Community-Based Care White Paper for State Fiscal Year ... · Community-Based Care White Paper for...
Transcript of Community-Based Care White Paper for State Fiscal Year ... · Community-Based Care White Paper for...
Community-Based Care White Paperfor State Fiscal Year 2005-2006
Prepared by:Amy C. Vargo, M.A.
Mary Armstrong, Ph.D.Neil Jordan, Ph.D.
Mary Ann Kershaw, B.S.Jennifer Pedraza, B.A.
Stephanie Romney, Ph.D.Svetlana Yampolskaya, Ph.D.
Submitted to theFlorida Department of Children and Families
June 27, 2006
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The authors gratefully acknowledge the assistance provided by Roxann McNeish, Stephen
Roggenbaum, Kathleen Cowan, and Kahjeelia Anderson. We would also like to thank all of the
lead agency staff and stakeholders who participated.
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Table of Contents
LIST OF FIGURES ...................................................................................................................... iv
LIST OF TABLES.......................................................................................................................... v
EXECUTIVE SUMMARY .............................................................................................................vii
POLICY RECOMMENDATIONS….. ............................................................................................. x
INTRODUCTION….......................................................................................................................1
Background ....................................................................................................................... 1
Florida’s Community-Based Care Initiative ........................................................... 1
Florida’s Current Community-Based Care Initiative .............................................. 3
Organization of Report ...................................................................................................... 5
Research Questions..........................................................................................................5
RESEARCH QUESTION 1: How Effective is Community-Based-Care at Designing and
Improving Systems and Services for Child Protection ................................................................. 6
Introduction ....................................................................................................................... 6
Methods ............................................................................................................................ 7
Statewide Data Collection ....................................................................................... 7
Site Visit Data Collection......................................................................................... 7
Data Analysis .................................................................................................................... 8
Organizational Structure ......................................................................................... 8
Structure of Lead Agencies..................................................................................... 9
Structure of Provider Networks ............................................................................. 16
Number of Counties per Lead Agencies ............................................................... 17
Presence of parent Organization ..........................................................................19
Retention of Case Management Services ............................................................ 20
Conclusions........................................................................................................... 29
Policy Recommendations...................................................................................... 29
RESEARCH QUESTION 2: To What Extent is CBC Governed by the Local Community .......... 31
Introduction ..................................................................................................................... 31
Methods .......................................................................................................................... 31
Statewide Data Collection ..................................................................................... 31
Site Visit Data Collection....................................................................................... 32
Data Analysis ........................................................................................................32
Results ............................................................................................................................ 32
Community as Governance Partners .................................................................. 32
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Board of Directors Roles and Responsibilities ................................................... 33
Board of Directors: Working Relationships and Collaborations ......................... 36
Board of Directors and Lead Agency....................................................... 36
Board of Directors and the DCF District/Regional Office......................... 36
Pathways of Accountability ...................................................................... 37
Board of Directors: Membership Guidelines and Conflicts of Interest ................ 38
Community Alliances ......................................................................................... 49
Community Alliance and Board of Directors ....................................................... 50
Conclusions..................................................................................................................... 51
Policy Recommendations................................................................................................ 52
RESEARCH QUESTION 3: How Effective is Community-Based-Care at Identifying and Meeting
the Needs of the Families and Children that have been Maltreated ........................................... 53
Introduction ..................................................................................................................... 53
Performance on Indicators o Child and Family Well being ............................................. 54
Family Engagement in Service Planning ......................................................................... 57
Customer Satisfaction ...................................................................................................... 61
Conclusions ...................................................................................................................... 63
Policy Recommendations ................................................................................................. 64
RESEARCH QUESTION 4: What Factors Affect Child Outcomes .............................................65
Introduction ..................................................................................................................... 65
Sources of Data ............................................................................................................... 66
Methodology ................................................................................................................... 66
Limitations ....................................................................................................................... 67
Findings........................................................................................................................... 68
Median Lengths of Stay of Children Who Were Served in Out-of-Home Care
During FY 04-05 .............................................................................................. 68
Predictors of Delayed Discharge for Children who Entered Out-of-Home Care
in FY03-04 ....................................................................................................... 71
Predictors of Reentry into Out-of-Home Care among Children Exiting During
FY03-04 ........................................................................................................... 73
Predictors of Maltreatment Recurrence (FY03-04 Entry Cohort) ..................... 75
Multi-Level Model Results ............................................................................................... 77
Lengths of Stay in Out-of-Home Care (Entry Cohort FY03-04) ....................... 77
Lengths of Stay in Out-of-Home Care for Children served in FY04-05........... 78
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Reentry into Out-of-Home Care .......................................................................... 79
Safety and Permanency in Florida, Federal Standards and National Trends ..... 79
Conclusions... ................................................................................................................. 80
Policy Recommendations ................................................................................................. 81
RESEARCH QUESTION 5: What is the Short and Long Term Effectiveness of Lead Agencies at
Managing Resources and Cost................................................................................................... 82
Introduction ..................................................................................................................... 82
Methods .......................................................................................................................... 83
Findings ........................................................................................................................... 83
Conclusions ..................................................................................................................... 86
Limitations ....................................................................................................................... 87
Policy Recommendations................................................................................................ 87
Conclusions and Policy Recommendations ............................................................................... 88
Organizational Analysis................................................................................................... 89
Programmatic Outcomes ................................................................................................ 90
Quality Performance ....................................................................................................... 90
Cost Analysis .................................................................................................................. 91
Appendix A. Bivariate & Multivariate Data: ................................................................................. 94
Appendix B: Types of Case Staffing Structures.......................................................................... 98
Appendix C: Budget & Actual Expenditures by Lead Agency & Funding Source, FY04-05 ..... 102
List of Figures
Figure 1. Status of CBC Implementation as of September 2005 .................................................. 3
Figure 2. Example of Low Vertical Differentiation: Community-Based Care of Brevard (CBCB)
organizational Chart.................................................................................................................... 11
Figure 3. Example of High Vertical Differentiation: Sarasota YMCA South organizational Chart12
Figure 4a. Model of Provider Structure with Parent Organizations............................................. 24
Figure 4b. Model of Provider Structure with Partner Organizations............................................ 24
Figure 4c. Model of Provider Structure without Parent/Partner Organizations ........................... 25
Figure 4d. Model of Provider Structure with Service Centers ..................................................... 27
Figure 4e. Model of Provider Structure with Country Operated Lead Agency. ........................... 28
Figure 5. Proportion of Children who Exited Out-of-Home Care During FY04-05 by
Lead Agency ............................................................................................................................... 69
Figure 6. Median Lengths of Stay (in months) by Lead Agency ................................................. 70
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Figure 7. Probability of Successful Discharge by Reunification after Exiting Out-of-Home Care73
Figure 8. Probability of Reentry by Reunification as a Reason for Discharge ............................ 74
Figure 9. Overall Variance Percentage by Lead Agency, FY04-05 ............................................ 85
Figure 10. IV-E Variance Percentage by Lead Agency, FY04-05............................................... 86
List of Tables
Table 1. Lead Agencies and Counties Included in the Evaluation ................................................ 4
Table 2. Research Questions ....................................................................................................... 5
Table 3. Research Question 1: How Effective is Community-Based-Care at Designing and
Improving Systems and Services for Child Protection .................................................................. 6
Table 4. Common Organization Strengths.................................................................................. 14
Table 5. Lead Agency by Organizational Types. ........................................................................ 17
Table 6. Lead Agency Economic Outcomes by Lead Agency Number of Counties, FY04-05 ... 19
Table 7. Lead Agency Economic Outcomes by Lead Agency Parent Organization Status ........ 20
Table 8. Lead Agency Economic Outcomes by Lead Agency Case Management Retention
Status.......................................................................................................................................... 21
Table 9. Research Question 2: To What Extent is CBC Governed by the Local Community ..... 31
Table 10. Role of the Board of Directors..................................................................................... 34
Table 11. Board Subcommittees and Responsibilities................................................................ 35
Table 12. Board of Directors and DCF District/Regional Offices ................................................ 37
Table 13. Community-Based Care Governance Agreements..................................................... 40
Table 14. Type of Potential Conflict Situations ........................................................................... 48
Table 15. Research Question 3: How Effective is Community-Based-Care at Identifying and
Meeting the Needs of the Families and Children that have been Maltreated ............................. 53
Table 16. Findings on Child and Family Well-Being Indicators from 2001 Federal CFSR.......... 56
Table 17. Finding from the Florida CFSR in FY04-05................................................................. 57
Table 18. Research Question 4: What Factors Affect Child Outcomes ...................................... 65
Table 19. Factors Associated with Discharge for Children Served in FY04-05 ......................... 71
Table 20. Factors Associated with Discharge Based on Cohort FY03-04 ................................. 72
Table 21. Predictors of Reentry into Out-of-Home Care-Multivariate Model Exit Cohort FY03-04 75
Table 22. Predictors of Maltreatment Recurrence Based on FY03-04 Cohort............................ 76
Table 23.Multilevel Model Results .............................................................................................. 78
Table 24.Multilevel Model Results .............................................................................................. 78
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Table 25.Multilevel Model Results .............................................................................................. 79
Table 26. Research Question 5: What is the Short and Long Term Effectiveness of Lead
Agencies at Managing Resources and Cost............................................................................... 82
Table 27. Budget vs. Actuals Statewide (FY04-05) .................................................................... 84
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Executive Summary
The 1996 Florida Legislature mandated the outsourcing of child welfare services through
the use of a lead agency design. The intent was to strengthen the support and commitment of
local communities to the “reunification of families and care of children and their families,” and to
increase the efficiency and accountability of services. This evaluation of Community-Based
Care (CBC) examines the organizational structure of lead agencies and their provider networks,
the involvement of community members in lead agency governance and resource development,
and safety and permanency outcomes and indicators of quality (including child well-being
indicators and family satisfaction). In addition, the report provides baseline expenditure data in
anticipation of the expected October 2006 start date for the statewide implementation of
Florida’s new IV-E Waiver. By triangulating findings across evaluation components, the
evaluation team was able to construct an informed and comprehensive picture of the strengths
and challenges of Florida’s child welfare system. Importantly, consistent themes emerged
throughout the various components comprising this evaluation; these themes are useful in
identifying areas for system improvement, as well as areas requiring more in-depth examination
in the future.
The first research question, which included an analysis of organizational structures,
identified five models of provider network configurations and their relationship to the lead
agency including: a provider structure that answers to a parent organization, a provider structure
that maintains a lead agency comprised of partner organizations, a model that depicts the use
of service centers in the provider structure, a more traditional provider model that excludes
parent/partner organizations, and a provider structure that involves a lead agency that is run by
county government. The differences in lead agency and provider network configurations
indicate that lead agencies are developing structures based on the availability of resources in
their local communities while creating strategies to reach all the children and families in their
catchment’s area.
In addition, three lead agency characteristics were examined across evaluation
components: the number of counties in a lead agency’s jurisdiction, presence of a parent
organization, and retention of case management services (versus subcontracting out for case
management services). Lead agencies with more than one county in their service area used a
lower proportion of their total contract expenditures for out-of-home services (58.8%) than lead
agencies that serve a single county (65.6%). Associations between child-level outcomes and
the three lead agency characteristics were not statistically or substantively significant.
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The second research question explored the extent to which Community-Based Care is
governed by the local community. Board members most frequently mentioned their role in
making sure the lead agency was fiscally responsible and viable. Additional responsibilities
include: ensuring that the long-term viability of the lead agency, ensuring that children are
receiving the highest level of care available to promote safety and permanency in their lives,
ensuring that the lead agency is a good custodian of federal and state money, (and is in
compliance with acceptable financial regulations), and careful selection of qualified Board
members to mitigate conflicts of interest.
Despite initial reactions to the contractual requirement of lead agencies to have Boards
of Directors comprised of 100% community members, the majority of Boards have now met that
requirement or are actively moving in that direction. Two lead agencies are contractually
allowed to have only 85% community stakeholders as voting Boards members. Board members
mentioned that conflict of interest statements were signed as part of the Board member
application process, and that when these situations arose, whether the potential conflict was
“real or perceived”, the Board member in question must refrain from voting on issues under
question. A few survey respondents acknowledged that the contractual requirement of Boards
to be comprised of 100% community members continues to be a difficult issue for some lead
agencies, which as risk bearing entities, are different than a typical non-profit. These concerns
were often voiced by lead agencies who reported maintaining positive and supportive
partnerships with provider network and parent organizations.
The Community Alliances represent a potentially important community governance
partnership for lead agencies; however, in some communities other local stakeholder groups
are more influential. Some Alliances continued to request more authority over their local lead
agency. However,the scope of Community Alliances was often seen as being much broader
than that of the Board, in that the Alliance encompasses the health and wellbeing of all children
and families.
The research question related to quality performance focused on the well-being of
children and families as measured by the findings from the Child and Family Service Reviews,
the engagement of caregivers in service planning by lead agencies, and the collection of data
regarding caregiver satisfaction with services. The findings all point to the same conclusion—
the best way to know whether, and to what degree, services are successful is to include the
service recipient in the process, continuously assess their progression in reaching outcomes,
and gather their input as to the quality of services. The evaluation identified a variety of
mechanisms that lead agencies have created to solicit caregiver input and engagement.
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The research questions related to child outcomes revealed that certain child
sociodemographic characteristics are associated with poorer ASFA requirement outcomes.
Specifically, boys and younger children are less likely to achieve permanency and more likely to
reenter the system. While reunification and placement with relatives were found to be strongly
associated with discharge from out-of-home care, they also predict subsequent removal from
primary caregivers. Children who were reunified were four times more likely to reenter out-of-
home care than children who were discharged for other reasons.
In addition, the results of two-level analyses in this section indicated that a lower level of
funding was associated with an increased likelihood of reentry and decreased chance to exit for
children who received out-of-home care services.
The final research question explored the short and long-term effectiveness of lead
agencies at managing resources and costs. Nearly every lead agency spent fewer dollars than
allocated during FY04-05; overall variance ranged from -0.0% to -16.4%. The statewide
variance for overall expenditures was -3.4%. The variance related to IV-E funds was
considerably different than the overall variance, which is notable in light of the impending
implementation of a federal IV-E waiver expected to take effect in October 2006. Specifically,
two lead agencies spent more IV-E dollars than appropriated, and the other 15 under spent their
IV-E allocation. The spending flexibility associated with the IV-E waiver is expected to make it
easier for lead agencies to manage and spend federal child welfare funds. This flexibility will
enable lead agencies to spend IV-E funds on an array of innovative or existing services
designed to reduce out-of-home placements, which is hypothesized to reduce costs over time.
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Policy Recommendations
Specific recommendations based on the findings from each section of the evaluation are
presented below:
Organizational Analysis
1) It is recommended that Board members continue to expand their understanding of the
organizations and processes affecting the child welfare system, including legislative
changes, the court process, the role of other community stakeholder groups (e.g.,
Community Alliance and faith-based organizations), and the contractual obligation of
most lead agencies to have 100% community membership on their Boards of Directors.
Where appropriate, specific training is recommended to supplement Board members’
existing knowledge base.
2) Lead agencies and the Department may wish to conduct some pilot projects in which
one of the governance entities is removed, in order to determine if this would create a
more efficient and streamlined reporting process.
3) An investigation by the legislature and DCF is recommended to explore the potential
positive and negative effects of allowing parent organizations and providers to be
members of lead agency Boards of directors.
Programmatic Outcomes
4) It is highly recommended that newly-reunified families be provided additional services
and support throughout the first year after reunification to prevent a second reentry into
out-of-home care.
5) Findings indicate that being younger, male, or Caucasian is associated with a lower
likelihood of exiting out-of-home care within a timeframe consistent with federal
guidelines. Because the data used in these analyses did not allow examination of why
these demographic characteristics place children at heightened risk, further investigation
is recommended to better understand system-level influences that may account for
these findings.
Quality Performance
6) It is recommended that lead agencies should continue to develop and implement models
that further include families in the service planning process.
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7) In addition, a forum should be established in which lead agencies and their case
management organizations can share promising practices (e.g., Family Team
Conferencing) and learn from each others’ successful practices.
8) Lead agencies and child welfare legal services should coordinate their efforts statewide
to clarify the legal issues surrounding family conferences and the need for
representation pre-adjudication.
9) Lead agencies should continue to include items related to involvement in the service
planning process on measures of customer satisfaction, not only for family members, but
for all community stakeholders.
10) It is recommended that the Department, through its Quality Management efforts (QM),
review the lead agency QM plans on a regular basis to assure their implementation with
a particular focus on the inclusion of families and caregivers in the service planning
process.
Cost Analysis
11) DCF fiscal staff should continue to monitor IV-E variances before and after the IV-E
waiver implementation.
12) Although the spending flexibility associated with the IV-E waiver is expected to simplify
invoicing and the recording of services provided, DCF fiscal staff are encouraged to work
closely with lead agency fiscal staff during the IV-E waiver implementation to clarify
issues that arise regarding invoicing and the proper recording of new services.
13) Further research is recommended to investigate the spending barriers faced by lead
agencies to help explain what appears to be underutilization of allocated funds.
In addition to these policy recommendations based on the current report, five
recommendations from the Fiscal Year 2004-2005 Legislative report are still in the process of
being addressed:
To maximize timely exits from out-of-home care, lead agencies are encouraged to
review their policies regarding permanency staffings, service referrals for families of
origin, adoptive family recruitment, and other efforts that many facilitate the transition to
permanency.
The Florida Coalition should provide technical assistance by serving as a conduit for
dissemination of all existing forms and procedures utilized to measure customer
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satisfaction so that lead agencies have a variety of assessment examples and options
as they develop their own local system.
Lead agencies are encouraged to review their staffing procedures and to examine the
purpose (rather than the title) of each staffing. When appropriate, lead agencies should
consider combining staffings that are held for similar purposes or with the same
participants.
Lead agencies should continue to take steps to actively involve families in conferences
and staffings in which decisions regarding case planning and permanency are made.
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Introduction
Background
Florida’s Community-Based Care Initiative
In Florida, the 1996 Legislature mandated the outsourcing of child welfare services
(known in Florida as Community-Based Care) through the use of a lead agency design. The
intent of the original statute was to strengthen the support and commitment of local communities
to the “reunification of families and care of children and their families,” and increase the
efficiency and accountability of services. The responsibilities of lead agencies, as defined by the
original statute, include the ability to:
• “Coordinate, integrate, and manage all child protective services in the community while
cooperating with child protective investigations,
• Ensure continuity of care from entry to exit for all children referred,
• Provide directly or through contract with a network of providers all child protective
services,
• Accept accountability for achieving the federal and state outcome and performance
standards for child protective services,
• Have the capability to serve all children referred to it from protective investigations and
court systems, and
• Be willing to ensure that staff providing child protective services receive the training
required by the Department of Children and Families.” (s. 409.1671, F.S.)
In 1997, the evolution of Community-Based Care (CBC) was impacted by the passage of
the ASFA, which amended Title IV-B (child welfare) and Title IV-E (out-of-home care and
adoption assistance) programs of the Social Security Act. It was the first major child welfare
legislation to be enacted since 1980. ASFA stressed the importance of child safety,
permanency, and well-being over reunification or placement issues. The legislation also focused
on reducing the time children spend in out-of-home care. The seven major outcome goals that
ASFA seeks to achieve in all states are to:
• “Reduce the reoccurrence of child abuse and/or neglect,
• Reduce the incidence of child abuse and neglect in out-of-home care,
• Increase permanency for children in out-of-home care,
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• Reduce time in out-of-home care to reunification without increasing reentry to out-of-
home care,
• Reduce time in out-of-home care to adoption,
• Increase placement stability, and
• Reduce placements of young children in group homes or institutions.”
(U.S. Department of Health and Human Services, 1998)
Statewide expansion of CBC was mandated in 1998. In 1999, the Florida Legislature
brought the state into compliance with ASFA by revising Chapter 39 of the Florida Statutes and
amending the substantive legislation regarding CBC. The CBC Implementation Plan, issued in
July 1999 by the Florida Department of Children and Families (DCF), embraced the ASFA
goals, while transitioning to local community-based systems of care.
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Florida’s Current Community-Based Care Initiative
All of the counties in Florida have now implemented a Community-Based Care contract.
There are currenlty 20 lead agencies with 22 contracts serving Florida’s 67 counties.1 See
Figure 1 for a map of lead agencies in Florida.
Figure 1. Status of CBC Implementation as of September 2005
Available online at: http://www.dcf.state.fl.us/cbc/docs/cbcstatusmap.pdf
Table 1 lists the lead agencies (and counties) included in this evaluation, as well as the
acronym used to identify each agency throughout the remainder of the report. The total number
of children served by each lead agency in FY04-05 is also included in Table 1.
St.Lucie
Wakulla
Clay & Baker Kids Net, Inc. (CBKN)
Community-Based Care ofSeminole, Inc.
(CBC of Seminole)
Families First Network (FFN)Family Matters of Nassau
County (Family Matters)
Family Support Servicesof North Florida (FSS)
St. Johns County Board ofCounty Commissioners
(St. Johns)Community-Based Care ofVolusia & Flagler (CBCVF)
Community-BasedCare of Brevard, Inc.
(CBC of Brevard)
Family Services of Metro-Orlando, Inc. (FSMO)
YMCA Children, Youth, & FamilyServices, Inc. North (YMCA – North)
Hillsborough Kids, Inc. (HKI)
YMCA Children, Youth, & FamilyServices Inc., South (YMCA – South)
Children’s Network of Southwest Florida(Children’s Network)
Our Kids of Miami-Dade & Monroe, Inc. (Our Kids) ChildNet, Inc. (ChildNet)
Child & FamilyConnections, Inc.
(CFC)
Kids Central, Inc. (KCI)
Big Bend Community-Based Care, Inc. – 2A (BBCBC – 2A)
United for Families,Inc. (UFF)
Partnership for Strong Families (PSF)
Big Bend Community-BasedCare, Inc. – 2B (BBCBC – 2B)
Seminole
Escambia
Walton
OkaloosaSantaRosa
Nassau
Duval
Flagler
Volusia
Brevard
Orange
OsceolaPasco
Pinellas
Hillsborough
Hendry
GladeCharlotte
Lee
Collier
Dade
Monroe
Broward
Palm Beach
GulfBay
Jackson
Holmes
CalhounWashington
ClayBaker
Hardee
Polk
Highlands
Heartland for Children, Inc. (HFC)
Sarasota De Soto
ManateeMartin
Indian River
St. Johns
Taylor
Leon
Franklin
Madison
Jefferson
Liberty
Gadsden
Hernando
Marion
LakeCitrus
Col
umbi
AlachuaDixie Gilchrist
Lafayette
Levy
Suwannee
Hamilton
Bradford
Union
Putnam
Sumter
Okeechobee
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Table 1. Lead Agencies and Counties Included in the Evaluation
1 Big Bend Community-Based Care and Sarasota YMCA each held two service contracts for distinctgeographic areas during FY05-06
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2 Formerly served by Partnership for Families3 Formerly served by Family Continuity Programs, Inc.
DDiissttrriicctt LLeeaadd AAggeennccyy && CCoouunnttiieess SSeerrvveeddNNuummbbeerr ooff YYoouutthhsseerrvveedd FFYY0044--0055
UUnndduupplliiccaatteedd CCoouunnttDistrict 1 Family First Network (FFN)
Escambia, Santa Rosa, Okaloosa, & Walton4,991
Big Bend Community-Based Care 2A 2 (BBCBC-2A)Holmes, Washington, Bay, Jackson, Calhoun, & Gulf,
1,967District 2A & 2B
Big Bend Community-Based Care 2B (BBCBC-2B)Gadsden, Liberty, Franklin, Leon, Wakulla, Jefferson, Madison, &Taylor
1,846
District 3 Partnership for Strong Families (PSF)Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,Putnam, Suwannee, Levy, & Union
3,457
Family Support Services of North Florida, Inc. (FSS)Duval
4,476
Nassau County Board of County Commissioners (Family Matters)Nassau
305
St. Johns County Board of County Commissioners (St. Johns)St. Johns
519
District 4
Clay & Baker Kids Net, Inc. (CBKN)Clay & Baker
887
Sarasota Family YMCA, Inc. North3 (Sarasota YMCA North)Pasco & Pinellas
6,071
Sarasota Family YMCA, Inc. South (Sarasota YMCA South)Manatee, De Soto, & Sarasota
1,829
SunCoastRegion
Hillsborough Kids, Inc. (HKI)Hillsborough
7,158
Community-Based Care of Seminole, Inc. (CBC of Seminole)Seminole
1,144
Family Services of Metro-Orlando, Inc. (FSMO)Orange & Osceola
5,874
District 7
Community-Based Care of Brevard (CBC of Brevard)Brevard
2,689
District 8 Children’s Network of Southwest Florida (Children’s Network)Charlotte, Lee, Glades, Hendry, & Collier
2,656
District 9 Child & Family Connections, Inc. (CFC)Palm Beach
3,005
District 10 ChildNet, Inc. (ChildNet)Broward
6,130
District 11 Our Kids of Miami-Dade & Monroe, Inc. (Our Kids)Miami-Dade & Monroe
8,202
District 12 Community-Based Care of Volusia & Flagler Counties (CBCVF)Volusia & Flagler
2,513
District 13 Kids Central, Inc. (KCI)Marion, Citrus, Sumter, Lake, & Hernando
7,424
District 14 Heartland for Children (HFC)Polk, Hardee, & Highlands
5,659
District 15 United for Families (UFF)Okeechobee, St. Lucie, Indian River, & Martin
2,972
TOTAL 81.774
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Organization of Report
Research Questions
The following table (Table 2) details the research questions and the evaluation questions
in this evaluation.
Table 2. Research Questions
RReesseeaarrcchh QQuueessttiioonn EEvvaalluuaattiioonn QQuueessttiioonn
How are the lead agencies organized?How are the provider networks structured?How effective is
Community-Based Care atdesigning and improvingsystems and services for
child protection?
What types of interaction take place between the lead agencyand provider networks?
What types of community governance Boards support the leadagency?How are local community resources being developed andutilized?
How effective isCommunity-Based Care atinvolving the community in
child protection both asservice partners and
resource contributors?What conflicts of interest exist between lead agencies,providers, and Boards of Directors
How does Florida’s child welfare system perform on indicatorsof child and family well-being?
What efforts are being made by lead agencies to enhancefamily’s capacity to provide for their children?
How effective isCommunity-Based Care atidentifying and meeting theneeds of the families andchildren who have been
maltreated?What tools and processes are being implemented by leadagencies for the measurement of customer satisfaction?
What factors are associated with children’s delayed exit fromout-of-home care and affect median length of stay in out-of-home care?What factors are associated with reentry into out-of-home care?
What factors affect childoutcomes?
What factors are associated with recurrence of maltreatment?What is the impact of child welfare funding sources on actualexpenditures?Why is there variation among the lead agencies related to out-of-home expenditures?
What is the short and longterm effectiveness of lead
agencies at managingresources and cost? What predictors influence the variation in lead agency total
expenditures?
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Research Question 1: How effective is Community-Based Care at designing and
improving systems and services for child protection?
Introduction
In order to examine the effectiveness of CBC at designing and improving systems and
services for child protection, this research question includes the following evaluation questions,
indicators and data sources (Table 3). The first step toward effectiveness research is to
describe the process of service system reform in each lead agency’s local area in addition to
type of organizational structure and provider networks characteristics established by lead
agencies. A selection of lead agency key characteristics were then triangulated with child
outcome and fiscal data.
Table 3. Research Question 1
EEvvaalluuaattiioonnQQuueessttiioonnss IInnddiiccaattoorr//AAnnaallyysseess SSoouurrccee
How are the leadagenciesorganized?
• Analyses oforganizational charts ofCBC lead agencies
• Reported implementationsuccess/failuresattributable toorganizational structure
• Description of potentialconflicts of interest
Lead AgencyDocumentation
CEO Survey
Site Visits
How are theprovider networksstructured?
• Description oforganizational structure ofprovider network
CEO Survey
Lead AgencyDocumentation
Site Visits
HHooww eeffffeeccttiivvee iissCCoommmmuunniittyy--BBaasseedd
CCaarree aatt ddeessiiggnniinngg aannddiimmpprroovviinngg ssyysstteemmss
aanndd sseerrvviicceess ffoorr cchhiillddpprrootteeccttiioonn??
What types ofinteraction takeplace between thelead agency andprovidernetworks?
• Analysis ofcommunication andinteraction patternsbetween lead agency andproviders
Lead AgencyDocumentation
CEO Survey
Site Visits
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Methods
Statewide Data Collection
For the organizational component, team members began by contacting the 20 lead
agency CEOs to explain the purpose of the email survey and to request updated information
from those agencies that participated in the FY2004-05 evaluation. The CEOs were then e-
mailed an 18-question survey that covered: (1) community governance (Board of Director issues
and community participation); (2) differences in lead agency service systems; and (3) lessons
learned in CBC implementation. As part of this protocol (see Appendix X), lead agency CEOs
were asked to identify their Boards of Directors members and to describe their roles as well as
any potential conflicts of interest encountered in the Board member selection process.
Each lead agency CEO was also asked for a visual representation of community
governance and their service delivery model, or any documents they already had on these
topics that they were willing to share. The project team used this in conjunction with the survey
responses. Organizational models and charts previously received from lead agencies and
Central Office staff were also included in the analysis. In addition, a request was made for a
copy of each lead agency’s Network Management Plan.
Site Visit Data Collection
Site visits were conducted at two lead agencies: Heartland for Children (HFC) and
Family Services of Metro Orlando (FSMO). The goal of the site visits was to gain an
understanding of how local systems of care were planned, the current status of implementation,
the conditions and resources that facilitate the successful operation of CBC, obstacles to
implementation, and strategies being used to address the obstacles. Specific areas of
examination include governance, operations and management, local direction and ownership,
service array, and leadership. A second goal was to understand better the role of the primary
agencies involved in HFC and FSMO’s implementation, including the DCF Central Office, the
District and Zone Offices, and collaborating providers and community organizations and
members.
The site visits occurred in March and May, 2006. Methods included review of pertinent
documents; interviews with key stakeholders from HFC and FSMO, the District Offices, provider
agencies, and community stakeholders. A semi-structured interview protocol was used for the
interviews with key stakeholders. All interviews were audiotaped and transcribed.
9
Data Analysis
Content analysis of the documents and open-ended survey questions was used to
analyze the qualitative data collected for this study. Content analysis involves reviewing
qualitative data to identify common themes and trends. The primary goal of content analysis is
to condense a large amount of qualitative data into a list of variables that can be examined for
correlations, patterns and themes.
Organizational Structure
Organizational structure is the platform for all the organizational activities and decision-
making, as well as the framework that determines how well the organizational goals and
outcomes are met (Hall, 1996). Understanding the structure of an organization allows for a
better picture of the “daily” practices and procedures of an organization and the barriers or
facilitators that influence those practices and procedures.
The analysis of the lead agencies begins with a high level description of each lead
agency and provider network organizational structures, as depicted through their organizational
charts and responses to the CEO survey. It then continues with issues of process within these
structures as well as specific lead agency characteristics and how they may or may not be tied
to child level outcomes and expenditure patterns.
10
Focus On: Organizational Structure Definitions
Complexity: refers to how much difference exists in the various tasks, procedures and
practices in the organization (Fitzgerald, 2002). The degree of complexity in an organization is
measured by the amount of horizontal differentiation, vertical differentiation, and spatial
dispersion (Hall, 1996; Fitzgerald, 2002).
Horizontal Differentiation: indicates subdivided responsibilities and activities often
represented by the number of various positions and specializations across the organization or
the number of divisions and departments that segment the organization (Fitzgerald, 2002). The
level of job training/education for a specialization is an indicator of the level of horizontal
differentiation and therefore the complexity: the greater the number of jobs in an organization
that require special skills, the more complex the organization will be (Robbins, 1987).
Vertical Differentiation: refers to the number of employees, or hierarchical levels, from the
very top level of the organization to the lowest level and represents the degree of this
arrangement in the organization (Hall, 1996; Robbins, 1987).
Spatial Dispersion: refers to the number of offices not located in the immediate presence of the
“main” operations of the organization (Robbins, 1987).
Structure of Lead Agencies
Knowing the level of complexity of a lead agency is important because it can dictate how
communication and interaction occur throughout the organization, the amount of effort,
administration, and standardization needed to perform the activities of the organization, the
behavior of the employees, and the organization’s relationship to external environments.
Complexity is positively correlated with the size of the organization, the number of position titles,
and the number of departments or sections in an organization (Hall, 1996).
The degree of complexity in an organization is measured by the amount of horizontal
differentiation, vertical differentiation, and spatial dispersion (Fitzgerald, 2002; Armstrong et al.,
2004).
In terms of horizontal differentiation, the majority of lead agency organizational charts
examined for this evaluation showed four or five different departments/divisions across their
organizations as indicated by a distinct personnel title (e.g., Operations and Finance). In all,
approximately eight different titles appeared across the organizations that represent the varied
divisions of the lead agencies and reflect distinct areas of specialization, including:
• Operations
11
• Finance or Chief Financial Officer
• Quality Assurance
• Community Relation/Liaisons
• Network Development
• Client Services/Case Management
• Technology
• Child/Family Services
The consistency in number of divisions across the lead agencies (an average of 5
divisions) suggests that there are agreed upon specializations/training required for the activities
of lead agencies and a similar level of horizontal differentiation.
While horizontal differentiation was consistent across the lead agencies, analysis of the
lead agency organizational charts illustrates varying amounts of vertical differentiation. The
majority of lead agencies, for example Community-Based Care of Brevard (CBCB), Our Kidsof Miami, Dade & Monroe, Partnership for Strong Families (PSF), Family SupportServices of North Florida (FSS), United for Families (UFF) and FamiliesFirst Network(FFN), had an average of 2.5 persons between the lowest and highest levels of the organization
(see Figure 2 for Community-Based Care of Brevard organizational chart; inserted for visual
purposes only). In contrast, a few agencies, such as Community-Based Care of Volusia andFlagler Counties (CBCVF), Family Services of Metro Orlando (FSMO), Hillsborough Kids,Inc. (HKI), Sarasota YMCA South, Child and Family Connections (CFC), and ChildNet,Inc., had an average of four persons between the lowest and highest level of the organization
(see Figure 3 for Sarasota YMCA South’s organizational chart; inserted for visual purposes
only). While the difference may seem negligible, the group of lead agencies with the higher
vertical differentiation has almost two more persons between staff and the top-level
administration. The hierarchical increase would require more process and communication
standardization than that needed in the less vertically differentiated agencies.
12
Figure 2. Example of Low Vertical Differentiation: Community-Based Care of Brevard (CBCB) Organizational Chart
PT Court Aide
Dr. Patricia NelliusChief Executive Officer
Director PR &Procurement
Director Child &Family Services
Quality OperationsOfficer
CFO
Contract Manager
MIS Contract
PR Liaison
Admin. Ass’t. Court Liaison
IL Specialist
Intake Specialist
Intake Specialist
Assessment Spec.
Assessment Spec.
Caregiver Liaison
Data IntegritySpec.
Central Care Mgr.
Admin. Ass’t. Receptionist
North Center Mgd
Admin. Ass’t Receptionist
South Care Mgr.
Admin. Ass’t. Receptionist
Prof Dev. Mgr.
Admin.. Ass’t.
Rev. Max Coord. Accounting Spv.
Rev Max Specialist
Rev Max Specialist
ICWIS Analyst II
ICWIS Analyst I
Acctg. Clerk II
Acctg. Clerk I
EA/HR Liaison
Prof. Dev. Spec
P & D Care Coord.
Family Partner
P & D Care Coord
Care Coord.
Care Coord
. Care Coord.
Prof Dev Specialist
13
Figure 3. Example of High Vertical Differentiation: Sarasota YMCA South Organizational Chart
Executive Assistant
YMCA Corporate Board
YMCA Branch Boards(includes Pinellas & Pasco Counties)
President/CESarasota Family YMCA,
StakeholdersAlliances & Community Groups
Communitie
Fiscal Services/ManagementInformation Technology/Contracts Human ResourcesExecutive Vice
President
Senior Vice PresidentCBC Operations
Administrative Asst.
Director of CBCQuality
Sarasota, Manatee, DeSoto,Pasco & Pinellas Counties
QualityImprovementCoordinator
Pasco/Pinellas
TrainingCoordinator
Pasco/Pinellas
Training/QICoordinator
Sara/Mana/DeSoto
Senior CBCProgram ManagerSarasota, Manate &
DeSoto Counties
Director ofIndependent Living
Services
Independent LivingSpecialist (3)
Independent LivingCoordinator (Sarasota)
Independent LivingCoordinator (Manatee/DeSoto)
Independent LivingSpecialist (2)
Director of Recruitment/Licensing, Retention/
Relicensing, Placement
Recruitment/Licensing,Retention/Relicensing,
Placement Staff
Licensing Supervisor
Relicensing Supervisor
Placement Supervisor
Foster CareClothes Closet
AdministrativeSupport Staff
Sara/Mana/DeSoto (1)
Infant Care ProgramSara/Mana/DeSoto
Grammy’s HouseSara/Mana/DeSoto
Enhanced FosterCare Program
Sara/Mana/DeSoto
Director of OperationsDeSoto/Manatee
Senior Assistant Directorof Operations (Manatee/DeSoto)
AdministrativeSupport Staff (2)
Director of Operations Sarasota Senior Assistant Directorof Operations (Sarasota)
Administrative Support Staff (1)
Executive Asst.
Senior CBCProgram Manager
Pasco & Pinellas Counties
Director of Adoptions& Related Services
Sarasota, Manatee, DeSoto,Pasco & Pinellas Adoptions Coordinator
Pasco & Pinellas
Adoption Subsidy SpecialistPinellas
Adoption Subsidy SpecialistPasco & Pinellas
Adoption Subsidy SpecialistSarasota, Manatee & DeSoto
Director ofClient Relations
Sarasota, Manatee, DeSoto,Pasco & Pinellas
Admin Support
ReceptionistsPinellas (2)
Director of OperationsPasco
Assistant DirectorOf Operations
Pasco E
Assistant DirectorOf Operations
Pasco W
Admin Support Staff& Recepetionists
Pasco
Director of OperationsPinellas
AssistantDirector of
Operations (5)
AdministrativeSupport Staff
(3)Ass’t Director of Recruitment/
Licensing, Retention/Relicensing, Placement
Sara/Mana/DeSoto/Pasco/Pinellas
Director of Recruitment/Licensing, Retention/
Relicensing, PlacementPasco/Pinellas
Recruitment/Licensing,Retention/Relicensing,
Placement StaffPasco/Pinellas (16)
Administrative Support StaffPasco/Pinellas (4)
Licensing SupervisorPinellas
Licensing SupervisorPasco/Pinellas
Placement SupervisorPasco/Pinellas
Director ofUtilization
Sarasota, Manatee, DeSoto,Pasco & Pinellas Counties
Single Point of AccessPasco &Pinellas
Counties
Single Point of AccessSarasota, Manatee &
DeSoto Counties
Assistant SinglePoint of Access
Sarasota, Manatee, DeSoto,Pasco & Pinellas Counties
of CBC DataSenior
Background ScreeningSupervisor
Sarasota, Manatee,DeSoto, Pasco &
Pinellas
BackgroundScreening AnalystsSarasota, Manatee,
DeSoto Pasco &Pi ll (4)
Revenue MaximizationSupervisor
Sarasota, Manatee,DeSoto, Pasco & Pinellas
Revenue MaximizationSpecialist
Sarasota, Manatee, &DeSoto (3)
Revenue MaximizationSpecialist
Pasco & Pinellas (5)
Admin AssistantSarasota, Manatee,
DeSoto, Pasco &Pinellas (1)
Data Entry SupervisorSarasota, Manatee,DeSotot, Pasco &
Pinellas
Data Entry SpecialistSarasota & DeSoto (2)
Data Entry SpecialistManatee (1)
Data Entry SpecialistsPinellas (5)
Data Entry SpecialistsPasco (2)
Invoicing SpecialistsPasco/Pinellas (3)
Invoicing SpecialistSara/Mana/DeSoto (1)
Data SpecialistPasco/Pinellas (1)
Records SpecialistSupervisor
Sarasota, Manatee,DeSotot, Pasco &
Pinellas
Records SpecialistManatee (1)
Records SpecialistDeSoto/Sarasota (1)
Records SpecialistSarasota (1)
Records SpecialistPinellas (1)
Asst. Records SpecialistPinellas (1)
Records SpecialistsPasco (2)
File ClerksPasco (2)
Asst. Records SpecialistManatee (1)
File ClerksPinellas (6)
14
The last measure of complexity, spatial dispersion, affects those lead agencies with
offices or service centers not located in the same geographic location as the “main” office. In
addition, those lead agencies serving multiple counties, with or without service centers, will have
greater structural complexity simply due to geography (see Table 5 for county versus multiple
counties issue). For example, FFN, BBCBC, PSF, Clay and Baker Kids Network (CBKN) and
KCI have greater spatial dispersion because their services are spread across the multiple
counties they serve through service centers. However, a large county such as Hillsborough has
both urban and rural areas, and may face the same complexity related issues as that of a lead
agency with four smaller counties.
Overall, all of these measures can be placed on a continuum from low to high so that
mixed variations of the measures can exist across the lead agencies or across the divisions or
departments of the lead agency (Hall, 1996). Specific measures can also impact one another.
For example, an organization with high spatial dispersion such as FFN, may then require high
vertical differentiation to account for multiple personnel positions needed at each individual
service center.
When considering the descriptions and measures of how complex lead agencies are
based on their organizational charts and the responses from the CEO survey, it is important to
note that this is only the first step in describing and understanding each agency’s organizational
structure. Understanding the complexity of their lead agency will allow administrators to
recognize the needs of the organization based on structure (e.g., increase workforce as
complexity increases). Lead agencies may also find that their structure is too complex, or not
complex enough, to adequately perform the activities of their organization.
The CBC lead agency CEOs also had an opportunity in the CEO survey to respond to
questions concerning the strengths and challenges of their organizational structure. Table 4
delineates the various organizational strengths described by lead agency CEOs. These
strengths were not attributable to one lead agency model, but rather reflected responses across
model types.
15
Table 4. Common Organization Strengths
SSttrreennggtthhss
• Highly flexible to move with the needs of a fluid child welfare system• Senior management of lead agency has a high standard of professional and personal
integrity• Management team encourages employees to find ways to use resources efficiently• Strong relationships and lines of communication between lead agency staff, Board of
Directors, DCF, provider network and community• There are several venues for providers, consumers, and advocates to bring issues to the
attention of workgroups for discussion, review, and action• Minimum administrative overhead• Board of Directors is very supportive of CBC and is the essence of community
governance, where in none of the members are providers, but rather an eclectic mixtureof local citizens
• The majority of services are contracted out to a diverse network of local providers• The lead agency has recognized the “fragility” of the system and has regarded itself as a
change agent for child welfare practice rather than “just an ASO”
An assortment of challenges reported by lead agency CEOs were lack of knowledge on
the part of lead agency finance staff, insufficient staff for contract management and monitoring,
problems with invoicing, an excessive amount of paperwork and procedures, and for those lead
agencies with responsibilities for many different counties; what to do with such a large and
diverse geopolitical landscape. CEOs also mentioned that, while not an organizational
characteristic, these challenges were further exacerbated by historical inequities in funding. An
example of how organizational characteristics come together to facilitate CBC implementation is
shown in the following Focus On box.
16
Focus On: Family Services of Metro Orlando’s Organizational Structure
FSMO is organized into three divisions: (1) Administration, (2) Policy and Program
Development, and (3) Permanency and Operations. A vice president heads up each division.
Additionally, the office of the Executive Director has a Community and Media Relations
individual who works full time with the media and other community stakeholders. This individual
also supports Board governance. Administration oversees all contracting, financial activities
including invoicing, as well as revenue maximization activities. Additionally, Administration
provides support on SSI and payment issues to foster parent and providers.
Policy and Program Development oversee utilization management (UM) activities as well as
CQI and the records management system. There is a strong research component built in with a
full time data analyst. The UM team principally focuses on the “deep end” of the system.
Additionally, UM oversees a Case Assignment Unit that “triages” calls from PIs for removals.
The CAU assigns cases to FSMO’s case management organizations (CMOs) which maintain
their own placement units.
Permanency and Operations oversee the “front-end” and “back-end” of the system of care.
Front-end activities are supported by resource specialists who are housed in each service
center. They are held accountable for understanding the nature of removals, showing cause for
safety factors, as well as ruling out any potential safety plans. They also assist PIs in finding
relatives. Back-end activities are overseen by child welfare specialists who oversee the
development of case planning as well as a 10-month permanency case review. There is a
strong quality assurance component to the role of child welfare specialists.
FSMO, however, has realized that the organizational structure does not have enough staff for
contracts management, finance management, and monitoring. The nature of invoicing has
created a challenge in terms of requiring additional resources to be utilized for this purpose. The
organizational structure is not so much a risk as is the antiquated nature of procurement and
contracting with DCF. FSMO has anticipated this by expanding a few fiscal positions. Through
its contract with Kids Hope United, FSMO now receives onsite support from a controller. Also,
vouchering with providers is being completely revamped with an email notification process
replacing manual paper processes.
17
Structure of Provider Networks
A provider network is the most critical and primary type of interagency relationship for a
CBC lead agency. Overall, lead agencies hold approximately 500 subcontracts with their
provider networks, with 64 for case management services and 436 for direct services
(OPPAGA, 2006). Three aspects of lead agency provider networks were of special interest to
the Department: whether lead agencies had jurisdiction over one versus multiple counties,
whether or not a lead agency and its provider network answered to a parent organization, and
whether lead agencies retain case management services or sub-contracted for them. Lead
agencies are classified by these three characteristics in Table 5. As can be seen in Table 5, six
lead agencies answer to parent organizations, eight serve only one county, and five have
chosen to retain case management services rather than subcontract for them.
18
Table 5. Lead Agency by Organizational Types
Number of Counties per Lead Agency
One of the many issues lead agencies seem to struggle with is the varying cultures
across counties. Each county seems to brings with it its own culture, own providers (with
cultures of their own), and unique socioeconomic challenges (e.g., unemployment, housing,
DDiissttrriicctt LLeeaadd AAggeennccyy
PPaa rr
ee nntt
OOrr gg
aa nnii zz
aa ttii oo
nn
NNoo
PPaa rr
ee nntt
OOrr gg
aa nnii zz
aa ttii oo
nn
SSii nn
gg llee
CCoo uu
nn ttyy
MMuu ll
tt ii --CC
oo uunn tt
yy
RRee tt
aa iinn
CCaa ss
eeMM
aa nnaa gg
ee mmee nn
tt
CCoo nn
tt rr aacc tt
CCaa ss
eeMM
aa nnaa gg
ee mmee nn
tt
District 1 Family First Network (FFN) X X X
Big Bend Community-Based Care 2A (BBCBC-2A) X X XDistrict2A & 2B Big Bend Community-Based Care 2B (BBCBC-2B) X X XDistrict 3 Partnership for Strong Families (PSF) X X X
Family Support Services of North Florida, Inc. (FSS) X X XNassau County Board of County Commissioners(Family Matters)
X X X
St. Johns County Board of County Commissioners(St. Johns)
X X X
District 4
Clay & Baker Kids Net, Inc. (CBKN) X X XSarasota Family YMCA, Inc. North (Sarasota YMCA North) X X XSarasota Family YMCA, Inc. South (Sarasota YMCA South) X X X
SunCoastRegion
Hillsborough Kids, Inc. (HKI) X X XCommunity-Based Care of Seminole, Inc. (CBC of Seminole) X X XFamily Services of Metro-Orlando, Inc. (FSMO) X X X
District 7
Community-Based Care of Brevard (CBC of Brevard) X X XDistrict 8 Children’s Network of Southwest Florida
(Children’s Network)X X X
District 9 Child & Family Connections, Inc. (CFC) X X XDistrict 10 ChildNet, Inc. (ChildNet) X X XDistrict 11 Our Kids of Miami-Dade & Monroe, Inc. (Our Kids) X X XDistrict 12 Community-Based Care of Volusia & Flagler Counties
(CBCVF)X X X
District 13 Kids Central, Inc. (KCI) X X XDistrict 14 Heartland for Children (HFC) X X XDistrict 15 United for Families (UFF) X X X
19
transportation, etc.). This cultural complexity may be heightened in areas where the Sheriff's
Office is responsible for investigations.
There are eight lead agencies that serve a single county: Duval (Family Support
Services of North Florida, Inc.), Nassau (Nassau County Board of County Commissioners), St.
Johns (St. Johns County Board of County Commissioners), Hillsborough (Hillsborough Kids,
Inc.), Seminole (Community-Based Care of Seminole, Inc.), Brevard (Community-Based Care of
Brevard), Palm Beach (Child & Family Connections, Inc.), and Broward (ChildNet, Inc.).
Correlational analyses were performed to examine the association between serving a
single county versus multiple county and (a) the proportion of children exiting out-of-home care
among children served in FY04-05, (b) the proportion of children exiting out-of-home care
among children who entered out-of-home care in FY03-04, (c) the proportion of children who
reentered out-of-home care after exiting in FY03-04, (d) the proportion of children with
recurrence of maltreatment, (e) the proportion of children reunified, (e) the proportion of children
placed with relatives, and (f) the proportion of children with adoption finalized. No significant
associations were found for the outcomes.
There is modest evidence of a relationship between the number of counties served by
lead agency and economic outcomes, as shown in Table 6. Lead agencies with more than one
county in their service area used a lower proportion of their total contract expenditures for out-
of-home services (58.8%) than lead agencies that serve a single county (65.6%; t=2.01, p=.06).
Although this 7 percentage point difference is outside the conventional .05 level of statistical
significance, the Cohen’s d statistic of 1.14 indicates a large effect (Cohen, 1992) of lead
agency number of counties on the proportion of total contract expenditures for out-of-home
services. Thus, while the finding is not statistically significant, it is substantively significant.
Lead agencies with multiple county service areas also had lower average expenditures per child
served ($6715) than single county lead agencies ($8029; t=1.46, p=.16; d=.77), and the data
indicate a medium effect of number of counties on average expenditures per child served. The
number of counties served also had a medium-sized effect on average expenditures per child
day, which were lower for multiple county lead agencies ($33) than for single county lead
agencies ($39; t=1.39, p=.18; d=.74). Again, these findings are of interest despite the fact that
they are not statistically significant.
20
Table 6. Lead Agency Economic Outcomes by Lead Agency Number of Counties, FY 04-05
LLeeaadd AAggeenncciieess wwiitthhMMuullttiippllee CCoouunnttyy
SSeerrvviiccee AArreeaa ((nn==1122))
LLeeaadd AAggeenncciieesswwiitthh SSiinnggllee CCoouunnttyySSeerrvviiccee AArreeaa ((nn==66))OOuuttccoommee
MMeeaann ((9955%% CCII))tt pp CCoohheenn’’ss
dd
Percent of Cost forOut-of-Home Services
58.8 (53.9 to 63.6) 65.6 (60.6 to 70.7) 2.01 .06 1.14
Average Cost per Child Served 6715 (5585 to 7845) 8029 (6088 to 9970) 1.46 .16 .77Average Cost per Child Day 33 (28 to 37) 39 (28 to 49) 1.39 .18 .74
*This analysis excludes the four lead agencies that did not have a full year service contract during FY04-05 (CBC ofBrevard, CBC of Seminole, Our Kids of Miami-Dade/Monroe, and Partnership for Strong Families)
It is important to recognize that a single county may also have significant cultural
diversity within its own boundaries. For example, Hillsborough County has a large urban center
(Tampa), which co-exists with a very rural area, including a large number of migrant workers
and their families. In addition, despite having medium and large effect size findings in the
analysis of lead agency number of counties and expenditure outcomes, we cannot conclude
that a causal relationship exists between number of counties and expenditures. Because our
data are non-experimental, these variables can only be thought of as correlated or associated,
despite the term effect size.
Presence of Parent Organization
The following lead agencies were identified as having a parent organization: Family First
Network (FFN), Clay and Baker Kids Net, Inc. (CBKN), Sarasota Family YMCA North, Sarasota
YMCA Inc., South, Family Services of Metro-Orlando (FSMO), Children’s Network of Southwest
Florida, and Heartland for Children (HFC). Correlational analyses were performed to examine
the association between having a parent organization versus not and (a) the proportion of
children exiting out-of-home care among children served in FY04-05, (b) the proportion of
children exiting out-of-home care among children who entered out-of-home care in FY03-04, (c)
the proportion of children who reentered out-of-home care after exiting in FY03-04, (d) the
proportion of children with recurrence of maltreatment, (e) the proportion of children reunified,
(e) the proportion of children placed with relatives, and (f) the proportion of children with
adoption finalized. No significant associations were found, possibly due in part to a very small
sample size (N = 21).
21
The relationship between lead agency corporate parent status and expenditures was
negligible (see Table 7). Lead agencies with a corporate parent had a 1 percentage point lower
rate of direct services expenditures spent on out-of-home care (60.3% vs. 61.4%; t=0.30, p=.77,
d=.16) than lead agencies without a corporate parent, but the difference was not statistically or
substantively significant. The differences in average expenditures per child served and average
expenditures per child day were also very small and not statistically or substantively significant.
Table 7. Lead Agency Economic Outcomes by Lead Agency Parent Organization Status, FY 04-05
LLeeaadd AAggeenncciieess wwiitthhaa CCoorrppoorraattee PPaarreenntt
((nn==66))
LLeeaadd AAggeenncciieesswwiitthhoouutt aaCCoorrppoorraattee
PPaarreenntt ((nn==1122))OOuuttccoommee
MMeeaann ((9955%% CCII)) tt pp CCoohheenn’’ssdd
Percentage of Cost forOut-of-Home Services 60.3 (49.9 to 70.6)
61.4 (57.4 to65.5) 0.30 .77 .16
Average Cost per Child Served 7254 (5034 to 9474) 7103 (5948 to8258)
0.56 .88 .08
Average Cost per Child Day 34 (25 to 43) 35 (30 to 41) 0.18 .86 .09*This analysis excludes the 4 lead agencies that did not have a full year services contract during FY04-05 (CBC ofBrevard, CBC of Seminole, Our Kids of Miami-Dade/Monroe, and Partnership for Strong Families)
Retention of Case Management Services
The following lead agencies were identified as those that retained case management
services: Family Matter of Nassau County, St. John’s County Board of County Commissioners,
CBKN, Family First Network, and ChildNet. Correlational analyses were performed to examine
the associations with (a) proportion of children exiting out-of-home care among children served
in FY04-05, (b) proportion of children exiting out-of-home care among children who entered out-
of-home care in FY03-04, (c) proportion of children who reentered out-of-home care after exiting
in FY03-04, (d) proportion of children with recurrence of maltreatment, (e) proportion of children
reunified, (f) proportion of children placed with relatives, (g) proportion of children with adoption
finalized. No significant associations were found.
There was also, for the most part, a negligible relationship between case management
retention status and lead agency expenditures (Table 8). However, there was a small effect
(d=.38) of case management retention status on average expenditures per child day. Lead
agencies that retained the case management function had 9% higher average expenditures per
22
child day than lead agencies that subcontracted case management services ($37 vs. $34; t=-
0.68, p=.50), although the difference was not statistically significant.
Table 8. Lead Agency Economic Outcomes by Lead Agency Case Management Retention
Status, FY 04-05
LLeeaadd AAggeenncciieess tthhaattRReettaaiinneedd CCaassee
MMaannaaggeemmeenntt ((nn==55))
LLeeaadd AAggeenncciieesstthhaatt
SSuubbccoonnttrraacctteeddCCaassee
MMaannaaggeemmeenntt((nn==1133))
OOuuttccoommee
MMeeaann ((9955%% CCII)) tt pp CCoohheenn’’ssdd
Percentage of Cost forOut-of-Home Services 61.0 (55.2 to 66.8)
61.1 (56.0 to66.2) 0.01 .99 .01
Average Cost per Child Served 7057 (4726 to 9389) 7190 (6024 to8356)
0.13 .90 .07
Average Cost per Child Day 37 (24 to 51) 34 (29 to 39) -0.68 .50 .38*This analysis excludes the 4 lead agencies that did not have a full year services contract during FY04-05 (CBC ofBrevard, CBC of Seminole, Our Kids of Miami-Dade/Monroe, and Partnership for Strong Families)
Overall, the analysis identified five models of provider network structures that can be
used to visually depict the provider network configurations and their relationship to the lead
agency including: (1) a provider structure that answers to a parent organization (Figure 4a); (2)
a provider structure that maintains a lead agency comprised of partner organizations (Figure
4b); (3) a more traditional provider model that excludes parent/partner organizations (Figure 4c);
(4) a model that depicts the use of service centers in the provider structure (Figure 5d); and (5)
a provider model that involves a lead agency that is run by a county government (Figure 4e).
The models are discussed in the text that follows, with lead agency examples given based on
the most salient characteristics of each lead agency’s provider network. However, it should be
noted that the models are not synonymous with any one lead agency. As is the goal of
Community-Based Care, each lead agency and local system of care is comprised of a unique
blend of different organizational features (see Table 5).
Heartland, utilizing a provider structure that involves a parent organization (Figure4a),
has a two-tiered provider network that includes network providers and community providers. In
this approach, the network providers are four organizations that provide case management
services, including the Devereux Foundation, Heartland’s parent organization. The community
providers that make up the second tier of Heartland’s provider network are those community-
23
based organizations providing services related to residential care; prevention; and wraparound,
including foster care; Family Builders; and parenting services. Non-contracted community
providers are also used to provide services through a “community resources staffing process.”
This process refers families to the Heartland Community Resource Staffing Master, who uses a
family conferencing model to engage families with representatives from the non-contracted
community providers.
Operating under a parent company has garnered some attention from child welfare
stakeholders and the Department as having an increased potential for conflicts of interest.
Heartland has many relationships with Devereux. Previously, the Board of Directors was
dominated by/solely composed of Devereux staff. In addition, Devereux is a member of the HFC
provider network. Perhaps because of these various relationships, some community members
expressed confusion about the relationship of HFC with Devereux: “you know, sometimes that
gets a little fuzzy to me on which one is which.”
Like Heartland, FSMO contracts with several providers in its network for case
management services. The primary difference is that one of FSMO’s case management
providers, Kids Hope Florida, is a “sister” organization. FSMO and Kids Hope Florida are two of
the five not-for-profit organizations that are part of Kids Hope United (KHU). KHU is a 100 year-
old not-for-profit, national federation committed to child welfare leadership, practice reform, and
service delivery. Via an administrative services organization subcontract, KHU provides lead
agency administrative services (e.g., payroll, accounts payable) and practice and policy
leadership on a national level to FSMO. An advantage of this arrangement is that KHU helps
FSMO with the integration of best practices and provides economies of scale for administration
activities, which enables FSMO to reinvest more dollars for services. KHU initially provided
working capital, consultation, system of care support, and leadership development to FSMO and
its community partners. KHU continues to provide support to FSMO, particularly around
consultation in fund development, marketing, and financial and HR administration.
With regard to CBC governance, FSMO has its own Board, budget, and program
authority. FSMO is a separate 501(c)(3) organization with a local community Board of Directors.
Two members of the FSMO Board also sit on the KHU federation Board, which has
representatives from five partner agencies in four states. FSMO stakeholders were generally
positive about the presence of a parent organization. One respondent stated:
“[T]he beauty of our lead agency, I think, compared to many lead agencies, is
we’re only one entity. And we are an entity, and so it really helps in terms of
24
decision-making, having this background, this knowledge from over a hundred
years, so when we did the system design, we used things that had worked in
Illinois, because our biggest contractor is the State of Illinois, and we’re doing
foster care and adoption and the same services there, but not as the lead
agency, so we brought a lot of the strength, and unto this day, have the strength
of the organization.”
Overall, FSMO’s providers reportedly get along very well with KHU as a peer provider agency,
although there was a small concern that KHU’s contractual adoption goal was different from
other provider agencies.
Children's Network of Southwest Florida (CNSF) is a limited liability company (“LLC”),
of which Camelot Care, Inc. is the sole member. While recent restructuring has added another
organizational layer between the lead agency and Camelot, CNSF can still access Camelot’s
line of credit and insurance coverage if needed, and Camelot maintains a certain level of risk
regarding the lead agency’s contract terms and conditions. CNSF does not provide any
services directly. They believe that this structure allows for stronger accountability within their
provider agencies, as well as the ability of the lead agency to focus on its core competencies of
quality, utilization and network management. In this way, it is the “managing entity” that is more
focused on big picture concerns rather than daily operations. The lead agency has developed
“single points of accountability” for geographic regions by dividing the district into three zones
and contracting with a case management organization (CMO) in each of those zones. The case
management organizations are responsible for case management, foster home recruitment,
training and support and for placement of children in those foster homes. The case
management organizations also are contracted to provide supervised visitation and family-
centered services. In addition, the lead agency has specialty providers to provide either highly
specialized services or low economy of scale services (e.g., emergency shelter, medical case
management, drug screens).
In contrast, organizations such as Our Kids, Partnership for Strong Families (PSF),HKI, CFC, and UFF (Figure 4b) are comprised of partner organizations that provide either all, or
part, of the services related to case management, foster care, adoption, and crisis intervention,
in addition to contracting with community-based organizations for the provision of services. UFFhas four community partners who also share financial risk, including Children’s Home Society of
Florida, Family Preservation Services of Florida, Exchange Club CASTLE and New Horizons of
the Treasure Coast.
25
HKI represents a hybrid of the partnership and service center models. For example, HKI
has five partner organizations that provide services and share financial risk, with three of these
organizations (Children’s Home, Inc., Children’s Home Society of Florida, and Northside Mental
Health Center, Inc.) each operating a care center with geographic responsibility for child
protection services. Camelot Care Center, the organization responsible for adoptive and foster
parents, serves as the coordinator for the Foster Home and Adoption Network (FHAN), which is
composed of seven partner and contracted community-based organizations. Outside of this
structure, HKI contracts with many other providers in the community to provide auxiliary
services that meet the needs of the children and families.
Figure 4a: Model of Provider Structure with Parent Organizations
Figure 4b: Model of Provider Structure with Partner Organizations
Meetings occurwith variouscombinations ofproviders/partners.May include parentorg, only the providernetwork or jointmeetings.
ParentOrganization
Provider/Community Network(Some providers are co-located asindicated by the solid connector line.These providers may also beresponsible for all services in adefined geographic area.)
Board ofDirectors
Structured andReoccurring
Provider/LeadAgency Meeting
Parent Organizations(Typically providing servicessuch as case management.)
Someproviders
may have aperson
serving onthe BOD.
LeadAgency
Provider/Community Network(Some providers are co-located asindicated by the solid connector line.These providers may also beresponsible for all services in adefined geographic area.)
Board ofDirectors
Structured andReoccurring
Provider/LeadAgency Meeting
Partner Organizations(Typically providing servicessuch as case management.)
Someproviders
may have aperson
serving onthe BOD.
LeadAgency
Meetings occurwith variouscombinations ofproviders/partners.May include parentorg, only the providernetwork or jointmeetings.
26
FSS and Seminole utilize a more traditional provider network that does not include
parent or provider organizations (Figure 4c). To maintain natural neighborhood boundaries and
build on the supports provided by the individual neighborhoods, FSS uses eight main providers
across Duval County that are responsible for services in the neighborhood in which they are
located. In addition, FSS has residential services providers. Functions of CBC of Seminole are
primarily system oversight, finances, contract and operational management. The 16 employee
lead agency manages the primary service center and maintains a records and administrative
support unit. CBC of Seminole purchases case management from two case management
agencies (Children’s Home Society and Human Services Associates).
Many lead agencies, such as CBC of Brevard, ChildNet, CBCVF, CBKN, FFN andKids Central, utilize service centers across their county/counties to provide services to a
defined geographic area (Figure 4d). For CBC of Brevard, what was conceptualized in the
design phase has been modified to protect CBC of Brevard from potential risk. CBC of Brevard
has a mix of direct service staff as well as administrative positions. For example, they have
retained intake and placement as there is financial risk in the management of this function. CBC
of Brevard has utilization management staff that facilitate family team conferencing and
authorize services. The lead agency retains Care Center Management positions to ensure a
Figure 4c: Model of Provider Structure without Parent/Partner Organizations
The providers and lead agency meet atan organized meeting.
Board ofDirectors
Structured andReoccurring Provider/Lead
Agency MeetingLead
Agency
Provider Network. Some providersare co-located as indicated by thesolid connector line. Theseproviders may also be responsiblefor all services in a definedgeographic area.
27
team atmosphere and cultural shift (versus a corporate culture) would be promoted in case
practice and to provide on site quality assurance. In addition, CBC of Brevard has converted our
system from a fixed price contracting methodology to various forms of contracting to create a
more efficient and responsive service delivery system.
Kids Central’s daily operations are managed by a Chief Executive officer and other
administrative staff with child welfare and not for profit expertise. Kids Central’s Provider
Network consists of case management, foster home recruitment/licensing/retention, crisis
response, in-home services (family team coaches), adoptions, emergency and group home
residential, supervised visitation providers, prevention and intervention services. Case
management services are provided by the Harbor in Citrus and Hernando Counties; by
LifeStream in Lake County; by the Centers and Camelot Community Care in Marion; and by the
Children’s Home Society in Sumter County. Foster home recruitment/licensing/retention
services are provided by Camelot throughout the district. Crisis response services (similar to the
services once provided in the Intensive Crisis Counseling Programs) are provided by the
community mental health providers in their catchment area (Harbor, the Centers, and
LifeStream). The Children’s Home Society provides the family team coaching and adoptions
services throughout the five counties served by Kids Central.
Kids Central has rate agreements with four emergency shelter/group home residential
providers within the district (Youth and Family Alternatives, Christian Care Center, Sheltering
Arms and the Arnette House). Supervised visitation is provided by a provider in each county.
Kids Central also has rate agreements with residential centers outside of the five counties.
Prevention services are provided by Devereux Kids. Intervention services are provided by
University of Florida’s Child Abuse Prevention (Nurturing) Program.
Clay & Baker Kids Net, Inc. (CBKN) was founded by Clay Behavioral Health Center, Inc.
(CBHC) and is a private, non-profit, 501 (c) (3) organization. Both CBKN and CBHC are
governed by a volunteer Board of Directors. Most services are provided by in-house staff;
however, CBKN sub-contracts for in-home parenting, parenting groups, preservation and
reunification services and supervised visitation.
28
Figure 4d: Model of Provider Structure with Service Centers
B o ard of D irecto rs M ay o r m a y n o th av e P aren t o rP art n er O rg s
S erv iceC en t er
S erv iceC en t er
S erv iceC en t er
S erv ice C en t er
S erv ice C en t er
S o m e s e r v i c e c e n te r s a r e
s p r e a d a c r o s s o n e
c o u n ty a n d s e r v e d i ffe r e n t
g e o g r a p h i c a r e a s .
O th e r s a r e a c r o s s
m u l ti p l e c o u n ti e s
(c o n n e c te d to g e th e r
b y th e s o l id l i n e ) a n d
m a y a c c e s s th e s a m e
p r o v i d e r s fo r s e r v i c e s
a s i n d i c a te d b y th e d a s h
l i n e .
S t r u c t u re d a n dRe o c c u r r in g
P r o v id e r /Le a d a g e n c yM e e t in g
L ea d A ge ncy
Th e L e a d A g e n c yc o n tr a c ts w ithc o m m u n ity -b a s e d p r o v id e r s to s e r v eth e s e r v ic e c e n te r s .
P r ovides s er vic es and s u ppor ts for a l l s er vic e c enter s .
P r ovides s er vic es forC ounty.
St. Johns County and Nassau County each have a county run model for CBC (Figure
4e). Family Matters is a department of the local government under the umbrella of the Board of
County Commissions, and is under contract with the State Department of Children and Family
Services, through the Board of County Commissions. Strengths of this arrangement include
being under the umbrella of the Board of County Commissions. This has afforded staff use of
29
peripheral services such a central recording system, human resources and maintenance.
Potential weaknesses of this model include being under the umbrella of the Board of County
Commissions, to the extent that it adds an additional layer of rules and regulations staff are
required to follow beyond those required by DCF. Additional barriers Family Matters has
encountered are lack of adequate staff and the relative small size of the agency itself. Although
not an organizational characteristic, a reported lack of funding has exacerbated these issues.
St. John’s County’s network includes the County Social Services Department, County-
run Behavioral Health Department, and all of the independent agencies (24 total) receiving
county funding for Health and Human Services, including Primary Care services, as well as the
Sheriff’s Department, the Health Department, and the Department of Juvenile Justice. The lead
agency reports that the public structure circumvents some areas where other lead agencies
have met with barriers. For example, risk management and authorization checks are not
problematic due to the close relationship with the county government. The specific provider
network structure was modeled from Wraparound Milwaukee, a publicly operated national
system of care model.
Figure 4e: Model of County Operated Lead Agency
Board of CountyCommissioners(BOD for CBC)
CBC Program
Administration
CommunityAlliance
FamilyProgram/
Case
Involvementw/othercountyboards
(advisory
CBC Program utilizes existing county
programs such as mentalhealth services, socialservices, and Sheriffs
office. Also Includesindependent agencies
receiving county funds.
County Administration
Monthly ProviderFeedback Meeting
30
Conclusions
Analysis of the organizational structures of the lead agencies demonstrates a difference
in the level of complexity across CBC lead agencies. While the agencies were consistent in the
amount of horizontal differentiation, they varied on their level of vertical differentiation and
spatial dispersion. Understanding the complexity of their lead agency can allow administrators
to respond to the needs of their organization and recognize strengths and weakness that can be
attributed to their structure.
Three lead agency characteristics were examined across evaluation components:
number of counties in a lead agency’s jurisdiction, presence of a parent organization, and
retention of case management services (versus subcontracting out for case management
services). Lead agencies with more than one county in their service area used a lower
proportion of their total contract expenditures for out-of-home services (58.8%) than lead
agencies that serve a single county (65.6%).
In regard to provider network structure, five models can be used to visually depict the
way in which lead agencies are arranging their provider network (with slight variations across
lead agencies). These models represent those agencies with a parent organization involved,
agencies comprised of partner organizations, the more traditional perspective that does not
involve partner/parent organizations, a model that includes the use of service centers, and a
lead agency that is run by a county government. The differences in provider network structures
indicates that CBC lead agencies are developing their provider networks based on the
availability of resources in their individual communities while creating ways to reach all of the
children and families in their service area.
Policy Recommendations
• It is recommended that Board members continue to expand their understanding of the
organizations and processes affecting the child welfare system, including legislative
changes, the court process, the role of other community stakeholder groups (e.g.,
Community Alliance and faith-based organizations), and the contractual obligation of
most lead agencies to have 100% community membership on their Boards of Directors.
Where appropriate, specific training is recommended to supplement Board members’
existing knowledge base.
• Lead agencies and the Department may wish to conduct some pilot projects in which
one of the governance entities is removed, in order to determine if this would create a
more efficient and streamlined reporting process.
31
• An investigation by the legislature and DCF is recommended to explore the potential
positive and negative effects of allowing parent organizations and providers to be
members of lead agency Boards of directors.
32
Research Question 2:
To what extent is Community-Based Care governed by the local community?
IntroductionIn order to examine the extent to which CBC is governed by the local community, this research
question includes the following evaluation questions, indicators and data sources (Table 9):
Table 9. Research Question 2
EEvvaalluuaattiioonnQQuueessttiioonnss
IInnddiiccaattoorr//AAnnaallyyssiiss SSoouurrccee
What types ofcommunitygovernance Boardssupport the leadagency?
• Description of role andresponsibilities of Boardof Directors membersand their relationshipwith lead agencies
• Description ofCommunity Alliancesand their relationshipwith lead agencies
CEO Survey
Board of DirectorsSurvey
Site Visits
TToo wwhhaatt eexxtteenntt iissCCoommmmuunniittyy--BBaasseeddCCaarree ggoovveerrnneedd bbyy
tthhee llooccaallccoommmmuunniittyy??
What potentialconflicts of interestexist between leadagencies,providers, andBoards of Directors
• Review of BoardMembership
• Description of pathwaysof accountability
CEO Survey
Board of DirectorsSurvey
Site Visits
Methods
Statewide Data Collection
For the community governance component, team members pilot tested a new Board of
Directors email survey that requested members discuss their role and responsibility as Board
members, their relationship and types of interaction with the lead agency, and issues regarding
membership guidelines and conflicts of interest. Fifteen Board members from seven different
lead agencies responded to the survey. In addition, as part of the lead agency email survey
described in the organizational analysis section, each of the 20 lead agency CEOs were asked
33
to discuss issues specific to their Boards of Directors and additional community stakeholder
groups, such as the Community Alliances.
Site Visit Data Collection
Site visits were conducted at two lead agencies: Heartland for Children (HFC) and
Family Services of Metro Orlando (FSMO). The issue of community governance and
stakeholder groups was a prominent theme. The site visits occurred in March and May, 2006.
Methods included review of pertinent documents; interviews with key stakeholders from HFC
and FSMO, the District Offices, provider agencies, and community stakeholders. A semi-
structured interview protocol was used for the interviews with key stakeholders. All interviews
were audiotaped and transcribed.
Data Analysis
Content analysis of the documents and open-ended survey questions was used to
analyze the qualitative data collected for this study. Content analysis involves reviewing
qualitative data to identify common themes and trends. The primary goal of content analysis is
to condense a large amount of qualitative data into a list of variables that can be examined for
correlations, patterns and themes.
Results
Community as Governance Partners
Focusing on the community in terms of leadership and governance is one of the vital
components of CBC. Community building, which involves bringing together those community
stakeholders involved in children’s issues, and child protection, community officials and citizens,
etc., allows for the community to guide decision-making for better outcomes for children and
families. With the use of innovative, empowering, collective community partnerships,
communities can better understand the needs of their own children and families and create
community goals for child protection that will generate positive results (Barter, 2001).
One platform for organizing community partnerships that can have significant influence
on child and family outcomes is the development of a governance partnership in the form of a
Board of Directors, a legislatively mandated entity such as the Community Alliance or a locally
created independent stakeholder group. For example, it is a requirement for all non-profit
organizations (501(c)(3)) to maintain a Board of Directors. Through these cooperative
partnerships, initiatives and programs for children and families can be planned more effectively,
34
monitored more efficiently, and have the capacity for change as the needs of the community
change.
However, making such an impact on the lives of children and families in the community
requires power. The governance Boards or independent entities created within the community
must have the power and backing to be heard and respected in the community. To do this,
partnerships must establish their legitimacy early on and be credible in the eyes of the
community. For many governance partnerships this includes government mandates that support
the formation and continuation of the joint venture, or, ensuring that high profile community
individuals serve in the partnership (CSSP, 1998).
Boards of Directors: Roles and Responsibilities
Length of time on the Board ranged from approximately one to thirteen years of service.
Survey respondents that reported the longest lengths of stay on their local Boards came from
the non-profit agencies that had been in existence before CBC implementation, such as
Lakeview Center in the Panhandle. Members who were part of a Board of Directors for a newer
lead agency, tended to be the ones with shorter lengths of stay on the Board, indicating that
once actively engaged, Board members tend to consider their role in the community as an
enduring one. Members were asked to describe their role and function. Survey respondents
mentioned providing policy direction for lead agency staff, monitoring lead agency performance,
acting as an advisor to lead agencies, and ensuring goals, objectives, and contractual
agreements are met. The following table outlines three overlapping but unique perspectives
from Board members. It is interesting to note that one stresses practice level issues, one
stresses financial and policy level issues, and the third mentions community relations.
Table 10. Role of Board of Directors
BBooaarrdd ooff DDiirreeccttoorr RRoolleess
“The first role of the Board is to protect the children we serve, to insure the lead agency is agood steward of public monies, to insure proper case management, and to providepermanent placement as quickly and safely as possible.”“The role of a Board member is to be knowledgeable of the program and operational andfinancial matters of the agency. The Board must contribute and assist in the developmentof agency policy. The Board should question and comment on the direction of the agencyon a policy level. The Board should not be involved in the day-to-day operation of theagency.”“As a Board member it is my responsibility to attend Board meetings, to support policies asapproved by the Board and to familiarize myself [with] child welfare theories and practices.
35
My role as a Board member is to establish connections in the community and make thelead agency visible in a positive way.”
As can be seen from the above quotes, different Board members focus on varying roles
and aspects of the child welfare system. While a few lead agencies that are smaller, more rural,
or only covering one county maintain smaller Boards that function as a whole, the majority of
Boards are subdivided into several standing committees with different, but complimentary
agendas. The following table outlines each type of subcommittee found across Boards, and the
responsibilities of each group.
Table 11. Board Subcommittees and Responsibilities
SSuubbccoommmmiitttteeeess RReessppoonnssiibbiilliittyy
Executive Committee Address issues on an interim basis between meetingsand prepare the full Board for review.
Finance Committee Oversee budgeting and financial performance. Insure allfunds are being used in line with state and federalguidelines and that the lead agency has adequatefunding.
Planning and ProgramCommittee
Keep the Board informed with monthly updates of thevarious programs, for overseeing and making programrecommendations related to service design, and qualityassurance policies.
Nominating/Membership/BoardDevelopment Committee
Select new Board members and officers to berecommended for election by the full Board of Directors.Provide new members with access to training.
Legislative Committee Assist in identifying strategies for presenting the needsof the agency and clients (children and foster parents) tothe Legislature.
Community Relations Ensure positive image of lead agency and communitysupport. Networking with local stakeholders.
Board members most frequently mentioned their role in ensuring the lead agency was
fiscally responsible and viable. Several Boards noted that they are directly responsible for the
review of the financial records of the lead agency, as well as directing the lead agency CEO if
problems are identified. While overseeing the lead agency and reviewing its records, Board
members considered the following aspects:
36
• Organizational Responsibility (ensure that the organization is operated in a manner,
financially and otherwise, to ensure its long term viability)
• Responsibility to population served (ensure that children are receiving the highest
level of care available to promote safety and permanency in their lives)
• Responsibility to Taxpayers and Government (ensure that lead agency is a good
custodian of federal and state money, and is in compliance with acceptable financial
regulations), and
• Responsibility to Avoid Conflicts of Interest (ensure careful selection of qualified
members).
In order to carry out these responsibilities, Board members reviewed balance sheets,
account summaries, and projected spending on a monthly basis, in addition to funding an
independent annual financial audit of the lead agency. In addition some Boards must approve
all contracts and contract amendments with the Department of Children and Families, must
review and approve the lead agency annual budget, and have the authority to hire and
supervise the President/CEO of the lead agency.
Boards of Directors: Working Relationships and Collaboration
Board of Directors and Lead Agency
Board members reported positive working relationships with their respective lead agency
CEOs. Teamwork, trust, and respect were common themes that emerged from this section of
the Board member survey. Another important aspect is that the lead agency CEO responds
quickly and thoroughly to any issue surfaced by the Boards. Several Board members
mentioned that the lead agency CEO was charged with keeping them informed and up to date
on the lead agency’s status, and at least one member indicated that it may be useful to include
more informants beyond that of the CEO as local community-based systems of care mature
across the state. It should also be remembered that the Board, in some cases, has the duty to
hire and evaluate the lead agency’s CEO. The following passage shows how several of these
themes merge from the perspective of one Board member:
“We have a good working relationship with our CEO. Generally, we work to
provide him with a set of mentors to help him perform his job; however, as issues
arise requiring Board attention, we serve as a sounding and advisory Board for
37
the CEO. I would say, overall, that we have a quality professional relationship
with a CEO that we highly respect.”
Board of Directors and the DCF District/Regional Office
Board members reported that a representative from DCF was often present at Board
meetings, or that Board members were welcome to meet with or call their District office if a need
arose. One Board member described this as an “open phone policy”. DCF and Boards also
come into contact at times during a lead agency’s contract negotiation process, and Board
members receive copies of DCF monitoring reports. The Board of Directors was most
commonly seen as the fiduciary head of a not-for-profit private organization while the DCF
District/Regional office was viewed as a part of the state agency, which contracts with lead
agencies. Generally, Board members did not see any overlap in roles designated to DCF and
the Board. The following table contrasts these different responsibilities.
Table 12. Board of Directors and DCF District/Regional Offices
BBooaarrdd ooff DDiirreeccttoorrss RReessppoonnssiibbiilliittiieess DDCCFF RReessppoonnssiibbiilliittiieess
Responsible for the success of lead agency,as a contracted entity of DCF. Vendor,contracted to provide a service, working inclose collaboration with customer.
Responsible for monitoring a contract.
Oversee expenditure of all allocated funds toclients and advise the lead agency
Check/balance review that these funds arehandled according to state and federalrequirements.
Clearly understand the obligations theagency has to DCF and to ascertain that allmandates are being met.
Monitor the agency and provide regular feed-back on performance standards establishedby contract.
Assist staff when needed, assure compliance,be a resource for information.
Assure compliance with contract from a payersource
Pathways of Accountability
Board members were asked if their lead agency experienced problems in operations,
financial management, quality assurance or other areas, what group(s) is responsible for
holding the lead agency accountable? The majority of respondents stated that it was the
Board’s responsibility in most cases, with DCF being the other entity of authority. The lead
agency was normally seen as reporting to the Board, and the Board was seen as responsible to
38
DCF. Only one survey respondent mentioned the Community Alliance as a group that could
hold the lead agency accountable. The following passage summarizes how the various entities
must work together to ensure successful operation of local systems of care:
“In the case of Community-Based Care agencies there is not one single entity. The
Board of Directors has a responsibility to put in motion a plan of corrective action. DCF has a
responsibility to identify problems and to communicate them in a concise and understandable
matter to the administration and Board of Directors. In return, the Administration and Board of
Directors must communicate to the stakeholders. The relationships between the administration
of the agency, the various stakeholders, the Board of Directors and DCF should be such that
the issue of accountability can be addressed in a positive rather than a negative environment. In
short, the agency administration must hold the stakeholders accountable, Board of Directors
must hold administration accountable and DCF has been given the role of holding the entire
organization—stakeholders, administration and Board—accountable.”
Board members felt that when communication was open between the state and the
Board, that any problem could be discussed and resolved. Members also made the distinction
that whereas the Board was responsible for any lead agency issue, DCF and the Alliance had
authority over public perception and contract compliance issues.
The following focus on box delineates governance roles in one lead agency geographic area.
Focus On: Heartland for Children Governance Structure
HFC’s leadership is relatively clear about the roles that various entities play in the governance
of HFC. The Board of Directors has the responsibility to advise and direct the management of
HFC, and to “hold the management accountable”. The Department of Children and Families is
described as having a contractual oversight role; a “relationship of deliverables”. The
governance role of the Community Alliance was less clear, with some describing the role as
community advisement, as something other than governance. Another perception is that the
Community Alliance has oversight over both DCF and HFC because they make sure that the
welfare and interests of the clients and the community are served.
Boards of Directors: Membership Guidelines and Conflicts of Interest
Designing and improving CBC systems also means recognizing and reducing the
potential for conflicts of interest that could lead to problems for CBC lead agencies. Two types
39
of conflict related to CBC lead agencies are interlocking Boards and a lack of diversity in Board
membership.
The phenomena of interlocking Boards of directors, when the Board members from one
organization sit on the Board of another organization, is an example of a relationship between
Boards that may be considered a conflict of interest, especially when those Boards are in
contractual relationships (Hall, 1996). The lack of diversity of members on the Board of
Directors can represent a type of conflict for the community being served. One of the potential
outcomes of a lack of diversity on the Boards and interlocking Boards can be a lack of fairness
and openness when provider agencies are competing for services. For example, if it is a
requirement of a contracted service provider or partner organization to be the sole provider of a
service this can result in a lack of opportunity for other providers and the lead agency.
An illustration of interlocking Boards would be that demonstrated by many lead agencies
in previous years, where in representatives from contracted provider organizations, or partner
organizations, serve as lead agency Board members. Either through lead agency partner
demand or lack of available and knowledgeable Board members, several lead agencies had
contracted providers as Board members. However, the Department has made it mandatory for
lead agency Board of Director membership to be 100% community representatives rather than
lead agency stakeholders. A number of lead agencies initially encountered challenges in
meeting this goal. Since they are financially liable, network providers wanted to have a role in
the activities of the Board of Directors and were reluctant to maintain funding if not a member of
the Board. Some lead agencies had also suggested that they were too small to meet this
mandate; citing that most of the community representatives they included on the Board were
also network providers.
Despite these initial concerns and reactions to the Department’s mandate, the majority
of Boards are either 100% community-based or are actively moving in this direction (see Table
13). All Boards are required to be 100% community-based (although date by which this must be
accomplished varies per lead agency contract) with the exception of two lead agencies:
Heartland and ChildNet. These two lead agencies have language in their contract stating the
following: “any existing Board member whose organization represents less than 15% voting
authority on the Board is excluded from this requirement”.
40
Table 13. Community-Based Care Governance Agreements
DDiissttrriicctt LLeeaadd AAggeennccyy GGoovveerrnnaannccee LLaanngguuaaggee DDaatteeAAmmeennddeedd
D1Lakeview Center,
Families FirstNetwork
The CBC provider’s Board of Directors shall be comprised of 100% ofcommunity members who shall have no business or financial ties to the CBCprovider or its subcontractors that result in a personal financial gain.
5/17/06
D2ABig Bend
Community-BasedCare, Inc
By March 1, 2006 the CBC provider's Board of Directors shall be comprised of100% of community members who shall have no business or financial ties tothe CBC provider or its subcontractors that result in a personal financial gain.
3/14/06
D2BBig Bend
Community-BasedCare, Inc.
By March 1, 2006 the CBC provider's Board of Directors shall be comprised of100% of community members who shall have no business or financial ties tothe CBC provider or its subcontractors that result in a personal financial gain.
3/14/06
D3 Partnership forStrong Families
The CBC provider’s Board of Directors shall be comprised of a minimum of51% of community/non-partner members. The community/non-partnerBoard members shall have no business or financial ties to the CBC or itssubcontract providers that result in a personal financial gain.
By 3/31/06 the CBC provider’s Board of Directors shall be comprised of100% of community members who shall have no business or financial ties tothe CBC provider or its subcontractors that result in a personal financial gain.
1/27/06
D4(Duval)
Family SupportServices of North
Florida Inc.
The CBC provider’s Board of Directors shall be comprised of a minimum of51% of community/non-partner members within ninety (90) days of thesigning of this contract. The community/non-partner Board members shallhave no business or financial ties to the CBC or its subcontract providers thatresult in a personal financial gain.
By January 1, 2007 the CBC provider’s Board of Directors shall becomprised of 100% of community members who shall have no business orfinancial ties to the CBC provider or its subcontractors that result in apersonal financial gain.
2/16/06
41
DDiissttrriicctt LLeeaadd AAggeennccyy GGoovveerrnnaannccee LLaanngguuaaggee DDaatteeAAmmeennddeedd
D4Nassau CountyBoard of CountyCommissioners
Not applicable to county government
D4St Johns CountyBoard of CountyCommissioners
Not applicable to county government
D4 Clay & Baker KidsNet Inc.
The CBC provider’s Board of Directors shall be comprised of aminimum of 51% of community/non-partner members within ninety(90) days of the signing of this contract. The community/non-partner Board members shall have no business or financial ties tothe CBC or its subcontract providers that result in a personalfinancial gain.
By January 1, 2007 the CBC provider’s Board of Directors shall be comprisedof 100% of community members who shall have no business or financial tiesto the CBC provider or its subcontractors that result in a personal financialgain.
2/23/06
SCR Sarasota FamilyYMCA, Inc.
The CBC provider’s Board of Directors shall be comprised of a minimum of51% of community/non partner members within ninety (90) days of the signingof this contract. The community /non partner Board members shall have nobusiness of financial ties to the CBC or its subcontract providers that result ina personal financial gain.
By January 1, 2006 the CBC provider’s Board of Directors shall be comprisedof 100% of community members who shall have no business or financial tiesto the CBC provider or its subcontractors that result in a personal financialgain.
2/2/06
SCRQJ6B6
Sarasota FamilyYMCA, Inc.
By July 1, 2006, the CBC provider’s Board of Directors shall be comprised of100% of community members who shall have no business or financial ties tothe CBC provider or its subcontractors.
2/2/06
42
DDiissttrriicctt LLeeaadd AAggeennccyy GGoovveerrnnaannccee LLaanngguuaaggee DDaatteeAAmmeennddeedd
SCR Hillsborough Kids,Inc.
The CBC provider’s Board of Directors shall be comprised of 100% ofcommunity members who shall have no business or financial ties to the CBCprovider or its subcontractors.
6/30/05
D7 Community-BasedCare of Seminole Inc.
The Community-Based Care provider's Board of Directors shall be comprisedof a minimum of 51% of community/non-partner members within ninety (90)days of the signing of this contract. The community/non-partner membersshall have no business or financial ties to the Community-Based Care provideror its subcontract providers.
Within twelve (12) months of the signing of this contract, the Community-Based Care provider's Board of Directors shall be comprised of 100%community members who shall have no business or financial ties to theCommunity-Based Care provider or its subcontractors.
6/8/05
D7 Community-BasedCare of Brevard Inc.
The CBC provider’s Board of Directors shall be comprised of a minimum of51% of community/ non-partner members at the signing of this contract. Thecommunity/ non-partner Board members shall have no business or financialties to the CBC or its subcontract providers.
Within twelve (12) months of the signing of this contract, the CBC provider’sBoard of Directors shall be comprised of 100% of community members whoshall have no business or financial ties to the CBC provider or itssubcontractors.
2/1/05
43
DDiissttrriicctt LLeeaadd AAggeennccyy GGoovveerrnnaannccee LLaanngguuaaggee DDaatteeAAmmeennddeedd
D7Family Services ofMetro- Orlando Inc.
a. The CBC provider’s Board of Directors shall be comprised of aminimum of 51% of community/non-partner members withinninety (90) days of the signing of this contract. Thecommunity/non-partner Board members shall have no businessor financial ties to the CBC or its subcontract providers thatresult in a personal financial gain.
b. By June 30, 2006 the CBC provider’s Board of Directors shall becomprised of 100% of community members who shall have nobusiness or financial ties to the CBC provider or itssubcontractors that result in a personal financial gain.
5/10/06
D8 Children’s Network ofSW Florida
a)The provider’s Board of Directors shall be comprised of at least 51% ofpersons residing in the State of Florida. Of the state residents, at least51% must also reside within the service area. The Board membersresiding within the service areas shall have no business or financial ties tothe provider or the subcontracted providers that result in a personalfinancial gain.
b) The department and the provider agree that the provider will establish aLimited Liability Company. Once this is accomplished, the provider agreesto have a Board of Directors comprised of 100% of community memberswho shall have no business or financial ties to the provider or itssubcontractors that result in a personal financial gain. This 100% Boardwill be in place within 30 days of the provider becoming a Limited LiabilityCompany.
4/21/06
D9 Child and FamilyConnections, Inc.
The CBC provider’s Board of Directors shall be comprised of 100% ofcommunity members who shall have no business or financial ties to the CBCprovider or its subcontractors that result in a personal financial gain.
2/3/06
D10 ChildNet Inc.The provider agrees that all of the members of its Board of Directors shall becomprised of community/non-partner members who shall have no business orfinancial ties to the lead agency or its subcontractor providers. Any existing
5/3/05
44
DDiissttrriicctt LLeeaadd AAggeennccyy GGoovveerrnnaannccee LLaanngguuaaggee DDaatteeAAmmeennddeedd
Board member on February 1, 2005 whose organization represents less than15% voting authority on the Board is excluded from this requirement.
D11 Our Kids of Miami-Dade/Monroe, Inc
The Lead Agency agrees that all of the members of its Board of Directors shallbe community/non-partner members who shall have no business or financialties to the Lead Agency or its subcontractors
4/15/05
D12Partners for
Community-BasedCare
Provider’s Board of Directors shall be comprised of a minimum of 51%community/ non-partner members by no later than April 1, 2005. ByDecember 31, 2005, 100% of the members the Board of Director’s shall becommunity/ non-partner members. The community/ non-partner Boardmembers shall have no business or financial ties to provider or any of itssubcontract providers.
3/22/05
D13 Kids Central, Inc.
The CBC provider’s Board of Directors shall be comprised of a minimum of51% of community/ non-partner members within ninety (90) days of thesigning of this contract. The community/ non-partner Board members shallhave no business or financial ties to the CBC or its subcontract providers.
Within twelve (12) months of the signing of this amendment, the CBCprovider’s Board of Directors shall be comprised of 100% of communitymembers who shall have no business or financial ties to the CBC provider orits subcontractors.
5/23/05
D14 Heartland ForChildren
The CBC provider’s Board of Directors shall be comprised of aminimum of 51% of community/non-partner members within ninety(90) days of the signing of this contract. The community/non-partner Board members shall have no business or financial ties tothe CBC or its subcontract providers that result in a personalfinancial gain.
By June 30, 2006, the provider agrees that all of the members of its Board ofDirectors shall be comprised of community/non-partner members who shallhave no business or financial ties to the lead agency or its subcontractor
2/14/06
45
DDiissttrriicctt LLeeaadd AAggeennccyy GGoovveerrnnaannccee LLaanngguuaaggee DDaatteeAAmmeennddeedd
providers. Any existing Board member on February 1, 2006 whoseorganization represents no more than 15% (no less than one member) votingauthority on the Board is excluded from this requirement.
D15 United For FamiliesInc.
The CBC provider’s Board of Directors shall be comprised of aminimum of 51% of community/non-partner members within ninety(90) days of the signing of this contract. The community/non-partner Board members shall have no business or financial ties tothe CBC or its subcontract providers that result in a personalfinancial gain.
By 11/30/2006 the CBC provider’s Board of Directors shall be comprised of100% of community members who shall have no business or financial ties tothe CBC provider or its subcontractors that result in a personal financial gain.
2/3/06
*Table obtained from the Department of Children & Families, Office of Provider Relations, 2006
46
For example, HFC has made many changes in the composition of its Board of Directors
in order to comply with the regulation regarding community representation. Key staff appear to
be satisfied with the “compromise” with DCF that allows for 15% of the Board to be non-
community and a Devereux national representative (HFC is one of two lead agencies with this
arrangement). The perception of some interviewees during the site visit was that Devereux had
handled the issue of potential abuse vis-à-vis conflicts of interest, with a strong ethical stance. It
was also noted that HFC has benefited greatly from both the expertise and the financial
resources of Devereux.
Another example of recent lead agency changes impacting Board of Director
membership is Children’s Network of Southwest Florida (CNSF). As discussed earlier in the
report, the agency has recently established a Limited Liability Corporation (LLC), although the
agency’s ties to Camelot Care have not been severed completely. The presence of this LLC
has resulted in a local Board of Directors that is comprised of members from CNSF’s five county
service area. This new configuration moves the lead agency into compliance with the 100%
community membership rule. In addition, CNSF has decided to maintain one local Board
member on the Camelot Community Care Board of Directors.
Board members, via survey, were asked to give their perspective on membership
guidelines and conflicts of interest. Generally, Board members described attempts to maintain a
broad spectrum of members from different geographic, ethnic, and occupational backgrounds.
One Board member stated, “The most important qualification for Board membership is a
commitment to our children.” In addition, Board members stressed that there should be clear
guidelines for Board membership that require regular attendance, willingness to serve on at
least one committee and a commitment to educating oneself on the child welfare system.
Regarding conflicts of interest, the majority of members mentioned that conflict of
interest statements were signed as part of the Board member application process, and that
when these situations arose, whether the potential conflict was “real or perceived”, the Board
member in question must refrain from voting on issues under question. There was a general
consensus that conflicts of interest would arise from time to time, and if occasional, should not
be seen as a scarlet letter. A Board member explained, “Identify the conflict, address it, and
handle it on individual basis keeping in mind a single conflict does not negate the value of the
member.”
A few survey respondents acknowledged that the requirement of Boards to be 100%
community members continues to be a difficult issue for some lead agencies, which as risk
bearing entities, are different than a typical non-profit. One Board member stated, “We have
47
solicited leaders from various areas of the county to become members of the Board of Directors.
As a private corporation, I do not believe that DCF should be allowed to dictate any guidelines
for Board membership. I believe that any requirements for Board membership beyond what is
required in statute is intrusive into the workings of a private corporation.”
Table 14 delineates the types of situations where conflicts of interest can occur, the
factors that sustain these situations, and the problems that can arise due to these situations.
Previous evaluations of Community-Based Care (Armstrong et al., 2004) have identified several
of the problems noted in Table 14, among Florida’s lead agencies (e.g., lack of community and
client representatives, contracted providers on Boards having difficulty remaining neutral).
However, the move toward mandating 100% community representation has resolved the
intensity, and in many cases, existence of such problems.
48
Table 14. Types of Potential Conflict Situations4
PPootteennttiiaallCCoonnfflliicctt
FFaaccttoorrss tthhaatt SSuussttaaiinn tthheeSSiittuuaattiioonn
PPrroobblleemmss AAssssoocciiaatteedd wwiitthh tthheeSSiittuuaattiioonn
LLaacckk ooffmmeemmbbeerr
ddiivveerrssiittyy oonnBBooaarrdd ooff
DDiirreeccttoorrss//
IInntteerrlloocckkiinnggBBooaarrddss
1) May be requirement ofcontracted providers to maintaina seat on the lead agency Boardfor their best interest.
2) A new lead agency needs timeto develop a more roundedBoard; difficulty finding relevantBoard members.
3) The lead agency does not havean individual Board; the parentorganization’s Board is used.
4) May increase the power anagency has in the community byplacing respected, highly visibleindividuals already involved withchildren and families on theBoard.
5) Interlocking Boards of directors.
1) Board can become laden with membersthat have more face value and potentialthan actual expertise and action.
2) An established parent organizationBoard may not be close enough to thelead agency to provide proper directionand/or influence decision-making.
3) Lack of community membership onBoard may reduce the Board’s ability torecognize community issues andrespond to families and children in thecommunity.
4) The lack of client representatives (e.g.,foster parent) on the Board may reducerecognition of client related issues.
5) Representatives from contractedproviders may have difficulty remainingfree from conflicts of interest.
LLaacckk ooffOOppeenn//FFaaiirr
PPrrooccuurreemmeennttffoorr SSeerrvviicceess
1) Lack of providers/services in the“geographic market”necessitates the use ofavailable providers.
2) Reduces risk by contracting withknown providers.
3) May be requirement of partneragencies to ensure viability ofthe lead agency and reducerisk.
4) Political statement. “Restrictedmarket entry” to thoseorganizations identifying withsame community politics.
5) Certain types of services do notlend themselves easily to acompetitive process, andmultiple changes in providers
1) Non-profit networks (and providernetworks) can limit the number ofproviders allowed access to thenetwork, thus creating an organizedmonopoly for services.
2) Forced dependence on providers thatmay not be performing successfully.
3) Failure of an organization that has beenthe sole provider of a service.
4) Potential to drive up costs of services ifproviders of certain specializations“collectively organize.”
5) Interlocking Boards of directors canincrease the likelihood that the marketwill be closed to “outside” organizations.
4 Van Slyke, D.M. (2003). The mythology of privatization in contracting for social services. PublicAdministration Review, 63(3), 296-315.
Hall, R.M. (1996). Organizations: Structures, processes, and outcomes. Prentice Hall, Englewood Cliffs,NJ.
49
require budget increases.
6) Interlocking Boards of directors.
Community Alliances
The Community Alliances were mandated by the Florida Legislature to “provide a focal
point of community participation and governance of community-based services“ (s. 20.19(6)(a),
F.S.). The Alliances, although unique to each community, were designed to consist of a broad
spectrum of community stakeholders. The Alliances’ duties were to include needs assessment,
setting priorities, planning for resource utilization, determining locally-driven outcomes to
supplement state–required outcomes, and community education. The scope of the Community
Alliances was designed to include Community-Based Care issues, in addition to broader human
service areas.
The majority of Alliances continue to focus on issues of child welfare and CBC.
Alliances can be specific to county, lead agency, or both. This makes for creative combinations
of geographic regions and political allies. For example, HFC deals with one Community Alliance
that spans the three counties that the lead agency covers: Polk, Hardee, and Highlands. In
contrast, Children’s Network of Southwest Florida provides services to five counties (Collier,
Lee, Charlotte, Glades, and Henry), but works with only four Community Alliances (Collier, Lee,
Charlotte, and Glades/Henry), each of which provides different types of supports.
The Heart of Florida Community Alliance serves Hardee, Highlands, and Polk counties.
The Community Alliance meets bimonthly to discuss various issues related to children in the
three counties served. Primarily, attention is paid to children and families in the child welfare
system. The Community Alliance brings together key stakeholders from DJJ, the school
system, the mental health community, and others. Heartland for Children (HFC) staff also
attend the meeting on a regular basis, providing updates as well as any additional information
requested by the Alliance. Overall, Community Alliance members indicated that they have a
good relationship with HFC, pointing out that HFC actively participates in all meetings and is
responsive to any requests from the Alliance.
Concerns were raised that all counties do not actively participate in Alliance activities.
Several county representatives continually miss meetings and do not stay in touch with other
Community Alliance members via e-mail, phone, or mail outside of meetings. This means that
certain counties and certain services within counties are not represented at the Community
Alliance.
50
In addition, some Alliance members expressed frustration that the Community Alliance
had limited power to effect change. Although HFC has been very open and willing to address
the Alliance’s concerns, the Alliance does not have the authority to require that something be
done or be done in a certain amount of time. An increase in authority would necessitate
revision of the Legislature’s intended model for Florida’s Alliances.
The Orange County Alliance for Children and Families and the Osceola County Alliance
for Children and Families cover the two counties served by Family-Services of Metro-Orlando. A
variety of community members are represented, including local judicial, health, and mental
health providers. The Orange County Alliance meets monthly to discuss various social welfare
issues in the county. Although the Orange County Alliance continues to meet regularly,
stakeholders indicated that it has been approximately six months since the Osceola County
Alliance has met.
Several stakeholders interviewed during the FSMO site visit indicated that they
participate on task forces established by the Orange County Alliance, including task forces on
domestic violence, drug abuse, adoptions, independent living, and child abuse. These task
forces were designed to promote awareness and prevention as well as to provide a forum to
develop connections and encourage collaboration among local provider agencies.
FSMO staff attend Orange County Alliance meetings and serve on some of the task
force committees. Alliance members indicated that they are in close contact with FSMO staff on
a regular basis regarding a variety of issues. FSMO staff provide the Community Alliance with
feedback and updates regarding child welfare activities in Orange County. The majority of
Alliance members felt that FSMO was open and responsive to concerns or issues brought up by
the Alliance. However, some Alliance members expressed frustration that the Community
Alliance has no formal role or formal line of input to either FSMO or the Department of Children
and Families at the state or local level. Without a formal role and oversight, Alliance members
indicated that both FSMO and DCF can ignore their suggestions. In fact, the Orange County
Alliance has gone directly to the Legislature when neither FSMO or DCF took action on an
independent living issues the Alliance felt was important.
Community Alliances and Boards of Directors
In the majority of cases, survey respondents indicated that the Board of Directors did not
have regular interaction with the Community Alliance(s) in their lead agency’s local area. A
small portion of Board members were uncertain as to what group the Community Alliance was.
However, one Board reported that the chairperson of the Community Alliance is a non-voting
51
member of the Board and provides updates at every meeting. This Board reported that the
relationship has “provided a mechanism for communication and seems to be working well.” An
additional Board reported that the Alliance was welcome to attend Board meetings as needed.
In contrast other Boards saw no overlap whatsoever, and were pleased that individuals were not
members of both groups.
Generally speaking, the Community Alliances were seen as being much broader than
that of the Board. One member explained, “the Community Alliance’s responsibility extends
beyond children and families involved in the foster care/adoption arena. It encompasses the
community’s response to all children and family issues.”
Conclusions
In conclusion, this research sought to describe the extent to which Community-Based
Care is governed by the local community. Board members most frequently mentioned their role
in making sure the lead agency was fiscally responsible and viable. Additional responsibilities
included ensuring that the long term viability of the lead agency, ensuring that children are
receiving the highest level of care available to promote safety and permanency in their lives,
ensuring that the lead agency is a good custodian of federal and state money, and is in
compliance with acceptable financial regulations), and ensuring careful selection of qualified
Board members to mitigate conflicts of interest.
Despite initial concerns and reactions to the Department’s mandate that Boards of
Directors be comprised of 100% community members, the majority of Boards are now 100%
community-based or are actively moving in this direction (see Table 13). Despite these initial
concerns and reactions to the Department’s mandate, the majority of Boards are either 100%
community-based or are actively moving in this direction (see Table 13). All Boards are
required to be 100% community-based (although date by which this must be accomplished
varies per lead agency contract) with the exception of two lead agencies: Heartland and
ChildNet. These two lead agencies have language in their contract stating the following: “any
existing Board member whose organization represents less than 15% voting authority on the
Board is excluded from this requirement”.
Board members mentioned that conflict of interest statements were signed as part of the
Board member application process, and that when these situations arose, whether the potential
conflict was “real or perceived”, the Board member in question must refrain from voting on
issues under question. A few survey respondents acknowledged that the requirement of Boards
to be 100% community members continues to be a difficult issue for some lead agencies, which
52
as risk bearing entities, are different than a typical non-profit. These concerns were often
voiced by lead agencies who reported that they maintained positive and supportive partnerships
with provider network and parent organizations.
The Community Alliances represent a potential important community governance
partnership for lead agencies; however, in some communities other local stakeholder groups
are much stronger. At the present time, interaction between Boards and Alliances varies by lead
agency. In some cases, Alliance members are welcomed as nonvoting members of their
community’s Board, while in other cases individuals are only affiliated with one of the
organizations. The scope of Community Alliances was often seen as being much broader than
that of the Board, in that the Alliance encompasses the health and wellbeing of all children and
families.
Policy Recommendations
• It is recommended that Board members continue to expand their understanding of the
organizations and processes affecting the child welfare system, including legislative
changes, the court process, the role of other community stakeholder groups (e.g.,
Community Alliance and faith-based organizations), and the contractual obligation of
most lead agencies to have 100% community membership on their Boards of Directors.
Where appropriate, specific training is recommended to supplement Board members’
existing knowledge base.
• Lead agencies and the Department may wish to conduct some pilot projects in which
one of the governance entities is removed, in order to determine if this would create a
more efficient and streamlined reporting process.
• An investigation by the legislature and DCF is recommended to explore the potential
positive and negative effects of allowing parent organizations and providers to be
members of lead agency Boards of directors.
53
Research Question 3: How effective is Community-Based Care at identifying and meeting the
needs of the families and children who have been maltreated?
Table 15. Research Question 3
EEvvaalluuaattiioonnQQuueessttiioonn
IInnddiiccaattoorr((ss)) SSoouurrccee((ss))
How does Florida’schild welfaresystem perform onindicators of childand family well-being?
• Families have enhancedcapacity to provide fortheir children’s needs.
• Children receiveappropriate services tomeet their educationalneeds.
• Children receiveadequate services tomeet their physical andmental health needs.
Federal CFSRfindingsFlorida CFSRfindings
What efforts arebeing made by leadagencies toenhance family’scapacity to providefor their children?
• Description of staffingand conferencingmechanisms employedby selected leadagencies.
Interviews andobservations at sitevisits to Heartlandfor Children andFamily Services ofMetro-Orlando
HHooww eeffffeeccttiivvee iissCCoommmmuunniittyy--BBaasseeddCCaarree aatt iiddeennttiiffyyiinnggaanndd mmeeeettiinngg tthhee
nneeeeddss ooff tthhee ffaammiilliieessaanndd cchhiillddrreenn wwhhoo
hhaavvee bbeeeennmmaallttrreeaatteedd??
What tools andprocesses arebeing implementedby lead agenciesfor themeasurement ofcustomersatisfaction?
• Description of tools andmeasures
Self-report of leadagencies andfollow-upcommunication
Introduction
Throughout the implementation of community-based care and its associated evaluation
efforts, there has been a struggle in the measurement of quality performance as required by
Florida statute (s. 409.1671, F. S.). Quality performance, in the most general terms, suggests
that the services being provided consistently and effectively meet the needs and expectations of
the children and families engaged in the child welfare system. While most can agree with that
definition, at least from an ideological standpoint, the measurement of quality performance is
much more elusive.
54
Part of the challenge to measuring quality in any human service field is the matter of
perspective, from whose vantage point is performance being viewed. For example, services
may conform to all guiding policies and guidelines yet promote no change or skill development
for the children and families receiving the service. In another situation, the services may be
viewed as beneficial by the family, but not considered “quality” service by the service provider.
As a result, it is imperative that feedback be gathered from multiple perspectives, most
commonly from service providers, families, and foster parents.
Another challenge is in the approach to measurement, quantitative versus qualitative.
The federal government has attempted to implement two, interrelated measurement systems
that represent the two approaches. The Adoption and Foster Care Analysis and Reporting
System (AFCARS) attempts to systematically gather standardized data from each state’s
system; while the Child and Family Services Review (CFSR) uses that data to create a state
profile and then attempts to gather information about the status of practice and its direct
influence on outcomes for children and their families. The Florida Department of Children and
Families has followed suit by promoting its Dash Board indicators as well as implementing the
Florida CFSR and other review mechanisms such as the now defunct Child Welfare Integrated
Quality Assurance Tool (CWIQA) that has been replaced by the new Core Element Review
Tool.
Over the course of this evaluation, various quantitative and qualitative methods have
been employed in efforts to adequately reflect varying perspectives as the implementation of
CBC has occurred statewide. The purpose of the current set of evaluation activities is to
integrate existing methods to more deeply explore the specific quality-related topic of child and
family well-being. In order to do so, three interrelated topics will be discussed:
(1) Florida’s performance on indicators of child and family well-being,
(2) Lead agency efforts to enhance family’s capacity to provide for their children, and
(3) Lead agency tools and processes for the measurement of customer satisfaction.
Performance on Indicators of Child and Family Well-Being
The federal government has attempted to incorporate a measurement of quality
performance into its review of states. The 1994 Amendments to the Social Security Act (SSA)
authorized the Department of Health and Human Services (DHHS) to review state child welfare
practices to ensure conformance with IV-B and IV-E requirements. This review, known as the
Child and Family Services Review (CFSR) is not only interested in conformance, but also with
55
understanding what practice looks like at the child and family level. Ultimately, the goal of the
CFSR is to help states to improve child welfare services as defined by attainment of outcome
standards in the areas of (1) safety, (2) permanency, and (3) child and family well-being. Safety
and permanency are largely considered in the Child Outcomes section of this report. Therefore,
the primary focus of this section is on measuring child and family well-being within the context of
a comprehensive quality assurance system. The Child and Family Services Review defines
three indicators of child and family well-being:
(WB1) Families will have enhanced capacity to provide for their children's needs.
(WB2) Children will receive appropriate services to meet their educational needs.
(WB3) Children will receive adequate services to meet their physical and mental health
needs.
Florida was the 11th state to participate in the federal CFSR. The review was conducted
in 2001 as a partnership between the Administration for Children and Families (ACF) and the
Florida Department of Children & Families (DCF). During the first phase of the review, ACF
developed a state profile using AFCARS data in conjunction with data from the National Child
Abuse and Neglect Data System (NCANDS). The second phase of the review involved an on-
site review and an intensive examination of 50 randomly selected cases. Findings from that
review on the child well-being indicators are presented in Table 16 (Data provided by DCF
Quality Management). It is important to note that these data are now five years old and are
intended as a benchmark for comparison rather than a reflection of current practice.
56
Table 16. Findings on Child and Family Well-Being Indicators from 2001 Federal CFSR
PPeerrcceenntt rraatteedd aass““ssuubbssttaannttiiaallllyy
aacchhiieevveedd””WB1 Overall: Families have enhanced capacity to provide for theirchildren’s needs.
62%
Item 17. Needs and services of child, parents, foster parents 72%
Item 18. Child and family involvement in case planning 53.1%
Item 19. Worker visits with child 75.5%
Item 20. Worker visits with parent(s) 69%
WB2 Overall: Children receive appropriate services to meet theireducational needs
78.9%
Item 21. Educational needs of the child 78.9%
WB3 Overall: Children receive adequate services to meet theirphysical and mental health needs.
74%
Item 22. Physical health of the child 85.1%
Item 23. Mental health of the child 76.3%
Of the three indicators of child and family well-being, Florida’s lowest level of performance was
related to enhancing families’ capacity to provide for their children. A strength identified as part
of the review was that “reviewers noted a broad consistent involvement of families, foster
parents, relatives, and lawyers in case planning activities” (ACF, 2001). The lowest rating,
however, was for the specific item related to child and family involvement in case planning, that
was determined to be sufficient in just over half of the cases in the sample (53.1%). The highest
item rating was for assurance of basic and emergent health care services for children in child
protective services.
As part of their statewide Quality Management activities, DCF conducted Florida CFSR
reviews with five lead agencies during FY04-05 (the focus of this report). Those agencies
included: Children’s Network of Southwest Florida, Inc., Hillsborough Kids, Inc., Family Support
Services of North Florida, Inc., Families First Network, and CBC of Brevard, Inc. Ten randomly
selected cases were reviewed at each site. Findings presented here are not identified by lead
agency, but rather represent a range of average ratings for each of the well-being indicators and
items (Table 17).
57
Table 17. Findings from the Florida CFSR in FY04-05
PPeerrcceenntt rraatteedd aass““ssuubbssttaannttiiaallllyy
aacchhiieevveedd””WB1 Overall: Families have enhanced capacity to provide for theirchildren’s needs.
20-40%
Item 17. Needs and services of child, parents, foster parents 40-60%
Item 18. Child and family involvement in case planning 12.5-70%
Item 19. Worker visits with child 50-100%%
Item 20. Worker visits with parent(s) 16.7–55.6%
WB2 Overall: Children receive appropriate services to meet theireducational needs
60-100%
Item 21. Educational needs of the child 60-100%
WB3 Overall: Children receive adequate services to meet theirphysical and mental health needs.
20-90%
Item 22. Physical health of the child 40-90%
Item 23. Mental health of the child 50-100%
The Florida results are lower in general and reveal a great deal of variability across the
five lead agencies reviewed, but the overall pattern of results is similar to those of the federal
CFSR review. The indicator with the lowest achievement is enhancing families’ capacity for
caring for their children and the lowest individual item is family and child involvement in case
planning.
Family Engagement in Service Planning
Previous evaluation activities have included the tracking of staffing and conferencing
mechanisms that have been developed by each of the lead agencies to manage their caseloads
and to move their children and families toward permanency. Through that effort, various family
conferencing models have been identified (e.g., Family Team Conferencing and Family Group
Conferencing) that are being implemented throughout Florida. Vargo et al. (2005) reported that
13 lead agencies were implementing some form of family conferencing. Further, it was reported
that the lead agencies that had introduced the practice of these various models demonstrated
shorter lengths of stay and lower rates of reentry into care. It is hypothesized that the key
element to the success of the models is the engagement of caregivers in the care of their
children. Research has clearly demonstrated that family engagement is critical in the success of
services to children and adolescents (Hoagwood, 2005).
58
Family conferencing in its various forms is a concept that is gaining momentum
throughout the State of Florida. It has been mentioned specifically in the Florida Performance
Improvement Plan (PIP) developed in response to the 2001 federal CFSR as a practice
improvement strategy to increase family involvement in service planning. A staffing observation
form was developed and initial pilot testing has begun for possible future use in the evaluation
(Appendix 1). The form is based on the Team Observation Form5 and incorporates the child and
family well-being indicators from the CFSR. The form is intended for use at staffings in which
family members or other caregivers are in attendance in order to identify key elements of family
involvement (e.g., caregiver’s opportunity to offer preferences for services). Pilot testing was to
occur during site visits to Heartland for Children (HFC, March 2006) and Family Services of
Metro-Orlando (FSMO, May 2006), but due to limited opportunities to observe staffings with
family attendance, the pilot test was not completed. As part of the HFC site visit, 10 staffings
were observed – six Early Services Intervention (ESI), three Permanency Reviews (for children
in care 9-12 months) and one Family Team Conference. During the FSMO site visit, one
Permanency Case Review was observed that integrated aspects of family conferencing. It was
found that the observation tool itself was most useful when observing the Family Team
Conference (at Gulfcoast Community Services, case management organization for HFC) and
the Permanency Case Review (at Devereux, case management organization for FSMO).
Both lead agencies that participated in site visits have greatly enhanced their case
staffing mechanisms in order to move cases through the system in a more timely manner (e.g.,
as seen by ESI staffings being held three times weekly at HFC), to engage community
providers, and to include children and families more fully in the case planning process. HFC’s
primary staffing processes include:
• Child Protective Investigations Staffings (PI) – these staffings are described as a
“fact-finding, decision-making, and assessment process designed to obtain sufficient
information to support departmental decisions for investigative case disposition
(Cowan, 2006).”
5 The Team Observation Form was developed by Dr. Michael Epstein at the University of Nebraska-Lincoln. It was designed to assess the degree to which evidence that behaviors observed throughoutfamily case planning meetings reflect system of care and Wraparound principles. Trained observersattend meetings in which families are engaged by family counselors and other providers in identifyingtheir needs and planning services, and record their observations.
59
• Early Services Intervention Staffings (ESI) – to review and assess the service
intervention needs of the child and family at the time of “handoff” from investigations
to the receiving case management organization.
• Community Resource Staffings (CR) – to assist families by connecting them to
community resources, preventing entry into the child protective system. Families are
always in attendance at these meetings.
• Permanency Staffings (PS) – these staffings are held at 3, 5, 8, and 11-months
following removal from the home. The purpose of these staffings is to monitor
compliance with the case plan and to identify barriers to timely permanence.
In addition, both Gulfcoast Community Services, one of the four case management
organizations contracted with HFC, and Devereux Kids, a sub-contractor with HFC conduct
Family Team Conferences with select cases within the HFC system of care (See Focus On box
for more information).
FSMO has also designed a series of staffing mechanisms to support practice and
ensure quality service delivery. Among the key processes are the following:
• Front-End Staffing – a weekly review of all cases that have been staffed from the
child protective investigations to the services unit.
• Permanency Case Review – these staffings are held at 45 days and 10 months from
removal in out-of-home cases, and six months from services initiation in in-home
cases. As a result, they are scheduled on a rolling basis. The primary purpose of
these staffings is to ensure “the safety, permanence, and well-being of the children
served by the Case Management Organizations contracted by Family Services of
Metro Orlando” (Quality Management Plan, 2006).
60
Focus On: Family Team Conferencing within Heartland’s System of Care
Family Team Conferencing (FTC) was originally introduced to the Polk County human service
community through the Neighborhood Partnership Project sponsored by the Florida
Department of Children and Families (DCF). FTC is a process of family engagement that
builds on family strengths and works in a partnership with the family to move toward safety
and self-sufficiency. Devereux Kids was the unit selected for implementation in two selected
zip codes in Lakeland. They have since grown the program to cover all of Lakeland. As a
sub-contract provider to Heartland for Children (HFC), Devereux Kids provides services to
many families where there are child maltreatment concerns, primarily in an effort to prevent
out-of-home placement. Referrals come from various sources:
Family Team Conferencing is the standard practice with all cases they open. The program is
staffed by a program coordinator, an integrated services worker, two facilitators, and a
secretary. Training in the FTC model was received from the Professional Development Centre
(PDC) at the University of South Florida (USF).
In addition, Gulfcoast Community Services, one of the four case management
organizations contracted with HFC, implements Family Team Conferencing with selected cases
within their caseload. Reportedly, the practice has not be adopted for use in all cases due to
concerns by the local legal community that families should not participate in conferences without
legal representation or before legal proceedings have occurred. (Note: This has been raised as
an issue elsewhere in the state, but does not consistently present a challenge to providers.) As
a result, Gulfcoast attempts to identify cases at the time of ESI staffing that could realistically
avoid going to trial by putting services in place early in the process. The Family team
conference is a means to demonstrate family efforts to avoid adjudication. Gulfcoast has six
FTC facilitators (assigned to each of the six units). Training in the model was also received from
the PDC at USF.
o from the child protective investigation (CPI) units of DCF to prevent future calls,
o from the case management organizations during protective services or to aid in
reunification,
o or as family support cases referred directly from the community (e.g.,. self-referral or from community providers such as the Salvation Army).
61
Customer Satisfaction
During the fall of 2005, lead agencies were contacted as part of the CBC evaluation and
asked to report on any customer satisfaction tools or processes they had in place. This request
was made in reaction to the 2005-2008 Strategic Plan released by DCF in October 2005
emphasizing that “the Florida tax payer [is] a significant stakeholder that requires evidence of
efficiency and effectiveness.” The related success indicator is an “increased percent of
customers satisfied with service provided by or funded by the department.” A discussion of the
responses was included in the Report to the Legislature (Vargo, et al., 2005) submitted to DCF
in January 2006. A compilation of those tools has been created as a companion document to
this report (Compendium of CBC Satisfaction Tools).
At that time, four lead agencies (Families First Network, Big Bend, Family Services of Metro-
Orlando, and CBC of Brevard) reported they were either developing or revising their existing
tools. Follow-up contact was made with each of those agencies during the spring of 2006. FFN
and Big Bend had not progressed to a point where they were comfortable sharing their
instruments, FSMO had made revisions, but did not send a copy for inclusion, and CBC of
Brevard had begun using their new surveys in February 2006.
The Partnership for Strong Families (PSF) in District 3 has created six surveys for use
with various constituents: Stakeholder Satisfaction Survey, Adoptive Parent Satisfaction Survey,
Child and Adolescent Satisfaction Survey, Contract Providers Satisfaction Survey, Foster
Parents Satisfaction Survey, and Parent-Guardian Satisfaction Survey. An interesting note
regarding the PSF surveys is that each of the surveys asks the respondent about their
involvement in Family Team Conferences, creating a direct link between involvement in service
planning and overall satisfaction with services.
Two surveys have been developed by Hillsborough Kids, Inc. (HKI) in the SunCoast
Region. The first is a general 10-item Satisfaction Survey that can be completed by a caregiver,
parent, attorney, provider, Guardian ad Litem, or any other case participant. It includes a
general item regarding “input during the progress of the case” although not specific to any
model of family involvement. The second survey is a Child Satisfaction Survey for use at the
time of service termination. The inclusion of a youth survey is a step in the direction of more
complete youth involvement.
CBC of Brevard began implementation of their newly developed satisfaction tools in
February 2006. They have developed five satisfaction survey formats: Adoptive Parent, Foster
Parent, Parent, Network Provider, and Community Stakeholder. The Parent Satisfaction Survey
asks whether or not the respondent has participated in a Family Team Conference. Each of the
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remaining four surveys asks the respondent to rate their level of participation. During the Fall
of 2005, the Children’s Network of SW Florida in District 8 was one of two lead agencies that
reported being involved in interviews around quality of care (the other was CBC of
Volusia/Flagler to be discussed later). The Children’s Network reported that they do “not keep
quantitative data for client satisfaction”, but use qualitative data gathered during quality reviews
of cases throughout the year. The interview/survey formats are included in Appendix 5.
Annually, foster parents are interviewed at the time of relicensing and the Foster Parent and
Relicensing surveys are completed. As part of the annual relicensing, staff input (Staff Inquiry)
and community input (Community Input) are sought. Exit interviews are conducted with foster
parents using the Foster Parent Exit Survey at the time of a home closure, and with children
over the age of 5 who have been a home longer than 30 days at the time of re-placement. The
final survey is the Stakeholder Survey that is used as an interview annually as part of the
monitoring process.
Heartland for Children (HFC) in District 14 has developed a series of surveys and tools
to evaluate customer satisfaction. Heartland staff conducts telephone surveys with a random
sample of caregivers who have received a monthly visit from their case manager to ask
questions about those interactions (Home Visit Follow-up). Surveys are completed with foster
parents either face-to-face or by telephone with randomly selected foster parents to assess their
interactions with case managers as well as the completeness of records provided by the agency
regarding children in their care (Foster Parent Survey). In order to assess involvement of
various stakeholders in staffings, surveys are conducted at randomly selected ESI staffings (ESI
Staffing QA Survey), CPI staffings (PI Staffing QA Survey), and Permanency staffings
(Permanency Staffing QA Survey). These surveys ask, for example, about their comfort with the
staffing process, their ability to participate, and the overall utility of the meetings.
United for Families (UFF) in District 15 has developed a web-based survey system to
generate surveys and distribute them via e-mail to providers and community stakeholders.
Paper copies are generated for use with biological, foster, and adoptive parents. In addition,
surveys are children in licensed care are completed when the child leaves the placement (i.e.,
exit interview). UFF staff report that all the survey results are recorded in the back-end database
and the reports generated “are utilized for reviewing the overall quality in meeting the needs of
children, families and other stakeholders.”
In addition to the measures and processes included in the Compendium of CBC
Satisfaction Tools, CBC of Volusia/Flagler further reported about their survey efforts. During the
fall of 2005, they reported that they cooperate with their local foster parent coalition in an annual
63
foster parent survey/interview. The survey includes the collection of demographic information
(e.g., length of time as foster parent, number of children in home, household income, etc.) and
17 survey questions about their MAPP training, ongoing training, responsiveness of their foster
care provider/agency and case manager, and involvement in service planning and delivery for
the children in their care. During 2005, 72 surveys were conducted out of 236 foster homes in
the CBC Volusia/Flagler system of care (31% sample).
Sharing of these measures is timely since all lead agencies are now required to submit a
CBC Quality Management Plan as part of the shift to the 3-Tiered Quality Assurance Plan being
promoted by the Department. One of the criterion included in the Plan is “Agency
Responsiveness to the Community” and includes a step that reads “The plan addresses a
mechanism for input from customers and other stakeholders specific to the array of service
provision and need” (DCF working document, 2006). It is hopeful that the move to the 3-Tiered
Quality Assurance Model will increase the formalization of quality assurance practices. By
holding the lead agencies and their sub-contractors accountable for their services, it is not
unreasonable to expect that the quality of practice will improve. If nothing else, the availability of
data around which to assess quality will be more readily available.
Conclusions
The measurement of quality performance is a multi-faceted task, especially in the
delivery of human services. How is one able to determine if services are being provided
consistently and effectively to meet the needs and expectations of the children and families
involved in the child welfare system? The answer may be as simple as “ask them”. This section
has focused on the well-being of children and families as measured by the CFSR, the inclusion
of caregivers in service planning, and the collection of opinions related to satisfaction with
services. All three reach the same conclusion – the best way to know if services are successful
is to include the service recipient in the process, continuously assess their progression through
services, and gather their input as to the quality.
There is evidence that lead agencies and DCF have made progress in that respect. This
evaluation has repeatedly noted a variety of mechanisms created to include input from families
into services. This increased attention was noted in the site visits to Heartland for Children and
Family Services of Metro-Orlando, through their staffing mechanisms and development of
integrated QA systems. Perhaps most importantly though, it is recognized by DCF in its
oversight role by the requirement delineated in the QM Plan outline and in its Strategic Plan.
64
Policy Recommendations
• It is recommended that lead agencies should continue to develop and implement models
that further include families in the service planning process.
• In addition, a forum should be established in which lead agencies and their case
management organizations can share promising practices (e.g., Family Team
Conferencing) and learn from each others’ successful practices.
• Lead agencies and child welfare legal services should coordinate their efforts statewide
to clarify the legal issues surrounding family conferences and the need for
representation pre-adjudication.
• Lead agencies should continue to include items related to involvement in the service
planning process on measures of customer satisfaction, not only for family members, but
for all community stakeholders.
• It is recommended that the Department, through its Quality Management efforts (QM),
review the lead agency QM plans on a regular basis to assure their implementation with
a particular focus on the inclusion of families and caregivers in the service planning
process.
65
Research Question 4: What factors affect child outcomes?
Table 18. Research Question 4
EEvvaalluuaattiioonnQQuueessttiioonn
IInnddiiccaattoorr//AAnnaallyyssiiss SSoouurrccee
What factors areassociated withchildren’s delayedexit from out-of-home care andaffect median lengthof stay in out-of-home care?
• Proportion of childrenexiting out-of-homecare within 12 months.Median length of stay
• (Event History Analysis)
HSn
What factors areassociated withreentry into out-of-home care?
• Proportion of childrenreentering out-of-homecare within 12 monthsafter exit
• (Event History Analysis)
HSnWhat factors affectchild outcomes?
What factors areassociated withrecurrence ofmaltreatment?
• Proportion of childrenwith maltreatmentrecurrence within 12months afterexperiencing their firstepisode
• (Event History Analysis)
HSn
Introduction
To date, Community-Based Care has begun implementation in all counties in Florida.
The implementation of Community-Based Care was designed to improve the 1997 Adoption and
Safe Families Act (ASFA) required major outcomes: achieve permanency, safety, and well-
being for children who are removed from their homes. Therefore, estimating the success of CBC
and understanding what factors are associated with reaching ASFA goals becomes a critical
task of the Community-Base Care evaluation.
For the current evaluation study various child and lead agency level characteristics were
examined. The following child characteristics were included:
a) gender,
b) age,
c) minority status, defined as having any race/ethnicity other than Caucasian,
d) reunification as a reason for discharge,
e) placement with relatives as a reason for discharge, and
66
f) adoption finalized.
In addition, the following lead agency level factors were included:
g) presence of a parent organization,
h) number of counties served by a lead agency,
i) retention of case management services,
j) average expenditures per child served and
k) average expenditures per child day.
To assess child safety and permanency and to examine the performance of community-
based agencies the following outcome measures were chosen:
a) proportion of children exiting out-of-home within 12 months and within 24
months,
b) median length of stay for children entering out-of-home care during FY03-04,
c) median length of stay for children served (i.e., received at least one day of
services during FY04-05 regardless of their date of entry), in FY04-05,
d) proportion of children who reentered out-of-home care,
e) proportion of children with recurrence of maltreatment.
These outcome measures were developed in collaboration with Florida Department of
Children and Families and were examined in relation to both child level characteristics and lead
agency level factors.
Sources of Data
The primary source of data for the quantitative child protection indicators used in this
report was the State Child Welfare Information System (SCWIS) for the State of Florida –
HomeSafenet (HSn). A second source of data was Florida Accounting Information Resource
(FLAIR).
Methodology
The outcome measures described above were calculated for every lead agency and
were based on entry cohorts for FY03-04 when proportion of children exiting out-of-home,
median length of stay of children entering out-of-home care, and proportion of children with
recurrence of maltreatment were analyzed. Exit cohorts for FY03-04 were used when reentry
67
into out-of-home care was examined. All counties that had transitioned or were in the process of
transitioning to Community-Based Care as of June 2005 were included in the analysis. As a
result, all 22 lead agency contracts6 were included in the analyses. When the effects of
predictors were examined, all counties in the State of Florida were included.
Statistical analyses consist of Cox regression (Cox, 1972) – a type of event history or
survival analysis, correlational analyses, and two-level survival analysis using MPlus, version
4.0 (Muthèn & Muthèn, 2006). Cox regression was conducted to examine the effect of child
level predictors on outcomes. Odds ratios were used to evaluate the importance of these
predictors. Multilevel analyses were performed to examine the effect of organizational and
funding factors related to the county/lead agency on outcome measures. Pseudo-z statistics
were used to test significance of the covariate effects when multilevel analyses were performed.
Finally, correlational analyses were performed to examine the associations of lead agency level
characteristics with child outcomes.
Limitations
A few limitations should be noted. First, this study was limited by the use of measures of
lead agency performance that only relate to child safety and permanency outcomes. Second,
when the effects of level of funding on outcome measures was examined four lead agencies
were excluded from the analyses because their service contracts had started after the beginning
of FY04-05. Third, a limited number of lead agency level characteristics were examined.
Additional data gathered during future years will allow for examining different organizational
factors.
6 There are only 20 lead agencies, but the Sarasota Family YMCA, Inc. and Big Bend Community-BasedCare both hold two lead agency contracts.
68
Findings
Median Length of Stay of Children who Were Served in Out-of-Home Care During FY04-05.
Description of the Indicator
Researchers obtained information from Life Tables7 on the proportion of children who
were served in FY04-05 (i.e., received at least one day of services during FY04-05 regardless of
their date of entry) and the proportion of children who exited out-of-home care at 12 and 24
months after entry. It was important to examine the discharge rates among children served
during a specific year as an indicator of the lead agency’s ability to deal with children who had
been in the system for longer periods of time and therefore were at higher risk. All children who
were served in out-of-home care during FY04-05 were followed for 12 and 24 months after entry
into out-of-home care as indicated by the removal date in HSn, and the proportion of children
who exited out-of-home care (i.e., discharged) was calculated. The proportion of children exiting
out-of-home care within 12 and 24 months was calculated for each lead agency (See Figure 5).
The median length of stay (LOS) for children served in FY04-05 in out-of-home care or an out-
of-home care episode also was calculated (See Figure 6). An out-of-home care episode was
defined as a continuous period of time in out-of-home care, which begins on the date when the
child was removed from his/her parents’ or caregivers’ home (i.e., Removal Date) and ends on
the date when the child was discharged from an episode of out-of-home care (i.e., Discharge
Date). An out-of-home care episode may consist of multiple placements (e.g., family shelter
home, residential treatment, pre-adoptive home, supervised practice, independent living), which
were all included in a single episode of out-of-home care if there was no Discharge Date after
the placement ended.
Results
Figure 5 shows the proportion of children exiting out-of-home care for children who were
served for at least one day in FY04-05. As shown in Figure 5, Community-Based Care of
Brevard had the highest proportion of children exiting out-of-home care (43%) within 12 months
and Community-Based Care of Flagler/Volusia had the lowest proportion of children exiting out-
of-home care (12%).
7Life Tables are a type of event history analysis
69
Figure 5. Proportion of Children who Exited Out-of-Home Care During FY04-05 by Lead Agency
0 10 20 30 40 50 60 70
Community Based Care of Brevard
Families First Network
Kids Central, Inc.
Clay & Baker Kids Net, Inc.
Big Bend Community-Based Care - 2A
St. John’s County Board of County Commissioners
Sarasota YMCA South
Big Bend Community-Based Care - 2B
Partnerships for Strong Families
Community-Based Care of Seminole, Inc.
Heartland for Children, Inc.
ChildNet
Family Matters of Nassau County
United for Families, Inc.
Family Services of Metro-Orlando, Inc.
Children’s Network of South Florida
Family Support Services of North Florida, Inc.
Sarasota YMCA North
Child & Family Connections
Hillsborough Kids, Inc.
Our Kids of Miami
Community-Based Care of Flagler/Volusia
Proportion exited in 12 Months Proportion exited in 24 Months
* The Mean for the proportion of children exiting during 12 months was 29.13 and the Mean for the proportion ofchildren exiting during 24 months was 50.73.
70
Figure 6 Median Length of Stay (in months) by Lead Agency
St. Johns had the shortest median LOS (13.8 months), while HKI had the longest
median LOS (49.7months) as shown in Figure 6. On the average, children who were served in
FY04-05 remained in out-of-home care for 25 months.
The association between child sociodemographic characteristics and the likelihood of
being discharged from out-of-home care among children who were served during FY04-05 was
examined using multivariate model. The results of Cox regression analyses indicated that
gender, age, and minority status were significantly associated with timely exit from out-of-home
care. Being a female, being older and having minority status are factors that significantly
15.31
15.41
15.52
16.61
15.7
13.83
19.03
16.88
20.89
21.3
21.45
27.8
23.41
32.92
28.29
27.55
27.18
37.32
35.17
45.16
30.15
49.69
0 5 10 15 20 25 30 35 40 45 50
Community Based Care of Brevard
Families First Network
Kids Central, Inc.
Clay & Baker Kids Net, Inc.
Big Bend Community-Based Care - 2A
St. John’s County Board of County Commissioners
Sarasota YMCA South
Big Bend Community-Based Care - 2B
Partnerships for Strong Families
Community-Based Care of Seminole, Inc.
Heartland for Children, Inc.
ChildNet
Family Matters of Nassau County
United for Families, Inc.
Family Services of Metro-Orlando, Inc.
Children’s Network of South Florida
Family Support Services of North Florida, Inc.
Sarasota YMCA North
Child & Family Connections
Hillsborough Kids, Inc.
Our Kids of Miami
Community-Based Care of Flagler/Volusia
71
increase the likelihood of exiting out-of-home care sooner. However, Odds Ratio for gender and
age indicated that this increase was not substantial (see Table 19 and Appendix A, Table 1).
Table 19. Factors Associated with Discharge for Children Served in FY04-05
CChhiillddrreenn EExxiittiinngg OOuutt--ooff--HHoommee CCaarree ((NN == 5500,,002255))
Age XGender XMinority status XReunification XxPlacement with relatives XxAdoption X
X – indicates a statistically significant associationXx – indicates a very strong statistical associationNs – indicates no statistically significant association
Children who were served in out-of-home care in FY04-05 were almost nine times more
likely to get discharged within 12 months if their discharge was reunification with parents and
were six times more likely to get discharged within 12 months if their discharge reason was
placement with relatives (see Appendix A, Table 2).
Predictors of Delayed Discharge Among Children Who Entered Out-of-Home Care in FY03-04.
Description of the Indicator
The proportion of children who exited out-of-home care during the first 12 months after
entry in FY03-04 was obtained from Life Tables. All children who entered out-of-home care
during FY03-04, as indicated by the removal date in HSn, were followed for 12 months and the
proportion of children who exited out-of-home care (e.g., discharged) was calculated. The
proportion of children exiting out-of-home care was calculated for each lead agency. The
median length of stay (LOS) in out-of-home care or an out-of-home care episode was also
calculated based on an entry cohort from FY03-04.
Results
The results of Event History analyses (i.e., Cox regression) indicated that among
sociodemographic characteristics age and minority status were significantly associated with
delayed discharge from out-of-home care. Specifically, younger and minority children were likely
to stay in out-of-home care longer. Age at entry into child protection system relates to exit from
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out-of-home care such that a one-year change (i.e., being one year younger) corresponds to
almost 2% decreased likelihood for children to get discharged within a 12 month period (see
Table 20 and Appendix A, Table 3).
Table 20. Factors Associated with Discharge Based on Cohort FY03-04.
CChhiillddrreenn EExxiittiinngg OOuutt--ooff--HHoommee CCaarree ((NN == 2299,,338877))
Age XGender NSMinority status XReunification XxPlacement with relatives XxAdoption Xx
X – indicates a statistically significant associationXx – indicates a very strong statistical associationNs – indicates no statistically significant association
Children who exited out-of-home care into permanency were discharged much sooner
compared to children who exited for other reasons, but reunification as a reason for discharge
was the strongest predictor of timely exit. Children who were reunified with their primary
caregivers were 12 times more likely to be discharged within 12 month after entry in out-of-
home care compared to children who were discharged for other reasons (see Table 20 and
Appendix A, Table 4).
As shown in Figure 7, the line for children who were discharged for other than
reunification reasons (bottom line) is clearly dissimilar to the top line (line for children who were
reunified) and it has a sharper curve indicating that the event (e.g., discharge from out-of-home
care) is happening faster.
73
Figure 7. Probability of Successful Discharge by Reunification After Exiting Out-of-
Home care
Predictors of Reentry Into Out-of-Home Care Among Children Exiting During FY03-04.
Description of the Indicator
The calculation for this indicator was based on exit cohorts of children (i.e., children
who exited their first out-of-home care episode during FY03-04 or who had a Discharge Date
during FY03-04). An unduplicated count of children (i.e., only children who exited their first
episode of out-of-home care) was used for this indicator. A unique number given by the HSn
system identified individual children and reentry into out-of-home care was indicated by a
Removal Date after an existing Discharge Date for the same child. All children who were
discharged during FY03-04 were followed for 12 months to determine if they reentered out-
of-home care. The last day of the follow-up period was June 30, 2005.
74
Results
Among child sociodemographic characteristics both age and minority status were
associated with an increased likelihood of reentering out-of-home care. Only 6% of minority
children among those who exited out-of-home care in FY03-04 experienced a reentry event
compared to approximately 8% of children who did not have minority status. Children who did
not have minority status were 1.3 times more likely to reenter than minority children. Age was
associated with reentry into out-of-home care, such that for every one-year increase in age,
children were approximately 1% less likely to experience reentry (see Appendix A, Table 5).
Children who were reunified were four times more likely to reenter than children who were
discharged for other reasons, and children who were placed with relatives were 1.5 times more
likely to reenter than children discharged for other reasons. The bottom line in Figure 8, which
represents children who were reunified after exiting out-of-home care, has a sharper curve and
is very dissimilar to the top line that identifies children discharged for other reasons. The
dissimilarity between the two lines indicates a considerable difference in likelihood of reentry for
children who were reunified compared to children who were discharged for other reasons.
Figure 8. Probability of Reentry by Reunification as a Reason for Discharge
75
Table 21. Predictors for Reentry Into Out-of-Home Care ~ Multivariate Model, Exit Cohorts
FY03-04.
CChhiillddrreenn WWhhoo RReeeenntteerreedd((NN == 2211,,113311))
Gender NSMinority Status XAGE XReunification XxPlacement withrelatives X
Adoption XX – indicates a statistically significant associationXx – indicates a very strong statistical associationNs – indicates no statistically significant association
Predictors of Maltreatment Recurrence (FY03-04 Entry Cohort)
Description of the indicator
The percentages of children with recurrence of maltreatment reported here are
proportions obtained from Life Tables.8 The proportion of children with recurrence of
maltreatment was calculated based on fiscal year entry cohorts; in other words, the proportion
of all children who experienced a maltreatment incident during a specific fiscal year was
calculated. Only children with “founded” maltreatment (i.e., when the protective investigation
resulted in a finding of abuse, neglect, or threatened harm and/or when there was some
indication of maltreatment) were included in the analysis. Recurrence of maltreatment was
defined as a second founded episode of maltreatment (i.e., when there was some indication of
maltreatment or maltreatment verified) within 12 months of a child’s first founded episode.
Results
Life Table analyses indicated that for entry cohort 2003-2004 there was 9.02% of
maltreatment recurrence in the State of Florida. This is a substantial decrease compared to
FY02-03 when maltreatment recurrence was 12.62. The results of multivariate analyses (i.e.,
Cox Regression) indicated that being White (i.e., not having a minority status) predicted
recurrence of maltreatment. Specifically, White children were almost 1.5 more likely to have a
8 Life Tables are a type of event history analysis
76
second episode of maltreatment. Neither child age nor gender was significantly associated with
recurrence of maltreatment.
Table 22. Predictors of Maltreatment Recurrence Based on FY03-04 Cohort.
CChhiillddrreenn EExxiittiinngg OOuutt--ooff--HHoommee CCaarree ((NN == 113300,,337777))Age NSGender NSMinority status XAbsence of a caregiver XHarm XNeglect XAbuse X
X – indicates a statistically significant associationXx – indicates a very strong statistical associationNs – indicates no statistically significant association
To test the effect of maltreatment type on maltreatment recurrence a multivariate
analysis where all predictors were entered simultaneously into the model was conducted. Four
types of maltreatment were examined including:
a) absence of a caregiver,
b) threatened harm,
c) neglect, and
d) abuse.
Based on the Allegation Matrix (State of Florida Department of Children and Families,
1998) developed by the Florida Department of Children and Families, abuse is defined as a
willful action that resulted in the listed injury or harm (e.g., bruises, cuts, burns, bone fractures).
Neglect is defined as an omission, which is a serious disregard of parental
responsibilities for the child’s welfare including: (a) prolonged or repeated lack of supervision or
failure to exercise a minimum degree of care that resulted in the listed injury of harm and (b)
failure to make reasonable efforts to stop the actions of another person, which resulted in the
listed injury or harm (e.g., inadequate supervision, conditions hazardous to health, inadequate
shelter, clothing or food). Threatened harm is defined as a behavior, which is not accidental and
which is likely to result in harm to the child, such as family violence that threatened child (State
of Florida Department of Children and Families, 1998). According to Florida statute, special
conditions (e.g., incarceration or death of a parent resulting in absence of a caregiver) are not
abuse or neglect but are tracked in the data system because they require a protective response.
77
Both absence of a caregiver and neglect were significantly associated with recurrence of
maltreatment. Children who were neglected were almost 1.5 times more likely to experience
recurrence of maltreatment, and children with absence of caregivers were 1.2 times more likely
to have a second episode of maltreatment.
Multilevel Model Results
To address research questions related to the effect of funding level and to examine the
effect of lead agency characteristics multilevel analyses (i.e., two-level continuous survival
analysis using Cox Regression) were performed, in which children were nested within lead
agencies. Child sociodemographic characteristics were examined as predictors at level 1 (i.e.,
child level) and expenditures per child and per child day were examined as predictors at level 2
(county /lead agency level).
Length of Stay in Out-Of-Home Care (Entry Cohort FY03-04).
At the first level, the results of multilevel analyses confirmed the results of Cox
regression analyses that older, non-minority children were more likely to get discharged from
out-of-home care within 12 months after entry. These findings were confirmed by the results of a
study conducted by Wulczyn, Hislop, & Goerge (2000), who found that in a number of states
children who entered foster care as infants had longer median lengths of stay than all the other
children.
In addition, the results of multilevel analyses indicated that females were more likely to
exit out-of-home care compared to males. No statistically significant associations were found
when the effect of expenditures per child and expenditures per child day on the length of stay in
out-of-home care was examined (see Table 23 and Appendix A, Table 7).
78
Table 23. Multilevel Model Results
RRiisskk FFaaccttoorrss wwiitthhiinn CCoouunnttyyPredictors Length of Stay in Out-of-Home Care (FY03-04
Entry Cohort)Gender Xx
Age X
Minority Status NS
RRiisskk FFaaccttoorrss bbeettwweeeenn CCoouunnttiieessAverage expenditures per child NS
Average expenditures per child/day NS* Due to multi-colinearity average expenditures per child and average expenditures per child day were entered in themodel separately.
Length of Stay in Out-of-Home Care for Children Served in FY04-05
Similar to the results of Cox regression, findings from multilevel analyses at level 1
indicated that age, gender, and minority status were significantly associated with shorter lengths
of stay in out-of-home care. Minority children, older children, and females exited out-of-home
care sooner. Statistically significant association was found at level 2 when the association
between expenditures per child and the length of stay in out-of-home care were examined.
Multilevel analyses showed that lower expenditures per child were associated with longer length
of stay. However, no statistically significant association was found when the effect of
expenditures per child day was examined (see Table 24 and Appendix A, Table 8).
Table 24. Multilevel Model Results
RRiisskk FFaaccttoorrss wwiitthhiinn CCoouunnttyy
Predictors Length of Stay in Out-of-Home Care for
Children Served During FY04-05
Gender Xx
Age X
Minority Status X
RRiisskk FFaaccttoorrss bbeettwweeeenn CCoouunnttiieess
Average expenditures per child X
Average expenditures per child/day NS* Due to multi-colinearity average expenditures per child and average expenditures per child day were entered in themodel separately.
79
Reentry Into Out-of-Home Care
Multilevel survival analyses revealed significant association between child
sociodemographic characteristics and time to reentry at level 1. Boys, younger children, and
children who do not have minority status were likely to reenter out-of-home care and they
reentered faster than children who did not have these characteristics. At level 2 a statistically
significant association was found between expenditures per child and time to reentry as well as
expenditures per child day and time to reentry. Specifically, lower expenditures per child
predicted earlier reentry. Similarly, lower expenditures per child day was associated with earlier
reentry into out-of-home care (see Table 25 and Appendix A, Table 9).
Table 25. Multilevel Model Results
RRiisskk FFaaccttoorrss wwiitthhiinn CCoouunnttyyPredictors Reentry into Out-of-Home Care (FY03-04
Exit Cohort)Gender XAge XMinority Status X
RRiisskk FFaaccttoorrss bbeettwweeeenn CCoouunnttiieessAverage expenditures per child XAverage expenditures per child/day X* Due to multi-co linearity average expenditures per child and average expenditures per child day were entered in themodel separately.
Safety and Permanency in Florida and Federal Standards and National trends
In 2004 there were 129,914 indicated and substantiated child maltreatment victims in
Florida. The rate of child victims in Florida (32.5%) was based on the number of victims divided
by the state's child population, and then multiplied by 1,000 (U.S. Department of Health and
Human Services, Administration for Children and Families, 2004). According to the Children's
Bureau of the U.S. Department of Health and Human Services (2004), the national rate of child
victims was 11.9%.
In addition, the Children's Bureau has established a national standard for recurrence of
maltreatment as 6.1% or fewer children who had another substantiated or indicated report within
six months. However, maltreatment recurrence within six months in Florida was 9.2% in 2004
(U.S. Department of Health and Human Services, Administration for Children and Families,
2004).
80
According to the Child Welfare Outcomes 2002 Annual Report, a median of 9.9% of
children who entered foster care in FY02-03 reentered the system within 12 months of a
previous discharge (U.S. Department of Health and Human Services, 2005). As shown in Child
Welfare Annual Statistical Data Tables (2005), during FY04-05 8.59% of children reentered out-
of-home care after reunification or release to relatives in Florida (Florida Department of Children
and Families, 2005).
In 2003 the median length of stay in months nationwide was 18 months. By comparison,
the median length of stay in Florida during FY04-05 ranged from 11.4 to 13.1 months (Florida
Department of Children and Families, 2005). Furthermore, in FY02-03, the median percentage
of children discharged to a permanent home was 86.1 across all states. The national standard
for reunifications occurring within 12 months of entry into foster care is 76.2% or more. During
the same year 92.5% of children exited to permanency in Florida.
Conclusions
The quantitative analysis of children who entered and were served by the Florida child
protection system revealed that certain child sociodemographic characteristics are associated
with poorer outcomes. It appears that lead agencies are less successful in meeting ASFA
requirements for certain categories of children. In particular, boys and younger children are less
likely to achieve permanency and more likely to reenter the system.
Although reunification and placement with relatives are strongly associated with
discharge from out-of-home care, they also predict subsequent removal from primary
caregivers. Furthermore, reunification is the strongest predictor of reentry into out-of-home care.
Children who were reunified were four times more likely to reenter than children who were
discharged for other reasons.
Level of funding is associated with outcomes for children. Lower expenditures per child
increase the likelihood of reentry and decreases chances to exit for children who received out-
of-home care services. Future analysis will include lead agency characteristics, such as the
number of counties per lead agency, presence of a parent organization, and retention of case
management services within a multilevel analysis framework
81
Policy Recommendations
• It is highly recommended that newly-reunified families be provided additional services
and support throughout the first year after reunification to prevent a second reentry into
out-of-home care.
• Findings indicate that being younger, male, or Caucasian is associated with a lower
likelihood of exiting out-of-home care within a timeframe consistent with federal
guidelines. Because the data used in these analyses did not allow examination of why
these demographic characteristics place children at heightened risk, further investigation
is recommended to better understand system-level influences that may account for
these findings.
82
Research Question 5: What is the short and long-term effectiveness of lead agencies at
managing resources and cost?
Table 26. Research Question 5
EEvvaalluuaattiioonnQQuueessttiioonn
IInnddiiccaattoorr((ss)) SSoouurrccee((ss))
What is the impactof child welfarefunding sources onactualexpenditures?
• Average expendituresper child served
• Average expendituresper child day
• Out-of-homeexpenditures as apercentage of totaldirect servicesexpenditures
Lead agencydocumentation
CEO Survey
FLAIR
HSn
Why is therevariation among thelead agenciesrelated to out-of-home expenditures?
WWhhaatt iiss tthhee sshhoorrttaanndd lloonngg tteerrmm
eeffffeeccttiivveenneessss oofflleeaadd aaggeenncciieess aatt
mmaannaaggiinngg rreessoouurrcceessaanndd ccoosstt??
What predictorsinfluence thevariation in leadagency totalexpenditures?
Introduction
With the federal government’s recent approval of DCF’s application for a Title IV-E
waiver, Florida’s child welfare system is preparing to undertake several important changes that
have the potential to increase the efficiency and effectiveness of all dollars invested in child
welfare services. Historically, federal rules limited the use of IV-E funds to out-of-home,
adoption, and independent living services. With an increasing emphasis on prevention, early
intervention, and diversion from out-of-home care via in-home services, Florida’s lead agencies
found themselves unable to use all available IV-E funds to provide an appropriate mix of
services for children in care. With an expected start date of October 2006, the IV-E waiver will
allow lead agencies to flexibly use all IV-E funding for any type of child welfare services. One
hypothesis is that the IV-E waiver will ultimately lead to increased spending for prevention, early
intervention, and diversion services and decreased spending for out-of-home care.
83
As preparations begin to evaluate the effectiveness of the IV-E waiver, it is important to
establish baseline data so that the above hypothesis may ultimately be tested. The purpose of
this analysis is to compare contract and expenditure amounts by funding source and lead
agency, with a particular focus on the extent to which lead agencies were able to spend all
available IV-E funding.
Methods
Lead agency appropriations and expenditures for FY04-05 were analyzed for the 16 lead
agencies that had a services contract for the entire fiscal year9. Allocation amounts (i.e., the
lead agency’s total budget for child protective services) reflect each lead agency’s total contract
amount for the fiscal year and were pulled from the final version of Attachment II from each lead
agency’s FY04-05 service contract. FY04-05 expenditure data were extracted from the Florida
Accounting Information Resource (FLAIR)10. The overall difference between allocation and
expenditures (i.e., the variance) for each lead agency was calculated. The variance percentage,
which is equal to the variance amount divided by the budget amount, was also calculated.
The variance was also calculated by funding source for each lead agency. Funding
sources include Title IV-E (referred to here as IV-E); Temporary Assistance to Needy Families
(TANF); state general revenue, state matching, and other state funding sources (referred to
here as state); and other federal funding sources (e.g., Social Security Block Grant, Promoting
Safe & Stable Families), referred to here as Other.
Findings
Statewide, CBC lead agencies spent nearly $490 million11 on child protective services
during FY04-05, as shown in Table 27. This amount represents a total expenditure that was
3.4% lower than the overall budget ($507 million) for lead agency services. Actual IV-E
expenditures ($125.5 million) were 8.1% lower than the budgeted amount. The IV-E spending
shortfall was the largest dollar contributor to the overall variance, while Other expenditures were
responsible for the highest percentage variance. Expenditures of state funds, which make up
9 The 16 lead agencies represent 17 services contracts (the Sarasota YMCA had 2 contracts for separateservice areas in the Suncoast Region).10 Expenditures that were incurred during FY04-05 but certified forward and not paid until FY05-06 wereincluded if recorded by December 31, 2005.11 FY04-05 expenditures (total and by funding source) for each lead agency are listed in Appendix 1.
84
the largest portion of the total budget for lead agency services, were 7.1% lower than the overall
budget.
Table 27. Budget Vs. Actuals, Statewide (FY04-05)
FFuunndd SSoouurrccee BBuuddggeett AAccttuuaall VVaarriiaannccee VVaarriiaannccee %%IV-E $ 127,051,899 $ 116,741,342 $ (10,310,557) -8.1%
TANF 70,149,125 71,893,800 $ 1,744,675 2.5%
State 236,383,820 219,586,995 $ (16,796,825) -7.1%
Other 73,502,524 81,548,331 $ 8,045,807) 10.9%
TOTAL $ 507,087,368 $ 489,770,468 $ (17,316,900) -3.4%
Nearly every lead agency spent less than its total budget for FY04-05 (see Figure 9).
Three lead agencies (HKI, PCBC and ChildNet) had total expenditures within 1% of their fiscal
year budget; HKI’s expenditures were within $1 of its total budget. Three other lead agencies
(BBCBC-2B, KCI, and FSSNF) spent within 2% of their total budget. Conversely, two lead
agencies had total expenditures that were over 10% under budget (Family Matters and CBKN).
85
Figure 9. Overall Variance % by Lead Agency, FY04-05
-16.4%
-14.1%
-9.7%
-7.9%
-7.0%
-6.1%
-5.6%
-4.3%
-4.3%
-3.4%
-3.3%
-3.0%
-1.9%
-1.8%
0.0%
-0.2%
-0.2%
-1.2%
-18.0% -16.0% -14.0% -12.0% -10.0% -8.0% -6.0% -4.0% -2.0% 0.0%
CBKN
Family Matters
St Johns
UFF
FSMO
CNSWF
FFN
HFC
YMCA South
STATEWIDE
YMCA North
CFC
FSSNF
KCI
BBCBC-2B
ChildNet
PCBC
HKI
There was considerably more lead agency variation in the distribution of IV-E variance
percentages, as shown in Figure 10. Two lead agencies spent IV-E dollars in excess of the
budget amount, while 15 lead agencies were unable to completely use their IV-E budgets. One
of the two lead agencies with excess IV-E expenditures overspent by less than 1% (HKI), while
the other (CFC) overspent their IV-E budget by over 11%. Two lead agencies had IV-E
expenditures within 1% of the budgeted amount (BBCBC-2B and PCBC). Six lead agencies
underspent their IV-E budget by more than 10%, while CBKN underspent its IV-E budget by
more than 28%. The statewide IV-E variance was -8.1%.
86
Figure 10. IV-E Variance Percentage by Lead Agency, FY04-05
-28.2%
-19.2%
-17.6%
-15.6%
-14.7%
-13.7%
-11.1%
-9.9%
-9.7%
-9.2%
-8.1%
-7.4%
-6.1%
0.6%
11.3%
-0.6%
-4.8%
-0.7%
-35.0% -30.0% -25.0% -20.0% -15.0% -10.0% -5.0% 0.0% 5.0% 10.0% 15.0%
CBKN
FFN
HFC
Family Matters
UFF
ChildNet
FSMO
St Johns
YMCA North
YMCA South
STATEWIDE
FSSNF
KCI
CNSWF
PCBC
BBCBC-2B
HKI
CFC
Conclusions
Nearly every lead agency with a CBC services contract during FY04-05 spent fewer
dollars than allocated. Overall variance percentages ranged from -0.0% (HKI) to –16.4%
(CBKN). The statewide variance percent for overall expenditures was -3.4%. Five lead agencies
underspent their total budget by 7% or more, and all five of those lead agencies were “new” lead
agencies during the prior fiscal year. These findings suggest there may be need for additional
training or technical assistance for lead agency or DCF fiscal staff during the early stage of new
services contracts.
The variance related to IV-E funds was considerably different than the overall variance.
Two of the 17 lead agencies spent more IV-E dollars than were appropriated, while the other 15
underspent their Title IV-E budget. The IV-E variance percent ranged from -28% to +11%.
Interestingly, the IV-E variance was the largest contributor to total variance for only 5 of the 17
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lead agencies, which suggests that IV-E spending restrictions are not the only reason that lead
agencies spent less than their overall budget.
Limitations
This analysis has a few limitations. The budget amounts and expenditures reported here
are limited to those reported to DCF, and do not reflect lead agency spending of non-DCF
resources (e.g., state Medicaid funding not directly tied to child welfare, locally generated
revenue). Another limitation of this budget variance analysis is that accounting data do not allow
us to assess whether underspending can be attributed to more efficient service provision,
withholding of necessary services, and/or restrictions on uses of funds. Future research should
investigate, via qualitative methods, the spending barriers faced by lead agencies to help
explain these baseline findings prior to the implementation of the IV-E waiver.
In conclusion, FY04-05 lead agency budget and expenditure data suggest that most lead
agencies failed to spend their entire IV-E budget. This finding, along with a similar analysis of all
lead agencies using FY05-06 data, provides a baseline measure to be compared with IV-E
variance after the waiver is implemented in FY06-07.
Policy Recommendations
• DCF fiscal staff should continue to monitor IV-E variances before and after the IV-E
waiver implementation.
• Although the spending flexibility associated with the IV-E waiver is expected to simplify
invoicing and the recording of services provided, DCF fiscal staff are encouraged to work
closely with lead agency fiscal staff during the IV-E waiver implementation to clarify
issues that arise regarding invoicing and the proper recording of new services.
• Further research is recommended to investigate the spending barriers faced by lead
agencies to help explain what appears to be underutilization of allocated funds.
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Conclusions & Policy Recommendations
The current evaluation of Community-Based Care (CBC) focused on safety and
permanency outcomes and indicators of quality (including child well-being indicators), as well as
providing baseline expenditure data in anticipation of the October 2006 start date for the
statewide implementation of the IV-E waiver. In addition, the evaluation included an extensive
description of the range of organizational structures comprising the network of CBC lead
agencies. Exploratory correlational analyses detected positive associations between certain
organizational characteristics, such as the number of counties within a lead agency’s jurisdiction
and cost-related outcomes, but failed to yield substantive findings for child outcomes. By
triangulating findings across evaluation components, the evaluation team was able to construct
a more informed and comprehensive picture of the strengths and challenges of Florida’s child
welfare system. Importantly, consistent themes emerged throughout the various components
comprising this evaluation; these themes are useful in identifying areas for system
improvement, as well as areas requiring more in-depth examination in the future.
For example, two child-level findings from the Child Outcomes section have implications
for system-level improvements, particularly in the areas of fiscal management and practice.
These key findings were:
• Reunification with families of origin (vs. discharge to other living arrangements) is the
strongest predictor of re-entry into out-of-home care by a factor of four.
• Children who experience caregiver absence or neglect are more likely to experience a
recurrence of maltreatment than children who experience other forms of initial
maltreatment.
The finding that caregiver absence and neglect predict recurrence of maltreatment is
consistent with findings from the Quality section about family engagement. Lead agencies
utilizing family conferencing models have demonstrated increased family engagement, which in
turn, has been associated with lower rates of re-entry into out-of-home care. Since a common
characteristic of both caregivers who are absent and those who neglect their children appears to
be lack of engagement, use of family conferencing models with these parents may be a
promising approach to improving outcomes for their children.
In addition, these families may benefit from the fiscal flexibility provided by the
implementation of the IV-E waiver October 2006, which was discussed in the Cost Section. Title
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IV-E funds, which previously had been earmarked exclusively for out-of-home care services, will
be allowed to be applied to in-home services that may prevent removal from the home. For
example, in cases of neglect, these funds could be used for homemaker services to prevent
children from being removed from their families solely due to hazardous conditions.
Similarly, the finding that reunification predicts reentry into out-of-home care suggests
that reunified families are not receiving the level of system support they need to maintain safety
for their children. Use of a family conferencing model is one approach to increase family
engagement with the services necessary to prevent a second removal of the child from the
home. Similarly, the new flexibility of IV-E funds may provide an avenue for lead agencies to
fund needed services post-reunification.
The services considered appropriate targets for re-allocation of Title IV-E funds will
invariably depend on the array of existing local resources in each community. A thorough
understanding of the scope and availability of these local resources is essential for ensuring that
families involved with the child welfare system receive the services they need in order to
progress. As reported in the Organizational Analysis section, lead agencies are actively
attending to their contractual requirements regarding the composition of their Boards of
Directors. It is expected that cultivating locally-based Board memberships will facilitate
appropriate resource allocation and responsiveness to community concerns.
In addition to these integrated policy recommendations, specific recommendations
based on the findings from each section of the evaluation are presented below:
Organizational Analysis
1) It is recommended that Board members continue to expand their understanding of the
organizations and processes affecting the child welfare system, including legislative
changes, the court process, the role of other community stakeholder groups (e.g.,
Community Alliance and faith-based organizations), and the contractual obligation of
most lead agencies to have 100% community membership on their Boards of Directors.
Where appropriate, specific training is recommended to supplement Board members’
existing knowledge base.
6) Lead agencies and the Department may wish to conduct some pilot projects in which
one of the governance entities is removed, in order to determine if this would create a
more efficient and streamlined reporting process.
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7) An investigation by the legislature and DCF is recommended to explore the potential
positive and negative effects of allowing parent organizations and providers to be
members of lead agency Boards of directors.
Programmatic Outcomes
8) It is highly recommended that newly-reunified families be provided additional services
and support throughout the first year after reunification to prevent a second reentry into
out-of-home care.
9) Findings indicate that being younger, male, or Caucasian is associated with a lower
likelihood of exiting out-of-home care within a timeframe consistent with federal
guidelines. Because the data used in these analyses did not allow examination of why
these demographic characteristics place children at heightened risk, further investigation
is recommended to better understand system-level influences that may account for
these findings.
Quality Performance
14) It is recommended that lead agencies should continue to develop and implement models
that further include families in the service planning process.
15) In addition, a forum should be established in which lead agencies and their case
management organizations can share promising practices (e.g., Family Team
Conferencing) and learn from each others’ successful practices.
16) Lead agencies and child welfare legal services should coordinate their efforts statewide
to clarify the legal issues surrounding family conferences and the need for
representation pre-adjudication.
17) Lead agencies should continue to include items related to involvement in the service
planning process on measures of customer satisfaction, not only for family members, but
for all community stakeholders.
18) It is recommended that the Department, through its Quality Management efforts (QM),
review the lead agency QM plans on a regular basis to assure their implementation with
a particular focus on the inclusion of families and caregivers in the service planning
process.
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Cost Analysis
19) DCF fiscal staff should continue to monitor IV-E variances before and after the IV-E
waiver implementation.
20) Although the spending flexibility associated with the IV-E waiver is expected to simplify
invoicing and the recording of services provided, DCF fiscal staff are encouraged to work
closely with lead agency fiscal staff during the IV-E waiver implementation to clarify
issues that arise regarding invoicing and the proper recording of new services.
21) Further research is recommended to investigate the spending barriers faced by lead
agencies to help explain what appears to be underutilization of allocated funds.
In addition to these policy recommendations based on the current report, five
recommendations from the Report to the Legislature Evaluation of the Department of Children
and Families Community-Based Care Initiative Fiscal Year 2003-2004 are still in the process of
being addressed:
To maximize timely exits from out-of-home care, lead agencies are encouraged to
review their policies regarding permanency staffings, service referrals for families of
origin, adoptive family recruitment, and other efforts that many facilitate the transition to
permanency.
The Florida Coalition should provide technical assistance by serving as a conduit for
dissemination of all existing forms and procedures utilized to measure customer
satisfaction so that lead agencies have a variety of assessment examples and options
as they develop their own local system.
Lead agencies are encouraged to review their staffing procedures and to examine the
purpose (rather than the title) of each staffing. When appropriate, lead agencies should
consider combining staffings that are held for similar purposes or with the same
participants.
Lead agencies should continue to take steps to actively involve families in conferences
and staffings in which decisions regarding case planning and permanency are made.
92
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Report to the Legislature Evaluation of the Department of Children and Families
Community-Based Care Initiative Fiscal Year 2003-2004
Armstrong, M., Jordan, N., Kershaw, M. A., Vargo, A., Wallace, F., & Yampolskaya, S. (2004).
Statewide Evaluation of Florida’s Community-Based Care: 2004 Final Report. Tampa, FL:
University of South Florida.
Barter, K. (2001). Building Community: A conceptual framework for child protection. Child Abuse
Review, 10, p.262-278.
Center for the Study of Social Policy. (1998). Creating a Community Agenda: How governance
partnerships can improve results for children, youth, and families.
Child Welfare System Performance Mixed in First Year of Statewide Community-Based Care,
Report No. 06-50, June 2006
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155-159.
Cowan, K. (2006). Heartland for Children Summary.
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http://www.netLibrary.com/urlapi.asp?action=summary&v=1&bookid=67240
Fred H. Wulczyn, F. H., Hislop, K. B., & Goerge, R. M. (2000). A Report from the Multistate
Foster Care Data Archive. ILL: Chicago: Chapin Hall Center for Children at the University of
Chicago
Hall, R.M. (1996). Organizations: Structures, processes, and outcomes. Prentice Hall,
Englewood Cliffs, NJ.
Hoagwood, K. W. (2005). Family-based services in chidren's mental health: a research review
and synthesis. Journal of Child Psychology and Psychiatri, 46(7), 690-713.
Robbins, S.P. (1987). Organization Theory: Structure, Design, and Applications. Prentice Hall,
Englewood Cliffs, NJ.
State of Florida Department of Children & Families, Office of Provider Relations (2006).
Community-Based Care Governance Agreements, Tallahassee, FL.
State of Florida Department of Children and Families. (1998). Allegation Matrix. Tallahassee,
FL:
93
U.S. Department of Health and Human Services, Administration on Children, (2005). Child
Maltreatment 2003. Washington, DC: U.S. Government Printing Office.
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(2004) Summary of the results of the 2001-2004 child and family services reviews.
Retrieved October 25, 2004 from www.acf.hss.gov/programs/cb/cwrp/results.htm
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Administration of Children Youth and Families, Children’s Bureau (1998). Child welfare
outcomes 1998: Annual report. Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services, National Center on Child Abuse and Neglect.
(1997). Child maltreatment 1995: Reports from the states to the national child abuse and
neglect data system. Washington, DC: U.S. Government Printing Office.
Van Slyke, D.M. (2003). The mythology of privatization in contracting for social services. Public
Administration Review, 63(3), 296-315.
Vargo, A.. Armstrong, M., Jordan, N., Kershaw, M., Pedraza, J., Romney, S., Yampolskya, S.
(2006). Report to the Legislature Evaluation of the Department of Children and Families
Community-Based Care Initiative Fiscal Year 2004-2005. Tampa, FL: University of
South Florida.
94
Appendix A.
Table 1. Results of Cox Regression. Sociodemographic Predictors of Delayed Discharge
for Children Served in FY04-05 (Multivariate Model)
Children Exiting Out-of-HomeCare (N = 50,025)
B χ2(1) Odds Ratio
Age .02 139.93* 1.02
Gender .08 36.77* 1.09
Minority status .31 492.37* 1.36
Note. *p < .05.
Table 2. Results of Cox Regression. Reasons for Discharge as Predictors for Longer Stay in
Out-of-Home Care for Children Served (Multivariate Model)
Children Exiting Out-of-HomeCare (N = 50,025)
B χ2(1) Odds Ratio
Reunification 2.17 19654.47* 8.73
Placement with relatives 1.85 11471.15* 6.39
Adoption 0.93 1954.50* 2.54
Note. *p < .05.
Table 3. Results of Cox Regression. Sociodemographic Predictors of Discharge
Based on Entry Cohort FY03-04 (Multivariate Model)
Children Exiting Out-of-HomeCare (N = 29,387)
B χ2(1) Odds RatioAge .02 134.13* 1.02Gender -.03 2.31 .97Minority status -.07 11.90* .94
Note. *p < .05.
95
Table 4. Results of Cox Regression. Reasons for Discharge as Predictors for Longer Stay inOut-of-Home care Based on Entry Cohort FY03-04 (Multivariate Model).
Children Exiting Out-of-HomeCare (N = 29,387)
B χ2(1) Odds RatioReunification 2.52 7562.81* 12.34Placement withrelatives 2.19 4905.93* 8.95
Adoption 1.71 1016.13* 5.52Note. *p < .05.
Table 5. Predictors for Reentry Into Out-of-Home Care.Exit Cohorts FY03-04. N = 21,131 (Multivariate Model).
B χ2(1) Exp(B)
Gender 0.03 0.35 1.03
Minority Status -0.24 29.89* 0.79
AGE -0.02 25.53* 0.98
Reunification 1.27 200.07* 3.55
Placement with
relatives0.38 14.83* 1.47
Adoption -2.50 98.65* 0.09
Note. *p < .05.
Table 6. Results of Cox Regression. Predictors of Maltreatment Recurrence Based onFY03-04 Cohort (N = 130,377)
Children Exiting Out-of-HomeCare (N = 130,377)
B χ2(1) Odds Ratio
Age -0.01 1.1.1 1.00
Gender 0.01 0.01 1.00
Minority status -0.35 334.76* 0.70 (1.42)
Absence of a caregiver 0.19 22.81* 1.22
Harm -0.26 178.52* 0.77
Neglect 0.30 237.33* 1.35
Abuse -0.07 10.52* 0.93
Note. *p < .05.
96
Table 7. Multilevel Model Results – Length of Stay in Out-of-Home Care (FY03-04 Entry Cohort)
B SE pseudo-z β
Risk factors within county
Gender 0.092 0.027 7.04* 0.90
Age 0.020 0.003 3.38* 0.39
Minority Status 0.011 0.033 0.35 0.05
Risk factors between counties
Average expenditures
per child
0.00 0.00 -0.64 -1.00
Average expenditures
per child/day
0.01 0.01 0.71 1.00
Table 8. Multilevel Model Results – Length of Stay in Out-of-Home Care for Children Served in
FY04 - 05
B SE pseudo-z β
Risk factors within county
Gender 0.15 0.02 9.37* 0.47
Age 0.02 0.01 3.07* 0.55
Minority Status -0.21 0.03 -6.59* -0.65
Risk factors between counties
Average expenditures
per child
0.00 0.00 -2.49* 1.00
Average expenditures
per child/day
-0.01 0.01 -0.69 -1.00
97
Table 9. Multilevel Model Results – Time to Reentry into Out-of-Home Care (FY03 – 04 Exit
Cohort)
B SE pseudo-z β
Risk factors within county
Gender -0.01 0.05 -0.05 -0.02
Age -0.01 0.01 -1.91 -0.82
Minority Status -0.08 0.06 -1.26 -0.60
Risk factors between counties
Average expenditures
per child
0.00 0.00 -3.18* -1.00
Average expenditures
per child/day
-0.03 0.01 -2.55* -1.00
98
Appendix B. On-Site Case Staffing Observation Form
CBC Evaluation FY05-06Case Staffing Observation Form
Date of Staffing:Caregiver interview: Y N
Team Members Present (by role)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Life Domain Areas addressed:
Family
Safety
Legal
Cultural/Spiritual
Educational
Vocational
Medical/Self-Care
Mental Health
Substance Abuse
Residential
Social/Recreational
Other team members (by role) & reasons unable
to attend:
1.
2.
3.
4.
5.
Comments related to attendance:
Comments related to content of staffing:
General comments:
Type of Staffing (e.g., permanency, ESI, etc.):
Location
Polk County
Hardee County
Highlands County
Orange County
Osceola County
99
Families have enhanced capacity to provide for theirchildren’s needs.
Convenient arrangements Y N NA
for family’s presence at
meeting are made (e.g.,
location, time, transportation,
day care arrangements).
The caregiver/child is seated Y N NA
or invited to sit where he/she
can be included in the
discussion.
Individuals (non-professionals) Y N
important to the family are present
at the meeting.
Family members are Y N NA
involved in designing the
plan of care.
If an initial plan of care meeting, Y N NA
the caregiver is asked what treatments
or interventions he/she felt worked/
did not work in the past.
Strengths of family members Y N
are identified and discussed at
the meeting.
The family is asked what Y N NA
goals they would like to
work on.
The caregiver is asked about Y N NA
the types of services or
resources/interventions he/she
would prefer for his/her family.
Family counselor advocates Y N
for services and resources for the
family (e.g., identifies and
argues for necessary services).
All services needed by family Y N
are included in plan (i.e., no
needed services were not
100
offered).
In the plan, the family and team Y N NA
members are assigned (or asked)
tasks and responsibilities that
promote the family’s independence
(e.g., accessing resources on own,
budgeting, maintaining housing).
Family members voice Y N NA
agreement/disagreement
with plan of care.
Children receive appropriate services to meet theireducational needs.Is attention paid to academic Y N NA
achievement?
Is attention paid to school Y N NA
behavior?
Is attention paid to school Y N NA
attendance?
Are any referrals generated Y N NA
pertaining to educational needs?
If yes, does the child/caregiver have Y N NA
opportunity to discuss options?
Children receive adequate services to meet their physical and
mental health needs.
Was there any discussion of physical Y N NA
health needs for the child?
Were appropriate referrals made for Y N NA
physical health care services?
Were there any discussions regarding Y N NA
mental health needs of the child?
Were there any discussion regarding Y N NA
mental health needs of any family
members?
Were appropriate referrals made for Y N NA
mental health services?
101
Were there any discussions regarding Y N NA
substance use needs of the child?
Were there any discussion regarding Y N NA
substance use needs of any family
members?
Were appropriate referrals made for Y N NA
substance abuse services?
Did the child/caregiver have the Y N NA
opportunity to discuss options and/or
preferences for referrals?
General Process
What process is used to facilitate the meeting (i.e., family
group conferencing or family team conference)?
Is this process explained to attendees? Y N NA
Who presents the family’s perspective (e.g., caregiver, care
manager, etc.)?
Does any part of the discussion regarding Y N NA
the family occur without all parties in the
room?
If yes, is this planned? Explain.
General comments regarding observation:
102
Appendix C. Budget & Actual Expenditures by Lead Agency and Funding Source, FY04-05.Lead Agency Budget Amt Expenditures VarianceVariance %
FFN IV-E $ 7,084,108 $ 5,722,496 $ (1,361,612) -19.2%
TANF $ 5,785,204 $ 5,733,981 $ (51,223) -0.9%
State $ 11,133,570 $ 11,214,073 $ 80,503 0.7%
Other $ 4,263,153 $ 4,004,822 $ (258,331) -6.1%
Total $ 28,266,035 $ 26,675,372 $ (1,590,663) -5.6%
PFF - D2A IV-E $ 1,891,841 $ 1,800,979 $ (90,862) -4.8%
TANF $ 1,278,780 $ 1,902,426 $ 623,646 48.8%
State $ 3,780,296 $ 2,684,390 $ (1,095,906) -29.0%
Other $ 1,064,993 $ 1,493,634 $ 428,641 40.2%
Total $ 8,015,910 $ 7,881,429 $ (134,481) -1.7%
BBCBC - D2B IV-E $ 3,065,172 $ 3,046,830 $ (18,342) -0.6%
TANF $ 2,003,323 $ 2,332,654 $ 329,331 16.4%
State $ 5,909,250 $ 5,311,633 $ (597,617) -10.1%
Other $ 1,749,048 $ 1,877,692 $ 128,644 7.4%
Total $ 12,726,793 $ 12,568,809 $ (157,984) -1.2%
PFSF - D3 IV-E $ 5,010,007 $ 4,841,523 $ (168,484) -3.4%
TANF $ 3,611,060 $ 2,741,101 $ (869,959) -24.1%
State $ 8,959,093 $ 9,379,491 $ 420,398 4.7%
Other $ 2,306,202 $ 1,973,526 $ (332,676) -14.4%
Total $ 19,886,362 $ 18,935,642 $ (950,720) -4.8%
CBKN - D4 IV-E $ 1,718,870 $ 1,234,840 $ (484,030) -28.2%
TANF $ 934,219 $ 760,116 $ (174,103) -18.6%
State $ 3,213,453 $ 2,813,045 $ (400,408) -12.5%
Other $ 967,870 $ 908,088 $ (59,782) -6.2%
Total $ 6,834,412 $ 5,716,088 $ (1,118,324) -16.4%
FSSNF - D4 - Duval IV-E $ 8,280,499 $ 7,668,590 $ (611,909) -7.4%
TANF $ 4,240,201 $ 4,038,004 $ (202,197) -4.8%
State $ 14,947,410 $ 14,749,569 $ (197,841) -1.3%
Other $ 4,338,056 $ 4,748,134 $ 410,078 9.5%
Total $ 31,806,166 $ 31,204,297 $ (601,869) -1.9%
103
Family Matters - D4 - Nassau IV-E $ 552,305 $ 466,112 $ (86,193) -15.6%
TANF $ 290,548 $ 215,205 $ (75,343) -25.9%
State $ 1,010,609 $ 859,127 $ (151,482) -15.0%
Other $ 299,797 $ 309,605 $ 9,808 3.3%
Total $ 2,153,259 $ 1,850,049 $ (303,210) -14.1%
St Johns - D4 IV-E $ 1,023,448 $ 921,923 $ (101,525) -9.9%
TANF $ 569,503 $ 522,423 $ (47,080) -8.3%
State $ 1,959,439 $ 1,725,519 $ (233,920) -11.9%
Other $ 615,354 $ 592,402 $ (22,952) -3.7%
Total $ 4,167,744 $ 3,762,267 $ (405,477) -9.7%
YMCA North - SR (PP) IV-E $ 11,011,517 $ 9,947,611 $ (1,063,906) -9.7%
TANF $ 5,668,507 $ 4,858,290 $ (810,217) -14.3%
State $ 19,532,639 $ 19,335,186 $ (197,453) -1.0%
Other $ 6,147,422 $ 6,823,034 $ 675,612 11.0%
Total $ 42,360,085 $ 40,964,120 $ (1,395,965) -3.3%
HKI - SR IV-E $ 13,530,221 $ 13,612,678 $ 82,457 0.6%
TANF $ 6,229,973 $ 5,891,415 $ (338,558) -5.4%
State $ 24,179,234 $ 22,710,250 $ (1,468,984) -6.1%
Other $ 7,516,778 $ 9,241,862 $ 1,725,084 22.9%
Total $ 51,456,206 $ 51,456,205 $ (1) 0.0%
YMCA South - SR IV-E $ 5,828,928 $ 5,291,826 $ (537,102) -9.2%
TANF $ 2,104,360 $ 2,760,081 $ 655,721 31.2%
State $ 10,278,355 $ 8,864,091 $ (1,414,264) -13.8%
Other $ 2,963,309 $ 3,351,611 $ 388,302 13.1%
Total $ 21,174,952 $ 20,267,609 $ (907,343) -4.3%
FSMO - D7 IV-E $ 9,593,762 $ 8,531,280 $ (1,062,482) -11.1%
TANF $ 3,595,653 $ 5,831,671 $ 2,236,018 62.2%
State $ 21,069,734 $ 14,590,508 $ (6,479,226) -30.8%
Other $ 5,515,142 $ 8,032,410 $ 2,517,268 45.6%
Total $ 39,774,291 $ 36,985,869 $ (2,788,422) -7.0%
104
Brevard - D7 IV-E $ 307,174 $ 11,113 $ (296,061) -96.4%
TANF $ 226,863 $ 180,063 $ (46,800) -20.6%
State $ 713,961 $ 1,352,394 $ 638,433 89.4%
Other $ 417,715 $ 71,407 $ (346,308) -82.9%
Total $ 1,665,713 $ 1,614,976 $ (50,737) -3.0%
Seminole - D7 IV-E $ 1,648,299 $ 1,425,091 $ (223,208) -13.5%
TANF $ 1,500,276 $ 1,529,562 $ 29,286 2.0%
State $ 4,334,352 $ 4,425,022 $ 90,670 2.1%
Other $ 1,360,073 $ 1,454,249 $ 94,176 6.9%
Total $ 8,843,000 $ 8,833,925 $ (9,075) -0.1%
CNSWF - D8 IV-E $ 5,583,405 $ 5,317,288 $ (266,117) -4.8%
TANF $ 3,184,852 $ 3,098,792 $ (86,060) -2.7%
State $ 11,070,232 $ 10,065,596 $ (1,004,636) -9.1%
Other $ 3,393,553 $ 3,323,160 $ (70,393) -2.1%
Total $ 23,232,042 $ 21,804,837 $ (1,427,205) -6.1%
CFC - D9 IV-E $ 8,452,134 $ 9,406,003 $ 953,869 11.3%
TANF $ 3,509,004 $ 2,414,613 $ (1,094,391) -31.2%
State $ 15,723,508 $ 15,199,036 $ (524,472) -3.3%
Other $ 4,898,666 $ 4,578,490 $ (320,176) -6.5%
Total $ 32,583,312 $ 31,598,142 $ (985,170) -3.0%
ChildNet - D10 IV-E $ 16,795,760 $ 14,496,796 $ (2,298,964) -13.7%
TANF $ 5,914,052 $ 6,853,755 $ 939,703 15.9%
State $ 29,698,855 $ 27,631,010 $ (2,067,845) -7.0%
Other $ 10,124,271 $ 13,442,926 $ 3,318,655 32.8%
Total $ 62,532,938 $ 62,424,488 $ (108,450) -0.2%
Our Kids - D11 IV-E $ 1,075,413 $ 941,847 $ (133,566) -12.4%
TANF $ 1,371,537 $ 632,272 $ (739,265) -53.9%
State $ 2,447,259 $ 2,358,303 $ (88,956) -3.6%
Other $ 780,577 $ 815,018 $ 34,441 4.4%
Total $ 5,674,786 $ 4,747,440 $ (927,346) -16.3%
PCBC - D12 IV-E $ 5,266,398 $ 5,229,986 $ (36,412) -0.7%
105
TANF $ 2,592,519 $ 2,751,536 $ 159,017 6.1%
State $ 9,421,547 $ 9,607,618 $ 186,071 2.0%
Other $ 3,186,493 $ 2,846,300 $ (340,193) -10.7%
Total $ 20,466,957 $ 20,435,439 $ (31,518) -0.2%
KCI - D13 IV-E $ 6,730,755 $ 6,321,941 $ (408,814) -6.1%
TANF $ 6,325,338 $ 6,343,408 $ 18,070 0.3%
State $ 14,574,313 $ 14,061,207 $ (513,106) -3.5%
Other $ 4,223,616 $ 4,548,116 $ 324,500 7.7%
Total $ 31,854,022 $ 31,274,673 $ (579,349) -1.8%
HFC - D14 IV-E $ 8,335,128 $ 6,864,050 $ (1,471,078) -17.6%
TANF $ 6,053,417 $ 7,684,529 $ 1,631,112 26.9%
State $ 15,249,958 $ 13,684,613 $ (1,565,345) -10.3%
Other $ 4,917,022 $ 4,830,897 $ (86,125) -1.8%
Total $ 34,555,525 $ 33,064,088 $ (1,491,437) -4.3%
UFF - D15 IV-E $ 4,266,755 $ 3,640,537 $ (626,218) -14.7%
TANF $ 3,159,936 $ 2,817,903 $ (342,033) -10.8%
State $ 7,176,753 $ 6,965,316 $ (211,437) -2.9%
Other $ 2,453,414 $ 2,280,948 $ (172,466) -7.0%
Total $ 17,056,858 $ 15,704,703 $ (1,352,155) -7.9%
Statewide combined IV-E $ 127,051,899 $ 116,741,342 $(10,310,557) -8.1%
TANF $ 70,149,125 $ 71,893,800 $ 1,744,675 2.5%
State $ 236,383,820 $ 219,586,995 $(16,796,825) -7.1%
Other $ 73,502,524 $ 81,548,331 $ 8,045,807 10.9%
Total $ 507,087,368 $ 489,770,468 $(17,316,900) -3.4%