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  • August 23, 2022

    Family First and Qualified Residential Treatment Programs

    The Family First Prevention Services Act refocuses child welfare goals from reaction to prevention, requiring qualified residential treatment programs to meet more stringent qualifications for funding. Grace Tressler explores the Act’s various impacts, especially how its implementation in Wisconsin transforms the current landscape of the treatment programs.

    Grace Tressler

    The Family First Prevention Services Act of 2018 was signed into law in an effort to induce a dramatic shift in child welfare goals toward prevention and family preservation.1 Although Wisconsin deferred implementation until Oct. 1, 2021, the prevention services and appropriate placement model is now in full effect in the state.2

    The child welfare system’s reconceptualization focuses on changing from reaction to abuse and neglect, to connection with services for families at risk of entering the system. The main concern with a reaction-based model is that too many children were being removed from their families based on suspected abuse and neglect, when connection to services to prevent those concerns could be effective in preventing further abuse or neglect.3

    Grace Tressler headshot Grace Tressler, Marquette Class of 2023, is interested in practicing child and family law after graduation.

    About the Family First Prevention Services Act of 2018

    Two main focuses of the Act include Title I: Prevention Services, and Title II: Ensuring Appropriate Placements. The Act works to shift the focus from child-centered to family-centered by reallocating federal funds from Title IV-B and Title IV-E of the Social Security Act to “reimburs[e] states’ for families mental health services, substance abuse treatment, and in-home parenting skills training.”4

    The Act also seeks to transform the role of foster care into a biological family support system instead of replacement, ultimately aiming for family reunification.5

    This trauma-informed and community focused legislation does come with several limitations, however – one of the biggest being the change in procedure for group home placements.

    To achieve the goal of ensuring appropriate placements, the Act only allows states to collect Title IV-E funding for placements longer than two weeks if they are foster homes, specialized placements for pregnant or parenting youth, specialized placement for victims of sex trafficking, supervised independent living for youth 18+, family-based residential treatment facilities for substance abuse, or qualified residential treatment programs (QRTP). QRTP’s are designated for youth with serious mental health or behavioral needs and are utilized only when appropriate care is unavailable in their home.6

    Essentially, the Act prevents states from collecting federal reimbursements for children in group home for more than two weeks unless they fall within one of the enumerated categories.7 For continued federal reimbursement, the Act requires that the QRTP agency follow specified criteria including being a certified QRTP facility that is nationally accredited, has a nurse available 24/7, and uses a trauma-informed treatment model. The QRTP must, within 30 days of the initial placement, assess a child with a tool created by Health and Human Services. Court review and approval is mandatory within 60 days of the placement.

    If a child is placed in a congregate facility for over 12 consecutive months (18 nonconsecutive months for a child under 13), the head of the welfare agency must approve the placement. Finally, the QRTP must also provide aftercare support for six months post-discharge.8

    A Change in the Landscape for Treatment Programs

    So how does the implementation of 2021 Wisconsin Act 42 change the current child welfare landscape pertaining to QRTPs? In limiting funding to congregate care facilities or group homes unless all qualifications are met, the Act results in foster youth having fewer placements in group homes – known to negatively impact their well-being.

    Research indicates that institutional care is not optimal for children of any age, because it inhibits secure attachment to parental figures, which will in turn promotes risk of psychological harm, among other adversities.9 Even if a youth connects with an adult in a congregate care facility, the nature of the shift work and ever-changing staff make that attachment insecure. Adolescents without secure bonds to parental figures are likely to turn to their peers and are susceptible to deviant influence.

    A Positive Step?

    With stricter guidelines for congregate care facilities that receive federal funding, more facilities will close their doors. While limiting group home care may sound like a positive change in policy, where will the children, who would have been placed in these facilities, go?

    Closed congregate care facilities may result in larger foster homes or less-than-ideal foster placements, not prevention of foster care.10 Many states are already facing a shortage of foster homes and Wisconsin is no exception.11 Other worries include premature placement in a foster home following a group care placement due to the limit of 12 months if not approved by the head of the agency.12

    Furthermore, because of Medicaid’s exclusion of funding for Institutions for Mental Disease, most QRTPs cannot be federally funded if they contain 16 or more beds.13

    While the Family First Prevention Services Act is a much-needed overhaul of child welfare systems across the country, child welfare advocates must be proactive in identifying the weaknesses of this new legislation. Timeliness in making QRTP initial assessment, court findings, and detailed permanency plans highlighting the safety, necessity, and appropriateness of continued QRTP placement are crucial for ensuring that children get the care they need in the appropriate placement.14

    This article was originally published on the State Bar of Wisconsin’s Children & the Law Section Blog. Visit the State Bar sections or the Children & the Law Section webpages to learn more about the benefits of section membership.


    1 Fabiola Villalpando, Family First Prevention Services Act: An Overhaul of National Child Welfare Policies, 39 Child Legal Rts. J. 283 (2019).

    2 Justin Wolff and Dana Johnson, “Qualified Residential Treatment Programs (QRTP)” webinar, Children’s Court Improvement Program and Wisconsin Department of Children and Families, Oct. 13, 2021.

    3 Id.

    4 Caitlyn Garcia, “Replacing Foster Care with Family Care: The Family First Prevention Services Act of 2018, American Bar Association, 2019.

    5 Villalpando, at 284.

    6 Wolff and Johnson.

    7 Villalpando, at 285.

    8 Federal Family First Prevention Act Services DSP Informational Memo, Wisconsin Department of Children & Families, 2018.

    9 Dozier et al., Consensus Statement on Group Care for Children and Adolescents: A Statement of Policy of the American Orthopsychiatric Association, 84 Am. J. of Orthopsychiatry 3, 219-225, 2014.

    10 Garcia, supra note 6.

    11 Noelle Friel, “Brown County in need of foster homes,” NBC26, Sept. 17, 2021; Erin Sullivan, Fostering Through COVID: Pandemic brings foster care system & families new challenges, WMTV, Jan. 6, 2021.

    12Family First Act: a False Narrative, a Lack of Review, a Bad Law,” Child Welfare Monitor, Oct. 1, 2019.

    13Frequently Asked Questions About: The Family First Prevention Services Act, Quality Residential Treatment Programs (QRTPs), and the Medicaid IMD Exclusion Rule,” FamilyFirst.Org, Jan. 14, 2022.

    14 Wolff and Johnson.

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    Children & the Law Blog is published by the Children & the Law Section and the State Bar of Wisconsin; blog posts are written by section members. To contribute to this blog, contact Christie Christie and review Author Submission Guidelines. Learn more about the Children & the Law Section or become a member.

    Disclaimer: Views presented in blog posts are those of the blog post authors, not necessarily those of the Section or the State Bar of Wisconsin. Due to the rapidly changing nature of law and our reliance on information provided by outside sources, the State Bar of Wisconsin makes no warranty or guarantee concerning the accuracy or completeness of this content.

    © 2024 State Bar of Wisconsin, P.O. Box 7158, Madison, WI 53707-7158.

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