Reliance on congregate care for foster youth went down in the year following the Family First Prevention Services Act’s new restrictions on federal funding for group foster care settings — but significant barriers persist in achieving the vision of the reform, according to a new report from the American Academy of Pediatrics and the University of Chicago’s Chapin Hall.
The report revealed that states are still failing to meet the law’s requirement that facility placements be limited to short-term interventions for youth with acute clinical need. States still lack the infrastructure to prevent unnecessary stays, the report states — child welfare administrators reported struggling to use residential care “as a specific treatment as opposed to an available placement slot” — and to help youth transition back into their community after stints in treatment centers.
And, tellingly, young people living in these group settings report little to no change in the culture or treatment services.
Increasing the number of foster youth living in family settings was among the key goals of the 2018 Family First Act. To push states to meet this goal, the law limits federal funding that pays for congregate care to just two weeks. But the law carved out several exceptions for places that could house youth longer, with federal funds, as long as a court signed off:
- Qualified residential treatment programs (QRTP), which are meant to be accredited sites for treating acute health needs while preparing a youth for a return to the community;
- Supervised independent living programs for older teens transitioning out of foster care;
- Programs for pregnant or parenting teens;
- Programs for youth who have experienced or are considered at risk for experiencing sex trafficking.
Researchers relied on a survey sent to child welfare directors in all 50 states, Washington, D.C. and Puerto Rico, and focus groups with child welfare administrators, QRTP leaders and young people who’ve lived in the treatment settings. California — home to the country’s largest child welfare system — did not participate in the study.
Overall, states have succeeded in reducing the number of children living in congregate care, and have simultaneously increased the number of children living with relatives. State leaders indicate that their congregate care reform efforts are ongoing and aligned with the vision of Family First.
Prior to the law’s implementation, 60% of states had 10% or less of their foster care population in group settings. Since Family First took effect, 75% of states house 10% or less in congregate care, the study found.
The study found that while some states have transitioned the majority of their congregate care facilities to licensed QRTPs, some states only offer supervised independent living settings or facilities for pregnant and parenting youth or trafficking survivors. Some states have none of the new type of approved treatment centers, and are routinely sending youth to out-of-state QRTPs as a result — a practice that has drawn harsh criticism from youth and advocates in recent years, and has since been halted in California.
Worth noting: Administrators in states like Texas and Georgia, whose foster care placement crises have led to youth sleeping in offices and hotels, have publicly blamed the decline in congregate care ability for the problem, but researchers said they found no evidence to support those claims.
“There was no significant association between states’ having reduced congregate care placement capacity and a lack of congregate care placement capacity being the reason for the inability to provide timely and appropriate placements,” the report states.
States reported that the biggest barriers to fully implementing the reforms laid out in Family First were issues with adequately staffing QRTPs, a dearth of foster families and therapeutic foster care options, and insufficient funding. Most states fund QRTPs through Title IV-E or a combination of IV-E and Medicaid dollars, the study found.
Young people and administrators alike reported concerns that facilities were understaffed, and that those working in these settings did not have the training or skills needed to provide the level of care residents required. Researchers point to high turnover, low pay, and lack of growth opportunity as factors leading to these workforce conditions.
Because of this, QRTPs struggle to provide services tailored to the individual needs of each resident. The report notes “a perceived lack of change in QRTPs from pre-existing congregate care culture and practice.”
Report authors listed a handful of policy recommendations aimed at helping states better meet the standards set by the Family First Act. Chief among them is providing funding and technical assistance to help states increase their supply of foster homes and array of community-based mental health resources and therapeutic foster care models that can serve as alternatives to facility placement.
Increasing and professionalizing residential treatment facility staff is also listed as a priority — bumping up pay, increasing training opportunities and keying in on retention strategies — in an effort to create more individualized and supportive care for youth. The authors also stress the need to integrate families into the programs’ treatment plans, and to support young people’s connection to social networks and communities.
Establishing treatment and outcome standards, comprehensive oversight, data tracking protocols, and an advisory committee to offer technical assistance on providing youth- and family-centered treatment also made the list of suggested improvements.
The full report is available here.