Assessing Gaps in Nebraska's Prevention Service Array

To achieve maximum impact of the Family First Prevention Services Act (FFPSA), there should be a clear match between programs that are in state’s prevention plans, and the service needs of children and families in their respective geographic location. However, there is little research on the alignment between the existing capacity of prevention programs (i.e. mental health, substance use, and parenting skills) to serve families and a granular understanding of families’ needs relative to the location of providers. In collaboration with the Nebraska (NE) Children and Family Services Department (CFS), we created and implemented a statewide prevention services gap analysis to inform NE’s prevention planning. This paper has three aims, to: (1) describe the development of a statewide provider survey, (2) present descriptive findings related to provider service capacity by geographic area and child race, perceptions of child and family needs for culturally relevant services, and barriers to service access, and (3) demonstrate how survey and child welfare administrative data were used to map EBP statewide gaps to inform prevention service planning.

Method. An online provider survey was developed and distributed in 2020 to inquire about evidence-based practice (EBP) and non-EBP service provision, capacity, child and family needs, and provider and family barriers to service. The Family Strengths and Needs Assessment (FSNA) from child welfare administrative data was used to identify child and caregiver prevention service needs. Descriptive analyses were conducted using means, proportions, bivariate t-tests, and ANOVA. Geographic mapping in R statistical software was used to depict gaps between family needs (based on administrative data) and provider capacity (based on provider survey). Co-interpretation of findings was conducted with NE stakeholders to generate recommendations to inform NE’s prevention service array.

Results. One-quarter of all children assessed by CFS in 2020 met NE’s FFPSA candidacy criteria (n=6,372; 24%). Over one-third of families had identified trauma, MH, or SA issues at intake. Providers (n=86) indicated offering 286 programs, 68% that were EBPs (n=195). Gap analysis indicated generally sufficient provider capacity to serve FFPSA-eligible families, but insufficient capacity to meet families’ needs when only considering EBPs included in NE’s approved prevention plan. Gaps were largest in rural and frontier areas of the state, and for Latino/a and Native American families indicating a need for culturally relevant services.

Conclusions. Using a data-driven approach to FFPSA prevention planning yielded new information about treatment providers, programs, and FFPSA candidates during NE’s early implementation of FFPSA. This analysis facilitated decision making about prevention planning about scale-up to best meet child and family needs. Gaps were identified when considering only the EBPs NE initially included in their prevention plan, and using a race equity lens found these gaps were more pronounced for Native American and Latino/a families. Results also suggest the tremendous demand for additional infrastructure, resources, and training to support the provision of EBPs. Overall, this gap analysis was critical for identifying how NE can plan and implement their Prevention Plan to most effectively meet the needs of FFPSA-eligible families involved with NE’s child welfare system.