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Checking on progress: The Family First Prevention Services Act

By CARF International

In February of 2018, Congress passed the Family First Prevention Services Act (FFPSA), also known as the Bipartisan Budget Act of 2018, to help children at risk of entering the foster-care system to remain safely with their family members whenever possible.

Although the intended outcome of FFPSA is a goal shared by many, as often happens when new legislation is introduced, it has been met with mixed reviews. Some state agencies and service providers are charging full steam ahead, while others are taking a more cautious approach. 

A Law Designed to Protect Families

Service providers and state agencies can think of FFPSA as beneficial finance reform for child welfare servicers, says Laura Boyd, Ph.D., a member of the Family Focused Treatment Association who was involved with crafting the bill and now advises providers and states on implementing the legislation.

FFPSA redirects federal funds to provide preventive services to keep children safely with their families and out of foster care, Boyd says. States can now use Title IV-E foster care funds to support children considered at risk of entering foster care.

“For the first time, these services are available to the biological or kinship family,” Boyd says. “We want to keep the family whole or support the caregiver so we can keep the child out of foster care permanently.”

Sometimes, though, the family is so fragile that foster placement is the only option. FFPSA strengthens the system by allowing federal reimbursement for care in family-based settings and certain residential treatment programs for children with emotional and behavioral issues requiring special treatment. It also establishes criteria for such programs to be considered Qualified Residential Treatment Programs (QRTPs). To receive funding, a QRTP must be licensed and accredited by CARF or another accreditor approved by the U.S. Department of Health & Human Services (HHS).

Although the overarching goal may be to keep families intact, “we need QRTPs. Some kids will always need access to that level of care,” Boyd says.

Perceived Benefits and Barriers

Benefits and barriers are where paths diverge, Boyd says. Some states and service providers immediately saw the benefits of the legislation in providing new funding mechanisms for keeping children and families safe and supported, at whatever point they are engaged along the system.

Others perceived barriers to meeting the legislation’s tight implementation timeline and the criteria required for accreditation.

The original deadline for accreditation by an HHS-approved accreditor was October 1, 2019. States were able to request a delay of up to two years to prepare.

The criteria for consideration as a QRTP stipulate that programs:

  • Operate based on trauma-informed treatment models.
  • Provide 24/7 care by registered and licensed nursing and clinical professionals.
  • Proactively reach out to try to engage participants’ families.
  • Provide discharge planning and family-based after-care supports for six months following discharge.

“When the law was passed and the gates opened, some states moved quickly to get on the bandwagon, but some waited. That’s dangerous,” Boyd says.

CARF advises the accreditation process takes about 12 to 18 months from first contact, through an on-site peer-review survey, to accreditation decision. Boyd says the exact time frame depends on the readiness of the program.

With limited collective capacity among the HHS-approved accreditors and the October 1, 2021, accreditation deadline, “states and providers need to be in the queue right now,” she says. “There is no time to wait.”

Alaska, Arkansas, Kansas, Kentucky, Maryland, Nebraska, North Dakota, Utah, Washington, the District of Columbia, and West Virginia are among the early adopters actively partnering with providers to implement FFPSA. About half of the remaining states are slowly working toward implementation, Boyd estimates.

The tight timeframe and insufficient guidance from the federal government initially have posed challenges.

“This is huge, like learning a Chinese dialect,” Boyd says. “It changes the way we do business and the way we are compensated for service to families.”

The Bottom Line

The key to successful implementation, Boyd says, is a strong working relationship between the relevant state agencies and the provider community.

“The 11 states that have moved quickly to implement the changes have great resources. Philosophically, they say, ‘Yes, this is what we want to do to keep kids and families together and safe, and now we can get funding.’ There’s excitement and the courage it takes to make change.”

Boyd’s message to service providers: “If your state is not reaching out to you, don’t wait. You need to approach them and insist on being in the conversation.”

“Everyone has the same bottom line—keeping children and families safe.”

For more information about the Family First Prevention Services Act, the accreditation process, and additional resources, visit


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