Five years on, the Family First act has failed in its aims

It’s been five years since the Family First Prevention Services Act (FFPSA) was signed into law with bipartisan support in Washington. At the time, many advocates hailed the law as a historic, transformative achievement. But the results so far leave much to be desired.

FFPSA had two primary aims — to make more federal dollars available to states for programs that would strengthen families and keep more children out of the foster care system, and to restrict federal funding for congregate care with the idea of keeping more foster children in family placements instead of group homes.

The law thus far largely has failed on both fronts. On the prevention side, there are several statutory problems that have impeded the law’s effectiveness, including rigid standards regarding what constitutes an “evidence-based” program; eligibility restrictions that limit services to children and families at “imminent risk” of foster care; and numerous administrative burdens that make the law challenging to implement for states and counties.

The results of these bureaucratic barriers are clear. The latest available federal data reveal that just 6,200 kids across the entire country are receiving an FFPSA-funded service, costing a grand total of $29 million. Given that there are about 800,000 substantiated reports of abuse and neglect per year, FFPSA has proved to be woefully inadequate. Oddly, there has been little discussion in Washington about the shockingly limited rollout of these prevention services.

Meanwhile, FFPSA’s restrictions on federal funding for congregate care have proved to be deeply harmful to the children it was intended to help. If you want to understand why foster children across the country are being housed in a range of inappropriate temporary settings, including county and state offices, hospitals, hotels and shelters, FFPSA is a significant factor. 

An August investigation by the Philadelphia Inquirer found that the city’s Department of Human Services housed more than 300 kids in its offices for at least one night over the previous year. Most nights, five to 10 children with complex needs are sleeping in the “child care room,” where young children are co-mingled with teenagers and safety concerns are rampant — including assault, vandalism and trafficking. Some children spend weeks if not months there.

The crisis is perhaps most acute in Illinois, where the state’s Department of Children and Family Services (DCFS) has since 2018 documented more than 2,000 cases of foster children being improperly held in inappropriate settings including offices, shelters and psychiatric hospitals. The DCFS director was held in contempt of court 12 times in 2022 for failure to provide an appropriate placement for foster children. Since 2015, the state has lost at least 460 children’s residential treatment beds. 

These states are not outliers. Similar stories have emerged in Colorado, Virginia, Oregon, Georgia, New Mexico, Washington and North Dakota, among others. Because of increasing levels of need within the foster care population (the result of waiting longer to remove kids from abusive and neglectful homes and a larger youth mental health crisis), and financial challenges facing direct service providers, group homes were already being stretched thin. Thousands of children have nowhere safe to sleep. 

FFPSA amplified these challenges by establishing a new category of congregate care programs — Qualified Residential Treatment Programs (QRTPs) — and requiring direct service agencies to meet specific standards to remain eligible for federal reimbursement. With few exceptions, programs that did not meet QRTP standards are ineligible for federal funding after two weeks of placement, including community group homes as well as programs designed to “step down” youth from the juvenile justice system back into the community. At the same time, FFPSA also triggered a regulatory issue in the Medicaid program known as the Institutions for Mental Disease (IMD) exclusion, which has forced many providers to limit their number of beds to 16 or below, further straining capacity in the system.

Unfortunately, there continues to be a widespread refusal to acknowledge that some children in the foster care system actually do need care in a group home, even if it is on a temporary basis or as a transition from higher level psychiatric facilities. 

It is hard for anyone — let alone for legislators who worked for years to achieve bipartisan support on a significant change in the law — to acknowledge that they were wrong. But in reality, Family First is too restrictive and administratively difficult and it is in desperate need of change. If Congress wants FFPSA to fulfill its promise and meet the expectations of legislators and the public, there needs to be a real discussion about amending the law to address these shortcomings. 

At minimum, the evidence-based standards should be loosened, eligibility for prevention services should be expanded, some of the restrictions on federal funding for congregate care should be repealed, and the federal government should support states in developing alternative placements for children historically served in congregate care. Until then, Family First will continue to put children last.

Sean Hughes is founder of Social Change Partners LLC, which provides policy consulting to clients in child welfare and related areas. Naomi Schaefer Riley is a senior fellow at the American Enterprise Institute.