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Most states have reduced their use of congregate care and rely more on kinship care.

AAP teams with research group to probe state progress on congregate care reforms

April 11, 2023

Most states have reduced their use of congregate care and rely more on kinship care — goals that align with the Family First Prevention Services Act, according to a new AAP report. However, improvements are needed to implement policy reforms.

Family First offers federal funding for states that place fewer children in out-of-home care and place those who are in out-of-home care into family-like settings. There have been major concerns about systemic abuse and other mistreatment in many congregate care facilities (e.g., group homes, residential facilities and other institutional settings).

The report Family First Implementation: A One-Year Review of State Progress in Reforming Congregate Care was a partnership with the University of Chicago’s Chapin Hall, a nonpartisan, nonprofit research organization focused on children, youth and families.

Family First, signed into law in 2018, also provides funding for some nonfamily settings, including qualified residential treatment programs (QRTPs). These settings are accredited and have licensed staff such as nurses on site. They facilitate outreach to family members, offer trauma-informed treatment and provide discharge planning and family-based support for six months after discharge.

Researchers surveyed child welfare agency leaders in 50 states, Washington, D.C., and Puerto Rico, between June and August 2022. They held focus groups with child welfare administrators, congregate care settings that converted to QRTPs and young people who lived in facilities that converted to the QRTPs during implementation of Family First.

The child welfare administrators noted that they were relying less on congregate care due to both Family First and state-led reforms. More than half of the states expect additional improvements over the next two years.

Still, state leaders cited lack of funding, staff and foster families as barriers.

Although QRTPs play a key role in many states’ congregate care, the study found a significant number of states have few or none of them; some states even send youths to out-of-state QRTPs.

In addition, while some states converted existing facilities to QRTPs, the young people reported that they did not notice substantive changes. They highlighted lack of specialized medical care and little assistance in fostering family connections, friendships and access to extracurricular activities in the community.

Policy recommendations 

To further advance Family First congregate care reform, the report recommends the following:

  • Provide states with additional resources to increase child welfare staff, foster homes, therapeutic care models as alternatives to congregate care and comprehensive community-based mental health services that support placement in the least restrictive environment.
  • Professionalize and invest in QRTP staff to ensure high-quality, individualized treatment.
  • Establish standards for youth- and family-driven QRTP treatment.
  • Require oversight for the array of congregate care placements, including supervised independent living and settings for survivors of sex trafficking, and the use of out-of-state QRTP placements.
  • Provide funding guidance to implement QRTPs.
  • Integrate QRTPs into the child welfare system’s continuum of prevention and aftercare, and reduce the unnecessary use of out-of-state care.
  • Establish performance- and outcome-based monitoring of QRTPs.

“We believe well-supported and well-resourced implementations of these changes could have a positive impact on youth and families,” researchers concluded.

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