Our work shaping and reporting on national mental health policy is made possible through a capacity grant from the Perigee Fund.

At a time when many federal developments in health and social services feel uncertain or discouraging, the Family First Prevention Services Act (FFPSA) stands out as a beacon of hope. Enacted in 2018, there has been little awareness among leaders in the field of maternal mental health about the Act, despite its powerful potential to address maternal depression and substance use disorders early and effectively. FFPSA has the potential to transform the child welfare system by allowing states to use Federal Title IV-E funding not just for foster care, but for services that keep families together and children out of foster care. The purpose of FFPSA is to provide enhanced support to children and families and prevent foster care placements through the provision of:  

  • Mental health treatment
  • Substance use* prevention and recovery programs
  • In-home, skill-based parenting programs
  • Navigator kinship programs

These programs are for children at imminent risk of entering foster care (which is defined by the states), their parents or kin caregivers and pregnant or parenting youth in foster care. 

What Types of Programs are Eligible for Funding?

The Title IV-E Prevention Services Clearinghouse, established by the U.S. Department of Health and Human Services, evaluates programs to determine their effectiveness. As of March 2025, the Clearinghouse has reviewed 193 programs, with 93 rated as “promising,” “supported,” or “well-supported”—the benchmarks required for federal reimbursement. States must spend at least 50% of their FFPSA funds on well-supported programs, ensuring investments are rooted in strong evidence. The other 50% of the state’s FFPSA funds can be used for programs that are in the supported and promising categories and are included in the state’s FFPSA plan.

How Are Maternal Mental Health and Substance Use Recovery Programs Included?

A number of eligible programs directly support maternal mental health and recovery from substance use—critical areas for improving outcomes for both caregivers and children. Examples of programs that have been rated by the Clearinghouse include:

  • Home-Visiting Models: Promote secure caregiver-child relationships through strengths-based parenting strategies.
  • Parenting and Family Support Programs: Focus on relapse prevention, stress management, and family functioning.
  • Depression-Focused Parenting Programs: Use mindfulness and cognitive behavioral tools to help parents manage depression.
  • Medication-Assisted Treatment (MAT): Provides evidence-based treatment for opioid and heroin addiction.
  • Multisystemic Therapy for Substance-Abusing Families (MST-BSF): A comprehensive model treating the entire family, with an emphasis on adult recovery and child safety.
  • Peer and Wraparound Support Services: Offer personalized help from recovery mentors and connect families to long-term support networks.

Another provision in FFPSA does not need to be part of the state’s prevention plan. This provision allows Title IV-E foster care reimbursement funds to be paid to a residential substance abuse treatment agency to allow a child to be placed with its parent in residential care. To date this provision has been greatly underutilized. The foster care funds can be used to pay the room and board charges for the child to stay with the parent in a residential family-based treatment program. While in residential care, additional FFPSA prevention funds can be utilized to cover the substance use disorder treatment and other services provided to the child and parent as part of the state’s FFPSA plan. 

What Barriers Limit Program Access and Expansion?

Many strong programs remain unfunded because they haven’t yet been reviewed or rated by the Clearinghouse and the state has not included them in their FFPSA state plan. The high cost of rigorous evaluations and limited research capacity can prevent otherwise impactful programs from gaining approval. This leaves states with fewer options and may disproportionately affect smaller, community-based providers, especially those serving maternal mental health needs. A beginning step for programs to be considered by the Clearinghouse is to ensure the program has a manual or other documentation that describes how to implement or administer the intervention and to develop an evaluation plan. 

Is Family First Prevention Services Act Funding at Risk?

Title IV-E funding under the FFPSA is classified as mandatory entitlement spending, meaning it is not subject to the annual appropriations process that affects many other federal programs. However, the President’s FY 2026 budget request reflects a projected 19.7% decrease in Title IV-E funding compared to FY 2024 appropriations.

A Path Forward for Maternal Mental Health and Substance Use Disorder Treatment

By prioritizing prevention and expanding access to evidence-based care, FFPSA offers a powerful platform to address maternal mental health and substance use, an often-overlooked driver of child and family well-being. With continued investment and a commitment to reviewing and funding more maternal-focused models, FFPSA can help break intergenerational cycles of trauma, ensuring mothers receive the care they need to thrive, and their children grow up safe, supported, and at home.

*The Federal Family First Prevention Services Act uses the term substance abuse; for this blog we are using the term substance use.