Trump’s Top Child Welfare Official: An Interview with Alex Adams

(upbeat music) This episode is sponsored by I Foster. I Foster is the nation's largest lived experience community. Annually, I Foster connects foster youth and their families to over $432 million in resources and employs hundreds of transition age youth interns who then serve over 25,000 of their peers, helping them successfully transition out of care and into self-sufficiency. I Foster's suite of supportive programs is proven to improve lives by reducing family needs while increasing youth independence and employability. Join us at I Foster.org. That's ISOSTR.org. - Hello and welcome to the Imprint Weekly Podcast. I'm John Kelly, senior editor of the Imprint, a daily news site covering child welfare and youth justice around the country. You can read all of our coverage at ImprintNews.org or check us out on Facebook or Twitter at @TheImprintNews. You can also sign up on our homepage for our free weekly and monthly newsletters and for professionals and child welfare and youth justice, subscribe to our Youth Services Insider section for a closer look at news on business policy and practice. The Imprint Weekly Podcast is also a member of the Safe Camp Audio Network. You can check out our show page and all of Safe Camp's other great podcasts at safecampaudio.org on the web or @safecampaudio on social media. On this week's episode, you won't be hearing from me. My colleague Imprint reporter, Michael Fitzgerald, was in Washington last week to interview Alex Adams, who was confirmed in October to serve as the assistant secretary for family support at the administration for children and families, which is the division of the Department of Health and Human Services that oversees family policy, child welfare services, and much more. Over the span of an 80-minute conversation, Fitzgerald asked Adams about a wide range of subjects. They discussed the administration's goal of a home for every child and how Adams plans to achieve that, how and why he plans to barbecue, that is his words, much of the regulatory language for states when it comes to federal funding and child welfare practices, why the administration has made demands that states rollback policies that are meant to protect LGBTQ+ youth, the role of kinship caregivers, and much more. Now, it's hard to have a conversation that long about child welfare and federal policy without a few acronyms and initials getting thrown around, so I put together a little key of the ones that God mentioned during this interview, and I'm gonna include that in the show notes for this episode. I think a lot of our listeners will pick up on some of them or most of them, but just in case, if you hear some initials or an acronym and you don't know what it means, flip to the show notes on your phone or on your laptop and we'll have those there for you. Before we get to this conversation, let me remind our listeners once again that the imprint is participating in the National News Match campaign, which means every dollar you give us in a donation between now and the end of the year will be doubled. Your support fuels powerful investigative reporting, lifts up voices that are too often unheard and helps hold the powerful accountable while giving communities the coverage that they deserve. So give today and make your impact go twice as far in supporting journalism that makes a difference. You can do that by going to imprintnews.org/donate. One more time that is imprintnews.org/donate. And now without further ado, here is the Imprint's interview with Trump's Assistant Secretary for Family Support, Alex Adams. (upbeat music) As it's joined today by Alex Adams, who is confirmed in US Senate in October to lead the administration for children and families at the Department of Health and Human Services. We're going to discuss his career leading up to this post, the Trump administration's child welfare priorities and more. Assistant Secretary Adams, thanks for joining us on the imprint weekly podcast. - Glad to be here. - So a house rules on this podcast, since we delve into mostly serious matters, we try to start on a lighter note and help listeners get to know you first. So give us a recent favor to in any of these categories. Movie, TV show, book, musical group, or sports team. - Sports team, we'll go Detroit Tigers. I grew up in the Toledo area. So closest major market to us was Detroit. So I grew up a Tigers fan. Music will go counting crows as favorite band of all time. - Okay, great. And any Idaho teams? - I know it doesn't have professional sports, so we have minor league teams. So everyone roots for the Boise State Broncos. It's a big Boise State Broncos fan, not less champions for the third straight year. And I know with a Boise band, I'll go with youthfully good in Idaho's own youthfully good. - Interesting, deep cut. So just to set the scene for our listeners also, we're in a fairly typical government office waiting room here, but there is some rather striking wallpaper of what I think might be birch trees. It's a whole forest surrounding us with the peeling bark and they're white. And it kind of looks like something you might see in an Idaho forest. So obviously, do you pick this one? - I think I should have thought. I've never been a big fan of renovating government offices on here to do the work, not for the decorations. - So let's talk about your career. It has included training as a pharmacist. You've advocated for chain drug stores, and you've overseen the budget of the entire state of Idaho. But I'm curious about the shift you made in 2024 to take over Idaho's Department of Health and Welfare. And you said you wanted to focus on foster care and adoption specifically, even though it has a much wider range of responsibilities, that agency. So how did that career shift come about? What did you know about child welfare before taking that job? - Yeah, well, I think all careers are shaped by elements of pure chance. And I think that's what makes life fun. When I went to school, I went to be a pharmacist. It was the family business dad was a pharmacist, grandpa was a pharmacist, great-grandpa was a pharmacist. So I was following the family path and found out pretty early. I probably didn't enjoy practicing pharmacy. I felt like pharmacists were trained to do much more than they were actually allowed to do legally and in practice. And I didn't have the patience to sit around and hope that practice changed. And I wanted to make that change. Certainly the challenge was, at that time, the entry level pharmacist salary far exceeded the entry level policy salary for a junior staffer if I wanted to work on the hill or at an agency. So had to find a path that kind of married those up and found a path for it in the pharmacy advocacy world first in Washington DC. So here I met my wife. She was the Idaho native. And suddenly, moving to Idaho is a priority that might not have been discussed prior to marriage. But it was a great journey for us, ran for agencies in Idaho. And as you said, most recently, the state HHS agency in Idaho, it's an umbrella agency. It's souped nuts, Medicaid, SNAP, TANF, licensing of health care facilities. It's got a lot of different focuses. And one of the challenges I saw with my predecessors is with an agency that size, you just become a firefighter. It's very easy to be just careening from priority to priority, putting out fire, putting out fire. The joke is, in a lot of states, if you're an umbrella HHS agency, your dream is that it's broken up into different components in states with different components. Their dream is for it to be combined into an umbrella agency. So we use the leadership philosophy called 4DX, the 4D splints of execution and said, if everything's a priority, nothing is a priority, if we try to focus on too many things, we'll just be firefighting. Where can we make the biggest difference? And child welfare was where we determined we could make the biggest difference. I was quoted often in Idaho saying 86% of my budget was Medicaid by 86% of my problems were child welfare. I was going to spend my 86% of time where my 86% of problems were we had reported after report from our GAO equivalent suggesting areas of reform. We had legislative oversight committees. And then that was a former state budget director. We had that vexing problem of the number of kids coming into care going down but our budget growing log rhythmically. And I thought it was a very interesting challenge for us to solve. I thought it was very human challenge that if we made a difference that it would impact lives positively, and also when I started that role in a five-year-old daughter, so it was personal for me. I wanted every kid in Idaho to have the opportunities my daughter had. So it was familiar with the issues from the budget perch, HHS issues, and I'd drive budget issues. But outside of the budget, I didn't have a lot of deep experiencing. Look at that as a positive or negative. I see it as a positive in many ways because you're unburdened by the history of how we got there, and you could look at problems and know and fresh and say, well, what should we be doing, not what has happened over the last 20 years? And were there any big surprises? I guess as you've got to know the field. A number of things. I mean, first, I had to forget everything I thought I knew about child welfare financing. I was in the budget shop. I was allolled into the sense that the feds were the primary payer. They're not state local government's kick and the majority of financing for child welfare. I was allolled into the belief that the feds covered 50% of administrative costs. They don't. They cover 50% of your administrative costs for the declining proportion of kids that are eligible. So the effective match rate is less than 20%. So I had to relearn a lot of those financing facts. The other thing is I had to kind of go back to basics and say, how does a kid end up in foster care? Look at how many kids are there in Idaho? Usually the first step of the journey is there's a call to intake. After intake, we put them into a level of priority. We send up assessors and assessor determines if they're safe or unsafe. If they determine to be unsafe, there's a court hearing. If there's a court hearing, they can be in prevention cases or in placement and placement. You can have them in foster homes, kin homes, congregate care, other facilities. Yeah, then there's the path to permanency. Going back to basics, we're able to isolate the three budget variables. How many kids come through the front door is your most important driver? If you can keep a kid in their home and provide services or broker services for them and keep that family together, you will have better outcomes for the child and you avoid the trauma of removal. In Idaho, I was paying a buck 80 per day for in-home prevention cases. I build out my prevention team to prevent kids coming into care. Prevention should be the goal, but it's not possible in all cases. We can't take the eye off the ball that there are some cases that will necessarily come into foster care, abuse cases, sexual abuse, physical abuse. When they come into foster care, their second budget driver is where you place them. Kinship care is generally your lowest cost often tied with non-relative care. In Idaho, I was paying $16 a day for each. If I did not have a home available for them and they had to come into congregate care, I was paying on an average $385 per day in congregate care. That's the average. There's a wide range. In some cases, we're paying $1,200 a day for out-of-state, complex care. Because it's a seller's market, that rate kept creeping up and as a state agency had, I had no choice but to say, "Where do I sign?" Your third budget driver is how long they're in care. If you can reunify them or if there's a time layer path to permanency, you have better outcomes with a permanent plan in lower cost because it reduced length of stay. Then we basically isolated three budget drivers, front door placement setting, length of stay, and then we talked about as a leadership team. If we were going to set one goal, what would that be? Because we had a lot of people coming to us and seriously saying you should focus on Kinship, you should focus on prevention, you should focus and on Budsmen, you should focus on all these things. The center of the square was always the best interest the child, but the outer wings were very divergent. So we as a leadership team side, you know what we wanna do is, we wanna increase our ratio of homes to children. And looking at it as a ratio, gave us the ability to make progress on both sides of that equation. You can get the ratio up by focusing on your numerator, your numerators, your number of homes. So you can get your homes up through retention through faith-based partnerships, through recruitment campaigns, streamline KIN licensure, making it as easy as possible to get KIN through the door. More importantly, you can get your denominator down by preventing kids coming in, having incredible alternatives that preserve families, keep them together, provide services for the root causes of kids coming into care. You can get your denominator down through legal advocacy for children, you can get your denominator down through how you deploy predictive analytics and other things like that. So we measured our success in the state through our ratio of homes to children. - I've got some questions about that that we'll get to. - Yes sir. - Sorry to catch you off. I did just wanna ask though, you've written that you left that job in Idaho, a place you love for Washington after 16 months because you quote, "it'll call to this work." So what was that calling you heard to bring you to Washington? - Yeah, I mean, the decision directly to Idaho is a tough decision. I don't know how many of your listeners have been there, but it's the fastest growing state in the nation for reasoning, pristine alpine lakes, mountains, blue turf, potatoes, it's a good life there and it felt like I had ridden my back and a lot of gas in the tank to make a difference at that agency. So I did not know that the job I always wanted in Idaho would be the shortest job I held because I got this call. And you know, when you get a call like this, it's a range of emotions. Been here, pure honored. - This is from the president himself or? - I was called by the way, I was liaison's office. So you're honored to get that call. You're honored that somebody saw that you might be able to make a difference, but you have to compare that to the life that you have. And honestly, when I broached my wife about it, I thought it was gonna be a pretty quick no. My daughter just started first grade. This isn't the right time, but she was very supportive and said, "if this is what you wanna do, let's do it." And I felt like what we were doing in Idaho would be a very interesting model. That doesn't necessarily mean people have to replicate what we did, but going back to basics. Yes, prevention is a goal. Yes, we want to limit the number of kids coming into foster care. But when it is necessary, having a robust, safe, safety bag where there are loving homes for kids where we are reoriented to having a stable network of kin homes or non-relative homes, reduce the use of congregate care that we could produce better outcomes at lower cost. This is one of the few areas as a former budget director. Everyone is overselling you on the ROI. This is one of the few areas where the budget outcomes and the child welfare outcomes are aligned in holy matrimony. You get better outcomes in prevention at lower cost and bucket your day. Your second best outcomes when they do come into care are with kinship families at $16 a day. They reunify faster. They maintain cultural tradition. They are much likely to be in the same county. Your budget outcomes and your child welfare outcomes are perfectly aligned. What I saw as a state child welfare agency leader was too much divergence at the federal level trying to pull us into too many different directions. There's a mountain of paperwork. There's a mountain of busy work. The CFSR process and the APSR process and the whole alphabet soup of federal periodic episodic oversight of states has not worked yet. I thought, "Okay, to my background of cutting through red tape, centering on the best interest of children, cutting through the clutter." I felt like I was in a position to make a difference, and hopefully that's what I'm able to say is I make the long drive back to Idaho, home from Washington DC at the end of the administration. Hopefully you can fly, but now if you have inherited leadership of an agency that is significantly smaller than it was a year ago due to retirements and layoff spearheaded by department of government efficiency also known as DOGE and the Office of Management and Budget and the administration's water efforts to significantly shrink the federal government. Have you reviewed those decisions and do you feel your agency's current staffing is adequate to accomplish the goals that you're setting out? You know, I think the most important thing for any leaders to drive forward using the windshield and not look in the room for your mirror. I'm going to make a difference with a team that I have here and I'll say top to bottom. The thing that I heard unequivocally heading into this, I called through as many of my predecessors who would take my call. The thing that came up over and over again was how high caliber the ACF staff is. I can attest to that in my two months here. I have a top shelf to you. I have some of the best talent in the world in this building on the child welfare space. My job is to harness that talent and take the team that I have here and make results. ACF is completely different than running a state agency. When I ran the state child welfare agency, we licensed foster homes. We did the assessments. We ran central intake. We were the direct service provider. We were in the courtroom with these children. Here, our role is a little bit more arm's length. We are a financier. We are an overseer. We might be the minority shareholder, but we need accountability for the $12 billion investment that the federal government makes. And I think right sizing that role can help deliver better outcomes for states and for the children that they serve. And if you communicated anything to the staff that are here about what I imagine might have been kind of a nerve wracking year for some in terms of job security. And I got nominated. I mean, you think, how are you going to introduce yourself to a team? I mean, it's a very odd process, right? You have an acting who's running the ball down the field. And then several months later, you show up and say, well, they'll take the ball. It's probably not the way anyone would envision taking the reins of an agency. I was in wait for about seven months. So during that time, you spend quite a bit of time thinking through, how am I going to introduce myself to the team? What is the tone I'm going to set? Then as you said, I just won in in October. And in October, we were at a shutout. I had 48% by staff for a lot. So I tried to strike the right tone when I introduced myself to the team I set out by initial email and introduced myself. But basically said, hey, we're back at full strength. Let's get together. I did it all, staff made me wind out my priorities, told them why I'm focused on growing the number of foster homes relative to the number of kids. About that means it's not just a recruitment campaign, it's prevention league, all advocacy, et cetera. And then I've been using my time to go kind of team my team. I've met with Children's Bureau earlier this week just trying to get to know folks deeper into the organization and introduce myself, make sure they understand what I stand for, why I'm here, trying to get to know them and reverse. OK, and during your time as budget director in Idaho, you helped advance something known as zero-based regulation. And this work has been celebrated widely in conservative circles, Elon Musk even retweeted a chart showing how many pages of regulations you helped cut. In Idaho, he added a heart-eyes emoji. I guess because he loved it so much. So can you explain to our audience what zero-based regulation is and how it might be applied in child work? So zero-based regulation is the concept that regulations rise like rockets but fall like feathers. The zeal to add regulations and just pile them on top of each other is not met with the same zeal to take some of them off the box. So in Idaho, what we did is we constructed a system whereby, once every five years, we reviewed regulations and say, does this still make sense? Do we still need a regulation from December of 1968, spellin' out a dress code for the deputy state veterinarian? Do we still need regulations on the books for a lottery game show that never aired since 1983 and started to call the herd and shrink it to what actually still applies? When you shrink it to what still applies, you shine a brighter spotlight on what the true expectations are. I do think it is a philosophy that can be applied to ACF. And I do think it is my expectation that when I walk out at this office that I leave maybe a lighter print than I found when I started. So what we've been doing the last two months is a lot of benchmarking. Feel the gas, how many pages of subregulatory guidance ACF has this organization? What will your gas be? I did see your speech about this exact statistic a couple of days ago. So I know it's about 43,000. You've got to bury the lead there. But yeah, so it's 43,000 pages. And you know, you put yourself, certainly ACF is much broader than the children's feelings. It's where I'm putting my disproportionate energy, my disproportionate time. But ACF has had start. It has childcare, block grant, social services, block grant, TANF, all of those. All of those programs layer guidance on top of guidance. And if you put yourself in the shoes of a state agency director who's updating their SSBG plan or their TANF plan, states are often operating in a gray area. They know what the statute says they can do. In some cases, it says what they can't do. But there's a whole wide range of decisions that they have to make in the gray area. So oftentimes what happens is a state will say, you know, well, let's push the envelope a little bit on SSBG. Nothing of the statute of rank says it's prohibited. Nothing says it's permitted. So let's move forward. And then their lawyer will tell them, well, we'd go through the guidance documents. Then you pull up ACF's guidance document. You'll find literally 43,000 pages of guidance documents. Nobody has time for that. Nobody can credibly sort through that. And most importantly, everyone lives in fear of the state level that some bureaucrat and the limestone building in Washington, DC is going to nail you for saying, how did you miss the July of 1996 guidance document on this? It's right there on our website. So what happens is you get states being gun shy. And then when they're gun shy, then they flood our offices, asking clarification questions. Can I use the funds for this? Every clarification question then begins more guidance documents. Yes, you can use it for that. And then stakeholders, when they're unsure, they go to Congress and when you reauthorize 4B, you then add a bunch of clarifications. Yes, you can use it for this. Specificity breeds specificity. I would rather empower states. I would rather trust states. I don't look at states as damsels in distress. I want states to be able to make good reason decisions that are in the best interest of children and not worry about in August of '92, if there was a guidance document that has been scanned at a 15 degree angle that looks like an old type written page, I want them to take care of their kids. I don't want them to spend time thumbing through a mountain of paperwork. So you could rest assured that we're going to barbecue a lot of sacred cow. And we are going to get a lot of the sub-regulatory guidance documents off the books. And we're going to pair back the regulations. The one thing I would make crystal clear, though, is in so doing. Regulations are in the necessarily collaborative process. I'm not a slash and burn guy. I make right size and optimize government guy. I want to get these right. I would rather, instead of the 200 data points that are submitted to us today, that we barely do anything with in their two years out of date. By the time we get them, I would rather focus on the 20 right data points much more frequently. I'll give you guys a little bit of love here. I mean, we've talked about the ratio of homes to kids. And I know, I had 74 homes for every 100 kids coming in. When I ended, I had 104 homes to every 100 kids. How many homes to kids are there nationally? You don't know. We didn't think it was one of those important databases. That's why you guys have a website called Who Cares. You know, Who Cares? I care. I care how many homes there are. So if we use the data that's on your website, and divide it by the AFCAR's data, most proximate to it, two years and a rears, we estimate there's 57 homes for 100 kids. How has it changed our last two years? I don't know. I think you guys have some new data coming out that's self-reported and hopefully every state measured it the same way and had the same technical definition, but we don't know. I would rather sharpen our focus, focus on a couple big things, put my shoulder into that, turn that wheel, then just dabble in a bunch of guidance documents, clarifying things and providing more specificity and specificity over time. Thanks for the shout out to Who Cares. That's the data we have collected from every state at fostercarecapacity.com. And a question about that point you just made about the barbecue. Are there any examples, more specific examples of the administrative burdens as you put it, that are ready for this metaphorical barbecue? We could just go through our regulations. Title 45, subsection B, blah, blah, blah. You go through them and you'll find this whole mountain of things. Under CSBG, we have a whole rag around how you can submit those on PCDiscat. When's the last time you submitted anything on PCDiscat? I don't know if I ever have. That rag lists two names and if we could submit it to, I would be stunned if either of those two individuals has been employed by ACF in the last 10 years. We've got grant programs. They're on the books that haven't been funded since '98. We've got the TANF bonus awards still on the books. The last time a bonus award was paid out was 2005. You can debate the merits of getting that off the books, but as a type a child, you know, HHS state agency director who's going through these and trying to learn these programs and you summon your TANF team to your office and say, hey, are we getting those bonuses? How do we get those bonuses? And your team says, we have no idea what the hell those bonuses are. And like, what do you need? You don't know what they are. It's right there on the books. And then you have to study it and you find out, no, that hasn't been paid out for 20 years. You need to clean this up. We need to make it simpler. We need to make it easier. We need to barbecue this stuff so that people know what they are actually expected to do. And I think you're going to see a bottom fire next year and I would be stunned if anyone misses it because it's program instructions for yesteryear. It's grants that haven't been funded since I was in diapers. It's those types of things. Once you get that off the books, then you go through a code of polish and say, what are the policy reforms that are necessary? And you can believe that I've got a very keen interest in that next layer, but you can't get to the policy debate until you shrink your footprint until what is actually necessary. This episode is sponsored by Binti. Binti is a technology company modernizing child welfare whose work closely aligns with the priorities of the administration for children and families. Binti currently supports 550 agencies across 36 states, including 13 states statewide, serving 47% of children in care nationwide. Binti's licensing model increases the number of foster families licensed annually by 30%. Binti's family finding and service referral modules reduce children in care by finding more kin and driving prevention. Social workers using Binti see a 20 to 40% reduction in time spent on administrative work. Learn more at Binti.com. - Stepping back from those kind of nuts and bolts issues, how did you incorporate the perspective of people with lived experience in these systems in Idaho? And what is your plan to do so now on the federal level? - I know, it was a front and center thing. We had a standing policy at the state level. My door was open, any current or former foster parent, my door was open to any current or former foster youth, and people certainly took us up on that. I was in the state position for a pretty short period of time, but I had more than 10% of all foster families either come through my door or do a web ex or zoom with me to share their experiences. We learned a lot from current former youth, current and former foster parents, an occasional bio parent who had been impacted by the system. And tried to put the Venn diagram together of what their concerns were with my agency. And a lot of it just centered around communication, how they felt treated, how they felt engaged. And we were able to make a lot of policy decisions based on those things as simple as foster parents who felt like it was hard to reunify because they were very nervous about communicating with the bio parent. So we bought one of those apps where you can communicate without having to share each other's personal cell phone numbers. We heard from quite a few former foster parents who didn't get the level of service they needed. They didn't feel involved in the case plan. They didn't feel like they had a venue to redress grievances. So we used that to build a bill of rights for foster parents. We heard from a lot of current and former foster youth about challenges they had accessing services, yet it changed how we approached our work to youth. So it was something that was really important to me and certainly it's something that I bring with me to this role and will ensure that we have lived experience in the voice of current former foster parents as we make those decisions. I don't know how practical it is to have such a stand-in open door policy of the national level, especially since our role at the national level is oversight. It's financing and it's not direct provision of services. But we've talked to a number of groups whose forte is engaging lived experience and will be available in ourselves to those offers and assistance. - Okay, and there's some link breaking news I wanted to ask you about this was a press release that your agency sent out this morning announcing that the administration for children and families your agency today sent letters to 39 governors calling for immediate action to address state child welfare agencies diverting foster youths, earned social security survivor benefits. And just reading from the press release here, it said that state child welfare agencies often intercept federal benefits such as social security survivor benefits, earned through a deceased parent's lifetime contributions that are intended for a child in foster care. This has been an issue that's been widely reported on recent years including by our news outlet. Agencies then use these funds to reimburse their own costs. So the goal for your agency it sounds like is to ensure that these earned benefits are no longer taken from foster youth and are instead preserved to support them as they transition out of foster care. And the press release goes on to say you're planning to provide resources in addition to existing technical assistance to help those 39 states change their practice. Yet as this press release notes, only 11 states have taken action in recent years including eye to help. So both these other 39 states face consequences that they don't move fast enough or how do you kind of help them along? Since it seems to have been a slow process for many states. - Yeah, well a couple of things. I mean, there is a moral right at a moral wrong. And this is one of those issues where it is unequivocal what the moral right is. So if your parents die and you enter foster care, it is morally objectable for a state to take those assets from that youth and divert them to cover state costs, even if they are used for foster care maintenance payments. You know, when I discovered this was happening in Idaho, I pulled in the team that was filing his representative pays for these youth and asking them about the process and how the youth is engaged in that process. And the more I learned, the more objectionable I found it to be. So we ended the practice. I, you know, I don't know that I feel much pride in having ended the practice because I'm disappointed the practice existed writ large. Certainly can't go back and change the past, but I could change what happened moving forward and wanted to put a clear mark in the ground about what moral clarity there was around the issue and that we were not ever ever going to do that again in Idaho. You know, the issue's been around for a while, let's such as yours have highlighted the issue, why the issue exists, how it's wrong. But there's quite a bit of turnover at the state level. I don't know that every governor who state has this going on knows that it's going on. I don't know that every state legislature, or this is going on, knows that's going on. I can tell you that unequivocally because we were just at a meeting with a fair number of state legislators and when we would ask them if they knew about this issue, their blood pressure shot through the roof, similar to mine when I first learned about the issue. So, you know, I think we have a microphone, we have a pulpit and I think we can use that in a way that might highlight the issue in a manner that outlets such as yours have done, but hopefully carry a little bit of weight when we use that pulpit. You're starting to see action. We saw a state legislator from Pennsylvania recently just come out with legislation that he intends to bring this upcoming session. We know of several other states where legislation is likely. And I think what we wanted to do, at least initially, is put a flag in the ground, say this is wrong, we stand to work with them and provide resources. But, you know, certainly as a former state official, we received a 118 federal grants. You know, the strings that attach to those, you know, sometimes there's honey, sometimes there's vinegar. I think you're gonna see a start a little bit more on the honey side of the house, but maybe work up to the vinegar side of the house. But I think what I would say is I've been very emboldened by the conversations we've had at the state level. We've heard from various executive branches at the state level as well as various legislatures at the state level where I have a high degree of confidence that there's moral clarity seen around this issue. And that we might see quite a bit of action. This upcoming legislative session at the state level. - So let's talk about another big initiative that you mentioned earlier, and you announced a home for every child recently. There's a large banner with that phrase hanging on the side of the building we sit in now. And according to your announcement, the goal and as mentioned this earlier, is to achieve a one-to-one ratio of foster homes to foster children. Can you say a little bit more about how you were going to achieve this, particularly since states run their own child welfare system? - Yeah. I mean, it did on the crux of the issue. I mean, the federal government is the overseer and the financeer, the minority shareholder states are ultimately the final decision makers. I mean, some states have county administered systems, but I won't get into that level of the weeds. A lot of what we've been doing is just raising awareness of the measure of homes to children. And why we think that is something that's useful to look at. There's criticisms of the measure, I mean, some hearing on the surface, and think it's just a recruitment campaign. It is not, it could be. Nothing could be further than the truth. You could get lost in the weeds, why homes, why not beds, all of that. But what I saw in Idaho is having a simple measure that you look at regularly where you can make progress by focusing on a number of different tactics or strategies. It gives you a chance to engage in rapid cycle innovation. So we said, you can get your numerator up through how you define kin, how easily it is to get kin licensed and through your door, how you do recruitment campaigns, how well you retain your existing foster parents mean retention as a function of service delivery. There's a number of different things you can focus on to get your numerator up. You can also focus on ways to get your denominator down. Prevention, preventing kids from coming into foster care in the first place by having robust family-based supports robust theos, substance use disorder services, things like that. You can get your denominator down by hastening time to permanency, by reunifying faster, or by having more adoption homes and timelier permanency. You can get your denominator down by providing legal advocacy for foster youth or bio families. It gives states a whole different array of things to focus on. I don't purport to know what Kansas needs. I don't purport to know what main needs. They might need to focus more on their numerator than their denominator. I don't know their best position to make that decision. As I said, my general default is to trust states. I want to structure our oversight to allowing states to focus on that suite of services that makes the most sense to them. Why I like focusing on that measure is I could look at that weekly in Idaho and see if my efforts were working. If they're working, put the foot on the gas, press down even harder. If they're not working, that's fine. Let's change course. Let's try something different. Right now, a lot of our oversight is through the CFSR process. It's episodic. Not one state has ever passed the CFSR. Round one, all 50 states failed. Round two, all 50 states failed. Round three, all 50 states failed. Round four, every state that has taken it to date has failed. That I probably have bad news for the remaining 19 states who have not gone through it. I don't want to presuppose the outcome, but this is one where history has been rather clear than unforgiving. That means all 50 states have toiled under PIP's program improvement plans. Have the PIP's improved performance? Well, round one to round two, states did worse. Round two to round three, states did worse. Round three to round four to date, states did worse. We're gonna ask questions like, does it make sense to put the PIP on a PIP? And rather than have states chase 14 ghosts that haven't demonstrated any progress, what if we orient those around a home for every child and had a ratio where states reporting to that us more frequently, you can then use that measure to benchmark all 50 states, look cross jurisdictionally, look over time series and see if states are doing better, yet which states are doing the best. And then let's learn from those that are doing the best. The joke was in Idaho, if you wanted to motivate or legislator, nothing motivated them faster than Utah doing slightly better than us. And I do believe that there is a name and shame role that can be played from ACF. I think there is a competitive juices, a sport that can be played by having better data. The problem with our data to always like making data driven decisions, that's how you make better decisions is to have that informed and evidence based. AFCARS is great. Our new website that we put out is unequivocally in improvement over what we used to have. You can do subgroup analyses, you can compare states a little bit better. It's two years out of date. I don't make decisions based on data that's two years out of date. As a state child welfare leader, if your AFCARS data looks good, Terry or Rotator cuff patting yourself in the back saying, look how good I did. If it doesn't look good, you say it's two years out of date. My predecessor made those decisions. Here's everything I've done since then. There's a happy medium where we can get the right data reported more frequently for cross jurisdictional comparisons and time series comparisons rather than more data, two years out of date that nobody does anything with. I'll let your readers in on a dirty little secret as a child welfare leader. I never read my annual performance report. 97% of it has recycled content year over year over year. I don't have a lot of interest in check boxes and williputian rope dancing. I want to drive outcomes. I want better child welfare outcomes in the country. And we think centering the debate around ratio of homes to kids is a good starting point for there. You can obviously get your ratio of homes to kids up through good ways or bad ways. There's little merit in stuffing your numerator with homes that are just going to take inputs. There's little merit in reducing your denominator by saying that Bruce didn't look that bad. There's good ways to do this. There's bad ways to do it. So even though we're centering a lot of our focus on that ratio of homes to kids, if as we go in that direction, we look at how we change oversight. In smart size, the federal role, we would pair that with a lot of chaser measures that then make sure states are doing it the right way. What are maltreatment rates in the state? Repeat maltreatment rates. How timely is permanency? And some of those things that are currently part of statewide data indicators, but looking at those more frequently to make sure they're doing it the right way, not the wrong way. You mentioned earlier in your answer there that prevention was a part of a home voter child preventing driving down the number of kids removed from their homes. So regarding prevention of entries in the foster care, the Think Tank America First Policy Institute, which is closely connected to the president, issued a vision for reclaiming foster care last month. I called for dramatic reforms to expand your process for parents who are under investigation or accused of child maltreatment. I called for making federal child welfare funding into a block grant. And it also called for funding for non-governmental community led compacts to serve families without formal child welfare system involvement. What did you think of that paper? And how much of it aligns with what you intend to pursue policy-wise? Yeah, I can't purport that I've read that paper. What I've been focused on is what I told the Senate during my confirmation here in life, told HHS in my meetings with senior leadership here is I want to increase the ratio of homes to kids. I take a view that the federal role is oversight and finance here. State's role is to make those decisions on the front lines, how you license, how you define neglect, how you provide legal advocacy for children. Those are all fundamentally state decisions. And I start from the standpoint I trust states as we've talked. That said, we will be focused on data, more timely data, more usable data, cross-state comparisons. And as we isolate who's doing well and who's not doing well, I do think there's a role for us to provide technical assistance, share best practices, and do other things to help supplement states. But I want to be very cautious about viewing states as damsels and distress, but for the federal governments, savior complex can't run their own systems. In 2018, Donald Trump signed the Family First Prevention Services Act, keeping up on the theme of prevention of foster care. And that will form, allow new flexibility for states to pay for services that can, again, help prevent entries of children into foster care. But there is widespread frustration with how little states have spent on prevention through that act. It does not appear many families have received these services more than half a decade later. So what is your vision for addressing this? You know, at the state level, I was very prevention-focused. I always talked about flip the script. In Idaho, I 85% of my kids in placement in foster care or congregate care in 15% in prevention cases. I wanted to flip that script. I wanted to 85% in prevention and 15% in placement. I thought a lot of what we were handling is neglect could have been kept in the home safely with appropriate oversight, with brokerage or direct delivery of services, most commonly for substance use or mental health. And I thought if we build out our network, we could flip that script and keep kids safe in their homes at lower cost and better outcome for both the child as well as the family. We had a 4A plan that we build $0, too, because a lot of the strictures that are in it, there's a limited toolbox of things that are promising, supported, or well-supported. And it has to be the pair of last resort. And a lot of the things that are covered as meeting the evidentiary standards were already covered in our state Medicaid system because we knew they worked and that they were effective prevention. So what we did night out was we build out our staffing to demonstrate to the courts that we could keep more kids in the prevention cases. And we did so using state funds. That's how committed I was to it. I didn't want to wait on Washington. No one at night out sat me out wakes up in the morning and says, boy, I wonder what's happening in Washington, DC. We led because we knew it could make a difference. What I view here is-- and I've had ups and downs in how I've been thinking about this. But I'd like to build out our prevention in the clearing house as far and as wide as we can. So I've spent quite a bit of time with that team learning it. I yield a lot of fact, check these numbers. But I think the most recent number is 210 programs have been reviewed by the clearing house. But of those, if you look at how many states have 4A prevention plans and how many states have built at least a nickel to those plans, there's only 29 services that are in those plans that have been rated as promising, well-supported or supported. And if you look at those 29, it's mostly home visiting. That's great. Home visiting works. OPRA just published a study if delivered appropriately, the structured appropriately prevention is well-served with a robust portfolio of home visiting. - OPR being-- - OPR office performance research evaluation. - What about administration for children and families in house-- - Yeah, great team, great researchers. And home visiting works when delivered to the right audience, structured appropriately delivered with fidelity. So it's great that that is the tool mouth. But substance use disorders and metal health disorders are among the most common reasons for entry. I want to build out what I can. I want to push as hard as I can to supplement what states can build for those through 4A prevention. Yeah, we're having a lot of conversations. Have we tightened the belt around 4A prevention too tight as an agency relative to what the framers of family first intended? I agree wholeheartedly with the spirit of family first. I want to prevent what we can. I want as many tools in the tool belt that are evidence based as we can. I want every state to have a prevention plan and go deep on in home supports, prevention of metal health and substance use disorders. But, you know, the challenge is threefold. How you define candidate? The evidentiary standards and then the three categories that are enumerated in statute. I don't want us to have any red tape beyond the statute. And I want us to push as far as we can within the confines of the current statute. So that more states can have more robust prevention plans. That said, you know, as you said, it's a tiny fraction. I mean, it's under current. How much is being built for prevention is like 2% to 3% of the overall 4A bucket. And if you look at the CBO 10 year forecast, at its peak, they project it to be 5% of the overall bucket. So we might grow from 2% to 3% to 5% over time under the current trajectory. So that there's some realities about it. I believe in prevention, but you can't turn the wheel so far in that direction that you forget not every entry into foster care is preventable. There are some that will never be preventable. Sexual abuse, most likely, is going to need a placement. And prevention services is a goal, but it should not take our eye off the ball that there needs to be a robust safety net for children, where that is not possible. And when that is not possible, you want them in a kinship home or a family home. And you want congregate care to be the tool of last resort, not a tool of oh crap. We forgot to build out our network. Kids do not do well in congregate care. And what we saw in my state and too many others is when you take your eye off the ball and you have kids coming into care and you're bursting up the seams. You're putting them in air being these or putting them in hotels or having them sleep in government office buildings, or in a government office building. They're not nice. They're not places that are conducive to child-rearied and development and nurturing safe, loving environments. So a lot of my message, and that's why I like looking at the ratio where you can focus on both the numerator and the denominator, is I want to avoid the temptation of folks to pull the wheel in any direction too far, where you then have to over-correct on the other side. I very low to believe that there's a silver bullet that is going to solve child welfare. And I think we have to get out of that thinking, which is why I like measuring things as a ratio because it gives you something that you're centered on and gives you multiple different inputs where you can make a difference and you can make a difference in short order. As I said, we looked at that measure weekly in Idaho. And as the measure went up, it was kind of a dopamine-most for staff. And as you got that little dopamine-most, it then motivated you and our efforts can work. I think too much in child welfare, you're looking at leg indicators two years after the factor, you're looking at a CFSR, where you fail. And you feel like a failure. And then most of the media attention is negative. And I wanted to bring positivity, energy, and excitement to my team to motivate them because I needed them. I needed them to be the best case workers. They can be, I needed them to be the best social workers they can be. And when all they read was negativity, it's hard to be an effective social worker. So having a measure that is movable with effort. Yes, prevention works. Yes, legal advocacy works. Yes, timely piramidancy works. And being able to see the fruits of that labor, we posted scorecards at each of our offices. I had 40 offices across the state. You could walk into our buildings and see where we were that day. It was motivating to help us achieve higher results. Speaking of foster home capacity, the previous administration did implement a rule aimed at making it easier for states to approve kinship caregivers. These are relatives or family friends who take in a child while also putting them on equal footing with other foster parents in terms of financial support. And a lot of states, including Idaho, have been moving towards establishing those kin specific licensing. Do you expect that rule to survive the regulatory barbecue that you talked about earlier and that you have planned? Well, let me just be clear. On the regulatory barbecue at CL, PC, discount here, grant that hasn't been funded since the Clinton administration there. It's sharpening what we have back to what actually exists in practice today. I have very little interest in tearing down things that are working. And I've seen enough evidence that suggests kin placement works at the better outcomes for the kid, time layer permanency, maintains cultural traditions, religious traditions, all of that stuff. I became a big believer in the kin in Idaho where we tried to push the definition of kin a little bit further and we did streamline our licensure to make it as easy as possible to get kin in the system. We also in Idaho invested in technology to better identify kin so that you could identify the cousins and aunts and uncles because kids frankly do better with kin. You know, as we've discussed multiple times today, we're in a different role of ACF. We're finding it's here and overseer. We're in the direct service provider. So I will sing from the abins why I think kin licensure makes sense, but those are ultimately state decisions. I think as we measure the ratio of homes to kids, I frankly as a state that would be trying to get my ratio up, I would invest heavily in kin. If you're a football fan, kin is like man coverage versus zone defense, if you bring someone in and you have a kin that you quickly licensed, easy way to get to one-to-one pretty quick is through man coverage. But if you just think about it, it makes sense conceptually. If you're a non-relative who's talking about fostering, yes, you can have a long lead up of licensure. Yes, you can go through 30 hours of training. Yes, you can have an on-site home study and self-inspection and make sure that you've got the four-foot fence around your pond and that your rabbits are up to date when their vaccines kin is different. You get a knock in the middle of the night saying, hey, something happened with your brother, can you take the kids in? You don't have time to then go through those 30 hours of training while the kids are waiting for a placement. We do need to have separate licensing standards that said, you also have to ensure safety. So I mean, I think the model standards that I've seen out there strike that appropriate balance it requires criminal history. Back on checks and basic things that weed them out, it looks at abuse and neglect registries, but it doesn't measure the square footage or if there's bunk beds or individual beds. I think it strikes them more appropriate balance. I think why it's been perceived as a bipartisan thing going to kin licensure is a nice deregulatory effort, but it's one of those deregulatory efforts that truly leads to better outcomes for kids at lower cost. Hi, everyone, it's journalist Lisa Ling, and I'm sure you will agree that it is so important for there to be good trustworthy journalism on children and families, and nobody does that better than the imprint. I am such a devotee of the imprint, and I listen to the imprint weekly podcast because it is so comprehensive and so substantive, and it is by far the best news source for anyone interested in critical issues, like foster care, juvenile justice, youth homelessness, and so much more. During this holiday season of giving, I hope you'll consider donating to the imprint. If you do so between now and the end of the year, your donation will be doubled thanks to the National News Match campaign. To give it so easy, go to imprintnews.org/donate. That's imprintnews.org/donate. Thank you so, so much. - So, President, I recently signed an executive order on foster care, I was hoping you could discuss. You were in the room standing right next to him, we'll be signed this order with First Lady Melania Trump. There's three issues it addresses. One is that the executive order calls for a yearly report card on state performance and outcomes. When your administration see that as replacing the current report card-like system, which you mentioned earlier, the child and family services review, or in addition to that. - Well, first, let me just say, we are very, very excited about the executive order, and we're very excited about the leadership of President Trump and First Lady Melania Trump on this issue. Executive order fostering the future is going to be a game changer, an absolute game changer for child welfare, for a number of reasons. As you said, I'm very excited about the score card in particular because I do think healthy competition between the states. I always wanted to be the best. I always wanted to one-up Utah. I always wanted to go to the RGK meetings and walk around with a chip on my shoulder about how good we were doing on our efforts. Is that the Republican governors? - Yes, yes, certainly. I know it's a different position than a lot of other states, but we wanted to be the best. We wanted to be the state. People talked about, we wanted to be the state. People looked at with envy on some of these issues. I think healthy competition across states work, and I think the President and the First Lady acknowledged that by calling for a score card system, I think we can elevate what we're doing with that. I don't know that two years out of date, that it makes good decisions, driving forward, looking at only three or windshield. I don't want to look through the rear view mirror. I do care about what happened in the past, but I care more about what we can do moving forward. And I think a scoreboard in near real time with the 10 right measures is going to be much more meaningful than 200 data points two years out of date. What I like about the executive order and the President, the First Lady, struck the appropriate tone in this is they gave direction on what those measures could look like. They suggest things like repeat mail treatment, timeliness, dependency, and things like that. I think they've appropriately diagnosed the problem and they're looking at the right the solutions. We are looking at how you bring that forward. If you do bring that forward, we'd be a necessarily collaborative process. I mean, if we're going to go through the process of updating CFSR, APSR, or AFCARS, those are all in sconst and federal regulation. So you'd have to do a notice and comment period. Everybody would have an opportunity to provide input. But because I like data informed decisions, before we even get to that stage, I want to look at what authority do we have to pilot some of these things? Now there isn't strictly speaking waiver authority in florey. But because PIPs are negotiated between the state and federal government, could we use the PIP process to maybe see if we can get some of this data more timely or more frequent? And build a de facto scoreboard, see what works, proof of concept, and then use that as the basis to go in and clean up the regulations the right way. I've never been overly interested in trafficking and theoreticals. I do like that. I do like evidence. And you know, I'm looking at how could we do a pilot within our PIPs? Are there some states that would raise their hand? Are there some states that would have interest in that? It's unequivocal. The current PIP process is a complete not a waste of time. And I don't have a lot of interest in wasting time. I didn't drive here from Idaho to waste my time or to spin my wheels or to get a title. I drove here to make a difference. And I think there might be a world in which we can use the PIP process to pilot with some states improvements that could be the basis for future regulatory updates. But it'd be a collaborative process. Everyone would have a chance to be involved in those regulatory changes, including lived experience and hopefully get there. - Now, obviously one of the most serious, but also rare tragedies that child welfare systems must address are child maltreatment fatalities. How do you see maltreatment fatalities in the context of assessing the performance of child welfare systems? - Yeah, so I mean, you know, I talked earlier about not turning the wheel too far in either direction and being aware of silver bullets salesmen, you know, I believe in prevention, but there is also a reason why the child welfare system exists. And I don't want to take that eye off the ball and forget that foster care is necessary, unfortunately, for a subset of the population. So as I said, there's right ways to do prevention. There's wrong ways to do it. And one of my colleagues here has stated, he will celebrate the decline in the number of foster youth coming into the system. And we see a concomitant decrease in child fatalities. I do think we should have more transparency around child fatalities. I do think there should be more eyes on it. I do think we should talk more about how they can be prevented. I do think we should look at substance exposed newborns and some of those issues more. And as we supplement the measures that wrap around the ratio of homes to kids, you can rest assured that we will not take the eye off the ball of safety because that is fundamentally why child welfare systems exist. So another provision in the Trump's executive order really focuses on older youth and foster care, including those who might not have landed in a permanent home out of foster care, either being reunified with their families or adopted or placing guardianship with relatives. So the main federal support for this group it has a long name, but it's commonly just called the Chafee program. You oversaw as a leader of the agency in Idaho. So what's good bad or missing when it comes to federal support for older youth through Chafee? Yeah, so in Idaho, about 4% of our kids aged out each year. And that was my most disappointing part of the child welfare system. Every child deserves a permanent home. Every child deserves to have love and support. It is stable structure for them to turn to throughout their life, including their older years. So first of all, I would commend first lady Melania Trump in particular for focusing on older youth for using her voice to make a difference. And I think the executive order hit the nail on the head. Too much of Chafee funds are returned unused. So what the executive order calls for is an AI-backed resource, where if I'm a foster youth in Philadelphia, I can see what is available to me. Is there an FYI voucher available to me? Is there an ETV voucher available to me? I think it will help curate what is available so that fewer resources go returned unused. The other thing I really like about it is it sets a clear marker in cases where funds are returned unused. It's directing us to work with members of Congress and others to look how we can use those resources for good so that they can go to additional supports for older foster youth. So I think the executive order strikes the appropriate tone centers the conversation on how can we appropriately support these youth who need more support than most. The executive order also calls for promoting the involvement of faith-based organizations and people of faith in child welfare, including as foster parents. And that order gives you 180 days to take numerous action. But one of them is to address state and local policies and practices that inappropriately prohibit participation in child welfare programs by individuals or organizations based upon their sincerely held religious beliefs or moral conviction. So what is your understanding of what that means? And what is a policy that inappropriately prohibits participation? Yeah, well, at ACF I'm focused on a home for every child. I'm focused on getting the ratio of foster homes up relative to the number of foster kids coming in to the system, understanding both sides of that equation or dynamic. And there's studies to show that families of faith are more likely to raise their hand and volunteer. So we have to be very careful about the message that we send and not break the chain at the first link. Too many folks conflate licensing with placement. Licensing is the gateway. Licensing is when a family raises their hand. Submits an application, goes through a home study, answers all of the questions and says, we are willing to take a child in my home. Placement occurs when a child enters foster care, and the individual's child's needs are matched with the foster family's capabilities. It is a collaborative process. It is overseen by the courts that you've have Casas regarding ad items advocating for their best interest in elevating their voice. And I think too many people have been conflating a licensure with placement. Licensure should be fast. Licensing should be easy. You should roll out the red carpet and be as welcoming and inclusive of everybody. Everybody ad placement should be the customized match of the child's needs with the demonstrable capabilities of the foster family. And when states break that chain at that first link, you will never get the match right. And that's why you have too many kids sleeping in offices, too many kids in congregate care facilities where you get your worst outcomes at the highest cost. And I think the executive order strikes the appropriate balance, striking the difference between the licensure and placement. He had reminding us that we need to roll out the red carpet to all families because I've been in one of the benefits being a state child welfare director. You get to meet most of your sister state peers. I've been in, in the most literal sense, dozens of conversations with most other state child welfare directors. Not once have I ever heard someone say, you know, my biggest problem is I have too many foster families. It's the opposite. Let's not conflate licensing with placement. Let's make licensing easy. Let's roll out the welcome mat. Let's get our ratios up. So you can customize the match, which is placement. And related to that, we reported in October the USENT letters to New York, Vermont, Illinois, California, and Washington asking them to review and where necessary amend policies requiring foster parents to affirm the gender identity of youth and their care. I assume things like proper pronouns and providing clothing a choice to youth who might identify as transgender. So you suggested such rules were unconstitutional violations of the First Amendment. Have you received any response from those states? And what is likely to be your next steps in this inquiry? Yeah, I think we've received three responses today. So we're reviewing those and we're evaluating options. As we focus on getting the ratio of homes to kids up, as I just said, our goal is, I don't want kids waiting on homes, I want homes waiting on kids. We had policies that inappropriately suppress the numerator or conflate licensing with placement. I think it's proper for us to ask questions. My default is I trust states. My default is I think states make good decisions. But when we see states making bad decisions like stealing survivors benefits from foster youth, I do think there is an appropriate role for us to play using our poll, but using our microphone and course correcting where those bad decisions may be. And are you considering withholding federal trial welfare funding from those states that they do not satisfy the demands of those letters about gender identity? Executive order asked us to explore appropriate actions. We will explore appropriate actions. Several states also have laws that protect faith-based child welfare providers from losing their contracts because they will not work with certain people based on religious ideology. Is the administration considering making this a national policy through rules and regulations or is it your view that Congress will need to pass a law to shield all faith-based child welfare providers? - You know, we haven't had to make conversations about that yet in my two months. My general default is I want licensing to be as broad as possible. I don't know of any state that uses a sole source for recruitment. So I think we should be looking at engaging as many different organizations or nonprofits as possible because, again, I've never heard any states say, my biggest challenge is I have too many foster families. I want to roll out the red carpet for all, including our faith-based families. As I said, there's evidence to suggest faith-based families are much more likely to raise their hand and volunteer run towards the system, be part of the solution. Yet I want to be very careful about the message we send to them. I do want them to apply. I do want them to be part of the solution. I do want them to open their heart and their home to these children. And I think the message is that this administration will send as we are open for business. And we will respect the sincerely held religious beliefs and moral convictions of these individuals that they can open their heart and their home to children. - Now, apart from licensing or placement with foster homes, do you think it's important for states to take any proactive steps for LGBTQ youth in foster care to make sure that they end up in homes where they do feel safe and supported in terms of their sexual orientation or gender identity? - I think care should be individualized to the needs of the child. But the first link in the chain is having a robust licensure network. If you artificially smother licensure, you will never have placement customization and you will never match the best interest of the child. Placement stability is something that we will probably look at as one of the chase or measures as we already talked about. Placement stability is a function of getting the match right. One of the things I like to do in the executive order is it talked about the use of AI or predictive analytics. I think there's a pretty interesting use case about how you might be able to use that to guide the match, the match between the child's individual needs at placement with the demonstrable capabilities of the foster family that you have appropriately licensed. But if you don't have a robust network of licensed foster families, nothing else in that chain works as intended. OK, so on indigenous child welfare issues in July, your agency, the administration for children, the families, sought comment from the public on how it could support states in better implementing the Indian child welfare act, popularly known as Iqua. And that request for comments said that ACF believes that states and tribes working together to ensure that the protections of Iqua are afforded to Indian children is paramount. So can you share any insights that your agency has gained from those public comments? And what are your ideas in general for helping states live up to the letter and spirit of Iqua? I think the statement matches my personal belief. I was a state with five sovereign tribes. And in my multiple capacities in the state as budget director, as well as health care director, I worked very closely with the tribes. I was blessed to have many of their support as I navigated this process. I think three of my tribes were letters of support for me to Congress as I navigated by nomination, working with tribes, treating them as sovereign entities, respecting their trust and treaty rights is something that's gonna be really important to me. And I look forward to engagement. This is an area where Secretary Kennedy has demonstrated incredible leadership in nearly every meeting I've been in with him. He's elevated the voice of tribes and asked us as operating heads to do the same. And the one issue we have heard about front tribes is the kind of unique challenges they have in terms of accessing Title 4E and Title 4B funding. These are two major federal child oaths. They're funding streams. And is this an issue for them too? - Well, they're not alone. That strings associated with 4B would certainly be described as a regulatory figure. I wanna break those barriers down, not just for tribes, but for states, you know, we had one tribe in Idaho that had a 4E plan that got into place. And they're building to it was some, you know, some optimal relative of what they expected because of the significant regulatory hurdles. I wanna clarify that for tribes as well as states because, you know, I think this is an area that's become unnecessarily alerted up. - One issue we've been looking into recently is how states are struggling with teens entering foster care, not because of abusive room-of-life role parents, but because their families can't get them to health care, mental health care that they need and can't keep them safe at home without some kind of resources. So on the flip side, child welfare agencies and the states often say they're not a quit to give these kids the level of care they need either. Is this an issue that you encountered in Idaho and are you looking at any strategies to address this particular issue? - Yeah, and I know, I think my stat was about 18% of the kids coming into foster care were because the child had a behavioral health issue or the child themselves had a substance use disorder issue just like you said. That number, we didn't have a good time series comparison but my longstanding case workers say that's double or triple what it would have been 15 years ago. So we had more kids coming into the system for that reason, as opposed to parental issues. If you look at why our costs were going up, acuity was going up and then we were over using congregate care. Some congregate care usage was out of necessity. We didn't have enough family homes, but some congregate care usage was because of the complexity of the children that are coming in. A lot of what we spent time on our mantra was right kid, right place, right time and optimizing the fit for the kid based on what they need is critical. We in Idaho tried to build out to through Medicaid, a broader behavioral health system to prevent these problems and even up at the doorstep of child welfare system that was under prepared to deal with it and building out more community based options for support for these kids was something that was really important to me. - And some states, including I think Idaho, if I'm wrong on that, have created a no fault pathway for parents to put kids in the foster care system to get services, whereas typically they might have been deemed abandoned or neglected. Do you have a stance on that issue? - Well, we did have it in Idaho and I would say it's an important process to have, but it is heartbreaking that any parent is ever in that position that they have to access care through that manner. We need to look further upstream and prevent putting parents in that horrific decision-making point in the first place. And I think how you build out community support, how you build out your Medicaid how you build out behavioral health systems and linkages to care really matters so that you can prevent putting parents in that situation in the first place. - We also published earlier this year an investigative series about the failure of some states to properly oversee psychotropic drug prescriptions for foster youth, including antipsychotics that can have powerful side effects and limited evidence of effectiveness in children. Dozens of experts that I consulted all agree that states have made progress on this issue over the past 15 years, but many still have a long way to go. Given your pharmacy background and that you have spent years working with that field, have you put any thought into this issue in child welfare and do you have any plans to act on it? - I think you can safely assume that this is going to be a priority focus of ours. This aligns with the make America healthy again agenda, the report that was issued by the secretary earlier this year. And I was in my state agency capacity for a much shorter period of time that I anticipated. I get a call I was not expecting, but we had started looking into our Medicaid data. If a child is in foster care, they're categorically eligible for Medicaid. So we started looking at psychotropic use in foster youth versus non foster youth. And as many other studies and you guys probably unequivocally found in your analyses, is that foster youth use psychotropic drugs at a much higher rate than matched equivalent non foster youth is that appropriate use probably not in many cases. So we've had conversations. I think one of the great things about this administration is they've brought in a lot of state leadership or we've talked to our friends over at CMS where they brought in folks who served in similar capacities what I did where they oversaw Medicaid at the state level but also child welfare systems. And I think there's a broad recognition that this is an issue that needs more thought leadership around. You can believe we're having a lot of conversations around this and what we can do better for the betterment of these youth. - On July 4th, President Trump signed a tax and spending plan. That placed new restrictions on public benefits like food stamps or staff that former foster youth and relative caregivers in particular lie heavily on. This is supplemental nutrition assistance program for example. And I have talked to child welfare agency readers in both red and blue states who are concerned that whatever the necessity and broader merits of the cuts in the one big beautiful bill act, they could also be uniquely devastating for families who have child welfare system involvement or at risk of that. Maybe even drive up the foster care numbers. Do you share that concern at all that it could overwhelm the prevention efforts that states are taking? - That's not how I viewed it. I mean that bill passed kind of still running the Idaho agency and frankly we liked a lot of what we saw in the bill and thought it had a lot of important reforms. I've read the pieces from former foster youth who have aged out who have expressed concerns about how many older foster youth end up homeless and raising the expectation of helping them get on a pathway to self-sufficiency might not be a bad thing. So I think it's much more nuanced than just looking at the bill and projecting humor gloom. We saw some positive attributes to it, Idaho and on the whole sod as a positive bill. - Now at the end of your time here, this is the last question, but at the end of your time with ACF, what are you hoping your legacy is going to look for? - Yeah, well, yeah, I've alluded to I drove here and I had to at the end of this three years and a couple of weeks at this point, I'll be driving back to the great state of Idaho and look in the rear view mirror. As I said, I like looking forward and driving forward. I think that's your best bet. But it's all like in the rear view mirror. I think the thing I would like to leave behind isn't just less paperwork and less administrative clutter. I want states to have more homes per kids. I want every state's ratio of homes to kids to increase. We believe the who cares database and think that 57 homes per 100 kids is the current baseline. I want to see how hard we can push that number and how high we can push that number through effective prevention, effective legal advocacy, kin-based licensure, streamlined licensing, better retention efforts and the whole laundry list of tactics and strategies and things that can be done to move the need on those sides of the equation. - Alex Adams, thank you for joining us. - Thank you. - Thanks to Alex Adams, assistant secretary for family support at the administration for children and families for joining us today. And thank you to I Foster and Binti for sponsoring this episode of the Imprint Weekly Podcast. The Imprint Weekly Podcast is a production of the Safe Camp Audio Network, which is a division of fostering media connections. Please visit safecampaudio.org on the web or at Safe Camp Audio on all major social media. This podcast is produced and mixed by Christine Anjoco with music by Luke Taro and Cyrus Alia. If you enjoyed this episode, we would love it. 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