Policy & Practice | Spring 2023

Policy & Practice | Spring 2023

The Magazine of the American Public Human Services

Association Spring 2023

Navigating Upstream to Build Resilient Communities Prevention in Practice



#APHSASUMMIT23 @APHSA1 Hyatt Regency Baltimore | Baltimore, MD MAY 21 24

Join us to learn The latest trends and innovations in policy, practice, and programs as we dive into this year's themes: • Strengthening the Sector • Advancing Social and Economic Mobility • Moving Human Services Upstream • Family First at Five Years

Top 5 Reasons to A end: 1. HEAR from Federal Partners 2. NETWORK with Peers from Across the Country 3. ATTEND Top Tier Educational Sessions 4. BE INSPIRED by Thought Leaders 5. DISCOVER Solutions for the Future Together

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Vol. 81, No. 1 Spring 2023




The Road Ahead Strengthening Families When the Public Health Emergency Ends

Leveraging Economic Supports Upstream A Pathway Forward for Families



Prioritizing Prevention Reflecting on Five Years of Family First

How Will Your Child Welfare System Stack up Against the Laws of Gravity? Capacity-Building Strategies to Strengthen Your Agency’s Foundation


3 President’s Memo

8 From Our Partners

31 Staff Spotlight

Aspirations for the Future of Human Services—Part Two: Community Engagement

Human Services' Unique Position: Flexing New Ways to Pursue Environmental Justice

Adrian Saldaña, Organizational Effectiveness Consultant

32 Staff Spotlight

5 Editor’s Note

26 Technology Speaks

Morgan McKinney, Project Associate, Process Innovation

Opening Our Digital Doors

Shifting from Health Systems to Systems of Health: Embracing

6 Research Corner

Staff Spotlight Francesca Sena, Instructional Designer

Technology Upstream to Address Homelessness

Call to Action: Connecting TANF and SNAP Spending with Child Welfare Outcomes

28 Race Equity Champions

Kansas Racial Equity Collaborative


Spring 2023 Policy & Practice

Strategic Industry Partners

APHSA Executive Governing Board

Chair Dannette R. Smith, CEO, Nebraska Department of Health and Human Services Vice Chair Rodney Adams, Former Director, Mecklenburg County (NC) Department of Community Resources Immediate Past Chair David A. Hansell, Former Commissioner, New York City Administration for Children’s Services Treasurer Kathy Park, CEO, Evident Change Elected Director Derrik Anderson, Executive Director, Race Matters for Juvenile Justice Elected Director Vannessa L. Dorantes, Commissioner, Connecticut Department of Children and Families

Elected Director Grace B. Hou, Secretary, Illinois Department of Human Services Elected Director


Sherron Rogers, Vice President and CFO, Johns Hopkins All Children’s Hospital Elected Director Terry J. Stigdon , Agency Head/Executive Director, Indiana Department of Child Services Elected Director Jennifer Sullivan , Senior Vice President for Strategic Operations, Atrium Health Elected Director Eboni Washington , Assistant Director, Clark County (NV) Juvenile Justice Services Leadership Council Representative Justin Brown, Secretary, Oklahoma Department of Human Services Local Council Representative Dan Makelky , Director, Douglas County (CO) Department of Human Services




Policy & Practice Spring 2023

president’s memo By Tracy Wareing Evans

Aspirations for the Future of Human Services Part Two: Community Engagement

O ver the past decade, leaders of human services agencies have increasingly focused on shifting supports to meet the needs of people and communities “upstream”— reducing the need for “downstream” and more costly services while also advancing social and economic mobility so families can succeed in the long term. Along this journey, it has become increasingly clear that if the human services system is to meet people not just where they are, but where they dream, we need to shift how we work. Through a series of interactive sessions with our member and partner network last year, APHSA explored what leaders aspire to for the future of human services by the year 2030. Three broad themes emerged: (1) community engagement, (2) systems alignment, and (3) the human services workforce. I previously shared key insights and major takeaways from these gatherings in my December article (see https://bit.ly/Dec22Memo) , and now I’ll dive deeper into the three themes that arose, starting with com munity engagement , and defining what the concept entails, exploring what progress would look like, and describing how we can achieve that progress through concrete steps. In future articles, I’ll explore systems alignment and the human services workforce . These insights offer a richer understanding of what’s needed to move from concept to operational and institutional realities. Indeed, what we learned from this visioning work played a key role in shaping APHSA’s updated strategy and

focus. Check out our updated Strategic Playbook and 2023 Action Plan to learn more (visit https://bit.ly/41mlBFT) . Understanding the Work of Community Engagement Leaders share a sense of optimism about the possibility of enhanced com munity engagement, as the dramatic shifts collectively experienced through the pandemic opened pathways to what is possible when people and com munities drive systems to work for them—instead of requiring people to “work” the systems. There is broad consensus that changing how we work is founda tional to advancing the equitable outcomes we desire for families and communities. Community engagement is not simply a matter of enhanced leadership development or additional training of the workforce. For many, the shift

requires new mental models and a new operating paradigm across all levels of government that puts community at the center. To achieve this, leaders rec ognize that we must reckon with the harm that systems—including human services—have done while demon strating that systems can and must work for the common good. Observations of our current practices include the following: n Public agencies typically do not organize or engage communities well. n Structural power 1 is inherent in our public services systems, and yet it is rarely acknowledged, let alone explicitly discussed, by the agencies (and by extension, agency leaders) that hold that power. n There is a need for a deep reckoning with how systems and struc tures have contributed directly to See President’s Memo on page 30


Spring 2023 Policy & Practice

Vol. 81, No. 1


Policy & Practice™ (ISSN 1942-6828) is published four times a year by the American Public Human Services Association, 1300 N. 17th Street, Suite 340, Arlington, VA 22209. For subscription information, contact APHSA at (202) 682-0100 or visit the website at www.aphsa.org. Copyright © 2023. All rights reserved. This magazine may not be reproduced in whole or in part without written permission from the publisher. The viewpoints expressed in contributors’ materials are the authors’ own and do not necessarily reflect the policies or views of APHSA. Postmaster: Send address changes to Policy & Practice 1300 N. 17th Street, Suite 340, Arlington, VA 22209

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2023 Advertising Calendar


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Community-Led Solutions: Partnerships for System Change

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Policy & Practice Spring 2023

editor’s note By Jessica Garon

Opening Our Digital Doors G reetings, members, partners, and friends! If you’re a long-standing reader of Policy & Practice , you may notice a few changes this year. First, our publi cation calendar has changed, and we will be publishing the magazine four times a year moving forward—spring, summer, fall, and winter.

us! And if you happen to be reading the print version right now, I encourage you to also stay up to date on our website at https://bit.ly/PolicyPracticeMag . You can catch up on past issues, share articles you love with colleagues and friends, or learn how to contribute your own stories of success to future issues. Last, just as in years past—because not everything should always change—you can pick up the latest issue of Policy & Practice at any of our conferences. Check out our 2023 lineup below. I hope to see you soon!

Second, to further our reach and increase knowledge throughout the human services sector and beyond, we are opening our digital version of the magazine to anyone and everyone. If you are a new reader, we’re glad you’ve joined




MAY 15−18

AAICPC Annual Business Meeting, Training Workshop, & Child Welfare Conference New Orleans, LA | aphsa.org/AAICPC/default.aspx



National Human Services Summit

Baltimore, MD | www.aphsanationalsummit.com


Economic Mobility & Well-Being Conference

Long Beach, CA | www.emwbconference.com

Information Technology Solutions Management for Human Services (ISM) and the Public Human Services Attorneys (PHSA) Education Conference & Expo


www.APHSA.org @APHSA1 T h e C a t a l y s t B L O G

Kissimmee, FL | www.ismconference.com

National Staff Development and Training Association (NSDTA) Annual Education Conference

Find the latest engagement opportunities with APHSA Visit https://bit.ly/APHSAevents

Pittsburgh, PA | www.nsdtaconference.com


Spring 2023 Policy & Practice

research corner

By Laura Haffield

Call to Action: Connecting TANF and SNAP Spending with Child Welfare Outcomes

C onsidering how much the price of everything—from milk to plane tickets—has changed in the past two years, it’s surprising that the budget allocation for Temporary Assistance for Needy Families (TANF) hasn’t changed in nearly two decades. Along with the Supplemental Nutrition Assistance Program (SNAP), TANF’s $16.5 billion block grant represents a major vehicle human services agencies have at their disposal for assisting families in times of need. Because of the flexibilities permitted in how states administer the program, it presents a significant research opportunity to shape policy. Evidence is also mounting that these investments have positive ripple effects on programs like child welfare. Dr. Michelle Motoyama-Johnson, pro fessor and associate dean for academic affairs at The Ohio State University College of Social Work, and Dr. Donna Ginther, professor of economics and director of the Institute for Policy & Social Research at the University of Kansas, recently authored two studies 1,2 gaining national attention on this topic. Their research builds on years of evidence 3 showing links between economic resources, child maltreat ment, and child welfare involvement. It examines the relationship between the generosity or restrictiveness of policies in assistance programs like SNAP and TANF, and the downstream impacts on child welfare. Some key findings: n Each TANF policy that restricted access to benefits was associated What Does the ResearchTell Us?

Ginther explained, “I’m an economist. In Kansas, TANF maximum payments per month for a family of three are $429, but average cost of foster care (with average stay of 19 months) is $2,000. It just doesn’t make fiscal sense.” Even more important are the costs in terms of preventing trauma of involving child protective services and family sepa ration. 4 Motoyama-Johnson emphasized, “Prevention is a change in mindset. There is a fiscal side to it, and a human side to it. These are life-long impacts.” Summing up the importance of these findings, Ginther said, “To the extent you can connect families with federal or state resources to support them, you’ll have better outcomes for kids.” What Can We Do Now? n Improve data matching and data sharing among programs. “These systems were not built for research purposes,” said Motoyama-Johnson.

with a 13 percent reduction in TANF caseloads, which then increased child welfare involvement. According to the study, “states that imposed TANF restrictions experienced […] statisti cally significant increases in neglect victims, total foster care placements, and foster care placements for reasons of neglect.” n In reverse, “extrapolating these numbers to the 2015 US child popu lation of 73.7 million would mean easing TANF restrictions may have resulted in 29,112 fewer children entering foster care.” What’s the Cost of Maintaining the Status Quo? Increasing access to benefits might sound pricey but consider the return on investment. TANF and SNAP tend to be less costly programs to administer, both in dollars and workforce resources.

Illustration by Chris Campbell


Policy & Practice Spring 2023

funding amounts and flexibilities allowed to states. They should also consider other federal programs like the Family First Prevention Services Act or the recent Child Care Tax Credit for additional opportunities to expand cash assistance. It’s time to take serious action to advocate for the prevention we know works. “It’s timely now that we pause and examine what the safety net looks like in each state. Take all the benefits together and cost of living into consid eration,” said Motoyama-Johnson. Specific questions to consider: l What other federal or state programs are supporting families alongside TANF and SNAP? l Are any local agencies piloting inno vative guaranteed income or other cash assistance programs that show impact? l What are some examples of suc cessful collaboration across these major programs? “We have enough evidence to make policy decisions based on the existing body of literature,” said Motoyama Johnson. “We don’t need to wait a

moment longer to change policies in a way that are more generous and increase access for families who are really in need of support.”

This limits academics’ ability to analyze and provide guidance on cross-system impacts. n Support policy with technology. Any technology that allows for greater access to benefits, and an understanding of what benefits a citizen may qualify for, will likely have a positive impact. Think client portals like MNbenefits, or data sharing and workflow automa tion between programs like SNAP Infants, and Children. Ginther noted that technology must be designed thoughtfully—for example, portals should be mobile-friendly to truly provide enhanced access. n Offer more generous, stable benefits that sufficiently support families. TANF payments vary from $250 to nearly $1,000 across states. Technology that reduces barriers to applying won’t impact outcomes if the benefits are still restrictive and unstable. n Revisit program structure. The federal government should re-examine both the block grant and the Special Supplemental Nutrition Program for Women,

Laura Haffield is the Director of Advocacy at Northwoods.

Reference Notes 1. Ginther, D., & Motoyama-Johnson, M. (2022). Associations between state TANF policies, child protective services involvement, and foster care placement. Health Affairs, 41 (12), 1744–1753. https://doi.org/10.1377/hlthaff.2022.00743 2. Johnson-Motoyama, M., Ginther, D. K., Oslund P., Jorgenson, L., Phillips, R., …Sattler, P. L. (2022). Association between state SNAP policies, child protective services involvement, and foster care in the US, 2004–2016. JAMA Network Open. https://doi.org/10.1001/ jamanetworkopen.2022.21509 3. Child Welfare Information Gateway. The national incidence study (NIS). https://www.childwelfare.gov/topics/ systemwide/statistics/nis/ 4. Child Welfare Information Gateway.

(2020). The importance of a trauma informed child welfare system. Issue Briefs . https://www.childwelfare.gov/ pubpdfs/trauma_informed.pdf

Connecting People WITH PURPOSE

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Courage to be more.

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Spring 2023 Policy & Practice

from our partners

By Chloe Green, Colleen Psomas, Matt Stagner, and Alex Bauer

Human Services’ Unique Position: Flexing New Ways to Pursue Environmental Justice

O n the surface, human services agencies may not play the most obvious role in how federal, state, and local governments respond to climate change. After all, they aren’t involved in agriculture, energy, or environmental policy. But human services agencies are responsible for enhancing the health and well-being of individuals and families across the country—and climate change and related environmental injustices impact the health and well-being of the people they serve every day. APHSA president and chief execu tive officer Tracy Wareing Evans, recently appeared as a guest on an episode of Mathematica’s podcast, On the Evidence , that dove into how human services fit into climate con versations. Wareing Evans joined Michael A. Becketts, director of the Fairfax County Department of Family Services; Shavana Howard, a former assistant secretary for the Louisiana Department of Children and Family Services; Matt Stagner, a vice presi dent at Mathematica; and podcast host J.B. Wogan to share the following insights into how they believe human services are positioned to address the inequitable impacts of climate change, promote environmental justice, and foster more resilient communities.

As severe climate events become increasingly commonplace, human services agencies are more frequently being stretched beyond their limits. The individuals and families that par ticipate in these services outside of emergency situations are further dis advantaged as the services on which they rely bleed dry, exacerbating existing health disparities and social inequities. In this way, communities

devastate a community by increasing food insecurity, heightening exposure to pollution, contaminating drinking water, and causing greater housing displacement. In the immediate after math, human services agencies react quickly and are often on the scene to provide support and resources to anyone in an affected area, whether they regularly rely on human services agencies or not.

Where Human Services and Environmental Justice Intersect

The human services sector is no stranger to responding to climate change’s damaging effects. An extreme weather event like a hurricane can

Illustration by Chris Campbell


Policy & Practice Spring 2023

By working together, human services agencies can learn what their peers are doing to respond to climate events and environmental inequities. Interdepartmental and cross-community conversations and connections can support more equitable access to programs, services, and resources in times of acute need and help human services agencies to become more proactive.

that have been historically under served, both economically and socially, bear the brunt of the impacts of climate change, though they are often the least equipped for adapting to or mitigating its risks. This dispro portionate suffering is exactly why the pursuit of environmental justice is a human services issue and why the U.S. Department of Health and Human Services houses an Office of Environmental Justice. Their mission is to “protect the health of disadvan taged communities and vulnerable populations on the frontlines of pollu tion, and other environmental hazards that affect health.” Envisioning a New Future for Human Services Many of the individuals, families, and communities human services agencies are designed to serve are the ones most directly impacted by environmental injustice and climate related hazards. Yet, the conversations surrounding the role human services should play in advancing environ mental justice are nascent, particularly when compared to other sectors such as health or agriculture. To develop programs and policies that can more proactively address communities’ needs in the face of climate change, human services agencies must examine how they might do things differently. Leaders need to consider how diverting from the status quo may uncover new ways to increase access to resources, services, and supports and create more equitable and resilient communities that can withstand—and even thrive amid—the current and future impacts of a changing climate. Getting Started Human services agencies have many existing responsibilities and may be hesitant to add more to their plate by taking on a more prominent role in responding to climate change. In reality, though, much of what agencies and leaders require to do this work already exists. Agencies deeply under stand the communities they serve, and now they need to learn to flex their existing muscles in new ways to respond to evolving needs. Below

inequitable impacts of climate change. Plus, rich qualitative data, gathered through conversations with impacted communities, can show where service gaps exist; identify those whom climate events may affect and how; and guide where to invest attention and resources in pursuit of environmental justice on broader and more localized levels. won’t have all the answers right away when diving into efforts to advance environmental justice, they can’t be afraid to try new things. They can talk to each other about missteps and wins while learning from both. Otherwise, the human services sector runs the risk of staying stagnant while the impacts of climate change barrel forward. The national conversation sur rounding human services’ role in advancing environmental justice has just begun. However, by talking about it, working together, looking to the evidence, and having the courage to try innovative ideas, agencies can pave the way for more equitable, resilient communities in the face of climate change. Chloe Green is a Senior Policy Associate for Food and Nutrition Services at the American Public Human Services Association. 4. Try It! While human services leadership

are some key ways human services agencies and leaders can get started:

1. Raise Awareness The impacts of climate change and environmental injustice are certainly not new, but the focus on these issues within human services is. As such, it’s crucial for leaders who grasp their vital role in advancing environmental justice to spread the word and create awareness among their peers. Dialogues that result from these awareness-raising efforts can drive a collective push toward devising equitable and enduring solutions to serve communities disproportionately affected by climate change. 2. Increase Partnerships and Collaboration By working together, human services agencies can learn what their peers are doing to respond to climate events and environmental inequities. Interdepartmental and cross-commu nity conversations and connections can support more equitable access to programs, services, and resources in times of acute need and help human services agencies to become more pro active. Pooling ideas and approaches can better equip agencies to provide critical social supports to the commu nities they serve and better position them to withstand adverse climate and weather events. 3. Leverage Data To help meet participants’ immediate needs and build stronger, more resilient communities, human services leaders need to look to the data. Agencies have access to a wealth of quantita tive data about the communities they serve, which can shine a light on the

Colleen Psomas is the Senior Communications Specialist at Mathematica.

Matt Stagner is the Vice President of Human Services at Mathematica.

Alex Bauer is an Advisory Services Analyst at Mathematica.


Spring 2023 Policy & Practice

Leveraging Economic Supports Upstream A Pathway Forward for Families

By Adrian Saldaña in conversation with Clare Anderson and Yasmin Grewal-Kök


Policy & Practice Spring 2023


Foundation and the Doris Duke Foundation. Kicking off in 2021, the AFEM initiative has brought together human services agency leaders from across the country to participate in regional and national learning communities that share strategies and innovations to remove systemic barriers to sustainable family economic mobility and well-being. Chapin Hall at the University of Chicago, a research and policy institution focused on child and family well-being, co-facilitated one AFEM learning community with support from members of APHSA’s Organizational Effectiveness (OE) team. At the learning com munity’s launch, state teams of child welfare and other human services leaders from Ohio, Oregon, New York, and Missouri received an overview of the current evidence linking ECS and child welfare outcomes. Thus began a six-month peer exchange to generate new and creative solutions to leveraging ECS as a primary prevention strategy to reduce family involvement in the child welfare system.

he 2010 National Incidence Study on Child Abuse and Neglect, published by the Administration for Children and Families, indicates that among

households with low socioeconomic status, rates of child maltreatment are five times higher than for all other children. Economic and concrete supports (ECS) have traditionally been deployed as poverty reduction tools, but research increas ingly links these financial supports, such as the Earned Income Tax Credit (EITC), Medicaid expansion, and Temporary Assistance for Needy Families (TANF), with reduced risk for inves tigations, foster care placements, and child fatalities—all critical child welfare outcomes. Human services leaders are increasingly looking to understand which upstream ECS can effec tively stabilize families to prevent involvement with the child welfare system. The American Public Human Services Association (APHSA) administers the Advancing Family and Economic Mobility (AFEM) initiative through generous support from the W.K. Kellogg


Spring 2023 Policy & Practice

looked at whether the associated effects of the policy increased or decreased risk for child welfare involvement. There’s a preponderance of evidence that when families lack access to ECS, are unable to meet their basic needs, or experience economic shocks, their risk for involvement with the child welfare system goes up. But when policies designed to provide ECS are available and made more accessible, we see decreased risk. Yasmin Grewal-Kök: The brief also lays the groundwork for the his torical policy context. As a result of our policy choices, we have a child welfare system that’s been separated and siloed from our economic support system, and they really need to be working together to address the root several strategies we’ve undertaken to bring the evidence to life and make it actionable. Our translational research was designed to bring it together, put it in one place, and help people understand the implications. Too often, child welfare is centered as the solution for child abuse and neglect, and the evidence points to much broader responsibilities. There is a need to deploy ECS as an explicit primary prevention strategy, as well as to pair ECS with more intensive supports or evidence-based practices when risk is high or families are being served by child welfare. As depicted in our roadmap illus tration (see page 13), this research is clear that prevention occurs upstream of child welfare, and it occurs in large and small policy decisions made across the human services sector. From here, I think the direction is to move beyond understanding the evidence and have it inform policy action. causes of child maltreatment. Clare: The policy brief is one of Adrian: At the launch of our learning community, we focused on an article, “State Spending on Public Benefit Programs and Child Maltreatment.” 1 Why did that study stand out? Clare: This analysis looked at state spending across several public benefits and very elegantly showed that additional spending—about $1,000 annually per person in poverty—was associated with reductions in reports to child welfare, substantiated cases

of child maltreatment, foster care placements, and child fatalities due to maltreatment. It is a clear study, linking together an easily understood policy analysis and spending analysis with system outcomes. Among the biggest takeaways of this body of science is that across the human services sector and across the macroeconomic policy framework, the decisions made by a policymaker in, for example, TANF, Medicaid, or the Supplemental Nutritional Assistance Program (SNAP) has an association with whether or not families come to the attention of child welfare. Yasmin: The study shows that if we want to have an impact on pre venting child maltreatment and child welfare involvement, we need to take a public health approach. For example, increased spending per person expe riencing conditions of poverty across different state policy options—health care, child care, tax credits, etc.—can have a broad impact at the population level as it relates to reducing involve ment with child welfare. Adrian: How can states trans late these research findings into actionable strategies led by human services leaders and practitioners, particularly within a systems- alignment framework? Yasmin: While many of these strategies will involve strengthening cross-system collaboration and larger systems alignment, there are studies showing that agencies can make changes that would improve the lives of children and families. For example, removing full-family sanctions for noncompliance with TANF work requirements or revising what is con sidered income when determining who is eligible for supportive services. Adrian: What are some effective ways to frame upstream prevention in a return on investment or cost savings context? Yasmin: Long-term cost savings are important and can resonate across the country. Placing a child in foster care has enormous financial implica tions when you look at the long-term costs programmatically, across the life course, and to society in general.

Adrian Saldaña , OE Consultant at APHSA, met with Clare Anderson , Senior Policy Fellow, and Yasmin Grewal-Kök , Senior Policy Analyst, at Chapin Hall to unpack the policy and practice implications of the body of research. This interview was edited for brevity and clarity. Adrian Saldaña: Chapin Hall released a policy brief (see https:// bit.ly/CHpolicybrief) , “System Transformation to Support Child and Family Well-Being: The Central Role of Economic and Concrete Supports” and a related slide deck (see https://bit.ly/ChapinDeck) . What were its core takeaways? Clare Anderson: The policy brief emerged as we were reviewing evidence from the last 30 years on ECS. Many of the studies from researchers across the country assessed a policy decision either at the state or federal level and then

Adrian Saldaña is an Organizational Effectiveness Consultant at the American Public Human Service Association (APHSA).

Clare Anderson is a Senior Policy Fellow at Chapin Hall.

Yasmin Grewal Kök is a Senior Policy Analyst at Chapin Hall.


Policy & Practice Spring 2023

access to ECS, you can reduce risk for child welfare involvement due to both neglect and physical abuse. This pro tective impact is particularly strong for families with young children. Conversely, several studies show a rela tionship between decreased access to ECS and increased hospital admissions for abusive head trauma among children younger than age five. I think we can all see how preventing devasting injury in the earliest years reduces life course economic burden and increases return on investment for the policy decisions toward which the evidence points us.

States in the AFEM learning com munity were intrigued to see, in the Puls study, that each additional 13 percent that states invested annually in public benefit programs, which is equivalent to spending an additional $1,000 per person living in poverty, was estimated to have upfront costs but save up to $153 billion in the long term due to reduced maltreatment related costs. Investing in families will likely save an enormous amount of money over time and result in reduced trauma, family separation, and decreased disproportionate rep resentation of children and families of color in child welfare.

Clare: We make decisions to resource out-of-home foster placement, which costs tens of thousands of dollars a year for each child. Even a portion of those dollars provided to families to meet their basic needs would have a return on investment that allows children to stay at home, in their com munities, and create a context in which it’s possible to thrive. We have the potential to unlock untapped human capital and generate broad societal benefits in addition to fiscal savings. Yasmin: Another thing that really stood out to the learning community from the research we shared is that by resourcing families and increasing

See Economic Supports on page 33


Spring 2023 Policy & Practice

Prioritizing Prevention

Reflecting on Five Years of Family First

By Meg Dygert, Lynn Tiede, and Kelly Crane


Policy & Practice Spring 2023


that demonstrate evidence of impact and are there fore eligible for 50 percent reimbursement. To receive reimbursement for programs under Family First, Title IV-E agencies must submit a Prevention Plan for review and approval by the Children’s Bureau in the Administration for Children and Families, the federal office that oversees the use of all Title IV-E funding. The Prevention Plan outlines each jurisdiction’s definition of candidacy, why that population is con sidered to be at “imminent risk,” and which programs they will use to reduce those risk factors. Plans are approved for a five-year period and can be amended at any time. Since the enactment of Family First, 40 states, 3 tribes, and the District of Columbia have approved Prevention Plans, 1 and 66 programs have been approved for use by the Clearinghouse.

February 2018, Congress passed the Family First Prevention Services Act (Family First) which, among other provisions, for the first-time authorized Title IV-E federal funding to be used for prevention services that address the causes of child maltreatment and not just its consequences. Under Family First, Title IV-E funding can now be used to provide evidence-based services—including in-home parenting programs, mental health services, substance misuse prevention and treat ment, and kinship navigator services—to children, youth, and families before the need for out-of-home care develops. The Title IV-E Prevention Services Clearinghouse (Clearinghouse), developed in accor dance with Family First, evaluates and rates programs


Spring 2023 Policy & Practice

Promising Approaches In the five years since Family First was passed, states, territories, and tribes have made incredible strides in reengineering existing service and administrative infrastructures to strengthen the implementation of prevention services. States are using Family First to create a pathway that leads families away from the child welfare system and toward the creation of an array of prevention supports that proactively promote family well-being and stability. The fol lowing three examples represent some promising approaches under Family First.

New York

NewYork’s Family First Prevention Plan is designed to build on the state’s history of investing in prevention, while also continuing to reform the child welfare system to address root causes. New York created two tracks for

families to become candidates for Family First prevention services. The Child Welfare Services Track serves families who have come to the attention of the child welfare system and are considered at risk to have their child(ren) removed. The second track begins to provide support to families before they encounter child welfare. The Healthy Families New York (HFNY) Track considers all families enrolled in the Healthy Families America (HFA) program as categorically eligible for Family First prevention funding. Healthy Families America, 2 the signature home visiting program of Prevent Child Abuse America is an evidence-based, early childhood home visitation program that is considered “well supported” in the Clearinghouse and serves families prenatally and with children up to age five. In the future, New York plans to expand their Family First services to include a Community Prevention Track that will support more families and children who are being served by community-based providers or other state agencies. While providing additional pathways for families to receive support, New York is being intentional about serving families without opening a child welfare case and reducing the reach of the child welfare agency. The Title IV-E agency also plans to invest and leverage resources to provide concrete and economic support such as child care and housing to families, and will explore a Universal Basic Income pilot. By shifting to a community-based, public health approach, New York plans to leverage Family First to invest in communities that are under-resourced and take steps to address historical inequities.

Meg Dygert is the Senior Policy Associate for Child & Family Well-Being at APHSA.


Colorado’s Family First Prevention Plan continues the state’s effort to serve more families before a report is made to child welfare. It builds on an array of existing state prevention efforts, including the Core Services Program, which funds strengths-based resources

Lynn Tiede is the Healthy Families America Public Policy Deputy at Prevent Child Abuse America.

and support to families. To leverage that existing prevention infrastructure, Colorado defined Family First candidacy very broadly. Families can be eligible even if they have not been subject to a child maltreatment report but share characteristics that identify risk, such as those battling substance use disorder, mental illness, or are in need of additional support for their child. This was done with the explicit intent “to proactively strengthen and support families as early as possible, before they are in crisis.” This candidacy definition provides flexibility for Colorado’s diverse county-administered system while also supporting further expansion and access to prevention services. Similar to New York, Colorado explicitly acknowledges the risk of further stigmatizing and unintentionally increasing child welfare involvement by providing Family First prevention support to more families. As they expand Family First–eligible services, the state is seeking to do so without opening a child welfare case. They are also monitoring data statewide for disproportionality and continuing to engage communities and tribes throughout implementation.

Kelly Crane is the State Policy Specialist at Prevent Child Abuse America.


Policy & Practice Spring 2023


eligible programs are delivered to families within the context of the INFPS, however, the state is submitting the INFPS model to the Title IV-E Clearinghouse for approval. Similar to

Indiana is another state leveraging the opportunities within Family First to expand the types of support families receive and to reach more families before they are in crisis. For child welfare–involved families, Indiana utilizes an intensive service model called Indiana Family Preservation Service Standard (INFPS). The INFPS providers conduct a holistic assessment and identify services and concrete supports, such as housing or transportation, that support families and ensure they can remain together. Providers are paid on a per diem basis and held accountable for family outcomes, incentivizing them to choose services that fit the family best, and to address their underlying needs and challenges. Currently, Indiana’s Family First–

New York, Indiana also expanded Family First prevention eligibility to families outside of child welfare through their Healthy Families Indiana (HFI) program. The HFI is available statewide and by creating this eligibility category, it provides an additional funding source for community-based providers to support families at high-risk “preemptively rather than reactively” and helps prevent any involvement with child welfare.

Limitations of Family First Family First represents a crucial shift within the child welfare system and how it functions, but it limits the prevention strategies that Title IV-E agencies can use to address the systemic conditions that largely con tribute to child abuse and neglect. As currently designed, interventions used under Family First primarily focus on individual behaviors and manage the impact of existing hard ships, only intervening after a family is in crisis. Data from the 2020 Child Maltreatment Report shows that the majority of child welfare system involvement is driven by conditions related to poverty, which the current system often conflates with willful

a comprehensive prevention infra structure that is human centered and includes community organizations.

neglect. None of the narrowly defined programs under Family First, and approved by the Clearinghouse, addresses the lack of concrete or economic resources that families face, leaving agencies unable to use Title IV-E funding to directly address the root causes of family instability. Additionally, Family First requires states to create a child-specific preven tion plan and collect data to track the child’s progress, even after prevention services have concluded. This level of case management and tracking perpetu ates the over-surveillance of families experiencing poverty, disproportionately affecting communities of color. Instead, fostering the conditions that allow all families to thrive requires jurisdictions to create a comprehensive prevention infrastructure that allows families to easily access supportive services whenever they need them. This com prehensive approach to child welfare

Prioritizing Prevention Family First offers an important tool for states, territories, and tribes to rethink how services are delivered and how organizations can partner to rei magine the range of supports available to keep families safely together and prevent children from entering foster care. Family First provides the legisla tive foundation for states to reorient their child welfare systems around pre vention and supporting families. It also has the potential to leverage additional federal funding to strengthen preven tion services in our country and create a system that is better equipped to support families and reduce the need for children to ever experience foster care. Through Family First, states can begin to demonstrate their com mitment to a coordinated continuum of services that reduces the need for foster care. However, there is more work that needs to be done to allow jurisdictions to create a prevention-led and equitable public services system. Reference Notes 1. U.S. Department of Health and Human Services. Status of submitted title IV-E prevention program five-year plans. https://www.acf.hhs.gov/cb/data/status submitted-title-iv-e-prevention-program five-year-plans 2. https://www.healthyfamiliesamerica.org/

The American Public Human Services Association (APHSA) and its affinity group, the National Association of Public Child Welfare Administrators (NAPCWA), have partnered with Prevent Child Abuse America to host a series of webinars in 2023 that will center on the Family First Prevention Services Act (Family First) and how human services has been advancing the use of prevention services to create a proactive system, centered on child and family well-being. The following article provides key background information, current implementation status, and opportunities to improve and maximize Family First in advancing the use of prevention services.

system prevention requires part nership with other supportive

services and community based organizations that

interact with and hold trust for families. The system would be co-designed and driven by those with lived expertise with the child welfare system and other public services. States, like those highlighted above, are great examples of how

Family First can be lev eraged to begin building


Spring 2023 Policy & Practice


Policy & Practice Spring 2023

ore than three years after the COVID-19 pandemic sent the world into lockdown, the U.S. public health emergency (PHE) will officially end this spring. 1 By Martha Donnelly, Jamia McDonald, C. “Parker” Parker, Tiffany Dover Fishman, Amy Grippi, and Beryl Washington The Road Ahead M Strengthening Families When the Public Health Emergency Ends

Delaware, for example, is participating in demonstration projects that provide certifica tion for free or reduced-price school meals through Medicaid. Under this program, Medicaid administrators can “directly certify” a student to receive these meals, eliminating the need for a separate application. “With direct certifica tion, the administrative burden on schools is reduced and the application process for families is simplified, thereby improving the integrity of this important nutrition program,” says Dr. Patty Bennett, Food and Nutrition Services Mid Atlantic Region Administrator. 6 On the housing front, rising rents coupled with inflation will increase housing insecurity and homelessness. In 2020, the U.S. Government Accountability Office estimated that a $100 increase in median rent corresponds to a 9 percent increase in the homelessness rate. 7 Since the number of families facing housing challenges often exceeds available supports, it’s essential to target assistance effectively. Los Angeles County uses a computer model developed by UCLA’s California Policy Lab to predict clients’ risk of homelessness, allowing its outreach workers to focus their efforts on those at greatest risk. As Janey Rountree, the lab’s founding executive director, explains, “You would never have enough money to provide pre vention for everyone who appears to be at risk. You really need another strategy to find out who’s actually going to become homeless if they don’t get immediate assistance.” 8 The county’s model uses a broad range of data from eight county systems, covering everything from emergency room visits and psychiatric hospitalizations to receipts of cash and food

In its aftermath, the outlook for families that are facing poverty looks much bleaker, and the human services workforce that will answer their calls and review their cases has been depleted; the costs of food, rent, and utilities have risen sharply; 2 Supplemental Nutrition Assistance Program benefits are returning to pre-pandemic levels; community food pantries are stretched perilously thin; 3 and current estimates indicate that up to 15.8 million Americans stand to lose their Medicaid coverage. 4 This doesn’t bode well for children who face increased risks as poverty exerts additional stress on parents and caregivers due to limited resources that can impact a child’s health and well-being. 5 Protecting children in these unstable situations will require a robust multi-system and com munity response, one that strengthens families’ economic well-being, minimizes disruptions to health coverage, supports the human services workforce that serves them, and enhances com munity prevention efforts to reduce the strain on our overburdened child welfare system. Strengthening Families’ Health and Economic Well-Being As PHE supports and protections expire, human services agencies should look for creative ways to offset increased food and housing inse curity for families and minimize disruptions to health coverage.


Spring 2023 Policy & Practice

Those looking for ideas can take a page from Georgia’s playbook. The “Georgia Access” campaign increases awareness of affordable private and state health care options through a data-driven approach that helps the state better understand uninsured audiences, their pain points and behaviors, and the channels they use. Various audiences are met on the channels they use every day, with tailored content across TV, radio, newspaper, Google, social media, and online ads. The program has been credited with a 30 percent increase in enrollment on Healthcare.gov over the previous year. Supporting a Strained Human Services System Ask human services leaders, espe cially those in child welfare, what they worry about these days and the work force crisis tops the list. The staffing challenges facing their agencies aren’t new, of course. Human services is often an underpaid, emotionally taxing, and thankless job. These typical workforce challenges have been exacerbated by the pandemic. There is insufficient staff to meet the demands of the work, including seeing children in a timely fashion, maintaining reasonable caseload sizes, and meeting statutory timeframes. An exodus of supervisors has left new

caseworkers without support and men torship. Parallel workforce crises in behavioral health and criminal justice add to the problem. And a dearth of students entering social work programs is creating pipeline challenges. 10 More evictions, increased homeless ness, rising food insecurity, and other economic stresses will increase the volume of calls and further strain an already overwhelmed workforce. The PHE led states to rapidly hire new eligibility workers and case workers while changing the typical day-to-day responsibilities of staff with expanded coverage require ments. Staff hired in the past two years generally need more experience processing renewals and doing home visits. Even more tenured workers need refresher training. Many states have started to broaden the incentives they offer to attract and retain workers. Some have increased compensation through salary increases and pay for overtime, hazardous duty, and on-call service. Others have intro duced flexible work schedules, offered work-from-home and hybrid arrange ments, enhanced benefits, and adopted tuition reimbursement programs—all strategies designed to improve the value proposition they offer current and prospective employees. To improve the well-being of its staff, Nebraska’s Division of Child and Family

assistance. Those at greatest risk of homelessness receive direct outreach from the county’s Housing for Health Division, which offers financial assis tance and referrals to other services. 9 When the PHE ends, millions of Americans will move from Medicaid to the Affordable Care Act mar ketplace, an employer plan, or the Children’s Health Insurance Program (CHIP). Many others could lose their coverage or experience coverage gaps as states resume annual eligi bility reviews. This transition raises myriad issues. Renewal forms can be confusing and can’t always be completed online or over the phone; clients who moved during the pandemic won’t even receive notice of their need to renew if their contact information isn’t current. Many clients who are no longer eligible for Medicaid may not know to enroll for marketplace coverage. To minimize the disruption to families, successful states will imple ment comprehensive strategies to reduce churn and incorrect Medicaid enrollments and to ease families’ tran sition from Medicaid or CHIP to the marketplace. Given the increased risk for children with disabilities, chronic illness, or behavioral or mental health conditions, jurisdictions may priori tize families with children affected by these conditions.

C. “Parker” Parker , LAPSW, is a manager with Deloitte Consulting LLP’s Government & Public Services practice.

Martha Donnelly is a specialist leader with Deloitte Consulting LLP.

Jamia McDonald, JD, is a principal with Deloitte Consulting LLP’s

Government & Public Services practice.

Amy Grippi , LSW, is a manager with Deloitte Consulting LLP’s Government & Public Services practice.

Tiffany Dovey Fishman is a Senior Manager with Deloitte’s Center for Government Insights practice.

Beryl Washington is a specialist leader with Deloitte Consulting LLP’s

Government & Public Services practice.

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