Given a provisional top-tier evidence rating, states planning to use it now face doing so without federal support
In December 2019, supporters of the Family Centered Treatment (FCT) model received the news so many child welfare programs are hoping for these days: it was approved for federal funding under the Family First Prevention Services Act. The program, which is used to train both foster and biological parents on the effects of trauma on children, even received the highest rating of efficacy: Well-Supported.
Several states added FCT to their plans for Family First, which opens up the federal Title IV-E entitlement program to include approved services for addressing family issues that could lead to a foster care removal. Some even began to fund the services using their share of a $500 million transition fund set up by Congress.
Last week the momentum came to a crashing halt. Family Centered Treatment had gained its approval through a transitional review process, meant to help expedite progress on Family First as the recently created Prevention Services Clearinghouse got up and running. But the clearinghouse, which is operated by Abt Associates essentially downgraded the model from Well-Supported to “Does Not Meet Criteria,” which means it is not fundable through Family First dollars.
The abrupt reversal has caused a snag in planning for states expecting to fund FCT, and has incensed the leadership at the nonprofit group that runs point on training around the model and advocating for its use. Under the rules for transitionally approved services, federal funding will cease in a few months.
“We strongly feel they have not looked at all the information that other reviewers did who feel [FCT] meets the qualifications for Family First,” said Tim Wood, executive director of the Family Centered Treatment Foundation, which is contracted by states to train and certify workers on the model. “The nature in which we…were notified, given that services are already being provided to hundreds of families, created an absolutely chaotic situation.”
The foundation sent a strongly worded email, obtained by Youth Services Insider, to the Children’s Bureau and several congressional staff alerting them to the situation, accompanied by a formal letter to the bureau requesting that re-review quickly be conducted on Family Centered Treatment.
“If this situation is not addressed quickly there is an immediate negative impact for hundreds of children and families currently receiving FCT and thousands of families due to receive this service,” said the email, which came from Wood. “Likewise, serious financial ramifications exist for the numerous human service providers and their employees contractually providing the services.”
The Children’s Bureau had no comment, and said it “will hold off on responding to any inquires about its contents until it has been reviewed and a response sent to the writer, as is appropriate. There is not a timeline for that happening at this point.”
An email for comment sent to Abt Associates spokesperson Mary Maguire received no reply. Wood said that after numerous attempts to call and email the clearinghouse about the decision, the Family Centered Treatment Foundation received an automated email informing it that a re-review was being considered.
The Family First Act became law in February of 2018 and took effect in October of last year. It enables states to use IV-E money – previously reserved for foster care and adoption support – to fund services aimed at working with parents without the need for a family separation. Those services must be evidence-based and apply to three areas: parenting, substance abuse treatment and mental health interventions.
Those services are limited to substance abuse, mental health and parenting interventions. And it is further restricted to models of services that are deemed to be promising practices or evidence-based interventions by the Prevention Services Clearinghouse, which is run via contract by Abt Associates..
In 2019, with Family First just months from taking effect, the clearinghouse had approved only a few allowable services. So the federal Children’s Bureau announced that it would let states directly seek approval for programs they want funded through the new rules. It wasn’t easy though: the state had to pay for a review of the service, then submit the findings to the bureau, which had to agree with the review team about the impact of the model.
Two states hired reviewers to assess Family Centered Treatment for their Family First plans: Nebraska and Arkansas. Both reviews ended up concluding that FCT met the Well-Supported threshold, the highest available rating for Family First services. Arkansas submitted its plan and the review first; Children’s Bureau concurred, and approved the treatment model in Arkansas’ plan.
Because Family Centered Treatment was approved for the Arkansas plan, it became an allowable service for any other state that had been approved for prevention services funding under Family First. Most states have delayed the law’s provisions, and are still in the planning stages, but several are underway including Arkansas, Kansas, Kentucky, Maryland, Nebraska, Utah and Washington, along with the District of Columbia.
But this month, the clearinghouse announced that its review of the existing body of evidence on FCT rated it Does Not Meet Criteria. That decision starts a clock on how long any state can draw funding for it through the original transitional approval; in the case of Arkansas, Wood said, federal funding for Family Centered Treatment will stop on June 30.
The difference between the clearinghouse’s finding and that of state and federal reviewers seems to be over a quasi-experimental 2018 study done by Indiana University, funded by the federal government and conducted as part of the evaluation on Indiana’s now-expired IV-E waiver program.
Using what’s called propensity score matching, the study compared children who received FCT to similarly situated children. It found that the additional cost of FCT was connected to improved outcomes.
“Children who participated in FCT were more likely to remain in-home during their involvement with [Indiana’s child welfare agency], as well as be reunited with their family in [a] shorter timeframe and more likely to be ranked as conditionally safe,” the study said.
Indiana has continued to operate the model, Wood said, and is among the states that submitted a Family First plan with FCT included.
The reviewers found the Indiana study to be indicative of the highest Well-Supported rating. The clearinghouse’s rates the study as “Low,” meaning its results could not factor into the determination of FCT’s impact.
The stated reason, on the clearinghouse website: “This study received a low rating because none of the target outcomes met measurement standards.”
Wood said he is confident that a clearinghouse reviewer did not take into consideration available updates in properly assessing the Indiana study and others, and that the issue could be addressed quickly with a meeting. But short of the automated response to the foundation’s request for a re-review, he has not heard from Abt Associates.
Meanwhile, states already operating Family First services and their child welfare providers are scrambling to adopt contingency plans in the event that there is a prolonged debate over Family Centered Treatment.
“Our first priority is moving forward with completing our FCT certification process because despite the model’s status, it’s important that we see this through,” said Gary Ivory, president of Youth Advocate Programs, whose organization has been contracted by Arkansas to deliver the model. The group hired four behavioral specialists to handle the work, all of whom have gone through the certification process to deliver FCT.
Ivory said that the organization is working with Arkansas to determine other family support models approved by the clearinghouse that could be used as a backup plan.
St. Francis Ministries, which has contracts to provide Family Centered Treatment in multiple states, said it might try to couple the model with an approved clearinghouse service and make it work that way, subject to the approval of states and the U.S. Children’s Bureau.
“We are aware that the Family Centered Treatment Foundation is appealing the decision, and we’re hopeful that appeal will be successful,” said Diane Carver, vice president of child and family services for St. Francis. “We believe the data from the recent years of offering FCT shows a significant impact for children and families.”
At the foundation, Wood said he and other FCT advocates have grown increasingly frustrated by the lack of communication from the clearinghouse.
“States are angry and in chaos, this has put them in a deep mess, and [the clearinghouse] response has been, ‘We’ll get to you when we get to you,’” said Wood. “We are growing increasingly frustrated that the Clearinghouse is not recognizing the urgent need to address this situation.”