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


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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.

viii

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

xii

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

5

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

6

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?

7

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


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


CEO Survey

Site Visits

8

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


Single Point of AccessPasco &Pinellas

Counties

Single Point of AccessSarasota, Manatee &

DeSoto Counties

Assistant SinglePoint of Access


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

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aa nnii zz

aa ttii oo

nn

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nn

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nn ttyy

MMuu ll

tt ii --CC

oo uunn tt

yy

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eeMM

aa nnaa gg

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tt

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tt rr aacc tt

CCaa ss

eeMM

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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.


• It is recommended that Board members continue to expand their understanding of the







• Lead agencies and the Department may wish to conduct some pilot projects in which



31

• An investigation by the legislature and DCF is recommended to explore the potential



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):


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


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


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


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


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


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


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.


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.


• It is recommended that Board members continue to expand their understanding of the







• Lead agencies and the Department may wish to conduct some pilot projects in which



• An investigation by the legislature and DCF is recommended to explore the potential



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?


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

62

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


• It is recommended that lead agencies should continue to develop and implement models


• In addition, a forum should be established in which lead agencies and their case



• Lead agencies and child welfare legal services should coordinate their efforts statewide



• Lead agencies should continue to include items related to involvement in the service



• It is recommended that the Department, through its Quality Management efforts (QM),



process.

65

Research Question 4: What factors affect child outcomes?



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


HSnWhat factors affectchild outcomes?

What factors areassociated withrecurrence ofmaltreatment?

• Proportion of childrenwith maltreatmentrecurrence within 12months afterexperiencing their firstepisode


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.


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

72

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


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.


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

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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


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).


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).


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


• It is highly recommended that newly-reunified families be provided additional services


out-of-home care.

• Findings indicate that being younger, male, or Caucasian is associated with a lower





these findings.

82

Research Question 5: What is the short and long-term effectiveness of lead agencies at

managing resources and cost?



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

87

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.


• DCF fiscal staff should continue to monitor IV-E variances before and after the IV-E


• Although the spending flexibility associated with the IV-E waiver is expected to simplify




• Further research is recommended to investigate the spending barriers faced by lead


88

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

89

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







6) Lead agencies and the Department may wish to conduct some pilot projects in which



90

7) An investigation by the legislature and DCF is recommended to explore the potential



Programmatic Outcomes

8) It is highly recommended that newly-reunified families be provided additional services


out-of-home care.

9) Findings indicate that being younger, male, or Caucasian is associated with a lower





these findings.

Quality Performance

14) It is recommended that lead agencies should continue to develop and implement models


15) In addition, a forum should be established in which lead agencies and their case



16) Lead agencies and child welfare legal services should coordinate their efforts statewide



17) Lead agencies should continue to include items related to involvement in the service



18) It is recommended that the Department, through its Quality Management efforts (QM),



process.

91

Cost Analysis

19) DCF fiscal staff should continue to monitor IV-E variances before and after the IV-E


20) Although the spending flexibility associated with the IV-E waiver is expected to simplify




21) Further research is recommended to investigate the spending barriers faced by lead


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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Statewide Evaluation of Florida’s Community-Based Care: 2004 Final Report. Tampa, FL:

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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,

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U.S. Department of Health and Human Services, Administration on Children, (2005). Child

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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)


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)


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).


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)


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


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


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



per child

0.00 0.00 -2.49* 1.00


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


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



per child

0.00 0.00 -3.18* -1.00


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?


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?


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%

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