Though it does not make media headlines, a team of children’s advocates, congressional staff, and members of Congress from both sides of the aisle have been quietly working over the past two years toward an ambitious goal of reforming our child welfare system to better serve vulnerable children and their families. Big, bipartisan bills with buy-in from both chambers are rare these days, even rarer in election years. But the hard work of champions and members of Congress alike who recognize the need for this kind of effort have led us to an important precipice: a bill, the Family First Prevention Services Act of 2016 (H.R. 5456/S. 3065), that’s passed the House and one that’s soon to advance in the Senate. As President of the American Academy of Pediatrics (AAP) and a pediatrician who works with vulnerable children, including those at-risk for entering and currently involved in the child welfare system, I understand the impact this kind of legislation will have if it passes.

Because of histories of abuse, neglect, and other trauma, some children in the child welfare system have extensive behavioral health needs, which are best met in a residential facility. Current federal standards do not outline requirements for the treatment provided in these facilities, leading many children to languish in overly restrictive settings that fail to meet their needs. This bill would create a new category: Qualified Residential Treatment Programs. These programs are specifically designed to serve the needs of the most vulnerable children and help them heal. The AAP strongly supports this new category, and a dozen medical and advocacy organizations representing health professionals, foster parents, adoption organizations, children’s advocates, and foster youth, agree. The bill is right to require that specially trained clinical and nursing staff are located in congregate care sites where children live. The staff would be physically present onsite during business hours, and available 24-7 to address children’s health needs. Without this requirement, the bill would put already vulnerable children at unnecessary risk, prioritizing the wellbeing of companies providing congregate care over the children who need these services. 

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Without this kind of onsite medical care, diagnosing and treating a mental health condition over time becomes next to impossible. Routine, daily insulin checks for children with diabetes can instead become trips to the emergency room. These measures also save money, by preventing costly medical complications, reducing the time needed in congregate care, avoiding treatment programs that have not been shown to work, and keeping families intact whenever possible.

Unfortunately, there are groups representing congregate care providers advocating for Congress to remove the provisions for licensed, knowledgeable staff in group homes, citing concerns around the costs associated with improving staff quality and the lack of flexibility in implementing the new requirements. The Congressional Budget Office estimates that watering down those staffing quality provisions would cost the federal government hundreds of millions of dollars, while providing a lower quality of care to our most vulnerable children.

The AAP’s support for the Family First Prevention Services Act of 2016 (H.R. 5456/S. 3065) rests on the inclusion of this essential provision. I urge the Senate to keep this provision in the bill when they take up the legislation next week, and commend Sens. Orrin HatchOrrin Grant HatchHow President Biden can hit a home run Mellman: What happened after Ginsburg? Bottom line MORE (R-Utah) and Ron WydenRonald (Ron) Lee WydenSenate Democrats nix 'Plan B' on minimum wage hike Senate mulls changes to .9 trillion coronavirus bill House Democrats pass sweeping .9T COVID-19 relief bill with minimum wage hike MORE (D-Ore.) for their leadership and steadfast commitment to protecting our nation’s most vulnerable children. I am proud to lend pediatricians’ voices to the effort. We are so close to achieving real, meaningful child welfare reform; we can’t afford to pass up the opportunity to improve the system for children and youth by weakening this essential provision.


Benard P. Dreyer, MD, FAAP is president of the American Academy of Pediatrics