. Family First as well provides states that accept extended foster care programs with the option to extend Chafee supports and services to immature adults until age 23 and extends eligibility for Teaching and Training Vouchers to young adults until age 26.^²⁰,²¹ Recognizing the need for more than inquiry on transition outcomes, Family unit First requires improved data collection of the experiences and outcomes of adolescents and young adults in care. Finally, agencies must provide adolescents and young adults who have aged out of foster intendance with official documentation showing they were previously in care.^{^nine} This documentation allows young adults to establish eligibility for special categories of benefits targeted at persons formerly in foster care, including Medicaid and financial aid for postsecondary education and grooming.

Implications for Public Health

Family First mandates important new reforms to the child welfare system, and researchers whose work touches the young persons and families involved in that system should familiarize themselves with these changes. Equally implementation of the statute continues, child welfare service providers, wellness care professionals, policy makers, advocates, and other stakeholders must piece of work together to accost key issues, such as how to effectively scale up prove-based practices, strategies for developing a true continuum of family unit-based alternatives to group care, and means to avoid unintended consequences, such as expansion of the juvenile justice system. Enquiry and program evaluation volition be vital to understanding the success of the statute's implementation and to ensuring that the hope of its reforms translates into meaningful improvements in the wellness and well-being of children and families.

Acknowledgments

The authors give thanks Jennifer Pokempner for her valuable feedback and contributions to this article.

Footnotes

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this commodity.

Funding: The authors received no financial support for the research, authorship, and/or publication of this commodity.

ORCID iD: Karen U. Lindell, JD An external file that holds a picture, illustration, etc. Object name is 10.1177_0033354919900892-img1.jpg https://orcid.org/0000-0002-8424-7689

References

one. Bipartisan Budget Deed of 2018, Hr 1892, 115th Cong (2017-2018).

5. US Section of Health and Man Services, Administration for Children and Families, Children's Bureau. A national look at the utilise of congregate intendance in child welfare. https://www.acf.hhs.gov/sites/default/files/cb/cbcongregatecare_brief.pdf. Published May 13, 2015. Accessed March 22, 2019.

7. Dozier M, Kaufman J, Kobak R, et al. Consensus argument on group care for children and adolescents: a statement of policy of the American Orthopsychiatric Association. Am J Orthopsychiatry. 2014;84(3):219–225. doi:10.1037/ort0000005 [PubMed] [Google Scholar]

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19. U.s. Department of Wellness and Man Services, Administration on Children, Youth and Families. Programme instruction ACYF-CB-PI-18-07. Public Law 115-123, the Family unit First Prevention Services Deed: implementation of Title IV-Eastward program requirements. https://www.acf.hhs.gov/sites/default/files/cb/pi1807.pdf. Published 2018. Accessed March 22, 2019.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036616/