Title IV-E Prevention Services Plan

This is a mandatory collection of information related to the Plan for Foster Care and Adoption Assistance, funded and authorized by Title IV-E of the Social Security Act, and is being conducted by the Children’s Bureau (CB). The information collection also incorporates the plan requirements to participate in the optional Guardianship Assistance and Kinship Navigator programs, and the Title IV-E Prevention Services Plan. Approval to publish these notices will allow CB to comply with the Paperwork Reduction Act (PRA) when requesting the information from respondents. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the PRA of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0433 and the expiration date is 07/31/2025. If you have any comments on this collection of information, please contact Liliana Chakrabarti by e-mail at [email protected].

State Plan for title IV-E prevention services and program OMB Approval No: 0970-0433

Expiration Date: (XX/XX/XXXX)

B. STATE PLAN FOR TITLE IV-E OF THE SOCIAL SECURITY ACT: PREVENTION SERVICES AND PROGRAMS

STATE OF

U.S. Department of Health and Human Services Administration for Children and Families Children’s Bureau

SECTION 1. Service description and oversight SECTION 2. Evaluation strategy and waiver request SECTION 3. Monitoring child safety

SECTION 4. Consultation and coordination SECTION 5. Child welfare workforce support SECTION 6. Child welfare workforce training SECTION 7. Prevention caseloads

SECTION 8. Assurance on prevention program reporting

SECTION 9. Child and family eligibility for the title IV-E prevention program

ATTACHMENT I: State Title IV-E Prevention Program Reporting Assurance

ATTACHMENT II: State Request for Waiver of Evaluation Requirement for a Well-supported Practice ATTACHMENT III: State Assurance of Trauma-informed Service-delivery

ATTACHMENT IV: State Annual Maintenance of Effort (MOE) Report

ATTACHMENT V. State title IV-E Prevention Program Five-year Plan Renewal Assurance

As a condition of the receipt of Prevention Services and Program funds under title IV-E of the Social Security Act (hereinafter, the Act), the

__________________________________________________________________

(Name of State Agency)

submits here a plan to provide, in appropriate cases, Prevention Services and Programs under title IV-E of the Act and hereby agrees to administer the programs in accordance with the provisions of this plan, title IV-E of the Act, and all applicable Federal regulations and other official issuances of the Department. This Pre-print is provided as an option for title IV-E agencies to use over the course of the five years that the Prevention Services and Programs Plan is in effect.

The state agency understands that if and when title IV-E is amended or regulations are revised, a new or amended plan for title IV-E that conforms to the revisions must be submitted.

Federal Regulatory/Statutory References1	Requirement	State Regulatory, Statutory, and Policy References and Citations for Each
Section 1. Services Description and Oversight
471(e)(1)	A. SERVICES. The state agency provides the following services or programs for a child and the parents or kin caregivers of the child when the need of the child, such a parent, or such a caregiver for the services or programs are directly related to the safety, permanence, or well-being of the child or to preventing the child from entering foster care: MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION AND TREATMENT SERVICES. — Mental health and substance abuse prevention and treatment services provided by a qualified clinician for not more than a 12-month period that begins on any date described in paragraph (3) of Section 471(e) with respect to the child. IN-HOME PARENT SKILL-BASED PROGRAMS. — In-home parent skill-based programs for not more than a 12-month period that begins on any date described in paragraph (3) of Section 471(e) with respect to the child and that include parenting skills training, parent education, and individual and family counseling.
471(e)(5)(B)(i)	B. OUTCOMES. The state agency provides services and programs specified in paragraph 471(e)(1) is expected to improve specific outcomes for children and families.

¹ Statutory references refer to the Social Security Act. Regulatory references refer to Title 45 of the Code of Federal Regulations (CFR).

Federal Regulatory/Statutory References1	Requirement	State Regulatory, Statutory, and Policy References and Citations for Each
471(e)(5)(B)(iii)(I)(IV) 471(e)(4)(B) 479B(c)(1)(E)(i)	the services or programs selected by the state, and whether the practices used are promising, supported, or well supported, and, if applicable, for services or programs provided by a tribe operating under an agreement with the state under section 472(a)(2)(B)(ii) of the Act, the services or programs provided by the tribe through the agreement, and whether the services meet the practice criteria identified by the tribe; how the state plans to implement the services or programs, including how implementation of the services or programs will be continuously monitored to ensure fidelity to the practice model and to determine outcomes achieved and how information learned from the monitoring will be used to refine and improve practices (Not applicable to title IV-E prevention programs and services operated by tribal title IV-E agencies and tribes with a 472(a) agreement.); if applicable, for services or programs provided by a tribe operating pursuant to an agreement with the state consistent with section 472(a)(2)(B)(ii) of the Act, any adaptations used by the tribe operating pursuant to the agreement; how the state selected the services or programs; the target population for the services or programs; an assurance that each prevention or family service or program provided by the state meets the requirements at section 471(e)(4)(B) of the Act related to trauma-informed service-delivery (states must submit Attachment III for each prevention or family service or program); and how each service or program provided will be evaluated.	Attachment III
Section 2. Evaluation strategy and waiver request
471(e)(5)(B)(iii)(V)	EVALUATION STRATEGY. With respect to the prevention and family services and programs specified in subparagraphs (A) and (B) of paragraph 471(e)(1), information on the specific practices the state plans to use to provide the services or programs, including a description of how each service or program provided will be evaluated through a well-designed and rigorous process, which may consist of an ongoing, cross-site evaluation approved by the Secretary, unless a waiver is approved for a well-supported practice, and

Federal Regulatory/Statutory References1	Requirement	State Regulatory, Statutory, and Policy References and Citations for Each
471(e)(5)(C)(ii)	B. REQUEST FOR WAIVER OF WELL DESIGNED, RIGOROUS EVALUATION OF SERVICES AND PROGRAMS FOR A WELL- SUPPORTED PRACTICE. The state must provide evidence of the effectiveness of the practice to be compelling and the state meets the continuous quality improvement requirements included in subparagraph 471(e)(5)(B)(iii)(II) with regard to the practice. (Not applicable to title IV-E prevention programs and services operated by tribal title IV-E agencies and tribes with a 472(a) agreement.)	Attachment II
Section 3. Monitoring child safety
471(e)(5)(B)(ii)	The state agency monitors and oversees the safety of children who receive services and programs specified in paragraph 471(e)(1), including through periodic risk assessments throughout the 12-month period in which the services and programs are provided on behalf of a child and reexamination of the prevention plan maintained for the child under paragraph 471(e)(4) for the provision of the services or programs if the state determines the risk of the child entering foster care remains high despite the provision of the services or programs.
Section 4. Consultation and coordination
471(e)(5)(B)(iv) and (vi)	A. The state must: engage in consultation with other state agencies responsible for administering health programs, including mental health and substance abuse prevention and treatment services, and with other public and private agencies with experience in administering child and family services, including community-based organizations, in order to foster a continuum of care for children described in paragraph 471(e)(2) and their parents or kin caregivers and describe how the services or programs specified in paragraph (1) of section 471(e) provided for or on behalf of a child and the parents or kin caregivers of the child will be coordinated with other child and family services provided to

Federal Regulatory/Statutory References1	Requirement	State Regulatory, Statutory, and Policy References and Citations for Each
	the child and the parents or kin caregivers of the child under the state plans in effect under subparts 1 and 2 of part B.
Section 5. Child welfare workforce support
471(e)(5)(B)(vii)	The state agency supports and enhances a competent, skilled, and professional child welfare workforce to deliver trauma-informed and evidence-based services, including— ensuring that staff is qualified to provide services or programs that are consistent with the promising, supported, or well supported practice models selected; and developing appropriate prevention plans, and conducting the risk assessments required under clause (iii) of section 471(e)(5)(B).
Section 6. Child welfare workforce training
471(e)(5)(B)(viii)	The state provides training and support for caseworkers in assessing what children and their families need, connecting to the families served, knowing how to access and deliver the needed trauma informed and evidence-based services, and overseeing and evaluating the continuing appropriateness of the services.
Section 7. Prevention caseloads
471(e)(5)(B)(ix)	The state must describe how caseload size and type for prevention caseworkers will be determined, managed, and overseen.
Section 8. Assurance on prevention program reporting

Federal Regulatory/Statutory References1	Requirement	State Regulatory, Statutory, and Policy References and Citations for Each
471(e)(5)(B)(x)	The state provides an assurance in Attachment I that it will report to the Secretary such information and data as the Secretary may require with respect to the provision of services and programs specified in paragraph 471(e)(1), including information and data necessary to determine the performance measures for the state under paragraph 471(e)(6) and compliance with paragraph 471(e)(7).	Attachment I
Section 9. Child and family eligibility for the title IV-E prevention program
471(e)(2)	A. CHILD DESCRIBED. —For purposes of the title IV-E prevention services program, a child is: A child who is a candidate for foster care (as defined in section 475(13)) but can remain safely at home or in a kinship placement with receipt of services or programs specified in paragraph (1) of 471(e). A child in foster care who is a pregnant or parenting foster youth.

Title IV-E Plan – State of

PLAN SUBMISSION CERTIFICATION

Instructions: This Certification must be signed and submitted by the official authorized to submit the title IV-E plan, and each time the state submits an amendment to the title IV-E plan.

I (name) hereby certify that I am authorized to submit the title IV-

E Plan on behalf of (state). I also certify that the title IV-E plan was submitted to the governor for his or her review and approval in accordance with 45 CFR 1356.20(c)(2) and 45 CFR 204.1.

Date

(Signature)

(Title)

APPROVAL DATE: EFFECTIVE DATE:

(Signature, Associate Commissioner, Children's Bureau)

ATTACHMENT I

State Title IV-E Prevention Program Reporting Assurance

Instructions: This Assurance may be used to satisfy requirements at section 471(e)(5)(B)(x) of the Social Security Act (the Act), and will remain in effect on an ongoing basis. This Assurance must be re-submitted if there is a change in the assurance below.

In accordance with section 471(e)(5)(B)(x) of the Act, , (Name of State Agency) is providing this assurance consistent with the five-year plan to report to the Secretary such information and data as the Secretary may require with respect to title IV-E prevention and family services and programs, including information and data necessary to determine the performance measures.

Signature: This assurance must be signed by the official with authority to sign the title IV-E plan, and submitted to the appropriate Children’s Bureau Regional Office for approval.

(Date) (Signature and Title)

(CB Approval Date) (Signature, Associate Commissioner, Children’s Bureau)

ATTACHMENT II

State Request for Waiver of Evaluation Requirement for a Well-Supported Practice

Instructions: This request must be used if a title IV-E agency seeks a waiver of section 471(e)(5)(B)(iii)(V) of the Social Security Act (the Act) for a well-supported practice, and will remain in effect on an ongoing basis. This waiver request must be re-submitted anytime there is a change to the information below.

Section 471(e)(5)(B)(iii)(V) of the Act requires each state title IV-E agency to implement a well-designed and rigorous evaluation strategy for each program or service, which may include a cross-site evaluation approved by ACF. In accordance with section 471(e)(5)(C)(ii) of the Act, a title IV-E agency may request that ACF grant a waiver of the rigorous evaluation for a well- supported practice if the evidence of the effectiveness the practice is: 1) compelling and; 2) the state meets the continuous quality improvement requirements included in section 471(e)(5)(B)(iii)(II) of the Act with regard to the practice. The state title IV-E agency must demonstrate the effectiveness of the practice.

The state title IV-E agency must submit a separate request for each well-supported program or service for which the state is requesting a waiver under section 471(e)(5)(C)(ii) of the Act.

The (Name of State Agency) requests a waiver of an evaluation of a well-supported practice in accordance with section 471(e)(5)(C)(ii) of the Act for

(Name of Program/Service) and has included documentation assuring the evidence of the effectiveness of this well-supported practice is: 1) compelling and; 2) the state meets the continuous quality improvement requirements supporting this request.

Signature: This certification must be signed by the official with authority to sign the title IV-E plan and submitted to the appropriate Children’s Bureau Regional Office for approval.

(Date) (Signature and Title)

(CB Approval Date) (Signature, Associate Commissioner, Children’s Bureau)

ATTACHMENT III

State Assurance of Trauma-Informed Service-Delivery

Instructions: This Assurance may be used to satisfy requirements at section 471(e)(4)(B) of the Social Security Act (the Act), and will remain in effect on an ongoing basis. This Assurance must be re-submitted if there is a change in the state’s five-year plan to include additional title IV-E prevention or family services or programs.

Consistent with the agency’s five-year title IV-E prevention plan, section 471(e)(4)(B) of the Act requires the title IV-E agency to provide services or programs to or on behalf of a child under an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma and in accordance with recognized principles of a trauma-informed approach and trauma-specific interventions to address trauma’s consequences and facilitate healing.

The (Name of State Agency) assures that in accordance with section 471(e)(4)(B) of the Act, each HHS approved title IV-E prevention or family service or program identified in the five-year plan is provided in accordance with a trauma-informed approach.

Signature: This assurance must be signed by the official with authority to sign the title IV-E plan and submitted to the appropriate Children’s Bureau Regional Office for approval.

(Date) (Signature and Title)

(CB Approval Date) (Signature, Associate Commissioner, Children’s Bureau)

ATTACHMENT IV

U.S. DEPARTMENT OF HEALTH and HUMAN SERVICES

Administration on Children, Youth and Families Children's Bureau

State Annual Maintenance of Effort (MOE) Report

State:	FFY:
Baseline Year:
Baseline Amount: $
Total Expenditures for Most Recent FFY:

This certifies that the information on this form is accurate and true to the best of my knowledge and belief.

This also certifies that the next FFY foster care prevention expenditures will be submitted as

required by law.

Signature, Approving Official:

Typed Name, Title, Agency:

Date:

ATTACHMENT V

State Title IV-E Prevention Program Five-year Plan Renewal Assurance

Instructions: The state may submit this assurance for approval to continue the title IV-E prevention program as described in the state’s approved five-year title IV-E prevention plan effective (Effective Dates of Previous Five-Year Plan) for the five-year period of (Effective Dates of Five-Year Plan Renewal).

In accordance with section 471(e)(5) of the Act, (Name of State Agency) assures that the five-year plan effective (Effective Dates of Previous Five-Year Plan), including the preprint, the plan submission certification, attachments, assurances, and any amendments approved during the five-year plan period, will remain in effect without substantial changes for the five-year period of (Effective Dates of Five-Year Plan Renewal).

Signature: This assurance must be signed by the official with authority to sign the title IV-E plan and submitted to the appropriate Children’s Bureau Regional Office for approval.

(Date) (Signature and Title)

(CB Approval Date) (Signature, Associate Commissioner, Children’s Bureau)

(Plan Renewal Effective Date)