I 
116TH CONGRESS 
2D SESSION 
H. R. 7868 
To amend the Public Health Service Act to improve the health and well- 
being of maltreated infants and toddlers through the implementation 
of infant-toddler court teams within States, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 30, 2020 
Ms. DELAURO (for herself, Mr. BILIRAKIS, Mr. SUOZZI, Mr. SOTO, Mr. 
STEUBE, and Mr. RUTHERFORD) introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to improve the 
health and well-being of maltreated infants and toddlers 
through the implementation of infant-toddler court teams 
within States, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Strengthening Amer-
ica’s Families Act of 2020’’. 
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SEC. 2. INFANT-TODDLER COURT TEAMS FOR CHILDREN 
EXPERIENCING OR AT RISK OF MALTREAT-
MENT. 
Part Q of title III of the Public Health Service Act 
(42 U.S.C. 280h et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 330Z–3. INFANT-TODDLER COURT TEAMS FOR CHIL-
DREN EXPERIENCING OR AT RISK OF MAL-
TREATMENT. 
‘‘(a) CONTINUATION AND EXPANSION OF INFANT- 
TODDLER COURT PROGRAM.— 
‘‘(1) CONTINUATION AND EXPANSION OF PRO-
GRAM.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Admin-
istration— 
‘‘(A) shall continue in effect the Infant- 
Toddler Court Program; and 
‘‘(B) may, beginning with fiscal year 2021, 
carry out such program on a national basis. 
‘‘(2) INFANT-TODDLER
COURT
PROGRAM
DE-
FINED.—For purposes of paragraph (1), the term 
‘Infant-Toddler Court Program’ refers to the pro-
gram carried out pursuant to section 501(a)(2) of 
the Social Security Act that is designed— 
‘‘(A) to support research-based infant-tod-
dler court teams for purposes of changing child 
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welfare practices to improve well-being for in-
fants, toddlers, and their families, including ef-
forts to build on, and continue the work of, 
sites established through the Quality Improve-
ment Center for Research-Based Infant-Toddler 
Court Teams initiative funded by the Adminis-
tration for Children and Families; and 
‘‘(B) to provide training and technical as-
sistance in support of infant-toddler court 
teams’ efforts across the United States. 
‘‘(b) GRANTS TO STATES FOR IMPLEMENTATION OF 
INFANT-TODDLER COURT TEAMS.— 
‘‘(1) IN GENERAL.—The Secretary of Health 
and Human Services, acting through the Adminis-
trator of the Health Resources and Services Admin-
istration, may make grants to States for purposes of 
seeding the establishment of, or stabilizing and en-
hancing existing, infant-toddler court teams for chil-
dren experiencing or at risk of maltreatment. 
‘‘(2) USE
OF
FUNDS.—A State receiving a 
grant under this subsection may only use funds re-
ceived through the grant to— 
‘‘(A) designate a State lead agency as a 
focal point for statewide planning administra-
tion and coordination— 
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‘‘(I) to share information and ex-
pedite appropriate high-quality serv-
ices for young children and their fami-
lies in the child welfare system; and 
‘‘(II) to prevent recurrence of 
maltreatment, promote timely perma-
nency, and provide a community 
structure to help prevent entry into 
the child welfare system; 
‘‘(ii) protect young children in the 
child welfare system and at risk of enter-
ing the child welfare system from further 
maltreatment and developmental harm and 
address the damage already done; and 
‘‘(iii) identify and address the struc-
tural issues in the child welfare system 
that are harmful to infants and toddler de-
velopment and impede the ability to 
strengthen and stabilize families. 
‘‘(3) TERM
OF
GRANT.—A grant under this 
subsection shall be for a term of not less than 3 
years and may be renewed for a single term not to 
exceed 8 years. 
‘‘(4) APPLICATION PROCESS.— 
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‘‘(A) IN
GENERAL.—A State seeking a 
grant under this subsection shall submit an ap-
plication to the Secretary at such time, in such 
manner, and containing such information as the 
Secretary may require, including— 
‘‘(i) the information specified in para-
graph (5); and 
‘‘(ii) a plan for the establishment or 
enhancement and ongoing support of local 
community infant-toddler court teams in 
the State. 
‘‘(B) LEAD
STATE
AGENCY.—The Gov-
ernor of a State submitting an application 
under subparagraph (A) shall designate an ap-
propriate State lead agency, such as the State 
Court Improvement Program or the State agen-
cy that administers child welfare services, with 
the ability to carry out the activities specified in 
paragraph (2). 
‘‘(5) APPLICATION
CONTENTS.—The informa-
tion specified in this paragraph is— 
‘‘(A) a description of how the State lead 
agency designated pursuant to paragraph 
(4)(B) will implement infant-toddler court team 
projects that meet the criteria specified in para-
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graph (2)(C) and the communities in which 
local community infant-toddler court teams will 
be established, enhanced, or stabilized; 
‘‘(B) an assurance that the State lead 
agency will consult with representatives of State 
agencies providing services to infants, toddlers, 
and families, the State and local judiciary, and 
local communities and stakeholders, to develop 
a comprehensive plan for implementing infant- 
toddler court teams in the State, that includes 
a plan for determining how the court team 
structure and approach will inform and support 
building a family strengthening continuum, 
which may include using the infant-toddler 
court team structure in implementing preven-
tion and family services and programs under 
section 471(e) of the Social Security Act (42 
U.S.C. 671(e)); and 
‘‘(C) a certification that any infant-toddler 
court team established, enhanced, or imple-
mented using funds received through the grant 
meet the criteria specified in paragraph (8). 
‘‘(6) CONTINUUM
REQUIREMENTS.—The con-
tinuum referred to in paragraph (5)(B) shall— 
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‘‘(A) seek to ensure that children and their 
families, particularly families with histories of 
trauma and adversity, receive effective, timely 
services that strengthen protective factors; 
‘‘(B) begin as early as possible before fam-
ilies encounter the child welfare system— 
‘‘(i) to provide comprehensive sup-
portive community services to families with 
very young children in need of such serv-
ices; and 
‘‘(ii) to emphasize the social deter-
minants of health to strengthen families 
and prevent abuse and neglect; 
‘‘(C) for young children with substantiated 
cases of maltreatment, including those whose 
families have been placed in an alternative or 
differential response program, include a com-
prehensive approach to stabilizing and strength-
ening families and preventing children from 
being placed in foster care that provides serv-
ices and supports focused on in-home parent 
education and specialized programs that ad-
dress the risk factors for removal of infants and 
toddlers from the home; and 
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‘‘(D) use the community structure com-
bined with the judicial oversight within the in-
fant-toddler court team to improve outcomes for 
infants and toddlers who have been placed in 
foster care and their families through working 
with communities to ensure that— 
‘‘(i) parents receive intensive services 
and supports, including mental health and 
substance use disorder treatment, to in-
crease the likelihood of reunification; and 
‘‘(ii) young children receive intensive 
interventions that will address their devel-
opmental needs and heal the trauma of 
abuse, neglect, domestic violence, and sepa-
ration from their caregiver and family. 
‘‘(7) CONDITIONS.—A State selected to receive 
a grant under this subsection, shall, as a condition 
on receipt of such grant— 
‘‘(A) agree to work with the National In-
fant-Toddler Court Team Resource Center es-
tablished under subsection (c) to design or en-
hance and implement local infant-toddler court 
teams, including supporting data collection and 
continuous quality improvement; 
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‘‘(B) provide information to the National 
Infant-Toddler Court Team Resource Center on 
the plan developed pursuant to paragraph 
(5)(B), including the development of a con-
tinuum of family strengthening services that 
meets the conditions specified in paragraph (6); 
‘‘(C) commit to building sustainability into 
the State lead agency function and the plan re-
ferred to in subparagraph (B); and 
‘‘(D) ensure that any infant-toddler court 
team established, enhanced, or implemented 
using funds received through the grant meets 
the criteria specified in paragraph (8). 
‘‘(8) 
LOCAL
COMMUNITY
INFANT-TODDLER 
COURT TEAM CRITERIA.—The criteria specified in 
this paragraph with respect to a local community in-
fant-toddler court team established, enhanced, or im-
plemented using funds received through the grant 
are that the team— 
‘‘(A) organizes and promotes collaboration, 
with leadership from judges and the heads of 
child welfare agencies, among community stake-
holders and service providers to address the 
needs of families with infants and toddlers, 
through implementing trauma-informed prac-
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tices for infants and toddlers and their families 
in the child welfare system and for creating a 
community structure that can provide a con-
tinuum of services; 
‘‘(B) works to strengthen families to pre-
vent foster care placement, promote timely per-
manency, prevent recurrence of maltreatment, 
and promote positive early development; 
‘‘(C) is coordinated through a local com-
munity coordinator; 
‘‘(D) is composed of community stake-
holders that include legal and child welfare pro-
fessionals involved with families of infants and 
toddlers and community service providers 
that— 
‘‘(i) have experience solving problems 
and filling gaps at the community systems 
level, including with respect to evidence- 
based interventions appropriate for infants 
and toddlers and their families; 
‘‘(ii) receive training on the science of 
early childhood development, the impact of 
trauma, and the implications for child wel-
fare and family strengthening practice; 
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‘‘(iii) work to build a community 
structure for strengthening families across 
sectors, including work support, education, 
health (including mental health), and social 
supports; 
‘‘(iv) undergo a period of preparation 
and training before taking families into the 
infant-toddler court program; 
‘‘(v) provide a team of professionals 
that provides support to an individual fam-
ily to ensure the needs of individual chil-
dren within such family and such family as 
a whole are met; 
‘‘(vi) focus on infants and toddlers 
under the court’s jurisdiction or under in- 
home supervision; and 
‘‘(vii) as resources and team structure 
permit, work with families of infants and 
toddlers outside the child welfare system to 
provide preventive services to strengthen 
families of young children and avoid child 
welfare involvement; 
‘‘(E) supports parents’ strengths and 
needs in a compassionate, respectful, holistic, 
and individualized way; 
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‘‘(F) prevents children from entering and 
reentering the child welfare system; 
‘‘(G) addresses community service gaps 
and disparities using evidence-based strategies; 
‘‘(H) commits to working toward sustain-
ability for the infant-toddler court team pro-
gram; 
‘‘(I) removes barriers to racial equity and 
social justice, and prevents disparate outcomes 
for racial and ethnic minorities, Tribes, and les-
bian, gay, bisexual, transgender, and queer indi-
viduals; 
‘‘(J) integrates family support services to 
meet family needs in a comprehensive way, in-
cluding— 
‘‘(i) developmentally appropriate evi-
dence-based interventions for very young 
children and their families, including devel-
opmental 
screening, 
early 
intervention 
services, high-quality early care and learn-
ing programs such as Early Head Start, 
and multigenerational mental health treat-
ment focused on the child-caregiver rela-
tionship; and 
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‘‘(ii) assessments of parents’ needs, 
including past trauma, high-quality health 
services, including mental health services, 
for parents, including prenatal and post-
natal care, screening for depression, well- 
woman care, mental health treatment, and 
evidence-based 
substance 
use 
disorder 
treatment; 
‘‘(K) infuses a trauma-informed approach 
in the delivery of family support services that 
supports children, families, and professionals 
across systems of care; 
‘‘(L) provides for a continuum of parenting 
interventions and mental health and substances 
use prevention and treatment services con-
sistent with paragraph (7); 
‘‘(M) uses continuous quality improvement 
practices, including collecting project data ele-
ments established by the National Infant-Tod-
dler Court Team Resource Center under sub-
section (c) for case management and assessing 
progress; and 
‘‘(N) where placement of an infant or tod-
dler in foster care is necessary, uses— 
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‘‘(i) concurrent planning upon removal 
and limits the number of placements; 
‘‘(ii) mentoring and coparenting be-
tween birth and foster parents and kin 
caregivers and supports; 
‘‘(iii) 
preremoval 
conferences 
and 
monthly family team meetings to ensure 
support for family and child from the be-
ginning as well as timely action and serv-
ices to address child and family needs; and 
‘‘(iv) frequent, quality family time 
interaction or visitation in settings where 
families normally interact and coaches to 
support parent-child interactions. 
‘‘(c) NATIONAL INFANT-TODDLER COURT TEAM RE-
SOURCE CENTER GRANT.— 
‘‘(1) GRANT AUTHORIZED.—The Secretary shall 
award to an eligible entity a grant to establish a na-
tional center to carry out the activities specified in 
paragraph (3) to serve as a resource for infant-tod-
dler court teams (to be known as and referred to in 
this section as the ‘National Infant-Toddler Court 
Team Resource Center’). The term of a grant under 
this subsection shall be for not less than 3 years, re-
newable for up to 8 years. 
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‘‘(2) ELIGIBLE ENTITIES.—An entity is eligible 
to receive a grant under this subsection if the entity 
is a national early childhood development organiza-
tion with— 
‘‘(A) recognized experience as a training 
organization in infant-toddler development, in-
fant-early childhood mental health, and other 
related topics; 
‘‘(B) experience working in collaboration 
with, and providing training to, court officials, 
child welfare agencies, attorneys, guardians, 
court-appointed special advocates, and other in-
dividuals and community organizations pro-
viding services to infants and toddlers in the 
child welfare system, including— 
‘‘(i) specific expertise in educating 
judges, attorneys, child welfare staff, and 
community service providers about the im-
pacts of child maltreatment and trauma on 
early development and family functioning; 
and 
‘‘(ii) experience in incorporating the 
expertise described in clause (i) into the 
court and child-family service systems to 
promote change in the way courts and 
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communities address cases involving mal-
treated infants and toddlers and support 
other families with infants and toddlers in 
need of family strengthening services; 
‘‘(C) the capacity to carry out the activities 
of the National Infant-Toddler Court Team Re-
source Center; 
‘‘(D) a proven ability to provide training 
and technical assistance, collect data and sup-
port its use for continuous quality improvement 
and evaluation, and other tasks; and 
‘‘(E) a demonstrated ability to bring the 
collective impact of other national organizations 
together to address the needs of infants and 
toddlers that touch the child welfare system or 
are in need of preventive services to strengthen 
families and avoid the child welfare system. 
‘‘(3) ACTIVITIES
OF
NATIONAL
INFANT-TOD-
DLER COURT TEAM RESOURCE CENTER.—The Na-
tional Infant-Toddler Court Team Resource Center 
shall carry out the following activities: 
‘‘(A) Provide technical assistance to States 
and communities with infant-toddler court 
teams receiving funding under subsection (a) 
established through the Infant-Toddler Court 
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Program, or through other means in building 
the systemic team structure to identify and ad-
dress the needs of at-risk children and families 
before maltreatment occurs. 
‘‘(B) Provide technical assistance and 
training to States and local jurisdictions— 
‘‘(i) in selecting sites, coordinating 
systems, planning, and implementing, en-
hancing, or stabilizing evidence-based in-
fant-toddler court teams, including embed-
ding a child development approach to pro-
mote the healthy development and mitigate 
trauma of infants and toddlers experi-
encing or at risk of experiencing maltreat-
ment and their families, so that such court 
teams meet the criteria specified in sub-
section (b)(7); and 
‘‘(ii) in determining how to use the 
court team community structure to inform 
and support the continuum of family 
strengthening services described in para-
graph (6). 
‘‘(C) Develop materials to guide judges in 
the decision-making process regarding infants 
and toddlers, and train members of local infant- 
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toddler court teams and others in the commu-
nity regarding the appropriate care of infants 
and toddlers, including the importance of— 
‘‘(i) understanding early brain devel-
opment, the impact of abuse and neglect 
and placement in foster care, and the need 
for preventing such occurrences; 
‘‘(ii) the social determinants of health; 
‘‘(iii) placement stability and caregiver 
continuity for very young children; 
‘‘(iv) supporting the parent-child rela-
tionship; 
‘‘(v) comprehensive services for chil-
dren and parents to reduce the recurrence 
of abuse and neglect; 
‘‘(vi) comprehensive services to mon-
itor and improve the health, development, 
and well-being of infants and toddlers in 
foster care or in in-home placements; 
‘‘(vii) for children placed in foster 
care, timely permanent placement frequent 
parent-child visitation, and concurrent 
planning; and 
‘‘(viii) implementing a comprehensive 
service delivery plan addressing the needs 
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of children and parents at the proximate 
time of a child’s removal from the care of 
the child’s biological parents. 
‘‘(D) Provide information to States, com-
munities, and courts around the United States 
seeking to adopt an infant-toddler court team 
approach grounded in the science of early child-
hood development, including information related 
to— 
‘‘(i) the incorporation of knowledge 
about infant and toddler development into 
the resolution of cases by judges with ju-
risdiction over children in foster care and 
by child welfare agencies overseeing chil-
dren under in-home supervision; and 
‘‘(ii) methods to change State and 
local government systems to better address 
the needs of infants and toddlers in the 
child welfare system and their families. 
‘‘(E) Coordinate and facilitate peer learn-
ing opportunities for judges, community coordi-
nators, and other personnel through commu-
nities of practice, learning communities, con-
ferences, and other means. 
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‘‘(F) Ensure local infant-toddler court 
teams collect and report data specified under 
subparagraph (H) and provide technical assist-
ance in— 
‘‘(i) ensuring quality data collection 
and reporting; and 
‘‘(ii) using the data collected for case 
and site monitoring, to establish a contin-
uous quality improvement process to iden-
tify areas that need strengthening, to de-
velop a plan for such improvements, and to 
monitor progress. 
‘‘(G) Provide technical assistance to States 
and communities— 
‘‘(i) in evidence-based methods to 
change policies and practices to better ad-
dress the needs of infants and toddlers ex-
periencing maltreatment and their families 
as well as infants, toddlers, and families in 
need of services to strengthen families and 
prevent the likelihood of entry into the 
child welfare system; and 
‘‘(ii) through onsite implementation 
assistance to local infant-toddler court 
teams tailored to the needs of each unique 
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jurisdiction, using a process of assessing 
and building on community strengths. 
‘‘(H) Define key metrics and collect data 
from local infant-toddler court teams related to 
the operation and outcomes of the projects sup-
ported by States receiving a grant under sub-
section (b) and other existing infant-toddler 
court team sites on elements that include— 
‘‘(i) data on child and parent demo-
graphics and relevant family history; 
‘‘(ii) adult health care services, includ-
ing prenatal and postnatal care, depression 
screening, mental health services, sub-
stance use treatment, and well-woman 
care; 
‘‘(iii) child services, including multi-
generational mental health treatment fo-
cused on the relationship, developmental 
screening, early intervention services, well- 
child care and medical homes, and early 
childhood education; 
‘‘(iv) family engagement activities, 
such as family team meetings and court 
hearings; 
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‘‘(v) 
family 
well-being, 
including 
health equity and health insurance; 
‘‘(vi) court practices, such as fre-
quency of hearings, family team meetings, 
and stakeholder meetings; and 
‘‘(vii) foster care practices that sup-
port development and stable relationships, 
including placement type, visitation fre-
quency, and permanency outcomes and 
timeliness, with an emphasis on reunifica-
tion. 
‘‘(I) Compile such data annually and re-
port to the Secretary together with information 
from State planning processes reported under 
subsection (b)(7)(B). 
‘‘(J) In developing data elements under 
subparagraph (H), consult with the organiza-
tion awarded a contract under paragraph (4). 
‘‘(4) EVALUATION.—The National Infant-Tod-
dler Court Team Resource Center shall enter into a 
contract with an organization experienced in con-
ducting a child welfare national evaluation over the 
course of the grant period of the effectiveness of 
local evidence-based infant-toddler court teams sup-
ported by States receiving a grant under subsection 
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(b) as well as other infant-toddler court team sites 
that may participate in such evaluation in— 
‘‘(A) linking children and families to ap-
propriate services and supports that prevent 
foster care placements, expedite permanency 
where placements occur, and strengthen fami-
lies in improving family well-being and support 
for positive child development; 
‘‘(B) preventing, or reducing the recur-
rence of, abuse and neglect; 
‘‘(C) promoting access to timely, high-qual-
ity primary health care and oral health care in 
a medical home for children and parents; 
‘‘(D) promoting quality parent education, 
mentoring, and coaching to strengthen par-
enting skills; 
‘‘(E) promoting timely assessment, referral 
to, and receipt of, mental health treatment and 
substance use treatment for parents of infants 
and toddlers; 
‘‘(F) promoting timely permanent place-
ments of maltreated infants and toddlers; and 
‘‘(G) reducing costs through system im-
provements. 
‘‘(d) DEFINITIONS.—In this section: 
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‘‘(1) The term ‘child welfare system’ includes 
all services and supports provided through a State’s 
child welfare system. 
‘‘(2) The term ‘State’ means each State of the 
United States, the District of Columbia, each terri-
tory or possession of the United States, and each 
federally recognized Indian Tribe (as defined in sec-
tion 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 5304)). 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—There are authorized to be 
appropriated to carry out this section, $25,000,000 
for each of fiscal years 2021, 2022, 2023, and 2024. 
‘‘(2) 
RESERVATION
OF
FUNDS.—Of 
the 
amounts made available under paragraph (1) for a 
fiscal year, the Secretary shall reserve— 
‘‘(A) in the case of a fiscal year in which 
the amount made available under paragraph (1) 
does not exceed $15,000,000, not less than 
$5,000,000 for the National Infant-Toddler 
Court Team Resource Center established pursu-
ant to subsection (c); and 
‘‘(B) in the case of a fiscal year in which 
the amount made available under paragraph (1) 
equals or exceeds $15,000,000 but does not ex-
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ceed $25,000,000, not less than $7,000,000 for 
such Center.’’. 
SEC. 3. REPORTS TO CONGRESS. 
Not later than 3 years after the date of the enact-
ment of this Act, and not later than 5 years after such 
date of enactment, the Secretary shall submit to Congress 
a report addressing the implementation and effectiveness 
of the infant-toddler court teams pursuant to section 
330Z–3 of the Public Health Service Act, as added by sec-
tion 2, including— 
(1) a compilation of the data on local commu-
nity infant-toddler court teams included in the an-
nual report from the National Infant-Toddler Court 
Team Resource Center established pursuant to such 
section; and 
(2) interim or final results from the national 
evaluation of infant-toddler court teams conducted 
under such section. 
Æ 
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