Last week, Congress passed and the President signed into law the Family First Prevention Services Act.
It is an encompassing and complex piece of legislation that will take some time for states to figure out in terms of the opportunities, as well as the data collection, reporting, accountability and state plan requirements that accompany those opportunities.
While the Act addresses a range of issues in public child welfare, with this administration’s strong priority on preventing child abuse and neglect primarily through strengthening the resiliency and protective capacity of families, and my strong personal commitment to seeing a re-definition of public child welfare to include this priority, I will only address those components of the legislation directly related to prevention.
The Family First Act opens an opportunity for states to use Title IV-E foster care funds in ways that have not previously been available except through the IV-E waiver process. Well over 90 percent of the federal budget that the Administration on Children, Youth and Families (ACYF) is responsible for administering comes from Title IV-E foster care and adoption funds – that’s almost $9 billion of a $10 billion budget.
These funds offer very little flexibility beyond paying for foster care and adoption assistance payments for children removed from their parents’ care after bad things happen and the associated administrative, training and information systems costs.
In stark contrast, a miniscule percentage of ACYF funding is devoted to the primary prevention of child abuse and neglect, meaning the prevention of the initial occurrence of maltreatment through strengthening families, and not the prevention of re-occurrence of maltreatment after a child becomes involved with a state or local child welfare system. Under the Community Based Child Abuse Prevention provisions of the Child Abuse Prevention and Treatment Act (CAPTA), ACYF has close to $38 million to distribute among 50 states, the District of Columbia, and the territories designated for primary prevention activities. If we distributed the funds equally among states, which we do not, that would average about $670,000 per jurisdiction.
The Family First Act provides a very positive first step in changing a profoundly unbalanced and frankly illogical funding situation. The Act identifies a specific population that can benefit from the state option to use Title IV-E funds for prevention purposes, specifically, only children who are classified as “foster care candidates,” meaning they have already come to the attention of and are involved with the child protection system, and are deemed to be at imminent risk of entering foster care. Typically, that means they have already been determined to be victims of abuse or neglect and, with services, might be helped to avoid placement in foster care. Note that Family First also allows prevention services for pregnant or parenting youth in foster care who, by definition, are already involved in the system. The Act also specifies that federal Title IV-E funds to support those children and families can only be used for a few specific services that have a research-supported evidence base, and it limits the amount of time they can receive the services.
Again, let me emphasize that this is a positive step in the right direction. I commend Congress for taking this important first step. I, and my federal colleagues in child welfare, sincerely welcome the opportunity to use federal funds to help children who have been abused or neglected avoid unnecessary separation from their families and placement in foster care, along with the accompanying trauma that entails. But, I must emphasize that this is only the first step.
While it is critical to help children who become known to the child welfare system avoid unnecessary separation from their families when services can be offered to keep them together, it is even more important to help families and children avoid the situations that lead them to child welfare in the first place. When a report is made to a public child welfare system, it usually means that the harm has already occurred, a child has been abused or neglected, trauma has been inflicted, and any interventions from that point are remedial rather than preventative.
Add to that the fact that most parents who mistreat their children, intentionally or not, were mistreated themselves and their trauma was never resolved. When we choose, as a child welfare system, to intervene only after abuse or neglect has occurred, we are complicit in perpetuating that inter-generational cycle of trauma and maltreatment.
We can change that.
We must change that.
Imagine with me for a moment what the world would look like if the public health system’s major strategy to combat a serious disease such as polio was to invest in wheel chairs and crutches for patients after they fell ill, instead of investing in vaccines to prevent the illness; if car makers invested in jaws of life and ambulances to get victims out of mangled cars and to hospitals faster as their primary means for addressing automobile safety, rather than developing seat belts, air bags, warning systems and other safety features to prevent injuries in accidents; and if the primary way to deal with baseball or football injuries was to buy more icepacks, neck braces and slings as opposed to requiring players to wear helmets and shoulder pads.
Now, imagine this with me. Imagine that our country’s primary way of keeping children safe, protected and emotionally healthy was to invest nearly all of our money in placing children in homes other than their own, and in therapy to fix the trauma after they have been abused or seriously neglected, instead of investing in helping their parents to care for them safely before they are abused or neglected.
What would it look like if that were the case? It would look like 437,000 children in foster care – a 10 percent increase in the past five years. It would look like 4 million reports of child abuse per year, because that is the case. It would look exactly like what we have now; it’s what we do.
If we have any serious hope of stemming the ever-increasing demand for foster care; of committing ourselves to strengthening families’ capacity to care for their own children rather than committing to recruiting more and more foster homes; to reducing the numbers of children traumatized by abuse, neglect and family separation; and of breaking inter-generational cycles of trauma and maltreatment, we have to put our money and our efforts further up the river before families go over the first waterfall.
That requires a re-imagining of what public child welfare is all about, and this is the moment to do it.
The President’s proposed budget includes a provision that will allow states to opt into a flexible funding approach to use Title IV-E funds under a capped allocation, very similar to the existing IV-E waiver flexibilities that can be used to strengthen the protective capacities of families long before child welfare services are needed. In short, this will allow states to work with families earlier, to get them what they need and to prevent bad things from happening to children.
States, counties and communities know their families’ needs and their communities’ capacities, and we have to trust that they can take advantage of increased flexibilities that will benefit their citizens without restrictive laws that tell them which services they may or may not use to help a particular family or child.
We have marvelous examples of effective, well-conceptualized and implemented programs across the country where this kind of community-based, primary prevention, family-strengthening approach is working to keeping families strong and intact – notably, Live Well San Diego, the Harlem Children’s Zone, the Center for Family Life in Brooklyn, the Communities of Hope funded by Casey Family Programs across the country, in addition to specific county initiatives in places like Allegheny County, Pennsylvania; Jefferson County, Colorado; and Los Angeles County among many others. We would be remiss not to learn from these examples and do all we can to bring the primary prevention of maltreatment and family separation to scale as a major federal child welfare priority.
With the Family First Act we have reached one more step in the continuum of services to children and families in the United States. We now have prevention of foster care placement for those children brought to the attention of child welfare agencies, a limited population but a critical one in the continuum. That adds to the existing array of child welfare services that includes foster care and reunification support services, adoption services, and emancipation and transitional living services for youth exiting from foster care.
What remains missing is the ability to use substantial federal funds to strengthen families before maltreatment creates lasting, usually life-long trauma to children. We also lack the ability to provide strong community-based, universal family support services to families. Absent such services and support, many of those families will inevitably knock on the doors of public child welfare and cost us infinitely more in federal foster care dollars and in remediation efforts that could so clearly be avoided.
Failure to redefine the system to stem the tide of children entering care and keep families strong comes at great expense to everyone. Those costs are financial and societal. It’s an expense that is paid in inter-generational cycles of trauma that affect all sectors of our society. The family is the foundation of American society; we must treat it as such.
Jerry Milner is the associate commissioner of the Children’s Bureau and the acting commissioner of the Administration for Children, Youth and Families within the U.S. Department of Human Services.
If you are interested in federal juvenile justice and child welfare policy, read our special issue “Kids on the Hill.” Just hit this LINK.