FFTA Conversations on Family First Prevention Services Act Conversation #3: Diving Deep in FFPSA Part I – Prevention Services and IV-E Thursday August 23, 2018 Laura Boyd, Ph.D. FFTA Public Policy Director

Chapter 1: Prevention services to keep children safely with their families and out of foster care Who is eligible? “Candidate” for foster care, is defined as a youth at imminent risk of foster care (includes those who have been adopted or are in guardianship care) And who can remain safely at home (parents) or in a kinship placement with receipt of services or programs (… to prevent disruptions).

Who is a “candidate”? To demonstrate the range, here are three possible interpretations of that term that a state might decide to adopt. Very broad: Any child whose parent has tested positive for an illicit substance, or has a diagnosed mental health disability, is a candidate for foster care. Broad: Any child whose parent (or parents) has been referred to the state or local hotline for alleged maltreatment is a candidate for foster care. Narrow: Only pursuant to the substantiation of maltreatment a child is a candidate for foster care. Chapter 1: Prevention services to keep children safely with their families and out of foster care

Chapter 1: Prevention Activities under Title IV-E PREVENTION activities under Title IV-E Types of services: mental health and substance abuse prevention and treatment, in-home parent skill-based programs, parent education, individual and family counseling in the home. • Mental health prevention and treatment services provided by a qualified clinician for not more than a 12 month period. • Substance abuse prevention and treatment services provided by a qualified clinician for not more than a 12 month period. • In-home parent skill-based programs that include parenting skills training, parent education and individual and family counseling for not more than a 12 month period. Chapter 1: Prevention Activities under Title IV-E

Chapter 1: Prevention Activities under Title IV-E Duration: 12 months beginning on date of formal written prevention plan; renewable. Candidates for foster care must have a written, trauma-informed prevention plan that identifies the strategy for the child to remain safely out of foster care and the list of services or programs needed for the child or on behalf of the child. No income eligibility requirement for prevention services. Program Instruction for the IV-E prevention provisions will include information about financing and will be released from HHS in the late fall. Chapter 1: Prevention Activities under Title IV-E

Chapter 1: Prevention Activities under Title IV-E Services must meet EBP requirements: promising, supported, or well-supported.(By Oct 1, 2018, HHS will release guidance on these criteria and a ‘pre-approved’ list of services/programs that meet the requirements.) 50 percent of state spending on well- supported programs.

Chapter 1: Prevention Activities under Title IV-E Reimbursement rates for prevention activities are: Beginning October 1, 2019 through September 30, 2026, FFP is 50% Beginning October 1, 2026, FFP is the state’s FMAP rate.

Chapter 1: Prevention Activities under Title IV-E States who opt to administer a prevention program also may claim Title IV-E reimbursement for administrative costs at 50% and training costs at 50%. Program planning, coordination, contracting, continuous quality improvement and data collection, reporting. Training for child welfare staff and staff of state- licensed or approved child placing agencies. Topics include: how to determine eligibility, how to identify and provide appropriate services, how to oversee and evaluate ongoing appropriateness of the services. Chapter 1: Prevention Activities under Title IV-E

Evidence: All EBP programs must: have a book or manual, demonstrate no evidence of harm, overall studies show benefit, ”trauma- informed approach and trauma-specific interventions” Promising Publication in peer-review journal not required; follow up study not required (wait list, untreated, placebo) Practice “is superior to a comparison practice”

Evidence: Supported (does not require Randomized Control Trial) Rigorous RCT or quasi-experimental design comparison group study (wait list, untreated) At lease one study with 6 month follow up/sustained effect Well-Supported (does not require RCT study…unlike CEBC. Note that as of 9.30.19, at least 50% of interventions must be Well-Supported.) Two RCT or rigorous quasi-experimental design comparison group studies (wait list, untreated). At least one study must find effects at the 12- month follow-up/sustained effect Lots of questions. Wait for guidance from HHS. ”Well-supported” will probably be more flexible than CCHEBP …no blind/control study required. Oct. 1, 2019-Oct. 1, 2026 reimb at 50%. After Oct. 1, 2026, reimb at FMAP rate (avg. 63%) Federal Medical Assistance Percentage

State Plan Requirements States that choose to take the option to use Title IV-E funds for prevention will need to include a component in their state child welfare plan that details the services and programs and how they will improve outcomes for children, in addition to other specific elements.  The state plan must be approved by HHS to draw down these prevention funds. Begins Oct.1, 2019. States have option to delay up to two years; however, if they delay, they must also postpone IV-E prevention funds for same period. 

Chapter 1: Prevention Supports Kinship HHS will identify reputable model licensing standards for foster family homes. States will need to review how their standards compare to these standards and submit in their state plan to HHS why they are different if they are by April 1, 2019. Evidence-based Kinship Navigator Programs: begins Oct.1, 2018, with up to 50% reimbursement for navigator programs that meet EBP requirements. No income-eligibility requirements for Title IV-E. (Sec. 50713) for youth who are candidates for foster care.

Chapter 1: Other Supports under IV-B Regional Partnership Grants (IV-B Block Grants) Collaboratives to address substance abuse prevention and treatment Mandatory Partners: state child welfare and entity in charge of substance abuse prevention and treatment Optional Partners: non-profit and for-profit service providers Support facilitation, implementation, and effectiveness of new IV-E prevention services Chapter 1: Other Supports under IV-B On September 28, 2012, ACYF/CB awarded new 5-year RPGs to 17 partnerships in 15 states. ACYF/CB also funded 2-year extension grants to eight of the regional partnership grants funded in 2007. AK, AZ, CA, CO, FL, GA, ID, IL, IA, KS, KY, MA, MN, MO, NE, NV, NM, NY, NC, OH, OK, OR, RI, TN, TX, VT, WA, WI.

Chapter 1: Other Supports under IV-B Reauthorized a number of Title IV-B programs are for five years, from FY2017 through FY2021, including: (Title IV-B) Promoting Safe and Stable Families Program. Allows PSSF funds to be used for unlimited family reunification services for children in foster care and an additional 15 months of family reunification for all children once they return home.

Chapter 1: Other Supports under IV-B Reauthorized a number of Title IV-B programs are for five years, from FY2017 through FY2021, including: The Stephanie Tubbs Jones Child Welfare Services (Title IV-B) State Court Improvement Program Grants

“Devil” is/is not in the details. TBA Program Instruction for the IV-E prevention provisions will include information about financing and will be released from HHS in the late fall. Flexibility for county-administered states. While the state is required to make the decision whether to opt in or out of the IV-E prevention provisions, Milner interprets that implementation of the prevention provisions may be differentiated across the state. However, adherence to the congregate care provisions are required statewide.

“Devil” is/is not in the details. TBA Trauma-Informed. HHS may also prioritize services and programs that have been implemented using a trauma-informed approach. FFPSA statutory language [section 471(e)(4)(B)] states, ‘‘The services or programs to be provided to or on behalf of a child are provided under an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma and in accordance with recognized principles of a trauma- informed approach and trauma-specific interventions to address trauma’s consequences and facilitate healing.’’

“Devil” is/is not in the details. TBA Transition Support for Waiver Jurisdictions. HHS supports establishing a form of transitional authority to assist IV-E waiver jurisdictions with a transition to FFPSA implementation. 

FOCUS ON OPPORTUNITIES Children must be served in family settings unless clear evidence suggests that is not in best interest of treatment plan of the child. Requirements of trauma-specific treatment. Development of Evidence-Based Practices. Development and competency in SUD/OUD treatment. Focus on prevention and reunification needs, interventions, and services. Educating and forming partnerships with others in public and private sectors. Hosting site visits for members of their congressional delegation and other state and local decision makers FOCUS ON OPPORTUNITIES