One goal of Kentucky’s three-branch initiative was to reduce the number of child fatalities related to substance abuse within the child welfare system through a series of high-impact strategies, including improved court engagement with biological parents and other caregivers with SUDs, the incorporation of two-generation approaches in human services provision and the review of child protective services initiation timeframes. The initiative was led by the Kentucky Department for Community Based Services (DCBS). The core team included staff from DCBS; a member of the Kentucky Interim House Joint Committee on Health and Welfare and Family Services; the chair of the Kentucky Senate Committee on Health & Welfare, who was also the co-chair of the Child Welfare Oversight and Advisory Committee; and the Kentucky Administrative Office of the Courts (AOC).

Kentucky Case Study


Measurable Goal High-Impact Strategies Actions to Implement Strategies

Reduce the number of child fatalities related to parental substance abuse.

Improve court engagement with biological parents and other caregivers of origin with SUDs.

  • Participate in judicial training (Kentucky Cabinet for Health and Family Services [CHFS]/DCBS).
  • Explore national family-drug court models, and promote them to the extent possible (AOC).
  • Coordinate CHFS’ Child and Family Services Plan and the Program Review and Investigations Committee’s foster care and adoption recommendations with court improvements (AOC, CHFS/DCBS).

Improve court engagement with biological parents and other caregivers of origin with SUDs.

  • Support legislation and related efforts to address disproportionality in child welfare, juvenile justice, behavioral health and education (whole team).
  • Learn from best practices in other states (e.g., Tennessee) (CHFS/DCBS).
  • Consider search and application for grant and technical assistance opportunities (CHFS/DCBS).
  • Review DCBS practices and operations to incorporate approach to extent possible (DCBS).

Foster a higher profile for state review panels and improved dissemination and action planning regarding the panels’ recommendations.

  • Establish a cross-agency committee to identify common priorities, monitor implementation of strategies and recommendations, and develop a communication plan to disseminate information to stakeholders. (Kentucky Justice & Public Safety Cabinet [JPSC], CHFS/DCBS/ Kentucky Department for Public Health [DPH]).
  • Request technical assistance from national partners to assist the Child Fatality and Near Fatality External Review Panel with strategic planning and guidance in the areas of determining risks and formulating recommendations (JPSC).

Conduct an inventory, map regional and local programs and document promising practices related to working with families struggling with substance abuse and addiction.

  • Refer the matter to the State Interagency Council Service Array Subcommittee (CHFS/Kentucky CHFS Department for Behavioral Health, Developmental and Intellectual Disabilities [DBHDID]), and incorporate updates as they become available from the subcommittee (CHFS/DBHDID).
  • Develop a formalized continuum and related policy needs for DCBS in-home service provision (DCBS).

Review the DCBS initiation time frames for Kentucky Child Protective Services.

  • Study other states’ initiation time frames (DCBS).
  • Draft the proposal (DCBS).
  • Outline recommendations from the proposal if they differ from present-day initiation time frames through regulatory amendment, practice changes and supporting information technology infrastructure (DCBS).

Using the Three-Branch Approach

The core team was convened and staffed on a day-to-day basis by personnel at the Kentucky DCBS. The core team met on an approximately monthly basis to discuss project updates and ensure that the project stayed on schedule. The team included the state senator who chaired the Kentucky Senate Committee on Health & Welfare, the commissioner of the Kentucky DCBS, the state’s child welfare agency and the AOC.

The implementation team, which included representatives from multiple public and private agencies, met once as a large group, with ongoing contact through small-group meetings and by email. Members of the core and implementation teams struggled with constraints on time and their ability to carry out their ambitious agenda, but the meetings they held were worthwhile to the key state partners who attended them in terms of building support, planning and disseminating best practices across the state.


Kentucky’s three-branch approach created a lasting culture of collaboration and engagement among the three branches. The greatest success that the team lead identified was the positive momentum, commitment and strong partnerships forged among public partners of all branches of government and private partners. The strong partnership between the core team and the implementation team helped increase the capacity of the three-branch approach team in carrying out its overall vision. The initiative created peer learning opportunities where attendees heard about innovative approaches and best practices. The key advocates, program administrators and political leaders who participated committed to maximizing their resources to effect positive change for Kentucky’s families and children.

The three-branch approach affected policy and practice in each branch of state government. Judges can access training on parental substance abuse and substance-exposed newborns at a variety of judicial conferences to ensure that they are fully prepared to work with families dealing with SUD that appear before them in court. The AOC and DCBS worked with Jefferson County to establish a family drug court with the help of a private philanthropic group. The Legislature used its new knowledge of kinship care to pass legislation that would recognize fictive kin as a placement for a child and maintain current Kentucky practices in compliance with the Child Abuse Prevention and Treatment Act. The initiative informed the state child welfare agency’s legislative proposal and budget request for the 2018 session, including House Bill 1, an omnibus child welfare bill that was a priority of the 2018 Kentucky General Assembly. Finally, agency leadership amended administrative regulations governing child protective services initiation time frames, which were also subject to legislative oversight. The time frame change adopted in December 2017 was informed and supported through technical assistance received through the three-branch project.


A goal of Maryland’s three-branch initiative was to improve early identification of populations at high risk for SUD during pregnancy and provide appropriate services to decrease the impact of substance exposure on newborns. The initiative was led by the Maryland Department of Human Services (DHS); the core team included two staff members from Maryland DHS, two judges and two legislators.

Maryland Case Study

Using the Three-Branch Approach

The core team met weekly to discuss project updates and troubleshoot challenges to implementing the strategic plan. The larger implementation team met monthly and included:

  • Representatives from Maryland Department of Health.
  • Additional legislators from the Maryland House of Delegates and Senate.
  • A representative of county government. A representative from the Maryland Chapter, American Academy of Pediatrics (MDAAP).
  • A data analyst from the university system.
  • A representative from the home visiting program.
  • A representative from the law school legal clinic.
  • A representative from a major nonprofit child welfare provider.

Maryland often invited outside experts to present at core and implementation team meetings on issues relevant to their teams’ goals. In this way, core and implementation team members had the opportunity to learn together, building a shared sense of both the issue and the best strategies for moving forward. Team leads noted that legislators and judges remained involved in the core team but frequently attended and actively participated in implementation team meetings.

In developing its strategic plan, the teams identified several activities designed to improve early identification of high-risk populations and provide appropriate services to decrease the impact of substance exposure on newborns.

Activity Branch Lead

Reduce the number of child fatalities related to parental substance abuse.

  • Frequency.
  • Number reported to child welfare.
  • Jurisdiction.
  • Current services provided to determine needs at each point on the child welfare continuum.

Executive: Maryland Department of Health; University of Maryland, Baltimore (UMB); Maryland DHS; Maryland Children’s Health Program

Determine service array, capacity and funding sources of existing
substance use services.


Expand the availability of evidence-based early intervention services that can be provided to pregnant women during the pre- and postnatal period.

Executive: Maryland Department of Health, Maryland DHS, Maryland State Department of Education

Review current policies on substance use, revise them as needed and explore requiring new or revised standards of practice in local Departments of Social Services (DSSs).

Executive: Maryland Department of Health, Maryland DHS

Compare current legislative requirements to those set forth by amendments made through the Comprehensive Addiction and Recovery Act (CARA) to the Child Abuse Prevention and Treatment Act (CAPTA) regarding the development of plans of safe care and notification of child welfare agencies.


Examine current judicial practice related to mandating referrals to child welfare for infants born affected by substances.


Investigate current practice for weighing different drug addictions in family court proceedings.



Maryland’s three-branch initiative created a lasting culture of collaboration and engagement among the three branches. In addition, the peer learning opportunities provided at the core and implementation team meetings helped members of each branch develop a more comprehensive understanding of best practices for serving substanceexposed newborns and their families. Representatives of each branch worked to advance and implement policy and practice changes to create better outcomes for children and families in the state of Maryland.

Executive branch outcomes included the following:

  • Expanded the service array of evidence-based practices to help children and parents when substance misuse was detected
  •  Launched a training program to help child welfare workers better understand SUD and how it intersects with child welfare while also implementing evidence-based practices to serve parents with SUD.
  • Agency-wide changes provided training for child welfare, home visiting, and infant and toddler program frontline staff to better serve substance-exposed newborns and families affected by SUD in an interdisciplinary way


Legislative branch outcomes included the following:

  • Enacted 2018 House Bill 1744, Chapter 410, to bring the state into compliance with the CARA requirements for child welfare notification of a substance-exposed newborn.


Judicial branch outcomes included the following:

  • Creation of judicial training opportunities for judges on parental substance abuse and substance-exposed newborns at annual conference and at other educational convenings.
  • Developed a plan for consistently applying CARA requirements to the creation and monitoring of plans of safe care throughout the state.


The Virginia Department of Social Services (DSS) led several successful three-branch approaches. This case study provides an overview of Virginia’s participation in the 2016-17 Three-Branch Institute focused on promoting child safety and reducing child fatalities. The initiative was led by the Virginia DSS and the core team consisted of two representatives from Virginia DSS; a representative of the Virginia Department of Medical Assistance Services (DMAS); the chair of the House committee on Health, Welfare and Institutions; a member of the Senate Committee on Rehabilitation and Social Services; a leader from the Court Improvement Program (CIP); and a Juvenile and Domestic Relations Court judge.

Virginia Case Study

Using the Three-Branch Approach

Virginia DSS created a project manager position to staff its initiative by reassigning duties from an existing position within Virginia DSS. This project manager was responsible for managing day-to-day operations of the three-branch initiative, including developing meeting agendas, managing communications between branches and following through on action items.

The state formed work groups based on the four strategic goals:

  • Increase understanding of risk and protective factors that are predictive of or associated with child maltreatment and child fatalities
  • Assess the effectiveness of existing screening, safety and risk tools, and explore the development of new or expanded policies, practices and protocols
  • Strengthen existing efforts to enhance child safety through primary prevention and family engagement strategies across systems.
  • Enhance child welfare recruitment and retention efforts to create and sustain a culture of safety in the workforce.

Those work groups included members of the core and implementation teams, who met frequently to discuss project updates related to their individual work group goal. At core and implementation team meetings, representatives from the different work groups would provide status updates from their work groups to the larger team. The team would use these meetings to share lessons learned from work groups and to address challenges to accomplishing their goals.


Strategy High-Impact Strategy Actions to Implement Strategies Lead

Strategy 1: Provide education and public awareness focused on the family

Conduct judicial outreach to at least 50% of the Juvenile Domestic Relations District Court judges on the Virginia Children’s Services Practice Model, implementation of child welfare practice profiles and trauma-informed practice.

Prepare and present information at two judicial conferences.

Judicial: CIP Executive: Virginia DSS

Convene a joint briefing for members of the Virginia General Assembly on adverse childhood experiences, trauma, child safety and family well-being.

Consider the joint briefing to the Virginia General Assembly on adverse childhood experiences, trauma, child safety and family well-being.

Executive: Virginia DSS Legislative

Strategy 2: Evaluate opportunities to apply Medicaid and other financial resources to support primary prevention strategies.

Explore opportunities to expand home visiting programs through Medicaid and enhance collaboration with managed care organizations (MCOs).

Obtain outcome data on home visiting programs funded by Medicaid and MCOs.

Virginia DMAS

Obtain quarterly reports from the Pay for Success Council regarding the status of home visiting programs throughout the state.

Public sector: Prevent Child Abuse Virginia

Plan data briefings for the Virginia General Assembly on the progress of home visiting programs.

Executive: Virginia DSS

Propose budget amendment to implement the Nurse-Family Partnership model as a Medicaid service.


Explore initiating a safe sleep campaign to educate communities and reduce the risks of unsafe sleep-related fatalities

Research existing safe sleep campaigns, with a focus on programs that provide sleeping spaces (Baby Boxes, Pack n’ Plays, cribs, etc.).

Executive: Virginia DSS

Convene a work group of three-branch initiative members and community stakeholders to develop implementation and evaluation proposal for a safe sleep campaign and pilot program

Executive: Virginia DSS

Present and finalize a safe sleep campaign and pilot program proposal to the expanded implementation team.

Executive: Virginia DSS

Analyze data from the pilot program to identify trends and recommend further research, expansion and possible legislative and budget recommendations

Executive: Virginia DSS