Families First Act: A look at implementation and what’s at stake

An update on federal bills related to child welfare.
By Angelique Day, PhD

Angelique Day In the spring 2018 newsletter, I provided the context of the Family First Prevention Services Act (FFPSA) that was signed into law on Feb. 9, 2018. 

To recap, the law restructures the federal financing available for child welfare. In summary, the new law: 1) Limits the length of stay for children and youth in congregate care settings; 2) Loosens restrictions (starting in FY 2020) on Title IV-E of the Social Security Act to pay for services (include mental health, substance abuse treatment and in-home skill-based parenting services) that may allow children to stay with their families rather than enter foster care.  

On June 22, 2018, the U.S. Department of Health and Human Services (HHS), Administration for Children and Families, Children’s Bureau, released a federal register notice soliciting feedback on initial criteria and potential candidate programs and services for review in a clearinghouse of evidence-based practices in accordance with FFPSA. The clearinghouse will identify promising, supported, and well-supported practices for mental health and substance abuse prevention and treatment programs, in-home parent skill-based programs, and kinship navigator programs appropriate for children who are candidates for foster care pregnant or parenting foster youth, and the parents or kin caregivers of those children and youth.

Potential initial criteria for identifying eligible programs and services for review by the clearinghouse:

  • Prioritizing eligible programs and services for review.
  • Identifying eligible studies aligned with prioritized programs and services.
  • Prioritizing eligible studies for rating.
  • Rating studies.
  • Rating programs and services as promising, supported, and well-supported practices.

To qualify as an evidence-based intervention under the new law, the practice must have a book, manual or other available writings that specify the components of the practice protocol and describe how to administer the practice.

  • Book or manual
    There is no empirical basis suggesting that, compared to its likely benefits, the practice constitutes a risk of harm to those receiving it.
  • No empirical risk of harm
    If multiple outcome studies have been conducted, the overall weight of evidence supports the benefits of practice.
  • Weight of evidence supports benefits
    Outcome measures are reliable and valid, and are administered consistently and accurately across all those receiving the practice.
  • Reliable & valid outcome measures
    There is no case data suggesting a risk of harm that was probable caused by the treatment and that was severe of frequent.
  • No case data for severe or frequent risk of harm

Why was it important to weigh in on the federal registrar notice?

Jurisdictions and system partners had the opportunity to decide whether to weigh in on the approach ACF/HHS is taking as to how the clearinghouse will prioritize criteria and programs.

As practitioners and researchers, you have unique knowledge about programs you have implemented that may qualify for Title IV-E reimbursement under FFPSA, commenting on the prioritization guidelines for the clearinghouse gave psychologists and other behavioral health researchers the opportunity to have their comments reviewed in efforts to expedite/help the process.

There are some key differences between what the law says and how HHS is interpreting it and what it is proposing, and it is important for jurisdictions and system partners to understand them. One example of this key difference is how the kinship navigator programs are described in the law and how the DHHS has captured the program in the federal registrar notice. The FFPSA separates the kinship navigator program from the other prevention services language in the act. The federal registrar notice combines the kinship navigator programs under prevention services and imposes identical requirements on both.  

Members of APA’s Div. 37, Section on Child Maltreatment, in partnership with several other national child welfare advocacy organizations responded to this call. Please review the federal registrar notice

Casey Family Programs, one of the largest, private child welfare think tanks, reviewed multiple evidence-based clearinghouses and the law, identified more than 140 interventions that qualify for FFPSA funding. These included 82 mental health interventions designed to serve children and their parents, 25 substance abuse treatment programs, and 14 in-home parent skills training programs. The complete list is available online. Casey Family Programs is interested in hearing from experts that have ideas for additional interventions that fit the clearinghouse criteria that do not appear on their list that you believe should be included. Please share ideas with Peter Pecora.

All responses to the federal registrar were received by HHS on July 22, 2018. These comments are now being reviewed by the department and will impact the final regulations that will be put in place for state compliance.

Other related legislation recently signed into law

HR 3105/S. 1091 (Public Law No: 115-196) — Supporting Grandparents Raising Grandchildren Act (McGovern (D-MA-2/Collins, R-ME) Signed into law.

On July 7, 2018, S 1091 was signed into law. It establishes a task force to support grandparents who are primary caregivers for their grandchildren. The task force is charged with identifying, promoting, coordinating and disseminating information publicly about federal information, resources and best practices available — on the date of the determination — to help grandparents or other relatives raising children in their care meet the health, educational, nutritional and other needs of the children in their care as well as maintain their own physical and mental health and emotional well-being, including those raising children in their care as a result of the opioid epidemic. This bill’s assigned task force also seeks to ensure that the needs of members of Native American tribes are addressed.

By January 2019, the task force has been charged to submit a report to the Special Committee on Aging and the Committee on Health, Education, Labor and Pensions of the Senate that includes best practices, resources, and other useful information for grandparents and other relatives raising children in their care; and an identification of the gaps in needs of grandparents and other relatives raising children in their care.

This bill also stipulates a follow-up report from the Task Force to the Special Committee on Aging and the Committee on Health, Education, Labor and Pensions of the Senate within two years of the enactment of this bill. The task force is charged with establishing a process for public input to inform the development of — and updates to — the best practices, resources and other useful information and the gaps in needs, including a process for the public to submit recommendations to the task force and an opportunity for public comment.  The task force is due to terminate after three years.

Thank your members in the House and Senate for supporting the passage of this important legislation. Don’t know who your elected officials are? Please find them online