Assessing A Healthcare Program/Policy Evaluation

Promoting Safe and Stable Families (PSSF)

The Promoting Safe and Stable Families (PSSF) program, which is more formally known as Title IV-B subpart 2 of the Social Security Act, aims to avoid unnecessary separations between caregivers and their children, protect permanency for children by taking the necessary steps to reunite them with their parents, when possible, or another permanent living situation, and to improve the quality of care and programming services being offered to children and their families to achieve maximum chance for stable families (U.S. Department of Health & Human Services: Children’s Bureau, 2012).

The PSSF program has recently had two additional programs added, the Personal Responsibility Education Program (PREP) and abstinence education. The goal of the PREP program is to provide state funding aimed at teen pregnancy prevention, addressing prevalence of sexually transmitted infections (STIs) in the adolescent population, as well as teaching teens skills to prepare them for adulthood (ie financial responsibility and organization skills). The abstinence education portion provides grants to individual states to promote education to adolescents regarding delaying sexual activity in an effort to further reduce teen pregnancy rates, but also to promote development of healthy relationships and establishment of healthy boundaries in at-risk populations such as homeless teens or those in foster care (United States Department of Health & Human Services, 2018).

Success of the PSSF program has been measured by the fact that funding for this program became a mandatory component of the Administration for Children and Families (ACF) within the U.S. Department of Health and Human Services (HHS). The PSSF program has been reauthorized multiple times over the past 25 years and continues to be nationally implemented. Congress realized the success of this program, and ultimately the impact it has had on children, adolescents, and their respective families. Congress then began to require a budgetary commitment of mandatory funds toward this program to be awarded at the state level and to Native American tribes within the states who meet minimum requirements for award. To illustrate the success of the program in funding it is important to recognize that in 1994, $60 million was allocated in mandatory financial funding (Casey Family Programs, 2011), and in 2019, $345 million has been allocated (United States Department of Health & Human Services: Administration for Children and Families, 2019).

In the state of Colorado, in fiscal year 2016, the following data applied to the measurement of success of PSSF:

· 3,315 individuals were served by family preservation funds

· 3,023 individuals were served by family support funds

· 1,401 individuals were served by time-limited reunification funds

(Colorado Office of Children, Youth, & Families: Division of Child Welfare, 2018, p. 53)

Funding for PSSF is based on a formula that considers the population of children who receive Supplemental Nutrition Assistance Program (SNAP) aka “food stamps” in each state and respective Native American tribe. In order to remain eligible for PSSF funding each state must match 25% of the PSSF award amount in a Maintenance of Effort (MOE) account (State of California Health and Human Services Agency, 2014).

While the formula for determination of PSSF funding was not available, nationally one in four children receive SNAP benefits in a given month. This translates into between 20 and 22 million children receiving SNAP benefits in a given year. While not all of these children will need PSSF funding dollars these are the figures for which the state funding is determined (Center on Budget and Policy Priorities, 2017).

PSSF funding is determined based on 5-year plans within each state and Native American tribe. Analysis of program outcome data is conducted annually at the individual state level in alignment with the PSSF assurances, which include spending in in alignment with state and federal statutes.

Each state and tribe must submit their intended goals with PSSF funding. Each of the submitted plans must take into account collaborative efforts with key stakeholders. Title IV-B requires that PSSF plans be integrated into the state and/or tribal agency’s 5-year Child and Family Services Plan (CFSP) and provide annual updates by June 30th each year. The regional Children’s Bureau offices are responsible for communication and feedback to the respective states or tribes related to the annual reports.

Unintended consequences that have been identified since this program began in 1993 is that the program which began as a response to the growing number of children in foster care placement has expanded over the last 25 years and has been reauthorized under different legislative acts, most recently the Child and Family Services Improvement and Innovation Act of 2011. At current this program addresses permanency of children, Personal Responsibility Education Program and abstinence education (United States Health & Human Services: Administration for Children and Families, 2015).

Stakeholders identified in the evaluation of the PSSF program include

· Department of Human Services in each state and each county

· Native American tribes

· Vulnerable families with children at risk for abuse and/or neglect

· Families with open child protection cases; either court involved or non-court involved

· Foster parents

· Adoptive parents

· Hospitals and clinics

· Physicians and other healthcare providers

· Schools

· Teachers

· Law Enforcement

· Courts

· Community members

All of the stakeholders listed above will benefit from the results of PSSF program evaluation because the results will impact the direction for future grant funding for children and adolescents with regard to foster care, permanency, PREP, and abstinence education.

The PSSF program has met it’s intended objectives over multiple years. However, the population it serves is constantly changing and the objectives are fluid based on the legislative source of funding, so the measure of success is a target that is constantly moving and difficult to assess.

This program is already implemented in the state of Colorado and provides funding for valuable resources for children and adolescents within our state.

I would recommend implementation of this program because it aims to preserve the structure of families, provide family support to vulnerable families, provide time-limited reunification support, provide skills, guidance, and education for adulthood. Dividing families and removing children from their biological parents changes the heritage of a family forever. The PSSF program provides tools to prevent the division of families whenever possible.

In the role of a nurse advocate we can become involved in evaluation of a program via multiple different avenues. For example, nurses can volunteer to participate in the program planning committee that focuses on evaluation of the program one year after implementation. By becoming involved at this level nurses can help to influence discussions regarding needs for modification to the program in order to help make it more successful. Nurses can also participate in program evaluation by contacting legislators who support the program in order to provide a nursing perspective relative to the program.