Notes on Last Week’s Family First Act Regulations

Last week, The Chronicle of Social Change broke down the 12 models of service that will be the first up for consideration by the Family First Prevention Services Act Clearinghouse. The clearinghouse, which will be overseen by Abt Associates, will list all of the service options available for which states can get federal reimbursement to prevent the use of foster care in some child welfare cases.

But that was just part of the guidance and information put out by the Children’s Bureau (CB) last week, regarding the Family First Act, which takes effect in October of 2019. The agency has published a program instruction (PI) laying out some key details on the foster care prevention services portion of the law.

One of the big provisions in the law permits states to seek reimbursement under Title IV-E of the Social Security Act, which currently supports only foster care and adoptive placements, to serve families in crisis without relying on foster care. Presumably, further details are forthcoming regarding the act’s other big provision, the limitations on congregate care.

We’ll have a few separate columns coming this week on Family First matters, and you can click here to join our webinar on Thursday about the act. For now, here are a few things Youth Services Insider learned from the feds’ most recent instructions on Family First.

Mental Health Help for Youth

When one thinks about the notion of preventing the need for foster care, the natural assumption is that it relates to the behavior of parents. But the early list of clearinghouse considerations makes it clear that CB is taking a broader view than that.

Most of the mental health models listed are designed to address the behavior of young people, especially adolescents. Of the mental health models up first for review, all but one target youth behavior.

This will be particularly relevant for adoptive families and relatives taking in children permanently through a guardianship. When unknown mental health conditions present months or even years after permanency has been established, these families often face an anguish-inducing choice: pay for a level of care that might bankrupt them, or put a child back into foster care so that care is covered.

Still, Youth Services Insider was surprised not to see a few practice models associated with stabilizing adults after a mental health episode or psychotic break. That is not a field we are all that familiar with, so perhaps it’s just an assumption that well-supported interventions exist in this realm.

Critical Definitions

As Jerry Milner indicated would be the case when he testified over the summer, CB is going to take a pass on further defining some of the terms that govern eligibility beyond what appears in the law. The PI made it clear that states would have latitude to define the following things in the five-year plans connected to the law: “qualified clinician,” “trauma-informed approach,” “candidate for foster care” and “imminent risk.”

Those latter two are key, because they pertain to which families would be eligible for foster care prevention services. This is the basic definition of a candidate for foster care, per the law:

A child who is identified in a title IV-E prevention plan as being at imminent risk of entering foster care (without regard to whether the child would be eligible for title IV-E foster care maintenance payments, title IV-E adoption assistance or title IV-E kinship guardianship assistance payments), but who can remain safely in the child’s home or in a kinship placement as long as the title IV-E prevention services that are necessary to prevent the entry of the child into foster care are provided.

It will be left up to states to decide what conditions are tantamount to “imminent risk.” One state could view that as meaning that serious neglect or physical abuse had been substantiated. Another could take the view that the presence of certain drugs in the house, or that a single parent suffering a psychotic break, means foster care is imminent.

CB is also taking a liberal view of the term “in-home” when it comes to parenting skills programs. “We interpret the term ‘in-home’ broadly, in that it does not necessarily refer to the location in which the services are provided,” the PI said.

That means classroom-based or group parenting models could be made available. The first three models up for consideration, however, are all in-home: Nurse-Family Partnership, Healthy Families America and Parents As Teachers, all types of home visiting.


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Maintenance of Effort

The PI sets up the rules for how states will calculate their maintenance of effort, a basic requirement that states do not simply replace existing state efforts to prevent foster care with the new IV-E prevention match. The new instructions set up a few rules in this area.

First, the baseline year for “state foster care prevention expenditures” will be fiscal 2014. States with a child population of 200,000 or less could opt to use 2015 or 2016 if either was favorable. According to the 2014 Kids Count data, that exception will be available to Alaska, North Dakota, Vermont, Wyoming and Washington, D.C.

Second, CB lists what states can count toward the MOE:

  • State expenditures and federal matching funds provided to the state for title IV-B
  • Temporary Assistance for Needy Families (TANF) spent to prevent foster care
  • Social Services Block Grant (SSBG) spent to prevent foster care
  • Any foster care prevention services under a program other than IV-E 

The PI also notes that the opioid bill signed into law this year, the SUPPORT Act, has amended Family First to make clear that services under IV-E prevention do not permit a state to lower assistance to a family through other federally funded programs.

Time Limits, But No Limit on Times

Family First limits the window of time for IV-E foster care prevention services to a 12-month window. CB makes clear in the PI that in theory, the services can continue longer than that if courts are willing to sign off.

“A state may provide title IV-E prevention services to or on behalf of the same child for additional 12-month periods, including for contiguous 12-month periods,” the instruction said.

So let’s say as a hypothetical, a parent has gone through drug treatment, mostly done well, but around the 10-month mark suffered a relapse. If everyone agrees that more help is needed, but the family can stay intact, the fact that a contiguous continuation is allowed makes that possible.

That is a fairly important clarification, in our humble opinion. Because it takes away the framework of foster care as a sentence for missteps; it is an option if things go awry, but it’s not the only option.

Uneven Services Are Okay

Likely anticipating that many states will have some areas that are geographically or fiscally challenged to offer the front-end services, the PI establishes that this will not be a deal breaker:

“The state is not required to provide services in all counties and geographic locations in the state, nor is the state required to provide the same type of prevention services in the elected jurisdictions.”

This runs counter to, for example, the Fostering Connections to Success and Increasing Adoptions Act, through which a state could only get approved for extended foster care funding if that was available to all aging out foster youths.

Some Support for Non-Clearinghouse Services

As mentioned, states can only use IV-E to pay for services that appear on the yet-to-be-finished Family First clearinghouse. But the PI says states can get some federal help with other services aimed at keeping families together, as long as “the child is at imminent risk of removal from the home and the agency is making reasonable efforts to prevent the need to remove the child from the home.”

That means even if a family isn’t getting FFPSA clearinghouse services, the agency can claim a federal 50-50 split on the administrative costs to do other family preservation work. The state or county will have to pay for the service itself, but will get some reimbursement for other costs.

Join us on Thursday, December 13 for a webinar where Publisher Daniel Heimpel and Editor-in-Chief John Kelly will discuss the Family First Act. Click here to register!

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John Kelly
About John Kelly 1007 Articles
John Kelly is editor-in-chief of The Chronicle of Social Change.