1. Family First Prevention Services Act (FFPSA)
Statewide Webinar

2. Background

3. History
The Family First Prevention Services Act (FFPSA) was enacted February 9, 2018 as part of the Bipartisan Budget Act
The original version introduced in 2015 immediately drew objections from New York and California – states that had already invested heavily in prevention
New York proposed amendments, but they were not accepted
Because of prevention funding, most states supported or did not oppose the Act

4. Overview of the FFPSA
FFPSA is an extensive piece of legislation – more than 100 pages long
It covers a wide range of child welfare programs, including preventive services, foster care and adoption
There are multiple effective dates in the bill
It includes significant amendments to:
Title IV-E (foster care, adoption assistance and Chafee independent living services)
Title IV-B (child welfare services)

5. IV-E Funding for Services Under FFPSA

6. FFPSA Allows:
States have the option of using Title IV-E funding for prevention and family services
However, funding is limited and must meet strict conditions

7. What services are allowed under FFPSA?
Title IV-E reimbursement is available only for:
Mental health and substance abuse prevention and treatment services
Services must be provided by a qualified clinician
In-home parent skill-based programs
Must include parenting skills, training, parent education and individual counseling

8. Conditions for eligible services/programs
Services or programs must be:
Trauma-informed:
Be provided under a structure that involves understanding, recognizing and responding to all types of trauma
In accordance with recognized principles of trauma-informed approach and trauma-specific interventions to address trauma consequences and facilitate healing
Comply with general practice requirements (e.g., practice has writings that specify components and administration of the practice, no empirical basis that practice constitutes risk of harm, and multiple studies support benefits of practice)
Meet the requirements for a “promising, supported or well-supported practice”

9. How long may the family receive services?
Under FFPSA, Title IV-E funding is limited to 12 months from the date the child is identified in a prevention plan as either:
A candidate
Being pregnant or a parenting foster youth in need of services

10. What other conditions apply?
Eligible services or programs may only be provided if they are addressed in the child’s prevention plan
For candidates, the plan must include the child’s foster care prevention strategy, the list of services to be provided to ensure success of the child’s foster care prevention strategy and must comply with other DHHS requirements

11. For pregnant and parenting youth
The prevention plan must be included in the youth’s case plan
Plan must include the services or programs to be provided on behalf of the youth to ensure that the youth is prepared or able to be a parent
The plan must include the foster care prevention strategy for the youth’s child
Must comply with any DHHS requirements

12. Who is eligible under FFPSA?
A child who is a candidate for foster care who can safely remain at home or in a kinship placement with the receipt of mental health, substance abuse prevention and treatment services or services from an in-home parent skill-based program
A child in foster care who is pregnant or parenting a child
The parents or kin caregivers of such child
When the needs of the child, parent or caregiver for such services are directly related to the safety, permanency or well-being of the child or preventing the child from entering foster care

13. Who is eligible as a candidate?
A child identified in a prevention plan as being at imminent risk of entering foster care (whether or not the child would be eligible for Title IV-E foster care or adoption assistance) who could safely remain at home or in a kinship placement if services are provided to prevent the child from going into foster care
This includes children whose adoption or guardianship arrangement is at risk of disruption or dissolution, resulting in a foster care placement

14. FFPSA Reimbursement
Federal Title IV-E reimbursement for federal foster care prevention services and programs:
Beginning after September 30, 2019 and before October 1, 2026: % for services or programs
Beginning after September 30, 2026: federal medical assistance percentage for services and programs
50% for associated administrative and training costs
At least 50% of state expenditures reimbursed by Title IV-E funds must be for services and activities that meet federal requirements for well-supported practices
Administrative costs are eligible for Title IV-E reimbursement without regard to whether the expenditures were incurred on behalf of a child who is eligible or potentially eligible for foster care maintenance payments under Title IV-E

15. FFPSA Maintenance of Effort (MOE)
The state foster care prevention expenditures for the fiscal year shall not be less than the amount of the expenditures for federal fiscal year 2014, with an exception not applicable to large states like New York
State foster care prevention expenditures include: state or local expenditures for programs funded under TANF, Title IV-B and SSBG for foster care prevention services and activities and other state or local expenditures for foster care prevention services and activities whether federally matched or reimbursed or not
(Does not include state or local expenditures for foster care prevention services or activities under a federal waiver program)

16. Other requirements
DHHS must require each state to report expenditures for federal fiscal year 2014 and, as necessary, years thereafter to determine state compliance with the MOE requirement
State must collect and report to DHHS information on services and programs provided to each child receiving the Title IV-E-funded services for the duration of the 12-month period and in the case of a candidate child, the child’s placement status at the beginning and at the end of the 1-year period and whether the child entered foster care within 2 years after being deemed a candidate
The state may not receive reimbursement for a promising, supported or well-supported practice unless the prevention plan includes a well-designed and rigorous evaluation strategy for that practice

17. Considerations whether to opt in
Federal reimbursement is limited to 50% of the cost of services and administration – the remaining 50% must come from non-federal sources
FFPSA limits:
What services are Title IV-E reimbursable
Who is served, and
For how long
MOE obligates state and locals to maintain 2014 level of preventive services spending

18. How do we sign up?
Add a plan component to the New York Title IV-E State Plan
The plan component covering each 5-year period of its operation must include an extensive description of the state’s proposed implementation and administration of the program, its monitoring, oversight, assessments, training, caseloads and consultations in the plan component

19. Foster Care Placement Options Under FFPSA

20. Foster Care
Foster Homes
Congregate Care

21. FFPSA Provisions
Except where noted, this part of FFPSA is effective as of October 1, 2019
The federal government can extend the effective date for up to two years with the condition that there will be no Title IV-E reimbursement for preventive services
FFPSA imposes severe restrictions on availability of Title IV-E maintenance payments for foster children in federally-defined child care institutions, including New York-defined institutions, group residences, group homes and AOBHs

22. FFPSA Provisions
After two weeks of foster care maintenance payments for a child in a child care institution, there will be no Title IV-E maintenance payments for a child not placed in a foster home unless the child is placed in:
A qualified residential treatment program (QRTP)
A specialized setting providing prenatal, post-partum or parenting supports
A supervised setting where the child may live independently if the child is 18 years or older
A setting providing high-quality residential and supportive services to children who are survivors of or at risk of human trafficking, or
A licensed residential family-based treatment facility

23. What is a Qualified Residential Treatment Program? (QRTP)
Has a trauma-informed model of care designed to address the needs of children who have serious emotional or behavioral disorders or disturbances
Is able to implement the treatment identified in the 30-day assessment
Has registered or licensed nursing staff and other licensed clinical staff who:
Provide care within the scope of their practice
Are on site per the QRTP’s treatment model
Are available 24/7

24. A QRTP also…
Facilitates family member participation in the child’s treatment program, when appropriate and in the child’s best interest
Facilitates outreach to family members, documents how the outreach was made and maintains contact information for relatives
Documents how family members are integrated into the treatment process (including post-discharge) and how sibling connections are maintained
Provides after care support for at least 6 months post-discharge

25. Licensing and Accreditation
A QRTP is licensed and accredited by either:
The Commission on Accreditation of Rehabilitation Facilities
The Joint Commission on Accreditation of Healthcare Organizations
The Council on Accreditation
Any other independent, not-for-profit accreditation organization approved by DHHS

26. Additional Limitations on Federal Reimbursement
If a child is placed in a QRTP:
An assessment must be completed within 30 days of placement
A court review must be completed within 60 days of placement
If the assessment is not completed within 30 days of placement, there will be no Title IV-E maintenance reimbursement for the duration of the placement
*This does not apply to reimbursement for allowable administrative costs

27. 60-Day Court Review
30-Day Assessment

28. 30-Day Assessment
FFPSA mandates extensive case record documentation requirements on the assessment process and justification to support the placement in a non-foster home setting

29. Potential Loss of Funding
If the assessment is not completed within 30 days of placement, there will be no Title IV-E maintenance reimbursement for the duration of the placement

30. 30-Day Assessment
The 30-day assessment is led by a qualified individual who must:
Assess the child’s strengths and needs using an age-appropriate, evidence-based, validated, functional assessment tool approved by DHHS
Determine whether the child’s needs can be met with family or through placement in a foster home
If not a foster home, determine which setting would provide the best care for the child in the least restrictive environment consistent with the child’s short- and long-term goals
Develop a list of child-specific short-term and long-term mental and behavioral health goals

31. 30-Day Assessment A qualified individual:
Must be a trained professional or licensed clinician who is not an employee of the state agency (or LDSS) and is not connected to or affiliated with any placement setting where the state agency (or LDSS) places children
The state may apply to DHHS for a waiver certifying that the trained professionals or clinicians conducting the assessments shall maintain objectivity in determining the most effective and appropriate placement for a child. Waiver is subject to criteria established by DHHS

32. 30-Day Assessment
A family and permanency team for the child must be assembled consisting of:
all appropriate biological family members
the child’s relatives and fictive kin
professionals who are a resource to the child’s family
For children 14 years or older, the family and permanency team must include members of the permanency planning team the child selects in accordance with Title IV-E requirements

33. 30-Day Assessment
If the qualified individual determines that the foster child should not be placed in a foster home, the qualified individual must document:
The specific reasons why the child’s needs cannot be met in either a family home or in a foster home (shortage or lack of foster homes is not an acceptable reason)
Why placement in a QRTP will provide the child with the most effective and appropriate level of care in the least restrictive environment
How the placement is consistent with the child’s short-term and long-term goals as specified in the child’s permanency plan

34. The decision must be made part of the child’s case record
60-Day Court Review
Within 60 days of a child’s placement in a QRTP, the court must:
Consider the qualified individual’s 30-day assessment, determination and documentation
Determine whether the child’s needs can be met in a foster home or, if not, whether placement in a QRTP provides the most effective and appropriate level of care in the least restrictive environment consistent with the goals outlined in the child’s permanency plan, then approve or disapprove the placement
The decision must be made part of the child’s case record

35. 60-Day Court Review
While the child remains in the QRTP, at each status review (not defined) and permanency hearing, the state agency (or LDSS) must submit evidence documenting:
That ongoing assessment continues to support the determination that the child’s needs cannot be met in a foster home and that the QRTP placement remains the effective and appropriate placement for the child
Specific treatments or services that meet the child’s needs and how long the child will need them
Efforts to prepare the child to either return home, be placed with a willing relative, legal guardian or adoptive parent, or be placed in a foster home

36. Documentation Requirements
When a child is in a QRTP for more than 12 consecutive months, 18 non-consecutive months or 6 months for a foster child under age 13, the state agency must submit to DHHS:
The latest version of the evidence and documentation referenced in the previous slide provided to the court at the permanency hearing or status review
Signed approval by the state agency head for continued placement in the QRTP

37. Other FFPSA Provisions

38. No Juvenile Justice System Impact
In their Title IV-E State Plans, states must include an amendment certifying that they will not enact policies or practices that result in a significant increase in the juvenile justice system because of limitations on availability of Title IV-E foster care maintenance payments for foster children not living in foster homes

39. New Background Check Requirement
The FFSPA passed in the Bipartisan Budget Act of 2018 includes a new mandate requiring any adult working in federally-defined child care institutions, including QRTPs, to have:
A criminal history record check, including a FBI fingerprint check (NYS currently requires)
New York SCR check (NYS currently requires)
A check of any other state SCR where the individual resided within 5 years of applying for employment
Effective October 1, 2018 unless state legislation is needed

40. Foster Home Standards
DHHS must identify model foster home licensing standards by October 1, 2018
States have until April 1, 2019 to adopt the standards or explain why not adopted and must address where waivers are granted to relative foster homes

41. Foster Home Definition
FFPSA amends the federal definition of a foster home for Title IV-E purposes. It limits capacity to 6 foster children. States have the flexibility to allow:
A parenting youth in foster care to remain with the child of the parenting youth
Siblings to remain together
A child with an established meaningful relationship with the foster family to remain with the family
A family with special training or skills to care for a foster child with severe disabilities

42. Implementation Deadline
New Mandates Under FFPSA
New Requirement
Implementation Deadline
Implement an electronic ICPC
October 1, 2027
Develop statewide plan to prevent child abuse and neglect fatalities
October 1, 2018
Develop protocols to prevent inappropriate diagnosis of foster children resulting in non-foster home placements
January 1, 2018

43. Adoption Assistance
Rolls back and postpones elimination of application of ADC financial standards (de-linking) for eligibility for Title IV-E adoption assistance
Impacts children age 2 and under
Mandates a GAO study and report on state compliance with federal de-linking requirements and federal standards for state expenditures of savings associated with de-linking

44. Other Provisions
Expands youth eligibility for John H. Chafee Foster Care Independence Program for services and for education and training vouchers
Requires youth aging out of foster care to receive documentation of having been in foster care at discharge
Reauthorized the Adoption and Legal Guardianship Incentive Program

45. Other Provisions
Authorizes Title IV-E maintenance for foster child residing with parents in a licensed residential family-based substance abuse treatment program (limited to 12 months)
Authorizes Title IV-E for evidenced-based kinship navigator programs
Eliminates Title IV-B time limits on family reunification services for child in foster care and permitting up to 15 months for discharged foster child

46. Other Provisions
Enhances federal grants to improve well-being of families affected by substance abuse
Authorizes federal grants to support and retain foster families
Extends several Title IV-B child and family services programs
Lots of additional reporting requirements, including additional reporting of foster care placements

47. Next Steps

48. OCFS Action Plan
Assessing the impact of FFPSA on the state, local government, providers, families and children
Reached out to DHHS for information on implementation
Offered to assist DHHS in developing model foster home standards
Continues to work with other states on possible FFPSA amendments
Evaluating the impact of the MOE on the ability to draw down Title IV-E reimbursement for services

49. OCFS Action Plan Considering the significant systems impact of FFPSA
Evaluating how many preventive service providers currently meet FFPSA eligibility standards
Evaluating to what extent residential foster care agencies satisfy FFPSA QRTP requirements
Reviewing the need for state statutory and regulatory changes
Has engaged OCA on FFPSA
OCFS will form a statewide implementation work group

50. Questions?

51. OCFS Contacts John Stupp 52 Washington Street Rensselaer, NY 12144
Stephanie Deyoe
52 Washington Street
Rensselaer, NY 12144