U.S. GOVERNMENT PUBLISHING OFFICE

33–873 WASHINGTON : 2019

THE OPIOID CRISIS: IMPLEMENTATION OF THE 

FAMILY FIRST PREVENTION SERVICES ACT (FFPSA) 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HUMAN RESOURCES 

OF THE

COMMITTEE ON WAYS AND MEANS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFTEENTH CONGRESS 

SECOND SESSION 

JULY 24, 2018 

Serial No. 115–HR08 

Printed for the use of the Committee on Ways and Means 

( 


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COMMITTEE ON WAYS AND MEANS 

KEVIN BRADY, Texas, Chairman 

SAM JOHNSON, Texas 

DEVIN NUNES, California 

DAVID G. REICHERT, Washington 

PETER J. ROSKAM, Illinois 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

LYNN JENKINS, Kansas 

ERIK PAULSEN, Minnesota 

KENNY MARCHANT, Texas 

DIANE BLACK, Tennessee 

TOM REED, New York 

MIKE KELLY, Pennsylvania 

JIM RENACCI, Ohio 

KRISTI NOEM, South Dakota 

GEORGE HOLDING, North Carolina 

JASON SMITH, Missouri 

TOM RICE, South Carolina 

DAVID SCHWEIKERT, Arizona 

JACKIE WALORSKI, Indiana 

CARLOS CURBELO, Florida 

MIKE BISHOP, Michigan 

DARIN LAHOOD, Illinois 

BRAD R. WENSTRUP, Ohio 

RICHARD E. NEAL, Massachusetts 

SANDER M. LEVIN, Michigan 

JOHN LEWIS, Georgia 

LLOYD DOGGETT, Texas 

MIKE THOMPSON, California 

JOHN B. LARSON, Connecticut 

EARL BLUMENAUER, Oregon 

RON KIND, Wisconsin 

BILL PASCRELL, JR., New Jersey 

JOSEPH CROWLEY, New York 

DANNY DAVIS, Illinois 

LINDA SA ́ NCHEZ, California 

BRIAN HIGGINS, New York 

TERRI SEWELL, Alabama 

SUZAN DELBENE, Washington 

JUDY CHU, California 

GARY J. ANDRES, Staff Director 

BRANDON CASEY, Minority Chief Counsel 

SUBCOMMITTEE ON HUMAN RESOURCES 

ADRIAN SMITH, Nebraska, Chairman 

JACKIE WALORSKI, Indiana 

CARLOS CURBELO, Florida 

DAVID SCHWEIKERT, Arizona 

DARIN LAHOOD, Illinois 

BRAD R. WENSTRUP, Ohio 

DAVID G. REICHERT, Washington 

DANNY DAVIS, Illinois 

LLOYD DOGGETT, Texas 

TERRI SEWELL, Alabama 

JUDY CHU, California 


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C O N T E N T S 

Page 

Advisory of July 24, 2018 announcing the hearing ............................................... 2 

WITNESS 

Jerry Milner, Associate Commissioner, Children’s Bureau, and Acting Commissioner, Administration on Children, Youth and Families, United States 

Department of Health and Human Services ...................................................... 6 

MEMBER QUESTIONS FOR THE RECORD 

Rep. Danny K. Davis to Jerry Milner .................................................................... 142 

Rep. Jackie Walorski to Jerry Milner .................................................................... 144 

Rep. David Reichert to Jerry Milner ...................................................................... 144 

Rep. Judy Chu to Jerry Milner ............................................................................... 144 

Rep. Adrian Smith to Jerry Milner ........................................................................ 146 

Rep. Danny K. Davis to Jerry Milner .................................................................... 147 

Rep. Brad Wenstrup to Jerry Milner ..................................................................... 159 

Rep. Lloyd Doggett to Jerry Milner ....................................................................... 159 

Rep. Terri Sewell to Jerry Milner .......................................................................... 161 

Rep. Judy Chu to Jerry Milner ............................................................................... 161 

Rep. John Lewis to Jerry Milner ............................................................................ 163 

Rep. Carlos Curbelo to Jerry Milner ...................................................................... 164 

PUBLIC SUBMISSIONS FOR THE RECORD 

Zero to Three, statement ......................................................................................... 166 

CSH, statement ........................................................................................................ 176 

FamiliesFirst Network of Lakeview, statement .................................................... 180 

Florida Coalition for Children, statement ............................................................. 181 

Karin Axner, statement .......................................................................................... 183 

Children’s Home Society of America, statement ................................................... 185 

Alliance for Strong Families and Communities, statement ................................. 189 

County of Los Angeles Department of Children and Family Services, statement ...................................................................................................................... 195 

Eagle Accreditation, statement ............................................................................... 198 

Never Too Late, Inc., statement ............................................................................. 200 

The Methodist Home, statement ............................................................................ 201 

New York State Office of Children and Family Services, statement .................. 203 

Center for Fiscal Equity, statement ....................................................................... 213 


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THE OPIOID CRISIS: IMPLEMENTATION 

OF THE FAMILY FIRST PREVENTION 

SERVICES ACT (FFPSA) 

TUESDAY, JULY 24, 2018 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON WAYS AND MEANS, SUBCOMMITTEE ON HUMAN RESOURCES, Washington, DC. 

The Subcommittee met, pursuant to call, at 10:03 a.m., in Room 

1100, Longworth House Office Building, the Honorable Adrian 

Smith [Chairman of the Subcommittee] presiding. 

[The advisory announcing the hearing follows:] 


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@ 

WAYS AND MEANS 

CHAIRMAN KEVIN BRADY 

Chairman Smith Announces Human Resources Subcommittee 

Hearing on The Opioid Crisis: Implementation of the 

Family First Prevention Services Act (FFPSA) 

House Ways and Means Human Resources Subcommittee Chairman Adrian Smith (RNE) announced today that the Subcommittee will hold a bearing entitled "The Opioid 

Crisis: Implementation of the Family First Prevention Services Act (FFPSA)" on 

Tnesday, July 24, 2018 at 10:00 AM in 1100 Longwol'th House Office Building. This 

hearing will review the Department of Health and Human Services' ongoing progress 

implementing recently enacted legislation to address family substance abuse issues, 

improve child well-being, support kin caregivers, and strengthen families. 

In view of the limited time to hear witnesses, oral testimony at this hearing will be from 

invited witnesses only. However, any individual or organization may submit a written 

statement for consideration by the Committee and for inclusion in the printed record of 

the hearing. 

DETAILS FOR SUBMISSION OF WRITTEN COMMENTS: 

Please Note: Any person(s) and/or organization(s) wishing to submit written comments 

for the hearing record must follow the appropriate link on the hearing page of the 

Committee website and complete the infom1ational forms. From the Committee 

homepage, http://waysandmeans.house.gov, select "Hearings." Select the hearing for 

which you would like to make a submission, and click on the link entitled, "Click here to 

provide a submission for the record." Once you have followed the onl.ine instructions, 

submit all requested information. ATTACH your submission as a Word document, i.n 

compliance with the fonnatting requirements listed below, by the close of business on 

Tuesday, August 7, 2018. For questions, or if you encounter technical problems, please 

call (202) 225-3625. 

FORMATTING REQUIREMENTS: 

The Committee relies on electronic submissions for printing the official hearing record. 

As always, submissions will be included in the record according to the discretion of the 

Committee. The Committee will not alter the content of your submission, but we reserve 

the right to fonnat it according to our guidelines. Any submission provided to the 
3 

f 

Chairman SMITH. The Subcommittee will come to order. Welcome to today’s hearing on the implementation of the Family First 

Prevention Services Act. 

After steady declines in the number of children in foster care, we 

have, unfortunately, begun to see an increase again. Both the data 

and the experience of those on the front lines indicate substance 

abuse, specifically opioid use and overdose, are a contributing factor. 

More than 3 years ago, this Subcommittee set out to reverse this 

trend and do what Americans across this country expect of us. We 

worked together across the aisle and across the Capitol. Inspired 

by a desire to improve outcomes for children, we knew we had to 

strengthen families, whether they are biological, foster, or adoptive. 

We remained steadfast to the questions we were hearing from 

former foster youth, such as, ‘‘Why did you take me away,’’ ‘‘Why 

didn’t you help my mom,’’ or ‘‘Why didn’t you help my dad?’’ 

Backed by research in the field, we set out to change the role of 

Federal taxpayer dollars in foster care and adoption. We wanted to 

reset the incentives and focus resources earlier, with upfront prevention services for substance abuse, mental health, and parenting 

for all families, so fewer children would have to experience additional trauma of being removed from his or her home. 


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4 

We listened to advocates, researchers, States, providers and, 

most importantly, foster youth during the multiyear policy development process. For me, one of those voices was Nebraska’s own Boys 

Town and Reverend Steven Boes, where, for more than 100 years, 

Boys Town, has been helping children and healing families. Feedback from Boys Town helped us further our goal of providing the 

right kind of supports at the right time for each child in care. 

Now, 6 months after the enactment of the Family First Prevention Services Act, we return to talk about the implementation of 

this important law, again using those same voices to drive our 

questions today. 

To provide the answers, we are pleased to be joined by HHS Associate Commissioner for the Children’s Bureau and lead policy official for the implementation of Family First, Jerry Milner. He 

brings with him more than 40 years of practice, management, and 

technical assistance experience in child welfare at the local, State, 

and Federal levels of government. He has been a busy man over 

the last 6 months, traveling the country to spread the word about 

Family First and address outstanding questions. 

Thank you, Mr. Milner, for being here today and for all of your 

efforts to Family First. 

I also want to commend my home State of Nebraska for being 

on the leading edge of implementation and setting a strong example for others under the leadership of Dr. Courtney Phillips, CEO 

of the Nebraska Department of Health and Human Services; and 

Director Matthew Wallen of the Division of Child and Family Services, DCFS. 

In June, DCFS hosted a kickoff meeting, marking the official 

start of the State’s efforts to implement the act and included a 

number of child welfare stakeholders, such as judges, advocates, 

providers, families, and others often involved in the State’s child 

welfare system. 

This type of cross-collaboration is precisely what Family First is 

all about and will create the type of positive systems change to improve outcomes for children and families for years to come. 

They also set up working groups on specific topics which need to 

be addressed under Family First, and those groups will be meeting 

regularly over the next few months to develop strategies for implementing Family First. Nebraska DHHS also created a website 

where the public can engage in the process of implementing Family 

First and monitor the progress. 

The use of technology also exists to their creative thinking families in the rural and sometimes remote areas of our state when it 

comes to providing prevention services. And they are thinking 

about ways to dovetail Family First with their existing ‘‘Bring Up 

Nebraska’’ initiative, which is a primary prevention program focused on developing nurturing communities to raise strong and 

healthy children. 

Every State is different and will have to chart its own course for 

Family First, but States like Nebraska, Oregon, and others are 

showing it can be done when everyone focuses on what is truly important: better outcomes for children and families. 

I now recognize the distinguished Ranking Member, Mr. Davis, 

for 5 minutes for his opening statement. 


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Mr. DAVIS. Thank you, Mr. Chairman. 

And before getting into my opening comments, I would like to 

recognize my colleague Congresswoman Karen Bass, who is here 

today observing our hearing. Congresswoman Bass is a tremendous 

leader on foster care issues, was a valued partner and resource 

throughout our efforts to enact this landmark change in foster care. 

I look forward to continuing to work closely with her and as we implement the law. And I might indicate that she also organized the 

foster care caucus that any number of us are members of. 

Mr. Chairman, thank you for scheduling this bipartisan oversight hearing. Child welfare is a deeply important issue to me and 

to the people of Illinois. I am grateful that we are working together 

so closely to ensure effective implementation of the landmark new 

law, the Family First Prevention Services Act, or Family First. 

Frederick Douglas was fond of saying that it is easier to build 

strong children than to repair broken men. There are very few 

places that this lesson is more evident than in our troubled foster 

care system, which has historically provided help only when it was 

too late to keep families together. 

When I ask foster youth what policymakers could do to make 

child welfare better, they almost always say: ‘‘You could have 

helped my mom and dad.’’ 

That is exactly what we tried to do in Family First. 

I am proud of our work together to enact this law to fundamentally shift child welfare from separating families to strengthening 

them, but our work is not done until children and families receive 

the help that they were promised. That is why we hold this hearing 

today, and that is why we will continue our active involvement in 

its implementation. 

Family First provides a number of opportunities to strengthen 

families and build strong children. For families struggling with 

mental health, substance abuse, or parenting skills and challenges, 

it will provide uncapped Federal matching funds for State services 

to address those challenges and to make foster care unnecessary. 

Importantly, these services are available to parents, children, and 

other family members. They are also available to youth in foster 

care who are pregnant and those who are parents, both mothers 

and fathers, to prevent the cycle from repeating. 

To trigger the Federal investment in these services, States will 

need to develop prevention plans and provide a contribution. Child 

welfare advocates state that local officials and State legislators 

have told us they have a number of questions that need to be answered so that we can do that. We will ask our questions today, 

and we hope to get answers that will support positive action. 

Another aspect of the new law that is close to my heart is the 

opportunity to better support grandparents and other kinship caregivers. My congressional district has the highest percentage of children living with grandparent caregivers in the Nation. We know 

that if children can’t live safely with their parents, being with family is the next best option. But these kin caregivers need help and 

support. 

I commit to personally making sure that the new Federal funding for kinship navigators provides services to all grandfamilies 


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that need them and that States update their policies to involve and 

support kin. 

The Department of Health and Human Services has already 

begun issuing policy guidance and soliciting applications for kinship navigator funds and regional partnership grants to address 

family substance abuse that will be available even before the permanent prevention funding, but there is a great deal of work to do. 

I appreciate Jerry Milner for being here with us today to answer 

our questions and his commitment to making the law a success. I 

look forward to working with the administration as we move ahead 

on behalf of the families we represent. 

Thank you, Mr. Chairman, and I yield back. 

Chairman SMITH. Thank you, Mr. Davis. 

I would like to welcome our witness to the table: Mr. Jerry Milner, Associate Commissioner at the Children’s Bureau and Acting 

Commissioner of the Administration on Children, Youth and Families, and with the United States Department of Health and Human 

Services. 

Our witness is reminded to limit his oral testimony to 5 minutes. 

And certainly, your written statement will be included in the 

record. I would also like to remind our witness and Members that 

time is limited today and that the topic for today’s hearing is oversight of the implementation of Family First Prevention Services 

Act. 

While there are certainly many important issues we are all facing today, this hearing is part of a larger effort to make Family 

First a success by addressing outstanding questions that are holding States back from moving forward on this very important legislation. 

I would kindly suggest that if there is a veering off track, I will 

not hesitate to make sure that we bring the hearing back to its primary focus. 

With that, Mr. Milner, you may begin when you are ready. 

STATEMENT OF JERRY MILNER, ASSOCIATE COMMISSIONER, 

CHILDREN’S BUREAU, AND ACTING COMMISSIONER, ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, UNITED 

STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Mr. MILNER. Thank you, Chairman Smith, Ranking Member 

Davis, and Members of the Subcommittee. Thank you very much 

for inviting me here today to testify about something that is near 

and dear to me and the work that I have done over many years 

now. 

I also want to acknowledge the large number of former foster 

care youth who are in the room today, many of whom I know and 

have had the pleasure of meeting with over time. I unabashedly 

say that their voice gives me a voice, and it means a lot to me that 

they are here today. 

I began my career as a case—— 

Chairman SMITH. One moment. If you don’t mind my interruption, former foster youth in the audience, would you raise your 

hand? Very good. It is great to have you here. And, again, I apologize for interrupting, but your input is very valuable, and we are 

glad you are here. Please proceed. 


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Mr. MILNER. Thank you. I began my career as a case-carrying 

social worker, and child welfare has, frankly, remained my life’s 

work. Before joining the administration, my experience in child 

welfare included providing technical assistance to States to improve services to children and families as well as serving as Alabama’s State child welfare director. 

In more than four decades of work in child welfare, I have seen 

far too many situations where all the factors that place children at 

risk of serious harm went unaddressed by the child welfare system 

until a serious injury, psychological damage, or something much 

worse occurred. These things do not typically happen because of a 

lack of will or a lack of skill within the child welfare workforce but, 

rather, because of the way our system has been designed and funded. 

Traditionally, the majority of Federal funds have been used for 

foster care, and in comparison we spend only a tiny fraction of Federal funds for actual prevention of child maltreatment before children become known to child welfare agencies. It does not have to 

be that way. 

I am pleased to report to you that we have made significant 

progress in implementing the Family First Act, and we are absolutely committed to timely and effective implementation. 

By permitting, for the first time States and Tribes to use title 

IV–E funds to prevent children from entering foster care, the Family First Act provides a pathway for the child welfare system to 

help some families stay together rather than placing their children 

in foster care. Our approach to Family First implementation allows 

for as much flexibility as the statute permits. We do not intend to 

regulate definitions of key concepts beyond what is already in the 

statute. We will also strive to provide maximum flexibility to 

States and Tribes in claiming funding for prevention services. Our 

first program instruction to States and Tribes was published on 

May 31st and addressed the amendments to title IV–B of the Social 

Security Act and the Chafee Foster Care Independence Program. 

Our program instruction on the amendments to title IV–E, the Foster Care Prevention and Permanency Program, was published on 

July 9th. 

In order to participate in the new title IV–E Prevention Services 

Program, States and Tribes will submit a plan to us that describes 

how they will carry out the program. We will provide information 

to States and Tribes on how to submit this plan in a further program instruction that we expect to publish in the first quarter of 

Federal fiscal year 2019. 

We are in the process now of procuring contract support to create 

the clearinghouse that will identify interventions that satisfy the 

requirement for reimbursement under the Prevention Services Program, and we expect to award a contract in the coming weeks. 

I also want to acknowledge a few of the implementation challenges that States and Tribes, as well as other stakeholders in the 

child welfare community, are sharing with us. We have heard concerns about the availability of the array of prevention services 

needed to be effective, about developing alternative placement options for children in congregate care who may not be able to succeed in a foster family home, about the expensive upfront cost of 


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evidence-based programs and about the time limits on reimbursable prevention services in light of wait lists and delays in getting 

families into services. Some States that have had the flexibility of 

title IV–E waivers for quite some time are also concerned about the 

loss of that flexibility. 

While some of these challenges are undoubtedly very complex, we 

are committed to providing States and Tribes with assistance to 

promote their opportunities for success. Creating a child welfare 

system that we can be proud of as a Nation and one that children, 

families, and communities will see as a source of support and 

strength as opposed to a system to fear will take collaboration 

across the three branches of government. 

We have a collective duty and a responsibility to ensure that 

Federal policy and funding protects children to the best extent possible, which includes living in resilient, healthy families. I look forward to working with you as we continue implementation, and I 

am happy to answer your questions. 

Chairman SMITH. Thank you, Mr. Milner. Thank you for sharing your insight and expertise. 


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Statement by 

Jerry Milner 

Associate Commissioner 

The Children's Bureau 

Administration for Children and Families 

U.S. Department of Health and Human Services 

Before the 

Subcommittee on Human Resources 

Committee on Ways and Means 

United States House of Representatives 

July 24, 2018 
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Chainnan Smith, Ranking Member Davis, and Members of the Subcommittee, thank you for 

inviting me to testify on behalf of the Department of Health and Human Services (HHS). I am 

Jerry Milner, the Associate Commissioner of the Children's Bureau, and the Acting 

Conunissiooer for the AdJUinistration on Children, Youth and Families. I am here today to 

discuss our progress in implementing the Family First Prevention Services Act (FFPSA). 

Child welfare is my life's work. Before joining the Administration, I served as the Vice 

President for Child Welfare Practice at the Center for the Support ofF amilies, providing 

assistance to states in improving services to children and families. My prior experience in child 

welfare also includes servi11g as Alabama's state child welfare director and working as a career 

employee in the Children's Bureau to implement and manage the Child and Family Service 

Reviews. I began my career as a case-carrying child welfare social worker. 

Each of these experiences strengthened my conviction that we must re-envision child welfare in 

the United States as a system that strengthens fami lies and breaks hannful cycles of trauma and 

family disruption, rather than waiting until children are hurt to respond. Foundational principles 

and values should guide our work in child welfare, including the recognition that all parents and 

families could become vuh1erable with a twist of fate, that all families are worthy and deserve 

respect, that all children love their parents, and that everyone needs a little help at times in 

overcoming life's challenges. 

In more than four decades of work in child welfare, I have seen too many situations where all the 

factors that place children at risk of serious bann went unaddressed by tbe child welfare system 

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until a serious injury, psychological damage, or something much worse occurred. These things 

do not typically happen because of lack of will or skill within the child welfare workforce, but 

rather because of the way our systems are designed and funded. Traditionally, the overwhelming 

majority of federal funds have been used for foster care. There are now more than 437,000 

children in foster care and more than four million reports of maltreatment per year and the 

numbers are increasing. We spend only a tiny fraction of federal funds on preventing the 

maltreatment of children before they become known to child welfare agencies. It does not have 

to be that way. 

President Trump signed FFPSA into law in February of this year. As you are aware, FFPSA sets 

aggressive timelines for the substantial changes contemplated by the legislation. I am pleased to 

report that we have made significant progress in implementation of its provisions and 

requirements, and we arc committed to a timely and effective implementation. 

Before describing our progress further, I would like to explain the central role that we believe 

FFPSA will perform in changing child welfare programs in tbe United States and our approach 

to implementation of the law. 

Role of FFPSA 

By permitting, for the first time, states and tribes to use federal title IV-E funds to prevent 

children from entering foster care, FFPSA provides a pathway for the child welfare system to 

help some fami lies to stay together rather than placing children in toster care. In fiscal year (FY) 

20 16, close to I 0 percent of the children exiting foster care were in care for less than 30 days. 

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The percentage of such short stays has declined slightly over the past five years, but the question 

remains whether prevention services offered to many of the more than 24,000 children could 

have prevented them from being placed in foster care in the first place. 

FFPSA provides a tremendous opportunity to make substantial improvements in the outcomes of 

children and families in the child welfare system. Such improvements, as FFPSA seeks to 

create, require shifts in long-held mindsets, a new vision of serving children and families, and a 

commitment to a different way of working with communities and the broader child welfare 

system. If states and tribes focus their efforts solely on meeting the technical requirements of the 

law, they may not achieve the goals ofFFPSA. Successful implementation must also occur in 

communities and in collaboration with stakeholders that affect the lives of families in those 

conununities every day, including the legal and judicial community, and public and private 

service providers. Communities know their residents' needs better than anyone in Washington, 

D.C., and we should assist them in supporting their families. 

Approach to Implementation 

Our approach to FFPSA implementation allows for as much flexibility as the statute permits. 

We do not intend to regulate defmitions of key concepts beyond what is in the stanate, such as 

"candidate," "inm1inent risk of foster care entry," and " risk of sex trafficking." We will also 

strive to provide maximum flex ibility to states and tribes in claiming funding for prevention 

services. 

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While the law is prescriptive in terms of the evidence base required for allowable prevention 

services, we will seek to open the door of"promising" practices so that stales and tribes using 

practices shown outcomes to support fami lies and children in remaining together safely, while 

continuing to use those services while building the necessary evidentiary support. We will also 

look for flexibilities to incorporate basic community-based, family support services into the 

realm of reimbursable prevention services to the extent possible. 

To prepare for implementation that meets the spirit and intent of the FFPSA, we are engaging 

stakeholders to hear their concerns, respond to questions, and assist states and tribes. Our efforts 

include: regional listening sessions witb states and tribes; fonnal requests for public comment; 

site visits in many states to observe effective community-based prevention programs; national 

webinars; in-person discussions with our relevant grant clusters; participation in child welfare 

professional membership or association meetings; and individual meetings and calls with state 

and county child welfare leaders. We will also use our formal tribal consultation process to 

address tribal FFPSA issues. Our intent in making these significaut efforts is to develop a 

thoughtful, well-infom1ed, and comprehensive implementation plan that will best position all 

states, territories, and tribes for success. 

Our goal is to provide guidance and instruction in a fom1at and timeline that enables the 

Children's Bureau, states, and tribes to meet statutory deadlines. Through an initial infonnation 

memorandum published on April 12, we provided an overview of the FFPSA provisions and 

requirements. 

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Amendments to Title IV -B of the Social Security Act 

Our first program instmction to states and tribes was published on May 31 and addressed the 

amendments to title IV -B of the Social Security Act and the Chafee Foster Care Independence 

Program (now renamed as the John H. Chafee Foster Care Program for Successful Transition to 

Adulthood) and Education and Training Vouchers (ETV) Program. States and eligible tribes 

submit plans to operate both the title IV-B and Chafee programs in their five-year Child and 

Family Se1vices Plans, and update these plans annually through the Annual Progress and 

Services Reports (APSR). This guidance document serves as an addendum to instructions for 

submission of the 2018 APSR and includes instruction on the following provisions: 

Implementing procedures and protocols to ensure that children in foster care are not 

inappropriately diagnosed and placed in settings that are not foster family homes as a 

result; 

Providing services and activities that address the developmental needs of all 

vulnerable children under the age of five; 

Compiling accurate information on child maltreatment deaths and developing 

comprehensive plans to prevent child maltreatment fatalities. Tracking trends, 

planning service improvements, and preventing child maltreatment deaths; 

Redefining "family support services" and "family reunification services"; 

Revising the population of children and youth that may be served by the Chafee 

Program; and 

Extending ETV eligibility up to age 26, and adding a five-year limit on receipt of 

vouchers. 

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States and tribes, where applicable, must describe how they intend to comply with these 

provisions no later than August 15, 2018. 

Amendments to the Title IV-E Foster Ca•·e Maintenance Payments Program 

Our program instruction on the amendments to the title IV-E Foster Care, Prevention, and 

Permanency Program was published on July 9. It instructed states and eligible tribes on how to 

amend their title IV -E plans to submit evidence of compliance for the following provisions: 

• Delaying the Adoption Assistance phase-in that de-links Aid to Families with 

Dependent Children eligibility from program eligibility criteria; 

Providing proof that a youth was in foster care; 

• Pennitting time-l.imited placements in a licensed residential family-based 

treatment facility for substance abuse; 

Conducting criminal record and child abuse and neglect registry checks for all 

adults working in child care institutions; 

• Adhering to model licensing standards for foster family homes; 

• Preventing states and tribes from implementing new policies that increase the 

juvenile justice population; 

• Limiting title IV -E payments to children placed in child care institutions; and 

• Implementing requirements for placements in qualified residential treatment 

programs (QRTP). 

The program instruction also provides instmctions to states and tribes that opt to delay some of 

these provisions, as pennitted by law. Timelines for demonstrating compliance vary 

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significantly based on the statutory effective dates of the provisions and/or the applicable 

delayed effective date. 

Implementation or the Title JV-E Pt·evention Services PJ"ogJ"am 

To participate in the new title IV-E prevention services program, states and tribes will submit a 

plan to the Children's Bureau that describes how the state or tribe will carry out the program, the 

population served, and the approved evidence-based intervention(s). The Children's Bureau will 

provide information on how to S\>bmit these plans through a program instruction for states and 

another for tribes that we expect to publish in the first quarter of FY 2019. 

Operation of a title IV-E prevention services program will require use of an approved set of 

evidence-based interventions that fall into one of three levels of evidence set forth in the statute. 

The statute requires HHS to develop and publish criteria for detennining what level of evidence 

interventions meet and are, therefore, approved for title IV-E funding. HHS is also required to 

create a clearinghouse of the criteria and approved interventions. 

We are procuring contract support to create the clearinghouse that will be responsible for 

identifying interventions that satisfy the criteria for reimbursement under the title IV-E 

prevention services program and expect to award a contract in the coming weeks. We arc 

developing the criteria for systematically reviewing programs and services this summer. Further, 

we are engaged in a broad consultation effort on development of the criteria. This effort began 

with a notice for public comment published in the Federal Register on June 22. 

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Our intent is to include the criteria and an initial list of programs and services identified for 

review by the clearinghouse in the program instntction, which we will publish in the ftrst quarter 

ofFY 2019. Contracted support will administer the clearinghouse, which includes ongoing 

review and identification of interventions eligible for reimbursement under the 

title IV-E prevention services program, and, to the extent that any oftbe appropriated funds for 

the clearinghouse are available, for limited support to states in evaluating their services. 

FFPSA Implementation Challenges 

In addition to the opportunities for improving child welfare through FFPSA implementation, I 

also want to share the implementation challenges. Based on extensive contacts with state child 

welfare leaders and other stakeholders, we have heard concerns about the availability of the array 

of prevention services needed to be effective and about developing alternative placement options 

for children in congregate care. Some states that have had the flexibi lity of the title IV-E waivers 

for long periods of time are also concemed about the loss of flexibility wben tbe waiver authority 

expires next year, and bow their current work will be supported under FFPSA. 

Through our analysis of tbe legislation, our interactions with states and tribes, and our initial 

implementation efforts, we have identified the following important implementation challenges. 

Start-up costs are a potential barrierfor states 

Title IV -E is a cost reimbursement program and agencies must pay the full cost of prevention 

services up front. Therefore, state and tribal access to start-up funding required for initial 

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participation in the title IV-E Prevention Services Program may be a barrier, as evidence-based 

interventions can be very expensive to implement. 

Availability of an adequate array of placement options for children in foster care 

While congregate care placements have declined nationally from 14.6 percent of the tester care 

population in 2012 to 12.2 percent in 20 16, some youth currently in congregate care may be 

unable to succeed in a foster family home because they may have needs that cannot be addressed 

in a family setting. FFPSA reduces the types of allowable facilities to a few that focus on 

specialized populations such as pregnant youth, and may be insufficient for the full population of 

youth in foster care. HHS will work with states to help ensure all youth are placed in the most 

appropriate setting. 

Twelve-monlf1 availability of prevention services is too short for many families' needs 

States are rarely able to enroll families in programs and services immediately due to limited 

availability of services, wait lists, and other barriers. As a result, availability of federal 

reimbursement under the title IV-E Prevention Services Program is likely to be less than the 

12 months from the time the state identifies the child as being in need of programs and services 

as allotted in the statute. States are also seeing a significant increase in the misuse of opioids and 

other substances, often resulting in more families encountering the child welfare system. \Vhile 

we anticipate that FFPSA can provide substantial funding for substance abuse treatment services 

to fami lies whose children are at imminent risk of entering foster care, states will need to ensure 

they can promptly place families in these services to ensure they are taking full advantage of the 

twelve-montl1 period of availability provided by the statute. 

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Review of all studies on prevemion programs and services as parr of!he clearinghouse 

Although FFPSA statutory criteria and evidence review requirements closely align with existing 

evidence-based clearinghouses, significant differences exist that will likely make reviews timeconsuming and resource-intensive. Many studies of relevant programs and services have not 

been reviewed in accordance with the statutory requirements. For example, FFPSA broadens the 

type of research that may meet criteria to include rigorous quasi-experimental research designs in 

addition to randomized control trials for designating well-supported and supported practices. 

Further, FFPSA requires the risk of harm to be assessed for studies (including case data) on 

programs and services. These requirements will result in a large number of studies needing 

to be reviewed with the new criteria. 

Limiled currem availabiliry of well-supported prevemion programs and services 

FFPSA requires states to spend at least 50 percent of their IV -E prevention funding on wellsupported programs. Few programs have been documented as well-supported to date and states 

will need to train and support child welfare staff to ensure suc-cessful implementation and fidelity 

to existing well-supported program models. 

Dijficulry de1ermining which kinship navigalor programs would meel slaruiOJy crileria 

FFPSA opens up title IV -E reimbursement for kinship navigator programs that meet one of the 

levels of evidence required in the prevention programs. To date, it is unclear whether any 

kinship navigator programs meet statutory criteria because they have not been included in 

existing evidence reviews. The clearinghouse will need to review studies on these kinship 

navigator programs to determine eligibility for IV -E reimbursement. 

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Limited number of qualified residential treatment programs meeting !he statuto1y criteria 

There are currently a limited number ofQRTPs that meet the statutory criteria, FFPSA requires 

programs to be accredited by certain organizations, be trauma-infonned, and provide aftercare 

services for six months following discharge, among other things. There are additional 

requirements, such as court approval, for children placed in these programs that may reduce or 

eliminate federa l participation for children placed there. 

Limiled availability of qualified individuals 10 assess placements in QRTPs 

ln order to receive reimbursement for a child placed in a QRTP, a state must ensure that a child's 

placement is assessed by a "qualified individual" within 30 days of the start of the placement. 

States already stmggle to meet existing needs and requirements given the low supply of qualified 

clinicians, and this may become more difficult under the new requirements. 

While some of these challenges are undoubtedly complicated, we are committed to providing 

states and tribes with resources, guidanc.e, and technical assistance to promote their success in 

complying with the FFPSA amendments and in taking advantage of this historic opportunity to 

access prevention funds and realign the child welfare system in the United States. 

Conclusion 

In addition to sharing infonnation on our work to implement this legislation effectively and 

capitalize on the opportunity, I also would like to articulate the importance of working with 

families even further upstream through efforts to prevent maltreatment from occurring in the first 

place, as part of a broad continuwn of prevention services and flexible funding. 

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In several jurisdictions, primary prevention efforts are contributing to reductions in reports of 

maltreatment, decreased numbers of children entering foster care, and improved overall wellbeing for children and families. FFPSA 's funding stream to prevent unnecessary removals, 

coupled with the President's legislative proposal to provide additional flexibility to use title IV -E 

funds lor primary prevention of maltreatment, would provide an expansive continuum of 

prevention efforts that could help to break the inter-generational cycles of unresolved trauma and 

maltreatment that are a part of so many children's and families' lives. 

Creating a child welfare system that we can be proud of as a nation and that children, families 

and communities will see as a source of support and strength, as opposed to a system to fear, will 

take collaboration across the three branches of government, as well as with states and tribes. We 

have a collective duty and responsibility to ensure that federal policy and funding protects 

children to the best extent possible, which includes living in resilient, healthy families. I look 

forward to working with you as we continue to implement this landmark piece of legislation. 

would be happy to answer any questions you have. 

13 
22 

Chairman SMITH. In preparation for this bipartisan hearing on 

implementation, Ranking Member Davis and I solicited questions 

directly from States and their representative organizations. In 

total, we received nearly 200 questions, and today we are going to 

do our best to get them answered so States can continue to move 

forward with the important task of implementing this important 

bill to strengthen families and improve outcomes for children. 

We heard States greatly appreciate the Children’s Bureau’s efforts to provide summaries and overviews through the recent program information releases, but State and local leaders request 

more specific information on timelines for policy releases and expected implementation milestones, both for the Children’s Bureau 

as well as for implementing State agencies. 

We also heard human services leaders and child welfare administrators welcome the opportunity to implement a new vision for 

child welfare and to expand the continuum of services oriented toward prevention. 

In order to move forward with key decisions on implementation 

or delay, budget forecasting, workforce planning, community-based 

partner engagement and State legislative activities, State and local 

leaders need a more concrete and regular communication and guidance from the Children’s Bureau to facilitate implementation. 

Please tell us more about the timeline for upcoming guidance, 

what States can expect will be included and not included in upcoming guidance, also timelines for States taking action, submitting 

plans and the like. And for States that are delaying, how are those 

timeframes impacted? On the issue of State option to delay implementation for 2 years, the law is explicit that States have full control over their decision to delay implementation, but yet the program guidance mentions no less than six times approval by HHS 

and asks for a decision by November 9. 

There was no deadline requirement for this decision in the law, 

and by expecting a decision now for a year later appears to push 

States to make rushed decisions about these important reforms before thoughtful consideration and discussions can happen with various stakeholders, before the results of State elections allow new 

policymakers to make decisions about resource allocations, and before State and local budgets are finalized that would impact the 

State’s ability to implement these reforms. 

I understand the November 9th deadline is not binding but merely for planning purposes, and a State can change its mind at any 

point, both to go ahead or delay. Is that correct? 

Mr. MILNER. That is correct. 

Chairman SMITH. Thank you. On the topic of what families will 

be eligible for prevention—what families will be eligible for prevention services, known as the candidate of imminent risk issue, I 

would like to highlight what you said in your written and oral testimony. The Children’s Bureau does not intend to regulate a definition beyond what is already in law, correct? 

Mr. MILNER. That is correct. 

Chairman SMITH. Does this mean States should be setting out 

to define it themselves and, if they wanted to in the future, could 

adjust it? 


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Mr. MILNER. Presumably so. States have flexibility under the 

current title IV–E Foster Care Program to make certain decisions 

about who is a candidate there. We want to give them that maximum flexibility there as well, and we don’t intend to impose any 

restrictions on those definitions beyond what is already in statute. 

Chairman SMITH. Okay. Very good. Can you reflect a little bit 

on the timelines that I mentioned earlier? 

Mr. MILNER. Yes, sir. I am happy to. Let me first of all say we 

are absolutely committed to timely implementation, but we are also 

committed to doing it well. I am far more interested in seeing 

States truly move the culture and the foundation of their child welfare systems to one that is designed to strengthen families and gets 

the outcomes that Family First contemplates as opposed to a purely technical implementation that may not, in fact, improve the outcomes for children and families. We issued our first information 

memorandum in April of 2018, which was an overview of the requirements of the Family First Act. Our first program instruction 

was issued in May of 2018, which covered the requirements under 

title IV–B of the Social Security Act. Our second PI was issued 

July 9, I believe, which covers the requirements of title IV–E of the 

Social Security Act. 

We currently have in clearance a Federal Register notice in 

clearance, which will be issued regarding the Family First requirement that we issue model licensing standards; and we will be sending that information out for comment before finalizing it. We expect 

in the first quarter of Federal fiscal year 2019 to issue additional 

program instructions for both States and Tribes on the new IV–E 

Prevention Funding Program, which is part of Family First. 

In the meantime, I think it is important to note that while we 

recognize that States and Tribes have a tremendous number of 

questions, as evidenced by the 189 that I received sometime yesterday afternoon, we are trying our best to be as responsive as we can 

to those questions going forward. Many of the answers to those 

questions have been addressed in the program instructions. Many 

of those questions are addressed in the statute itself. Where there 

are gaps, we are committed to issuing either clarifying instructions 

for States and Tribes or meeting with them in order to answer 

those questions. We are participating in, and cohosting with the 

Casey Family Programs, a series of three listening sessions across 

the country to address State concerns and to respond to the questions. I participated in the first of those a couple of weeks ago in 

Seattle, and we have two more forthcoming. Even as we speak 

today, we have a State call that is being conducted to answer questions and to help respond to the concerns that States are raising 

with regard to the implementation of the Family First Act. We 

have four more of those calls scheduled with States. 

Chairman SMITH. Thank you. On the model licensing standards, 

you expect that to be available when? 

Mr. MILNER. Very soon. It is in clearance right now. We have 

drafted that. Within the coming weeks, that should be out there 

and available for comment. 

Chairman SMITH. So well in time for States to run that through 

their respective legislative processes? 


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Mr. MILNER. Yes. Our deadline on that is October 1 of 2018. We 

will come out with that before that October 1 deadline. 

Chairman SMITH. Okay. Thank you very much. 

I now recognize the distinguished Ranking Member, Mr. Davis, 

for 5 minutes for any questions he might have. 

Mr. DAVIS. Thank you very much, Mr. Chairman. 

And, Mr. Milner, thank you again. Starting October 1, 2018, the 

Federal Government will provide a dollar-for-dollar match for State 

expenditures for the Kinship Navigator Program, which will help 

provide needed support to grandparents and other kin caregivers 

who have stepped up to keep children with their families and out 

of care. The law clearly provides this funding separately from the 

prevention funding, and it was Congress’ intent that kinship navigator programs be allowed to serve all kin caregivers, not only 

those caring for children at imminent risk of foster care. This 

broader target population of kinship families is consistent with previously federally supported Kinship Navigator Program funding in 

the Fostering Connections to Success and Increasing Adoption Act 

of 2008, which is referenced in Family First. 

Is it your understanding of the law as well that States should 

serve a broader population of kinship caregivers beyond simply 

those caring for children at imminent risk of care? 

Mr. MILNER. Yes, sir. 

Mr. DAVIS. Thank you for that. 

Similarly, the requirement that 50 percent of interventions must 

meet the well-supported evidence standard only applies to the prevention services funding, not to the kinship navigator programs. 

The kinship navigator programs simply need to be evidence-based, 

which means they meet the promising standard in the law. Is that 

your understanding of the law as well? 

Mr. MILNER. I believe. I am clear that the kinship navigator 

programs must meet the evidence-based requirements. I am less 

clear in the moment about the 50 percent requirement there, but 

we will be absolutely glad to clarify that for you. 

Mr. DAVIS. Thank you very much for that. 

In your testimony, you said there might not be any models of 

kinship navigator programs that meet the evidence standard. What 

are you doing to make sure there are models available to States in 

time for States to claim funding in fiscal year 2019? 

Mr. MILNER. Well, first of all, to clarify that statement, we have 

heard from a number of stakeholders that there are not many or 

possibly any kinship navigator programs out there that would meet 

the evidentiary standards required by Family First. We believe one 

program that we have begun to look at that might meet those 

standards, and we are actually going to be pursuing that, hopefully, as one of our priorities in determining the evidence-based 

programs that are reimbursable under Family First. 

Apart from that, you mentioned the prior work that we have 

funded. We are going to be looking at those programs as possible 

candidate programs in the kinship navigator realm that we could 

fold into the list of approvable services to be funded under title IV– 

E. 

We are also working with our Office of Planning, Research, and 

Evaluation to fund a contract that is designed to build the evidence 


ralbany on LAP520R082 with HEARINGS
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for promising programs out there so that we can expand the entire 

array of reimbursable services. Kinship navigator programs are a 

part of that work that is going forward. 

Mr. DAVIS. And, finally, Family First makes pregnant and parenting foster youth categorically eligible for prevention services 

even if their children are not at imminent risk of entering foster 

care. We wrote the language to ensure that this group of youth include fathers as well as mothers. 

Family First allows service provision on behalf of pregnant and 

parenting youth, meaning that services should be available to their 

kin caregiver. Does HHS plan to emphasize these important points 

in its guidance to States to ensure that they know teen fathers and 

kin caregivers of pregnant and parenting foster youth can also be 

served? 

Mr. MILNER. Absolutely. The whole issue of responsible fatherhood and engagement of fathers in the lives of their children and 

families is of critical importance to us. It has been an area that I 

personally have been focused on through the Child and Family 

Services Reviews since 2001, and we continue to work with States 

on ways to improve their response to that. 

I am going to add that, just a few weeks ago, I was fortunate 

enough to meet with a group of parenting youth who were either 

still in foster care or emancipated from foster care and a couple of 

those youth who were about to become parents. That was in your 

home State of Nebraska, Chairman Smith. That group of youth 

gave me a tremendous amount of information about how important 

it is that they get the services that they need. 

I will also say that they gave me hope. They gave me hope that, 

despite so many obstacles that they have faced, their goals were incredibly lofty. One of the young women in that meeting had strong 

desires of attending law school. My special assistant who was with 

me there and is also a lawyer was able to meet with her and link 

her up with some resources that she could begin that whole process 

of living out her dream and her goal. 

So you are raising a critical issue here, and we are entirely supportive of providing as much of an array of services to that population served under Family First as we can. 

Mr. DAVIS. Thank you, Mr. Chairman, and I yield back. 

Chairman SMITH. Thank you. 

I now recognize Mrs. Walorski from Indiana. 

Mrs. WALORSKI. Thank you, Mr. Chairman. 

And thank you, Mr. Milner, for being here. For all of you that 

came with him, thank you so much. Seeing your faces this morning 

gives me hope and very tangible evidence, sitting here today with 

all of you being here. Thank you so much for joining us today. 

The opioid crisis has put unprecedented strains on our communities and social service agencies. Indiana has seen a huge spike 

in the number of children in the foster care system due in large 

part to this epidemic. I was proud to vote for the Family First Prevention Services Act because we needed to reframe the conversation and to put a greater emphasis on prevention rather than just 

treating problems as they happened and to verify that children 

were being placed in quality settings. 


ralbany on LAP520R082 with HEARINGS
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Mr. Milner, when it comes to accreditation of group homes, there 

is a lot of anxiety in my home State of Indiana. Part of that stems 

from the fact that Family First congregate care provisions, only facilities that meet the qualified residential treatment program criteria are eligible for Federal reimbursement. In order to meet these 

criteria, a facility must be accredited by an independent not-forprofit accrediting organization. I think this is a great thing. This 

ensures quality. However, the anxiety kicks in when they look at 

the fact that the process takes 1 to 2 years to complete, and there 

is a limited number of accrediting organizations who will be facing 

a significant uptick in their workload. 

How are you planning to work with States to ensure these aren’t 

negative impacts on service delivery? 

Mr. MILNER. It is a tough issue, and in no way do I want to 

minimize the importance of that issue. Among the States, Tribal 

representatives, and other groups out there that I talk to, that is 

one of the top two issues that I consistently hear about. 

We are meeting with the different organizations that could potentially be involved in this. I would be misrepresenting to you if 

I said we understand completely the range of possible accreditation 

options out there. We don’t have all of those details worked out. 

But in our consultation with States, as we are hearing about their 

concerns—and I mentioned that we are in the process of having 

three of these listening sessions around the country as well as five 

calls—they are raising those concerns to us. We are committed to 

developing an implementation strategy and a plan that will, to the 

best of our ability, address those critical concerns. It is, frankly, a 

very big concern. 

Mrs. WALORSKI. Would States with a pending accreditation be 

allowed to provide reimbursable services? And can any IV–E funds 

be made available to assist providers in being accredited? 

Mr. MILNER. I am not aware of any IV–E funds that would 

allow States to use that for the accreditation process. I am not 

going to speak definitively on that, but I can say that I am not 

aware of that. And could you repeat your first question, please? I 

am sorry. 

Mrs. WALORSKI. Sure. Would States with a pending accreditation be allowed to provide reimbursable services? 

Mr. MILNER. I am not aware of any flexibility in the statute 

that would permit that. 

Mrs. WALORSKI. Are States able to identify accreditation standards apart from the national standards? 

Mr. MILNER. The standards would apply to the accrediting 

body. So the body that—for example, the Council on Accreditation 

and the Joint Commission on Accreditation of Healthcare Organizations would probably have slightly different accreditation standards there. So it would depend upon the accrediting body that the 

State chose to use. 

Mrs. WALORSKI. Will standards defining trauma-informed program models be incorporated into those standards? 

Mr. MILNER. I think the statute does require that the programs, 

the qualified RTPs, provide services that are trauma-informed. So 

they would have to be a part of that process. 

Mrs. WALORSKI. Great. 


ralbany on LAP520R082 with HEARINGS
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Thank you, Mr. Chairman. I yield back. Thank you. 

Chairman SMITH. Thank you. 

I now recognize Ms. Sewell for 5 minutes. 

Ms. SEWELL. Thank you, Mr. Chairman. 

Firstly, I want to welcome our guest, Commissioner Milner, a fellow Alabamian. Since you went to both schools, War Eagle and Roll 

Tide. 

Mr. MILNER. War Eagle. 

Ms. SEWELL. I believe Members of both sides of the aisle saw 

the passage of the Family First legislation as a huge success. We 

all know that foster care placements are on the rise. In 2016, 3,769 

children in my home State of Alabama, our home State, entered 

the foster care system, and over 36,000 Alabama kids were involved in an investigation of maltreatment. 

However, the Family First Act has provided States like Alabama 

with an opportunity to invest Federal funds in preventive services 

that will keep kids out of foster care, wherever possible. Right now, 

Alabama spends about $54 million on foster care, but only one-fifth 

of that on preventive and permanency services. 

Under the new Family First law, this spending imbalance can be 

corrected and States like Alabama can begin to invest more resources in substance abuse, mental health, and parenting skills 

training. However, in order for States to successfully implement 

the new law, HHS must provide the proper guidance and assistance to States, which leads me to my first question. 

When the Family First law requires HHS to identify national 

model foster care licensing standards and requires States to report 

whether they have implemented them or not, the House has passed 

that provision three times that HHS should help identify national 

model foster care licensing standards. And the House has passed 

provisions three times, including voting for a separate bill, H.R. 

2866. 

At the time that we were debating H.R. 2866, my colleague Mr. 

Kelly from Pennsylvania and I engaged in a floor colloquy to make 

very clear our intent that the National Association for Regulatory 

Administration model standards, which were the result of a 

multiyear effort incorporating input from key national associations 

and professional licensors, should be the foundation of such standards. 

I would like to enter for the record a copy of the model family 

foster home licensing standards from the National Association for 

Regulatory Administration. 

Chairman SMITH. Without objection. 


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,_,........---. 

nara 

Model Family Foster Home 

Licensing Standards 

ll!\ (Mttoton 

(hildrM Mid tlw III'A' 

generations >r un1tea \L. THE ANNIE E. CASEY rouNoATION 

Because we'te stronger together 
29 


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The American Bar Association, Center on Children and the Law 

The ABA is the largest voluntary professional association in the world with nearly 400,000 

members. The ABA Center on Children and the Law improves children's lives through advances 

in law, justice, knowledge, practice and public policy by focusing on child abuse and neglect, 

child welfare and protective services system enhancement, family preservation, adolescent 

health and other child protective legal issues. 

The Annie E. Casey Foundation 

The Annie E. Casey Foundation is a private philanthropy that creates a brighter future for the 

nation's children by developing solutions to strengthen families, build paths to economic 

opportunity and t ransform struggling communities into safer and healthier places to live, work 

and grow. 

Generations United 

Generations United is a national membership organization focused solely on improving the lives 

of children, youth, and older people through intergenerational collaboration, public policies, 

and programs for the enduring benefit of all. For well over a decade, Generations United's 

National Center on Grandfamilies has been at the forefront of national efforts to support 

grandfamilies through federal and state legislative testimony and briefings, publications, 

training, and technical assistance. 

National Association for Regulatory Administration 

The National Association for Regulatory Administration (NARA) is an international professional 

organization dedicated to promoting excellence in human care regulation and licensing through 

leadership, education, collaboration, and services. NARA represents all human care licensing, 

including adult residential and assisted living, adult day care, child care, child welfare and 

program licensing for services related to mental illness, developmental disabilities and abuse of 

drugs or alcohol. 

The American Bar Association, Center on Children and t he Law, Generations United, and the 

National Association for Regulatory Administration gratefully acknowledge the Annie E. 

Casey Foundation for their support of this project. 

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the 

American Bar Association and, accordingly, should not be construed as representing the policy of the American Bar 

Association. The American Bar Association Center on Children and the Law is a program of the Young lawyers 

Division. 

Model Family Foster Home licensing Standards 2 
30 


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Model Family Foster Home Ucensing Standards 

Table of Contents 

Purpose Statement............................................................................................. 4 

Principles....................................................................................................................... 5 

Model Standards.......................................................................................................... 6- 14 

Interpretive Guide....................................................................................................... 15 - 39 

Purpose and Use of Cross-Walk Tool....................................................................... 40 - 41 

Cross-Walk Tool........................................................................................................... 42 - 96 

Model Family Foster Home licensing Standards 3 
31 


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Model Family Foster Home Licensing Standards 

Purpose Statement 

The American Bar Association Center on Children and the Law, the Annie E. Casey Foundation, 

Generations United and the National Association for Regulatory Administration have developed 

Model Family Foster Home licensing Standards that, for the first time, help ensure children in 

foster care are safe while also establishing a reasonable, common-sense pathway to enable more 

relatives and non-relat ed caregivers t o become licensed foster parents. 

These standards, which are the only comprehensive national guidelines, fill a previous void by 

giving the federal government a set of clear and practical requirements to reference and guide 

states In their efforts to license homes. Under federal law, states have extraordinary flexibility to 

create family foster home licensing standards, and the law requires only that states develop 

guidelines "reasonably in accord" with national organizations' recommendations. 

Model Family Foster Home licensing Standards help ensure that children in foster care: 

live in safe and appropriate homes under child welfare and court oversight, 

receive monthly financial assistance and supportive services to help meet their needs, and 

can access the permanency option of assisted guardianship in the states and tribes that 

participate in the federal Guardianship Assistance Program (GAP). 

The Model Family Foster Home Licensing Standards, which encompass all the necessary 

components to license a family foster home, are flexible enough to respond to individual 

circumstances, but most importantly they help ensure that children in out-of-home care have 

safe and appropriate homes. These standards should not be considered "minimum" criteria, but 

instead should be adopted as all the criteria necessary to license a safe home. 

The standards are accompanied by an interpretative guide and crosswalk tool. The guide 

summarizes the purpose of each standard, and provides instructions necessary for compliance 

determinations. The crosswalk tool is designed to assist states compare and align their current 

standards with the model standards. 

While we acknowledge that not all states will be able to implement this model in its entirety 

without any modifications, we challenge all states to use it t o assess their own standards and 

ultimately to align their standards with this model. For the development and 

implementation of tribal foster care standards, please refer to the National Indian Child 

Welfare Association (NICWA) materials at http://www.nicwa.org/resources/booklets/. 

In creating these model licensing standards, our hope is that all children, regardless of the state in 

which they live, will be in homes that have met the same reasonable and achievable safet y 

standards. 

Model Family Foster Home Licensing Standards 4 
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Model Family Foster Home Licensing Standards 

Principles 

(1) Family foster home licensing standards should be reasonable and achievable and based 

on the need to find a safe and appropriate home for each child in out of home care. 

(2) Each child in state or county custody needs to be in a licensed home (recognizing that 

courts can still order a child to be placed in a specific, unlicensed home). 

(3) Family foster home licensing standards should promote the opportunity for adults to 

apply to become foster parents. The licensing process should be based on an assessment 

of abilities and continued desire to care for children in out of home care. Not everyone 

will be able to meet the needs of abused or neglected children. 

(4) The licensure of family foster homes is typically a distinct process with different standards 

than the placement of children in family foster homes. These processes must work 

together to ensure that children in out of home care are placed in the best homes for 

them. 

(5) Family foster home licensing standards should be flexible and reflect community 

standards and cultural considerations. If necessary, the agency should assist the 

applicant with costs associated with meeting the standards. 

(6) The licensure of family foster homes should recognize that family systems change over 

time and therefore assessments must be ongoing. 

(7) Family foster home licensing standards must be distinct from licensing standards for child 

care and adult care settings. Family foster homes should not also be licensed as child care 

or adult care sett ings. 

(8) Family foster home licensing standards are necessary to promote safety and consistency 

in licensing assessments and to give licensors the tools to make good decisions. Over 

regulation should be avoided. 

(9) The role of regulation is intended to help safeguard vulnerable individuals who are unable 

to protect themselves. Rules and the regulatory process must be respectful of the 

individuals being regulated and, in turn, be respected by them and by the public. 

(10) When working with American Indian and Alaska Native families, public and private 

agencies should consult with tribes and nearby urban Indian organizations with expertise 

in recruiting and licensing tribal family homes. 

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Model Family Foster Home Licensing Standards 

Model Standards 

1. DEFINITIONS 

A. "Applicant"- an individual{s) who has submitted an application and is seeking a license from 

the licensing agency as a family foster home. 

B. "Community standards" -local norms bounding acceptable conduct. For housing, the term 

means acceptable building standards based on the neighborhood and similar homes. 

C. "Corporal punishment" - any form of physical discipline in which a child is spanked, paddled 

or hit on any part of the body with a hand or instrument. 

D. "Family foster care"- continuous 24 -hour care and support services provided for a child in a 

family foster home. 

E. "Family fost er home" - a private home, including adjacent grounds belonging t o the home, in 

which a child is placed for family foster care under the supervision of the licensing agency. 

This term includes a kinship, relative, and child-specific home. 

F. "Foster parent" - an individual who provides family foster care with a license from the 

licensing authority. 

G. "Functional lit eracy" - the ability to read and write at the level necessary to participat e 

effectively in society. 

H. "Household member"- any relative or non-relative who regularly lives, shares common 

areas, and sleeps in a home. An individual who is living, sharing common areas, and sleeping 

in a home temporarily for more than two consecutive weeks is considered a household 

member. 

I. "license"- the approval, verification or certification of a home and applicant to provide family 

foster care. 

J. "licensing agency" (also known as "agency")- the entity, either private or public, that has 

authority to consider and approve a family foster care license. 

K. "Licensing authority"-the governmental body responsible for carrying out licensing and 

regulatory functions, including monitoring compliance with applicable state laws and rules. 

L. "Relative"- an individual who is related by blood, marriage or adoption or who has a close 

family-like relationship to another individual. For American Indian and Alaska Native 

children "relative" could also include a tribally defined extended family relationship. 

M. "Sibling''- brothers and sisters by birth or adoption, stepbrothers, stepsisters, half-brothers, 

and half-sisters. 

2. ELIGIBILITY STANDARDS 

A. All applicants must submit a complete application and accompanying documentation for a 

family foster home license, and keep copies in their home. 

B. To apply for a family foster home license: 

1. Applicants must be age 18 or older. 

2. Applicants must be able to communicate with the child in the child's own language. 

3. Applicants must be able to communicat e with the licensing agency and health care and 

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other service providers. 

4. At least one applicant in the home must have functional literacy, such as have the ability 

to read labels on medications in order to properly administer them. 

5. Applicants must have income or resources to make timely payments for shelter, food, 

utility costs, clothing, and other household expenses prior to the addition of a child in 

foster care. 

C. The agency must not deny to any individual the opportunity to become a foster parent on 

the basis of the race, color, or national origin of the individual, or of the child, as required by 

the federal Multiethnic Placement Act (MEPA), 42 U.S.C.A. sec. 1996b and Title IV-E of the 

Social Security Act, 42 U.S.C.A. sec. 671(18). MEPA also provides that this law must not be 

construed to affect the application of the Indian Child Welfare Act, which contains 

preferences for the placement of eligible American Indian and Alaska Native children in foster 

care, guardianship, or adoptive homes. Furthermore, the agency must not discriminate with 

regard to the application or licensure of a foster family on the basis of age, disability, gender, 

religion, sexual orientation, gender identity or marital status. 

3. PHYSICAL AND MENTAL HEALTH STANDARDS 

A. All applicants and household members must have physical exams from a licensed 

health care professional recognized by the agency. The exam results, which must be no 

older than 12 months prior to application, must indicate that the applicants are capable 

of caring for an additional child. The agency may require further documentation and/or 

evaluation to make such a determination. 

B. All children who are household members must be up to date on immunizations jointly 

recommended by the American Academy of Pediatrics, the Advisory Committee on 

Immunization Practices of the Centers for Disease Control and Prevention, and the 

American Academy of Family Physicians, unless the immunization is contrary to the 

child's health as documented by a licensed health care professional. 

C. Applicants and all household members must disclose any past or current mental 

health and/or substance abuse issues. The agency may require further documentation 

and/or evaluation to determine the suitability of the home. 

4. HOME STUDY STANDARDS 

A. The agency must conduct a written comprehensive family assessment and home study in 

collaboration with the applicants to include: 

1. At least one scheduled on-site visit to assess the safety of the home using these licensing 

standards. 

2. At least one scheduled in home, individual interview of each household member to 

observe family functioning and assess the family's capacity to meet the needs of a child 

in foster care. The agency will determine whether to interview or just observe each 

household member based on his or her age and development. 

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B. The agency must obtain at least three references, including at least one from a relative and 

one from a non-relative. 

C. Tribal agencies may also be involved in conducting home studies for American Indian and 

Alaska Native children. 42 U.S.C.A. sec. 671(26){B) provides that any receiving state must 

treat any tribal home study report as meeting the requirements imposed by the state for the 

completion of a home study. 

5. CAPACITY STANDARDS 

A. The total number of children in a family foster home, including the family's own children living 

in the home, must not exceed 8, of which no more than 5 may be children in foster care. The 

agency may determine lower capacities based on the family assessment and home study. 

1. No more than 3 children total under age 2. 

2. No more than 4 children total under age 5. 

3. No more than 4 children total between the ages of 5-13. 

4. No more than 4 children total over the age of 13. 

B. The maximum number of children may be increased with agency approval to allow for 

siblings to remain together or to allow applicants to provide care to a child who has an 

established, meaningful relationship with the applicants' family, such as a child who was 

formerly in fost er care with the family. 

6. SLEEPING STANDARDS 

A. Each child in foster care must have a sleeping space with an individual bed or crib, mattress 

and linens, as appropriate for the child's needs and age and similar to other household 

members. 

1. Children who are relatives may share a bed with agency approval. 

2. All cribs in the home must be in compliance with Consumer Product Safety Commission 

standards. 

3. All bunk beds in the home must not have more than two tiers. 

a. The upper tier must have rail ings on both sides to prevent falling. 

b. The top tier must not be used by a child under the age of 6. 

B. There must be no more than 4 children total sharing a room used as a sleeping space. 

1. A child over the age of 5 must not share a room used as a sleeping space with a child of 

the opposite sex. 

2. Children who are relatives may share a room used as a sleeping space with agency 

approval. 

3. A child under 12 months of age in an individual crib may share a room used as a sleeping 

space with the foster parent. 

4. A child over 12 months of age may share a room used as a sleeping space with the foster 

parent with agency approval. 

7. OTHER LIVING SPACE STANDARDS 

A. The home may be a house, mobile home, housing unit or apartment occupied by an 

individual or a family. 

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B. The applicants' home and all structures on the grounds of the property must be maintained 

in a clean, safe, and sanitary condition and in a reasonable state of repair within community 

standards. 

C. The home must satisfy the following living space standards: 

1. Be free from objects, materials, and conditions that constitute a danger. 

2. Prevent or eliminate rodent and insect infestation. 

3. Regularly dispose of trash and recycling. 

4. Have a working phone or access to a working phone in close walking proximity. 

5. Have at least one toilet, sink, and tub or shower in safe operating condition. 

6. Have kitchen facilities with a sink, refrigerator, stove, and oven in safe operating 

condition. 

7. Have heating and/or cooling as required by the geographic area, consistent with 

accepted community standards and in safe operating condition. 

8. Have ventilation where household members and children in foster care eat, sleep, study, 

and play. 

9. Have artificial lighting where household members and children in foster care study and 

read. 

8. FIRE SAFETY/EVACUATION PLAN STANDARDS 

A. The applicants' home must meet the following fire safety/evacuation plan standards: 

1. Have at least one UL (Underwriter's Laboratory) approved smoke detector on each level 

of occupancy of the home and near sleeping areas. 

2. Have at least one operable fire extinguisher that is readily accessible. 

3. Be free of obvious fire hazards, such as defective heating equipment or improperly 

stored flammable materials. Household heating equipment must be equipped with 

appropriate safeguards, maintained as recommended by the manufacturer. 

4. Have a written emergency evacuation plan to be reviewed with the child within 24 hours 

of placement in the home and posted in a prominent place in the home. The plan must 

identify multiple exits from the home, and designate a central meeting place close to the 

home that is known to the child yet at a safe distance from potential danger. 

B. Applicants must maintain a comprehensive list of emergency telephone numbers, including 

poison control, and post those numbers in a prominent place in the home. If there is a land line 

phone located in the home, the numbers must be posted next to the phone. 

9. ADDITIONAL HEALTH AND SAFETY STANDARDS 

A. The applicants' home must meet the following standards concerning weapons: 

1. The following weapons must be st ored in an inoperative condition in a locked area 

inaccessible to children: 

a. Firearms; 

b. Air guns; 

c. BBguns; 

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d. Hunting slingshots; and 

e. Any other projectile weapon. 

2. All ammunition, arrows or projectiles for such weapons must be stored in a locked space 

separate from the weapons. 

3. Applicants who are also law enforcement officials and can document that their 

jurisdiction requires them to have ready and immediate access to their weapons may be 

exempt from these weapon requirements provided the applicants adopt and fol low a 

safety plan approved by the agency. 

B. The applicants' home must meet the following standards concerning water: 

1. A family foster home must have a continuous supply of safe drinking water. 

2. If a home uses private well water or another source of drinking water other than water 

through the municipal water supply, then it must be tested for safety. 

3. The temperature of any water heaters must be set in accordance with the 

manufacturer's recommendations. 

C. The applicants' home must meet the following standards concerning animals: 

1. Any animal that poses a threat to the safety or health of a child in foster care must be 

confined in a place away from the child and inaccessible to the child. 

2. Pets that are required to be vaccinated by state or tribal law must be vaccinated against 

diseases that can transmit to humans, including rabies. 

D. The applicants' home must meet the following standards concerning swimming pools, hot 

tubs, and spas: 

1. Swimming pools must have a barrier on all sides at least four feet high. 

2. Swimming pools must have their methods of access through the barrier equipped with a 

safety device, such as a bolt lock. 

3. Swimming pools must be equipped with a life saving device, such as a ring buoy. 

4. If the swimming pool cannot be emptied after each use, the pool must have a working 

pump and filtering system. 

5. Hot tubs and spas must have safety covers that are locked when not in use. 

E. The applicants' home must meet the following standards concerning hazardous materials 

and first aid supplies: 

1. Prevent the child's access, as appropriate for his or her age and development, to all 

medications, poisonous materials, cleaning supplies, other hazardous materials, and 

alcoholic beverages. 

2. Maintain first aid supplies as recommended by the Red Cross. 

10. CRIMINAL HISTORY RECORDS CHECK STANDARDS 

A. Applicants and any other household members who are adults age 18 or older must submit 

to fingerprint-based checks of national and state crime information databases and checks of 

state or local crime information databases before the applicants may be approved for 

placement of a child. 

B. The agency must also check sexual offender registries for mention of the applicants and any 

other household members who are adults age 18 or older. 

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c. If a record check reveals a felony conviction for child abuse or neglect, for spousal abuse, for 

a crime against children (including child pornography), or for a crime involving violence, 

including rape, sexual assault, or homicide, but not including other physical assault or battery, 

and a state finds that a court of competent jurisdiction has determined that the felony was 

committed at any time, approval for placement of a child must not be grant ed. 

D. If a record check reveals a felony conviction for physical assault, battery, or a drug-related 

offense, and a State finds that a court of competent jurisdiction has determined that the felony 

was committed within the past 5 years, approval for placement of a child must not be granted. 

E. If an applicant was convicted for a crime other than those included in C. and D., the applicant 

will not be automatically rejected as a foster parent. The agency must consider the following: 

1. the type of crime; 

2. the number of crimes; 

3. the nature of the offenses; 

4. the age of the individual at the time of conviction; 

5. the length of time that has elapsed since the last conviction; 

6. the relationship of the crime and the capacity to care for children; 

7. evidence of rehabilitation; and 

8. opinions of community members concerning the individual in question. 

F. Applicants and all household members have an ongoing duty to report any juvenile offenses 

committed by any member of the household. The existence of a household member with a 

juvenile offense does not automatically exclude the applicants. The agency must consider the 

suitability of the home based on the criteria used to assess crimes set forth in C.- E. of this 

standard and standard 11. B. and C. 

11. A BUSE AND NEGLECT BACKGROUND CHECK STA NDARDS 

A. The agency must meet the following abuse and neglect background checks standards: 

1. Check all child abuse and neglect registry and adult protective services registry 

maintained by the stat e, tribe or locality for information on applicants and any other 

household members who are adults age 18 or older. 

2. Request that any other state in which applicants and other adult household members 

who are adults age 18 and older have resided in the preceding 5 years also check all child 

abuse and neglect registry and adult protective services registry maintained by that 

state. 

3. Comply with any request described in A.2. that is received from another state. 

B. The applicants must not be licensed if the applicants or any household member who is an 

adult age 18 or older has been the subject of a substantiat ed allegation of sexual exploitation or 

sexual abuse of a child or has been substantiated for child abuse that resulted in a child fatality. 

c. If there is a substantiated report of child abuse or neglect, other than those listed in B., 

involving the applicants or any household member who is an adult age 18 or older, the 

application is assessed on a case-by-case basis, which includes a discussion with the applicants 

and household members, to determine if the safety of any child in the home will be impacted. If 

not impacted, the results of the abuse and neglect background check may not prevent licensure. 

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D. Applicants and all household members have an ongoing duty to report any juvenile offenses 

committed by any member of the household. The existence of a household member with a 

juvenile offense does not automatically exclude the applicants. The agency must consider the 

suitability of the home based on the criteria used to assess crimes set forth in B.-C. of this 

standard and standard 10 C.-E. 

12. ASSURANCES FROM APPLICANTS 

A. Applicants must sign an agreement containing the following assurances that they and all 

household members will comply with their roles and responsibilities as discussed with the 

agencv once a child is placed in their care: 

1. They will not use any corporal or degrading punishment on any children in the home. 

2. They will not use any illegal substances, abuse alcohol by consuming it in excess 

amounts, or abuse legal prescription and nonprescription drugs by consuming them in 

excess amounts or using them contrary to as indicated. 

3. They will not smoke in the presence of the child in foster care, in the fami ly foster home, 

or in any vehicle used to transport the child. Furthermore, guests will not be allowed to 

smoke in the presence of the child in the family foster home or in any vehicle used to 

transport the child. 

4. They will closely supervise the child in foster care when the child is in close proximity to 

any swimming pool or body of water. When they cannot supervise, they must restrict 

the child's access to swimming pools or bodies of water. The child must never be left to 

swim alone. 

5. They will provide water safety instruction to the child in foster care as appropriate for his 

or her age and development if the home is adjacent to any body of water or has a 

swimming pool. Water safety instruction addresses key knowledge and skills on how to 

be safe around water and does not necessarily mean swimming lessons. 

6. They will maintain the swimming pool in safe condition, including testing and 

maintaining the chlorine and pH levels as required by the manufacturer's specifications. 

7. They will lock all entry points when the swimming pool is not in use. 

8. They will remove or secure any steps or ladders to the swimming pool to make them 

unusable when the pool is not in use. 

9. They will set up and maintain wading pools according to the manufacturer's instructions, 

and empty and store them when not in use. 

10. They will ensure that the child in foster care has legal and safe transportation to and 

from health care, therapy, and agency appointments; school; extracurricular activities; 

social events; and scheduled meetings or visitation with parents, siblings, extended 

family members, and friends. 

11. They will ensure that if a privately-owned vehicle, owned by the appl icants, family or 

friends, is used to transport the child in foster care, it must be inspected (if applicable 

under state or tribal law), registered, and insured, and meet all applicable state or 

tribal requirements to be an operable vehicle on the road. 

a. The driver will have a valid driver's license. 

b. Safety restraints will be used that are appropriate to the child's age, height, and 

weight. 

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c. Weapons must not be transported in any vehicle in which the child is riding unless 

the weapons are made inoperable and inaccessible. 

12. They may need to take additional steps for the safety of the child in foster care, 

depending on the home, the area in which it is located, and the age and any cognitive 

and behavioral challenges of the child. For example, applicants may be required to child 

proof their home or place a fence to prevent the child from accessing nearby railroad 

tracks or another hazard. 

B. The agency will review the assurances agreement with the foster parents at initial licensing, 

when a child is placed in their care, and annually thereafter. 

13. PRE-LICENSE TRAINING STANDARDS 

A. All applicant s must complete at least 6 hours of pre-license training on care of the child. 

B. Pre-license training t opics must include: 

1. An overview of the child welfare system: 

a. legal rights, roles, responsibilities and expectations of foster parents; 

b. Agency purpose, policies, and services; and 

c. Courts, and applicable laws and regulations. 

2. Information, including trauma concepts and behavioral management, to provide for the 

needs of the child who is or may be placed in the home. 

14. EMERGENCY PLACEMENT STANDARDS 

A. A child may be placed in a home on an emergency basis pending licensure for a maximum 

of 90 calendar days with a relative. The applicants must agree to complete the full 

assessment and approval process for a family fost er home license within 90 calendar days. 

For emergency placements of American Indian and Alaska Native children, agencies should 

work closely with tribal and urban Indian organizations that have expertise in recruiting and 

licensing tribal family foster care homes. 

B. The agency must complete the following prior to approving an emergency placement: 

1. State and/or local criminal background check of applicants and any other household 

member who is an adult age 18 or older. To determine eligibility, the results of the 

check will be assessed using the criteria in 10. C., D., and E. above. 

2. State, tribal, and/or local child abuse and neglect registry and adult protective services 

registry check for information on applicants and any other household member who is 

an adult age 18 or older. To determine eligibility, the results of the check will be 

assessed usinl!. the crit eria in 11. B. and C. above. 

3. For other states in which applicants and any other household member who is an adult 

age 18 and older have resided in the preceding five years, applicants and household 

members must attest that they are not on the child abuse and neglect registry or the 

adult protective services registry. At that time, the agency will submit its request that 

the other states check their registries. 

4. Preliminary visual inspection to assess the safety of the home. 

5. Preliminary assessment of the ability of the applicants to meet the needs of the child. 

6. Discuss assurances agreement, as described in standard 12 above, with applicant s and 

obtain their signatures on the agreement. 

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c. If the home is not licensed within 90 calendar days, the child must be removed from the 

home, unless: 

1. A direct placement of the child in the home is ordered by the court while the child is still 

in the custody of the child welfare agency. 

2. The applicants file for and receive care and custody of the child directly from the court. 

3. The agency grants an extension of up to 90 calendar days for applicants to complete 

licensure if it determines that removal of the child would be detrimental to the best 

interests of the child. 

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Model Family Foster Home licensing Standards 

Interpretive Guide 

PURPOSE OF THE INTERPRETIVE GUIDE 

This guide is designed to assist licensing staff meet the requirements of the Model Family 

Foster Home Licensing Standards (Model Standards). The guide provides parameters for the 

licensing process. It also provides information on the purpose of each standard as well as any 

special instructions necessary for compliance determination. This guide will hopefully serve as 

a practical document that facilitates a better understanding of the standards in preparation for 

licensure and for maintaining on-going compliance. 

The guide is organized in the following format: 

• The complete standard. 

• The 'intent' statement, which summarizes the purpose of the standard - the 'why' of 

the standard. 

• The guidelines, which include the assessment methods for evaluating compliance with 

the standard. 

Note: This guide must not be construed to reduce, limit, or restrict the licensing authority to 

enforce applicable statues and regulations. It does not establish a precedent or otherwise bind 

the licensing authority in any other action and must not be construed as evidence of practice, 

policy, or interpretation with respect to any dispute or issue not addressed herein. 

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BALANCED PRACTICE PRINCIPLES IN THE LICENSING ASSESSMENT 

(Adapted from the National Association for Regulatory Administration (NARA) Licensing 

Curriculum) 

1. Use the least enforcement necessary. Violations must be cited, but correction does not 

need to go beyond w hat is needed to accomplish lasting compliance. Enforcement 

responses should be risk-based and consistent to be seen as fair. 

2. Use technical assistance appropriately. Technical assistance is a positive enforcement 

and consumer protection tool. It is not a substitute for citing violations or requiring 

prompt correction. 

3. Show respect for the standards by explaining and teaching their protective intent. The 

merits of t he standards are not a subject for personal opinion or debate. Licensees do a 

better job of compliance though, when they understand the underlying risks and their 

role in reducing those risks. 

4. If a standard is specific, it must be enforced. If a standard can be met in several 

acceptable ways, the licensee must be free to exercise his/her preference for how to 

comply with the standard. Use organizational resources. For example, when disputes 

ari se, encourage the use of available resolution services or skills. Use the power and 

expertise inherent in the collective experience of colleagues and supervisors. 

s. Gather facts fully and objectively. 

6. Provide findings promptly, clearly, and factually to help the licensee understand how to 

comply. Delayed or unclear findings heighten anxiety; factual findings defuse an 

emotionally charged situation. 

7. Learn and practice good verbal and non-verbal communication. 

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L. "Relative"- an individual who is related by blood, marriage or adoption or who has a close 

family-like relationship to another individual. For American Indian and Alaska Native 

"relative" could also include a defined extended fa 

- brothers and sisters by birth or adoption, stepbrothers, stepsisters, halfand half-sisters. 

INTENT: To help both the applicants and the agency begin the licensing process and determine 

if the applicants and household can be considered as a family foster home, applicants must 

submit a complete application and keep copies. The process of completing an application may 

help applicants determine whether they can meet all the criteria or whether they should select 

themselves out of the licensing process. 

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GUIDELINE: The agency should review application materials for accuracy as they are 

submitted. If any errors or omissions are not ed, the agency should promptly return the 

materials for correction and completion. The application is considered complete once all the 

information request ed by the agency has been submitted. The agency should promptly notify 

the applicant s once the application is considered complet e. 

B. To apply for a family foster home license: 

1. Applicant s must be age 18 or older. 

2. Applicants must be able t o communicate with the child in the child's own language. 

3. Applicants must be able t o communicate with the licensing agency and health care and 

other service providers. 

4. At least one applicant in the home must have functional literacy, such as have the ability 

to read labels on medications in order to properly administer them. 

5. Applicants must have income or resources to make timely payments for shelter, food, 

utility costs, clothing, and other household expenses prior to the addition of a child in 

foster care. 

INTENT: To help determine their suitabilit y, there are threshold requirements for applicant s. 

GUIDELINE: Applicants must be able to meet the needs of a child to be placed in the home. It 

is the responsibility of the agency to ensure that applicants underst and the standards and 

expectations of becoming a foster parent. The key is t o articulate the requirements in a 

manner that is appropriate and understandable to the applicants for the benefit of a child. 

Communication is critical to the success of any placement. The agency should be flexible when 

working with applicant s and understand that communication is more than verbal. Applicant s 

must be able to follow agency and service provider instructions to best meet the needs of the 

child placed in the home. However, communicating and understanding instructions can occur 

through various means, including through the use of translators. Translators can be an agency 

staff member or an applicant's tribe, community organization, colleague, neighbor, family 

member or friend. 

Functional lit eracy does not necessarily require functional literacy in English. Rather, it means 

that the applicants have the ability to read and write at the level necessary t o participate 

effectively in the societ y or community in which they live. For example, they must be able to 

read street signage, medicine labels, and complete basic school and other forms in their 

community. Their community may include another language and culture and therefore 

functional literacy in English would not be necessary. 

In order to determine the financial stabilit y of the applicant s, the agency should ask applicants 

to att est t o that stability through the use of an income and expense stat ement or other form. 

Later, during the home study and family assessment, if the agency determines through 

observation that the home does not have adequat e food, heat, etc., the agency should request 

verification of income/financial resources t o make timely payments of household expenses. 

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C. The agency must not deny to any individual the opportunity to become a foster parent 

on the basis of the race, color, or national origin of the individual, or of the child, as 

required by the federal Multiethnic Placement Act (MEPA), 42 U.S.C.A. sec. 199Gb and Title 

IV-E of the Social Security Act, 42 U.S.C.A. sec. 671(18). MEPA also provides that this law 

must not be construed to affect the application of the Indian Child Welfare Act, which 

contains preferences for the placement of eligible American Indian and Alaska Native 

children in foster care, guardianship, or adoptive homes. Furthermore, the agency must 

not discriminate with regard to the application or licensure of a foster family on the basis 

of age, disability, gender, religion, sexual orientation, gender identity or marital status. 

INTENT: To help make clear to all involved that the values and cultural traditions of each 

applicant and child are understood and respected, the agency must communicate and observe 

anti-discriminatory standards. 

GUIDELINE: Only the most compelling reasons may serve to justify the consideration of race, 

color, and national origin (RCNO) as part of a placement decision. Such reasons emerge only in 

the unique and individual circumstances of each child and each applicant. However, the 

application of the Indian Child Welfare Act (e.g. placement preferences) must not be 

affected by implementation of these federal law requirements. The Indian Child Welfare Act 

(25 U.S.C.A. sec. 1931) provides that for the purposes of qualifying for assistance under a 

federally assisted program, such as Title IV-E, tribal licensed or approved foster care or 

adoptive homes, and institutions are equivalent to state licensing or approval. 

A. All applicants and household members must have physical exams from a licensed 

health care professional recognized by the agency. The exam results, which must be no 

older than 12 months prior to application, must indicate that the applicants are capable 

of caring for an additional child. The agency may require further documentation and/or 

evaluation to make such a determination. 

INTENT: To ensure that each household member is physically, mentally, and emotionally 

healthy and the risk of harm to children in foster care is thereby reduced, physical exam 

requirements must be met. The health status of each household member has a direct 

impact on the health and safety of children in foster care as well as on others in the 

home. 

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GUIDELINE: The agency should directly discuss health history with the applicants and adult 

household members. The agency should discuss with the applicants the health history of 

any minors in the home. Applicants should be free from health conditions that would 

prevent them from adequately caring for a child in foster care. When assessing the 

applicants' health condition, the agency should determine if the condition in question 

interferes with the applicants' ability to care for the child. If a household member has a 

health condition that requires the applicants to provide care for that household member, 

the agency assessment should include how that care would impact the applicants' ability to 

care for a child placed in the home. The agency should obtain additional information if it is 

necessary to determine the ability of the applicants to care for the child. Active efforts 

should be made to determine if the applicants have access to services that could remedy 

any perceived barriers to his/her ability to care for a child. The agency should make all 

necessary referrals to available services. 

B. All children who are household members must be up to date on immunizations 

jointly recommended by the American Academy of Pediatrics, the Advisory Committee 

on Immunization Practices of the Centers for Disease Control and Prevention, and the 

American Academy of Family Physicians, unless the immunization is contrary to the 

child's health as documented by a licensed health care professional. 

INTENT: To prevent the spread of vaccine preventable communicable disease, all 

children in the home must have documentation of current immunizations. 

GUIDELINE: Applicants must provide the agency with a written copy of an immunization 

record for each child residing in the home. A child should not be required to satisfy all 

the immunization requirements if a health care professional has found that 

immunization is contrary to the child's health. For example, a child's immunization 

schedule may need to be modified if the child is undergoing chemotherapy or radiation 

therapy. 

C. Applicants and all household members must disclose any past or current mental 

health and/or substance abuse issues. The agency may require further documentation 

and/or evaluation to determine the suitability of the home. 

INTENT: To ensure that each household member is physically, mentally, and emotionally 

healthy and the risk of harm to children in foster care is thereby reduced, applicants and 

household members must disclose mental health and/or substance abuse issues. The 

health status of each household member has a direct impact on the health and safety of 

children in foster care as well as on others in the home. 

Model Family Foster Home Licensing Standards 20 
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GUIDELINE: The agency should directly discuss health history, including any history of drug or 

alcohol abuse or treatment, with the applicants and adult household members. The agency 

should also discuss with the applicants the health history, including any history of drug or 

alcohol abuse/treatment, of any minors in the home. The discussion should include the nature 

and circumstances of the drug or alcohol abuse and/or treatment. A history of drug or alcohol 

abuse that includes appropriate treatment, including current ongoing treatment, should not 

automatically exclude the applicants from consideration for approval as a foster home. 

using these licensing 

standards. 

2. At least one scheduled in home, individual interview of each household member to 

observe family functioning and assess the family's capacity to meet the needs of a child 

in foster care. The agency will determine whether to interview or just observe each 

household member based on his or her and 

INTENT: To ensure that family functioning and the home itself allow children to participate in 

safe exploration and learning thereby contributing to their overall growth and development, 

the agency must conduct a comprehensive family assessment and home study. 

GUIDELINE: The home study process should be mutually respectful and collaborative. The 

agency should call the family to schedule the visit, unless a significant safety concern requires 

an unannounced visit. The agency should inform the applicants what to expect from the 

agency and how to contact agency staff if the applicants' assigned caseworker is not available. 

The home study and family assessment should include the following: child, adult and family 

functioning; perceptions of children; history of parenting and interpersonal relationships; 

extended family relationships; understanding of issues in birth families; preparation to be a 

foster home; understanding of the needs of children requiring foster care, including children's 

need for permanency and his/her cultural considerations. When assessing the home and 

family, the agency should use a template or checklist with clear assessment criteria, which 

helps to standardize the approval of the foster home, increase uniformity in decision making, 

and promote accountability. An example of such a checklist is the "Action for Child 

Protection: The Safe Foster Home. A Study and Assessment Method," available 

at www.grandfamilies.org. It has 14 indicators and then is scored accordingly to identify the 

presence of positive parenting and effective family functioning; likelihood of stability; and 

indication of safety. 

This tool also provides a template for a support plan that can be developed with the family. The 

Model Family Foster Home Licensing Standards 21 
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support plan is designed to remedy the potential for disruptive conditions identified during 

the home study or to strengthen applicant s' skills and abilities. Agencies should consider 

providing in-kind and financial support to help applicants meet licensing standards when 

they are otherwise qualified. 

The agency must either interview or observe each household member. The agency should 

det ermine whether to interview or observe based on the household member's age and 

development. Under the definitions for these standards, household members include an 

individual who is living, sharing common areas, and sleeping in a home temporarily for more 

than two consecutive weeks. An individual who uses the home as his or her legal residence, 

but does not live there all year, is also a household member. Consequently, college students, 

individuals performing seasonal work, deployed military or individuals in other situations that 

take them from their residency must be interviewed by the agency. If a household member 

is unable to return promptly to the home to be interviewed in-person, the agency can 

exercise its discretion and interview the individual via the Internet using Skype or similar 

technology that allows the agency staff person to see the household member. Telephone· 

only interviews of household members do not meet this standard, unless exceptional 

circumstances exist. 

at least three references, including at least one from a relative and 

INTENT: To obtain additional information about the applicants and verify information that has 

been provided, the agency must obtain references for all applicants. 

GUIDELINE: The agency should obtain references by phone or in writing sent directly to the 

agency. If the applicants provide the agency with copies of the references, the agency should 

contact the references to verify the content. If possible, references should be obtained from 

adult children of the applicants who do not reside in the home. The agency should review and 

discuss negative references with the applicants. The agency may need to obtain additional 

information or references. 

C. Tribal agencies may also be involved in conducting home studies for American Indian 

and Alaska Native children. 42 U.S.C.A. sec. 671(26)(B) provides that any receiving state 

must treat any tribal home study report as meeting the requirements imposed by the state 

for the completion of a home study. 

Model Family Foster Home licensing Standards 22 
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INTENT: To provide a family setting and to care for each individual child in the home, the 

number of children must be limited. 

GUIDELINE: The agency should determine how many children to be placed in the home by 

conducting at least one visit to the home to perform the home study and family assessment. 

When determining capacity, the agency should consider: the living space, other children 

receiving full time care in the home, and the applicants' ability to provide adequate physical 

and emotional care while maintaining current family stability. 

The standards do not require specific square footage in the sleeping spaces or in the home itself. 

The agency should not let arbitrary space requirements prevent the licensing of an appropriate 

and safe home. The agency should exercise common sense in determining capacity limits based 

on the living space. While assessing the home, the agency should consider that sufficient space 

decreases risk of injuries, and child behavior tends to be more constructive when space is 

organized to promote developmentally appropriate skills. Overcrowding has been shown to be 

associated with increased respiratory infections. 

B. The maximum number of children may be increased with agency approval to allow for 

siblings to remain together or to allow applicants to provide care to a child who has an 

established, meaningful relationship with the applicants' family, such as a child who was 

in foster care with the 

INTENT: To promote stability and connections, children be placed with siblings 

and with applicants with whom they an established relationship when appropriate. 

GUIDELINE: The total number of children to be placed in the home should be based on the 

family assessment and home study. The best interest of the child must be the determining 

factor. When determining whether to exceed capacity limits, the agency should consider if the 

applicants can provide care for more than the maximum number of children permitted by the 

standard, based on the living space, other children receiving full time care in the home, and the 

applicants' ability to provide adequate physical and emotional care while maintaining current 

family stability. If the agency determines that capacity limits should be exceeded to allow 

siblings to remain together or to care for a specific child, the agency should note the reasons to 

exceed the maximum capacity in the home study document. 

A. Each child in foster care must have a sleeping space with an individual bed or crib, mattress 

and linens, as appropriate for the child's needs and age and similar to other household 

members. 

2. All cribs in the home must be in compliance with Consumer Product Safety Commission 

standards. 

Model Family Foster Home Licensing Standards 23 
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a. The upper tier must have railings on both sides to prevent falling. 

b. The top tier must not be used by a child under the age of 6. 

INTENT: To promote safety and comfort, children need to have their own identified sleeping 

space that is assigned to them for use while they are in placement. 

GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting the sleeping arrangements for all household members and 

prospective children in foster care, including the specific crib or bed, and noting the 

arrangements in the home study document. Sleeping arrangements should be similar to all 

other children in the home. Children in foster care should sleep in safe and comfortable 

sleeping spaces with appropriate furnishings to meet their basic needs and ensure privacy. 

The term sleeping spaces rather than bedroom is used intentionally. The agency may find that 

a home should be licensed even ifthere are not separate bedrooms as such, provided that a 

room may also be used as a sleeping space with a bed that fits the child. Children in foster care 

should not, however, be made to sleep in routinely designed public spaces when other children 

in the home have their own bedrooms. All children in the home should be treated equitably. If 

that equity exists, the agency should exercise discretion and some children, for example, may 

be allowed to use murphy beds or a bed that doubles as a sitting place for the family during the 

day. 

All cribs and beds should be age or developmentally appropriate for the children who are placed 

in the home. The agency should ensure that all children in foster care are provided a crib that 

meets Consumer Product Safety Commission (CPSC) standards. Drop side cribs must not be 

used for children in foster care. If necessary, the agency should assist applicants who are 

otherwise qualified to obtain a safe crib or an appropriate bed. 

B. There must be no more than 4 children total sharing a room used as a sleeping space. 

1. A child over the age of 5 must not share a room used as a sleeping space with a child of 

the opposite sex. 

2. Children who are relatives may share a room used as a sleeping space with agency 

approval. 

3. A child under 12 months of age in an individual crib may share a room used as a sleeping 

space with the foster parent. 

4. A child over 12 months of age may share a room used as a sleeping space with the foster 

parent with agency approval. 

INTENT: To ensure a family like environment in the foster home, the number of children 

assigned to a bedroom or sleeping space must be limited. 

Model Family Foster Home Licensing Standards 24 
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GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and assessing the sleeping space for all household members and children 

in foster care and noting that space in the home study document. The agency should identify 

each approved bedroom or sleeping space and include the number of approved occupants for 

each space. 

A. The home may be a house, mobile home, housing unit or apartment occupied by an 

individual or a family. 

INTENT: To allow for the licensing of any suitable and safe foster family home, families can 

reside in a variety of types of housing. 

GUIDELINE: Any type of permanent structure is permissible as a fami ly foster home provided it 

meets all the standards. The family may rent or own the home. The family must have a stable 

home and be able to demonstrate they have the financial resources to make timely payments 

for the cost of the home as required in Standard 2 B.S. of these standards. The agency should 

confirm the applicant s' home status by viewing rental agreements, mortgage statements or 

other documents. The agency should document how it verified a stable home in the home 

study assessment tool. 

B. The applicants' home and all structures on the grounds of the property must be maintained 

in a clean, safe, and sanitary condition and in a reasonable state of repair within community 

standards. 

INTENT: To be able to meet the needs of the child, the living arrangements and housing must 

meet certain standards. 

GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting how compliance was verified in the home study document. The 

agency can use a site and safety checklist to ensure consistent assessments and to verify the 

areas that were assessed. 

These standards require that homes comply with "community standards," so that applicants 

living in low-income areas may qualify as foster parents. Middle class norms should not dictate 

the homes that get licensed. The agency should assess whether a home is maintained in a 

clean, safe and sanitary condition and in a reasonable state of repair within community 

standards. The agency should take into account neighborhood norms while being mindful of 

any potential health and safety risks. For example, 19'" century row houses may not meet a 

city's new building ordinances, however, provided the agency considers such a home safe for 

children and perhaps assists the applicants in making safety modifications as necessary, the 

home may be licensed if the applicants otherwise qualify. 
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7. 

8. 

9. 

as required by the geographic area, consistent with 

cnoTlrru on,orvstandards and in safe operating condition. 

where household members and children in foster care eat, sleep, 

INTENT: To be able to meet the needs of the child, the living arrangements and housing must 

be safe, clean and include basic features. To ensure the ability to communicate during 

emergencies, telephones must be available in the home, on the grounds or in close walking 

one visit to the home and noting how compliance was verified in the home study document. 

The agency can use a site and safety checklist to ensure consistent assessments and to verify 

the areas that were assessed. 

These standards seek to accommodate many types of homes, including, for example, rural 

homes that may not have a bathroom inside the home or homes that lack electricity, but have 

other means of safe lighting and refrigeration. Agency staff should exercise discretion and 

consider the community where the home is located. For example, some cultures do not allow 

electricity in their homes; therefore, access to a working telephone may be a phone in close 

proximity or short walking distance, e.g., a neighbor's phone. Consideration should be given 

to homes in rural, geographically isolated areas that may have limited communications 

infrastructure and family resources. Proper ventilation may include the use of fans, screens 

on windows and doors or a central air system that circulates air in the home. 

Agencies should provide in-kind and financial support to help applicants meet living space 

licensing standards when they are otherwise qualified. 

Model Family Foster Home Licensing Standards 26 
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3. Be free of obvious fire hazards, such as defective heating equipment or 

stored flammable materials. Household heating equipment must be equipped with 

appropriate safeguards, maintained as recommended by the manufacturer. 

4. Have a written emergency evacuation plan to be reviewed with the child within 24 hours 

of placement in the home and posted in a prominent place in the home. The plan must 

identify multiple exits from the home, and designate a central meeting place close to 

the home that is known to the child yet at a safe distance from potential danger. 

INTENT: To protect children and household members from risk of harm, the home must be 

assessed for fire safety and evacuation plans. The development of safety procedures and 

emergency plans increase the probabil ity of safety and injury prevention for each household 

member. The practice of emergency procedures fosters calm, competent use of the 

procedures in an actual emergency. 

GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting how compliance was verified in the home study document. 

The agency can use a site and safety checklist to ensure consistent assessments and to verify 

the areas that were assessed. A fire inspection by a fire safety inspector is not required to 

license a home. However, if the agency or applicants have concerns about fire risks, the agency 

or applicants can ask for an inspection by a fire safety inspector. 

The agency should verify that operable smoke detectors are located in all areas specified in the 

standard or as recommended by the fire safety inspector. The agency should verify that they 

are operable by viewing an indicator light on the detectors or by testing the detector by 

pushing the test button. Although the standards do not require carbon monoxide detectors for 

all homes, the agency should consider factors such as connected garages and types of artificial 

heat in determining whether such detectors should be required. The agency should examine 

the fire extinguisher and verify that the extinguisher is in operating condition by viewing either 

the gauge on the extinguisher or a service tag from a competent authority. An extinguisher 

with a broken seal does not meet this standard. 

The agency should review the written emergency evacuation plan to verify that it meets this 

standard. The evacuation plan must be posted in a conspicuous place in the home. Within one 

day of placement, the foster family should review the emergency procedures for evacuation for 

fire, and any natural disasters that occur in their area, such as tornados or earthquakes, so that 

al l household members know how to exit safely, with a planned meeting spot. 

B. Applicants must maintain a comprehensive list of emergency telephone numbers, including 

poison control, and post those numbers in a prominent place in the home. If there is a landline 

phone located in the home, the numbers must be posted next to the phone. 

INTENT: To ensure that emergency numbers are readily available in case of an emergency, they 

should be compiled and posted in a prominent place in the home. 

Model Family Foster Home Ucensing Standards 27 
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GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting compliance in the home study document. The agency should 

verify that the applicants keep a list of appropriate emergency telephone numbers including 

fire, police, ambulance, poison control, and all agencies working with the family. The agency 

should further verify that the list is posted in a prominent place in the home. If there is a 

land line phone located in the home, the numbers must be posted next to the phone. The 

numbers should be accessible and all children should be shown where to find such numbers in 

case of emergency. The agency could provide the family with a sticker or magnet that is preprinted with emergency and important numbers along with space to add personal numbers 

such as the family doctor. 

In a home that does not have a phone, but instead relies on a phone in close walking proximity, 

the numbers should be posted near the home's exit to permit household members to take the 

emergency phone numbers with them to the phone's location. During the home study, the 

agency should check the phone that the family relies upon, if it is in walking distance, and if the 

family who owns that phone permits ready access to it. 

2. All ammunition, arrows or projectiles for such weapons must be stored in a locked 

space separate from the weapons. 

3. Applicants who are also law enforcement officials and can document that their 

jurisdiction requires them to have ready and immediate access to their weapons 

may be exempt from these weapon requirements provided the applicants adopt 

and follow a safety plan approved by the agency. 

INTENT: To verify that the applicants' home will provide an environment in which children in 

foster care will be protected from any conditions that threaten their safety and well-being, 

weapons must meet safe storage standards. The potential for injury or death of children due to 

firearms is substantial. 

Model Family Foster Home Licensing Standards 28 
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GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting the location and type of any weapons in the home in the 

home study document. The agency can use a site and safety checklist to ensure consistent 

assessments and to verify the areas that were assessed. 

Weapons in a foster home or in a vehicle used to transport children in care are strongly 

discouraged. However if the applicants own weapons, appropriate safety measures must be 

taken to make sure the children do not have access to such weapons. Further, no child in the 

home may have unsupervised access to the weapons. When an applicant or household 

member is not carrying a weapon, it must be stored as specified in this standard. As part of the 

interview of all household members, the agency should ask if there are any weapons or 

ammunition located in the home or grounds. If the applicants or household members have 

weapons in the home, the agency should ask for verification that the individual has the required 

license or permit. The agency should view the areas where the weapons and/or ammunition 

are stored to verify that they are inaccessible to children. The agency should visually inspect the 

weapons to verify that they are stored unloaded and under lock. The agency should verify that 

the ammunition is stored in a separate locked space away from the weapons. 

B. The applicants' home must meet the following standards concerning water: 

1. A family foster home must have a continuous supply of safe drinking water. 

2. If a home uses private well water or another source of drinking water other 

than water through the municipal water supply, then it must be tested for 

safety. 

3. The temperature of any water heaters must be set in accordance with the 

manufacturer's recommendations. 

INTENT: To provide for a child's hygiene needs and safe consumption, the home must have 

access to clean, sanitary water. 

GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting the water supply and temperature in the home study 

document. The agency should check the source of the water supply by asking the applicants to 

provide documentation, such as a water bill or confirmation of hook up to a public water 

source. All water not from a public water source must be tested by a means that the 

community accepts or a detailed description of how the water is treated to make it safe for 

consumption. It might be an internal agency inspection, another government agency or an 

outside contractor. Homes that use wells often already conduct water tests at periodic 

intervals; this satisfies the requirement if the applicants can provide certification that the water 

has been tested. Commercially bottled drinking water must be used until water testing results 

are available or if the results show that the tested water is unsafe to drink. 

Model Family Foster Home Licensing Standards 29 
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The agency may use a waterproof digital thermometer held under running water in all sinks, 

showers or tubs to verify that the temperature does not exceed 120 degrees Fahrenheit. The 

water must be tested on all levels or floors of the home. The agency should also view the water 

heater to verify that it is set in accordance with the manufacturer's instructions. 

C. The applicants' home must meet the following standards concerning animals: 

1. Any animal that poses a threat to the safety or health of a child in foster care 

must be confined in a place away from the child and inaccessible to the child. 

2. Pets that are required to be vaccinated by state or tribal law must be 

vaccinated against diseases that can transmit to humans, including rabies. 

INTENT: To ensure safety, children should be protected from any hazardous animals kept in 

the home or on the grounds. 

GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting the type and location of any animals in the home study 

document. By documenting them, referring or placing agencies will be aware that there are 

animals in the home. Some children are allergic or fearful of animals, and the home may not be 

a suitable placement for those children. Remember, children can be intrigued by animals and 

wander into confined areas, therefore, confinement areas must be secure and not accessible to 

the child without adult supervision. 

The agency should ask for verification that any animals located in the home or on the grounds 

of the home have vaccinations as required by tribal, local or state laws. The agency should 

observe where the animals are located in the home or on the grounds and verify that children 

are kept safe from potentially dangerous animals. The agency should contact local 

veterinarians or local law enforcement for assistance as needed. 

D. The applicants' home must meet the following standards concerning swimming 

pools, hot tubs and spas: 

1. Swimming pools must have a barrier on all sides at least four feet high. 

2. Swimming pools must have their methods of access through the barrier 

equipped with a safety device, such as a bolt lock. 

3. Swimming pools must be equipped with a life saving device, such as a ring 

buoy. 

4. If the swimming pool cannot be emptied after each use, the pool must have 

a working pump and filtering system. 

s. Hot tubs and spas must have safety covers that are locked when not in use. 

INTENT: To ensure the safety of chi ldren, swimming pools and hot tubs must meet certain 

standards. 

Model Family Foster Home Licensing Standards 30 
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GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting any swimming pools, hot tubs and spas in the home study 

document. The agency should verify that any swimming pools have proper barriers and that 

access is equipped with a safety device, such as an alarm, key lock, self-locking door, bolt lock 

or other lock that is not accessible to children. lifesaving devices that must be available at any 

swimming pool include a ring buoy, rescue tube, flotation device with a rope, or a shepherd's 

hook sufficiently long t o cover the area. Resources regarding pool safety features can be found 

through the American Academy of Pediatrics, Safe Kids Coalition, and the Consumer Products 

Safety Commission websites. 

E. The applicants' home must meet the following standards concerning hazardous 

materials and first aid supplies: 

1. Prevent the child's access, as appropriate for his or her age and 

development, to all medications, poisonous materials, cleaning supplies, 

other hazardous materials, and alcoholic beverages. 

2. Maintain first aid supplies as recommended by the Red Cross. 

INTENT: To prevent poison exposure, certain storage standards must be met. There are over 

two million human poison exposures reported to poison centers each year. Children under six 

account for over half of those potential poisonings. The substances most commonly involved in 

poison exposures of children are: cosmetics, cleaning substances, and medications. Plastic bags 

and aerosols present increased risks of injury and death as well. Medicines can be crucial to 

the health and wellness of children. However, they can also be very dangerous if the wrong 

type or amount is given to the wrong person at the wrong time. 

GUIDELINE: The agency should assess compliance with these standards by conducting at least 

one visit to the home and noting how hazardous materials are stored and the availability of first 

aid supplies in the home study document. The agency should take into consideration the age, 

and any cognitive and behavioral challenges of the child placed in the home when assessing the 

method to prevent that child's access to medications, poisonous and other hazardous 

materials, and alcoholic beverages. However, all medications should be kept in locked storage 

and inaccessible to all children at all times. During the inspection for the home study, the 

agency should ask the applicants to view the storage areas where alcoholic beverages, 

poisonous materials, cleaning materials, and other hazardous materials that could be a danger 

to children are kept to ensure that this st andard is being met. 

First aid supplies should be maintained in the home. As recommended by the Red Cross, these 

supplies for a family of four are: 2 absorbent compress dressings (5 x 9 inches); 25 adhesive 

bandages (assorted sizes); 1 adhesive doth tape (10 yards x 1 inch); 5 antibiotic ointment 

packets (approximately 1 gram); 5 antiseptic wipe packets; 2 packets of aspirin (81 mg each); 1 

blanket (space blanket); 1 flashlight; 1 breathing barrier (with one-way valve) for 

cardiopulmonary resuscit ation (CPR); 1 instant cold compress; 2 pair of non-latex gloves (size: 

Model Family Foster Home Licensing Standards 31 
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large); 2 hydrocortisone ointment packets (approximately 1 gram each); 1 roller bandage (3 

inches wide); 1 roller bandage (4 inches wide); 5 sterile gauze pads (3 x 3 inches); 5 sterile 

gauze pads (4 x 4 inches); 1 oral thermometer (non-mercury/non-glass); 2 triangular bandages; 

scissors; tweezers; any vital medications as prescribed by a health care professional; emergency 

phone numbers; and a first aid instruction booklet. These first aid supplies should increase 

proportionally if there are more than four family members, including the child in foster care. 

B. The agency must also check sexual offender registries for mention of the 

applicants and any other household members who are adults age 18 or older. 

C. If a record check reveals a felony conviction for child abuse or neglect, for 

spousal abuse, for a crime against children (including child pornography), or for a 

crime involving violence, including rape, sexual assault, or homicide, but not 

including other physical assault or battery, and a state finds that a court of 

competent jurisdiction has determined that the felony was committed at any time, 

D. If a record check reveals a felony conviction for physical assault, battery, or a 

drug-related offense, and a state finds that a court of competent jurisdiction has 

determined that the felony was committed within the past 5 years, approval for 

cement of a child must not be 

E. If an applicant was convicted for a crime other than those included in C. and 

D., the applicant will not be automatically rejected as a foster parent. The agency 

must consider the 

F. Applicants and all household members have an ongoing duty to report any juvenile offenses 

committed by any member of the household. The existence of a household member with a 

juvenile offense does not automatically exclude the applicants. The agency must consider the 

suitability of the home based on the criteria used to assess crimes set forth in C.-E. of this 

standard and standard 11. B. and C. 

Model Family Foster Home Licensing Standards 32 
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INTENT: To ensure that the agency is not approving a foster home where any applicants or 

household members have certain previous criminal convictions, comprehensive criminal 

background checks are performed in accordance with federal and state laws. 

GUIDELINE: This standard mirrors the requirements under the federal Adam Walsh Child 

Protection and Safety Act, P.L. 109-248, July 27, 2006, 120 Stat. 587, which requires these 

types of national criminal background checks on all applicants and adult household 

members. The Adam Walsh Act rloes not require state or local criminal backgrounrl checks, 

as are required under these standards. That requirement acknowledges the lack of a wel l 

unified criminal background database. 

The agency should review the criminal background checks for all applicants and adult 

household members to ensure that they meet these standards. The agency should obtain 

copies of the checks and maintain them in the applicants' record. For those crimes that do 

not automatically disqualify applicants, the agency should consider each factor listed in E. of 

this standard. The agency may want to contact legal counsel for assistance as needed. 

The Adam Walsh Act does not require criminal background checks on juvenile household 

members. The agency should inform applicants and all household members that they have 

an ongoing duty to report any juvenile offenses committed by any member of the 

household. During the interview of each household member, the agency should ask if he or 

she has committed a juvenile offense or knows of any household member who has 

committed a juvenile offense. The agency should note the responses to the questions 

regarding juvenile offenses in the home study document. The existence of a household 

member with a juvenile offense does not automatically exclude the applicants. The agency 

should consider the suitability of the home based on the criteria used to assess crimes set 

forth in C.-E. of this standard and standard 11. B. and c. 

A. The agency must meet the following abuse and neglect background checks 

standards: 

1. Check all child abuse and neglect registry and adult protective services registry 

maintained by the state, tribe or locality for information on applicants and any 

other household members who are adults 18 or older. 

2. Request that any other state in which applicants and other adult household 

members who are adults age 18 and older have resided in the preceding 5 

years also check all child abuse and neglect registry and adult protective 

Model Family Foster Home Licensing Standards 33 
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B. The applicants must not be licensed if the applicants or any household member 

who is an adult age 18 or older has been the subject of a substantiated allegation of 

sexual exploitation or sexual abuse of a child or has been substantiated for child abuse 

that resulted in a child fatality. 

C. If there is a substantiated report of child abuse or neglect, other than those listed 

in B., involving the applicants or any household member who is an adult age 18 or 

older, the application is assessed on a case-by-case basis, which includes a discussion 

with the applicants and household members, to determine if the safety of any child in 

the home will be impacted. If not impacted, the results of the abuse and neglect 

background check may not prevent licensure. 

D. Applicants and all household members have an ongoing duty to report any j uvenile 

offenses committed by any member of the household. The existence of a household 

member with a juvenile offense does not automatically exclude the applicants. The 

agency must consider the suitability of the home based on the criteria used to assess 

crimes set forth in B.-C. of this standard and standard 10 C.-E. 

INTENT: To ensure that the agency is not approving a foster home where any applicants or 

household members have substantiated allegations of abuse or neglect, these comprehensive 

background checks are performed in accordance with federal and state laws. 

GUIDELINE: The agency must complete a state child abuse and neglect registry and adult 

protective services registry check for each adult household member. For any other state in 

which the adult household member resided within the most recent 5 years, the agency must 

request that those states check their registries or any applicable tribal registries. The state 

contact for those child abuse and neglect checks can be found at the following 

link: http://www.dfps.st at e.t x.us/Child Care/Other Child care Information/abuse registry. 

Ei!L(O pdf can also be found at www.grandfamilies.arg) All states should respond to 

requesting states within 30 calendar days with the results of the registry checks, so as not to 

delay the licensing process. The agency should maintain copies of all the checks in the 

applicants' record. lf the results of the check show a positive history, then the agency must 

assess those results consistent with B. and C. of these standards. The agency must discuss the 

results with the applicants and household members. 

As with criminal background checks, federal law does not require child abuse and neglect 

registry checks on juvenile household members. The agency should inform applicants and all 

household members that they have an ongoing duty to report any juvenile offenses committed 

by any member of the household. During the interview of each household member, the agency 

should ask if he or she has committed a juvenile offense or knows of any household member 

who has committed a juvenile offense. The agency should note the responses to the questions 

regarding juvenile offenses in the home study document. The existence of a household 

member with a juvenile offense does not automatically exclude the applicants. The agency 

should considerthe suitability of the home based on the criteria used to assess crimes set forth 

in standards 10. C.-E. and B. and C. of this standard. 

Model Family Foster Home Licensing Standards 34 
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A. Applicants must sign an agreement containing the following assurances that 

they and all household members will comply with their roles and responsibilities as 

discussed with the once a child is in their care: 

1. They will not use any corporal or degrading punishment on any children in 

the home. 

2. They will not use any illegal substances, abuse alcohol by consuming it in 

excess amounts, or abuse legal prescription and nonprescription drugs by 

them in excess amounts or them to as indicated. 

3. They will not smoke in the presence of the child in foster care, in the family 

foster home, or in any vehicle used to transport the child. Furthermore, 

guests will not be allowed to smoke in the presence of the child in the family 

foster home or in vehicle used to the child. 

4. They will closely supervise the child in foster care when the child is in close 

proximity to any swimming pool or body of water. When they cannot 

supervise, they must restrict the child's access to swimming pools or bodies 

of water. The child must never be left to swim alone. 

5. They will provide water safety instruction to the chi ld in foster care as 

appropriate for his or her age and development if the home is adjacent to 

any body of water or has a swimming pool. Water safety instruction 

addresses key knowledge and skills on how to be safe around water and 

does not necessarily mean swimming lessons. 

6. They will maintain the swimming pool in safe condition, including testing 

and maintaining the chlorine and pH levels as required by the 

manufacturer's <noocilfir;lticln 

or ladders to the swimming pool to 

make them unusable when the not in use. 

9. n wading pools according to the 

store them when not in use. 

10. They will ensure that the child in foster care has legal and safe 

transportation to and from health care, therapy, and agency appointments; 

school; extracurricular activities; social events; and scheduled meetings or 

visitation with extended and friends. 

11. They will ensure that if a privately-owned vehicle, owned by the applicants, 

family or friends, is used to transport the child in foster care, it must be 

inspected (if applicable under state or tribal law), registered, and insured, 

and meet all applicable state or tribal requirements to be an operable 

Model Family Foster Home Licensing Standards 35 
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as a foster home, the applicants' sign assurances at the time of licensing concerning their 

future behavior when a child is placed in their care. 

GUIDELINE: The agency can use this list to create an assurances agreement that the agency 

and applicants will sign. Before signing, the agency should carefully review it with the 

applicants along with the reasons for these assurances. It can be used as an education and 

training tool, as well as to provide clear expectations. The assurances cover behaviors after 

the home is licensed, and these behaviors cannot be verified as part of the home study. These 

are considered conduct requirements and will be assessed after the placement of the child. 

This assurance tool is a way to help foster parents understand the need to follow these safe 

INTENT: To provide information to applicants prior to licensing so they can make an informed 

decision about their commitment to foster a child, pre-license training must occur. Pre-license 

training should complement the life experiences that applicants bring to their child rearing 

skills. 

GUIDELINE: The agency should exercise discretion in determining how many hours of training 

are needed. These standards simply say no less than six, but expect that agencies may provide 

more. 

2. 

INTENT: To provide applicants with current knowledge of the child welfare system and access 

to education that will prepare and provide ongoing instruction to support their parental roles, 

certain pre-training topics must be addressed. 

Model Family Foster Home Licensing Standards 36 
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GUIDELINE: These standards concern pre-license training only. At that point in time, 

applicants may or may not know the child who is to be placed with them. Training for the care 

of a specific child and his or her needs is particularly important. 

Training may be comprised of different training modalities including video and Internet-based, 

to complement in-person, and the agency should maintain a list of training resources. The 

agency should approve in advance any video or Internet-based training. Training may need to 

be conducted in an applicant's native language or may need to be translated from English 

through the use of translators. Special consideration should be given to provide training that 

incorporates the culture of those fami lies who are receiving the training, including the 

acknowledgement and acceptance of different cultural practices in child-rearing that still 

maintain child safety. 

No later than the first 30 days after a foster parent has been licensed and a child has been 

placed with him or her, the agency should develop and implement a written needs assessment 

and continuing training plan for the foster parent. When creating the individualized training 

plan, the agency should take into account the parenting knowledge and skills of the foster 

parent, the needs of the specific child, and the ability of applicants to attend trainings, 

especially in rural areas where training may be conducted far from the applicants' home. 

A. A child may be placed in a home on an emergency basis pending licensure for a 

maximum of 90 calendar days with a relative. The applicants must agree to complete the 

full assessment and approval process for a family foster home license within 90 calendar 

days. For emergency placements of American Indian and Alaska Native children, 

agencies should work closely with tribal and urban Indian organizations that have 

expertise in recruiting and licensing tribal family foster care homes. 

INTENT: To allow children to be placed with an individual known to them, 

emergency placements pending full licensure are permissible. 

GUIDELINE: All emergency placement screening requirements should be completed no 

later than within the first 24 hours of placement. During those 24 hours, the complete 

process for full licensure should be reviewed with the emergency placement provider to 

identify any potential obstacles to licensure that would require the child to endure another 

move. 

complete the following prior to approving an emergency 

1. State and/or local criminal background check of applicants and any other 

household member who is an adult age 18 or older. To determine eligibility, 

the results of the check will be assessed using the criteria in 10. C., D., and E. 

above. 

Model Family Foster Home Licensing Standards 37 
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2. State, tribal, and/or local child abuse and neglect registry and adult protective 

services registry check for information on applicants and any other household 

member who is an adult age 18 or older. To determine eligibility, the results of the 

check will be assessed using the criteria in 11. B. and C. above. 

3. For other stat es in which applicants and any other household member who is an 

adult age 18 and older have resided in the preceding five years, applicants and 

household members must attest that they are not on the child abuse and neglect 

registry or the adult protective services registry. At that time, the agency will submit 

its request that the other states check their registries. 

4. Preliminary visual inspection to assess the safety of the home. 

5. Preliminary assessment of the ability of the applicants to meet the needs of the 

child. 

6. Discuss assurances agreement, as described in standard 12 above, with applicants 

and obtain their signatures on the agreement. 

INTENT: To ensure the safety and well-being of children in foster care, certain safety standards 

must be met prior to emergency placement. 

GUIDEL.INE: In order to immediately and safely place a child with a family known to him or her, 

the agency must conduct a basic assessment for safety and the ability to adequately care for 

the child as delineated in this standard. All information collected should be documented and 

kept as part of the application for licensure. 

c. lfthe home is not licensed within 90 calendar days, the child must be removed 

from the home, unless: 

1. A direct placement of the child in the home is ordered by the court while the 

child is still in the custody of the child welfare agency. 

2. The applicants file for and receive care and custody of the child directly from 

the court. 

3. The agency grants an extension of up to 90 calendar days (for a total of 180 

calendar days maximum) for applicants to complete licensure if it 

determines that removal of the child would be detrimental to the best 

interests of the child. 

INTENT: To ensure that each child in state or county custody be in a licensed home that meets 

certain safety criteria, children cannot remain for more than 90 calendar days in an emergency 

placement. 

Model Family Foster Home Licensing Standards 38 
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GUIDELINE: Emergency placement will need to be monitored by the agency to ensure family 

foster home licensure is met within the federal and state timeline requirements. Agency 

monitoring of the emergency placement should include periodic onsite visits. 

The agency should review the required timeline for full licensure with the emergency 

placement provider to identify any potential obstacles to licensure that would require the 

children to endure another move. Emergency placement providers should understand that if 

they are unable to meet federal and state guidelines for family foster home licensure, children 

will need to be moved to another placement. 

To minimize disruption to children's lives, the agency will work in partnership with emergency 

placement providers if children are moved. 

Model Family Foster Home Licensing Standards 39 
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Model Family Foster Home licensing Standards 

Purpose and Use of Cross-Walk Tool 

The cross-walk tool is designed to assist regulatory staff and providers compare the 

requirements of the Model Family Foster Home Licensing Standards (Model Standards) with 

current state family foster home licensing standards, in order to develop a plan to align with the 

Model Standards. In addition to completing this tool, there are additional resources available 

to assist states in the alignment and revision of their current family foster home licensing 

standards. 

Collaborating Organizations 

The American Bar Association, Center on Children and the Law 

The ABA is the largest voluntary professional association in the world with nearly 400,000 

members. The ABA Center on Children and the Law improves children' s lives through advances 

in law, justice, knowledge, practice and public policy by focusing on child abuse and neglect, 

child welfare and protective services system enhancement, family preservation, adolescent 

health and other child protective legal issues. www.americanbar.org/groups/child law.html 

The Annie E. Casey Foundation 

The Annie E. Casey Foundation is a private philanthropy that creates a brighter future for the 

nation's children by developing solutions to strengthen families, build paths to economic 

opportunity and transform struggling communities into safer and healthier places to live, work 

and grow. www.aecf.org 

Generations United 

Generations United is a national membership organization focused solely on improving the lives 

of children, youth, and older people through intergenerational collaboration, public policies, 

and programs for the enduring benefit of all. For well over a decade, Generations United's 

National Center on Grandfamilies has been at the forefront of national efforts to support 

grandfamilies through federal and state legislative testimony and briefings, publications, 

training, and technical assistance. www.gu.org 

National Association for Regulatory Administration 

The National Association for Regulatory Administration (NARA) is an international professional 

organization dedicated to promoting excellence in human care regulation and licensing through 

leadership, education, collaboration, and services. NARA represents all human care licensing, 

including adult residential and assisted living, adult day care, child care, child welfare and 

program licensing for services related to mental illness, developmental disabilities and abuse of 

drugs or alcohol. 

NARA offers agencies in-depth consulting services tailored to specific needs such as: 

development of interpretive guidelines for licensing rules; manual development or revision 

(e.g. for policies, procedures and rules); best practices training; review of administrative 

Model Family Foster Home Licensing Standards 40 
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policies and procedures and licensing enforcement systems; design and implementation of 

efficient licensing measurement systems and automation systems, such as key indicator 

systems; operational analyses of the licensing program and review and revision assistance with 

licensing rules. www.naralicensing.org 

Other Resources 

The Grandfamilies State Law and Policy Resource Center 

A project of the ABA Center on Children and the Law, Generations United, and Casey Family 

Programs, the Grandfamilies State Law and Policy Resource Center serves as a national 

resource on state laws and policies that support kinship care. The website includes a searchable 

database of laws and legislation, narrative analyses of legal topic areas, practical 

implementation and advocacy ideas, personal stories, relevant resources and publications. The 

resources, analyses and legislative database are updated regularly. This website contains state 

licensing standards, as well as other licensing resources. www.grandfamilies.org 

The National Indian Child Welfare Association (NICWA} 

NICWA is a private, nonprofit, membership organization, which is a national voice for American 

Indian children and families. NICWA is the most comprehensive source of information on 

American Indian child welfare and the only national American Indian organization focused 

specifically on the tribal capacity to prevent child abuse and neglect. Review their Development 

and Implementation of Tribal Foster Care Standards, which provide a process through which 

tribes can develop locally appropriate standards. 

http://www.nicwa.org/resources/booklets/. 

Kinship Process Mapping: A Guide to Improving Practice in Kinship Care 

Kinship Process Mapping is a tool that allows child welfare agencies to assess their agency 

practices with identifying, approving, and supporting kin for children who cannot safely live 

with their parent s. The Kinship Process Mapping guide outlines a step-by-step process that 

agencies can use to prepare for, conduct, and analyze the results of kinship process mapping 

sessions. The Guide also includes best practices for ensuring that children have an opportunity 

to be placed with and connected to their kin whenever 

possible. www.aecf.org/-(media/Pubs[Iopics/Child%20Welfare%20Permanence/Kinship/Kinsh 

ipProcess MappingGuide/KinshipProcessMappingGuide.pdf 

Technical Assistance 

Attorneys at Generations United and the ABA Center on Children and the Law are available to 

provide technical assistance to jurisdictions seeking to align their current rules, policies and 

practices w ith the M odel Family Foster Home Licensing Standards. This technical assistance is 

available free of charge thanks to support from the Annie E. Casey Foundation. Contact Ana 

Beltran at abeltran@gu.org or Heidi Redlich Epstein at Heidi.Epstein@americanbar.org 

Model Family Foster Home Licensing Standards 41 

33873.057ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucenslne Model Ucenslne comparable State State Standard Alfcnment Identify chances Plan to address All&nment Commeftts 

Standards Title Standards Rule Standud SOurce · lndicatt with Model needed to allan Legislative, Policy or 

and Rule COntent the dtatlon for Ucenslne Procedure 

Numbe< aM (stiltutes, Standards 

recul.ions/ 

administrative <Odes, policies, 

etc.) 

1. Definitions Oves 0 No 

A. "Applicant"- an 

individual(s) who 

has submitted an application and is 

seeking a license 

from the licensing 

agency as a family 

foster home. 

B. "Community Oves 0No 

standards"-local 

norms bounding 

acceptable conduct. 

For housing. the 

term means 

acceptable building 

standards based on 

the neighbomood 

and similar homes. 

c. ""Corporal O ves 0 No 

punishment"- any 

form of physical 

discipline In which 

a child is spanked, 

paddled or hit on 

any part of the 

body with a hand 

or instrument. 

Model Family Foster Home Licensing Standards 4

33873.058ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

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and Rule Content the citation for Procedure 

Number aU (statutes, Standards 

naulatlons{ 

admlnlstratfve 

poll<le$, 

0. ,.Family foster care" Oves 0 No 

- continuous 24 • 

hour care and 

support services 

provided for a child 

in a family foster 

home. 

E. "Family foster O ves 0 No 

home ... - a private 

including 

adjacent grounds 

belonging to the 

in which a 

child is placed for 

family foster c.are 

under the 

supervision of the 

licensing agency. 

This term includes a 

kinship, relative, 

and <hild·specific 

home. 

F. ,.Foster parent"- Oves 0 No 

an individual who 

provides family 

foster c.are with a 

license from the licensing authority. 

Model Family Foster Home Ucensing Standards 4

33873.059ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensine ModtiUcensin& Comparable State State Standard AJisnment Identify "'•1111•• Plan to address Alia:nment - Comments 

Standards Tide Standards Rule Standard SOurce · Indicate with Model neecltdtoal;,n Polley or 

and Rule Content the citation for Procedure 

Number aU (statutes, Standards 

naulatlons{ 

admlnlstratfve 

poll<le$, 

G. ,.Functional Oves 0 No 

literacyR - the ability to read and 

at the level 

necessary to 

participate 

effectively in 

society. 

H. "Household Oves 0 No 

member"-any 

relative or non· 

relative who 

regularly live.s, 

shares common 

areas, and sleeps In a home. An 

individual who is living, sharing 

common areas, and 

sleeping in a home 

temporarily for 

more than two 

consecutive weeks 

is considered a 

household 

member. 

Model Family Foster Home Ucensing Standards 4

33873.060ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

I. the Oves 0No 

approval, 

verification or 

certification of a 

home and applicant 

to provide family 

foster care. 

I. "'Licensing Oves 0No 

{also known as 

"agency")- the 

entity, either 

private or public, 

that has authority 

to consider and 

approve a family 

foster care license. 

K. "Licensing Oves 0No 

authority"-the 

governmental body 

responsible for 

carrying out 

licensing and 

regulatory 

functions, inc:ludin.g 

monitoring 

compliance with applicable state 

laws and rules. 

Model Fami ly Foster Home Licensing Standards 4

33873.061ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modtl lkensln& Mocltllkensln& State State Standard Allsnment Identify manaes Plan to addreS$ Allerwnent - COmments 

Standards Standards Source· Indicate with Model netdtd to allan PoNcy or 

Content the cftation for Llcensine ProcedW'e 

Number all (statutes, Stancllrds 

reaulodons/ 

odmlnlstrotlve 

codes, policies, 

etc.} 

l. "Relative"- an Oves 0 No 

individual who is 

related by blood, marriage or 

adoption or who 

has a close family .. 

like relationship to another individual. 

For American Indian and Alaska 

Natlve children 

"'relative"' coukl 

also in elude a 

tribally defined 

extended family 

relationship. 

M. "Sibling" - brothers Oves 0 No 

and si.sters by birth 

or adoption, 

stepbrothers, 

stepsisters, half· 

brothers, and half· 

sisters. 

2. ELIGIBILITY O ves 0 No 

STANDARDS 

A. All applicants must 

submit a complete 

application and 

Model Family Foster Home Licensing Standards 4

33873.062ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensine ModtiUcensin& Comparable State State Standard AJisnment Identify "'•1111•• Plan to address Alia:nment - Comments Standards Tide Standards Rule Standard SOurce· Indicate with Model neecltdtoal;,n Polley or 

and Rule Content the citation for Procedure 

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naulatlons{ 

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accompanying 

documentation for 

a family foster 

home license, and 

keep copies in their 

home. 

B. To apply lora Oves 0 No 

family foster home 

license: 

1. Applicants mus-t be 

age 18 or older. 

2. Applicants must be Oves 0 No 

able to 

communicate with 

the thild in the 

child1 s own 

language. 

3. Applicants must be O ves 0 No 

able to communicate with 

the licensing 

agen<y and health care and other 

service providers. 

Model Family Foster Home Ucensing Standards 4

33873.063ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Licenslns Modellunol"' Comparable State State SQncllrd Alignment Identify chanpos Plan to i<l4t-eu AUcnment- Comments 

Standilrds n t le StandJrds Rule Stand•d Source- lnclic:ate wiltl Model needed to aliJn Polky or 

andRde Content the citation for Uc.nsl"' Procedure 

Number all (statutes, Standarcts 

reaulations/ 

administrative code$, policies, etc. I 

4. At least one D Yes 0 No 

applicant In the 

home must have 

functional literacy, 

such a,s have the 

ability to read 

labels on 

medications in 

order to properly administer them. 

s. Applicants must O v .. 0 No 

have income or 

re-sources to make timely payments 

for shelter, food, 

utility costs, 

clothing. and other 

household 

e)(pen.ses prior to 

the addition of a 

child In foster care. 

c. The agency must Q v .. 0 No 

not den•t to any 

individual the 

opportunity to 

become a foster parent on the basis 

of the race, color, 

Model Family Foster Home licensing Standards 4

33873.064ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

or national origin of 

the indhridual, or of 

the child, as 

required by the 

federal Multiethnlc 

Placement Act 

(MEPA), 42 U.S.C.A. 

sec. 1996b and Title 

IV·E of the Social 

Security Act, 42 

U.S.C.A. sec. 

671(18). MEPA also 

provides that this 

law must not be 

construed to affect 

the application of the Indian Child 

Welfare Act, which 

contains 

preferences for the 

placement of 

eligible American 

Indian and Alaska 

Native children In 

fosterc.are, 

guardianship, or 

adoptive homes. 

Furthermore, the 

agency must not 

Model Fami ly Foster Home Licensing Standards 4

33873.065ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

-IUcensin1 Model Lkensins Comp•able State State Standard Allcnme-nt ldontlfy m. • ..,. Plin to address Alicnment - Comment5 

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and Rule Content the citation for llcensinl Procechre 

Nu- all Standards 

reculidons/ 

administrative coHs, etc.) 

discriminate with 

regard to the 

applk:ation or 

licensure of a foster 

family on the basis of age, disability, 

gender, religion, 

s.exual orientation., 

gender Identity or 

marital status. 

3. PHYSICAL O ves 0No 

AND MENTAL 

HEALTH 

STANDARDS 

A. All applicants and 

household 

members must have physical 

exams from a 

licensed health care 

professional 

recognized by the 

agency. The exam 

results, which must 

be no older than 12 months prior to 

applk.ation, must 

indicate that the 

Model Family Foster Home Licensing Standards s

33873.066ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modol Uconslnt Model Comparable State State Standard AliJ'Imenl Identify chances Plan to address AIIJ'Imont- COmments 

Standards Tltle Standards Rule Sta.ndard Source • Indicate with Model neecledtoalfcn Leclslatlve, Polley or 

and Rule Content tlledt .. lonlo< Ucenslrc Procedure 

N...,be< all (statutes. Standard$ 

admlnfstrat.fve 

codes, policies, 

etc.) 

applicants are 

capable of carin.g 

for an additional 

child. The agency 

may require further 

documentation 

and/or evaluation 

to make such a 

determination. 

B. All children who are O ves 0No 

household members must be up to date on 

Immunizations 

jointly 

recommended by 

the American 

Academy of 

Pediatrics, the 

Advisory 

Committee on 

Immunization 

Practices of the 

Centers for Disease Control and 

Prevention, and the 

American Academy 

of family 

Physicians, unless 

Model Family Foster Home Licen sing Standards 5

33873.067ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensln1 Modellkenslns Comp.-able State State Standard Alfcnment lclentlfychoniOS Plln to adG-es.s Allcnment- Comments 

Stondotds rrtle Standilrds Rule St..,dord Source Indicate wtthModel neecledtoalipl Lel hlotive, Poii<Y 0< 

and Rule Content the citation for Ucensina Procedure 

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regulations/ 

admlnistrattve codes, poMdH, 

etc. I 

the Immunization Is 

contrary to the child's heatth as 

documented by a 

licensed health care 

professional. 

c. Applic.ants and all O ves 0 No 

household 

members mu.st 

disclose any past or 

current mental 

health and/or 

substance abuse issues. The agency 

may require further 

documentation 

and/or evaluation 

to detennlne the 

suitability of the 

home. 

4. HOME STUDY O ves 0 No 

STANDARDS 

A. 

The agency must 

conduct a written 

comprehensive 

famity assessment 

and home study in 

Model Family Foster Home Licensing Standards 5

33873.068ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededto allrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

collaboration with 

the applicants to 

include: 

1. At lea,st one Oves 0No 

scheduled on .. slte 

visit to assess the 

safety of the home 

using these 

licensing standards. 

2. At least one Ov.s 0No 

scheduled in home, Individual interview 

of each household 

member to observe 

famUy functioning 

and assess the 

famRy's <apacity to 

meet the needs of a 

child in foster care. 

The agency will 

determine whether 

to interview or just 

observe each 

household member 

based on his or her 

age and 

Model Fami ly Foster Home Licensing Standards 5

33873.069ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

development. 

B. The agency must Oves 0No 

obtain at teast 

three references, 

Including at least 

one from a relative 

and one from a 

non·relative. 

c. Tribal agencies may 

also be Involved In 

conducting home 

studies lor 

Americ-an Indian 

and Alaska Native children. 4Z 

U.S.C.A. sec. 

671(Z6)(B) provides 

that any receiving 

state must treat 

any tribal home 

study report as meeting the 

requirements 

Model Fami ly Foster Home Licensing Standards 5

33873.070ralbany on LAP520R082 with HEARINGS

M odel Family Foster Home Licensing Standards Cross-Walk Tool 

Modo!Ucenslna MocH!llcensina Companble State State Standard Alipment Identify chances Plan to address AllaNnent - Comments 

Standards Tltle Standards Ru" Standard Source ·Indicate with Model needed to allen Polley or 

ondRule Content the dtation for licensin& Procedure 

Number oll(stotvt ... Standards 

resu'-tions/ 

edmini$trative 

codes, policies, etc.) 

imposed by the 

state for the 

completion of a 

home study. 

5. CAPACITY O ves 0 No 

STANDARDS 

A. The total number of 

children In a family 

foster home, 

including the 

family's own chUdren living in 

the home, must not 

exceed 8, of which 

no more than 5 

may be children in 

foster care. The 

asency may 

determine lower 

capacities based on 

the family 

auessment and 

home study. 

Model Family Foster Home licensing Standards 5

33873.071ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

1. No more than 3 Oves 0No 

children total under 

age 2. 

2. No more than 4 Oves 0No 

children total under 

ages. 

3. No more than 4 Ov.• 0No 

children total 

between the ages 

of5·13. 

4. No more than 4 Oves 0No 

children total over 

the aseofU. 

Model Fami ly Foster Home Licensing Standards 5

33873.072ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensln1 Modellkenslns Comp.-able State State Standard Alfcnment lclentlfychoniOS Plln to adG-es.s Allcnment- Comments 

Stondotds rrtle Standilrds Rule St..,dord Source Indicate wtthModel neecledtoalipl Lel hlotive, Poii<Y 0< 

and Rule Content the citation for Ucensina Procedure 

Number all (statut es, Standards 

regulations/ 

admlnistrattve 

codes, poMdH, etc. I 

8. The maximum O vos 0 No 

number of children 

may be increased 

agency 

approval to aUow 

for siblings to 

remain together or 

to allow applicants 

to provide care to a 

child who has an 

established, 

meaningful 

relationship with 

the 

family, such as a 

child who was 

formerly in foster 

care with the family. 

6. SLEEPING O ves 0 No 

STANDARDS 

A. Each child in foster 

care must have a 

sleeping spac;.e with an individual bed or 

crib, mattress and 

linens, as 

appropriate for the 

Model Family Foster Home Licensing Standards 5

33873.073ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

child's needs and age and similar to other household members. 

1. Children who are Oves 0No 

relatives may share 

a bed with agency 

approval. 

2. All cribs in the Oves 0No 

home must be in 

compliance with 

Consumer Product 

Safety Commission 

standards. 

3. All bunk beds in the Ov.s 0No 

home must not 

have more than 

two tiers. 

a. The upper tier 

must have railings 

on both sides to 

prevent falling. 

b. The top tier must 

Model Fami ly Foster Home Licensing Standards 5

33873.074ralbany on LAP520R082 with HEARINGS

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Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

not be used by a child under the age of6. 

B. There must be no Oves 0No 

morethan4 

children total 

sharing a room 

used as a sleeping 

space. 

1. A chlkl over the age O v., 0 No 

of 5 must not share 

a room used a.s a 

sleeping space with 

a child ofthe 

opposite sex. 

2. Children who are O ves 0 No 

relatives may share a room used as a sleeping space with agency approval. 

Model Family Foster Home Licensing Standards 5

33873.075ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modellkensln& Modellicensln& comparable State State Standatd AIIIP'ment ldentlfV monaes Plan to address AIICM\ent- COmments 

Standards Standards Rule Standard Source • Indicate with Model needed to allen Policy or 

and Rule Content the cftatfon for lkensinc ProcedLWe 

Number all (statutes, Standards 

reculadons/ 

admlnlstratfve codes, poWcies, 

etc. I 

3. A child under 12 Oves 0 No 

months of age in an 

individual crib may 

share a room used 

as a sleeping space 

with the foster 

parent. 

4. A child over 12 O ves 0 No 

months of age may 

share a room used 

as a sleeping spate 

wfth the foster 

parent with agency 

approval. 

7. OTHER liVING O ves 0 No 

SPACE STANDARDS 

A. The home may be a 

house, mobile 

home, housing unit 

or apartment occupied by an 

individual or a 

family. 

Model Family Foster Home licensing Standards 6

33873.076ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

ModeiUcMsiOI Model Ucenslng Comparable State State Standard ANsnment I<Hnlllyd\angH Plan to address AJI&nment- Comments 

Standards Tltte Standards Rule Standard Source • lndkate nHded to alil1n Lecistattve1 Policy Of 

and Rule COntent me dt-atlon fOf Lkensins Procec:hM'e 

Number all(statutH, Standards 

, ... lations/ 

1dmlnlstratlve 

codes, policies, 

etc.) 

8. The applicants' O ves 0 No 

home and all 

structures on the 

grounds of the 

property must be 

maintained in a 

clean, safe, and 

sanitary condition 

and In a reasonable 

state of repair 

within community 

standards. 

c. The home must 

satisfy the 

following living 

spaee standards: 

1. Be free from O ves 0No 

objects, materials, 

and conditions that 

constitute a 

danger. 

2. Prevent or Oves 0 No 

eliminate rodent and Insect 

infestation. 

Model Family Foster Home Licensing Standards 6

33873.077ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensi ng Standards Cross-Walk Tool 

Model Licenslns Modellunol"' Comparable State State SQncllrd Alignment Identify chanpos Plan to i<l4t-eu AUcnment- Comments 

Standilrds n t le StandJrds Rule Stand•d Source- lnclic:ate wiltl Model needed to aliJn Polky or 

andRde Content the citation for Uc.nsl"' Procedure 

Number all (statutes, Standarcts 

reaulations/ 

administrative code$, policies, etc. I 

3. Regulariy dl$pose D Yes 0 No 

of tram and 

recycling. 

4. Have a wor·king Q v .. 0No 

phone cr access to 

a working phone In dose walking 

proximity. 

s. Have at least one O ves 0 No 

toilet, sink, and tub 

or shower in safe 

operating 

condition. 

6. Have kitchen O ves 0No 

facilities with a 

sink, refrigerator, 

stove, and oven in safe operating 

condition. 

7. Have heotlng O ves 0 No 

and/or cooling as 

required by the 

geographic area, 

consistent with accepted community 

Model Family Foster Home licensing Standards 6

33873.078ralbany on LAP520R082 with HEARINGS

M odel Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensln1 Modellkenslns Comp.-able State State Standard Alfcnment lclentlfychoniOS Plln to adG-es.s Allcnment- Comments 

Stondotds rrtle Standilrds Rule St..,dord Source Indicate wtthModel neecledtoalipl Lel hlotive, Poii<Y 0< 

and Rule Content the citation for Ucensina Procedure 

Number all (statut es, Standards 

regulations/ 

admlnistrattve codes, poMdH, etc. I 

standards and ln safe operating 

condition. 

8. Have ventilation O v .. 0 No 

where household 

members and 

children in foster 

care eat, sleep, 

study, and play. 

9. Have artificial O ves 0 No 

lighting where 

household 

members and 

children in foster 

care study and 

read. 

8. FIRE SAFrTY/ 

EVACUATION 

PLAN 

STANDARDS 

A. The applicants' 

home must meet 

the following fire 

safety/evacuation 

plan standard$: 

Model Family Foster Home Licensing Standards 6

33873.079ralbany on LAP520R082 with HEARINGS

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Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

1. Have at least one Oves 0No 

UL (Underwriter's 

Laboratory) 

approved smoke 

detector on eath 

level of occupancy 

of the home and near sleeping areas. 

2. Have at lea.st one Ov.s 0No 

operable fire 

extinguisher that is 

readily accessible. 

3. Be free of obvious Oves 0No 

fire hazards, such as defective heating 

equipment or 

Improperly stored 

flammable 

materials. 

Household heating 

equipment must be 

equipped with 

appropriate safeguards, 

maintained as 

recommended by 

the manufacturer. 

Model Fami ly Foster Home Licensing Standards 6

33873.080ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

4. Have a written Oves 0No 

emergency evacuation plan to 

be reviewed with 

the child within 24 

hours of placement 

In the home and 

posted in a 

prominent place In 

the home. The plan 

must Identify multiple exhs from 

the home, and 

designate a central 

meeting piau close 

Model Family Foster Home Licensing Standards 6

33873.081ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modo!Ucenslna MocH!llcensina Companble State State Standard Alipment Identify chances Plan to address AllaNnent - Comments 

Standards Tltle Standards Ru" Standard Source ·Indicate with Model needed to allen Polley or 

ondRule Content the dtation for licensin& Procedure 

Number oll(stotvt ... Standards 

resu'-tions/ 

admini$trative 

codes, policies, 

etc.) 

to the home that is 

known to the child 

yet at a safe 

distance from 

potential danser. 

8. Applicants must O ves 0No 

maintain a 

comprehensive list of emergency 

telephone 

numbers, including 

poison and post those numbers In a prominent 

place in the home. 

If there is a landline phone located in 

the home, the 

numbers must be 

posted ne.Kt to the phone. 

9. ADDITIONAL 

HEALTH AND 

SAFETY 

STANDARDS 

A. The applicants' 

home must meet 

Model Family Foster Home licensing Standards 6

33873.082ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Mocle!Ucenslnc Moclelllcenslnc Comparable State State Standard Allp1ment Identify chanJts Plan to address AUanment Comments 

Standarch Standards Rule Standwd Source · Indicate w ith Model needed to alii" lep slatlve, Polley or 

and Rule Content the lor Ucensi"C Procedure 

Numbe< ,II Standards 

idmlnistr'ltive 

codes, policies, 

etc.) 

the following 

standards 

concerning 

weapons: 

1. The following Oves 0No 

weapons must be 

stored in an 

inoperative 

condition in a 

locked area inaccessible to 

children: 

a. Firearms; 

b. Alr guns; 

c. BB guns; 

d. Hunting 

slingshots; 

e.Anyother 

projectile weapon. 

z. All ammunition, Oves 0No 

arrows or 

projectiles for such 

weapons must be 

stored in a locked 

space separate from the weapons. 

Model Family Foster Home Licensing Standards 6

33873.083ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensina State Stlte Standilrd AN&nrnent Identify chances l>tan to addre$$ Allcrwnent- Comments 

Tttle St111dard$ Rule Standtrd Sowce · tndic:lte wkhModel needed to JJiicn lesislitive, Policy or 

andRde Content the dtatton for lkenslnc Procedwe 

Nolmber all (statutes, Standards 

resutations/ 

administrative 

codes, polldes, 

ett.l 

3. Applk:ants who are Oves 0No 

also law 

enforcement 

officials and can document that 

their jurisdiction 

requires them to 

have ready and 

immediate access 

to their weapons 

may be eKempt 

from these weapon 

requirements 

provided the 

appll<ants adopt and follow a safety 

plan approved by 

the agen<v. 

8. The appll<ants' 

home must meet 

the following 

standards 

concerning water: 

Model Family Foster Home Licensing Standards 6

33873.084ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

ModeiUconsl,. ModeiUcenslnc Comparable State StMe Standard Ali,grvnent ldentlfv<Nnces Plan to address Allcrvnent- Comments 

Standards Tkle Stllr\dards Rule Standard Source • Indicate needed to aNcn Lepslative, Polley or 

and Rule Content the citation fOf Licenslna Procedure 

Number all(statutes, Standards 

reculations/ 

idministri'tive 

oodes, policies, etc.) 

1. A family foster Oves 0 No 

home must have a 

continuous supply of safe drinking 

water. 

2. If a home uses O ves 0 No 

private well water 

or another source of drinking water other than water 

through the municipal water 

supply, then it must 

be tested for 

safety. 

3. The temperature of Oves 0 No 

any water heaters 

must be set in 

accordance with 

the manufacturer's recommendations. 

c. The 

home must meet the following 

standards 

concernin,g animals: 

Model Family Fost er Home Licensing Standards 6

33873.085ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensina State Stlte Standilrd AN&nrnent Identify chances l>tan to addre$$ Allcrwnent- Comments 

Tttle St111dard$ Rule Standtrd Sowce • tndic:lte wkhModel needed to JJiicn lesislitive, Policy or 

andRde Content the dtatton for lkenslnc Procedwe 

Nolmber all (statutes, Standards 

resutations/ 

administrative codes, polldes, 

ett.l 

1. Any animal that O ves 0 No 

poses a threat to 

the safety or health 

of a thild in foster 

are must be 

confined In a place away from the <hlld and inaccessible to 

the <hlld. 

2. Pets that are Oves 0No 

required to be 

vaccinated by state 

or tribal law must 

be vaccinated 

against diseases 

that can transmit to humans, inc:ludin.g rabies. 

D. The applicants' 

home must meet the following 

standards 

concerning 

swimming pools, 

hot tubs and spas: 

Model Family Foster Home Licensing Standards 7

33873.086ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Llcenslnl Model Llcenslnc Comparabte State State Standard Alisnment Identify chln,es Plan to lddress Alltnment- Comments 

Standards lltle Standards Rule Standard Source· tndla.te with Model needldtoaiiiP' Polley or 

and Rule Content thedt.ltlonfOf Ucensinc Proc.edure 

Nwnber all Standards 

rqulations/ administrative 

codes, poNcies, etc.} 

1. Swimming pools Oves 0No 

must have a barrier 

on all sides at least 

four feet high. 

2. Swimming pools Oves 0No 

must have their 

methods of access 

through the barrier 

equipped with a 

safety device, such 

as a bolt lock. 

3. Swimming pools Oves 0No 

must be equipped 

with a life savins 

device, such as a 

ring buoy. 

4. If the swimming Oves 0 No 

pool cannot be 

emptied after each use, the pool must 

have a working 

pump and filtering 

system. 

Model Family Foster Home Licensing Standards 7

33873.087ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensina State Stlte Standilrd AN&nrnent Identify chances l>tan to addre$$ Allcrwnent- Comments 

Tttle St111dard$ Rule Standtrd Sowce • tndic:lte wkhModel needed to JJiicn lesislitive, Policy or 

andRde Content the dtatton for lkenslnc Procedwe 

Nolmber all (statutes, Standards 

resutations/ 

administrative 

codes, polldes, ett.l 

5. Hot tubs and spas O ves 0 No 

must have safety 

covers that are 

locked when not In 

use. 

E. The applicants' 

home must meet 

the following 

standards 

concerning 

hazardous materials and first 

aid supplies: 

1. Prevent the child's Oves 0No 

access, as 

appropriate for his or her aae and 

development, to all 

medications, 

poisonous 

materials, cleaning 

supplies, other 

huardou.s mat erials, and 

alcoholic 

beverages. 

Model Family Foster Home Licensing Standards 7

33873.088ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

-IUcensin1 Model Lkensins Comp•able State State Standard Allcnme-nt ldontlfy <honi"S Plin to address Alicnment - Comment5 

Standards Title Standards Ru'- Standard Sourclt- Indicate with Model needed to align legislative, Policy or 

and Rule Content the citation for llcensinl Procechre 

Nu- all Standards 

reculidons/ 

administrative coHs, etc.) 

z. Maintain first aid Oves 0No 

supplies as 

recommended by 

the Reel Cross. 

10. Criminal O ves 0No 

History Records 

Check Standards 

A. 

Applicants and any 

other household 

members who are 

adults age 18 or 

okter must submit 

to fingerprint· 

based checks of 

national and state 

crime Information 

databases and 

checks of state or 

local crime 

information 

databases before 

the applicants may 

be approved for 

piacement of a 

child. 

Model Family Foster Home Licensing Standards 7

33873.089ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Licenslns Modellunol"' Comparable State State SQncllrd Alignment Identify chanpos Plan to i<l4t-eu AUcnment- Comments 

Standilrds n t le StandJrds Rule Stand•d Source- lnclic:ate wiltl Model needed to aliJn Polky or 

andRde Content the citation for Uc.nsl"' Procedure 

Number all (statutes, Standarcts 

reaulations/ 

administrative 

code$, policies, 

etc. I 

B. The agMcy must D Yes 0 No 

also check sexual 

offendet registries 

for mention of the 

applicants and any 

other household 

members who are 

adults age 18 or older. 

c. If a recad check O ves 0 No 

reveals a felony 

conviction for child abuse 01 neglect, 

for spousal abuse, 

for a crime against 

children {including 

child pornography), 

or for a crime involving violence, 

including rape, 

sexual assault, or 

homicide, but not 

intluding other 

physic.al assault or battery,anda state 

finds th't a court of 

competent 

jurisdiction has 

determined that 

Model Family Foster Home licensing Standards 7

33873.090ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modellicenslnc Model Ucensinc Comparable State State Standard All.,mtnt lclentifychonses Plin to address Alianment- Comment5 

Standards n tte Standards Rule Standard Source- Indicate wfthModel needed to alilfl legislative, Policy or 

andRL4e Conttnt the citation for Ucenol,. Procedure 

Number all (statutes. Standards 

rqulatlons/ 

administrative code$, polities, 

etc.) 

the felony was 

committed at any 

time, approval for 

placement of a 

child must not be 

sranted. 

D. If a record check D Yes 0 No 

reveals a f elony 

conviction for 

physical assault, battery, or a drusrelated offense, 

and a State finds 

that a court of 

competent 

jurisdiction has 

determined that 

the felony was 

committed within 

the past 5 years, 

approval f or 

placement of a 

child must not be 

granted. 

Model Family Foster Home Licensing Standards 7

33873.091ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

ModeiUconsl,. ModeiUcenslnc Comparable State StMe Standard Ali,grvnent ldentlfv<Nnces Plan to address Allcrvnent- Comments 

Standards Tkle Stllr\dards Rule Standard Source • Indicate needed to aNcn Lepslative, Polley or 

and Rule Content the citation fOf Licenslna Procedure 

Number all(statutes, Standards 

reculations/ 

idministri'tive 

oodes, policies, 

etc.) 

E. If an applicant was Oves 0 No 

convicted for a crime other than 

those lnduded in C. 

and 0., the 

applicant will not 

be automatically 

rejected as a foster 

parent. The agency 

must consider the 

following: 

1. the type of crime; Oves 0 No 

2. the number of O ves 0 No 

crimes; 

3. the nature of the D Yes 0 No 

offenses; 

4. the age of the O ves 0 No 

individual at the time of conviction; 

s. the length of time O ves 0 No 

that has elapsed 

since the last conviction; 

Model Family Foster Home Licensing Standards 7

33873.092ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

6. the relationship of Oves 0No 

the crime and the 

capacity to care for 

children; 

7. evidence of Oves 0No 

rehabilitation; and 

8. opinions of O ves 0 No 

community 

members 

concerning the 

Individual in 

question. 

F. Applicants and all Oves 0No 

household 

members have an 

ongoing duty to 

report any juvenile 

offenses committed 

by any member of 

the household. The 

existence of a 

household member 

with a juvenile 

offense does not 

automatic-ally 

e xclude the 

applicants. The 

agency must 

Model Family Foster Home Licensing Standards 7

33873.093ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modo!Ucenslna MocH!llcensina Companble State State Standard Alipment Identify chances Plan to address AllaNnent - Comments 

Standards Tltle Standards Ru" Standard Source ·Indicate with Model needed to allen Polley or 

ondRule Content the dtation for licensin& Procedure 

Number oll(stotvt ... Standards 

resu'-tions/ 

edmini$trative 

codes, policies, 

etc.) 

consider the 

suitability of the 

home based on the 

criteria used to 

assess crimes set 

forth in C. E of this 

standard and 

standard 11. B. and 

c. 

11. ABUSE AND Oves 0No 

NEGlECT BACKGROUND 

CHECK STANDARDS 

A. The agency must 

meet the following 

abuse and neglect 

background checks 

standards: 

1. Check all child O ves 0 No 

abuse and neglect 

registry and adult 

protective services 

registry maintained 

by the state, tribe 

or locality for 

Model Family Foster Home licensing Standards 7

33873.094ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

information on 

applicants and any other household 

members who are 

adults age 18 or 

older. 

2. Request that any Oves 0No 

other state In which 

applicants and 

other adutt 

household members who are 

adults age 18 and 

older have resided 

In the preceding 5 

years also check all 

child abuse and 

neglect registry and 

adult protective 

services registry 

maintained by that 

state. 

3. Comply with any DYes 0No 

request described 

in A. 2. that is 

received from 

another state. 

Model Fami ly Foster Home Licensing Standards 7

33873.095ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

B. The applicants Oves 0No 

must not be 

licensed lfthe applicants or any 

household member 

who is an adult age 

18or older ha• 

been the subject of 

a oub5tantlated 

allegation of sexual 

exploitation or 

sexual abuse of a 

child or has been 

substantiated for 

child abuse that 

resulted in a child 

fatality. 

c. If there is a O ves 0 No 

substantiated 

report of child 

abuse or neglect 

other than those 

li5ted in B., 

involving the 

applicants or any 

household member 

who Is an adult age 

18 or older, the 

application is 

Model Fami ly Foster Home Licensing Standards 8

33873.096ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

assessed on a caseby· case basis. 

which indudes a 

discussion with the 

applicants and 

household 

members, to 

determine if the 

safety of any child 

in the home will be 

Impacted. If not 

impacted, the 

results of the abuse 

and neglect 

background check 

may not prevent 

licensure. 

D. Applicants and all O ves 0 No 

household 

members have an 

ongoing duty to 

report any juvenile 

offenses committed 

by any member of 

the household. The 

existence of a 

household member 

with a juvenile 

offense does not 

Model Fami ly Foster Home Licensing Standards 8

33873.097ralbany on LAP520R082 with HEARINGS

M odel Family Foster Home Licensing Standards Cross-Walk Tool 

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resu'-tions/ 

edmini$trative 

codes, policies, etc.) 

automatically exclude the a pplicants. The 

agency must 

consider the 

suitability of the 

home based on the 

criteria used to 

3$$ess crimes set 

forth in B.· C. of this 

standard and 

standard 10 C.·E. 

12. ASSURANCES 

FROM 

APPliCANTS 

A. Applicants must 

sign an agreement 

containin,g the 

following 

a.ssurances that 

they and all 

household 

members will 

comply wit h their 

role.s and 

responsibilities as 

discussed with the 

agency once a chlld 

Model Family Foster Home licensing Standards 8

33873.098ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

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Standards n tte Standards Rule Standard Source- Indicate wfthModel needed to alilfl legislative, Policy or 

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Number all (statutes. Standards 

rqulatlons/ 

administrative code$, polities, 

etc.) 

is placed in their 

care: 

1. They will not US<! D Yes 0 No 

any corporal or 

degrading 

punishment on any 

children in the 

home. 

2. They will not uS<! O ves 0 No 

any illegal 

substances, abuse 

alcohol by 

consuming it in 

exc;ess amounts or 

abuse legal 

prescription and 

nonprMCtlption 

drug.s by consuming 

them in excess 

amounts or using 

them contrary to as 

indicated. 

Model Family Foster Home Licensing Standards 8

33873.099ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Licenslns Modellunol"' Comparable State State SQncllrd Alignment Identify chanpos Plan to i<l4t-eu AUcnment- Comments 

Standilrds n t le StandJrds Rule Stand•d Source- lnclic:ate wiltl Model needed to aliJn Polky or 

andRde Content the citation for Uc.nsl"' Procedure 

Number all (statutes, Standarcts 

reaulations/ 

administrative code$, policies, etc. I 

3. They wl:l not smoke O ves 0 No 

in the presence of 

the child in foster 

care# in the famity 

foster home or in 

any veh:e:le used to 

transport the child. 

Furthermore, 

guests will not be 

allowed to smoke 

In the presence of 

the <hild in the 

family foster home 

or in any vehicle 

used to transport 

the child. 

4. They wl:l dosely O ves 0No 

supervise the child 

in foster cate when 

the child is in dose 

proximity to any 

swimming pool or 

body of water. 

When they cannot 

supervise, they 

must restrict the 

child's access to 

swimming pool.s or 

Model Family Foster Home licensing Standards 8

33873.100ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Licenslns Modellunol"' Comparable State State SQncllrd Alignment Identify chanpos Plan to i<l4t-eu AUcnment- Comments 

Standilrds ntle StandJrds Rule Stand•d Source- lnclic:ate wiltl Model needed to aliJn Polky or 

andRde Content the citation for Uc.nsl"' Procedure 

Number all (statutes, Standarcts 

reaulations/ 

administrative code$, policies, etc. I 

bodies of water. 

The child must 

never be left to 

swim alone. 

5. They wtl provide O ve< 0No 

water safety 

Instruction to the 

child in foster care as appropriate for 

his or her age and 

development If the 

home Is adjacent to 

any body of water or has a swimming 

pool. Water safety 

instruction 

addresse< key 

knowledge and 

skllls on how to be safe around water 

and does not 

necessarily mean 

swimmillg lessons. 

Model Family Foster Home licensing Standards 8

33873.101ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

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Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

6. They will maintain Oves 0No 

the swimming pool 

in safe condition, 

Including testing 

and maintaining 

the chlorine and pH 

levels as required 

by the 

manufacturers 

specifications. 

7. They will lock a ll Oves 0No 

entry points when 

the swimming pool 

is not in use. 

8. They will remove or O ves 0No 

secure any steps or 

ladders to the 

swimming pool to 

make them 

unusable when the 

poolls not in use. 

Model Fami ly Foster Home Licensing Standards 8

33873.102ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Licenslns Modellunol"' Comparable State State SQncllrd Alignment Identify chanpos Plan to i<l4t-eu AUcnment- Comments 

Standilrds n t le StandJrds Rule Stand•d Source- lnclic:ate wiltl Model needed to aliJn Polky or 

andRde Content the citation for Uc.nsl"' Procedure 

Number all (statutes, Standarcts 

reaulations/ 

administrative code$, policies, 

etc. I 

9. They wl:l set up and O ves 0 No 

maintain wading 

pools according to 

the manufacturer's 

instrut:tions, and 

empty and store 

them when not In 

use. 

10. They wtl ensure O ves 0 No 

that the child In 

foster cue has legal and safe 

transportation to 

and from health care, therapy, and 

agency appointments; 

school; 

extracurricular 

activities; social events; and 

scheduled meetings 

or visitation with 

parents, siblings, 

extended family 

members, and friends. 

Model Family Foster Home licensing Standards 8

33873.103ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Licenslns Modellunol"' Comparable State State SQncllrd Alignment Identify chanpos Plan to i<l4t-eu AUcnment- Comments 

Standilrds ntle StandJrds Rule Stand•d Source- lnclic:ate wiltl Model needed to aliJn Polky or 

andRde Content the citation for Uc.nsl"' Procedure 

Number all (statutes, Standarcts 

reaulations/ 

administrative code$, policies, etc. I 

11. They wl] ensure D Yes 0 No 

that ifa privately· 

owned vehicle, owned by the 

applicants, family 

or friends, Is used 

to transport the 

child In foster care, 

It must be 

inspected (n applicable under 

state or tribal law), 

registered, and 

Insured, and meet 

all applicable state or tribal 

requirements to be 

an operable vehicle 

on the road. 

b. Safety restraints 

will be used that 

are appropriate to 

the child's age, 

height, ond weisht. 

c. Weapons must 

not be transported 

in any vehicle in 

Model Family Foster Home licensing Standards 8

33873.104ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

Model Ucensina State Stlte Standilrd AN&nrnent Identify chances l>tan to addre$$ Allcrwnent- Comments 

Tttle St111dard$ Rule Standtrd Sowce · tndic:lte wkhModel needed to JJiicn lesislitive, Policy or 

andRde Content the dtatton for lkenslnc Procedwe 

Nolmber all (statutes, Standards 

resutations/ 

administrative 

codes, polldes, 

ett.l 

whl<h the thlld Is 

riding unlessthe 

weapons are made 

Inoperable and 

inaccessible. 

l.Z. They may need to Oves 0No 

take additional 

steps for the safety 

of the child in foster care, 

depending on the 

home, th e area in 

which It lslo<ated, 

and the age and any cognitive and 

behavioral 

challenges of the 

child. For example, 

applicants may be 

required to <hlld 

proof their home or place a fence to prevent the<hlld 

from accessing 

nearby railroad 

tracks or another 

hazard. 

Model Family Foster Home Licensing Standards 8

33873.105ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

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and Rule Content the citation fOf Licenslna Procedure 

Number all(statutes, Standards 

reculations/ 

idministri'tive 

oodes, policies, 

etc.) 

B. The agency will Oves 0 No 

review the 

agreement with the 

foster parents at 

initiallkensing, 

when a child Is 

placed ln their care, 

and annually 

thereafter. 

13. PRE· O ves 0 No 

LICENSE 

TRAINING 

STANDARDS 

A. All applicants must 

complete at feast 6 

hours of pre·license 

training on care of 

the child. 

B. Pre·licen.se training O ves 0 No 

topksmust 

include: 

1. 

An overview of the 

child welfare 

system: 

a. Legal rights, 

Model Family Fost er Home Licensing Standards 9

33873.106ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

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resu'-tions/ 

edmini$trative 

codes, policies, etc.) 

roles, 

responsibilities and 

expectations of 

foster parents; 

b. Agency purpose, 

policies, and 

services; and 

c. Courts, and 

applicable laws and 

regulations. 

2. Information O ves 0No 

including trauma 

concepts and 

behavioral 

management, to 

provide for the 

needs of the child 

who Is or may be 

placed in the home. 

14. EMERGENCY Ov.s 0No 

PlACEMENT 

STANDARDS 

A. A<hildmaybe 

placed in a home 

Model Family Foster Home licensing Standards 9

33873.107ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

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Standilrds n t le StandJrds Rule Stand•d Source- lnclic:ate wiltl Model needed to aliJn Polky or 

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Number all (statutes, Standarcts 

reaulations/ 

administrative 

code$, policies, 

etc. I 

on an emergency 

basis pending 

licensure for a 

ma»Cimunof 

90 days 

with a relative. The 

applic.ants must agree tc complete 

the full assessment 

and approval 

process for a family 

foster home lk:ense within 90 calendar 

days. For emersency 

placements of 

American Indian 

and Alaska Native children, agencies 

sho•ld work closely 

with tribal and 

urban Indian 

organizattons that 

have expertise In recruiting and 

licensinc tribal 

family foster care homes. 

Model Family Foster Home licensing Standards 9

33873.108ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

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and Rule COntt:nt the citation for Ucenslnc Procech.re 

NumHr alll•tatutes, Standards 

resulatlons/ 

admlnistrttlve 

codes, policies, etc.) 

B. The agenty must 

complete the 

following prior to 

approving an emergency 

placement: 

1. State and/or local O ves 0 No 

criminal 

bacl<cround checl< 

of applicants and 

any other 

household member 

who is an adult age 

18 or older. To 

determine ellglbiHty, the 

results of the check 

will be assessed 

using the criteria in 

10. C., 0., and E. 

above. 

2. State, tribal, and/or Oves 0No 

local child abuse 

and neglect regbtry and adult 

protective services 

registry check for 

Model Family Foster Home Licensing Standards 9

33873.109ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

Modelllc:onslnr Model Licotulnr Comporable State State Standard Alicnment Identify chances Plan to address Allanment - Comments 

Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

administrative 

codes, polide:s, 

etc.) 

information on 

applicants and any other household 

member who is an 

adult age 18 or 

older. To determine 

eligibility, the 

results of the check 

will be assessed 

using the criteria in 

11. B. and C. above. 

3. For other states In Oves 0No 

which applicants 

and any other 

household member 

who is an adult age 

18 and older have 

resided In the 

preceding five 

years, applicants 

and household 

members must attest that they are not on the child 

abuse and neglect 

registry or the adult 

protective services 

Model Fami ly Foster Home Licensing Standards 9

33873.110ralbany on LAP520R082 with HEARINGS

Model Fami ly Foster Home Licensing Standards Cross-Walk Tool 

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Standardslltle Standards Rule Standard Source Indicate with Model neededtoallrn Polity or 

and Rule Content the citation for Ucensi,. Procedure 

all (statute$, Standards 

rqulations/ 

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codes, polide:s, 

etc.) 

registry. At that 

tlme1 the agency 

will submit its 

request that the 

other states check 

their registries. 

4. Preliminary visual DYes DNo 

Inspection to assess 

the safety of the 

home. 

s. Preliminary DYes DNo 

assessment of the ability olthe applicants to meet 

the needs of the 

child. 

6. Discuss assurances D Yes D No 

agreement, as 

desetlbed In 

standard 12 above, 

with applicants and 

obtain their 

signatures on the 

agreement. 

Model Fami ly Foster Home Licensing Standards 9
f 


33873.111ralbany on LAP520R082 with HEARINGS

Model Family Foster Home Licensing Standards Cross-Walk Tool 

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Nolmber all (statutes, Standards 

resutations/ 

administrative 

codes, polldes, 

ett.l 

c. If the home Is not O ves 0 No 

licensed within 90 

calendar days, the 

child must be 

removed from the 

home, unless: 

1. A direct placement Oves 0No 

oft he <hild in the 

home Is ordered by 

the court while the 

thlld Is still In the tu<to<ly of the child 

welfare agency. 

2. The applicants file O ves 0 No 

for and receive eare 

and custody of the 

child dlrertly from 

the court. 

3. The agency grants O ves 0 No 

an extension of up 

to 90 calendar days 

for applicants to 

complete lk:ensure 

if it determines that 

removal of the child 

would be 

detrimental to the 

best interetts of 

the child. 

Model Family Foster Home Licensing Standards 9
124 

Ms. SEWELL. It was our expectation, Congressman Kelly and I, 

and our hope that, after reviewing the model licensing standards, 

the States would modify their own standards to address any inappropriate barriers to licensing relatives caring for children or kinship caregivers whom the child welfare system is increasingly relying on, often as a result of the opioid crisis. 

How will you encourage or how will HHS encourage these licensing standards? 

Mr. MILNER. Well, first of all, let me say that we have reviewed 

the NARA standards. I have personally reviewed the document 

that you have just entered into the evidence. We have also reviewed standards from other licensing bodies, in addition to Statespecific and some Tribal-specific licensing standards as well. 

We have put that information into our proposed standards in a 

Federal Register notice which, again, is currently going through 

clearance. We expect, and will strongly encourage, States, Tribes, 

and others, including the accrediting bodies, to respond to give us 

comments before we finalize those rules and regulations. That is 

going to be forthcoming quite soon. 

Ms. SEWELL. Sure. You know, regarding the 12-month limit on 

substance abuse treatment services and family-based residential 

treatment, what happens if a patient lapses, say, in the 14th 

month? I guess I am trying to get at incidences where people will 

actually relapse after the 12-month period. Clearly, while there is 

a 2-month gap, the reality is that that person still needs treatment. 

Mr. MILNER. Sure. 

Ms. SEWELL. So what would happen for those who lapse beyond 

the 12 months? 

Mr. MILNER. As far as Federal title IV–E funding is concerned, 

I am not aware of provisions where the funding for that service 

could go beyond 12 months. It is a very technical question, and I 

will go back and be absolutely certain about that. 

Beyond that, you have hit on a concern and a challenge that I 

think many States are raising to us. While it is incredibly positive 

that we can now spend money up to 12 months for services that 

we previously could not do with very serious cases of substance 

abuse, particularly with the rise in opioid use right now—— 

Ms. SEWELL. And the recurrence of that. 

Mr. MILNER. Yes, absolutely. 

Ms. SEWELL. I am just trying to get to the point of future access 

to treatment. And the reality is that maybe we should consider a 

longer period. 

Thank you, Mr. Chairman, for letting me extend. And thank you, 

sir. 

Chairman SMITH. Thank you. 

I now recognize Mr. Reichert from Washington State. 

Mr. REICHERT. Thank you, Mr. Chairman. 

Glad to hear that you stopped by the Casey family in Seattle. I 

have done a lot of work with them. 

I do have a question for you at the end of my 5 minutes, but I 

can’t help myself; I have got to make a few comments first. 

First of all, I would like to thank you so much for your service. 

I know that the young people in the audience today and those listening, looking at your record starting as a caseworker and conVerDate Sep 11 2014 01:05 Jun 19, 2019 Jkt 033873 PO 00000 Frm 00128 Fmt 6633 Sfmt 6602 I:\WAYS\IN\33873\33873.XXX 33873

ralbany on LAP520R082 with HEARINGS
125 

tinuing on all these years to help children, that takes compassion 

and dedication. I am a 33-year veteran of law enforcement. And 

also, just for the information of the students and the young people 

in the room, I am a survivor of domestic violence, the oldest of 

seven kids, and a runaway. And I think you will find that most of 

the people up here have a story to tell. 

And so, when you look at us, we are people like you. We went 

through struggles and trials. And so I am assuming that out of all 

the hands that were raised in the audience, I am assuming all of 

you want to be Members of Congress. Raise your hand, please, who 

wants to be a Member of Congress. I don’t see any hands, Mr. 

Chairman. 

Chairman SMITH. They may have higher expectations. 

Mr. REICHERT. How about President? Oh, there is one, okay. 

Thank you. Yeah, don’t do it, somebody said. 

I just wanted to share that with you because, you know, it is all 

real formal and everything, but we care about you, and we are here 

to try and figure out a way to help. Right? 

Mr. MILNER. Thank you. 

Mr. REICHERT. So I look at this, and some have mentioned the 

opioid problem. It is just devastating our country and our children. 

And, you know, the percentage of children entering foster care is 

due to, a lot of it, parental substance abuse and its dramatic increase. And, in fact, every 25 minutes a baby is born suffering from 

opioid withdrawal. Every 25 minutes a baby is born addicted to 

opioids, every 25 minutes. In Washington State, 5,700 children 

were placed into foster care in 2016, 34 percent of infants—34 percent of infants. 

The passage of the Family First law gives us an awesome opportunity to bend this curve, and we can do that. So this is not about 

just children. It is not only children, but it is about drug and alcohol abuse. It is about human trafficking. It is about crime. It is 

about keeping families together and keeping children safe and 

healthy, keeping them in school then, right? If they have a loving 

home and a loving family, they get educated. They get jobs. They 

are successful. They have pride in their lives and their families. 

That is what this is about, and it is about the success of America. 

And there is one agency in Seattle that I am particularly close 

with because I have two drug-addicted grandchildren who I was a 

foster grandparent and an adoptive grandparent. And they went 

through an organization called PICC, the Pediatric Interim Care 

Center, in Kent. And what they do is they provide specialized 24- 

hour care for drug-exposed and medically fragile newborns. They 

offer treatment that allows the baby to completely withdraw from 

drug dependency and transition, and they want to get them home 

safely without medication. They want to keep the families together. 

So they work with mom and dad if they are around and try to keep 

them together. If they don’t, then they get adopted into families 

like my daughter’s and her husband’s and they become a blessing 

to all of us. 

So how can an organization like PICC, how can we ensure and 

be sure that programs like PICC are eligible for prevention services 

funding provided by Family First? 


ralbany on LAP520R082 with HEARINGS
126 

Mr. MILNER. They are eligible. Private agencies have long been 

a foundational part of the service delivery system in the child welfare system in our country. Under Family First, the requirements 

to deliver services that are evidence-based will still be there for the 

private providers, but we are actively encouraging State child welfare agencies to work in strong collaboration with their partners in 

the private sector, the rest of the public sector, the faith-based community, as well as other organizations. 

Mr. REICHERT. What is the process? They have got to be evidence-based, but what is the process, real quick? 

Mr. MILNER. Typically, they would have some sort of contractual arrangement with the State child welfare agency to be a service provider there. 

Mr. REICHERT. And meet the evidence-based? 

Mr. MILNER. Yes. 

Mr. REICHERT. I yield back. Thank you. Thank you. 

Mr. MILNER. Thank you. 

Chairman SMITH. Thank you. 

And next we have Ms. Chu from California. 

Ms. CHU. Thank you. 

Last night I went to the congressional foster care dinner that 

Karen Bass is the head of and heard very wonderful testimony 

from foster care children or former foster care children, who said 

how much Family First would change their lives and finally provide the resources available to keep families together versus letting 

more kids enter the foster care system. So I think this is certainly 

a step in the right direction. 

But States have a lot of questions about the implementation of 

this, and that includes my home State of California and my county 

of Los Angeles, which is responsible for the largest child welfare 

system in the Nation and in 2017 oversaw nearly 35,000 children. 

It currently has a IV–E waiver, which has allowed them to provide 

innovative preventive services, including substance and mental 

health services to populations who are not title IV–E eligible, but 

they have also done a dramatic job to reduce the foster care population 23 percent between 2007 and 2010, and they have also reduced the number of children in group homes and other institutionalized settings by one-third. 

So I think they have been trying to do the same kind of goals 

that are in Family First. And they have also provided home visiting services, aftercare networks, creative partnerships with other 

community agencies like job centers, and reduced the number of 

children entering care and increasing permanency. 

I understand, Commissioner Milner, that you had a productive 

meeting with L.A. County about their program, and my first question would be whether you saw that they were making progress 

along these lines in a similar fashion to Family First? 

And then my second question has to do with the timeline for implementation and whether there can be any kind of consideration 

for those who are on the title IV–E waiver programs, whether there 

can be guidance or technical assistance or any kind of other consideration for counties like Los Angeles to help them transition from 

their waiver to the implementation of the provisions of the Family 

First Act. 


ralbany on LAP520R082 with HEARINGS
127 

Mr. MILNER. Let me say that thank you very much for raising 

that issue. It is a very important issue for me and for those of us 

in the Children’s Bureau. Yes, I did have a very productive onsite 

visit with Bobby Cagle and his staff in L.A. County. I have also 

met with the board of supervisors for L.A. County to hear their 

concerns; last week, I spent a couple of days up in San Francisco 

visiting a community-based program; and I have made visits down 

to San Diego as well. 

All of those programs have in common, I believe, a very strong 

commitment to moving their systems toward one that strengthens 

families, strengthens children, and prevents bad things from happening to children. L.A. County has done a tremendous amount of 

work there. The First 5 work, which is a home visiting program, 

is one that they are really quite proud of. 

The loss of the flexibility of the title IV–E waiver dollars is going 

to be a big hit for the counties in California because the State office 

has pushed those flexible waiver dollars down to the counties, 

where they have used those dollars to create upfront primary prevention services for children and families, not just preventing them 

from coming into foster care but preventing them from being maltreated in the first place. 

The transition to Family First means a lot of different things for 

them, including a loss of the flexibility. Even though they are able 

to use title IV–E dollars now for certain prevention services, Family First does not replace the entire flexibility that they have under 

the IV–E waivers right now, where they have a capped allocation, 

and they are using that money accordingly. 

California has expressed great interest in some sort of a transitional authority to continue that, to help them make the transition 

in ways that they can be even more successful with Family First 

rather than at a certain point just having to give up the flexibility 

that they have had. 

We would actually support that. And I believe that there is a 

strong need for us to do this in an orderly fashion in a way that 

allows States to plan as carefully and as thoughtfully as they can 

to move to the new system under Family First. 

Ms. CHU. Thank you so much for that answer. I really appreciate it. 

Chairman SMITH. Thank you. 

Now we move on to Mr. Wenstrup from Ohio. 

Mr. WENSTRUP. Thank you, Mr. Chairman. 

Thank you, Mr. Milner, for being here today. Just in the scheme 

of the big picture, I just want to share that my wife and I just recently experienced the joy of adoption. 

Mr. MILNER. That is wonderful. 

Mr. WENSTRUP. It is wonderful. And we would like to see more 

of that take place. It is a beautiful thing. 

And Family First presents a real opportunity to shift kind of the 

way we think about the role of Federal foster care dollars and how 

they can be more effectively spent. Our system in Ohio, in Cincinnati area especially, is very overcrowded. It is a real problem for 

the agencies. And we have this opportunity to provide alternatives 

for our youth, and I think that that is something that we all look 

forward to. We have been greatly affected by the opioid epidemic. 


ralbany on LAP520R082 with HEARINGS
128 

As a matter of fact, that has been a huge driver of the need for 

an increase in our foster care system to be able to work. 

But Ohio has held the title IV–E waiver since 1997, and so, 

across the State, we are anxiously awaiting a timeline of how we 

deal with this transition from the waiver to Family First. We really 

need some guidance on that, and the sooner, the better—if we are 

going to be effective. We want some clarity on that if you can provide it, and is there technical assistance? I am following up on that 

question. But the sooner we can get a real timeline, it would be 

very, very helpful. 

And then the other thing that I am concerned about is, what is 

the process for States to identify and get approved new practices 

that are not specifically preapproved? How can we innovate in the 

areas of making this whole system work better? 

Mr. MILNER. I was fortunate enough to spend some time with 

the child welfare leadership from Ohio last week. We had teams of 

10 people from every State come here to Washington, which included not just the child welfare agency but the legal/judicial community and the prevention partners. And it was a pleasure to be 

able to spend some time at the Ohio table and also to hear some 

of their concerns. 

The process of getting services introduced into the approvable 

pool is going to be an ongoing process, as well it should. We will 

come out with an initial list of programs that we will be reviewing, 

but Family First is inspiring a great deal of attention to building 

the evidence for programs out there so that we hope to expand the 

array of services over time. States can submit to us programs that 

they want us to consider. 

Again, later this year, we will also again be issuing a Federal 

Register announcement that will describe that process for reviewing the criteria that we intend to use to review for programs that 

are reimbursable under the prevention funding stream and also 

provide guidance for States to submit those programs if they want 

us to take a look at those—— 

Mr. WENSTRUP. So where are you in that stage right now? I 

mean, where—— 

Mr. MILNER. I am sorry? 

Mr. WENSTRUP. Where are we as far as staging? You can submit an idea, an innovative idea right now. Do you have a particular 

form you fill out? Do you have to have documentation? I mean, I 

think that is what we are looking for, and then the timeframe of 

that. 

Mr. MILNER. We will contract for a clearinghouse that will be 

responsible for carrying out those activities of reviewing the programs, soliciting nominations or candidates for programs to be in 

that pool. The procurement is on the street at this point and we 

expect that contract to be issued by October 1. 

As soon as we get the clearinghouse procedures in process, those 

procedures, we will be able to release and move forward with it. 

States could submit programs to us right now. Clearly, we don’t 

have the ability at this moment until we have the clearinghouse in 

place to actually conduct a review of those programs and start adding them to the bank. But we anticipate moving forward with that 

on October 1. 


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Mr. WENSTRUP. And some of the ideas that people come forward with, are they going to be able to test the waters a little bit? 

In other words, you want to have evidence-based ideas, if you will, 

preferably. Are they going to be able to test the waters, try something on a small basis and then expand it if it is successful? Is that 

what we can look forward to? 

Mr. MILNER. I am not sure if I understand the question. Certainly, an evidence-based program could be implemented on a limited basis. If you want to do it in one of your counties and perhaps 

not statewide, there is nothing prohibiting you from doing that. 

The statute is quite specific, however, that to be reimbursable 

under the prevention funding services stream, it must meet the criteria for evidence-based, either at promising, supported, or wellsupported levels. 

Our intent is to open the promising door as wide as we can open 

it, so that States can begin to use or continue to use services that 

they believe are effective in serving children and families while 

they build the evidence to get those services up to the higher rungs 

of the evidence ladder. 

Mr. WENSTRUP. Thank you. My time has expired. 

Chairman SMITH. Thank you. 

I next recognize Mr. LaHood from Illinois. 

Mr. LAHOOD. Thank you, Mr. Chairman. 

And, Mr. Milner, I also want to recognize and thank you for your 

service and your lifelong commitment to helping young people to 

succeed and all the good work that you do. 

And I also want to acknowledge the young people in the crowd 

here today. Thank you for being here. Your presence is important, 

and we are honored to have you here today as part of this hearing. 

Prior to elected office, Mr. Milner, I spent a lot of time with the 

Big Brothers Big Sisters organization. I was a big brother myself 

in my hometown of Peoria, Illinois, and saw the really good work 

that has gone on there. And, you know, many of our young people, 

through no fault of their own, are born into very difficult situations. 

And from a public policy standpoint, trying to figure out what we 

can do to help many of these good organizations, I have also spent 

time and served on a board locally, the Center for Prevention of 

Abuse, that works with young people that are affected by abuse 

and also domestic violence. And I am happy that we are having 

this discussion here today, and let me get into a couple issues here. 

I guess when we think about strengthening families and the implementation of the Family First Prevention Services Act and how 

we can make sure that this is the most efficient and effective program possible in this country, implementing a major reform in the 

current system comes with its challenges. And I want to commend 

your willingness to be here today and answer questions about this 

implementation of the legislation and to make this smooth transition for our State and the local stakeholders. 

It is my understanding that HHS will provide a preapproved, 

quote, clearinghouse list of evidence-based practices that the States 

will be permitted to use. 

Given that there are limited self—sorry. Given that there are 

limited well-supported evidence-based programs that have been taiVerDate Sep 11 2014 01:05 Jun 19, 2019 Jkt 033873 PO 00000 Frm 00133 Fmt 6633 Sfmt 6602 I:\WAYS\IN\33873\33873.XXX 33873

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lored for child welfare populations, there is a need for HHS to provide guidance on States conducting these program evaluations so 

that more evidence-based programs are established in the well-supported category and ultimately added to the clearinghouse list. 

Can you talk a little bit about what is the process for States to 

identify and have approved other practices not specified on the 

preapproved list of the evidence-based programs? 

Mr. MILNER. Again, going back to Representative Wenstrup’s 

question, we will come out with our final guidance on that later 

this fall, once the clearinghouse established and we have those procedures in place. I can’t tell you precisely that they are going to fill 

out a form or we are going to respond in a certain period of time, 

but there will be a clearly defined process so that we can identify 

services that States and Tribes want to use. 

As soon as we get the comments back on the criteria, the process, 

and the priorities for reviewing those services, we will be in a much 

better position to guide States on how they can raise or elevate 

their services for consideration. 

Mr. LAHOOD. Additionally, Mr. Milner, is Federal reimbursement available for evaluation activities of time-limited services? 

Mr. MILNER. The only funding that I believe Family First allocates for that is for us to use the clearinghouse and the technical 

assistance. One million dollars, not a whole heck of a lot of money, 

was allocated for us to do that. 

When we have the clearinghouse in place, it will offer that level 

of technical assistance, to the extent that the funding allows it to, 

on evaluation and implementation of those services within the 

States. 

Mr. LAHOOD. Got you. Well, we look forward to working with 

you as a committee and wish you much success. Thank you. 

Mr. MILNER. Thank you so much. 

Chairman SMITH. Thanks. Next, I recognize Mr. Schweikert 

from Arizona. 

Mr. SCHWEIKERT. Thank you, Mr. Chairman. Like Dr. 

Wenstrup, we have an adopted daughter. As a matter of fact, she 

is third generation adopted now in the family, so obviously we are 

doing something wrong. Come on. Can I walk you through, though, 

first I know antidotes aren’t policy, but they give you a little bit 

of a window. Three years ago, my wife and I spent a summer getting certified to be foster parents. And we had, you know, folks 

from the State come as trainers. We had an agency. It was a trainer. It was very comprehensive, and sometimes the conversations 

were absolutely devastating, and heartbreaking. A couple of the 

most stressful evenings I ever had with my wife were the drive 

home when we had foster families that had been in fostering for 

20 years and the roller coaster that their lives were. 

We also heard repeatedly, particularly in a State like Arizona, 

there was a tremendous shortage of those parents, either those 

households that were ready to do short-term, long-term, older kids. 

So I guess I am asking you saying, okay, we have done a piece of 

legislation. There is all sorts of evidence base, so we have much 

better math and statistics. There is some resources with it. Where 

is the greatest fragility you see out there in our society? Is it a 

shortage of foster parents? Is it a shortage of good data? Is it a 


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shortage of resources to do intervention for substance abuse? If you 

had to give me one, two, and three, overall, what is really missing 

out there in the system today? 

Mr. MILNER. I think we need to focus squarely on resolving the 

reasons that children need to come into foster care to begin with. 

I think that if we don’t focus our efforts on the primary prevention 

of child maltreatment, we are going to continue to chase our tails. 

We are going to continue to be scurrying around trying to find 

more money in State budgets, more caseworkers, more lawyers, 

more foster homes, and we are going to continue to raise children 

in the foster care system who don’t have all the skills they need 

to become healthy, productive adults. 

Mr. SCHWEIKERT. Okay. You are actually heading in the direction—so child maltreatment—— 

Mr. MILNER. Yes. 

Mr. SCHWEIKERT [continuing]. Is that parents with substance 

abuse, is it households that have a mental health issue? I mean, 

and I am asking for some granularity on—and I know this—and 

I am not asking for antidotes, but I am asking, sir, for your perception. 

Mr. MILNER. I think it is all of the above. I think quite honestly, many families, if not all families, could be at risk of having 

involvement in the child welfare system with a slight twist of fate. 

The most successful programs that I am visiting out there I could 

name them: Live Well San Diego is one of those programs; the Center for Family Life in Brooklyn, New York. The list goes on. They 

provide services that strengthen families before they get into the 

ditch of child maltreatment and trauma, and can’t get themselves 

out of that. It could be targeted to families that already have displayed some risk, but simply by strengthening families in communities and offer them a nonstigmatizing way to get the support 

they need would go a long way. 

Mr. SCHWEIKERT. When we use language like strengthening 

families—— 

Mr. MILNER. Yes. 

Mr. SCHWEIKERT [continuing]. Give me an actual example of 

what the program in San Diego is actually doing. 

Mr. MILNER. Addressing the protective factors of families. We 

know—— 

Mr. SCHWEIKERT. No, no, no, no, no. I am asking you what are 

they actually doing? They are knocking on the door, are they demanding drug—I mean, what are they actually doing that is so 

powerful that it reaches your top of your mind? 

Mr. MILNER. Over 300 partners have come together in San 

Diego, including the educational system, the housing system, the 

transportation system, the Chamber of Commerce, parks and recreation, transportation, and the child welfare system. 

Mr. SCHWEIKERT. So they built a coalition. 

Mr. MILNER. Yes. 

Mr. SCHWEIKERT. What are they actually doing? 

Mr. MILNER. They are promoting the notion of living well for 

the citizens of San Diego, regardless of what the particular entity 

is involved with. If it is the medical field, they address living well 

and in healthy ways in that domain. 


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Mr. SCHWEIKERT [continuing]. For your help. Maybe I am 

just—because I am, you know, done the foster care training, I have 

a household. I have these poor kids that are just living in hell. How 

was that system there making—protecting those kids? What are 

they doing that is so unique that protects those children? 

Mr. MILNER. I think that they are doing a couple of things. I 

think they are trying to help those families get the concrete supports that they need before they get to the living hell part of their 

lives. And that is where primary prevention comes into play. 

Mr. SCHWEIKERT. We will do some follow-up because I would 

love more to understand the tactical. 

Mr. MILNER. Sure. 

Mr. SCHWEIKERT. Is it—and Mr. Chairman, I know I am over 

time, and I may be an outlier here. I know we passionately want 

to keep families together, but I also passionately want to protect 

these kids. 

Chairman SMITH. Thank you. And we will begin a second round 

here as we do move forward. Let me touch a little bit on nonchild 

welfare issues. Family First is unique because the expectation is 

for most of the services and interventions—the expectation is for 

most of the services and interventions to come from sources outside 

of the foster care and adoption agency. Therefore, it is essential for 

the Children’s Bureau to take the lead and set an example for how 

to coordinate and collaborate with other agencies. How is the Children’s Bureau working with SAMHSA, HRSA, Medicaid, and other 

HHS agencies on the development of approved programs that meet 

evidence standards to provide substance abuse, mental health, and 

parenting programs under FFPSA. 

Mr. MILNER. We have begun the process of having discussions 

with all of those agencies. HRSA, around the home visiting, with 

SAMHSA, our policy folks are already in conversation with CMS 

because Medicaid is going to be a tremendous interface between 

the work that we do. We have to sort out issues with Medicaid 

around payment for evidence-based services, payments in the facilities, how our board payments would interface with those. We are 

in the process now of compiling as many of the issues that we are 

aware of that we know that we need to resolve. We are in the early 

phases of that, but we are absolutely committed to working in partnership with those other Federal agencies to make this a comprehensive implementation process. I am scurrying around from 

coast to coast encouraging States to work in strong partnership 

with their local partners for implementation, and it would be hypocritical of me not to be doing the same thing at the Federal level. 

It is not just those obvious agencies that we think we need to 

have strong partnerships. We are meeting with other groups that 

will have a tremendous impact on implementation, such as the National Governors Association and the National Association of Counties. I spoke a couple weeks ago to the National Conference of State 

Legislators, and even this morning before I came here, I was in 

contact with our Head Start agency to try to find those interfaces, 

particularly in some of the very rural communities out there where 

an array of prevention services is going to be hard to come by. 

So we are quite aware of that, and it is very high on our implementation priority list. 


ralbany on LAP520R082 with HEARINGS
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Chairman SMITH. Thank you. Now, also, when will States know 

more about how to handle the billing situations, like substance 

abuse services where services are eligible for Medicaid reimbursement and Family First, and what is being done to reduce the potential for double-billing? 

Mr. MILNER. That is further into the implementation process 

than we are right now. Once we are able to issue our guidance on 

the prevention services program, which will come, again, within the 

first quarter of Federal fiscal year 2019, we will be able to respond 

to those very technical questions. 

Chairman SMITH. Because I think you can appreciate that 

States might be a little reluctant to move forward, you know, 

knowing that they need to, but if there is concern that they may 

or may not be able to be reimbursed for that. 

Mr. MILNER. I do understand that. I don’t think that the reimbursement procedures are going to be the criteria that States use 

to determine whether to go forward with the optional prevention 

services programs or not. I certainly hope it is not. I hope that they 

are thinking much more broadly about how they want to serve children and families, and understand that we are absolutely going to 

work with them to work out those very technical details that we 

are nowhere near being able to respond to right at this moment. 

Chairman SMITH. Okay. How are programs previously funded 

under various HHS grants, such as the regional partnership 

grants, pregnant and postpartum women, MIECHV home visiting, 

children affected by meth, how are they being consulted to provide 

input into this list of evidence-based programs? 

Mr. MILNER. We are taking advantage of the opportunity to 

look at the services that those programs have provided, particularly 

our regional partnership grants. I appreciate you bringing that up. 

That is one of our programs that we are absolutely proud of, particularly in the efforts to fight substance abuse issues within families. We believe that those programs give us a rich pool of possible 

interventions if the evidence base is there. If the evidence base is 

not there, they may also identify programs where we can focus efforts to begin building that evidence, because many of those programs have actually shown to be quite successful in getting to the 

desired outcomes. 

Chairman SMITH. Thank you. And now I will recognize Ranking 

Member Davis. 

Mr. DAVIS. Thank you, again, Mr. Chairman. Commissioner, in 

your previous answer, you suggested that Health and Human Services would need to individually approve any intervention not in the 

clearinghouse. We had expected you would do that by approving 

the State plan that includes the intervention. Is that correct, or do 

you plan a different approval process? 

Mr. MILNER. Given the criteria that are set forth in the statute 

for an evidence-based program, we will have to review the actual 

program itself. Simply putting it in a State plan will not give us 

the information we need to know if it meets the criteria in the statute. 

Mr. DAVIS. Following up on your answer to the Chairman on 

candidate for care, I appreciate that in your testimony, you clarified that HHS does not plan to define, and I quote, candidate for 


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care on imminent risk beyond what is in the statute. Because the 

question is repeatedly asked in my State, I would like to know if 

other States are hearing the same question. Could you reaffirm 

that this means that HHS is not planning to issue a national definition of imminent risk, or candidate for care, and will instead rely 

on States to explain their State standard in their prevention plans? 

Mr. MILNER. It is not our intent, as I put in my written testimony, to define those concepts any further than the statute already 

defines them. 

Mr. DAVIS. Does HHS plan to issue any guidance or parameters 

for States to use as they explain their eligibility criteria in their 

State prevention plans, and if so, when will those be issued? 

Mr. MILNER. We will be issuing guidance on the prevention 

services program later this year. We anticipate issuing that guidance within the first quarter of Federal fiscal year 2019, and hopefully, we will be able to address those questions satisfactorily in 

that program instruction. 

Mr. DAVIS. Does the Children’s Bureau intend to publish program guidance for States about drawing down the kinship navigator match before the provision becomes effective, and if so, when? 

Mr. MILNER. We will produce guidance on the kinship navigator 

program that should include—I am getting—that is getting a little 

bit more technical than I am prepared for, but the guidance that 

we issue on that should cover any kind of billing procedures. I can’t 

imagine why it would not, but I am not able to—I am not able to 

speak any more definitively than that. 

Mr. DAVIS. Do you anticipate that a State would need to amend 

its IV–E plan in order to claim kinship navigator matching funds? 

Mr. MILNER. I don’t know the answer to that question. We will 

have to get back with you on that. 

Mr. DAVIS. Under State law, or by law, HHS is required to provide technical assistance and disseminate best practices for providing and evaluating the evidence-based prevention services funded under Family First. Could you identify how this will take place? 

Mr. MILNER. We will be issuing guidance on the clearinghouse 

and that whole process in the first quarter of Federal fiscal year 

2019, and, if I am understanding your question correctly, that 

should provide the information that States will need. 

Mr. DAVIS. Thank you very much, and I yield back, Mr. Chairman. 

Chairman SMITH. Thank you. Thank you. Next, I recognize Mr. 

Reichert from Washington State. 

Mr. REICHERT. Thank you, Mr. Chairman. And I want to kind 

of drill down into one of the issues that I mentioned in my first 

question, and that is human trafficking. And all of us on this panel, 

as I said, want to help our youth. 

Mr. MILNER. Absolutely. 

Mr. REICHERT. And most of the young people who are out there 

on the streets involved in sort of this lifestyle have been victimized 

at home, sexually abused, mentally, emotionally, physically, and 

are driven to the streets and they are abused, victimized again. 

And then back in the day when I was working in the sheriff’s office, they were victimized once again by a judicial system that realVerDate Sep 11 2014 01:05 Jun 19, 2019 Jkt 033873 PO 00000 Frm 00138 Fmt 6633 Sfmt 6602 I:\WAYS\IN\33873\33873.XXX 33873

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ly didn’t understand that these young kids are victims, not criminals. 

Today, we have been enlightened a little bit and discovered that 

really we need to help these young people involved in human trafficking. And the reason I know so much about this topic, you may 

or may not be aware of my background in law enforcement. I 

worked on a serial murder case for 19 years, called the Green River 

serial murder case. The person responsible for the murders in this 

case pled guilty to 49 murders. We think he killed 60 to 70 little 

girls and young women. I personally was at body sites of scores and 

scores and scores over those years. 

So, Family First allows Federal funds for settings providing high 

quality residential care and supportive services to children and 

youth who have been found to be or at risk of becoming sex trafficking victims. 

Mr. MILNER. Yes. 

Mr. REICHERT. The July 9 program instruction indicates that 

ACF will not further define that setting. Does the Children’s Bureau plan to issue any guidance about the kinds of settings? 

Mr. MILNER. About the kinds of settings? 

Mr. REICHERT. Yes, that this might entail. 

Mr. MILNER. I am not sure I am going to be able to answer the 

question completely on the types of settings. The law sets forth the 

criteria for qualified residential treatment program. The accreditation body would also add to any of those requirements there. To my 

knowledge, we do not have intent of issuing any further guidance 

around those particular settings, but I say that somewhat tentatively. 

You are absolutely correct that we do not intend to define victims 

of sex trafficking, or at risk of sex trafficking, any further than it 

has already been defined in the law. 

Mr. REICHERT. Well, I just think we need to take another look 

at that and maybe you and I can have a discussion. 

Mr. MILNER. Surely. 

Mr. REICHERT. Since children in out-of-home care are already 

at increased risk of trafficking. 

Mr. MILNER. Yes. 

Mr. REICHERT. This is going to be important for States to have 

a clear understanding, so that they can use this placement setting 

appropriately. 

Mr. MILNER. I cannot agree with you more. I have had several 

conversations with States myself around their intent and how they 

would like to define the terms of at risk of sex trafficking, and I 

believe that States are coming at it from different places. But part 

of our plan also is to allow States that flexibility, so that they can 

craft a program that will best meet the needs of youth in their 

States. 

I also just want to add, just for general interest, I visited one of 

those programs in your home State in Seattle a while back, and I 

also was fortunate enough to be able to attend the ribbon cutting 

for a drop-in center there in Seattle designed for youth who are victims of sex trafficking, to have a place to go. 


ralbany on LAP520R082 with HEARINGS
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So I have seen firsthand in your State the value and the importance and talked to some of those youth myself about their experiences there, so we share that concern and commitment. 

Mr. REICHERT. I appreciate your answer. I yield back. 

Chairman SMITH. Thank you. I next recognize Ms. Chu from 

California. 

Ms. CHU. Well, I have more questions from the State of California. In California, each county is responsible for administering 

its own child welfare program, and California is made up of 58 

counties. As a result, the counties vary in capability and capacity 

and access to providers who can deliver prevention services. So 

Family First requires that the prevention component to the State’s 

IV–E plan must describe the target population for the services or 

programs. 

So my question is whether the State has to opt in for the Family 

First program, and do all counties and geographic locations have 

to provide the same level of prevention services, or can there be a 

targeting of those prevention services on a geographic basis versus 

having every county do every service? 

Mr. MILNER. Yes. It is my understanding that as you have said, 

the State has to take the option, but I do not have the understanding that every single county would have to provide the same 

level of service delivery. In the title IV–E waiver, which is admittedly a different program, there are four counties in California that 

are providing those services, so that is not a State-wide effort 

there. I see no reason why that could not be the same way in Family First, and frankly, would fully expect it to be that way. You 

have some very rural counties in California, as do the other Members in their States, and the reality is, many of the prevention programs are going to be hard to come by in those very rural areas. 

I don’t think we can have a reasonable expectation that there is 

going to be a uniform level of service delivery across counties. 

Ms. CHU. My other question is about the quality residential 

treatment program, or QRTP. Those provisions in the Family First 

program have time limits that the States have to meet in order to 

be reimbursed for such a placement. 

Now, right now, California takes more than 30 days to do an assessment as to whether a child should or should not be in one of 

these facilities in a group home or a foster care home. I know that 

the Family First program is a step forward, because there is some 

States that don’t do any assessment whatsoever, so there needs to 

be an assessment. 

Mr. MILNER. Sure. 

Ms. CHU. But my question is, whether there is any flexibility on 

the 30 days in order for the State to be reimbursed, because it 

would seem to me that the best thing would be to have a good assessment, what if it is 31 days? What would be the situation with 

that? 

Mr. MILNER. The statute requires 30 days. I am not aware of 

any flexibility in the statute on that. 

Ms. CHU. How about this situation: Would a State be reimbursed if at the 60-day court review, the court disproves the placement of the child? 


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Mr. MILNER. I am not able to answer a question that is quite 

that technical, so we will have to respond to you in writing on that, 

I am sorry. 

Ms. CHU. And how about if a child moves from one QRTP program to another, would a new 30-day assessment be required? 

Mr. MILNER. That is also a very technical question that I don’t 

think I am prepared to answer for you today. We will get back with 

you on that. 

Ms. CHU. Okay. I will submit those questions. Then I also wanted to ask about administrative costs. The requirement that 50 percent of the State’s prevention services spending be related to services or programs does not make clear whether there can be claims 

for administrative services like training and evaluation. So can administrative reimbursement for such things be in this program? 

Mr. MILNER. We will also have to give you a written response 

on that. I can’t say definitively what is included in the admin costs 

at this point. 

Ms. CHU. Okay. I appreciate you getting back to me on that. 

Mr. MILNER. Thank you. 

Chairman SMITH. Thank you. Next is Mr. Wenstrup from Ohio. 

Mr. WENSTRUP. Thank you, just a quick follow-up question, if 

you will. Our State is one where the county administers the work. 

Mr. MILNER. Yes. 

Mr. WENSTRUP. So in these States like that, can the local 

areas, counties opt in or opt out, or if programs put in place, does 

it have to be statewide, or is there going to be that type of flexibility for the counties? 

Mr. MILNER. As I was saying to Representative Chu, I believe 

that States will have to work with their counties to determine 

where they are going to be able to offer some of the specific services. Whether there is a formal opt in or opt out, I wouldn’t attempt 

to answer that for you at this point with any real confidence there. 

The State has to make the decision to be a part of the program, 

but then the State would have to work with its counties in order 

to determine how they were going to comply, particularly with the 

prevention services program. That is what I am primarily speaking 

about right now. The congregate care provisions would not be an 

optional thing for a State or a county to select from. 

Mr. WENSTRUP. I think we have to think about that because 

there may be initiatives that one or two counties really need, and 

the others don’t. 

Mr. MILNER. Sure. 

Mr. WENSTRUP. And you don’t want to waste money setting 

something up that another county doesn’t need, but is needed 

somewhere else. So I hope that there is that type of flexibility that 

can take place within the State, so especially when they are being 

run by the county, you know, you don’t want to make them do 

something they don’t need. 

Mr. MILNER. Yes. 

Mr. WENSTRUP. And allow those that need something else be 

able to do it. 

Mr. MILNER. And that is entirely consistent with the vision that 

we have for child welfare in our country coming from the Children’s Bureau right now. In addition to a strong commitment to 


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moving towards a primary prevention focus of our work, we believe 

that those efforts have to happen at the county and community 

level. The best examples that I see of programs effectively serving 

and strengthening families out there are not necessarily happening 

on a State-wide level. They are happening in the communities 

where children and families live. That is where they can get the 

services and supports that are available to them in most situations 

that are culturally appropriate for them and that are responsive 

enough for them to sustain progress once they have made that 

progress. 

Mr. WENSTRUP. Well, and I have seen some of the benefits that 

a local level. One of my counties just in addressing poverty, was 

part of a short-term trial called Rural Impact. The caseworker had 

authority to make changes. I meet a family with six kids, and I 

meet the parents and, you know, they are living in a one-room 

home. And he said, I can’t take a third shift job, I have nowhere 

to sleep. So she gets them into a home with a couple bedrooms, and 

they go to work. The whole dynamic changes. There is that local 

level ability to fit what is needed case-by-case that I really hope we 

are driving towards so that we can really have a positive fact. And 

this is a situation where the person working with you, they are not 

just a signature on a piece of paper somewhere. They have been to 

your house. 

Mr. MILNER. Exactly. 

Mr. WENSTRUP. They understand what has taken place. Anyway, thank you. I yield back. 

Chairman SMITH. Thank you. Next, I recognize Mr. LaHood 

from Illinois. 

Mr. LAHOOD. Thanks, Mr. Chairman. Commissioner Milner, I 

wanted to focus a little bit on criminal background checks, and I 

mentioned earlier, I was involved with the Big Brothers Big Sisters 

program, and I know when we were screening for Big Brothers and 

Big Sisters, I worked as 10 years as State and Federal prosecutor, 

so we would do the background check for that. And obviously it is 

important that we make sure we have the best people that are involved in the child welfare system. 

I know, for instance, there is a clear standard set for foster parents and adoptive parents and the background check there. Can 

you talk a little bit about the proper oversight and enforcement for 

States, and particularly, for child care centers, and whether there 

is a national standard that has been established and how that implementation happens, not only for criminal background, but for 

maybe other professional misconduct or drug use and where we are 

at with the implementation of that? 

Mr. MILNER. With regard to background checks, the Federal 

statutes address the criminal background checks, not necessarily 

the other areas that you might have some concerns about. We have 

long held a requirement that adults in a foster family home undergo a criminal background records check. Family First adds a requirement that staff, all staff of the congregate care facilities must 

now have that background check, which must include a check of 

relevant criminal databases. Other Federal legislation gets very 

specific on what would disqualify someone based on a background 

check. States do have some flexibilities in terms of making excepVerDate Sep 11 2014 01:05 Jun 19, 2019 Jkt 033873 PO 00000 Frm 00142 Fmt 6633 Sfmt 6602 I:\WAYS\IN\33873\33873.XXX 33873

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tions to those rules, but they are required to have very specific procedures in place if they want to do so. 

I actually believe Family First is a giant step forward in terms 

of requiring the background checks in congregate care facilities. I 

should note that we have had a requirement in place for some time 

that requires that States address safety concerns with regard to 

staff in a much more general way. It has been a part of our programs where we have found that States have not, across the board, 

done all that well with compliance. 

Under Family First, I believe we have a greater opportunity to 

enforce the more specific requirement through our review processes. The way that we would primarily review that from the Federal level is with our title IV–E eligibility reviews, where we would 

look at whether or not there was evidence that the criminal background checks had been conducted or not. We will be revising those 

procedures, those forms and that whole process to comport with 

Family First as we go into full implementation. 

Mr. LAHOOD. And I guess thinking ahead with full implementation, so if there is a State that is deficient in terms of the standard 

and proper oversight—— 

Mr. MILNER. Yes. 

Mr. LAHOOD [continuing]. Or enforcement, what happens? 

Mr. MILNER. They are required to enter into a program improvement plan and make the correction. Typically, we are not able 

to withhold Federal funds until they have had an opportunity to 

correct whatever the problem is. So we work with the States 

through our regional offices to develop a process for making the 

corrective action. If they are not able to comply with their plan, 

then they would be subject to Federal withholding of funds. 

Mr. LAHOOD. Okay. Thank you. Those are all my questions. 

Chairman SMITH. Thank you. I want to touch on another issue 

here, and then I will certainly go to Mr. Davis for some follow-up 

as well. Maintenance of effort. We know that Family First was intended to supplement, not replace the State efforts. 

Mr. MILNER. Sure. 

Chairman SMITH. And so the need to calculate the maintenance 

of effort is certainly there. Is the Bureau going to provide guidance 

to States in terms of how they can calculate their maintenance of 

effort? 

Mr. MILNER. Yes, we will. 

Chairman SMITH. And when can the States expect those—— 

Mr. MILNER. I would anticipate that that is going to be a part 

of our program instructions on the prevention program itself. The 

MOE is specific to the prevention services program, and the PI is 

where we would be able to cover that later this year when we issue 

that guidance. 

Chairman SMITH. Okay. And in terms of previous prevention 

expenditures, my understanding is that they are intended to mirror 

the services and populations that are allowable under Family First. 

Is that correct? 

Mr. MILNER. I am not sure that I can give you a definitive response on that. 

Chairman SMITH. Okay. If you could follow up on that. 

Mr. MILNER. Surely. 


ralbany on LAP520R082 with HEARINGS
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Chairman SMITH. Maintenance of effort is not limited to just 

funds that were spent in child welfare prior to Family First because for nonwaiver State mental health, substance abuse and parenting were not funded under child welfare. Is that correct? 

Mr. MILNER. Correct. 

Chairman SMITH. And for waiver States that may have been 

spending on substance abuse, mental health, and parenting, how 

do you see them calculating their maintenance of effort? 

Mr. MILNER. We are going to have to give you something more 

specific on that. I am not immersed in the maintenance of effort 

part of that. It is far too technical for me to be able to give you 

any hint of a satisfactory response, but we will give you something 

in writing on that. 

Chairman SMITH. Okay. Well, I think all the States would appreciate that and certainly there is—— 

Mr. MILNER. Surely. 

Chairman SMITH [continuing]. I know, a great deal of interest 

on that. 

So with that, Mr. Davis, do you have any follow-up? 

Mr. DAVIS. Thank you. Thank you, again, Mr. Chairman. And 

I also thank you again for holding this very important hearing. 

It is my understanding that many kinship navigator programs 

have not been evaluated so that they can meet an evidence-based 

standard. 

Mr. MILNER. Yes. 

Mr. DAVIS. What is HHS doing to support identification and development of additional evidence-based models for these important 

services? 

Mr. MILNER. I mentioned a little bit earlier, we fund a contract 

right now in collaboration with our Office of Planning, Research 

and Evaluation that is designed to build the evidence for a number 

of programs that are out there. Kinship navigator programs are a 

part of that effort. 

In addition to that, we are looking to the programs that do exist, 

and we have asked for comment on that, particularly in the Federal Register announcement that we just put out the criteria for 

evidence-based practices. 

In addition, we will be looking at the one program that we think 

might have an evidence base behind it to see if it comports with 

the criteria that are in Family First. 

Mr. DAVIS. Congress provided appropriated funds so that every 

State could receive funding for kinship navigator programs now, as 

a bridge to the Family First funding. The deadline for States to tell 

HHS their planned use of these funds was last week. 

Mr. MILNER. Correct. 

Mr. DAVIS. Can you tell us how many States applied and how 

HHS plans to reallocate any funds which were not claimed? 

Mr. MILNER. Forty-five States, two territories, and eight Tribes 

have indicated to us that they intend to apply for those funds. 

Since it is not every one of the States, there will be some balance 

that is left over, and we will have to determine how we are going 

to distribute that balance of funds across those who do apply. 

Mr. DAVIS. And my last question is that obviously, home visiting is an evidence-based intervention, which has been demVerDate Sep 11 2014 01:05 Jun 19, 2019 Jkt 033873 PO 00000 Frm 00144 Fmt 6633 Sfmt 6602 I:\WAYS\IN\33873\33873.XXX 33873

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onstrated to improve outcomes for pregnant mothers, parenting 

mothers and fathers, and their children. In your work on the evidence clearinghouse, are you leveraging the MIECHV clearinghouse, especially to find interventions appropriate for pregnant and 

parenting foster youth? 

Mr. MILNER. I am unable to tell you specifically which clearinghouses we are looking at, but I can tell you that we are looking 

very broadly. We also recognize that the home visiting programs 

have shown a tremendous amount of effectiveness in that area, and 

we have every interest and every desire to make sure that they are 

accessible and available to States and Tribes under the title IV–E 

prevention services funding. 

Mr. DAVIS. Thank you for being with us. Thank you, Mr. Chairman, for this very important hearing, and I yield back the balance 

of my time. 

Chairman SMITH. Thank you, Mr. Davis. And certainly thank 

you, Mr. Milner, for your participation here today. Please be advised that Members will have 2 weeks to submit written questions 

to be answered later in writing. Those questions and your answers 

will be made part of the formal hearing record. 

Now, I know that there were several questions asked today that 

you will need to follow up on. Can you say how long that—how long 

it might take for you to be able to follow up on these questions that 

were posed earlier? 

Mr. MILNER. If we have the answers, we should be able to get 

those to you without much of a delay at all. I can’t tell you that 

we have even formulated the answers to all of those questions, particularly when it gets to things like maintenance of effort and what 

is going to be included in that. We are still very much in the process of consulting with States and with Tribes. 

As I mentioned, yesterday we had a call with States to hear their 

concerns and to get their input. Twenty-eight States participated in 

that. One of those calls is going on today. Three more will be taking place. We have two more listening sessions coming up in August in Atlanta and in Denver coming up in August. We have several sessions planned with the Tribes to hear their unique concerns 

around this. I don’t want to shortcut that consultation process, and 

that very valuable input by making all of those decisions without 

giving States and Tribes full opportunity to share their concerns 

with us. So we may not have answers to all of those questions, and 

if we don’t have answers, we will absolutely let you know that and 

respond when we do have the answers. 

Chairman SMITH. Certainly. And I think you can appreciate the 

desire by the States and Tribes to have the timely responses. 

Mr. MILNER. I do. 

Chairman SMITH. With that I want to say thank you again, and 

the Subcommittee stands adjourned. 

[Whereupon, at 11:40 a.m., the Subcommittee was adjourned.] 

[Member Submissions for the Record follow:] 


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House Committee on \Vays and Means Subcommittee on Human Resources 

Heat·ing on: "The Opioid C•·isis: Implementation of the Family First 

Prevention Services Act (FFPSA) 

July 24, 2018 

fffiS Witness: Associate Commissione•· J etTy Milne•· 

Hearing Questions 

Questions asked at the hearing and Mr. Milner promised to get back to the Members. 

Congressman Danny K. Davis 

1) The requirement that 50 percent of interventions must meet the "well-supported" evidence 

standard Q!!J.y applies to the prevention services funding, not to the kinship navigator 

programs. The kinship navigator programs simply need to be "evidence-based," which means 

they meet the "promising" standard in the law. Is that your understanding of the law. as well? 

Answer: Yes. This requirement only applies to title IV-E prevention programs. 

2) Obviously, home visiting is an evidence-based intervention which has been demonstrated to 

improve outcomes for pregnant mothers, parenting mothers and fathers, and their children. In 

your work on the evidence clearinghouse, are you leveraging the MIECHV clearinghouse, 

especially to find interventions appropriate for pregnant and parenting foster youth? 

Answer: We are engaging in conversations with our colleagues from across the Department to 

identify interventions to assess for inclusion in the clearinghouse. We published a notice for 

public comment in the Federal Register (83 FR 29122) soliciting comments on initial criteria 

and potential programs and services for inclusion in the clearinghouse, and we are now analyzing 

those responses. 

Questions regarding the Kinship Navigator Match: 

3) Does the Children's Bureau intend to publish program guidance for states about drawing 

down the kinship navigator match before the provision becomes effective? When? 

Answer: Yes, we will provide these instructions by the end of the first quarter ofFFY 2019. 

a) Do you anticipate that a state would need to amend its IV -E plan in order to claim kinship 

navigator matching funds? 

Answer: We will address this issue in the official instructions and guidance we intend to issue by 

the end of the first quarter of FFY 2019. 

4) You said you said HHS was currently reviewing one kinship navigator program model that 

may meet the evidence standard. When will that review be completed? 

Answer: We are unable to provide a specific date at this time. We expect to issue a FRN during 

the first quarter of FFY 2019 that will describe the criteria for reviewing programs and services 

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to determine if they meet evidentiary requirements, and will include a preliminary list of the 

services that we intend to review first. 

5) Congress provided appropriated funds so that every stale could receive funding for kinship 

navigator programs now, as a bridge to the Family First funding. The deadline for states to 

tell HHS they planned to use those funds was last week. Can you tell us how many states 

applied, and how HHS plans to reallocate any funds which were not claimed? 

Answer: We have received kinship navigator submissions from 46 states and the District of 

Columbia, two territories and eight tribes. The title IV-E agencies that applied are: Alabama, 

Alaska, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, 

Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, 

Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New 

Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, 

Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, 

Vem1ont, Virginia, Washington, West Virginia, Wisconsin, Wyoming and Puerto Rico and the 

Virgin Islands. 

Eight title IV -E tribes submitted kinship navigator applications: Eastern Band of Cherokee 

Indians, Keweenaw Bay Indian Community, Navajo Nation, Pascua Yaqui Tribe, Penobscot 

Indian Nation, Port Gamble S'Klallam Tribe, Salt River Pima Maricopa Indian Community and 

Tolowa Dee-n.i ' Nation of Smith River. 

The four states that did not apply for kinship navigator funding are: Delaware, Idaho, Ma ine and 

South Dakota. One tribe (Chickasaw Nation) did not apply for funding. 

The funds for the jurisdictions that did not apply will be distributed by formula to other 

jurisdictions that requested additional funds if they became available. 

Technical Assistance 

6) In response to questions, you suggested that HHS plans to provide technical assistance and 

guidance specifically for states transitioning off waivers early next year. Is that c-orrect? If so, 

what fonn will that guidance take, and what month will it be available? We would strongly 

encourage you to provide specific guidance as soon as possible. 

Answer: We have been providing ongoing technical assistance to jurisdictions operating waiver 

demonstrations to assist them in successfully implementing and evaluating the interventions they 

have operated under the waiver demonstration authority. Technical assistance has been, and will 

continue to be, provided by both federal staff and our contracted technical assistance providers. 

As we move into the fma l year of waiver authority, we are working with jurisdictions to assist 

them in identifying practices, strategies and lessons learned in the implementation of their waiver 

demonstrations that we think will serve them well as they make the transition to the requirements 

and opportunities ofFFPSA. Areas of discussion and technical assistance include the 

implementation and evaluation of evidence-based interventions designed to strengthen families 

and prevent foster care placements that may qualify for title IV -E prevention services funding, as 

well as strategies to reduce the use of congregate care and improve supports to k.inship care 

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families. In addition, for states that have been operating under a capped allocation of title IV -E 

foster care funding, we are providing technical assistance to ensure that they are prepared to 

retum to "traditional" title IV -E, claiming only for allowable costs on behalf of eligible children 

in allowable settings. The mode and timing of technical assistance varies, including our annual 

in-person waiver demonstration meeting, webinars, teleconferences, and site visits. 

Congresswoman Jackie Walorski 

I) Will States with a pending accreditation be allowed to provide reimbursable services? And 

can any IV-E funds be made available to assist providers in being accredited? 

Answer: No, there is no t1exibility in the statute to allow title IV -E foster care maintenance 

payments (FCMPs) for a child placed in a Qualified Residential Treatment Program with a 

pending accreditation (see 472(k)(4)(G) of the Act). Further, using title IV-E funding for QRTP 

facilities to become accredited does not c.omport with the proper and efficient administration of 

the title IV-E state plan. 

Congressman David Reiche•·t 

I) Will HHS issue specific guidance to states about settings which qualify for reimbursement 

under the "sex trafficking" category, and if so, when? 

Answer: As stated in testimony, we do not intend to define victims of sex trafficking, or at risk of 

sex trafficking, any fi1rtber than it bas already been defined in the law. The Children's Bureau 

issued guidance on this in Program Instmction ACYF-CB-PI-18-07 on July 9, 2018 and 

spc.cified that title IV -E agencies have t1cxibility in determining which children are " found to be 

or are at at-risk of becoming" victims of sex trafficking (consistent with the definition of"victim 

of sex trafficking'' noted in section 475(9) of the Act). 

Congresswoman Judy Chu 

I) What specific technical assistance does HHS plan to provide to states with IV-E waivers 

about transitioning from their waivers to Family First prevention funding? 

Answer: We have been providing ongoing technical assistance to jurisdictions operating waiver 

demonstrations to assist them in successfully implementing and evaluating the interventions they 

have operated under the waiver demonstration authority. Technical assistance has been, and will 

continue to be, provided by both federal staff and our contracted technical assistance providers. 

As we move into tbe final year of waiver authority, we are working witb jurisdictions to assist 

them in identifying practices, strategies, and lessons leamed in the implementation of their 

waiver demonstrations that we think will serve them well as they make tbe transition to the 

requirements and opportunities ofFFPSA. Areas of discussion and technical assistance include 

the implementation and evaluation of evidence-based interventions designed to strengthen 

fami lies and prevent foster care placements that may qualify for title IV-E prevention services 

funding, as well as strategies to reduce the use of congregate care and improve supports to 

kinship care families. In addition, for states that have been operating under a capped allocation 

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of title IV-E foster care funding, we are providing technical assistance to ensure that they are 

prepared to return to " traditional" title IV -E, claiming only for allowable costs on behalf of 

eligible children in allowable settings. The mode and timing of technical assistance varies, 

including our annual in-person waiver demonstration meeting, webinars, teleconferences, and 

site visits. 

2) Can a state be reimbursed for a QRTP placement if the court disproves it (up to the point of 

the court decision)? 

Answer: We addressed this issue in ACYF-CB-Pl- 18-07. If a c.ourt disapproves a child's 

placement in a QRTP, the title IV-E agency may claim title IV-E FCMPs to transition a child 

from the QRTP to the next placement or permanent home for up to 30 days (section 472(k)(3)(B) 

of the Act). This would not affect title IV -E FCMPs for the time period before the court 

disapproval. 

3) If a child previously assessed to need QRTP care is moved from one QRTP placement to 

another, does there need to be a new assessment? 

Answer: If a child moves from one QRTP placement to a different QRTP placement, the agency 

must meet the statutory requirements for a new QRTP placement, including a 30 day assessment. 

Among other things, the assessment must detem1ine what setting specified in section 472(k)(2) of 

the Act can meet the needs of the child if he/she cannot be placed with fami ly members or in a 

foster family home. 

4) When will the Secretary inform the states of the specific services and activities that are 

considered as state foster care prevention expenditures to enable a state to calculate its 

maintenance of effort, as required by 42 U.S.C. §671 (e)(7)? 

Answer: We will address this in future guidance that we anticipate providing in the first quarter of 

FFY 2019. 

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Questions fot· the Record 

House Committee on Ways and Means Subcommittee on Human Resources 

Hea ring on: " The Opioid Crisis: Implementation of the Family First 

Prevention Set·vices Act (FFPSA) 

J uly 24, 2018 

HHS Witness: Associate Commissioner J erry Milner 

Ch airman Adrian Smith 

I) When will States know more about how to handle the billing situations, like substance 

abuse services where services are eligible for Medicaid reimbursement and Family First, 

and what is being done to reduce the potential for double billing? Will the Children's 

Bureau and CMS be issuing joint guidance or model agreements for states to use? 

Answer: We will address these questions in guidance that we anticipate issuing in the first 

quarter ofFY 2019. While we have met with our counterparts at CMS, it is too soon to know if 

joint guidance will be needed, and thus we are unable to respond to th is specific question. 

2) Family First was intended to supplement, not replace the State efforts. And so, the need 

to calculate the maintenance of effort is certainly there so states can make funding 

decisions in their upcoming legislative sessions. How will States be expected to calculate 

their maintenance of effort? For waiver States that may have been spending on substance 

abuse, mental health, and parenting, bow do you see them calculating their maintenance 

of effort? 

Answer: We will address these questions in guidance that we plan to issue in the first quarter of 

FY 2019. 

3) Please be specific about how the Children's Bureau working with SAMHSA, HRSA, 

Medicaid, and other HHS agencies on the development of approved programs that meet 

evidence standards to provide substance abuse, mental health, and parenting programs 

under FFPSA. Please include dates for any meetings that arc platmcd or may have 

already happened; and issues that have been identified that will require clarification. 

Answer: We have engaged in initial conversations with our colleagues from across the 

Department. We will continue to do so to get their assistance in the technical implementation of 

the program, as well as in ideotifying interventions to assess for inclusion i11 the Clearinghouse. 

Family First opens up reimbursement under title IV -E for activities and services that might 

othenvise be claimed under Medicaid. ACF policy staff met with their counterparts at CMS in 

August to discuss the Medicaid benefits for resideotial treatment programs aod substance 

abuse/mental health treatment. Earlier this summer, I had conversations with leadership at 

SAMHSA to discuss how to support states in meeting the congregate care requirements. In 

addition, we intend to engage HRSA and SAMHSA to discuss collaborative efforts and identify 

the interventions to assess first. We will further engage with our partners across the Department 

once we establish the criteria we will use to designate programs and services as "promising," 

"supported," and "well-supported" practices. We are also exploring vehicles for providing 

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technical guidance to states for understanding what activities and services can be charged to 

Medicaid and those more appropriately charged to title IV-E. 

Congressman Danny K. Davis 

Questions regarding prevention services: 

1) You clarified that the Children's Bureau does not plan to further define "candidate for foster 

care" but how will the Children's Bureau ensure that states do not get penalized for the 

flexibility this creates for states? Will there be general parameters that Regional Offices will 

follow when working with the states? If so, when, specifically (which month) does the 

Children's Bureau expect to provide that guidance? 

Answer: We will address these questions in future guidance that we anticipate providing in the 

first quan er ofFY 2019. 

2) There is already existing guidance and information in the Child Welfare Policy Manua l on 

candidacy - what are your plans for updating or removing that existing guidance to avoid 

confusion as states begin to plan for candidacy as it relates to the new prevention dollars? 

Answer: The existing guidaoce in the Child Welfare Policy Manual (CWPM) on caodidacy is 

related to the provision in 4 72(i) of the Social Security Act that allows agencies to claim title IVE administrative costs for certain activities. This section of the CWPM will remain unchanged 

because Family First did not change that authority in law. We will issue guidance on allowable 

prevention services for candidates for foster care at the end of the calendar year. We will later 

detennine whether we will update the CWPM regarding foster care candidate eligibility for 

prevention services. 

3) As you told Mr. Reichcn, Family First prevention services can be administered by another 

state or county agency, and can also be contracted out by the child welfare agency, so long as 

the service-providing entity is supervised by the IV-E agency. Wl1en does the Children's 

Bureau p lan to update its existing guidance on IV-E agency supervision to ensure that states 

know how to take advantage of this option to involve appropriate other agencies in delivering 

services to families? 

Answer: We will address this issue in future g1aidance that we anticipate providing in the ftrst 

quarter of FY 2019. 

4) A state's prevention component to its Title IV -E plan must describe training and support 

provided to caseworkers, including a discussion of caseload size and there is also specific 

discussion of prevention services claims for training expenses in the law. We believe states 

will be able to make claims for training related to carrying out prevention services. 

a) Is that the Children's Bureau's understanding, as well? 

Answer: Yes, that is the Children's Bureau's understanding of section 474(a)(6)(B)(ii) of the 

Social Security Act. 

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b) Do you intend to provide additional guidance about what types of training may be 

supported, who can receive the training, or the duration of the training, or leave that to 

states to define in their prevention plans? 

c) If you do intend to issue guidance, when will that guidance be available to states? 

d) If you do not intend to issue guidance, how can states be assured that appropriate training 

costs will not be disallowed? 

Answer to b), c) and d): We will address these issues in future guidance that we anticipate 

providing in the first quarter of FY 2019. 

5) The requirement that 50% of a state's claimable prevention services spending be re lated to 

well-supported services or programs is tied to services spending. That 50% limitation is not 

linked to administrative claims for prevention services. Further, Family First explicitly states 

that prevention component administrative claims may be made for "activities approved by 

the Secretary that promote the development of necessary processes and procedures to 

establish and implement the provision of services and programs for individuals who are 

eligible." Because of this we would expect that CB could offer states the flexibility of 

providing administrative reimbursement for things like working to establish and implement 

trauma-infonned practices, as well as carrying out evaluation projects and any other work 

needed to establish a program as meeting one of the evidence-based criteria (promising, 

supported, or well-supported) or moving that program/service toward higher evidence-based 

category. Is that the Children's Bureau's understanding, as well? 

Answer: We will address this issue in future guidance that we anticipate providing in the first 

quarter ofFY 2019. 

6) One of the outcomes we should clearly be looking at for pregnant and parenting foster youth 

is delaying additional pregnancies, since this outcome correlates with better outcomes for the 

youth and their children. How does HHS plan to encourage and measure this outcome? 

Answer: We will address the outcome measures that states must report for the title IV-E 

prevention services program in future guidance that we anticipate providing in the first quarter of 

FY 20 19. 

7) Under the law, states can provide prevention services to either or both eligible groups --

children at risk of foster care and their fami lies and pregnant and parenting foster youth, 

correct? 

Answer: Yes, that is correct. See sections 47l(e)(l) and (2) of the Social Security Act. 

8) What role will the Children's Bureau play in making the prevention services available to 

youth who are at risk of entering or re-entering foster care in a state that offers extended 

foster care to youth 18 and older? What about in a state that has not opted to extend foster 

care? How will HHS encourage states to offer prevention services to these youth? 

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Answer: As you know, the Children's Bureau bas been strongly encouraging states to invest 

more heavily in prevention services overall. As to this specific population, the Clearinghouse is 

tasked with identifYing appropriate services that meet the statutory criteria, and those have not 

yet been identified. The identification of these services, and the issue of title IV-E prevention 

services for older youth will be addressed in future guidance. 

9) How will the Children's Bureau de tine "qualified clinician" for purposes of the substance 

abuse and mental health services provided under Family First authority? Am I correct that 

the type of staff approved for and by individual evidence-based programs will be assumed to 

meet that definition? 

Answer: We will address this issue in future gltidance that we anticipate providing in the first 

quarter ofFY 2019. 

lO)Family First provides administrative support for "the proper and efficient administration of 

the State plan for the provision of the services and programs specified in section 

47l(a)(e)(J)." We understand this to mean that states may c laim IV-E administrative support 

for the kinds of activities that states are required to do in order to claim federal prevention 

ti.mding - e.g., develop prevention plans for children at imminent risk of entering foster care 

and for pregnant and parenting youth in foster care - along with any number of activities that 

must be spelled out in the prevention component of a state's IV-E plan --e.g., monitoring 

and overseeing children receiving IV -E prevention services, including periodic risk 

assessments; and assessing children, parents, and kin-caregivers for eligibility. We believe 

that this work - prevention planning and periodic risk assessment, both of which may involve 

family team meetings or related family assessment and engagement work - may be supported 

at the IV-E prevention administrative rate (50% federal reimbursement). Is that the 

Children's Bureau's understanding, as well? 

Answer: We will address this issue in future guidance that we anticipate providing in the first 

quarterofFY 2019. 

ll)Family First allows states taking the prevention component to make IV-E claims for data 

collection and data reporting related to prevention services (Sec. 474(a)(6)(B)(i)). Can you 

explaiu how this authorization expand on what are currently allowed IV-E data collection 

and reporting claims? How does HHS expect to require states to repo11 data needed for the 

Family First prevention measures? 

Answer: We will address this issue in future gltidance that we anticipate providing in the first 

quarterofFY 2019. 

Questions regarding evidence: 

12) It's important that the evidence clearinghouse includes interventions targeted at the pregnant 

and parenting teen population, and that the measured outcomes include increasing time 

between pregnancies, which strongly correlates with improved maternal and child outcomes. 

HHS should plan to include interventions specific to this population in the Clearinghouse, 

and also identify interventions which are close to meeting the standard, so that they can be 

studied and brought up to the standard. Is that part of your plan? 

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Answer: We will address this issue in future guidance that we anticipate providing in the first 

quarter ofFY 2019. 

I3)By law, HHS is required to provide technical assistance and disseminate best practices for 

providing and evaluating the evidence-based prevention services funded under Family First. 

One way to comply with part of this mandate would be to include interventions in the 

Clearinghouse on a provisional or conditional basis - that is, to identify interventions which 

are very close to meeting an evidence level in the law, and commit to fund them if they 

provide additional information to take an additional step. This is a very important way to 

make sure states have a wide range of options available to meet local needs and to move the 

evidence base forward. Is the Children's Bureau planning to use conditional approval as a 

tool to advance evidence-based child welfare policy? 

Answer: We will address this issue in future guidance that we anticipate providing in the first 

quarter ofFY 2019. 

14) Can you describe for us what the proce~s will be to maintain the Clearinghouse on evidencebased prevention services and programs? 

a) How will the Children's Bureau ensure that this is a dynamic Clearinghouse that is 

frequent ly updated and reflects the ongoing and growing knowledge from the field on 

evidence-base-d programs? 

b) Will programs be added to the Clearinghouse as soon as they are approved, rather than 

once a year or on a scheduled date? How will jurisdictions be notified about these 

updates? How can programs be added to the list - are they only approved if submitted by 

a jurisdiction, or can researchers and universities and other entities submit models to be 

approved by the Children's Bureau? 

c) In addition to delivering evidence-based services, the law requires states to use traumainformed practices in delivering those services. What guidance will the Children's 

Bureau provide to states regarding maintaining fidelity to evidence-based models while 

also incorporating trauma-infonned practices, if those practices were not explicitly part of 

what was tested in the original research? 

Answer: We will address these questions in future guidance that we anticipate providing in the 

first quarter ofFY 2019. 

Questions regarding the Kinship Navigator Match: 

15) What resources is OPRE dedicating to supporting development of evidence-based models for 

kinship navigator and prevention programs, and how is the Children's Bureau working with 

and involving ASPE? 

Answer: ACF is engaging in conversations with our colleagues from across the Department, 

including ASPE, to identify interventions to assess for inclusion in the Clearinghouse. The ACF 

Ofl'ice of Planning, Research and Evaluation (OPRE) is taking the lead for the Department in 

meeting the requirement in the law that, "the Secretary shall issue guidance to States regarding 

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the practices criteria" required for prevention services or programs. OPRE took the lead in 

drafting the notice for public conunent published in the Federal Register soliciting comments 

until July 22, 2018 on initial criteria and potential programs and services for inclusion in the 

Clearinghouse, and are now analyzing those responses (83 FR 29122). We expect to issue 

guidance during the first quarter of FY 2019 that will describe the criteria for reviewing 

programs and services to detennine if they meet evidentiary requirements, and will include a 

preliminary list of the services that we intend to review first. 

16) Family First requires states or tribes operating a prevention program to ensure that 50 percent 

of its program meets the law's highest category for evidence, known as well-supported. How 

does the Children's Bureau intend to measure that 50 percent? Will it be by cost, or by 

families served? 

Answer: We will address these questions in futu re guidance that we anticipate providing in the 

first quarter ofFY 2019. 

Questions regarding foster care: 

17) With the recent circulation of Program Instruction from HHS regarding Title IV -E plan 

amendments and the new Title IV -E pre-print, we expect state child welfare agencies to tum 

their attention to developing these plans. What steps can HHS take to ensure that regional 

offices arc working with a shared understanding ofHHS guidance, and to avoid any 

confusion that might arise from conflicting regional decision-making with states? 

Answer: The Children's Bureau c.entral office works closely with the regiona.l offices to ensure 

the smooth implementation of new federal laws. Further, title IV -E plan submissions are 

approved at the centra.! offic.e level. We agree that consistency in interpretation is critical. With 

that in mind, in developing and implementing the gu idance on the title IV -E plans, we have and 

will continue to hold conference calls with the regional offices to ensure the Children's Bureau 

staff are all on the same page in understanding and interpreting the guidance on Families First. 

18) It was our intent and is our understanding of the law that the requirements for assessments 

and placement in allowable group care settings apply on.ly to placements for which states 

receive IV-E funds. Could you clarify that states continue to have the option of funding 

placements that do not meet federal standards with I 00% state funds, and that doing so in no 

way requires them to select the optional delay or otherwise delay providing federally funded 

prevention services? 

Answer: As stated in the statute and in our guidance in ACYF-CB-PI- 18-07, these restrictions 

apply to title IV-E Federal reimbursement. 

19)Congressional intent for the group care provisions of Family First was quite clear that it 

should apply to all children in such settings once the policy becomes effective. The original 

Congressional Budget Office score for Family First notes that the policy "would end, 

beginning in 2020, most federa.l reimbursement for foster care placements in group settings 

that don't provide specialized treatment services" and that "CBO estimates that about 70 

percent of the children residing in group settings other than RTFs in 2020 would simply 

become ineligible for any reimbursement under title IV-E." However, the July 9 Program 

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Instruction allows states to continue receiving Title IV -E Maintenance Payments for children 

in group care - regardless of whether the youth or facility meets the new standards under 

Family First- if the children were placed in the setting prior to the effective dates for 

changes in group care made in Family First. This provision essentially "grandfathers in" 

those children in group care at the time the law takes effect, exempting them from the 

improvements made and protections added in Family First in perpetuity. 

a) Why was this decision made? 

Answer: The Children's Bureau followed the plain lang1•age of the statute in drafting the 

Program Instruction. The statute states that the new restrictions and increased oversight for 

congregate care fac ilities begin from the date the child is placed in such a fac ility. If the date of 

a child's placement in a child-care institution occurs prior to the effective date of the Jaw, then 

those provisions that are triggered on the first day of placement do not apply. We see nothing in 

the law that would apply the restrictions retroactively to existing placements. 

b) How does the Cl1ildren's Bureau plan to prevent states, especially those who elect an 

implementation delay, from placing more children in group care prior to the elTective 

date for changes in group care in order to qualify for the exception? 

Answer: States are already required by federal law to ensure that " each child has a case plan 

designed to achieve placement in a safe setting that is the least restrictive (most family like) and 

most appropriate setting available and in close proximity to the parents' home, consistent with 

the best interest and special needs of the child" (section475(5)(A) of the Social Security Act). 

Generally, case workers do not make placement decisions based on a child's eligibility for a 

federal benefit, and are not even aware of the child's eligibility status. Moreover, placement 

decisions are not made in a vacuum, but are made on a case-by-case basis considering the needs 

of the child, with the oversight of the court, and with youth participation. Placement decisions 

are made when a child is removed from the home or when the current placement is no longer 

appropriate. Further, placements in group settings are already limited and often require a 

significant amount of paperwork; it would be difficult to move a large group of children into 

these seniogs quickly. 

c) How many children do you expect this policy to exempt from the protections in the law, 

and for how long? 

Answer: The law supports states in maintaining existing placements for children that were made 

considering the needs of the child. These case decisions are made at the tribal, state, and local 

agency level, and there are many factors to c.onsider to provide an estimate of the number of 

childreu who will be maintained in these placements. We could not predict the length of a 

placement in a particular facility even if we knew the details of the case. 

d) How will the Children's Bureau protect these children from any ham1ful consequences of 

this exemption? 

Answer: Children receiving title IV-E foster care maintenance payments while in a child care 

institution will continue to be afforded the same protections afforded to children in foster care 

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under title IV-E. The law prior 10 the amendments made by Family First already required annual 

court reviews and administrative reviews every six months. 

e) Does the Children's Bureau believe this "grandfathering" will also exempt those children 

from having their placements reassessed every six months, as required under current law 

and Family First? If not, when will you issue guidance to c larify this issue? 

Answer: The six month periodic review requirement in section475(5)(B) of the Social Security 

Act will continue to apply to placements of children in child care institutions. 

20) II was our expectation and hope that afier reviewing the model licensing standards, the states 

would modify their own standards to address any inappropriate barriers to licensing relatives 

caring for children or "kinship caregivers" whom the child welfare system is increasingly 

relying on, often as a result of the opioid crisis. How will you encourage that? 

Answer: As we indicated in the Federal Register announcement on the draft model foster family 

licensing standards, the standards apply to relative and non-relative foster families (83 FR 

37495). While we agree with the importance of using lcinship caregivers to care for children in 

foster care, the law allows the states and tribes to determine their standards. 

21) With many stales also facing an increased need for unrelated foster parents, often as a result 

of the opioid crisis, is the expectation and hope for states to modify their standards to address 

any unnecessary barriers to licensing unrelated foster parents, recognizing that state standards 

can impact the ability to recruit them? How will you encourage that? For example, South 

Carolina increased their capacity standards to address licensing barriers faced by both related 

and unrelated foster parent applicants by adopting the capacity standards in the National 

Association for Reg11latory Administration (NARA) Model Family Foster Home Licensing 

Standards. 

Answer: The model licensing standards apply to relative and non-relative foster families (83 FR 

37495). The law allows the states and tribes to determine the standards for licensing foster 

homes. In regard to the capacity standards, the NARA standards limit the number of children by 

age that may be placed in a foster family home, a limit which is not imposed by Federal law. 

When we issue the final version of the model licensing standards, we will clarify that, under the 

law, they are not bound by those standards. 

22) The inclusion of fw1ding for competitive grants to help states and tribes in recruiting and 

retaining high quality foster families is a critical component of the refonu bill. What plans 

does the Children's Bureau have to draw on the lessons teamed from federa l grantees 

involved with the National Resource Center on Diligent Recruitment? 

Answer: The Children's Bureau funded three clusters of Diligent Rccmitment grants with a total 

of22 grantees. TI1e Children's Bureau, along with Child Welfare Information Gateway and 

James Bell and Associates, developed a synthesis of the work completed by the first two clusters 

and will do the same when the third cluster of grants ends in 2018. The synopsis includes 

infomJation such as grantee project stmcture, target population to be served, strategies 

implemented, evaluation results, lessons learned and recommendations for improving the field. 

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This infonnation is disseminated to the field by the Children's Bureau's training and technical 

assistance providers including the Child Welfare Information Gateway website and through 

webinars, podcasts, and other products. In addition to the knowledge transfer available to the 

field, lessons learned from these projects will infonnth~ new recnaitmcnl grants. We anticipate 

the forecast for that project will be published in November, 20 18. 

Time line for Action: 

23) Please provide a timeline for when HHS plans to issue the following guidance, in each case 

indicating what month the guidance will be issued and what fonn (Federal Register 

publication, infonnation memorandum to slates, program instruction, etc. you expect it to 

take): 

a) Instructions for state prevention plans, including 

i) Process for approval of an evidence-based intervention not yet in the Clearinghouse 

Answer: We will provide the process for approval of an evidence-based intervention not yet in 

the Clearinghouse in future guidance by the end of the calendar year. However, we do not have 

a specific date or fonnal yet since we are still engaged in the contracting process. 

ii) Additional examples of populations eligible for prevention services, including 

pregnant foster youth, parenting mothers and fathers in foster care, children at risk of 

returning to foster care after reunification or placement in adoption or guardianship, 

and older foster youth 

iii) Detailed infonnation about administrative and training costs which will be eligible for 

reimbursement along witb the direct prevention services 

iv) Parameters for states to usc in dctennining their maintenance of effort level or their 

"imminent risk" standard 

Answer: We will address questions ii-iv in future guidance that we anticipate providing in the 

farst quarter of FY 2019 through a Program Instruction. 

b) Guidance for kinship navigator programs, for which funding begins October I, 2019 

Answer: We will provide guidance on the kinship navigator program through a Program 

Instruction that we anticipate provid.ing in the first quarter ofFY 2019. 

c) Further guidance on adhering to the QRTP standards and other requirements for 

placements not in a family foster home, including measures to prevent slate gaming of 

the requirements allowed under tbe July 9 guidance. 

Answer: We are unable to provide a definite date for additional guidance, as we will assess the 

need to provide technical assistance and guidance based on rcqtaests from states and the 

Children's Bureau Regional Offices. 

d) Tite first set of interventions which meet the evidence standard 

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e) Final information on the evidence clearinghouse and what interventions need to provide 

to be included in it 

Answer: We will address questions (d) and (e) through guidance during the first quarterofFY 

2019 that will describe the criteria for reviewing programs and services to detenninc if they meet 

evidentiary requirements, and will include a preliminary list of the services that we intend to 

review first. We have not yet detcm1ined the fom1at of that guidance. 

Tribal Prevention Plans 

24) Wl1en crafting Family First this Committee made sure that the major refom1s made in the Act 

would also benefit tribes, especially given the substantial challenges facing children and 

families witl1in those communities. 

a) How is the Children's Bnreau ensuring that the unique needs of tribes are taken i.nto 

considerations during development of guidance or other technical assistance and 

implementation support from your agency? 

Answer: The Children's Bureau is committed to providing tribes with maximum flexibility in 

implementing the program, consistent with the requirements of the law. We are seeking the 

input of tribal leaders through two tribal consultation teleconference calls on August 27 and 29, 

2018, and one in-person consultation on September 13,2018. In addition to participating in the 

tribal consultation conference calls, Tribal Leaders are invited to submit comments in writing. 

We also participated in a listening and information sharing event that we co-sponsored with 

Casey Family Programs on July I 0 that was primarily targeted to tribal implementation of 

FFPSA. In two subsequent listening sessions primarily directed to state concerns but with some 

tribal participation, on July 31 and August 16, Children's Bureau leadership also had the 

opportunity to hear and address concems regarding FFPSA implementation and participated with 

a tribal representative in panel discussions. This feedback and information will be used in our 

deliberations about guidance. 

b) What efforts will be made to encourage states in agreements with tribes to include 

provisions in their plans that will maximize the ability of tribes in tribal-state agreements 

to utilize family ftrst? 

Answer: We will address these questions in future guidance that we anticipate providing in the 

first quarter ofFY 2019 through a Program hlstn1ction. 

c) How will tribal c-onsultations be structured to ensure that there is adequate tribal input as 

the tribal-specific guidance is being developed? 

Answer: To prepare for consultation, the Children's Bureau provided a brieftng webinar for 

Tribal Leaders and/or staff on August 14. The briefing webioar provided an opportunity to learn 

more about the Title IV -E Prevention Services Program and to consider areas in which tribes 

may require additional flexibility to ensure effective implementation in tribal communities. 

Participation in this briefing assisted tribes by providing infonuation and context for a more 

meaningful exchange during tribal consultation. During the brieftng, the Children's Bureau 

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highlighted some questions that tribes may want to consider when providing feedback during the 

consultation. 

d) How will the Children's Bureau make sure that things like considerations for cultural 

adaptations to evidence-based programs are made in a way that don't penalize tribes for 

trying to make this law work in a way that best supports their children and fami lies? 

Answer: The Children's Bureau is committed to providing tribes with maximum flexibility in 

implementing the program, consistent with the requirements of the law. Following completion 

of tribal consultation, we will address these questions in future guidance that we anticipate 

providing in the ftrst quarter of FY 2019 through a Program Instruction. 

Justice System Interaction 

25) Family First requires states to certify that their implementation of the law will not increase 

the number of children placed in the juvenile justice system, and we note that you have 

already issued guidance to states about that requirement. How does the Children's Bureau 

plan to monitor states on an ongoing basis to make sure they are using all tools at their 

disposal to keep families out of the justice system, when possible? 

Answer: This provision is a title IV -E plan requirement subject to a specific regulatory process 

for monitoring agency compliance. Specifically, the regulations at45 CFR section 1355.32(d) 

clarify that we will usc a partial review to determine conformity with State Plan requirements 

outside the scope of the child and family services reviews. 

26) Family First evidence-based substance abuse and mental health interventions should include 

interventions which work with the courts to keep famil ies together and prevent incarceration. 

How does the Children 's Bureau plan to ensure that interventions which prevent fami ly 

separation are prioritized for evidence review and given guidance about meeting the 

standard? 

Answer: We expect to issue guidance during the first quarter ofFY 2019 that will describe the 

criteria for reviewing programs and services to detennine if they meet evidentiary requirements, 

and will include a preliminary list of the services that we intend to review ftrst. 

27) Family First allows states to serve the entire family to create a safe, stable environment in the 

best interest of the child. That includes incarcerated or recently released parents. How will 

HHS ensure that this is clear to states in upcoming guidance? 

Answer: We presume the question is in regard to the title IV-E prevention and services program. 

The law allows parents and caregivers of children who are candidates for foster care to be 

eligible for services, and docs not exclude incarcerated or recently released parents. However, 

we are in the process of developing the guidance to be released during the first quarter of FY 

2019, and are unable to specifically answer this question at this time. 

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Teclmical Assistance 

28) What in-depth technical assistance and support will the Children's Bureau be providing to 

the states, tribes and territories as they begin to plan for implementation and then as they 

begin to implement the different reforms under Family First? What type ofT A and support 

will be available and how can states access it? 

Answer: We have been providing technical assistance (fA) to states and tribes since the passage 

of the legislation through a variety of mechanisms from both central and regional offices: in 

person meetings, conference calls, webinars, and written guidance. In tenus ofT A on the 

prevention services and criteria, contract development is underway and therefore, we are unable 

to provide further information until the Clearinghouse is operational. Also, see response to Q32 

below for further infonnation on T A. 

29)How can we ensure states are getting the help they need to make sure Family First is 

implemented successfully? 

Answer: Successful implClllentation of Family First is one of our major priorities. The previous 

question identifies some of the methods we are using to ensure the states and tribes are getting 

the help they need and we will continue to provide ongoing assistance along these paths. 

30) What will be the role of the Regional Offices in providing or coordinati11g this TA and 

support? 

Answer: As noted earlier, contract development is underway and therefore, we are unable to 

provide further infonnation on the role of the Regional Offices until the Clearinghouse is 

operational. 

31) How will you ensure Regional Offices understand the guidance you issue to states to ensure 

consistency in implementation from region to region? In the past, states have often gotten 

conflicting interpretations from region to region. 

Answer: We agree that consistency in interpretation is critical. With that in mind, in developing 

and implementing the guidance, the Regional Offices have had a central role from the early draft 

stages to the final product. We have held, and will continue to hold, conference calls with the 

Regional Offices to ensure the Children's Bureau staff are all on the same page in understanding 

and interpreting the guidance on Family First. 

32) What role will the Children's Bureau's Child Welfare Capacity Building Collaborative play in 

helping public and tribal child welfare agencies, and the courts, in implementation of the 

FFPSA? Can you share with us how the Collaborative currently responds to requests for 

assistance from states [i.e. the type and topics ofT A currently provided) and conunent on 

what changes, if any, you expect with respect to the focus of technical assistance provided by 

the Collaborative going forward? 

Answer: On behalf of the Children's Bureau, the Capacity Building Collaborative including the 

Center for States, the Center for Tribes, the Center for Courts, and the Child Welfare Information 

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Gateway will provide resources, training, and technical assistance to support child welfare 

agencies and courts in states, tribes, and territories to implement the provisions of Family First. 

In addition to the ongoing development, dissemination, and delivery of resources, like 

publications, e-leaming modules, podcasts, and peer learning events on topics such as family 

engagement, reducing reliance on congregate care, and continuous quality improvement that are 

currently available to promote best practice$ consistent with the new law, the Centers also offer 

services tailored specifically to the unique needs of agencies and courts. Tailored services are 

available to support the implementation of Family First provisions in conjunction with other 

federal mandates. These tailored services frequently include: assistance with collecting and 

analyzing data to understand underlying needs of jurisdictions and barriers that may prevent 

effective practice, identification of suitable programs and services that are likely to address these 

challenges, support for successful implementation, and ongoing monitoring to assess changes in 

outcomes for children and families. As a part of this process, tribes, states and courts may 

receive assistance with activities such as: developiJlg training on particular aspects of the 

legislation, implementing new standards into an agency's information system, or coaching on the 

incorporation practice standards into supervisory coaching processes. Tailored services staff 

from each Center are available to assess the specific needs of the jurisdiction and develop an 

individualized plan for meeting the identified needs regarding the legislation. 

Child Abuse and Neglect Fatalities 

33) Do you view the provision for states to work on improving multi-source data collection and 

reporting on !atalities and near-fatalities as binding and mandatory? Do you believe Family 

First requires that states complete work on this plan and submit it for review? Do you 

understand Family First to require states to adopt and implement these improved methods for 

collecting and reporting on this data? 

Answer: Section 422(b)(l9)(A) of the Social Security Act requires "a description of the steps 

the state is taking to compile complete and accurate information on (child maltreatment deaths to 

be reported to NCANDS], including gathering relevant infonnation on the deaths from the 

relevant organizations in the state including entities such as state vita l statistics department, child 

death review teams, law enforcement agencies, offices of medical examiners, or coroners." As 

such, that was the instruction provided in ACYF-CB-PI-18-06. 

34) Do you view the provision for states to submit their work on developing a comprehensive 

multidisciplinary fatality prevention plan as obligatory and binding? Do you believe Family 

First requires states to complete work on a plan and submit it for review? Do you believe 

Family First requires states to adopt and in1plement a fatality prevention plan? 

Answer: Section 422(b)(l9)(B) of the Social Security Act requires "a description of the steps the 

state is taking to develop and implement a comprehensive, statewide plan to prevent (child 

maltreatment] fatalities that involves and engages relevant public and private agency partners, 

including tbose in public health, law enforcement, and the courts." As such, that was the 

instruction provided in ACYF-CB-PI-18-06. 

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a) Will you be able to detennine whether the state has met the requirement to work on this? 

Answer: States must submit this information to the Children's Bureau in the Child and Family 

Services Plan for FYs 2020-2024, due June 30,2019 (unless the state bas received Children's 

Bureau approval for a later effective date for this provision). The state must also provide aruma) 

updates on this requirement in accordance with section 432(a)(5) of the Social Security Act. 

b) Have you identified how you will bold states accountable if they are not complying with 

this state plan requirement? 

Answer: The regulations at45 CFR section 1355.32(d) clarify that we will use a partial review to 

detennine confonnity with State Plan requirements outside the scope of the child and family 

services reviews. Once the compliance issue is identified, the state is required to develop and 

implement a program improvement plan that brings it into compliance. 

c) Are you planning to issue regulations, guidance, or technical assistance to states relating 

to these provisions, beyond what is in ACYF-CB-PI-18-06? 

Answer: We are unable to provide a definite response at this time and will assess the need to 

provide technical assistance and guidance based on requests from states and Children's Bureau 

Regional 0 ffices. 

Congressman Br·ad Wcnstrup 

I) Do all counties and geographic locations have to provide the same level of prevention 

services, or can there by a targeting of those prevention services on a geographic basis versus 

having every county do every service? 

2) In Ohio the county administers the work. In states like Ohio, can the local areas and counties 

opt in or opt out? And for programs put in place, does it have to be statewide, or is there 

going to be flexibility for the counties? 

Answer: To respond to both of your questions, as I stated in the bearing: the state has to make 

the decision to be a part of the program, but then the state would have to work with its counties 

in order to determine how they were going to comply. We will address the issues about the 

flexibility available to counties in future guidance that we anticipate providing i.n the first quarter 

ofFY 2019. 

Congressman Lloyd Doggett 

I) Has HHS established guidelines concerning which expenditures for evidence-based practices 

are reimbursable under the Family First Prevention Services Act? 

Answer: We will address this question in future guidance that we anticipate providing in the tlrsl 

quarter ofFY 2019. 

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2) Family First reimbursement for services to support families dealing with substance abuse is 

not limited to opioid use. What is HHS doing to ensure states have access to strategies that 

address the root cause of parental substance use and, and how can the policy broaden the 

scope to include illegal substance use, not solely focused on opioid use? 

Answer: As you lmow, the Children's Bureau has been strongly encouraging states to invest 

more heavily in prevention services overall, and the Clearinghouse will identify substance abuse 

treatment services that meet the statutory criteria. Family First allows title IV-E funding for 

substance abuse treatment that meets the practice criteria in the law, which does not limit it to 

legal substance abuse treatment only. 

3) Are there intervention programs that work to preserve the family, while children maintain 

connections and attachments with the primary caregivers who are receiving substance use 

treatment? What is HHS doing to ensure states can use the option of family residential 

substance abuse treatment starting on October I? How is the Children's Bureau working 

with ASPE to identify and evaluate similar interventions and ensure that they are in the 

evidence clearinghouse? How are they being used in states now? 

Answer: We are engaging in conversations with our colleagues from across the Department to 

identify interventions to assess for inclusion in the Clearinghouse. As previously noted, we 

published a notice for public comment in the Federal Register soliciting comments on initial 

criteria and potential programs and services for inclusion in the Clearinghouse, and we are now 

ana lyzing those responses. We expect to issue guidance during the first quarter ofFY 2019 that 

will describe the criteria for reviewing programs and services to determine if they meet 

evidentiary requirements, and will include a preliminary list of the services that we intend to 

review ftrst. 

With regard to ensuring states can use the option of family residential substance abuse treatment, 

we provided instruction in ACYF-CB-PI-18-07 that beginning October I, 2018, title IV-E 

agencies may claim title IV -E foster care maintenance payments for a child plac.ed with a parent 

in a licensed residential family-based treatment facility for substance abuse for up to 12 months 

in accordance with requirements in sections 472(j) and 472(a)(2)(C) of the Social Security Act. 

We also provided instmctions for submitting a title IV-E plan amendment, explained the child 

requirements and some of the facility requirements, and identified allowable costs under title IVE for a child placed with the parent in the facility. 

4) How will HHS use technical assistance and guidance about administration and training 

funding to ensure that states use Family First's !lex.ible funding for evidence-based 

prevention and home-based parenting programs that best meet family needs and 

circumstance and ensure model fidelity, including supporting program retention and 

completion? 

Answer: We are unable to provide specific information at this time. We will address the training 

and administrative cost funding for title IV -E prevention services by the end of the first quarter 

ofFY 2019. 

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S) In your testimony and during the hearing, you said that HHS will not define "imminent risk" 

beyond what is in the statute, and states will be able to set their own defmitions. How will 

states receive approval for these definitions from HHS? For example, CPS referral is 

automatic for newborns substance exposed, so "imminent risk" could be identified before 

birth. Will HHS provide states with additional guidance on the wide range of partners who 

could help states identify these risks, how they could identify the risks, and which of these 

expenses will be available for administrative matching? 

Answer: We will address the relevant issues in future guidance on the title lV -E prevemion 

program that we anticipate providing in the first quarter ofFY 20 19, such as the statutory 

provisions for addressing the imminent risk of a child's placement into foster care. 

6) We know young children, especially babies, do poorly without attachment and 

consistency. What treatment and parenting programs focused on maintaining the relationship 

with the family during treatment, in the hospital, and in court proceedings has HHS identified 

that meet the Family First evidence standard? lfHHS has not identified such interventions, 

what is HHS doing to promote research and evaluation of such strategies? 

Answer: The Clearinghouse is tasked with identifying appropriate services that meet the 

statutory criteria, and those have not yet been identified. We expect to issue guidance during the 

first quarter of FY 2019 that will describe the criteria for reviewing programs and services to 

detenni11e if they meet evidentiary requirements, and will include a preliminary list of the 

services that we intend to review first. 

Congl"esswoman TerTi Sewell 

l) In your response to me at the hearing, you correctly stated that family first does not provide 

funding for an episode lasting more than 12 months. However, it was our clear intent and my 

understanding of the law that if a family's period of prevention services ended, and then the 

family needed new services in the future (perhaps because of a relapse), that would begin a 

new episode, for which another 12 months of services could be provided. Could you clarify 

that this is, in fact, the case? 

Answer: We will address this question in future guidance that we anticipate providing in the first 

quarter of FY 2019. 

Congl"esswoman Judy Chu 

1) How are family Centered Treatment (fCT) Programs going to be identified? It seems they 

will not have to be licensed as a Child Care Institution (CCI) and that payment will be 

limited to basic board and care. Will that be a set amount? Will the State's Child Welfare 

System maintain responsibilities for ensuring services are provided? Why will background 

checks on staff at these FTC programs not be required? 

Answer: Section 472(j) of the Social Security Act pennits title IV -E agencies to claim title IV -E 

foster care maintenance payments for children placed with a parent who is in a licensed 

residential family-based treatment facility for substance abuse. As stated in ACYf-CB-PI-18-07, 

these children must be in the placement and care of the agency. As is current practice, the 

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amount of the foster care maintenance payment will be established by the individual state or 

tribe. 

These placements are considered a separate, new type of allowable placement under title IV -E 

(i.e., these are not child care institutions (CCI), nor are they foster family homes). Because they 

are not a child care institution or foster family home as defined in section 472(c) of the Act, the 

treatment facility must be licensed, but there is no requirement that it meet the title IV -E 

licensing and background check requirements for a CCI or foster family home (see ACYF-CBPI-18-07). 

2) Nonnally a facility would have to be licensed by the state as a foster care provider to receive 

these payments. Will the regulations require licensure of family Centered Treatment 

Programs prior to approving payment or are they going to accept the Substance Use Disorder 

(SUD) license on its own as proof of the ability to care for children? 

Answer: We do not intend to issue regulations in this area. However, as indicated in ACYF-CBPI-18-07, a licensed residential fami ly-based treatment facility for substance abuse is not a child 

care institution (CCI) as defmed in section 472(c) of the Social Security Act. Therefore, while 

the facility must be licensed, there is no requirement that it meet the title IV-E licensing 

requirements for a CCI. 

3) Can states rely on the fact of a state plan approval as a defense against cost disallowance? 

Answer: No, the approval of a state plan is a separate function from detennining whether the 

costs that a state or tribe submits for reimbursement are allowable. Disallowances are taken for a 

variety of reasons, such as non-compliance with the title lV -E plan requirements, claiming 

unallowable costs under title IV -E, and claiming for costs that were not properly allocated or 

documented. These disallowances could be taken even if the state or tribe has an approved title 

IV -E plan (which the state or tribe may not be following). 

4) Part I requires the Secretary to publish a pre-approved list of evidence-based, trauma-infonned 

prevention services states or counties may select to include in the new opt-in Prevention 

Services provision oftbe law. The l.ist is to be established by October I, 2018. As research 

and evaluations of the efficacy of different programs continue to evolve, wiU the Secretary 

issue guidance explicitly stating that the pre-approved list of services will continue to evolve 

alongside newly identified research-based, tested prevention services? 

Answer: We expect to issue guidance during the first quarter of FY 20 19 that will describe the 

criteria for reviewing programs and services to detennine if they meet evidentiary requirements, 

and will include a preliminary list of the services that we intend to review first. Given the 

breadth of interventions that could potentially be approved for reimbursement, we anticipate the 

review and approval of interventions, both to add new interventions and move approved 

interventions into new categories, to be an ongoing exercise. 

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5) What is the anticipated mechanism/timeframe for states to meet reporting requiremems 

specified in Section 50744? When will any guidance related to data collection and submission 

requirements be shared? 

Answer: Section 50744 of Family First modified the Child Welfare Outcomes Report to include 

data on children in foster care who have been placed in settings that are not foster family homes. 

To the extent feasible, data for most of the outcomes are derived from the National Child Abuse 

and Neglect Data System (NCANDS) and the Adoption and Foster Care Analysis and Reporting 

System (AFCARS). AFCARS docs not include all of the information required. The spring 2018 

Unified Agenda lists an NPRM on AFCARS with an anticipated publication date of May 2019. 

Thus, we cannot anticipate when the first AFCARS data will come in to be used for the 

outcomes report. 

Congressman John Lewis 

I) Evidence-based Practices: What kind of flexibility with HHS have in allowing states to 

balance existing community-based interventions versus evidence-based interventions listed in 

the clearinghouse? There is a question about the flexibility in what the state can detcnninc to 

be "evidence-based." In particular, there is a concern that the clearinghouse of evidence 

based interventions may not easily apply to complex family needs. For example, for one 

program that currently provides an intervention for children with medical complexities, there 

is not an existing evidenced-based intervention that easily applies. So, providers would be 

challenged to retrofit existing community-based interventions into manualized evidencebased programs, which would take time and may not meet the needs of children and families. 

What if effective community interventions have not reached the level of rigor expected in tbe 

family first law? And, how will evidence-based parenting programs be identified? 

Answer: We intend to implement Family First as flexibly as possible within the parameters of 

the law to account for complex needs. The law does not allow for flexibility with regard to 

funding programs that do not meet the evidence-based interventions in the law. As to these 

specific interventions, the Clearinghouse is tasked with identifying appropriate services that meet 

the statutory criteria, and those have not yet been identified. This will be addressed in future 

guidanc·e that we anticipate providing in the ftrst quarter ofFY 2019. 

2) Transition Process: How can states better structure the program to be a stable component of 

child and family services? There were concems about the time it will take to restrucn1re the 

current constellation of services to fit eligibility for family first funding. For example, in GA, 

foster care services have been privatized and there is a concem that family first undercuts 

private providers with a six bed limit. More fundamentally, agencies are concerned about 

interim-planning processes altogether. In particular, a few administrators described the 

importance of avoiding a foster care system that relies primarily on the Department of Family 

and Children Services, and is therefore vulnerable to elected office changes. Instead, they 

expressed the importance of permanent planning for foster care that integrates a number of 

state institutions to provide more planning and programming stability overall. 

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Answer: We understand these questions to be about the concerns over reductions in title IV-E 

funding when the foster care mainteuance paymeut limitations are in effect. As such, many 

states will likely need to restructure their placement options in order to claim FFP under title IVE. However, states will need to do their own inventory and analysis as there will not be a one 

size fits all approach that all states can follow. Each state will need to redesign its programs to 

address the needs of the population of children in its state. 

3) Performance Measures: How will outcomes be measured? There were concerns about 

whether process and outcome measures would inform the fidelity of evidence-based 

programs for varying populations. Also, agency administrators questioned prevention 

services measures. How will family first objectives be measured in a way that assures proper 

implementation so that poor prevention methods can be identified early? 

Answer: We will address this question in futllfe guidance that we anticipate providing in the first 

quarter of FY 2019. 

Congressman Carlos C urbelo 

I) Florida bas accomplished a great deal with the tlexibility afforded to them by federal waivers 

since 2006. Our state has been a leader in improving outcomes for vulnerable children and 

families. 

We have heard from various stakeholders in Florida that while they are very supportive of 

Family First, they are very concerned about trausitiou challenges they expect as they work to 

comply with the law. We want to make sure that as Florida and other states transition from 

the previous system, they are able to serve families effectively and limit any disruptions. It's 

my understanding that other states have similar concerns in cettain counties, while in Florida, 

tltis is a concern for the entire state. 

With that in mind, how is the Administration planning to assist states as they transition to 

Family First? Are there any mechanisms in p lace that can help ensure that important services 

similar to those cuncntly being provided to families under the waivers are able to continue 

after September of20 19? 

Answer: We have been providing ongoing technical assistance to jurisdictions operating waiver 

demonstrations to assist them in successfully implementing and evaluating the interventions they 

have operated under the waiver demonstration authority. Technical assistance has been, and will 

continue to be, provided by both Federal staff and our contracted technical assistance providers. 

As we move into tbe ti11al year of waiver authority, we are working witb j urisdictions to assist 

them in identifYing practices, strategies, and lessons learned in the implementation of their 

waiver demonstrations that we think will serve them well as they make tbe transition to the 

requirements and opportunities of Family First. Areas of discussion and technical assistance 

include the implementation and evaluation of evidence-based interventions designed to 

strengthen fami lies and prevent foster care placements that may qualify for title IV -E prevention 

services funding, as well as strategies to reduce the use of congregate care when not appropriate 

and to improve supports to kinship care families. In addition, for states that have been operating 

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under a capped allocation of title IV -E foster care funding, we are providing technical assistance 

to ensure that they are prepared to rerum to " traditional" title IV -E claiming only for allowable 

costs on behalf of eligible children in allowable settings. The mode and timing of technical 

assistance varies, including our annual in-person waiver demonstration meeting, webinars, 

teleconferences, and site visits. 

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[Public Submissions for the Record follow:] 


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Subcommittee on Human Resources, Committee on Ways and 

Means: Hearing on The Opioid Crisis: Implementation of the 

Family First Prevention Services Act (FFPSA) 

Statement for the Record of Matthew E. Melmed, Executive 

Director, ZERO TO THREE 

r 

ZERO TO THREE 

Thank you, Mr. Chairman, Ranking Member Davis, and Members of the Subcommittee, for holding this hearing 

looking at the intersection of the great challenges many families fac.e, particularly from substance abuse, and 

one of the most promising opportunities for changing their lives. The Family First Prevention Services Act 

(FFPSA) represents a chance to achieve something we strive for in our own work: transforming the thild 

welfare system into a child wellbeing system. At ZERO TO THREE, we focus on families with infants and 

toddlers, the age group most likely to experience maltreatment and placement in foster care. My remarks are 

based on our experience in developing and implementing the Safe Babies Court Team"" (SBCT) approach, 

which works in courts and communities from Alaska to Florida to use the science of early childhood 

development and the impact of trauma to t ransform how they work with infants, toddlers, and families in t he 

child welfare system. 

Based on this e•perlence, as you look at the implementation of FFPSA and the prevalence of substance abuse 

this new funding authority will help address, my principal recommendation is this: ensure that comprehens;ve 

approaches encompassing the three service areas identified in FFPSA ore included in evidence-based programs 

approved tor funding. Substance abuse is only one aspect in a range of complex family needs. All these needs 

must be considered in a comprehensive way for any effort to be successful, whether its preventing 

maltreatment or foster care placement, reunifying families, or reaching some other form of permanency. 

Transforming child welfare is not an easy t ask. It means more than simply increasing the availability of a few 

seNices.lt means a cultural shift in working with families and reQuires a comprehensive approach with an 

organizing principle grounded in science that guides how eac.h famity is considered individually. 

Founded more than 40 ye.ars ago, ZERO TO THREE is a national nonprofit organization whose mission is to 

ensure that all babies and toddlers have a strong st art in life. We translate the science of early childhood 

development into useful knowledge and strategies for parents, practitioners, and polieymakers. We work to 

ensure that babies and toddlers benefit from the family and community connections critical to their wellbeing 

and healthy development. Nowhere are these connections that are so essential to early brain development 

more important than for babies in the child welfare system. Over t he last decade, we have worked around the 

country to bring the science of early brain development to local child welfare agencies, courts and the 

communities that surround them. 

The Safe Babies Court Team (SBCT) approach is an evidence-based practice that uses this science to drive 

change at both the systems and practice levels for infants, toddlers, and families in the child welfare system. 

From the judge who leads the team, to every caseworker, attorney, and service provider, the teams transform 

the culture of working with families, the community systems that must come together to meet families' needs. 

and t he lives of the children and families themselves. 

What does this mean in real terms? Culture is changed as all professionals as well as the families themselves 

learn to make decisions within a framework of early childhood development and the impacts of trauma. A 

central tenet is valuing birth parents as individuals and in their important relationships with their children. 

Systems are changed as stakeholders come together to identify needed services, and particularly, to select 

appropriate evidence-based practices and make them more widely available and integrated within the 

community. At the famitylevel, it means their needs are approached in a holistic way, starting with 

assessments of children ond parents, and ensuring they receive evidence-based mental health, substance 

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ZERO TO THREE Statement. Heanng on The Op101d Cns1s and FFPSA 

abuse treatment, and parenting services as part of an array of supports and services that includes support to 

keep the child' s early development on track. Although both parents and babies carry a heavy trauma burden as 

measured by Adverse Childhood Experiences (ACEs), SBCT's two-generation approach is showing great success 

in keeping families together. Auguring well for the feasibility of working with many families within the 12· 

month FFPSA limit, 84 percent of closed SBCT cases reach permanency within a year.' SBCT has reduced further 

maltreatment to levels surpassing what is acceptable under national standards: 0.7 percent of SBCT cases 

experience a recurrence of maltreatment compared with the national standard of 9.1 percent.' 

As the Subcommittee works with the Administration to implement FFPSA, I urge you to ensure that 

comprehensive approaches such as SBCT, which provide a science-based framework for changing child welfare 

policy and practice as well as evidence-based interventions, are included in the Clearinghouse in the programs 

and practices approved for states as they develop their plans. Funding for services such as substance abuse 

and mental health treatment as well as parenting support will greatly enhance the ability to work with families, 

many of whom are currently offered very few services. But using this funding authority effectively means 

having a coherent overall approach that ensures the structure is In place for assessing and addressing 

individual families' needs; providing guidance to communities that need assistance in selecting which 

evidence-based interventions to use; and avoiding situations where services are prescribed simply because 

funding is available, or where a less intensive service is provided because the overall framework is not in place 

to determine that a more intensive intervention is needed. FFPSA requires states to address some of these 

steps, such as assessing needs and developing case plans. But it would help to enable states and communities 

to easily access approaches that can provide those steps as part of a comprehensive and integrated whole. 

Several other recommendations flow from SBCT and our experience in identifying evidence-based practices for 

our Court Teams and communities to draw on.m First, while the Department of Health and Human Services 

(HHS) is contemplating a fairly short list of pre-approved interventions, addressing the needs of individual 

families calls for a broader range of interventions as well as the flexibility to add new ones as warranted by 

family needs, as I discuss later. The fact that states will be able to define their population "at imminent risk" 

also argues for a longer list to accommodate different levels of family complexity. The Clearinghouse also 

needs to ensure that interventions appropriate for different age groups and populations are included on the 

approved list, so that states do not exclude groups based on a lack of approved interventions. In addition, we 

encourage HHS in concert with the Clearinghouse, once established, to develop a research agenda to fill gaps 

in evidence-based interventions for particular groups and work with states to implement that agenda. 

Infants and Toddlers ore Particularly Vulnerable to Impacts of Maltreatment 

We emphasize the inclusion of services for distinct age groups, because science tells us that infants and 

toddlers are the age group most vulnerable to maltreatment, and their rapid development requires responses 

tailored to their unique needs. They make up the largest age group entering foster care, accounting for a third 

of all placements. Infants (children under one year of age) alone now account for 18 percent of all foster care 

entries." Some part of this increase may be due to the explosion of opioid use in some areas of the country, 

although drugs such as meth are found in other areas, and alcohol- a known teratogen with well-documented 

detrimental impacts on development-is ever-present. From news reports, we know that some communities 

are overwhelmed by parental opioid use, and their reflexive response is to remove children from their parents' 

care. Such a separation is not necessarily the best way to help either young children or families. Separation 

from parents can be wrenching for babies who cannot understand what is happening to them. It may also be 

detrimental to the parents' ability to get their lives back on track. However, communities often lack capacity 

for an alternative response. 

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ZERO TO THREE Statement. Heanng on The Op101d Cns1s and FFPSA 

These encounters with the child welfare system occur during the most rapid period of human brain 

development. Babies' brains create more than one million new neural connections a second, laying the 

foundation for all learning that life will bring them. The architecture of the developing brain is shaped by a 

baby's experiences, whether positive or negative. These experiences occur in the context of close relationships 

with trusted adults, without which babies cannot thrive. So, it is not surprising that maltreatment can harm the 

development of vulnerable young brains or that building strong, trusting relationships may be a particular 

need if the cycle of stress, trauma, and unhealthy behaviors is to be broken. More than half of children under 

age two who come to the attention of the child welfare system are at high risk for neurological or 

development impairment.• Studies have found extremely high rates of attachment dist ances. ~"" Other 

longer·term effects include poor self·esteem and behavior control, deficits in language development and 

school success, and later in life, delinquency, substance abuse, and depression."'; 

ZERO TO THREE's child welfare work began out of concern that infants and toddlers entering the child welfare 

system rarely receive care based on their developmental needs. Child welfare practices, such as multiple foster 

care placements, a lack of parental contact, and little attention to supporting early development can 

compound effects of eat en ~ A survey of state child welfare policies found that few states had policies 

or practices differentiated to address the unique needs and rapid development of infants and toddlers. ' 

Moreover, states have a long way to go in understanding and meeting parent$' needs to help them address 

their own issues and become successful parents to their infants and toddlers. Fewer than half of states had 

policies requiring that birth parents be offered services and supports to overcome their own past trauma, as 

well as mental health, substance abuse, and domestic violence ss es. ~ So, the child welfare system seems 

particularly ill-equipped to respond supportively to either the child's development or the parent's substance 

abuse and other problems. 

Community Responses Must Address Families' Complex Trauma Histories 

Our work around the country has built a picture of the complex needs of families with very young children who 

enter the child welfare system. Substance abuse is indeed prevalent in the families we serve- 90 percent have 

some substance abuse involvement, and it is a reason for removal in 69 percent of foster care placements."; 

However, I want to underscore that the central issue for these families Is trauma. And I speak not only of the 

trauma that abuse or neglect, exposure to substance abuse, etc., brings to the children, but of the wrenching 

experiences many of their parents have carried with them since childhood. It is this trauma burden that is 

associated with their child's ultimate permanency outcome- remaining together as a birth family, placement 

with relatives, or adoption."" Congr ess was right to insist that the interventions funded under FFPSA be 

trauma-informed. I would go further and suggest that the whole system of child we/fore and court 

professionals, as well as other stakeholders, must understand both the basics of early childhood development, 

the effects of trauma on that development, and the central role of recognizing and healing parents' past 

trauma in keeping families together or guiding them toward another outcome for the child. 

To measure the trauma burden of SBCT birth parents, we looked at the number of Adverse Childhood 

Experiences (ACE),., in their backgrounds. Out of the ten experiences identified in the original ACE study, a 

score of four is the tipping point at which the likelihood of poor adult outcomes, such as heart disease, cancer, 

diabetes, mental health problems, or substance abuse, dramatically increase and continue to climb with each 

additional ACE. With that scale in mind, o staggering 63 percent of parents in our study had four or more ACEs, 

ond one in six parents had from eight to all ten ACEs.w Thus, it is not astonishing that so many parents had 

substance use problems. It would have been more astounding if they did not. The most common type of ACEs 

experienced by these parents in their own pasts were parental separation or divorce (80%), household 

substance abuse (64%), physical abuse (52%), and emotional neglect (51%). 

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ZERO TO THREE Statement, Heanng on The Op1o1d Cns1s and FFPSA 

Children who have not yet reached their third birthday may seem too young to have accumulated a trauma 

history, but that is not the case for infants and toddlers with whom the Court Teams work. 59 percent hod on 

ACE score of 4 or higher. Even at a very young age, the majority of babies had already reached the "tipping 

point" at which t he odds of poor health and behavioral outcomes in adulthood had vastly increased. In 

addition to maltreatment, the most common adverse experiences fell under the " Household Dysfunction" 

category: parental separation or divorce (89%), household substance abuse (79%), and household mental 

illness (64%). 47 percent had a household member who was or had been incarcerated. 

Safe Babies Court Teams: How a Comprehensive Approach Changes Communities and Changes Lives 

Much as Congress enacted FFPSA to change the conditions that lead to foster care placement, the Safe Babies 

Court Team movement began in 2005 in response to family court judges' frustration with the cycle of abuse 

and neglect that played out in their court rooms and their determination to find a way to break it. ZERO TO 

THREE worked with a core group of judges and communities to bring the science of early childhood 

development to bear on both decision-making and interventions with families, growing an approach that could 

be tailored to community needs and meet communities where they are, whether resource-rich or lacking in 

evidence-based approaches and other services. I want to emphasize that SBCT is not a "specialty court," but 

rather an approach that can be applied in any court and community serving children and families in the child 

welfare system. SBCT is now being implemented or developed in more than 70 sites around the country. The 

approach has garnered widespread attention and support from the judges and communities that have adopted 

it. Interest in bringing the approach to more locations has grown significantly over the past four years. For 

example, Tennessee passed legislation establishing 10 Court Teams. The State of Maryland recently began a 

Court Team with IV·E waiver funding. Court Teams in Florida's statewide program have expanded from 5 

original teams supported by the ZERO TO THREE Court Teams staff to 21 sites. 

Each SBCT is led by a judge and/or a child welfare agency leader who recognizes both the impact of trauma on 

families and the importance of a child's first three years in avoiding the next generation of maltreatment. A 

key figure in program success is the community coordinator, who works with the judge to coordinate services 

and resources for the babies and families overseen by the court. Along with the families, the team is composed 

of key community stakeholders, all committed to restructuring the way the community responds to the needs 

of the babies and families. In addition to court.s, attorneys, and child welfare professionals, stakeholders 

include providers of health care/Medicaid, mental health treatment, early care and education (particularly 

Early Head Start), early intervention, substance abuse treatment, domestic violence treatment, parenting 

education, housing and energy assistance, and more. SBCT originally focused on promoting stability, 

permanency and positive child development for infants and toddlers in foster care, but increasingly its 

powerful structure is being used for addressing needs as soon as children come to the attention of the child 

welfare system and helping support them in their own homes. We firmly believe that this approach, built on 

community collaboration among service providers outside of the child welfare system, has profound 

implications for supporting families before they reach that system."" 

FFPSA Requirements: Administrative processes 

Built into the SBCT approach are elements required under FFPSA for case management and state planning that 

include (1) case plans detailing a prevention plan with services to be provided and a description of how the 

state will monitor the children: SBCT provides de toiled case plans coupled with monthly court ond staff 

oversight to ensure progress; (2) assessments of parents' and children's needs, described below; (3) plans to 

implement and monitor services selected and use information from monitoring to refine and improve 

practices: SBCT uses a data collection system across sites that allows all levels of management to monitor in 

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ZERO TO THREE Statement. Heanng on The Op101d Cns1s and FFPSA 

real time and promotes Continuous Quality Improvement at the caseworker, site, and notional program levels 

while also providing multisite evaluation data; (4) consultation with other agencies and coordination of 

services: SBCT includes all service providers in the team, so consultation occurs frequently and oil services ore 

coordinated; and (5) steps to support a child welfare workforce to deliver trauma-informed and evidence· 

based services: SBCT provide training and support for professionals in the child welfare agency, court, and 

community stakeholders in early childhood development and trauma impacts. The holistic SBCT approach 

means all services regardless of funding source are automatically coordinated, as FFPSA requires. 

While I discuss some of the systems-level impacts below, I want to point out how the court team functions for 

families. In traditional child welfare practice, services are usually provided to families in isolation of each other 

in a kind of hub-and-spoke configuration where the caseworker is the hub and the service providers are the 

spokes, connected only to the hub, not each other. Now, think of the court team as the wheel rim, where 

everyone touching the family meets frequently, through monthly court hearings, family team meetings, 

stakeholder meetings, as well as regular e-mails and phone calls. One team member noted, "One thing I always 

notice-all the providers, our team, know each other really well and know our cases. It almost creates less 

work because we are always communicating with each other."""' 

FFPSA Emphasis: Addressing Trauma within SBCT 

FFPSA requires services and programs to be "provided under an organizational structure and treatment 

framework that involves understanding, recognizing, and responding to the effects of all types of trauma." 

SBCT is built around an understanding of trauma infused within the entire team and approach. Parents receive 

comprehensive medical and mental health assessments, including evaluation for their own childhood trauma, 

prenatal alcohol exposure, substance abuse, and domestic violence. Sites are required to have a Continuum of 

Behavioral Services, enabling the development of service plans that include supporting the parent·child 

relationship and increasing a parent's ability to provide emotional support, create structure, set limits, and 

help the child learn. Based on the assessment, clinicians provide recommendations to the team and the court 

on the types of evidence-based interventions needed by the family, including visit coaching. psychoeducational 

parent education, and Child-Parent Psychotherapy (CPP).In CPP, one of the few dyadic mental health 

interventions validated for infants and toddlers with their caregivers, the therapist helps the parent 

understand how their own early experiences may affect how they feel about and interact with their child."'"' 

Parents also need mental health and substance abuse treatment services to help them address their 

underlying mental or emotional concerns, which the SBCT works effectively to obtain. Almost three quarters of 

parents who are screened and referred for substance abuse treatment begin services within a week of referral. 

(See Figure 1.) 

Figure 1: SBCT Parents Experience Prompt Screening and Receipt 

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ZERO TO THREE Statement. Heanng on The Optotd Cnsts and FFPSA 

Of Substance Abuse and Mental Health Services"" 

Substance Abuse & Mental Health 

Services: 

Time from Referral to Receipt 

Substance Abuse Treatment 

Substance Abuse Screening$ 

Mental Health Treatment 

Mental Health Sc.reenlngs 

0 20 40 60 80 100 120 

• less than a week 7 to 30 days 

• 31 to 60 days. • More than 60 day:s 

FFPSA Requirement, Coordination with other services: SBCT Assesses and Addresses Children's Needs 

For young children who, because of experiences of adversity in their homes and communities, have 

dysregulated behaviors and emotions, we may think that these experiences have set these children on a 

negative lifelong path. Yet, research shows us that these experiences do not have to dictate a child's future; 

when negative early experiences occur concurrently with protective factors, there is an opportunity to 

promote resilience."' Though involvement in the SBCT will not undo ACE experiences for young children, the 

SBCT approach provides concrete strategies that support resilience in young children and their families. An 

infant-Toddler court team uses their unique knowledge of their community to find local solutions and 

interventions that meet the developmental needs of infants and toddlers in foster care. While infant-early 

childhood mental health services are a key need for the children, so are services to support overall 

development. As states and communities implement FFPSA, it is critical that their approaches to children's and 

families' needs begin with, but ore not limited by, the services that con be funded through FFPSA. 

Based on the Ages & Stages Questionnaires (ASQ-3) completed with parents/caregivers of children aged 1 

month to 5.5 years, about 70% of children have one or more developmental areas that need to be monitored 

or were below normal development. SBCT guidelines include ensuring that all children are screened within the 

first 3 months of becoming involved with the court team. Developmental screening was identified as a service 

need among more than 95% of children. After screening, early intervention (including occupational therapy, 

physical therapy, speech therapy, and early intervention education services) was identified among needed 

services for more than 40 percent of children. Other services needed by children included CPP (51%), dental 

care (25%), and Early Head Start (12%)."" 

SBCT is effective in obtaining needed services for these developmentally vulnerable babies. 97 percent of 

children identified for services such as developmental screening and early intervention receive them, while 94 

percent of children needing Child Parent Psychotherapy (evidence-based mental health therapy for parents 

and children together) receive services- limited mostly by the lack of infant-early childhood mental health 

clinicians."' (See Figure 2.) 

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ZERO TO THREE Statement. Heanng on The Op101d Cns1s and FFPSA 

Figure 2: Services Support SBCT Children's Development""" 

Receipt of Services among children in need: 

QIC-CT Sites 

~99 .s 98 1 98 97 97 .§ 97 

I I ~ 96 

.Jl96 I ~ 

~ 95 94 -~ 94 I ~ 93 

'ij 

~ 92 

* Child Pan~nt OentaiC'.are Developmental E~tlv Head Early P$ychotherapy Scfeening St•n lnterventton 

Systems Change: Ensuring Communities are Trauma-Informed and Focused on Evidence-Based Practice 

A major reason for SBCT's effectiveness in obtaining needed services is the team's role at the community 

systems level. The team of large and diverse stakeholder groups meet monthly to discuss various topics at 

hand: early childhood court policies and procedures, case and system issues, and community resources. Some 

sites have workgroups to target specific issues. Stakeholders report being more informed on the needs of 

infants and toddlers; attachment and infant mental health; the impact of child maltreatment, trauma, and 

foster care placements; parents' Individual trauma; and historical trauma influencing the community. 

Two outcomes help promote FFPSA goals on trauma and evidence: (1) The increased focus on trauma has led 

the court teams to respond to the needs of birth parents in the context of traumatic stressors and their post 

histories of trauma; and (2) the court teams hove worked to improve the ovoilobility of evidence-based 

practices (EBP) within the community. Judges are part of this focus on implementing EBPs, often inquiring 

about progress through such interventions during hearings. One example is their work to make Child-Parent 

Psychotherapy (CPP), the EBP of choice for many teams, more w idely available. Several sites found the need 

for additional ESP providers, including the training of clinicians certified to provide CPP, was necessary to 

implement and sustain EBPs. The SBCT national staff offered certified training to expand capacity. Still, the lack 

of certified CPP clinicians continues to be a barrier to use of this practice that is a particularly effective 

intervention for babies and parents. As FFPSA is implemented, we urge consideration of allowing funds to be 

used to expand the presence of EBPs as with training clinical providers, rather than only paying for what is 

readily available. The ability of FFPSA funds to pay for mental health and other services will help communities 

sustain evidence-based practices, but this may depend on how reimbursement is structured. Some states do 

not cover dyadic treatment for families under Medicaid, and in many states, the reimbursement rate is so low 

that the Court Team cannot sustain the evidence-based practice. 

Regarding the total number of evidence-based practices included in the FFPSA Clearinghouse, we recommend a 

strategy that gives states and communities o wide enough choice to ensure they con provide the most 

appropriate services for the families they serve. These choices w ill not always be obvious as a state is w riting its 

state plan, but may become apparent as actual practice proceeds. For example, ZERO TO THREE identified 

Copyright ~ 2016 ZERO TO THREE All rights reserved. 7 
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ZERO TO THREE Statement, Heanng on The Optotd Cnsts and FFPSA 

several evidence-based parenting skills curricula recommended for sites to use. However, when the sites found 

that many parents had intellectual disabilities hampering their ability to absorb parenting information in 

traditional formats, we identified and worked with them to implement Step-by-Step Parenting, an evidence· 

based approach developed for parents with this type of challenge. Such an experience makes a strong case for 

more flexibility for states and communities, rather than a short-list of options. 

Another example of the court teams working at the systems level occurred in Iowa, where a parent overdosing 

on heroin in court brought the SBCT judge face to face with the opioid crisis. In seeking a solution to opioid· 

involved families-cases which the family drug court judge indicated he did not take-the SBCT judge 

discovered there was only one accessible MAT program in the area, a provider who was at odds with the 

human services agency. The SBCT community coordinator was able to bring the parties together and heal this 

breach, opening the door to treatment. But the work went further. As the only available MAT provider, this 

provider could not take all cases needing MAT and also provide behavioral therapy. An agreement was worked 

out so other providers did the behavioral therapy, freeing up the only MAT clinic in the area to work with more 

patients. This cooperation opened up more treatment services for all courts. As the judge noted, who would 

have thought that a court focusing on babies could have such a broad effect? While HHS indicated in its 

request for comment on implementing the Clearinghouse that it would not consider access to services as on 

outcome, we note that outcomes cannot be achieved without systemic efforts to ensure access. 

Evidence of Effectiveness 

The SBCT approach has undergone multiple evaluations. One evaluation was a quasi-experimental design using 

a subsample of infants and toddlers from the National Survey of Child and Adolescent Wellbeing (NSCAW) 

database for a mixed-method analysis of length of time to permanency and type of permanency outcome. In a 

current evaluation, the American Institutes for Research (AIR) is conducting a natural experiment that relies on 

the random assignment of families to judges that naturally occurs in three sites currently implementing SBCT. 

This study will compare cases in courts implementing SBCT to cases in regular dependency courts. It will 

answer questions about length of time in foster care, rate of exposure to reoccurring abuse or neglect, and 

level of family and child well-being. 

Major outcomes identified in the first study:""' 

Court Teams children exit foster care faster regardless of the type of exit: the median exit for Court 

Teams children was about a year faster than the median in the control group. 

Court Teams cases experience a different pattern of exits from the foster care system: Reunification is 

the most common type of exit for Court Teams cases (38%) while adoption is the most prevalent for 

the comparison group (41%). Overall, Court Teams children were more likely to experience 

reunification, placement with a relative, or non-relative guardianship. 

Court Teams children reach permanency sooner, regardless of the type of exit, meaning that the 

difference in rates of adoption do not account for the overall difference in time to permanency. 

Based on the first evaluation, the California Evidence-Based Clearinghouse for Child Welfare rated SBCT as 

Promising Research Evidence whose Child Welfare System Relevance Level is High. 

Comparison of SBCT Outcomes with Federal Standards: 

Safety outcomes-Recurrence of Maltreatment: The most recent evaluation of infants and toddlers in SBCT 

found that maltreatment recurrence within 12 months (CFSR 3, Safety outcome 2) among 251 children across 

sites using the SBCT approach was just 1.2 percent.""' Since that evaluation, updated analysis of 430 cases at 

Copyright © 2016 ZERO TO THREE. All rights reserved. 
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ZERO TO THREE Statement. Heanng on The Optotd Cnsts and FFPSA 

SBCT sites between April 2015 (or date of site initiation up to 2016) to July 2018 have reduced the 

maltreatment recurrence within 12 months to 0.7 percent.""" These findings compare to: 

National standard of the Children's Bureau for Safety Performance Area 2, recurrence of maltreatment 

during a 12-month period: 9.1%,.,;1 

Analysis of data that combined the second National Survey of Child and Adolescent Well-Being 

(NSCAW) and the National Child Abuse and Neglect Data System of cases with a median time of 12 

months of children regardless of age, substantiation status, and placement out of home, found that 

6.9% of all children had maltreatment recurrence, but among a subsample of caseworkers who were interviewed at follow up (because the case was still open or there had been contact with the CWS 

since closing the investigation), maltreatment recurrence was 24.1%.""'" 

The latest data on child welfare outcomes based on 2014 reported a national median of 4.9% for 

recurrence of maltreatment among children of any age within a 6-month period.""' 

Pcrm.,ncncy ;)nd St.,bility: lmplieiltion$ for FFPSA 12 Mo nth limit 

The recent study found permanency outcomes that echoed the earlier evaluation and by far exceeded the 

federal standard. 84 percent of children with closed cases reached permanency within a year, double the 

national standard expectations established by the Children's Bureau of 41 percent. Reaching success with 

such a caseload suggests that a comprehensive approach can reach successful outcomes with families whose 

children might otherwise be placed In foster care within the 12-month limit established by FFPSA. Moreover, 

this impressive outcome occurred in a caseload where parents had more risk factors than a nationally 

representative sample (NSCAW II) of children investigated for maltreatment: 90% of SBCT children w ith closed 

cases had one or both parents with substance use disorders, compared with 10% of primary caregivers in the 

national sample; dose to two-thirds of the SBCT children had parents with mental health problems, compared 

with 15% in the national sample. Over half of the children had a parent who had been incarcerated. As with 

the earlier evaluation, reunification was the permanency outcome in a large proportion of cases, 49 percent . 

Adoption was more prevalent where parent s had extremely high ACE scores (7·10 ACEs), but reunification was 

possible in 30 percent of those cases with high risk factors.""' 

Conclusion 

We at ZERO TO THREE are heartened by the possibilities opened up by the enactment of FFPSA. At the same 

time, we urge that the implementation of this important new funding stream consider how best to maximize 

the effectiveness of services provided, the ability to transform culture and practice, and above all, to meet 

families' needs in a comprehensive manner that in the long run truly leads to healthier lives and thriving 

children. The experience of SBCT illustrates how comprehensive approaches provide a framework within w hich 

the needs of individual families are appropriately considered, services are integrated, and the community's 

ability to respond with the most appropriate evidence-based interventions is enhanced. We hope that in 

implementing FFPSA, the Congress and the Administration will work together in considering the myriad needs 

of families, what drives their long-term outcomes, and enable states and communities to build thoughtful 

systems of services to support family and child wellbeing. 

1 Casanueva, C., Smith. K .• Harris, S., Carr, C .• & 8utfeind, C. ~2018). Advt~ childhood ~xpttitnc~.fomily fiskfoctors, ond child 

pttmontncyouccomts of very youJtg chfldt~n Involved in Soft Sables Court Ttom"" sites. Prepared for ZERO TO THREE. Quality 

Improvement Center fOf Rese~rch-Based Infant· Toddler Court Teams. 

11 Electronic corre$pondence with Cecilia Ca~nueva, Ph.O. (Juty 17, 2018}. RTI InternationaJ. 

m Quality lmprov(!mtnt Cent(!r for Infant· TOddler Court Teams (2015). A rtv~w of tvidtntt!·bostd inrt~nt ons for fomilits strved by 

infont-toddltrcourt ttoms. ZERO TO THREE. Available at 

http://www.gi((t otsf$it(!l$ldefaul5/fifM/AR@yiew0fEvidcn<¢Bas«<lntrorgntions08061S.odf 

Copyright @ 2016 ZERO TO THREE. All rights reserved. 9 
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ZERO TO THREE Statement. Heanng on The Optotd Cnsts and FFPSA 

w U.S. Department of Health and Human Services, Administration for Children and Families. (2017). The AFCARS report: Preliminary FY 

2016 estimates os of Oct 20, 2017. Retrieved at https://www.ad.hhs.govfsites/defauh/fi!C"Sicb/afcarsreoort24 odf 

"Department of Health and Human Services, Administration for Children and Families, Orfice of Program Research and Evaluation 

(2007). Notionol Svrvey of Child ond Adolescent We/1-~ing Research Brief No.4: Infants ond Toddlers in the Child Wei/ore System. 

Washington, OC: Administration for Children and Families, Office of Program Research and Evaluation. 

'"' Jones Harden, B. (2007). Infants in the Child Wel{ore System: A Developmetltol Fto~WOtkjot Polley ond l>roctiu. Washington, DC: 

ZERO TO THREE .

._.Dante Chkch(!tti, Fred A. Rogosth, an-d St\efee L Toth, .. fon«.mng secure Attachment in Infants in Maltreating Families through 

Preventive InterventiOns.· Development ond Psychopathology 18 (2006), 623~649. 

- Cohen, J .. Cole, P., & Slrom, J. (2011) A caJI to action on behalf of motrreoted Infants ond toddlers. Wa.shlngton, DC: ZERO TO 

THREE, American Humane Association, C~nter for the Study of Social Policy, Child Welfare League of America, and Children's Defense 

Fund. 

• Cohen, J., et aLA coli to oction on beholf of moltreoted infants ond toddlers. 

:. Jordan, e .• Szrom, J., Colvard, J •• Cooper, H., & DeVooght, K. (2013). Changing the courMJ for Infants and toddlers: o survey of state 

chHd we/fore p()/kits and initiotives. Washington, DC: ZERO TO THREE and Child Trends. https:Uwww . .zerotothre-e.org/resources/218· 

changing-the-s.ourse·for-Jnfants-and-todd!cq 

"'ZERO TO THREE and Child Trends.. (2013) Understanding and me-eting the tteeds of birth porertts. Retrieved from 

https://www zerotothree.org/resources/1005-understanding-.and·meetins-the·needs-of-birth·p~nent.s 

IIi Casanueva, C., Hartis. S., carr, C., Burfeind, C., & Smith, K. (2017). Fino/ Evaluation Repon of tht Quality tmpr~mMt Ceflter for 

Reseotch·Bosed Infant-Toddler Court Teams. Research Triangle Park: RTIInternationat 

Nil Ca-sanucv.a, C., et al. Adverse chifdhood experiences. family risk foctors, ond child petmonency outcomes of very young children 

involved in So/e Bobies Covrt Teom"• sites. 

• In a major retrospective study of adults conducted a t Kaiser Permanente in san Diego, invtsti.gators surveyed 17,000 members of the 

health maintenance Of8anization on their exposure to ten advet$e childhood experiences (ACE). Each factor was separatefy tallied and 

each study participant was given an ACE score of the number of separate ACE they reported experiendng as children. When the 

inves:tigatof'S correlated the number of ACEs with the patients' current medical status their findings confirmed that the more troubling 

the childhood, the greater the number iJnd severity of medical and psychologk.al conditiOns in adulthood. Four or more ACEs predicted 

significant adult health issues and early death. 

"Osofsky, J.D., Lewis, M.L., & Szrom, J. (2018). The adverse experiences of very young children ond their parents involved 

in infont·toddfer court teams. Washington, OC: Quality Improvement Center for Research· Based Infant· Toddler Court 

Teams. http://www.gicet.oro/sites/default/foles/ACES%20Policv%20Brief%20%20v4%20%28003%29.pdf 

:M Hudson, l. (2017). A gvide to implementing the Sole Bobies Ccwrt Teams opprooch. Washinston, DC: ZERO TO THREE. 

ll"ooii Ca.sanucva, C., et al. FIJtOI evo/uotlon report of the Quality lmpr~ment Center for Reseorch·Bostd lnfont·Toddfer Court Teoms . 

.IIVill ZERO TO THREE & the Quality Improvement Center for Research·Based Infant-Toddler Court Teams (2017). Flyer on Child·Porent 

Psychotherapy (CPP). Adapted with permission from Osofsky, J. (June 12, 2017), Child·Parent Psychotherapy. Pet$0nal communication. 

Accessed at htto·J/www .gicct.orgtcy;derw:.e-bas¢<1 • 

• Casanueva, C., et. al. Fino/ evaluation report of the Quality lmpr<Wemenr Center for Reseorch·Bosed lnfant·Toddler Court Teams. 

lQI Osofsky, J.D., et al. The adverse experiencN of very young children ond their parents involved In Infant-toddler court teams. 

IXi Casanueva, C., et. a I. Fino/ tvoluorion report of the Quality lmprovemtM Ctnur for Rt1torch·Bastd Infant-Toddler Court Ttoms . 

.a~ casanuev.a, c .. et. a I. Fino! evofvotion report of the Qvofity Improvement Center for Reseorch·Bosed lnfont-Toddler Court Teams. 

d C.as.anueva, C., ct. al. Final evoiiJofion report of the Quolity Improvement Center for Reseorch·Bosed lnfont·Toddler Court Teams. 

xlti\• McCombs· Thornton, K. t.., & Foster, E. M. (2012). The effect of the ZERO TO THREE Court Teams initiative on types of exits from 

the foster care system • A competing risks analysis. Children ond Youth Services Review, 34(1}, 169·118. doi: 

10.1016/j.chfldyouth.2011.09.013. 

l:illt casanueva, C .• et. al. Final evaluation report of the Quollty Improvement Center for Research·Bcsed Infant-Toddler Court Teoms . 

..,..... Electronic correspondence with Cecilia c.asanueva, Ph.D. (Jufy 17, 2018). RTIIntemational. 

.u\111 Administration for Children and Families. (2015}. Statewide Data lndk:.ators and National Standards for Child and famity services 

Reviews. Washington, DC: Department of Health iJnd Human Services, Administration for Children and Families. 

:.wg Casanucva, C., Tueller, S., Dolan, M., Testa, M., Smith, I(., & Day, 0. (2015). Examining predictors of re·reports and recurrence of 

child maltreatment using two national data sources. Chifdrtn ond Youth Services R~iew, 48, 1·13. doi : 

10.1016/j.childyout h.Z014.10.006 

.,. Administration for Children and Families. (2017}. Child Welfare Ourcomes 2010.2014: Repotr to Co11gress. Washington1 DC. 

(Q casanueva, C., et aJ. Adverse childhood experiences, family risk factors; and child permanency outcomes of very young children 

involved in Sofe Babies Court Teom,. sites. 

Copyright C 2016 ZERO TO THREE. All rights reserved. 10 
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-IICSH 

Augus

-t 7, 2018 

The Honorable Adrian Smith The Honorable Danny Davis 

Chainnan, Subcommittee on Human Resources 

Committee on Ways and Means 

Ranking Member, Subcommittee on Human Resources 

Committee on Ways and Means 

United States House of Representatives United States House of Representatives 

Chainnan Smith, Ranking Member Davis, and Members of the Subcommittee: 

Thank you for providing an opportunity for Corporation for Supportive Housing (CSH) to provide written testimony 

for the record regarding the implementation of Family First Prevention Services Act of 2018 (FFPSA) and its 

potential impact on the opioid crisis. 

What We Do 

CSH is a national non·profrt that works with communities across the country to create supportive housing -

affordable housing connected to health, human services, and community supports - to help individuals and families 

thrive in their communities. Supportive housing is an innovative and proven solution to some of communities' 

toughest problems, successfully helping homeless adults and families achieve housing stability. Quality supportive 

housing is recognized by SAMHSA and the U.S. Department of Housing & Urban Development (HUD) as a best· 

practice for reducing chronic homelessness, which in tum leads to better outcomes for mental health and substance 

use disorders. Children receive the stability needed to reach their potential in school settings, parents receive the 

services needed to improve their own health and the health of their family, and ultimately, families are able to grow 

stronger together both during and after formal child welfare case involvement. 

Our Experience Related to Substance Abuse 

As the Subcommittee is aware, the opioid crisis has impacted every comer of the country, becoming a massive 

driver of homelessness and child welfare-involvement. 

• A survey by the United States Conference of Mayors found that 68 percent of cities reported that substance 

abuse was the largest cause of homelessness for single adults. Substance abuse was also reported as one 

of the top three causes of family homelessness by 12 percent of cities' 

In another study in New Haven, Connecticut, 25 percent of homeless people surveyed identified drug use 

as the primary reason for homelessness.2 

• A study to determine the leading risk factors for homelessness among veterans indicated that substance 

abuse may have the highest impact on relative risk for homelessness in this population, even more so than 

bipolar disorder and schizophrenia.• 

1 htte:Uwww.nc:dsv.ol'g/images/USCM Hunget·homelessness·Sutvey·in·America's-Cities 12"202008.pdf 

t http·//es psvchiatrvonljne.org/doi/abs/10 1116/os 43 2 166 

) httos://www.ncbi.nfm nih.goy/omc/articles/PMC39§9139/ 

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• 

-

A 2015 study of veterans initiating medication-administered treatment (MAT) screened each of these 

patients for risk of homelessness and found that the prevalence of homelessness in veterans with OUD is 

10 times more than the general veteran population.' 

• A recent study in Boston Showed that overdose has surpassed HIV as the leading cause of death among 

homeless adults, and found that opioids are responsible for more than 80 percent of these deaths. Homeless 

adults, 25-44, were nine times more likely to die from an overdose than their counterparts who were stably 

housed.

5 

In December 2015, CSH released a paper on supportive housing as a component of a strategy to manage the 

heroin crisis for the chronically homeless. The National Center on Addiction and Substance Abuse at Columbia has 

demonstrated that supportive housing is an effective and cost-efficient intervention for homeless individuals 

struggling with addiction. They evaluated a program that offered supportive housing to individuals not willing to 

commit to abstinence. The program was successful in reducing use of Shellers, jail and medical services. The 

reductions in crisis service use were associated with considerable savings, which offset the cost of the housing 

program• 

Our Experience with Child Welfare-Involved Families 

CSH began its supportive housing efforts for child welfare-involved families through a small pilot program In 2007, 

which later blossomed into our signature program- Keeping Families Together (KFT). The mix and intensity of 

KFT supportive housing services are tailored to the unique needs of each member of the family unit and address 

the trauma that many of these families have experienced. Utilizing a unique approach and collaborative service 

structure. supportive housing helps keep families together. 

The two-year evaluation of the pilot showed 90% families stably housed after 2 years, 61% of child welfare cases 

closed, 100% children eligible for reunification retumed home to families from placement, and children attended 25 

more days of school per year. The evaluation report also discusses the outcomes for parents substance use: "Many 

parents reported in the focus group that their greatest success and biggest challenge was maintaining their sobriety, 

although nearly all of the families who entered with a substance abuse problem were now clean and sober."' These 

early successes with the initial KFT pilot led to the ACYF Partnerships to Demonstrate the Effectiveness of 

Supportive Housing for Families in the Child We~are System, with the Random Control Trial (RCT) evaluation 

scheduled for lonna! release January 2019. 

CurrenUy active in eight states, KFT provides access to affordable housing and essential supports that help every 

member of the family, this model is reuniting children with their parents, reducing unnecessary foster-care 

placements and lowering costs. Last year, New Jersey expanded their Keeping Families Together initiative, 

adding 215 units, as part of their statewide opioid plan. 

•https:/!www.researchsate.net/publication/294278000 Screening for homele-ssness among Individuals Initiating medication· 

assisted treatment for opiold use disorder In the Veterans Health Administration 

s https://www,ncbl.nlm.nlh.gov/pubmed/23318302 

6 htto;//www.csh.orglwo=content!uoloads/2015/12/CSHPo!icyBrief SypoortiveHousing NYSQpioldEpidemic 12.8.1S.pdf 1 Keepjng Families Together: An evaluation ot the implementation and ootoomes ol a plot $Upportive housing model lot fsmlies lrwolved In the chlki welfare 

system. Metis Associates. November 2010. tJttp:IJ\wtw.melisassoc:iates oomtpob!icalion!ld<HIIfoacts.)4eds 1 1·10 KfiReoort rxlf 

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Our C

-

oncerns and Suggestions for FFPSA Implementation 

As noled in our formal comment letter to ACF regarding the establishment of the FFPSA Clearinghouse, CSH 

appreciates that the unde~ying statute provides ACF with some flexibility with respect to random-controlled trials 

(RCT) required for supported and well-supported practices through the indusion of the language "or, if not available, 

a study using a rigorous quasi-experimental research design." While there are many studies that highlight the 

positive outcomes and growing evidence for a number of key emergent interventions, the relatively emergent nature 

of key interventions in response to rapidly shifting child welfare issues and practices may limit the availably of longterm RCT studies. However, ensuring that the body of evidence points to the growing promise and efficacy of the 

intervention remains critical. One suggestion would be for ACF to bracket RCT and quasi-experimental 

methodologies together as the same rating ; based on our experience, there are reasons why an RCT was flawed 

and the quasi-experimental group was a better comparison. Another suggestion would be to limit the weight of the 

RCT and quasi-experimental altogether; cities and counties that contain rural areas woukf be excluded from highty 

rated evaluation designs due to smaller populations than perhaps are required to create appropriately sized control 

groups. CSH encourages the Subcommittee to work with ACF to set reasonable requirements of studies that utilize 

quasi-experimental research designs in order to encourage innovation and to allow more robust evidence base for 

emerging practices. 

CSH also urges ACF to acknowledge the multiple methodologies and multiple geographies, i.e. that some studies 

oblain different results (including conflicting results for favorable and unfavorable effects) depending on how 

evaluators cut the dala or sub-divide the target population. Consider an intervention could show no favorable effect 

looking across all participants but demonstrate a favorable effect with a certain sub-set. For example, the evaluation 

of CSH's Social Innovation Fund awards saw no favorable results pooling the populations across sites, but found 

favorable results in two individual sites, when using two different methodologies. This approach would comply with 

the unde~ying statute's acknowledgement that the Clearinghouse should recognize •culturally specifiC, or locationor population-based adaptations of the practices." CSH would argue that supportive housing is both location- and 

population-based intervention; location-specific due to the variance in (1) housing market conditions (e.g . tight 

housing market like NYC that slarted with a 29 family pilot due to available housing), (2) the amount of families 

eligible for supportive housing, (3) the sophistication of the service providers, and (4) the unde~ying relationship 

and shared practices between local housing providers and child welfare agencies, and population-specific given 

our focus on those experiencing or at-risk of homelessness. 

More broadly, CSH would also note that there does not seem to be any mention of the how ACF envisions further 

reviews of literature as new studies become available, how often these subsequent reviews would occur, and how 

much weight a new study may be given in upgrading or downgrading a program or services final rating in the 

Clearinghouse. For example, the Urban Institute is currently in the midst of their RCT evaluation for the Children's 

Bureau Demonstration for Supportive Housing for Child-Welfare Involved Families, but the study may not be 

complete in time for the initial review into the Clearinghouse. As such, we have no way of knowing how we could 

later provide additional evidence that might alter the rating of the program. 

One suggestion would be for ACF to establish a standard practice to automatically review research and evaluations 

sponsored by ACF for indusion into the Clearinghouse. and thus growing the body of work to support a program 

or service. We would also suggest ASPE research agenda be informed by strongly performing interventions in 

order to bolster the evidence for some of the most critical and effective interventions. Finally, CSH would point to 

the California Evidence Based Clearinghouse for Child Welfare and its broader ratings scale to also indicate 

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programs 

-or services that do not presently meet their criteria. CSH believes a similar tactic should be utilized for 

this Clearinghouse to promote transparency and efficiency in the review process, while also pointing to areas of 

work that may benefit from further evidence. 

CSH would also urge the Subcommittee to exercise its oversight authority to ensure that once the Clearinghouse 

is established, ACF provides a transparent protocol for submitting new research for consideration into the 

Clearinghouse. 

If you have any questions or need additional input and information, please do not hesitate to contact me at 

deborah.desantis@csh.org or at 212-986-2966. 

Sincerely, 

Deborah De Santis 

President & CEO 

CSH 

61 Broadway, Suite 2300 

New York, New York 10006 

csh.org 

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FamiliesFirst Network 

of Lakeview 

('il BAPTIST HEAI.nl CARE 

Dear Ways and Means Committee, 

1221 W. Lakeview Ave., Bldg. B 

Pensacola, FL 32501 

Phone: (850) 429-6667 

Fax: (850) 453-7763 

On behlf of FarniliesFirst Network of Lakeview Center, the community based care lead 

agency for child welfare in the Floirda panhandle, I am \:vriting to comment that while 

FFPSA has many positive characteristics that will advance the foster care system 

nationally, it will have unintended negative consequences for Florida. 

Under the federal Title IV -E Waiver, Floirda has been on the forefront of child welfare 

reform for the over 10 years. FFPSA will radically change the funding environment 

within which Floirda has operated so successfi.•lly. This will result in an estimated $80 

million loss in funding to the state, which will destabilize our foster care system .. 

It is my request and recommendation that in the interest of safety and stability for 

Florida's children the federal IV-E Waiver continue beyond 2019 for Florida to allow 

time for gradual implementation of FFPSA. 

I am also Chair Emerims of the Florida Coalition for Children board, and therefore their 

position on thi as well. 

Thank you for consideration of my comments. 

Sincerely, 

Shawn Salamida 
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~ FloridaCoalition 

~ forChildren 

July 19,2018 

Dear Congressman Curbelo, 

4 t 1 E. College Ave. 

Tallahassee, FL 3230 t 

(850) 561 -1102 www.FLChildren.org 

I am writing on behalf of the Florida Coalition for Children (FCC) in support of a multi-year 

extension of the current Title N-E waivers. 

The mission of the Florida Coalition for Children is to advocate on behalf of Florida's abused, 

abandoned, neglected, and at-risk children, and to support the agencies and individuals who work 

on their behalf. Our mission also is to promote a system of child welfare that is fully resourced, 

well managed and fulftl ls the needs of vulnerable children. 

With over 60 years of history in the state, FCC has grown and transfonned alongside the child 

welfare system. In 2002, after the statewide implementation of a new community based child 

welfare system, FFC was restmctured to advance an unprecedented partnership between child 

welfare service providers and the community based care lead agencies. 

This partnership continued after Florida successfully secured a state-wide flexible funding 

waiver. Our members include every lead agency in the Stale of Florida and over 6o provider 

agencies. 

Since 2006, Florida has operated its child welfare system under a series of waiver demonstration 

projects. 

Florida's flexible funding demonstration includes the following components: 

Expanding the array of conununity based ch.ild welfare services and programs 

Implementing a wide variety of strategies to integrate child welfare with other health and 

human services programs 

Quality Parenting Initiatives 

Trauma-Informed Care 

As a result of these efforts, Florida has accomplished the fo11owing positive outcomes for 

children and families: 

Decreased number of children in out- of- home care 

Increased adoptions, reunification, and relative placement 
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~ FloridaCoalition 

~ forChildren 

Improved child safety 

4 11 E. College I\ ve. 

Tallahassee, FL 3230 I 

(850) 561-1102 

www.FLChildren.org 

Expansion of child welfare services to address the unique needs of communities 

FCC does not believe it is in the best interest of children and fami lies to back away from the key 

interventions that have netted such positive results. 

As you may know, all current IV-E waivers will expire on September 30,2019. On the next day, 

the Family First Prevention Services Act (PFFSA) will go into effect. 

We support FFPSA and want to see the new Jaw successfully implemented. 

However, we have concems that the timeline included in FFPSA is too aggressive and would 

undennine the effective efforts that are already in place. 

We believe it is possible to accomplish a smooth transition (rom the current ch.ild welfare system 

to FFPSA if Florida and the providers the state works with have the time to make the 

changeover. 

FCC is also concemed about the ellects of the opioid epidemic on Florida's child welfare system. 

Recent reports indicate that many opioid abusers have children who were placed in foster care 

because of their parent's addiction. 

Given the strain that the opioid epidemic is placing on child welfare systems, now is NOT the 

time to pull back from successful interventions and services to vulnerable families. 

Therefore, given the need to successfully transition to FFPSA, as well as the ongoing need to 

address the effects of the opioid epidemic, we support a multi-year extension of current IV-E 

waivers and hope that you will join our effort to pursue legislation to accomplish this goal. 

Thank you, 

Florida 

~~ Coalition for Children 
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Tuesday, July 24, 2018, House W ays and Means Subcommittee on Human 

Resources hearing on the opioid crisis: "Implementation of the Family First 

Prevention Services Act (FFPSA) 

Chairman Smith, Ranking Member Davis, and members of the Subcommittee, my name is Karin 

Axner and I am a proud Ohioan attorney who works with families that, among other things, 

have been affected by the opioid crisis. I appreciate the opportunity to provide a statement 

about the Family First Prevention Services Act, which seeks to prevent chi ldren from entering 

foster care by allowing federal reimbursement for, among other things, substance use 

treatment. 

We have, unfortunately, seen an increase in the number of people that are affected by the 

opioid crisis. This includes children whose parents have become addicted to opioids. In order to 

ensure that these chi ldren are safe, well cared for, and have the best possible future ahead of 

them, we sometimes need to find them new guardians. 

I work throughout Northeast Ohio assisting families in juvenile court with custody matters, as 

well as working as a Guardian ad Litem (GAL) in Cuyahoga County. Many of the families I have 

helped in both my law practice and through my work as a GAL has been a result of a parent 

with substance abuse issues. In my law practice, I have assisted grandparents in obtaining 

custody of their grandchildren due to the parents' inability to care for their own children due to 

addiction issues. In my work as a GAL, the court has appointed me to determine what is in the 

best interest of children in similar situations. 

One of the families I have worked with involved grandparents that were seeking custody of 

their grandchildren. Their daughter was incarcerated for drug offenses and the father of the 

children ended up in a rehab facility from an overdose. Through my work, the grandparents 

were granted guardianship of the chi ldren, where they are currently happy and thriving. 

None of these parents chose addiction. For some, their issues started after they were 

prescribed opioids after a surgery. Every year, millions of patients prescribed opioids after a 

surgery transition to persistent opioid use, meaning they are still taking these medications 

three to six months after their operation. If we could provide surgery patients access to nonopioid alternatives, which are currently available, instead of opioids to treat post-surgical pain, 

we could take one important step to reducing the risk of opioid abuse. Unfortunately, current 

federal rules for Medicare limit patient access to non-opioid pain treatment after surgery. On 

behalf of t he families I see and the children we all want to protect, I urge Congress to provide 

more access to non-opioid options. 

Not only could such changes prevent addiction, I believe it could also save money. In the cases 

where a county must take custody of these children, taxpayers take on the financial burden to 

not only care for these children, but also compensation of the county prosecutors, the county 

social workers, and the courts to process the multitude of cases they see as a result of parents 

of minor chi ldren with addiction issues. 
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Thank you for your leadership in this subcommittee to focus on the effects borne by children in 

this opioid crisis. I urge you to use all the tools at your disposal to not only improve options for 

families impacted by the epidemic, but to prevent opioid addiction from happening in the first 

place. 

Thank you. 
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July 31,2018 

Chainnan Smith 

House Ways and Means Committee 

Subcommittee on Human Services 

Children's Home Society OF AMERICA 

1102 Longworth House Office Building 

Washington, DC 20515 

Ranlcing Member Davis 

House Ways and Means Committee 

Subcommittee on Human Resources 

II 02 Longworth House Office Building 

Washington, DC 20515 

RE: Subcotmnittee Hearing: "The Opioid Crisis: Implementation of the Family First Prevention 

Services Act (FFPSA)." 

Chainnan Smith and Ranking Member Davis: 

Children's Home Society of America (CHSA) respectfully submits the following comments in 

response to the Committee's hearing on Tuesday, August 24 "The Opioid Crisis: Implementation 

of the Family First Prevention Services Act (FFPSA)." CHSA is the oldest network of childwelfare agencies in the United States serving tens of thousands of children and families each 

year with an array of services supported by federal financial participation. We appreciate the 

opportunity to comment on the Families First Prevention and Services Act and look forward to 

engaging with both Congress and HHS as this sweeping reform continues to unfold. 

Defining Legislative Terminology 

CHSA applauds HHS for considering the broadest definitions of various tenninologies within the 

legislation and thereby extending tremendous nexibility to the states. In particular, CHSA has 

been coocemed about how HHS might choose to define mental health services, substance abuse 

prevention and treatment servic.es, and target populations as narrow definitions would prove 

hannful to many children and families. 

Over the last several decades, our understanding of the mental health needs of children and 

adolescents has grown exponentially. Advances in neuroscience clearly demonstrate that the 

developing brain is negatively impacted when exposed to neglect, abuse, and trauma. For both 

children and adults, exposure to trauma often results in emotional and behavioral challenges 

including increased anxiety, depression, suicidality, substance abuse and other compromising 

behaviors. The relationship between these behaviors and the underlying mental health conditions 
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is complex and multifaceted, and interventions designed to respond to these challenges should 

not be unduly limited by a very narrow definition of what constitutes a mental health program. 

Children and their families now defined as candidates under the FFPSA are clearly at greater risk 

of these mental health and behavioral challenges due to their exposure to trauma. We believe that 

this necessitates an array of mental health programs spanning a full spectrum of interventions. 

For this reason, CHSA supports HHS in adopting a broad definition of mental health programs, 

interventions, and services that are requjred to address the wide-ranging needs of this population 

without creating new, unhelpful silos and service categories. 

For many of the same reasons noted above, CHSA also supports HHS's intent to allow the same 

level of latitude and flexibility to states as they define substance abuse prevention and treatment 

services. We cannot ignore the opioid epidemic facing our nation and the direct impact this is 

having on the health, safety, and well-being of children and youth. We should understand clearly 

the consequences of this epidemic conceming the growth in the numbers of children entering the 

children welfare system due to parental addiction. Responding to this crisis will re.quire a twogeneration strategy including prevention and educational opportunities targeting at-risk youth. 

Accordingly, CHSA applauds the HHS's decision to allow the states maximum flexjbility in 

defining substance abuse prevention and treatment services. CHSA believes that this will help to 

limit any unintended consequences of programmatic and funding silos, as addressing these issues 

requires collaboration and cross-agency participation. The opioid epidemic has touched diverse 

communities and populations across the country making it critical that substance abuse 

prevention and treatment services be defined accordingly. 

Additionally, CHSA would like to offer the following thoughts on defining target populations 

with regard to evidence-based programs. CHSA hopes that HHS will look at an expanded 

population of children and families, similar to those in the child welfare system, representing the 

intersectionality of children and families with underlying characteristics that place them at 

greater risk of child welfare involvement. 

When defming a target population for appropriate evidence-based interventions to include in the 

Clearinghouse, CHSA has encouraged HHS to look at a broad conceptualization of"similar" to 

reflect the complex needs and risks facing a wider population at greater risk of child welfare 

involvement. While more discreet and specific populations, such as those in the juvenile justice 

system, might easily constintte "similar," this would limit the inclusion of potentially robust 

interventions that are effective for populations with characteristics si1nilar to those we are most 

familiar. HHS should look to other programs administered or funded through federal agencies to 

get a broader sense of the ecosystem where this population is overly represented due to poverty, 

homelessness, health and other characteristics. CHSA has cautioned HHS to maintain a broad 

lens with respect to target population when including evidenced-based interventions appropriate 

for the Clearinghouse. 

Kinship Navigator P1·ogram 
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As stated by several Members during the hearing, CHSA shares concerns regarding the 

definitions, treatment, and implementation of !he Kinship Navigator Programs. We otTer the 

following comments in hopes that Congress will continue to monitor the implementation of !his 

aspect of the legislation. Of greatest concern to CHSA thus far is the fact that HHS's guidance 

combuJed this program with foster care prevention services and programs in tbe Family First 

Prevention Services Act. 

The Family First Prevention Services Act has specific provisions concerning Kinship Navigator 

Programs, which are separate from those for Foster Care Prevention Services and Programs. The 

recent federal register notice, bowever, combines the two categories of programs and services 

and imposes identical requirements on both, some ofwhicb are inconsistent with the federal law. 

The Clearinghouse of Evidence-Based Practices must recognize the Act's distinctions between 

Kinship Navigator Programs and prevention services and programs. 

Kinship Navigator Programs can serve a broad group of kinship families and are not limited 

to serving families with children who are candidates of foster care. 

Kinship Navigator Programs are not included in the Family First Act requirement that 500/o of 

prevention programs meet the well-supported programs evidence-based standard. 

Federal reimbursement for evidence-based Kinship Navigator Programs becomes effective 

beginning October I, 2018. This is different from the later (October I, 2019) effective date for 

prevention programs and services for candidates of foster care. 

IV-E Wavie•· Con cerns 

Finally, CHSA would like to applaud the Committee's concerns regarding the intersection 

between FFPSA and existing state IV-E waivers. As noted by several Members including the 

Chairman, this incongruence must be resolved before the October 2019 deadline or the states, 

and therefore their children and families, are at severe risk of losing critical services supporting 

their safety and well-being. 

FFPSA 's initial dra fts would have allowed adequate time for states to make a more seamless 

transition between the programs operated via waivers and those that would qualify under the 

prevention and family preservation title of the law. However, given the law passed only a few 

months ago, the 2019 deadline will come about far too soon for many of these states to prepare 

for this transition and may, therefore, lead to the demise of successfi.tl programs based merely on 

a newly imposed deadline. We respectfully request that Congress work with both the public and 

private sector to develop options and possible solutions to this dilemma in a manner that does not 

jeopardize the intentions of the Jaw. 

CHSA would like to thank the Committee for this oppornmity to submit comments and offers 

our network of agencies as a resource to Congress as this legislation, and its implementation, 

continues to unfold. Thank you for the oppornuuty to submit comments on this vitally important 

legislation. 

Subnutted by: 
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Brian Maness 

Board Chair, Children's Home Society of America 

President & CEO, Children's Home Society of North Carolina 

604 Meadow Street, Greensboro, NC 27405 

Phone: 336-369-3815 

Fax: 336-274-7347 

Email: bmaness@chsnc.org 
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Susan N. Dreyfus 

President and CEO 

Officers 

Molly Greenman 

Chai1 

Annette Rodriguez 

Vice Chail 

Ron Mandersc hied 

Treasurer 

MaryHoll:e 

Secreta•y 

August 7, 2018 

The Honorable Adrian Smith 

Chairman 

Committee on Ways and Means, Subcommittee on Human Resources 

U.S. House of Representatives 

Washington, D.C. 20515 

The Honorable Danny Davis 

Ranking Member 

Committee on Ways and Means, Subcommittee on Human Resources 

U.S. House of Representatives 

Washington, D.C. 20515 

Re: Hearing on the Opioid Crisis: Implementation of the Family First Prevention Services 

Act 

Dear Chairman Smith and Ranking Member Davis, 

On behalf of the community-based, social service organizations that are part of the 

Alliance for Strong Families and Communities' strategic action network (the Alliance), 

we write to thank you very much for holding the hearing on the "Opioid Crisis: 

Implementation of the Family First Prevention Services Act (FFPSA)" on July 24, 2018. 

The information conveyed was very helpful to Alliance member organizations that work 

across the country in partnership with local, state and federal governments to ensure 

that all children are protected from abuse and neglect. 

As a representative of organizations that bring forward on·the·ground insights, and 

work at the nexus of people and public systems, the Alliance has a distinct vantage point 

to articulate both opportunities and challenges that come with the implementation of 

any major public policy, such as the FFPSA. Our members quickly encounter similar 

questions and concerns, also held by public agency leaders, that fulfill the functions of 

the child welfare system, that could thwart progress from moving In the direction 

envisioned by this new law. The Alliance network sees the potential in FFPSA to lay the 

foundation for a child and family well·being system that provides supports and services 

that build on families' strengths, helps them overcome adversity, and keeps famil ies 

together. We are hopeful that Congress and the Administration can work together to 

quickly resolve issues so that FFPSA can be effectively implemented. 

The focus of this hearing on the intersection between the opioid crisis and FFPSA is 

important. Because the opioid epidemic is fueling an increase in the number of children 

and families involved in the child welfare system, quick and effective implementation of 

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Alll.lncc for Suong FJm·l~~ Jnd Communln~ l.llltolnccl.org 
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the FFPSA should be considered an important component of the federal government's 

response to the crisis. For example, Ohio's Public Children Services Association is 

projecting a 60 percent increase in its child welfare population by 2020, less than two 

years from now, due to the opioid crisis. This underscores the need for states to be 

equipped to move ahead to implement the FFPSA, which will provide substance abuse 

treat ment, mental health treatment and parent skill-building. 

There are some barriers that Congress and the Administration should work together to 

remove to facilitate smooth, quick, efficient and effective implementation of the FFPSA. 

A. Financing Considerations 

1} There is insufficient information related to major financing considerations, which 

is challenging community-based, nonprofit organizations in their efforts to plan 

and prepare for FFPSA implementation. Further, states do not have sufficient 

information about the new financing structure of Title IV-E from the 

Administration to make decisions required to meet the deadlines set in the law 

and Program Instruction (PI) dated July 9, 2018. 

For example, FFPSA creates a new category of child welfare providers, Qualified 

Residential Treatment Program (QRTP), that includes a detailed description of 

requirements for QRTPs. However, what is unknown is how the federal 

government will finance the services provided by QRTPs. The law could be 

interpreted as requiring Title IV-E reimbursement for all QRTP requirements. The 

PI issued on July 9 stated, "Foster care maintenance payments for a child in 

foster care may cover the cost of (and the cost of providing) food, clothing, 

shelter, daily supervision, school supplies, a child's personal incidentals, liability 

insurance with respect to the child, and reasonable travel to the child's home for 

visitation with fami ly, or other caretakers and reasonable travel for the child to 

remain in the school in which the child is enrolled at the time of placement ... In 

the case of child care institutions, such term must include the reasonable costs 

of administration and operation of such institutions as are necessarily required 

to provide the items described in the preceding sentences." Because QRTPs are 

also required to: provide trauma-informed treatment that meets clinical needs; 

have nursing and cl inical staff working within the scope of their practice; and 

support fami ly engagement and after care for six months, there remains a lack of 

clarity about what financing stream(s) will pay for the full complement of 

supports required of QRTPs. 

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2) There is a pending question about the application of the Medicaid Institution for 

Mental Disease (I MD) Exclusion to QRTPs. QRTPs with more than 16 beds could 

be classified by Medicaid as IMDs, and thereby make any child placed in that 

program ineligible for all Medicaid-funded services (including physical and dental 

care). Medicaid auditors can determine whether a program is an IMD based on 

the "character" of a program (size, staffing, clients, services), not how it defines 

itself or how the state defines it. IMD classification is based on this 

determination, not the funding source. QRTPs with over 16 beds, providing 

treatment, with clinical and nursing staff, and with over SO percent of youth 

served having a mental health diagnosis, would fit the characteristics of an I MD. 

The only current exception to the IMD Rule for children under 21 are psychiatric 

hospitals, psychiatric wards of regular hospitals, and an "other as determined by 

the Secretary" category that currently only includes Psychiatric Residential 

Treatment Facilities (PRTFs- not every state licenses these programs). QRTPs 

were not intended to be PRTF levels of care requiring "medical necessity;" 

however the HHS secretary could similarly exempt QRTPs from the IMD 

Rule. The IMD Rule waiver process for programs was also implemented in an 

effort to combat the opioid crisis and allow larger programs to provide 

Substance Use Disorder services without being classified as IMDs; however, 

mental-health-only requests for IMD waivers are being denied by CMS and they 

are only approving Substance Use Disorder I MD. 

3) Additional financing questions include: how costs of implementing evidencebased practices will be reimbursed; what will be reimbursable as administrative 

costs, such as building program and service delivery infrastructure for FFPSA 

implementation; what Medicaid will pay for versus what Title IV-E will 

reimburse; and whether or not proposed or pending TANF reforms will change 

the way states can apply those funds for FFPSA-related programs, such as home 

visiting programs. 

It is clear that there is insufficient information and direction from the 

Administration that answers the numerous questions both state agencies and 

child welfare providers have regarding the new financing structure of the federal 

contribution to child welfare systems nationwide. Not having the necessary 

information from the federal government about the new financing structure 

confounds sound decision making and planning in the field. 

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Questions for the record: 

• During the hearing, Acting Commissioner Milner stated that financing 

information related to the IV-E prevention program will be issued through 

a Program Instruction slated for distribution this fall. Is there an update 

on how quickly financing information related to Part 4 of the law can be 

provided? 

• There are many questions on how Medicaid and IV-E will interact to pay 

far the health care services of children in the foster care system. How is 

the Administration for Children and Families working with the Centers for 

Medicare and Medicaid Services to drive cross-system functioning and 

financing? 

• Will the Administration take action to ensure that QRTPs are not classified 

by Medicaid as IMOs? 

B. Waiver Transition Support 

The current Federal Child Welfare Waiver Demonstration program expires on 

September 30, 2019. Many of the new uses for Title IV-E, as outlined in FFPSA, were 

derived from the successes and learnings of the frontrunning states that effectively 

implemented waivers. Unfortunately, the timeline for FFPSA implementation and 

the termination of the Waiver Demonstration program are not aligned, making it 

difficult for states to make a sound decision as to whether or not to take up the 

option of the two-year delay. 

As written in FFPSA, any waiver state that does not implement Part IV of FFPSA by 

October 1, 2019, will lose the flexible, current use of Title IV-E per the authority of 

the waiver that is key to continuing the very types of prevention services that FFPSA 

is intended to support and expand. For example, there are states, like Indiana, that 

have been using IV-E funds to pay for prevention programs since its most recent 

waiver in 2012. At the same time, Indiana does not require that congregate settings 

be accredited in order to serve children in the foster care system. Under FFPSA, the 

newly defined QRTPs require accreditation, which means a state must make an 

assessment of the accredited QRTP capacity required to support the needs of 

children in the foster care system. Since the accreditation process can take twelve to 

18 months or longer, there may be sufficient reason for a state like Indiana to decide 

the best decision is to delay implementation of Part IV of FFPSA. Doing so will result 

in Indiana, or any state, being unable to drawdown Title IV-E dollars for prevention 

services described in Part I of FFPSA for the entirety of the state's delay. A delayed 

implementation of FFPSA without a waiver extension means an abrupt halt to the 

provision of the very kind of prevention programs and services that FFPSA promises 

to make available. 

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Question for the record: 

Would the Administration work to authorize a solution that will address the shortterm need for a transition period for states with waivers so that no child or family is 

cutoff from programs and services that would help them achieve better outcomes 

and likely save public dollars? 

C. Technical Assistance Support 

As a network of nonprofit, community-based providers that are critical partners in 

implementing FFPSA, the Alliance has observed inconsistencies across states in the 

uptake of multi-sector, collaborative approaches to planning for FFPSA 

implementation. Some states have initiated a public-private approach that includes 

a diverse group of stakeholders for information sharing, system needs assessment, 

system designing, and strategic planning. While other states have not progressed to 

this necessary developmental stage. Even in states with well-intentioned 

collaborative efforts underway, the nature of implementing the most significant 

federal child welfare system transformation in decades, under a set of tight 

deadlines like those in FFPSA, is presenting a steady stream of adaptive and 

technical challenges that are difficult to resolve quickly and effectively. 

Some Alliance members who work with programs sponsored by the Department of 

Housing and Urban Development (HUD) have experienced that agency's capacity 

for providing technical assistance in support of local continuums of care. In the case 

of housing, HUD provides technical assistance and supports for answering t he 

tough questions about how to end homelessness, how to bring together multiple 

stakeholders, how to develop a community plan that delivers meaningful 

outcomes, etc. In our members' experience, this type of technical assistance is 

valuable to achieving successful deployment of federal financing. 

The nation's public and private leaders charged with implementing FFPSA would 

benefit from a technical assistance center to help ease implementation and provide 

reliable information and expertise. It is a necessary investment for the success of 

implementing FFPSA and the sooner it is established the greater the opportunity 

will be for leveraging the FFPSA to its fullest potential and helping our country 

real ize the vision of a system that helps to ensure child and family well-being. 

Question for the record: 

How can Congress better support the Administration to provide the necessary 

resources to deliver much needed technical assistance in support of FFPSA 

implementation? 

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The Alliance thanks you, again, for holding this important hearing and looks forward to 

working with Congress and the Administration to ensure successful implementation of 

FFPSA. Should you be interested in connecting with our office or members of the 

strategic action network, please contact Marlo Nash, senior vice president of public 

policy and mobilization, at mnash@alliancel.org or 202.429.0270. 

Sincerely, 

Marlo Nash 

Senior Vice President, Public Policy and Mobilization 

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County of Los Angeles 

DEPARTMENT OF CHILDREN AND FAMILY SERVICES 

425 Shatto Place, Los Angelos, California 90020 

(213) 351·5602 

-

. 

. . 

BOBBY 0. CAGLE 

Oil ector 

BRANDON T. NICHOlS 

Chief Deputy Director 

July 23, 2018 

Bo•rd of ~'*"l•on 

HILDA L.SOUS 

flnt016trkl 

MARK RlDLEY·THOM.AS 

S.COitdOitertcc 

SHEILA KUEHL 

Th.lrdOIItJkt 

JANICE HAHN 

Fourth District 

KATHRYN 8ARG£R 

Fifth District 

Good afternoon Chairman Smith and Ranking Member Davis. Thank you for holding this 

important hearing on "The Opioid Crisis: Implementation of the Family First Prevention 

Services Act (FFPSA)". 

I am Bobby Cagle, Director of the Los Angeles County Department of Children and Family 

Services (DCFS), and I'm pleased to have this opportunity to submit testimony on this 

important topic. 

Los Angeles County, is the most populous county in the United States, with more than 10 

million residents as of 2017 and a population that is larger than that of 41 individual U.S. 

states. The County also has approximately 30,000 youth in foster care. 

I commend the Subcommittee for your attention to this national crisis. The opioid 

epidemic is raging unabatedly. The latest data from the Centers for Disease Control and 

Prevention estimates that drug addiction claims more lives than car crashes, homicides, 

or the Vietnam War. 

The factors contributing to the opioid epidemic are diverse and far-ranging. They include 

over-prescribing by physicians, deep and persistent poverty, and the lack of effective 

addiction identification and treatment options. 

The opioid epidemic is straining the social safety net at every level. And, as with every 

substance abuse epidemic from crack to methamphetamine to opioids, the crisis has 

deep implications for the child welfare system. In order to combat this crisis, states need 

time and flexibility and as many resources as possible. Now is not the time to curtail vital 

services and supports. 

The Subcommittee deserves a great deal of credit for identifying the link between the 

opioid crisis and the need to provide federal resources for up-front prevention services to 

help keep families safely together. 

For many years, Members of the Subcommittee and your staff have heard from states 

that federal funding for child welfare has been misaligned, with the majority of federal 

"To Enrich Lives Through Effective and Caring SeNice" 
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Chairman Smith 

Ranking Member Davis 

July 23, 2018 

Page 2 

dollars supporting the least desirable outcome: the removal of a child from their home 

and placed with strangers- a situation that is exacerbated by the current opioid crisis. 

You have heard that the flexibility to use federal IV-E dollars to provide up-front abuse 

and neglect prevention services would better enable states and counties to keep children 

safely at home, as well as more effectively address the opioid crisis. 

You've also heard from the child welfare professionals that an over-reliance on 

congregate care does not serve the best interests of most children in foster care. 

As responsible stewards of the public trust, you acted on what you heard and through 

your efforts, FFPSA is now law. 

For some states this action means that for the first time, they are able to access Federal 

IV-E dollars to support certain, as yet to be determined, prevention activities for children 

and youth at imminent risk of entering foster care. 

For those states, this is a big step forward. 

I understand why FFPSA has generated support from these states. 

However, for other states and jurisdictions. the array of services permitted under FFPSA 

is more limited than what is currently being provided through a IV-E waiver. 

States and counties are using their IV-E waiver to provide the following: 

• Upstream prevention services that would prevent a child from being at imminent 

risk for entry into foster care regardless of the IV-E eligibility status of the child 

• Robust kinship services and support 

• Concrete services and support 

• Coordination between child welfare systems and health delivery systems 

These key services and supports are critical tools that waiver states are using to improve 

outcomes for vulnerable children and families, as well as providing the necessary 

flexibility to address the opioid epidemic. 

In LA County, we are using the flexibility under our IV-E wavier to provide: 

• Prevention and Aftercare services 

• Family-Centered practice with the Core Practice Model 

• Upstream prevention, regardless of the IV-E eligibility status of the child 
197 

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Chairman Smith 

Ranking Member Davis 

July 23, 2018 

Page 3 

• Concrete support 

• Partnership with juvenile justice and mental health systems 

This has resulted in: 

• Decreased entries into foster care 

• Fewer children in foster care 

• Reduced time in out-of-home care 

• Fewer children in residential care 

In Los Angeles County, we do not want to retreat from these successful interventions that 

have contributed to such positive results. 

The County understands that the Subcommittee is deeply invested in the successful 

implementation of FFPSA Now that FFPSA is the law of the land, the County also has 

a clear stake in its ultimate success. 

As you know, all IV-E waivers expire one day before the enactment date of FFPSA 

The County is concerned that this timeline is not conducive to a smooth transition for 

states and counties that are addressing the opioid epidemic through the flexibility 

provided under the IV-E waiver. 

We believe that without a pathway from the waiver to the FFPSA, the implementation and 

success of FFPSA will be imperiled. 

We do believe it is possible to accomplish the transition from the current child welfare 

systems to FFPSA if states and counties have the time to make the change-over. 

Los Angeles County hopes that in the following months, we can work with the 

Subcommittee on legislation that will ensure the successful implementation of FFPSA 

Sincerely, 

BOBBY D. CAGLE 

Director 

BDC:vm 
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E~GLE 

August 6, 2018 

WAYS AND MEANS 

Human Resources Subcommittee Hearing on The Opioid Crisis: Implementation of the Family 

First Prevention Services ACT (FFPSA) Hearing for Tuesday, July 24, 2018 at 10:00 AM 

RE: Statement for consideration to include submission for the printed record: 

Dear Committee Members: 

My name is Mary Kemper and I am President and CEO of the United Methodist Association of 

Health and Welfare Ministries, a national association of diverse human service ministries across 

the country. A flagship of the Association is the EAGLE Accreditation (www.eaglel.orgl that 

was established in 1984 as a unique, voluntary, self-assessment, followed by rigorous peer 

review program for faith-based organizations committed to quality. It is the only faith-based 

accrediting body in the country. 

I am asking, on behalf of the EAGLE Accredited organizations serving families and communities 

of young people, that EAGLE Accreditation be considered as "an independent, not for profit 

organization specified in the statute" as described in 472{c)(4){G){iv) of this legislation. 

The EAGLE Accreditation process includes robust principles centered around best practice in 

Governance, Leadership, Workforce Excellence, and Financial Management. A total of 16 

children, youth, and family organizations adhere to these standards, are affirmed annually and 

are reviewed on site every four years. EAGLE Accredited organizations are represented 

throughout the country in Alabama, Arizona, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, 

Maryland, Ohio, and West Virginia. 

ERGLE ACCREDITATIOn 

5285 Wesrviow Orin #200 I Frod.,idc, MD 21703 I p, 301556.1340 I www.ourUMAorg 
199 

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EAGLE 

We enjoy partnerships with Council on Accreditation, Joint Commission on Accreditation of 

Healthcare Organizations, Commission on Accreditation of Rehabilitation Facilities, and 

Continuing Care Retirement Community and offer complimenting standards as a path for the 

EAGLE Accreditation for these member organizations. 

Please consider the request to include the EAGLE Accreditation as an option for accreditation in 

this legislation and as a part of the written record of this hearing. 

Respectfully Submitted, 

Mary Kemper, CEO 

United M ethodist Association of 

Health and Welfare Ministries (UMA) 

5285 Westview Drive 

Bethesda, MD 21703 

Telephone #301-556-1341 

Fax # 301-291-7385 

EAGLE A C CREDITATIOn 

5285 Wcsrview Drive #200 I F<ederi<k, MD 21703 I p, 301556.1340 I www.ourUMA.org 
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Comments submitted to: Administration for Children and Families, HHS. 

Reference: 83 FR 29122, Decisions Related to the Development of a 

Clearinghouse of Evidence-Based Practices in Accordance With the Family First 

Prevention Services Act of 2018. 

From: Bernard R. Andrews Ill 

Director, Never Too Late, Inc. 

P.O. Box 181 

Monticello, GA 31064 

As I am sure you know, the FFPSA has everyone in many, if not most states, running around confused. 

Whereas the goals of this Act are noble and worthwhile pursuits, there are some serious flaws which, 

with correction, can allow the Act to be implemented w ith fidelity. First, the implementation period is 

short given the requirements that must be met by the various Family and Children Services divisions 

across the nation. Also, relative to timing. contradictions and confusion w ith dates and deadlines need 

to be rectified. Second, as evidenced by your solicitation for comments, the language of the Act needs 

more clarity and specificity. 

When consideration is given to how the FFPSA impacts children, the lofty goals of the Act simply cannot 

be implemented in just two or three years. The Act should have the timeframes at least 

doubled. Providing more budgetary support will not necessarily shorten, at least appreciably, the ability 

of the states to fully comply with the prescribed deadlines. For example, in Georgia, there is a woeful 

shortage of foster families. Years will be required to increase this number to a point where my state can 

meet the increased demand for loving and caring foster family homes created by this Act. Throwing 

money at the issue will not just up and create suitable foster families. 

Increasing the number of foster families while at the same time working t hrough the logistics of dealing 

with the "baggage" and vetting process of many potential foster families, especially kinship placements, 

cannot be done in a couple of years. This is especially the case when care must be taken to ensure 

children are not forced into an environment which could be detrimental to their growth and 

development. Al so, state legislation will no doubt need to be enacted to facil itate compliance. Such 

legislation may take two cycles of the Georgia Legislature. 

Hard evidence and science that leads to clearly spelled out, peculiar to FFPSA, terms such as Targeted 

Outcome, Qualified Residential Treatment Program, Trauma Informed, etc. must be accomplished to 

help ensure proper implementation and compliance with the Act. Of course, gathering and vetting all of 

the studies to support the Act wi ll take a period of time in excess of the deadlines for implementation as 

they currently stand. 

The FFPSA is an act which can help foster children. However, it is clear the Act was w ritten without the 

necessary background work having been done. Your solicitation for comments does show a willingness 

to help develop that background information albeit after the fact. 
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The Methodist Home Alison E. Evans, President· CEO 304 Pierce Avenue • Post Office Box 2525 • Macon, Georgia 31203·2525 

478·75 1·2800 • www.TheMethodlstHome .org 

August 3, 2018 

Macon 

IBn 

WAYS AND MEANS 

Ame ricus 

1994 

Valdosta 

1997 

Columbus 

2002 

St. Marys 

2002 

Waverly Hall 

2008 

Human Resou rces Subcommittee Hearing on The Opio id Crisis: Implementation of 

the Family First Prevention Services ACT (FFPSA) Hearing for Tuesday, July 24, 2018 

at 10:00 AM 

RE: Sta tement for consideration to include submissio n for the printed record: 

Dear Committee Members: 

It is the intent of leaders at The Methodist Home to ensure the EAGLE Accreditation is 

included as "an independent. not for profit organization specified in the statute as one 

of the acceptable accred itations" as defined in 472(c)( 4)(G)(iv) of the Act. 

The Methodist Home of the South Georgia Conference, located in Maco n, Geo rgia, and 

in five other small towns throughout South Georgia, has been providers of child ren 

and family services si nce 1872. The Methodist Home is supported by over 600 

churches delivering services to over 450 youth and fami lies this year. These services 

include residentia l treatment, foster care, community counseling. intensive family 

visitatio n that incl udes family coaching of birth parents, early child hood education, 

and an accredited school. 

The Methodist Home has been accred ited by the EAGLE Accreditation Commission 

since 1986. 

Educational Assessment Guidelines Leadi ng toward Excellence (EAGLE) is the only 

faith-based accrediting body in the world. We are concurrently accredited by Council 

on Accredita tion, ad ditiona lly accredited by AdvancED for our school, Price Academy 

and additionally certified as a trauma informed care environment by the Sanctuary 

Institute. Subscribing to the highest levels of service delivery methods in a ll a reas of 

the organization is the practice of The Methodist Home. 

EAGLE Accreditation ensu res we, as other faith based o rganizations, a re compliant 

with principles that a re not add ressed by other accrediting bodies. Some examples 

include principles of Community Involvement, Social Accountability and Holistic Care. 

EAGLE 

()::: . MKO'I~d~«

SOV!ti~~MCf',I.WtltdMe'lhod!Mhowch - lk~br~•o(Gtot~ 

Af.t~mo~ u.w·.-~~--<Soedbvft...,.._Me!llodiMJo.uodMO!IofltHI!t!MICIWff!.,tM!'II5~ 

,,."*''!,~i-OO'I(fMII~Ity(~D¥14~ 

1 f " 3 J4 fl: ·as J'd ) h • t'b' a. nzr.. •N ~,. eC .., d · ·.1•w ' J • .,u• ,., • h = '{)' chm+JO) 
202 

f 


ralbany on LAP520R082 with HEARINGS33873.172

Again, we would like to make s ure there is consideration for the EAGLE Accreditation 

as "an independent, not for profit organization specified in the statute as one of the 

acceptable accreditations" as defined in 472(c)(4)(G)(iv) of the Act. 

Thank you very much for the opportunity to make a submission for the record. 

Sincerely, 

jill Myers 

Executive Vice President 

The Methodist Home 

304 Pierce Avenue 

Macon, Georgia 31204 

478-751-2800 

Fax#: 478-746-9332 

Alison Evans 

President/CEO 

The Methodist Home 

304 Pierce Avenue 

Macon, Georgia 31204 

478-751-2800 

Fax#: 478-746-9332 
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ralbany on LAP520R082 with HEARINGS33873.173

4 w 

RK 

~TE 

Office of Children 

and Family Services 

Statement by 

Sheila J. Poole 

Acting Commissioner 

New York State Office of Children and Family Services 

Before the 

Subcommittee on Human Resources 

Committee on Ways and Means 

United States House of Representatives 

August 7, 2018 
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Chairman Smith, Ranking Member Davis and other distinguished members of the 

Subcommittee, I am Sheila J. Poole, the Acting Commissioner for the New York State 

Office of Children and Family Services (OCFS}. Thank you for the opportunity to submit 

this written statement on behalf of OCFS about the important work, discussions and 

efforts that OCFS has undertaken toward implementation of the Family First Prevention 

Services Act (FFPSA} that was signed into law as part of the Bipartisan Budget Act of 

2018 (P.L. 115-123} on February 9, 2018. 

New York endorses the intent underlying FFPSA. We support many of the provisions of 

FFPSA that are designed to improve outcomes for vulnerable families, respond to the 

needs of children engaged in the child welfare system, and minimize placements in 

congregate care settings. We further wish to acknowledge the written statement dated 

July 24, 2018 that was submitted by Jerry Milner, Associate Commissioner of the 

Children's Bureau, Administration for Children and Families of the U.S. Department of 

Health and Human Services, particularly his recitation of the implementation challenges 

that states are facing under FFPSA. The implementation challenges that Commissioner 

Milner identified in his statement are all concerns and challenges we share in New York 

State. We highlight below a few of those implementation challenges and offer New 

York's perspective, focusing on those related to the provision of prevention services and 

limitations on congregate care. 

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Prevention Services 

New York commends the emphasis FFPSA places on prevention services. Beginning 

in 2019 under FFPSA, states for the first time will be able to receive federal funds under 

Title IV-E of the Social Security Act (Tille IV-E) to provide services. FFPSA expands 

access to Title IV-E funds for social services that will provide opportunities for children 

to remain in their homes with their parents or with kinship caregivers. The intent of 

FFPSA is to keep families together. avoid the need to place their child(ren) in foster 

care, and provide the supports necessary for families to continue to be successful. 

FFPSA now allows for the provision of certain prevention services to children and youth 

who are candidates for foster care. However, the limited scope of prevention services 

provided by FFPSA and the short 12- month time period for which funding is available 

for those services, presents significant challenges to states in achieving the spirit of the 

law. 

Our experience in New York demonstrates the successes borne by investment in 

prevention services. New York has seen a significant reduction in foster care 

placements that is attributable to our robust prevention services funding scheme at the 

state level. New York State is a state-supervised, locally-administered child welfare 

system. Local departments of social services at the county and New York City level are 

responsible for providing a vast array of child welfare services. Prevention services are 

mandated to avoid initial foster care placements. enable more timely discharge from 

foster care, and prevent re-entry into care. New York State provides enhanced funding 

(62 cents on the dollar) to localities (which contribute 38 cents on the dollar) for 

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prevention services. As a result of New York's focus and investment on prevention 

services, New York State's foster care population has declined from more than 54,000 

children in care in 1995 to around 16,000 children at the close of 2016. The number of 

children requiring congregate care placements has also decreased (7,399 children in 

1995 to 2,822 children in 2016). 

While the availability of partial federal reimbursement for some prevention services 

under FFPSA is welcomed and laudable, there are unfortunately a number of limitations 

in FFPSA that severely restrict the legislation's aim of averting foster care placements 

by focusing on prevention. 

Under FFPSA, prevention services that are eligible for partial federal reimbursement are 

limited to mental health, substance abuse treatment, and in-home parent skill-based 

programs for children at imminent risk of entry into foster care, are in foster care and 

pregnant or parenting or the parents or kin caregivers of such children. In addition to 

the narrow focus on the types of services that are covered, those services must also be 

trauma-informed and promising, supported, or well-supported practices. Many existing 

or new prevention services will need to meet the newly created evidence based 

standards and as access to Title IV-E funds are through a reimbursement program, 

programs will not have access to sufficient start-up capital to build the capacity to meet 

those standards prior to service delivery. Additionally, out-of-home placements are 

caused by many other factors and consideration and flexibility should be afforded to 

4 
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ralbany on LAP520R082 with HEARINGS33873.177

states to provide targeted prevention services. States and localities are best positioned 

to know what prevention services best meet the needs for children in their communities 

and what is needed to keep their vulnerable families together. 

Moreover, and it bears reiterating, federal funding is limited to only 12 months under 

FFPSA. This time limit is too short for some services and the needs of families that 

place children at serious risk of foster care placement. Especially those services 

designed to address chronic illnesses such as substance use and mental health 

disorders. Children and youth in danger of being placed into foster care, desperately 

need their parents to receive comprehensive services for substance use, alcohol use, or 

mental health treatment. Some families may need longer lengths of service delivery to 

achieve the best outcomes. The most vulnerable families will likely face long waiting 

periods for service availability, due to the evidence based thresholds required under 

FFPSA, which will impact the number of qualifying programs available to these high-risk 

families. Once families can access FFPSA compliant programs, they should be able to 

continue receiving critical prevention services, especially when they are progressing 

well in their treatments, and if such treatment tailored to that family needs to go beyond 

12 months for the most successful outcome. Also, under the maintenance of effort 

(MOE) provisions in FFPSA for a state like New York, state prevention expenditures 

must be equal to or greater than the expenditures for federal fiscal year 2014. The 

MOE provision unfairly penalizes states like New York that have invested significant 

non-federal resources for prevention services to reduce and prevent congregate care 

placements. 

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For these reasons, statutory amendments are recommended to more fully accomplish 

the legislative intent of Part I of FFPSA: 

• Broaden the scope of prevention services eligible for states to use federal funds 

under Title IV-E beyond mental health, substance abuse prevention and 

treatment, and in-home parent skill-based programs, in order to make eligible a 

more inclusive range of evidence-based programs in domains such as child and 

family health outcomes. parent-child interactions. positive parenting strategies. 

child maltreatment, prevention, school readiness and educational outcomes, 

behavioral issues, and family self-sufficiency. 

• Expand the eligible population for prevention services to include families, parents 

and children who are at high risk for future child welfare involvement and/or outof-home care. 

• Lengthen the time period during which eligible programs may serve a child and 

family in order to make eligible extended services where programs have 

demonstrated success over a period greater than twelve months (e.g., Healthy 

Families and substance abuse prevention programs). 

• Count only federal dollars invested for prevention servioes toward the 

maintenance of effort requirement to maintain equity among those states that 

have invested significant resources for prevention services. 

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ralbany on LAP520R082 with HEARINGS33873.179

Limits on Congregate Care 

New York shares the drafters' aim of reducing out-of-home placements for at-risk 

children and youth and where placement is necessary, for children to be placed in the 

least restrictive, most appropriate setting capable of meeting the child's needs and 

achieving the child's permanency goal. As previously noted, New York has significantly 

reduced its foster care population. However, the remaining children in care require 

various levels of congregate care to provide them with the appropriate services they 

need. Generally, they have serious and multiple needs, which often involve significant 

clinical, behavioral health and developmental needs. Many of the children in 

congregate care settings have had unsuccessful placements in lower levels of care. 

FFPSA limits federal reimbursement beyond two weeks for children placed in 

congregate care settings. Under FFPSA, federal reimbursement is limited to certain 

categories of congregate care, one type being the newly-created Qualified Residential 

Treatment Program (QRTP). Among other things, in order to receive federal 

reimbursement, FFPSA establishes stringent QRTP requirements. For example, all 

foster children placed in a QRTP must have assessments by a non-affiliated, 

independent "qualified individual" assessor who is a trained professional or clinician 30 

days following placement. The placement must also be assessed by the court within 60 

days after placement. Failure to complete a timely 30-day assessment would result in 

the loss of Title IV-E funding for maintenance costs of the child for the duration of the 

placement. Tile IV-E funding would also be lost should the court not approve the 

placement in the QRTP. 

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ralbany on LAP520R082 with HEARINGS33873.180

These overly stringent QRTP requirements may have the unfortunate and unintended 

effect of harming some of our most vulnerable children. To avoid these negative 

consequences, statutory amendments are recommended to provide states with 

increased flexibility to determine the most appropriate placements for, and receive 

sufficient federal funding to provide necessary supports to the children in care. 

• Authorize a child specific exception to the 30-day assessment requirement for 

children placed in a QRTP. We recommend exempting children from the 30-day 

assessment requirement who have had a recent clinical or medical assessment 

or probation report authorizing placement in other than a foster home, as well as 

such youth as sex trafficking victims and youth with other needs where 

placement in a foster home would be dangerous for the youth or others. 

Exempting certain children from the 30-day assessment requirement would avoid 

unnecessary reassessments, potential for conflicting opinions, and possible 

trauma to the child. 

• Extend the time period of assessment to 60 days. We recommend extending the 

time period of assessment on the need for a QRTP placement from 30 days to 

60 days. Such extension would eliminate the need for assessment for short-term 

placements, enable more thorough assessments. address issues with securing 

the required assessor, and enhance identification and participation by family and 

other interested persons. 

8 
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ralbany on LAP520R082 with HEARINGS33873.181

• Amend who may be considered the "qualified individual" for purposes of 

conducting the 30-day assessment. We recommend applying the rule for the 

third-party reviewer that is federally allowed to be the service plan reviewer (42 

USC §§675(5)(B), 675(6)). This individual could be a trained government or 

voluntary agency employee, but could not be responsible for the case 

management or delivery of services to the child or family. Expanding the 

definition would increase the pool of suitable assessors to conduct timely 

assessments. 

• Eliminate the requirement of a court assessment within 60 days of a QRTP 

placement and instead allow the issue of appropriateness of continued 

placement in the congregate setting be part of the periodic permanency hearing. 

While we support the involvement of the courts, we are concerned about the 

strict 60-day timeframe that would be outside the control of child welfare 

agencies and submit that this requirement is an unnecessary imposition that 

adds additional costs and strains resources for New York's already busy family 

courts. The 60-day court assessment is further redundant of the requirement for 

an assessment by a qualified individual, which could potentially lead to conflicting 

opinions and possible trauma to the child being subjected to multiple 

assessments. For these and other reasons, we recommend amending the 

legislation to allow states flexibility on how periodic reviews of QRTP placements 

should be conducted, such as allowing the appropriateness of the placement to 

be part of the periodic permanency hearing. 

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In closing, we appreciate the opportunity to comment on this landmark federal 

legislation designed to help families stay together and improve outcomes for children 

and families in the child welfare system. New York remains committed to providing 

necessary critical prevention and treatment services to vulnerable children and families. 

We are available to further discuss our implementation efforts and challenges, and we 

also look forward to our continued collaboration with our federal partners in carrying out 

the provisions of FFPSA. 

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Comments fot· the Record 

United States House of Representatives 

Committee on Ways and Means 

Human Resout·ces Subcommittee 

Hearing on The Opioid Crisis: Implementation of the 

Family First Pt·evention Services Act (FFPSA) 

Tuesday, July 24, 20 18, 10:00 AM 

By Michael G. Biudner 

Center for Fiscal Equity 

Chairman Smith and Ranking Member Davis, thank you for the opportunity to submit my 

comments on this topic. This hearing will review the Department of Health and Human Services' 

ongoing progress implementing recently enacted legislation to address family substance abuse 

issues, improve child well-being, support kin caregivers, and strengthen families. I submit these 

comments as past health research data manager, prevention community leader, and a current 

recovered abuser and Medicare patient. I will leave the progress report to the Agency witnesses 

and address the relevant items. 

Family Substance Abuse Issues 

Substance abuse can occur in families in a variety of ways. One of the parents, but not the other, 

could be using, either innocently because of bad pain management or intentionally. Another 

pattern can be both parents using as a couple. When Cannabis is used this way, it is less 

dan1aging once the kids are down for the night. That cannot be said of the grip of an opioid 

addiction, however acquired. Lastly, one or more of the children, usually teens, sometimes even 

younger cl1ildren or grown children iJl the household may be the addict. Prevention and 

intervention are different in each case. 

Accidental addiction can be prevented by better medical treatment. No one needs opioids past 

their follow-up appointment to an inj ury or surgery and that appointment should be as soon as 

possible, with no pain management following. 

If addiction is surrendered to or mutual, then adult intervention strategies are necessary, 

including family services to either monitor the situation or remove the minor children. Likewise, 

addiction by teens or adult children demands intervention. These drugs are so lethal that waiti11g 

for the user to have enough may result in death. 

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ralbany on LAP520R082 with HEARINGS33873.184

lmpt·ove Child Well-being 

From our example above, the best thing for children if only one parent is an addict is to get the 

addict out of the home, with or without treatment. Family services and criminal justice already 

know how to do that and, except for the shortage of treatment beds and temporary housing, there 

is already a system in place to help both addicted adults and children, especially if managed by 

the Drug Court system. 

The current penal system could be replaced by mandatory treatment rather than incarceration, 

with extended stays and funded pre-release programs, but that costs money but is cheaper than 

jail or prison, u11less you own stock i11 Correctio11s Corporation of America, who 1 am sure is 

paying attention to these proceedings. 

If both parents are addicted, temporary placement is necessary for the children outside the home. 

However, this should not be an excuse to sell the home, let it lapse into foreclosure or 

pem1anently place the children in foster care or adoptive services. 

Recovery is more likely if the government and family care agenc ies do not further aggravate 

conditions by kidnapping the children. Instead, families should be fostered as a unit - both 

children and parents once they are able and are past the point of needing to be with their kids to 

stay sober - because if that is their excuse, they won't do so. 

Sobriety needs to be pursed for one's self, but it is still easier when tbe perception that someone 

else wants your kids is removed. Of course, if the parents are frequent relapsers, there may not be 

any way to keep the family together, but that should be the rare case for people who fall into 

opioid addiction through bad medicine. 

Support Kin Caregivers 

If one or both parents is an addict, often siblings or parents are called to serve as foster care 

providers or to help deal with the addict in early recovery. They don't have the option that 

sponsors do to walk away (carry the message, not the mess) and it is a hard role to take, 

especially if social services proves intrusive in establishing suitable guardianship. 

As important is the provision of financial assistance to guardians. If there were a decent child lax 

credit that met the cost of living a middle class life style (which would require not punishing the 

poor for being poor), adequate funding would be no problem because the tax credit would come 

from the foster caregiver's job, although the parents who are addicted would fight to keep that 

money. It is still not an excuse to not pay it. 
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ralbany on LAP520R082 with HEARINGS33873.185

Another problem is that guardians become protective of the children and may not want to give 

them up to family members who may still be at risk. Managing that is the function of local 

family services agencies. It is a hard job. The Federal Government needs to provide the money 

to pay them more. 

Stt"engtben Families 

The best way to strengthen families is to help make them less susceptible to addiction by 

providing all concerned with good quality education and training, including payment to train or 

get remedial education if the system has failed so far. 

While the system loves low wage labor, especially in nursing homes, reinstituting slavery 

through welfare programs should not be a societal goal. Eliminating poor people as a permanent 

source of cheap labor will prevent both drug sales and drug use. Ending the mass incarceration of 

African American males will strengthen their fami lies as well, saving multiple generations at 

once. Whether Black Lives Maner or All Lives Matter, shutting down mass incarceration sends 

the message that this Act and these hearings are about more than public relations. 

Prevention may also help prevent teen addiction if it offers a profitable way, such as paying 

students in danger of dropping out to attend school at enough of a wage, for them to not feel the 

need to sell drugs or be depressed enough to succumb to their use. This is not a cheap alternative; 

however it is cheaper than prison (unless you are paid to run the prison). The current regime has 

not expressed a willingness to spend the necessary resources to do what I suggest, as it is cheaper 

and more popular with its base to blame the poor for their poverty and addiction. At some point, 

that will no longer be acceptable. The Opioid Crisis may make that point sooner than later. 

Thank you for the opportunity to address the committee. We are, of course, ava ilable for direct 

testimony or to answer questions by members and staff. 

3 
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Contact Sheet 

Michael Bindner 

Center for Fiscal Equity 

14448 Parkva1e Road, Suite 6 

Rockville, MD 20853 

301-871-1395 1andline 

240-81 0-9268 cell 

No fax 

fi$calequitycenter@yahoo.com 

Human Resom·ces Subcmnmittee 

Hearing on Tbe Opioid Crisis: Implementation of tbe Family First P•·evention Se•·vices Act 

(FFP SA) 

Tuesday, July 24, 2018, 10:00 AM 

All submissions must include a list of all clients, persons ancllor organizations on whose behalf 

the witness appears: 

This testimony is not submitted on behalf of any client, person or organization other than the 

Center itself, which is so far unfunded by any donations. 

4