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February 2023Vol. 24, No. 1Spotlight on the Title IV-E Prevention Program and the Family First Prevention Services Act

This issue of CBX highlights the Family First Prevention Services Act (FFPSA), which was enacted to enhance support services for families to help children remain at home, reduce the unnecessary use of congregate care, and build the capacity of communities to support children and families. Read a message from Associate Commissioner Aysha E. Schomburg about the Children's Bureau's four main priorities and the importance to leveraging the experiences of children, youth, and families in building a better child welfare system. This issue also includes the latest resources and tools for child welfare professionals and the families they serve.

Issue Spotlight

  • A Message From the Associate Commissioner

    A Message From the Associate Commissioner


    Written by Associate Commissioner Aysha E. Schomburg

    In March, I will celebrate my second anniversary as the Associate Commissioner. We have accomplished so much over the past 2 years. When I started, I made it a priority to take time to listen to what people had to say about what children and families need. I set aside time to listen to youth, parents, external organizations, my colleagues in the federal government, as well as the team at the Children’s Bureau. These conversations took time; however, it was a priority to seriously consider how people have been impacted, what we can do differently, and what is important now. As a result of those conversations, we created our four Children’s Bureau priority goals: (1) prevention; (2) support for kinship caregivers; (3) ensure youth leave care with strengthened relationships, holistic supports, and opportunities; and (4) invest in the workforce.

    We have made progress with respect to goals 1 and 2. We are raising awareness about the fact that so many children come into care due to poverty and that this is often confused with neglect and maltreatment. We have approved Family First prevention plans in 44 jurisdictions, and we have established our plan to promulgate a regulation that would advance equity and provide much needed support for kinship caregivers. There is still a lot of work to do, but I am encouraged about how far we’ve come.

    As I launch into my third year, I want to leverage the conversations that I’ve had with youth and young adults impacted by the foster care system. They have been so generous with me about sharing the challenges that young people face when they have to transition out of foster care—particularly when they don’t have everything they need to succeed as adults. We have to do more. We have to do everything we can to ensure that youth and young adults are fully equipped to experience success. The fact is that they are the next generation of parents and kin caregivers, and they are the pipeline into the workforce. When we support young people—we are tackling all four of the priority goals. We must employ a multigenerational strategy; Our investment in young people today will benefit generations to come.  So, in this third year, I will spend time having action-oriented summits with young adults from all over the country so that they can help us prioritize what they need to be set up for success. We will lean into their vision of success for themselves. Together, we will explore the federal tools the Children’s Bureau can use to support their vision in a way that will have a lasting impact for them and their children. This is not only about their future; inevitably, it is about ours. Let’s lean forward.

  • Promoting the Health and Well-Being of LGBTQIA2S+ Youth Involved With Child Welfare Through FFPSA

    Promoting the Health and Well-Being of LGBTQIA2S+ Youth Involved With Child Welfare Through FFPSA

    Children and youth who identify as lesbian, gay, bisexual, transgender and/or gender expansive, queer and/or questioning, intersex, asexual, and two-spirit (LGBTQIA2S+) experience both disproportionate involvement with child welfare and, once involved, disparate outcomes, including more placement instability and longer stays in foster care. The Center for the Study of Social Policy published a brief, Advancing Healthy Outcomes: Eight Ways to Promote the Health and Well-Being of LGBTQ+ Youth Involved With Child Welfare Through FFPSA, which explores how systems can leverage the Family First Prevention Services Act (FFPSA) to improve outcomes and well-being for LGBTQIA2S+ children and youth involved with child welfare.

    The brief suggest eight strategies that systems should implement to promote family preservation, healthy adolescent development and well-being, and successful transitions into adulthood as well as to affirm identities:

    • Ensure prevention services are responsive to LGBTQIA2S+ youth needs
    • Expand the definition of family
    • Implement policies to prevent overplacement of LGBTQIA2S+ youth in congregate care
    • Focus on recruiting and retaining affirming foster parents
    • Develop and implement training and guidance on affirming practices
    • Implement nondiscrimination policies
    • Use performance-based contracting to ensure service providers are affirming
    • Ensure accountability mechanisms are effective at addressing discrimination

    The changes that FFSPA makes to child welfare is an opportunity to create programs and practices that will address the unique needs of this population and create a more supportive, holistic system that reduces disparity. LGBTQIA2S+ partners within the community should be engaged with when developing the suggested training, guidance, policies, and services.

  • Family First Prevention Services Act Celebrates 5 Years

    Family First Prevention Services Act Celebrates 5 Years

    Since 2018, the Family First Preservation Services Act (FFPSA), which was signed into law as part of Public Law 115–123, has helped states enhance their support services for families to help children remain at home, reduce the use of congregate care, and build the capacity of communities to support children and families. On the eve of its 5-year anniversary, the Children’s Bureau, within the Administration for Children and Families (ACF), U.S. Department of Health and Human Services would like to acknowledge the efforts of states so far in creating their plans and achieving their goals for the preservation of families involved with child welfare.

    FFPSA amended the title IV-E programs to create new optional IV-E funding for time-limited prevention services for mental health, substance use, and in-home parent skills-based programs for children or youth who are candidates for foster care, pregnant or parenting youth in foster care, and the parents and kin caregivers of those children and youth. States and title IV-E-eligible tribes interested in claiming the new funding submitted Title IV-E Prevention Services Plans to the Children’s Bureau for review of compliance with FFPSA requirements. As of January 12, 2023, 50 title IV-E prevention program 5-year plans have been submitted and 39 plans have been approved.


    To support development of Title IV-E Prevention Services Plans, ACF established the Title IV-E Prevention Services Clearinghouse to systematically review research on programs and services intended to provide enhanced support to children and families and prevent foster care placements. The clearinghouse, developed in accordance with FFPSA, rates programs and services as “promising,” “supported,” “well-supported,” or “does not currently meet criteria.” As of December 2022, the clearinghouse has reviewed 129 programs and services, and 62 of these programs have been rated as promising, supported, or well-supported.


    As of October 1, 2019, states and tribes with an approved Title IV-E Prevention Service Plans have been able to claim title IV-E for a portion of trauma-informed, evidence-based mental health services, substance use services and in-home parent skills-based programs. The Capacity Building Center for the States offers an infographic of the evidence-based programs included in the approved Title IV-E Prevention Services Plans. For more information on valuable FFPSA resources from the Center for States, visit its website. You can also read the article “Resources to Support Title IV-E Prevention Program Planning” in the Strategies and Tools for Practice section of this issue.


  • Family First Prevention Services Act Opportunities for Early Childhood Programs

    Family First Prevention Services Act Opportunities for Early Childhood Programs

    The BUILD Initiative released the fifth webinar in its Child Welfare and Early Childhood: Cross-Systems Collaboration to Improve Outcomes for Young Children and Their Families series, "Family First Prevention Services Act (FFPSA) Opportunities for Early Childhood Programs."

    The objectives for the series are centered on raising awareness about young children and their families encountering the child welfare system, educating participants about racial disparities in family separation due to child welfare involvement, promoting opportunities and strategies for prevention, and providing examples of cross-system collaboration. This 90-minute webinar is particularly focused on how FFPSA is being used to expand home visiting programs and examining one state's expanded home visiting program.

    Panelists provide insight into a number of different initiatives supporting these programs. Viewers can find brief explorations of several topics related to the intersection of FFPSA and early childhood programs, including the following:

    • Which states have developed prevention plans, including those that include community pathways in their redesign
    • What benefits, opportunities, and challenges exist when developing prevention plans
    • What types of collaboration are needed and who needs to be involved

    Agency leaders, service providers, and policymakers can use the lessons learned about how the state's expanded home visiting was implemented and how it impacted well-being and positive outcomes when exploring how to use FFPSA to expand their own early childhood programs.

  • Congregate Care in the Age of FFPSA

    Congregate Care in the Age of FFPSA

    The Capacity Building Center for States published a brief, Congregate Care in the Age of Family First, for those interested in learning how to use the provisions in the Family First Prevention Services Act (FFPSA) to improve their use of congregate care and qualified residential treatment program assessments. Although it is preferred to keep children in the least restrictive setting when they need to be in out-of-home care, children and youth who have complex behavioral or clinical needs may benefit from a short-term stay in a residential treatment facility. The passage of FFPSA opened pathways of funding for states to focus on building and supporting children's connections to family through prevention services and improving the quality of residential care for the children who do need it. Child welfare managers, administrators, and others can find foundational information in the brief for implementation and potential next steps.

    The brief breaks down the law into three main tenets: (1) prevention of entry into care, (2) family-based placements, and (3) residential treatment program requirements. It also includes considerations for planning, strategies, and state examples. Agency leaders and policymakers can also find suggestions for creating a collaborative and data-driven process when planning for the appropriate use of congregate care, such as the following:

    • Develop an internal implementation team.
    • Convene a partner group.
    • Examine the data.
    • Explore other state's approaches.
    • Create a plan.

    For more detail on planning considerations, read Congregate Care in the Age of Family First on the Center for States website.

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  • March 2024

    Spotlight on Diversity and Racial Equity in Child Welfare

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News From the Children's Bureau

In this section, find the latest news, resources, and publications from the Administration for Children and Families, the Children's Bureau, and other offices within the U.S. Department of Health and Human Services as well as a listing of the latest additions to the Children's Bureau website.

  • HHS Roadmap for Behavioral Health Integration

    HHS Roadmap for Behavioral Health Integration

    The U.S. Department of Health and Human Services (HHS) released a strategic plan to address the gaps between the need for mental health care and substance use disorder care and the accessibility of such services. Concerns about the importance of mental health and challenges of substance use increased in the wake of the pandemic. Self-reported symptoms of anxiety and the rate of overdose deaths have both increased, while the use of mental health and substance use disorder services has decreased. President Biden has made mental health a priority and created a three-pillar strategy to address it:

    • Strengthen system capacity
    • Connect Americans to care
    • Support Americans by creating health environments

    The HHS Roadmap for Behavioral Health Integration also examines what further steps can be taken to advance the President's Mental Health Strategy through integrated care and equity. Integrating behavioral health into larger health-care and social systems—and vice versa—helps treats a person holistically and makes behavioral health services easier to access. Ensuring equity helps decrease disparities in care received and increase access to care for underserved populations.

    The brief highlights selected policies and programs HHS is pursuing to support the pillars of the President's Strategy. While it is not an exhaustive list of all the behavioral health initiatives within the department, it is a showcase of efforts intended to help drive the Nation toward integrated care and a transformation of the U.S. behavioral health system.

  • CB Website Updates
  • Letter Provides Guidance to States on SUPPORT Act Requirements

    Letter Provides Guidance to States on SUPPORT Act Requirements

    The Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services released a letter regarding changes made through the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (Pub. L. No. 115-271). The SUPPORT Act would expand the mandatory Medicaid eligibility to individuals who were in foster care from other states and simplify eligibility determinations and enrollment processes for this population. The guidance in this letter provides states and stakeholders with new information regarding the effective date and requirements for the new requirements outlined in the SUPPORT Act.

    Currently, youth who were formerly in foster care in a state other than their state of residence were not eligible to be part of the mandatory Medicaid eligibility group. The modified SUPPORT Act would deem these youth eligible for Medicaid if they were receiving Medicaid while in foster care in any state, after meeting all other eligibility requirements. In addition, the new guidance would allow youth formerly in care to be eligible for the mandatory Medicaid group even if they also meet requirements for another mandatory eligibility group as long as they are not enrolled in the other group.

    These changes apply exclusively to individuals who turn 18 years old on or after January 1, 2023, and meet the following additional requirements:

    • Are under age 26
    • Are not enrolled in an eligibility group described in section 1902(a)(10)(A)(i)(I)-(VII) of the Social Security Act (even if they meet the eligibility requirements for such group)
    • Were in foster care under the responsibility of any state upon attaining age 18 (or such higher age as the state has elected in its title IV-E plan)
    • Were enrolled in Medicaid in any state while in such foster care

    Read the letter to learn more about these important modifications to the SUPPORT Act. 


  • ACF Releases Resources to Strengthen the Child Welfare Response to Human Trafficking

    ACF Releases Resources to Strengthen the Child Welfare Response to Human Trafficking

    The Administration for Children and Families (ACF) within the U.S. Department of Health and Human Services released new resources to help state agencies and community providers strengthen the child welfare response to human trafficking. These resources include tools to help human services professionals, including child welfare professionals, respond to and prevent human trafficking of children and youth at risk for, currently experiencing, or have previously experienced trafficking. 

    The set of resources include a SOAR training module, Responding to Human Trafficking Through the Child Welfare System, delivered through the ACF Office on Trafficking in Persons (OTIP) National Human Trafficking Training and Technical Assistance Center. The accredited training module is free to access and aims to prepare professionals for their work in preventing trafficking among the families they serve and to ensure their work aligns with priority actions outlined in the National Action Plan to Combat Human Trafficking.

    The training module is accompanied by an information memorandum (IM), published jointly by the Administration on Children, Youth and Families, Children’s Bureau, Family and Youth Services Bureau and OTIP, that highlights resources available to help states in meeting the legal requirements to protect children and youth from negative outcomes associated with human trafficking. 


    The IM can help child welfare agencies develop client-centered, trauma-informed screening and reporting protocols to ensure children and youth who have experienced or at increased risk of human trafficking, particularly those returning to foster care after going missing, are appropriately screened and connected to supportive and culturally competent services. 

    Visit the resources on the ACF website to learn more.





  • AFCARS Report #29

    AFCARS Report #29

    The latest data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) are now available. State and tribal title IV-E agencies are required to report AFCARS case-level information on all children in foster care and on children who have been adopted and have had title IV-E agency involvement. The data are intended to help policymakers at the federal, tribal, and state levels to assess how many children are in foster care, the reasons they entered care, and how they exited care as well as to develop strategies to prevent unnecessary out-of-home placements. The AFCARS report also provides information about the children who are removed from their homes, their placement details, and foster/adoptive parents. 

    Some notable data from the current report, which presents data from fiscal year 2021, include the following:

    • There were 391,098 children in foster care in 2021, which is a drop from 407,318 in 2020.
    • A total of 216,812 children entered foster care.
    • A total of 214,971 children exited care.
    • A total of 606,031 children were served by the foster care system.
    • A total of 113,589 children were waiting to be adopted.

    To view the complete AFCARS report for fiscal year 2021, visit the Children's Bureau website


Training & Technical Assistance Updates

This section features resources and updates from the Children's Bureau's technical assistance partners to support practices and systems that improve the lives of children and families.

Child Welfare Research

In this section, we highlight recent studies, literature reviews, and other research on child welfare topics.

  • Child Trends Paper Highlights Importance of Positive Youth Development Approaches in Child Welfare

    Child Trends Paper Highlights Importance of Positive Youth Development Approaches in Child Welfare

    A paper from Child Trends explores the importance of implementing positive youth development (PYD) and racial equity and inclusion approaches in child welfare and juvenile justice systems. Research indicates that PYD approaches that focus on young people’s assets and build on protective factors can improve their mental and physical health, education, and employment outcomes. These approaches are especially important for young adults, as data shows that youth who interact with the child welfare and justice systems have difficulty adjusting to independence and living healthy, fulfilling lives. These outcomes are even more prominent for young people of color and youth who are lesbian, gay, bisexual, transgender and/or gender expansive, queer and/or questioning, intersex, asexual, and two-spirit (LGBTQIA2S+).


    The paper outlines the following reasons for implementing equity-oriented PYD approaches:


    • Research in adolescent brain science, youth development, and trauma underscores the need for age-appropriate support and resources that foster positive development.
    • Experts have called for a reduction of congregate care.
    • Some service providers have begun to implement strengths-focused and positive youth frameworks.
    • Data document the disproportionate number of Black, American Indian, Hispanic, and LGBTQIA2S+ youth in child welfare and justice systems.


    The paper also introduces “STRENGTH,” a conceptual framework that programs and communities can use to guide their work supporting adolescents and young adults in child welfare and justice systems. The “STRENGTH” model focuses on positive characteristics rather than a young adult’s deficits and is structured around eight principles drawn from PYD frameworks: systems integration; trustworthy and safe; relationships; equity, inclusion, and belonging; needs are met holistically; growth, leadership, and opportunities to fail and learn; training and education; and healing. These principles provide public systems with a roadmap to reevaluate how they approach youth and families.


    The paper is part of Child Trends’ ongoing work related to integrating PYD and equity-driven approaches in child welfare and justice systems. The next step is to develop a toolkit to provide concrete supports to programs and systems that are implementing or expanding on these approaches for young adults.


    More information is available in the paper, Integrating Positive Youth Development and Racial Equity, Inclusion, and Belonging Approaches Across the Child Welfare and Justice Systems, which is available on the Child Trends website.

  • Report Documents the Ways Child Welfare Is Failing Youth Who Age Out of Care

    Report Documents the Ways Child Welfare Is Failing Youth Who Age Out of Care

    Think of Us published a second edition of its report on how the child welfare system is failing youth transition out of foster care. The report is based on research conducted between fall 2019 and spring 2020 in five participating sites: Santa Clara County in California, First Place for Youth in Solano and San Francisco Counties in California, The New York Foundling in New York City, Hennepin County in Minnesota, and Uplift Family Services in San José, California. At these sites, researchers engaged a total of 206 youth in care, youth who were formerly in care, child welfare staff, supportive adults, foster papers, and other participants.


    Findings from the study demonstrate that youth who age out of the foster care system are largely left unhealed, unprepared, and unsupported. The report is organized into the following three chapters:


    • Healing and Dealing With Trauma: This chapter explores the impact of trauma on the lives of foster youth, including the ways in which the foster care system should respond to trauma to promote healing.
    • Preparing for Adulthood: This chapter discusses the system’s current attempts to prepare youth for adulthood and ways in which those attempts can improve.
    • Building a Supportive Network: Based on the experiences of study participants, this chapter demonstrates that youth in care often do not have supportive adults in their lives and that the system needs to help them build these social networks.


    These three major issues addressed in the report are illustrated through the stories of five fictional characters/archetypes who exemplify the experiences of the 81 youth who participated in the study.


    The first edition of the report was published in December 2020. The second edition was prompted by the needs of transition-age youth being intensified by the pandemic and a growing urgency to address those needs.


    More information is available in the report,  Aged Out: How We’re Failing Youth Transitioning Out of Foster Care.

Strategies and Tools for Practice

This section of CBX offers publications, articles, reports, toolkits, and other resources that provide evidence-based strategies or other concrete help to child welfare and related professionals.

  • Resources to Support Title IV-E Prevention Program Planning

    Resources to Support Title IV-E Prevention Program Planning

    Written by the Capacity Building Center for States

    In February 2018, the Family First Prevention Services Act (FFPSA) was signed into law with the potential to radically reform child welfare. The
    FFPSA incentivizes jurisdictions to reduce the use of congregate care and allows payment of federal title IV-E funds for programs and services to prevent children from entering foster care. Jurisdictions must have a 5-year title IV-E prevention program plan approved by the Children's Bureau to use these funds, which are available for mental health and substance use treatment and prevention services and for in-home parenting skill programs. Implementing the FFPSA and prevention plans will help jurisdictions improve the quality of services and supports to strengthen and keep families together, build the capacity of communities to support children and families, and ensure children and youth grow up in safe and loving families. By the fifth anniversary of the FFPSA, most states, eligible tribes, and territories have opted into the use of title IV-E funds for prevention programs and are in various stages of the planning and implementation process. Wherever jurisdictions are in this process, the Capacity Building Center for States has readily available resources to support plan implementation; build infrastructure to sustain and improve efforts; enhance community collaboration; and, for those just starting out, support plan preparation and revision.


    Implement and Sustain Prevention Plans

    Find resources to put plans into action and navigate both the technical and adaptive challenges of prevention planning and implementation.

    • Prevention Planning Into Action—Find resources to help you tackle common adaptive challenges and identify collaborative, data-driven, and equity-centered approaches to planning and delivering prevention services.
    • Strategic Planning in Child WelfareFind tools to help you identify opportunities to align your prevention plan with other federal and internal agency processes and support coordinated strategic and long-term planning, monitoring, and review processes.
    • Continuous Quality Improvement and ImplementationFind resources, such as learning experiences, peer networking opportunities, practical guides, and tools, to support child welfare leaders as they implement and manage change.

    Engage Others in Planning

    Build a more racially equitable, prevention-oriented approach to child welfare by engaging youth, families, and collaborative partners in planning.

    Enhance Kinship Programming and Reduce Congregate Care

    Lessen the trauma that results when children are placed in out-of-home care by supporting kin caregivers and reserving customized congregate care for children and youth with complex clinical or behavioral needs.

    Learn From People With Experience

    Find out what works and which pitfalls to avoid by listening to other people’s experiences.  

    Start Here if You're Just Beginning to Plan

    Get everyone on the same page with resources to help you build common understanding among collaborative partners about prevention services and change management.

    • Change and Implementation Prevention Planning Crosswalk—Read this to guide your thinking about specific considerations for applying change and implementation topics to your prevention work. Pay special attention to the following sections of the crosswalk as you think about how to get started with prevention planning: Readiness, Teaming, and Problem Exploration.
    • Working Across the Prevention Continuum to Strengthen Families—Learn about what an integrated, comprehensive, prevention-focused approach looks like along a three-tiered prevention continuum and how you can establish common understanding of the continuum among community partners, legislators, child welfare agency staff, caregivers, youth, and other partners.

    Looking for more support?

    Find resources to help your agency form collaborative partnerships and establish a vision for prevention on the Center for State’s Prevention-Focused Systems page. To learn more about key provisions of the FFPSA and find tips and strategies to support implementation, check out the Center for State’s FFPSA and Advancing the Children’s Bureau’s Vision: Family First Prevention Services Act pages. For technical assistance to support your agency’s response to the FFPSA, contact your state’s Child Welfare Capacity Building Collaborative liaison.

  • Addressing the Developmental and Mental Health Needs of Infants and Toddlers Involved in Child Welfare

    Addressing the Developmental and Mental Health Needs of Infants and Toddlers Involved in Child Welfare

    The National Center for Children in Poverty published a brief in 2022 that examines strategies used in three states to address the developmental and mental health needs of infants and toddlers involved in child welfare. This population is at risk for poor social-emotional, behavioral, and learning outcomes for a variety of reasons, including trauma, maltreatment, and separation from primary caregivers. The brief explores the roles of state and local child welfare and Part C early intervention (EI) agencies in promoting the well-being of these children.


    The brief lists four reasons for focusing on child welfare and EI:


    • Child welfare is a critical point of contact for many infants and toddlers who have experienced or are at risk of maltreatment.
    • EI is the program most explicitly mandated to address early developmental difficulties in children.
    • States must have procedures that support the referral of children involved in founded cases of abuse or neglect to EI, as mandated by the Child Abuse Prevention and Treatment Act and the Individuals with Disabilities Education Act.
    • Children of color are disproportionately involved in child welfare and deserve equitable access to child development supports.


    The brief includes strategies for children in founded cases and those in unfounded cases, who also experience high rates of developmental and mental health issues.


    More information, including information about EI, state strategies, and recommendations, are available in the brief, Child Welfare and Early Intervention: Policies and Practices to Promote Collaboration and Help Infants and Toddlers Thrive.


This section of CBX presents interesting resources, such as websites, videos, journals, funding or scholarship opportunities, or other materials, that can be used in the field or with families.

Training and Conferences

Find trainings, workshops, webinars, and other opportunities for professionals and families to learn about how to improve the lives of children and youth as well as a listing of upcoming events and conferences.