Primary Prevention

Late last year, the federal Children’s Bureau (CB) published a memo on reshaping the child welfare system to focus on primary prevention.  When “reshaping” is the goal, this is an announcement that bears closer scrutiny.  Here is some of the text providing the reasoning:

“To reverse troubling trends of increasing foster care populations and reports of maltreatment, along with unsatisfactory outcomes, CB’s top priority is to reshape child welfare in the United States to focus on proactively strengthening families through primary prevention of child maltreatment. To accomplish this, CB believes strongly that primary prevention services must be located in communities where families live, where they are easily accessible, and culturally responsive. Those services should also focus on the overall health and well-being of both children and families and be designed to promote resiliency and parenting capacity.”

After noting that primary prevention is the least supported intervention through federal funding, the memo continues:

“Committing to a broader continuum of prevention services that emphasizes primary prevention is contingent on a change of mindset and reorientation of what child welfare is intended to accomplish. Child protection will always be paramount and will always be needed, but the system can and should be designed to protect children by keeping families safe, healthy, and together whenever possible before remedial efforts become necessary.”

While there is likely no dissent to keeping families safely together before remedial efforts become necessary, the difficulty lies in developing effective prevention programs within funding constraints.  Prevention already receives little funding from the federal government. Ironically, the new federal funding mechanism to match state dollars in the Family First Prevention Services Act does not include any funding for primary prevention.  Compounding the lack of funding, the US Preventive Services Task Force examined primary prevention programs, including home visiting, and concluded that there is not sufficient evidence to determine the benefits of these programs on preventing child maltreatment.

So where can we turn to find assistance with implementing primary prevention services?  The New York City child welfare agency (ACS) has published a concept paper on prevention services.   Here’s their goal:

Prevention services aim to support families in their communities, promote family stability and well-being, and reduce the need for placement in foster care. These services may include case management, counseling, and clinical interventions offered primarily in-home and in a manner aligned with the diverse cultures and needs of NYC families.

Providers will be expected to assess safety and risk, give families voice and choice, harness data to drive quality assurance, and address racial inequities and social justice.  Families will be supported through building protective factors and addressing trauma, economic mobility, assessing and improving family well-being, meeting concrete needs, and helping families build positive relationships and social connections.

New York City intends to contract for 3 areas of prevention services and providers will be required to choose a pre-approved practice model under each area as follows:

  • Family Support:

Mobility Mentoring

Solution-Based Casework

Family Connections

 

  • Therapeutic and Treatment Programs:

Brief Strategic Family Therapy

Child Parent Psychotherapy

Functional Family Therapy

Multisystemic Therapy

Trauma Systems Therapy

 

  • Clinical Enhancements:

Trauma Treatment (TF-CBT)

Mental Health (CBT)

Special Needs (NYC is seeking input on promising models)

 

April is National Child Abuse Prevention Month so we will be hearing a lot more about prevention in coming weeks.

 

To view the Children’s Bureau memo visit: https://www.acf.hhs.gov/sites/default/files/cb/im1805.pdf

 

The New York City Concept Paper is available here: https://a068-rfponline.nyc.gov/rfponline/jsp/RFPDownloadDML.jsp

 

Posted by Priscilla Martens, NFPN Executive Director

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