The Family First Prevention Services Act, which passed the House earlier this week, has garnered the sworn fealty of many national and state-level child welfare advocacy groups back when it was just a draft, much of which has been retained by the pared-down version. It is perhaps the only major bill in Congress with true bipartisan support at the moment.
So who’s against it? So far, only one constituency has been vocal in opposition, but it’s a significant one: The State of California.
County and state leadership in the Golden State have coalesced in a united front to express deep concerns about the impact of Family First on the state’s own plans for child welfare reform. And the Los Angeles Board of Supervisors, which oversees the country’s single largest child welfare system, will soon consider a motion to send a letter to California Sens. Barbara Boxer and Dianne Feinstein asking them to stall the bill.
Think two Senators can’t defeat a bill? Think again. If the Family First Act does not get a floor vote, and the bill’s Senate leaders have to seek unanimous consent, either could place a hold on the bill and kill it for the time being if they wanted.
So what is California’s beef with Family First? It is unlikely the state is the only entity opposed to the bill, but at the moment it is the only vocal opponent. Youth Services Insider combed over the public letters of concern from three California bodies – the state’s Department of Social Services (DSS), the California State Association of Counties (CSAC) and the Child Welfare Directors Association (CWDA) – and will now attempt to articulate their collective problems.
Actually, let’s start with what the problem is not: the bill’s central feature of offering federal IV-E support for certain services aimed at preventing the use of foster care. There are quibbles with the structure, but not the idea.
The most consistent theme in those letters is that the bill would threaten California’s already existing plan for child welfare reform that focuses in part on reducing the use of congregate care, a goal it shares with the Family First Act.
After years of preparation, California is moving forward with the Continuum of Care Reform (CCR), which moved from idea to law with the passage of Assembly Bill 403 last year. Here is a description of CCR written by Lee Collins of San Luis Obispo, the longest-tenured county social services director in the state:
“CCR completely upends the system of congregate care, eliminating group homes and directing that a broad range of therapeutic services be delivered locally, including within foster family homes and in the homes of relatives. Children will be assessed regularly by participants in child and family teams, and it is expected that every child with an assessed need for therapy will receive those services in the milieu in which services will be most effective.”
In 2011, California joined the ranks of New York, Pennsylvania and a few other states where the counties administer child welfare on a local level. The state is a distributor of money for social services, with very little desire to dictate policy.
So CCR was built as an overall framework of standards that all counties had to live up to, and it anticipated no major sea change in the way that federal funding factored into the system.
As mentioned, CCR severely constrains the circumstances under which it is appropriate to place children in congregate care settings. But the Family First Act even more severely limits federal contributions to congregate care. The end result: some CCR-allowable group care models in California, funded in part by federal dollars, will no longer get those federal dollars (or at least, not for more than two weeks).
“CWDA’s members recognize that the proposed federal legislation intends to address many of the same issues as our state law, but the federal overlay of several proposed requirements of this act will further exacerbate and make even more challenging an already massive undertaking to increase capacity and support for foster families…while simultaneously reducing the use of congregate care.”
“We are very concerned about Title II of the bill, since it will negatively affect state and county efforts underway to accomplish the same objectives to reduce reliance on congregate care whenever possible and appropriate. California’s counties are working tirelessly with the state to implement our Continuum of Care Reform by January 1, 2017. Unfortunately, some of the federal provisions conflict with our initiatives and other federal mandates in the bill which overlay our efforts will make it even more costly for the counties and state to implement the CCR.
Congregate Care Variance
Family First does make three exceptions to its limitation on federal support for congregate care: pre- and post-natal services to parenting foster youth, settings for youth over 18 in foster care, and what are called qualified residential treatment programs (QRTP).
The hallmarks of a QRTP are set out in the bill, and the most stringent criteria is the presence of on-site nursing staff.
From a letter penned by DSS Director Will Lightbourne:
“The bill’s requirement that there be on-site nursing staff at QRTP would create a significant burden for the facilities we have created as part of CCR.”
Lightbourne urged Congressional bill managers to “allow states to determine appropriate staffing for QRTP” based on the needs of their foster children and documented assessments.
He cited three specific populations that CCR envisioned benefitting from congregate settings that would no longer get federal support: commercially exploited youth, juvenile sex offenders, and kids who are affiliated with or impacted by gangs.
CWDA took particular exception to limiting group settings available to juvenile offenders in general, who many foster parents will not take and for whom congregate care can represent a less-severe alternative to incarceration, or a step-down from such a setting. From the association’s letter:
“CWDA questions why states would be required to certify that they will not implement policies that will result in a “significant increase” in juvenile justice placements. If there is a federal policy interest in this matter, it would appear to be one in which states should align their policies with this federal act and make efforts to reduce the juvenile justice population.”
Prohibitions, CWDA argue, are “likely to increase placement into these less-desired, more-restrictive settings.”
Restraints on Prevention Funding
As mentioned, the spirit of the IV-E prevention services aspect of Family First is supported by all of the California groups that weighed in. But they expressed problems with three key aspects of the prevention structure: the litmus test for eligibility, the time limit and the services allowed. YSI will go through each briefly here.
The IV-E prevention dollars would only be available in cases where a child is deemed to be at “imminent risk” of entering foster care, which in YSI’s humble opinion puts to rest any question about the scope of “prevention” being addressed by Family First. This is a bill aimed at preventing foster care, not maltreatment.
You would, of course, hope that reductions in abuse and neglect followed here, but the legislative intent is to try to help states mitigate existing maltreatment in some cases without resorting to foster care. Perhaps the best tagline for it would be preventing future maltreatment, because Family First isn’t going to help any family who isn’t already known to be in crisis.
Legislators intentionally left “imminent risk” without a checklist of approved risks. From the Family First committee report by House Ways and Means:
“The Committee believes the intent of this legislation is for states to use these new matching funds in the panoply of possible scenarios under which a child may be at imminent risk of entering foster care.”
CWDA’s letter says the “imminent risk” standard is too narrow:
“Children and their families should have access to these services before abuse and neglect rises to the level that warrants imminent removal, in order to avoid trauma and harm to the child and increase the likelihood of maintaining an intact and functioning family unit.”
DSS Director Lightbourne wrote: “The proposed 12-month time limit may not meet the needs of all children and families and could be damaging to our shared goal of family stability.”
He asked for exceptions to the time limit, “either in specific circumstances or at state discretion.”
CWDA called for a change such that “families, in limited circumstances when deemed necessary, be afforded up to 24 months for services.”
Lightbourne also lamented that the scope of allowable services under IV-E prevention would be limited to substance abuse, mental health services, and parenting preparation and training. That array, he wrote, is “narrower than the range of prevention and family services provided by counties participating in the Title IV-E Waiver Demonstration Project.”
“For states such as California that already maximize Medicaid reimbursement for substance abuse and mental health, it may be difficult to fully utilize the potential of IV-E funding for prevention and family services,” Lightbourne wrote.
Los Angeles County Supervisor Mark Ridley-Thomas has moved that the county formally request that Sens. Feinstein and Boxer attempt to hold up the process on Family First.
“Since the bill’s draft language was not released until June 10, state and local governments were not allowed adequate time to provide meaningful input on the legislation,” Ridley-Thomas wrote in his motion calling for the letter.
The bill does have public support from two states already: Utah, home state of Family First co-author Orrin Hatch, and Illinois, whose child welfare director, George Sheldon, oversaw the IV-E waiver in Florida that enabled the state to use foster care funds for the kind of services allowed in Family First.
But our sense is that, as Ridley-Thomas suggests, many states and counties are still mulling this bill over. Child welfare agencies in two large states, Florida and Texas, told YSI that they were still reviewing the bill and had not formed an official position; same response from the National Association of Counties.
The bottom line is that opposing any of those three limitations on prevention, or the congregate care framework, is basically tantamount to opposing the bill itself. Limiting the cases, the timeline and the allowable services for IV-E prevention are all part of a political compromise to move the bill from nice in theory to passable legislation.
The congregate care limits are for some Family First champions a driving interest for the legislation, and for others it’s the savings mechanism for funding prevention services.
There might be very small slivers of wiggle room on any of these tenets, and kudos to California’s leadership for both analyzing its interests and vocalizing them. The political reality in Washington is that no massive increase in spending is going to make it through both chambers and to the president, and all of the discussed components of the bill work in tandem to keep it from amounting to a spending increase.
So if you take the premise that this bill will pass pretty much as-is or not at all, there are really two questions to ask.
First, does it offer a better future for child welfare finance than the status quo?
Second, is it possible that waiting for political change will yield a better bill?
The answer on question two is really unknowable at the moment. It sounds like, for California’s county and state leadership, the answer to question one is “status quo.”
Click here to read all of The Chronicle‘s continuing coverage of the Family First Prevention Services Act.