TITLE IV-E CHILD WELFARE WAIVER DEMONSTRATION PROJECT …centerforchildwelfare.fmhi.usf.edu/kb/GenIVE/IV-E... · INITIAL DESIGN AND IMPLEMENTATION REPORT As required in Section 2.3

1 Revised 10/2015

TITLE IV-E CHILD WELFARE WAIVER DEMONSTRATION PROJECT FOR THE STATE OF FLORIDA

INITIAL DESIGN AND IMPLEMENTATION REPORT

As required in Section 2.3 of the Terms and Conditions, the Department of Children and Families (DCF) hereby submits the Initial Design and Implementation Report for the five year extension period. I. Overview

The overall goals of the state’s waiver demonstration are to:

Improve child and family outcomes through the flexible use of title IV-E funds;

Provide a broader array of community-based services, and increase the number of children eligible for services; and

Reduce administrative costs associated with the provision of child welfare services by removing current restrictions on title IV-E eligibility and on the types of services that may be paid for using title IV-E funds.

Florida’s waiver demonstration project was designed to determine whether increased flexibility of Title IV-E funding would support changes in the state’s service delivery model, maintain cost neutrality to the federal government, maintain safety, and improve permanency and well-being outcomes.

1. Over the life of the demonstration project, fewer children will need to enter out-of-home care.

2. Over the life of the demonstration project, there will be improvements in child outcomes, including child permanency, safety and well-being.

3. Waiver implementation will lead to changes in or expansion of the existing child welfare service array for many, if not all, of the lead agencies. Consistent with the CBC model, the flexibility of funds will be used differently by each lead agency, based on the unique needs of the communities they serve.

4. Expenditures associated with prevention and in-home services will increase, although no new federal dollars will be spent as a result of waiver implementation.

Theory of Change

The theory of change is based on federal and state expectations of the intended outcomes of the waiver demonstration, and the hypotheses about practice changes developed from knowledge of the unique child welfare service arrangements throughout the state. The expectation is that the waiver renewal will build on the lessons learned and progress made in Florida’s child welfare system of care during the initial waiver period. The goals of the waiver demonstration are to:

Improve child and family outcomes through the flexible use of Title IV-E funds;

Provide a broader array of community-based services, and increase the number of children eligible for services;

Reduce administrative costs by removing current restrictions on Title IV-E eligibility and on the types of services that may be paid for using Title IV-E funds.

2 Revised 10/2015

Over the life of the waiver demonstration, it is expected that fewer children will need to enter out-of-home care and stays in out-of-home care will be shorter, resulting in fewer total days in out-of-home care. Costs associated with out-of-home care are expected to decrease following waiver implementation, while costs associated with in-home services and prevention will increase, although no new dollars will be spent as a result of waiver demonstration implementation. A major initiative that Florida’s waiver demonstration renewal supports is the recent implementation of the new (Safety Methodology) Practice Model which provides a set of core constructs for determining when children are unsafe, the risk of subsequent harm to the child and strategies to engage caregivers in achieving change. These core constructs are shared by child protective investigators, child welfare case managers, and community-based providers of substance abuse, mental health, and domestic violence services. Other key contextual factors include the role of Community-Based Care lead agencies as key partners with shared local accountability in the delivery of child welfare services as well as the broader system partners including the judicial system. The assumption is that implementation of the new Practice Model will enhance the skills of child protective investigators, child welfare case managers, and their supervisors in assessing safety, risk of subsequent harm, and strategies to engage caregivers in enhancing their protective capacities including the appropriate selection and implementation of community-based services. Waiver implementation will continue to result in increased flexibility of IV-E funds. The flexibility will allow these funds to be allocated toward services to prevent or shorten the length of child placements into out-of-home care or prevent abuse and re-abuse. The Department has developed a typology of Florida’s service array that categorizes services into four domains: family support services, safety management services, treatment services, and child well-being services. The typology provides definitions and objectives for the four domains as well as guidance regarding the conditions when services are voluntary vs. when services are mandated and non-negotiable. The waiver funding flexibility will lead to changes in or expansion of the existing child welfare service array for many, if not all, of the lead agencies. Consistent with the CBC model, the flexibility will be used differently by each lead agency, based on the unique needs of the communities they serve. The Department is conducting an assessment of the availability of the service array in partnership with the CBCs and the case management organizations. The survey also asks about the level of evidence based/evidence informed effectiveness of the current service array. The results of the survey will inform the CBCs’ decisions regarding the local expansion of services that is made possible by the waiver’s funding flexibility. The consistent focus on family centered practice through the Practice Model as well as the enhanced service array made possible by the waiver’s funding flexibility, are expected to positively affect child outcomes including permanency, safety and child well-being.

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The evaluation of Florida’s Title IV-E Waiver Demonstration will include a focus on Treatment

Services and Family Support Services, although a broader array of child and family services fall

within the scope of the demonstration. Florida’s practice model represents a statewide change

in child welfare practice that is an important contextual factor for the waiver demonstration, but

that falls beyond the scope of the demonstration itself. Additionally, the population of children

the State of Florida is most interested in learning about are “safe” children in high/very high-risk

households1 that are receiving Family Support Services. Participation in Family Support

Services is voluntary for this population and their families. The services that this population and

their families receive should be documented in FSFN (Florida’s SACWIS).

Under the Practice Model, all families assessed as high or very-high risk for future maltreatment

are offered Family Support Services that target the building of family protective factors to

improve the long-term safety of children in the home. Families with a child who is assessed as

unsafe, are provided treatment services. Treatment services are specific, usually formal,

services utilized to achieve fundamental change in functioning and behavior associated with the

reason that the child is unsafe, ultimately mitigating the need for a safety plan. One expectation

of the Waiver Demonstration during the extension period is that these services will include a

broader array of service options to address family needs than the voluntary services available

prior to the extension. It is also expected that through the implementation of the Practice Model,

improved efforts to effectively engage families in these voluntary services will result in greater

service engagement and adherence, and ultimately better outcomes for these families.

1 This category includes children who are not at imminent risk of maltreatment or removal from the home, but whose home and environmental circumstances contribute to a greater likelihood of maltreatment or removal in the future.

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As the evaluation focuses on Treatment Services and Family Support Services, the following two outcome chains will inform the evaluation design: Treatment Services

After a thorough assessment of the family we implement treatment services (substance abuse, mental health, domestic violence) for families with unsafe children

AND Those families are actively engaged in treatment

AND Communication and coordination between case managers and service providers occurs

SO THAT Caregivers’ protective capacities2 are increased

AND Treatment needs are met

SO THAT Children can be safely cared for in the home (without an Agency managed safety plan). Family Support Services

After a throughout assessment we offer voluntary Family Support Services for families with safe, safe-high-risk, and safe- very high-risk children

AND Attempts are made to engage those families

AND Communication and coordination between case coordinators, CBCs, and service providers occurs

SO THAT Families’ protective factors are increased

AND Family Support Services providers document outcomes Child safety remains Florida’s number one goal before decreasing out-of-home care placements. In addition, achieving permanency through reunification, permanent guardianship, or adoption is stressed as another very important proximal outcome. Another change is that child well-being is considered both a proximal and distal outcome rather than viewing it simply as a long term outcome. Well-being focuses on a child’s physical and mental health status as well as their school performance. While, over the long term, family well-being within the community focuses on no further reports and recurrence of maltreatment.

Florida’s demonstration does not contain the measurement of a waiver group and a control/comparison group. Rather, the measurement of success uses the comparison of child and family outcomes at periods before and throughout the waiver period, as well as maintaining cost neutrality over the five years with a capped allocation of Title IV-E foster care funds. Children and families benefit from a wide array of services and resources as a result of the Title

2 Protective Capacities include: social connections, concrete resources, resiliency, nurturing and attachment, knowledge of child and youth development, and social and emotional competency.

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IV-E waiver. Restrictions were removed that prevented a child and his/her family from receiving critical services in the home, and they were replaced with the flexibility to provide targeted in-home services where it was possible to do so and still maintain child safety. Florida’s waiver serves all children already known to the child protective system, as well as new cases reported for alleged maltreatment throughout the life of the project. While major progress has been made in many key areas of child welfare across Florida, there are areas where we must focus increased attention. The state’s demonstration is a flexible funding project that includes:

Foster care maintenance payments.

Foster care administration and related costs, excluding State Automated Child Welfare Information System (SACWIS) development and operational costs and state and training costs.

The flexibility allows for a broader array of services, many of which employ research or evidence-based or evidence informed practices for this population. However, these practices are not available statewide. We intend to maintain and expand the array of community-based services and programs provided by lead agencies or other contracted service providers using Title IV-E funds pursuant to this waiver.

II. Clearly Defined Target Population

Target Population

The target population for Florida’s demonstration is all families and children presenting to Florida’s child welfare system through a report of alleged maltreatment. The target population includes sub-groups of individuals: all Title IV-E eligible and non IV-E eligible children, ages 0 until age 18, who are receiving in-home or out-of-home services from a Community-Based Care lead agency and all new families with a report of alleged child maltreatment during the course of the demonstration project. Waiver funds may also be used for prevention and intervention for children and families identified as being at risk of maltreatment. The project is statewide.

Because the demonstration is statewide with evaluation based on program outcomes, the protocols associated with child welfare demonstrations that involve specific counties or identification of treatment and control groups are not applicable to this demonstration. However, the Department is targeting the population of children who are deemed safe yet have a high or very high risk of future maltreatment.

The table on the following page provides the specific child, placement, and family characteristics of the Florida target population that result in the needs the demonstration aims to address:

6 Revised 10/2015

Specify target population: The waiver demonstration population is all children and families presenting to

Florida’s child welfare system through a report of alleged maltreatment.

Characteristic Check if

applicable Evidence

Child characteristics:

Age of child

√ The need for family support (prevention), safety, in-home and

permanency services for all children ages 0 until their 18th birthday. Permanency services geared to youth ages 15 until their 18th birthday are needed as these youth remain in care for longer periods of time.

The number of child intakes or reports to the Florida Abuse Hotline increased 1.35% from state fiscal year 2012/13 to state fiscal year 2013/2014. See Figure 1.

During SFY 2013/2014, the count of initial plus additional investigations received ranged from 12,862 to 17,466 a month. Of these, 18.8% resulted in a most serious finding of “verified.” During this same time frame, 21.44% of the allegations each month involved “family violence threatens child;” 22.77% of allegations were “substance misuse;” and 17.24% were inadequate supervision.

The disproportionate number of investigations received, allegations verified and removals of children in the age groups of 0 to 4 and 5 to 9 depicts the need to provide prevention, intervention, safety and in-home services.

The proportions of children in their own homes by age has remained relatively flat during SFY 2013/2014 (Figure 3). As depicted in Table 3, the proportion of children served in their own homes by age, race and Hispanic ethnicity has remained consistent. Of the 19,803 children in out-of-home care at a point in time during the month, 48.4% are age 5 or younger; 20.2% are ages 6 to 9; 13.7% ages 10 to 13; and 17.7% between the ages of 14 and 17. Youth between the ages of 15 and 18 remain in out-of-home care for longer periods of time. See Table 5.

7 Revised 10/2015




applicable Evidence

Age of child (cont) Between October 2014 and December 2014, 8,547 children were deemed safe with a high/very high risk of future maltreatment. A sub-study of this population is included in the Waiver Evaluation Plan. DCF Child Fatality Trend Analysis addressing child fatalities shows the need to focus on prevention, safety and in-home services. (Attachment 5)

Race or ethnicity of child √ There is variation in the proportions of children served in their own homes by race or ethnicity (Table 3). Of the children in their own home, 61.44% are white. The disproportionality of children in out-of-home care by race of child shows that 59% are white and remains static See Figure 6, Statewide Children by Race in Out-of-Home Care.

Gender

Sexual orientation/gender identity

Developmental disability

Mental health diagnoses/problems √ Need to improve child (mental) health well-being and focus services on results of child’s mental/behavioral health assessment. FSFN psychotropic medication report shows that there has been a substantial decline in the number of children on psychotropic medications between July 2009 and July 2013 except for the age 0 to 5 population. The number of younger children on psychotropic medication has risen. In state fiscal year 2012/2013, statewide quality assurance data shows that 81% of children received appropriate services based on the mental and behavioral health assessment.i

8 Revised 10/2015




applicable Evidence

Medical problems √ Need to improve availability and accessibility of physical and dental health care services for children in care or under protective supervision.

In state fiscal year 2012/2013, statewide quality assurance data shows - a child’s health care needs are assessed initially and on an on-going basis in 83% of cases. - concerted efforts were made to provide appropriate services to address the child’s physical health needs in 81% of the cases. - concerted efforts were made to address dental health care needs in 73% of cases - appropriate services were provided to address the dental health care needs in 71% of cases. Effective October 2014, Florida adopted the Child and Family Service Review (CFSR) items for ongoing case reviews. Of the 170 cases reviewed statewide for well-being item 17, physical and dental health is a strength in 114 cases (67.1%). Also, Florida’s Child Welfare Services Gap Analysis, April 2014, confirms the need to improve availability and accessibility of physical and dental health care services. The recently created Health Care Information Report for children in out-of-home care focuses on data entry of health care information as well as children receiving a medical service within the last 12 months. Of the 18,575 children in out-of-home care as of 10/1/2014, 97% received a medical service within the last 12 months. See Attachment 1 for an example of the report.

9 Revised 10/2015

Internalizing/externalizing behaviors

School problems √ Need to provide education supports to improve a child’s educational outcome. The CBC scorecard includes a measure that tracks educational achievement of children aging out of foster care. Attachment 2 is an example of the Scorecard. Florida NYTD results show that 64% of former foster care youth ages 18 to 22 years have a diploma or GED. QA data for 2012-13 shows that - 82% of children had their educational needs assessed on an ongoing basis - necessary educational services were engaged in 82% of cases. Effective October 2014, Florida adopted the Child and Family Service Review (CFSR) items for ongoing case reviews. Of the 173 cases reviewed statewide for well-being item 16, educational needs is a strength in 109 cases (63%).

History of child abuse/neglect √ Need to provide safety and in-home services to address recurrence of maltreatment and improve safety, permanency and well-being outcomes. See Figure 3 and Table 2. FSFN report on Number and Percent of Children Returning to Foster Care within one year of Reunification shows children reentering care (Jan 2015) - 10.5 % within 0 to 2 months - 19.9 % within 3 to 5 months - 12.23 % within 6 to 8 months - 23.9% within 9 to 11 months Florida’s CFSR Data Profile dated 2/05/2015 shows absence of recurrence of maltreatment in 94.1 % of cases and absence of child abuse and /or neglect in foster care at 99.02%.

Substance abuse (see under Family Characteristics)

Homelessness/housing instability

Poverty/resource insufficiency

Other (specify):

10 Revised 10/2015

Placement characteristics:

Initial reason for removal √ Top three verified maltreatment allegations are family violence threatens child, inadequate supervision, substance misuse. During SFY 2013/2014, 21.4% of allegations each month involved “family violence threatens child;” 22.77% of allegations were “substance abuse;” and 17.24% were inadequate supervision.

Type of removal (court/voluntary)

Number of prior removals

Type and number of living arrangements

Other (specify):

Family characteristics:

Family structure

Siblings

Parent competency

Developmental disability

Mental health diagnoses/problems

Medical problems

Substance abuse √ During the first seven months of SFY 2013/2014, 22.77% of allegations were “substance misuse.”

Homelessness/housing instability √ During the first seven months of SFY 2013/2014, 12.60% of the allegations were of environmental hazards.

Parenting attitudes

Lack of social support

Other (specify): Family Violence √ During the first seven months of SFY 2013/2014, 21.44% of the allegations each month involved “family violence threatens child.”

Other (specify): Parent in need of Assistance √ During calendar year 2014, the hotline screened in 3,346 “Parent in Need of Assistance” reports. The need is for family support services to prevent involvement of child welfare system.

11 Revised 10/2015

The total child number of child intakes or reports to the Florida Abuse Hotline increased 0.82% from state fiscal year 2010-2011 to state fiscal year 2011-2012. In state fiscal year 2012-2013, the number of child intakes or reports decreased 1.86% from the prior fiscal year. The number of intakes or reports has increased 1.35% from state fiscal year 2012/13 to state fiscal year 2013/2014. This indicates that the number of reports or intakes is beginning to increase.

Figure 1

0

50,000

100,000

150,000

200,000

250,000

FY 11-12 FY12-13 FY13-14

# o

f In

take

s/R

epo

rts

Child Intakes/ReportsFlorida Abuse HotlineFY 11/12 - FY 13/14

Screened in Screened out

FY 11-12 FY12-13 FY13-14

225,309 205,512 212,096

50,317 64,998 62,075

275626 270510 274171

Screened in

Screened out

Total Intakes/Reports

Source: Hotline Date: 3/30/2015

12 Revised 10/2015

Since July 2013, the number of incoming investigations has fluctuated. The first six months of calendar year 2014 shows a slight increase in the number of incoming investigations over the preceding six months.

Figure 2

Source: Count of Investigations Received Initial and Additional Trend Data, 4/15/2015

10000

15000

20000

25000

30000N

ov-

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Jan

-12

Mar

-12

May

-12

Jul-

12

Sep

-12

No

v-1

2

Jan

-13

Mar

-13

May

-13

Jul-

13

Sep

-13

No

v-1

3

Jan

-14

Mar

-14

May

-14

Jul-

14

Sep

-14

No

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# o

f In

vest

igat

ion

sChild Protective Investigations

StatewideNov 2011 - Dec 2014

13 Revised 10/2015

Child Protective Investigations Received by Circuit Initial & Additional

Nov 2011 – Dec 2014 Table 1

1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th

11-Nov 728 254 194 1142 992 1223 886 400 1402 733

11-Dec 704 226 148 1064 936 1147 785 333 1229 619

12-Jan 812 251 212 1186 1036 1242 812 374 1307 760

12-Feb 743 294 223 1245 985 1259 844 374 1410 758

12-Mar 847 305 227 1204 1046 1436 923 427 1425 750

12-Apr 844 266 208 1222 1102 1369 932 405 1482 825

12-May 865 326 232 1308 1117 1446 894 438 1530 850

12-Jun 736 233 187 989 823 1134 764 348 1110 620

12-Jul 759 300 211 1095 926 1079 774 318 1170 630

12-Aug 766 266 209 1158 1000 1232 810 375 1211 676

12-Sep 777 274 173 1082 916 1285 840 377 1322 724

12-Oct 834 327 202 1189 1053 1321 853 407 1499 896

12-Nov 715 240 155 1052 902 1086 704 313 1257 705

12-Dec 657 241 177 923 848 1029 655 322 1225 629

13-Jan 762 263 190 1163 1018 1250 814 383 1368 706

13-Feb 739 282 190 1081 943 1173 815 360 1418 765

13-Mar 794 308 199 1128 916 1178 802 395 1311 720

13-Apr 843 333 228 1230 1105 1383 923 439 1600 868

13-May 920 348 228 1430 1111 1426 964 443 1603 906

13-Jun 683 286 174 1046 857 1039 749 336 1210 665

13-Jul 733 261 198 1046 804 1021 729 363 1077 642

13-Aug 753 309 165 1169 934 1137 752 384 1277 737

13-Sep 802 308 196 1161 1048 1198 871 418 1406 775

13-Oct 816 319 235 1258 1000 1272 854 410 1518 878

13-Nov 729 278 186 1156 964 1116 770 332 1281 719

13-Dec 693 262 174 1018 938 1071 706 371 1300 732

14-Jan 701 300 200 1124 934 1235 836 370 1424 799

14-Feb 751 277 181 1107 891 1151 731 386 1374 718

14-Mar 746 308 192 1203 997 1297 794 402 1423 772

14-Apr 841 328 250 1327 1109 1371 900 451 1559 946

14-May 872 306 290 1405 1100 1287 907 412 1694 860

14-Jun 774 301 210 1113 911 1117 772 367 1308 735

14-Jul 760 296 198 1160 928 1095 826 399 1152 725

14-Aug 843 329 215 1152 929 1088 852 348 1280 764

14-Sep 842 323 282 1218 992 1275 811 382 1508 819

14-Oct 855 362 216 1194 1066 1320 847 366 1584 890

14-Nov 642 292 201 1055 888 1088 725 369 1287 714

14-Dec 754 293 194 1049 932 1084 742 321 1310 782

Circuits

14 Revised 10/2015

During SFY 2013/2014, the count of initial plus additional investigations received ranged from 12,862 to 17,466 a month. Of these, 18.8% resulted in a most serious finding of “verified.” During this same time frame, 21.44% of the allegations each month involved “family violence threatens child;” 22.77% of allegations were “substance misuse;” and 17.24% were inadequate supervision. It is important to note that an increase in the number of investigations generally occurs due to high profile situations such as a child death or serious injury, local and statewide child abuse

11th 12th 13th 14th 15th 16th 17th 18th 19th 20th

11-Nov 1226 590 875 313 850 55 1078 939 425 844

11-Dec 1033 519 813 310 815 41 1019 797 426 759

12-Jan 1223 601 962 346 831 56 1086 875 434 873

12-Feb 1188 600 1045 357 973 45 1230 875 453 858

12-Mar 1132 659 1061 360 973 51 1154 975 451 894

12-Apr 1174 582 1010 337 955 62 1112 916 404 918

12-May 1208 626 1119 388 986 49 1213 953 482 898

12-Jun 888 451 837 309 714 36 963 723 354 678

12-Jul 890 447 831 327 678 36 907 791 329 741

12-Aug 952 553 866 295 818 48 978 909 352 845

12-Sep 1061 565 892 366 868 41 1048 808 440 862

12-Oct 1267 641 991 367 989 54 1193 902 491 1006

12-Nov 1052 479 798 284 854 47 984 788 389 816

12-Dec 919 474 746 255 827 50 982 771 354 698

13-Jan 1097 598 944 383 851 61 1080 802 438 886

13-Feb 1004 574 930 291 918 54 1034 849 447 853

13-Mar 1076 532 899 303 853 66 1040 815 425 798

13-Apr 1344 666 1105 361 987 56 1180 928 465 943

13-May 1267 618 1069 377 1047 42 1136 935 497 919

13-Jun 967 476 788 318 710 48 976 697 346 660

13-Jul 946 498 784 283 691 36 1003 702 322 723

13-Aug 1147 525 901 309 797 39 1020 878 359 836

13-Sep 1176 585 989 334 892 44 1053 908 434 866

13-Oct 1273 664 1030 356 1064 53 1241 921 432 975

13-Nov 1076 578 908 279 899 41 1056 793 393 890

13-Dec 1057 550 851 310 881 50 1075 796 395 843

14-Jan 1096 608 968 322 895 56 1137 897 428 875

14-Feb 1086 560 939 305 865 68 1049 817 468 828

14-Mar 1161 611 1002 343 894 52 1202 912 436 937

14-Apr 1220 670 1063 369 1005 58 1227 929 497 930

14-May 1191 685 1108 439 1064 52 1302 983 517 992

14-Jun 960 539 843 328 777 45 1032 803 430 803

14-Jul 920 511 895 396 734 44 1078 734 359 757

14-Aug 977 569 851 379 835 46 1131 842 418 821

14-Sep 1202 653 1013 325 895 75 1234 949 494 877

14-Oct 1160 661 999 338 884 46 1380 950 527 929

14-Nov 1067 549 800 300 815 51 1103 806 398 770

14-Dec 1040 596 902 281 823 45 1048 763 411 786

Circuits

15 Revised 10/2015

and neglect awareness campaigns, arrests of mandated reporters who fail to report abuse or neglect of a child, etc. The age of the child is also a factor; during FY 2013/2014, 43.87% of the children who were victims of verified abuse were ages 0-4 (or 320,321 children), as reported in the 2014 Annual Report of the Office of Adoption and Child Protection. It appears that the number of children receiving in-home services has remained relatively flat. However, the balance of the children and families served in-home versus out-of-home is in flux due to implementation of new child safety and risk interventions.

Children In-Home Statewide

July 2013 – June 2014 Figure 3

11500

11600

11700

11800

11900

12000

12100

12200

12300

Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Source: Services Trend Report;Children in Home2/23/2015

2013/2014July Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Children

In Home 11,811 11960 11812 11748 11896 12095 12132 12067 12066 12168 12221 12149

16 Revised 10/2015

Table 2

As depicted below, the proportions of children in their own homes by age has remained consistent. There is no reason to anticipate any variation in this pattern. There is slight variation in the proportions of children in their own homes by race. See Attachment 3 titled Demographics of Children Receiving In-Home Services for county specific data.

Table 3

Children Served By Age, Race, and Hispanic Ethnicity

In-Home Services

Age:

January 2014 January 2015

0-2 Years 2,730 25.53% 2,646 25.98%

3-5 Years 2,390 22.35 2,160 21.21%

6-9 Years 2,565 23.98 2,558 25.12%

10-13 Years 1,810 16.92 1,723 16.92%

14-17 Years 1,121 10.48 1,027 10.08%

18+ Years 79 0.74 71 .70%

Race:

White 6,893 64.52 6,245 61.44%

Black 3,975 37.21 4,007 39.42%

Other 260 2.43 347 3.41%

Hispanic Ethnicity 1,888 17.67 352 3.46%

Note: Race and Ethnicity numbers and percents are greater than the total number of children served because a child may have multiple races and/or ethnicities SOURCES: DCF’s Florida Safe Families Network (FSFN) monthly reports Demographics of Children Receiving In-Home Services and Demographics of Children Receiving Out-of-Home Services.

The number of children in out-of-home care has fluctuated over the past three years. During state fiscal year 2011/12, the number of children in out-of-home care varied monthly from as low of 19,372 to a high one month of 20,030. In 2012/13, the number of children in care started to

Circuit July Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

1 927 873 822 819 865 868 822 760 692 649 632 610

2 246 233 238 216 205 191 162 185 179 175 189 167

3 151 181 180 198 188 198 195 187 169 163 155 137

4 933 924 958 982 988 1015 1000 1039 1012 1080 1103 1001

5 980 973 1004 1080 1119 1123 1178 1199 1148 1007 956 928

6 936 929 921 873 884 837 854 844 815 818 820 812

7 463 438 426 438 408 387 398 360 385 353 371 369

8 224 252 232 234 261 272 297 297 293 295 273 275

9 712 712 712 712 712 712 712 712 712 712 712 712

10 571 557 543 538 554 548 560 538 508 520 497 484

11 1347 1433 1392 1353 1330 1352 1360 1407 1450 1606 1685 1773

12 330 361 370 329 311 292 275 277 304 284 318 278

13 1068 1053 973 941 962 1027 1004 950 964 958 974 953

14 314 327 333 319 309 313 304 244 245 225 215 216

15 531 542 573 595 608 593 613 641 659 633 649 677

16 52 53 53 76 76 89 92 86 79 80 98 91

17 739 758 738 709 679 701 707 709 713 750 798 842

18 419 416 433 431 418 468 467 474 487 510 490 502

19 467 520 474 469 474 490 476 513 587 611 638 654

20 461 464 487 518 575 619 670 693 689 730 662 624

Children Active in In Home Care

2013-2014

17 Revised 10/2015

decline from 19,665 to 17,591. In 2013/14, the state experienced an increase in the number of children in care. Statewide children in out-of-home care increased by 11% over the 12 month period June 2013 through May 2014. Over 90% of the out-of-home care growth occurred in five circuits, 4, 11, 15, 17 and 20. The pattern of investigations is nearly identical to the rest of the state over the same 12 month period, as well as the number of children with a verified finding. The removals follow the seasonal pattern of investigations, increase as school begins, drop around the holidays, slight increase after the winter school break and increase as school ends. In October 2014 a Community Based Care (CBC) and Department Workgroup in partnership with Casey Family Programs was convened in response to the rise in out-of-home care. The Workgroup charge was to analyze trends and identify root causes for the increase in children in out-of-home care at the state level and across local communities. See Attachment 4, power point entitled, Out-of-Home Care Workgroup.

Figure 4

Source: Child Welfare Services Trend Report, 4/15/2015

16000

16500

17000

17500

18000

18500

19000

19500

20000

20500

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

# o

f C

hild

ren

Children in Out-of-Home CareStatewide

2012/2013/2014

2011/2012 2012/2013 2013/2014

2011/2012 2012/2013 2013/2014

Jul 19428 19665 17633

Aug 19642 19494 17803

Sep 19846 19595 18003

Oct 19939 19574 18328

Nov 19738 19219 18326

Dec 19372 18669 18091

Jan 19625 18745 18331

Feb 19838 18592 18533

Mar 19968 18518 18665

Apr 19971 18391 19135

May 20030 18198 19507

Jun 19730 17591 19299

18 Revised 10/2015

Figure 5

Source: Child Welfare Services Trend Report, 4/15/2015

In addition to the total number of children who were residing in out-of-home care as of the end of June for the past three years, the disproportionality of this population by race has also remained relatively static. Refer to Attachment 4.

Figure 6

Source: Disproportionality of Children in Out-of-Home Care Report, 3/30/2015

CIRCUIT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Dec-11 1299 264 270 1100 1103 1914 1134 445 1324 1077 1688 861 1900 376 951 85 1341 718 662 860

Dec-12 1032 218 261 937 1093 2116 1058 366 1165 1105 1613 797 1876 449 874 63 1327 769 618 932

Dec-13 925 233 241 905 1084 1639 791 420 1108 970 1822 643 1618 434 1120 106 1648 735 658 991

19 Revised 10/2015

The children in out-of-home care by race varies by circuit as shown in the tables below.

Table 4

Jun-12 Jun-13 Jun-14

Black 6432 5704 6596

Other 1295 1193 1308

White 12003 10694 11395

Total 19730 17591 19299

Children in Out-of-Home Care By Race

Statewide

Jun-12 Jun-13 Jun-14 Jun-12 Jun-13 Jun-14

Black 329 229 242 Black 166 131 123

Other 116 99 107 Other 73 63 62

White 822 619 700 White 953 845 845

Total 1267 947 1049 Total 1192 1039 1030


Black 183 103 117 Black 352 300 286

Other 19 10 14 Other 218 187 167

White 86 77 94 White 1509 1352 1180

Total 288 190 225 Total 2079 1839 1633


Black 41 36 41 Black 234 195 158

Other 19 19 17 Other 68 54 47

White 195 198 199 White 921 718 544

Total 255 253 257 Total 1223 967 749


Black 461 337 399 Black 163 136 126

Other 58 39 79 Other 19 22 25

White 571 398 543 White 212 202 225

Total 1090 774 1021 Total 394 360 376

Circuit 5

Circuit 2

Circuit 3

Circuit 4

Circuit 6

Circuit 7

Circuit 8

Circuit 1

20 Revised 10/2015


Black 458 392 434 Black 133 105 121

Other 60 44 72 Other 75 75 39

White 746 615 652 White 614 517 504

Total 1264 1051 1158 Total 822 697 664


Black 257 229 210 Black 789 639 729

Other 45 64 46 Other 144 103 104

White 762 706 742 White 1078 982 928

Total 1064 999 998 Total 2011 1724 1761


Black 1031 974 1247 Black 72 81 91

Other 47 52 73 Other 30 47 36

White 630 592 804 White 366 344 348

Total 1708 1618 2124 Total 468 472 475

Circuit 9

Circuit 10

Circuit 11

Circuit 12

Circuit 13

Circuit 14


Black 496 468 585 Black 165 182 189

Other 42 25 24 Other 73 59 95

White 392 420 529 White 525 484 534

Total 930 913 1138 Total 763 725 818


Black 17 19 23 Black 181 211 210

Other 4 3 5 Other 42 44 49

White 50 58 87 White 414 397 415

Total 71 80 115 Total 637 652 674


Black 748 776 1077 Black 156 161 188

Other 60 95 140 Other 83 89 107

White 501 531 674 White 656 639 848

Total 1309 1402 1891 Total 895 889 1143

Circuit 15

Circuit 16

Circuit 17

Circuit 18

Circuit 19

Circuit 20

21 Revised 10/2015

Finally, the percentage of children by age group that received out-of-home care services at some point during the month indicates that 48.4% of out-of-home care services recipients are age 5 or younger.

Table 5

The single entry point to child welfare services in Florida is the Florida Abuse Hotline. All child abuse and neglect allegations received through the centralized Florida Abuse Hotline occur twenty-four hours a day, seven days a week. Some situations reported to the Florida Abuse Hotline include such circumstances that do not rise to the level of a protective investigation may be addressed as a “prevention referral.” These situations, called “Parent in Need of Assistance” in Florida’s SACWIS system, are more appropriately addressed by a less adversarial assessment of needs and offer of services outside of the child welfare system. Engaging families in a less threatening way, when the situation does not warrant a formal investigation, increases the likelihood a family will acknowledge problems and agree to receive recommended services. This practice component is designed to give the Department an opportunity to help communities identify and provide services for families in order to avoid formal entrance into the child welfare system. The Department tracks and monitors such prevention referrals. During calendar year 2013, the hotline received 3,436 “Parent in Need of Assistance” reports that would be eligible to receive referrals for family support services. Family support services are voluntary supportive family services to prevent future child maltreatment among at-risk families. Based on the above data, DCF Child Fatality Trend Analysis, January 1, 2007 through June 30, 2013 (Attachment 5), and Florida Child Welfare Services Gap Analysis Report, April 2014 (Attachment 6), special attention must be given to services necessary to meet the unmet needs that affect child safety. There are gaps in safety management services (services that should be in place in order to respond and manage threats to child safety, see practice guidelines 9 (Attachments 7, 8, and 9). Additional guidance on determining the appropriate safety actions to

0 - 2 3 - 5 6 - 9 10 - 13 14 - 17 Total

Circuit 1 347 259 268 140 162 1176

Circuit 10 283 213 184 153 183 1016

Circuit 11 542 453 461 312 458 2226

Circuit 12 214 137 151 98 107 707

Circuit 13 505 365 344 237 259 1710

Circuit 14 109 94 96 60 78 437

Circuit 15 304 191 202 166 248 1111

Circuit 16 23 19 22 15 20 99

Circuit 17 556 405 399 278 387 2025

Circuit 18 226 180 190 137 180 913

Circuit 19 209 165 150 100 115 739

Circuit 2 63 49 36 20 62 230

Circuit 20 353 246 249 167 196 1211

Circuit 3 95 42 57 40 28 262

Circuit 4 283 191 174 114 155 917

Circuit 5 299 200 211 148 153 1011

Circuit 6 482 281 320 204 283 1570

Circuit 7 239 174 186 119 152 870

Circuit 8 109 81 75 65 73 403

Circuit 9 375 224 226 144 195 1164

Grand Total 5616 3970 4003 2718 3496 19803

Source: Children and Young Adults in Out-of-Home Care or Receiving In-Home Services Listing - OCWDRU Report #1077

22 Revised 10/2015

take, structuring of the plan, implementation of plan elements, and monitoring of the plan refer to: “Safety Planning” Practice Guidelines, All Staff, “Safety Plan Involving Other Parent Home Assessment” Practice Guidelines, All Staff, “Family Arrangements” Practice Guidelines, All Staff, “Informal Providers in Safety Plans” Practice Guidelines, All Staff “Monitoring a Safety Plan”, Practice Guidelines Case Management, “Modifying a Safety Plan”, Practice Guidelines Case Management) and in services known to be effective in the prevention and treatment of child abuse and neglect. This is especially true as we work to meet the needs of the younger children ages 0 to 4 and 5 to 9 years. Data shows that these two age groups of children are over represented as they comprise the majority of removals. Of particular note, the DCF Child Fatality Trend Analysis emphasizes the importance of in-home services. This trend analysis depicts that prior in-home services are shown to reduce the odds of death by 90%. There are also identified gaps in assessment services such as mental health assessments for adults and children. Although a multitude of necessary services are available at the community level, many are perceived as inaccessible. This may be due to a lack of public transportation, hours of operation, waiting lists, etc. Accessibility and availability of services continues to be a gap across the state. A statewide planning session is scheduled in May to discuss with community stakeholders from across the state. While Florida has made substantial progress on improving educational outcomes for children in care, the K-12 Report Card, the plans for 67-counties’ local agreements with local school boards and Department of Education partners, and electronic data sharing agreement are each important initiatives. In 2013, as part of the implementation of the Uninterrupted Scholars Act, the Department began an electronic data exchange pilot project between the Department and eight local school districts throughout the state. Through this project, the Department determined that 13 counties share educational information with case managers through an automated data exchange, 36 counties provide case managers with access to a parent portal, 16 counties provide information upon request, and 2 counties do not have a current process in place for the exchange of educational information. As a result, the Department has adjusted the original plan to develop an automated data exchange system that could be implemented statewide, to instead working to support the individual counties that are encountering data exchange challenges. The Department currently participates in several workgroups and committees within the Department of Education, including the State Secondary Transition Interagency Committee for students with disabilities and the Project AWARE State Management Team for student mental health services. Additionally, the Department collaborates with the Bureau of Exceptional Education and Student Services to host quarterly conference calls with the School District Foster Care Liaisons throughout the state. In January of 2015, the Department requested educational data from the Department of Education for the purpose of trend analysis. Casey Family Programs has agreed to provide analysis of the resulting files and meet with the Department in early June to review the findings and determine appropriate benchmarks for improvement. Educational services that further impact a child’s educational success are needed. The following survey findings are derived from a combination of both the Independent Living and Transition Critical Services Checklist and the My Services surveys. Years included in each table reflect the when data collection began; however, not all questions were included from the beginning of data collection.

23 Revised 10/2015

Table 6

Education

Caseworker

reviews school

grades and

report cards

Year 2007 2008 2009 2010

Spring

2011

Fall

2011

Spring

2012

Fall

2012

Spring

2013

Spring

2014

Percentage Yes 73% 71% 69% 72% 71% 67%

Number Yes 1,139 1,204 1,189 1,035 943 858

Total 1,560 1,699 1,712 1,441 1,319 1,272

Youth has an

Education &

Career Path Plan

[This may be

your EPEP]

Year 2007 2008 2009 2010

Spring

2011

Fall

2011

Spring

2012

Fall

2012

Spring

2013

Spring

2014

Percentage Yes 52% 40% 35% 34% 36% 29%

Number Yes 818 681 599 491 475 368

Total 1,560 1,699 1,712 1,441 1,319 1,272

Youth has

an Individualized

Education Plan

[IEP]

Year 2007 2008 2009 2010

Spring

2011

Fall

2011

Spring

2012

Fall

2012

Spring

2013

Spring

2014

Percentage Yes 43% 43% 41% 43% 41% 39%

Number Yes 669 723 709 622 543 501

Total 1,560 1,699 1,712 1,441 1,319 1,272

Youth has

changed schools

at least once

during the school

year

Year 2007 2008 2009 2010

Spring

2011

Fall

2011

Spring

2012

Fall

2012

Spring

2013

Spring

2014

Percentage Yes 47% 30% 47% 31% 49% 49%

Number Yes 734 506 800 440 650 626

Total 1,560 1,699 1,712 1,441 1,319 1,272

Source: My Services Survey - Responses by youth ages 13-17.

Survey results indicate nearly three-fourths of foster teens reported their grades and report cards were reviewed by their caregiver or caseworker. The surveys also indicated teens appear to be unaware or disconnected from the educational planning process, given that only about one-third to one-half of the respondents stated they had an Education and Career Path Plan or Individualized Education Plan. Teens also reported school stability as a major problem; nearly half of all teens reported they had changed schools within the past year. The Department of Education has a series of professional development programs and training available on-line to prepare school personnel on the relationships between the trauma of abuse and neglect and behavioral and emotional disabilities for educational decision-makers for children under protective supervision. This training will enhance the educational decision-makers ability to effectively advocate for the children. The training is available on-line or upon request from the Department at the local level. http://www.fldoe.org/schools/family-community/activities-programs/child-abuse-prevention.stml Florida law (s. 402.402, F.S.) was amended during the 2014 Legislature session that directs the Department to recruit and hire Child Protective Investigators (CPI) and CPI Supervisors with social work degrees. Our efforts are guided by the goal that at least 50% of the CPIs and CPI Supervisors have social work degrees by July 1, 2019. It gives the Department flexibility in hiring CPIs with the following suggested preferences:

24 Revised 10/2015

1) Social Work degree,

2) Degree in social sciences such as psychology, sociology, counseling, special education, education, human development, child development, family development, marriage and family therapy, and nursing

3) Baccalaureate degrees who have a combination of directly relevant work and volunteer experience preferably in a public service field related to children’s services. The key systemic barriers to achieving Florida’s identified outcomes that especially affect our target population are checked below:

Staffing barriers

√ Staff recruitment restrictions

√ Hiring qualifications

__ Training

√ Caseload sizes

__ Staff attitudes __ Other (specify):

Organization support/service barriers

√ Availability of appropriate family homes

Absence of permanency planning services

√ Lack of physical health services

√ Lack of behavioral health services

__ Other (specify): Leadership barriers

√ Agency

__ Legislature __ Courts __ Inter-agency collaborations __ Provider agencies __ Other (specify): __ Other systemic barriers (specify):

25 Revised 10/2015

The current numbers of children in the Florida target population.

Target population Measurement basis of numerical information*

Number of children in target group using the measurement

basis

All children and families who come to the attention of child welfare through a report of alleged child maltreatment

268,102 Children in active investigations (Child

Investigations Trend Report July 2013 – June 2014)

12,149 In-Home 19,464 Out of Home Care (Child Welfare Services Trend Report June 2014)

14,680 Prevention/ Intervention (Source: Florida

NCANDS FFY 2013)

Estimate 314,395 children and families will be served under the demonstration annually. The tables and graphs above depict the population by circuit and service category, investigations, in-home and out-of-home.

All children who are safe in their own home but at a high or very high risk of future maltreatment and would receive family support services.

Between 10/1/2014 and 12/31/2014, from 20,969 investigations there were 8,547 families with children who were deemed safe but at a high/very high risk of future maltreatment. The table below provides the information by circuit.

Estimate the number of children found safe with a high or very high risk of future maltreatment to remain constant. This estimate is likely to change as this practice model is in an early implementation stage.

*E.g., number in the system at a point-in-time, in an entry cohort such as at case opening or foster care placement, ever served in a year, etc.

26 Revised 10/2015

Number of In-home Investigations by Circuit received between 10/1/2014 and 12/31/2014 that have at least one child determined to be safe with a risk level of high/very high.

Source: V3b report with Risk Assessment data added; 4/14/2015

Note: Circuit 16 did not have any Safety Methodology Practice investigations received during this time frame.

Florida’s new child welfare practice model is a very broad, integrated approach that affects child safety through increased intake analyst (Hotline) and child protective investigator ability to identify, assess, and make decisions about potentially unsafe children. It also includes aspects of case management and services for permanency and well-being.

Florida’s integrated approach to:

Initial identification of potentially unsafe children by the Florida Abuse Hotline;

Further assessment of safety and safety decision making by investigators;

Ongoing safety management and service provision to enhance parental protective capacities (emotional, cognitive and behavioral), address and enhance child well-being needs (emotional, behavioral, developmental, academic, relationships, physical health, cultural identity, substance abuse awareness, and adult living skills); and

Providing a framework for safe reunification (conditions for return) or decision-making points for other needed permanency options by case managers.

The practice model also incorporates the classification of risk for safe children that results in appropriate community referrals and family support services for safe children at high risk of abuse in the future. The function of risk assessment is to ensure that families at risk of future maltreatment are identified and served. The Department has identified actuarial risk tools known as Structured Decision Making® (SDM), developed by the Children’s Research Center (CRC)

Circuit Investigations

Circuit 1 755

Circuit 10 663

Circuit 11 4

Circuit 12 157

Circuit 13 82

Circuit 14 230

Circuit 15 591

Circuit 17 209

Circuit 18 507

Circuit 19 420

Circuit 2 38

Circuit 20 468

Circuit 3 126

Circuit 4 904

Circuit 5 953

Circuit 6 1038

Circuit 7 396

Circuit 8 199

Circuit 9 807

Grand Total 8547

27 Revised 10/2015

as the preferred option available for assessing risk. By utilizing the risk assessment tools, agency resources are targeted to higher risk families with a greater potential to reduce subsequent maltreatment. Using a statewide, evidence based actuarial risk assessment tool will help investigations and supervisors identify family risk levels using consistent constructs and language and will allow us to standardize prevention programs, allowing for evaluation of program effectiveness. This supports replication of best practice programs from community to community.

The risk assessment is built around two indexes, one for abuse and one for neglect; but only the total risk level matters. The instrument will not tell you if the family is at higher risk for abuse or neglect. The family risk level is based on the highest score of the two indexes and has policy overrides built in as well. In effect, based on the family’s characteristics (not risk factors), how likely are they to abuse or neglect their children in the next 12 to 24 months? This concept of risk supports child welfare to allocate resources more effectively to people who have identifiable characteristics that more regularly present with difficulties. Please see Attachment 7, Assess and Respond to Risk”, Safety Methodology Practice Guidelines, All Staff, page 54.

To address long-term permanency, the practice model utilizes a structured assessment tool known as the Family Functioning Assessment – Ongoing, which is used to assess:

Are danger threats being managed with a sufficient safety plan?

How can existing protective capacities be built upon to make changes?

What is the relationship between danger threats and the diminished caregiver capacities - What must change?

What is the parent's perspective or awareness of his/her caregiver protective capacities?

What are the child's needs and how are the parents meeting or nor meeting those needs?

What are the parents really and willing to work on in the case plan to change their behavior?

What are the areas of disagreement with the parents as to what needs to change?

What change strategy will be used to address diminished protective capacities?

The Family Functioning Assessment – Ongoing (FFA-O) is the first formal intervention during on-going case management. It begins at the point the CPI worker transfers a case to ongoing case management. The assessment is a collaborative process that will result in identifying specific change strategies. However, the bulk of the conversation during the assessment is concerned with having caregivers recognize and identify protective capacities associated with impending danger and seek areas of agreement regarding what must change to eliminate or reduce danger threats and sufficiently manage threats to child safety.

The philosophy behind this assessment tool is that safety is paramount and is the basis for the intervention; however, the case planning process and interventions can be more clearly defined around the use of safety concepts and behavior change. The FFA-O also sets up conditions of return. These conditions of return are simply the conditions that must exist for children in-out-home care to return to the home safely. That is, what it would take to have children safely maintained in their own home. These conditions are derived from the safety analysis questions used to create the out of home safety plan. Reconciling information gathered during the on-going case management intervention against the existing safety analysis questions is the

28 Revised 10/2015

foundation to creating and analyzing the conditions for return, thus facilitating permanency through reunification.

Lastly, the progress evaluation, or Progress Update, is an on-the-record assessment that involves focused information collection and standardized decision making while case managers are considering progress for change and safety plan sufficiency. The formal intervention occurs at least at 90 days and at critical junctures. It is precise, fair and objective, reflected in progress measurements of no progress, minimal progress, significant programs and outcome achieved. Areas of assessment during the evaluation are caregiver protective capacities, child needs, family time and visitation, and case plan outcome evaluations. These measurements are connected to assessment driven actions: No Change, Change in case plan, Change in safety plan and Change in visitation plan (if the child is removed). The above measurements are currently being captured in FSFN for cases where the new practice is utilized.

The assessment of well-being and the attention to children's strengths and needs is included in every FFA-O and Progress Update. Child strengths and needs items measure the extent to which certain desired conditions are present in the life of the child within a recent timeframe. The child indicators are directly related to a child's well-being and success (emotion, behavior, family and peer relationships, development, academic achievement, life skill attainment). When the Department is involved with families whose children are unsafe, the case manager is responsible for assuring that the child's physical and mental health, development and educational needs are addressed by their caregivers as well as other caregivers when the child is in an out of home setting. The information gathered through assessment of these indicators is used to systematically identify critical child needs that should be the focus of thoughtful case plan interventions. The information needed by the case manager to complete the assessment will be gathered from the child, parent and other caregivers, and collateral source such as child care providers, teachers and/or other professionals. The scaling constructs for measuring the strength or need are as follows:

A=Excellent: Child demonstrates exceptional ability in this area

B= Acceptable: Child demonstrates average ability in this area

C= Some attention needed: Child demonstrates some need for increased support in this area

D=Intensive support needed: Child Demonstrates need of intensive support in

Action for Child Protection trained a group of 43 Super Safety Practice Experts for 4 weeks in February 2013 on the Safety Methodology of which the Family Functioning Assessment is the foundation. Following that training, 20 of the Super Safety Practice Experts went on to train Safety Practice Experts, for 8 days, in the regions with Action for Child Protection coaching and guiding then. These persons were deemed proficient as trainers in the Safety Methodology Practice Model by Action for Child Protection. After those trainings, more trainers were deemed proficient to train the Practice Model. All existing field staff have now received the 8 day Safety Methodology Practice Model training. The Safety Methodology Practice Model 8 day curriculum was inserted into the existing pre-service curriculum for newly hired Child Protective Investigators and Case Managers in July 2013 to ensure that all new staff was also trained. The new pre-service curriculum released in January 2015, also provides for in-depth training of the Family Functioning Assessment and the Safety Methodology.

29 Revised 10/2015

The Family Functioning Assessment is initially created by the Child Protective Investigator, when children are deemed to be unsafe, the case is transferred to case management and the Case Manager will update and add new information to the Family Functioning Assessment and will continue to update the Family Functioning Assessment-Ongoing until permanency is achieved.

An implementation journey guided by implementation science and the support of national experts from Casey Family Programs, the National Resource Center for Child Protection and the Children’s Research Center is in the initial implementation stage. The utilization of the practice model is being woven into all critical areas of practice and policy and supported by a statewide steering committee and various subcommittees with key stakeholder representation.

When child protective investigation indicates that parents or guardians can't, don't or won't protect their children, the Department quickly steps in to help, providing a full spectrum of services from in-home supervision services to referrals for parenting classes and child care, to foster care placement in a licensed home or placement with a relative. In-home services are emphasized in order to keep children in their own families whenever possible and safe to do so.

For the most part, in-home protective services are intended to support families with strengthening caregiver protective capacities while at the same time implementing in-home, agency directed and managed safety plans. Below is a brief description of in-home safety services that may be offered, and a list of examples of each. Availability of each type of service depends on the local CBC service structure and system of care to address community needs and population differences. Please refer to Attachment 11, Services Section of Attachment 1 to the CBC Contract.

Safety Plan Service: Behavioral Management. Behavioral management is concerned with applying action (activities, arrangements, services, etc.) that controls (not treats) caregiver behavior that is a threat to a child’s safety. While behavior may be influenced by physical or emotional health, reaction to stress, impulsiveness or poor self-control, anger, motives, perceptions and attitudes, the purpose of the services are only to control the behavior that poses a danger threat to a child. Services are concerned with managing any aggressive behavior, passive behavior or absence of behavior which threatens a child’s safety.

Safety Plan Service: Supervision and Monitoring. Supervision and monitoring is the most common safety service in safety intervention. It is concerned with caregiver behavior, children’s conditions, the home setting, and the implementation of the in-home safety plan. Child welfare professionals oversee people and the plan to manage safety. Supervision and monitoring is almost always used when other safety services are employed.

Examples: Case Manager visits, professional monitoring (e.g., drug testing for compliance with substance abuse treatment), Domestic Violence Specialist visits.

Safety Plan Service: Stress Reduction. Stress reduction is concerned with identifying and alleviating stressors occurring in the caregiver’s daily experience and family life that can influence or prompt behavior that the in-home safety plan is designed to manage.

Examples: Changing work schedule/amount of hours, re-aligning household responsibilities.

30 Revised 10/2015

Safety Plan Service: Behavior Modification. Safety management services or activities are not concerned with changing behavior; they are focused on immediately controlling threats. Safety management service is an attempt to limit and regulate caregiver behavior in relationship to what is required in the in-home safety plan. Modification is concerned with influencing caregiver behavior: a) to encourage acceptance and participation in the in-home safety plan and b) to assure effective implementation of the in-home safety plan.

Examples: Parent calls an informal safety support (family member, friend); or, under certain circumstances, parent lives temporarily away from the home.

Safety Plan Service: Crisis Management. Crisis is a perception or experience of an event or situation as horrible, threatening, or disorganizing. The event or situation overwhelms the caregiver’s and family member’s emotions, abilities, resources and problem solving. A crisis for families child welfare professionals serve is not necessarily a traumatic situation or event in actuality. A crisis is the caregiver’s or family member’s perception and reaction to whatever is happening at a particular time. With respect to safety management, a crisis is an acute matter to be dealt with so that present or impending danger is controlled and the requirements of the in-home safety plan continue to be carried out. The purposes of crisis management are crisis resolution and prompt problem-solving in order to control present danger or impending danger.

Safety Plan Service: Social Connection Social connection is concerned with present danger or impending danger that exists in association with or influenced by caregivers feeling or actually being disconnected from others. The actual or perceived isolation results in non-productive and non-protective behavior. Social isolation is accompanied by all manner of debilitating emotions: low self-esteem and self-doubt, loss, anxiety, loneliness, anger, and marginality (e.g., unworthiness, unaccepted by others).

Florida will use this safety category alone or in combination with other safety categories, such as Supervision and Monitoring, in order to reinforce and support caregiver efforts, and to evaluate how the caregiver is doing with behavior management is a secondary value of social connection. (See Behavior Management – Supervision and Monitoring.)

Safety Plan Service: Friendly Visiting. Friendly visiting is an intervention that was among the first used in social work history. The original intent of friendly visiting was essentially to provide casework services to the poor. In safety intervention, friendly visiting is directed purposefully at reducing isolation and connecting caregivers to social support.

Friendly visiting can include professional and non-professional safety management service providers, and other resources or support networks. When informal providers make arrangements for friendly visiting, it is necessary for child welfare professionals to direct and coach them in terms of the purpose of the safety management service and how to proceed, set expectations, and seek their accountability.

Examples: Healthy Families, Early Head Start, family members or friends, children’s school teachers, clergy members.

Safety Plan Service: Basic Parenting Assistance. Safety intervention is concerned with parenting behavior that is threatening to a child’s safety. Basic parenting assistance is concerned with developing specific, essential parenting that affects a child’s safety. This

31 Revised 10/2015

safety management service is focused on essential knowledge and skills a caregiver is missing or failing to perform. Typically these are skills related to caring for children with special needs (e.g., infant, disabled child). Building support persons into the in-home safety plan can become a significant social connection to help parents/caregivers with challenges they have in basic parenting behavior, which is fundamental to the children remaining in the home.

Examples: Child-specific medical training, breastfeeding support (e.g., La Leche League), parenting mentors.

Safety Plan Service: Supervision and Monitoring as Social Connection. Some in-home safety plans will require social connection and behavior management, specifically supervision and monitoring. Supervision and monitoring occurs through conversations during routine safety management service visits, along with information from other sources. The point here is to promote achievement of objectives of different safety categories and safety management services when the opportunity is available. (See Supervision and Monitoring.)

Safety Plan Service: Social Networking. In this safety management service, child welfare professionals are facilitators or arrangers. Social networking as a safety management service refers to organizing, creating, and developing a social network for the caregiver. The idea is to use various forms of social contact, formal and informal; contact with individuals and groups; and use of contact that is focused and purposeful.

Safety Plan Service: Resource Support. Resource support refers to safety category that is directed at a shortage of family resources and resource utilization, the absence of which directly threatens child safety.

Services/Examples:

Activities and safety management services that constitute resource support used to manage threats to child safety or that are related to supporting continuing safety management include:

Resource acquisition related specifically to a lack of something that affects child safety.

Transportation services particularly in reference to an issue associated with a safety threat.

Financial/Income/Employment assistance as an assistance aimed at increasing monetary resources related to child safety issues.

Housing assistance that seeks a home that replaces one that is directly associated with present danger or impending danger to a child’s safety.

General health care as an assistance or resource support that is directly associated with present danger or impending danger to a child’s safety.

Food and clothing as an assistance or safety management service that is directly associated with present danger or impending danger to a child’s safety

Home furnishings as an assistance or safety management service that is directly associated with present danger or impending danger to a child’s safety.

32 Revised 10/2015

Safety Plan Service: Separation. Separation is a safety category concerned with danger threats related to stress, caregiver reactions, child-care responsibility, and caregiver-child access. Separation provides respite for both caregivers and children. The separation action creates alternatives to family routine, scheduling, demand, and daily pressure. Additionally, separation can include a supervision and monitoring function concerning the climate of the home and what is happening. Separation may involve anything from babysitting to temporary out-of-the-home family-made arrangements to care for the child or combinations.

Examples of actions that could be taken in this category include:

Planned absence of caregivers from the home.

Respite care.

Day care that occurs periodically or daily for short periods or all day long.

After school care.

Planned activities for the children that take them out of the home for designated periods.

Family-made arrangements to care for the child out of the home; short-term, weekends, several days, few weeks.

Because the practice model is focused on safely maintaining children in their own homes whenever possible, and facilitating reunification based on improving caregiver protective capacities and effecting behavior changes, demonstration funds will be used to support services provided through the new practice model.

III. Clearly Defined Demonstration Components and Associated Interventions

The Department is currently undergoing a statewide structured implementation of a new child welfare practice model. As embodied in Florida’s Child Welfare Practice Model, the vision is rooted in principles and practices that are safety-focused, family centered and trauma informed. Florida’s practice model focuses on seven general professional practices and directed toward the major outcomes of safety, permanency, and child and family well-being.

Engage the family;

Partner with all involved;

Gather information;

Assess and understand information;

Plan for child safety;

Plan for family change;

Monitor and adapt case plans. Interventions:

1.) Increase availability and access to services.

This intervention challenges CBC lead agencies and local communities to increase availability and access to services based on the needs of children and families at the local level. An area

33 Revised 10/2015

that has not developed as widely as we had hoped is service array and evidence-based or evidence informed family support services across the state. Florida is a large state with a diverse population with varying needs. Casey Family Programs in partnership with the University of South Florida conducted a statewide electronic survey in January and February 2014 to examine service gaps in Florida’s child welfare system. The purpose of the survey was to conduct a comprehensive gap analysis of services available at the community level for families at risk of involvement or involved with Florida’s child welfare system. The final report was issued April 8, 2014.

Overall, a wide range of services were rated between occasionally or usually available and accessible. A small number of key service gaps do exist. The respondents identified 13 services as critical unmet needs that affect child safety. Four of these: (1) crisis management, (2) behavior management- in-home supervision and monitoring, (3) in-home crisis intervention, and (4) after school care are safety management services. Three of these are in-home services: (1) behavior management- in-home supervision and monitoring, (2) Safe at Home, and (3) in-home crisis intervention. Two of the services are evidence-based practices: (1) Safe at Home, and (2) Parent-Child Psychotherapy. Currently Safe at Home is offered in Circuits 9 and 18. Parent Child Psychotherapy is available in five circuits – Circuits 4, 10, 15, 17 and 18. The recommendations from the final report will serve the regions and CBCs well as they work with local community providers and funders to further develop service network within the local community.

Moreover, CBCs are required by contract to provide services and programs that are evidence-based. Below is the excerpted language from the CBC contract:

“The Lead Agency agrees to expand the array of community-based services and programs using title IV-E funds as outlined in the Waiver Terms and Conditions. Expanded services, supports, and programs may include, but are not limited to:

Early intervention services in situations of developing family need to prevent crises that jeopardize child safety and well-being;

One-time payments for goods or services that reduce short-term family stressors and help divert children out-of-home placement (e.g., payments for housing, child care, etc.);

Evidence-based, interdisciplinary, and team-based in-home services to prevent out-of-home placement;

Services that promote expedited permanency through reunification when feasible, or other permanency options as appropriate;

Enhanced training for child welfare staff and supervisors in service delivery and supervisory practices;

Improved needs assessment practices that take into account the unique circumstances and characteristics of children and families; and

Long term supports for families to prevent placement recidivism.” A few specific examples of partnering to expand service arrays from the regions and their CBCs include: Northwest Region:

A Medical Home Model, in partnership with the local Pediatric Foundation, providing a Nurse Care Coordinator to work with child protective investigators and case managers.

34 Revised 10/2015

Child Welfare, Substance Abuse, and Mental Health service integration pilot programs for infant mental health and children ages 0-5, as well as data sharing.

Northeast Region:

With the Department of Juvenile Justice, implementing the Georgetown Crossover Youth Model with a multidisciplinary team staffing. The State Attorney’s Office, local law enforcement, and local school board also participate.

Children’s Partnership Councils, including traditional and nontraditional partners, increasing outreach in rural areas.

Central Region:

Together IN Partnership committee with Brevard County Government and many other local organizations, for information sharing and problem-solving around topics such as child substance abuse and family management.

Participation on the local Children’s Services Council, Healthy Start Coalition, and many other relevant workgroups.

Casey Family Programs initiatives [also at state level and in other regions] on many education, assessment, and service delivery topics.

SunCoast Region:

Pinellas County Sheriff’s Office relationships for child protective investigations for appropriate and expeditious services to families.

Family Strengthening Initiative with the faith-based community

Local Teen Advocacy Council for former foster youth empowerment.

Southeast Region:

With the Early Learning Coalition, to maintain prioritization and access to quality childcare.

Working with the Florida Department of Law Enforcement in the area of human trafficking, including a statewide conference.

Partnering with the Children’s Home Society on adoption services, such as the local Heart Gallery.

Southern Region:

A Motivational Support Program with the behavioral health managing entity to enhance integration across behavioral health and child welfare.

Collaborating with the local school system, Children’s Legal Services, and the court to facilitate availability of Skype in the schools so children can participate in court hearings if they so choose.

In January 2015, Florida embarked on an assessment of Florida’s service array in partnership with community based care and case management organizations with a heightened focus on family support and safety management services. The survey includes an inquiry regarding what family support services each CBC has and the services level of evidence based/informed

35 Revised 10/2015

effectiveness. The front-end services survey results show that the availability of evidence-based and evidence-informed services is limited and varies across the state. There remains substantial work to increase the level of evidence-based or evidence-informed front-end

services in all communities in Florida. In conjunction, the Secretary recently established a

Priority of Effort initiative to ensure a full network service array of integrated and coordinated services in every Florida community to enhance a child’s well-being and success and parental/caregiver protective capacity.

The Office of Court Improvement (OCI) and the Department of Children and Families are among several child welfare partners who participate in monthly multiagency collaboration meetings. These meetings provide an excellent forum for information sharing as to various agency initiatives, in addition to the opportunities for collaboration among the various initiatives. Over the past year, the Office of Court Improvement and the Model Courts Project have supported the Evidence-Based Parenting (EBP) Initiative by facilitating monthly technical assistance calls between the participating circuits and Dr. Lynne Katz, parenting and child development specialist from the University of Miami. The initiative focuses on universal requirements for evidence-based parenting classes, pre and post-test measures, parent readiness and parent-child observations with children 5 and under. Through this ongoing process judges, judicial staff and community stakeholders have been able to define and understand the process for a parenting program to become evidence-based as well as understanding the process for accessing programs meeting research-based criteria. Currently 13 judicial circuits are participating in the initiative with plans to expand statewide. The Office of Court Improvement has entered into a services agreement with Dr. Lynne Katz (Director of the University of Miami, Linda Ray Intervention Center), to provide the one-on-one technical assistance needed. While the OCI maintains the lead in this model courts initiative, each local jurisdiction participating in the initiative includes the partnership of the Department and community based care agencies. The specific waiver activities are determined on a local level and implemented with full partner collaboration. 2) Integration of Services for Child Welfare and Behavioral Health

Behavioral health concerns are among the most common involved in allegations of child abuse and neglect. In a nod to the psychological concept defined by one source as “the organization of the psychological or social traits and tendencies of a personality into a harmonious whole,” the Department’s Offices of Child Welfare, Substance Abuse and Mental Health participate in several integration initiatives to address issues for shared clients in order to bring processes and policies into a “harmonious whole” across the programs. These integration approaches involve children and their families; that is, adult behavioral health and child behavioral health are both involved. Though many of these efforts also involve child and family well-being, first and foremost is their impact on the ability of the Department to promote child safety.

Assessment in children and families involved with child welfare are often related to behavioral health (substance abuse or mental health). By increasing the skills and knowledge of child welfare professionals about behavioral health, and by pursuing integration of practice and services, the Department can address these critical factors in a holistic manner across the two systems.

Integration of services for child welfare, mental health, substance abuse and domestic violence is another intervention component. Integrated services will ensure early identification of the needs of the family and timely access to necessary interventions, resulting in an improved response to issues such as, developmental disabilities, substance-exposed newborns, and domestic violence.

36 Revised 10/2015

Four regions, involving seven CBCs, are involved in piloting Child Welfare/Substance Abuse/Mental Health Integration projects called the Family Intensive Treatment Team (FITT) model. During fiscal year 2014-15, the Department expects to assess the outcomes of the FITT model to see if there is evidence to support use statewide.

Some integration efforts are short term, such as presentations at joint conferences or particular media campaigns (notably the joint “Who’s Watching Your Child” campaign). However, there are several initiatives that are significant, long term, and will affect the overall ability of the child welfare program to achieve the broad goal of increasing safety for children. These include:

A behavioral health initiative affecting child welfare that involves the implementation of Managing Entities within the Substance Abuse and Mental Health program. The Department contracts for behavioral health services through regional systems of care called Managing Entities (MEs). These entities do not provide direct services; rather, they allow the Department’s funding to be tailored to the specific behavioral health needs in the various regions of the state. There are seven Managing Entities that “develop, implement, administer, and monitor a behavioral health Safety Net” throughout the state.

Managing Entities (ME) are under contract with the Department to manage the day-to-day operational delivery of behavioral health services. The ME must ensure that resources are community focused and build on the unique strengths and meet the specific needs of the local communities.

Provision of training in the area of trauma-informed care for staff and caregivers, specifically as part of the pre-service curriculum and on-line training developed by the Florida Certification Board, and in alignment with the child welfare Practice Model;

Care coordination/case management program inclusion of behavioral health and trauma-informed care under the Child Welfare Specialty Plan under Medicaid Managed Care (refer to Florida CFSP 2015-2019, Health Care Oversight and Coordination Plan) and local coordination of child welfare agencies with services provided by the Behavioral Health Managing Entities;

Florida Children’s Mental Health System of Care Expansion Grant and Integration with Child Welfare;

Project LAUNCH (Linking Actions to Unmet Needs in Children’s Health), a five-year grant from the Substance Abuse and Mental Health Administration (SAMHSA). This grant is grounded in the public health approach and works towards coordinated programs that take a comprehensive view of health by addressing the physical, emotional, social, cognitive and behavioral aspects of well-being.

The Substance Abuse Mental Health Program will provide content expertise on prescription drug treatment and prevention, Family Intervention Specialists (FIS), and child welfare issues related to substance abuse and mental health. The SAMH Program is also partnering with the Florida Alcohol and Drug Abuse Association to develop and deliver seven webinars to train Child Protective investigators and FIS staff statewide in the recognition and assessment of behavioral health disorders. The six webinars to train substance abuse, mental health and child welfare professionals to recognize and access behavioral health disorders are:

o Making the Case: The Connection Between Substance Abuse and Child Maltreatment

o Understanding Substance Use, Abuse, Dependence and Associated Harms o Parental Substance Use Behaviors that Contribute to Child Maltreatment

37 Revised 10/2015

o Recognizing Parental Use of Alcohol and Drugs (including Nonmedical Use of Prescription Drugs)

o Screening and Assessment of Substance Use Disorder (SUDs) o Effective Treatment for Substance Use Disorders (SUD) and the Role You Can

Play These training videos are available statewide at no cost via the Florida Alcohol and Drug Abuse Association (FADAA, Inc.) website: http://www.fadaa.org/resource_center/webinars.php

A critical part of the child welfare/behavioral health integration process is the role of FIS. As appropriate, child welfare policies and procedures have been revised to include the FIS services. Further, FIS protocols have been developed which delineate the service delivery process to this population. It is significant to note that FIS are co-located with the child welfare staff to promote communication, easy access and improved continuity of care.

Other integration components concern administration and oversight of psychotropic medication for children in foster care. Florida has made positive efforts to address the overutilization of psychotropic medications in foster care. Psychotherapeutic medications are to be provided to the child only with the express and informed consent of the child’s parent or legal guardian. Court authorization, after consultation with the prescribing physician, must be sought if parental rights are terminated, the whereabouts of the child’s parents are not known, or a parent declines to give express and informed consent. A mandatory pre-consent review by a child psychiatrist contracted by the Department is required prior to prescription of a psychotropic medication for any child between the ages of birth through five (5) years who is in the custody of the Department in out-of-home care. The Department works closely with Agency for Healthcare Administration (AHCA) to ensure oversight of psychotropic medication. The oversight of prescription medicines, including psychotropic medications, is critical to safeguard appropriate practice of management and administration of medication to children placed in out-of-home care. Medication information is required to be documented in the Florida Safe Families Network (FSFN) in data fields that can be easily queried and analyzed. Among others, the data fields include the name of the medication, the condition(s) the medication addresses, and whether or not the medication is psychotropic, and whether the medication is administered for psychiatric reasons.

AHCA contracts with the University of South Florida for the Medicaid Drug Therapy Management Program (MDTMP) for Behavioral Health to maintain and develop evidence based guidelines for the use of psychotropic medications for children. This program includes the development of Florida-specific best practice guidelines and their dissemination through a variety of methods created and implemented by the prescriber community. These treatment guidelines will represent a consensus of the prescriber community and will reflect the best available scientific information.

The MDTMP also includes a claims review process and educational mailings to inform physicians of prescribing behavior that may be worth reviewing. The mailings, containing patient-specific prescription information and clinical considerations, are designed to reduce the frequency of practices that are inconsistent with the guidelines. National experts, Florida physicians, AHCA, and DCF staff meet biennially to update medication guidelines.

38 Revised 10/2015

Florida has a Florida Pediatric Psychiatry Consult Hotline. This service is administered by the Florida Medicaid Drug Therapy Management Program for Behavioral Health located at the Florida Mental Health Institute (FMHI) at the University of South Florida. The Florida Pediatric Psychiatry Hotline, a network of regional children’s behavioral health consultation teams, is designed to help primary care clinicians meet the needs of children with psychiatric conditions. The goals of the program are to provide consultation about psychotropic medications for children with psychiatric illness and promote a primary care clinician’s and child psychiatrist’s collaborative relationship. Currently there are three consultation hotlines (University of Florida Division of Child and Adolescent Psychiatry in Gainesville; University of South Florida Division of Child and Adolescent Psychiatry in the Department of Pediatrics, Rothman Center for Neuropsychiatry in St. Petersburg; and Florida International University).

3) Child Welfare and Physical Health Assessments Although Florida has increased timeliness of medical and dental services, we still have considerable way to go in completing comprehensive health care assessments when children come into care, and in following periodicity schedules for immunizations and well-child checkups. The well-being standards do not demonstrate improvements in the percent of children receiving the services identified through assessments, such as Child Health Check-Up and Child Behavioral Health Assessment (CBHA). This includes lags in physical and dental health particularly. (The Demonstration Project Evaluation Plan.) The Agency for Healthcare Administration (AHCA), has placed the 72 hour screening requirement in all contracts for Medicaid Managed Assistance (e.g., Sunshine Health and other plans). This requirement is addressed in the Protective Custody Coverage Provisions of the managed care contract and requires the following:

The Managed Care Plan shall provide a physical screening within seventy-two (72) hours, or immediately if required, for all enrolled children/adolescents taken into protective custody, emergency shelter or the foster care program by DCF. a) The Managed Care Plan shall provide these required examinations without requiring prior authorization, or, if a non-participating provider is utilized by the Department of Children and Families, approve and process the out-of-network claim. c) For all Child Health Check Up Screenings for children/adolescents whose enrollment and Medicaid eligibility are undetermined at the time of entry into the care and custody of the Department, and who are later determined to be enrollees at the time the examinations took place, the Managed Care Plan shall approve and process the claims. All children must have ongoing assessments following the Child Health

Check-up periodicity schedule. The child may enter the periodicity schedule at any time. For example, if a child has an initial screening at age 4, then the next periodic screening is performed at age 5.

Child Heath Check Up Age of Child

birth

2-4 days

2 months

4 months

6 months

9 months

12 months

15 months

18 months

Once every year for ages 2-20

39 Revised 10/2015

Furthermore, AHCA will monitor performance through the contract performance measures required within the Child Welfare Specialty Plan contract. AHCA has adopted a set of quality metrics that sets targets on the metrics that equal or exceed the 75th percentile national Medicaid performance level. In addition, these metrics will be used to establish plan performance, improvement projects focusing on areas such as improved prenatal care and well child visits in the first 15 months and better preventive dental care for children. A Medical Service Date report for each child in out-of-home care is available in the FSFN Reporting Environment for use by case managers and management. This reports assists with identifying children who are in need of medical services based on their periodicity schedule. Attachment 1 is an example of the report. 4) Quality Parenting Initiative

The Quality Parenting Initiative (QPI) integrates practice across various systems to ensure foster families are provided the support they need to provide high quality care to children. All of Florida’s CBCs are actively participating in QPI. This involves ongoing technical assistance, as well as special initiatives.

The Quality Parenting Initiative (QPI) is one of Florida's approaches to strengthening foster care, including kinship care. It is a process designed to help a site develop new strategies and practices, rather than imposing upon it a predetermined set of "best practices." If a child's own parents are unable to safely care for him or her, the system must ensure that the foster or relative family caring for the child provides the loving, committed, skilled care that the child needs, while working effectively with the system to reach the child's long term goals.

QPI recognizes that the traditional foster care "brand" has negative connotations and this deters families from participating. QPI is an effort to rebrand foster care, not simply by changing a logo or an advertisement, but by changing the core elements underlying the brand. When these changes are accomplished, QPI sites are better able to develop communication materials and to design recruitment training and retention systems for foster parents. The key elements of the QPI process are:

To define the expectations of caregivers;

To clearly articulate these expectations; and then

To align the system so that those goals can become a reality.

The major successes of the project have been in systems change and improved relationships. Sites have also reported measurable improvement in outcomes such as:

Reduced unplanned placement changes;

Reduced use of group care;

Reduced numbers of sibling separation: and

More successful improvements in reunification.

QPI and the Department currently are partnering on a number of initiatives, including:

• Streamlining licensing requirements;

• Recruitment & retention of foster homes for teens;

• Coordinating objectives with the Federal Intelligent Recruitment Grant awarded to four of Florida’s CBCs, and directed by the Department.

40 Revised 10/2015

5) Trauma Informed Care

Florida’s child welfare system recognizes that children who have experienced maltreatment and have been removed from their homes face considerable trauma. These children must be protected from events that may add to the traumatic experiences and must receive the necessary early intervention and trauma informed therapeutic treatment. Caregivers struggling with their own history of trauma may also need specialized treatment to build and enhance parental capacity. A trauma informed system recognizes the impact of trauma on staff and those it serves, provides respect, information, collaboration, hope, and works to identify and change policy or procedure that has the potential to be traumatizing. To this end, Florida seeks to integrate trauma informed care screening practices to help identify, assess, and refer parents and children in need of specialized treatment.

All case management staff receive trauma-informed training during pre-service training and we have in-service trainings available for all staff. The foster parent pre-service training, Positive Parenting, is a trauma informed based curriculum. The Foster and Adoptive Parent Associations invite local experts to provide trauma informed care training as part of their Association meetings. Additionally foster parents are encouraged to view the on-line training provided through the Center for the Advancement of Child Welfare website. Currently the CBC in Volusia County has engaged the Chadwick Center for Children and Families. The priorities for the next 6 months are:

1) Implement a tool more specifically for trauma, such as the SCARED-Short; consider embedding some form of trauma screening into the Practice Model (Can look at embedding it into the 6th Core Practice and possibly begin with high-risk criteria cases).

2) Provide advanced training on trauma using the Child Welfare Trauma Training Toolkit.

3) Provide staff with training and support regarding the evidenced-based practices that are available in their community with conducting a survey of evidenced based practices available in Volusia County as first step.

4) Provide training for birth parents on trauma and its impact.

5) Establish a Baby Court Team; Chadwick Trauma Informed Systems Dissemination and Implementation Project (CTISP-DI) staff is working with Chrissy Curtis from CPC to develop training for Case Managers, as well as caregivers, daycare employees, visitation monitors, medical providers and others.

6) Engage staff to obtain feedback and their input on what strategies, supports, and services they feel would be beneficial to them around the area of Secondary Traumatic Stress.

Florida is committed to working in collaboration with the Children’s Bureau and the demonstration waiver’s evaluation contractor to expand on the efforts to improve measurement and outcomes related to well-being. These efforts will include the use of data from the family functional assessments as deployed through the practice model.

IV. Assessing Readiness to Implement the Demonstration The contract template for negotiations with Community-Based Care (CBC) lead agencies includes a comprehensive list of “Standards of Quality, Safety, and Practice Requirements”. This Authority and Requirement attachment is part of the contract with all 18 CBC lead

41 Revised 10/2015

agencies. Included in the Authority and Requirements document are the following major requirements by category:

Federal laws and policy regarding child welfare

Florida laws regarding child welfare, substance abuse, mental health, and contracting requirements

Florida administrative code chapters regarding child welfare (rules)

Florida departmental operating procedures regarding child welfare and organization management and

Federal cost principles. As noted in Section V. Work Plan, the CBC lead agency agreements incorporate requirements related to the demonstration. This includes maintenance and improvements to the array of services provided by CBC lead agencies, issues related to use of funds, expenditure reporting, etc. The Attachment 10 to this report, Authorities and Requirements, provides the current requirements.

V. Work Plan

In order to manage the demonstration, an oversight team has been established. This oversight group is composed of senior managers from DCF along with executive leadership from Community-Based Care (CBC) Lead Agencies. This group includes:

Sallie Bond, Operations Management Consultant Manager, Office of Child Welfare, DCF

Glen Casel, ED., Chief Executive Officer, Community Based Care of Central Florida

Elisa Cramer, Community Services Manager, Office of Child Welfare, DCF

David Fairbanks, Deputy Secretary, DCF

Lee Kaywork, Chief Executive Officer, Family Support Services of North Florida, Inc.

Mark Mahoney, Director of Revenue Management, DCF

Lisa Peyton, Chief Operating Officer, IMPOWER

Cheri Sheffer, Chief Operating Officer, Devereux Community Based Care

Janice Thomas, Assistant Secretary for Child Welfare, DCF

Sallie Bond will serve as primary point of contact with the Administration for Children and Families (ACF), Children’s Bureau for matters related to the demonstration project.

The details of the implementation of the demonstration are being accomplished by work teams that include persons with the expertise in specific issues or practice areas. As the demonstration project proceeds, additional work groups may be formed as additional need for expertise is identified. For the demonstration, the following groups have been established to accomplish the tasks necessary for a successful demonstration:

Eligibility – This work group will review and modify procedures, as necessary, to ensure that IV-E eligibility determinations are made for all children who are involved in the demonstration project to ensure eligible children retain their eligibility after the demonstration ends and to

42 Revised 10/2015

ensure that IV-E eligibility can be properly determined for the purpose of Adoption Assistance Payments.

Fiscal Accounting and Reporting – This work group will address issues related to cost allocation, financial accountability and reporting related to the demonstration. The group will develop procedures to ensure that financial information related to the demonstration is reported on Form CB 496 and relevant attachments are completed in sufficient detail to assure that information needed for effective management of the demonstration is provided. This work group will also provide information necessary for preparation of the fixed schedule of payments for the five-year demonstration period as required by section 4 of the Terms and Conditions and recommend any subsequent modification to this schedule. This work group will also assure the cost neutrality provisions of section 4 of the Terms and Conditions are met.

Provider Relations/ Contract Provisions – This work group will develop or modify any necessary modifications or attachments to contracts between DCF and the CBC Lead Agencies in order to meet the requirements of section 2.1 of the Term and Conditions.

Array of Service/ Practice Issues – This work group will provide guidance and/or technical assistance on program practice in order to best use the flexibility of the demonstration to improve child welfare practice. This group will consider how the improved array of community-based services provisions of the demonstration in section 2.1 of the Terms and Conditions can be used to accomplish the permanency and safety outcomes for children and families and to improve the well-being of children and families.

Communication and Training– This work group will develop effective mechanisms to share information about the demonstration with stakeholders and interested parties. This group is also responsible for development and deployment of training material related to the demonstration.

Evaluation – This work group will assure that an independent evaluation is conducted that meets the requirements of the waiver terms and conditions. This will include procuring the evaluator, assuring that an evaluation design document is submitted for review and approval by the Children’s Bureau, and ongoing coordination with the evaluator throughout the course of the demonstration. In January 2015, the Department contracted with the University of South Florida, Florida Mental Health Institute, as the third party independent evaluator.

Schedule of Events and Deadlines for Securing Evaluator

ACTIVITY DATE Status/Comments

RFP advertised and released on Florida VBS

7/18/2014 Completed

Submission of written inquiries must be received by:

8/4/2014 Completed

Deadline for Department's Response to Inquiries

8/8/2014 Completed

Sealed Proposals must be received by the Department

8/22/2014 Completed

Proposal Opening and Review of Mandatory Requirements

8/22/2014 Completed

Debriefing Meeting of the Evaluators and ranking of the proposals

9/3/2014 Completed

43 Revised 10/2015

ACTIVITY DATE Status/Comments

Anticipated posting of intended Contract Award

9/9/2014 Completed

Anticipated Effective Date of Contract 10/1/2014 Completed

Contract Executed 1/26/2015 Completed The following work plan shows the major tasks, deliverables and time frames for accomplishing the tasks as assigned to each of the work groups and oversight team. This work plan will be reviewed and updated as the demonstration progresses to assure that implementation of the demonstration proceeds in accordance with the Terms and Conditions. Each of the work groups as delineated on the work plan will develop detailed plans that provide description of key tasks, responsible parties, timeframes, and benchmarks of progress. At this time, the cost of specific interventions and evidence-based practices is unavailable. The evaluator will assist with determining these costs for inclusion in future progress reports. Key Tasks, Reporting Requirements, Timelines

Major Tasks/ Deliverables Due/ Completed Assigned/ Comments

1. Organize the activities necessary to prepare for implementation of the waiver during the renewal period. Establish a waiver management and support structure to guide the effort.

02/2014

Completed

Oversight Committee

2. Submit a document showing the fixed schedule of payments for the five year demonstration period.

03/2014

Completed

Oversight Committee

3. Submit an Initial Design and Implementation Plan/Report.

05/2014

03/2015

04/2015

10/2015

Submitted

Oversight Committee

IDIR modified to address system changes

3.1. Eligibility 04/2015

Completed

Sallie Bond

(DCF & CBC)

44 Revised 10/2015


3.1.1. Complete review and modification of eligibility protocol, as appropriate.

08/2014

Completed

Eligibility work group

Complete. Eligibility enhancements identified for FSFN and design specification documents completed.

3.1.2. Implement revised eligibility protocol, if needed.

01/2015

Completed

Eligibility work group

Complete. Amended operating procedure published.

Operating procedure modified in May 2015.

3.1.3. Incorporate eligibility revisions into FSFN, as appropriate

04/2015

Completed.

Eligibility work group & FSFN IT Team

Complete. FSFN enhancements in production in April 2015.

3.2. Fiscal Accounting and Reporting 08/2015 and ongoing

Mark Mahoney Barney Ray

Allison Hill, Lake view

John Aitken, Kids Central

Pam Griffith or Nicole Strobel, Eckerd

Bob Miller, Family Support Svcs of North FL

Kellie Messer , Devereux

3.2.1. Determine the federal reporting requirements for the Florida waiver through discussion with ACF Atlanta and Washington.

05/2014

Completed

Fiscal accounting and reporting work group

45 Revised 10/2015


3.2.2. Revise State accounting codes necessary to capture data for the Federal report, State program modifications, State reports and internal reports.

08/2014

Completed


3.2.3. Modify the GRANTS System to accommodate the changes necessary to correctly report expenditures by Federal grant based upon analysis of the Federal reporting requirements and program delivery modifications and changes.

08/2014

Completed


3.2.4. Determine the elements of a revised Cost Allocation Plan for the Community-Based Care (CBC) projects.

07/2015

Completed


3.2.5. Modify the CBC expenditure reports to reflect the elements contained in the new cost allocation plan, as appropriate.

07/2015

And ongoing


3.2.6. Modify the CBC contracts for implementation of the waiver renewal.

7/2015

Completed

Contract provisions work group in coordination with fiscal accounting and reporting work group.

3.3. Contract Provisions Cameo Bryant

3.3.1. Identify the specific Lead Agencies that will be involved in the provision of waiver-funded services, and the geographic region or regions served (per section 2.1of the T&C).

03/2014

Completed

See CBC Map in Attachment 12

The waiver is statewide.

46 Revised 10/2015


3.3.2. Incorporate into the contracts with each Lead Agency provisions related to standards of quality, safety and practice requirements.

03/2014

Completed

Existing standards are summarized in section IV of this report and the Attachment 10 titled, “Authority and Requirements”.

3.3.3. Incorporate provisions into Lead Agency contracts specifying payment rates, contact between case managers and children and their families, documentation and reporting requirements and mechanisms for regular review of progress towards achieving each child and family’s safety, well-being, and permanency goals.

03/2014

Completed

Contract provisions work group

See Attachment 11

3.3.4. Incorporate provisions into Lead Agency contracts specifying quality assurance responsibilities.

03/2014

Completed


See Attachment 11

3.3.5. Specify in the contract the responsibilities of the State in supporting Lead Agencies in providing services and supports to eligible children and families and in monitoring the contract.

03/2014

Completed


See Attachment 11

3.4. Array of Service/ Practice Issues 12/2015

Ginger Griffeth/ Traci Leavine

47 Revised 10/2015


3.4.1. Review and modify, as necessary, draft list of principles and values to guide further development of the array of services.

12/2015

Ongoing

Array of service/ practice issues work group

Survey of Services in progress as of January 2015. Survey responses compiled in June 2015.

Secretary’s Priority of Efforts: Operationalize World Class Child Welfare Practice

High level service array menu defined and aligned with practice. Refinements are underway and will be informed by the face-to-face service array assessments in the regions.

Anticipate completion of Region Visits and face-to-face service array assessments by 11/4/2015.

Identify full array of services menu to be available in each community by end of December 2015.

3.4.2. Coordinate with Contract Provisions group to ensure consistency between needs of systems of care for flexibility in service planning and identification of supports.

Ongoing Array of service/ practice issues work group and contract provisions work group

48 Revised 10/2015


3.4.3. Coordinate with evaluation group to ensure that linkage between changes to services and supports and outcomes are incorporated into evaluation.

Ongoing Array of service/ practice issues work group and evaluation work group

3.4.4. In conjunction with communications group, develop processes to share best practices among CBC Lead Agencies.

Ongoing Array of service/ practice issues work group and communications and work group

3.5. Communication and Training 12/2015 Ginger Griffeth

Todd Darling

3.5.1. Establish an intranet site for collection and dissemination of information regarding demonstration.

Ongoing

Complete

Communications and Training work group

Complete

http://www.centerforchildwelfare.org/Funding/TitleIVE.shtml

3.5.2. Develop communications processes to ensure internal and external customers have appropriate information regarding demonstration.

Ongoing


Waiver article in Child Welfare Today Newsletter

http://www.centerforchildwelfare.org/docs/childwelfarenews/March%20Newsletter%20Publication%202015%20-%2003.31.15.pdf

3.5.3. Coordinate with other groups regarding development and deployment of training material related to the demonstration.

Ongoing Communications and Training work group

49 Revised 10/2015


3.5.4. Incorporate into pre-service and in-service training curriculum documentation requirements and mechanisms for regular review of progress towards achieving each child and family’s safety, well-being, and permanency goal.

01/2015

Completed


Statewide Training Plan

See CFSP 2015-2019 and APSR 2015

3.6. Evaluation 1/2015 Eleese Davis

Sallie Bond

3.6.1. Submit specifications or RFP for evaluation to ACF.

05/2014

Completed

Evaluation Work group

Submitted draft specifications/RFP on 5/21/2014. Received ACF comments on 5/28/14.

ACF/CB approved specifications on 6/17/2014.

Complete.

3.6.2. Final draft of evaluation plan and related contract submitted to ACF.

4/26/2015

Completed

Evaluation Work group; evaluator

Complete. Submitted draft Evaluation Plan on 4/10/2015.

4. Submission of semiannual progress reports

10/30/2014

semiannually thereafter

Sallie Bond Oversight and coordination team

Phase Down Plan As shown in task 3.1 of the work plan, key items of information required for title IV-E eligibility will be collected through a simplified eligibility protocol and checklist. This information will be available so that IV-E eligibility can be documented for purposes of adoption assistance. The information will similarly be available to permit transition from the demonstration to normal program requirements at the conclusion of the demonstration or in the event that the

50 Revised 10/2015

demonstration is terminated. In addition to information needed for title IV-E eligibility, information will be collected for eligibility for Temporary Assistance for Needy Families (TANF) funding and to permit children in out-of-home care to be placed on the Medicaid eligibility file. Upon conclusion of the waiver, this information will be used to determine the IV-E eligibility status of all children in out-of-home care. These determinations will be made in year five of the waiver so that all children will have an updated eligibility determination prior to month 60 of the waiver. In the event that the waiver is terminated either by the Federal agency or the State agency pursuant to section 1.0 of the Waiver Terms and Conditions, the eligibility status of each child in out-of-home care will be updated within 90 days of the termination, so that title IV-E foster care funds can be properly claimed. VI. Training and Technical Assistance Assessment The waiver demonstration implementation is entering a new five-year extension period. The work teams identified in Section V may identify needs for training and technical assistance as their work continues. At this time, there is no specific need identified where the state is not already receiving technical assistance. Florida is currently receiving technical assistance from several of the national resource centers (NRC): Center for Capacity Building, NRC for Diligent Recruitment, ACTION for Child Protection, and James Bell Associates (JBA). As needs are identified, the CBCs and Regions will contact the Office of Child Welfare to coordinate the request with the Children’s Bureau. The Department has asked for technical assistance with strategic planning and the integration of multiple plans. The Children’s Bureau approved the Capacity Building Plan for Florida in September 2015. The Agreement between the Department and the Center for States was subsequently executed. Information from the Capacity Building Center will continue to be shared statewide. VII. Anticipated Major Barriers and Risk Management Strategies Florida does not anticipate major barriers at this time. The 2014 Florida Legislature passed a major child welfare bill that modifies how child welfare conducts its business and addresses accountability. There is greater emphasis on continuous quality improvement; further professionalization of child protective investigator staff; and the creation of an Institute for Child Welfare.

i All children taken into state custody must have a comprehensive behavioral health assessment within 30 days of entering care. For in-home cases, a CBHA must be completed if mental/behavioral health issues are relevant to the reason for the Department’s involvement.

Documents

TITLE IV-E CHILD WELFARE WAIVER DEMONSTRATION PROJECT …centerforchildwelfare.fmhi.usf.edu/kb/GenIVE/IV-E... · INITIAL DESIGN AND IMPLEMENTATION REPORT As required in Section 2.3