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June 2023Vol. 24, No. 5A Review of 1 Year of Congregate Care Reform Under Family First

The Family First Prevention Services Act of 2018 (Family First) contains several significant child welfare policy reforms, including efforts to reduce the number of children entering out-of-home care, promote family-based foster care placements when possible, and improve the standards for congregate care settings, such as group homes and residential facilities.

As part of the congregate care facility reform, Family First created categories of allowable nonfamily placement settings, including Qualified Residential Treatment Programs (QRTPs); settings specializing in prenatal, postpartum, or parenting supports; supervised independent living settings for those age 18 and older; and settings offering support to those who are, or are at risk of becoming, sex trafficking survivors. The QRTP models are designed to be appropriate, time-limited, and meet a child’s needs.

In response to Family First, many states made reforms, including converting congregate care settings to QRTPs. The deadline for states to implement these reforms was October 2021. In March 2023, the American Academy of Pediatrics and Chapin Hall released a progress report detailing where states stand approximately 1 year after the implementation deadline. The report examines the early status, successes, and barriers that states have experienced as they implement congregate care reforms. It draws on research findings from a survey of child welfare agency leaders as well as focus groups with child welfare professionals, congregate care centers that have converted to QRTPs, and young people with lived experience.

The following are key findings outlined in the report:

  • Ongoing congregate care reforms align with Family First.
  • States have reduced the use of congregate care and simultaneously increased the use of kinship foster care.
  • QRTPs are now a primary component of congregate care placement arrays in many states.
  • States undertake various strategies to establish and implement QRTPs to meet federal requirements.
  • Top implementation barriers concern resource needs in workforce and staff, therapeutic foster care models, funding, and foster families.
  • QRTP treatment, quality staff, and aftercare tailored to youth’s needs is lacking.
  • There is a perceived lack of change in QRTPs from preexisting congregate care culture and practice.
  • Child welfare systems need evidence that QRTPs are accountable for improving young people’s lives and outcomes.

The report acknowledges that many state reforms are in the early stages and will require more research as time passes. For more information, including policy recommendations, read the report Family First Implementation: A One-Year Review of State Progress in Reforming Congregate Care.