The Family First Prevention Services Act, which was signed into law as part of the Bipartisan Budget Act on February 9, 2018, offers an historic opportunity for child welfare leaders to re-imagine a child welfare system for the 21st century.
By placing an emphasis on prevention, early intervention and evidence-based practices for children and families, this groundbreaking legislation is requiring child welfare providers to rethink the policies, practices and systems of yesterday and reshape service provision to address child and family needs and do so using trauma-informed approaches.
One of the areas that will be most impacted by the bill is residential care. In today’s child welfare system, there are an estimated 57,000 children living in residential care. Residential services are provided by public, private nonprofit and for-profit child welfare agencies and may be campus-based, community-based, self-contained or secure facilities. In these settings, children youth, and their families are offered a variety of services, such as therapy, counseling, education, recreation, health, nutrition, daily living skills, pre-independent living skills, reunification services, aftercare and advocacy.
“Therapeutic Residential Care,” as it is known, focuses specifically on providing treatment for youth who have a mental health diagnosis or have experienced trauma and need help regulating their emotions. According to recent research from Casey Family Programs, it is most effective when it is relatively brief, when families are deeply involved and when the care continues after reintegration.
However, according to recent data, more than 4 in 10 children who are currently in residential care have no mental health diagnosis, medical disability or behavioral problem that would warrant such a setting.
There is a growing body of research that indicates that better outcomes are achieved when children are cared for in a family- or community-based setting and when they achieve permanency. Recent research suggests that young children living in residential programs are at a higher risk for developing physical, emotional and behavioral problems. These young children are also less likely to be placed in a permanent home than those who live in foster care.
The Family First Act is facilitating this change by shifting funding to more outcomes-driven, family-focused care. With its greater emphasis on preventative services and trauma-informed care, Family First is making resources available from the federal government to provide early intervention services that could prevent children, who are already known to the system, from entering foster care or residential treatment.
A great deal of advocacy at state and local levels will be required to fully implement Family First. The theory of change represented within the bill requires a robust array of home- and community-based services, yet there was no federal funding put in the bill to help states build up that part of the system. So, state legislatures and local governments are going to need to make further investments into developing this part of the system in order to keep children in the least restrictive, most family-like settings.
Another area that will need state and local resources is the court process for presiding over residential placements. Advocacy to elected officials will be required to ensure the resources are there to assist in training for judges to ensure they are well-informed through the status review processes.
These challenges must be addressed quickly because many child welfare providers are faced with increasingly stringent state
regulations including stricter referral policies, contractual requirements on how services are delivered, and mandated maximum lengths of stay, all part of a tightening fiscal reality that makes the old model of residential treatment more cost-prohibitive.
Beyond these funding and resource concerns, many organizations looking to make the shift into children and family-focused child welfare programming face both organizational and cultural challenges.
That is why, since 2014, the Alliance has engaged child- and family-serving community-based organizations in a series of cohort initiatives to help inform and advance a transformational shift from traditional residential care to evidence-based stabilization and treatment as part of a home- and community-based system of care.
This shift requires residential providers to make significant changes in policy, practice, budget, historical programming and organizational culture. The growing evidence base continues to point to this change movement as being in children’s best interests and necessary, yet providers continue to seek out clearer and more efficient pathways to understand this new reality and make this transformation a reality.
Many child welfare providers and operators of residential treatment facilities have a tremendous amount of equity and capital in their physical structures and campuses and a large portion of their organizational identity is encompassed in their role as residential providers. For example, Daniel Magnusson, president and CEO of cohort participant Lad Lake, pointed out that while only 20 percent of the youth they served were in their residential program, it represented 53 percent of Lad Lake’s revenue.
It can be challenging for leaders and board members of these organizations to still deliver on their stated mission when such a large part of that mission is being transformed. Child welfare providers are among the oldest community-based nonprofits in the country, with a significant number of them owning and operating facilities that began as orphanages more than a century ago. These physical campuses make up a large part of their equity portfolio and many organizations are hesitant to make the leap to repurpose or divest these resources.
Through the cohort initiative, the participants achieved a greater understanding of the changes needed to manage a shift from residential to community-based services while meeting the needs of the families they serve.
There will always be a need for out-of-home care because there will be times when children need to be removed temporarily from their homes. But the role of out-of-home care, particularly residential care, has clearly changed. When out-of-home care is needed, it will be accessed as a short-term emergency crisis stabilization service for families, rather than a long-term solution.
Ultimately, successful transformation efforts will require the support of a myriad of interconnected components that recognize the importance and impact of culture, financing, staff development, program and service adaptation and policy drivers.
Jennifer Jones is the director of the Change in Mind Institute at the Alliance for Strong Families and Communities with funding from the Robert Wood Johnson Foundation. Theresa Covington is the director of Within Our Reach, an office established at the Alliance for Strong Families and Communities to promote the recommendations of the Commission to Eliminate Child Abuse and Neglect Fatalities and supported by Casey Family Programs. Covington and Jones serve as content experts in the Alliance’s safety and security impact area.