When Congress passed the Family First Prevention Services Act, it made a simple but profound promise: that we would invest in keeping families safely together, not just in responding after a child has already entered foster care.
President Trump has taken this sentiment further: “The best foster care system is one that is not needed in the first place.”
That promise was — and remains — the right one. But we also need to be honest about the gap between aspiration and reality.
Several years into implementation, prevention services still account for less than 2% of total Title IV-E spending. Claims data through fiscal year 2023 indicated that six in ten jurisdictions with approved prevention plans had never submitted a single prevention claim. And the services that are being claimed are heavily concentrated in a narrow band of interventions that have not primarily included substance abuse treatment and prevention programs.
Optimism about the prevention landscape changing is not reflected in Congressional estimates; in fact, the budget office has estimated it to grow to just 5% of total Title IV-E spending a decade after passage of the law.
This is not because states or communities doubt the value of prevention. It is because, in too many cases, the system we built to support prevention has been harder to use than it needed to be.
Evidence standards are rigorous by design — and rightly so — but the process for clearing services has often been slow, resource-intensive, and mismatched with urgent community needs. In practice, that has meant that some of the most effective tools for addressing root causes of foster care entry, particularly parental substance use, have remained out of reach.
At the Administration for Children and Families (ACF), we believe prevention should be real, usable, and impactful — not theoretical. That is why we are cutting red tape, accelerating access to evidence-based services, and rolling out the welcome mat for states ready to act.
Cutting Red Tape and Fast-Tracking Reviews
Earlier this month, ACF used a new Fast-Track Evidence Review Procedure for the first time. This process was specifically designed to move faster without lowering the bar for evidence or safety.
The fast-track approach leverages the rigorous FDA approval and post-market surveillance process to meet statutory requirements under Family First. It allows the Title IV-E Prevention Services Clearinghouse to focus review on the studies that matter most, streamline requests for additional information, and reach determinations more efficiently — while still ensuring there is no risk of harm that exceeds the clear evidence of effectiveness.
This is not about shortcuts. It is about modernizing how we review evidence so that families are not left to wait years for help we already know works.
Why We Started with Medications for Opioid Use Disorder (MOUD)
The first services approved through this new fast-track process are three FDA-approved medications for opioid use disorder: buprenorphine, methadone, and naltrexone. Each has now received a “well-supported” evidence rating through our new process, and is eligible for inclusion in Title IV-E prevention plans.
This matters — especially for rural communities and families who are not Medicaid beneficiaries. In 2024 alone, over 53,000 children – nearly one-third of all foster care entries – came into the system because of caretaker drug use.
With Title IV-E prevention funding, states can now receive a 50 percent federal match to provide these treatments to parents and caregivers when children are at imminent risk of entering foster care but who can remain safely in the home or in a kinship placement with the provision of those treatments. Importantly, the match rate for all title IV-E prevention services will be equal to the Medicaid matching rate starting October 1 of this year — which is much higher in many states — including more than an 80% match for most tribes.
That means expanded access to lifesaving care, delivered earlier, and in more places. And not after a family has already been separated.
Substance use treatment is prevention. When we stabilize parents, we stabilize families, and we can reduce foster care entries.
Closing the Uptake Gap
Evidence alone is often not enough. We also have to make it easier for states to act to close what some have called the “last mile” problem in child welfare.
Title IV-E Prevention is like a leaky bucket. More than 200 programs have been reviewed for inclusion in the Clearinghouse, and 95 of which have been included in the Clearinghouse. But only 27 have been embedded into a IV-E prevention plan by at least one jurisdiction, and not all of these 27 programs have even been billed to date.
To help close the last mile uptake gap, ACF has issued template language that states can add as an addendum to an approved Title IV-E prevention plans specific to three FDA-Approved MOUDs. This will reduce administrative burden, speed plan amendments, and eliminate guesswork about how to claim these services appropriately.
The goal is making it easier for states to say yes to prevention, easier to claim for what works, and easier to bring proven services to families who need them now.
ACF is exploring this template approach as a new model for other well-supported prevention services. We are building out the Family First Prevention Implementation Hub through the National Child Welfare Center on Innovation and Advancement to laser focus on increasing uptake of Title IV-E prevention services by states. This Hub will deliver a robust suite of services to support jurisdictions in accelerating implementation of approved prevention plans. Through rapid-cycle, data-driven assistance, practical tools, and peer-to-peer learning opportunities, the Hub will foster innovation and share best practices.
The National Center on Substance Abuse and Child Welfare, co-funded by the Administration for Children and Families and the Substance Abuse and Mental Health Services Administration, also provides training and technical assistance to state, tribal, and local jurisdictions to improve child and family outcomes. The center has a number of resources to provide tools, and strategies to help professionals, families, and systems understand and implement MOUDs as part of comprehensive care.
Prevention Is How We Get to a Home for Every Child
We believe in prevention — not as a slogan, but as a strategy.
ACF is aligning its policies to increase the ratio of foster homes to foster children. This gives states two focuses: increasing the numerator of foster homes or, more importantly, safely reducing the denominator of children in the foster care system.
Reducing the denominator of children entering foster care through effective prevention is how we improve outcomes for those who do. It is how we strengthen and stabilize families. Effective substance use disorder services are a key component of any prevention strategy, and we encourage all states to amend their IV-E prevention plan to include the well-supported MOUD services.
The promise of Family First is still within reach. By cutting red tape, expanding access to evidence-based treatment, and meeting states where they are, we are working to turn prevention from an underutilized opportunity into a lived reality.
That is how we build a future with a home for every child.
