New federal child welfare legislation could reduce trauma for young children who are in foster care or at risk of entering the child welfare system, if it is implemented effectively in concert with investments in our child- and family-serving systems. That was the message at a half-day briefing and discussion jointly hosted in Raleigh this week by NC Child, Prevent Child Abuse NC, The Duke Endowment, and the NC Department of Health and Human Services.
The federal Families First Prevention Services Act enacts a series of important changes in federal child welfare financing that allow more funding to be invested in prevention for children and families. Those changes will come on top of child welfare system reforms in North Carolina stemming from recent state-level legislation. Both the federal and state changes, if implemented effectively, have the potential to impact the short-term safety and long-term health and education outcomes of young children in North Carolina.
Families First Prevention Services Act – Federal Financing Changes
The new federal Act, passed in February, puts new financing mechanisms in place to:
- Allow states to invest in prevention and family services for children and families at risk of coming into the child welfare system. Until this Act was passed, states could only receive federal reimbursement for services and treatment provided to children and families who were already in the system. The new Act also requires that a percentage of those services meet the highest level of evidence-base.
- Ensure that children in foster care are placed in family foster care settings unless a residential treatment placement is medically necessary.
- Put in place standards for residential treatment programs to ensure they are high quality, for those children who require those placements.
The Act also requires new data collection that can help to improve North Carolina’s data on children and families in the child welfare system.
Rylan’s Law – State-Level System Reform
North Carolina’s Rylan’s Law was passed in June 2017 and named after Rylan Ott, a Moore County two-year-old who wandered away from home and drowned in 2016. In addition to putting in place safeguards to ensure children in foster care are not returned to their birth parent(s) prematurely, the law:
- Creates regional partnerships of county departments of social services.
- Requires the state to hire an independent third-party contractor to review the statewide child welfare system.
- Shortens the time frame given to parents to appeal a custody decision.
- Establishes a pilot program for youth in foster care to obtain a driver’s license.
The third-party evaluation is currently underway and advocates expect it to result in recommendations to reform the child welfare system in NC.
These two pieces of legislation reflect both growing understanding about child development and the current state and national contexts. Brain science has made it clear that the early years are a critical time for brain development, and that trauma that happens to children during those years is built into their brains and bodies as they grow. Research has shown that most children do best at home with their families, and that being removed from home is a trauma in and of itself. We also understand more than ever before about what works to prevent child abuse and neglect and the critical importance of caregivers in mitigating the effects of trauma and building children’s resilience.
National and state context played a role in the passage of these two laws, including:
- Increasing pressure on the foster care system from the opioid crisis
- More intense mental health needs of children in the child welfare system
- Evidence that there are children in foster care group homes or residential settings who do not have a clinical need for those placements
- Individual cases—like Rylan Ott’s—that were seen at least partly as system failures
The new federal legislation presents opportunities and challenges for North Carolina.
Opportunities include:
- Access to Services. More children and families can gain earlier access to mental health, substance abuse, parenting skills, kinship navigation and residential treatment services, which can prevent children from needing to be removed from their homes.
- Driving Higher Quality Community-Based Services. To be reimbursable with federal funds, treatment services for children and families must be trauma-informed, evidence-based and provided by qualified clinicians. There are three categories of “evidence-based” programs: promising programs, supported programs and well-supported programs. Half of the services reimbursed under Families First must be in the well-supported category.
- Appropriate Placements. For most children in foster care, a family foster care home is the best, least restrictive, setting. To be reimbursed for a child placed in any placement other than a family foster home, states must assess the child and provide a reason. Insufficient foster families will not be an acceptable reason for a group home or residential treatment program placement.
- Driving Higher Quality Residential Treatment Services. To be reimbursable, residential treatment services must be trauma-informed, designed to meet the particular needs that are identified in a child’s assessment, have licensed clinical staff either on-site or available 24/7, intentionally support family participation in treatment, provide discharge planning and family-based aftercare for six months after discharge, and be licensed and accredited.
There are also implementation challenges and outstanding questions, including:
- State Funding. Under the federal Act, the federal government would pay 68% of the total cost of the reimbursable costs, and the state would be responsible for the remaining 32%. States can only draw down federal dollars for prevention if they provide state money as a match. Many current activities apply towards that match, but whether the state will invest sufficient state dollars is a question.
- Foster Parent Recruitment and Retention. Ensuring that children are in the least restrictive possible setting (for most children, a family foster home) is best practice. Shifting more children into family foster homes (as opposed to group homes or residential treatment facilities) will create a need for more foster families.
- Meeting High New Standards. New trauma-informed and evidence-based standards for residential treatment and community-based services are intended to raise the bar and result in better outcomes for children. Meeting those standards will require significant investment in the state’s mental health and substance abuse treatment continuum for children and families.
- Building Provider Capacity. Ensuring that North Carolina has sufficient high quality child welfare, mental health and substance abuse clinicians and service providers, particularly for young children or dyadic (parent and child together) services, continues to be a challenge.
All of these challenges and opportunities will intersect with state-level child welfare system reforms resulting from Rylan’s Law.
The new Families First Act enables states to provide supports to help prevent maltreatment and keep families together. Policy experts and advocates at this week’s briefing stressed, however, that building effective supports for families—and meeting the new federal requirements—are ultimately dependent on investments across the board in our systems and infrastructure.
Meeting the new federal requirements and seeing improved outcomes for children and families will require a shift in thinking and investments, including:
- A Cross-Sector Approach. Working with children and families to prevent child abuse and neglect is not the sole responsibility of the Division of Social Services. It requires sufficient long-term investment in the systems that touch children and families, including early care and education, K-12 education, mental health, Medicaid, public health, housing, transportation, juvenile justice and the courts. The NC General Assembly passed up an opportunity to deepen investments in our system with new federal funding for child care subsidies.
- A Focus on Social Determinants of Health. Most of our health is driven by where we live, work and play, but very little of our public investment in health is dedicated to improving those social determinants of health. The NC Department of Health and Human Services has shifted to a new focus on social determinants of health, which will inform the development of their Early Childhood Action Plan, due out later this year.
Child Abuse and Neglect is a NC Pathways to Grade-Level Reading Measure of Success. Child abuse and neglect impacts children’s short- and long-term health and educational outcomes, including early literacy. Maltreatment is linked to language deficits, reduced cognitive functioning, social and behavioral difficulties, and attention deficit disorders. The incidence of child abuse and neglect is reduced when protective factors (such as social support, high quality reliable out-of-home child care, access to treatment of depression, and decent housing) are strengthened, and risk factors (such as poverty, social isolation, absence of supportive adults, and violence in the home or neighborhood) are lessened.
Pathways to Grade Level Reading is bringing together diverse leaders working across disciplines, sectors, systems, and political ideologies to define a common vision, shared measures of success and coordinated strategies that support children’s optimal development beginning at birth. Pathways is an initiative of the NC Early Childhood Foundation in collaboration with NC Child, the North Carolina Partnership for Children (Smart Start) and BEST NC.
Speakers at this week’s Family First Prevention Services Act Briefing and Discussion included:
- Rob Geen, Director of Policy Reform and Advocacy, Annie E Casey Foundation
- Dan Duffy, President and CEO of Prevent Child Abuse America
- Lauren Berntsen, Domestic Policy Advisor, Senate Finance Committee, Ranking member Ron Wyden (D-OR) (via skype)
- Ryan Martin, Senior Human Services Advisor, Senate Finance Committee, Chairman Orrin Hatch (R-UT) (via skype)
In addition, Michelle Hughes, Executive Director of NC Child, moderated a panel discussion that included:
- Lisa Cauley, Deputy Director, Child Welfare Services, NC DHHS
- Sharon Hirsch, President and CEO, Prevent Child Abuse North Carolina
- Karen McLeod, President and CEO, Benchmarks
- Tracie Murphy, Children’s Services Committee Chair, NC Association of DSS Directors
The event was livestreamed and recorded. The recording and the PowerPoint presentations used at the event are available on the DHHS website.