The Family First Prevention Services Act: Key Issues for Social Work Practice

Context Setting – FFPSA California has been a national leader. Some provisions of FFPSA parallel efforts well underway in California: Reduction in use of Congregate Care Team-based decision making with youth/families at the center Efforts at prevention through Differential Response, Home Visiting Programs, Title IVE Waiver, etc. CA will likely delay implementation to Oct 1, 2021 to give time to address a range of implementation questions/issues. This gives us limited time to align our policies and training to the new federal requirements. Diana

Workforce Development Implications CWS policies are constantly changing and practice evolves. The challenge is to adapt our social work education system, and support CWS workforce, to adapt to these changes. The Integrated Core Practice Model (CPM) should continue to serve as a foundation to guide leadership and staff in their work through these changes. Additional investment in workforce development and implementation support is needed – regardless of FFPSA. FFPSA also offers so me opportunities to serve children, youth and families, aligned with the CPM requiring a skilled workforce. Services to parents to support Family Maintenance and Reunification. Working with MH, providers, courts to meet congregate care mandates. Navigating systems and services to achieve the best outcomes for children, youth and families. Diana

Two Main Areas of Focus of FFPSA FFPSA has two main objectives: Prevention: Expand IV-E entitlement to fund front-end services to prevent the need for foster care Limit Group Homes: Restrict the number of children planed in congregate care/group homes The bill attempts to accomplish these goals in a budget neutral manner (i.e. this is not a new infusion of resources to the child welfare system): FFPSA redirects federal savings currently used to support children in congregate care ($641 million) and delays additional federal funds for the Adoption Assistance program for another six years ($505 million) to finance the newly authorized prevention services

Level Setting on Maltreatment, Prevention, and Foster Care

The Scope of Child Maltreatment Perception Reality Research shows that the cumulative child maltreatment rate is much higher- 1 in 8 American children are confirmed as victims by the age of 18 (1 in 5 African-American children) Serious maltreatment is an issue that only impacts a small percentage of children (federal data shows less than 1% of U.S. children are confirmed as victims per year)

And It’s Only Getting Worse… And It’s Only Getting Worse…. Child Safety Indicators During Opioid Crisis Summary of Child Maltreatment Rates per 1,000 Children, 2012–2016

What We Mean By Prevention Perception Reality The term “prevention” refers to programs and services designed to prevent abuse, neglect and exploitation from occurring in the first place “Prevention” has become a catch-all term, often used to describe interventions that respond after the occurrence of maltreatment has been confirmed "Prevention” in the context of federal reform often refers to prevention of foster care entry, not prevention of maltreatment

Frequency of Removals into Foster Care Perception Reality The child welfare system is too punitive, frequently break up families unnecessarily. In 2016, despite investigating reports concerning almost 3 million children, CPS workers substantiated maltreatment in about 676,000 cases. Just 203,582 of these children were placed in foster care. Removal into foster care is an action that is undertaken infrequently to keep children safe.

Length of Stay in Foster Care Perception Reality Families are permanently broken when a child is moved into foster care. Most children languish in foster care for many years without going back home or finding a forever family. Child welfare systems are designed to support and strengthen families, to reunify children with their parents whenever safe and possible. Most children who enter foster care end up going back home to their families. 51% of exits from foster care in 2016 were through reunification. Child welfare systems have also made great strides in reducing the length of stay in foster care, moving children to permanency much faster. In 2016, the average length of stay for children in foster care was 20.1 months. Almost half of those children spent less than a year in foster care, and about ¾ spent less than 2 years.

Federal Child Welfare Funding: A Patchwork of Programs Title IV-E serves children in out-of-home care (foster care, group care, shelter care, kinship/guardianship, etc) as well assistance for children adopted out of care. Considerable flexible funding comes from TANF. SSBG, Medicaid, and Title IV-B. These funds can be used for a broad ranger of services including prevention, family preservation, and substance abuse and mental health treatment. Through home visiting programs (not pictured), the federal government also provides hundreds of millions of dollars in additional funding to support at-risk pregnant and parenting mothers and their families. Source: Child Trends national child welfare survey (October, 2016)

Prevention & Diversion Under FFPSA

Optional Prevention Services Opens Title IV-E for specified services to be provided at state option: Mental health and substance abuse prevention and treatment services provided by a qualified clinician In-home parent skill-based programs that include parenting skills training, parent education and individual and family counseling Prevention services can be given for up to 12 months

Supported or promising Only prevention services that meet one of the three “evidence-based” (promising, supported, and well- supported) federal standards will be eligible for reimbursement. States are required to spend at least 50% of the total amount claimed for federal reimbursement for prevention services on “well- supported” programs. A recent survey of programs across the country found that there are only 28 mental health services, 4 substance abuse prevention and treatment services, 4 parenting skills training or education programs, and 3 individual family counseling programs that have been identified as “well-supported” practices. Agencies must spend $1 on well supported to claim $1 on other prevention $1 $1 Supported or promising Well supported

Implications for Social Work FFPSA does not enable child welfare systems to draw down federal funds for a broad range of prevention programs. Only a limited set of programs that have met rigorous evaluation criteria will be eligible for federal Title IV-E reimbursement.

Who is Eligible? Who is eligible to receive new optional prevention services: A child who is a “candidate” for foster care; Youth in foster care who are pregnant, parenting - or – A parent or kin caregiver of the child who is a candidate for foster care is eligible regardless whether or not they meet AFDC income eligibility requirements required for Title IV-E reimbursement

Definition of “Candidate” For purposes of this title, “candidate for foster care” means the following: A child who is identified in a prevention plan as being at imminent risk of entering foster care (same as current definition of candidacy), but who can remain safely in the child’s home or in a kinship placement as long as services available under the new title that are necessary to prevent the child’s entry into foster care are provided Includes a child whose adoption or guardianship arrangement is at risk of a disruption or dissolution that would result in a foster care placement GC can chime in here about how this narrow set of services for a limited population doesn’t help our existing continuum of true secondary prevention activities.

Gaps in Expanding Prevention Due to Limitations on Which Children and Programs Meet Requirements 3.5 million children involved in referrals screened in for an investigation or assessment - 19% of CPS investigations are substantiated - 1.750 fatalities (national estimate) 1.3 million children Received services 7.4 million referrals involved in referrals alleging maltreatment Limited number of youth who will be considered “candidates” and able to remain safely at home with support of an evidenced-based program Beginning in 2020, CBO estimates that only 30% of spending on prevention services provided by states that exceed the MOE would be eligible for federal reimbursement in the initial years because states do not have these evidenced based programs in place. According to HHS/ACF, states serve approximately 160,000 candidates on an average monthly basis. Child Welfare: Title IV-E Proposals in the President’s FY2016 Budget (May 6, 2015) 273,500 children entered foster care

Implications for Social Work New federal funds are not available for up-front, primary prevention programs to prevent child abuse and neglect from occurring in the first place. IV-E funds are only available after families are in signiciant crisis and children are on the doorstep of foster care.

Where can the child be living while preventative services are provided? Where children can be living: In the home of the parent(s) In the home of kin caregiver until child can be safely reunified In the home of kin caregiver who child will live with permanently In a licensed residential treatment facility for substance abuse if Recommendation for placement is specified in the child’s case plan before the placement The treatment facility provides, as part of the treatment for substance abuse, parenting skills training, parent education, and individual and family counseling The substance abuse treatment, parenting skills training, parent education and individual and family counseling is provided under an organizational structure and treatment framework that is trauma-informed

Gaps in Services: Focus on Parent to Exclusion of the Child Services available through FFPSA are largely directed at the parent Mental Health Counseling Substance Abuse Treatment Parenting Skills Training Services are ONLY available to children kept out of foster care, depriving the child of: Foster care payments, including adoption assistance and guardianship assistance Reunification services Case management Representation and advocacy by an attorney who is charged with representing the best interest of the child Categorical Medicaid eligibility Educational supports and rights Gaps in Services: Focus on Parent to Exclusion of the Child

Gaps in Services: Focus on Parent – Not the Kinship Caregiver Services available through FFPSA are largely directed at the parent Mental Health Counseling Substance Abuse Treatment Parenting Skills Training Services do not address the stated needs of kinship caregivers and do NOT include: Monthly financial assistance Housing or rental assistance Respite care Crisis intervention services Child care Gaps in Services: Focus on Parent – Not the Kinship Caregiver

FFPSA Creates Two Paths for Youth Living with Kin Prevention Path with Diversion to Kinship Caregiver Placement Path: Enabling Kin to Meet Licensing Standards Funding for Caregiver? Limited funding available to support kin caregiver – in most states, TANF is available (in some states, kin cannot even receive TANF) Full foster care funding – in CA this includes access to specialized care increment, clothing allowance, infant supplements, and dual agency rates Who receives services? Prevention services targeted primarily at the bio parent/home of removal Reunification services offered to the parent while child receives legal representation and case management services Duration of services? Prevention services offered limited to 12 months No limitation on amount of time for reunification services while child is in foster care + 15 months of post-reunification services Permanency options and funding for permanency? No requirement that the state make a formal placement with the relative if the child is not able to be reunified with the parent – FFPSA allows the prevention strategy to be the permanent home of the relative without any additional services or funding  Child is either reunified or can remain with relative through adoption, guardianship, or as an Fit and Willing Relative – all options offer continued funding for kin families (AAP, KinGAP, or continued foster care funding) Supports for TAY? No eligibility to receive extended foster care, independent living services, or Education and Training Vouchers Eligible to receive extended foster care (if in care at age 18) independent living skill services (if in care at age 14) or Education and Training Vouchers (if either in care at 16 or adopted/guardianship at 14 or older) Education rights to promote school stability? No right to school of origin placements or funding, immediate enrollment, partial credits, etc. Child has the right to attend their school of origin, the ability to utilize partial credit and immediate enrollment laws – these rights attach to foster care

Who Are Our Kinship Caregivers? Senior Citizens: 15 – 20% of relative caregivers are over the age of 60 Fixed Incomes: 39% of kinship households live below the federal poverty line Disabled: 38% of kinship caregivers have a limiting condition or disability Limited training: Kinship foster parents receive little, if any, advance preparation in assuming their role as caregivers.

Reliance on TANF to Support Kinship Placements Sets Families Up to Fail TANF child-only vs. TANF 3-child grant vs. Basic Foster Care Rate as a % of Estimated Cost of Providing for the Needs of a 15-18 Year Old GC can chime in here re: the efforts we have undertaken to create equity and increase support services for kin (ARC, upfront family finding, RSS, etc) Source: 2011 data from GAO Report. Foster Care Payments are from the Annie E Casey Report and the data is from 2011. The monthly cost of care is estimated in the same Annie E Casey report using 2011 data.

Implications for Social Work The prevention services authorized under FFPSA work best if the child can be safely maintained in their home while the services are delivered. However, because services are not authorized until a child is at the doorstep of foster care, many children will likely have to be removed at least temporarily to ensure their safety. This causes problem if children are inappropriately diverted from foster care.

Implications for Social Work FFPSA provides legal authority for the practice of diversion – moving a child out of their home and into the home of a relative without bringing them into the foster care system- both temporarily and permanently. Child welfare systems must avoid diverting children to kinship families without ensuring those families receive adequate resources and supportive services to provide care.

Restrictions on Use of Congregate Care

The Appropriate Role of Congregate Care Perception Reality Children do not belong in group homes, they belong in families. Child welfare systems warehouse children in group homes unnecessarily because it is easier. Group homes recruit and profit off of children. Congregate care programs serve the most vulnerable youth in the child welfare system. Compared to their peers in foster care, these youth are: 3x as likely to have a mental health diagnosis 6x as likely to have behavior problems More than 3/4 of these youth have already been in a family-based placement that did not work out prior to being placed in congregate care Congregate care programs provide a structured and therapeutic environment to stabilize youth and treat mental and behavioral health conditions The average stay is just 8 months long Group homes are the most expensive placements- systems have no financial incentive to place children there Group homes in CA are non-profit organizations, and they do not make decisions on which children are placed with them- that is the role of public agencies

Overview of Congregate Care Changes With respect to congregate care, FFPSA primarily does the following: Changes the list of valid placement types for federal payment “beginning with the third week for which foster care maintenance payments are made on behalf of a child.” Creates a new placement type called a Qualified Residential Treatment Program (QRTP) Defines who QRTPs may serve and the types of services that they must offer to children and youth in care Places numerous requirements on QRTPs to be eligible for federal reimbursement, including nurse/clinical staffing, trauma informed models of care, post-discharge planning and support, accreditation, etc. Sets forth requirements on when and how children are to be assessed for placement in QRTPs, and who may do it Overview of Congregate Care Changes

Placement Types Eligible for IV-E Funding FFPSA cuts off federal IV-E funding after 2 weeks for children who are placed in congregate care programs, with four exceptions: “Qualified residential treatment programs” (QRTPs) Specialized settings for pregnant or parenting youth Transitional housing programs for youth 18 and older Programs providing support services to CSEC youth Limits the number of children that can be served in a “foster family home” to 6, unless the home: Allows parenting youth in foster care to remain with their children Allows siblings to live together Allows a child with a meaningful relationship with the family to remain with the family Allows a family with specialized skills to care for a child with a severe disability Placement Types Eligible for IV-E Funding

Gaps in Services: Closing the Front Door Programs must serve certain profile of children: Children with “serious emotional or behavioral disorders or disturbances” DSM diagnosis- very focused on children and youth with Mental Health challenges Limited profile does NOT include: Children and youth with behavioral challenges, that may lack a diagnosis Gaps in Services: Closing the Front Door

Implications for Social Work Since FFPSA requires children to have a DSM diagnosis in order to be served in a QRTP, child welfare systems must ensure that all children who face these underlying challenges are adequately screened and diagnosed. This is especially true for crossover youth who may have been served in the juvenile justice system.

QRTP Assessments and Oversight Must be made within 30 days of initial day of placement ”Independent assessor” must be a trained or licensed clinician who has no connection to the public agency or to direct service providers Court must review within 60 days of placement Ongoing review at each permanency hearing If child is in QRTP for more than 12 consecutive months (or 18 nonconsecutive months), or if child is under age 13 and has been in QRTP for 6 consecutive or nonconsecutive months, states must submit documentation to HHS and state director must sign for approval

Implications for Social Work FFPSA requires up-front and ongoing assessment and oversight of children in a QRTP. California is working to ensure that Child & Family Teams (CFTs) meet the criteria of an “independent assessor.”

Gaps in Services: Insufficient Investments in Alternative Placements California’s Continuum of Care Reform (CCR) $130 million in investments in foster parent recruitment and retention over past few years in single state Investments in the development of specialized foster homes to serve higher-needs youth FFPSA $8 million, one-time investment to be distributed across 50 states to recruit and retain foster parents No efforts to develop specialized foster homes as an alternative placement for high-needs youth Gaps in Services: Insufficient Investments in Alternative Placements

Congregate Care: The Bottom Line FFPSA redirects hundreds of millions of dollars in federal funding away from programs and services designed to support vulnerable children and youth in out-of-home care Safely and effectively reducing the number of children and youth being served in congregate care requires a much more comprehensive approach than FFPSA provides You can’t assume all youth can be easily placed with relatives or foster parents. Children and youth in congregate care possess greater challenges than their peers in foster care, and the vast majority have already been placed with families before moving to congregate care. Forcing these kids back into family-based care without the proper supports increases the likelihood that they will experience worse outcomes and/or cross over into other systems (juvenile justice, homelessness, etc.) Investments must be made in foster parent recruitment and retention, the development of specialized “therapeutic” foster homes, increased access to community-based mental and behavioral health services, etc. GC can chime in here re: IVE waiver and unique partnership with Probation and the impact of FFPSA on youth in halls or camps ready to step down to a group home.