INTRODUCTION
Background
The Family First Prevention Services Act (Family First) introduces a shift in the way states serve children and families at risk of separation and out-of-home placement. Family First gives child welfare systems the opportunity to utilize Title IV-E funding to provide evidence-based interventions designed to keep children at home with family whenever it is safe to do so. Thus, Family First effectively incentivizes prevention services that reduce entry into foster care. In addition to the prevention services provision, Family First includes provisions that limit Title IV-E spending for children placed in group care settings. The provisions restrict the use of Title IV-E funds for these settings for longer than 2 weeks. Under the law, a child’s Title IV-E eligibility ends after 2 weeks of placement in a childcare institution, unless the institution is one of four allowable group settings that are exempt from these restrictions (Family First Prevention Services Act, 2018). These four settings include:
- a Qualified Residential Treatment Program (QRTP);
- a setting specializing in providing prenatal, postpartum, or parenting supports for pregnant or parenting young people;
- in cases when the child is 18 years old, a supervised independent living setting; or
- a setting with high-quality residential care and support services for youth who have been found to be, or are at risk of becoming, sex trafficking survivors, defined by each state’s policies and procedures (Family First Prevention Services Act, 2018).
A QRTP is defined as a residential program that:
- uses a trauma-informed treatment model
- works with families in treatment, as appropriate
- provides onsite, registered or licensed nursing and clinical staff who are available 24 hours a day and 7 days a week
- engages in and documents outreach to family members and family integration in treatment
- provides discharge planning and a minimum of 6 months family-based aftercare services
- meets Title IV-E licensure requirements and is accredited by an approved independent, nonprofit organization (Family First Prevention Services Act, 2018)
To remain eligible for Title IV-E, children placed in a QRTP must receive an independent assessment within 30 days of placement to ensure their needs cannot be adequately met in the community and the treatment setting is appropriate (Family First Prevention Services Act, 2018). The assessment must be completed by a “qualified individual” (defined as “a trained professional or licensed clinician who is not an employee of the State agency and who is not connected to, or affiliated with, any placement setting in which children are placed by the State”; Family First Prevention Services Act, 2018). Following the assessment, the court must then approve the QRTP placement within 60 days. Longer stays (over 6 months for children under 13 and over 12 consecutive months or 18 non-consecutive months for youth 13 and older) require approval from the state child welfare agency’s director to ensure the QRTP placement remains clinically necessary (Family First Prevention Services Act, 2018).