Family First is making changes regarding how federal Title IV-E funds can be spent by states, territories and tribes. Previously, they were used only for children that had entered foster care. On October 1, 2019, states will have the option to claim federal reimbursement for approved prevention services. These services include, but are not limited to, evidence-based in-home parenting training and mental health and substance abuse treatment. The act also provides incentives for states to change their use of congregate care. For federal reimbursement, there is a cap on six foster care children in a household with some exceptions. For reimbursement for a child’s stay in a congregate care setting or residential group home, the program must be designated as a qualified residential treatment program. Such programs must be licensed and accredited, use a trauma-informed treatment model, have registered or licensed nursing staff, engage families in the treatment process and provide support after discharge. Assessment of a child must indicate the need for residential care, and each child’s treatment must be regularly reviewed. Other types of facilities or services that qualify include prenatal, postpartum or parenting support programs for teen moms, and high-quality residential settings for youth who have been, or are at risk of becoming, victims of trafficking. Legislators will be busy assessing the foster care prevention services in their states and identifying which children in congregate care can be placed safely in family-based care. All these changes will require them to find ways to increase the number of foster families and therapeutic care options.