Implementing California’s Child Welfare Prevention Services Program

analysis full 2026-27 BUDGET Implementing California’s Child Welfare Prevention Services Program GABRIEL PETEK | LEGISLATIVE ANALYST JANUARY 2026 www.lao.ca.gov 1 analysis full AN LAO REPORT 2 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Executive Summary California Working to Implement Prevention Services Program. The Legislature passed Chapter 86 of 2021 (AB 153, Committee on Budget)—creating the Family First Prevention Services (FFPS) program—to provide services to children and families to prevent the need for child welfare system involvement and foster care placement. The program allows counties to receive federal Title IV-E dollars for eligible services—a new and expanded use of this uncapped federal funding source. In addition to federally eligible prevention services, FFPS also encourages counties to deliver a broad range of prevention activities tailored to their local populations. Alongside the state legislation, the 2021-22 budget provided $222.4 million for block grants to counties to develop their programs and begin implementing prevention services. The block grants are available for expenditure through June 30, 2028. Implementation Includes Many Steps and Will Take Years to Execute Fully. Implementing the prevention services program established by FFPS represents a major undertaking and reflects a broader shift within child welfare policy over time to focus more on preventing entry into foster care. Implementing FFPS entails many steps that the Department of Social Services (DSS) and counties (as well as service providers and other stakeholders) must take. At this stage of implementation, DSS and counties have completed a number of essential steps in terms of preparation and planning and currently are working to implement services (with some counties already beginning to implement some new prevention services). This report provides a comprehensive update of implementation progress to date and highlights major areas where key program guidance remains forthcoming. Developing Sustainable Funding Plans Will Be Needed for Prevention Services Program to Meet Its Goals. While the new federally allowable use of Title IV-E funding for prevention services is significant, there are some notable limitations of the funding—such as the types of eligible programs and criteria for participation. In addition, Title IV-E reimbursement for services requires that counties provide $1 of local funding for every $1 of federal funding claimed. Counties’ initial capacity to provide a local funding match is unclear. Additionally, services beyond the scope of federally eligible programs will need to be funded entirely by state/local sources. Child welfare funding in California is complex, with counties receiving dedicated revenues from the state to operate their child welfare programs. These revenues are based on complex formulas that are not directly tied to current caseloads and costs. While counties should achieve foster care cost savings by implementing effective child welfare prevention services (because there should be fewer children entering foster care), achieving those savings requires up-front investments. Given these factors, both the state and counties will need to consider how multiple funding streams—including Medi-Cal, local, state, and other federal sources—could be used to support child welfare prevention services. Opportunities for Legislative Input. Our review of initial implementation by DSS, counties, and other stakeholders identifies some challenges and opportunities for the state. This report offers the Legislature a number of considerations to help ensure implementation of child welfare prevention services can continue in a manner that (1) allows the state to maximize federal funding whenever possible and (2) helps promote prevention services that can benefit as many at-risk families across the state as possible. As the state remains in the relatively early phases of implementation, now is a good time for the Legislature to weigh in. www.lao.ca.gov 3 analysis full AN LAO REPORT 4 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT INTRODUCTION In recent years, California’s child welfare system services since 2021-22. First, we provide has focused on prevention services as a way to background information regarding California’s try to mitigate maltreatment risks and the need for child welfare system and how it is funded. child removal and placement into foster care. The Second, we describe progress at the state level in state’s efforts were bolstered by the 2018 passage developing and overseeing the new child welfare of the federal Family First Prevention Services prevention services program. Third, we describe Act (FFPSA). The law allows states to receive counties’ plans for implementing child welfare federal foster care funding when providing certain prevention services at the local level, as well as prevention services to specific at-risk families, in some challenges they have faced. Finally, we addition to other federal law changes impacting provide some considerations and options for the other areas of child welfare and foster care policy. Legislature moving forward to help improve the California began implementing FFPSA in 2021-22 state’s prevention services program and ensure and provided a one-time $222.4 million General implementation proceeds in a manner that (1) allows Fund block grant to local child welfare agencies for the state to maximize federal funding whenever prevention services. possible and (2) helps promote sustainable In this publication, we discuss the state’s and prevention services that can benefit as many at-risk counties’ ongoing implementation of prevention families across the state as possible. BACKGROUND California’s Child Welfare System Serves California’s Child Welfare System Is to Protect Children and Strengthen Families. Locally Implemented, With Requirements When children experience abuse or neglect, the and Oversight From State and Federal state provides a variety of services to protect Governments. Local child welfare agencies children and strengthen families. The state implement child welfare programs on behalf of provides prevention services—such as substance the state, with oversight from the Department of use disorder treatment and in-home parenting Social Services (DSS) and federal government. support—to families at risk of child removal to Local agencies include county child welfare help families remain together, if possible. When departments, county probation departments, children cannot remain safely in their homes, and certain tribes. (We will refer to the various the state provides temporary out-of-home types of local child welfare agencies as “counties” placements through the foster care system, often throughout this publication for simplicity.) Funding while providing services to parents with the aim for child welfare programs comes from the federal of safely reunifying children with their families. and state governments, along with local funds. If children are unable to safely return to their The federal and state governments set standards in parents, the state provides assistance to establish terms of the service components that all local child a permanent placement for children, for example, welfare agencies must implement and oversee the through adoption or guardianship. (For a more quality of service delivery. detailed overview of California’s child welfare California’s Child Welfare System Is Funded system, refer to our publication California’s Child by a Mix of Federal, State, and Local Funds. Welfare System: Addressing Disproportionalities The state’s diverse array of child welfare programs and Disparities.) is funded by federal, state, and local funds, as www.lao.ca.gov 5 analysis full AN LAO REPORT shown by Figure 1. The proportional mix of funds monthly costs. In addition to the monthly assistance used to support any particular child welfare payment amount, other costs related to the child payment or service varies depending on whether and parents’ needs may include, for example, a family is eligible for federal financial participation Medi-Cal coverage for behavioral health services. (a determination generally based on the income Foster care and permanent placements represent of the family from which a child was removed about half of the state’s General Fund spending in foster care cases). Furthermore, the cost of on child welfare programs. Therefore, effective services and supports may vary greatly based on prevention efforts could help significantly reduce the needs of the individual child and family (and the state’s overall costs in this area. whether the child has been placed into foster care Federal Funding Includes a Couple Major or is able to remain safely at home). For example, in Uncapped and Capped Sources. When a family 2025-26, the estimated average monthly assistance requires child welfare services or foster care, payment for foster care across all placement states may claim federal funds (that is, seek federal types is around $3,500, although for an individual reimbursement) for part of the cost of providing child that payment may range from around $1,300 care and services for the child and family if they to nearly $18,000 or more depending on where meet federal eligibility requirements. State and a child is placed and the level of care needed. local governments provide funding for the portion Figure 2 provides more information about the of costs not covered by federal funds, based on different out-of-home foster placements (that is, cost-sharing proportions determined by the federal not those who are able to remain safely in their government. These federal funds are provided homes) and permanent placement types, along with pursuant to Title IV-E (related to foster care) and Title IV-B (related to child welfare) of the Social Figure 1 Security Act. • Title IV-E. These funds are an uncapped Federal, State, and Local Funding for Child federal entitlement—meaning there is no limit Welfare Totals $10 Billion in 2025-26 on how much Title IV-E dollars states are able (In Billions) to claim for eligible expenditures—although eligible expenditures are relatively limited. Primarily, states may claim these funds for foster care, adoption, and guardianship assistance payments for eligible families. Eligibility for Title IV-E federal financial Federal participation in foster care cases generally $3.5 depends on the income of the family from Localª which a child was removed. More specifically, $5.1 families must meet 1996 federal Aid to Families with Dependent Children eligibility requirements. This roughly equates to earnings of under $1,000 per month for a State $1.1 family of four. (In 2025-26, an estimated Reimbursements $0.3 53 percent of foster care cases meet this requirement.) California must spend about $1 from nonfederal sources for every $1 a Local funding primarily comes from counties' 1991 and 2011 realignment allocations. of Title IV-E funding the state receives (the Note: Includes estimated local assistance expenditures for foster care programs, child federal matching rates differ across states welfare services, Adoption Assistance Program, Kinship Guardianship and for different program components). In Assistance Payment Program, Approved Relative Caregiver Program, and associated automation costs. California, the nonfederal funds come primarily from counties’ 2011 realignment allocations. 6 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Figure 2 Foster and Permanent Placement Types and Costs Number of Placements, 2025-26 90,000 Foster youth with intensive behavioral Average $1,707 health needs preventing them from being 80,000 placed safely or stably with a resource KinGAP and AAP are permanent family may be placed in a congregate placements. Youth are no longer in care setting, providing specialty foster care, but their permanent 70,000 behavioral health services and 24-hour guardians/adoptive parents receive Resource families may be relatives, a supervision. Placements are designed to monthly support to help ensure the foster family approved by the county, be short term, with the goal of safely child's ongoing stability. transitioning youth to resource families. 60,000 or a family approved by a private FFA. FFA-approved foster families receive additional supports through 50,000 the FFA and therefore may care for Older, more self-sufficient youth may youth with higher-level physical, be placed in supervised independent mental, or behavioral health needs. 40,000 living placements or transitional housing. These are independent settings, such as apartments, where 30,000 M r o a n n t g h e ly f r c o o m st s y re o c u e th iv e m m ay o n liv th e l y in f d o e s p te e r n c d a e r n e t l p y a a y n m d e nts. $1,301-$3,396 per child/youth 20,000 Average $1,535 Range from 10,000 $2,617-$7,078 Average $2,896 Varies $17,616 or more Placements With Placements With Congregate Care Independent and Other Foster KinGAPª AAPª County-Approved FFA-Approved Placements Transitional Placement Resource Families Resource Families Placements for Older Youth a Children remain counted in KinGAP and AAP from the time they are placed until they age out (in most cases at age 18). Other foster placement includes pre-adoption placements, tribally approved homes, court specified homes, placements with guardians, and others. Number of placements for county-approved and FFA-approved resource families, congregate care, independent and transitional, and other placements reflect reported placements as of July 1, 2025. Number of placements for KinGAP and AAP are Department of Social Services' estimates for 2025-26 average monthly placements. FFA = Foster Family Agency; KinGAP = Kinship Guardianship Assistance Payment Program, and AAP = Adoption Assistance Program. Realignment is explained in the box on Other federal funding sources (all of which are the next page. For federal fiscal year capped) that California uses for foster care and 2024, an estimated nearly $10 billion in broader child welfare purposes include some Title IV-E funding was provided nationally. Temporary Assistance for Needy Families dollars • Title IV-B. On the other hand, allowable uses and various federal grants, such as the Child for Title IV-B funds are significantly broader Abuse Prevention Program and Chafee Program for and can be used more generally for child and Successful Transition to Adulthood. family services. However, these funds are FFPSA Expanded Allowable Uses of Title IV-E provided to states as annual capped amounts to Include Prevention Services. Passed as part (with the specific amounts varying from year of the 2018 Bipartisan Budget Act, FFPSA expands to year based on the federal appropriation allowable uses of federal Title IV-E funds to include and other factors). Title IV-B funding also support for certain federally approved services to includes some competitive grants that states help prevent children and families from entering (or may apply for related to child welfare research, reentering) the foster care system. States are able training, and demonstration projects. States to claim Title IV-E funds for this new, expanded must spend at least $1 from nonfederal purpose within specific parameters. For example: sources for every $3 of Title IV-B funding the (1) services must be provided to children/families state receives. For federal fiscal year 2024, who are “candidates” for foster care (as assessed around $1.4 billion in Title IV-B funding was by states/local child welfare agencies) or to provided nationally. pregnant/parenting youth in foster care; (2) funds www.lao.ca.gov 7 analysis full AN LAO REPORT 2011 Realignment California’s Child Welfare Programs Were “Realigned” to Counties. Until 2011-12, the state General Fund and counties shared significant portions of the nonfederal costs of administering child welfare programs. In 2011, the state enacted legislation and the voters adopted constitutional amendments (in 2012) known as 2011 realignment, which gave counties full nonfederal fiscal responsibility for child welfare. The legislation also dedicated a portion of the state’s sales and use tax and vehicle license fee revenues—along with a portion of the associated growth in these revenues—to counties to administer these programs (as well as some public safety, behavioral health, and adult protective services programs). In addition to dedicated 2011 realignment dollars, counties also may choose to spend other local funds (such as county general fund resources) on child welfare programs. As a result of Proposition 30 (2012), under 2011 realignment, counties either are not responsible or only partially responsible for child welfare programmatic cost increases resulting from federal, state, and judicial policy changes. Proposition 30 establishes that counties only need to implement new state policies that increase overall program costs to the extent that the state provides the funding for those policies. Counties are responsible, however, for all other increases in child welfare costs—for example, those associated with rising caseloads. Conversely, if overall child welfare costs fall, counties retain those savings. Realignment Shifted Some Child Welfare Program Dynamics. Parameters set by realignment and Proposition 30 have resulted in some important dynamics within local- and state-level child welfare program implementation: • The state has implemented many newer child welfare program components as county options rather than mandated programs. • California’s 58 counties make different implementation choices for child welfare programs. This approach can allow counties to make program choices that best meet the needs of their local populations, but at the state level can create challenges in tracking local program choices. Tracking how counties choose to spend their realignment dollars also presents challenges at the state level. • Counties have incentive to achieve programmatic savings because they can retain those savings, freeing up funds for other child welfare services. However, because counties only receive realignment funds from the state to cover their costs, they also must identify other resources when costs exceed those amounts. may be claimed only for specific evidence-based care systems and programs, such as limiting practices (EBPs) in the areas of mental health, the circumstances in which federal funding substance use, in-home parenting skills, and may be used to pay for congregate foster care kinship navigation that are included in a federal placements. These changes must be made before clearinghouse; and (3) states must be able to track states may seek Title IV-E reimbursement for certain metrics for the individual/family receiving prevention services. these services, to monitor expenditures and to California Working to Implement Prevention demonstrate whether services help to reduce foster Services Program. In response to FFPSA, placements. A summary of these requirements, with California’s Legislature passed Chapter 86 of 2021 some additional detail, is included in Figure 3. (AB 153, Committee on Budget)—creating the Beyond expanding allowable uses of Title IV-E Family First Prevention Services (FFPS) program—to funding for prevention, FFPSA requires states enact the federally required changes under FFPSA to make a number of changes to their foster and to establish a new state prevention services 8 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Figure 3 Federal Requirements for States to Claim Title IV-E Dollars for Prevention Services States must prepare a five-year prevention plan, States must track a number of data elements for each which must be approved by the federal government. individual child/family receiving services. • Data include basic demographic information and individual-level service provision and expenditure information, as well as whether the child Services must be provided to children/families who the enters foster care within 12 months. state determines are at risk of foster placement, and may be provided only for a limited time. States must include a well-designed and rigorous • Assessment made by state/local child welfare agency. evaluation strategy for each evidence-based practice • Services may be provided for up to 12 months from the time of candidacy determination. included in their state prevention plan. • An individual prevention services plan must be developed for each child/family. • Evaluation waivers may be requested for programs that have received • States must ensure a trauma-informed approach to service delivery. the highest rating from the federal clearinghouse. States must monitor and oversee the safety of children while they/their families receive prevention services. States must use Title IV-E prevention services to supplement, and not supplant, their existing foster care • Monitoring should include periodic risk assessments and prevention expenditures. re-assessments. • Federal government provides guidelines for calculating a state's required maintenance of effort. Funds may be claimed only for specific evidence-based practices in the areas of mental health, substance use, Title IV-E is the payor of last resort for prevention services. in-home parenting skills, and kinship naviagation that are included in a federal clearinghouse. • Primarily, this means that any services eligible for federal Medicaid funding must first draw down those funds prior to Title IV-E dollars. • Services in the clearinghouse are rated via review of existing program evaluations and research studies, according to clearinghouse standards. Ratings are based on the extent to which programs have demonstrated positive outcomes. Prior to claiming Title IV-E for prevention services, state • Services must be delivered to "model fidelity," meaning implementation is conducted in line with specific criteria across various program domains, must be in compliance with other mandatory requirements relating to areas such as training requirements, practitioner qualifications, under the Family First Prevention Services Act (FFPSA). and data tracking. • States must ensure at least 50 percent of federal funds are used for • This includes new federal congregate care and aftercare requirements services that receive the highest rating from the clearinghouse (meaning under FFPSA Part IV. these programs were found by the clearinghouse to have the most evidence in support of positive outcomes). program to take advantage of the expanded and counties (as well as service providers and other eligible uses for Title IV-E funds and implement a stakeholders) must take, as described throughout broader array of prevention services. Alongside the remainder of this report. At a high level, major this state legislation, the 2021-22 budget provided steps and their current status are laid out in $222.4 million for block grants to counties to begin Figure 4 on the next page and described in further implementing Title IV-E prevention services, as detail in the following sections. At this current well as any other non-federally eligible prevention stage of implementation, DSS and counties have services they choose to implement. The block completed a number of essential steps in terms grants are available for expenditure through of preparation and planning. Counties currently June 30, 2028. are preparing to implement services (with some FFPS Implementation Includes Many Steps. counties already beginning to implement some new Implementing the prevention services program prevention services). established by FFPS entails many steps that DSS www.lao.ca.gov 9 analysis full AN LAO REPORT care, and reduce disproportionate Figure 4 entries into foster care” for overrepresented groups. The FFPS FFPS Program Prevention Services Implementation Steps program marks an important milestone of shifts over time Implementation Step Responsible Entity Status within California’s child welfare Develop five-year state prevention services plan for DSS Complete policy focus toward prevention. federal approval Simultaneously, the state is Develop individual county prevention services plans Counties Complete undergoing other complementary efforts to help reshape child Issue state block grant dollars DSS Complete welfare policy. As one notable example of Train child welfare workers and service providers DSS, counties Ongoing prevention-related activities around prevention outside of FFPS, major efforts are underway to reform mandated Coordinate with Medi-Cal program to determine DSS Ongoing what services are eligible for Medi-Cal funding reporting of child maltreatment. Mandated reporters are defined in I m ss o u n e it o s r t i a n t g e - a le n v d e l e c v o a n lu t a ra ti c o t n s , f a o n r d te o c t h h n e ic r a p l r a o s g s ra is m ta n e c le e m , ents DSS Ongoing state law as individuals in specific occupations (such as teachers, Issue program guidance for counties DSS Ongoing medical professionals, and law enforcement) who are required to Develop county-level MOUs and issue contracts for Counties report any known or suspected Ongoing service providers child maltreatment. Reporting maltreatment is an important Begin delivering prevention services to eligible families Counties, service providers Ongoing part of protecting children. However, various stakeholders B ev e id gi e n n c c l e a - im ba in s g e d T i p tle re I v V e - n E t i f o u n n d se in r g v ic fo e r s allowable DSS, counties Not yet have raised concerns that the begun current mandated reporting law and practices overemphasize Develop plans to sustain prevention services funding Counties beyond the duration of state block grant Ongoing liability and result in trauma due to unnecessary reports to child FFPS = Family First Prevention Services; DSS = Department of Social Services; welfare, rather than focusing on and MOU = Memorandum of Understanding. supporting families and preventing formal child welfare system FFPS Program Represents One Important involvement when not necessary for a child’s safety. Pillar of State’s Shift Toward Prevention Focus. These complementary reform efforts directed at The state’s prevention services program goes mandated reporting and other policy areas will be beyond implementing federally eligible services, important to help achieve the state’s overall vision with the overall aim to “improve outcomes for for its prevention services program. children and families, reduce entries into foster STATE’S PROGRESS TOWARD IMPLEMENTING FFPS PREVENTION PROGRAM Typically, when legislation creates a new implementation guidance to counties, often child welfare program or directs changes to through all-county letters, which are distributed existing programs, DSS provides more detailed to local child welfare program directors and 10 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT published online. Depending on the level of detail State Plan Includes Ten Well-Supported required, DSS usually provides program guidance EBPs. The federal clearinghouse rates EBPs as within 6 to 12 months. For more substantial well-supported, supported, promising, or not program changes, such as those required to having enough evidence. See the box on the next implement FFPS, guidance may take longer to page for a more detailed explanation of these develop. As implementation of the FFPS program federal ratings. California’s state plan includes progresses, DSS has published, and continues to the ten EBPs in the federal clearinghouse that work toward developing, numerous major pieces were rated as well-supported at the time of of guidance for counties, as described throughout plan development. These ten EBPs include four this section. home-visiting/parenting skills programs, two mental health programs, one substance abuse program, Five-Year State and three programs that are designed to address Prevention Services Plan more than one of those areas. The EBPs are: DSS Developed State Prevention Plan. As a • Nurse-Family Partnership: Home-visiting first step toward implementing the prevention program for low-income, first-time mothers. services portion of FFPS (prior to issuing internal Visiting nurses support mothers with parenting state-level guidance on specific program skills, preventative health practices, and components), DSS needed to develop a state individualized goal setting and planning. prevention plan for federal approval. According to • Healthy Families America: Home-visiting federal requirements, state plans must detail the program delivered by community-based state’s selection of evidence-based prevention organizations for new families with children services; plans for identifying populations at at risk for maltreatment or adverse childhood imminent risk of entry or reentry into foster care experiences, typically offered for three years. (who may be assessed as candidates); and the Overall program goals are to strengthen approach that will be used to comply with federal nurturing parent-child relationships, promote evaluation, model fidelity, activity and outcome healthy child development, and reduce tracking and reporting, and safety and risk risk factors. monitoring requirements. (The concept of “model • Parents as Teachers: Home-visiting parent fidelity” is described in the nearby box.) education program wherein trained parent In developing the state plan, DSS held numerous educators teach new parents skills intended stakeholder feedback sessions. DSS also received to promote positive child development and significant feedback from the federal government prevent child maltreatment. Sessions also may upon initial submission of the state plan. be delivered in schools, child care centers, or The updated plan ultimately was approved by the other community spaces. federal government in April 2023. Model Fidelity “Model fidelity” refers to how closely an implemented program adheres to the original, evidence-based model on which it is based. A program delivered to high fidelity refers to a program that is implemented as designed in terms of factors such as planning and implementation phases, staff qualifications and training, data collection, and tracking outcomes. A program implemented in a way that deviates significantly from the model on which it is based would have low fidelity and not adhere to model fidelity requirements. Model fidelity is important in the context of evidence based practices because if programs are not implemented in the same way they are tested and modeled, they are unlikely to yield the desired results. www.lao.ca.gov 11 analysis full AN LAO REPORT Federal Clearinghouse Ratings The federal Title IV-E Prevention Services Clearinghouse rates programs as “well-supported,” “supported,” “promising,” or not meeting criteria at the time of federal review. To make a rating, federal reviewers review available program evaluations and research studies that assess the program in question. The clearinghouse maintains a Handbook of Standards and Procedures, which lays out the specific criteria and methods used for rating programs. For example, reviewers consider program goals and how interventions are designed to meet those goals, how implementation is carried out, and to what extent program participation results in desired outcomes. The particular standards that programs must meet for each rating level in terms of design and execution and demonstrating positive outcomes are described in the nearby figure. Federal Title IV-E Prevention Services Clearinghouse Ratings Criteria Standards to Achieve Rating Rating Design and Execution Favorable Effects Well-supported • At least two studies with nonoverlapping • At least two studies must demonstrate favorable effects samples carried out in usual care or practice in a target outcome domain. settings must achieve a rating of moderate or • At least one study must demonstrate a sustained high on design and execution. favorable effect of at least 12 months beyond the end of treatment on at least one target outcome. Supported • At least one study carried out in a usual care • At least one study must demonstrate a sustained or practice setting must achieve a rating of favorable effect of at least six months beyond the end of moderate or high on design and execution. treatment on at least one target outcome. Promising • At least one study must achieve a rating of • At least one study must demonstrate a favorable effect moderate or high on study design and execution. on a target outcome. Does not meet Programs that do not meet any of the other rating thresholds upon review of all studies are rated as not currently criteria meeting criteria. There are a few advantages to states choosing well-supported programs. First, these programs are proven to achieve results. Additionally, the federal Family First Prevention Services Act (FFPSA) requires states to rigorously evaluate the evidence-based practices (EBPs) they select; however, states can request to waive this requirement for well-supported EBPs—thereby allowing states to avoid the costly process of intensive evaluation. (California has received waivers for all of its selected well-supported EBPs.) Finally, FFPSA requires states to ensure that at least 50 percent of Title IV-E funding received for prevention services goes toward well-supported programs. (By choosing all well-supported programs, California is guaranteed to meet this requirement.) • Parent-Child Interaction Therapy: Mental • Multisystemic Therapy: Intensive mental health counseling for young children and their health program for older youth to promote caregivers that aims to decrease externalizing pro-social behavior and reduce criminal child behavior problems, increase positive activity, mental health symptoms, out-of-home parenting behaviors, and improve the quality placements, and substance use. Master’s of the parent-child relationship. Parents are level therapists carry small caseloads and coached by Master’s level specially trained deliver the intensive interventions typically for therapists in behavior-management and a few months. relationship skills. 12 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT • Brief Strategic Family Therapy: Family State Plan Identifies Many Characteristics therapy program for children and youth who of At-Risk Populations. Candidates for Title display or are at risk for developing behaviors IV-E prevention services are individuals who are such as substance use, conduct problems, demonstrated to be at “imminent risk” of entry and delinquency. Trained counselors typically or reentry into foster care, and/or their parents meet with families weekly for 12 to 16 sessions or kin caregivers. Child welfare agencies must in community centers, clinics, or in home. assess each individual candidate to determine their • Family Check-Up: Family therapy program eligibility. (Pregnant or parenting foster youth are for children ages 2 through 17, aimed automatically eligible for prevention services and at building parenting skills and family do not require individual assessments.) California’s management practices with the goal of state plan requires counties to assess individuals to improving child emotional, behavioral, and determine candidacy using an “unbiased process academic outcomes. and/or tools to assess risk.” (To aid counties in this assessment, DSS is working to develop a • Functional Family Therapy: Family therapy candidacy determination guide including concrete program for at-risk, older youth who have examples on how to assess for candidacy in an been referred for behavioral or emotional unbiased manner.) Specific groups which the problems. Therapists typically meet weekly state has identified in the state plan as targets with families for three to six months. for potential candidates—those with potentially • Homebuilders: Intensive home-visiting higher likelihood of imminent need for foster program providing counseling, skill building, placement, but who could remain safely at home and support services for families who have with intervention (to be determined via the individual children at imminent risk of out-of-home assessment)—include: placement or who are in placement and cannot be reunified without intensive • Youth and families receiving voluntary or in-home services. court-ordered Family Maintenance services. • Motivational Interviewing: Method of • Probation youth. counseling or more general case management • Youth whose guardianship or adoption is at practice that aims to identify ambivalence for risk of disruption. change and increase motivation by helping • Youth who are subject to a maltreatment clients prepare for and act on changes allegation and investigation but for whom the (including behavioral changes) needed to court does not pursue a case. attain their personal goals. The plan includes • Youth with a sibling in foster care. practices for general case management and • Homeless or runaway youth. substance abuse treatment. • Substance-exposed newborns. More detailed descriptions of these EBPs, • Youth who were victims of commercial along with additional information, can be found in sexual exploitation. Appendix A at the end of this publication. • Youth exposed to domestic violence. Many of these EBPs (or versions of them) can • Youth whose caretakers experience substance already be found in parts of California to varying use disorder. degrees. For example, according to the state plan, Nurse-Family Partnership currently is operated State Plan Allows Community Pathway for (primarily by county public health departments) in Connecting Families to Prevention Services. 22 counties, and specially trained Master’s level California’s state plan includes a “community therapists offer Parent-Child Interaction Therapy in pathway,” which is intended to support a “no 40 cities. However, prior to FFPSA, none of these wrong door” approach for families to access EBPs have been offered by child welfare agencies prevention services. Essentially, a community specifically as prevention services. pathway will allow families to access prevention www.lao.ca.gov 13 analysis full AN LAO REPORT services prior to a call being made to the child welfare hotline, Figure 5 thus potentially mitigating for that family the trauma and stigma Pathways to Child Welfare Prevention Services that can accompany formal child welfare system involvement. Child may be experiencing or at risk of experiencing maltreatment. This is a novel approach to expand access for families to prevention Community Pathway to Services: Traditional/Child Welfare Agency Pathway to Services: services, and California is one of only a few states to include such an approach in its state plan. Under the community pathway Family is referred or independently A mandated reporter (or someone seeks supports/services from a else who knows the child/family) outlined in California’s plan, a trusted community organization, makes an allegation to a child abuse such as a family resource center. hotline or law enforcement. community-based organization such as a family resource center— rather than the local child welfare agency—will be the family’s Local child welfare agency or tribe primary liaison to supports and determines whether the child/family are candidates for Title IV-E prevention services. The community-based services. organization will be responsible for overseeing the child’s/family’s prevention services plan and ensuring the child remains safe in If it is determined that the child can If it is determined that the child remain safely at home with supportive can remain safely at home with the home. The local child welfare services, then the county's contracted supportive services, then the family community organization(s) will facilitate may be referred to the county's agency still will need to be involved services to stabilize and strengthen the Differential Response program tangentially in the family’s case in family and will be responsible for (for participating counties) or may monitoring the child's safety. participate in voluntary or that the agency will be responsible court-mandated Family Maintenance for confirming the child/family is services. an eligible candidate for Title IV-E prevention services. Figure 5 illustrates a theoretical community pathway, compared to a traditional Data about the family and their services child welfare agency pathway. are recorded in CWS-CARES and used for claiming Title IV-E funding when eligible. DSS will provide additional guidance for counties around the specific requirements of implementing a community If at any point it is determined that the child cannot remain safely at home, the local child pathway. As one initial step, in welfare agency will facilitate a foster placement March 2025, DSS published a and/or take other steps necessary to ensure the child's safety. community pathway framework brief, which details various activities that the state, local Note: Illustrative only. Reflects high-level information in the California Five-Year Prevention Plan. Actual pathways may vary by county and specifics of community pathway will depend on guidance from the Department of child welfare agencies, and Social Services. community partners will need CWS-CARES = Child Welfare System-California Automated Response and Engagement System. to complete as they take steps toward implementing county-level community pathways. 14 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Other State Actions Prevention Training for Child Welfare Workforce. FFPSA requires states to provide DSS Reviewed and Approved Counties’ training and support for caseworkers in assessing Comprehensive Prevention Plans (CPPs). what children and their families need, connecting Counties opting in to receive state block grant to the families served, knowing how to access dollars to help implement prevention services were and deliver the needed trauma-informed and required to create CPPs. (More information about evidence-based services, and overseeing and the specific elements of CPPs and counties’ efforts evaluating the continuing appropriateness of the in completing them is provided in the next section.) services. Training for California’s child welfare social CPPs go beyond the specific EBPs eligible for workers and other child welfare staff is provided federal reimbursement and require counties to by five regional training academies (collectively scope comprehensive prevention service offerings referred to as CalAcademies), which offer training to serve their local populations. In addition to on a wide variety of topics and professional preparing the state plan, DSS reviewed and educational opportunities for child welfare staff. approved counties’ individual CPPs, which were Most of the CalAcademies are affiliated with required to be completed and submitted to DSS regional University of California and California by July 2023. To assist counties in developing their State University campuses, alongside Los Angeles CPPs, DSS shared guidance, offered technical County’s child welfare training department. assistance, and provided templates for counties CalAcademies also track workforce training and to use. conduct evaluations of child welfare staff through Coordination With County Behavioral Health pre- and post-surveys using an online learning and and Medi-Cal. FFPSA specifies that Title IV-E management system. In the State Prevention Plan, funding is the “payor of last resort.” This means DSS describes a three-tiered training approach to that, for EBPs that already may be funded (partially ensure child welfare staff and community providers or wholly) by Medicaid or other federal sources, are prepared to implement prevention services: counties must first draw down those other eligible funding streams prior to receiving Title IV-E dollars. • Tier 1 focuses on prevention principles and Beyond the scope of child welfare programs, consists of a series of webinars for county the Department of Health Care Services (DHCS) staff, community-based organization staff, and is working to implement a number of statewide tribal staff at all levels. reforms to Medi-Cal, the state’s Medicaid program. • Tier 2 focuses on specific elements of FFPS These health care reforms include efforts to expand program requirements, such as candidacy and coverage of EBPs available under Medi-Cal. In eligibility and monitoring and risk assessment. May 2025, DHCS clarified (via a joint DSS/DHCS These trainings are more targeted toward all-county letter) Medi-Cal coverage for EBPs child welfare caseworkers/other county child focused on children and youth, including some welfare staff. of the ten EBPs which DSS included in the State • Tier 3 focuses on implementing EBPs. Prevention Plan for FFPSA. All county behavioral Trainings are targeted toward providers as well health plans are required to cover these services as child welfare staff. for Medi-Cal-enrolled youth under the age of Initial trainings under Tier 3 have been provided, 21. Additionally, DHCS is supporting counties to and DSS released guidance (via All-County develop their capacity to deliver these services Letter 25-73) in October 2025 with more detail to eligible youth and families who access them as about the specific training sessions and required prevention services. participants for Tier 1. Curriculum development for The two departments plan to provide additional Tier 2 is ongoing and guidance will be released in guidance on model fidelity standards for the the coming months. EBPs, Title IV-E prevention services that intersect with Medi-Cal services, and a model joint written protocol related to payor of last resort. www.lao.ca.gov 15 analysis full AN LAO REPORT DSS Administrative Progress. To help the Child and Family Policy Institute of California guide ongoing FFPS program development, (CFPIC) to help coordinate and communicate with DSS formed the FFPS Advisory Committee, counties and other program stakeholders. CFPIC tasked with monitoring and advising on program has conducted numerous technical assistance implementation. The committee includes webinars, helps coordinate the FFPS Advisory subcommittees focused on the community Committee and its subcommittees, and maintains pathway, Title IV-E advisory, training and technical a consolidated cache of program resources online. assistance, continuous quality improvement DSS also contracted Chapin Hall to develop a (CQI), and fiscal advisory. The FFPS Advisory series of CQI frameworks with specific outcome Committee was launched in spring 2023 and and model fidelity measures for each of the meets quarterly. Additionally, as DSS often does state’s selected EBPs. In March 2025, Chapin when implementing new, significant program Hall published a statewide CQI plan and also has changes, the department hired some third-party published individual EBP frameworks for each contractors to assist with various elements of FFPS of the state’s selected EBPs (all available online implementation. For example, DSS contracted through CFPIC’s resources webpage). COUNTIES’ PREVENTION PLANS While DSS has provided state-level guidance In developing CPPs, counties conducted needs and as described above—because California’s capacity assessments, mapped current services child welfare system is state-supervised and and providers, defined the specific EBPs and other county-administered—actual implementation prevention services they will implement and who decisions are made by counties and vary across the target populations will be, and more. Counties the state. This section details the steps counties will continue to scope their programs and build have taken toward full implementation of FFPS the needed capacities to deliver their selected program prevention services. Our analysis is services in the coming years. We describe some informed by our review of counties’ comprehensive trends from the counties and their CPPs in the next prevention plans, as well as by conversations with several paragraphs. (Appendix B offers more detail various counties. regarding which counties selected specific EBPs.) Most Counties Noted Benefits of the Process Counties Prepared Individual of Developing CPP. During discussions with Prevention Plans various counties across the state, nearly all of To Receive State Block Grant Funding, the counties we met with shared that they found Counties Developed CPPs. As noted earlier, the process of developing a CPP beneficial. the state provided $222.4 million in 2021-22, In particular, counties noted that mapping their with multiple years of expenditure authority, to current services and defining existing strengths support counties with initial implementation of as well as service gaps and needs—which they prevention services under the FFPS program. were required to do in coordination with local Prevention services are an optional child welfare behavioral health, education, tribal leadership, program; counties are not required to participate. service providers, and other stakeholders—was Ultimately, 51 counties and 2 Title IV-E tribes opted a useful endeavor and helped to strengthen to participate and are receiving the one-time state existing cross-sector relationships. However, some block grant dollars. To participate, DSS required counties also experienced some challenges around counties to prepare CPPs for approval by DSS. cross-sector coordination, noting communication CPPs are intended to go beyond the scope of EBPs silos and difficulty engaging certain groups. eligible for Title IV-E funding to encompass other services and broader community-based initiatives as counties deem relevant for their populations. 16 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT In Their CPPs, Counties Identified Trends Within Target Populations. Counties Existing Strengths… As part of their capacity took varying approaches to identifying the specific self-assessments within their CPPs, around populations and groups within their borders for 20 counties described existing strengths to include whom they will focus their prevention efforts. county leadership and other partners having Some counties identified target populations based good existing collaboration and communication, on risk factors, such as children whose caregivers strong motivation for change, and commitment to are experiencing substance use disorder, children prevention services. Around one-third of counties exposed to domestic violence, families with a (especially larger and more urban counties, as well general neglect allegation but no case opened, as some more medium-sized counties) additionally or families participating in family maintenance noted that they benefit from numerous existing services. Other counties chose broader groups, community-based organizations and family such as children ages zero to five (who often resource centers with some existing capacity to have the highest rates of entry into foster care by implement EBPs. age) or older youth (who may have more intensive …And Service Needs, Gaps, and Challenges. behavioral health support needs). In some Across the board, counties described as part other cases, counties identified communities by of their capacity self-assessments within their geography, such as those living in certain zip codes CPPs the acute need for more mental health and with higher rates of foster care entry or those in substance use disorder services (even those more remote areas of the county who historically counties with some existing capacity tended to have had lower levels of access to services. note these service gaps). Counties described Counties Selected Some how the current services offered in these areas EBPs From the State Plan may not be the most effective interventions for the specific populations at greater risk of potential Most Commonly Selected EBPs From the involvement with the child welfare system (such State Plan. By selecting EBPs from the state plan, as groups experiencing poverty at higher rates counties eventually will be able to claim Title IV-E and groups with linguistic and/or cultural barriers). funding reimbursement for eligible candidates who Counties additionally stated that stakeholders receive those services. Of the ten EBPs included and other service recipients often noted the need in the state plan, the most commonly selected for more family-friendly service options, child practice is Motivational Interviewing (MI), with all but care, transportation, and other related services a few counties including MI in their CPPs. Based in order to access services. Many counties also on conversations with counties, many counties discussed the need for domestic violence services. opted to include MI in their CPPs because it is a Counties also noted an existing need for programs practice that is broadly applicable to many different providing concrete supports, such as housing target populations, it can be implemented internally assistance, especially in areas with higher cost of (rather than relying on external service providers living. More rural, mountainous, and geographically to implement a specific program), and—relative large counties described logistical challenges to to other EBPs—the training and model fidelity service delivery, such as lack of transportation and requirements are less onerous. Additionally, some difficulties reaching and engaging with communities counties note that child welfare staff and/or staff in more remote areas of the county. Around of partner organizations already use MI or similar 20 counties (especially smaller and more rural models and have achieved positive results, making counties) also noted an overall shortage of service MI the most straight forward to implement of the providers, in particular providers possessing state’s ten selected options. After MI, the most the resources to deliver EBPs to model fidelity. frequently selected EBP is Parents as Teachers, (We discuss some of these issues more in the which over half of counties included in their CPPs. next section.) Roughly one-quarter to one-third of counties selected Functional Family Therapy, Healthy Families America, Nurse-Family Partnership, or www.lao.ca.gov 17 analysis full AN LAO REPORT Parent-Child Interaction Therapy. Smaller numbers Counties’ CPPs Also Include Other of counties opted for the remaining EBPs included in Prevention Services Not in the the state plan. Figure 6 illustrates how many counties State Plan selected each EBP in their CPPs. Appendix B Many Counties Also Implement Other EBPs provides a full list of which counties selected Not Included in the State Plan. Beyond the ten each EBP. EBPs included in the State Prevention Plan, more FFPS Provides Opportunity to Expand than half of participating counties indicated in their Existing Services to Child Welfare Populations CPPs that they have providers in their communities With Federal Funding. Implementing FFPS currently delivering other EBPs. Whether providers provides counties an opportunity to expand some are able to meet fidelity standards for the program already offered services to focus on maltreatment models is sometimes unclear, however. In some prevention. For example, around 20 counties cases, these EBPs are included in the federal included Nurse-Family Partnership as a selected Title IV-E Prevention Services Clearinghouse. EBP in their CPPs. In most of these counties, the However, because DSS did not include them local public health department already delivers this in California’s state plan, counties are not able program (typically serving first-time, low-income to receive Title IV-E funding for them as child mothers and infants). To implement the service as a welfare prevention services. For example, in child welfare prevention program, local child welfare their CPPs, a number of counties specified that departments will contract with their public health their local providers currently offer EBPs such as counterparts to expand the program for eligible child Mindfulness-Based Cognitive Therapy (rated as welfare candidates. In addition, DHCS and DSS well-supported), Eye Movement Desensitization recently instructed county behavioral health plans to and Reprocessing (rated as supported), Positive cover certain EBPs focused on children and youth Parenting Program (various models rated as behavioral health for youth up to age 21 enrolled promising), and other therapy and program models. in Medi-Cal. These services include: Parent-Child Some Counties Also Include Wraparound Interaction Therapy, Multisystemic Therapy, and as a Prevention Service. Wraparound refers to Functional Family Therapy. For counties that already the practice of partnering with families to provide have providers who are able to offer these services, intensive services to children and families with counties could coordinate with local behavioral health complex needs using a team-based approach. to expand access to these treatment models for their A child and family, working with a team of service target child welfare prevention populations. providers, develops and follows a service Figure 6 plan that is intended Selection of Child Welfare Prevention Services Evidence-Based Practices to be comprehensive, Number of Counties family-centered, strengths-based, and 50 needs-driven. Since 45 2022, all counties 40 have been required to 35 provide wraparound 30 services to foster 25 20 youth transitioning 15 out of congregate 10 care placements for 5 at least six months. Motivational Parents Healthy Parent-Child Nurse-Family Functional Family Multisystemic Brief Homebuilders This state requirement Interviewing as Families Interaction Partnership Family Check-Up Therapy Strategic Teachers America Therapy Therapy Family aligns with federal Therapy requirements under 18 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT FFPSA, as described more in the nearby box. child welfare system—support families by helping Additionally, all counties are in the process of to facilitate interactions with social workers and updating their wraparound services to align with the courts, and to navigate the array of county new, higher-level statewide standards—referred and local services. Similarly, a number of counties to as “high fidelity wraparound.” High fidelity offer “promotoras y promotores” programs, which wraparound is a “promising” practice in the federal offer a similar model specifically tailored for Title IV-E Prevention Services Clearinghouse. Some Hispanic/Latino/Spanish-speaking communities. counties included high fidelity wraparound services These program models are not currently included in as part of their CPPs. However, because the EBP is the federal clearinghouse. However, some counties not included in the state’s prevention plan, counties have evaluated their programs and found them to will not be able to receive Title IV-E funding for it reduce the number of families that enter foster care even if they choose to expand this service to eligible and increase family reunifications. candidates for foster care. Several counties with significant tribal A Number of Counties Implement Culturally presence also partner with local tribes/tribally led Relevant Programs. Around 20 counties— organizations to implement culturally relevant and particularly those with significant Black, Native community-led programs. For example, several American, and Hispanic/Latino populations— counties mention in their CPPs that they offer the describe in their CPPs that they are currently Family Spirit program. This program is a home implementing programs that aim to serve visiting model for young Native American expectant specific communities using culturally informed, and parenting mothers, with the goal of addressing strengths-based, and linguistically relevant intergenerational behavioral health challenges approaches. For example, a number of California and promoting positive behavioral and emotional counties have “cultural broker” programs, which outcomes among mothers and children, while are community-led initiatives that work with Black also helping families process historical traumas families who have an open child welfare case (or by embracing local languages, legends, and are at risk of child welfare system intervention). Native American history. Family Spirit is rated as a Through these initiatives, community members— promising practice in the federal clearinghouse. who typically also have been involved with the California High Fidelity Wraparound In addition to implementing prevention services as allowed by the federal Family First Prevention Services Act (FFPSA), California also is implementing separate, required components of FFPSA related to congregate care. Specifically, FFPSA requires states to make certain changes in order to retain eligibility to claim Title IV-E reimbursement for congregate care foster placements. One of these new federal requirements specifies that youth transitioning out of a congregate care placement must receive planning and support for at least six months post-discharge (that is, aftercare services). Counties and their providers are responsible for meeting this new requirement by way of wraparound services (with models differing across counties and providers). In July 2025, the Department of Social Services and the Department of Health Care Services published guidance (via All-County Letter 25-47) for California High Fidelity Wraparound as the state’s uniform model of aftercare services. Counties and providers are now working to ensure their wraparound services achieve these statewide standards. www.lao.ca.gov 19 analysis full AN LAO REPORT COUNTIES’ IMPLEMENTATION CHALLENGES Since counties have begun to implement state plan is not without trade-offs. Specifically, their CPPs, they have encountered a variety of including EBPs federally rated as supported or challenges—some anticipated and some not. In promising (rather than well-supported) likely would this section, we describe some trends across require the state and counties to take on new counties in terms of these identified hurdles, costs to meet federal monitoring and evaluation based on discussions with counties and other requirements. (We discuss these trade-offs in more stakeholders. Where relevant, we also have detail in the next section.) noted steps DSS is taking to help mitigate these Limited Selection of EBPs That Are Culturally challenges. Because implementation is underway, Relevant. Many counties noted that the state plan new guidance to help address challenges is issued and federal clearinghouse more generally include regularly. As such, we have tried to include the most few programs specifically designed for communities up-to-date information in our analysis. However, who disproportionately face child maltreatment as implementation proceeds, some of these risks, such as higher-poverty Black and Native challenges may resolve and others may emerge. American communities. Given the significant overrepresentation of these groups in California’s Implementing EBPs child welfare system, counties noted that this Array of EBPs in State Plan Does Not Always lack of culturally specific services could potentially Correspond to Counties’ Prevention Needs. limit the effectiveness of programs for these Some counties noted a general lack of alignment populations. That said, the state plan does describe between the needs of their populations and the culturally relevant programs as an important focal EBPs that are included in the state prevention area for California’s overall prevention vision. plan (and even more broadly in the federal Capacity of Providers. Most counties clearinghouse). For example, many counties raised that community-based organizations and selected target populations for prevention services other service providers could face challenges based on identified risk factors, such as children in implementing EBPs in line with federal whose caregivers are experiencing substance use requirements. Particularly in smaller and more rural disorder, children exposed to domestic violence, counties with relatively fewer providers, counties and families with a general neglect allegation but raised issues related to hiring and maintaining no case opened. At the same time, only one of qualified staff and meeting EBP model fidelity the state’s selected EBPs (MI for substance use) requirements around staff training, data tracking, directly aims to mitigate caregiver substance and other elements due to high costs. Building use disorder as its primary goal. Moreover, no provider capacity is a focal area for DSS and its programs in the federal clearinghouse are focused contractors through the three-tiered statewide primarily on supporting children/families exposed training initiative and by developing resources to domestic violence, nor are there any programs and guidance. in the federal clearinghouse that focus on providing concrete supports (which could help address Funding and Accounting Challenges factors underlying general neglect allegations). All counties discussed concerns and State Plan Omits EBPs That Counties Already complexities surrounding prevention services Provide. As described earlier, counties currently funding. We describe these challenges in provide various EBPs that are in the federal this section. clearinghouse but were not included in the state Title IV-E Claiming. As described in the plan. As a result, counties cannot claim federal background, Title IV-E reimbursement in funding for these services despite being approved California generally requires counties to spend at the federal level. However, adding them to the $1 from local sources for every $1 of federal 20 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT monies claimed. Counties currently may seek implementation of the EBP. They provide training, Title IV-E reimbursement for administration and resources, and guidance to ensure fidelity and training activities in preparation for implementing effective implementation, often charging counties or EBPs. They are not able to receive Title IV-E the service provider fees to do so. In some cases, reimbursement for the prevention services counties shared that it would cost them several provided until the state’s new child welfare hundreds of thousands of dollars to contract with data system—Child Welfare System-California the developer/purveyor to provide the required Automated Response and Engagement System initial training and guidance to begin implementing (CWS-CARES)—launches. The statewide launch an EBP. In these cases, some counties ultimately of this new system is planned for October 2026. decided not to pursue implementation of EBPs that Prior to the new system coming online, counties they had included in their CPPs due to the costs. cannot claim Title IV-E funds for prevention services As a result, DSS is exploring a potential state-level because the state’s legacy child welfare data contract to assist counties with meeting model system does not meet federal requirements around fidelity requirements, specifically for MI. individual-level prevention services tracking and Funding Sustainability. A challenge that outcomes reporting. As a result, counties can only nearly every county emphasized is how to sustain use local and state block grant dollars to implement their prevention programs financially once their new or expand existing prevention services in the state block grant dollars expire. Even once meantime. Some counties are taking the approach CWS-CARES launches and counties can claim of trying to hold off on using some of their state Title IV-E reimbursement for eligible EBPs, how to block grant dollars until they can begin drawing fund the required local match remains a challenge down Title IV-E matching funds. Other counties for counties. Counties receive their flexible 2011 report having spent nearly all their state block grant realignment funds for child welfare programs— dollars already—well in advance of being able to which DSS has indicated counties will be able to use these one-time state resources as the required use as the ongoing local funding component—but local match to receive federal reimbursement. some counties report exhausting these funds Medi-Cal Funding and Billing. Given that to provide the basic mandatory child welfare federal rules specify Title IV-E is the payor of last program components. As the state block grant resort, and some EBPs are Medi-Cal-eligible period draws to a close over the next few years, services, counties expressed a need for clear counties will be looking to DSS for more guidance guidance from the state related to Medi-Cal billing and individualized financial planning assistance to and how different funding streams can be used sustain their prevention programs. together. While DSS and DHCS have provided Other Challenges some guidance related to Medi-Cal coverage for certain EBPs (as described earlier), counties report Staffing Challenges. Nearly all counties noted continued confusion and the need for more detailed in their CPPs and during conversations that they and individualized guidance around braiding struggle to recruit and retain child welfare social together Medi-Cal, Title IV-E, and other funding workers (and oftentimes local service providers face sources. Additionally, some counties shared similar challenges). This is a general challenge local concerns that their EBP providers may not have child welfare agencies face, not specifically related the staffing or resource capacity to take on the to prevention services. Insufficient staffing can complexities of direct Medi-Cal billing. make implementing new initiatives difficult. More specifically related to staffing EBPs—because EBPs Cost of Implementing to Model Fidelity. require relatively rigorous, often expensive training Most EBP models are “owned” by the service and ongoing monitoring—counties noted that staff developer/purveyor, which is the entity (such as turnover could add to the hurdles of meeting model a university or independent service provider) fidelity requirements. responsible for creating and supporting the www.lao.ca.gov 21 analysis full AN LAO REPORT Questions Around Community Pathway. pathways and are working with DSS to inform For counties that plan to implement a community forthcoming guidance. pathway option (as described in the State Need for More Specific and Tailored Prevention Plan) for families to access services Technical Assistance. Some counties have hired outside of the usual child welfare system pipeline, their own contractors to help formulate their CPPs many questions remain around how the community and guide implementation efforts. Other counties, pathway will work. Counties need more state however, are not able to do so. In particular for this guidance around the specific requirements, in some latter group, counties expressed needing more cases because they are still uncertain whether their in-depth and individualized technical assistance community-based organizations or family resource from the state. Counties noted that the various centers will have the capacity and resources to webinars and other learning opportunities provided meet the requirements. A few counties have moved by DSS, state contractors, regional training ahead with implementing their individual community academies, and others are helpful but tend to remain higher level. CONSIDERATIONS AND OPPORTUNITIES FOR LEGISLATURE In this section, we highlight some considerations to add additional EBPs from the federal Title IV-E for the Legislature alongside opportunities to Prevention Services Clearinghouse. Specifically, provide additional direction and guidance to the the Legislature could direct DSS to include EBPs administration and support for counties to help that multiple counties already implement (such ensure implementation of child welfare prevention as Mindfulness-Based Cognitive Therapy and services can continue in a manner that (1) allows Positive Parenting Program models). Furthermore, the state to maximize federal funding whenever given that high fidelity wraparound is included in possible and (2) helps promote prevention services the federal clearinghouse and that all counties that can benefit as many at-risk families across the will be implementing the California model of this state as possible. program to meet FFPSA aftercare requirements, the State-Level Support for Model Fidelity. Legislature could consider directing inclusion of this To support counties in meeting the often rigorous service in particular into the state’s prevention plan. requirements surrounding EBP implementation, Inclusion of these EBPs in the state plan would the state could consider state-level contracts—or allow counties to receive Title IV-E funding for these help facilitate regional contracts—for training and services when provided to eligible candidates. model fidelity monitoring. DSS already is exploring Additionally, by expanding the EBPs included in the this option for MI, which is the EBP selected by state plan, counties could access federal funding nearly all counties in their CPPs. The Legislature for programs that potentially correspond more could direct DSS to explore similar options for other directly to their target populations’ needs (such as EBPs, particularly the other services selected by more services directly aiming to mitigate caregiver the largest numbers of counties. This state-level substance use). or regional-level support could be particularly …While Weighing Trade-Offs. Importantly, useful for smaller counties, for whom the cost however, inclusion of additional EBPs in the state of implementing EBPs to model fidelity could plan would not be without trade-offs. Namely, otherwise prove prohibitive. for any new services added to the plan that are Consider Updating State Plan to Include rated as supported or promising, DSS would need Other EBPs… The Legislature could consider to ensure that at least 50 percent of Title IV-E directing DSS to update the State Prevention Plan dollars are claimed for well-supported services. 22 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT (Currently, because all EBPs included in the state plan Consider What Data Legislature Would Want are rated as well-supported, meeting the 50 percent for Future Evaluation. Implementing child welfare federally required threshold is not a concern.) comprehensive prevention services is a major Additionally, for services rated as supported or undertaking and emblematic of a broader shift promising, DSS and counties could face new cost within child welfare policy over time to focus more pressures related to federal evaluation requirements. on preventing entry into foster care. Additionally, (Again, because all currently included EBPs are the state block grant funds of $222.4 million well-supported, DSS was able to obtain waivers General Fund represent a significant discretionary for some of the federal evaluation requirements.) augmentation for child welfare programs. As such, The Legislature may want to weigh the opportunity the Legislature likely will want effective measures for for counties to obtain additional Title IV-E dollars assessing the impact these funds and new services against these trade-offs in consultation with the are having. Given that many counties are still in the administration prior to directing an expansion of EBPs relatively early phases of implementing their CPPs in the state plan. (and are not yet able to claim Title IV-E funding for Consider How to Maximize Medi-Cal eligible prevention services), now is an opportune Coverage for EBPs. In addition to considering time for the Legislature to consider what specific expanding access to Title IV-E funding for additional data and outcomes measures it will want in the child welfare prevention services, the Legislature future. For any determined measures that also could consider how to maximize Medi-Cal DSS/counties do not currently report on, the coverage for eligible EBPs. Specifically, considering Legislature could direct any necessary additional that local behavioral health plans are required data collection now to ensure impacts may be to provide coverage for Parent-Child Interaction measured over time. Regardless of any new data Therapy, Multisystemic Therapy, and Functional collection the Legislature may wish to add, the state Family Therapy, what steps could the state take to will collect the federally required data elements once expand access to these services for eligible child the new child welfare data system (CWS-CARES) welfare prevention candidates? Additionally, are comes online. These data will include basic there other child welfare prevention EBPs (either demographic information alongside tracking the currently included in the State Prevention Plan or to specific prevention services that individual be considered for future inclusion) that also could be children/families receive, the cost of those services, covered by Medi-Cal? and the status of the child/family 12 months after receiving prevention services (for example, has the Explore Options for Submitting Other child entered foster care). Programs to Clearinghouse. Aside from the EBPs already included in the federal clearinghouse, Consider Long-Term Funding Sustainability many counties implement other programs—such for CPPs… While the state block grant funds as cultural broker programs—that counties have provide counties with new resources to implement found to be effective for their target populations. child welfare prevention programs, the funding is The Legislature could work with the administration one time. Future access to Title IV-E reimbursement to explore options for submitting such programs to for prevention services will continue to require local the federal clearinghouse for review and potential matching contributions. Moreover, the Title IV-E rating. This effort would help address existing gaps, funding comes with numerous requirements and particularly in terms of culturally relevant prevention counties may not always be able to draw down any programs that could be eligible for federal dollars. federal support for their programs (to the extent that Additionally, currently there are no programs in the they choose to implement services beyond the EBPs federal clearinghouse focused on serving families included in the State Prevention Plan). For example, exposed to domestic violence or providing concrete some important types of prevention programs for supports to families—yet these are some of the needs at-risk families—such as concrete supports and of target populations counties identified in their CPPs. domestic violence intervention—are not currently The Legislature could work with the administration to eligible for Title IV-E financial participation. understand what options exist to pursue expansion of the federal clearinghouse to include such programs. www.lao.ca.gov 23 analysis full AN LAO REPORT …Particularly in Light of the Incentives stated that they already have spent all or most and Trade-Offs of Realignment. Under 2011 of their state block grant dollars—prior to being realignment, counties have a fiscal incentive to able to claim any Title IV-E matching funds for deliver effective CPPs whether or not the state eligible EBPs. Because federal reimbursement for provides General Fund funding: effective prevention prevention services will require $1 local funding services should mean fewer families entering to match every $1 of federal monies claimed— foster care, thereby lowering counties’ realigned and given the constraints and complexities of child welfare program costs while allowing them counties’ local realignment dollars described in to retain the savings. However, the reality is more the previous paragraph—some counties may not complicated, with many factors that contribute be in a position to provide the needed matching to families’ risk for child maltreatment—such funds. Given these factors, to the extent the as poverty—existing far outside of local child Legislature may be in a future position to provide welfare agencies’ control. Additionally, numerous additional one-time state resources, another counties report that growth in their baseline child round of state block grant funding for counties’ welfare program costs exceeds realignment child welfare prevention programs could be an funding growth, leaving them without room in area to consider. However, before providing any their realignment budgets for new or discretionary additional funding, we recommend first ensuring programs. Under 2011 realignment, however, the that a couple of conditions are met to help counties state has limited insight into how counties use their maximize federal funding and create financial realignment dollars, making it difficult to assess the sustainability for prevention programs beyond true impact of various cost pressures. Whenever the duration of any state funding. First, any future considering increased program requirements funding should be provided after the launch of and/or funding for child welfare—as a realigned CWS-CARES (anticipated for October 2026) to program area—we recommend bearing these ensure counties are able to claim federal Title complex factors in mind. IV-E reimbursement for eligible services. Second, Timing for Any Additional State Funds Is detailed Medi-Cal claiming guidance should be Important. In theory, counties will achieve foster available to ensure counties and providers are care cost savings once they implement effective able to draw down Medi-Cal funding for eligible child welfare prevention services—meaning there is services. Once these conditions are met, additional a natural incentive to invest in prevention programs. state block grant funding could help counties begin However, achieving those savings will require generating savings—thereby promoting long-term significant upfront investment, which may not be funding sustainability. possible using only local funds. Many counties CONCLUSION California has undertaken significant efforts There remains much to be done before the state toward implementing the state’s new prevention and counties can realize the full extent of federal services program available for federal Title IV-E benefits. As counties have taken steps toward reimbursement under FFPSA. Additionally, implementing their individual comprehensive California’s policy goals for prevention services prevention plans, some key challenges and extend beyond the scope of EBPs eligible for Title opportunities for additional legislative guidance IV-E reimbursement and aim to include wider local and input have come to light. As the state remains arrays of services that can respond to the needs in the relatively early phases of implementation, of at-risk populations across counties. This move now is a good time for the Legislature to weigh in to toward prevention is a major shift in child welfare help ensure prevention services work can continue policy focus that will take time to implement. efficiently and benefit as many at-risk families as possible across the state. 24 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT GLOSSARY Glossary Acronym/Term Definition Candidacy A “candidate for foster care” is a child at imminent risk for removal from their home and foster placement. This is defined more specifically by states, and is an individual child or family eligible for federal Title IV-E financial participation for prevention services. Community Pathway California’s new federally allowable approach for families to access prevention services, without formal involvement of the local child welfare agency. Counties have the option of implementing their own local version of this approach—in line with state guidelines, which are under development. Comprehensive Prevention These are the state-required plans that counties prepared in order to opt in to receive state block grant Plans (CPPs) dollars. Culturally Relevant A program utilizing an approach that incorporates the unique cultural and linguistic norms and needs of Program a community. Evidence-Based Practices These are specific program/service models that have been rated by the federal clearinghouse as (EBPs) having sufficient evidence to support the program’s ability to achieve its intended positive outcomes amongst the target population. Federal Clearinghouse The federal Title IV-E Prevention Services Clearinghouse, which rates evidence-based practices as “well-supported,” “supported,” “promising,” or not meeting criteria at the time of federal review. The clearinghouse maintains a Handbook of Standards and Procedures, which lays out the specific criteria components and methods used for rating programs. Family First Prevention California’s state program to implement FFPSA and prevention services more broadly. Services Program (FFPS) Family First Prevention Federal law requiring various changes to states’ child welfare practice and allowing states the option to Services Act (FFPSA) claim Title IV-E funding for certain evidence-based services for child welfare prevention. Motivational Interviewing One of California’s selected evidence-based practices. (MI) Model Fidelity Refers to how closely an implemented program adheres to the original, evidence-based model on which it is based. A program delivered to high fidelity refers to a program that is implemented as designed in terms of factors such as planning and implementation phases, staff qualifications and training, data collection, and tracking outcomes. State Block Grant State General Fund funding provided to counties that opted in to provide child welfare prevention services under FFPS. The 2021-22 Budget Act provided $222.4 million for this purpose. State Plan California’s Five-Year State Prevention Plan, as required by the federal government to allow California to claim Title IV-E financial participation for select prevention services delivered to eligible candidates. Title IV-B Funding provided to states via Title IV, part B of the federal Social Security Act. Funding supports broad child welfare and prevention programs. Title IV-E Funding provided to states via Title IV, part E of the federal Social Security Act. Funding supports primarily foster care, adoptions, and guardianships. Title IV-E Pathway The traditional way in which families access prevention services, meaning their case is brought to the (Also Referred to as attention of the local child welfare agency. Traditional Pathway) www.lao.ca.gov 25 analysis full AN LAO REPORT APPENDIX A Appendix A Overview of Evidence-Based Practices Included in State Plan Program/ Type of Clearinghouse Service Target Group Intended Outcomes Fidelity Indicators Service Rating Nurse-Family First-time parents/ • Increased positive • Provider receives and • In-home Well-supported Partnership caregivers with parenting practices. maintains required training. parent skill (NFP) a child under • Improved maternal • Meets staffing qualification based. two years of health. requirements. age (beginning • Family self- • 1:8 supervisor to staff ratio. prenatally). sufficiency. • 1:25 caseload ratio. • Use of NFP standardized web-based data system. Description Home visiting program that is typically implemented by trained registered nurses. NFP serves young, first-time, low-income mothers beginning early in their pregnancy until the child turns two. The primary aims of NFP are to improve the health, relationships, and economic well-being of mothers and their children. Typically, nurses provide support related to individualized goal setting, preventative health practices, parenting skills, and educational and career planning. However, the content of the program can vary based on the needs and requests of the mother. NFP aims for 60 visits that last 60-75 minutes each in the home or a location of the mother’s choosing. For the first month after enrollment, visits occur weekly. Then, they are held bi-weekly or on an as-needed basis. Healthy Parents/caregivers • Increased positive • Provider receives and • In-home Well-supported Families with a child who parenting practices. maintains required training. parent skill America is newborn to • Increased nurturing • Meets staffing qualification based. (HFA) five years of age, parent-child requirements. generally starting relationships. • 1:6 supervisor to staff ratio. within three months • Meets caseload of birth. requirements. • Performance on ratings of HFA Best Practice Standards. Description Home visiting program for new and expectant families with children who are at-risk for maltreatment or adverse childhood experiences. HFA is a nationally accredited program that was developed by Prevent Child Abuse America. The overall goals of the program are to cultivate and strengthen nurturing parent-child relationships, promote healthy childhood growth and development, and enhance family functioning by reducing risk and building protective factors. HFA includes screening and assessments to identify families most in need of services, offering intensive, long-term and culturally responsive services to both parent(s) and children, and linking families to a medical provider and other community services as needed. Each HFA site is able to determine which family and parent characteristics it targets. Enrollment begins prenatally and continues up to three months after birth. Most families are offered services for a minimum of three years, and receive weekly home visits at the start. After six months, families receive visits less frequently depending on their needs and progress. Parents as Parents/caregivers • Increased number • Adherence to PAT 17 • In-home Well-supported Teachers with a child of developmental Essential Requirements. parent skill (PAT) who is newborn milestones met. • Annual submission of each based. (or beginning • Increased positive essential requirement prenatally) to parenting practices. progress through the kindergarten age. • Improvement of Affiliate Performance parent/caregiver Report (APR). emotional and mental • Providing the Performance health. Measures Report after APR submission. • 1:12 supervisor to staff ratio. Description Home visiting parent education program wherein trained parent educators teach new and expectant parents skills intended to promote positive child development and prevent child maltreatment. PAT aims to increase parent knowledge of early childhood development, improve parenting practices, promote early detection of developmental delays and health issues, prevent child abuse and neglect, and increase school readiness and success. The PAT model includes four core components: personal home visits, supportive group connection events, child health and developmental screenings, and community resource networks. PAT is designed so that it can be delivered to diverse families with diverse needs, although PAT sites typically target families with specific risk factors. Families can begin the program prenatally and continue through when their child enters kindergarten. Services are offered on a biweekly or monthly basis, depending on family needs. Sessions are typically held for one hour in the family’s home, but can also be delivered in schools, child care centers, or other community spaces. 26 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Program/ Type of Clearinghouse Service Target Group Intended Outcomes Fidelity Indicators Service Rating Parent-Child Families with children • Reduction in child • Provider receives and • Mental Well-supported Interaction ages two to seven negative behaviors. maintains required training. health Therapy who experience • Increased positive • Meets staffing qualification (youth and (PCIT) emotional and parenting practices. requirements. parent). behavioral • Improvement of • Use of Eyberg Child problems that parent/caregiver Behavior Inventory and are frequent and emotional and mental Dyadic Parent-Child intense. health. Interaction Coding System, and Therapy Attitude Inventory. Description PCIT is a program for two- to seven-year-old children and their parents or caregivers that aims to decrease externalizing child behavior problems, increase positive parenting behaviors, and improve the quality of the parent-child relationship. Parents are coached by Master’s level specially trained therapists in behavior-management and relationship skills. During weekly sessions, therapists coach caregivers in skills such as child-centered play, communication, increasing child compliance, and problem-solving. Therapists use “bug- in-the-ear” technology to provide live coaching to parents or caregivers from behind a one-way mirror (there are some modifications in which live same-room coaching is also used). Parents or caregivers progress through treatment as they master specific competencies, thus there is no fixed length of treatment. Most families are able to achieve mastery of the program content in 12 to 20 one-hour sessions. Multisystemic Youth ages 12 to 17 • Decrease in youth • Provider receives and • Mental Well-supported Therapy and their families. delinquent behavior maintains required training. health (MST) Target populations and substance use. • Completion of the (youth and include youth who • Improvement of Therapist Adherence parent). are at risk for or parent/caregiver Measure Revised. • Substance are engaging in emotional and mental • Completion of the abuse delinquent activity health. Supervisor Adherence (youth). or substance Measure. misuse, experience • At least 66 percent of mental health therapists have a Master’s issues, and are at degree in social work or risk for out-of-home counseling. placement. Description Intensive treatment for troubled youth delivered in multiple settings. This program aims to promote pro-social behavior and reduce criminal activity, mental health symptomology, out-of-home placements, and illicit substance use in 12- to 17-year-old youth. The MST program addresses the core causes of delinquent and antisocial conduct by identifying key drivers of the behaviors through an ecological assessment of the youth, family, and school and community. The intervention strategies are personalized to address the identified drivers. The program is delivered for an average of three to five months, and services are available 24/7, which enables timely crisis management and allows families to choose which times will work best for them. Master’s level therapists from licensed MST providers take on only a small caseload at any given time so that they can be available to meet their clients’ needs. Brief Strategic Families with children • Improved child • Provider receives and • Mental Well-supported Family or youth (6- to behavioral maintains required training. health Therapy 17-years old) who and emotional • Meets staffing qualification (youth and (BSFT) display or are at functioning. requirements. parent). risk for developing • Decrease in youth • Ongoing completion of • Substance problem behaviors delinquent behavior the BSFT Adherence abuse including: drug use and substance use. Certification Checklist. (youth and and dependency, • Decrease in parent/ parent). antisocial peer caregiver substance • Parent associations, use. skill- bullying, or truancy. based. Description Structured family systems approach to treat families with children or adolescents (6- to 17-years old) who display or are at risk for developing problem behaviors including substance abuse, conduct problems, and delinquency. There are three intervention components. First, counselors establish relationships with family members to better understand and ‘join’ the family system. Second, counselors observe how family members behave with one another in order to identify interactional patterns that are associated with problematic youth behavior. Third, counselors work in the present, using reframes, assigning tasks and coaching family members to try new ways of relating to one another to promote more effective and adaptive family interactions. BSFT is typically delivered in 12 to 16 weekly sessions in community centers, clinics, health agencies, or homes. BSFT counselors are required to participate in four phases of training and are expected to have training and/or experience with basic clinical skills common to many behavioral interventions and family systems theory. www.lao.ca.gov 27 analysis full AN LAO REPORT Program/ Type of Clearinghouse Service Target Group Intended Outcomes Fidelity Indicators Service Rating Family Check- Families with children • Improved child • Provider receives and • Mental Well-supported Up or youth ages 2 behavioral maintains required training. health to 17. and emotional • Meets staffing qualification (youth). functioning. requirements. • Parent • Increased positive • Use of COACH Rating skill- parenting practices. Form. based. Description Brief, strengths-based intervention for families with children ages 2 through 17. The intervention aims to improve parenting skills and family management practices, with the goals of improving a range of emotional, behavioral, and academic child outcomes. The Family Check-Up consists of three main components: (1) an initial interview that involves rapport building and motivational interviewing to explore parental strengths and challenges related to parenting and the family context; (2) an ecological family assessment that includes parent and child questionnaires, a teacher questionnaire for children that are in school, and a videotaped observation of family interactions; and (3) tailored feedback that involves reviewing assessment results and discussing follow-up service options for the family. Follow-up services may include clinical or support services in the community. They may also include the Everyday Parenting program, which is a parenting management program that is typically delivered by the provider. Functional Families with youth • Improved child • Provider receives and • Mental Well-supported Family ages 11 to 18 who behavioral maintains required training health Therapy have been referred and emotional (three phases of training). (youth). (FFT) for behavioral or functioning. • Meets staffing qualification • Substance emotional problems • Decrease in youth requirements. abuse by juvenile justice, substance use. • Completion of Weekly (youth). mental health, • Improvements in Supervision Checklist. school, or child parental capabilities. • Supervisor completion of welfare systems. Global Therapist Ratings. Family discord is also a target factor for this program. Description Short-term prevention program for at-risk youth and their families. FFT aims to address risk and protective factors that impact the adaptive development of 11- to 18-year-old youth who have been referred for behavioral or emotional problems. The program is organized into multiple phases and focuses on developing a positive relationship between therapist/program and family, increasing motivation for change, identifying specific needs of the family, supporting individual skill-building of youth and family, and generalizing changes to a broader context. Typically, therapists will meet weekly with families face to face for 60 to 90 minutes and by phone for up to 30 minutes, over an average of three to six months. Homebuilders Families with children • Increase in family • Meets staffing qualification • In-home Well-supported or youth (ages 0 interactions. requirements. parent to 18) at imminent • Improvements in • 1:3 caseload ratio. skill- risk of out-of-home family safety. • Families met within 24 based. placement or who • Improvements in hours of referral. are in placement parental capabilities. • Meets supervision and cannot be requirements. reunified without intensive in-home services. Description Intensive in-home counseling, skill building, and support services for families who have children (0- to 18-years old) at imminent risk of out-of-home placement or who are in placement and cannot be reunified without intensive in-home services. Homebuilders practitioners (typically Master’s level practitioners) conduct behaviorally specific, ongoing, and holistic assessments that include information about family strengths, values, and barriers to goal attainment. Homebuilders practitioners then collaborate with family members and referents in developing intervention goals and corresponding service plans. These intervention goals and service plans focus on factors directly related to the risk of out-of-home placement or reunification. Throughout the intervention the practitioner develops safety plans and uses clinical strategies designed to promote safety. Practitioners support families by providing concrete goods and services related to the intervention goals, collaborating with formal and informal community supports and systems, and teaching family members to advocate for themselves. Homebuilders services are concentrated during a period of four to six weeks with the goal of preventing out-of-home placements and achieving reunifications. Homebuilders therapists typically have small caseloads of two families at a time. Families typically receive 40 hours or more of direct face-to-face services. The family’s therapist is available 24 hours per day, 7 days per week. 28 LEGISLATIVE ANALYST’S OFFICE analysis full AN LAO REPORT Program/ Type of Clearinghouse Service Target Group Intended Outcomes Fidelity Indicators Service Rating Motivational Wide range of • Decrease in youth’s • Provider receives and • Substance Well-supported Interviewing youth and parent/ substance use. maintains training. abuse (MI)— caregiver target • Decrease in parent/ • Provider uses a valid and (youth and Substance populations dealing caregiver substance reliable rating instrument, parent). Abuse with substance use. which yields feedback Treatment abuse. • Improved that can be used by physiological, practitioners to increase psychological, and clinical skill and measures lifestyle outcomes. how well a practitioner is using MI. Description Method of counseling clients designed to promote behavior change and improve physiological, psychological, and lifestyle outcomes. MI aims to identify ambivalence for change and increase motivation by helping clients progress through five stages of change: pre- contemplation, contemplation, preparation, action, and maintenance. It aims to do this by encouraging clients to consider their personal goals and how their current behaviors may compete with attainment of those goals. MI uses clinical strategies to help clients identify reasons to change their behavior and reinforce that behavior change is possible. These clinical strategies include the use of open-ended questions and reflective listening. MI can be used to promote behavior change with a range of target populations and for a variety of problem areas. The Prevention Services Clearinghouse reviewed studies of MI focused on illicit substance and alcohol use or abuse among youth and adults, and nicotine or tobacco use among youth under the age of 18. MI is typically delivered over one to three sessions with each session lasting about 30 to 50 minutes. Sessions are often used prior to or in conjunction with other therapies or programs. They are usually conducted in community agencies, clinical office settings, care facilities, or hospitals. While there are no required qualifications for individuals to deliver MI, training can be provided by Motivational Interviewing Network of Trainers-certified trainers. MI—Cross- Wide range of • Enhanced internal • Provider uses a valid and • Not Well-supported Cutting youth and parent/ motivation to change. reliable rating instrument, specified. Case caregiver target • Plan developed which yields feedback Management populations and for to achieve change. that can be used by a variety of problem practitioners to increase areas. clinical skill and measures how well a practitioner is using MI. Description MI can be used as part of casework practice beyond its application to substance use disorder treatment. In this manner, MI is used as a method to promote behavioral change and improve physiological, psychological, and lifestyle outcomes by identifying ambivalence factors and increasing motivation to change. Notes: Information compiled from the California Five-Year State Prevention Plan and the federal Title IV-E Prevention Services Clearinghouse. www.lao.ca.gov 29 AN LAO REPORT APPENDIX B Appendix B Summary of Services Included in County CPPs County/Tribe Alameda Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Inyo Karuk Tribe Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino / Cahto Merced Mono Napa Nevada Orange Placer Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tulare Tuolumne Ventura Yolo Yuba Yurok Tribe Notes: In the "Community Pathway" column, a gray box reflects that the county might implement a community pathway depending on future guidance. A green box indicates they do intend to implement a community pathway. Information reflects our best understanding of counties' approved CPPs as available online through CFPIC. In some cases, counties may have since updated their plans. In some cases, counties mentioned implementing one of the 10 EBPs but it was unclear if they plan to expand services to eligible candidates and claim Title IV-E funding. 30 LEGISLATIVE ANALYST’S OFFICE yparehT ylimaF cigetartS feirB pU-kcehC ylimaF yparehT ylimaF lanoitcnuF aciremA seilimaF yhtlaeH sredliubemoH gniweivretnI lanoitavitoM yparehT cimetsysitluM pihsrentraP ylimaF-esruN srehcaeT sA stneraP yparehT noitcaretnI dlihC-tneraP detnemelpmi yltnerruc sPBE rehtO yawhtap ytinummoC analysis full analysis full AN LAO REPORT www.lao.ca.gov 31 analysis full AN LAO REPORT LAO PUBLICATIONS This report was prepared by Angela Short, and reviewed by Ginni Bella Navarre and Carolyn Chu. The Legislative Analyst’s Office (LAO) is a nonpartisan office that provides fiscal and policy information and advice to the Legislature. To request publications call (916) 445-4656. This report and others, as well as an e-mail subscription service, are available on the LAO’s website at www.lao.ca.gov. The LAO is located at 925 L Street, Suite 1000, Sacramento, California 95814. 32 LEGISLATIVE ANALYST’S OFFICE