From Disparities to Delivery: How State Family First Prevention Act Plans Address Issues of Equity

Background/Purpose: The 2018 Family First Prevention Services Act (FFPSA) authorized federal funding for upstream prevention services (e.g., mental health, substance use, and in-home parent skill-based programs) aimed at preventing foster care entry. To access these funds, states must submit Title IV-E prevention plans to the Administration for Children and Families (ACF), which provides guidance on required components such as defining target populations, describing workforce support, and outlining stakeholder engagement. Although Black, Indigenous, and families of color are overrepresented in child welfare, states are not required to address equity or disparities in these plans. Instead, they are only encouraged to assess whether programs or policies may perpetuate systemic barriers. As a result, it remains unclear whether and how states engage with issues of equity. This study examines: (1) which populations are identified, (2) what types of disparities are described, and 3) what strategies are used to address them.

Methods: As of February 2025, 42 state prevention plans had been approved by ACF and were included in the analysis. We conducted a content analysis using a structured coding framework capturing: (a) populations, (b) types of disparities, and (c) strategies to address disparities. Codes were developed inductively and refined iteratively. A consensus coding approach was used to ensure reliability and consistency across coders.

Results: Among the 42 plans analyzed, 13 (31%) did not mention equity or disparities. Among the remaining 29 plans, most referenced racial and ethnic minoritized groups (n=26; 90%), followed by gender and sexual identity groups (n=7; 24%). Racial and ethnic disparities were the most commonly identified (n=26; 90%), followed by systemic and institutional disparities (n=18; 62%) such as bias in reporting and investigation. Socioeconomic and structural disparities (e.g., poverty) were identified in only 8 plans (28%). The most common strategy was community partnership and shared power (i.e., co-creating solutions with families and communities) in 26 plans (90%), followed by culturally responsive practice (i.e., adapting services to reflect the culture of populations served) in 21 plans (76%), and data, evaluation, and continuous quality improvement (i.e., using data to monitor and reduce inequities) in 17 plans (59%). The least common strategies were policy and systems reform (n=7; 24%) and cross-sector collaboration to address root causes (n=3; 10%).

Conclusions/Implications: Findings reveal limited use of structural strategies in state prevention plans. Racial and ethnic disparities were primarily addressed through culturally responsive practices rather than structural interventions. In contrast, structural strategies, such as policy reform and cross-sector collaboration, were rare and most often applied to socioeconomic disparities. These patterns suggest that states tend to frame racial inequities as issues of service delivery and cultural responsiveness, while reserving structural interventions for economic disadvantage. Stronger federal and state guidance may be needed to support integration of structural equity approaches into prevention planning. For practitioners and systems leaders, this includes aligning culturally responsive services with efforts to address upstream drivers of inequity.