On June 10, the House and Senate released the text of a bipartisan, bicameral child welfare reform bill that would substantially increase funding for evidence-based prevention services. The House Ways and Means Committee is expected to take up the legislation (HR 5456) on June 15.
Under the legislation, states could use federal child welfare entitlement (Title IV-E) funds to cover the cost of up to 12 months of preventive mental health, substance abuse, or in-home parenting programs for children at risk of entering the foster care system and/or for their parents or caregivers. Pregnant or parenting foster youth are also eligible.
Federal funding would subsidize a portion of state costs, similar to the matching rates used for other entitlements like Medicaid. According to a preliminary estimate from the nonpartisan Congressional Budget Office, the cost of these prevention-oriented services would be partly offset by keeping families together and reducing the use of more expensive group homes for foster children.
To qualify for federal funding, the services must meet the bill’s standards for practices that are promising, supported, or well-supported by evidence (as defined below). Starting October 1, 2019, at least half of the federal share of funding for such services must meet the highest (well-supported) evidence standard.
The Department of Health and Human Services is directed to issue a pre-approved list of services that satisfy the bill’s requirements by October 1, 2018 and to update the list as often as it deems necessary. The legislation also authorizes the creation of a clearinghouse for evaluating research on these services.
Update: The House Ways and Means Committee approved the bill on June 15. It is now awaiting consideration on the House floor and in the Senate.
Evidence Tiers
PROMISING PRACTICE.—A practice shall be considered to be a promising practice’ if the practice is superior to an appropriate comparison practice using conventional standards of statistical significance (in terms of demonstrated meaningful improvements in validated measures of important child and parent outcomes, such as mental health, substance abuse, and child safety and well-being), as established by the results or outcomes of at least 1 study that—
(I) was rated by an independent systematic review for the quality of the study design and execution and determined to be well-designed and well-executed; and
(II) utilized some form of control (such as an untreated group, a placebo group, or a wait list study).
SUPPORTED PRACTICE.—A practice shall be considered to be a supported practice’ if—
(I) the practice is superior to an appropriate comparison practice using conventional standards of statistical significance (in terms of demonstrated meaningful improvements in validated measures of important child and parent outcomes, such as mental health, substance abuse, and child safety and well-being), as established by the results or outcomes of at least 1 study that—
(aa) was rated by an independent systematic review for the quality of the study design and execution and determined to be well-designed and well-executed;
(bb) was a rigorous random-controlled trial (or, if not available, a study using a rigorous quasi-experimental research design); and
(cc) was carried out in a usual care or practice setting; and
(II) the study described in subclause (I) established that the practice has a sustained effect (when compared to a control group) for at least 6 months beyond the end of the treatment.
WELL-SUPPORTED PRACTICE.—A practice shall be considered to be a well-supported practice’ if—
(I) the practice is superior to an appropriate comparison practice using conventional standards of statistical significance (in terms of demonstrated meaningful improvements in validated measures of important child and parent outcomes, such as mental health, substance abuse, and child safety and well-being), as established by the results or outcomes of at least 2 studies that—
(aa) were rated by an independent systematic review for the quality of the study design and execution and determined to be well-designed and well-executed;
(bb) were rigorous random controlled trials (or, if not available, studies using a rigorous quasi-experimental research design); and
(cc) were carried out in a usual care or practice setting; and
(II) at least 1 of the studies described in subclause (I) established that the practice has a sustained effect (when compared to a control group) for at least 1 year beyond the end of treatment.
Related
- Foster Care Innovation Initiative Charts a Different Path to Evidence (December 6, 2014)
- Building Performance Systems in Child Welfare (February 8, 2016)
- Pay for Success in Child Welfare: A Case Study (February 12, 2015)