Family first policy to practice: Using implementation science and CQI to advance prevention focused practice

• Family First is a historic chance to shift child welfare from separation to prevention and family preservation. • The system lacks infrastructure, tools, skills, and services to meet Family First goals and prevent foster care placement. • We propose a change approach grounded in implementation science and CQI to support the shift to prevention-focused practice. • We outline core implementation drivers—leadership, organization, and competency—with examples from Oregon and Virginia. • We conclude with recommendations for administrators advancing Family First and shifting to prevention-focused child welfare. Enacted in February 2018, the Family First Prevention Services Act represents a fundamental shift in federal child welfare policy that enables state child welfare systems to receive federal title IV-E reimbursement to provide evidence-based programs (EBPs) and services to prevent children from entering foster care. Despite this significant opportunity to drastically reduce the use of foster care, states are not maximizing spending for prevention services because the infrastructure for a true prevention-oriented child welfare service delivery system does not exist. Technical and adaptive infrastructure is needed to support the child welfare workforce in making the transition to prevention casework practice. We offer a change management approach grounded in Implementation Science that leverages continuous quality improvement as the mechanism for system change.