Early on in Sen. Ron Wyden’s (D-Ore.) efforts to revamp the federal Title IV-E entitlement to include family preservation services, Youth Services Insider wrote the following in a column about his earliest trial balloon:
It would be foolish for anyone to think this bill, as presently constituted, is going to become law during this Congress. Wyden is the ranking minority on the Senate Finance Committee. His counterpart, Chairman Orrin Hatch (R-Utah), has yet to weigh in on what he’d want out of a comprehensive reform package. The bill is without the endorsement of Hatch or any other Senate Republican.
So right out of the gate, you can expect some horse trading and compromising before the bill even has a chance to make it out of the Finance Committee.
Indeed, compromise has transpired as the bill has evolved through several iterations. And as we reported over the weekend, the Family First Prevention Services Act will be introduced in both the House and Senate, most likely this week.
Here are a few key details and notes about the new version:
It’s Paid For
When Wyden’s first version of this bill was circulated, it doubled up spending on Title IV-B and included a long list of allowable avenues of spending to help prevent kids from entering foster care. Speculation was that Wyden’s vision for reforms would have a price tag in the billions.
The Congressional Budget Office (CBO) has confirmed that the version awaiting introduction is budget neutral, YSI has learned. In other words, the spending offsets in the bill wash out any estimated increase in federal spending on the family preservation services.
A more specific table from CBO is forthcoming; by law, it needs to be available before the full Senate or House can vote on the bill. But make no mistake: the budget neutrality, coupled with the support of Republicans on House Ways and Means, moves this bill into the category of “passable.”
It’s Way, Way Smaller in Scope
The first iteration of Family First listed several services that would be allowable under IV-E, including parent-to-parent mentoring, counseling, housing support, assistance with utility payments and substance abuse programs.
That list, in particular the housing part, was a fiscal albatross around the neck of the bill in terms of legit passage. There was, in our humble opinion, no chance this Congress was going to pass a bill that included an open-ended offer to pay for housing.
The list has narrowed to three preventive services sectors: substance abuse treatment, mental health services and in-home parenting assistance.
You can bet that pared-down list has been cause for a couple dozen conference calls and 8,000-email-long chains among advocates and providers that have already signed on to support Family First. Will they continue to support a reform that only opens up IV-E for this smaller scope of assistance to families in crisis?
There are arguments for and against, of course. On the “for” side, you are still getting behind the first-ever bipartisan push to bring family preservation into a federal entitlement. And the list, while smaller, still supports some major drivers of preventable placements into foster care.
The “against” argument is simply that if this law gets signed, the window for reform might close for a while. So if you are fully dedicated to the idea that housing or something else needs to be on the table, you are backing this bill knowing that it might be years before Congress gets motivated again.
Our guess is that few if any supporters will jump off. We will certainly be pressing for comments at The Chronicle.
Upset Over Offsets, Part 1: Congregate Care
There are two camps that are certainly poring over the new bill to see if they can support it. One of those camps is the residential and congregate care industry.
The primary offset in this bill is the change in policy when it comes to federal funds for congregate foster care. At the moment, there is no limitation (other than the standard IV-E eligibility determination) on federal reimbursement for group homes and other congregate settings.
This has been a part of the bill ever since an original compromise was reached between Wyden and Sen. Orrin Hatch (R-Utah), who chairs the Senate Finance Committee. Hatch originally wanted to draw a line in the sand at age 13, and forbid any federal spending on congregate care for kids younger than that.
Now the bill cuts off federal support after two weeks, and also includes exceptions for three settings:
- Qualified residential treatment programs.
- A prenatal, postpartum or parenting support program.
- An independent living program for people who remain in foster care after age 18.
The latter two need no elaboration; everyone will support an exception for pregnant and parenting foster youth, and group settings are integral to the Fostering Connections extensions in many states.
But advocates are already reviewing the bill’s guidelines for what constitutes a “qualified residential treatment program.”
From Marlo Nash, spokeswoman for the Alliance for Strong Families and Communities, which represents providers including congregate care facilities across the country:
“We’re analyzing the new QRTP definition and related provisions … to ensure the definition allows for the range of fully funded residentially-based settings needed to ensure that the system can serve children at the right time with the right treatment with measurable results.”
In February, The Alliance supported the Family First legislation in tandem with the American Public Human Services Association and the National Organization of State Associations for Children.
Upset Over Offsets, Part 2: Adoption
In 2008, the Fostering Connections to Success and Increasing Adoptions Act set a timeline for “de-linking” federal adoption support from income standards set in 1996. Under the old regime, the feds would only fund adoption support for children whose parents were under the poverty line in 1996.
Fostering Connections enacted a 10-year phase-out of that policy, starting with older teens and incrementally including all children including newborns. By 2018, under Fostering Connections, the feds would support adoptions of any foster youth.
This saves states money and increases the federal burden to support adoptions. Since the vast majority of the kids adopted from care are younger, the majority of new federal spending comes in the final two years of the de-link.
The shift proposed in Family First would essentially freeze the de-link in place, and kick it down the road about two-and-a-half years. So the de-link would still come to completion, but not until 2021.
The motive is money, but YSI has learned there is also a policy reason in play. There is concern among some child welfare leaders in Congress that states are not living up to the promise to reinvest the money being saved on de-linking.
Some adoption advocacy groups were still discussing the change when we called today. Mary Boo, executive director for the North American Council on Adoptable Children, said her organization would continue to support the bill.
“It wouldn’t have been our first choice,” Boo said of the offset. “We’re an adoption advocacy group but we firmly believe in prevention.”
Boo also noted a valuable clarification in language stating that preservation funding could be spent on children adopted from foster care. This has the potential to steer serious resources toward a blind spot in the child welfare continuum: adoptions from foster care put into jeopardy by mental health problems.
We recall well a briefing some years back, hosted by the Congressional Coalition on Adoption Institute, in which an adoptive mother was forced to place her child back into foster care because of serious mental health challenges that caseworkers had not prepared her for. Foster care, she said, was the only way to access emergency services because the family could not afford them.
Earlier iterations of the bill would have required that by the year 2023, IV-E dollars for prevention services could only be used for “well-supported” programs, meaning
- The criteria for deeming a program well-supported is the completion of at least two randomized controlled trials (RCTs), or control or comparison groups with pre- and post- outcome assessments. Those studies must:
- Have found the practice to be superior to an appropriate comparison practice;
- Have been reported in published, peer-reviewed literature; and
- In at least one of these RCTs or control or comparison group the practice has shown to have a sustained effect at least one year beyond the end of treatment, when compared to a control group.
In January, Patrick Lester of the Social Innovation Center penned a policy paper quoting research experts with concern about the ability of any state to meet that standard.
The current version will require that half of prevention spending go toward well-supported programs, but also permits half to go toward promising practices or evidence-supported programs.
“Phil” the Effects
YSI sat next to one of the Senate staffers involved in Family First at the recent informal hearing about opioid addiction and child welfare, starring TV’s own Dr. Phil McGraw. Among his comments to a fawning group of House members:
“In the 40-plus years I’ve been involved in substance-abuse issues, keeping the family unified should be the absolute objective in everything we consider doing legislatively.”
The staffer, while quietly taking notes and without looking up: “I’m so happy right now!”
The train was already rolling on Family First when Dr. Phil came to town. But let’s put it this way: YSI does not think it’s a coincidence that the word opioid or substance abuse was mentioned in three of the four statements from legislators included in the press release about this bill Friday.
Click here to read all of The Chronicle‘s continuing coverage of the Family First Prevention Services Act.