Child Welfare Services Statewide Quality Assurance Report - Florida ...

Department of 

Children and Families 

Family Safety Program Office 

Child Welfare Services 

Statewide Quality Assurance Report 

An Assessment of 

the Quality of Practice of 

Case Management Services 

Provided to Children & Families 

George H. Sheldon 

Secretary 

David L. Fairbanks 

Assistant Secretary for Programs 

Alan Abramowitz 

State Director for Family Safety 

November 2010

Florida Department of Children and Families 

Case Management Services - 2009-2010 Quality Assurance Report 

TABLE OF CONTENTS 

Executive Summary…………………………………………………………………………………………………………………......2 

I. Overview of the Child Welfare Case Management System ................................................... 4 

II. 

Case Review Process ……………………………………………………………………………………………………..….4 

III. General Findings and Practice Trends ................................................................................... 6 

a) Assessment .................................................................................................................... 6 

b) Family Engagement ...................................................................................................... 12 

c) Service Planning and Provision .................................................................................... 14 

d) Promoting Case Progress ............................................................................................. 20 

e) Supervisory Review ...................................................................................................... 24 

f) Placement Stability ..................................................................................................... 25 

g) Visits and Preserving Connections…………………………………………….................................27 

h) Independent Living Assessments and Planning…….………………………………………………….30 

i) Children Prescribed Psychotropic Medication………………………………….………………………32 

IV. 

Youth Voice………………………………………………………………….…………………………………………………35 

V. Federal Safety, Permanency, and Well-Being Domains…………………………………………………..51 

VI. 

Status of QA Standards Linked to Florida’s Quality Improvement Plan (QIP)…...................57 

Appendix 1 – Statewide Table………………………………………………………………………………………………..…..59 

Appendix 2 - FY 08-09/09-10 Comparison Table… …………………………………….……………………………....66 

Office of Family Safety | Page 1



Executive Summary 

This annual quality assurance report offers a “window into practice” for child welfare case 

management services. The information contained in this report was obtained between July 1, 2009 and 

June 30, 2010 through a comprehensive review of 1,575 case management files including case work 

information contained in the Florida Safe Families Network (FSFN). Quality Assurance (QA) staff from 

the Department of Children and Families regional offices and Community-based Care (CBC) lead 

agencies review child welfare cases to assess practice related to: 

• The prevention of separation of children from their families. 

• The protection of children alleged to be dependent or dependent children including provision of 

emergency and long-term alternate living arrangements. 

• The reunification of families who have had children placed in foster homes or institutions. 

• The permanent placement of children who cannot be reunited with their families or when 

reunification would not be in the best interest of the child. 

• The transition to self-sufficiency for older children who continue to be in foster care as 

adolescents. 

• The preparation of young adults that exit foster care at age 18 to make the transition to selfsufficiency 

as adults. 

On June 30, 2010 the CBCs and local case management organizations were serving 18,548 1 children 

in out-of-home care and 10,807 2 children residing at home. In addition, case management agencies 

successfully helped 14,211 3 children achieve permanency through adoption, reunification, guardianship, 

or relative placement. 

Quality Assurance practice data should be used as a guidepost for management when looking at 

strengths and weaknesses in their system of care. In addition to the quality of practice case review 

information, this report includes data on Florida’s performance on the federal safety, permanency, and 

well-being measures, performance on the quality of practice standards linked to Florida’s federally 

mandated Quality Improvement Plan, and observations and recommendations from youth who are 

currently in the foster care system or have recently aged out of the foster care system. The information 

from all of these sources should be considered when training case workers and developing annual 

quality improvement plans. Overall, Community-based Care lead agencies are doing a very good job 

1 FSFN Child Welfare Services Trend Report, run date September 2010 for point in time June 30, 2010 


3 FSFN ad-hoc report, run date September 2010 for point in time June 30, 2010 




developing resources to serve children and families and providing oversight and guidance to case 

management organizations. There are noted strengths in many case management service areas. These 

strengths include: 

• Providing interventions that successfully prevented re-abuse of children; 

• Developing appropriate case plan goals; 

• Identifying, recruiting, and ensuring timely approval of adoptive families; 

• Keeping placements stable and placing children close to their parents; 

• Keeping the courts informed of placement changes; and 

• Providing independent living case workers who are engaged with youth and are helping 

them prepare for transition. 

There are five key areas that require further attention to improve practice. Family engagement 

is an area that is critical to the safety, permanency, and well-being of children and is the core of 

good child welfare practice. Because many of the quality of practice standards are tied to family 

engagement activities, full implementation of the Family Centered Practice Model should result in 

improvements to casework practice. The areas needing improvement are: 

1. Full development and implementation of the Family Centered Practice model (impacts many 

child welfare practice areas) 

2. Ensuring local systems of care provide appropriate healthcare and dental care to children. 

3. Ensuring appropriate educational assessments and services are provided to children. 

4. Improving communication with local service providers. 

5. Ensuring supervisors have leadership skills and the breadth of child welfare knowledge 

needed to coach caseworkers. 

Detailed QA reports for individual CBCs are located at Florida’s Center for the Advancement of Child 

Welfare Practice: http://centerforchildwelfare.fmhi.usf.edu/qa/QA_Reports/Forms/AllItems.aspx 




I. Overview of the Child Welfare Case Management System 

Child welfare case management services in Florida are provided under the framework of the 

recently adopted Family Centered Practice Model. Family centered practice is a way of working with 

families and teams to create a meaningful, well-integrated partnership to enhance the family’s 

capacity to care for and protect their children. It focuses on the needs and welfare of children within 

the context of their families and home communities. Family centered practice recognizes the 

strengths of family relationships and builds on these strengths to achieve optimal results for children 

and families. Services are provided to families who need assistance in the protection and care of their 

children, when children must live with foster families because they are not safe at home, and when 

children are being prepared for adoption or other permanent family connections when leaving foster 

care. 

Child welfare case management services in Florida are privatized through twenty nonprofit 

community-based care (CBC) lead agencies and one county government lead agency. These lead 

agencies are responsible for providing foster care and related services including family preservation, 

prevention and diversion, dependency case work, out-of-home care, emergency shelter, independent 

living, and adoption services. Lead agencies generally sub-contract with local community child welfare 

provider organizations for case management and direct care services to children and their families. 

The Department of Children and Families (DCF) remains responsible for program oversight. 

On June 30, 2010 the CBCs and local case management organizations were serving 18,548 4 children 

in out-of-home care and 10,807 5 children residing at home. In addition, case management agencies 

successfully helped 14,211 6 children achieve permanency through adoption, reunification, 

guardianship, or relative placement. 

II. Case Review Process 

This annual quality assurance report offers a “window into practice” for child welfare case 

management services. The information contained in this report was obtained through a 

comprehensive review of 1,575 case management files including case work information contained in 

the Florida Safe Families Network (FSFN). Quality Assurance (QA) staff from the DCF regional 

offices and CBC lead agencies review child welfare cases to assess practice and identify strengths 



6 FSFN ad-hoc report, run date September 2010 for point in time June 30, 2010 




and opportunities for improvement. Each quarter CBC QA staff reviewed seventeen randomly 

selected cases to determine practice for seventy-one quality of practice standards. 

An in-depth 

Quality of Services Systemic Review was completed on at least two cases each quarter from the 

sample set of seventeen cases. In-depth reviews include stakeholder interviews with judges, 

attorneys, Child Protection Teams, foster parents, trainers, and other community members involved 

in the child welfare network. 7 

In addition, DCF QA staff and CBC QA staff jointly reviewed eight 

cases each quarter. The process of reviewing the same case, at the same time, using the same 

standards, and subsequently reaching consensus on measuring practice, helps assure inter-rater 

reliability and builds positive working relationships and partnerships. The DCF QA staff also 

conducted an independent in-depth Quality of Services Systemic Review on at least two cases each 

quarter from the sample of eight side-by-side cases. The results of the in-depth reviews are used 

locally to improve the child welfare system. The case review process is illustrated below: 

Quality Assurance Case Review Process 

FY 2009/2010 

Case Review Process 

CBC Lead 

Agencies 

17 Cases Quartertly 

6 Cases Annually 

In-Depth Quality of Services 

Systemic Review 

CBC and DCF 

Joint Case Review 

8 Cases Quarterly 

DCF Independent 

Review 

6 Cases Annually 

In-Depth Quality of Services 

Systemic Review 

In FY 2009/2010 a purposive 

8 

sample selection was used that was based on the six federal 

permanency goals: Maintain and Strengthen Families, Reunification, Adoption, Permanent 

7 Results of interviews are managed locally and not rolled up for a statewide view. 

8 The particular approach used here is also known as a non-proportional quota sample. 




Guardianship, Permanent Placement with a Relative, or Another Planned Permanent Living 

Arrangement. Guidelines were provided to select a certain number of cases from each goal, but 

with some local flexibility. Detailed QA reports for individual CBCs are located at Florida’s Center for 

the Advancement of Child Welfare Practice: 

http://centerforchildwelfare.fmhi.usf.edu/qa/QA_Reports/Forms/AllItems.aspx 

In addition to the case file review, feedback from youth was solicited through Youth Roundtables 

that were facilitated across the state. This youth empowerment activity allowed youth a legitimate 

voice in the system. In addition, the Youth Roundtables provided a forum for youth to become a 

partner in influencing local and state policy. The Youth Roundtable process and a summary of their 

critical concerns are in section IV of this report. Youth perspective were written by youth and 

submitted to be included in this report. Their writings offer an insight into their perspective of the 

child welfare system. 

III. General Findings and Practice Trends 

Child welfare case work practice encompasses the range of activities designed to help families 

with children strengthen family functioning and address challenges that may threaten family 

stability. These activities include family centered assessment and case planning; case management; 

specific interventions with families including counseling, education, and skill building; advocating for 

families; and connecting families with the supportive services and resources they need to improve 

their parenting abilities and achieve a nurturing and stable family environment. In child welfare, a 

combination of good case work practices increases the likelihood that optimal outcomes can be 

achieved. The tables and graphs contained in this report provide a view of inter-related activities 

that tell a story about child welfare practice in Florida. Each practice impacts the other and if poor 

performance is noted in one area, the likelihood for success overall decreases. 

a) Assessment 

Assessment is the process of gathering information that will support service planning and 

decision-making regarding the safety, permanency, and well-being of children, youth, and 

families. It begins with the first contact with a family and continues until the case is closed. The 

assessment is based on the assumption that for services to be relevant and effective, case 

workers must systematically gather information and continuously evaluate the needs of children 

and parents/caregivers as well as the ability of family members to use their strengths to address 

their problems. Many assessments are conducted for different purposes throughout a family's 




involvement with the child welfare system. Assessments of safety and risk are also used to 

guide decisions when new concerns are identified and before major case decisions are made 

such as reunification. But safety and risk assessments alone are not sufficient for understanding 

the range of issues related to the present concerns. There is a need to gather information on 

broader issues that will affect each family's ability to resolve concerns that led to their 

involvement with the child welfare system. It is also critical to gather information on the 

strengths, resources, supports, connections, and capacities that will help families nurture their 

children and keep them safe. 

Conducting thorough initial and ongoing assessments on the children and families being 

served is a basic child welfare function. Case workers and supervisors should be assessing every 

aspect of a case with each contact made, whether the contact is with the child, the parents, 

caregivers, providers, etc., and in every supervisory discussion, staffing, family team meeting, 

court appearance or other activity. Assessments should include information gathered from the 

family story, other family members, and professional evaluations. Ongoing, active 

communication and collaboration with the family and the other persons involved are important 

to the case worker’s ability to adequately update the family assessment. Good assessments 

impact all other aspects of case management, service delivery and achieving goals. 

Improvements in practice related to assessments were noted in each related area except 

updated family assessments (#7) documented in FSFN. This is in part due to the new 

requirement for FY 2009/2010 that the family assessment must be documented in the electronic 

case record in FSFN. Documenting the Family Assessment in FSFN has been the subject of ongoing 

discussions. OurKids in Miami has approval to use Structured Decision Making instead of 

the Family Assessment in FSFN. 

To ensure improvement, local action is needed to guide practice in the development of the 

initial family assessments and updated family assessments. In addition, it is critical that prior to 

a placement change, a multi-disciplinary staffing/assessment is conducted to ensure placement 

stability of each child in out-of home care and prevent placement disruptions. This staffing is 

intended to ensure placement moves are made only when necessary and the child’s needs and 

the appropriateness of the placement are thoroughly assessed. 




Quality of Practice for Initial Assessments 

Std# Standard # Cases Yes No 

5 

A thorough initial family assessment was conducted following the investigative 

safety assessment that sufficiently addressed child safety factors and 

emerging risks. 

# of Applicable 

Cases 

Practice 

Rating 

1575 236 124 360 66% 

7 

The updated family assessment was focused on the immediate and 

prospective safety of the child, as well as any changes and implications in the 

family's situation related to emerging concerns and service needs. 

1575 435 1058 1493 29% 

9 

A thorough safety assessment of the home was completed prior to 

reunification or placement of the child in an unlicensed out-of-home care 

setting. 

1575 437 150 587 74% 

12 

A multi-disciplinary staffing/assessment for placement planning was 

conducted before each placement to ensure the placement or move was 

unavoidable. 

1575 332 218 550 60% 

Table IIIa-1 

Conducting Thorough Initial Assessments 

FY 2008/2009 Compared to FY 2009/2010 

100% 

80% 

60% 

66% 

75% 

71% 

74% 

60% 

40% 

55% 

29% 

51% 

FY 08-09 

FY 09-10 

20% 

0% 

5 Initial family 

assessment 

7 Updated family 

assessment 

9 Assessment of the 

home 

12 Staffings and 

assessment for each 

placement 

Source: FY 2009-10 QA Web Tool 

Graph IIIa-1 




The family assessment includes a needs assessment to identify the underlying issues that 

are driving or influencing a parent’s behavior, such as obtaining adequate income, housing 

and/or health care. The needs may be emotional ones, such as a need to cope with past 

traumas, to experience safety in partner relationships, and to maintain a sense of control. 

Services are provided as an intervention to meet needs. When we are successful in reaching 

consensus with parents about their needs in order to help them become better caregivers for 

their children, we have set the stage for appropriate planning to address needs. Most 

importantly, we can define the result we want from case plan interventions in terms of meeting 

a need; for example, improving parents behaviors as opposed to completing a parenting class. 

Supervisory coaching and mentoring around the identification of child and family needs is also 

an important strategy to assist case workers with the identification of underlying family needs. 

The Family Centered Practice Training Series includes training on the case worker skills 

needed to identify needs. The Gabriel Myers Workgroup noted that all decision making should 

be guided by the principle that it is important to comprehensively address all concerns in a 

child’s life: health, education, and social/emotional issues, as well as providing behavioral 

supports so that a child’s behavioral and mental health issues can be addressed in the least 

restrictive setting and in the context of a comprehensive treatment plan. This workgroup also 

identified the need to ensure presenting needs of a child are identified and met in a timely 

manner. Although incremental improvements were noted, data indicates not much change 

from the previous fiscal year regarding assessing individual needs. Local action is especially 

needed to improve practice related to assessing the needs of fathers specific to identifying the 

services necessary to achieve case plan goals. 

Quality of Practice for Assessment of Needs 

# of Applicable Practice 

Std# Standard # Cases Yes No Cases Rating 

48 

An ongoing assessment of the child(ren)'s needs was conducted to provide 

updated information for case planning purposes. 

1575 1352 193 1545 88% 

49 An assessment for residential group care was completed when required. 1575 99 24 123 80% 

50 

52 

54 

An ongoing assessment of the mother's needs was conducted to provide 


An ongoing assessment of the father's needs was conducted to provide 


An ongoing assessment of the out-of-home care providers or pre-adoptive 

parent's service needs was conducted in order to ensure appropriate care for 

the child. 

1575 901 265 1166 77% 

1575 528 389 917 58% 

1575 978 132 1110 88% 

Table III a-2 




Assessment of Needs 


100% 

88% 

88% 

80% 

86% 

79% 

80% 

75% 

77% 

86% 

60% 

58% 

56% 

40% 

FY 08-09 

FY 09-10 

20% 

0% 


child(ren)'s needs was 

conducted. 

49 Assessment for 

residential group care was 

completed. 


mother's needs was 

conducted. 


father's needs was 

conducted. 

54 Assessment of the outof-home 

care providers or 

pre-adoptive parent's 

service needs was 

conducted. 

Source: FY 2009-10 QA Web Tool Graph III a-2 

Child welfare case planning must include an assessment of a child’s education, physical 

health, dental health, and mental health needs. The table and graph on the following page 

illustrate that assessments of a child’s individual mental/behavioral health needs are slightly 

improved from last year, but education, physical and dental health assessments took a 

downward turn; most significant of which is the child’s physical health assessments. Regions 

and CBCs should review individual performance in this area and consider conducting root cause 

analyses to help identify the underlying problem and develop counter measures as necessary. 

Anecdotally, it is said that the reason for poor performance in dental health assessments is due 

to a lack of resources, i.e., finding dentists who are willing to accept Medicaid payments. 

Additional and ongoing local and state recruitment and public awareness campaigns may be 

needed because meeting dental health needs affects a child’s entire health system. 




Quality of Practice for Assessment of Child’s Individual Needs 



Cases 

Practice 

Rating 

58 

Concerted efforts were made to assess the child’s educational needs during 

out-of-home placement. 

1575 801 151 952 84% 

61 Concerted efforts were made to assess the child’s physical health care needs. 1575 755 320 1075 70% 

63 Concerted efforts were made to assess the child's dental health care needs. 1575 443 501 944 47% 

65 

An assessment(s) of the child's mental/behavioral health needs was 

conducted. 

1575 959 119 1078 89% 

Table III a-3 

Assessment of Child’s Individual Needs 


100% 

80% 

84% 

86% 86% 

70% 

87% 

89% 

60% 

40% 

50% 

47% 

FY 08-09 

FY 09-10 

20% 

0% 

58 Educational needs 

were assessed. 

61 Physical health care 

needs were assessed. 

63 Dental health care 65 An assessment of the 

needs were assessed. child's mntl/bhvrl health 

needs was conducted. 


Graph III a-3 




b) Family Engagement 

Family engagement is the foundation of good case work practice that promotes the safety, 

permanency, and well-being of children and families in the child welfare system. Family 

engagement is a family centered and strengths-based approach to partnering with families in 

making decisions, setting goals, and achieving desired outcomes. It is founded on the principle 

of communicating with families openly, honestly, and with empathy to increase the likelihood of 

disclosure of culture, family dynamics, and personal experiences in order to meet the individual 

needs of every family and every child. Engagement goes beyond simple involvement by 

"motivating and empowering families to recognize their own needs, strengths, and resources 

and to take an active role in working toward change" (Steib, S. (2004). Engaging families in child 

welfare practice. Children’s Voice. Retrieved September 10, 2010, from the Child Welfare 

Information Gateway at: http://www.childwelfare.gov/pubs/f_fam_engagement/) 

Key to building a productive case worker-family relationship, family engagement is the 

foundation from which change occurs. It is important throughout the life of a child welfare 

case—from screening and assessment; through case planning and decision-making; to service 

delivery, case reviews, and ultimately case closure. To build on a family's resources and kinship 

connections, family engagement activities focus not only on the immediate family but also on 

the active involvement of parents, extended family, and the family's natural support systems. 

Beyond specific cases, engaging families as key stakeholders must extend to policy 

development, service design, and evaluation. 

Family engagement reflects the actions of case workers and providers to create trust-based 

relationships with parents and caregivers. When a family and older youth are meaningfully 

engaged and involved in assessment, planning and decision-making they are more likely to 

succeed with making the important life changes that will result in improved safety, permanency 

and well-being. 

Family engagement is critical to successful outcomes for children and families. Managers 

and supervisors in Florida’s child welfare system are focusing efforts on improving its processes 

to engage and work with families as one of the QIP goals. Case workers must make concerted 

efforts to promote, support, and maintain positive relationships between a child in out-of-home 

care and their mother, father, or primary caregiver. Parents and caregivers must be engaged 

and involved in decisions about their child’s needs and activities. Case workers must make an 

effort to identify a parent or caregivers barriers to involvement such as transportation, job 




hours, financial issues, etc. Case workers must also understand the importance of involving 

fathers in case planning. Research shows that children growing up without fathers are more 

likely to fail at school or to drop out, engage in early sexual activity, develop drug and alcohol 

problems, and experience or perpetrate violence. (Best Practice: Next Practice, Family Centered 

Child Welfare, National Child Welfare Resource Center for Family-Centered Practice, Children’s 

Bureau, 2002) 

Although the quality of practice case review data show improvements in efforts to engage 

family members and actively involve them in the case planning process, this area needs 

substantial attention, especially with engagement of fathers. Case workers should encourage 

mothers to identify fathers early in the case. If this fails, they should use alternative means to 

identify and locate fathers through interviews with relatives and family friends, child support 

information, etc. Local administrators are encouraged to monitor and support family 

engagement practices. 

Quality of Practice for Family Engagement for Case Planning 



36 

The mother was encouraged and supported to participate in making decisions 

about her child's needs and activities. 

1575 463 404 867 53% 

37 

51 

The father was encouraged and supported to participate in making decisions 

about his child's needs and activities. 

Concerted efforts were made to support the mother's engagement with 

services. 

1575 251 375 626 40% 

1575 788 303 1091 72% 

53 Concerted efforts were made to support the father's engagement in services. 1575 414 307 721 57% 

Table III b-1 




Family Engagement for Case Planning 


100% 

80% 

72% 

69% 

60% 

53% 

68% 

57% 

63% 

40% 

49% 

40% 

53% 

FY 08-09 

FY 09-10 

37% 

20% 

0% 

36 Mother encouraged to 

participate. 

37 Father encouraged to 

participate. 

51 Concerted efforts 

were made to support 

the mother's engagement 

with services. 


were made to support 

the father's engagement 

in services. 


were made to actively 

involve all case 

participants. 


Graph III b-1 

c) Service Planning and Provision 

Family centered case planning ensures the involvement and participation of family members 

in all aspects of case planning, so services are tailored to best address the family's needs and 

strengths. It includes the family members' recommendations regarding the types of services that 

will be most helpful to them, timelines for achieving the plan, and expected outcomes for the 

child and family. Case planning requires frequent updates based on the case worker’s and 

family's assessment of progress toward goals. 

An important consideration in selecting and providing services is an assessment of the 

family’s readiness to change. It is important to select initial interventions that will increase a 

family’s motivation to change by offering some reasonable choices and identifying the family’s 

needs for accessing services, such as transportation, child care, or accommodating work 

schedules. The case worker’s ability to engage families in meaningful decisions about service 

options and support needs to access services will hinge on the local system of care’s service 

array and how services are accessed. The use of dedicated resource specialists is one approach 




many systems have used to help case workers know about and expedite access to needed 

services. Quality of practice case review data indicates that case workers do a fairly good job in 

this area. Although work remains to be done, practice is showing in an upward trend. 

Quality of Practice for Service Planning to Address Child Safety 



Cases 

Practice 

Rating 

3 

If a child was re-abused or re-neglected, immediate and ameliorative 

interventions were initiated on behalf of the child. 

1575 156 15 171 91% 

4 

Concerted efforts were made to provide or arrange for appropriate services for 

the family to protect the child and prevent the child's entry into out-of-home 

care. 

1575 458 31 489 94% 

6 

Completed service referrals were consistent with the needs identified through 

investigative assessment(s), and other assessments related to safety. 

1575 1275 163 1438 89% 

8 

All immediate and emerging safety concerns were addressed and additional 

needed interventions were provided to protect the child. 

1575 687 220 907 76% 

Table III c-1 

Family Engagement for Service Planning to Address Child Safety 


100% 

91% 94% 

89% 

80% 

84% 

87% 

83% 

76% 

72% 

60% 

FY 08-09 

FY 09-10 

40% 

20% 

0% 

3 If a child was re-abused or 

re-neglected, immediate 

interventions were 

initiated. 

4 Concerted efforts were 

made to protect the child. 

6 Service referrals were 

consistent with the needs 

identified. 

8 All safety concerns were 

addressed & interventions 

provided. 


Graph III c-1 




Exit interviews are one method of assessing the provision of services from the viewpoint of 

the child. Florida Administrative Code requires that an exit interview be conducted when a child 

“leaves licensed out-of-home placement if the child resided in that placement for thirty days or 

more.” These interviews are conducted by a case worker. Exit interviews are also conducted 

with age appropriate youth when he/she is moved from one group home to another even if the 

group homes are overseen by the same provider. The interview is not to be conducted in the 

home the child just exited, but in a setting where the child feels comfortable and the 

conversation is private. For each qualifying placement, the QA reviewer must review the exit 

interview document and ensure it was completed and any concerns were acted upon. 

Progress reports are another method of assessing service delivery. The case worker must 

provide progress reports to document the effectiveness of service interventions, and share 

information with providers regarding significant changes in the family’s situation. The tragic 

death of Gabriel Myers underscored the need for providers to communicate and share 

information, functioning as a unified team. The Gabriel Myers Workgroup noted this as a critical 

gap that that needed to be addressed to ensure sharing of information among all stakeholders 

responsible for a child’s care. All provider contacts should be purposeful and directed toward 

achieving the case plan goal. Case workers must facilitate and lead communication among local 

service providers about services for the child and other case participants. The case worker 

should address progress on the case plan tasks on a routine basis. Quality of practice data 

demonstrates the need for continued attention to these initiatives. Local action should be taken 

to explore ways to improve communication and share information and to ensure case workers 

conduct exit interviews with children. 

Quality of Practice for Child Exit Interviews and Sharing Information 



Cases 

Practice 

Rating 

17 

In cases involving a child in a licensed placement setting, an exit interview was 

conducted with the child when moved from one placement to another, and 

appropriate action was taken if the exit interview documented a concern. 

1575 222 61 283 78% 

25 

The services worker communicated with service providers about the 

effectiveness of services for involved case participants. 

1575 973 497 1470 66% 

Table III c-2 




Exit Interviews and Sharing Information 


100% 

80% 

78% 

60% 

69% 

64% 

66% 

40% 

FY 08-09 

FY 09-10 

20% 

0% 

17 An exit interview was conducted with the 

child. 

25 The services worker communicated with 

service providers about the effectiveness of 

services for involved case participants. 


Graph III c-2 

Appropriate educational, health, and mental health services must be provided to address a 

child’s identified needs. The engagement of necessary educational services to address identified 

needs are required for children in out-of-home care and for children residing at home when the 

educational issue is relevant to the reason for the agency’s involvement with the family. 

Education services should always be addressed in the case plan. If the child had identified 

educational needs, services must be provided to address those needs. For example, did the child 

with an Individual Education Plan (IEP) for special education services need extra help or tutoring 

with school work, advocacy with the school system, early intervention through a preschool 

program, etc.? Were appropriate services provided to address the identified needs? Did the 

agency advocate for the youth remaining in the school of origin if that was in the child’s best 

interest? The delivery of appropriate services will also effectively reduce or resolve the issues 

that interfere with the child's education, with a goal of positively impacting the child's school 

performance and success in life. 




Appropriate services must also be obtained to address the child's physical health needs. This 

applies to all children in out-of-home care and for children residing at home when the physical 

health issue is relevant to the agency's reason for involvement. Child health records must be up 

to date and included in the case file, to the extent they are available and accessible; case plans 

must address heath care needs; caregivers must be provided with the child’s health records 

(Child Resource Record), to the extent they are available and accessible; and, health records 

must include the names of the child’s health care providers, a record of the child’s 

immunizations, child’s known medical problems, child’s medications, and any other relevant 

health information. This includes efforts to address the child’s dental health needs once the 

needs are identified. If a child is Medicaid eligible, these services should be obtained through a 

Medicaid provider. If a child is not Medicaid eligible, these services must still be provided. The 

child’s dental records should be up to date and included in the case file to the extent available 

and accessible; case plans must address the issue of dental care needs; and, caregivers must be 

provided the child’s dental records to the extent they are available or accessible. 

Finally, services must be provided to address the child’s mental/behavioral health needs. 

These services may include screenings and diagnostic tests to determine finite or long term 

needs. National research underscores the importance of providing services to address these 

needs. A 2010 report published by the National Center for Children in Poverty states “Children 

younger than three years of age are the most likely of all children to be involved with child 

welfare services and children three and younger who have been maltreated are subsequently at 

risk for experiencing developmental delays. Maltreatment in children younger than 3 years of 

age has been found to be associated with concurrent gross and fine motor delays, failure to 

thrive, heightened arousal to negative emotions, speech and language delays, and hyper 

vigilance. Age of the first episode of maltreatment is associated with mental health problems in 

adulthood. For example, maltreatment at age 2 to 5 has been linked with anti-social personality 

disorder by age 29. Younger ages of onset (birth to 2) were associated with depression and 

other internalizing disorders by age 40.” (National Center for Children in Poverty, Addressing 

the Mental Health Needs of Young Children in the Child Welfare System: What Every 

Policymaker Should Know, Janice L. Cooper, Patti Banghart, and Yumiko Aratani, September 

2010). 

The 2008 Florida CFSR noted that Florida’s performance on meeting the physical health 

needs and mental health needs of the children was an area needing improvement. The Florida 




QA practice reviews show that although the provision of educational and mental health services 

has remained relatively stable during this reporting period, the provision of physical and dental 

health needs dropped significantly. There has also been a downward trend in assessments in 

these areas. The quality of practice data demonstrates the need for local analysis of practice to 

determine root causes so that action can be taken to improve practice. 

Quality of Practice for Educational, Behavioral and Mental/Physical Health Needs 



Cases 

Practice 

Rating 

59 

If educational needs were identified, necessary educational services were 

engaged. 

1575 394 83 477 83% 

60 

Services effectively reduced or resolved the issues that interfered with the 

child's education. 

1575 303 84 387 78% 

62 

Concerted efforts were made to provide appropriate services to address the 

child’s identified physical health needs. 

1575 564 271 835 68% 

64 

Appropriate services were provided to address the child's identified dental 

health needs. 

1575 217 234 451 48% 

66 

Appropriate services were provided to address the child's mental/behavioral 

health needs. 

1575 670 155 825 81% 

Table III c-3 

Educational, Behavioral and Mental/Physical Health Needs 


100% 

80% 

81% 

83% 

83% 

78% 

82% 

82% 

81% 

68% 

60% 

67% 

48% 

40% 

FY 08-09 

FY 09-10 

20% 

0% 

59 Necessary 

educational services 

were engaged. 

60 Services effectively 

reduced or resolved the 

issues that interfered 

with the child's 

education. 

62 Appropriate services 

to address the child’s 

identified physical health 

needs were made. 


were provided to 

address the child's 

identified dental health 

needs. 


were provided to 

address the child's 

mental/behavioral 

health needs. 


Graph III c-3 




d) Promoting Case Progress 

Evaluating family progress toward case plan goals should continue throughout the life of the 

case until appropriate outcomes have been achieved. Goals 

need to be specific, realistic, flexible, and culturally sensitive. 

In each case involving a child placed in out-of-home care, an 

initial case plan must be prepared within 60 calendar days of 

removal from the home. The case plan must be submitted to 

the court by the date of the dispositional hearing at the 

latest. For in-home cases, a case plan must be finalized within 

30 days of the case being accepted for services. The case 

plan’s compliance period expires no later than 12 months 

after the initial removal or no later than 12 months after the 

case plan was accepted by the court, whichever occurred 

sooner. A case plan may not be extended beyond 12 months 

unless extraordinary circumstances exist and it is in the 

child's best interest. The extension reasons must be factually 

documented and presented to the court at the 12 month 

permanency review hearing with supportive documentation 

in the Judicial Review Social Services Report. The case plan 

may be amended to change the case plan goal, and/or 

employ the use of concurrent planning. In addition, a case 

plan must be amended if an oversight is identified or new 

information is obtained following case plan approval, i.e., 

unaddressed condition that may prevent the child from safely 

returning to or remaining in the home; child’s need for 

permanency, given age and developmental needs; a party's 

failure to substantially comply; or the ineffectiveness of a 

service previously offered. 

Case plan goals must be based on the child’s and family’s 

I want the adults to feel the 

pain of a 12 year old boy 

that doesn’t have a home. 

Goes to school with the 

same pair of shoes every 

day, isolated from everyone 

else because he isn’t “cool”. 

Pushed around, bullied, 

kicked, punched, and 

jumped after school. Has to 

run home and can’t 

socialize, and even if he 

wanted to socialize cant 

because doesn’t anyone 

want to be around him. 

Neglected, disrespected, 

has one million secrets but 

can’t tell anyone because 

no one wants to listen. 

Father beats him to 

straighten him to become a 

man. Mother is never home. 

Big brother tries to be a role 

model but is persuaded by 

the streets to be a gangster. 

Little sister is gone in the 

wind with her friends. He 

tries to keep the family 

together but there is none. 

Marcus 

Former Foster Child Placed 

in a Group Home 

circumstances. For children in out-of-home care, the 

permanency goals, in order of preference per Chapter 39, 

Florida Statutes, are reunification, adoption ( if a petition for 




termination of parental rights has been or will be filed), permanent guardianship of a dependent 

child, permanent placement with a fit and willing relative, and placement in another planned 

permanent living arrangement (APPLA). The case plan goal for court ordered in-home or noncourt 

ordered in-home cases is Maintain and Strengthen. 

Case plan tasks must be designed to improve the conditions in the home, aid in maintaining 

the child in the home, facilitate the child’s safe return to the home, ensure proper care of the 

child, or facilitate the child’s permanent placement. The case plan must clearly match the 

child’s, parents’, and/or caregivers’ needs with services, contain realistic timeframes, and 

document appropriate strategies and adequate support to successfully complete assigned tasks. 

The services offered must be the least intrusive possible; focus on clearly defined objectives; 

and provide the most efficient path to successfully achieve the Maintain and Strengthen case 

plan goal, timely reunification or permanent placement given the circumstances of the case, and 

the child’s need for safe and proper care. The tasks, services, and supports must be tailored to 

each individual family member to provide the necessary treatment and supports, formal and 

informal, needed to achieve case goals and mitigate factors affecting child safety, emerging risk 

and overall child and family well-being. The tasks should be realistic, achievable, and time 

limited, and the services should be available. Quality of practice case reviews indicate good 

practice related to case plan goals. Continued improvement is needed in keeping case plans 

current and assigning appropriate tasks to participants. 

Quality of Practice for Case Plan Goals and Tasks 



Cases 

Practice 

Rating 

21 The case record contained a current (not expired) case plan. 1575 1152 401 1553 74% 

22 

The current case plan goal was appropriate based on the child's, and family's 

circumstances. 

1575 1113 69 1182 94% 

24 

The case plan is designed to achieve permanency (out-of-home care cases) and 

safety and stability (in-home cases) through appropriate tasks for the case 

participants. 

1575 930 140 1070 87% 

Table III d-1 




Case Plan Goals and Tasks 


100% 

80% 

74% 

93% 

94% 

87% 

87% 

74% 

60% 

40% 

FY 08-09 

FY 09-10 

20% 

0% 

21 The case record contained a 

current case plan. 

22 The current case plan goal 

was based on the child's, and 

family's circumstances. 

24 The case plan is designed to 

achieve permanency and safety 

and stability through 

appropriate tasks for the case 

participants. 


Graph III d-1 

Case plan progress is also measured by the timeliness of the Termination of Parental Rights 

(TPR) petitions and judicial reviews. If the child was in out-of-home care for at least 12 of the 

most recent 22 months or met other Adoption and Safe Families Act criteria for terminating 

parental rights, a TPR petition must be filed or joined. The state is required to file or join a TPR 

petition unless there are compelling reasons for not filing. Case workers must take appropriate 

steps to identify and recruit an adoptive family that matches the child’s needs. If TPR has 

occurred, appropriate steps must be taken to identify and recruit an adoptive family. If TPR has 

not occurred, recruitment efforts must be initiated. It is critical that judicial reviews are held in a 

timely manner and include a Judicial Review Social Study Report (JRSSR) that provides a 

thorough investigation and social study concerning all pertinent details relating to the child. The 

judicial review QA standard #69 was added in FY 2009/2010, so this information provides a 

baseline of current performance. Children’s Legal Services is currently closely monitoring 

progress on timeliness of TPRs. 




Quality of Practice for Activities Associated with Termination of Parental Rights 


41 

If a Termination of Parental Rights petition was not filed, there were 

compelling reasons and an exception for not filing the petition was 

documented. 


Cases 

Practice 

Rating 

1575 176 130 306 58% 

42 

43 

69 

Appropriate steps were taken to identify and recruit an adoptive family that 

matched the child's needs. 

Appropriate steps were taken to process and approve an adoptive family that 


Judicial Reviews were held in a timely manner and Judicial Review Social Study 

Report's (JRSSR's) provided a thorough investigation and social study 

concerning all pertinent details relating to the child. 

1575 172 26 198 87% 

1575 194 25 219 89% 

1575 1293 220 1513 85% 

Table III d-2 

Termination of Parental Rights 


100% 

80% 

87% 

87% 89% 

84% 

85% 

60% 

60% 

58% 

40% 

FY 08-09 

FY 09-10 

20% 

0% 

41 If a TPR petition was not 

filed an exception for not 

filing the petition was 

documented. 

42 Appropriate steps were 

taken to identify and recruit 

an adoptive family. 

43 Appropriate steps were 

taken to process and approve 

an adoptive family that 


69 Judicial Reviews were held 

in a timely manner and 

Judicial Review Social Study 

Report's (JRSSR's) provided a 

thorough investigation and 

social study. 

Source: FY 2009-10 QA Web Tool Graph III d-2 

*Standard 69 is new for 09/10 therefore no 08/09 data reflected. 




e) Supervisory Coaching and Mentoring 

The job of the frontline child welfare supervisor is critically important – perhaps the most 

demanding and difficult in the entire agency. Much has been written about the direct 

connection between the quality of supervision and important employee measures such as staff 

turnover rates, morale, and job performance and commitment. Good supervisors produce 

engaged employees which results in lower staff turnover rates and improved organizational 

performance, ultimately producing desired outcomes for children and families. Supervisors 

must coach and mentor case workers daily and, as part of the regular supervisory case review, 

conduct qualitative discussions with case workers to discuss all aspects of the child’s safety, 

well-being and permanency. The reviews should be focused on coaching the case worker to 

improve the quality of the case work so that gaps in services are identified and corrected. 

Qualitative supervisory reviews and follow through are important components of ensuring 

sound case work practices are in place that should lead to positive outcomes for children and 

families. Although practice has improved, and completing reviews timely seems to receive more 

attention, practice data reflects continued performance gaps in the quality and follow through 

of supervisory oversight. Practice reviews document the need for targeted work with 

supervisors to improve skills in the areas of coaching staff. This is an area that needs local 

assessments in order to effect necessary change. The Department is currently pursuing several 

initiatives to improve supervisory skills that will have a direct impact on case work practice. 

Quality of Practice for Supervisory Coaching and Mentoring 



20 

Qualitative supervisory reviews and follow through were conducted as needed 

and required. 

1575 785 790 1575 50% 

20.1 Reviews were completed quarterly. 1575 1196 377 1573 76% 

20.2 

20.3 

Supervisor considered all aspects of the child's safety, well-being and 

permanency. 

Supervisor ensured follow through on guidance and direction or documented 

the reasons the guidance and direction were no longer necessary. 

1575 965 609 1574 61% 

1575 757 803 1560 49% 

Table III e-1 




Supervisory Reviews and Follow Through 


100% 

80% 

76% 

60% 

66% 

61% 

50% 

53% 

49% 

40% 

37% 

38% 

FY 08-09 

FY 09-10 

20% 

0% 

20 Qualitative supervisory 

reviews & follow through 

were conducted as 

needed and required. 

20.1 Reviews were 

completed quarterly. 

20.2 Supervisor 

considered all aspects of 

the child's safety, wellbeing 

and permanency. 

20.3 Supervisor ensured 

follow through on 

guidance & direction or 

documented reasons they 

were no longer necessary. 


Graph III e-1 

f) Placement Stability 

Placement stability is important for children to develop healthy secure and serves to reduce 

the potential stressors that arise from being displaced multiple times relationships (Leathers, S.J 

(2002). Foster Children’s Behavioral Disturbance and Detachment from Caregivers and 

Community Institutions. Children and Youth Services Review, Vol. 24, No. 4, pp 239-268). 

Frequent placement moves not only compound the issue of being separated from one’s parents, 

but can also result in separation from siblings, relocating to a new geographical area, and 

experiencing a sense of not belonging. All of these can have a profound negative emotional 

impact and produce a fear of forming secure healthy relationships. Additionally, placement 

stability is especially important for youth success in foster care. 

Youth who experience minimal placement changes are more likely to experience fewer 

school changes, less trauma and distress, less mental health and behavioral problems and 

increased probabilities for academic achievement and experiencing a lasting positive 




relationship with an adult (Gauthier, Fortin, & Jeliu, 

2004; Rubin, Alessandrini, Feudtner, Mandell, 

Localio, & Hadley, 2004). Every child who must be 

removed from their own home because of abuse or 

neglect deserves to be placed in an out-of-home 

care setting that is safe, stable and nurturing. Safe, 

stable and nurturing out-of-home care settings are 

critical to achieving optimum outcomes and 

permanency for children whether the goal is 

“If someone would have listened to me or 

tried to understand what I was saying, or 

took the time to figure out why I was acting 

out, maybe I wouldn’t have ended up 

jumping around from home to home, 

committing a crime, getting pregnant, or 

dropping out of high school. “ 

Former Foster Care Youth 

reunification, guardianship, adoption, or Another Planned Permanent Living Arrangement. The 

more that a child remains in a stable placement while in out-of-home care, the more likely that 

child will thrive into the future. Quality of practice data indicates improvement is needed 

regarding planning placement moves, a critical factor in avoiding placement change. 

Quality of Practice for Placement Stability 



Cases 

Practice 

Rating 

13 

The child's current placement is stable and appropriate to meet the child's 

needs with no apparent or significant risks or projections of disruption. 

1575 1040 87 1127 92% 

14 

Concerted efforts were made to identify, locate and evaluate other potential 

relatives and possible permanent placements for the child. 

1575 658 174 832 79% 

15 

16 

19 

The child experienced no more than two out-of-home care placement settings 

during the period under review. 

If No was entered for #15, all placement changes were planned in an effort to 

achieve the child's case goals or to meet the needs of the child. 

The court was informed of the child's placements and reasons for changes in 

placement. 

1575 1084 164 1248 87% 

1575 93 92 185 50% 

1575 581 68 649 90% 

Table III f-1 




Placement Stability 


100% 

80% 

91% 

92% 

79% 

80% 

87% 

91% 

90% 

60% 

40% 

67% 

46% 

50% 

FY 08-09 

FY 09-10 

20% 

0% 

13 The child's current 

placement is stable with no 

apparent risks or projections 

of disruption. 


made to identify, locate & 

evaluate other relatives & 

possible placements for the 

child. 

15 The child experienced no 

more than two out-of-home 

care placement settings. 

16 If No for #15, all placement 

changes were planned to 

achieve the child's case goals. 

19 The court was informed of 

the child's placements and 

reasons for changes in 

placement. 

Source: FY 2009-10 QA Web Tool Graph III f-1 

g) Visits and Preserving Connections 

Children need visits to maintain their family attachments and comprehend what has 

happened to them. Visits are also an important opportunity for parents to increase their 

understanding of and ability to meet their children’s needs. Major contributing factors to 

successful outcomes for children and families in the child welfare system are the frequency and 

the quality of case worker visits with all of the people involved in a case; to include mother, 

father, child, siblings, and other caregivers. Frequent and qualitative visits show the family the 

case worker is investing time and interest in them and that helps establish trust and effective 

working relationships that are needed to achieve positive outcomes. Frequent and quality visits 

promote ongoing assessment of the child and family in real time, help improve placement 

stability, and ensure appropriate interventions are relevant for current needs. When family 

members are not living together, but the intent is to reunify and maintain and strengthen the 

family in the future, it is the child welfare system’s responsibility to preserve family connections 

until that can happen. 




Although substantial improvements were seen in frequency and quality of worker visits 

which should lead to improved outcomes for children and families, action is needed to improve 

in this area. Supervisors should continue to support and encourage these visits as one of the 

most effective means of engaging families, promoting case progress, and preserving the 

important connections between children and their families. 

Quality of Practice for Child Visitation 


23 

The case plan specifically addressed visitation and other contact plans with all 

case participants. 


Cases 

Practice 

Rating 

1575 545 234 779 70% 

30 

31 

56 

57 

Concerted efforts were made to ensure visitation (or other contact) between 

the child and parents were sufficient to maintain or promote the continuity of 

the relationship between them. 

Concerted efforts were made to ensure visitation (or other forms of contact if 

visitation was not possible) between the child and his or her siblings and it was 

of sufficient frequency to maintain or promote the continuity of the 

relationship. 

The frequency of the services worker's visits with all case participants was 

sufficient to address issues pertaining to the safety, permanency goal, and wellbeing 

of the child. 

The quality of the service worker's visits with case participants was sufficient 

to address issues pertaining to the child's safety, permanency and well-being. 

1575 757 160 917 83% 

1575 298 96 394 76% 

1575 910 653 1563 58% 

1575 1079 487 1566 69% 

Child Visitation 


Table III g-1 

100% 

80% 

80% 80% 

70% 

83% 

73% 

76% 

69% 

60% 

58% 

59% 

FY 08-09 

FY 09-10 

40% 

39% 

20% 

0% 

23 The case plan 

specifically addressed 

visitation & other 

contact plans with all 

case participants. 


were made to ensure 

visitation b/w child & 

parents were sufficient 

to maintain their 

relationship. 


were made to ensure 

visitation b/w child & 

siblings was made to 

maintain their 

relationship. 

56 Frequency of the 

services worker's visits 

was sufficient to address 

issues. 

57 Quality of the services 

worker's visits was 

sufficient to address 

issues. 


Graph III g-1 




When the case plan goal is reunification, the child must be placed as close as possible to the 

parent with whom reunification is planned. When placing children, the case worker must take 

into consideration the family’s home address, its proximity to the placement, and the impact on 

frequency of parent/child visitation. Every possible effort must be made to place siblings in the 

same home, when two or more siblings are in licensed or non-licensed out-of-home care. 

Concerted efforts are required to maintain the child’s connections to his or her neighborhood, 

community, faith, extended family, tribe, and friends. The most appropriate available out-ofhome 

care placement should be chosen based on the child's community ties and school 

placement. To ensure continuity of education, concerted efforts are required to maintain the 

child within the same school, if at all possible. 

When removal or court ordered supervision occurs, the case worker must inquire of the 

mother or father (or a maternal or paternal relative if the mother or father could not be located) 

about whether they are of Native American or Alaskan Native descent. The service agency is 

responsible for ensuring that a child who is receiving services has been appropriately identified 

as to heritage. Each area showed improvement, but significant improvement was noted in 

placing siblings together and making inquiries related to Native American or Alaskan Native 

heritage. 

Quality of Practice for Child Placement 



Cases 

Practice 

Rating 

26 

The child's current placement was in close proximity to the parents to facilitate 

face-to-face contact between the child and parents while the child was in outof-home 

care. (applicable to out-of-home care cases) 

1575 748 64 812 92% 

28 

The child was placed with siblings who were also in licensed and/or nonlicensed 

out-of-home care. 

1575 449 304 753 60% 

32 Concerted efforts were made to maintain the child's important connections. 1575 1022 167 1189 86% 

33 

An inquiry was made to determine if the child was of Native American or 

Alaskan Native heritage. 

1575 671 777 1448 46% 

Table III g-2 




Placement 


100% 

91% 

92% 

86% 

80% 

85% 

60% 

60% 

40% 

53% 

46% 

FY 08-09 

FY 09-10 

20% 

21% 

0% 

26 The child's current 28 The child was placed with 

placement was in close siblings who were also in 

proximity to the parents to licensed and/or non-licensed 

facilitate face-to-face contact out-of-home care. 

between the child and parents. 


made to maintain the child's 

important connections. 

33 An inquiry was made to 

determine if the child was of 

Native American or Alaskan 

Native heritage. 

Source: FY 2009-10 QA Web Tool Graph III g-2 

h) Independent Living Assessment and Planning 

Older children and youth in out-of-home care should receive independent living services to 

help prepare them for self-sufficiency in adulthood. They can receive these services while they 

are living in any type of out-of-home care placement (such as kinship care, family foster care, or 

residential/group care). Youth receiving independent living services can be working toward 

achieving any of the permanency goals (such as reunification, adoption, or guardianship) or they 

may be approaching aging out of foster care to adulthood on their own. Independent living 

services generally include assistance with money management skills, educational assistance, 

household management skills, employment preparation, and other services. 




Independent living assessments beginning at 13 years of age are intended to address the 

teen’s individual needs, life skills, education, and social skill development in order to prepare 

them for the future, and especially for the teen to live independently if he/she ages out of foster 

care upon reaching 18 years of age. While in foster care, however, the expectation is that the 

teen can live as much of a normal life as possible while preparing to transition. Education and 

career paths, normalcy, and transitioning standards were added for FY 2009/2010, so the data 

for these three practices is baseline data. Addditional information can be found in the 

Independent Living Special QA Review Reports for Phase I dated September 2009 and Phase II 

dated June 2010. These reports can be viewed at the website for the Florida Center for the 

Advancement of Child Welfare Practice: 

http://centerforchildwelfare.fmhi.usf.edu/qa/SpecialQA_Reviews/Forms/AllItems.aspx. 

Quality of Practice for Independent Living 



Cases 

Practice 

Rating 

44 

If the case involves a youth who has reached 13 but not yet 15 years of age and 

he/she is living in a licensed, out-of-home care placement, a pre-independent 

living assessment was completed that identified service needs and services 

were provided. 

1575 83 24 107 78% 

45 

If the child is 13 years of age or older and in licensed foster care, the case 

management agency provided guidance and assistance in developing an 

educational and career path that is based on the child's individual abilities and 

interests. 

1575 232 67 299 78% 

46 

47 

The teen-aged focus child is afforded opportunities to participate in normal life 

skills activities in the foster home and community that are reasonable and 

appropriate for his/her respective age or special needs. 

For youth 15 years of age but not yet 18, the agency appropriately monitored 

his/her progress towards successfully transitioning from foster care to 

independence through regular informative staffings. 

1575 214 66 280 76% 

1575 186 54 240 78% 

Table III h-1 




Independent Living Assessment and Planning 


100% 

80% 

78% 78% 76% 78% 

73% 

60% 

40% 

FY 08-09 

FY 09-10 

20% 

0% 

44 Pre-independent 45 Guidance in 46 Participation in normal 

living assessment 

identified service needs. 

developing educational & 

career paths 

life skills activities. 

47 Appropriate 

monitoring of progress 

toward successful 

transition (age 15-17) . 

Source: FY 2009-10 QA Web Tool Graph III h-1 

*45,46,47 - no 08/09 data 

i) Children Prescribed Psychotropic Medication 

When a child is placed in an out-of-home care setting and a prescribing physician has 

recommended the child be placed on psychotropic medication, the child welfare agency must 

ensure that the child and the family consult with the prescribing physician before medication is 

administered. If parental rights are intact, parents must be given an opportunity to give express 

and informed consent that is based on a thorough understanding of the reasons why the 

medication is being prescribed. This requires parental consultation with the prescribing 

practitioner to discuss the nature and purpose of the treatment, alternative treatments for their 

child, and factors such as potential side effects and how to respond to them. During the first 

quarter of FY 2009/2010, regional and CBC quality assurance staff conducted an exhaustive case 

file review of each child in out-of-home care that was prescribed a psychotropic medication. 

The special QA review ultimately resulted in identifying and taking action to resolve issues 

related to children in out-of-home care who were prescribed a psychotropic medication. The 




Gabriel Myers Workgroup recommended the development of new QA standards to ensure there 

was a standardized process for on-going review of practice in this area. The quality of practice 

data indicates more training and supervisory oversight is needed to ensure parental consent 

constitutes the meaning of “valid and informed”. Supervisors must also carefully review cases 

to ensure the accuracy of FSFN. Some of the issues identified by QA staff include: 

o FSFN shows court authorization is obtained but the court order is not current. 

o The file review identifies that a child is on a psychotropic medication but there is no 

documentation in FSFN. 

o There is no documentation that the case manager facilitated communication between 

parents and doctors to obtain consent. 

o Court authorization is being obtained without making any effort to obtain consent from 

a parent who is engaged in the case planning process. 

o Data entry errors regarding dates of prescriptions are being made. 

o Consent may be present for only one psychotropic medication but the child is on two or 

more medications and consent was not obtained for each medication. 

o FSFN will not allow a medication to be entered in FSFN until the date of consent or date 

of court authorization is entered. Case managers forget to go back and enter the 

information. 

o The required Medical Report is not used and the physician does not use a report that 

includes all information required to be in the Medical Report. Or, the Medical Report is 

incomplete. 

o If the case manager does not check the psychotropic medication tab when a child is on a 

psychotropic medication for medical purposes, the case cannot be identified through ad 

hoc reporting. 

o Some dates in FSFN for informed consent are not accurate. For example, an informed 

consent date is in FSFN, but upon review the date pm the Medical Report differs. 

When deficiencies were noted during the QA practice review, a Request for Action (RFA) 

was submitted to management. Region and CBC QA staff track all RFAs to ensure corrective 

action is taken. Local managers and supervisors should develop local processes to ensure all 

close oversight of this population of children. In addition, because there is always staff 

turnover, in-service training should be routinely provided to case management organizations as 

needed. 




Quality of Practice Related to Children Prescribed Psychotropic Medications 


67 

The Medical Report documenting Informed consent was complete or a court 

order was in the file. 


Cases 

Practice 

Rating 

1575 202 72 274 74% 

68 

Data in the Florida Safe Families Network accurately documented the child's 

prescribed psychotropic medication. 

1575 162 95 257 63% 

Table III j-1 

Psychotropic Medications 


100% 

80% 

60% 

74% 

63% 

FY 09-10 

40% 

20% 

0% 

67 The Medical Report documenting 

Informed consent was complete or a court 

order was in the file. 

68 Data in the Florida Safe Families Network 

accurately documented the child's prescribed 

psychotropic medications. 


Graph III j-1 




IV. 

Youth Voice: Empowering Youth to Improve 

Child Welfare Practice 

In 2010, as part of the Quality Assurance review 

process, eight Youth Perspective Roundtables 

were facilitated across the state. The purpose of 

the Youth Perspective Roundtable was to learn 

from youth in foster care and empower them to 

talk about their challenges, needs, feedback, 

and recommendations that could improve child 

welfare practice and the quality of the foster 

care system. The Youth Perspective 

Roundtables consisted of a series of discussions 

with youth in foster care, ranging in age from 13 

years to 22 years. A youth who was still in foster 

care led each group in a 90 minute discussion 

that focused on six areas: placement, 

education, transportation, services, 

independent living, and community resources. 

Within each area the youth: 

1) identified “important people” in their 

lives and defined their characteristics; 

my mother, father, pastor, caseworker, 

etc. 

2) described their feelings about being “in 

care” and “out of care” and the process 

of (or expectations for) transitioning to 

adulthood, and 

3) brainstormed ways in which their 

experience foster care might be 

“changed,” with a focus on ways of 

strengthening relationships. 

Taran’s Story – A Struggle from Birth 

I entered foster care for the first time as a newborn 

and I was in and out of shelter and foster care for 

the next 18 years. My behavior was not always 

good. I was angry. I had a failed adoption and 35 

different foster home placements; I was in four 

group home placements and I was incarcerated in 3 

different commitment programs. At 17 after my last 

commitment program in secure detention, I was 

advised by my Independent Living Coordinator that 

it’s time to change, time to grow up, you change 

now before it is too late. And I did. 

Having supportive adults in my life helped me begin 

to believe I could achieve success and knowing there 

were people who cared about me inspired me to 

take the steps I needed to start being successful. 

My supports/mentors listened to me and never gave 

up. They often gave constructive advice, even if I did 

not take their advice at that time it influenced my 

decisions later in life when the words would come 

back to me. Words like “stay focused”, “stay 

determined” “you are a good person” you CAN DO 

IT”. 

I have made every effort to take advantage of the 

opportunities offered to me during my experience in 

foster care. Programs like the Independent Living 

program and AMI Kids (formerly Escambia Bay 

Marine Institute) helped me learn to set goals and to 

make a real plan to achieve those goals. Even 

though it seemed like I was always in trouble, I loved 

school and finally realized I had all the help I could 

need if I only used it. Asking for help was a hard 

thing to learn to do. 

I graduated from high school, earned an AA degree 

in Pre-law and I am now attending a four year 

University. 

If I could talk to every kid in foster care I would tell 

them to make those important connections with 

supportive adults. I would encourage foster children 

to learn to see life from other perspectives-to ask for 

help, to have faith and to trust enough to reach out 

to the community. 

I have been asked to speak at conferences and 

training seminars. I put my message out there to 

everyone: My message is to believe that life can be 

lived as you want and not lived how you have 




Children in foster care are particularly vulnerable as they often come into state care 

traumatized due to their exposure to maltreatment, family instability, and a number of other 

risk factors that compromise their healthy development. Children in care may be witnesses to, 

and victims of, family violence, or may have been subjected to inadequate and impaired care 

giving that result from a variety of parental issues, such as substance abuse, mental illness, and 

developmental disabilities. Moreover, these children are predominantly from impoverished 

backgrounds, a situation that intensifies the risk factors they experience. 

Youth and young adults who are either currently in foster care, or who have recently aged 

out of foster care, must be empowered to have a voice in the child welfare system. This section 

provides a summary of the perspectives, ideas, experiences, knowledge, and actions of young 

people. Every time a statute, administrative code, policy or law is implemented or changed, we 

hear, “Did you ask the youth? What do they think?” The youth voice is essential to any type of 

these changes. The more information the Department receives from youth, the better our 

ability to improve the delivery of quality services. 

An interesting dynamic developed in one area where there was a sibling group of four youth 

who were 17-24 years of age. All four children grew up in foster care. One youth, age 24, and 

another who was 20, talked about all the supports, guidance, and resources they did not have as 

compared to their younger siblings; who felt they were receiving these supports and resources. 

The youth acknowledged how much progress Florida has made in helping youth prepare to live 

independently. The results of the youth perspective about the child welfare system are 

summarized below. This information should be used at the local level to improve practice. 

1. There is generally a lack of discussion between the youth and the case worker about placement 

options. 

2. Youth understood that they could not always be placed with a sibling. Their concern was the 

failure of foster parents or case workers to help them keep connected with a sibling who was 

also in foster care, through visits and telephone calls. 

3. Youth struggle to stay caught up in school because many times they are moved and must 

change schools. Although recognizing some placement moves were due to their acting out 

behavior, school was a safe place that offered stability in their life. The loss of school, teachers, 

and friends made them feel unsafe again. Youth who turn 18 while in high school are fearful 

about losing their foster care placement prior to graduation. 




4. Youth acknowledged that many of them have mental health issues. They felt foster parents 

needed to be better prepared to handle their behavior. Furthermore, youth did not understand 

their diagnosis, their behaviors, or treatment with medication. Although generally told their 

diagnosis, no one explained it to them in age appropriate terms. Youth believe that when foster 

parents don’t understand the diagnosis, there is a risk of placement failure when the youth acts 

out. 

5. Youth expressed concern that case workers frequently change, forcing them to rebuild trust and 

relationships. They felt this impacted their case plan and goals for a permanent home. 

6. Youth want mentors in the community who can be a permanent connection when they 

transition from foster care. Although they may have an independent living caseworker or GAL, 

they felt they needed someone outside of government that they could turn to in times of need. 

7. Youth could not always participate in after school activities such as drama club, dance, football, 

and so forth due to lack of transportation. Youth were also concerned that they are unable to 

get a driver’s license when they turn 16. Case workers and foster parents don’t feel comfortable 

signing for underage youth. 

8. Youth praised the Department’s Independent Living (IL) Programs. They felt well supported by 

their IL workers. They expressed concern about possible reductions in their Road to 

Independence payments. Some of the youth in group home shared instances where rules 

prohibit driving, cooking, and sleepovers due to liability issues. 

In summary, these youth offer many insights into the child welfare system of care. Their 

thoughts and observations must be valued and used to improve practice in local systems of care. 

Their perspective and their voice are critical to improving practice as they are our primary 

consumer. They know there are challenges but they want all future children entering foster 

care to always feel they are loved as part of a family. 

The information below was written by youth and provides their perspective of the child 

welfare system. 




Hillsborough Youth Perspective Roundtable 

Youth Perspective Roundtable Report 

September 2010 

Introduction. The voice of the youth in Hillsborough County matters! We appreciate the 

opportunities that we have had to share our concerns, thoughts and opinions through our 

involvement in the Youth Empowerment Board. As programming improvements are made 

locally and statewide, it is important for policy makers to realize that an opportunity for growth 

still exists. Listening and accepting the youth voice will allow future partnership between youth 

and adults striving to make system change. 

Methodology. The youth in Hillsborough County that participated in the “Youth Perspective 

Roundtable” came together through an invitation from Independent Living staff and an open 

invitation during our monthly Youth Empowerment Board meeting. Our ages ranged from age 

14 to age 18 and our foster care experience included residing in foster homes, group homes and 

living independently. Although, the majority of the youth present were currently residing in a 

group home. Youth present hoped to provide ideas as to what was working and suggestions on 

what areas within foster care could be improved. 

Analysis and Discussion. Listed below are some areas discussed during the roundtable 

discussion. 

Placement- Areas of further improvement included wanting more freedom/normalcy, 

wanting increased allowance and the concern regarding the lack of or minimal communication 

regarding placement changes which leads to unstable placements. What we found that is 

working is the homes that we live in care about us and accept us for who we are and where we 

have been. We are supported in our sibling visits and relationships. 

Education- Areas of further improvement included wanting to be informed early on 

regarding college options especially for those that are behind or have fallen behind in the past 

and also ways to prevent and advocate for no school switches when placement changes occur. 

What we found that is working is that we are taught to advocate for ourselves so that we stay in 




the same school to avoid any further disruptions and opportunities through ILS, school and our 

placements to get exposed to colleges, tutoring, IMPACT- credit recovery programs and we see 

the general care and follow up from those that want to see us succeed. 

Transportation- Areas of further improvement include gaining resources to assist youth in 

purchasing their first car, paying for car insurance and accessing bus passes preferably at a 

discounted rate. What we found that is working is that many of us have our learners permit 

thanks to the help of our care managers and caregivers. We are supported with our desire to 

take drivers training at school if available. We feel that our transportation needs to doctors 

appointments and sibling visits are always met by our care manager most of the time and 

sometimes our caregivers. 

Independent Living Services- Areas of further improvement includes increased Life Skills 

training in the area of savings and investments. What we found that is working is the creative 

Life skills training that include incentives and hands on learning, the state funding of Road to 

Independence to insure continued education past the age of 18, Florida tuition waiver to assist 

with the educational needs of those in college/vocational school and what also works is having 

an increased awareness of the needs of the teens in care resulting in creative programs like the 

IL Teen center and Hillsborough Kids Teen Wrap foster home program. 

Community- Areas of further improvement includes lack of connections with community 

supportive adults and services early on. What we found that is working is an effort to maintain 

sibling relationships and encourage relationships with family members. 

Conclusion and Recommendations 

So as you can see, in our opinion we have a lot of things that are working in our favor but since 

we are often told not to settle we have some recommendations that might address the areas of 

further improvement. 

Training- Educate caregivers that teens need time to spend on normalcy activities outside of 

the group or family. Educate caregivers (again) that EVERYONE does not need background 

checks. Educate care managers, caregivers and policy makers that they can ask teens directly 

about their thoughts on foster care and they will sure learn a lot. Educate youth, caregivers and 

care managers that Hillsborough County has a Hillsborough Public Schools counselor on special 

assignment for foster care youth to specifically address any school issues. Provide education to 

care managers and caregivers on the use of technology to support family relationships such as 

using webcams to communicate with those not living nearby or those that do have set visits. 




Resources- Provide opportunities for youth to get exposure to career programs through 

shadowing, tours and internships. Seek out resources to secure funding, grants and donations 

to assist youth in purchasing their first car and paying for car insurance. Work with the local 

Hartline bus company for “real” meaningful discounts for monthly bus passes as $60 and even 

$45 if discounted is a lot for teens that work only a few hours a week or only receive $12 a 

month in allowance. Seek local and state support for the continued funding of Road to 

Independence and Independent Living. 

West Palm Beach - Youth Perspective Roundtable 

Hello, I am Marcus former group home resident. I am 18 years of age and now have my 

own apartment at Vita Nova Villages. I attend Palm Beach Lakes Community High School in West 

Palm Beach FL. I am a senior and also the Head Drum Major of my band. I feel as though my 

voice is important because I am the source to all of your problems. I am the solution; I am the 

“come to” person. You all have questions and I have the answers. There are flaws and loose 

screws in certain places that you need my help to tighten them. I am one of the many youth that 

can help you take that next step towards perfection to make these programs a better, supreme, 

and more of a “home like” environment. The problems I see in group homes are gratefulness, 

appreciation, role models, attention, stern guidance, and academics. These six problems can 

cause the youth to be ill prepared once he or she has leaves the program and now have to be an 

upstanding citizen in our community and role models for the toddlers, youth, and teenagers of 

the new generation. I was always told “it starts at home” which means whatever is enforced at 

home it will be instilled into the youth and the youth will perform it in the community wherever 

he or she goes. So this goes from as far as respect, discipline, manners, communication skills, 

appreciation, and so forth and so on. The men and women that work at the group homes are 

not only serving the youth but also the world. I say that because the youth that they are 

watching will learn their habits, language, and morals, and that will rub off onto the youth and 

the youth will take that and copy cat that where they go. It is imperative that the staff members 

set a good example for these kids because we are the future. I feel as though the staff members 

should take their jobs seriously and teach these kids by example and start practicing whatever 

they preach. If the kids are not brought up the way we know is the right way I hate to say it but 

instead of looking at your future business men and women, your doctors, you lawyers, your this 




and you that you’re looking at you future thieves, murderers, unemployed, drug dealers, drug 

pushers, drug uses, repeat felons, high school drop outs, jail population, and worse come to 

worse you body count in the morgue. I was asked personally by my Independent Living 

Coordinator Mr. Eric Peterman to come to the meeting because I was the “house leader” in my 

group home and also the oldest, wises, and most well spoken. I wanted to attend this meeting 

because I know the board would appreciate what I had to say, the answers I provided, and I 

seen it as a way to help out the youth that will be in group homes all over Florida after I leave. 

The age groups ranged from 14-21 I believe. I didn’t identify any missing age group or 

placement. I hope that the youth will be looked at more a son or daughter instead of a 

paycheck. Really look at their needs and help them develop into men and women. I want the 

adults to feel the pain of a 12 year old boy that doesn’t have a home. Goes to school with the 

same pair of shoes every day, isolated from everyone else because he isn’t “cool”. Pushed 

around, bullied, kicked, punched, and jumped after school. Has to run home and can’t socialize, 

and even if he wanted to socialize cant because doesn’t anyone want to be around him. 

Neglected, disrespected, has one million secrets but can’t tell anyone because no one wants to 

listen. Father beats him to straighten him to become a man. Mother is never home. Big brother 

tries to be a role model but is persuaded by the streets to be a gangster. Little sister is gone in 

the wind with her friends. He tries to keep the family together but there is none. Out of all that 

he is taken from one place to another and this place is called a group home. NOW AT THIS VERY 

POINT I WANT THE ADULTS TO TELL ME EXACTLY HOW YOU WANT TO BE TREATED IN THIS NEW 

ENVIORNMENT. See you have to put yourself in the youth shoes and walk the walk and not just 

talk the talk. How would you want to be treated after all this? Would you like to be called good 

names and hugged and told that you’re loved? That’s what I want to happen then you will see 

an improvement in the staff then it will trickle down to the youth. Embrace our presence with 

love. I believe the placement, services, Independent Living, and Community are great really 

wouldn’t change too much. With Transportation, Education these are two things that we must 

look at and improve. You al can get involved by doing periodically checkups on certain youth in 

the programs and also ask questions. In conclusion, all I would like to see youth be treated 

better and molded into the fine adults they can be. Listen to the youth……. then act! 




Pinellas & Pasco Counties Youth Perspective Roundtable 

The group was called by ILS Director to come together and discuss the concerns, what works 

and some possible solutions with DCF staff. We attended because our IL Specialist asked us to 

and we knew that we would have gotten fed. We had a wide range of participants from 15- 

18; we could have had a few younger teens to see how they felt the system has changed based 

on the stories they have heard. Our hope is that out of this meeting, change can be made that 

would help us be great in life! 

We came together as a group of teens that have all aged out of foster care and reside in 

Pinellas and Pasco counties. We receive Independent Living Services through Camelot 

Community Care and our CBC is Eckerd Youth Alternative. We believe that our voices are 

important because we are the ones that have experience the foster care system and know what 

changes are needed to assist us in obtaining our goals and dreams out of life. 

As you can see from our notes, some of the areas of concerns we identified were siblings 

separations, placements not being educated about who we are, being treated differently than 

the other children in the home (bio-kids), school records not being transferred to new schools, 

not passing FCAT, lack of proper transportation in our area; especially Pasco county, obtaining 

drivers license/insurance, obtaining SS card/birth certificate and regular ID card to name a few. 

The areas that we saw as being important were placement, education, transportation, 

services, IL and our community since Pinellas has more resources than Pasco County and 

Camelot and ECA is aware of this fact. We never want to come off as if things aren’t working, so 

here is a few that we identified: family centered practice, being supported by our placements, 

Pinellas bus pass (special cost only $4.20), having friends that has a car or just plain networking, 

GAL, Reach for the Stars program sponsored through Connected By 25, Medicaid until age 21, 

Gulf Coast Young Adult Transition Program, St. Petersburg College, Ready for Life Community 

Organization, other community partnerships to much to mention and the check! 

Some solutions we thought that could be beneficial are teens assisting in choosing 

placements, workers/group homes/foster parents being educated about the youths’ going into 

their home up front, in reference to education just better planning, improving transits system, 

taxi vouchers, communication with case workers can make some great changes, hands on 

budgeting, maybe a grace period with having to enroll into post-secondary education just to 

maintain RTI benefits after you graduate or receive your GED etc. 




We think by letting us know that what we are talking about can and will make a difference: 

don’t tell us but show us the difference! 

During this meeting we brought up a discussion on how to improve the Independent Living 

Services that are provided to our teen in the foster care system. We met with DCF staff at our 

ILS office Camelot Community Care and had an open discussion about some areas that we 

identified was of concerns. We came up with some solutions that we feel are actually 

attainable. We realize that Pinellas and Pasco County has some room to grow, but we also know 

that our community is rich of assistance that can help us as we transition into adulthood. 

Basically in closing, let our voices be heard and let us see the change even if it is small 

changes on a local and statewide level. Make sure that the rules are clear and we know what 

we need to do, also the biggest thing is support us-let us know that we matter to someone! 

Monroe County Youth Perspectives Report 

The Florida Keys are like a whole other world than the rest of the state of Florida, due to 

our remote location (four hours from the closest big city) and very distinctive way of life. There 

are very high instances of domestic violence and substance abuse, but very limited resources to 

treat these. There are very limited resources for youth. The cost of living is extremely high, and 

the Keys are very dependent on the tourism and service industries, which causes an extreme 

divide between the wealthy and the very poor. Because of these factors, the Keys have 

historically had a disproportionally high number of children in care. There has also historically 

been limited foster homes, especially those willing to take on older youth. Frequently children, 

and especially teens, must be placed in non-home-like settings or in Miami-Dade County. Larger 

sibling groups also often must be placed in those settings, group homes, shelters and other 

counties in order to stay together. The distance makes visitation with family almost impossible, 

and living in a shelter in order to stay with siblings, or maintain contact with birth parents, while 

maybe the best option, is not a good one. This report was compiled by Wesley House Family 

Services staff, but it is completely built upon the thoughts and ideas of Monroe County’s youth. 

This group came together because they were invited by their Independent Living 

coordinator, Transitional Services specialist and Quality Assurance Manager from Wesley House 

Family Services to sit down as a group and discuss the strengths and needs of the current foster 




care system, and to try to come up with solutions for the future. They were promised pizza and 

the opportunity to have their voices heard, potentially as high up as legislators in Tallahassee. 

The original meeting was predominantly youth who have already transitioned out of care. At 

that point, the youth currently in foster care declined to participate. Since that initial meeting, 

however, the younger teens have become more involved in the discussions and have provided 

some valuable input. The group has consistently been youth either currently in licensed care or 

aged out of licensed care. There has been little to no representation from youth placed in nonlicensed 

settings. 

Some of the youth have separately provided their descriptions of what has been positive for 

them in the foster care system, as well as what could be improved. A continuous theme across 

reports from youth of all ages and backgrounds is a lack of what we call normalcy. Specific 

examples of this lack of normalcy include: 

‣ Inability to travel for fun 

‣ Limited personal relationships – due to requirements placed by the CBC and the Group Home 

where she lives, it is a limited pool of people she is approved to spend time with and limited 

activities she is able to do 

‣ Temporary placements and frequent moves make it impossible to be involved in extra-curricular 

and school activities. This comes from a youth who has lived in 6 placements during her 9 total 

years in care 

‣ Inability to go on dates without a chaperone 

Another common theme is issues with the case management agency. Examples of this include: 

‣ Case managers not answering their phone calls 

‣ Agency not listening to the youth and taking their voices into consideration 

‣ Not having consistent, positive role models 

‣ Not being able to have a personal relationship with the case managers; it’s all business 

Situational factors that the youth have concerns with: 

‣ Separation from siblings 

‣ Not being enrolled in school in a timely fashion 

‣ Failure to take schooling into account when placing children 

‣ Failure to support children’s educational development while in care 

‣ Inconsistent transportation causing them to miss out on services and normalcy 

‣ Only one mental health center, and they have a high staff turnover 




‣ Inadequate preparation for living on their own 

‣ Failure to educate youth about changing policies and procedures that directly impact their lives 

‣ Being bullied in school because everyone knows your business in a small community 

Positives that were identified by the youth were: 

‣ Getting them out of a bad situation and giving them an alternate, safe, place to live 

‣ At least having a case manager, even if they have no one else to count on 

‣ What works: 

• Family outings at the shelter were fun 

• Some staff was cool, caring, and volunteered on their days off. 

• Placement had good individual educational assistance 

• Self-advocacy 

• Youth searched and found own placement 

• Parenting classes for teen parents 

• High school in Key West is making up courses to help them pass easier 

• Additional college assistance for entrance exams 

• Weekly tutoring 

• A foster family pushed child to do well and achieved straight “A”s 

• Extracurricular activities and exercise 

• Educational advocate motivated the youth group and helped with homework and used 

volunteer time for field trips 

• Affordable bus system and given bus passes 

• State bought youth a bike and lock. 

• Some youth able to make appointments 

• Therapist that lasted and built trust 

• Services paid for 

• Financial help for daily living, school, and misc. items 

• ACCESS 

• Free bus passes 

• WIC 

• Health center 

• Family and Friends 




The youth were able to identify many possible solutions for the problems that they 

identified during the round table discussion. With regards to placements, they believe that 

youth should be educated about the reasons for their removal, live closer to family, and be kept 

with their siblings. Case management staff should be of a higher quality so as to be more 

appropriate placement for kids, more child friendly, and more experienced with traumatized 

children. 

Regarding educational concerns, they believe it would help for them to be enrolled in 

better quality schools, be enrolled immediately, placement close to their original school to 

prevent educational disturbances, being allowed to finish the school year prior to moving 

whenever possible. They suggested educational advisors to advocate like a parent would to 

meet with the youth and their teachers to discuss grades and classes. They believe that 

teachers should be better educated about what is going on in the home of the children so they 

are better equipped to handle behavioral concerns. Foster and group home parents should be 

trained as educational liaisons, to assist with children’s schooling, not just what goes on in the 

homes. 

Regarding services, the youth feel that they would benefit from better sex education, 

especially since this has been pulled from many schools. A major issue they identified is 

turnover of case managers, but no solution has been identified to prevent this. They requested 

continual mental health checkups and for doctors to take the time to really get to know them, 

especially prior to deciding if a child needs continued therapy based on identified behaviors. 

Youth state they would benefit from being better trained on local resources which are available 

to them. 

When independent living and life skills were discussed, the youth identified a 

combination of agency assistance as well as personal empowerment. They identified better 

communication and training both for and by RTI/IL staff and foster/group home parents as a 

need. Interestingly, they also identified many ways that they can benefit from the experiences 

of their peers including a Youth Advisory Board, and RTI Youth Group, and using each other as a 

resource. 

Monroe County is a beautiful area and a close-knit community, but it falls short on many 

services due in part to its distance from “civilization.” In order to overcome these shortfalls, we 

must educate legislators about the special needs of our area. The youth of Monroe County have 

much to say including many great ideas. We encourage anyone who makes decisions about 




services and funding for youth to take these ideas into consideration and allow their voices to be 

heard. 

Sarasota (12 th Circuit) Roundtable Report 

The Teen Advisory Council of the 12 th Circuit feels that our voice is important because we 

have a better understanding of what occurs to youth in care and how to improve the overall 

foster care system. We feel that there are several areas of foster care that can be improved. 

Some of our concerns center around state and federal funding, placements, staff, current 

procedures, and some of the obstacles faced by the youth both in care and those who have 

transitioned out of care. 

The local advisory board meeting occurs monthly at the same location and at the same 

time. We take responsibility for notifying the potential participants and the members that are in 

attendance are regular council members. We attend these meetings in order to ensure that our 

voice is heard and to attempt to have input on the needed modifications to the foster care 

system. The ages of the participants in the Quality Assurance Youth Perspective Roundtable 

meeting were from 14-21. There was not a good representation of the youth that were placed 

with relatives or non-relatives. 

We would like for there to be more financial allocations for the staff that work at the 

shelters and group homes. We suggest that there be more extensive trainings as to the needs of 

teenagers and a better understanding of what foster youth have gone through and how this 

impacts their behaviors. They should also be required to have more than a High School 

education and should have ongoing in-service trainings that focus on communications and 

appropriate confidentiality practices. The youth would also like to have the opportunity to 

participate in the development of policies and procedures. This would allow the youth to 

provide feedback from their perspective. 

All Case Managers need to be accessible when we need them. There are times when we 

leave messages and do not receive call backs for several days. Typically, when we are calling it is 

because we need immediate assistance and are dealing with a situation in that moment. We 

would like for there to be a back up in place at all times particularly when staff are on leave or 

are out of the office. 




Currently we have very good IL Case Managers that listen to us and are fairly easily 

reached. The ability to text should be available for all Case Managers as this is helping us greatly. 

The SIL program is very beneficial and there are currently two mentoring programs that work 

well in our circuit. The Kalish House Resource Center is proving to be one of our most valuable 

assets and also The GAL program, although, we would like for them to be able to transport us. 

The RTI subsidy is a necessity, without it we would not be able to sustain our living 

arrangements and do not feel like school would be as high of a priority as it currently is. 

The TAC is going to attempt to host more social events in order to get more youth 

involved. We would also like to start some form of recreational sports league to reach out to 

other youth that may not currently be involved. 

This report was generated by 6 core members of the local teen advisory group and 

transcribed by the IL coordinator, Cain Blackwell. The input was solely the opinions of the youth 

that participated. The ILC does offer one suggestion and that is in the future when we are 

conducting these types of surveys and meetings that the facilitator determine what time period 

the questions being asked reference. This would make it easier to understand if the issues that 

arise are something that occurred well in the past and have since been addressed or if this is a 

current problem that needs the attention of the administration. Some of the youth that 

participated in our roundtable have been in care for numerous years and have a good deal of 

both positive and negative experiences. This suggestion would also provide an opportunity for 

direct attention to be given to particular situation as well as could impact the current 

procedures if the issue is present on multiple occasions. 

We would like for our suggestions to be taken seriously and possibly be reviewed for 

possible considerations. 

Miami - Youth Perspective Roundtable Report 

Introduction: There were 15 youth at the roundtable. The youth greatly appreciated being 

asked about their concerns. 

The discussion started off with placements. The youth were concerned about the quality of 

their foster care placements. Although some youth have had positive experiences with 

placements, many youth had negative experiences. 




Youth would like to see foster parents and group home staff undergoes stricter background 

checks. Youth also stated that they would also like caseworkers to do more unannounced visits 

to the foster care placements. Additionally, youth recommended that foster parents and staff 

undergo more youth-sensitive trainings so that they can be more familiar with how to treat their 

foster youth, especially teenagers. The youth also expressed concern that siblings should be 

placed together. The youth additionally expressed concern that foster youth should not be 

treated differently from biological youth, and their access to common areas in the home should 

not be restricted. 

Further, the youth expressed concerns over not being involved in their court hearings. The 

youth felt that it was very important to be involved in their court hearings so they could talk to 

the judge directly about their placements and any other concerns, as well as know about their 

legal rights in foster care. 

Many youth at the roundtable experienced going to more than one school during the 

school year. Youth expressed that there was a lack of support from the educational system 

itself, because no one knew that they were in foster care. Some youth also stated that they did 

not want to be identified as being in foster care and labeled. Locally, Educate Tomorrow has an 

educational mentoring program for foster youth, which the youth have found to be very 

beneficial. Additionally, Educate Tomorrow has collaborated with the Miami Dade County 

Public Schools to train high school counselors to help foster youth with their educational needs 

and has started foster youth support groups in high schools with the largest number of foster 

youth, for those youth who wish to participate. 

Also, the local juvenile court and Miami Dade public schools are beginning to experiment 

with video-conferencing, so that some youth may participate in their court hearings from 

school. 

Transportation: Transportation is a major issue for youth in foster care. Many youth expressed 

that they were not transported to medical appointments, to family visitations, to court hearings, 

and to other important appointments. Sometimes, there were disagreements between the 

caseworker and the foster parents as to whom should be responsible for transportation. The 

youth expressed the need to have this disagreement resolved. The youth also expressed that it 

is important to have someone with them for medical appointments so that someone can 

communicate with the doctor and they are not just dropped-off. 




For youth over age 18 who are in the Road to Independence program, transportation was 

also a concern. Previously, the Miami Dade County Commission had provided free bus passes to 

these youth, but this program stopped. This had been very beneficial to the youth financially, 

because of their limited RTI funds. The youth discussed trying to advocate to restore this 

program. 

Services: Youth expressed that they received some form of counseling while they were in foster 

care. However, many youth did not receive counseling with their parents or with their foster 

parents. Youth expressed that they would like to receive more counseling with their parents, as 

well as counseling with their foster parents to maintain harmony in their placements. 

The youth expressed concerns about being over-labeled with psychiatric diagnoses and 

being given unnecessary psychotropic drugs that negatively impact them. 

The youth appreciate receiving Medicaid. The youth would like to see Medicaid extended until 

the age of 23. 

Many youth feel that the Independent Living classes are not helpful to them and do not 

prepare them for adulthood. They believe that the IL classes should be more hands-on and 

practice-based. 

Youth were concerned about being in the middle of high school when they turn age 18. They 

are concerned about a lack of places where they can live and an inability to support themselves 

while they complete high school. Youth greatly appreciate the Road to Independence program. 

The youth depend on the RTI monthly stipend to be able to complete their education, and the 

youth are very afraid about the possibility of the RTI stipend being reduced. 

Additionally, youth are concerned that in the last several months, many youth have been denied 

Transitional funds for books and furniture and Aftercare funds for housing and other 

emergencies. Some youth have been able to appeal decisions with the help of legal agencies, 

but other youth have been unable to wait to appeal while they experience the emergency. The 

youth are also concerned that some youth don’t receive their monthly foster care allowance, 

and some youth only receive a very small amount. Youth receive very different amounts, 

depending on what case management agency they are with, and the youth feel that this unfair. 

The youth feel that all teenagers in foster care should receive the same allowance amount and 

there should be accountability to ensure that the allowance is provided to them. 

The youth appreciate community organizations that assist them. Locally, the youth 

expressed that Educate Tomorrow, the Miami Chapter of Florida Youth SHINE, and Casa 




Valentina were particularly helpful to them. The youth expressed the need for more mentors to 

assist them, more job opportunities for transitioning foster youth, and more support for youth 

when they are turning age 23 to help them make a successful transition from the Road to 

Independence program. 

Conclusion: The youth greatly appreciated having their concerns heard at the roundtable. The 

youth also greatly hope that actions will be taken to address their concerns. 

Some youth have been involved in the Miami Chapter of Florida Youth SHINE. A few years 

ago, youth in the Miami Youth SHINE chapter worked together to produce a written 

presentation, “Seeing Through Our Eyes: Foster Youth Share Our Voices, Our Experiences, and 

Our Solutions.” Many of the same concerns were raised by other youth at the roundtable. The 

youth involved in Youth SHINE expressed that they want to work together with the foster care 

system to resolve the concerns and to put in place solutions that will improve the system for 

themselves and their peers 

V. Florida’s Performance with Federal Safety, Permanency and Child Well-Being 

Requirements 

Florida’s quality assurance system is the state level process for assessing child welfare 

practice. At the federal level, the Administration for Children and Families (ACF) assesses the 

quality of practice through the Child and Family Services Review (CFSR) process. 

The CFSR 

assesses the performance of State child welfare agencies with regard to achieving positive 

outcomes for children and families. The CFSR is authorized by the Social Security Amendments of 

1994 requiring the U.S. Department of Health and Human Services to promulgate regulations for 

reviews of State child and family services programs under titles IV-B and IV-E of the Social Security 

Act. Florida’s case management child welfare Quality of Practice Standards closely align with the 

federal measures in the CFSR protocol, but are tailored to Florida’s child welfare system. Each 

standard is linked to a practice rating within the three CFSR domains: Safety, Permanency and 

Well-Being. These three domains include the following seven outcomes. 

• Safety 1: Children are, first and foremost, protected from abuse and neglect 

• Safety 2: Children are safely maintained in their homes whenever possible and appropriate 

• Permanency 1: Children have permanency and stability in their living situations 

• Permanency 2: The continuity of family relationships and connections is preserved for 

children 




• Well-being 1: Families have enhanced capacity to provide for their children’s needs 

• Well-being 2: Children receive appropriate services to meet their educational needs 

• Well-being 3: Children receive adequate services to meet their physical and mental health 

needs 

The tables on the following pages illustrate Florida’s performance at the Circuit, Region and 

State level on the federal data indicators associated with the CFSR Permanency Outcome. These 

indicators make up the four Permanency Composites for which the Department is held accountable 

in the Child and Family Services Review. Data for determining performance on these measures 

comes from ad-hoc reports programmed from the Florida Safe Families Network (FSFN). There are 

five measures shaded in blue that are both federal measures and CBC contract measures. These 

measures are color coded with a green, yellow, or red icon to identify areas of high and low 

performance. Performance is compared to the national median and 75 th percentile (located at the 

bottom of each table) from the 2008 federal fiscal year. 

• Percentage at or above the national 75 th percentile: green icon (good performance) 

• Percentage between the national median and 75th percentile: yellow icon (cautionary) 

• Percentage below the national median: red icon (improvement needed) 

There is one contract measure where the national median and national 75 th percentile is a low 

percentage. Therefore, a low percentage equates to good performance. 

• Percentage less than the 75th percentile: green icon (good performance) 

• Percentage between the median and 75th percentile: yellow icon (cautionary) 

• Percentage higher than the national median: red icon (improvement needed) 

It should be noted that statewide performance on these measures will be slightly different than 

the performance calculated by the Administration for Children and Families. 




Federal Data Indicators Associated with the Child and Family Services Review Permanency Outcome 

July 1, 2009 - June 30, 2010 

Table continued on next page 












Table V-1 




VI. Status of QA Standards Linked to Florida’s Quality Improvement Plan (QIP) 

Florida’s child welfare system did not achieve substantial conformity for any of the safety, 

permanency, or well-being outcomes during the 2008 federal Child and Family Services Review; 

therefore, the state was placed under a Performance Improvement Plan, known in Florida as the 

Quality Improvement Plan (QIP). Failure to successfully complete the QIP could result in financial 

penalties to the State. The Florida QIP includes a requirement to assess progress in child welfare 

outcomes. The state used QA practice review results from July – December 2008 to establish QIP 

baselines and goals , and review results from January 2009 onward to measure progress throughout 

the QIP reporting period. The following table shows comparative results on specific CFSR items for 

reporting on the QIP. The Administration for Children and Families has formally acknowledged that 

Florida has met all performance targets except for Item 10 (QA standard 71) regarding children with 

the goal of Another Permanent Planned Living Arrangement (APPLA). 

Practice Summary for QA Standards Linked to the Federal Quality Improvement Plan 

QA Findings of Percent 

Achieved for: 

QPS # Standard FY 2008-09 FY 2009-10 QIP Status 

CFSR Item 3 - Services to family to protect child in home and prevent removal or re-entry into foster care 

Concerted efforts were made to provide or arrange for appropriate 

4 services for the family to protect the child and prevent the child's 87% 94% QIP Target Met 

entry into out-of-home care. 

6 

Completed service referrals were consistent with the needs 

identified through investigative assessments, and other 

83% 89% QIP Target Met 

assessments related to safety. 

10 

Concerted efforts were made during post-placement supervision to 

manage the risks following reunification and prevent re-entry into 

out-of-home care. 


CFSR Item 4 - Risk assessment and safety management 

3 

5 

8 

9 

If a child was re-abused or re-neglected, immediate and 

ameliorative interventions were initiated on behalf of the child. 

A thorough initial fmaily assessment was conducted following the 

investigative safety assessment that sufficiently addressed child 

safety factors and emerging risks. 

All immediate and emerging safety concerns were addressed and 

additional needed interventions were provided to protect the child. 


reunification or placement of the child in an unlicensed out-ofhome 

care setting. 









QA Findings of Percent 

Achieved for: 

QPS # Standard FY 2008-09 FY 2009-10 QIP Status 

CFSR Item 7 - Permanency goal for child 

22 

The current case plan goal was appropriate based on the child's 

and family's circumstances. 


CFSR Item 10 - Permanency goal for child 

71 

For children with the goal of another planned permanent living 

arrangement, the agency made concerted efforts to provide the 

needed services that would adequately prepare the child for 

transition to adulthood. 

CFSR Item 17 - Needs and Services 

NA 

new for 

FY 2009-10 

94% Baseline 

48 

An ongoing assessment of the child(ren)’s needs was conducted to 

provide updated information for case planning purposes. 


50 

An ongoing assessment of the mother’s needs was conducted to 



51 

52 

53 

Concerted efforts were made to support the mother’s engagement 

with services. 

An ongoing assessment of the father’s needs was conducted to 


Concerted efforts were made to support the father’s engagement in 

services. 




CFSR Item 18 - Child and Family Involvement in Case Planning 

55 

Concerted efforts were made to actively involve all case 

participants in the case planning process. 

CFSR Item 19 - Case Worker Visits with Child 


56-C 

The frequency of the services worker's visits with the child was 

sufficient to address issues pertaining to the safety, permanency 

goal, and well-being of the child. 


57-C 

56-A 

The quality of the services worker's visits with the child was 



CFSR Item 20 - Case Workers Visits with Parent 

The frequency of the services worker's visits with the mother was 





56-B 

57-A 

57-B 

The frequency of the services worker's visits with the father was 



The quality of the services worker's visits with the mother was 



The quality of the services worker's visits with the father was 






Table IV-1 




APPENDIX 1 

Statewide Quality of Practice Findings 

By Quarter FY 2009/2010 

The following table provides the statewide quality of practice trend data for each child welfare practice 

standard for quarters two (September-December), three (January-March), and four (April-June) of FY 

2009/2010. 

StdNum Question Q2 Q3 Q4 Annual 

1.0 No child living in the home was re-abused or neglected. 79% 81% 81% 80% 

2.0 The focus child was not re-abused or re-neglected. 95% 94% 95% 94% 

3.0 


interventions were initiated on behalf of the child. 92% 92% 90% 91% 

4.0 

Concerted efforts were made to provide or arrange for appropriate 

services for the family to protect the child and prevent the child's entry 

into out-of-home care. 93% 95% 93% 94% 

5.0 

A thorough initial family assessment was conducted following the 

investigative safety assessment that sufficiently addressed child 

safety factors and emerging risks. 75% 63% 61% 66% 

5.1 

The assessment included the caregivers' (if removed from)/parents' 

capacity to protect and nurture the child. 76% 68% 72% 71% 

5.2 

The assessment included observations of interactions between the 

child and siblings and household members. 58% 49% 47% 51% 

5.3 The assessment included emerging risk factors. 80% 66% 71% 72% 

5.4 

The assessment included actions needed to address emerging risk 

factors . 76% 61% 66% 67% 

5.5 The assessment implementation of a safety plan when needed. 68% 58% 63% 62% 

6.0 

Completed service referrals were consistent with the needs identified 

through investigative assessment(s), and other assessments related to 

safety. 88% 87% 90% 89% 

7.0 

The updated family assessment was focused on the immediate and 

prospective safety of the child, as well as any changes and 

implications in the family's situation related to emerging concerns and 

service needs. 30% 25% 32% 29% 

7.1 

The updated family assessment included a review of changes in the 

family’s condition or circumstances since the initial assessment that 

positively or negatively impacted the child’s safety. 34% 32% 36% 34% 

7.2 

The updated family assessment included a review of the short and 

long-term implication of any changes in individual or family factors 

affecting family resources, strengths and/or protective capacities. 33% 30% 36% 33% 

7.3 

The updated family assessment included an evaluation of signs of 

emerging danger and a plan to address them. 32% 29% 33% 31% 

7.4 

The updated family assessment included a review of the case plan 

goals met and are remaining, and the plan to address any barriers that 

exist to fully meet the case plan goals. 34% 28% 35% 32% 

Statewide Quality of Practice Findings by Quarter FY 2009/20010 continued 





All immediate and emerging safety concerns were addressed and 

8.0 additional needed interventions were provided to protect the child. 77% 74% 77% 76% 

9.0 


reunification or placement of the child in an unlicensed out-of-home 

care setting. 74% 73% 76% 74% 

10.0 

Concerted efforts were made during post-placement supervision to 

manage the risks following reunification and prevent re-entry into outof-home 

care. 74% 75% 74% 74% 

11.0 

The child remained safe in his/her home after being discharged from 

out-of-home care and did not re-enter out-of-home care at least 12 

months following discharge. 62% 85% 66% 70% 

12.0 

A multi-disciplinary staffing/assessment for placement planning was 

conducted before each placement to ensure the placement or move 

was unavoidable. 59% 57% 65% 60% 

13.0 

The child's current placement is stable and appropriate to meet the 

child's needs with no apparent or significant risks or projections of 

disruption. 92% 95% 90% 92% 

14.0 

Concerted efforts were made to identify, locate and evaluate other 

potential relatives and possible permanent placements for the child. 79% 80% 77% 79% 

15.0 

The child experienced no more than two out-of-home care placement 

settings during the period under review. 87% 85% 89% 87% 

16.0 

If No was entered for #15, all placement changes were planned in an 

effort to achieve the child's case goals or to meet the needs of the 

child. 46% 48% 60% 50% 

17.0 

In cases involving a child in a licensed placement setting, an exit 

interview was conducted with the child when moved from one 

placement to another, and appropriate action was taken if the exit 

interview documented a concern. 75% 80% 81% 78% 

17.1 

An exit interview was conducted with the child when he/she was 

moved from one placement to another to discuss the previous 

placement experience. 78% 79% 81% 79% 

17.2 

Appropriate action was taken if the exit interview documented a 

concern. 68% 74% 70% 71% 

18.0 The parents were notified of all the child's placement changes. 76% 76% 77% 77% 

19.0 

The court was informed of the child's placements and reasons for 

changes in placement. 91% 86% 91% 90% 

19.1 The court was informed of the number and type of placement. 93% 88% 91% 91% 

19.2 The court was informed of the reason for the change in placement. 86% 82% 90% 86% 

20.0 

Qualitative supervisory reviews and follow through were conducted as 

needed and required. 50% 48% 51% 50% 

20.1 Reviews were completed quarterly 76% 77% 75% 76% 

20.2 

Supervisor considered all aspects of the child's safety, well-being and 

permanency. 63% 60% 62% 61% 

20.3 

Supervisor ensured follow through on guidance and direction or 

documented the reasons the guidance and direction were no longer 

necessary. 49% 46% 51% 49% 

21.0 The case record contained a current (not expired) case plan. 73% 76% 73% 74% 






The current case plan goal was appropriate based on the child's, and 

22.0 family's circumstances. 91% 95% 96% 94% 

23.0 

The case plan specifically addressed visitation and other contact plans 

with all case participants. 70% 68% 72% 70% 

23.1 Mother 74% 72% 77% 74% 

23.2 Father 70% 69% 70% 69% 

23.3 Caregiver (removed from) 71% 70% 77% 72% 

23.4 Between siblings 54% 61% 60% 58% 

24.0 

The case plan is designed to achieve permanency (out-of-home care 

cases) and safety and stability (in-home cases) through appropriate 

tasks for the case participants. 82% 90% 89% 87% 

24.1 Mother 86% 90% 89% 88% 

24.2 Father 79% 86% 85% 84% 

24.3 Child (if developmentally or age appropriate) 73% 83% 85% 81% 

24.4 Caregiver (removed from) 87% 87% 90% 88% 

25.0 

The services worker communicated with service providers about the 

effectiveness of services for involved case participants. 66% 66% 67% 66% 

25.1 Mother 66% 65% 68% 67% 

25.2 Father 63% 62% 69% 64% 

25.3 Child 67% 66% 68% 67% 

25.4 Out of Home Care Provider (includes relative/non-relative) 81% 82% 87% 83% 

26.0 

The child's current placement was in close proximity to the parents to 

facilitate face-to-face contact between the child and parents while the 

child was in out-of-home care. 93% 92% 92% 92% 

26.1 Mother 92% 92% 91% 91% 

26.2 Father 87% 85% 85% 86% 

27.0 

If No was entered for #26, the location of the child's current placement 

was based on the child's needs and achieving the case plan goal. 97% 93% 91% 94% 

28.0 

The child was placed with siblings who were also in licensed and/or 

non-licensed out-of-home care. 61% 59% 60% 60% 

29.0 

If No was entered for #28, there was clear evidence separation was 

necessary to meet the child's needs. 74% 81% 79% 78% 

30.0 

Concerted efforts were made to ensure visitation (or other 

contact) between the child and parents were sufficient to maintain or 

promote the continuity of the relationship between them. 85% 81% 82% 83% 

30.1 Mother 85% 83% 86% 85% 

30.2 Father 77% 72% 69% 72% 

31.0 

Concerted efforts were made to ensure visitation (or other forms of 

contact if visitation was not possible) between the child and his or her 

siblings and it was of sufficient frequency to maintain or promote the 

continuity of the relationship. 79% 68% 80% 76% 






Concerted efforts were made to maintain the child's important 

32.0 connections. 86% 84% 88% 86% 

33.0 

An inquiry was made to determine if the child was of Native American 

or Alaskan Native heritage. (applicable to out-of-home care and court 

ordered supervision cases - life of case) 38% 50% 52% 46% 

34.0 

35.0 

36.0 

37.0 

38.0 

39.0 

40.0 

41.0 

42.0 

43.0 

44.0 

45.0 

46.0 

47.0 

If the child is of Native American or Alaskan Native heritage, the tribe 

was provided timely notification of its right to intervene in any state 

court proceedings seeking court ordered supervision, an involuntary 

out-of-home care placement or termination of parental rights. 14% 33% 41% 31% 

Concerted efforts were made to place the child in out-of-home care in 

accordance with the Indian Child Welfare Act placement preferences if 

the child was of Native American or Alaskan Native heritage. 36% 36% 62% 44% 

The mother was encouraged and supported to participate in making 

decisions about her child's needs and activities. 50% 53% 57% 53% 

The father was encouraged and supported to participate in making 

decisions about his child's needs and activities. 36% 39% 45% 40% 

For cases in which an out-of-state placement was, or is being, explored 

for the focus child, a complete Interstate Compact for the Placement of 

Children (ICPC) packet requesting a home study was submitted within 

the required timeframe. 63% 56% 71% 63% 

The information provided in the ICPC packet regarding the focus child 

was sufficient to enable the receiving state to make an appropriate 

decision concerning approval of the proposed placement for the focus 

child. (applicable to out-of-home care cases) 94% 96% 88% 93% 

If the child was in out-of-home care for at least 12 of the most recent 

22 months or met other ASFA criteria for TPR, a TPR petition was filed or 

joined. 61% 55% 60% 59% 

If a Termination of Parental Rights petition was not filed, there were 

compelling reasons and an exception for not filing the petition was 

documented. 47% 65% 60% 58% 

Appropriate steps were taken to identify and recruit an adoptive family 

that matched the child's needs. 84% 87% 90% 87% 

Appropriate steps were taken to process and approve an adoptive 

family that matched the child's needs. 83% 91% 93% 89% 

If the case involves a youth who has reached 13 but not yet 15 years of 

age and he/she is living in a licensed, out-of-home care placement, a 

pre-independent living assessment was completed that identified 

service needs and services were provided. 81% 74% 79% 78% 

If the child is 13 years of age or older and in licensed foster care, the 

case management agency provided guidance and assistance in 

developing an educational and career path that is based on the child's 

individual abilities and interests. 75% 74% 84% 78% 

The teen-aged focus child is afforded opportunities to participate in 

normal life skills activities in the foster home and community that are 

reasonable and appropriate for his/her respective age or special 

needs. 69% 76% 85% 76% 

For youth 15 years of age but not yet 18, the agency appropriately 

monitored his/her progress towards successfully transitioning from 

foster care to independence through regular informative staffings. 77% 77% 78% 78% 






An ongoing assessment of the child's needs was conducted to provide 

48.0 updated information for case planning purposes. 87% 88% 88% 88% 

49.0 

An assessment for residential group care was completed when 

required. 85% 77% 81% 80% 

50.0 

An ongoing assessment of the mother's needs was conducted to 

provide updated information for case planning purposes. 80% 75% 77% 77% 

51.0 

Concerted efforts were made to support the mother's engagement with 

services. 73% 71% 73% 72% 

52.0 

An ongoing assessment of the father's needs was conducted to provide 

updated information for case planning purposes. 59% 59% 55% 58% 

53.0 

Concerted efforts were made to support the father's engagement in 

services. 58% 54% 59% 57% 

54.0 

An ongoing assessment of the out-of-home care providers or preadoptive 

parent's service needs was conducted in order to ensure 

appropriate care for the child. 87% 89% 89% 88% 

55.0 

Concerted efforts were made to actively involve all case participants in 

the case planning process. 68% 67% 71% 69% 

55.1 Mother 69% 67% 70% 69% 

55.2 Father 52% 54% 54% 53% 

55.3 Child (if developmentally appropriate) 69% 73% 72% 71% 

55.4 Out-of-Home Providers 72% 74% 77% 75% 

56.0 

The frequency of the services worker's visits with all case participants 

was sufficient to address issues pertaining to the safety, permanency 

goal, and well-being of the child. 59% 59% 56% 58% 

56.1 Mother 44% 46% 44% 45% 

56.2 Father 34% 29% 30% 31% 


56.4 Caregiver (out-of-home) 72% 79% 75% 76% 

57.0 

The quality of the services worker's visits with case participants was 

sufficient to address issues pertaining to the child's safety, 

permanency and well-being. 67% 69% 70% 69% 

57.1 Mother 71% 72% 72% 72% 

57.2 Father 57% 56% 61% 58% 


57.4 Caregiver (out-of-home) 78% 83% 82% 81% 

58.0 

Concerted efforts were made to assess the child’s educational needs 

during out-of-home placement. 84% 84% 84% 84% 

59.0 

If educational needs were identified, necessary educational services 

were engaged. 85% 80% 82% 83% 

60.0 

Services effectively reduced or resolved the issues that interfered with 

the child's education. 78% 73% 84% 78% 

61.0 

Concerted efforts were made to assess the child’s physical health care 

needs. 72% 70% 69% 70% 

61.1 

If the child was removed during the period under review, or if not 

removed but brought into the dependency system due to health related 

issues, he/she received an EPSDT screening within 72 hours. 57% 64% 58% 59% 






After the removal episode or health issues that resulted in 

interventions by the dependency system, and the EPSDT screening was 

not done within 72 hours, a medical screening was completed within a 

61.2 week. 58% 60% 56% 58% 

61.3 

The diagnoses from physical health care screenings are documented in 

the case file, medical passport, and/or child's resource record. 73% 70% 72% 71% 

62.0 

Concerted efforts were made to provide appropriate services to 

address the child’s identified physical health needs. 71% 69% 63% 68% 

62.1 

Documentation reflects that the services agency complied with the 

periodicity schedule pertinent to the child's age and needs. 71% 67% 64% 67% 

62.2 

Documentation reflects that the services agency followed-up on 

treatment plans that the doctor ordered. 72% 74% 65% 70% 

63.0 

Concerted efforts were made to assess the child's dental health care 

needs. 50% 47% 43% 47% 

64.0 

Appropriate services were provided to address the child's identified 

dental health needs. 51% 46% 48% 48% 

64.1 

Documentation reflects that the services agency complied with the 

periodicity schedule pertinent to the child's age and needs. 48% 49% 44% 47% 

64.2 

Documentation reflects that the services agency followed-up on 


65.0 

An assessment(s) of the child's mental/behavioral health needs was 

conducted. 88% 88% 91% 89% 

66.0 

Appropriate services were provided to address the child's 

mental/behavioral health needs. 86% 77% 81% 81% 

66.1 

Documentation reflects that the services agency matched the needed 

services specific to the child's mental/behavioral concerns. 87% 79% 82% 83% 

66.2 

Documentation reflects that the services agency followed-up on all 


67.0 

The Medical Report documenting informed consent was complete or a 

court order was in the file. 64% 77% 79% 74% 

67.1 

The case management organization involved the child and the 

parents/legal guardian in the decision making process by facilitating 

contacts with physicians for treatment planning. 49% 66% 74% 64% 

67.2 

Prior to seeking a medical evaluation to determine the need to initiate 

or continue a psychotropic medication, the case manager provided the 

Prescribing Practitioner all pertinent medical information known to the 

agency at the time. 56% 78% 77% 70% 

67.3 

The case manager documented communication with the child's parent 

or guardian to ensure parental awareness of the need to provide 

express and informed consent for the prescription of each psychotropic 

medication. 53% 60% 72% 62% 

67.4 

When express and informed consent could not be obtained from the 

child's parents, the case management organization submitted a 

request for court authorization to Children's Legal Services. 71% 76% 81% 76% 

67.5 When there was a need for a court order, one was obtained. 69% 76% 79% 75% 

Data in the Florida Safe Families Network accurately documented the 

68.0 child's prescribed psychotropic medication. 63% 60% 66% 63% 

68.1 Name of medication and dosages prescribed 76% 67% 73% 72% 






68.2 If the medication is for psychotropic purposes 74% 81% 74% 76% 

68.3 Prescription begin and end dates 70% 66% 66% 67% 

68.4 Dates of expressed and informed parental consent or court order 64% 67% 70% 67% 

68.5 Name of prescribing practitioner 78% 80% 72% 77% 

68.6 Reason the medication was prescribed 79% 77% 71% 76% 

69.0 

Judicial Reviews were held in a timely manner and Judicial Review 

Social Study Report's (JRSSR's) provided a thorough investigation and 

social study concerning all pertinent details relating to the child. 85% 88% 83% 85% 

70.0 

Based on all of the information reviewed, it is likely the child will live 

in a safe and nurturing environment with his/her needs being met on a 

permanent basis during the next 12 months. 86% 90% 86% 87% 

Table Appendix - 1 




Statewide Quality of Practice Findings 

By Fiscal Year 

APPENDIX 2 

The following table provides the statewide quality of practice trend data for each child welfare practice 

standard for fiscal year 2008/2009 and 2009/2010. 

StdNmbr Standard 08-09 Annual 09-10 Annual 

1 

2 

3 

4 

5 

No child living in the home was re-abused or neglected. (applicable to in-home 

cases) 

The focus child was not re-abused or re-neglected. (applicable to out-of-home 

care cases) 


interventions were initiated on behalf of the child. (applicable to all cases) 

Concerted efforts were made to provide or arrange for appropriate s ervices for the 

family to protect the child and prevent the child’s entry into out-of-home care. 

(applicable to in-home cases) 

A thorough initial family assessment was conducted following the investigative 

safety assessment that sufficiently addressed child safety factors and emerging 

risks. (applicable to all cases) 

73% 80% 

91% 94% 

84% 91% 

87% 94% 

55% 66% 

5.0.1 Caregivers’ (if removed from)/parents’ capacity to protect and nurture the child 59% 71% 

5.0.2 

Observations of interactions between the child and siblings and household 

members 

48% 51% 

5.0.3 Emerging ris k factors 63% 72% 

5.0.4 Actions needed to address emerging risk factors 59% 67% 

5.0.5 Implementation of a safety plan when needed 47% 62% 

6 

Completed service referrals were consistent with the needs identified through 

investigative assessment(s), and other assessments related to safety. (applicable 

to all cases - Life of Case) 

83% 89% 

7 

7.0.1 

7.0.2 

7.0.3 

The six-month family assessment was focused on the immediate and prospective 

safety of the child, as well as any changes and implications in the family’s 

situation related to emerging danger and services needs. (applicable to all cases) 

Changes in the family’s condition or circumstances since the initial assessment 

that positively or negatively impacted the child’s safety 

Short and long-term implication of any changes in individual or family factors 

affecting family resources, strengths and/or protective capacities 

An assessment of new or existing identified risks to the child(ren) and the actions 

needed to ameliorate them 

75% 29% 

81% 34% 

77% 33% 

75% 31% 

7.0.4 An evaluation of signs of emerging danger and a plan to address them 74% 32% 

Statewide Quality of Practice Findings by Fiscal Year continued 





8 

9 

10 

11 

12 

13 

14 

15 

All immediate and emerging safety concerns were addressed and additional 

needed interventions were provided to protect the child. (applicable to all cases) 

A thorough safety assessment of the home was completed prior to reunification or 

placement of the child in an unlicensed out-of-home care setting. (Applies to 

cases involving post placement supervision, and where a child will be placed in 

an unlicensed [relative/non-relative] placement) 

Concerted efforts were made during post-placement supervision to manage the 

risks following reunification and prevent re-entry into out-of-home care. 

(applicable to in-home post-reunification cases) 

The child remained safe in his/her home after being discharged from out-of-home 

care and did not re-enter out-of-home care at least 12 months following discharge. 

(applicable to out-of-home cases) 

A multi-disciplinary staffing/assessment for placement planning was conducted 

before each placement to ensure the placement or move was unavoidable. 

(applicable to out-of-home care cases) 

The child’s current placement is stable and appropriate to meet the child’s needs 

with no apparent or significant risks or projections of disruption. (applicable to 

out-of-home care cases) 

If No was entered for #13, concerted efforts were made to identify, locate and 

evaluate other potential placements for the child. (applicable to out-of-home 

care cases) 

The child experienced no more than two out-of-home care placement settings 

during the period under review.(applicable to out-of-home care cases) 

72% 76% 

71% 74% 

69% 74% 

67% 70% 

51% 60% 

91% 92% 

67% 79% 

80% 87% 

16 

17 

17.0.1 

If No was entered for #15, all placement changes were planned in an effort to 

achieve the child’s case goals or to meet the needs of the child. (applicable to outof-home 

care cases) 

In cases involving a child in more than one licensed placement setting: 

(applicable to licensed out-of-home care cases) 

An exit interview was conducted with the child when moved from one placement to 

another to discuss the previous placement experience. 

46% 50% 

69% 78% 

67% 79% 

17.0.2 Appropriate action was taken if the exit interview documented a concern. 65% 71% 

18 

19 

The parents were notified of all the child’s placement changes. 


The court was informed of the child’s placements and reasons for changes in 

placement. (applicable to out-of-home care cases) 

73% 77% 

91% 90% 

19.0.1 Number and type of placement 93% 91% 

19.0.2 Reason for the change in placement. 85% 86% 






20 

Qualitative supervisory reviews and follow through were conducted as needed and 

required. (applicable to all cases) 

37% 50% 

20.0.1 Reviews were completed quarterly 66% 76% 

20.0.2 Supervisor considered all aspects of the child’s safety, well-being and permanency 53% 61% 

20.0.3 

Supervisor ensured follow through on guidance and direction or documented the 

reasons the guidance and direction were no longer necessary. 

38% 49% 

21 

The case record contained a current (not expired) case plan. (applicable to all 

cases) 

74% 74% 

22 

The current case plan goal was appropriate based on the child’s, and family’s 

circumstances. (applicable to all cases) 

93% 94% 

23 

The case plan specifically addressed visitation and other contact plans with all 

case participants. (applicable to out-of-home care cases) 

80% 70% 

23.0.1 Mother 86% 74% 

23.0.2 Father 78% 69% 

23.0.3 Caregiver (removed from) 71% 72% 

23.0.4 Between Siblings 66% 58% 

24 

The case plan helped achieve permanency (out-of-home care cases) and safety 

and stability (in-home cases) through appropriate tasks for the case participants. 

87% 87% 

24.0.1 Mother 88% 88% 

24.0.2 Father 82% 84% 

24.0.3 Child (if age 13 and older and involved in Independent Living) 82% 81% 

24.0.4 Caregiver (removed from) 84% 88% 

25 

The services worker communicated with service providers about the effectiveness 

of services for involved case participants. (applicable to all cases) 

64% 66% 

25.0.1 Mother 66% 67% 

25.0.2 Father 58% 64% 

25.0.3 Child 66% 67% 

25.0.4 Caregiver (out-of-home) 79% 83% 

26 

The child’s current placement was in close proximity to the parents to facilitate 

face-to-face contact between the child and parents while the child was in out-ofhome 

91% 92% 

care. (applicable to out-of-home care cases) 

26.0.1 Mother 91% 91% 

26.0.2 Father 83% 86% 

27 

If No was entered for #26, the location of the child’s current placement was based 

on the child’s needs and achieving the case plan goal. (applicable to out-of-home 

97% 94% 

28 

) 

The child was placed with siblings who were also in licensed and/or non-licensed 

out-of-home care. (applicable to out-of-home care cases) 

53% 60% 

29 

30 

If No was entered for #28, there was clear evidence separation was necessary to 

meet the child’s needs. (applicable to out-of-home care cases) 

Concerted efforts were made to ensure visitation (or other contact) between the 

child and parents were sufficient to maintain or promote the continuity of the 

relationship between them. (applicable to out-of-home care cases) 

73% 78% 

80% 83% 

30.0.1 Mother 83% 85% 

30.0.2 Father 69% 72% 

31 

Concerted efforts were made to ensure visitation (or other forms of contact if 

visitation was not possible) between the child and his or her siblings and it was 

of sufficient frequency to maintain or promote the continuity of the relationship. 

73% 76% 

( l bl f h ) 






32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

Concerted efforts were made to maintain the child’s important connections. 


An inquiry was made to determine if the child was of Native American or Alaskan 

Native heritage. (applicable to out-of-home care and court ordered supervision 

cases) 

If the child is of Native American or Alaskan Native heritage, the tribe was 

provided timely notification of its right to intervene in any state court proceedings 

seeking court ordered supervision, an involuntary out-of-home care placement or 

termination. (applicable to out-of-home care and court ordered supervision cases - 

Life of Case). 

Concerted efforts were made to place the child in out-of-home care in accordance 

with the Indian Child Welfare Act placement preferences if the child was of Native 

American or Alaskan Native heritage. (applicable to out-of-home care cases) 

The mother was encouraged and supported to participate in making decisions 

about her child’s needs and activities. 

The father was encouraged and supported to participate in making decisions 

about his child’s needs and activities. 

For cases in which an out-of-state placement was, or is being, explored for the 

focus child, a complete Interstate Compact for the Placement of Children (ICPC) 

packet requesting a non-priority home study was submitted within the required 

timeframe. (applicable to out-of-home care cases) 

The information provided in the ICPC packet regarding the focus child was 

sufficient to enable the receiving state to make an appropriate decision 

concerning approval of the proposed placement for the focus child. (applicable to 


If the child was in out-of-home care for at least 15 of the most recent 22 months or 

met other ASFA criteria for TPR, a TPR petition was filed or joined. (applicable to 

out-of-home care cases - Life of Case) 

If a Termination of Parental Rights petition was not filed, there were compelling 

reasons and an exception for not filing the petition was documented. 

Appropriate steps were taken to identify and recruit an adoptive family that 

matched the child’s needs. (applicable to out-of-home care cases) 

Appropriate steps were taken to process and approve an adoptive family that 

matched the child’s needs. (applicable to out-of-home care cases) 

85% 86% 

21% 46% 

14% 31% 

24% 44% 

49% 53% 

37% 40% 

63% 63% 

83% 93% 

64% 59% 

60% 58% 

87% 87% 

84% 89% 

44 

If the case involves a youth who has reached 13 but not yet 15 years of age and 

he/she is living in a licensed, out-of-home care placement, a pre-independent 

living assessment was completed that identified service needs and services were 

provided. (applicable to licensed out-of-home care cases) 

73% 78% 

45 

If the child is 13 years of age or older and in licensed foster care, the case 

management agency provided guidance and assistance in developing an 

educational and career path that is based on the child's individual abilities and 

interests. (applicable to licensed out-of-home care cases) 

84% 78% 

46 

The teen-aged focus child is afforded opportunities to participate in normal life 

skills activities in the foster home and community that are reasonable and 

appropriate for his/her respective age or special needs. (applicable to licensed 


No data 76% 






47 

48 

49 

50 

51 

52 

53 

54 

For youth 15 years of age but not yet 18, the agency appropriately monitored 

his/her progress towards successfully transitioning from foster care to 

independence through regular informative staffings. 

An ongoing assessment of the child(ren)’s needs was conducted to provide 

updated information for case planning purposes. (applicable to all cases) 

An assessment for residential group care was completed when required. 


An ongoing assessment of the mother’s needs was conducted to provide updated 

information for case planning purposes.(applicable to all cases) 

Concerted efforts were made to support the mother’s engagement with services. 

(applicable to all cases) 

An ongoing assessment of the father’s needs was conducted to provide updated 

information for case planning purposes. (applicable to all cases) 

Concerted efforts were made to support the father’s engagement in services. 


An ongoing assessment of the out-of-home care providers or pre-adoptive parent's 

service needs was conducted in order to ensure appropriate care for the child. 


No data 78% 

86% 88% 

79% 80% 

75% 77% 

68% 72% 

56% 58% 

53% 57% 

86% 88% 

55 

Concerted efforts were made to actively involve all case participants in the case 

planning process: (applicable to all cases) 

63% 69% 

55.1 Mother 63% 69% 

55.2 Father 48% 53% 

55.3 Child (if developmentally appropriate) 64% 71% 

55.4 Caregivers 69% 75% 

56 

The frequency of the services worker's visits with all case participants was 

sufficient to address issues pertaining to the safety, permanency goal, and wellbeing 

of the child. (applicable to all cases) 

39% 58% 

56.1 Mother 31% 45% 

56.2 Father 21% 31% 

56.3 Child 50% 73% 

56.4 Caregiver (out-of-home) 56% 76% 

57 

The quality of the services worker’s visits with case participants was sufficient to 

address issues pertaining to the child’s safety, permanency and well-being. 


59% 69% 

57.1 Mother 57% 72% 

57.2 Father 45% 58% 

57.3 Child 60% 71% 

57.4 Caregiver 72% 81% 






58 

59 

60 

61 

Concerted efforts were made to assess the child’s educational needs and 

maintain the child within the same school during out-of-home placement. 

(applicable to out-of-home care cases and in-home cases if relevant) 

If educational needs were identified, necessary educational services were 

engaged. (applicable to out-of-home care cases and in-home cases, if relevant) 

Services effectively reduced or resolved the issues that interfered with the child’s 

education. (applicable to out-of-home care cases and in-home cases, if relevant) 

Concerted efforts were made to assess the child’s physical health care needs. 

(out-of-home care cases and in-home cases, if relevant) 

86% 84% 

81% 83% 

83% 78% 

86% 70% 

61.1 EPSDT conducted within 72 hours of removal No data 59% 

61.2 If no EPSDT within 72 hours, screening completed within a week No data 58% 

61.3 

Diagnoses documented in the case file, medical passport and/or child's resource 

record 

No data 71% 

62 

Concerted efforts were made to provide appropriate services to address the child’s 

identified physical health needs. (applicable to out-of-home care cases and inhome 

cases, if relevant) 

82% 68% 

62.1 Services agency complied with the periodicity schedule No data 67% 

62.2 Services agency followed up on doctors orders No data 70% 

63 

64 

65 

66 

Concerted efforts were made to assess the child’s dental health care needs. 

(applicable to out-of-home care cases and in-home cases if relevant) 

Appropriate services were provided to address the child's identified dental health 

needs. 

An assessment(s) of the child’s mental/behavioral health needs was conducted. 

(applicable to out-of-home care cases and in-home cases, if relevant) 

Appropriate services were provided to address the child's mental/behavioral 

health needs. (applicable to out-of-home care cases and in-home cases if 

relevant) 

50% 47% 

67% 48% 

87% 89% 

82% 81% 

66.1 Services agency matched needed services specific to needs No data 83% 

66.2 Services agency followed up on doctors orders No data 82% 

67 

The Medical Report documenting informed consent was complete or a court order 

was in the file. 

No data 74% 

67.1 Services agency involved the family in the decision making process No data 64% 

67.2 

Services agency provided prescribing practitioner with all pertinent medical 

information 

No data 70% 

67.3 Services agency ensured parental express and informed consent for each med No data 62% 

67.4 If express and informed consent not obtainable, services agency requested CLS No data 76% 

67.5 

A court order was obtained when needed 

No data 75% 






68 Data in the Florida Safe Families Network accurately documented the child's No data 63% 

prescribed psychotropic medication. 

68.1 Name of medication and dosages prescribed No data 72% 

68.2 If the medication is for psychotropic purposes No data 76% 

68.3 Prescription begin and end dates No data 67% 

68.4 Dates of expressed and informed parental consent or court order No data 67% 

68.5 Name of prescribing practitioner No data 77% 

68.6 Reason the medication was prescribed No data 76% 

69 

70 

Judicial Reviews were held in a timely manner and Judicial Review Social Study 

Report's (JRSSR's) provided a thorough investigation and social study concerning 

all pertinent details relating to the child. 

Based on all the information reviewed, it is likely that the child will live in a safe 

and norturing environment with his/her needs being met on a permanent basis 

during the next 12 months. 

No data 85% 

83% 87% 

Table Appendix - 2

Child Welfare Services Statewide Quality Assurance Report - Florida ...

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