As I mentioned in a prior piece in this series, the federal child welfare advocacy community increasingly seems myopically focused on increasing federal funding for “prevention.” Unfortunately, few, if any, are able to paint a picture of what increased investment in prevention would look like.
In fact, it’s not even clear that there is agreement about what precisely we’re trying to prevent. Are we talking about the prevention of child maltreatment, which can be referred to as “primary prevention?” Or are we talking about the prevention of removal to foster care, which is more accurately described as “early intervention,” and encompasses programs like differential response that activate after maltreatment has occurred?
These are important distinctions in the context of federal child welfare finance reform, but the universal calls for increased investment in “prevention” consistently fail to define the terms or discuss the strategies.
Every child advocate I’ve ever met believes the federal government should do more to prevent child abuse, and supports increased investments in primary prevention. And so, despite this ongoing ambiguity, the call has been constant and consistent enough to result in some very worthwhile investments.
For instance, the creation and subsequent expansion of the Maternal, Infant, and Early Childhood Home Visiting Services program, which provides information and coaching to new and expecting mothers to, among other things, prevent abuse and neglect from occurring in the first place.
Preventing unnecessary removal into foster care is another goal that, as far as I can tell, all advocates share. Yet, the advocacy community struggles to define what constitutes “unnecessary,” especially when missed opportunities to intervene become tragedies, demonstrating just how much is at risk.
Individual determinations are always very difficult to make, and are often influenced by policy objectives like caseload reduction. This can make “early intervention” programs at times controversial.
Differential response (DR) provides a good example. DR services are typically provided to families after maltreatment has been substantiated, placing them at imminent risk of losing their children into foster care. But what constitutes a “DR service” varies widely from jurisdiction to jurisdiction, and whatever a particular jurisdiction provides to families is not guaranteed to be based on a solid foundation of research evidence.
As many have noted, DR essentially constitutes a different philosophy of how to work with families, rather than a scalable, replicable program. The evidence that is most clear is that, when implemented improperly, DR can undermine child safety by leaving children in dangerous situations. Many of these issues with DR have been covered in depth on this website.
The same challenges that define differential response bedevil nearly every service labeled as “prevention.” With the exception of home visitation, very few prevention programs have even been rigorously evaluated, much less proven to be effective or scalable. The recent final report from the Commission to End Child Abuse and Neglect Fatalities (CECANF) highlights and laments this fundamental challenge. The paucity of federal funds available for research and evaluation of programs compounds this problem.
While there are legitimate concerns about the limitations on the availability of funding for prevention, many advocates undermine the credibility of their own arguments by failing to properly account for actual federal investment. A common refrain that is parroted in the advocacy community goes something like: “For every $1 the federal government spends on prevention, it spends $6 on out-of-home care.”
But this statistic is highly misleading, and only compares federal expenditures from Title IV-E (foster care) with Title IV-B (primarily front-end programs). It fails to take into account the considerable sums provided through home visitation and other major programs such as Temporary Assistance for Needy Families, Social Services Block Grant, and the Child Abuse Prevention and Treatment Act.
It’s possible that the definitional problems noted above make it difficult to accurately message the point, but it’s also possible that this is an example of finding the number that supports your argument, rather than building an argument from the actual numbers.
In light of the evidence, it’s important that any expansion of federal funding for front-end early intervention programs must ensure, first, that it does not jeopardize child safety and, second, that funds are used efficiently on programs that are proven to work.
Key staff in the House and Senate are currently working on legislation, known as the Families First Act, which would allow states to draw down IV-E funds for a range of support services for families deemed to be at “imminent risk” of having their children removed. Fortunately, a summary of the bill indicates that it would require states to use “evidence-based” programs, and limits the range of eligible services to mental health, substance abuse and parenting skills development programs.
This seems like a positive step to me. I also believe that predictive analytics, which can use data to focus prevention services on those families most at-risk, can and should play an important role here.
Again, I, along with every child advocate I know, support increased investment in prevention. Anything less is tantamount to accepting that there’s nothing we can do about the shockingly high rates of abuse and neglect in this country, and abandoning to maltreatment children we know to be at-risk.
But the federal policy discussion around bolstering front-end funding all too often sets up a sort of competition between prevention and foster care. As I’ve discussed previously, this is because the advocacy community has conceded budget neutrality, and is therefore willing to cut funds from services to children who can only be safe in foster care, in order to increase investment in prevention.
While I appreciate its focus on evidence-based practice, the latest draft of the Families First Act makes just this sort of trade-off. It would narrow the scope of federal support for group home placements and, rather than developing alternative placements for children in congregate care, redirect resources to foster care prevention.
The problem with that is many systems have few options other than group care for adolescents with significant behavioral and mental health needs. Rather than simply cutting off funding and hoping that the youth currently placed there don’t wind up somewhere worse, federal policymakers should instead support a range of strategies to build alternatives to group care. This could include:
- Increased funding and access to supportive services for kinship caregivers
- Better foster parent recruitment and retention
- Development of specialized foster homes
- Improved access to community-based mental health and other services for foster children and youth wherever they are placed
As these resources are put into place, youth can be intentionally transitioned from group care to community settings.
I believe the federal government should absolutely increase its commitment to front-end child welfare programs, especially primary prevention. But this should not be financed by dismantling or even diminishing the continuum of programs and services for children in out-of-home care. The reality is that we need increased investment in both prevention and a robust system of out-of-home care.
Sean Hughes is a managing partner at the consultancy firm Social Change Partners. Over the next few months, he will write a series of analysis pieces in The Chronicle about child welfare finance reform. We encourage readers to submit their own commentary and analysis on the subject.
Click here to read all of The Chronicle‘s continuing coverage of the Family First Prevention Services Act.