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AAP calls for innovative, comprehensive reauthorization of major child welfare law

April 1, 2024

The AAP is leading advocacy efforts to support the reauthorization of a major child welfare law set to expire at the end of the year.

Title IV-B of the Social Security Act funds key services to help families thrive, including preventing child maltreatment, supporting kinship and foster caregivers, and helping reunify families separated by the child welfare system.

This legislative session provides a critical opportunity for the Academy and its partners to elevate their priorities for strengthening the law and further reforming the child welfare system to be most supportive of children and families.

Helping families thrive

The Academy long has been calling for improvements to the child welfare system so it is aligned with the practices and policies that families need to thrive.

Pediatricians know children fare best in their families, and the AAP continues to emphasize the importance of keeping families together when it is safe and possible to do so.

Passage of the AAP-championed Family First Prevention Services Act in 2018 represented significant progress for child welfare reform, helping to shift the focus to support for families and preventing unnecessary foster care placement.

Title IV-B complements this approach by providing flexible funding to states and tribal communities for family preservation and reunification services. Title IV-B can fund services at the community level to prevent families ever encountering the child welfare system. Reunification services are vital since nearly half of children in foster care return home and need trauma-informed care and supports so their families remain stable.

Need for innovative, comprehensive reauthorization

Title IV-B recently has been funded through short-term extensions passed by Congress, including the 2022 year-end federal spending package that extended the law for one year without new funding or policy improvements.

In testimony submitted for the congressional record earlier this year, AAP President Benjamin D. Hoffman, M.D., FAAP, called for an “innovative and comprehensive reauthorization of Title IV-B.” The Academy also has been highlighting how the law can be strengthened as part of the reauthorization process.

Specifically, the AAP along with more than two dozen organizations, including adoption organizations, service providers, medical and public health groups, child welfare advocates and organizations representing those with lived experience, have coalesced around three main policy recommendations for Title IV-B’s reauthorization ( These priority areas include increasing funding for Title IV-B, supporting families’ mental health and building the workforce.

Increased funding

The AAP is calling for increased investments in key areas of Title IV-B, including family support services, family reunification efforts, and supports for kinship, foster and adoptive families.

With increased funding, Title IV-B can expand community-based prevention efforts that work to assist families before needing to interact with the child welfare system, such as Family Resource Centers that provide economic supports and needed supplies, like diapers and car seats.

For families involved in the child welfare system, it is critical that Congress invests in efforts to facilitate placement with other family members when possible and to recruit non-kin foster parents.

Additionally, more funding is needed to strengthen tribal child welfare protections to support American Indian/Alaska Native children and families, as well as to expand programs that prevent the need for foster care placement.

AAP Immediate Past President Sandy L. Chung, M.D., FAAP, emphasized these points in testimony submitted to a U.S. House of Representatives subcommittee late last year stating “…investing in Title IV-B now will save costs in the future; healthier children learn better, are more successful adults, and when a child lives in a safe, stable and nurturing household, they are imprinted with successful and healthy parenting strategies that they can utilize in their future.”

Mental health support

Supporting the mental health of children and families by creating a more trauma-responsive child welfare system is another priority for the AAP and its partners.

Children and families who interact with the child welfare system likely have experienced trauma and have unmet mental health needs. Through Title IV-B’s reauthorization, lawmakers can bolster systems and policies to better meet the needs of children and families and follow a trauma-informed approach.

Opportunities to improve how families’ mental health needs are addressed include training and recruiting staff and caregivers so they are equipped to nurture families and improving data collection to allow state and local child welfare agencies to identify trends and help families thrive.

The Academy also is urging Congress to look to research on child development and neuroscience to inform its policy approach to addressing trauma as well as to support efforts to better understand the national increase in parental substance use disorders and its impact on child health and well-being.

Workforce support

Lastly, the AAP is emphasizing the importance of a strong and stable workforce that is prepared to meet the needs of children and families no matter where they are in their interaction with the child welfare system.

It is essential that child welfare staff have the education, training and mental health support they need to navigate their complex and vital work, according to the Academy and its partners.

The child welfare workforce is under significant strain, compounded by severe shortages across the profession. The state of the workforce requires lawmakers to pass policies that address shortages, prevent burnout and provide adequate compensation to child welfare professionals.

Additionally, the AAP recognizes the important role of those with lived experiences in the child welfare system and is elevating the need to expand and fund services that engage peer experts in efforts to support families in the system.  

With bipartisan interest and momentum on its side, Title IV-B reauthorization serves as a critical opportunity to advance needed reforms to the child welfare system. The AAP, along with its partners, will continue to elevate these policy priorities to lawmakers as they consider the law’s reauthorization.

AAP members visit Capitol Hill to discuss child health issues

Members and liaisons of the AAP Committee on Federal Government Affairs (COFGA), along with AAP Executive Committee members, recently visited lawmakers on Capitol Hill to discuss two child health issues: supporting emergency medical services for children and protecting young people online. Pictured are COFGA members Kimberly Avila Edwards, M.D., FAAP (left), and Valerie Borum Smith, M.D., FAAP.

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