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Understanding the Family First Clearinghouse

December 4, 2019 | Cynthia Burnson, PhD

Mother holding baby

The Family First Prevention Services Act (FFPSA) became law in 2018 to support states in keeping children safely in their homes and out of foster care. To be eligible for this support, states must create a prevention plan listing the programs and services for which they will pursue reimbursement. The law requires that prevention programs or services be evidence based and rated as promising, supported, or well supported. They also need to address mental health, substance abuse, or in-home parenting skills. 

Many states are anxious to implement FFPSA to safely support children in their own homes while addressing family and child well-being. The Prevention Services Clearinghouse was set up to review programs and services and has released a handbook detailing the guidelines. Since the legislation passed in February 2018, 13 programs and services have been reviewed; 10 have been rated “promising” or above, making them eligible for reimbursement, and 16 additional programs are under review. 

The federal Administration on Children and Families has created an interim review process through which states can engage an independent reviewer to apply the clearinghouse’s review guidelines to determine if local programs meet the evidence criteria. States that engage an independent reviewer can submit for transitional payments until the Clearinghouse rates the program. 

Evident Change is available to serve as an independent reviewer. As one example, Evident Change researchers are partnering with the Arkansas Division of Children and Family Services (DCFS) to conduct an independent review of several programs that DCFS has included in its prevention plan. This review will result in a rating of the program, after which other states can use the designation to submit for transitional payments as well.  

Guidance for States Exploring FFPSA Funding

In the context of FFPSA funding, the criteria for an “evidence based” designation is that a program/service must aim to impact a target outcome, be in active use, have implementation and fidelity supports available, and have a manual or protocol.

For those programs with multiple adaptations or modifications, the clearinghouse reviews each adaptation separately. Key considerations in differentiating an adaptation versus slight modifications include the qualifications of those administering it, whether the adaptations use the same manual, the modality of the program (e.g., individual vs. group therapy), and the modules and session content. States should understand which adaptation they are considering by asking questions about the manual used, who is administering it, and what the session format and content are. Programs should strive to make their adaptations as clear as possible. Multiple names for the same program can cause confusion, as can published studies that do not clearly articulate which adaptation is under review.

While the standards put forth by the Prevention Services Clearinghouse and another well-known child welfare clearinghouse (the California Evidence-Based Clearinghouse) overlap considerably, the standards are not identical. Both entities:

  • Include peer-reviewed studies published in scholarly journals;
  • Include and prefer randomized-control trial (RCT) designs in which the participants were randomly assigned to the program or service or a control group;
  • Define “well-supported” studies as those published in non-overlapping samples and that demonstrate sustained positive effects of the program/service for at least one year for at least one of the studies; and
  • Assess for risk of harm to ensure that programs or services do not worsen outcomes for the group that receives a program or service.

Some key differences include the following.

  • The Prevention Services Clearinghouse will consider quasi-experimental designs in addition to RCTs. “Quasi-experimental” means that participants were not randomly assigned to receive the program or service or to be in a control group. These studies can be included as long as they meet high standards detailed in the handbook and provide evidence that the two groups being compared are truly comparable. Many programs could be assessed this way using already-existing administrative data, appropriate methodology, and sufficiently large sample sizes.
  • The Prevention Services Clearinghouse will consider both peer-reviewed studies published in scholarly journals and “gray literature” such as reports published by state, federal, tribal, foundation, and private agencies. The reports must be publicly available online to be eligible.
  • The Prevention Services Clearinghouse has a handbook of guidelines to use when determining eligibility and ratings. These guidelines are detailed and specific, especially around statistical and design criteria that studies must meet.

The Children’s Bureau continues to release guidance, some of which may change over time. Evident Change suggests that states and other entities check on the latest version of the guidance before investing time developing a prevention action plan.
 

Cynthia Burnson Cynthia Burnson, PhD, is a senior researcher at Evident Change. Another FFPSA-related blog post—regarding strategies for defining FFPSA candidacy criteria—can be    
found here.