• Severe Shortages of Adoption Competent Providers and Specialists

• Compounding Barriers to Treatment Engagement

• Privacy and Stigma Limit Help Seeking in Rural Communities

• Relationship Based Culture Shapes Engagement and Trust

Overview of the Section

Title IV-B funds can be used to address a diverse set of needs, including preventing abuse and neglect, strengthening families, supporting children and youth who are in foster care, and promoting reunification and permanency. You can read all about the scope of Title IV-B in the Child Welfare Advocacy Hub’s Primer on IV-B. 

Every five years, states, territories, and tribes must develop Child and Family Services Plans (CFSPs) that describe their use of federal funds, overarching goals and desired outcomes, the continuum of services for children and families, how they target services to populations most at risk of maltreatment, and how they measure success. Each plan must be approved by the federal Department of Health and Human Services (HHS). State agencies update these plans and report on progress annually.

The Supporting America’s Families Act broadens the group that a child welfare agency must consult in their planning to include those with lived experience in the child welfare system. As described by the Congressional Research Service:

"P.L. 118-258 requires that this consultation on plan development also include young people with experience in the child welfare system (including those on state boards or councils with lived experience) as well as parents with child welfare experience, foster parents, adoptive parents, and kinship caregivers. Further, HHS may only approve a PSSF plan if a state/tribe also prepared a report outlining how it has implemented suggestions from the children and youth consulted in the planning process and made the report publicly available (via an agency website)."

This provision was adapted from the Youth and Family Engagement in Child Welfare Act, sponsored by Representatives Adrian Smith (R-NE) and Gwen Moore (D-WI).

“By consulting those who have firsthand experience with the child welfare system, all states can better serve impacted children and families. This legislation can ensure their voices are not only heard, but that their recommendations are implemented in ways that improve the system.”

– Representative Gwen Moore (WI) 

”Improving outcomes in child welfare programming is a responsibility I take very seriously. This bipartisan bill takes a commonsense step toward ensuring state child welfare plans are informed by the insight of those whose lives are directly impacted by them.“

– Representative Adrian Smith (NE)

Consulting with Lived Experts Creates Policy Solutions that Meet Genuine Needs

The last few decades have seen a growing inclusion of the voices and perspectives of those who have experienced the child welfare system in designing policies and programs. From those who were children or youth in foster care, to parents, to kinship caregivers, and foster families – there is a heightened awareness of how they provide essential insights into child welfare systems and can guide a path to a system that better serves children and families. Their firsthand experiences can help to identify flaws, reduce barriers, develop creative solutions and ultimately ensure that child welfare agencies meet their needs and achieve better outcomes. 

In 2019, the federal government issued an information memorandum that summarized the research supporting the value of engaging those who have experienced the system in agency planning:

It is absolutely critical to strengthen our efforts to listen to the families and youth served by the system and integrate their voices into all aspects of child welfare planning and improvement. Effectively integrating family and youth voice into child welfare practice can help: 

• Prevent the initial occurrence of maltreatment and involvement in the child welfare system by ensuring that community resources are aligned with what families and youth tell us they need; 

• Prevent unnecessary parent child separation; 

• Enhance the engagement of parents and youth in case planning and service delivery; 

• Identify family and kinship resources when out of home placement is necessary; 

• Empower families and youth involved with the system to determine service needs to expedite reunification or other permanent, family based solutions; 

• Empower caregivers to operate in the best interest of the family and youth by using their voices and expertise as advocates for the family and child;

• Ensure child welfare services build strength and resilience in families and youth and connect them to their communities and the supports they need. 

In 2021, the U.S. Department of Health and Human Services released a brief, Methods and Emerging Strategies to Engage People with Lived Experience, that identifies lessons learned from federal initiatives that engaged youth, young adults and adults with lived experience. The brief is organized around the roles that lived experts can fill for federal, state or local agencies including storytellers, advisors, grantees, partners, and staff. It also provides examples of specific activities that they can engage in, such as:

• Helping conduct, contextualize, translate, disseminate research and program evaluation findings,

• Making recommendations to policymakers, planning agencies and executive-level officials related to funding, strategic partnerships, program planning and implementation, service delivery, training, evaluation and research,

• Providing direct services and trauma-informed support grounded in shared common experiences; and

• Shaping strategic communications about the practices, goals, and requirements for effective service and program delivery.

The brief identifies emerging strategies to support meaningful engagement and agency factors that contribute to success. 

Implementation Examples

To implement this provision of the Supporting America’s Families Act, states must create opportunities for those with lived experiences to shape their state’s child welfare agency planning. Ideally, state agencies will seek to create authentic partnerships with lived experts as they engage them in their child welfare planning overall, including the Title IV-B process. Authentic partnership requires being thoughtful about how lived experts are engaged and ensuring their involvement is not tokenistic. Authentic partnerships are characterized by:

• Fully engaging lived experts throughout the process, including the early conceptualizing of the issue and while “planning to plan,” 

• Taking the time to build trust and ensure everyone involved feels psychologically safe,

• Ensuring lived experts’ perspectives and opinions are valued equally with professionals,

• Moving beyond asking for input and including lived experts in the decision-making process,

• Financially and logistically supporting lived experts’ ability to participate, and

• Ensuring the experience supports everyone – agency staff and lived experts – in achieving their respective goals.

Many states are already engaging lived experts in their development of federal planning and reports. Examples include:

• Tennessee Department of Children’s Services developed a Lived Experience Consultants Program that is currently funded through Title IV-B, Part II. Community-based organizations are contracted to hire and support Lived Experience Specialists on a part-time basis. The Specialists are trained on the agency’s federal plans, help to engage stakeholders, and facilitate and participate in workgroups and meetings across many issues that inform the federal planning and reporting processes.

• In South Carolina, the Department of Social Services partners with community groups to support a Kinship Care Council, Foster Parent Advisory Council, Birth Parent Advisory Council, and regional Youth Engagement Advocates (YEA!). Members participate in workgroups that inform the state’s federal plans, e.g., on topics such as creating a kin-first culture or improving placement stability. Surveys are also regularly used to get input from a broader array of lived experts across the state.

• The Colorado Department of Human Services (DHS) brings together people with lived experience as well as child welfare professionals, lawmakers, providers and community members through the Reimaging Colorado’s Child Welfare System group. Members vote on issues that they want to work on, and agency staff bring issues or policy and funding changes for discussion. Agency staff who are working on federal reports or plans will meet with the group to share what they are developing and discuss how to incorporate their voices. DHS also engages lived experts through external partners such as the Office of Respondent Parents’ Counsel and the Office of the Child’s Representative Lived Experts Action Panel. These partners can create safe spaces for those who may not feel comfortable in a group overseen by the child welfare agency. 

• Hawaiʻi Child Welfare Services Branch (CWS) partners with lived experts including youth representatives from the HI H.O.P.E.S. Initiative, youth and parent employees from EPIC ‘Ohana, parents from other collaborative such as the Ho’iokaika Partnership, and kinship and other resource caregivers referred through the Licensing Division and partner agencies. To inform Family First Hawaiʻi implementation, CWS established a Lived Experience Advisory Group (LEAG) composed of birth parents, resource caregivers, and young people with foster care experience, including young parents. LEAG members now support broader child welfare initiatives while also providing guidance on Family First decisions, procedures, and training. Members are embedded in workgroups and decision-making bodies and serve in leadership roles as co-leads of select workgroups.

Implementation Tips from the Advocacy Hub

Review your state’s existing IV-B plan.  

Every state has a Child and Family Services Plan that outlines the goals and vision for the child welfare system, along with the specific policies and practices they plan to use to achieve those goals. Obtain your state’s plan (find it here, or from your state child welfare agency). As you review, consider:

• Has the state agency engaged lived experts in the plan’s development in the past? The plans often list who was involved in development.  

• When is your state agency due to develop or update its plan? Title IV-B plans are renewed every 5 years. Your state also needs to submit an annual report on their progress and update their plans. Find out the timing for the report development and advocate to bring lived experts into that process. 

Get to know the current landscape of policies and practice.

Get a better understanding of any lived experts currently working in your state, and how they and the state child welfare agency have interacted thus far.  

• Which groups of lived experts have been engaged with the child welfare agency to date around policy change or planning, and who hasn’t?  Does your state child welfare agency already have any advisory boards for youth and families? 

• What state or local groups are advocating on behalf of youth or caregivers in the child welfare system? 

• Do any of the national organizations listed below have state chapters or affiliated groups?

• What strategies do organizations in your state use to engage lived experts in their own work and/or in advocacy? 

Engage key stakeholders, including those who have experienced the system.

Implementation of this provision requires that youth and caregivers – parents, foster parents, adoptive parents and kinship caregivers – are all engaged in the development of the IV-B plan. Each of these groups have important, yet sometimes distinct, perspectives on the child welfare system and experience with being engaged in advocacy or planning. 

Talk with lived experts from each group, including those who have been consulted in the past, and consider:

• What efforts to engage lived experts in child welfare policy or planning have been successful? Where have challenges arisen? 

• Do they feel that their input was taken into account?

• What strategies have been most effective for engaging each group, whether by the state child welfare agency or other agencies and organizations? What can be learned from those experiences?  

• Are there ways to dovetail or expand on existing efforts? 

• What groups or perspectives are still missing from the table? Who should be sought out?  

• What additional training, support or information is needed to effectively engage these groups in the IV-B planning process? 

• Are there agencies or organizations that can serve as a resource or example for effective engagement of lived experts? 

Talk with child welfare agency staff and consider those same questions. 

Take action.

Develop a plan to begin engaging youth and families in the next IV-B planning process. Even if the plan renewal isn’t due soon, it is important to begin now to build the relationships, structures and support to engage each of these groups. 

Examples of Lived Experts Working at the Local, State and National Level

Lived experts are informing policy design and implementation at the federal, state and local levels. Examples of organizations and networks working with lived experts include: 

• Birth and Foster Parent Partnership at the Children’s Trust Fund Alliance is a partnership between birth and foster/resource parents advocating for policy and practices that benefit children and families. Check out their Parent Partnership Organizations Directory of national and state networks and organizations supporting parent voice.

• Birth Parent National Network (BPNN) promotes birth parents as leaders and strategic partners in prevention and child welfare reform. 

• CHAMPS is a national campaign to spur policy improvements nationally and in states to ensure children and youth in foster care experience the highest quality parenting. 

• Families Rising guides, connects and empowers individuals, professionals and families on their journey through adoption, foster care, and kinship care. 

• FosterClub takes a youth-led approach to providing direct support to young people and driving change in the foster care system.

• Generations United Grand Voices initiative brings together caregiver advocates who help shape policies and practices that support grandfamilies and kinship families raising children.

• The Jim Casey Youth Opportunities Initiative® is a systems-change effort that works at the local, state and national levels to advance policies and practices to most effectively meet the needs of young people transitioning from foster care to adulthood.

• Journey to Success is a policy advocacy campaign that seeks to improve opportunities and outcomes for all youth and young adults who experience foster care. 

• National Foster Parent Association advocates at the local, state and national levels for policies that support foster, kinship and adoptive families. 

• Think of Us partners with those closest to the system to rethink entrenched structures, and test and evolve new solutions.

Resources for Going Deeper 

This section of the Supporting America’s Families Act encourages states to invest in - and increases funding for - addressing challenges facing the child welfare workforce. 

Overview of the Section

The child welfare workforce is central to how well a child welfare system functions. Caseworkers, supervisors, and agency staff make critical decisions that have a significant impact on the lives of children, youth, parents, kin, foster parents, and the community. Research shows long-standing challenges in recruiting and retaining child welfare staff who have the training and support they need to succeed in their roles. 

This section of the Supporting America’s Families Act increases the federal investment in the monthly caseworker visiting program, with the intent of helping more child welfare professionals access the support they need and helping states build a more robust and sustained workforce. 

Specifically, the Act increases funding overall for monthly caseworker visit (MCV) grants from $20 million to $26 million and updates the funding formula so that each state receives a base award of $100,000. This new baseline will result in a boost in funding for 15 states and Washington DC, which received less than $100,000 in fiscal year 2024. 

The Act also requires the additional funds be used for improving the quality of caseworker visits by addressing the following challenges, described in the statute: 

• reducing the ratio of children to caseworkers, 

• reducing administrative burden, 

• implementing technology to streamline caseworker workload, 

• improving caseworker safety, 

• caseworker mental health and well-being programs, and 

• caseworker recruitment campaigns. 

In addition to this section, the provision of the Act that requires the reduction of administrative burdens also seeks to streamline processes that would save caseworkers and agency staff valuable time. 

Child welfare agencies “are overburdened and understaffed. Investing in efforts to recruit and retain caseworkers will ensure children and families are provided with the support they need to thrive.”

– Representative Lloyd Smucker (PA)

Provisions from Section 12 were adapted from the Child Welfare Workforce Development Act (H.R. 8745), introduced by Rep. Lloyd Smucker (R-PA)

Children and Families Fare Better When There is a Strong and Stable Child Welfare Workforce

The National Child Welfare Workforce Institute wrote a research summary on the impact of a supported and stable child welfare workforce, explaining how the child welfare workforce is connected to child outcomes, parent outcomes, and the overall costs of the system. For example, they found:  

• Having more consistent caseworkers makes it more likely children will achieve permanency.

• High rates of turnover cause youth in foster care to lose trusted relationships and struggle to reconnect with new workers.

• Parents are negatively impacted by caseworker turnover and by caseworkers carrying too great a caseload. 

Overwhelmed and under-supported caseworkers also suffer from stress and burnout, which can negatively impact their work in areas like timeliness, quality, and family engagement, in addition to the impacts on their own lives. There is also a documented financial cost to the system itself when the workforce is not stable, including direct costs associated with hiring and onboarding new staff and indirect costs to other staff who are trying to fill the gaps. 

The Quality Improvement Center for Workforce Development worked directly with child welfare and human resources leaders to better understand the drivers of the crisis. Among other things, they noted:

• High job expectations and low pay,

• Insufficient staff to do the work well,

• Changing priorities and dynamics when political and agency leadership shift,

• A less robust pipeline of workers, and 

• Too many administrative burdens and reporting requirements.

Implementation Examples

There are no easy fixes to the child welfare workforce challenges. However, we can learn from existing state efforts to support their child welfare workforce, including efforts to improve recruitment and retention and reduce burnout. States can leverage IV-B funding, along with available Title IV-E administrative dollars, to implement strategies that spur systems improvements. 

A Casey Family Programs issue brief on navigating workforce challenges identifies the following five areas of comprehensive workforce development strategies:  

1. Understanding workforce needs

2. Creating manageable, family wage jobs

3. Hiring and onboarding strong applicants

4. Building and maintaining a healthy, equitable climate and culture

5. Offering training, development and advancement opportunities 

The brief also shares many successful implementation strategies in states and communities:

• New York City conducted retention interviews (i.e., one-on-one conversations with staff about their work experience) to better understand and address workforce needs.

• A working group of caseworkers, supervisors, and program managers in Jefferson County, Colorado developed a personal choice work model and compressed workweeks. 

• The Oklahoma Department of Human Services implemented a competency-based personnel selection process and also offered recruitment and retention incentives for those who recruit former child welfare specialists who left the agency in good standing.

• New Jersey created an Office of Staff Health and Wellness focused on maintaining a workforce that is healthy in both their professional and personal lives. 

Implementation Tips from the Advocacy Hub

Review your state’s existing IV-B plan.

Every state has a Child and Family Services Plan that outlines the goals and vision for the child welfare system, along with the specific policies and practices they plan to use to achieve those goals.

Obtain your state’s plan (find it here, or from your state child welfare agency) and review it to begin to understand the strategies that your state is already implementing to support its child welfare workforce. 

Get to know the current landscape of policies, practice, and data.

If possible, find your state and local child welfare caseworker turnover rate. Keep in mind that how states determine their turnover rate can vary, so it is important to understand how it was calculated. Also, turnover rates can vary by region or community, and these variations can help point to challenges as well as effective strategies across your state. 

In addition to the state IV-B plan, review child welfare policy to learn about your state’s caseworker qualification requirements, pay scale and benefits, and caseload requirements. Search for state and local articles about child welfare workforce concerns. 

Learn more about workforce strategies that have been proven effective in other states and communities from the Casey Family Programs brief on navigating workforce challenges and in the Resources for Going Deeper section below. 

Engage key stakeholders, including those who have experienced the system. 

Most likely, your state or county child welfare agency is already undertaking workforce initiatives and/or has assessed specific workforce needs. Reach out to learn more and explore ways to work in partnership to support existing efforts. 

Talk with current and/or former caseworkers to learn more about what additional workforce strategies could be most effective in supporting them to do their jobs well. 

Engage lived experts including young people with foster care experience, birth and foster parents, and kinships caregivers to discuss their experiences with caseworkers and how the workforce challenges may have impacted their outcomes. 

Take action.

Based on what you’ve learned, determine what workforce strategies may be effective in your state or community and complement existing efforts. Collaborate with stakeholders to advocate for additional resources and emphasis on caseworker recruitment and retention. 

Be prepared to explain why supporting the workforce is important, such as highlighting its link to outcomes for children, the impact of secondary trauma for workers, and the return on investment. 

As an example, check out this resource on child welfare workforce development from the Pennsylvania Partnerships for Children.

Resources for Going Deeper

Several sections of the Supporting America’s Families Act were designed to support Native American children and families by increasing funding and streamlining administrative requirements for Tribes, and by promoting stronger implementation of the Indian Child Welfare Act (ICWA). 

Overview of the Sections

Tribes are sovereign nations, and as such have legal relationships with both the federal government and state governments. These relationships bring a myriad of different administrative structures and legal frameworks impacting the ways child welfare systems interact with Native American children and families. Tribal child welfare and prevention programs and agencies face layers of administrative complexities in accessing Title IV-B dollars. This can be particularly challenging for smaller Tribes, who do not receive much money, but have the same reporting requirements. 

“[Title]IV-B is complicated, and tribal access, as we’ve heard so much, there’s no parity to the states. Our access is often overburdened with a bureaucratic process. To make these things equitable to tribes, there has to be an increase of funding, but you also have to make the process easier and accessible to tribes. We see that…prevention is intensive. The funds are insufficient to make sure that we can prevent families from even entering into the child welfare system. When we ask Congress: what can you do? You can increase the funding that is available to tribes, you can increase the ease of access and make sure that there’s parity from the tribes; that tribes have access to the same tools that the states would as well.”

Council Member Mikah Carlos, Salt River Pima–Maricopa Indian Community

“Tribes face unique challenges when it comes to administering federal child welfare programs. Native American children, constituting just 1 percent of the total child population in the United States, are disproportionately represented in foster care placements, accounting for 2.7 percent of placements. Collaboration between state agencies and Tribes is necessary to ensure culturally appropriate interventions and placements within their communities to protect vulnerable children and keep families together whenever possible.”

Jason Smith (MO), Chairman of the House Ways and Means Committee  

There are also specific federal protections – including the Indian Child Welfare Act (ICWA) – designed to ensure that Native American children can live with their families and remain connected to their Tribes and cultural traditions. Since passed into law in 1978, there have been documented implementation challenges, preventing the law from fulfilling its promise. See more information on the goals of ICWA, and implementation challenges, below. 

The Supporting America’s Families Act includes provisions created to support Tribes and Native American children and families, including:  

1. Provides additional funding to Tribes who provide child welfare services

   • Requires a full 3% of Promoting Safe and Stable Families (PSSF) funds be reserved for Tribes. The Congressional Research Service estimates this to be an increase from the 2024 effective rate of 2.6% - around $2.1 million in mandatory funds. The Act also preserves 3% of PSSF discretionary funds for Tribes.

   • Establishes that 3% of Child Welfare Services (CWS) funds be reserved for Tribes. The Congressional Research Service estimates this to be an increase from the 2024 effective rate of 2.8%.

   • Doubles funding for Tribal Court Improvement Programs, from $1 million to $2 million. 

2. Reduces the administrative burden for Tribes 

   • Requires the U.S. Department of Health and Human Services (HHS) to consult with Tribes to modify reporting requirements for Tribes receiving $50,000 or less of Title B funding, which was 82% of Tribes that received funds in 2024.

   • Allows Tribes to use their negotiated indirect rates, rather than limiting them to a uniform 10% cap. This provides additional flexibility for Tribes who have already established a different indirect rate with the federal government. 

   • Includes Tribes in the Section 6 requirement to reduce administrative burden – ensuring Tribal input is provided to the required revisions of paperwork and data collection forms. 

3. Requires better coordination between Tribes and States, especially around implementation of the Indian Child Welfare Act (ICWA)

   • Places new requirements for state plans, such as requiring states to describe how they ensure Tribes receive information on child welfare cases that involve Native American children and a description of how the state complies with ICWA requirements. 

   • Requires HHS to consult with Tribes and states and create a technical assistance plan for supporting effective implementation of ICWA. The plan must address areas of improvement for identifying extended family members, timely notice of hearings, and information on why any requests to transfer jurisdiction were denied.

   • Requires HHS to submit a biennial Report to Congress on state compliance with ICWA and how HHS is supporting implementation. 

The Federal government has begun to take action on implementing this section of the Strengthening America’s Families Act. In July 2026, the Administration for Children and Families (ACF) and the Children’s Bureau (CB) released Supporting America's Children and Families Act – ACF’s Summative Tribal Consultation Report, which summarized the recommendations made by Tribal leaders and members about implementing the Act and ACF’s responses to those recommendations. In May 2026, they also released the Supporting America’s Children and Families Act Tribal Consultation Session Report, summarizing a February Tribal Consultation session and open record. Both reports describe the feedback of Tribal leaders and members on necessary technical assistance for ICWA implementation, strategies for reducing administrative burden, updated plan requirements, addressing administrative costs, tribal Court Improvement Programs, and improving the Prevention Services Clearinghouse.

The Children’s Bureau also released the Child and Family Services Plans and Annual Progress and Services Report Tribal Toolkit, and corresponding Program Instruction. These resources are designed to guide Tribes on federal funding reporting requirements. The Toolkit provides updates to the June 2026 Annual Progress and Services Report, which is a requirement for receiving federal funds including Title IV-B: 

“The APSR submission should not exceed five (5) pages. This represents a change from prior practice and is intended to improve the utility, clarity, and transparency of reported information…. Consistent with the statutory purpose of annual progress reporting, ACF requests that tribes succinctly summarize major changes, progress, and accomplishments related to their Child and Family Services Plan (CFSP). Submissions should focus on substantial updates since the prior APSR, including notable advancements, revisions to strategies, and priority areas for the coming year. Tribes should exercise discretion in determining which developments constitute critical updates and highlight the most meaningful information needed to inform the public about the status and direction of their child welfare programs.” 

In July 2025, the Administration for Children and Families released a request for public comment on providing technical assistance to the Indian Child Welfare Act. In addition to reading the request for comment, you can also see the many state, tribe, organizational, and individual responses at regulations.gov. 

Many of the provisions to specifically support Tribes and Native American children and families come from the Strengthening Tribal Families Act of 2024, cosponsored by Representatives Judy Chu (D-CA), Daniel Kildee (D-MI), Tom Cole (R-OK), Sharice Davids (D-KS), Mary Sattler Peltola (D-AK), Jimmy Panetta (D-CA), and Lauren Underwood (D-IL). 

Increased Investment and Supports Can Help Address the Needs of Native American Children and Families Who Are Involved with the Child Welfare System 

There are 574 federally recognized Tribes, with many additional Tribes that are recognized by states. As sovereign nations, Tribes can administer their own child welfare systems and programs that keep children safe and connected to their Tribal communities and cultures, and provide family preservation and stabilization resources within their Tribe and communities. Tribes also fund programs and services for Tribal member children and families who are involved in state child welfare systems and are a legal party in those cases when ICWA applies. 

Overall, overall 2% of children and youth in foster care are Native American. In the six states with the largest Native American population, those numbers fall between 8% and 53%. The disproportionate number of Native American children and families involved in the child welfare system is not new – it springs from the long and painful history of the forced removal of children from their families and communities, and placement in boarding schools with the intention of erasing their Tribal customs and cultures. A recent federal report (Federal Indian Boarding School Initiative Investigative Report, Vol, II) found that there were at least 417 such boarding schools in 37 states, and nearly 1,000 children died while attending the boarding schools. 

Stronger implementation of the Indian Child Welfare Act (ICWA) will keep more Native American children connected to their families and Tribes. 

The 1978 Indian Child Welfare Act (ICWA) created a set of protections for children who are members of federally recognized Tribes. The National Indian Child Welfare Association (NICWA), describes ICWA this way: 

“The Indian Child Welfare Act (ICWA) responded to the crisis of the forced removal of Native children from their families and communities at alarming rates of 25%–35%, with 85% being placed outside their families, even when relatives or Tribal members were available to care for them.

ICWA sets minimum federal standards for child custody cases involving Native children, prioritizing their best interests and strengthening family and Tribal stability. It mandates efforts to keep families intact, prioritizes out-of-home placements within their family and community, and ensures the child’s Tribal Nation and family are fully informed and involved in state court proceedings.“

Researchers and Tribes have documented numerous challenges implementing ICWA, meaning that it does not provide all the protections to children, families, and Tribes that are required. In its Supporting America’s Children and Families Act - Summative Tribal Consultation Report, ACF summarized the following implementation concerns that were shared by Tribal leaders:

• Timely identification of Indian children, notice to Tribes and Tribal engagement: “This area focuses on the need to strengthen ICWA implementation through earlier Tribal engagement, improved notice practices, and clearer procedural guidance. Tribal recommendations consistently highlighted delayed identification of Tribal children and late or incomplete notice to Tribes as significant barriers, often limiting Tribal ability to intervene, identify kinship placements, and influence critical case decisions. Tribes emphasized the importance of initiating inquiry into Tribal identification at the time children are taken into care and custody, clearly distinguishing between inquiry and formal notice requirements, and ensuring timely, accurate communication supported by up-to-date Tribal contact information.”

• ICWA Training, Active Efforts, and Qualified Expert Witness (QEW) Capacity: “This set of responses centers on the need to improve the consistency, quality, and cultural integrity of ICWA implementation through strengthened training and practice standards. Tribal recommendations identified widespread gaps in ICWA understanding across courts, agencies, and legal professionals as a primary driver of noncompliance, emphasizing that current training approaches are often inconsistent, onetime, and insufficiently grounded in Tribal perspectives. Tribes recommended sustained, role-specific training developed in partnership with Tribal subject matter experts, which incorporates historical context, Tribal sovereignty, culturally responsive practices, and clear distinctions between active and reasonable efforts.”

• ICWA Accountability, Jurisdictional Transfers, and Federal Coordination: “This area emphasizes the need to strengthen system-level accountability, oversight, and coordination to support effective ICWA implementation. Tribal feedback consistently called for clearer federal guidance, stronger accountability mechanisms, and more direct pathways for Tribes to elevate concerns regarding state and county practices to the federal government. Tribes also highlighted the importance of consistent data use and reporting structures to track compliance and outcomes. Tribes emphasized that insufficient incorporation of Tribal perspectives in QEW selection, jurisdictional transfer decisions, and compliance oversight undermines ICWA implementation.”

The new provisions in the Strengthening America’s Families Act – such as requiring state plans to include ICWA and technical assistance from HHS – are intended to help address some specific challenges in implementing ICWA. 

Streamlined funding requirements, with reduced administrative burden, will provide more funding for Tribes to use in the ways that are most responsive to their specific needs. 

The Congressional Research Services reports that in 2024, about 82% of the 171 Tribes that directly receive Title IV-B funds received $50,000 or less. However, these tribes have historically been required to submit the same level of reporting as states. This created a tremendous amount of work, for a relatively small amount of funding. As described by NICWA in their comments on Providing Technical Assistance Related to the Indian Child Welfare Act: 

“Almost two-thirds of federally recognized Tribal Nations have fewer than 2,000 members and their Tribal child welfare programs typically range between 1–5 staff. Tribal child welfare funding is almost entirely discretionary, meaning funding levels can fluctuate from year to year depending upon appropriated funding levels and whether state pass-through funding remains available. Tribal child welfare staff are often managing cases starting with investigation through permanency and are helping with home visits, foster home recruitment and licensing, transportation for parents and children, and attending court hearings and agency reviews. They may also be providing support to state case managers in ICWA, participating in Tribal-state forums and collaborative projects, and helping arrange training for state child welfare agencies. Tribal programs of this size don’t have dedicated grant writers or contract managers and have limited assistance for grant application development and program reporting.” 

Provisions of the Strengthening America’s Families Act are intended to help reduce this burden significantly. 

The field lacks adequate data on Native American children and families who are impacted by the child welfare system, including demographic details and outcomes. The newly required biennial report to Congress on ICWA implementation may help the field gain a greater understanding of strengths and challenges in supporting Native American children and Families. 

Implementation Tools

As state advocates, you can work with your state and county agencies to build and nurture constructive partnerships with Tribes. These relationships can help both Tribes and states in their implementation of new requirements under the Strengthening America’s Families Act, including those around implementing ICWA protections. One tool for doing that comes from the Capacity Building Center for Tribes – a project funded by the federal Children’s Bureau. 

The Center’s Tribal-State Partnership Toolkit contains the following resources:

• Sample meeting materials 

• Activities to “promote discussion and interaction to focus participants in ICWA or Indian child welfare issues and values, build open communication, acknowledge historical events and dynamics that impact tribal-state relations today, learn about each other, and accomplish the goal of building an effective and collaborative team”

• Multimedia videos and tools that provide education and background on Tribal issues

• A comprehensive reading list including research, roadmaps, and examples from Tribes and states

Resources for Going Deeper

This section of the Supporting America’s Families Act expands the development process and content of state health oversight plans to better ensure children and youth have access to the mental health services they need.

Overview of the Section

Children and youth in foster care are more likely to need mental health services than those who never experience child welfare involvement. Some studies have found that up to 80% of children in foster care meet the criteria for a significant mental health issue. Although the need is great, research and youth with lived experience in foster care have reported that they don’t have adequate access to the support they need and have been urging policy and system leaders to do more to improve mental health.

The Supporting America’s Families Act builds upon ongoing efforts by federal policymakers to improve mental health services and support a trauma-informed and responsive child welfare system. The Act aims to increase access to necessary mental health services in a few critical ways.

Better collaboration with mental health entities. Historically, the state child welfare agency is required to collaborate with the state’s Medicaid agency, providers, and others to create a health oversight plan to make sure that every child in foster care has their health needs met. The Supporting America’s Families Act expanded the list of groups that needed to collaborate on the plan by requiring mental health service providers and agencies be brought to the table to help ensure individualized care for children's mental health needs.

Explicitly including mental health in plans. Prior to the Act, plans were required to include elements such as screening schedules, continuity of care, and oversight of prescription medications. The expanded list of elements to include in the health oversight plan now includes the mental health services provided, the continuity of these services, and consultation with mental health providers when determining the treatment needs of children.

Informed consent. Health oversight plans must describe how states will receive the informed consent of youth for the prescription of psychotropic medications and ensure “compliance with professional practice guidelines.”

These provisions from Section 6 were adapted from the Foster Youth Mental Health Support Act (H.R. 8643), introduced by Representative Michelle Steel (R, CA)

Many Children and Youth in Foster Care Lack Access to the Mental Health Resources They Need

Having access to high-quality and appropriate mental health services and trauma informed care is key to helping children and youth in foster care heal and thrive. The American Academy of Pediatrics summarizes the challenges this way:

“Childhood trauma takes many forms — abuse and neglect; death of a parent (foster or birth) or kin; severe chronic illness of a parent (foster or birth) or kin; ongoing absence of a parent (foster or birth) or kin; significant impairment of parenting skills (often because of parental mental illness, substance abuse, or cognitive impairment); exposure to criminal activity or violence in home and neighborhood, etc. Birth parents of children in foster care have often been unemployed or involved with the criminal justice system. Poverty and housing or food insecurity are common.  Many children have been cared for by a variety of adults, even prior to foster care, and may not have experienced the predictable nurturance necessary for healthy development.

The emotional trauma of removal from all that is familiar and placement in foster care is emotionally traumatizing for all but the youngest infants. This is compounded by the ongoing separation, losses, and uncertainty that are endemic to foster care.”

Although there are mechanisms in place to screen and support access to the mental and behavioral health services that they need, challenges remain. For example, nearly all children in foster care are Medicaid-eligible and therefore entitled to services under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which requires states to provide any allowable service that is determined medically necessary.  States must also develop a schedule of recommended screenings for physical or behavioral health conditions. 

Despite the EPSDT benefit and screenings, studies have shown that many children and youth in foster care lack access to appropriate mental health services due to systemic issues such as:

• Disruptions in continuity of care due to entry into care, placement instability, and timely transfers in health electronic records,

• Limited access to trauma-informed screenings that accurately identify mental and behavioral health needs, and

• Limited availability of mental health providers, especially those who accept Medicaid and can provide trauma-informed care.

Due to these challenges, it is critical that state child welfare agencies, state Medicaid agencies, mental health providers, and those with lived experience come together to develop a clear plan to support the mental health needs of children and youth in foster care. This includes tackling broader systemic challenges as part of an overall strategy, such as placement stability, availability of mental and behavioral health providers, and the diversity of mental health therapies offered. 

Informed consent for psychotropic drugs, required under the Supporting America’s Families Act, should engage youth in shared clinical decision-making. 

Studies have shown that children and youth in foster care are at heightened risk for inappropriate use of psychotropic medications. Young people and advocates have raised concerns about psychotropic drug misuse for many years. In 2011, Congress responded by requiring states to put in place protocols to facilitate the oversight of psychotropic medications for children and youth in foster care. Recent federal efforts continue to focus on ensuring that psychotropic medications are appropriately used and are part of an overall treatment plan.

The Supporting America’s Families Act now requires states to receive the informed consent of youth for psychotropic medications and to follow professional practice guidelines. To be meaningful, a youth’s consent should be provided within a context of shared clinical decision-making, i.e., they must be truly empowered to make informed decisions about their treatment plans and its impacts on their life. To do so, youth need to understand their diagnoses and their options for treatment. And when psychotropic medications are a possible treatment, youth must also understand the purpose of the medication, the potential side effects and interactions, and how to safely discontinue use.

Implementation Examples

Improving access to mental health care

Better coordination between state child welfare and Medicaid agencies is critical to addressing mental health needs for children in foster care. Progress has been made when child welfare and Medicaid agencies collaborate, listen to the voices of young people with experience in foster care, and develop a clear plan that utilizes mechanisms through Medicaid to improve the array of mental health services and supports for children in foster care. 

Casey Family Programs and the Center for Health Care Strategies collaborated to highlight strategies and state examples for providing health and mental health care access for children in foster care. Examples show how states have leveraged Medicaid-funded services to support children in foster care, by providing access to screenings, assessments, home-and community-based services, and more.  

The National Foster Youth & Alumni Policy Council released a brief, Beyond Therapy: Redefining Mental Health Support in Foster Care, which translates the Council's recommendations into actionable systemic improvements for state and local child welfare leaders. Importantly, the brief acknowledges the urgency of the mental health challenges that youth in foster care are facing and provides examples of quick wins that can be implemented in the short term. 

Informed consent 

In Washington state, the Psychotropic Medication Management policy requires youth aged 13 or older to consent to the administration of their own medications. They also have the right to maintain confidentiality. The agency developed a youth-facing resource, called Your Rights, Your Life - A Resource Guide For Youth in Foster Care, that helps youth understand their rights including informed consent for medication. 

The psychotropic medication oversight section of Washington state’s Health Care Oversight and Coordination Plan describes their overall approach and how they ensure additional safeguards are in place. The plan also details the many different groups that serve as partners to their state child welfare agency, including their Developmental Disabilities Administration and children’s mental health specialists.

Implementation Tips

These core action steps can help build the blueprint for Title IV-B in states and communities. Read more about why we chose these steps in our intro to the series. 

Review your state’s existing IV-B plan.

Every state has a Child and Family Services Plan that outlines the goals and vision for the child welfare system, along with the specific policies and practices they plan to use to achieve those goals. The federally required Health Care Oversight and Coordination Plan is often an attachment to the plan. 

Start with reviewing your state’s most current plan and report.]Check your plan for the following information: 

• How does your state’s health oversight plan address the provision of mental health services for children and youth in foster care?

• Who was involved in the development of the health oversight plan? Were mental health providers and lived experts at the table? 

• How does your state monitor the appropriate use of psychotropic drugs for children and youth in foster care? Is youth consent for psychotropic drugs or other health-related decisions addressed?

Get to know the current landscape of policies, practice, and data.

There are many other information sources beyond your Child and Family Services Plan that can help paint a picture of access to mental health services and what informed consent looks like in your state.  

• Determine how children and youth in foster care in your states access Medicaid services, and in particular, mental health services. Is there a dedicated managed care organization? Are there mechanisms to ensure that all children and youth in foster care are receiving regular EPSDT screenings and being referred to appropriate services?

• Find out if your child welfare agency has staff dedicated to supporting and monitoring the health and well-being of children and youth in foster care (e.g., a child welfare medical director). If yes, what is the scope of their role? 

• If available, review your state or county data on psychotropic medication use for children and youth in foster care, ideally by age, race, and placement type. 

• Explore your state’s existing psychotropic medication policies and look for examples from other states in The Imprint’s 50-state review of policies on psychotropic prescribing for children and youth in foster care. 

• Review your jurisdiction’s current medical consent policies for children and youth in foster care. Do youth currently have an explicit role in providing consent for any health or mental health services? What existing medical consent policies need to change in order to align with and support youth consent?

• Learn more about youth’s existing role in making decisions about their health and well-being. Are there policies and practices to support shared clinical decision making with youth related to their health and mental health decisions? 

Engage key stakeholders, including those who have experienced the system.  

Bring together child welfare and Medicaid agency leaders to discuss what strategies have been tried, where there has been success, and what challenges and gaps remain. 

Invite lived experience experts to the conversation. Work with organizations supporting young people with lived experience in foster care. Be sure to create a supportive and trauma-informed environment to hear their perspectives. Consider using focus groups or other approaches that protect confidentiality. 

Within a trauma-informed setting, explore questions about young people’s experience seeking and receiving mental and behavioral health supports such as:

• Did they have access to the mental and behavioral support they needed when in foster care?  What were the barriers? What services were helpful and why? 

• Were they empowered to make decisions about their mental health treatment? What could have been done differently to engage them in a shared clinical decision-making process? 

• How can youth be supported to provide consent for psychotropic medications? What would that look like?

Keep in mind that youth with foster care experience are a diverse group and their experiences can vary widely. Be sure to include young people at different stages of their transition from foster care, with different foster care experiences, and from different parts of the state. 

Reach out to organizations in your community who support the mental and behavioral health of children and youth and are committed to providing trauma-informed care. Consider contacting local chapters of organizations such as the American Academy of Pediatrics, the American Mental Health Counselors Association, and the National Alliance on Mental Illness.

Take action.  

Based on what you’ve learned, identify opportunities and strategies to improve your state’s coordination between Medicaid and child welfare agency to address mental and behavioral needs of children and adolescents in foster care. Be prepared to share data and educate legislative and administrative policymakers about the barriers and gaps in these types of services.

Resources for Going Deeper