    [House Hearing, 115 Congress]
    [From the U.S. Government Publishing Office]

                    THE OPIOID CRISIS: IMPLEMENTATION OF THE
               FAMILY FIRST PREVENTION SERVICES ACT (FFPSA)

    =======================================================================

                                    HEARING

                                   before the

                        SUBCOMMITTEE ON HUMAN RESOURCES

                                     of the

                          COMMITTEE ON WAYS AND MEANS
                         U.S. HOUSE OF REPRESENTATIVES

                         ONE HUNDRED FIFTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 JULY 24, 2018

                                   __________

                              Serial No. 115-HR08

                                   __________

             Printed for the use of the Committee on Ways and Means

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                     U.S. GOVERNMENT PUBLISHING OFFICE

    33-873                   WASHINGTON : 2019

                          COMMITTEE ON WAYS AND MEANS

                          KEVIN BRADY, Texas, Chairman

    SAM JOHNSON, Texas                   RICHARD E. NEAL, Massachusetts
    DEVIN NUNES, California              SANDER M. LEVIN, Michigan
    DAVID G. REICHERT, Washington        JOHN LEWIS, Georgia
    PETER J. ROSKAM, Illinois            LLOYD DOGGETT, Texas
    VERN BUCHANAN, Florida               MIKE THOMPSON, California
    ADRIAN SMITH, Nebraska               JOHN B. LARSON, Connecticut
    LYNN JENKINS, Kansas                 EARL BLUMENAUER, Oregon
    ERIK PAULSEN, Minnesota              RON KIND, Wisconsin
    KENNY MARCHANT, Texas                BILL PASCRELL, JR., New Jersey
    DIANE BLACK, Tennessee               JOSEPH CROWLEY, New York
    TOM REED, New York                   DANNY DAVIS, Illinois
    MIKE KELLY, Pennsylvania             LINDA SANCHEZ, California
    JIM RENACCI, Ohio                    BRIAN HIGGINS, New York
    KRISTI NOEM, South Dakota            TERRI SEWELL, Alabama
    GEORGE HOLDING, North Carolina       SUZAN DELBENE, Washington
    JASON SMITH, Missouri                JUDY CHU, California
    TOM RICE, South Carolina
    DAVID SCHWEIKERT, Arizona
    JACKIE WALORSKI, Indiana
    CARLOS CURBELO, Florida
    MIKE BISHOP, Michigan
    DARIN LAHOOD, Illinois
    BRAD R. WENSTRUP, Ohio

                         Gary J. Andres, Staff Director

                     Brandon Casey, Minority Chief Counsel

                                     ______

                        SUBCOMMITTEE ON HUMAN RESOURCES

                        ADRIAN SMITH, Nebraska, Chairman

    JACKIE WALORSKI, Indiana             DANNY DAVIS, Illinois
    CARLOS CURBELO, Florida              LLOYD DOGGETT, Texas
    DAVID SCHWEIKERT, Arizona            TERRI SEWELL, Alabama
    DARIN LAHOOD, Illinois               JUDY CHU, California
    BRAD R. WENSTRUP, Ohio
    DAVID G. REICHERT, Washington

                                C O N T E N T S

                                   __________

                                                                       Page

    Advisory of July 24, 2018 announcing the hearing.................     2

                                    WITNESS

    Jerry Milner, Associate Commissioner, Children's Bureau, and
      Acting Commissioner, Administration on Children, Youth and
      Families, United States Department of Health and Human Services     6

                        MEMBER QUESTIONS FOR THE RECORD

    Rep. Danny K. Davis to Jerry Milner..............................   142
    Rep. Jackie Walorski to Jerry Milner.............................   144
    Rep. David Reichert to Jerry Milner..............................   144
    Rep. Judy Chu to Jerry Milner....................................   144
    Rep. Adrian Smith to Jerry Milner................................   146
    Rep. Danny K. Davis to Jerry Milner..............................   147
    Rep. Brad Wenstrup to Jerry Milner...............................   159
    Rep. Lloyd Doggett to Jerry Milner...............................   159
    Rep. Terri Sewell to Jerry Milner................................   161
    Rep. Judy Chu to Jerry Milner....................................   161
    Rep. John Lewis to Jerry Milner..................................   163
    Rep. Carlos Curbelo to Jerry Milner..............................   164

                       PUBLIC SUBMISSIONS FOR THE RECORD

    Zero to Three, statement.........................................   166
    CSH, statement...................................................   176
    FamiliesFirst Network of Lakeview, statement.....................   180
    Florida Coalition for Children, statement........................   181
    Karin Axner, statement...........................................   183
    Children's Home Society of America, statement....................   185
    Alliance for Strong Families and Communities, statement..........   189
    County of Los Angeles Department of Children and Family Services,
      statement......................................................   195
    Eagle Accreditation, statement...................................   198
    Never Too Late, Inc., statement..................................   200
    The Methodist Home, statement....................................   201
    New York State Office of Children and Family Services, statement.   203
    Center for Fiscal Equity, statement..............................   213

                       THE OPIOID CRISIS: IMPLEMENTATION

                         OF THE FAMILY FIRST PREVENTION

                              SERVICES ACT (FFPSA)

                                  ----------

                             TUESDAY, JULY 24, 2018

                 U.S. House of Representatives,
                           Committee on Ways and Means,
                               Subcommittee on Human Resources,
                                                        Washington, DC.
        The Subcommittee met, pursuant to call, at 10:03 a.m., in
    Room 1100, Longworth House Office Building, the Honorable
    Adrian Smith [Chairman of the Subcommittee] presiding.
        [The advisory announcing the hearing follows:]

     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Chairman SMITH. The Subcommittee will come to order.
    Welcome to today's hearing on the implementation of the Family
    First Prevention Services Act.
        After steady declines in the number of children in foster
    care, we have, unfortunately, begun to see an increase again.
    Both the data and the experience of those on the front lines
    indicate substance abuse, specifically opioid use and overdose,
    are a contributing factor.
        More than 3 years ago, this Subcommittee set out to reverse
    this trend and do what Americans across this country expect of
    us. We worked together across the aisle and across the Capitol.
    Inspired by a desire to improve outcomes for children, we knew
    we had to strengthen families, whether they are biological,
    foster, or adoptive.
        We remained steadfast to the questions we were hearing from
    former foster youth, such as, ``Why did you take me away,''
    ``Why didn't you help my mom,'' or ``Why didn't you help my
    dad?'' Backed by research in the field, we set out to change
    the role of Federal taxpayer dollars in foster care and
    adoption. We wanted to reset the incentives and focus resources
    earlier, with upfront prevention services for substance abuse,
    mental health, and parenting for all families, so fewer
    children would have to experience additional trauma of being
    removed from his or her home.
        We listened to advocates, researchers, States, providers
    and, most importantly, foster youth during the multiyear policy
    development process. For me, one of those voices was Nebraska's
    own Boys Town and Reverend Steven Boes, where, for more than
    100 years, Boys Town, has been helping children and healing
    families. Feedback from Boys Town helped us further our goal of
    providing the right kind of supports at the right time for each
    child in care.
        Now, 6 months after the enactment of the Family First
    Prevention Services Act, we return to talk about the
    implementation of this important law, again using those same
    voices to drive our questions today.
        To provide the answers, we are pleased to be joined by HHS
    Associate Commissioner for the Children's Bureau and lead
    policy official for the implementation of Family First, Jerry
    Milner. He brings with him more than 40 years of practice,
    management, and technical assistance experience in child
    welfare at the local, State, and Federal levels of government.
    He has been a busy man over the last 6 months, traveling the
    country to spread the word about Family First and address
    outstanding questions.
        Thank you, Mr. Milner, for being here today and for all of
    your efforts to Family First.
        I also want to commend my home State of Nebraska for being
    on the leading edge of implementation and setting a strong
    example for others under the leadership of Dr. Courtney
    Phillips, CEO of the Nebraska Department of Health and Human
    Services; and Director Matthew Wallen of the Division of Child
    and Family Services, DCFS.
        In June, DCFS hosted a kickoff meeting, marking the
    official start of the State's efforts to implement the act and
    included a number of child welfare stakeholders, such as
    judges, advocates, providers, families, and others often
    involved in the State's child welfare system.
        This type of cross-collaboration is precisely what Family
    First is all about and will create the type of positive systems
    change to improve outcomes for children and families for years
    to come.
        They also set up working groups on specific topics which
    need to be addressed under Family First, and those groups will
    be meeting regularly over the next few months to develop
    strategies for implementing Family First. Nebraska DHHS also
    created a website where the public can engage in the process of
    implementing Family First and monitor the progress.
        The use of technology also exists to their creative
    thinking families in the rural and sometimes remote areas of
    our state when it comes to providing prevention services. And
    they are thinking about ways to dovetail Family First with
    their existing ``Bring Up Nebraska'' initiative, which is a
    primary prevention program focused on developing nurturing
    communities to raise strong and healthy children.
        Every State is different and will have to chart its own
    course for Family First, but States like Nebraska, Oregon, and
    others are showing it can be done when everyone focuses on what
    is truly important: better outcomes for children and families.
        I now recognize the distinguished Ranking Member, Mr.
    Davis, for 5 minutes for his opening statement.
        Mr. DAVIS. Thank you, Mr. Chairman.
        And before getting into my opening comments, I would like
    to recognize my colleague Congresswoman Karen Bass, who is here
    today observing our hearing. Congresswoman Bass is a tremendous
    leader on foster care issues, was a valued partner and resource
    throughout our efforts to enact this landmark change in foster
    care. I look forward to continuing to work closely with her and
    as we implement the law. And I might indicate that she also
    organized the foster care caucus that any number of us are
    members of.
        Mr. Chairman, thank you for scheduling this bipartisan
    oversight hearing. Child welfare is a deeply important issue to
    me and to the people of Illinois. I am grateful that we are
    working together so closely to ensure effective implementation
    of the landmark new law, the Family First Prevention Services
    Act, or Family First.
        Frederick Douglas was fond of saying that it is easier to
    build strong children than to repair broken men. There are very
    few places that this lesson is more evident than in our
    troubled foster care system, which has historically provided
    help only when it was too late to keep families together.
        When I ask foster youth what policymakers could do to make
    child welfare better, they almost always say: ``You could have
    helped my mom and dad.''
        That is exactly what we tried to do in Family First.
        I am proud of our work together to enact this law to
    fundamentally shift child welfare from separating families to
    strengthening them, but our work is not done until children and
    families receive the help that they were promised. That is why
    we hold this hearing today, and that is why we will continue
    our active involvement in its implementation.
        Family First provides a number of opportunities to
    strengthen families and build strong children. For families
    struggling with mental health, substance abuse, or parenting
    skills and challenges, it will provide uncapped Federal
    matching funds for State services to address those challenges
    and to make foster care unnecessary. Importantly, these
    services are available to parents, children, and other family
    members. They are also available to youth in foster care who
    are pregnant and those who are parents, both mothers and
    fathers, to prevent the cycle from repeating.
        To trigger the Federal investment in these services, States
    will need to develop prevention plans and provide a
    contribution. Child welfare advocates state that local
    officials and State legislators have told us they have a number
    of questions that need to be answered so that we can do that.
    We will ask our questions today, and we hope to get answers
    that will support positive action.
        Another aspect of the new law that is close to my heart is
    the opportunity to better support grandparents and other
    kinship caregivers. My congressional district has the highest
    percentage of children living with grandparent caregivers in
    the Nation. We know that if children can't live safely with
    their parents, being with family is the next best option. But
    these kin caregivers need help and support.
        I commit to personally making sure that the new Federal
    funding for kinship navigators provides services to all
    grandfamilies that need them and that States update their
    policies to involve and support kin.
        The Department of Health and Human Services has already
    begun issuing policy guidance and soliciting applications for
    kinship navigator funds and regional partnership grants to
    address family substance abuse that will be available even
    before the permanent prevention funding, but there is a great
    deal of work to do.
        I appreciate Jerry Milner for being here with us today to
    answer our questions and his commitment to making the law a
    success. I look forward to working with the administration as
    we move ahead on behalf of the families we represent.
        Thank you, Mr. Chairman, and I yield back.
        Chairman SMITH. Thank you, Mr. Davis.
        I would like to welcome our witness to the table: Mr. Jerry
    Milner, Associate Commissioner at the Children's Bureau and
    Acting Commissioner of the Administration on Children, Youth
    and Families, and with the United States Department of Health
    and Human Services.
        Our witness is reminded to limit his oral testimony to 5
    minutes. And certainly, your written statement will be included
    in the record. I would also like to remind our witness and
    Members that time is limited today and that the topic for
    today's hearing is oversight of the implementation of Family
    First Prevention Services Act.
        While there are certainly many important issues we are all
    facing today, this hearing is part of a larger effort to make
    Family First a success by addressing outstanding questions that
    are holding States back from moving forward on this very
    important legislation.
        I would kindly suggest that if there is a veering off
    track, I will not hesitate to make sure that we bring the
    hearing back to its primary focus.
        With that, Mr. Milner, you may begin when you are ready.

     STATEMENT OF JERRY MILNER, ASSOCIATE COMMISSIONER, CHILDREN'S
     BUREAU, AND ACTING COMMISSIONER, ADMINISTRATION ON CHILDREN,
      YOUTH AND FAMILIES, UNITED STATES DEPARTMENT OF HEALTH AND
                             HUMAN SERVICES

        Mr. MILNER. Thank you, Chairman Smith, Ranking Member
    Davis, and Members of the Subcommittee. Thank you very much for
    inviting me here today to testify about something that is near
    and dear to me and the work that I have done over many years
    now.
        I also want to acknowledge the large number of former
    foster care youth who are in the room today, many of whom I
    know and have had the pleasure of meeting with over time. I
    unabashedly say that their voice gives me a voice, and it means
    a lot to me that they are here today.
        I began my career as a case----
        Chairman SMITH. One moment. If you don't mind my
    interruption, former foster youth in the audience, would you
    raise your hand? Very good. It is great to have you here. And,
    again, I apologize for interrupting, but your input is very
    valuable, and we are glad you are here. Please proceed.
        Mr. MILNER. Thank you. I began my career as a case-carrying
    social worker, and child welfare has, frankly, remained my
    life's work. Before joining the administration, my experience
    in child welfare included providing technical assistance to
    States to improve services to children and families as well as
    serving as Alabama's State child welfare director.
        In more than four decades of work in child welfare, I have
    seen far too many situations where all the factors that place
    children at risk of serious harm went unaddressed by the child
    welfare system until a serious injury, psychological damage, or
    something much worse occurred. These things do not typically
    happen because of a lack of will or a lack of skill within the
    child welfare workforce but, rather, because of the way our
    system has been designed and funded.
        Traditionally, the majority of Federal funds have been used
    for foster care, and in comparison we spend only a tiny
    fraction of Federal funds for actual prevention of child
    maltreatment before children become known to child welfare
    agencies. It does not have to be that way.
        I am pleased to report to you that we have made significant
    progress in implementing the Family First Act, and we are
    absolutely committed to timely and effective implementation.
        By permitting, for the first time States and Tribes to use
    title IV-E funds to prevent children from entering foster care,
    the Family First Act provides a pathway for the child welfare
    system to help some families stay together rather than placing
    their children in foster care. Our approach to Family First
    implementation allows for as much flexibility as the statute
    permits. We do not intend to regulate definitions of key
    concepts beyond what is already in the statute. We will also
    strive to provide maximum flexibility to States and Tribes in
    claiming funding for prevention services. Our first program
    instruction to States and Tribes was published on May 31st and
    addressed the amendments to title IV-B of the Social Security
    Act and the Chafee Foster Care Independence Program. Our
    program instruction on the amendments to title IV-E, the Foster
    Care Prevention and Permanency Program, was published on July
    9th.
        In order to participate in the new title IV-E Prevention
    Services Program, States and Tribes will submit a plan to us
    that describes how they will carry out the program. We will
    provide information to States and Tribes on how to submit this
    plan in a further program instruction that we expect to publish
    in the first quarter of Federal fiscal year 2019.
        We are in the process now of procuring contract support to
    create the clearinghouse that will identify interventions that
    satisfy the requirement for reimbursement under the Prevention
    Services Program, and we expect to award a contract in the
    coming weeks.
        I also want to acknowledge a few of the implementation
    challenges that States and Tribes, as well as other
    stakeholders in the child welfare community, are sharing with
    us. We have heard concerns about the availability of the array
    of prevention services needed to be effective, about developing
    alternative placement options for children in congregate care
    who may not be able to succeed in a foster family home, about
    the expensive upfront cost of evidence-based programs and about
    the time limits on reimbursable prevention services in light of
    wait lists and delays in getting families into services. Some
    States that have had the flexibility of title IV-E waivers for
    quite some time are also concerned about the loss of that
    flexibility.
        While some of these challenges are undoubtedly very
    complex, we are committed to providing States and Tribes with
    assistance to promote their opportunities for success. Creating
    a child welfare system that we can be proud of as a Nation and
    one that children, families, and communities will see as a
    source of support and strength as opposed to a system to fear
    will take collaboration across the three branches of
    government.
        We have a collective duty and a responsibility to ensure
    that Federal policy and funding protects children to the best
    extent possible, which includes living in resilient, healthy
    families. I look forward to working with you as we continue
    implementation, and I am happy to answer your questions.
        Chairman SMITH. Thank you, Mr. Milner. Thank you for
    sharing your insight and expertise.

     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Chairman SMITH. In preparation for this bipartisan hearing
    on implementation, Ranking Member Davis and I solicited
    questions directly from States and their representative
    organizations. In total, we received nearly 200 questions, and
    today we are going to do our best to get them answered so
    States can continue to move forward with the important task of
    implementing this important bill to strengthen families and
    improve outcomes for children.
        We heard States greatly appreciate the Children's Bureau's
    efforts to provide summaries and overviews through the recent
    program information releases, but State and local leaders
    request more specific information on timelines for policy
    releases and expected implementation milestones, both for the
    Children's Bureau as well as for implementing State agencies.
        We also heard human services leaders and child welfare
    administrators welcome the opportunity to implement a new
    vision for child welfare and to expand the continuum of
    services oriented toward prevention.
        In order to move forward with key decisions on
    implementation or delay, budget forecasting, workforce
    planning, community-based partner engagement and State
    legislative activities, State and local leaders need a more
    concrete and regular communication and guidance from the
    Children's Bureau to facilitate implementation.
        Please tell us more about the timeline for upcoming
    guidance, what States can expect will be included and not
    included in upcoming guidance, also timelines for States taking
    action, submitting plans and the like. And for States that are
    delaying, how are those timeframes impacted? On the issue of
    State option to delay implementation for 2 years, the law is
    explicit that States have full control over their decision to
    delay implementation, but yet the program guidance mentions no
    less than six times approval by HHS and asks for a decision by
    November 9.
        There was no deadline requirement for this decision in the
    law, and by expecting a decision now for a year later appears
    to push States to make rushed decisions about these important
    reforms before thoughtful consideration and discussions can
    happen with various stakeholders, before the results of State
    elections allow new policymakers to make decisions about
    resource allocations, and before State and local budgets are
    finalized that would impact the State's ability to implement
    these reforms.
        I understand the November 9th deadline is not binding but
    merely for planning purposes, and a State can change its mind
    at any point, both to go ahead or delay. Is that correct?
        Mr. MILNER. That is correct.
        Chairman SMITH. Thank you. On the topic of what families
    will be eligible for prevention--what families will be eligible
    for prevention services, known as the candidate of imminent
    risk issue, I would like to highlight what you said in your
    written and oral testimony. The Children's Bureau does not
    intend to regulate a definition beyond what is already in law,
    correct?
        Mr. MILNER. That is correct.
        Chairman SMITH. Does this mean States should be setting out
    to define it themselves and, if they wanted to in the future,
    could adjust it?
        Mr. MILNER. Presumably so. States have flexibility under
    the current title IV-E Foster Care Program to make certain
    decisions about who is a candidate there. We want to give them
    that maximum flexibility there as well, and we don't intend to
    impose any restrictions on those definitions beyond what is
    already in statute.
        Chairman SMITH. Okay. Very good. Can you reflect a little
    bit on the timelines that I mentioned earlier?
        Mr. MILNER. Yes, sir. I am happy to. Let me first of all
    say we are absolutely committed to timely implementation, but
    we are also committed to doing it well. I am far more
    interested in seeing States truly move the culture and the
    foundation of their child welfare systems to one that is
    designed to strengthen families and gets the outcomes that
    Family First contemplates as opposed to a purely technical
    implementation that may not, in fact, improve the outcomes for
    children and families. We issued our first information
    memorandum in April of 2018, which was an overview of the
    requirements of the Family First Act. Our first program
    instruction was issued in May of 2018, which covered the
    requirements under title IV-B of the Social Security Act. Our
    second PI was issued July 9, I believe, which covers the
    requirements of title IV-E of the Social Security Act.
        We currently have in clearance a Federal Register notice in
    clearance, which will be issued regarding the Family First
    requirement that we issue model licensing standards; and we
    will be sending that information out for comment before
    finalizing it. We expect in the first quarter of Federal fiscal
    year 2019 to issue additional program instructions for both
    States and Tribes on the new IV-E Prevention Funding Program,
    which is part of Family First.
        In the meantime, I think it is important to note that while
    we recognize that States and Tribes have a tremendous number of
    questions, as evidenced by the 189 that I received sometime
    yesterday afternoon, we are trying our best to be as responsive
    as we can to those questions going forward. Many of the answers
    to those questions have been addressed in the program
    instructions. Many of those questions are addressed in the
    statute itself. Where there are gaps, we are committed to
    issuing either clarifying instructions for States and Tribes or
    meeting with them in order to answer those questions. We are
    participating in, and cohosting with the Casey Family Programs,
    a series of three listening sessions across the country to
    address State concerns and to respond to the questions. I
    participated in the first of those a couple of weeks ago in
    Seattle, and we have two more forthcoming. Even as we speak
    today, we have a State call that is being conducted to answer
    questions and to help respond to the concerns that States are
    raising with regard to the implementation of the Family First
    Act. We have four more of those calls scheduled with States.
        Chairman SMITH. Thank you. On the model licensing
    standards, you expect that to be available when?
        Mr. MILNER. Very soon. It is in clearance right now. We
    have drafted that. Within the coming weeks, that should be out
    there and available for comment.
        Chairman SMITH. So well in time for States to run that
    through their respective legislative processes?
        Mr. MILNER. Yes. Our deadline on that is October 1 of 2018.
    We will come out with that before that October 1 deadline.
        Chairman SMITH. Okay. Thank you very much.
        I now recognize the distinguished Ranking Member, Mr.
    Davis, for 5 minutes for any questions he might have.
        Mr. DAVIS. Thank you very much, Mr. Chairman.
        And, Mr. Milner, thank you again. Starting October 1, 2018,
    the Federal Government will provide a dollar-for-dollar match
    for State expenditures for the Kinship Navigator Program, which
    will help provide needed support to grandparents and other kin
    caregivers who have stepped up to keep children with their
    families and out of care. The law clearly provides this funding
    separately from the prevention funding, and it was Congress'
    intent that kinship navigator programs be allowed to serve all
    kin caregivers, not only those caring for children at imminent
    risk of foster care. This broader target population of kinship
    families is consistent with previously federally supported
    Kinship Navigator Program funding in the Fostering Connections
    to Success and Increasing Adoption Act of 2008, which is
    referenced in Family First.
        Is it your understanding of the law as well that States
    should serve a broader population of kinship caregivers beyond
    simply those caring for children at imminent risk of care?
        Mr. MILNER. Yes, sir.
        Mr. DAVIS. Thank you for that.
        Similarly, the requirement that 50 percent of interventions
    must meet the well-supported evidence standard only applies to
    the prevention services funding, not to the kinship navigator
    programs. The kinship navigator programs simply need to be
    evidence-based, which means they meet the promising standard in
    the law. Is that your understanding of the law as well?
        Mr. MILNER. I believe. I am clear that the kinship
    navigator programs must meet the evidence-based requirements. I
    am less clear in the moment about the 50 percent requirement
    there, but we will be absolutely glad to clarify that for you.
        Mr. DAVIS. Thank you very much for that.
        In your testimony, you said there might not be any models
    of kinship navigator programs that meet the evidence standard.
    What are you doing to make sure there are models available to
    States in time for States to claim funding in fiscal year 2019?
        Mr. MILNER. Well, first of all, to clarify that statement,
    we have heard from a number of stakeholders that there are not
    many or possibly any kinship navigator programs out there that
    would meet the evidentiary standards required by Family First.
    We believe one program that we have begun to look at that might
    meet those standards, and we are actually going to be pursuing
    that, hopefully, as one of our priorities in determining the
    evidence-based programs that are reimbursable under Family
    First.
        Apart from that, you mentioned the prior work that we have
    funded. We are going to be looking at those programs as
    possible candidate programs in the kinship navigator realm that
    we could fold into the list of approvable services to be funded
    under title IV-E.
        We are also working with our Office of Planning, Research,
    and Evaluation to fund a contract that is designed to build the
    evidence for promising programs out there so that we can expand
    the entire array of reimbursable services. Kinship navigator
    programs are a part of that work that is going forward.
        Mr. DAVIS. And, finally, Family First makes pregnant and
    parenting foster youth categorically eligible for prevention
    services even if their children are not at imminent risk of
    entering foster care. We wrote the language to ensure that this
    group of youth include fathers as well as mothers.
        Family First allows service provision on behalf of pregnant
    and parenting youth, meaning that services should be available
    to their kin caregiver. Does HHS plan to emphasize these
    important points in its guidance to States to ensure that they
    know teen fathers and kin caregivers of pregnant and parenting
    foster youth can also be served?
        Mr. MILNER. Absolutely. The whole issue of responsible
    fatherhood and engagement of fathers in the lives of their
    children and families is of critical importance to us. It has
    been an area that I personally have been focused on through the
    Child and Family Services Reviews since 2001, and we continue
    to work with States on ways to improve their response to that.
        I am going to add that, just a few weeks ago, I was
    fortunate enough to meet with a group of parenting youth who
    were either still in foster care or emancipated from foster
    care and a couple of those youth who were about to become
    parents. That was in your home State of Nebraska, Chairman
    Smith. That group of youth gave me a tremendous amount of
    information about how important it is that they get the
    services that they need.
        I will also say that they gave me hope. They gave me hope
    that, despite so many obstacles that they have faced, their
    goals were incredibly lofty. One of the young women in that
    meeting had strong desires of attending law school. My special
    assistant who was with me there and is also a lawyer was able
    to meet with her and link her up with some resources that she
    could begin that whole process of living out her dream and her
    goal.
        So you are raising a critical issue here, and we are
    entirely supportive of providing as much of an array of
    services to that population served under Family First as we
    can.
        Mr. DAVIS. Thank you, Mr. Chairman, and I yield back.
        Chairman SMITH. Thank you.
        I now recognize Mrs. Walorski from Indiana.
        Mrs. WALORSKI. Thank you, Mr. Chairman.
        And thank you, Mr. Milner, for being here. For all of you
    that came with him, thank you so much. Seeing your faces this
    morning gives me hope and very tangible evidence, sitting here
    today with all of you being here. Thank you so much for joining
    us today.
        The opioid crisis has put unprecedented strains on our
    communities and social service agencies. Indiana has seen a
    huge spike in the number of children in the foster care system
    due in large part to this epidemic. I was proud to vote for the
    Family First Prevention Services Act because we needed to
    reframe the conversation and to put a greater emphasis on
    prevention rather than just treating problems as they happened
    and to verify that children were being placed in quality
    settings.
        Mr. Milner, when it comes to accreditation of group homes,
    there is a lot of anxiety in my home State of Indiana. Part of
    that stems from the fact that Family First congregate care
    provisions, only facilities that meet the qualified residential
    treatment program criteria are eligible for Federal
    reimbursement. In order to meet these criteria, a facility must
    be accredited by an independent not-for-profit accrediting
    organization. I think this is a great thing. This ensures
    quality. However, the anxiety kicks in when they look at the
    fact that the process takes 1 to 2 years to complete, and there
    is a limited number of accrediting organizations who will be
    facing a significant uptick in their workload.
        How are you planning to work with States to ensure these
    aren't negative impacts on service delivery?
        Mr. MILNER. It is a tough issue, and in no way do I want to
    minimize the importance of that issue. Among the States, Tribal
    representatives, and other groups out there that I talk to,
    that is one of the top two issues that I consistently hear
    about.
        We are meeting with the different organizations that could
    potentially be involved in this. I would be misrepresenting to
    you if I said we understand completely the range of possible
    accreditation options out there. We don't have all of those
    details worked out. But in our consultation with States, as we
    are hearing about their concerns--and I mentioned that we are
    in the process of having three of these listening sessions
    around the country as well as five calls--they are raising
    those concerns to us. We are committed to developing an
    implementation strategy and a plan that will, to the best of
    our ability, address those critical concerns. It is, frankly, a
    very big concern.
        Mrs. WALORSKI. Would States with a pending accreditation be
    allowed to provide reimbursable services? And can any IV-E
    funds be made available to assist providers in being
    accredited?
        Mr. MILNER. I am not aware of any IV-E funds that would
    allow States to use that for the accreditation process. I am
    not going to speak definitively on that, but I can say that I
    am not aware of that. And could you repeat your first question,
    please? I am sorry.
        Mrs. WALORSKI. Sure. Would States with a pending
    accreditation be allowed to provide reimbursable services?
        Mr. MILNER. I am not aware of any flexibility in the
    statute that would permit that.
        Mrs. WALORSKI. Are States able to identify accreditation
    standards apart from the national standards?
        Mr. MILNER. The standards would apply to the accrediting
    body. So the body that--for example, the Council on
    Accreditation and the Joint Commission on Accreditation of
    Healthcare Organizations would probably have slightly different
    accreditation standards there. So it would depend upon the
    accrediting body that the State chose to use.
        Mrs. WALORSKI. Will standards defining trauma-informed
    program models be incorporated into those standards?
        Mr. MILNER. I think the statute does require that the
    programs, the qualified RTPs, provide services that are trauma-
    informed. So they would have to be a part of that process.
        Mrs. WALORSKI. Great.
        Thank you, Mr. Chairman. I yield back. Thank you.
        Chairman SMITH. Thank you.
        I now recognize Ms. Sewell for 5 minutes.
        Ms. SEWELL. Thank you, Mr. Chairman.
        Firstly, I want to welcome our guest, Commissioner Milner,
    a fellow Alabamian. Since you went to both schools, War Eagle
    and Roll Tide.
        Mr. MILNER. War Eagle.
        Ms. SEWELL. I believe Members of both sides of the aisle
    saw the passage of the Family First legislation as a huge
    success. We all know that foster care placements are on the
    rise. In 2016, 3,769 children in my home State of Alabama, our
    home State, entered the foster care system, and over 36,000
    Alabama kids were involved in an investigation of maltreatment.
        However, the Family First Act has provided States like
    Alabama with an opportunity to invest Federal funds in
    preventive services that will keep kids out of foster care,
    wherever possible. Right now, Alabama spends about $54 million
    on foster care, but only one-fifth of that on preventive and
    permanency services.
        Under the new Family First law, this spending imbalance can
    be corrected and States like Alabama can begin to invest more
    resources in substance abuse, mental health, and parenting
    skills training. However, in order for States to successfully
    implement the new law, HHS must provide the proper guidance and
    assistance to States, which leads me to my first question.
        When the Family First law requires HHS to identify national
    model foster care licensing standards and requires States to
    report whether they have implemented them or not, the House has
    passed that provision three times that HHS should help identify
    national model foster care licensing standards. And the House
    has passed provisions three times, including voting for a
    separate bill, H.R. 2866.
        At the time that we were debating H.R. 2866, my colleague
    Mr. Kelly from Pennsylvania and I engaged in a floor colloquy
    to make very clear our intent that the National Association for
    Regulatory Administration model standards, which were the
    result of a multiyear effort incorporating input from key
    national associations and professional licensors, should be the
    foundation of such standards.
        I would like to enter for the record a copy of the model
    family foster home licensing standards from the National
    Association for Regulatory Administration.
        Chairman SMITH. Without objection.

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Ms. SEWELL. It was our expectation, Congressman Kelly and
    I, and our hope that, after reviewing the model licensing
    standards, the States would modify their own standards to
    address any inappropriate barriers to licensing relatives
    caring for children or kinship caregivers whom the child
    welfare system is increasingly relying on, often as a result of
    the opioid crisis.
        How will you encourage or how will HHS encourage these
    licensing standards?
        Mr. MILNER. Well, first of all, let me say that we have
    reviewed the NARA standards. I have personally reviewed the
    document that you have just entered into the evidence. We have
    also reviewed standards from other licensing bodies, in
    addition to State-specific and some Tribal-specific licensing
    standards as well.
        We have put that information into our proposed standards in
    a Federal Register notice which, again, is currently going
    through clearance. We expect, and will strongly encourage,
    States, Tribes, and others, including the accrediting bodies,
    to respond to give us comments before we finalize those rules
    and regulations. That is going to be forthcoming quite soon.
        Ms. SEWELL. Sure. You know, regarding the 12-month limit on
    substance abuse treatment services and family-based residential
    treatment, what happens if a patient lapses, say, in the 14th
    month? I guess I am trying to get at incidences where people
    will actually relapse after the 12-month period. Clearly, while
    there is a 2-month gap, the reality is that that person still
    needs treatment.
        Mr. MILNER. Sure.
        Ms. SEWELL. So what would happen for those who lapse beyond
    the 12 months?
        Mr. MILNER. As far as Federal title IV-E funding is
    concerned, I am not aware of provisions where the funding for
    that service could go beyond 12 months. It is a very technical
    question, and I will go back and be absolutely certain about
    that.
        Beyond that, you have hit on a concern and a challenge that
    I think many States are raising to us. While it is incredibly
    positive that we can now spend money up to 12 months for
    services that we previously could not do with very serious
    cases of substance abuse, particularly with the rise in opioid
    use right now----
        Ms. SEWELL. And the recurrence of that.
        Mr. MILNER. Yes, absolutely.
        Ms. SEWELL. I am just trying to get to the point of future
    access to treatment. And the reality is that maybe we should
    consider a longer period.
        Thank you, Mr. Chairman, for letting me extend. And thank
    you, sir.
        Chairman SMITH. Thank you.
        I now recognize Mr. Reichert from Washington State.
        Mr. REICHERT. Thank you, Mr. Chairman.
        Glad to hear that you stopped by the Casey family in
    Seattle. I have done a lot of work with them.
        I do have a question for you at the end of my 5 minutes,
    but I can't help myself; I have got to make a few comments
    first.
        First of all, I would like to thank you so much for your
    service. I know that the young people in the audience today and
    those listening, looking at your record starting as a
    caseworker and continuing on all these years to help children,
    that takes compassion and dedication. I am a 33-year veteran of
    law enforcement. And also, just for the information of the
    students and the young people in the room, I am a survivor of
    domestic violence, the oldest of seven kids, and a runaway. And
    I think you will find that most of the people up here have a
    story to tell.
        And so, when you look at us, we are people like you. We
    went through struggles and trials. And so I am assuming that
    out of all the hands that were raised in the audience, I am
    assuming all of you want to be Members of Congress. Raise your
    hand, please, who wants to be a Member of Congress. I don't see
    any hands, Mr. Chairman.
        Chairman SMITH. They may have higher expectations.
        Mr. REICHERT. How about President? Oh, there is one, okay.
    Thank you. Yeah, don't do it, somebody said.
        I just wanted to share that with you because, you know, it
    is all real formal and everything, but we care about you, and
    we are here to try and figure out a way to help. Right?
        Mr. MILNER. Thank you.
        Mr. REICHERT. So I look at this, and some have mentioned
    the opioid problem. It is just devastating our country and our
    children. And, you know, the percentage of children entering
    foster care is due to, a lot of it, parental substance abuse
    and its dramatic increase. And, in fact, every 25 minutes a
    baby is born suffering from opioid withdrawal. Every 25 minutes
    a baby is born addicted to opioids, every 25 minutes. In
    Washington State, 5,700 children were placed into foster care
    in 2016, 34 percent of infants--34 percent of infants.
        The passage of the Family First law gives us an awesome
    opportunity to bend this curve, and we can do that. So this is
    not about just children. It is not only children, but it is
    about drug and alcohol abuse. It is about human trafficking. It
    is about crime. It is about keeping families together and
    keeping children safe and healthy, keeping them in school then,
    right? If they have a loving home and a loving family, they get
    educated. They get jobs. They are successful. They have pride
    in their lives and their families. That is what this is about,
    and it is about the success of America.
        And there is one agency in Seattle that I am particularly
    close with because I have two drug-addicted grandchildren who I
    was a foster grandparent and an adoptive grandparent. And they
    went through an organization called PICC, the Pediatric Interim
    Care Center, in Kent. And what they do is they provide
    specialized 24-hour care for drug-exposed and medically fragile
    newborns. They offer treatment that allows the baby to
    completely withdraw from drug dependency and transition, and
    they want to get them home safely without medication. They want
    to keep the families together. So they work with mom and dad if
    they are around and try to keep them together. If they don't,
    then they get adopted into families like my daughter's and her
    husband's and they become a blessing to all of us.
        So how can an organization like PICC, how can we ensure and
    be sure that programs like PICC are eligible for prevention
    services funding provided by Family First?
        Mr. MILNER. They are eligible. Private agencies have long
    been a foundational part of the service delivery system in the
    child welfare system in our country. Under Family First, the
    requirements to deliver services that are evidence-based will
    still be there for the private providers, but we are actively
    encouraging State child welfare agencies to work in strong
    collaboration with their partners in the private sector, the
    rest of the public sector, the faith-based community, as well
    as other organizations.
        Mr. REICHERT. What is the process? They have got to be
    evidence-based, but what is the process, real quick?
        Mr. MILNER. Typically, they would have some sort of
    contractual arrangement with the State child welfare agency to
    be a service provider there.
        Mr. REICHERT. And meet the evidence-based?
        Mr. MILNER. Yes.
        Mr. REICHERT. I yield back. Thank you. Thank you.
        Mr. MILNER. Thank you.
        Chairman SMITH. Thank you.
        And next we have Ms. Chu from California.
        Ms. CHU. Thank you.
        Last night I went to the congressional foster care dinner
    that Karen Bass is the head of and heard very wonderful
    testimony from foster care children or former foster care
    children, who said how much Family First would change their
    lives and finally provide the resources available to keep
    families together versus letting more kids enter the foster
    care system. So I think this is certainly a step in the right
    direction.
        But States have a lot of questions about the implementation
    of this, and that includes my home State of California and my
    county of Los Angeles, which is responsible for the largest
    child welfare system in the Nation and in 2017 oversaw nearly
    35,000 children. It currently has a IV-E waiver, which has
    allowed them to provide innovative preventive services,
    including substance and mental health services to populations
    who are not title IV-E eligible, but they have also done a
    dramatic job to reduce the foster care population 23 percent
    between 2007 and 2010, and they have also reduced the number of
    children in group homes and other institutionalized settings by
    one-third.
        So I think they have been trying to do the same kind of
    goals that are in Family First. And they have also provided
    home visiting services, aftercare networks, creative
    partnerships with other community agencies like job centers,
    and reduced the number of children entering care and increasing
    permanency.
        I understand, Commissioner Milner, that you had a
    productive meeting with L.A. County about their program, and my
    first question would be whether you saw that they were making
    progress along these lines in a similar fashion to Family
    First?
        And then my second question has to do with the timeline for
    implementation and whether there can be any kind of
    consideration for those who are on the title IV-E waiver
    programs, whether there can be guidance or technical assistance
    or any kind of other consideration for counties like Los
    Angeles to help them transition from their waiver to the
    implementation of the provisions of the Family First Act.
        Mr. MILNER. Let me say that thank you very much for raising
    that issue. It is a very important issue for me and for those
    of us in the Children's Bureau. Yes, I did have a very
    productive onsite visit with Bobby Cagle and his staff in L.A.
    County. I have also met with the board of supervisors for L.A.
    County to hear their concerns; last week, I spent a couple of
    days up in San Francisco visiting a community-based program;
    and I have made visits down to San Diego as well.
        All of those programs have in common, I believe, a very
    strong commitment to moving their systems toward one that
    strengthens families, strengthens children, and prevents bad
    things from happening to children. L.A. County has done a
    tremendous amount of work there. The First 5 work, which is a
    home visiting program, is one that they are really quite proud
    of.
        The loss of the flexibility of the title IV-E waiver
    dollars is going to be a big hit for the counties in California
    because the State office has pushed those flexible waiver
    dollars down to the counties, where they have used those
    dollars to create upfront primary prevention services for
    children and families, not just preventing them from coming
    into foster care but preventing them from being maltreated in
    the first place.
        The transition to Family First means a lot of different
    things for them, including a loss of the flexibility. Even
    though they are able to use title IV-E dollars now for certain
    prevention services, Family First does not replace the entire
    flexibility that they have under the IV-E waivers right now,
    where they have a capped allocation, and they are using that
    money accordingly.
        California has expressed great interest in some sort of a
    transitional authority to continue that, to help them make the
    transition in ways that they can be even more successful with
    Family First rather than at a certain point just having to give
    up the flexibility that they have had.
        We would actually support that. And I believe that there is
    a strong need for us to do this in an orderly fashion in a way
    that allows States to plan as carefully and as thoughtfully as
    they can to move to the new system under Family First.
        Ms. CHU. Thank you so much for that answer. I really
    appreciate it.
        Chairman SMITH. Thank you.
        Now we move on to Mr. Wenstrup from Ohio.
        Mr. WENSTRUP. Thank you, Mr. Chairman.
        Thank you, Mr. Milner, for being here today. Just in the
    scheme of the big picture, I just want to share that my wife
    and I just recently experienced the joy of adoption.
        Mr. MILNER. That is wonderful.
        Mr. WENSTRUP. It is wonderful. And we would like to see
    more of that take place. It is a beautiful thing.
        And Family First presents a real opportunity to shift kind
    of the way we think about the role of Federal foster care
    dollars and how they can be more effectively spent. Our system
    in Ohio, in Cincinnati area especially, is very overcrowded. It
    is a real problem for the agencies. And we have this
    opportunity to provide alternatives for our youth, and I think
    that that is something that we all look forward to. We have
    been greatly affected by the opioid epidemic. As a matter of
    fact, that has been a huge driver of the need for an increase
    in our foster care system to be able to work.
        But Ohio has held the title IV-E waiver since 1997, and so,
    across the State, we are anxiously awaiting a timeline of how
    we deal with this transition from the waiver to Family First.
    We really need some guidance on that, and the sooner, the
    better--if we are going to be effective. We want some clarity
    on that if you can provide it, and is there technical
    assistance? I am following up on that question. But the sooner
    we can get a real timeline, it would be very, very helpful.
        And then the other thing that I am concerned about is, what
    is the process for States to identify and get approved new
    practices that are not specifically preapproved? How can we
    innovate in the areas of making this whole system work better?
        Mr. MILNER. I was fortunate enough to spend some time with
    the child welfare leadership from Ohio last week. We had teams
    of 10 people from every State come here to Washington, which
    included not just the child welfare agency but the legal/
    judicial community and the prevention partners. And it was a
    pleasure to be able to spend some time at the Ohio table and
    also to hear some of their concerns.
        The process of getting services introduced into the
    approvable pool is going to be an ongoing process, as well it
    should. We will come out with an initial list of programs that
    we will be reviewing, but Family First is inspiring a great
    deal of attention to building the evidence for programs out
    there so that we hope to expand the array of services over
    time. States can submit to us programs that they want us to
    consider.
        Again, later this year, we will also again be issuing a
    Federal Register announcement that will describe that process
    for reviewing the criteria that we intend to use to review for
    programs that are reimbursable under the prevention funding
    stream and also provide guidance for States to submit those
    programs if they want us to take a look at those----
        Mr. WENSTRUP. So where are you in that stage right now? I
    mean, where----
        Mr. MILNER. I am sorry?
        Mr. WENSTRUP. Where are we as far as staging? You can
    submit an idea, an innovative idea right now. Do you have a
    particular form you fill out? Do you have to have
    documentation? I mean, I think that is what we are looking for,
    and then the timeframe of that.
        Mr. MILNER. We will contract for a clearinghouse that will
    be responsible for carrying out those activities of reviewing
    the programs, soliciting nominations or candidates for programs
    to be in that pool. The procurement is on the street at this
    point and we expect that contract to be issued by October 1.
        As soon as we get the clearinghouse procedures in process,
    those procedures, we will be able to release and move forward
    with it. States could submit programs to us right now. Clearly,
    we don't have the ability at this moment until we have the
    clearinghouse in place to actually conduct a review of those
    programs and start adding them to the bank. But we anticipate
    moving forward with that on October 1.
        Mr. WENSTRUP. And some of the ideas that people come
    forward with, are they going to be able to test the waters a
    little bit? In other words, you want to have evidence-based
    ideas, if you will, preferably. Are they going to be able to
    test the waters, try something on a small basis and then expand
    it if it is successful? Is that what we can look forward to?
        Mr. MILNER. I am not sure if I understand the question.
    Certainly, an evidence-based program could be implemented on a
    limited basis. If you want to do it in one of your counties and
    perhaps not statewide, there is nothing prohibiting you from
    doing that.
        The statute is quite specific, however, that to be
    reimbursable under the prevention funding services stream, it
    must meet the criteria for evidence-based, either at promising,
    supported, or well-supported levels.
        Our intent is to open the promising door as wide as we can
    open it, so that States can begin to use or continue to use
    services that they believe are effective in serving children
    and families while they build the evidence to get those
    services up to the higher rungs of the evidence ladder.
        Mr. WENSTRUP. Thank you. My time has expired.
        Chairman SMITH. Thank you.
        I next recognize Mr. LaHood from Illinois.
        Mr. LAHOOD. Thank you, Mr. Chairman.
        And, Mr. Milner, I also want to recognize and thank you for
    your service and your lifelong commitment to helping young
    people to succeed and all the good work that you do.
        And I also want to acknowledge the young people in the
    crowd here today. Thank you for being here. Your presence is
    important, and we are honored to have you here today as part of
    this hearing.
        Prior to elected office, Mr. Milner, I spent a lot of time
    with the Big Brothers Big Sisters organization. I was a big
    brother myself in my hometown of Peoria, Illinois, and saw the
    really good work that has gone on there. And, you know, many of
    our young people, through no fault of their own, are born into
    very difficult situations.
        And from a public policy standpoint, trying to figure out
    what we can do to help many of these good organizations, I have
    also spent time and served on a board locally, the Center for
    Prevention of Abuse, that works with young people that are
    affected by abuse and also domestic violence. And I am happy
    that we are having this discussion here today, and let me get
    into a couple issues here.
        I guess when we think about strengthening families and the
    implementation of the Family First Prevention Services Act and
    how we can make sure that this is the most efficient and
    effective program possible in this country, implementing a
    major reform in the current system comes with its challenges.
    And I want to commend your willingness to be here today and
    answer questions about this implementation of the legislation
    and to make this smooth transition for our State and the local
    stakeholders.
        It is my understanding that HHS will provide a preapproved,
    quote, clearinghouse list of evidence-based practices that the
    States will be permitted to use.
        Given that there are limited self--sorry. Given that there
    are limited well-supported evidence-based programs that have
    been tailored for child welfare populations, there is a need
    for HHS to provide guidance on States conducting these program
    evaluations so that more evidence-based programs are
    established in the well-supported category and ultimately added
    to the clearinghouse list.
        Can you talk a little bit about what is the process for
    States to identify and have approved other practices not
    specified on the preapproved list of the evidence-based
    programs?
        Mr. MILNER. Again, going back to Representative Wenstrup's
    question, we will come out with our final guidance on that
    later this fall, once the clearinghouse established and we have
    those procedures in place. I can't tell you precisely that they
    are going to fill out a form or we are going to respond in a
    certain period of time, but there will be a clearly defined
    process so that we can identify services that States and Tribes
    want to use.
        As soon as we get the comments back on the criteria, the
    process, and the priorities for reviewing those services, we
    will be in a much better position to guide States on how they
    can raise or elevate their services for consideration.
        Mr. LAHOOD. Additionally, Mr. Milner, is Federal
    reimbursement available for evaluation activities of time-
    limited services?
        Mr. MILNER. The only funding that I believe Family First
    allocates for that is for us to use the clearinghouse and the
    technical assistance. One million dollars, not a whole heck of
    a lot of money, was allocated for us to do that.
        When we have the clearinghouse in place, it will offer that
    level of technical assistance, to the extent that the funding
    allows it to, on evaluation and implementation of those
    services within the States.
        Mr. LAHOOD. Got you. Well, we look forward to working with
    you as a committee and wish you much success. Thank you.
        Mr. MILNER. Thank you so much.
        Chairman SMITH. Thanks. Next, I recognize Mr. Schweikert
    from Arizona.
        Mr. SCHWEIKERT. Thank you, Mr. Chairman. Like Dr. Wenstrup,
    we have an adopted daughter. As a matter of fact, she is third
    generation adopted now in the family, so obviously we are doing
    something wrong. Come on. Can I walk you through, though, first
    I know antidotes aren't policy, but they give you a little bit
    of a window. Three years ago, my wife and I spent a summer
    getting certified to be foster parents. And we had, you know,
    folks from the State come as trainers. We had an agency. It was
    a trainer. It was very comprehensive, and sometimes the
    conversations were absolutely devastating, and heartbreaking. A
    couple of the most stressful evenings I ever had with my wife
    were the drive home when we had foster families that had been
    in fostering for 20 years and the roller coaster that their
    lives were.
        We also heard repeatedly, particularly in a State like
    Arizona, there was a tremendous shortage of those parents,
    either those households that were ready to do short-term, long-
    term, older kids. So I guess I am asking you saying, okay, we
    have done a piece of legislation. There is all sorts of
    evidence base, so we have much better math and statistics.
    There is some resources with it. Where is the greatest
    fragility you see out there in our society? Is it a shortage of
    foster parents? Is it a shortage of good data? Is it a shortage
    of resources to do intervention for substance abuse? If you had
    to give me one, two, and three, overall, what is really missing
    out there in the system today?
        Mr. MILNER. I think we need to focus squarely on resolving
    the reasons that children need to come into foster care to
    begin with. I think that if we don't focus our efforts on the
    primary prevention of child maltreatment, we are going to
    continue to chase our tails. We are going to continue to be
    scurrying around trying to find more money in State budgets,
    more caseworkers, more lawyers, more foster homes, and we are
    going to continue to raise children in the foster care system
    who don't have all the skills they need to become healthy,
    productive adults.
        Mr. SCHWEIKERT. Okay. You are actually heading in the
    direction--so child maltreatment----
        Mr. MILNER. Yes.
        Mr. SCHWEIKERT [continuing]. Is that parents with substance
    abuse, is it households that have a mental health issue? I
    mean, and I am asking for some granularity on--and I know
    this--and I am not asking for antidotes, but I am asking, sir,
    for your perception.
        Mr. MILNER. I think it is all of the above. I think quite
    honestly, many families, if not all families, could be at risk
    of having involvement in the child welfare system with a slight
    twist of fate. The most successful programs that I am visiting
    out there I could name them: Live Well San Diego is one of
    those programs; the Center for Family Life in Brooklyn, New
    York. The list goes on. They provide services that strengthen
    families before they get into the ditch of child maltreatment
    and trauma, and can't get themselves out of that. It could be
    targeted to families that already have displayed some risk, but
    simply by strengthening families in communities and offer them
    a nonstigmatizing way to get the support they need would go a
    long way.
        Mr. SCHWEIKERT. When we use language like strengthening
    families----
        Mr. MILNER. Yes.
        Mr. SCHWEIKERT [continuing]. Give me an actual example of
    what the program in San Diego is actually doing.
        Mr. MILNER. Addressing the protective factors of families.
    We know----
        Mr. SCHWEIKERT. No, no, no, no, no. I am asking you what
    are they actually doing? They are knocking on the door, are
    they demanding drug--I mean, what are they actually doing that
    is so powerful that it reaches your top of your mind?
        Mr. MILNER. Over 300 partners have come together in San
    Diego, including the educational system, the housing system,
    the transportation system, the Chamber of Commerce, parks and
    recreation, transportation, and the child welfare system.
        Mr. SCHWEIKERT. So they built a coalition.
        Mr. MILNER. Yes.
        Mr. SCHWEIKERT. What are they actually doing?
        Mr. MILNER. They are promoting the notion of living well
    for the citizens of San Diego, regardless of what the
    particular entity is involved with. If it is the medical field,
    they address living well and in healthy ways in that domain.
        Mr. SCHWEIKERT [continuing]. For your help. Maybe I am
    just--because I am, you know, done the foster care training, I
    have a household. I have these poor kids that are just living
    in hell. How was that system there making--protecting those
    kids? What are they doing that is so unique that protects those
    children?
        Mr. MILNER. I think that they are doing a couple of things.
    I think they are trying to help those families get the concrete
    supports that they need before they get to the living hell part
    of their lives. And that is where primary prevention comes into
    play.
        Mr. SCHWEIKERT. We will do some follow-up because I would
    love more to understand the tactical.
        Mr. MILNER. Sure.
        Mr. SCHWEIKERT. Is it--and Mr. Chairman, I know I am over
    time, and I may be an outlier here. I know we passionately want
    to keep families together, but I also passionately want to
    protect these kids.
        Chairman SMITH. Thank you. And we will begin a second round
    here as we do move forward. Let me touch a little bit on
    nonchild welfare issues. Family First is unique because the
    expectation is for most of the services and interventions--the
    expectation is for most of the services and interventions to
    come from sources outside of the foster care and adoption
    agency. Therefore, it is essential for the Children's Bureau to
    take the lead and set an example for how to coordinate and
    collaborate with other agencies. How is the Children's Bureau
    working with SAMHSA, HRSA, Medicaid, and other HHS agencies on
    the development of approved programs that meet evidence
    standards to provide substance abuse, mental health, and
    parenting programs under FFPSA.
        Mr. MILNER. We have begun the process of having discussions
    with all of those agencies. HRSA, around the home visiting,
    with SAMHSA, our policy folks are already in conversation with
    CMS because Medicaid is going to be a tremendous interface
    between the work that we do. We have to sort out issues with
    Medicaid around payment for evidence-based services, payments
    in the facilities, how our board payments would interface with
    those. We are in the process now of compiling as many of the
    issues that we are aware of that we know that we need to
    resolve. We are in the early phases of that, but we are
    absolutely committed to working in partnership with those other
    Federal agencies to make this a comprehensive implementation
    process. I am scurrying around from coast to coast encouraging
    States to work in strong partnership with their local partners
    for implementation, and it would be hypocritical of me not to
    be doing the same thing at the Federal level.
        It is not just those obvious agencies that we think we need
    to have strong partnerships. We are meeting with other groups
    that will have a tremendous impact on implementation, such as
    the National Governors Association and the National Association
    of Counties. I spoke a couple weeks ago to the National
    Conference of State Legislators, and even this morning before I
    came here, I was in contact with our Head Start agency to try
    to find those interfaces, particularly in some of the very
    rural communities out there where an array of prevention
    services is going to be hard to come by.
        So we are quite aware of that, and it is very high on our
    implementation priority list.
        Chairman SMITH. Thank you. Now, also, when will States know
    more about how to handle the billing situations, like substance
    abuse services where services are eligible for Medicaid
    reimbursement and Family First, and what is being done to
    reduce the potential for double-billing?
        Mr. MILNER. That is further into the implementation process
    than we are right now. Once we are able to issue our guidance
    on the prevention services program, which will come, again,
    within the first quarter of Federal fiscal year 2019, we will
    be able to respond to those very technical questions.
        Chairman SMITH. Because I think you can appreciate that
    States might be a little reluctant to move forward, you know,
    knowing that they need to, but if there is concern that they
    may or may not be able to be reimbursed for that.
        Mr. MILNER. I do understand that. I don't think that the
    reimbursement procedures are going to be the criteria that
    States use to determine whether to go forward with the optional
    prevention services programs or not. I certainly hope it is
    not. I hope that they are thinking much more broadly about how
    they want to serve children and families, and understand that
    we are absolutely going to work with them to work out those
    very technical details that we are nowhere near being able to
    respond to right at this moment.
        Chairman SMITH. Okay. How are programs previously funded
    under various HHS grants, such as the regional partnership
    grants, pregnant and postpartum women, MIECHV home visiting,
    children affected by meth, how are they being consulted to
    provide input into this list of evidence-based programs?
        Mr. MILNER. We are taking advantage of the opportunity to
    look at the services that those programs have provided,
    particularly our regional partnership grants. I appreciate you
    bringing that up. That is one of our programs that we are
    absolutely proud of, particularly in the efforts to fight
    substance abuse issues within families. We believe that those
    programs give us a rich pool of possible interventions if the
    evidence base is there. If the evidence base is not there, they
    may also identify programs where we can focus efforts to begin
    building that evidence, because many of those programs have
    actually shown to be quite successful in getting to the desired
    outcomes.
        Chairman SMITH. Thank you. And now I will recognize Ranking
    Member Davis.
        Mr. DAVIS. Thank you, again, Mr. Chairman. Commissioner, in
    your previous answer, you suggested that Health and Human
    Services would need to individually approve any intervention
    not in the clearinghouse. We had expected you would do that by
    approving the State plan that includes the intervention. Is
    that correct, or do you plan a different approval process?
        Mr. MILNER. Given the criteria that are set forth in the
    statute for an evidence-based program, we will have to review
    the actual program itself. Simply putting it in a State plan
    will not give us the information we need to know if it meets
    the criteria in the statute.
        Mr. DAVIS. Following up on your answer to the Chairman on
    candidate for care, I appreciate that in your testimony, you
    clarified that HHS does not plan to define, and I quote,
    candidate for care on imminent risk beyond what is in the
    statute. Because the question is repeatedly asked in my State,
    I would like to know if other States are hearing the same
    question. Could you reaffirm that this means that HHS is not
    planning to issue a national definition of imminent risk, or
    candidate for care, and will instead rely on States to explain
    their State standard in their prevention plans?
        Mr. MILNER. It is not our intent, as I put in my written
    testimony, to define those concepts any further than the
    statute already defines them.
        Mr. DAVIS. Does HHS plan to issue any guidance or
    parameters for States to use as they explain their eligibility
    criteria in their State prevention plans, and if so, when will
    those be issued?
        Mr. MILNER. We will be issuing guidance on the prevention
    services program later this year. We anticipate issuing that
    guidance within the first quarter of Federal fiscal year 2019,
    and hopefully, we will be able to address those questions
    satisfactorily in that program instruction.
        Mr. DAVIS. Does the Children's Bureau intend to publish
    program guidance for States about drawing down the kinship
    navigator match before the provision becomes effective, and if
    so, when?
        Mr. MILNER. We will produce guidance on the kinship
    navigator program that should include--I am getting--that is
    getting a little bit more technical than I am prepared for, but
    the guidance that we issue on that should cover any kind of
    billing procedures. I can't imagine why it would not, but I am
    not able to--I am not able to speak any more definitively than
    that.
        Mr. DAVIS. Do you anticipate that a State would need to
    amend its IV-E plan in order to claim kinship navigator
    matching funds?
        Mr. MILNER. I don't know the answer to that question. We
    will have to get back with you on that.
        Mr. DAVIS. Under State law, or by law, HHS is required to
    provide technical assistance and disseminate best practices for
    providing and evaluating the evidence-based prevention services
    funded under Family First. Could you identify how this will
    take place?
        Mr. MILNER. We will be issuing guidance on the
    clearinghouse and that whole process in the first quarter of
    Federal fiscal year 2019, and, if I am understanding your
    question correctly, that should provide the information that
    States will need.
        Mr. DAVIS. Thank you very much, and I yield back, Mr.
    Chairman.
        Chairman SMITH. Thank you. Thank you. Next, I recognize Mr.
    Reichert from Washington State.
        Mr. REICHERT. Thank you, Mr. Chairman. And I want to kind
    of drill down into one of the issues that I mentioned in my
    first question, and that is human trafficking. And all of us on
    this panel, as I said, want to help our youth.
        Mr. MILNER. Absolutely.
        Mr. REICHERT. And most of the young people who are out
    there on the streets involved in sort of this lifestyle have
    been victimized at home, sexually abused, mentally,
    emotionally, physically, and are driven to the streets and they
    are abused, victimized again. And then back in the day when I
    was working in the sheriff's office, they were victimized once
    again by a judicial system that really didn't understand that
    these young kids are victims, not criminals.
        Today, we have been enlightened a little bit and discovered
    that really we need to help these young people involved in
    human trafficking. And the reason I know so much about this
    topic, you may or may not be aware of my background in law
    enforcement. I worked on a serial murder case for 19 years,
    called the Green River serial murder case. The person
    responsible for the murders in this case pled guilty to 49
    murders. We think he killed 60 to 70 little girls and young
    women. I personally was at body sites of scores and scores and
    scores over those years.
        So, Family First allows Federal funds for settings
    providing high quality residential care and supportive services
    to children and youth who have been found to be or at risk of
    becoming sex trafficking victims.
        Mr. MILNER. Yes.
        Mr. REICHERT. The July 9 program instruction indicates that
    ACF will not further define that setting. Does the Children's
    Bureau plan to issue any guidance about the kinds of settings?
        Mr. MILNER. About the kinds of settings?
        Mr. REICHERT. Yes, that this might entail.
        Mr. MILNER. I am not sure I am going to be able to answer
    the question completely on the types of settings. The law sets
    forth the criteria for qualified residential treatment program.
    The accreditation body would also add to any of those
    requirements there. To my knowledge, we do not have intent of
    issuing any further guidance around those particular settings,
    but I say that somewhat tentatively.
        You are absolutely correct that we do not intend to define
    victims of sex trafficking, or at risk of sex trafficking, any
    further than it has already been defined in the law.
        Mr. REICHERT. Well, I just think we need to take another
    look at that and maybe you and I can have a discussion.
        Mr. MILNER. Surely.
        Mr. REICHERT. Since children in out-of-home care are
    already at increased risk of trafficking.
        Mr. MILNER. Yes.
        Mr. REICHERT. This is going to be important for States to
    have a clear understanding, so that they can use this placement
    setting appropriately.
        Mr. MILNER. I cannot agree with you more. I have had
    several conversations with States myself around their intent
    and how they would like to define the terms of at risk of sex
    trafficking, and I believe that States are coming at it from
    different places. But part of our plan also is to allow States
    that flexibility, so that they can craft a program that will
    best meet the needs of youth in their States.
        I also just want to add, just for general interest, I
    visited one of those programs in your home State in Seattle a
    while back, and I also was fortunate enough to be able to
    attend the ribbon cutting for a drop-in center there in Seattle
    designed for youth who are victims of sex trafficking, to have
    a place to go.
        So I have seen firsthand in your State the value and the
    importance and talked to some of those youth myself about their
    experiences there, so we share that concern and commitment.
        Mr. REICHERT. I appreciate your answer. I yield back.
        Chairman SMITH. Thank you. I next recognize Ms. Chu from
    California.
        Ms. CHU. Well, I have more questions from the State of
    California. In California, each county is responsible for
    administering its own child welfare program, and California is
    made up of 58 counties. As a result, the counties vary in
    capability and capacity and access to providers who can deliver
    prevention services. So Family First requires that the
    prevention component to the State's IV-E plan must describe the
    target population for the services or programs.
        So my question is whether the State has to opt in for the
    Family First program, and do all counties and geographic
    locations have to provide the same level of prevention
    services, or can there be a targeting of those prevention
    services on a geographic basis versus having every county do
    every service?
        Mr. MILNER. Yes. It is my understanding that as you have
    said, the State has to take the option, but I do not have the
    understanding that every single county would have to provide
    the same level of service delivery. In the title IV-E waiver,
    which is admittedly a different program, there are four
    counties in California that are providing those services, so
    that is not a State-wide effort there. I see no reason why that
    could not be the same way in Family First, and frankly, would
    fully expect it to be that way. You have some very rural
    counties in California, as do the other Members in their
    States, and the reality is, many of the prevention programs are
    going to be hard to come by in those very rural areas. I don't
    think we can have a reasonable expectation that there is going
    to be a uniform level of service delivery across counties.
        Ms. CHU. My other question is about the quality residential
    treatment program, or QRTP. Those provisions in the Family
    First program have time limits that the States have to meet in
    order to be reimbursed for such a placement.
        Now, right now, California takes more than 30 days to do an
    assessment as to whether a child should or should not be in one
    of these facilities in a group home or a foster care home. I
    know that the Family First program is a step forward, because
    there is some States that don't do any assessment whatsoever,
    so there needs to be an assessment.
        Mr. MILNER. Sure.
        Ms. CHU. But my question is, whether there is any
    flexibility on the 30 days in order for the State to be
    reimbursed, because it would seem to me that the best thing
    would be to have a good assessment, what if it is 31 days? What
    would be the situation with that?
        Mr. MILNER. The statute requires 30 days. I am not aware of
    any flexibility in the statute on that.
        Ms. CHU. How about this situation: Would a State be
    reimbursed if at the 60-day court review, the court disproves
    the placement of the child?
        Mr. MILNER. I am not able to answer a question that is
    quite that technical, so we will have to respond to you in
    writing on that, I am sorry.
        Ms. CHU. And how about if a child moves from one QRTP
    program to another, would a new 30-day assessment be required?
        Mr. MILNER. That is also a very technical question that I
    don't think I am prepared to answer for you today. We will get
    back with you on that.
        Ms. CHU. Okay. I will submit those questions. Then I also
    wanted to ask about administrative costs. The requirement that
    50 percent of the State's prevention services spending be
    related to services or programs does not make clear whether
    there can be claims for administrative services like training
    and evaluation. So can administrative reimbursement for such
    things be in this program?
        Mr. MILNER. We will also have to give you a written
    response on that. I can't say definitively what is included in
    the admin costs at this point.
        Ms. CHU. Okay. I appreciate you getting back to me on that.
        Mr. MILNER. Thank you.
        Chairman SMITH. Thank you. Next is Mr. Wenstrup from Ohio.
        Mr. WENSTRUP. Thank you, just a quick follow-up question,
    if you will. Our State is one where the county administers the
    work.
        Mr. MILNER. Yes.
        Mr. WENSTRUP. So in these States like that, can the local
    areas, counties opt in or opt out, or if programs put in place,
    does it have to be statewide, or is there going to be that type
    of flexibility for the counties?
        Mr. MILNER. As I was saying to Representative Chu, I
    believe that States will have to work with their counties to
    determine where they are going to be able to offer some of the
    specific services. Whether there is a formal opt in or opt out,
    I wouldn't attempt to answer that for you at this point with
    any real confidence there. The State has to make the decision
    to be a part of the program, but then the State would have to
    work with its counties in order to determine how they were
    going to comply, particularly with the prevention services
    program. That is what I am primarily speaking about right now.
    The congregate care provisions would not be an optional thing
    for a State or a county to select from.
        Mr. WENSTRUP. I think we have to think about that because
    there may be initiatives that one or two counties really need,
    and the others don't.
        Mr. MILNER. Sure.
        Mr. WENSTRUP. And you don't want to waste money setting
    something up that another county doesn't need, but is needed
    somewhere else. So I hope that there is that type of
    flexibility that can take place within the State, so especially
    when they are being run by the county, you know, you don't want
    to make them do something they don't need.
        Mr. MILNER. Yes.
        Mr. WENSTRUP. And allow those that need something else be
    able to do it.
        Mr. MILNER. And that is entirely consistent with the vision
    that we have for child welfare in our country coming from the
    Children's Bureau right now. In addition to a strong commitment
    to moving towards a primary prevention focus of our work, we
    believe that those efforts have to happen at the county and
    community level. The best examples that I see of programs
    effectively serving and strengthening families out there are
    not necessarily happening on a State-wide level. They are
    happening in the communities where children and families live.
    That is where they can get the services and supports that are
    available to them in most situations that are culturally
    appropriate for them and that are responsive enough for them to
    sustain progress once they have made that progress.
        Mr. WENSTRUP. Well, and I have seen some of the benefits
    that a local level. One of my counties just in addressing
    poverty, was part of a short-term trial called Rural Impact.
    The caseworker had authority to make changes. I meet a family
    with six kids, and I meet the parents and, you know, they are
    living in a one-room home. And he said, I can't take a third
    shift job, I have nowhere to sleep. So she gets them into a
    home with a couple bedrooms, and they go to work. The whole
    dynamic changes. There is that local level ability to fit what
    is needed case-by-case that I really hope we are driving
    towards so that we can really have a positive fact. And this is
    a situation where the person working with you, they are not
    just a signature on a piece of paper somewhere. They have been
    to your house.
        Mr. MILNER. Exactly.
        Mr. WENSTRUP. They understand what has taken place. Anyway,
    thank you. I yield back.
        Chairman SMITH. Thank you. Next, I recognize Mr. LaHood
    from Illinois.
        Mr. LAHOOD. Thanks, Mr. Chairman. Commissioner Milner, I
    wanted to focus a little bit on criminal background checks, and
    I mentioned earlier, I was involved with the Big Brothers Big
    Sisters program, and I know when we were screening for Big
    Brothers and Big Sisters, I worked as 10 years as State and
    Federal prosecutor, so we would do the background check for
    that. And obviously it is important that we make sure we have
    the best people that are involved in the child welfare system.
        I know, for instance, there is a clear standard set for
    foster parents and adoptive parents and the background check
    there. Can you talk a little bit about the proper oversight and
    enforcement for States, and particularly, for child care
    centers, and whether there is a national standard that has been
    established and how that implementation happens, not only for
    criminal background, but for maybe other professional
    misconduct or drug use and where we are at with the
    implementation of that?
        Mr. MILNER. With regard to background checks, the Federal
    statutes address the criminal background checks, not
    necessarily the other areas that you might have some concerns
    about. We have long held a requirement that adults in a foster
    family home undergo a criminal background records check. Family
    First adds a requirement that staff, all staff of the
    congregate care facilities must now have that background check,
    which must include a check of relevant criminal databases.
    Other Federal legislation gets very specific on what would
    disqualify someone based on a background check. States do have
    some flexibilities in terms of making exceptions to those
    rules, but they are required to have very specific procedures
    in place if they want to do so.
        I actually believe Family First is a giant step forward in
    terms of requiring the background checks in congregate care
    facilities. I should note that we have had a requirement in
    place for some time that requires that States address safety
    concerns with regard to staff in a much more general way. It
    has been a part of our programs where we have found that States
    have not, across the board, done all that well with compliance.
        Under Family First, I believe we have a greater opportunity
    to enforce the more specific requirement through our review
    processes. The way that we would primarily review that from the
    Federal level is with our title IV-E eligibility reviews, where
    we would look at whether or not there was evidence that the
    criminal background checks had been conducted or not. We will
    be revising those procedures, those forms and that whole
    process to comport with Family First as we go into full
    implementation.
        Mr. LAHOOD. And I guess thinking ahead with full
    implementation, so if there is a State that is deficient in
    terms of the standard and proper oversight----
        Mr. MILNER. Yes.
        Mr. LAHOOD [continuing]. Or enforcement, what happens?
        Mr. MILNER. They are required to enter into a program
    improvement plan and make the correction. Typically, we are not
    able to withhold Federal funds until they have had an
    opportunity to correct whatever the problem is. So we work with
    the States through our regional offices to develop a process
    for making the corrective action. If they are not able to
    comply with their plan, then they would be subject to Federal
    withholding of funds.
        Mr. LAHOOD. Okay. Thank you. Those are all my questions.
        Chairman SMITH. Thank you. I want to touch on another issue
    here, and then I will certainly go to Mr. Davis for some
    follow-up as well. Maintenance of effort. We know that Family
    First was intended to supplement, not replace the State
    efforts.
        Mr. MILNER. Sure.
        Chairman SMITH. And so the need to calculate the
    maintenance of effort is certainly there. Is the Bureau going
    to provide guidance to States in terms of how they can
    calculate their maintenance of effort?
        Mr. MILNER. Yes, we will.
        Chairman SMITH. And when can the States expect those----
        Mr. MILNER. I would anticipate that that is going to be a
    part of our program instructions on the prevention program
    itself. The MOE is specific to the prevention services program,
    and the PI is where we would be able to cover that later this
    year when we issue that guidance.
        Chairman SMITH. Okay. And in terms of previous prevention
    expenditures, my understanding is that they are intended to
    mirror the services and populations that are allowable under
    Family First. Is that correct?
        Mr. MILNER. I am not sure that I can give you a definitive
    response on that.
        Chairman SMITH. Okay. If you could follow up on that.
        Mr. MILNER. Surely.
        Chairman SMITH. Maintenance of effort is not limited to
    just funds that were spent in child welfare prior to Family
    First because for nonwaiver State mental health, substance
    abuse and parenting were not funded under child welfare. Is
    that correct?
        Mr. MILNER. Correct.
        Chairman SMITH. And for waiver States that may have been
    spending on substance abuse, mental health, and parenting, how
    do you see them calculating their maintenance of effort?
        Mr. MILNER. We are going to have to give you something more
    specific on that. I am not immersed in the maintenance of
    effort part of that. It is far too technical for me to be able
    to give you any hint of a satisfactory response, but we will
    give you something in writing on that.
        Chairman SMITH. Okay. Well, I think all the States would
    appreciate that and certainly there is----
        Mr. MILNER. Surely.
        Chairman SMITH [continuing]. I know, a great deal of
    interest on that.
        So with that, Mr. Davis, do you have any follow-up?
        Mr. DAVIS. Thank you. Thank you, again, Mr. Chairman. And I
    also thank you again for holding this very important hearing.
        It is my understanding that many kinship navigator programs
    have not been evaluated so that they can meet an evidence-based
    standard.
        Mr. MILNER. Yes.
        Mr. DAVIS. What is HHS doing to support identification and
    development of additional evidence-based models for these
    important services?
        Mr. MILNER. I mentioned a little bit earlier, we fund a
    contract right now in collaboration with our Office of
    Planning, Research and Evaluation that is designed to build the
    evidence for a number of programs that are out there. Kinship
    navigator programs are a part of that effort.
        In addition to that, we are looking to the programs that do
    exist, and we have asked for comment on that, particularly in
    the Federal Register announcement that we just put out the
    criteria for evidence-based practices.
        In addition, we will be looking at the one program that we
    think might have an evidence base behind it to see if it
    comports with the criteria that are in Family First.
        Mr. DAVIS. Congress provided appropriated funds so that
    every State could receive funding for kinship navigator
    programs now, as a bridge to the Family First funding. The
    deadline for States to tell HHS their planned use of these
    funds was last week.
        Mr. MILNER. Correct.
        Mr. DAVIS. Can you tell us how many States applied and how
    HHS plans to reallocate any funds which were not claimed?
        Mr. MILNER. Forty-five States, two territories, and eight
    Tribes have indicated to us that they intend to apply for those
    funds. Since it is not every one of the States, there will be
    some balance that is left over, and we will have to determine
    how we are going to distribute that balance of funds across
    those who do apply.
        Mr. DAVIS. And my last question is that obviously, home
    visiting is an evidence-based intervention, which has been
    demonstrated to improve outcomes for pregnant mothers,
    parenting mothers and fathers, and their children. In your work
    on the evidence clearinghouse, are you leveraging the MIECHV
    clearinghouse, especially to find interventions appropriate for
    pregnant and parenting foster youth?
        Mr. MILNER. I am unable to tell you specifically which
    clearinghouses we are looking at, but I can tell you that we
    are looking very broadly. We also recognize that the home
    visiting programs have shown a tremendous amount of
    effectiveness in that area, and we have every interest and
    every desire to make sure that they are accessible and
    available to States and Tribes under the title IV-E prevention
    services funding.
        Mr. DAVIS. Thank you for being with us. Thank you, Mr.
    Chairman, for this very important hearing, and I yield back the
    balance of my time.
        Chairman SMITH. Thank you, Mr. Davis. And certainly thank
    you, Mr. Milner, for your participation here today. Please be
    advised that Members will have 2 weeks to submit written
    questions to be answered later in writing. Those questions and
    your answers will be made part of the formal hearing record.
        Now, I know that there were several questions asked today
    that you will need to follow up on. Can you say how long that--
    how long it might take for you to be able to follow up on these
    questions that were posed earlier?
        Mr. MILNER. If we have the answers, we should be able to
    get those to you without much of a delay at all. I can't tell
    you that we have even formulated the answers to all of those
    questions, particularly when it gets to things like maintenance
    of effort and what is going to be included in that. We are
    still very much in the process of consulting with States and
    with Tribes.
        As I mentioned, yesterday we had a call with States to hear
    their concerns and to get their input. Twenty-eight States
    participated in that. One of those calls is going on today.
    Three more will be taking place. We have two more listening
    sessions coming up in August in Atlanta and in Denver coming up
    in August. We have several sessions planned with the Tribes to
    hear their unique concerns around this. I don't want to
    shortcut that consultation process, and that very valuable
    input by making all of those decisions without giving States
    and Tribes full opportunity to share their concerns with us. So
    we may not have answers to all of those questions, and if we
    don't have answers, we will absolutely let you know that and
    respond when we do have the answers.
        Chairman SMITH. Certainly. And I think you can appreciate
    the desire by the States and Tribes to have the timely
    responses.
        Mr. MILNER. I do.
        Chairman SMITH. With that I want to say thank you again,
    and the Subcommittee stands adjourned.
        [Whereupon, at 11:40 a.m., the Subcommittee was adjourned.]
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