Title IV-E Prevention Services Plan

This is a mandatory collection of information related to the Plan for Foster Care and Adoption Assistance, funded and authorized by Title IV-E of the Social Security Act, and is being conducted by the Children’s Bureau (CB). The information collection also incorporates the plan requirements to participate in the optional Guardianship Assistance and Kinship Navigator programs, and the Title IV-E Prevention Services Plan. Approval to publish these notices will allow CB to comply with the Paperwork Reduction Act (PRA) when requesting the information from respondents. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the PRA of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0433 and the expiration date is XX/XX/XXXX.If you have any comments on this collection of information, please contact Liliana Chakrabarti by e-mail at liliana.chakrabarti@acf.hhs.gov.

Tribal Title IV-E Agency Plan for prevention services and programs

Attachment I

OMB Approval No. 0970-0433
Expiration Date: (XX/XX/XXXX)

TRIBAL TITLE IV-E AGENCY PLAN FOR TITLE IV-E OF THE SOCIAL SECURITY ACT: PREVENTION SERVICES AND PROGRAMS

TRIBE:

U.S. Department of Health and Human Services Administration for Children and Families

Children’s Bureau

SECTION 1. Service description and oversight SECTION 2. Evaluations

SECTION 3. Monitoring child safety SECTION 4. Consultation and coordination SECTION 5. Child welfare workforce training SECTION 6. Child welfare workforce support SECTION 7. Prevention caseloads

SECTION 8. Assurance on prevention program reporting

SECTION 9. Child and family eligibility for the title IV-E prevention program

ATTACHMENT I: Tribal title IV-E prevention program reporting assurance ATTACHMENT II: Tribal title IV-E agency assurance of trauma-informed service-delivery

ATTACHMENT III: Tribal title IV-E agency prevention program five-year plan renewal assurance

Federal Regulatory/Statutory References1	Requirement	Tribal Regulatory, Statutory, and Policy References and Citations for Each
Section 1. Service Description and Oversight
471(e)(1)	A. SERVICES. The tribal title IV-E agency provides the following services or programs for a child and the parents or kin caregivers of the child when the need of the child, such a parent, or such a caregiver for the services or programs are directly related to the safety, permanence, or well-being of the child or to preventing the child from entering foster care: MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION AND TREATMENT SERVICES. —Mental health and substance abuse prevention and treatment services provided by a qualified clinician for not more than a 12-month period that begins on any date described in paragraph (3) of Section 471(e) with respect to the child. IN-HOME PARENT SKILL-BASED PROGRAMS. —In-home parent skill-based programs for not more than a 12-month period that begins on any date described in paragraph (3) of Section 471(e) with respect to the child and that include parenting skills training, parent education, and individual and family counseling.
471(e)(5)(B)(i)	B. OUTCOMES. The tribal title IV-E agency provides services and programs specified in paragraph 471(e)(1) is expected to improve specific outcomes for children and families.

¹ Statutory references refer to the Social Security Act. Regulatory references refer to Title 45 of the Code of Federal Regulations (CFR).

Federal Regulatory/Statutory References1	Requirement	Tribal Regulatory, Statutory, and Policy References and Citations for Each
471(e)(5)(B)(iii)(I)(IV) 471(e)(4)(B)	the services or programs selected by the tribal title IV-E agency, and whether the practices meet the practice criteria identified by the tribal title IV-E agency and, if applicable, the services or programs provided by a tribe operating pursuant to an agreement with the Tribal title IV-E agency consistent with section 472(a)(2)(B)(ii) of the Act; if applicable, for services or programs provided by a tribe operating pursuant to an agreement with the Tribal title IV-E agency under section 472(a)(2)(B)(ii) of the Act, any adaptations used by the tribe operating pursuant to the agreement; how the tribal title IV-E agency plans to implement the services or programs, how the tribal title IV-E agency selected the services or programs; the target population for the services or programs; and an assurance that each prevention or family service or program provided by the tribal title IV-E agency meets the requirements at section 471(e)(4)(B) of the Act related to trauma-informed service-delivery (tribal title IV-E agencies must submit Attachment III for each prevention or family service or program);

Federal Regulatory/Statutory References1	Requirement	Tribal Regulatory, Statutory, and Policy References and Citations for Each
Section 2. Evaluations
471(e)(5)(B)(iii)(V)	EVALUATIONS. The tribal title IV-E agency, and a tribe with which it has an agreement with under section 472(a)(2)(B)(ii) of the Act, is not required to comply with the evaluation requirements in section 471(e)(5)(B)(iii)(V) of the Act nor the continuous quality improvement requirements in section 471(e)(5)(B)(iii)(II) of the Act.
Section 3. Monitoring child safety
471(e)(5)(B)(ii)	The tribal title IV-E agency monitors and oversees the safety of children who receive services and programs specified in paragraph 471(e)(1), including through periodic risk assessments throughout the 12-month period in which the services and programs are provided on behalf of a child and reexamination of the prevention plan maintained for the child under paragraph 471(e)(4) for the provision of the services or programs if the tribal title IV-E agency determines the risk of the child entering foster care remains high despite the provision of the services or programs.
Section 4. Consultation and coordination
471(e)(5)(B)(iv) and (vi)	A. The tribal title IV-E agency must: 1. engage in consultation with other tribal agencies responsible for administering health programs, including mental health and substance abuse prevention and treatment services, and with other public and private agencies with experience in administering child and family

Federal Regulatory/Statutory References1	Requirement	Tribal Regulatory, Statutory, and Policy References and Citations for Each
	services, including community-based organizations, in order to foster a continuum of care for children described in paragraph 471(e)(2) and their parents or kin caregivers and 2. describe how the services or programs specified in paragraph (1) of section 471(e) provided for or on behalf of a child and the parents or kin caregivers of the child will be coordinated with other child and family services provided to the child and the parents or kin caregivers of the child under the Tribe’s plans in effect under subparts 1 and 2 of part B.
Section 5. Child welfare workforce support
471(e)(5)(B)(vii)	The tribal title IV-E agency supports and enhances a competent, skilled, and professional child welfare workforce to deliver trauma- informed and evidence-based services, including— ensuring that staff is qualified to provide services or programs that are consistent with the practice models selected by the tribal title IV-E agency; and developing appropriate prevention plans and conducting the risk assessments required under clause (iii) of section 471(e)(5)(B).
Section 6. Child welfare workforce training
471(e)(5)(B)(viii)	The tribal title IV-E agency provides training and support for caseworkers in assessing what children and their families need, connecting to the families served, knowing how to access and deliver the needed trauma-informed and evidence-based services, and overseeing and evaluating the continuing appropriateness of the services.

Federal Regulatory/Statutory References1	Requirement	Tribal Regulatory, Statutory, and Policy References and Citations for Each
Section 7. Prevention caseloads
471(e)(5)(B)(ix)	The tribal title IV-E agency must describe how caseload size and type for prevention caseworkers will be determined, managed, and overseen.
Section 8. Assurance on prevention program reporting
471(e)(5)(B)(x)	The tribal title IV-E agency provides an assurance in Attachment I that it will report to the Secretary such information and data as the Secretary may require with respect to the provision of services and programs specified in paragraph 471(e)(1), including information and data necessary to determine the performance measures for the tribal title IV-E agency under paragraph 471(e)(6) and compliance with paragraph 471(e)(7).	Attachment I
Section 9. Child and family eligibility for the title IV-E prevention program
471(e)(2)	A. CHILD DESCRIBED. — For purposes of the title IV-E prevention services program, a child is: A child who is a candidate for foster care (as defined in section 475(13)) but can remain safely at home or in a kinship placement with receipt of services or programs specified in paragraph (1) of 471(e). A child in foster care who is a pregnant or parenting foster youth.

Title IV-E Plan – Tribe:

PLAN SUBMISSION CERTIFICATION

Instructions: This Certification must be signed and submitted by the official authorized to submit the title IV-E plan, and each time the tribal title IV-E agency submits an amendment to the title IV-E plan.

I (name) hereby certify that I am authorized to submit the title IV-

E Plan on behalf of

(Name of Tribal Title IV-E Agency). I also certify that the title IV-E plan was submitted to the governor or designated tribal leader for his or her review and approval in accordance with 45 CFR 1356.20(c)(2) and 45 CFR 204.1.

Date

(Signature)

(Title)

APPROVAL EFFECTIVE

DATE DATE:

(Signature, Associate Commissioner, Children's

Bureau)

ATTACHMENT I

Tribal Title IV-E Prevention Program Reporting Assurance

Instructions for tribal title IV-E agencies: This Assurance may be used to satisfy requirements at section 471(e)(5)(B)(x) of the Social Security Act (the Act), and will remain in effect on an ongoing basis. This Assurance must be re-submitted if there is a change in the assurance below.

In accordance with section 471(e)(5)(B)(x) of the Act, (Name of Tribal Title IV-E Agency), is providing this assurance consistent with the five-year plan to report to the Secretary such information and data as the Secretary may require with respect to title IV-E prevention and family services and programs, including information and data necessary to determine the performance measures.

Signature: This assurance must be signed by the official with authority to sign the title IV-E plan, and submitted to the appropriate Children’s Bureau Regional Office for approval.

(Date) (Signature and Title)

(CB Approval Date) (Signature, Associate Commissioner, Children’s Bureau)

Tribal Title IV-E Agency Assurance of Trauma-Informed Service-Delivery

Instructions: This Assurance may be used to satisfy requirements at section 471(e)(4)(B) of the Social Security Act (the Act), and will remain in effect on an ongoing basis. This Assurance must be re-submitted if there is a change in the tribe’s five-year plan to include additional title IV-E prevention or family services or programs.

Consistent with the agency’s five-year title IV-E prevention plan, section 471(e)(4)(B) of the Act requires the title IV-E agency to provide services or programs to or on behalf of a child under an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma and in accordance with recognized principles of a trauma-informed approach and trauma-specific interventions to address trauma’s consequences and facilitate healing.

The (Name of Tribal Title IV-E Agency) assures that in accordance with section 471(e)(4)(B) of the Act, each title IV-E prevention or family service or program identified in the five-year plan is provided in accordance with a trauma- informed approach.

Signature: This assurance must be signed by the official with authority to sign the title IV-E plan, and submitted to the appropriate Children’s Bureau Regional Office for approval.

(Date) (Signature and Title)

(CB Approval Date) (Signature, Associate Commissioner, Children’s Bureau)

Tribal title IV-E Prevention Program Five-year Plan Renewal Assurance

Instructions: The tribal title IV-E agency may submit this assurance for approval to continue the title IV-E prevention program as described in the tribe’s approved five-year title IV-E prevention plan effective (Effective Dates of Previous Five-Year Plan) for the five-year period of (Effective Dates of Five-Year Plan Renewal).

In accordance with section 471(e)(5) of the Act, (Name of Tribal Title IV-E Agency) assures that the five-year plan effective (Effective Dates of Previous Five-Year Plan), including the preprint, the plan submission certification, attachments, assurances, and any amendments approved during the five-year plan period, will remain in effect without substantial changes for the five-year period of (Effective Dates of Five-Year Plan Renewal).

Signature: This assurance must be signed by the official with authority to sign the title IV-E plan and submitted to the appropriate Children’s Bureau Regional Office for approval.

(Date) (Signature and Title)

(CB Approval Date) (Signature, Associate Commissioner, Children’s Bureau)

(Plan Renewal Effective Date)