Last Tuesday, H.R. 5456, the Family First Prevention Services Act of 2016, which allocates federal resources for preventive and family support services while establishing a national standard for residential treatment, was passed in the House of Representatives. The bill is unconditionally supported by many reputable advocates including Child Welfare League of America, American Academy of Pediatrics, Children's Defense Fund, Alliance for Strong Families and Communities, The Children's Village, and other organizations like us. But passage through the Senate has been delayed due to opposition by a few.
H.R. 5456 deals with Title IV-E funding for foster care, which was established as part of the Adoption Assistance and Child Welfare Act of 1980. Title IV-E funding reimburses states for children removed into foster care rather than for preventive interventions that support families to avoid removal. Our experience over the past two decades demonstrates that, with the right level of preventive support, most children can remain safely with their families. In those instances where parents are unable or unwilling to care for their children, kinship care, family foster care and adoption, should be the primary option for out-of-home care.
For the subset of children who have experienced severe abuse, mental illness, and other trauma resulting in extensive behavioral health needs, well-funded residential treatment is sometimes still the best option - as long as the objective is to provide efficacious short-term treatment and return them to families as quickly as possible. Nationally, residential treatment, in some cases still driven by the historically antiquated orphanage model, has continued to be a final destination for far too many children in foster care.
The 2015 Children's Bureau review of foster care found that of the approximately 51,000 children age 13 and older who entered foster care in 2008, about half (25,535) entered residential treatment at some point. And, far too many remain there for far too long.
This bill, a rare bipartisan initiative made possible by the leadership of Senators Hatch (R-UT) and Wyden (D-OR), finally recognizes that children are best served in communities and when families are supported. While not perfect, it allocates $1.5 billion in federal resources for preventive and family support services over the course of ten years beginning in 2020. In two prior articles, Jess Dannhauser and I wrote about the services funded through FFA.
The legislation also creates a critically-needed national standard for residential treatment. In the absence of this, residential care is still a place where some children are unnecessarily placed and often end up languishing until they age out. In most states, the children who languish longest in foster care in general, and residential treatment in particular, are children of color, mostly black.
This national standard calls for Qualified Residential Treatment programs (QRTP). QRTP requires that children are only referred to residential treatment when there is a clearly established risk for harm to self or others. QRTP also requires that residential treatment programs have specially trained clinical and nursing staff physically present onsite during business hours and available 24/7 to address children's health needs. This is an enormous step forward in the treatment of our country's most vulnerable children.
The QRTP requirement has vigorous opposition by some who fail to understand the bill, choose not to understand it, or simply choose to protect the status quo. Among those who support the intent of the bill but oppose its passage through the Senate are those who point to the increased cost burden to support the national QRTP standard. I agree, it will be costly in some cases, but what is the cost of continuing to support a system that claims to provide residential treatment but refuses to fund the basic levels of clinical and nursing staff required to ensure treatment and safety? Don't children who have suffered so much that they require residential treatment deserve real treatment and safety standards that I would expect for my own children?
Another argument in opposition is that group homes will be financially disadvantaged. As a group home provider, I know that this is true. Our homes probably cannot become QRTP's, but most group homes are most likely not federally funded anyway. The reality is that federal funding for child welfare has been dropping steadily. Child Trends reports that "the federal share of total child welfare expenditures decreased since SFY 2010, while the combined state/local share increased. In SFY 2012, federal funds accounted for 45 percent of all spending (down from 46 percent in SFY 2010), while state dollars accounted for 39 percent, and local dollars 16 percent. Combined, state and local funds comprised more than half of all expenditures (approximately 55 percent) on child welfare in SFY 2012, up from 54 percent in SFY 2010." This means group homes that provide a needed service in any community can still be supported with local dollars because, as the report notes, about 50 percent of our current funding is local and not federal anyway.
My organization, The Children's Village, is a residential treatment provider in New York, a state that has served as the model for this act and probably has the least to gain. At The Children's Village, we know the importance of good residential treatment - it is life saving for those who need it. We are consistently and publicly assertive in making this position known. We also know that passing H.R. 5456, the Family First Prevention Services Act, will benefit the children and families we serve. We are already well ahead of the curve in moving toward preventive care (having begun this shift more than ten years ago), and we have already suffered the expenses of this transition, but we are proud to be on the right side of history. We believe this bill will move our country toward supporting the families who need it most by providing the highest standard of care to the children who have been neglected long enough.