O3004: Fostering Families: A 50-state Review of Family First Congregate Care Reform Implementation

Background: Effective October 1, 2021, the Family First Prevention Services Act (Family First) transforms the provisions of congregate care for children in foster care. The goals of Family First are to help families remain safely together and ensure children in foster care can live in family settings. Family First incentivizes states to provide in-home, high-quality preventative care and reduce unnecessary use of congregate care by restricting Title IV-E funding for specified settings, including Qualified Residential Treatment Programs (QRTPs), to ensure children are only placed in congregate care when clinically appropriate and when their needs cannot be met in family settings. This three-phase study uses interviews, surveys, and focus groups to examine the policy implications of Family First congregate care reforms. The American Academy of Pediatrics (AAP) will synthesize key findings from each phase in a congressional report on the state of Family First congregate care reforms.

Methods: The first phase of the study consists of in-depth interviews with pediatricians serving children in foster care in different states, to understand their clinical perspectives on Family First congregate care reforms. The second phase is an original survey of 50 state child welfare agency directors sharing their views on the vision, capacity, funding, and challenges of implementing Family First congregate care reforms in their states. The final phase involves multi-state focus groups with individuals directly impacted by Family First congregate reforms to understand their experience: youth with lived experience in congregate care, congregate care providers, and child welfare administrators.

Results: Results from each phase of the study will inform the next phase. Themes of the in-depth pediatrician interviews highlighted difficulty in obtaining QRTP accreditation, further investment in foster and family-based placements to compensate for a reduction in congregate care, and uncertainty about the impact of QRTPs on children’s outcomes. These interviews informed the development of the national survey sent to each state’s child welfare agency director. Descriptive results of the survey will be used to inform the design of the multi-state focus groups with youth with lived experience in congregate care, congregate care providers, and child welfare administrators.

Conclusion: This study provides a comprehensive understanding of the initial implementation of Family First congregate care reforms, of which AAP was extensively involved in writing. Lessons learned, barriers, facilitators, implementation strategies, and person-centered feedback from the three complementary study phases will identify areas of support and need for legislators to consider regarding the impact and sustainability of the AAP-supported Family First congregate care reforms.