Family First Prevention Services Act

What is the Family First Prevention Services Act?

On February 9, 2018, the landmark bipartisan Family First Prevention Services Act (FFPSA) was signed into law. The FFPSA includes reforms that support keeping children and youth, where possible, safely with their families, and helps ensure they are placed in the least restrictive, most family-like setting appropriate to their special needs when foster care is needed.

The FFPSA creates an expanded 50% reimbursement stream of federal funds to provide specific evidence-based models for in-home parenting, mental health and substance use disorder services to keep children and youth safely with their families without regards to income.

In addition, FFPSA increased the requirements for specific congregate care settings when youth with emotional and behavioral disturbance requiring special treatment and are unable to be cared for safely in a family-like setting.

With the Family First Prevention Services Act, the state has an opportunity to continue modernizing the child welfare system and enhance prevention services to strengthen families and prevent abuse and neglect. All children deserve the opportunity to grow up in safe, stable and nurturing families. The Family First Prevention Services Act represents meaningful steps towards better aligning federal child welfare policy with this critical vision for Montana’s children and families.

The Family First Prevention Services Act (FFPSA) provides an opportunity to improve resources and processes within Montana’s Child & Family Services Division, specifically efforts to address the critical needs of families who have children who are at risk of system involvement.

  • The law is the first major modernization of the child welfare system in three decades
  • Proper implementation of all elements will take time and continually guide the system to improve outcomes for families
  • Montana is developing a detailed Prevention Plan that will be used to support activities aimed at avoiding the entrance of children into the foster care system
  • Federally Approved Evidence-Based Prevention services when utilized with an individual family’s Prevention Plan can be reimbursed by 50% under Title IV-E funding
  • The approved prevention services are for in-home, skills-based training for parents; mental health therapy; and substance use disorder and treatment programs
  • Eligible services must be approved by the Title IV-E Prevention Services Clearinghouse


The Family First Prevention Services Act provides a focus on family foster care, with major reforms to certain levels of congregate care.

  • It imposes additional limits on congregate care beyond those recently implemented by Continuum of Care Reform. Title IV-E dollars may only be used to fund a congregate care placement for two weeks, unless: the youth is in a prenatal, postpartum, or parenting home to support teens; a supervised setting for a child 18 years of age or older; a high-quality residential facility for youth who have been victims of human trafficking; or a qualified residential treatment program (QRTP).
  • Children placed in a QRTP setting must be assessed within 30 days by a qualified individual to determine whether the needs of the child may be met in a lower level of care and a case-planning team meeting must be convened.
  • The Department of Public Health and Human Services has identified Therapeutic Group Homes as the appropriate level of care to meet the QRTP standard.
  • The FFPSA enacts a new court hearing for youth in a Therapeutic Group Home that requires the court, within 60 days of placement in a Therapeutic Group Home, to consider a qualified expert’s assessment to determine whether the child’s needs can be met in a foster family, and if not, determine whether the Therapeutic Group Home is the most appropriate level of care in the least restrictive environment.
  • Further, at every status review hearing the case plan must include evidence that the child’s continued placement is appropriate and meets the child’s needs in the least restrictive placement.

Initiating a Planning and Implementation Project

Montana Child and Family Services Division has instigated a FFPSA Planning and Implementation project, and has set the goal to provide understanding of the Family First Prevention Service Act, and use that understanding to plan and execute multiple sub-projects that will align Montana’s Child and Family Services Division practices with the requirements of the act.

Goals of Montana’s Planning and Implementation Project

The main goal of this project is to achieve compliance with the FFPSA and effectively communicate that compliance to the Administration for Children and Families (ACF). The project will achieve compliance with the FFPSA by October of 2021 but will include a roadmap for future achievements and compliance with future federal legislation.

Project Sub-Groups

The main project will develop and execute a series of sub-projects, including legislative updates and revisions to program guidelines. The stakeholder group will include DPHHS and CFSD representatives, members of the provider service community, academic subject matter experts, front-line social workers, legal counsel, tribal child welfare leaders, kinship care representatives, foster families, system-involved youth and children affected by the child welfare landscape in Montana.

Measuring Success

Project success will be achieved when all of the sub-plans have been completed, the ACF agrees that Montana’s actions have placed it in compliance with the Family First Prevention Service Act, and Montana Department of Public Health and Human Services leadership agrees that the state is properly positioned to make child welfare program changes in the future.

Montana is developing a detailed Title IV-E Prevention Plan, that will be used to support activities aimed at avoiding the entrance of children into the foster care system. Federally reimbursed services are meant to support and strengthen families, so children do not enter care. The plan is on target to be submitted to ACF in November 2020.

Eligible services must meet one of the following three thresholds:

  • Promising Practice: Created from an independently reviewed study that uses a control group and shows statistically significant results.
  • Supported Practice: Uses a random-controlled trial or rigorous quasi-experimental design. Must have sustained success for at least six months after the end of treatment.
  • Well-Supported Treatment: Shows success beyond a year after treatment


Current Federally Approved Evidence-Based Models requested in Montana’s Title IV-E Prevention Plan.

            Parents as Teachers

            Nurse Family Partnership

            Health Families America

            Parent Child Interaction Therapy

Children involved with the child welfare system should grow up in safe, stable and secure families that support their long-term well-being. Growing up in a family is essential for all children, especially those who have experienced abuse or neglect. Children and teens who cannot stay at home should live with relatives, close friends, family foster care or therapeutic foster care.

If children are unable to maintain in a family-like setting, then they should receive high-quality treatment services in the lowest level of care appropriate for their needs. Levels of congregate care utilized in Montana are:

  • Youth Shelter Care: Regularly serves youth under temporary conditions until the court, probation office, the department, or other appropriate social agency has made other provisions for their care. 
  • Youth Group Home: Means a youth care facility in which substitute care is provided to seven to twelve youth.
  • Therapeutic Group Home (Qualified Residential Treatment Program): Means a treatment facility providing therapeutic services licensed and under contract with the department as a youth care facility with the supervision and intensity of treatment required to manage and treat up to eight youth who present severe emotional disturbance and/or behavioral disorders as determined by the department.
  • Psychiatric Residential Treatment Facility: Means means a facility accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), Council on Accreditation (COA), or the Commission on Accreditation of Rehabilitation Facilities (CARF) or any other organizations designated by the Secretary of the United States Department of Health and Human Services as authorized to accredit psychiatric hospitals for Medicaid participation, and which operates for the primary purpose of providing residential psychiatric care to persons under 21 years of age. (The youth must meet the Montana Medicaid SED criteria for PRTF services).

There is a lot of information available about the Family First Prevention Services Act. Below are some resources we think will help!

Family First Act

Family First Legislation

State Level Child Maltreatment Data

Montana Kinship Navigator Program

Family First Montana Reference Sheet

If you have additional questions please contact Robert Cacace at