The Family First Prevention Services Act (FFPSA) of 2018 is a new federal law intended to prevent children from entering foster care, reduce the use of group residential care in favor of family-like, and strengthen support for kinship care. Recognizing that children do best when maintained safely in their own homes, the law provides additional federal resources to states to prevent children from entering foster care by increasing access to critical services for children and their caregivers.
Under FFPSA, states are able to draw down federal Title IV-E funding to pay for mental health, substance abuse, and parent training services for families whose children are at imminent risk of removal. Prevention services under FFPSA can be provided for children and/or their caregivers for up to 12 months, but only for programs that have been designated as an evidence-based practice (EBP) by a federal Clearinghouse established to conduct research reviews and assign evidence ratings. Implementation of the law, which will take effect in Texas in October 2021, requires careful planning and coordination among state agencies, policymakers, philanthropic funders, and the community of service providers throughout the state.
Introduction and Background
The Family First Prevention Services Act of 2018 (FFPSA) represents the most significant federal child welfare reform in over two decades. Recognizing that children do best when maintained safely in their own homes, the law provides additional federal resources to states to prevent children from entering foster care by expanding access to critical services.
Nationally, there are some 437,000 children in foster care.2 In Texas, there were 31,408 children in substitute care as of August 1, 2019.3 Though both of these figures are slightly lower than the previous year, they represent an overall trend of increases in the number of children in foster care that started in the mid- 2010s. Research suggests that, at a national level, the recent uptick in foster care cases is at least partially attributable to the rise in drug use, and in particular the opioid epidemic, over the past decade.5 FFPSA is part of a federal response to this problem, putting more resources into the prevention of foster care entries among families affected by drug abuse and other issues. Through providing additional support for vital services to families, FFPSA is an attempt to prevent the need for foster care and maintain more children in their homes.
FFPSA Prevention Services
This report is focused specifically on the prevention services component of FFPSA, which allows states to use Title IV-E funds for up to 12 months to pay for services intended to prevent children from entering substitute care. There are three categories of services eligible for funding under FFPSA: 1) mental health, 2) substance abuse, and 3) in-home7 skill-based parent training. Services must be provided by a qualified clinician and use a trauma-informed approach to be eligible for FFPSA funding.
Only certain individuals are eligible to receive services through FFPSA Title IV-E funding. Qualified recipients include children who the state designates as candidates for foster care, their caregivers, parenting or pregnant youth in foster care, and/or children in kinship care and their caregivers. Candidates for foster care are children who the state considers at imminent risk of removal. In Texas, a child is defined as a foster care candidate when 1) at any time a child is the subject of a safety plan and absent preventative services the plan is removal, or 2) a child is not the subject of a safety plan but is at high or very high risk of abuse or neglect, and absent preventative services the plan is removal.9 If the children of families receiving prevention services
The Family First Transition Act
In December 2019, the president signed the Family First Transition act – a new federal law providing additional resources to states to help with the start-up costs associated with FFPSA implementation. The law provides $500 million for one-time, flexible payments to states and tribes to cover some of the costs of transitioning to FFPSA-qualified programs and placements. Texas is expected to receive approximately $50 million in Transition Act funds, which must be spent within five years. The state is currently developing strategies for using Transition Act funds to support implementation in Texas.
States could opt to begin implementation of FFPSA as early as October 2019, however many states, including Texas, opted to delay implementation. FFPSA will go into effect in Texas in October 2021. According to the Texas Department of Family and Protective Services (DFPS)14, the main reasons cited for delaying implementation were not having enough providers in the state who offer evidence-based services, a lack of QRTPs in the state, and a need for further federal guidance on which programs will qualify for federal funding. The state is examining outcomes and costs for serving children in FFPSA-approved congregate care settings, implementing QRTPs, and training in evidence-based modalities. DFPS is also creating partnerships to assist with capacity building, determine the allocation of funds once FFPSA is implemented, and explore the development of a kinship navigator program. In September 2020, Texas must provide the Texas Legislature with a strategic plan for FFPSA implementation.
As FFPSA is a complex new federal law altering a broad swath of child welfare functions and funding mechanisms, state implementation of the law requires careful planning and preparation. A recently published technical guide on FFPSA implementation, prepared by the Children’s Defense Fund in collaboration with several other national child welfare organizations, identifies guiding principles critical for successful implementation by states and tribes.15 These principles will be relevant for all aspects of child welfare service delivery as Texas moves toward implementation.
This study focuses specifically on the prevention services component of FFPSA, which establishes eligibility requirements for services to be reimbursed by the federal government through Title IV-E. Because of the requirement that reimbursable services be designated as evidence-based, child welfare stakeholders in Texas have raised concerns that many community providers are not currently equipped to comply with the requirements related to qualifying prevention services.
To better understand the current statewide capacity of potentially reimbursable mental health, substance abuse, and in-home parent training services, the Texas Center for Child and Family Studies (the Center) partnered with Casey Family Programs, the Department of Family and Protective Services, and the Texas Health and Human Services Commission (HHSC) to empirically address the following questions:
1. What are the mental health, substance abuse, and in-home parent training services currently available for child welfare-involved families in the state?
2. To what extent do services currently being provided in these categories meet criteria for being evidence-based, according to current federal guidelines?
3. What are the barriers to expanding the state’s capacity to serve additional clients? What are the barriers to expanding providers’ service arrays to include more qualifying EBPs?
SURVEY DEVELOPMENT AND DATA COLLECTION
The study objectives were carried out through a statewide survey of community providers likely to be offering services in at least one of the service categories eligible for FFPSA funding.
The survey was developed by the Texas Center for Child and Family Studies based on ongoing input and oversight from a steering committee consisting of members from major FFPSA stakeholder groups: the Prevention and Early Intervention (PEI) and Child Protective Services (CPS) divisions of DFPS, the Behavioral Health Services division of HHSC, Casey Family Programs, and the Texas Alliance of Child and Family Services (TACFS). The survey was pilot tested by the committee, members of the DFPS data and analytics team, and external providers from the membership of TACFS. The steering committee approved the final version of the survey in July 2019. The full survey instrument is available from the Texas Center for Child and Family Studies.
Of respondents who do provide services in one of the eligible categories, the largest number of agencies provide mental health services, followed by parent training then substance abuse (Table 5).
Among agencies who responded to the survey, 46 (14.6%) are Child Advocacy Centers (CACs).25 Of the CACs in the survey, 42 provide mental health services, while 5 provide substance abuse services, and 6 provide in-home parent training services.
SERVICES BY REGION
Responding agencies provide services throughout the state as shown in Figures 1 and 2.26 The distribution of responding agencies roughly aligns with the child populations of the HHSC/DFPS service regions (Figure 1), which is an indication that the survey responses are at least somewhat representative of the statewide population of community provider agencies.
Discussion and Recommendations
Major Findings. The critical finding of this study is that there are significant gaps between the services currently being offered by community providers in the state and the programs that have been approved to date as FFPSA-qualifying evidence-based practices.
Though the overwhelming majority of providers who took part in the survey report that they are providing evidence-based programming, the majority of interventions they are providing have not been approved as EBPs by the federal Clearinghouse.46 The divide between services that are available in Texas and services that are reimbursable under FFPSA is not static; the Clearinghouse continues to review and rate programs, so new programs will continue to become FFPSA-eligible over time. In the meantime, as Texas moves closer to the deadline for submitting a plan for FFPSA implementation, the gap between available services and FFPSA-reimbursable services will have implications for the state’s ability to maximize federal funding for services to prevent foster care entries.
The extent and nature of the gaps in available and FFPSA-qualified services differ by service category.
The following recommendations are based on the findings of the capacity assessment as applied to implementing the provisions of FFPSA in Texas.
1. Strategically invest in expanding the supply of Clearinghouse-approved evidence-based programs throughout the state.
To realize the intended goal of preventing substitute care entries, more Clearinghouse-approved EBPs must be offered throughout the state, and they must have sufficient diversity to ensure the right services are available to meet the diverse needs of families. This capacity assessment shows that there are shortages of FFPSA-qualified programs in all service categories, and particularly in substance abuse and in-home parent training. This will require thoughtful decision-making about which programs to select for investment among the state’s community service providers.
The Family First Transition Act will provide approximately $50 million in funds, which must be spent within five years, to assist with FFPSA implementation. With those funds, the state could choose an initial round of programs covering each service category and assist local providers throughout the state in adding the programs to their service arrays. Investing in a smaller set of EBPs at the outset (rather than a wide array of programs) may be optimal because of the substantial provider resources needed to learn and implement a new intervention. After the first two years of implementation, additional programs will have been approved by the Clearinghouse, giving the state and providers more options for drawing down federal funding for prevention services.
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