Statewide Quality Assurance Report

Department ofChildren and FamiliesFamily Safety Program OfficeChild Welfare ServicesStatewide Quality Assurance ReportAn Assessment ofthe Quality of Practice ofCase Management ServicesProvided to Children & FamiliesGeorge H. SheldonSecretaryDavid L. FairbanksAssistant Secretary for ProgramsAlan AbramowitzState Director for Family SafetyNovember 2010

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportTABLE OF CONTENTSExecutive Summary…………………………………………………………………………………………………………………......2I. Overview of the Child Welfare Case Management System ................................................... 4II.Case Review Process ……………………………………………………………………………………………………..….4III. General Findings and Practice Trends ................................................................................... 6a) Assessment .................................................................................................................... 6b) Family Engagement ...................................................................................................... 12c) Service Planning and Provision .................................................................................... 14d) Promoting Case Progress ............................................................................................. 20e) Supervisory Review ...................................................................................................... 24f) Placement Stability ..................................................................................................... 25g) Visits and Preserving Connections…………………………………………….................................27h) Independent Living Assessments and Planning…….………………………………………………….30i) Children Prescribed Psychotropic Medication………………………………….………………………32IV.Youth Voice………………………………………………………………….…………………………………………………35V. Federal Safety, Permanency, and Well-Being Domains…………………………………………………..51VI.Status of QA Standards Linked to Florida’s Quality Improvement Plan (QIP)…...................57Appendix 1 – Statewide Table………………………………………………………………………………………………..…..59Appendix 2 - FY 08-09/09-10 Comparison Table… …………………………………….……………………………....66Office of Family Safety | Page 1

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportExecutive SummaryThis annual quality assurance report offers a “window into practice” for child welfare casemanagement services. The information contained in this report was obtained between July 1, 2009 andJune 30, 2010 through a comprehensive review of 1,575 case management files including case workinformation contained in the Florida Safe Families Network (FSFN). Quality Assurance (QA) staff fromthe Department of Children and Families regional offices and Community-based Care (CBC) leadagencies 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 ofemergency 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 whenreunification 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 asadolescents.• The preparation of young adults that exit foster care at age 18 to make the transition to selfsufficiencyas adults.On June 30, 2010 the CBCs and local case management organizations were serving 18,548 1 childrenin out-of-home care and 10,807 2 children residing at home. In addition, case management agenciessuccessfully 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 atstrengths and weaknesses in their system of care. In addition to the quality of practice case reviewinformation, this report includes data on Florida’s performance on the federal safety, permanency, andwell-being measures, performance on the quality of practice standards linked to Florida’s federallymandated Quality Improvement Plan, and observations and recommendations from youth who arecurrently in the foster care system or have recently aged out of the foster care system. The informationfrom all of these sources should be considered when training case workers and developing annualquality improvement plans. Overall, Community-based Care lead agencies are doing a very good job1 FSFN Child Welfare Services Trend Report, run date September 2010 for point in time June 30, 20102 FSFN Child Welfare Services Trend Report, run date September 2010 for point in time June 30, 20103 FSFN ad-hoc report, run date September 2010 for point in time June 30, 2010Office of Family Safety | Page 2

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportdeveloping resources to serve children and families and providing oversight and guidance to casemanagement organizations. There are noted strengths in many case management service areas. Thesestrengths 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 helpingthem prepare for transition.There are five key areas that require further attention to improve practice. Family engagementis an area that is critical to the safety, permanency, and well-being of children and is the core ofgood child welfare practice. Because many of the quality of practice standards are tied to familyengagement activities, full implementation of the Family Centered Practice Model should result inimprovements to casework practice. The areas needing improvement are:1. Full development and implementation of the Family Centered Practice model (impacts manychild 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 knowledgeneeded to coach caseworkers.Detailed QA reports for individual CBCs are located at Florida’s Center for the Advancement of ChildWelfare Practice: http://centerforchildwelfare.fmhi.usf.edu/qa/QA_Reports/Forms/AllItems.aspxOffice of Family Safety | Page 3

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportI. Overview of the Child Welfare Case Management SystemChild welfare case management services in Florida are provided under the framework of therecently adopted Family Centered Practice Model. Family centered practice is a way of working withfamilies and teams to create a meaningful, well-integrated partnership to enhance the family’scapacity to care for and protect their children. It focuses on the needs and welfare of children withinthe context of their families and home communities. Family centered practice recognizes thestrengths of family relationships and builds on these strengths to achieve optimal results for childrenand families. Services are provided to families who need assistance in the protection and care of theirchildren, when children must live with foster families because they are not safe at home, and whenchildren are being prepared for adoption or other permanent family connections when leaving fostercare.Child welfare case management services in Florida are privatized through twenty nonprofitcommunity-based care (CBC) lead agencies and one county government lead agency. These leadagencies are responsible for providing foster care and related services including family preservation,prevention and diversion, dependency case work, out-of-home care, emergency shelter, independentliving, and adoption services. Lead agencies generally sub-contract with local community child welfareprovider 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 childrenin out-of-home care and 10,807 5 children residing at home. In addition, case management agenciessuccessfully helped 14,211 6 children achieve permanency through adoption, reunification,guardianship, or relative placement.II. Case Review ProcessThis annual quality assurance report offers a “window into practice” for child welfare casemanagement services. The information contained in this report was obtained through acomprehensive review of 1,575 case management files including case work information contained inthe Florida Safe Families Network (FSFN). Quality Assurance (QA) staff from the DCF regionaloffices and CBC lead agencies review child welfare cases to assess practice and identify strengths4 FSFN Child Welfare Services Trend Report, run date September 2010 for point in time June 30, 20105 FSFN Child Welfare Services Trend Report, run date September 2010 for point in time June 30, 20106 FSFN ad-hoc report, run date September 2010 for point in time June 30, 2010Office of Family Safety | Page 4

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportand opportunities for improvement. Each quarter CBC QA staff reviewed seventeen randomlyselected cases to determine practice for seventy-one quality of practice standards.An in-depthQuality of Services Systemic Review was completed on at least two cases each quarter from thesample set of seventeen cases. In-depth reviews include stakeholder interviews with judges,attorneys, Child Protection Teams, foster parents, trainers, and other community members involvedin the child welfare network. 7In addition, DCF QA staff and CBC QA staff jointly reviewed eightcases each quarter. The process of reviewing the same case, at the same time, using the samestandards, and subsequently reaching consensus on measuring practice, helps assure inter-raterreliability and builds positive working relationships and partnerships. The DCF QA staff alsoconducted an independent in-depth Quality of Services Systemic Review on at least two cases eachquarter from the sample of eight side-by-side cases. The results of the in-depth reviews are usedlocally to improve the child welfare system. The case review process is illustrated below:Quality Assurance Case Review ProcessFY 2009/2010Case Review ProcessCBC LeadAgencies17 Cases Quartertly6 Cases AnnuallyIn-Depth Quality of ServicesSystemic ReviewCBC and DCFJoint Case Review8 Cases QuarterlyDCF IndependentReview6 Cases AnnuallyIn-Depth Quality of ServicesSystemic ReviewIn FY 2009/2010 a purposive8sample selection was used that was based on the six federalpermanency goals: Maintain and Strengthen Families, Reunification, Adoption, Permanent7 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.Office of Family Safety | Page 5

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportGuardianship, Permanent Placement with a Relative, or Another Planned Permanent LivingArrangement. Guidelines were provided to select a certain number of cases from each goal, butwith some local flexibility. Detailed QA reports for individual CBCs are located at Florida’s Center forthe Advancement of Child Welfare Practice:http://centerforchildwelfare.fmhi.usf.edu/qa/QA_Reports/Forms/AllItems.aspxIn addition to the case file review, feedback from youth was solicited through Youth Roundtablesthat were facilitated across the state. This youth empowerment activity allowed youth a legitimatevoice in the system. In addition, the Youth Roundtables provided a forum for youth to become apartner in influencing local and state policy. The Youth Roundtable process and a summary of theircritical concerns are in section IV of this report. Youth perspective were written by youth andsubmitted to be included in this report. Their writings offer an insight into their perspective of thechild welfare system.III. General Findings and Practice TrendsChild welfare case work practice encompasses the range of activities designed to help familieswith children strengthen family functioning and address challenges that may threaten familystability. These activities include family centered assessment and case planning; case management;specific interventions with families including counseling, education, and skill building; advocating forfamilies; and connecting families with the supportive services and resources they need to improvetheir parenting abilities and achieve a nurturing and stable family environment. In child welfare, acombination of good case work practices increases the likelihood that optimal outcomes can beachieved. The tables and graphs contained in this report provide a view of inter-related activitiesthat tell a story about child welfare practice in Florida. Each practice impacts the other and if poorperformance is noted in one area, the likelihood for success overall decreases.a) AssessmentAssessment is the process of gathering information that will support service planning anddecision-making regarding the safety, permanency, and well-being of children, youth, andfamilies. It begins with the first contact with a family and continues until the case is closed. Theassessment is based on the assumption that for services to be relevant and effective, caseworkers must systematically gather information and continuously evaluate the needs of childrenand parents/caregivers as well as the ability of family members to use their strengths to addresstheir problems. Many assessments are conducted for different purposes throughout a family'sOffice of Family Safety | Page 6

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportinvolvement with the child welfare system. Assessments of safety and risk are also used toguide decisions when new concerns are identified and before major case decisions are madesuch as reunification. But safety and risk assessments alone are not sufficient for understandingthe range of issues related to the present concerns. There is a need to gather information onbroader issues that will affect each family's ability to resolve concerns that led to theirinvolvement with the child welfare system. It is also critical to gather information on thestrengths, resources, supports, connections, and capacities that will help families nurture theirchildren and keep them safe.Conducting thorough initial and ongoing assessments on the children and families beingserved is a basic child welfare function. Case workers and supervisors should be assessing everyaspect 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 thefamily story, other family members, and professional evaluations. Ongoing, activecommunication and collaboration with the family and the other persons involved are importantto the case worker’s ability to adequately update the family assessment. Good assessmentsimpact all other aspects of case management, service delivery and achieving goals.Improvements in practice related to assessments were noted in each related area exceptupdated family assessments (#7) documented in FSFN. This is in part due to the newrequirement for FY 2009/2010 that the family assessment must be documented in the electroniccase record in FSFN. Documenting the Family Assessment in FSFN has been the subject of ongoingdiscussions. OurKids in Miami has approval to use Structured Decision Making instead ofthe Family Assessment in FSFN.To ensure improvement, local action is needed to guide practice in the development of theinitial family assessments and updated family assessments. In addition, it is critical that prior toa placement change, a multi-disciplinary staffing/assessment is conducted to ensure placementstability of each child in out-of home care and prevent placement disruptions. This staffing isintended to ensure placement moves are made only when necessary and the child’s needs andthe appropriateness of the placement are thoroughly assessed.Office of Family Safety | Page 7

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportQuality of Practice for Initial AssessmentsStd# Standard # Cases Yes No5A thorough initial family assessment was conducted following the investigativesafety assessment that sufficiently addressed child safety factors andemerging risks.# of ApplicableCasesPracticeRating1575 236 124 360 66%7The updated family assessment was focused on the immediate andprospective safety of the child, as well as any changes and implications in thefamily's situation related to emerging concerns and service needs.1575 435 1058 1493 29%9A thorough safety assessment of the home was completed prior toreunification or placement of the child in an unlicensed out-of-home caresetting.1575 437 150 587 74%12A multi-disciplinary staffing/assessment for placement planning wasconducted before each placement to ensure the placement or move wasunavoidable.1575 332 218 550 60%Table IIIa-1Conducting Thorough Initial AssessmentsFY 2008/2009 Compared to FY 2009/2010100%80%60%66%75%71%74%60%40%55%29%51%FY 08-09FY 09-1020%0%5 Initial familyassessment7 Updated familyassessment9 Assessment of thehome12 Staffings andassessment for eachplacementSource: FY 2009-10 QA Web ToolGraph IIIa-1Office of Family Safety | Page 8

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportThe family assessment includes a needs assessment to identify the underlying issues thatare driving or influencing a parent’s behavior, such as obtaining adequate income, housingand/or health care. The needs may be emotional ones, such as a need to cope with pasttraumas, 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 reachingconsensus with parents about their needs in order to help them become better caregivers fortheir children, we have set the stage for appropriate planning to address needs. Mostimportantly, we can define the result we want from case plan interventions in terms of meetinga 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 alsoan 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 skillsneeded to identify needs. The Gabriel Myers Workgroup noted that all decision making shouldbe guided by the principle that it is important to comprehensively address all concerns in achild’s life: health, education, and social/emotional issues, as well as providing behavioralsupports so that a child’s behavioral and mental health issues can be addressed in the leastrestrictive setting and in the context of a comprehensive treatment plan. This workgroup alsoidentified the need to ensure presenting needs of a child are identified and met in a timelymanner. Although incremental improvements were noted, data indicates not much changefrom the previous fiscal year regarding assessing individual needs. Local action is especiallyneeded to improve practice related to assessing the needs of fathers specific to identifying theservices necessary to achieve case plan goals.Quality of Practice for Assessment of Needs# of Applicable PracticeStd# Standard # Cases Yes No Cases Rating48An ongoing assessment of the child(ren)'s needs was conducted to provideupdated 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%505254An ongoing assessment of the mother's needs was conducted to provideupdated information for case planning purposes.An ongoing assessment of the father's needs was conducted to provideupdated information for case planning purposes.An ongoing assessment of the out-of-home care providers or pre-adoptiveparent's service needs was conducted in order to ensure appropriate care forthe child.1575 901 265 1166 77%1575 528 389 917 58%1575 978 132 1110 88%Table III a-2Office of Family Safety | Page 9

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportAssessment of NeedsFY 2008/2009 Compared to FY 2009/2010100%88%88%80%86%79%80%75%77%86%60%58%56%40%FY 08-09FY 09-1020%0%48 Assessment of thechild(ren)'s needs wasconducted.49 Assessment forresidential group care wascompleted.50 Assessment of themother's needs wasconducted.52 Assessment of thefather's needs wasconducted.54 Assessment of the outof-homecare providers orpre-adoptive parent'sservice needs wasconducted.Source: FY 2009-10 QA Web Tool Graph III a-2Child welfare case planning must include an assessment of a child’s education, physicalhealth, dental health, and mental health needs. The table and graph on the following pageillustrate that assessments of a child’s individual mental/behavioral health needs are slightlyimproved from last year, but education, physical and dental health assessments took adownward turn; most significant of which is the child’s physical health assessments. Regionsand CBCs should review individual performance in this area and consider conducting root causeanalyses 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 dueto 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 beneeded because meeting dental health needs affects a child’s entire health system.Office of Family Safety | Page 10

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportQuality of Practice for Assessment of Child’s Individual NeedsStd# Standard # Cases Yes No# of ApplicableCasesPracticeRating58Concerted efforts were made to assess the child’s educational needs duringout-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%65An assessment(s) of the child's mental/behavioral health needs wasconducted.1575 959 119 1078 89%Table III a-3Assessment of Child’s Individual NeedsFY 2008/2009 Compared to FY 2009/2010100%80%84%86% 86%70%87%89%60%40%50%47%FY 08-09FY 09-1020%0%58 Educational needswere assessed.61 Physical health careneeds were assessed.63 Dental health care 65 An assessment of theneeds were assessed. child's mntl/bhvrl healthneeds was conducted.Source: FY 2009-10 QA Web ToolGraph III a-3Office of Family Safety | Page 11

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reporthours, financial issues, etc. Case workers must also understand the importance of involvingfathers in case planning. Research shows that children growing up without fathers are morelikely to fail at school or to drop out, engage in early sexual activity, develop drug and alcoholproblems, and experience or perpetrate violence. (Best Practice: Next Practice, Family CenteredChild Welfare, National Child Welfare Resource Center for Family-Centered Practice, Children’sBureau, 2002)Although the quality of practice case review data show improvements in efforts to engagefamily members and actively involve them in the case planning process, this area needssubstantial attention, especially with engagement of fathers. Case workers should encouragemothers to identify fathers early in the case. If this fails, they should use alternative means toidentify and locate fathers through interviews with relatives and family friends, child supportinformation, etc. Local administrators are encouraged to monitor and support familyengagement practices.Quality of Practice for Family Engagement for Case Planning# of Applicable PracticeStd# Standard # Cases Yes No Cases Rating36The mother was encouraged and supported to participate in making decisionsabout her child's needs and activities.1575 463 404 867 53%3751The father was encouraged and supported to participate in making decisionsabout his child's needs and activities.Concerted efforts were made to support the mother's engagement withservices.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-1Office of Family Safety | Page 13

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportExit interviews are one method of assessing the provision of services from the viewpoint ofthe 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 ormore.” These interviews are conducted by a case worker. Exit interviews are also conductedwith age appropriate youth when he/she is moved from one group home to another even if thegroup homes are overseen by the same provider. The interview is not to be conducted in thehome the child just exited, but in a setting where the child feels comfortable and theconversation is private. For each qualifying placement, the QA reviewer must review the exitinterview document and ensure it was completed and any concerns were acted upon.Progress reports are another method of assessing service delivery. The case worker mustprovide progress reports to document the effectiveness of service interventions, and shareinformation with providers regarding significant changes in the family’s situation. The tragicdeath of Gabriel Myers underscored the need for providers to communicate and shareinformation, functioning as a unified team. The Gabriel Myers Workgroup noted this as a criticalgap that that needed to be addressed to ensure sharing of information among all stakeholdersresponsible for a child’s care. All provider contacts should be purposeful and directed towardachieving the case plan goal. Case workers must facilitate and lead communication among localservice providers about services for the child and other case participants. The case workershould address progress on the case plan tasks on a routine basis. Quality of practice datademonstrates the need for continued attention to these initiatives. Local action should be takento explore ways to improve communication and share information and to ensure case workersconduct exit interviews with children.Quality of Practice for Child Exit Interviews and Sharing InformationStd# Standard # Cases Yes No# of ApplicableCasesPracticeRating17In cases involving a child in a licensed placement setting, an exit interview wasconducted with the child when moved from one placement to another, andappropriate action was taken if the exit interview documented a concern.1575 222 61 283 78%25The services worker communicated with service providers about theeffectiveness of services for involved case participants.1575 973 497 1470 66%Table III c-2Office of Family Safety | Page 16

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportExit Interviews and Sharing InformationFY 2008/2009 Compared to FY 2009/2010100%80%78%60%69%64%66%40%FY 08-09FY 09-1020%0%17 An exit interview was conducted with thechild.25 The services worker communicated withservice providers about the effectiveness ofservices for involved case participants.Source: FY 2009-10 QA Web ToolGraph III c-2Appropriate educational, health, and mental health services must be provided to address achild’s identified needs. The engagement of necessary educational services to address identifiedneeds are required for children in out-of-home care and for children residing at home when theeducational 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 identifiededucational needs, services must be provided to address those needs. For example, did the childwith an Individual Education Plan (IEP) for special education services need extra help or tutoringwith school work, advocacy with the school system, early intervention through a preschoolprogram, etc.? Were appropriate services provided to address the identified needs? Did theagency advocate for the youth remaining in the school of origin if that was in the child’s bestinterest? The delivery of appropriate services will also effectively reduce or resolve the issuesthat interfere with the child's education, with a goal of positively impacting the child's schoolperformance and success in life.Office of Family Safety | Page 17

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportAppropriate services must also be obtained to address the child's physical health needs. Thisapplies to all children in out-of-home care and for children residing at home when the physicalhealth issue is relevant to the agency's reason for involvement. Child health records must be upto date and included in the case file, to the extent they are available and accessible; case plansmust 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 recordsmust include the names of the child’s health care providers, a record of the child’simmunizations, child’s known medical problems, child’s medications, and any other relevanthealth information. This includes efforts to address the child’s dental health needs once theneeds are identified. If a child is Medicaid eligible, these services should be obtained through aMedicaid provider. If a child is not Medicaid eligible, these services must still be provided. Thechild’s dental records should be up to date and included in the case file to the extent availableand accessible; case plans must address the issue of dental care needs; and, caregivers must beprovided 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 termneeds. National research underscores the importance of providing services to address theseneeds. A 2010 report published by the National Center for Children in Poverty states “Childrenyounger than three years of age are the most likely of all children to be involved with childwelfare services and children three and younger who have been maltreated are subsequently atrisk for experiencing developmental delays. Maltreatment in children younger than 3 years ofage has been found to be associated with concurrent gross and fine motor delays, failure tothrive, heightened arousal to negative emotions, speech and language delays, and hypervigilance. Age of the first episode of maltreatment is associated with mental health problems inadulthood. For example, maltreatment at age 2 to 5 has been linked with anti-social personalitydisorder by age 29. Younger ages of onset (birth to 2) were associated with depression andother internalizing disorders by age 40.” (National Center for Children in Poverty, Addressingthe Mental Health Needs of Young Children in the Child Welfare System: What EveryPolicymaker Should Know, Janice L. Cooper, Patti Banghart, and Yumiko Aratani, September2010).The 2008 Florida CFSR noted that Florida’s performance on meeting the physical healthneeds and mental health needs of the children was an area needing improvement. The FloridaOffice of Family Safety | Page 18

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportQA practice reviews show that although the provision of educational and mental health serviceshas remained relatively stable during this reporting period, the provision of physical and dentalhealth needs dropped significantly. There has also been a downward trend in assessments inthese areas. The quality of practice data demonstrates the need for local analysis of practice todetermine root causes so that action can be taken to improve practice.Quality of Practice for Educational, Behavioral and Mental/Physical Health NeedsStd# Standard # Cases Yes No# of ApplicableCasesPracticeRating59If educational needs were identified, necessary educational services wereengaged.1575 394 83 477 83%60Services effectively reduced or resolved the issues that interfered with thechild's education.1575 303 84 387 78%62Concerted efforts were made to provide appropriate services to address thechild’s identified physical health needs.1575 564 271 835 68%64Appropriate services were provided to address the child's identified dentalhealth needs.1575 217 234 451 48%66Appropriate services were provided to address the child's mental/behavioralhealth needs.1575 670 155 825 81%Table III c-3Educational, Behavioral and Mental/Physical Health NeedsFY 2008/2009 Compared to FY 2009/2010100%80%81%83%83%78%82%82%81%68%60%67%48%40%FY 08-09FY 09-1020%0%59 Necessaryeducational serviceswere engaged.60 Services effectivelyreduced or resolved theissues that interferedwith the child'seducation.62 Appropriate servicesto address the child’sidentified physical healthneeds were made.64 Appropriate serviceswere provided toaddress the child'sidentified dental healthneeds.66 Appropriate serviceswere provided toaddress the child'smental/behavioralhealth needs.Source: FY 2009-10 QA Web ToolGraph III c-3Office of Family Safety | Page 19

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportd) Promoting Case ProgressEvaluating family progress toward case plan goals should continue throughout the life of thecase until appropriate outcomes have been achieved. Goalsneed to be specific, realistic, flexible, and culturally sensitive.In each case involving a child placed in out-of-home care, aninitial case plan must be prepared within 60 calendar days ofremoval from the home. The case plan must be submitted tothe court by the date of the dispositional hearing at thelatest. For in-home cases, a case plan must be finalized within30 days of the case being accepted for services. The caseplan’s compliance period expires no later than 12 monthsafter the initial removal or no later than 12 months after thecase plan was accepted by the court, whichever occurredsooner. A case plan may not be extended beyond 12 monthsunless extraordinary circumstances exist and it is in thechild's best interest. The extension reasons must be factuallydocumented and presented to the court at the 12 monthpermanency review hearing with supportive documentationin the Judicial Review Social Services Report. The case planmay be amended to change the case plan goal, and/oremploy the use of concurrent planning. In addition, a caseplan must be amended if an oversight is identified or newinformation is obtained following case plan approval, i.e.,unaddressed condition that may prevent the child from safelyreturning to or remaining in the home; child’s need forpermanency, given age and developmental needs; a party'sfailure to substantially comply; or the ineffectiveness of aservice previously offered.Case plan goals must be based on the child’s and family’sI want the adults to feel thepain of a 12 year old boythat doesn’t have a home.Goes to school with thesame pair of shoes everyday, isolated from everyoneelse because he isn’t “cool”.Pushed around, bullied,kicked, punched, andjumped after school. Has torun home and can’tsocialize, and even if hewanted to socialize cantbecause doesn’t anyonewant to be around him.Neglected, disrespected,has one million secrets butcan’t tell anyone becauseno one wants to listen.Father beats him tostraighten him to become aman. Mother is never home.Big brother tries to be a rolemodel but is persuaded bythe streets to be a gangster.Little sister is gone in thewind with her friends. Hetries to keep the familytogether but there is none.MarcusFormer Foster Child Placedin a Group Homecircumstances. For children in out-of-home care, thepermanency goals, in order of preference per Chapter 39,Florida Statutes, are reunification, adoption ( if a petition forOffice of Family Safety | Page 20

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reporttermination of parental rights has been or will be filed), permanent guardianship of a dependentchild, permanent placement with a fit and willing relative, and placement in another plannedpermanent living arrangement (APPLA). The case plan goal for court ordered in-home or noncourtordered in-home cases is Maintain and Strengthen.Case plan tasks must be designed to improve the conditions in the home, aid in maintainingthe child in the home, facilitate the child’s safe return to the home, ensure proper care of thechild, or facilitate the child’s permanent placement. The case plan must clearly match thechild’s, parents’, and/or caregivers’ needs with services, contain realistic timeframes, anddocument 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 caseplan goal, timely reunification or permanent placement given the circumstances of the case, andthe child’s need for safe and proper care. The tasks, services, and supports must be tailored toeach individual family member to provide the necessary treatment and supports, formal andinformal, needed to achieve case goals and mitigate factors affecting child safety, emerging riskand overall child and family well-being. The tasks should be realistic, achievable, and timelimited, and the services should be available. Quality of practice case reviews indicate goodpractice related to case plan goals. Continued improvement is needed in keeping case planscurrent and assigning appropriate tasks to participants.Quality of Practice for Case Plan Goals and TasksStd# Standard # Cases Yes No# of ApplicableCasesPracticeRating21 The case record contained a current (not expired) case plan. 1575 1152 401 1553 74%22The current case plan goal was appropriate based on the child's, and family'scircumstances.1575 1113 69 1182 94%24The case plan is designed to achieve permanency (out-of-home care cases) andsafety and stability (in-home cases) through appropriate tasks for the caseparticipants.1575 930 140 1070 87%Table III d-1Office of Family Safety | Page 21

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportCase Plan Goals and TasksFY 2008/2009 Compared to FY 2009/2010100%80%74%93%94%87%87%74%60%40%FY 08-09FY 09-1020%0%21 The case record contained acurrent case plan.22 The current case plan goalwas based on the child's, andfamily's circumstances.24 The case plan is designed toachieve permanency and safetyand stability throughappropriate tasks for the caseparticipants.Source: FY 2009-10 QA Web ToolGraph III d-1Case 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 themost recent 22 months or met other Adoption and Safe Families Act criteria for terminatingparental rights, a TPR petition must be filed or joined. The state is required to file or join a TPRpetition unless there are compelling reasons for not filing. Case workers must take appropriatesteps to identify and recruit an adoptive family that matches the child’s needs. If TPR hasoccurred, appropriate steps must be taken to identify and recruit an adoptive family. If TPR hasnot occurred, recruitment efforts must be initiated. It is critical that judicial reviews are held in atimely manner and include a Judicial Review Social Study Report (JRSSR) that provides athorough investigation and social study concerning all pertinent details relating to the child. Thejudicial review QA standard #69 was added in FY 2009/2010, so this information provides abaseline of current performance. Children’s Legal Services is currently closely monitoringprogress on timeliness of TPRs.Office of Family Safety | Page 22

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportQuality of Practice for Activities Associated with Termination of Parental RightsStd# Standard # Cases Yes No41If a Termination of Parental Rights petition was not filed, there werecompelling reasons and an exception for not filing the petition wasdocumented.# of ApplicableCasesPracticeRating1575 176 130 306 58%424369Appropriate steps were taken to identify and recruit an adoptive family thatmatched the child's needs.Appropriate steps were taken to process and approve an adoptive family thatmatched the child's needs.Judicial Reviews were held in a timely manner and Judicial Review Social StudyReport's (JRSSR's) provided a thorough investigation and social studyconcerning 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-2Termination of Parental RightsFY 2008/2009 Compared to FY 2009/2010100%80%87%87% 89%84%85%60%60%58%40%FY 08-09FY 09-1020%0%41 If a TPR petition was notfiled an exception for notfiling the petition wasdocumented.42 Appropriate steps weretaken to identify and recruitan adoptive family.43 Appropriate steps weretaken to process and approvean adoptive family thatmatched the child's needs.69 Judicial Reviews were heldin a timely manner andJudicial Review Social StudyReport's (JRSSR's) provided athorough investigation andsocial 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.Office of Family Safety | Page 23

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reporte) Supervisory Coaching and MentoringThe job of the frontline child welfare supervisor is critically important – perhaps the mostdemanding and difficult in the entire agency. Much has been written about the directconnection between the quality of supervision and important employee measures such as staffturnover rates, morale, and job performance and commitment. Good supervisors produceengaged employees which results in lower staff turnover rates and improved organizationalperformance, ultimately producing desired outcomes for children and families. Supervisorsmust 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 toimprove 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 ensuringsound case work practices are in place that should lead to positive outcomes for children andfamilies. Although practice has improved, and completing reviews timely seems to receive moreattention, practice data reflects continued performance gaps in the quality and follow throughof supervisory oversight. Practice reviews document the need for targeted work withsupervisors to improve skills in the areas of coaching staff. This is an area that needs localassessments in order to effect necessary change. The Department is currently pursuing severalinitiatives to improve supervisory skills that will have a direct impact on case work practice.Quality of Practice for Supervisory Coaching and Mentoring# of Applicable PracticeStd# Standard # Cases Yes No Cases Rating20Qualitative supervisory reviews and follow through were conducted as neededand required.1575 785 790 1575 50%20.1 Reviews were completed quarterly. 1575 1196 377 1573 76%20.220.3Supervisor considered all aspects of the child's safety, well-being andpermanency.Supervisor ensured follow through on guidance and direction or documentedthe reasons the guidance and direction were no longer necessary.1575 965 609 1574 61%1575 757 803 1560 49%Table III e-1Office of Family Safety | Page 24

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportSupervisory Reviews and Follow ThroughFY 2008/2009 Compared to FY 2009/2010100%80%76%60%66%61%50%53%49%40%37%38%FY 08-09FY 09-1020%0%20 Qualitative supervisoryreviews & follow throughwere conducted asneeded and required.20.1 Reviews werecompleted quarterly.20.2 Supervisorconsidered all aspects ofthe child's safety, wellbeingand permanency.20.3 Supervisor ensuredfollow through onguidance & direction ordocumented reasons theywere no longer necessary.Source: FY 2009-10 QA Web ToolGraph III e-1f) Placement StabilityPlacement stability is important for children to develop healthy secure and serves to reducethe potential stressors that arise from being displaced multiple times relationships (Leathers, S.J(2002). Foster Children’s Behavioral Disturbance and Detachment from Caregivers andCommunity 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, andexperiencing a sense of not belonging. All of these can have a profound negative emotionalimpact and produce a fear of forming secure healthy relationships. Additionally, placementstability is especially important for youth success in foster care.Youth who experience minimal placement changes are more likely to experience fewerschool changes, less trauma and distress, less mental health and behavioral problems andincreased probabilities for academic achievement and experiencing a lasting positiveOffice of Family Safety | Page 25

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportrelationship with an adult (Gauthier, Fortin, & Jeliu,2004; Rubin, Alessandrini, Feudtner, Mandell,Localio, & Hadley, 2004). Every child who must beremoved from their own home because of abuse orneglect deserves to be placed in an out-of-homecare setting that is safe, stable and nurturing. Safe,stable and nurturing out-of-home care settings arecritical to achieving optimum outcomes andpermanency for children whether the goal is“If someone would have listened to me ortried to understand what I was saying, ortook the time to figure out why I was actingout, maybe I wouldn’t have ended upjumping around from home to home,committing a crime, getting pregnant, ordropping out of high school. “Former Foster Care Youthreunification, guardianship, adoption, or Another Planned Permanent Living Arrangement. Themore that a child remains in a stable placement while in out-of-home care, the more likely thatchild will thrive into the future. Quality of practice data indicates improvement is neededregarding planning placement moves, a critical factor in avoiding placement change.Quality of Practice for Placement StabilityStd# Standard # Cases Yes No# of ApplicableCasesPracticeRating13The child's current placement is stable and appropriate to meet the child'sneeds with no apparent or significant risks or projections of disruption.1575 1040 87 1127 92%14Concerted efforts were made to identify, locate and evaluate other potentialrelatives and possible permanent placements for the child.1575 658 174 832 79%151619The child experienced no more than two out-of-home care placement settingsduring the period under review.If No was entered for #15, all placement changes were planned in an effort toachieve 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 inplacement.1575 1084 164 1248 87%1575 93 92 185 50%1575 581 68 649 90%Table III f-1Office of Family Safety | Page 26

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportPlacement StabilityFY 2008/2009 Compared to FY 2009/2010100%80%91%92%79%80%87%91%90%60%40%67%46%50%FY 08-09FY 09-1020%0%13 The child's currentplacement is stable with noapparent risks or projectionsof disruption.14 Concerted efforts weremade to identify, locate &evaluate other relatives &possible placements for thechild.15 The child experienced nomore than two out-of-homecare placement settings.16 If No for #15, all placementchanges were planned toachieve the child's case goals.19 The court was informed ofthe child's placements andreasons for changes inplacement.Source: FY 2009-10 QA Web Tool Graph III f-1g) Visits and Preserving ConnectionsChildren need visits to maintain their family attachments and comprehend what hashappened to them. Visits are also an important opportunity for parents to increase theirunderstanding of and ability to meet their children’s needs. Major contributing factors tosuccessful outcomes for children and families in the child welfare system are the frequency andthe 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 thecase worker is investing time and interest in them and that helps establish trust and effectiveworking relationships that are needed to achieve positive outcomes. Frequent and quality visitspromote ongoing assessment of the child and family in real time, help improve placementstability, and ensure appropriate interventions are relevant for current needs. When familymembers are not living together, but the intent is to reunify and maintain and strengthen thefamily in the future, it is the child welfare system’s responsibility to preserve family connectionsuntil that can happen.Office of Family Safety | Page 27

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportAlthough substantial improvements were seen in frequency and quality of worker visitswhich should lead to improved outcomes for children and families, action is needed to improvein this area. Supervisors should continue to support and encourage these visits as one of themost effective means of engaging families, promoting case progress, and preserving theimportant connections between children and their families.Quality of Practice for Child VisitationStd# Standard # Cases Yes No23The case plan specifically addressed visitation and other contact plans with allcase participants.# of ApplicableCasesPracticeRating1575 545 234 779 70%30315657Concerted efforts were made to ensure visitation (or other contact) betweenthe child and parents were sufficient to maintain or promote the continuity ofthe relationship between them.Concerted efforts were made to ensure visitation (or other forms of contact ifvisitation was not possible) between the child and his or her siblings and it wasof sufficient frequency to maintain or promote the continuity of therelationship.The frequency of the services worker's visits with all case participants wassufficient to address issues pertaining to the safety, permanency goal, and wellbeingof the child.The quality of the service worker's visits with case participants was sufficientto 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 VisitationFY 2008/2009 Compared to FY 2009/2010Table III g-1100%80%80% 80%70%83%73%76%69%60%58%59%FY 08-09FY 09-1040%39%20%0%23 The case planspecifically addressedvisitation & othercontact plans with allcase participants.30 Concerted effortswere made to ensurevisitation b/w child &parents were sufficientto maintain theirrelationship.31 Concerted effortswere made to ensurevisitation b/w child &siblings was made tomaintain theirrelationship.56 Frequency of theservices worker's visitswas sufficient to addressissues.57 Quality of the servicesworker's visits wassufficient to addressissues.Source: FY 2009-10 QA Web ToolGraph III g-1Office of Family Safety | Page 28

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportWhen the case plan goal is reunification, the child must be placed as close as possible to theparent with whom reunification is planned. When placing children, the case worker must takeinto consideration the family’s home address, its proximity to the placement, and the impact onfrequency of parent/child visitation. Every possible effort must be made to place siblings in thesame 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-ofhomecare placement should be chosen based on the child's community ties and schoolplacement. To ensure continuity of education, concerted efforts are required to maintain thechild within the same school, if at all possible.When removal or court ordered supervision occurs, the case worker must inquire of themother 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 isresponsible for ensuring that a child who is receiving services has been appropriately identifiedas to heritage. Each area showed improvement, but significant improvement was noted inplacing siblings together and making inquiries related to Native American or Alaskan Nativeheritage.Quality of Practice for Child PlacementStd# Standard # Cases Yes No# of ApplicableCasesPracticeRating26The child's current placement was in close proximity to the parents to facilitateface-to-face contact between the child and parents while the child was in outof-homecare. (applicable to out-of-home care cases)1575 748 64 812 92%28The child was placed with siblings who were also in licensed and/or nonlicensedout-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%33An inquiry was made to determine if the child was of Native American orAlaskan Native heritage.1575 671 777 1448 46%Table III g-2Office of Family Safety | Page 29

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportPlacementFY 2008/2009 Compared to FY 2009/2010100%91%92%86%80%85%60%60%40%53%46%FY 08-09FY 09-1020%21%0%26 The child's current 28 The child was placed withplacement was in close siblings who were also inproximity to the parents to licensed and/or non-licensedfacilitate face-to-face contact out-of-home care.between the child and parents.32 Concerted efforts weremade to maintain the child'simportant connections.33 An inquiry was made todetermine if the child was ofNative American or AlaskanNative heritage.Source: FY 2009-10 QA Web Tool Graph III g-2h) Independent Living Assessment and PlanningOlder children and youth in out-of-home care should receive independent living services tohelp prepare them for self-sufficiency in adulthood. They can receive these services while theyare living in any type of out-of-home care placement (such as kinship care, family foster care, orresidential/group care). Youth receiving independent living services can be working towardachieving any of the permanency goals (such as reunification, adoption, or guardianship) or theymay be approaching aging out of foster care to adulthood on their own. Independent livingservices generally include assistance with money management skills, educational assistance,household management skills, employment preparation, and other services.Office of Family Safety | Page 30

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportIndependent living assessments beginning at 13 years of age are intended to address theteen’s individual needs, life skills, education, and social skill development in order to preparethem for the future, and especially for the teen to live independently if he/she ages out of fostercare upon reaching 18 years of age. While in foster care, however, the expectation is that theteen can live as much of a normal life as possible while preparing to transition. Education andcareer paths, normalcy, and transitioning standards were added for FY 2009/2010, so the datafor these three practices is baseline data. Addditional information can be found in theIndependent Living Special QA Review Reports for Phase I dated September 2009 and Phase IIdated June 2010. These reports can be viewed at the website for the Florida Center for theAdvancement of Child Welfare Practice:http://centerforchildwelfare.fmhi.usf.edu/qa/SpecialQA_Reviews/Forms/AllItems.aspx.Quality of Practice for Independent LivingStd# Standard # Cases Yes No# of ApplicableCasesPracticeRating44If the case involves a youth who has reached 13 but not yet 15 years of age andhe/she is living in a licensed, out-of-home care placement, a pre-independentliving assessment was completed that identified service needs and serviceswere provided.1575 83 24 107 78%45If the child is 13 years of age or older and in licensed foster care, the casemanagement agency provided guidance and assistance in developing aneducational and career path that is based on the child's individual abilities andinterests.1575 232 67 299 78%4647The teen-aged focus child is afforded opportunities to participate in normal lifeskills activities in the foster home and community that are reasonable andappropriate for his/her respective age or special needs.For youth 15 years of age but not yet 18, the agency appropriately monitoredhis/her progress towards successfully transitioning from foster care toindependence through regular informative staffings.1575 214 66 280 76%1575 186 54 240 78%Table III h-1Office of Family Safety | Page 31

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportIndependent Living Assessment and PlanningFY 2008/2009 Compared to FY 2009/2010100%80%78% 78% 76% 78%73%60%40%FY 08-09FY 09-1020%0%44 Pre-independent 45 Guidance in 46 Participation in normalliving assessmentidentified service needs.developing educational &career pathslife skills activities.47 Appropriatemonitoring of progresstoward successfultransition (age 15-17) .Source: FY 2009-10 QA Web Tool Graph III h-1*45,46,47 - no 08/09 datai) Children Prescribed Psychotropic MedicationWhen a child is placed in an out-of-home care setting and a prescribing physician hasrecommended the child be placed on psychotropic medication, the child welfare agency mustensure that the child and the family consult with the prescribing physician before medication isadministered. If parental rights are intact, parents must be given an opportunity to give expressand informed consent that is based on a thorough understanding of the reasons why themedication is being prescribed. This requires parental consultation with the prescribingpractitioner to discuss the nature and purpose of the treatment, alternative treatments for theirchild, and factors such as potential side effects and how to respond to them. During the firstquarter of FY 2009/2010, regional and CBC quality assurance staff conducted an exhaustive casefile 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 issuesrelated to children in out-of-home care who were prescribed a psychotropic medication. TheOffice of Family Safety | Page 32

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportGabriel Myers Workgroup recommended the development of new QA standards to ensure therewas a standardized process for on-going review of practice in this area. The quality of practicedata indicates more training and supervisory oversight is needed to ensure parental consentconstitutes the meaning of “valid and informed”. Supervisors must also carefully review casesto 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 nodocumentation in FSFN.o There is no documentation that the case manager facilitated communication betweenparents and doctors to obtain consent.o Court authorization is being obtained without making any effort to obtain consent froma 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 ormore 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 dateof court authorization is entered. Case managers forget to go back and enter theinformation.o The required Medical Report is not used and the physician does not use a report thatincludes all information required to be in the Medical Report. Or, the Medical Report isincomplete.o If the case manager does not check the psychotropic medication tab when a child is on apsychotropic medication for medical purposes, the case cannot be identified through adhoc reporting.o Some dates in FSFN for informed consent are not accurate. For example, an informedconsent 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 correctiveaction is taken. Local managers and supervisors should develop local processes to ensure allclose oversight of this population of children. In addition, because there is always staffturnover, in-service training should be routinely provided to case management organizations asneeded.Office of Family Safety | Page 33

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportQuality of Practice Related to Children Prescribed Psychotropic MedicationsStd# Standard # Cases Yes No67The Medical Report documenting Informed consent was complete or a courtorder was in the file.# of ApplicableCasesPracticeRating1575 202 72 274 74%68Data in the Florida Safe Families Network accurately documented the child'sprescribed psychotropic medication.1575 162 95 257 63%Table III j-1Psychotropic MedicationsFY 2008/2009 Compared to FY 2009/2010100%80%60%74%63%FY 09-1040%20%0%67 The Medical Report documentingInformed consent was complete or a courtorder was in the file.68 Data in the Florida Safe Families Networkaccurately documented the child's prescribedpsychotropic medications.Source: FY 2009-10 QA Web ToolGraph III j-1Office of Family Safety | Page 34

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportIV.Youth Voice: Empowering Youth to ImproveChild Welfare PracticeIn 2010, as part of the Quality Assurance reviewprocess, eight Youth Perspective Roundtableswere facilitated across the state. The purpose ofthe Youth Perspective Roundtable was to learnfrom youth in foster care and empower them totalk about their challenges, needs, feedback,and recommendations that could improve childwelfare practice and the quality of the fostercare system. The Youth PerspectiveRoundtables consisted of a series of discussionswith youth in foster care, ranging in age from 13years to 22 years. A youth who was still in fostercare led each group in a 90 minute discussionthat focused on six areas: placement,education, transportation, services,independent living, and community resources.Within each area the youth:1) identified “important people” in theirlives and defined their characteristics;my mother, father, pastor, caseworker,etc.2) described their feelings about being “incare” and “out of care” and the processof (or expectations for) transitioning toadulthood, and3) brainstormed ways in which theirexperience foster care might be“changed,” with a focus on ways ofstrengthening relationships.Taran’s Story – A Struggle from BirthI entered foster care for the first time as a newbornand I was in and out of shelter and foster care forthe next 18 years. My behavior was not alwaysgood. I was angry. I had a failed adoption and 35different foster home placements; I was in fourgroup home placements and I was incarcerated in 3different commitment programs. At 17 after my lastcommitment program in secure detention, I wasadvised by my Independent Living Coordinator thatit’s time to change, time to grow up, you changenow before it is too late. And I did.Having supportive adults in my life helped me beginto believe I could achieve success and knowing therewere people who cared about me inspired me totake the steps I needed to start being successful.My supports/mentors listened to me and never gaveup. They often gave constructive advice, even if I didnot take their advice at that time it influenced mydecisions later in life when the words would comeback to me. Words like “stay focused”, “staydetermined” “you are a good person” you CAN DOIT”.I have made every effort to take advantage of theopportunities offered to me during my experience infoster care. Programs like the Independent Livingprogram and AMI Kids (formerly Escambia BayMarine Institute) helped me learn to set goals and tomake a real plan to achieve those goals. Eventhough it seemed like I was always in trouble, I lovedschool and finally realized I had all the help I couldneed if I only used it. Asking for help was a hardthing to learn to do.I graduated from high school, earned an AA degreein Pre-law and I am now attending a four yearUniversity.If I could talk to every kid in foster care I would tellthem to make those important connections withsupportive adults. I would encourage foster childrento learn to see life from other perspectives-to ask forhelp, to have faith and to trust enough to reach outto the community.I have been asked to speak at conferences andtraining seminars. I put my message out there toeveryone: My message is to believe that life can belived as you want and not lived how you haveOffice of Family Safety | Page 35

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportChildren in foster care are particularly vulnerable as they often come into state caretraumatized due to their exposure to maltreatment, family instability, and a number of otherrisk 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 caregiving that result from a variety of parental issues, such as substance abuse, mental illness, anddevelopmental disabilities. Moreover, these children are predominantly from impoverishedbackgrounds, a situation that intensifies the risk factors they experience.Youth and young adults who are either currently in foster care, or who have recently agedout of foster care, must be empowered to have a voice in the child welfare system. This sectionprovides a summary of the perspectives, ideas, experiences, knowledge, and actions of youngpeople. Every time a statute, administrative code, policy or law is implemented or changed, wehear, “Did you ask the youth? What do they think?” The youth voice is essential to any type ofthese changes. The more information the Department receives from youth, the better ourability to improve the delivery of quality services.An interesting dynamic developed in one area where there was a sibling group of four youthwho were 17-24 years of age. All four children grew up in foster care. One youth, age 24, andanother who was 20, talked about all the supports, guidance, and resources they did not have ascompared 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 liveindependently. The results of the youth perspective about the child welfare system aresummarized 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 placementoptions.2. Youth understood that they could not always be placed with a sibling. Their concern was thefailure of foster parents or case workers to help them keep connected with a sibling who wasalso in foster care, through visits and telephone calls.3. Youth struggle to stay caught up in school because many times they are moved and mustchange schools. Although recognizing some placement moves were due to their acting outbehavior, 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 fearfulabout losing their foster care placement prior to graduation.Office of Family Safety | Page 36

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Report4. Youth acknowledged that many of them have mental health issues. They felt foster parentsneeded to be better prepared to handle their behavior. Furthermore, youth did not understandtheir diagnosis, their behaviors, or treatment with medication. Although generally told theirdiagnosis, no one explained it to them in age appropriate terms. Youth believe that when fosterparents don’t understand the diagnosis, there is a risk of placement failure when the youth actsout.5. Youth expressed concern that case workers frequently change, forcing them to rebuild trust andrelationships. 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 theytransition 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 toget a driver’s license when they turn 16. Case workers and foster parents don’t feel comfortablesigning for underage youth.8. Youth praised the Department’s Independent Living (IL) Programs. They felt well supported bytheir IL workers. They expressed concern about possible reductions in their Road toIndependence payments. Some of the youth in group home shared instances where rulesprohibit driving, cooking, and sleepovers due to liability issues.In summary, these youth offer many insights into the child welfare system of care. Theirthoughts 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 primaryconsumer. They know there are challenges but they want all future children entering fostercare to always feel they are loved as part of a family.The information below was written by youth and provides their perspective of the childwelfare system.Office of Family Safety | Page 37

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportHillsborough Youth Perspective RoundtableYouth Perspective Roundtable ReportSeptember 2010Introduction. The voice of the youth in Hillsborough County matters! We appreciate theopportunities that we have had to share our concerns, thoughts and opinions through ourinvolvement in the Youth Empowerment Board. As programming improvements are madelocally and statewide, it is important for policy makers to realize that an opportunity for growthstill exists. Listening and accepting the youth voice will allow future partnership between youthand adults striving to make system change.Methodology. The youth in Hillsborough County that participated in the “Youth PerspectiveRoundtable” came together through an invitation from Independent Living staff and an openinvitation during our monthly Youth Empowerment Board meeting. Our ages ranged from age14 to age 18 and our foster care experience included residing in foster homes, group homes andliving independently. Although, the majority of the youth present were currently residing in agroup home. Youth present hoped to provide ideas as to what was working and suggestions onwhat areas within foster care could be improved.Analysis and Discussion. Listed below are some areas discussed during the roundtablediscussion.Placement- Areas of further improvement included wanting more freedom/normalcy,wanting increased allowance and the concern regarding the lack of or minimal communicationregarding placement changes which leads to unstable placements. What we found that isworking is the homes that we live in care about us and accept us for who we are and where wehave been. We are supported in our sibling visits and relationships.Education- Areas of further improvement included wanting to be informed early onregarding college options especially for those that are behind or have fallen behind in the pastand 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 inOffice of Family Safety | Page 38

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportthe same school to avoid any further disruptions and opportunities through ILS, school and ourplacements to get exposed to colleges, tutoring, IMPACT- credit recovery programs and we seethe general care and follow up from those that want to see us succeed.Transportation- Areas of further improvement include gaining resources to assist youth inpurchasing their first car, paying for car insurance and accessing bus passes preferably at adiscounted rate. What we found that is working is that many of us have our learners permitthanks to the help of our care managers and caregivers. We are supported with our desire totake drivers training at school if available. We feel that our transportation needs to doctorsappointments and sibling visits are always met by our care manager most of the time andsometimes our caregivers.Independent Living Services- Areas of further improvement includes increased Life Skillstraining in the area of savings and investments. What we found that is working is the creativeLife skills training that include incentives and hands on learning, the state funding of Road toIndependence to insure continued education past the age of 18, Florida tuition waiver to assistwith the educational needs of those in college/vocational school and what also works is havingan increased awareness of the needs of the teens in care resulting in creative programs like theIL Teen center and Hillsborough Kids Teen Wrap foster home program.Community- Areas of further improvement includes lack of connections with communitysupportive adults and services early on. What we found that is working is an effort to maintainsibling relationships and encourage relationships with family members.Conclusion and RecommendationsSo as you can see, in our opinion we have a lot of things that are working in our favor but sincewe are often told not to settle we have some recommendations that might address the areas offurther improvement.Training- Educate caregivers that teens need time to spend on normalcy activities outside ofthe group or family. Educate caregivers (again) that EVERYONE does not need backgroundchecks. Educate care managers, caregivers and policy makers that they can ask teens directlyabout their thoughts on foster care and they will sure learn a lot. Educate youth, caregivers andcare managers that Hillsborough County has a Hillsborough Public Schools counselor on specialassignment for foster care youth to specifically address any school issues. Provide education tocare managers and caregivers on the use of technology to support family relationships such asusing webcams to communicate with those not living nearby or those that do have set visits.Office of Family Safety | Page 39

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportResources- Provide opportunities for youth to get exposure to career programs throughshadowing, tours and internships. Seek out resources to secure funding, grants and donationsto assist youth in purchasing their first car and paying for car insurance. Work with the localHartline 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 amonth in allowance. Seek local and state support for the continued funding of Road toIndependence and Independent Living.West Palm Beach - Youth Perspective RoundtableHello, I am Marcus former group home resident. I am 18 years of age and now have myown apartment at Vita Nova Villages. I attend Palm Beach Lakes Community High School in WestPalm Beach FL. I am a senior and also the Head Drum Major of my band. I feel as though myvoice 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 loosescrews in certain places that you need my help to tighten them. I am one of the many youth thatcan 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 cancause the youth to be ill prepared once he or she has leaves the program and now have to be anupstanding citizen in our community and role models for the toddlers, youth, and teenagers ofthe new generation. I was always told “it starts at home” which means whatever is enforced athome it will be instilled into the youth and the youth will perform it in the community whereverhe 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 arenot only serving the youth but also the world. I say that because the youth that they arewatching will learn their habits, language, and morals, and that will rub off onto the youth andthe youth will take that and copy cat that where they go. It is imperative that the staff membersset a good example for these kids because we are the future. I feel as though the staff membersshould take their jobs seriously and teach these kids by example and start practicing whateverthey preach. If the kids are not brought up the way we know is the right way I hate to say it butinstead of looking at your future business men and women, your doctors, you lawyers, your thisOffice of Family Safety | Page 40

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportand you that you’re looking at you future thieves, murderers, unemployed, drug dealers, drugpushers, drug uses, repeat felons, high school drop outs, jail population, and worse come toworse you body count in the morgue. I was asked personally by my Independent LivingCoordinator Mr. Eric Peterman to come to the meeting because I was the “house leader” in mygroup home and also the oldest, wises, and most well spoken. I wanted to attend this meetingbecause I know the board would appreciate what I had to say, the answers I provided, and Iseen 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 orplacement. I hope that the youth will be looked at more a son or daughter instead of apaycheck. Really look at their needs and help them develop into men and women. I want theadults to feel the pain of a 12 year old boy that doesn’t have a home. Goes to school with thesame pair of shoes every day, isolated from everyone else because he isn’t “cool”. Pushedaround, 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 tolisten. Father beats him to straighten him to become a man. Mother is never home. Big brothertries to be a role model but is persuaded by the streets to be a gangster. Little sister is gone inthe wind with her friends. He tries to keep the family together but there is none. Out of all thathe is taken from one place to another and this place is called a group home. NOW AT THIS VERYPOINT I WANT THE ADULTS TO TELL ME EXACTLY HOW YOU WANT TO BE TREATED IN THIS NEWENVIORNMENT. See you have to put yourself in the youth shoes and walk the walk and not justtalk the talk. How would you want to be treated after all this? Would you like to be called goodnames and hugged and told that you’re loved? That’s what I want to happen then you will seean improvement in the staff then it will trickle down to the youth. Embrace our presence withlove. I believe the placement, services, Independent Living, and Community are great reallywouldn’t change too much. With Transportation, Education these are two things that we mustlook at and improve. You al can get involved by doing periodically checkups on certain youth inthe programs and also ask questions. In conclusion, all I would like to see youth be treatedbetter and molded into the fine adults they can be. Listen to the youth……. then act!Office of Family Safety | Page 41

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportPinellas & Pasco Counties Youth Perspective RoundtableThe group was called by ILS Director to come together and discuss the concerns, what worksand some possible solutions with DCF staff. We attended because our IL Specialist asked us toand 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 basedon the stories they have heard. Our hope is that out of this meeting, change can be made thatwould help us be great in life!We came together as a group of teens that have all aged out of foster care and reside inPinellas and Pasco counties. We receive Independent Living Services through CamelotCommunity Care and our CBC is Eckerd Youth Alternative. We believe that our voices areimportant because we are the ones that have experience the foster care system and know whatchanges 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 siblingsseparations, placements not being educated about who we are, being treated differently thanthe 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, obtainingdrivers 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 andCamelot and ECA is aware of this fact. We never want to come off as if things aren’t working, sohere 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 CommunityOrganization, other community partnerships to much to mention and the check!Some solutions we thought that could be beneficial are teens assisting in choosingplacements, workers/group homes/foster parents being educated about the youths’ going intotheir 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 onbudgeting, maybe a grace period with having to enroll into post-secondary education just tomaintain RTI benefits after you graduate or receive your GED etc.Office of Family Safety | Page 42

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportWe 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 LivingServices that are provided to our teen in the foster care system. We met with DCF staff at ourILS office Camelot Community Care and had an open discussion about some areas that weidentified was of concerns. We came up with some solutions that we feel are actuallyattainable. We realize that Pinellas and Pasco County has some room to grow, but we also knowthat 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 smallchanges on a local and statewide level. Make sure that the rules are clear and we know whatwe need to do, also the biggest thing is support us-let us know that we matter to someone!Monroe County Youth Perspectives ReportThe Florida Keys are like a whole other world than the rest of the state of Florida, due toour remote location (four hours from the closest big city) and very distinctive way of life. Thereare very high instances of domestic violence and substance abuse, but very limited resources totreat these. There are very limited resources for youth. The cost of living is extremely high, andthe Keys are very dependent on the tourism and service industries, which causes an extremedivide between the wealthy and the very poor. Because of these factors, the Keys havehistorically had a disproportionally high number of children in care. There has also historicallybeen 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. Largersibling groups also often must be placed in those settings, group homes, shelters and othercounties 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, whilemaybe the best option, is not a good one. This report was compiled by Wesley House FamilyServices 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 Livingcoordinator, Transitional Services specialist and Quality Assurance Manager from Wesley HouseFamily Services to sit down as a group and discuss the strengths and needs of the current fosterOffice of Family Safety | Page 43

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportcare system, and to try to come up with solutions for the future. They were promised pizza andthe 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. Atthat 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 providedsome valuable input. The group has consistently been youth either currently in licensed care oraged out of licensed care. There has been little to no representation from youth placed in nonlicensedsettings.Some of the youth have separately provided their descriptions of what has been positive forthem in the foster care system, as well as what could be improved. A continuous theme acrossreports from youth of all ages and backgrounds is a lack of what we call normalcy. Specificexamples of this lack of normalcy include:‣ Inability to travel for fun‣ Limited personal relationships – due to requirements placed by the CBC and the Group Homewhere she lives, it is a limited pool of people she is approved to spend time with and limitedactivities she is able to do‣ Temporary placements and frequent moves make it impossible to be involved in extra-curricularand school activities. This comes from a youth who has lived in 6 placements during her 9 totalyears in care‣ Inability to go on dates without a chaperoneAnother 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 businessSituational 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 turnoverOffice of Family Safety | Page 44

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Report‣ 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 communityPositives 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 usedvolunteer 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 FriendsOffice of Family Safety | Page 45

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportThe youth were able to identify many possible solutions for the problems that theyidentified during the round table discussion. With regards to placements, they believe thatyouth should be educated about the reasons for their removal, live closer to family, and be keptwith their siblings. Case management staff should be of a higher quality so as to be moreappropriate placement for kids, more child friendly, and more experienced with traumatizedchildren.Regarding educational concerns, they believe it would help for them to be enrolled inbetter quality schools, be enrolled immediately, placement close to their original school toprevent educational disturbances, being allowed to finish the school year prior to movingwhenever possible. They suggested educational advisors to advocate like a parent would tomeet with the youth and their teachers to discuss grades and classes. They believe thatteachers should be better educated about what is going on in the home of the children so theyare better equipped to handle behavioral concerns. Foster and group home parents should betrained as educational liaisons, to assist with children’s schooling, not just what goes on in thehomes.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 isturnover of case managers, but no solution has been identified to prevent this. They requestedcontinual 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 availableto them.When independent living and life skills were discussed, the youth identified acombination of agency assistance as well as personal empowerment. They identified bettercommunication and training both for and by RTI/IL staff and foster/group home parents as aneed. Interestingly, they also identified many ways that they can benefit from the experiencesof their peers including a Youth Advisory Board, and RTI Youth Group, and using each other as aresource.Monroe County is a beautiful area and a close-knit community, but it falls short on manyservices due in part to its distance from “civilization.” In order to overcome these shortfalls, wemust educate legislators about the special needs of our area. The youth of Monroe County havemuch to say including many great ideas. We encourage anyone who makes decisions aboutOffice of Family Safety | Page 46

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Reportservices and funding for youth to take these ideas into consideration and allow their voices to beheard.Sarasota (12 th Circuit) Roundtable ReportThe Teen Advisory Council of the 12 th Circuit feels that our voice is important because wehave a better understanding of what occurs to youth in care and how to improve the overallfoster 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, currentprocedures, and some of the obstacles faced by the youth both in care and those who havetransitioned out of care.The local advisory board meeting occurs monthly at the same location and at the sametime. We take responsibility for notifying the potential participants and the members that are inattendance are regular council members. We attend these meetings in order to ensure that ourvoice is heard and to attempt to have input on the needed modifications to the foster caresystem. The ages of the participants in the Quality Assurance Youth Perspective Roundtablemeeting were from 14-21. There was not a good representation of the youth that were placedwith relatives or non-relatives.We would like for there to be more financial allocations for the staff that work at theshelters and group homes. We suggest that there be more extensive trainings as to the needs ofteenagers and a better understanding of what foster youth have gone through and how thisimpacts their behaviors. They should also be required to have more than a High Schooleducation and should have ongoing in-service trainings that focus on communications andappropriate confidentiality practices. The youth would also like to have the opportunity toparticipate in the development of policies and procedures. This would allow the youth toprovide feedback from their perspective.All Case Managers need to be accessible when we need them. There are times when weleave messages and do not receive call backs for several days. Typically, when we are calling it isbecause we need immediate assistance and are dealing with a situation in that moment. Wewould like for there to be a back up in place at all times particularly when staff are on leave orare out of the office.Office of Family Safety | Page 47

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportCurrently we have very good IL Case Managers that listen to us and are fairly easilyreached. 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 workwell in our circuit. The Kalish House Resource Center is proving to be one of our most valuableassets 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 livingarrangements 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 youthinvolved. We would also like to start some form of recreational sports league to reach out toother youth that may not currently be involved.This report was generated by 6 core members of the local teen advisory group andtranscribed by the IL coordinator, Cain Blackwell. The input was solely the opinions of the youththat participated. The ILC does offer one suggestion and that is in the future when we areconducting these types of surveys and meetings that the facilitator determine what time periodthe questions being asked reference. This would make it easier to understand if the issues thatarise are something that occurred well in the past and have since been addressed or if this is acurrent problem that needs the attention of the administration. Some of the youth thatparticipated in our roundtable have been in care for numerous years and have a good deal ofboth positive and negative experiences. This suggestion would also provide an opportunity fordirect attention to be given to particular situation as well as could impact the currentprocedures if the issue is present on multiple occasions.We would like for our suggestions to be taken seriously and possibly be reviewed forpossible considerations.Miami - Youth Perspective Roundtable ReportIntroduction: There were 15 youth at the roundtable. The youth greatly appreciated beingasked about their concerns.The discussion started off with placements. The youth were concerned about the quality oftheir foster care placements. Although some youth have had positive experiences withplacements, many youth had negative experiences.Office of Family Safety | Page 48

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportYouth would like to see foster parents and group home staff undergoes stricter backgroundchecks. Youth also stated that they would also like caseworkers to do more unannounced visitsto the foster care placements. Additionally, youth recommended that foster parents and staffundergo more youth-sensitive trainings so that they can be more familiar with how to treat theirfoster youth, especially teenagers. The youth also expressed concern that siblings should beplaced together. The youth additionally expressed concern that foster youth should not betreated differently from biological youth, and their access to common areas in the home shouldnot be restricted.Further, the youth expressed concerns over not being involved in their court hearings. Theyouth felt that it was very important to be involved in their court hearings so they could talk tothe judge directly about their placements and any other concerns, as well as know about theirlegal rights in foster care.Many youth at the roundtable experienced going to more than one school during theschool year. Youth expressed that there was a lack of support from the educational systemitself, because no one knew that they were in foster care. Some youth also stated that they didnot want to be identified as being in foster care and labeled. Locally, Educate Tomorrow has aneducational mentoring program for foster youth, which the youth have found to be verybeneficial. Additionally, Educate Tomorrow has collaborated with the Miami Dade CountyPublic Schools to train high school counselors to help foster youth with their educational needsand has started foster youth support groups in high schools with the largest number of fosteryouth, for those youth who wish to participate.Also, the local juvenile court and Miami Dade public schools are beginning to experimentwith video-conferencing, so that some youth may participate in their court hearings fromschool.Transportation: Transportation is a major issue for youth in foster care. Many youth expressedthat they were not transported to medical appointments, to family visitations, to court hearings,and to other important appointments. Sometimes, there were disagreements between thecaseworker and the foster parents as to whom should be responsible for transportation. Theyouth expressed the need to have this disagreement resolved. The youth also expressed that itis important to have someone with them for medical appointments so that someone cancommunicate with the doctor and they are not just dropped-off.Office of Family Safety | Page 49

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportFor youth over age 18 who are in the Road to Independence program, transportation wasalso a concern. Previously, the Miami Dade County Commission had provided free bus passes tothese 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 thisprogram.Services: Youth expressed that they received some form of counseling while they were in fostercare. However, many youth did not receive counseling with their parents or with their fosterparents. Youth expressed that they would like to receive more counseling with their parents, aswell as counseling with their foster parents to maintain harmony in their placements.The youth expressed concerns about being over-labeled with psychiatric diagnoses andbeing given unnecessary psychotropic drugs that negatively impact them.The youth appreciate receiving Medicaid. The youth would like to see Medicaid extended untilthe age of 23.Many youth feel that the Independent Living classes are not helpful to them and do notprepare them for adulthood. They believe that the IL classes should be more hands-on andpractice-based.Youth were concerned about being in the middle of high school when they turn age 18. Theyare concerned about a lack of places where they can live and an inability to support themselveswhile 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 theyouth 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 deniedTransitional funds for books and furniture and Aftercare funds for housing and otheremergencies. 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. Theyouth 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 andthere should be accountability to ensure that the allowance is provided to them.The youth appreciate community organizations that assist them. Locally, the youthexpressed that Educate Tomorrow, the Miami Chapter of Florida Youth SHINE, and CasaOffice of Family Safety | Page 50

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportValentina were particularly helpful to them. The youth expressed the need for more mentors toassist them, more job opportunities for transitioning foster youth, and more support for youthwhen they are turning age 23 to help them make a successful transition from the Road toIndependence program.Conclusion: The youth greatly appreciated having their concerns heard at the roundtable. Theyouth 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 yearsago, youth in the Miami Youth SHINE chapter worked together to produce a writtenpresentation, “Seeing Through Our Eyes: Foster Youth Share Our Voices, Our Experiences, andOur Solutions.” Many of the same concerns were raised by other youth at the roundtable. Theyouth involved in Youth SHINE expressed that they want to work together with the foster caresystem to resolve the concerns and to put in place solutions that will improve the system forthemselves and their peersV. Florida’s Performance with Federal Safety, Permanency and Child Well-BeingRequirementsFlorida’s quality assurance system is the state level process for assessing child welfarepractice. At the federal level, the Administration for Children and Families (ACF) assesses thequality of practice through the Child and Family Services Review (CFSR) process.The CFSRassesses the performance of State child welfare agencies with regard to achieving positiveoutcomes for children and families. The CFSR is authorized by the Social Security Amendments of1994 requiring the U.S. Department of Health and Human Services to promulgate regulations forreviews of State child and family services programs under titles IV-B and IV-E of the Social SecurityAct. Florida’s case management child welfare Quality of Practice Standards closely align with thefederal measures in the CFSR protocol, but are tailored to Florida’s child welfare system. Eachstandard is linked to a practice rating within the three CFSR domains: Safety, Permanency andWell-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 forchildrenOffice of Family Safety | Page 51

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance Report• 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 healthneedsThe tables on the following pages illustrate Florida’s performance at the Circuit, Region andState level on the federal data indicators associated with the CFSR Permanency Outcome. Theseindicators make up the four Permanency Composites for which the Department is held accountablein the Child and Family Services Review. Data for determining performance on these measurescomes from ad-hoc reports programmed from the Florida Safe Families Network (FSFN). There arefive measures shaded in blue that are both federal measures and CBC contract measures. Thesemeasures are color coded with a green, yellow, or red icon to identify areas of high and lowperformance. Performance is compared to the national median and 75 th percentile (located at thebottom 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 lowpercentage. 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 thanthe performance calculated by the Administration for Children and Families.Office of Family Safety | Page 52

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportFederal Data Indicators Associated with the Child and Family Services Review Permanency OutcomeJuly 1, 2009 - June 30, 2010Table continued on next pageOffice of Family Safety | Page 53

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportTable continued on next pageOffice of Family Safety | Page 54

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportTable continued on next pageOffice of Family Safety | Page 55

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportTable V-1Office of Family Safety | Page 56

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportVI. 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 theQuality Improvement Plan (QIP). Failure to successfully complete the QIP could result in financialpenalties to the State. The Florida QIP includes a requirement to assess progress in child welfareoutcomes. The state used QA practice review results from July – December 2008 to establish QIPbaselines and goals , and review results from January 2009 onward to measure progress throughoutthe QIP reporting period. The following table shows comparative results on specific CFSR items forreporting on the QIP. The Administration for Children and Families has formally acknowledged thatFlorida has met all performance targets except for Item 10 (QA standard 71) regarding children withthe goal of Another Permanent Planned Living Arrangement (APPLA).Practice Summary for QA Standards Linked to the Federal Quality Improvement PlanQA Findings of PercentAchieved for:QPS # Standard FY 2008-09 FY 2009-10 QIP StatusCFSR Item 3 - Services to family to protect child in home and prevent removal or re-entry into foster careConcerted efforts were made to provide or arrange for appropriate4 services for the family to protect the child and prevent the child's 87% 94% QIP Target Metentry into out-of-home care.6Completed service referrals were consistent with the needsidentified through investigative assessments, and other83% 89% QIP Target Metassessments related to safety.10Concerted efforts were made during post-placement supervision tomanage the risks following reunification and prevent re-entry intoout-of-home care.69% 74% QIP Target MetCFSR Item 4 - Risk assessment and safety management3589If a child was re-abused or re-neglected, immediate andameliorative interventions were initiated on behalf of the child.A thorough initial fmaily assessment was conducted following theinvestigative safety assessment that sufficiently addressed childsafety factors and emerging risks.All immediate and emerging safety concerns were addressed andadditional needed interventions were provided to protect the child.A thorough safety assessment of the home was completed prior toreunification or placement of the child in an unlicensed out-ofhomecare setting.84% 91% QIP Target Met55% 66% QIP Target Met72% 76% QIP Target Met71% 74% QIP Target MetTable continued on next pageOffice of Family Safety | Page 57

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportQA Findings of PercentAchieved for:QPS # Standard FY 2008-09 FY 2009-10 QIP StatusCFSR Item 7 - Permanency goal for child22The current case plan goal was appropriate based on the child'sand family's circumstances.93% 94% QIP Target MetCFSR Item 10 - Permanency goal for child71For children with the goal of another planned permanent livingarrangement, the agency made concerted efforts to provide theneeded services that would adequately prepare the child fortransition to adulthood.CFSR Item 17 - Needs and ServicesNAnew forFY 2009-1094% Baseline48An ongoing assessment of the child(ren)’s needs was conducted toprovide updated information for case planning purposes.86% 88% QIP Target Met50An ongoing assessment of the mother’s needs was conducted toprovide updated information for case planning purposes.75% 77% QIP Target Met515253Concerted efforts were made to support the mother’s engagementwith services.An ongoing assessment of the father’s needs was conducted toprovide updated information for case planning purposes.Concerted efforts were made to support the father’s engagement inservices.68% 72% QIP Target Met56% 58% QIP Target Met53% 57% QIP Target MetCFSR Item 18 - Child and Family Involvement in Case Planning55Concerted efforts were made to actively involve all caseparticipants in the case planning process.CFSR Item 19 - Case Worker Visits with Child63% 69% QIP Target Met56-CThe frequency of the services worker's visits with the child wassufficient to address issues pertaining to the safety, permanencygoal, and well-being of the child.50% 73% QIP Target Met57-C56-AThe quality of the services worker's visits with the child wassufficient to address issues pertaining to the safety, permanencygoal, and well-being of the child.CFSR Item 20 - Case Workers Visits with ParentThe frequency of the services worker's visits with the mother wassufficient to address issues pertaining to the safety, permanencygoal, and well-being of the child.56% 76% QIP Target Met31% 45% QIP Target Met56-B57-A57-BThe frequency of the services worker's visits with the father wassufficient to address issues pertaining to the safety, permanencygoal, and well-being of the child.The quality of the services worker's visits with the mother wassufficient to address issues pertaining to the safety, permanencygoal, and well-being of the child.The quality of the services worker's visits with the father wassufficient to address issues pertaining to the safety, permanencygoal, and well-being of the child.21% 31% QIP Target Met57% 72% QIP Target Met45% 58% QIP Target MetTable IV-1Office of Family Safety | Page 58

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportAPPENDIX 1Statewide Quality of Practice FindingsBy Quarter FY 2009/2010The following table provides the statewide quality of practice trend data for each child welfare practicestandard for quarters two (September-December), three (January-March), and four (April-June) of FY2009/2010.StdNum Question Q2 Q3 Q4 Annual1.0 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%3.0If a child was re-abused or re-neglected, immediate and ameliorativeinterventions were initiated on behalf of the child. 92% 92% 90% 91%4.0Concerted efforts were made to provide or arrange for appropriateservices for the family to protect the child and prevent the child's entryinto out-of-home care. 93% 95% 93% 94%5.0A thorough initial family assessment was conducted following theinvestigative safety assessment that sufficiently addressed childsafety factors and emerging risks. 75% 63% 61% 66%5.1The assessment included the caregivers' (if removed from)/parents'capacity to protect and nurture the child. 76% 68% 72% 71%5.2The assessment included observations of interactions between thechild and siblings and household members. 58% 49% 47% 51%5.3 The assessment included emerging risk factors. 80% 66% 71% 72%5.4The assessment included actions needed to address emerging riskfactors . 76% 61% 66% 67%5.5 The assessment implementation of a safety plan when needed. 68% 58% 63% 62%6.0Completed service referrals were consistent with the needs identifiedthrough investigative assessment(s), and other assessments related tosafety. 88% 87% 90% 89%7.0The updated family assessment was focused on the immediate andprospective safety of the child, as well as any changes andimplications in the family's situation related to emerging concerns andservice needs. 30% 25% 32% 29%7.1The updated family assessment included a review of changes in thefamily’s condition or circumstances since the initial assessment thatpositively or negatively impacted the child’s safety. 34% 32% 36% 34%7.2The updated family assessment included a review of the short andlong-term implication of any changes in individual or family factorsaffecting family resources, strengths and/or protective capacities. 33% 30% 36% 33%7.3The updated family assessment included an evaluation of signs ofemerging danger and a plan to address them. 32% 29% 33% 31%7.4The updated family assessment included a review of the case plangoals met and are remaining, and the plan to address any barriers thatexist to fully meet the case plan goals. 34% 28% 35% 32%Statewide Quality of Practice Findings by Quarter FY 2009/20010 continuedOffice of Family Safety | Page 59

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNum Question Q2 Q3 Q4 AnnualAll immediate and emerging safety concerns were addressed and8.0 additional needed interventions were provided to protect the child. 77% 74% 77% 76%9.0A thorough safety assessment of the home was completed prior toreunification or placement of the child in an unlicensed out-of-homecare setting. 74% 73% 76% 74%10.0Concerted efforts were made during post-placement supervision tomanage the risks following reunification and prevent re-entry into outof-homecare. 74% 75% 74% 74%11.0The child remained safe in his/her home after being discharged fromout-of-home care and did not re-enter out-of-home care at least 12months following discharge. 62% 85% 66% 70%12.0A multi-disciplinary staffing/assessment for placement planning wasconducted before each placement to ensure the placement or movewas unavoidable. 59% 57% 65% 60%13.0The child's current placement is stable and appropriate to meet thechild's needs with no apparent or significant risks or projections ofdisruption. 92% 95% 90% 92%14.0Concerted efforts were made to identify, locate and evaluate otherpotential relatives and possible permanent placements for the child. 79% 80% 77% 79%15.0The child experienced no more than two out-of-home care placementsettings during the period under review. 87% 85% 89% 87%16.0If No was entered for #15, all placement changes were planned in aneffort to achieve the child's case goals or to meet the needs of thechild. 46% 48% 60% 50%17.0In cases involving a child in a licensed placement setting, an exitinterview was conducted with the child when moved from oneplacement to another, and appropriate action was taken if the exitinterview documented a concern. 75% 80% 81% 78%17.1An exit interview was conducted with the child when he/she wasmoved from one placement to another to discuss the previousplacement experience. 78% 79% 81% 79%17.2Appropriate action was taken if the exit interview documented aconcern. 68% 74% 70% 71%18.0 The parents were notified of all the child's placement changes. 76% 76% 77% 77%19.0The court was informed of the child's placements and reasons forchanges 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%20.0Qualitative supervisory reviews and follow through were conducted asneeded and required. 50% 48% 51% 50%20.1 Reviews were completed quarterly 76% 77% 75% 76%20.2Supervisor considered all aspects of the child's safety, well-being andpermanency. 63% 60% 62% 61%20.3Supervisor ensured follow through on guidance and direction ordocumented the reasons the guidance and direction were no longernecessary. 49% 46% 51% 49%21.0 The case record contained a current (not expired) case plan. 73% 76% 73% 74%Statewide Quality of Practice Findings by Quarter FY 2008/2009 continuedOffice of Family Safety | Page 60

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNum Question Q2 Q3 Q4 AnnualThe current case plan goal was appropriate based on the child's, and22.0 family's circumstances. 91% 95% 96% 94%23.0The case plan specifically addressed visitation and other contact planswith 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%24.0The case plan is designed to achieve permanency (out-of-home carecases) and safety and stability (in-home cases) through appropriatetasks 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%25.0The services worker communicated with service providers about theeffectiveness 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%26.0The child's current placement was in close proximity to the parents tofacilitate face-to-face contact between the child and parents while thechild was in out-of-home care. 93% 92% 92% 92%26.1 Mother 92% 92% 91% 91%26.2 Father 87% 85% 85% 86%27.0If No was entered for #26, the location of the child's current placementwas based on the child's needs and achieving the case plan goal. 97% 93% 91% 94%28.0The child was placed with siblings who were also in licensed and/ornon-licensed out-of-home care. 61% 59% 60% 60%29.0If No was entered for #28, there was clear evidence separation wasnecessary to meet the child's needs. 74% 81% 79% 78%30.0Concerted efforts were made to ensure visitation (or othercontact) between the child and parents were sufficient to maintain orpromote 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%31.0Concerted efforts were made to ensure visitation (or other forms ofcontact if visitation was not possible) between the child and his or hersiblings and it was of sufficient frequency to maintain or promote thecontinuity of the relationship. 79% 68% 80% 76%Statewide Quality of Practice Findings by Quarter FY 2009/20010 continuedOffice of Family Safety | Page 61

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNum Question Q2 Q3 Q4 AnnualConcerted efforts were made to maintain the child's important32.0 connections. 86% 84% 88% 86%33.0An inquiry was made to determine if the child was of Native Americanor Alaskan Native heritage. (applicable to out-of-home care and courtordered supervision cases - life of case) 38% 50% 52% 46%34.035.036.037.038.039.040.041.042.043.044.045.046.047.0If the child is of Native American or Alaskan Native heritage, the tribewas provided timely notification of its right to intervene in any statecourt proceedings seeking court ordered supervision, an involuntaryout-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 inaccordance with the Indian Child Welfare Act placement preferences ifthe child was of Native American or Alaskan Native heritage. 36% 36% 62% 44%The mother was encouraged and supported to participate in makingdecisions about her child's needs and activities. 50% 53% 57% 53%The father was encouraged and supported to participate in makingdecisions about his child's needs and activities. 36% 39% 45% 40%For cases in which an out-of-state placement was, or is being, exploredfor the focus child, a complete Interstate Compact for the Placement ofChildren (ICPC) packet requesting a home study was submitted withinthe required timeframe. 63% 56% 71% 63%The information provided in the ICPC packet regarding the focus childwas sufficient to enable the receiving state to make an appropriatedecision concerning approval of the proposed placement for the focuschild. (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 recent22 months or met other ASFA criteria for TPR, a TPR petition was filed orjoined. 61% 55% 60% 59%If a Termination of Parental Rights petition was not filed, there werecompelling reasons and an exception for not filing the petition wasdocumented. 47% 65% 60% 58%Appropriate steps were taken to identify and recruit an adoptive familythat matched the child's needs. 84% 87% 90% 87%Appropriate steps were taken to process and approve an adoptivefamily 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 ofage and he/she is living in a licensed, out-of-home care placement, apre-independent living assessment was completed that identifiedservice needs and services were provided. 81% 74% 79% 78%If the child is 13 years of age or older and in licensed foster care, thecase management agency provided guidance and assistance indeveloping an educational and career path that is based on the child'sindividual abilities and interests. 75% 74% 84% 78%The teen-aged focus child is afforded opportunities to participate innormal life skills activities in the foster home and community that arereasonable and appropriate for his/her respective age or specialneeds. 69% 76% 85% 76%For youth 15 years of age but not yet 18, the agency appropriatelymonitored his/her progress towards successfully transitioning fromfoster care to independence through regular informative staffings. 77% 77% 78% 78%Statewide Quality of Practice Findings by Quarter FY 2009/20010 continuedOffice of Family Safety | Page 62

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNum Question Q2 Q3 Q4 AnnualAn ongoing assessment of the child's needs was conducted to provide48.0 updated information for case planning purposes. 87% 88% 88% 88%49.0An assessment for residential group care was completed whenrequired. 85% 77% 81% 80%50.0An ongoing assessment of the mother's needs was conducted toprovide updated information for case planning purposes. 80% 75% 77% 77%51.0Concerted efforts were made to support the mother's engagement withservices. 73% 71% 73% 72%52.0An ongoing assessment of the father's needs was conducted to provideupdated information for case planning purposes. 59% 59% 55% 58%53.0Concerted efforts were made to support the father's engagement inservices. 58% 54% 59% 57%54.0An ongoing assessment of the out-of-home care providers or preadoptiveparent's service needs was conducted in order to ensureappropriate care for the child. 87% 89% 89% 88%55.0Concerted efforts were made to actively involve all case participants inthe 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%56.0The frequency of the services worker's visits with all case participantswas sufficient to address issues pertaining to the safety, permanencygoal, and well-being of the child. 59% 59% 56% 58%56.1 Mother 44% 46% 44% 45%56.2 Father 34% 29% 30% 31%56.3 Child 70% 76% 72% 73%56.4 Caregiver (out-of-home) 72% 79% 75% 76%57.0The quality of the services worker's visits with case participants wassufficient 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%57.3 Child 68% 72% 73% 71%57.4 Caregiver (out-of-home) 78% 83% 82% 81%58.0Concerted efforts were made to assess the child’s educational needsduring out-of-home placement. 84% 84% 84% 84%59.0If educational needs were identified, necessary educational serviceswere engaged. 85% 80% 82% 83%60.0Services effectively reduced or resolved the issues that interfered withthe child's education. 78% 73% 84% 78%61.0Concerted efforts were made to assess the child’s physical health careneeds. 72% 70% 69% 70%61.1If the child was removed during the period under review, or if notremoved but brought into the dependency system due to health relatedissues, he/she received an EPSDT screening within 72 hours. 57% 64% 58% 59%Statewide Quality of Practice Findings by Quarter FY 2009/20010 continuedOffice of Family Safety | Page 63

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNum Question Q2 Q3 Q4 AnnualAfter the removal episode or health issues that resulted ininterventions by the dependency system, and the EPSDT screening wasnot done within 72 hours, a medical screening was completed within a61.2 week. 58% 60% 56% 58%61.3The diagnoses from physical health care screenings are documented inthe case file, medical passport, and/or child's resource record. 73% 70% 72% 71%62.0Concerted efforts were made to provide appropriate services toaddress the child’s identified physical health needs. 71% 69% 63% 68%62.1Documentation reflects that the services agency complied with theperiodicity schedule pertinent to the child's age and needs. 71% 67% 64% 67%62.2Documentation reflects that the services agency followed-up ontreatment plans that the doctor ordered. 72% 74% 65% 70%63.0Concerted efforts were made to assess the child's dental health careneeds. 50% 47% 43% 47%64.0Appropriate services were provided to address the child's identifieddental health needs. 51% 46% 48% 48%64.1Documentation reflects that the services agency complied with theperiodicity schedule pertinent to the child's age and needs. 48% 49% 44% 47%64.2Documentation reflects that the services agency followed-up ontreatment plans that the doctor ordered. 55% 53% 57% 55%65.0An assessment(s) of the child's mental/behavioral health needs wasconducted. 88% 88% 91% 89%66.0Appropriate services were provided to address the child'smental/behavioral health needs. 86% 77% 81% 81%66.1Documentation reflects that the services agency matched the neededservices specific to the child's mental/behavioral concerns. 87% 79% 82% 83%66.2Documentation reflects that the services agency followed-up on alltreatment plans that the doctor ordered. 85% 81% 79% 82%67.0The Medical Report documenting informed consent was complete or acourt order was in the file. 64% 77% 79% 74%67.1The case management organization involved the child and theparents/legal guardian in the decision making process by facilitatingcontacts with physicians for treatment planning. 49% 66% 74% 64%67.2Prior to seeking a medical evaluation to determine the need to initiateor continue a psychotropic medication, the case manager provided thePrescribing Practitioner all pertinent medical information known to theagency at the time. 56% 78% 77% 70%67.3The case manager documented communication with the child's parentor guardian to ensure parental awareness of the need to provideexpress and informed consent for the prescription of each psychotropicmedication. 53% 60% 72% 62%67.4When express and informed consent could not be obtained from thechild's parents, the case management organization submitted arequest 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 the68.0 child's prescribed psychotropic medication. 63% 60% 66% 63%68.1 Name of medication and dosages prescribed 76% 67% 73% 72%Statewide Quality of Practice Findings by Quarter FY 2009/20010 continuedOffice of Family Safety | Page 64

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNum Question Q2 Q3 Q4 Annual68.2 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%69.0Judicial Reviews were held in a timely manner and Judicial ReviewSocial Study Report's (JRSSR's) provided a thorough investigation andsocial study concerning all pertinent details relating to the child. 85% 88% 83% 85%70.0Based on all of the information reviewed, it is likely the child will livein a safe and nurturing environment with his/her needs being met on apermanent basis during the next 12 months. 86% 90% 86% 87%Table Appendix - 1Office of Family Safety | Page 65

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStatewide Quality of Practice FindingsBy Fiscal YearAPPENDIX 2The following table provides the statewide quality of practice trend data for each child welfare practicestandard for fiscal year 2008/2009 and 2009/2010.StdNmbr Standard 08-09 Annual 09-10 Annual12345No child living in the home was re-abused or neglected. (applicable to in-homecases)The focus child was not re-abused or re-neglected. (applicable to out-of-homecare cases)If a child was re-abused or re-neglected, immediate and ameliorativeinterventions were initiated on behalf of the child. (applicable to all cases)Concerted efforts were made to provide or arrange for appropriate s ervices for thefamily 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 investigativesafety assessment that sufficiently addressed child safety factors and emergingrisks. (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%5.0.2Observations of interactions between the child and siblings and householdmembers48% 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%6Completed service referrals were consistent with the needs identified throughinvestigative assessment(s), and other assessments related to safety. (applicableto all cases - Life of Case)83% 89%77.0.17.0.27.0.3The six-month family assessment was focused on the immediate and prospectivesafety of the child, as well as any changes and implications in the family’ssituation related to emerging danger and services needs. (applicable to all cases)Changes in the family’s condition or circumstances since the initial assessmentthat positively or negatively impacted the child’s safetyShort and long-term implication of any changes in individual or family factorsaffecting family resources, strengths and/or protective capacitiesAn assessment of new or existing identified risks to the child(ren) and the actionsneeded to ameliorate them75% 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 continuedOffice of Family Safety | Page 66

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNmbr Standard 08-09 Annual 09-10 Annual89101112131415All immediate and emerging safety concerns were addressed and additionalneeded interventions were provided to protect the child. (applicable to all cases)A thorough safety assessment of the home was completed prior to reunification orplacement of the child in an unlicensed out-of-home care setting. (Applies tocases involving post placement supervision, and where a child will be placed inan unlicensed [relative/non-relative] placement)Concerted efforts were made during post-placement supervision to manage therisks 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-homecare 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 conductedbefore 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 needswith no apparent or significant risks or projections of disruption. (applicable toout-of-home care cases)If No was entered for #13, concerted efforts were made to identify, locate andevaluate other potential placements for the child. (applicable to out-of-homecare cases)The child experienced no more than two out-of-home care placement settingsduring 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%161717.0.1If No was entered for #15, all placement changes were planned in an effort toachieve the child’s case goals or to meet the needs of the child. (applicable to outof-homecare 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 toanother 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%1819The parents were notified of all the child’s placement changes.(applicable to out-of-home care cases)The court was informed of the child’s placements and reasons for changes inplacement. (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%Statewide Quality of Practice Findings by Fiscal Year continuedOffice of Family Safety | Page 67

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNmbr Standard 08-09 Annual 09-10 Annual20Qualitative supervisory reviews and follow through were conducted as needed andrequired. (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%20.0.3Supervisor ensured follow through on guidance and direction or documented thereasons the guidance and direction were no longer necessary.38% 49%21The case record contained a current (not expired) case plan. (applicable to allcases)74% 74%22The current case plan goal was appropriate based on the child’s, and family’scircumstances. (applicable to all cases)93% 94%23The case plan specifically addressed visitation and other contact plans with allcase 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%24The case plan helped achieve permanency (out-of-home care cases) and safetyand 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%25The services worker communicated with service providers about the effectivenessof 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%26The child’s current placement was in close proximity to the parents to facilitateface-to-face contact between the child and parents while the child was in out-ofhome91% 92%care. (applicable to out-of-home care cases)26.0.1 Mother 91% 91%26.0.2 Father 83% 86%27If No was entered for #26, the location of the child’s current placement was basedon the child’s needs and achieving the case plan goal. (applicable to out-of-home97% 94%28)The child was placed with siblings who were also in licensed and/or non-licensedout-of-home care. (applicable to out-of-home care cases)53% 60%2930If No was entered for #28, there was clear evidence separation was necessary tomeet the child’s needs. (applicable to out-of-home care cases)Concerted efforts were made to ensure visitation (or other contact) between thechild and parents were sufficient to maintain or promote the continuity of therelationship 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%31Concerted efforts were made to ensure visitation (or other forms of contact ifvisitation was not possible) between the child and his or her siblings and it wasof sufficient frequency to maintain or promote the continuity of the relationship.73% 76%( l bl f h )Statewide Quality of Practice Findings by Fiscal Year continuedOffice of Family Safety | Page 68

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNmbr Standard 08-09 Annual 09-10 Annual323334353637383940414243Concerted efforts were made to maintain the child’s important connections.(applicable to out-of-home care cases)An inquiry was made to determine if the child was of Native American or AlaskanNative heritage. (applicable to out-of-home care and court ordered supervisioncases)If the child is of Native American or Alaskan Native heritage, the tribe wasprovided timely notification of its right to intervene in any state court proceedingsseeking court ordered supervision, an involuntary out-of-home care placement ortermination. (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 accordancewith the Indian Child Welfare Act placement preferences if the child was of NativeAmerican or Alaskan Native heritage. (applicable to out-of-home care cases)The mother was encouraged and supported to participate in making decisionsabout her child’s needs and activities.The father was encouraged and supported to participate in making decisionsabout his child’s needs and activities.For cases in which an out-of-state placement was, or is being, explored for thefocus child, a complete Interstate Compact for the Placement of Children (ICPC)packet requesting a non-priority home study was submitted within the requiredtimeframe. (applicable to out-of-home care cases)The information provided in the ICPC packet regarding the focus child wassufficient to enable the receiving state to make an appropriate decisionconcerning approval of the proposed placement for the focus child. (applicable toout-of-home care cases)If the child was in out-of-home care for at least 15 of the most recent 22 months ormet other ASFA criteria for TPR, a TPR petition was filed or joined. (applicable toout-of-home care cases - Life of Case)If a Termination of Parental Rights petition was not filed, there were compellingreasons and an exception for not filing the petition was documented.Appropriate steps were taken to identify and recruit an adoptive family thatmatched the child’s needs. (applicable to out-of-home care cases)Appropriate steps were taken to process and approve an adoptive family thatmatched 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%44If the case involves a youth who has reached 13 but not yet 15 years of age andhe/she is living in a licensed, out-of-home care placement, a pre-independentliving assessment was completed that identified service needs and services wereprovided. (applicable to licensed out-of-home care cases)73% 78%45If the child is 13 years of age or older and in licensed foster care, the casemanagement agency provided guidance and assistance in developing aneducational and career path that is based on the child's individual abilities andinterests. (applicable to licensed out-of-home care cases)84% 78%46The teen-aged focus child is afforded opportunities to participate in normal lifeskills activities in the foster home and community that are reasonable andappropriate for his/her respective age or special needs. (applicable to licensedout-of-home care cases)No data 76%Statewide Quality of Practice Findings by Fiscal Year continuedOffice of Family Safety | Page 69

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNmbr Standard 08-09 Annual 09-10 Annual4748495051525354For youth 15 years of age but not yet 18, the agency appropriately monitoredhis/her progress towards successfully transitioning from foster care toindependence through regular informative staffings.An ongoing assessment of the child(ren)’s needs was conducted to provideupdated information for case planning purposes. (applicable to all cases)An assessment for residential group care was completed when required.(applicable to out-of-home care cases)An ongoing assessment of the mother’s needs was conducted to provide updatedinformation 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 updatedinformation for case planning purposes. (applicable to all cases)Concerted efforts were made to support the father’s engagement in services.(applicable to all cases)An ongoing assessment of the out-of-home care providers or pre-adoptive parent'sservice needs was conducted in order to ensure appropriate care for the child.(applicable to out-of-home care cases)No data 78%86% 88%79% 80%75% 77%68% 72%56% 58%53% 57%86% 88%55Concerted efforts were made to actively involve all case participants in the caseplanning 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%56The frequency of the services worker's visits with all case participants wassufficient to address issues pertaining to the safety, permanency goal, and wellbeingof 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%57The quality of the services worker’s visits with case participants was sufficient toaddress issues pertaining to the child’s safety, permanency and well-being.(applicable to all cases)59% 69%57.1 Mother 57% 72%57.2 Father 45% 58%57.3 Child 60% 71%57.4 Caregiver 72% 81%Statewide Quality of Practice Findings by Fiscal Year continuedOffice of Family Safety | Page 70

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNmbr Standard 08-09 Annual 09-10 Annual58596061Concerted efforts were made to assess the child’s educational needs andmaintain 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 wereengaged. (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’seducation. (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%61.3Diagnoses documented in the case file, medical passport and/or child's resourcerecordNo data 71%62Concerted efforts were made to provide appropriate services to address the child’sidentified physical health needs. (applicable to out-of-home care cases and inhomecases, 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%63646566Concerted 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 healthneeds.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/behavioralhealth needs. (applicable to out-of-home care cases and in-home cases ifrelevant)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%67The Medical Report documenting informed consent was complete or a court orderwas in the file.No data 74%67.1 Services agency involved the family in the decision making process No data 64%67.2Services agency provided prescribing practitioner with all pertinent medicalinformationNo 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%67.5A court order was obtained when neededNo data 75%Statewide Quality of Practice Findings by Fiscal Year continuedOffice of Family Safety | Page 71

Florida Department of Children and FamiliesCase Management Services - 2009-2010 Quality Assurance ReportStdNmbr Standard 08-09 Annual 09-10 Annual68 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%6970Judicial Reviews were held in a timely manner and Judicial Review Social StudyReport's (JRSSR's) provided a thorough investigation and social study concerningall pertinent details relating to the child.Based on all the information reviewed, it is likely that the child will live in a safeand norturing environment with his/her needs being met on a permanent basisduring the next 12 months.No data 85%83% 87%Table Appendix - 2Office of Family Safety | Page 72