Early childhood is a developmental stage ripe with opportunities to support the healthy development of children, promote family well-being, and prevent the adverse effects of child maltreatment. States and communities across the country are taking different approaches to building out a robust continuum of prevention services and supports for families. Child- and family-serving systems, including child welfare and early childhood, play distinct but overlapping roles in providing support to families depending on their individual circumstances.
Through interviews with a range of child- and family-serving agencies and organizations across six states (Colorado, Michigan, Nebraska, New York, South Carolina, and Washington), we examined the current state of prevention and promotion efforts for families with infants and toddlers and how states are leveraging newer opportunities such as the federal Family First Prevention Services Act (Family First Act). We also explored facilitators and challenges states are facing as they seek to promote the holistic well-being of infants, toddlers, and their families and to prevent maltreatment and entry into foster care.
Across the board, each state expressed deep commitment and coordinated action designed to increase access to prevention services for families, including those with young children. Cross-system partners are enthusiastic about the ways in which they have begun expanding prevention services and have demonstrated great creativity in leveraging available, although limited, resources. Services for families with infants and toddlers include home visiting, infant and early childhood mental health services and supports, pre-and postnatal services, parental substance use treatment, Infant-Toddler Court (ITC) teams, and child care.
States are leveraging the Family First Act as an opportunity to maximize their resources for prevention across existing funding streams and build out a more robust continuum of primary, secondary, and tertiary prevention services, with a focus on moving supports as far “upstream” as possible. Child welfare agencies have historically operated at the secondary and tertiary prevention levels, supporting families with one or more risk factors for maltreatment (secondary prevention) and seeking to mitigate the harmful effects for families when maltreatment has already occurred (tertiary prevention). While the Family First Act reinforces this focus by requiring that children be at imminent risk for removal from their families in order to qualify for services, it has also spurred new activity. Planning for implementation has also brought new partners together across previously siloed systems and invigorated existing collaboration efforts.
While there are similarities across the states in their commitment to supporting families and preventing maltreatment, each state is also situated uniquely in its current and historical context. The six states therefore started their Family First Act planning from different places, which has shaped the opportunities they have stepped into. For example, some states had a strong infrastructure in place to deliver evidence-based practices (EBPs) through current providers, whereas others are building out a new service array and educating their caseworkers on these newly available services. Some states had strong cross-system relationships in place that facilitated more immediate collaborative planning, and others have used the Family First Act as an opportunity to build out needed partnerships. States are building on what they already had in place as they grow their prevention and promotion systems.
Holistic and responsive prevention systems extend far beyond the child welfare agency. States described cross-system collaboration as essential to supporting families. No one agency or organization can do this work alone, and it takes combining collective expertise and resources across partners to ensure families can access the supports they need within their communities, without entering the child welfare system. Each of the six states described using multisystem collaborative groups and regular cross-agency meetings to build and sustain the relationships needed to work in partnership. While partnership is essential, it is not easy; states described the importance of leaders committing to collaboration in the face of competing demands and priorities, and of all partners taking the time to develop relationships.
Prevention efforts must acknowledge and actively address the role of systemic racism and historic/current inequities in creating overrepresentation of Black, Hispanic, and Indigenous families; families living in poverty; and families with unmet health and behavioral health needs in the child welfare system. Strategies to advance equity used by states include conducting needs/readiness assessments, building equity into strategic plans and state budgets, establishing working groups, creating tools and resources, and focusing on building trust with families and communities who have been marginalized. Recognizing the unique government-to-government relationships between states and Tribes, tailored strategies to build and maintain relationships are needed to advance more equitable outcomes for Indigenous children and families. Each state also identified challenges to advancing equity through their prevention work (e.g., geographic access to services, a lack of culturally responsive services) and acknowledged that there was more work to be done (e.g., strengthening state-Tribal partnerships).
Each of the six states is striving to include individuals with lived expertise in their prevention planning, with room for ongoing improvement. One approach states have used to advance equity is engaging lived expertise throughout the development and implementation of prevention efforts. Some family engagement opportunities were more transactional (e.g., data collection), while others allowed for shared decision-making. The states most commonly engaged families in their planning through structured committees or advisory councils, either made entirely of individuals with lived expertise, or by bringing individuals with lived expertise together with other system partners.
While states braid together a variety of federal, state, and philanthropic funding sources to fund their prevention efforts, the funding requirements are complex and the available resources are insufficient. The requirements of the different sources can pose administrative challenges for both service providers and state agencies administering the funds. Restrictions and requirements for each funding source vary, as do the monitoring and billing systems used across agencies and divisions. Complying with the varied requirements is complex and time consuming, sometimes taking more effort than states can invest. Some states have not yet been able to draw down federal Title IV-E funding through the Family First Act due to administrative and data hurdles. States described the necessity of braiding together multiple funding sources for sustainability but stressed that available funding is not flexible enough to support the prevention work they envision.
The existing service array does not always align with families’ needs. Broadly, service availability can be limited in rural and frontier areas, and implementing evidence-based interventions can be prohibitively expensive. Specific to the Family First Act, states highlighted the importance of providing for families’ concrete needs, which is not reimbursable under the law, as well as the dearth of eligible programs designed for families of color, and for Black, Indigenous, or Hispanic families in particular.
Relatedly, the need to build and enhance the capacity of the child- and family-serving workforce remains a challenge to implementing prevention services. Specific workforce gaps include clinicians and other professionals trained to work with infants and toddlers; bilingual staff; staff who meet the credential requirements for various EBPs, particularly in rural areas; and mental health and substance use practitioners, including those specializing in infant mental health. States also described the importance of nurturing agency culture changes among child welfare case managers to shift to a prevention mindset and develop their understanding of available evidence-based programs in their communities. As states seek to incorporate greater family voice into their planning for practice and systems changes, many are also prioritizing hiring individuals with lived expertise to provide direct support to families.
States are optimistic about new and growing prevention efforts and eager to provide additional supports for families—including families with infants and toddlers—that truly meet their needs and reduce child maltreatment and child welfare system involvement. With the current emphasis on expansion, this is an ideal time for new and constructive partnerships between child welfare and early childhood agencies to set common goals, leverage new opportunities, and navigate challenges.
As states across the country continue to invest in prevention, we conclude the report with recommendations designed to help state leaders:
 The Family First Act allows states to draw down federal Title IV-E funding for services to prevent children from entering foster care. For more information on the Act, please see the full report.
Vivrette, R., McKlindon, A., Jordan, E., Haas, M., Ball, J., Mueterthies, G., Szrom, J., & Silloway, T. (2023). Using the Family First Act to grow and nurture support systems for families of young children: A look at promotion, prevention, and Family First Act implementation in six states. Child Trends. https://doi.org/10.56417/1882r3831m
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