Integrating Family First: Early Implementation, Outcomes, and Lessons Learned from Moving Child Welfare Upstream

The Family First Prevention Services Act, also known as the Family First Act, or FFPSA, was part of the Bipartisan Budget Act of 2018. The goals of FFPSA are to: 1) prevent children from entering the foster care system; and 2) increase the quality of foster care. To prevent children from entering the foster care system, FFPSA provides increased funding for keeping children with their families of origin or with kinship providers whenever possible. This goal is based on the ample research that shows that children who experience foster care encounter numerous negative outcomes. With FFPSA, Title IV-E funding which previously could only assist children after they entered the foster care system can now be used for prevention, thus removing the financial incentive for child welfare workers to remove children in the first place. Supports that are now funded by Title IV-E include mental health and substance abuse prevention and treatment for caregivers, as well as in-home parenting skills trainings and kinship navigation services for kin caregivers. Family First Prevention Services launched in one early adopting midwestern state in 2019, signaling a new statewide commitment and investment in prevention, opening access to additional community-based services to families with children deemed a candidate for care potentially at risk of out-of-home placement. However, principles associated with a prevention approach (i.e., orientation toward community- and family-engagement, application of a multisector collective impact framework, use of CQI with rapid-cycle feedback and longitudinal and comparative methods, an holistic family approach to service delivery and evaluation, and the integration of multiple data sources to support evaluation and robust CQI), raise important considerations when delivered in the context of the existing system. These fundamental differences between family-centered community-based prevention services and traditional child-centered child welfare services must be resolved to achieve the objectives of Family First.

Based on an implementation science informed approach, this session will highlight lessons learned from an evaluation of one state's Family First implementation, discussing the practical implications of this important shift toward prevention while centering community-based evaluation. Roundtable panelists will share the story and lessons of this statewide evaluation, highlighting several parallel comprehensive and continuous quality improvement processes used to address the emergent issues related to the integration of the Family First initiative into an historically rigid state child welfare system primarily prioritizing child safety over family preservation, and centering the child as the focal point and target of services.

First, panelists will describe the early implementation context, identifying system gaps, including: 1) a restricted referral pipeline, 2) top-down versus grassroots orientation, 3) variable eligibility criteria, 4) cross-sector data limitations, 5) mandate for robust evaluation, and 6) child-focused versus family-centered that emerged during early implementation. Next, panelists will describe approaches to implementation and evaluation applied to address identified gaps that were guided by Active Implementation Frameworks, including a recursive ecological systems approach to the improvement cycles framework (Fixsen, Blase & Van Dyke, 2019). Finally, panelists will preview early outcomes and successes, and share lessons learned along the journey.2022-->