Family Centered Treatment Becomes 11th Approved Family First Prevention Service

The Family First Act was signed into law in February 2018, and mostly takes effect in October 2019.

A model for working with families in crisis recently became the first service fast-tracked for federal funding under the Family First Prevention Services Act, the largest federal child welfare reform in decades.

With the process of approving foster care prevention programs delayed in the lead up to the law, the U.S. Children’s Bureau (CB) announced it would allow states another lane to seek approval in the early going.

Just before the holiday season, the bureau approved Family Centered Treatment (FCT), a model used to train both foster and biological parents on the effects of trauma on children.

A letter sent to the Arkansas Department of Human Services before the holidays by the bureau classified FCT as “Well-Supported,” the highest of three evidence-based standards for Family First-related services. The letter was sent by CB’s Region Six program manager, Janis Brown.

Family Centered Treatment is a clinical model addressing crisis points in vulnerable families, particularly those where a child welfare case has been opened or a youth is involved in the juvenile justice system. It was developed in the late 1980s as a model for working with families in crisis. Operating on a four-phase plan, clinicians make the decision about when a family is ready to advance to the next phase.

The goal is for an FCT-trained provider to engage quickly upon referral, and work with families to identify their strengths and areas of need. The clinician moves the family toward practicing healthier interactions in their daily life, and then works at getting families to see their new dynamic is about more than just getting through a crisis.

This is the first model approved directly by the Children’s Bureau under the Family First Act, which passed in February of 2018 and took effect in October of last year. It enables states to use the Title IV-E entitlement – previously reserved for foster care and adoption support – to fund services aimed at working with parents without the need for a family separation. Those services must be evidence-based and apply to three areas: parenting, substance abuse treatment and mental health interventions.

Family First’s front-end services are limited to substance abuse, mental health and parenting interventions. And it is further restricted to models of services that are deemed to be promising practices or evidence-based interventions by the newly established IV-E Prevention Services Clearinghouse.

Last summer, with Family First just months from taking effect, the clearinghouse had approved only a few allowable services. So the Children’s Bureau announced that it would let states directly seek approval for programs they want funded through the new rules.

Diagram of the four phases within the Family Centered Treatment model

“I understand that some states are concerned that the Clearinghouse timeline for reviewing and rating programs may delay their ability to implement the Title IV-E prevention program,” said CB Associate Commissioner Jerry Milner, in a June letter to state child welfare directors.

Family Centered Treatment becomes the eleventh service approved for use under the Family First Act. The 10 approved thus far by the clearinghouse include several home visiting programs for new parents; methadone treatment for parents struggling with substance abuse, and mental health interventions for both parents and adolescents. Another 15 programs are under clearinghouse review right now.

Once the Children’s Bureau approves a transitional service, any state in the country is able to use it with IV-E funding. Laura Boyd, who consults for the Family Centered Treatment Foundation, said in addition to Arkansas, Nebraska “is ready to launch” on using Family Centered Treatment in its Family First plan.

Only Washington, D.C., and Utah have had their full prevention spending plans approved by the Children’s Bureau so far. Arkansas and Nebraska are among eight other states that are pending approval – the others are Kansas, Kentucky, Maryland, Virginia, Washington and West Virginia.

Most states have elected to take a permitted delay of up to two years on implementing the Family First Act. This shields them from another part of the law – limits on federal funds for group homes and other congregate care options – but means they cannot use IV-E to pay for the permitted prevention services.

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