• TABLE OF CONTENTS
HIDE
 Front Cover
 Membership of the commission
 Title Page
 Table of Contents
 List of Tables
 Acknowledgement
 Introduction
 Methodology
 Background
 Demographic information
 Child poverty
 Health and health care
 Prenatal care
 Teen pregnancy
 Substance abuse among pregnant...
 Preventive health care
 Abuse and neglect
 Homelessness
 Emotional and cognitive develo...
 Out-of-home placements
 Concerns of foster parents
 The role of child protective investigations...
 The role of state attorney offices...
 Reference
 Meeting agendas
 Charge














Title: Report of the Study Commission on Child Welfare
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Permanent Link: http://ufdc.ufl.edu/UF00075698/00002
 Material Information
Title: Report of the Study Commission on Child Welfare
Physical Description: 2 v. : ; 28 cm.
Language: English
Creator: Florida -- Study Commission on Child Welfare
Publisher: The Commission
Place of Publication: Tallahassee
Publication Date: 1991
 Subjects
Subject: Child welfare -- Florida   ( lcsh )
Family services -- Florida   ( lcsh )
Family policy -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
non-fiction   ( marcgt )
 Notes
General Note: "March, 1991."
 Record Information
Bibliographic ID: UF00075698
Volume ID: VID00002
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 23750243

Table of Contents
    Front Cover
        Front Cover
    Membership of the commission
        Membership
    Title Page
        Title Page 1
        Title Page 2
    Table of Contents
        Page i
        Page ii
    List of Tables
        Page iii
        Page iv
    Acknowledgement
        Page v
    Introduction
        Page 1
    Methodology
        Page 2
    Background
        Page 3
        Page 4
        Page 5
    Demographic information
        Page 6
        Page 7
    Child poverty
        Page 8
        Page 9
        Page 10
        Page 11
    Health and health care
        Page 12
        Page 13
        Page 14
        Page 15
    Prenatal care
        Page 16
        Page 17
    Teen pregnancy
        Page 18
        Page 19
    Substance abuse among pregnant women
        Page 20
        Page 21
    Preventive health care
        Page 22
        Page 23
    Abuse and neglect
        Page 24
        Page 25
        Page 26
        Page 27
    Homelessness
        Page 28
    Emotional and cognitive development
        Page 29
    Out-of-home placements
        Page 30
        Page 31
        Page 32
    Concerns of foster parents
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
    The role of child protective investigations in abuse and neglect investigations
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
    The role of state attorney offices in the prosecution of child abuse and neglect
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
    Reference
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
    Meeting agendas
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
    Charge
        Page 82
        Page 83
Full Text











REPORT OF THE


STUDY COMMISSION ON


CHILD WELFARE









PART TWO


BACKGROUND AND FINDINGS









MARCH, 1991


HV
742
.F6
F671
1991
pt.2


1







MEMBERSHIP OF THE COMMISSION


The Honorable Rosemary Barkett, Chair
Justice Florida Supreme Court
Supreme Court Building
Tallahassee, FL



The Honorable William Bankhead
Member Florida Senate
Jacksonville, FL


William Bentley, Executive Director
Florida Network for Youth
& Family Services
Tallahassee, FL


The Honorable Corrine Brown
Member House of Represnetatives
Jacksonville, FL


The Honorable Lois Frankel
Member House of Representatives
West Palm Beach, FL



The Honorable Carolyn Fulmer
Judge 10th Judicial Circuit Court
Bartow, FL


The Honorable William Gladstone
Judge 11th Judicial Circuit Court
Miami, FL


The Honorable James Hill
Member House of Representatives
Hobe Sound, FL


Jay Kassack, Asst. Secretary
Children Youth & Family Services
Florida Department of Health and
Rehabilitative Services
Tallahassee, FL


H. Mary McKeown, Esq.
Growney, McKeown and Barber
St. Petersburg, FL


Donald Middlebrooks, Esq.
Steel, Hector & Davis
Miami, FL



Dianna Morgan, Vice President for
Governmental Relations
Walt Disney World
Lake Buena Vista, FL

The Honorable Eleanor Weinstock
Member Florida Senate
West Palm Beach, FL



Christina Zawisza, Esq.
Florida Legal Services Corporation
Miami, FL


Carole Zegel
State Guardian Ad Litem Program
Gainesville, FL















REPORT OF THE


STUDY COMMISSION ON


CHILD WELFARE










PART TWO

BACKGROUND AND FINDINGS










MARCH, 1991


-j


r~"'"'
5-, I


r












MEMBERSHIP OF THE COMMISSION


The Honorable Rosemary Barkett, Chair
Justice Florida Supreme Court
Supreme Court Building
Tallahassee, FL


The Honorable William Bankhead
Member Florida Senate
Jacksonville, FL

William Bentley, Executive Director
Florida Network for Youth
& Family Services
Tallahassee, FL

The Honorable Corrine Brown
Member House of Representatives
Jacksonville, FL


The Honorable Lois Frankel
Member House of Representatives
West Palm Beach, FL

The Honorable Carolyn Fulmer
Judge 10th Judicial Circuit Court
Bartow, FL

The Honorable William Gladstone
Judge 11th Judicial Circuit Court
Miami, FL

The Honorable James Hill
Member House of Representatives
Hobe Sound, FL


Jay Kassack, Asst. Secretary
Children, Youth & Family Services
Florida Department of Health and
Rehabilitative Services
Tallahassee, FL

H. Mary McKeown, Esq.
Growney, McKeown and Barber
St. Petersburg, FL

Donald Middlebrooks, Esq.
Steel, Hector & Davis
Miami, FL


Dianna Morgan, Vice President for
Governmental Relations
Walt Disney World
Lake Buena Vista, FL

The Honorable Eleanor Weinstock
Member Florida Senate
West Palm Beach, FL

Christina Zawisza, Esq.
Florida Legal Services Corporation
Miami, FL

Carole Zegel
State Guardian Ad Litem Program
Gainesville, FL








TABLE OF CONTENTS

Introduction 1
Methodology 2
The State of Florida's Children
and Selected Characteristics of the
Service Delivery System
Background 3
Demographic Information 6
Child Poverty 8
Health and Health Care 12
Prenatal Care 16
Teen Pregnancy 18
Substance Abuse Among 20
Pregnant Women
Preventive Health Care 22
Abuse and Neglect 24
Homelessness 28
Emotional and Cognitive 29
Development
Out-Of-Home Placements 30
Concerns of Foster Parents 33
The Role of the Child 43
Protective Investigator in
Abuse and Neglect
Investigations
The Role of the State 55
Attorney Offices in Abuse
and Neglect Investigations







APPENDICES


PAGE


A. References


B. Meeting Agendas


C. Charge









LIST OF TABLES

TABLE PAGE


1. Distribution of Children by Age Ranges and 7
Fiscal Year
2. Comparison of Floridians Living Below the 8
Poverty Level by Age Range, Based on 1987
Income
3. Indicators of Child Poverty in Florida and the 10
United States, 1979-1988
4. Percentage of Children Below the Poverty 11
Level Living in Florida Counties Which Do
Not Have School Breakfast Programs
5. Comparison of the Infant Mortality Rates for 12
the United States and Selected Countries
6. Indicators of Infant and Child Health for 13
Florida and the United States, 1979-1988
7. Florida Infant Mortality Rates for 1983-1988, 14
Including White and Non-White Rates
8. Low-Weight Births in Florida for 1983-1987, 15
Including White and Non-White Low-Weight
Births
9. Percentage of Entry Into Prenatal Care by 15
Trimester in Florida, 1983-1987
10. Infant Mortality Among Florida IPO and 17
Non-IPO Women, 1986-1988
11. Percentage of Those Who Lack Health 23
Insurance Coverage by Age in Florida and
the United States for 1987
12. Demographic Characteristics of Child Victims 24
with at Least One Neglect Maltreatment,
1989-1990
13. Demographic Characteristics of Child Victims 25
with at Least One Physical Abuse
Maltreatment, 1989-1990
14. Demographic Characteristics of Child Victims 26
with at Least One Sexual Abuse
Maltreatment, 1989-1990




m








LIST OF TABLES

TABLE PAGE


15. Comparison of Child Deaths by Fiscal 27
Year and Age
16. Return Rate (By District) of Foster 34
Parent Questionnaire
17. Capacity of Florida Foster and Shelter Homes 35
18. Frequency of Caseworkers Visits by HRS 36
District
19. Problems with Medicaid Cards by HRS District 40






ACKNOWLEDGEMENTS


During the November, 1989 Special Session, the Florida Legislature
appropriated resources to staff and fund the Study Commission on Child
Welfare, and directed the Florida Mental Health Institute (FMHI) at the
University of South Florida to provide staffing and administrative support
for this Commission.

The Commission wishes to recognize the efforts of FMHI Dean Max C.
Dertke, Ph.D., and Robert Friedman, Ph.D., Chairman of the FMHI
Department of Epidemiology and Policy Analysis for their support of the
Commission's work. The University graciously underwrote the cost of
administrative services for this project so that all of the funding received
from the Legislature directly supported the work of the Commission. Dr.
Dertke made numerous members of the faculty and support services
available to assist Commission staff in specialized areas of child mental
health, child abuse, and the training which is provided to individuals
working with children. Dr. Friedman offered his particular expertise in
child mental health issues and chaired a workgroup on state and local
initiatives for children's services as well.

The Commission also wishes to thank Christian H. Giblin, Ph.D., Staff
Director, for her leadership, innovative thinking and dedication. These
factors have played a major role in the development of this document. We
also thank Mary Lewis, Staff Assistant, Patricia Richardson and Brenda
Wood, Research Assistants, and Tim Alberts, Audio/Visual Specialist, for
their capable efforts in producing this report.


V








INTRODUCTION


The Florida Legislature created the Study Commission on Child Welfare
during a Special Legislative Session in November, 1989, after the deaths
of several children in state care. This Commission was directed to review
five state laws (Chapters 39, 63, 402, 409 and 415, F.S., relating to
dependency, delinquency, adoption, the guardian ad litem program, child
abuse and neglect, child care facilities, human services, and social and
economic services). In addition to these laws, the Commission was
instructed to review other state laws and programs relating to the child
welfare system and to address additional areas which are pertinent to that
system. The Commission was charged with making recommendations
which would ensure that state laws provide effective protection for children.
The recommendations were presented in March 1991 to the Governor, the
Senate President, the Speaker of the House of Representatives, and the
Chief Justice of the Supreme Court.

These recommendations are contained in Part One of the Commission's
report. Part Two contains the background information and data which form
the basis for these recommendations, the composition of the Commission,
agendas from the fourteen public meetings, and the Charge to the
Commission.

The Commission examined the state laws and policies which affect services
to children and their families, the services which are available, and the
extent to which resources are provided to address the unmet need. A
description of the characteristics of Florida children was developed; the
Commission considered reports of the Florida Bar Commission on Children,
the Advocacy Center for Persons with Disabilities, the American Bar
Association, the Center for the Study of Social Policy, the Children's
Defense Fund, the Governor's Constituency for Children, and, by holding
public hearings, listened to the concerns and viewpoints of parents,
interested citizens and professionals affected by the well-being of children.









METHODOLOGY



At the first Commission meeting, members identified the activities to be
undertaken in carrying out the charge. These included reviewing state and
federal laws, identifying the legislative intent regarding the state's
involvement with children and their families, and exploring specific aspects
of the child welfare system. With respect to the latter, members were
interested in such topics as services to support and preserve families,
turnover rates for staff who work with children, the adequacy of out-of-
home placements, the role of the state attorney offices, the termination of
parental rights, the concerns of foster parents, and the use of detention
programs. Members also requested that staff develop a description of the
state of Florida's children in terms of their social and economic status and
their physical and mental health, and a description of selected characteristics
of the service delivery system.

Data were provided by the Florida Legislature, the Florida Departments of
Education (DOE) and Health and Rehabilitative Services (HRS), and
various state and national organizations such as the Florida Center for
Children and Youth, the Advocacy Center for Persons with Disabilities, the
Children's Defense Fund, and the Center for the Study of Social Policy.
When information was not readily available, it was collected by
Commission staff. The Commission surveyed child protective investigators,
district detention programs, foster parents, and state attorney offices. These
data were analyzed using the Statistical Package for the Social Sciences
(SPSS, 1988), utilizing the Wylbur mainframe system at the University of
South Florida. Footnotes for Tables in this report are printed at the bottom
of each page.







THE STATE OF FLORIDA'S CHILDREN AND
SELECTED CHARACTERISTICS OF THE SERVICE
DELIVERY SYSTEM



BACKGROUND

Over the past thirty years, significant changes have occurred, not only in
the structure of the American family, but also in the communities in which
they live. In the past, the average family consisted of a father working
outside the home, a mother who worked inside the home, and between two
and five children. Multiple generations of families lived near or with each
other, providing contact for the children with adults other than their
parents.

Today, with the growing mobility of Americans and the increasing number
of families headed by single parents, the "average" family no longer exists.
Children are more likely to live with one parent in a different town than the
one in which their grandparents or other relatives live. They go to a school
which is probably larger than the one their parents attended (and which is
usually not located near their home), and may find themselves, at the end
of the school day, returning to an empty house.

Failing to meet the needs of a child during the developmental period has
significant, undesirable consequences, yet Florida children are more likely
than ever before to be at risk. They are more likely than any other age
group to live in poverty and, even if the family has adequate financial
means, the children may not have caring adults in their lives who are able
to devote the time and energy to help them develop as human beings.

Although changes have occurred in the family and in society, the basic
needs of children have not changed. From birth to adulthood, children have
certain needs which must be met. These include the need for medical care,
nutrition and protection from harm, and the opportunity for aesthetic,
emotional and cognitive development. Without adequate nutrition and
prenatal care, a mother may not give birth to a healthy infant. The wrong
types (or inadequate amounts) of food may significantly limit the
development of the infant's brain. Without the involvement of caring adults
(usually the parents or relatives), children may fail to develop cognitively







or emotionally. The result may be an individual who cannot respond to the
educational system or who cannot comprehend the possible consequences
of behavior.

In an effort to understand the state of Florida's children more thoroughly,
this section was developed. It describes them in terms of their numbers in
the general population, their demographic and economic characteristics,
their health care and nutritional needs, the extent to which they are
subjected to abuse or neglect and their need for programs designed to
support healthy emotional and cognitive development. Selected
characteristics of the service delivery system are also presented in this
section. Since Florida does not have a comprehensive, systematic data base
for children, this information was drawn from a variety of sources.

Overall, it presents a disheartening picture:

* In Florida, children are the underclass. Children make up the
greatest percentage of those Floridians who live below the poverty
level. Government assistance has minimal effect: The combination
of Aid to Families with Dependent Children (AFDC) grants and food
stamps was 56.8% of the poverty level in 1988, down from 58.1%
in 1980. Only eleven other states provide less assistance.

* Florida's infant mortality rate exceeds the national rate. Infants born
in this State are more likely to die during the first year of life than
infants born in Hong Kong or Singapore. Non-white infants born in
Broward County have a greater likelihood of dying in the first year
of life than those born in Jamaica or Costa Rica, despite the fact that
this county has one of the highest per capital income rates in the
state.

* It has been estimated that a Florida teenager gives birth every twenty
minutes. In addition, compared with births nationwide, infants born
in Florida are more likely to weigh less than the normal amount at
birth. If Florida's rate of low birth weight babies decreased by just
one percent, it would save four million dollars in care to these
infants annually.







* Even though every dollar spent on the Women, Infants and Children
(WIC) program saves three dollars by reducing the incidence of low
birth weight, Florida only serves 35 % of those eligible to participate;
that is the lowest state rate in the southeast region.

* Twenty-nine percent of Floridians who are under eighteen years of
age lack any form of private or government health insurance.

* Young children are the most vulnerable to the effects of abuse and
neglect, yet they are the most frequent target:

91% of the children who died during fiscal year (FY) 1989-
1990 as a result of abuse by a parent or caretaker were four
years of age or less. In the previous year, almost all of the
children who died in this manner were in that age range.

Almost 60% of the children who are sexually abused are nine
years of age or less.

More than one-third of all children physically abused are five
years of age or younger.

About one-half of the children found to be neglected are less
than six years old.


5







DEMOGRAPHIC INFORMATION

In terms of population, Florida is one of the largest states in the country.
Because of its sunshine, clean air and beaches, the state's population is
expected to continue to grow. However, the growth rate for adults is
expected to increase over the next decade, while the proportion of children
in the general population is expected to decline slightly.

The total population for the state of Florida was estimated to be 12.963
million in FY 1989-1990; slightly more than three and one-quarter million
of these individuals are nineteen years of age or younger (Florida
Legislature, 1990a). By FY 1999-2000, the total population is expected to
grow to 15.814 million, an increase of 22% over the decade of the 1990's
(Florida Legislature, 1990a). This increase will be, in large part, due to
the effect of aging, an inflow of retirees and growth in the labor force.

The rate of growth is not constant for each age category; proportionately
more adults will live in Florida at the end of the century than lived here in
the 1980's. In FY 1980-1981, 17.4% of the people in this state were at
least 65 years of age; by FY 1999-2000, it is projected that people who are
65 years of age or older will represent 19% of all Floridians (Florida
Legislature, 1990a). Floridians in "the prime labor force age range" (ages
25-54) made up 35.5% of the total population in FY 1980-81 and are
expected to increase to 40% in FY 1999-2000.

While the number of children continues to increase, it does not do so as
rapidly as the rest of the population. In FY 1980-1981, persons 19 years
of age and younger made up 27.3 % of the total population; by FY 1999-
2000, this percentage is projected to be 24.6% of the total population of the
state (Florida Legislature, 1990a).

Using four-year age categories beginning at birth, children in FY 1989-1990
were roughly equally distributed in each age range. This is expected to
change slightly over the next decade. By FY 1999-2000, the percentage of
children who are very young (0-4 years old) is expected to decrease by
three percent in comparison to all children. Table 1 contains information
on the numbers and percentages of children by ages ranges for fiscal years
1989-1990 and 1999-2000.








TABLE 1. DISTRIBUTION OF CHILDREN BY AGE RANGES AND
YEAR
Age All Children % of All All Children % of All
Range 1989-1990 Children 1990-2000 Children
0-4 896,170 27% 914,246 24%
5-9 831,594 25% 972,237 25%
10-14 750,100 23% 1,025,179 26%
15-19 799,218 24% 976,554 25%
TOTAL 3,277,082 100% 3,888,216 100%

(Florida Legislature, 1990a)

The differences between those who are young and those who are older in
this state is not limited to how their relative proportions will change over
the next decade. Florida will end the 1990's with not only proportionally
greater numbers of older citizens than it has ever had, but these citizens will
be wealthier and possibly healthier than the youngest citizens of this state.








CHILD POVERTY

During the past twenty years, the United States has been remarkably
successful in reducing poverty among the aged; through Social Security
retirement and survivors' benefits, Supplemental Security Income (SSI),
Medicare, food stamps and Medicaid, many of the elderly have been lifted
out of poverty (Schorr, 1988). Most of the rise in social spending in the
past twenty years has been directed to disabled and aged individuals, the so-
called "lucky" or "deserving" poor (Schorr, 1988). As a result, in 1974,
children replaced the aged as the poorest group in the nation; by 1980, the
poverty rate nationally among preschool children had become six times that
of the aged (Schorr, 1988). In Florida, even though children represented
about one-fourth of the general population in 1987, they represented over
40% of the poorest Floridians.

TABLE 2. COMPARISON OF FLORIDIANS LIVING BELOW THE
POVERTY LEVEL1 BY AGE RANGE, BASED ON 1987
INCOME

AGE
RANGE
0-19 20-44 45-64 65+ TOTAL
Percent in the
General Population 26.6% 37.9% 19.1% 16.4% 100%
Percent Living Below
Poverty Level 42.5% 31.0% 13.1% 13.4% 100%

(Florida Legislature, 1990c)

Studies have repeatedly shown that the nutritional status of the mother has
a profound effect on the fetus and its development. However, as a result
of poverty, some women will eat neither enough nor the right types of food
during pregnancy. The AFDC program provides financial assistance and
Medicaid directly to families which meet certain criteria. Florida's AFDC
grants are extremely low compared to the state's standard of need (the
amount the state estimates a family needs in order to maintain a minimal
subsistence existence). Florida AFDC grants pay 37% of the amount
needed for a family of three. In terms of dollars and cents, AFDC provides


Defined by the U.S. Bureau of Census for a family of four in 1987 as $11,611.







$3.23 per child per day and food stamps provide less than 65 cents per
meal (Florida Center for Children and Youth, 1990).

In January, 1989, Florida's standard of need for a family of three was $807
per month, however, the maximum allowable AFDC grant was $287 per
month. The addition of food stamps helped, but only marginally. Florida
ranked 39th among all states in the percentage of the poverty level which
the state's AFDC and food stamps benefits met; the value of AFDC and
food stamps combined was 56.8% of the poverty level in 1988, down from
58.1% in 1980 (Center for the Study of Social Policy, 1990).

Even though a substantial portion of the children in this state are living
below the poverty level, not all of them receive assistance. In 1987, over
192,000 children under the age of four lived below the poverty level
(Florida Legislature, 1990c). In 1990, 106,859 children, four years of age
or younger, were AFDC recipients. This means that there were many
young children who were living in extreme poverty and not receiving this
assistance. The percentages of those served differed a great deal depending
upon the county in which the child lived. Four percent of the young
children living in Clay County were AFDC recipients, in comparison to
23 % of those living in Gadsden County (Florida Senate, 1989). Seventeen
percent of the children under age 18 living in Clay County are below the
poverty level; over one-half of the children in this age range in Gadsden
County are below the poverty level (Florida Center for Children and Youth,
1990).








TABLE 3. INDICATORS OF CHILD POVERTY IN FLORIDA AND
THE UNITED STATES, 1979-1988


Benefits as a Percentage of
Percentage of Poverty Children Living
(AFDC and Food in Poverty2
Stamps')
1980 1988 1979 1987
Florida 58.1 56.8 18.5 21.1
United States 70.9 66.3 16.0 20.9

(Center for the Study of Social Policy, 1990)


Through an amendment to the Child Nutrition Act in 1974, the WIC
Program was initiated. WIC is funded by the U.S. Department of
Agriculture and administered by HRS, through Chapter 154, F.S., and
s.383.011, F.S.

WIC costs approximately $300 for a pregnant woman for the duration of
her pregnancy (HRS, State Health Office, 1990a). Every dollar which is
spent to provide pregnant women nutritional and health benefits saves an
estimated three dollars by reducing the incidence of low birth weight
(Florida House of Representatives, 1989). Studies have shown that WIC:

1. encourages earlier prenatal care for women and regular
medical care for children;
2. improves the dietary intake of pregnant women;
3. reduces the incidence of low birth weight babies; and
4. reduces infant mortality.







Percentage of the U.S. poverty threshold covered by the combination of state AFDC and Food Stamp
benefit levels (for a female-headed family of four with no income, adjusted to 1988 dollars).
2 Percentage of related children under 18 years of age in families with incomes below the poverty
threshold.








The number of potentially eligible persons in the State has been estimated
to be over 500,000 persons (Florida Bar, 1990). Yet, Florida's WIC
program only serves 35% of those eligible to participate; that is the lowest
state rate in the southeast region.

Children whose families receive AFDC and food stamps and children at or
below 150% of the federal poverty level are eligible for free meals in
school; children whose incomes are between 130-185% of this level can
receive reduced cost lunches or breakfasts. Despite this, fourteen Florida
counties do not have the School Breakfast Program. Table 4 contains a list
of these counties and the percentage of children under 18 years of age who
are below the poverty level. Current legislative changes require breakfast
programs to begin in all schools in FY 1991-92.


TABLE 4. PERCENTAGE OF CHILDREN BELOW THE POVERTY
LEVEL LIVING IN FLORIDA COUNTIES WHICH DO
NOT HAVE SCHOOL BREAKFAST PROGRAMS


% CHILDREN
BELOW
COUNTY POVERTY
LEVEL
Flagler 33%
Glades 22%
Gulf 29%
Hendry 34%
Hernando 25%
Holmes 42%
Jefferson 41%
LaFayette 30%
Union 18%
Wakulla 26%
Walton 38%

(State of Florida, 1989)








HEALTH AND HEALTH CARE

The United States has not reduced its infant mortality rate to the same
degree as have other industrialized nations. Japan began 1960 with an
infant mortality rate which exceeded that of this country, yet their 1988 rate
is one-half that of the U.S. rate. The infant mortality rate of Florida
children is not only higher than the national rate, but it is also higher than
the rate for children in a number of other countries. As Table 5
demonstrates, based on a 1988 infant mortality rate of 10.6 deaths per
1,000 live births, Florida infants are more likely to die during the first year
of life than children born in Hong Kong, Singapore, Ireland, France or
Japan.

TABLE 5. A COMPARISON OF THE INFANT MORTALITY
RATES FOR THE UNITED STATES AND SELECTED
COUNTRIES, 1960-1988


Infant Mortality Rate
(per 1000 live births)
Country 1960 1988
Japan 31 5
Ireland 31 7
France 28 8
Hong Kong 44 8
Singapore 36 9
United States 26 10

(National Commission to Prevent Infant Mortality, 1990)

In general, Florida children are more likely to be born of a teenage mother,
be of low birth weight (less than 5.5 pounds at birth), die within the first
year of life and live in poverty than other American children. This is the
case, even though tremendous improvements have been made in this state.
In 1980, Florida ranked above the national average in the percentages of
low-weight births, births with no or late prenatal care, births to teenage
mothers and the rates of infant mortality (Center for the Study of Social
Policy, 1990). Since that time, Florida's percentage of women under the
age of twenty who give birth, and its rate of infant mortality have dropped.


12







However, the percentage of low birth weight babies has increased slightly.

The most significant factor affecting infant mortality and disability is low
birth weight (National Commission to Prevent Infant Mortality, 1990).
While the national infant mortality rate declined dramatically (by almost
40%) between 1970 and 1980, there was no comparable decline in low-
weight births. For these infants, the risk of death is particularly high
during the first four weeks of life; a low birth weight infant is 40 times
more likely to die in the first month of life than normal weight infants
(United States House of Representatives, 1989). Even if the infant
survives, the consequences of low birth weight may be long-term physical
and learning disabilities.

Ethnicity is an important factor in infant mortality rates, as well as in other
child health indices. In 1988, there was a higher rate of infant deaths
associated with non-white births in Broward County (19.1 per 1,000 live
births) than was found during the same year for births in Jamaica or Costa
Rica. The rate for each of these countries was 18 deaths per 1,000 live
births (UNICEF, 1990 and HRS, State Health Office, 1990b). This
occurred despite the fact that Broward County has one of the highest per
capital income rates in the state.


TABLE 6. INDICATORS OF INFANT AND CHILD HEALTH FOR
FLORIDA AND THE UNITED STATES, 1979-1988


% Births w/no % Births to
Early Prenatal Infant % Low Birth Teens (under 20)
Care' Mortality2 Weight Mothers
1980 1987 1980 1987 1980 1987 1980 1987
Florida 32.1 31.5 14.6 10.6 7.6 7.7 18.2 14.0
United States 25.8 25.6 12.6 10.1 6.8 6.9 15.6 12.4

(Center for the Study of Social Policy, 1990)




SPercentage of births to women who did not start prenatal care in the first trimester.
2 Number of deaths of infants under one year of age, per 1,000 live births.








In 1980, as well as 1987, Florida ranked above the national average in the
percentages of low-weight births, births with no or late prenatal care, births
to teenage mothers and the rates of infant mortality (Center for the Study
of Social Policy, 1990). Since that time, for Florida, as well as the nation,
indices such as the percentage of teenage women who give birth, the
percentage of births with no early prenatal care and the rate of infant
mortality have dropped. However, the percentage of low birth weight
babies has shown a small increase. Tables 7 through 9 compare selected
state health indices over the past five and six calendar years for white and
non-white individuals. In general, the non-white rates of infant mortality,
neonatal mortality, and low birth weight, and the percentages of births with
no early prenatal care are almost twice that of the white population.


TABLE 7. FLORIDA INFANT MORTALITY RATES FOR 1983-1988,
INCLUDING WHITE AND NON-WHITE RATES


Year Total (R*) White (R*) Non-White (R)
1983 1,815 (12.2) 1,085 (9.9) 728 (18.6)
1984 1,681 (10.8) 984 (8.5) 696 (17.7)
1985 1,846 (11.3) 1,128 (9.2) 718 (17.3)
1986 1,837 (11.0) 1,097 (8.8) 739 (17.4)
1987 1,844 (10.5) 1,039 (8.0) 802 (17.9)
1988** 1,938 (10.5) 1,160 (8.5) 778 (16.2)

(HRS, State Health Office, Vital Statistics, 1983-1988)
* Rate per 1,000 live births, in each category
** 1988 data is provisional data
(due to deletion of those whose race was unknown, white and non-white infant deaths
do not always add up to the Total)


14










TABLE 8. LOW-WEIGHT BIRTHS IN FLORIDA FOR 1983-1987,
INCLUDING WHITE AND NON-WHITE LOW-WEIGHT
BIRTHS


Year Total Low- White Low- Non-White
Weight Weight Low-Weight
Births % Births % Births %
1983 11,108 7.5% 6,469 5.9% 4638 11.9%
1984 11,535 7.4% 6,947 6.0% 4583 11.7%
1985 12,341 7.5% 7,304 6.0% 5034 12.1%
1986 12,739 7.6% 7,464 6.0% 5273 12.4%
1987 13,427 7.7% 7,764 6.0% 5656 12.6%


(HRS, State Health Office, Vital Statistics, 1983-1988)

Although early entry into prenatal care is important,
percentage of Florida women who began prenatal care in
increased only slightly.


TABLE 9.


since 1983, the
the first trimester


PERCENTAGE OF ENTRY INTO PRENATAL CARE BY
TRIMESTER IN FLORIDA, 1983-1987


Total Porem Emtry Wite Pert Ealry N-W.WUe* Prced Eiry
Year
Id 2d 3rd Id 2ad 3rd 3rId d 3rd
tri fri Arri Irl Itri tri mdk tri Wri fri ,Mk
983 67.1% 22.9% 5.6% 4.4% 73.0% 18.8% 4.5% 3.7% 50.6% 34.6% 3.6% 6.2%
194 66.5% 22.9% 5.8S 4.8% 72.25 19.1% 4.8% 3.9X5 3.0% 34.2X5 IX. 7.0%
1985 66.4% 22.6% 5.8% 5.2X 72.4% 18.6% 4.7% 4.3% 48.3% 34.5% 9.1% 7.6%
196 67.5% 22.75 5.4% 4.4% 73.2% 18.8% 4.5% 3.5% 50.9% 34.2% 3.1% 6.85
97 68.5% 21.8% 5.1% 4.6% 74.2% 18.1% 4.1% 3.6% 52.1% 32.7% 7.6% 7.6%

(HRS, State Health Office, Vital Statistics, 1983-1987)







PRENATAL CARE


The United States Surgeon General established, as a 1990 goal, that 90%
of all pregnant women would obtain prenatal care within the first trimester
(Florida Healthy Mothers, 1988). Infants born to women who receive early
and comprehensive prenatal care are far less likely to die in their first year
or be left disabled for life (Children's Defense Fund, 1990). Unfortunately,
Florida has had little or no change in the timing of the first prenatal care
visit over the past ten years. In 1985, Florida ranked 48th among states in
the percent of babies born to women who received care in the first trimester
(Children's Defense Fund, 1988).

Women who receive no prenatal care during their pregnancies are three
times more likely to have a low weight infant than those whose care was
early and continuous (Florida Healthy Mothers, 1988). The average cost of
care for a low birth weight baby is $30,000; decreasing the percentage of
babies born at a low-weight by one percent will save an estimated four
million dollars in care (Mahan, 1990). Low birth weight is a major cause
of referrals to Florida's Regional Perinatal Intensive Care Center (Level III
neonatal intensive care units or NICUs). Failure to significantly reduce the
incidence of low birth weight, coupled with Florida's population growth has
led to serious overcrowding at these centers (Florida Healthy Mothers,
1988). In addition to the human tragedy, the cost of caring for these infants
places increasing financial strains on parents, insurance companies and the
taxpayers who must support not only the initial NICU cost, but who also
must care for individuals with lifelong disabilities.

Prenatal care is extremely cost-effective, yet it may be difficult to obtain for
poor women. According to estimates by the HRS State Health Office, over
66,000 women who were below 150% of the poverty level needed prenatal
care in FY 1988-1989. Through County Public Health Units (CPHUs) the
Improved Pregnancy Outcome (IPO) Program provided services to 54,322
women during that fiscal year at an average cost of $495 per client; almost
17,000 pregnant women who met the poverty criteria did not receive this
service through the IPO Program (HRS, State Health Office, 1990c). One
result of the IPO program is a striking reduction in the rate of infant
mortality among the participants. Table 10 compares the infant mortality
rates among Florida women who participated in this program and those who
did not.








TABLE 10. INFANT MORTALITY AMONG FLORIDA IPO AND
Non-IPO WOMEN, 1986-1988


(HRS, State Health Office, 1990c)
*Rate per 1,000 live births


Rate per 1985 1986 1987 1988
Live Births*
IPO 17.01 16.74 11.66 10.91
Non-IPO 10.35 9.97 8.11 8.36








TEEN PREGNANCY


Nationally, one-quarter of the teenagers who give birth have a second
pregnancy in one year; one-half have a second pregnancy within three years
(Governor's Constituency for Children, 1987). There were over 15,000
births to teens in Florida in 1985, which translated roughly to one birth to
a teenage mother every twenty minutes. This state has one of the nation's
highest percentage of births to women under the age of 15 and a higher
than average percentage of infants born to young women under age 20
(Florida Bar, 1990). In Florida, less than one-half of these young women
received prenatal care during the first trimester of their pregnancy.

Two medical problems associated with teen pregnancies are low birth
weight babies and medical complications. A high proportion of the state's
low birth weight babies are born to teenage mothers. Frequently, these
teens live in poverty and often reside in areas in which there is little or no
primary health care. However, it has been shown that innovative attempts
to provide such care, not only improves their quality of life by assuring that
medical needs are met, but it also may reduce the teen pregnancy rate and
cost less than other traditional ways of delivering these services.

In 1986, Florida's first school-based health center opened in the Shanks
High School in Quincy, a small town in Gadsden County. The Center was
established because few public high school students in this predominantly
poor, black, rural community had either a family physician or ready access
to primary health care services. In addition, there was a high pregnancy
rate among the students in this community. The Shanks Health Center
produced a number of positive results: Better access to health care, lower
costs and a decline in the pregnancy and the dropout rates (Florida State
University, 1989). Specifically:

1. The proportion of students who report they did not receive medical
care when they needed it declined by almost 30% between 1986 and
1989;

2. a cost analysis based on FY 1987-1988 data indicated that the cost
per patient contact at the Shanks High School Health Center ($10.11)
was less than the averages for the five satellite and one central
Gadsden County Public Health Unit sites (these average per patient
costs were $13.75 and $14.90, respectively);







3. the proportion of students who are sexually active has remained
unchanged since the Center opened; the proportion of these students
who report using effective contraceptive methods has increased each
year since the Health Center opened; and

4. student pregnancy rates declined by two-thirds within two years
following the Center's establishment.

In 1987, the Center was relocated away from the school grounds, across the
street; service volume dropped by 30% during FY 1987-1988 (Florida State
University, 1989).








SUBSTANCE ABUSE AMONG PREGNANT WOMEN

Nationally, the problem of substance-exposed infants has grown
dramatically; 375,000 newborns yearly are estimated to have positive drug
toxicologies (Juvenile Welfare Board of Pinellas County, 1990). A small
percentage of these infants will require intensive medical care, at an
estimated cost of $2.5 billion. Approximately 2600 drug-exposed Florida
infants were reported to HRS between July and December 1989; HRS
estimates that this represents only one-quarter of those who are born
exposed to drugs or alcohol.

Despite prevalence rates for substance usage which showed no statistically
significant differences between mother's race or socioeconomic level, black
women who gave birth were ten times as likely to be reported under
Florida's Child Abuse Statute as were white women who gave birth
(Chasnoff, Landress and Barrett, 1990). There are no uniform
requirements that a pregnant woman who exposes her fetus to harm from
drug or alcohol abuse while pregnant be referred for drug treatment or
counseling.

Research has indicated a relationship between drug-exposure and birth
problems. During a one-year period, researchers found that one-third of
the substance-exposed newborns weighed less than 5.5 pounds, compared
to 7.7% of all births (HRS, Office of Evaluation, 1989). Prenatal care can
make a difference; fewer of the infants whose mothers received this care
were of low weight at birth.

Approximately 4.6% of substance-exposed newborns weighed less than
three pounds, compared to 1.4% statewide (HRS, Office of Evaluation,
1989). While these newborns typically require long, neonatal intensive care
and have the potential need for long-term health care services, those who
are drug-exposed may also have increased complications, such as
respiratory and hearing problems, poor liver functioning, poor vision,
neurological damage and organ malformations.

In addition to the increased medical needs of alcohol and drug-exposed
infants, there are potential psychological and learning problems for these
infants, particularly for crack and cocaine-exposed babies. Crack babies are
more likely to be irritable than babies who are not exposed to drugs; as the
child grows older, learning problems, short attention spans and behavioral
extremes may occur (Wurm and Lambert, 1990).







The process which enables an infant to learn trust, resulting in attachment
to the mother or caregiver, is believed to occur between six and nine
months of age when the infant develops recall memory; the process of
bonding becomes difficult for the child of a substance-abusing mother. If
the infant is removed from the mother and placed in numerous residential
settings, the child is unlikely to develop trust, or the ability to "attach,"
which is essential for normal psychological development. In situations in
which the child remains with the mother and no change occurs in her drug
abuse, her behavior will make her too erratic to serve as an appropriate
attachment object for her child.

Some believe that the circumstances surrounding a crack baby are
exceptional and, in some cases, warrant extraordinary relief, such as early
termination of parental rights and the placement of the child for adoption.
They argue that an infant is more likely to be adopted than an older child.
In a stable, permanent home, an infant will be able to develop in a
psychologically healthy manner (Florida Bar, 1990).

Others, like Florida Legal Services (1990), believe that proposals to change
the procedure to terminate parental rights are debatable for two reasons:

a. They carve out certain classes or categories of parents for
extraordinary procedures and treat them unequally; and

b. they give the state an excuse for not providing the family with
reunification services by stating that services are unavailable.

A number of programs are being developed which will enable the
substance-abusing mother to receive treatment and remain with her child.
Operation PAR, in St. Petersburg, plans to open a residential facility for
drug-abusing mothers who will live at the treatment facility with their
children (these children were exposed to cocaine prior to birth). The
women are referred to this program by prosecutors in Pinellas County who
will give them the opportunity to receive treatment or face prosecution for
child abuse. Plans are under development in Miami, through private
donations and the University of Miami Medical School's Pediatric
Department, to establish a residential treatment program which will enable
mothers to remain with their children and receive parenting education.








PREVENTIVE HEALTH CARE

Preventive health services for children have been shown to save more than
$8 for every dollar which is spent (Maine Department of Human Services,
1983). Medicaid reimburses CPHUs and private physicians for Early
Periodic Screening, Diagnosis and Treatment (EPSDT), which is a specific
protocol of physician services. It provides for medical screening, including
physical exams, laboratory tests, updating routine immunizations, and
hearing and dental assessments. Effective October 1, 1988, Medicaid
eligibility was extended to children up to age five, whose family incomes
are below 100% of the federal poverty level.

Immunization protects children from severely debilitating and preventable
diseases. Vaccinations for polio, diphtheria, rubella, mumps and other
diseases are available at no cost from Florida county public health units.
For every dollar spent for immunizations, it is estimated that more than six
dollars are saved (Florida House of Representatives, 1989). The cost of
immunizing each child in this state was estimated to be $12.40 for FY
1989-1990.

In Florida, one of every three two-year old children have not received all
of the basic immunizations suggested for that age group (HRS, State Health
Office, 1989b). High-risk maternal factors (such as the mother's age and
educational level; those who had three or more children; marital status and
history of prenatal care) negatively influenced whether their child would
complete the immunization series. Forty-two percent of the children whose
mothers were in the high-risk group had either received no shots or had
partially completed the series.

Statewide, 93.7% of kindergarten students were reported as receiving all
immunizations required by state law for school attendance (HRS, State
Health Office, 1989b). In obtaining this information, the following
concerns were identified:

a. Statewide percentages are still below the objective of 95%. The
percentage of temporary medical exemptions which were issued
accounted for 88% of all exemptions. Temporary exemptions are
issued to students who have received all vaccines which can be
administered at the time of school entry and are still in the process
of receiving additional vaccines; and






b. ten counties reported that 685 students were allowed to attend school
without the proper documentation that immunizations had occurred,
despite the requirement in Section 232.032, F.S., that children
without proper documentation be temporarily excluded from school.

In Florida, a larger percentage of individuals do not have any insurance
coverage than is the case nationwide. Almost 20% of all Floridians do not
have any coverage, compared with 14.7% of people nationwide. Twenty-
nine percent of those who are 17 years old or younger lack any type of
health insurance. (Insurance Coverage in Table 11 refers to all types of
coverage, private and governmental).

TABLE 11. PERCENTAGE WHO LACK HEALTH INSURANCE
COVERAGE BY AGE: FLORIDA AND U.S. FOR 1987
(Data as indicated by 1988, March CPS)


Age Florida United States
under 18 years 28.9% 19.7%
18 to 24 years 32.1% 23.5%
25 to 34 years 22.8% 16.9%
35 to 44 years 17.5% 12.0%
45 to 54 years 17.8% 11.4%
55 to 64 years 13.8% 11.2%
65 years and over .8% .9%
All Years 19.5% 14.7%

(Florida Legislature, 1990b)

Since 1986, Florida law has required all individual and group health
insurance policies to provide preventive coverage for child health. These
services, sometimes called "well-child care," consist of up to eighteen
medical visits for children from birth to age 16 and are specifically exempt
from the deductible provision of the insurance policy. A study of this
coverage by the Florida Department of Insurance (1990) found that there
has been low use of this benefit; also, the coverage applies to those who
have individual or group health insurance policies -- approximately one-half
of Florida families. The remaining one-half are either uninsured or belong
to a self-insurance fund not subject to state mandatory insurance
requirements.








ABUSE AND NEGLECT

During the 1989-1990 fiscal year, over 126,000 child abuse or neglect
reports were received by HRS. More than one-half of the reports closed
during this fiscal year were determined to be unfounded (i.e., the
investigation revealed no indication of abuse or neglect). At most, one-half
of the instances of verified abuse involved physical injury, with sexual
maltreatment comprising the second largest category (29% of verified
abuse). Almost one-half of the verified neglect involved inadequate
supervision; environmental neglect made up the second largest verified
neglect category.

Younger children are more likely than older ones to be abused or neglected.
Children two years of age or less had a higher percentage of verified abuse
or neglect than any other age category. The following three tables contain
demographic characteristics of children who were victims of abuse or
neglect.


TABLE 12. DEMOGRAPHIC CHARACTERISTICS OF CHILD
VICTIMS OF AT LEAST ONE NEGLECT
MALTREATMENT FY 1989-1990


Age In Years Sex Race
0-2 26.11% Male 50.50% White 65.63%
3-5 21.71% Female 48.48% Black 33.24%
6-9 24.31% Unknown 1.02% Unknown 1.13%
10-13 16.25% TOTAL 100.00% TOTAL 100.00%
14-17 11.09%
18 0.02%
Unknown .51%
TOTAL 100.00%

(IRS, Protective Services System, 1991)








TABLE 13.


DEMOGRAPHIC CHARACTERISTICS OF CHILD
VICTIMS OF AT LEAST ONE PHYSICAL ABUSE
MALTREATMENT, FY 1989-19901


Race
White 1.21%
Black 74.04%
Unknown 24.75%
TOTAL 100.00%


(HRS, Protective Services System, 1991)


Over 19,000 verified sexual abuse cases were closed during FY 1989-1990.
Almost 60% of the children who were sexually abused were nine years of
age or less; over 2,000 children, two years of age or younger were victims
of a verified sexual abuse case which was closed during this time period.


25


Age In Years
0-2 17.23%
3-5 19.34%
6-9 22.98%
10-13 21.04%

14-17 18.98%
18 0.03%
Unknown .40%
TOTAL 100.00%


Sex
Male 51.48%
Female 47.91%
Unknown .61%
TOTAL 100.00%


includes sexual abuse








TABLE 14. DEMOGRAPHIC CHARACTERISTICS OF CHILD
VICTIMS OF AT LEAST ONE SEXUAL ABUSE
MALTREATMENT, FY 1989-1990


Age in Years Sex Race
0-2 10.41% Male 24.27% White 78.29%
3-5 23.82% Female 75.45% Black 20.68%
6-9 24.36% Unknown .28% Unknown 1.03%
10-13 21.46% TOTAL 100.00% TOTAL 100.00%

14-17 19.69%
18 0.02%
Unknown .24%
TOTAL 100.00%

(HRS, Protective Services System, 1991)








Since July, 1986, 178 children have died as a result of abuse or neglect by
a parent or a caregiver. For FY 1986-90, 87% of the children who died
were four years of age or younger. The death rates for these young
children has fluctuated somewhat, but is slightly higher for the past fiscal
year than for FY 1986-87; overall, the death rates for children five years
of age and older, has decreased since Fiscal Year 1986-1987.


TABLE 15.


COMPARISON OF CHILD DEATHS BY FISCAL
YEAR AND AGE


AGE RANGES
0-4 Death 5-17 Death 0-17 Death
Period Deathal Population2 Rate Deaths Population Rate Deaths Population Rate
7/86-6/87 32 809,630 3.95 8 1,917,795 0.42 40 2,727,425 1.47
7/87-6/88 41 840,173 4.88 11 1,972,033 0.56 52 2,812,206 1.85
7/88-6/89 40 871,326 4.59 1 2,027,332 0.05 41 2,989,658 1.41
7/89-6/90 41 900,989 4.55 4 2,079,164 0.19 45 2,980,062 1.51
TOTAL 154 24 178


I HRS, Protective Services System, 1991

2 Population figures were provided by the Division of Economic and Demographic Research for January
of each year (Florida Legislature)


27







HOMELESSNESS


Until recently, a panhandling alcoholic living in a city subway, represented
the stereotype of a homeless person. Now, it has become apparent that the
characteristics of the homeless population are more complex and their
numbers are greater than previously known. The United States General
Accounting Office (GAO) estimates that on any given day, Florida has
between 16,000 and 20,000 homeless persons. The demographic data on
Florida's homeless population is supplied by the state's twenty-one
homeless coalitions (HRS, 1990a). While data on the characteristics of
homeless children are not specifically collected, some information is
available on the general characteristics of homeless persons and families.

The majority of homeless people in Florida do not immigrate from another
state; two-thirds of them are residents of local communities who no longer
have a place in which to live (HRS, 1990a). Those who do migrate from
another state report perceived economic conditions and climate as primary
reasons for the move.

One-third of this country's homeless population, estimated to number 2.2
million, is composed of families with children (U.S. House of
Representatives, 1990). According to HRS, families comprise nearly forty
percent of the state's homeless population. Of these nearly one-half are
headed by single parents, usually mothers (HRS, 1990a). At least eight
percent of the homeless population in Florida is made up of chronic
runaway children and youth living on the street. Children in these growing
numbers of homeless families are at risk of placement into substitute care.







EMOTIONAL AND COGNITIVE DEVELOPMENT

Children may be removed from their parents' home because of actual abuse
or neglect, the risk of such occurrences, or their own behaviors (such as
delinquent acts, serious emotional problems, etc.). Many of the children
who are placed in state custody have significant, unmet mental health or
other therapeutic service needs and there are indications that the need is
growing. In a 1982 evaluation, HRS found that of the foster children
surveyed, nine percent had committed delinquent acts, nine percent had
emotional problems and six percent had developmental disabilities; a 1988
study of foster children found that twenty-six percent had committed
delinquent acts, thirty-eight percent had emotional disturbances and sixteen
percent had developmental disabilities (Florida Center for Children and
Youth, 1990). Over eighty percent of the adolescent foster children have
a behavioral, medical or developmental problem (Florida Center for
Children and Youth, 1990). HRS estimates that it would cost $58 million
to provide mental health services to the more than 13,000 children in its
custody who need help but are not now receiving it. The agency's FY
1990-91 budget request for therapeutic services was for roughly one-half
that amount, however, the total amount appropriated was $840,000.

Children who could remain with their parents are not receiving the services
they and their families need. As a result, unnecessary admissions into
psychiatric hospitals and placements out-of-home occur. One-third of the
children entering private or short-term psychiatric hospitals were admitted
due to adjustment reactions (e.g., truancy, running away and being
ungovernable) or conduct disturbance (delinquency). Irrespective of any
other variables, the placement of a child in detention has been found to be
the leading predictor of future out-of-home placement for a child either in
the youth correction or the child welfare system. (Schwartz, 1990).

Mental health service needs are also present in children who are not
exclusively in state care or custody. In a study of over 800 seriously
emotionally disturbed children served by Florida's public sector, over sixty
percent received a diagnosis of conduct disorder, more than one-half were
diagnosed as anxious or depressed and many also suffered from cognitive
and social skill deficiencies, and family problems (Friedman, 1987).
According to one national study, between three and five percent of the
school population are emotionally disturbed and at least two-thirds of these
children are not receiving the special help from public schools to which
they are entitled (Knitzer, Steinberg.& Fleisch, 1990).







OUT-OF-HOME PLACEMENTS


Out-of-home placement of the child is made to address temporary problems
(emergency shelter care) as well as long-term problems (substitute care
services such as foster or residential group care). Emergency shelter is
used to provide a place for the temporary care of a child who is alleged to
be dependent or who has been adjudicated dependent, and whose safety and
well-being cannot be assured without such placement. This placement
option is used until adjudicatory and dispositional hearings are held, or until
some other less intrusive but safe, placement option can be secured.
Children are intended to spend no more than 30 days in this temporary
option.

When emergency shelter beds are not available, foster family beds are used.
At the beginning of FY 1988-1989, 34% percent of the 1,770 children in
shelter placements were in foster care beds. There was an increase in the
average length of stay in shelter for FY 1988-1989 to 29.6 days; in FY
1987-1988, the average length of stay was 24.9 days.

The number of children admitted into emergency shelter care has increased
over the past year. According to HRS, there was a 13% increase in
admissions to shelter care during FY 1988-1989. New admissions totaled
16,666 compared to 14,755 the previous year.

As this program grew, it outstripped the budget provided for shelter care.
The total cost for this program was $9.7 million for FY 1988-1989,
however, the general revenue appropriation was approximately $7.5 million
(HRS, CYF, 1990). Despite the need to increase the-number of shelter
beds in the state, the HRS FY 1989-1990 budget request was not fully
funded. The Department requested over eight million dollars to increase
the number of emergency shelter beds; this request was reduced by the
Governor's Office to approximately two million dollars and the Legislature
appropriated $1.9 million.

Children in substitute care (foster family or residential group care) are
awaiting reunification with their natural family, awaiting adoption or
preparing for independent living. Florida law requires that efforts to return
a child to the biological parents or to an adoptive family "shall be made as
soon as possible," and that no child should remain in foster care for longer
than one year. In fact, Florida children remain in foster settings for much
longer than twelve months, and the length of stay is increasing. The 1989







length of stay ranged from 20 months in District 1 to 50 months District
11, with an average of over 30 months (HRS, CYF, 1989). The largest
percentage of substitute placements were made in District 6 and the recent
experiences of this district are illustrative of what may be happening on a
smaller scale in other parts of the state. Over the past 12 months, this
district has experienced unusual increases in the number of children entering
out-of-home placements. The children who need such care have problems
(i.e., sexual, emotional, aggressive, substance-abuse related, etc.) which
may cause foster parents to be unwilling to accept them. As a result, while
about one-half of the homes in this district are under their licensed capacity,
the remaining homes are bearing the burden of caring for not only increased
numbers of children, but also children with significant problems.

At the end of May, 1990, District 6 had a total of 1621 beds for children,
and a total of 1642 children in foster or shelter placements. While these
resources appear to be adequate, one-half of the 1642 children were in
over-crowded conditions because some children have problems or
characteristics that make them unacceptable to licensed foster and shelter
parents.

The over-crowding situation in foster settings is monitored by HRS (as one
of a number of performance indicators) on a monthly basis in the
Department's Performance Indicators Report. This Report reflects that
from April, 1989, to April, 1990, 35 to 58% of District 6 children in foster
or shelter placements were in settings which exceeded their licensed
capacity. On paper, this information reflects only numbers. It became
more meaningful, recently, when a Tampa television station aired on the 6
o'clock news, a videotape of children sleeping without pillows or mattresses
on the floor of the Intake Offices in the Hillsborough Detention Center.
These children could not be placed in foster or shelter beds because none
were available which would accept them.

In fact, during a one-month period of time, in the spring of 1990, the HRS
Inspector General found that 20 non-delinquent children spent the night in
the offices of the Hillsborough Detention Center. Two of the children were
foster care placement runaways and spent 14 and 11 nights, in these offices.
Two of the 20 were girls, aged 12 to 14. The 18 boys ranged in age from
11 to 17 years. Fourteen of the 20 were foster care runaways, five were
being taken into protective supervision and one was a protective services
client.







After this investigation, the District Administrator accepted
recommendations which prohibited the over-night use of the detention
center for such non-delinquent children. As a result of the lack of
alternative resources, District 6 continues to place children in overcrowded
foster and shelter homes. In this district, up to 16 children are living in one
home which is licensed for 3. For every licensed bed in a District 6 over-
capacity home, there are 1.83 children.

This situation is not unique to District 6; dependent children have also been
reported sleeping on mattresses in administrative offices of the Duval
County Detention Center. Boys and girls sleep in the same room and,
during the day, have no age appropriate activities. They are not enrolled
in school, but accompany the placement worker to work while an attempt
is made to find appropriate placements for them.

Efforts to provide a sufficient number of additional beds have not been
productive. The Department requested $3.5 million to expand the number
of foster care beds; the Governor reduced the request to $400,000 and the
Legislature provided $500,000.







CONCERNS OF FOSTER PARENTS

Foster and shelter care parents spoke during several Commission meetings
about difficulties they and the children in their care were experiencing.
During November, 1990, Commission staff surveyed the 4298 foster and
shelter care parents and asked them about such topics as the frequency with
which caseworkers visit these children, the availability of transportation to
take the children to physician or dentist appointments and the difficulties
they experience with obtaining Medicaid cards for these children.

In September and October, 1990, each HRS district supplied a list of the
names and addresses for the foster and shelter care parents. (It should be
noted, however, that the list included some names of individuals who were
only "applicants" at the time the list was provided. For example, District
11 provided a list which was last updated in February, 1990. In addition,
some of the parents who were surveyed responded that they were licensed
but did not have any placements).

The overall return rate was 25.5%. The total licensed capacity of these
homes was 3268, with an average of 3 children per home. Homes were
filled to 74% of their capacity; 89% of these children are foster children
and 11% are shelter children.








TABLE 16. PERCENT RETURN RATE BY DISTRICT OF FOSTER
PARENT QUESTIONNAIRES


% of
District Return Rate # Sent # Respondents Overall
Sample
1 35% 149 52 5
2 40% 212 84 8
3 22% 476 103 9
4 25% 446 111 10
5 35% 269 95 9
6 33% 477 155 14
7 38% 233 88 8
8 26% 426 109 10
9 17% 620 102 9
10 18% 380 69 6
11 17% 610 105 10
Unknown 23 2

Districts 3, 4, 9, 10 and 11 had the lowest rate of return, based upon the
number of foster and shelter parents in those districts. In the other
districts, between 26 and 40% of those who were surveyed returned
questionnaires.








The following breakdown, by district, lists the reported licensed capacity,
the number of foster and shelter children who were reported as currently
living in the licensed homes, and the total number of children living in the
licensed homes. The percentage of the licensed capacity which is filled is
also included.


TABLE 17. CAPACITY OF FOSTER AND SHELTER HOMES


Licensed # of Foster # of Shelter Total # of % of
District Capacity Children Children Children Capacity
1 139 98 11 109 78
2 215 126 5 131 61
3 365 202 33 235 64
4 323 185 31 216 69
5 271 167 26 193 71
6 518 379 82 461 89
7 259 211 21 232 90
8 321 206 9 215 67
9 315 191 23 214 68
10 184 140 2 142 77
11 290 188 30 218 75


Of the respondents who specified the type of home (foster or shelter), 85%
are foster homes, 5% are shelter homes, and 10% serve as both shelter and
foster homes.








Frequency of Visits by Caseworkers


The respondents were asked about the frequency with which the
caseworkers made visits to the children in their care (either to check on
their well-being, or transport them to visit their parents). Six response
choices were given. These choices were; several times per month, once a
month, every two months, every six months, every year, and longer than
one year. For purposes of the analysis, there is a seventh column that
refers to the percentage of respondents who did not choose one of the six
response choices and reported a another frequency. The frequency of
caseworker visits is contained in Table 18:


TABLE 18.


FREQUENCY OF CASEWORKERS
DISTRICT


VISITS BY


Several Every Every Longer
Times a Once a Two Six Every Than One
District Month Month Months Months Year Year Other Total
Statewide 20.0% 36.0% 14.0% 10.0% 3.0% 4.0% 13.0% 100%
District 1 34.0% 44.0% 10.0% 2.0% 0.0% 0.0% 10.0% 100%
District 2 32.0% 44.0% 8.0% 5.0% 4.0% 1.0% 6.0% 100%
District 3 13.5% 43.5% 12.0% 13.5% 2.0% 2.0% 13.5% 100%
District 4 19.0% 34.0% 17.0% 6.0% 1.0% 6.0% 17.0% 100%
District 5 25.5% 52.0% 8.5% 3.0% 0.0% 0.0% 11.0% 100%
District 6 18.0% 40.0% 16.0% 8.0% 1.0% 3.0% 14.0% 100%
District 7 21.0% 35.0% 22.0% 11.0% 1.0% 5.0% 5.0% 100%
District 8 19.0% 25.0% 17.0% 11.0% 5.0% 6.0% 17.0% 100%
District 9 20.0% 27.0% 15.0% 16.0% 3.5% 3.5% 15.0% 100%
District 10 17.0% 22.0% 15.0% 22.0% 6.0% 3.0% 15.0% 100%
District 11 15.0% 27.0% 12.0% 12.0% 10.0% 7.0% 17.0% 100%

Those who did not respond to the response choices provided comments as
to the frequency of the visits of their caseworkers. These comments are
contained in full in a separate report on foster parent concerns. Of the
"other" responses, 137 also provided a narrative answer. Of these, 62
(51%) stated that they never received home visits from their caseworkers.


36







These comments included:


"No visits whatsoever. However, I've only had my child five
months."

"They never visit unless to bring children (to be placed)."

Forty-three percent of these respondents reported inconsistent visits and
frequently noted different practices from one caseworker to another.

"One caseworker (visits) several times per month. One
caseworker (visits) once per month. One caseworker (visits)
about every six months, but hasn't been in my home for the
past seven months. "

Nine (6%) of the respondents noted differences in frequency of visits by
caseworkers for shelter and foster children.

"Shelter children (are visited) several times a month; once a
month for foster children. "

"Every two monthsfor shelter children, once a yearforfoster
children. "

HRS regulations regarding caseworkers' visits specify that a shelter child
is to be visited once weekly "in his home" and a foster child is to be visited
once a month "in his home." Caseworker visits do not include contact with
transport personnel, visits in the HRS office, telephone calls or encounters
about town.

Some respondents commented that they only see the caseworker when they
dropped the child off, or that contact involved only talking to them on the
phone, or seeing them when the foster parent visited the HRS office.

"The child I have now has been in our home since August
20th. There was a caseworker here September 30th. I have
not seen one since. "

Other comments had to do with the differences between caseworkers and
the frequencies of the visits.







"I have three social workers. One I see once a month. The
others I never see unless I make a trip to the office."

"The caseworker for the ten year old gives me the impression
that she doesn't want to communicate with my husband and
myself in regards to the child's problems and needs. I have
even asked to have the caseworker changed, and was told that
I needed to talk to the present worker. The caseworker for
the one year old is very attentive to his needs and assists us
in every way possible. "

"There are three caseworkers that are supposed to come to
our home. One has not been here since on or about August
17. The other two usually come once a month. One of them
usually comes on Saturday at 6:30 or 7:00 a.m. or at noon
and as late as 8:00 p.m. She hasn't been here for over a
month. We got a downs syndrome baby May 15, 1989, and
kept her until she was 7 1/2 months old. Her caseworker
never entered our home."


Sufficient Information on Child to Provide Adequate Care

When respondents were asked if they received sufficient information about
the child (i.e., medical history, behavioral or emotional characteristics,
special needs, etc.), to provide adequate care for him, 29% responded yes,
38 % responded sometimes and 33 % responded no.

Comments on this issue suggest that if more information had been provided,
the foster parents could have dealt with the problems in a more effective
way (e.g., bedwetting, allergies, immunization histories, and past abuse
histories).

"When receiving children from community control, I have had
one counselor who refused to give me any behavioral
information, stating that it was none of my business and all I
needed to do was to take care of the child. As a result I
encountered some very serious situations with the school, my
neighbors, and I sustained a substantial amount of property
damage."







Several parents stated that they felt the workers held back information for
fear of not making the placement. Some reported that when they did get
information, it was incorrect. For example, children were placed with a
sibling's name and date of birth, rather than their own.


Therapeutic Services

When asked how many of the foster or shelter children in the care of the
respondents need mental health or substance abuse services, 31% of the
children in care were reported to be in need of these types of services. Of
those children who need these services, 60% are receiving them. However,
one-fifth are experiencing severe enough problems that their current
placements are in jeopardy.


Transportation Issues

When asked whether HRS provides the transportation for children to visit
their parents or to go to medical appointments, 20% responded yes, 37%
responded sometimes, and 43% responded no. It is interesting to note,
however, that many of the respondents indicated that they would rather not
have HRS provide transportation, and emphasized this desire when referring
to physician visits. Because they take their own children to the physician,
in an effort to make the foster child feel like one of the family, they would
like to do the same for him or her. Furthermore, the foster parent prefers
to hear the physician's instructions and comments first hand, rather than
from the HRS worker or transporter.








Medicaid Cards


When asked if they experience problems in receiving Medicaid cards for the
children in their care, 37% responded yes, 24% responded sometimes and
39% responded no. The following is the district breakdown:

TABLE 19. PROBLEMS WITH MEDICAID CARDS


District No Yes Sometimes
District 1 43% 28% 29%
District 2 49% 31% 20%
District 3 44% 35% 21%
District 4 44% 34% 22%
District 5 43% 33% 24%
District 6 32% 41% 27%
District 7 34% 31% 35%
District 8 27% 46% 27%
District 9 42% 43% 15%
District 10 38% 45% 17%
District 11 37% 44% 19%


Respondents reported
needed, or sometimes


that the medicaid cards are late, unavailable when
not received at all.


"In most cases the card goes to HRS and is then forwarded to
us, making it late in the month before it gets to us. "

Several respondents stated that they continued receiving the cards months
after the child had been transferred elsewhere.

"You have to beg for them. I have never received a child with
adequate coverage in the beginning. I have to pay for most
medical care. Then when the card does come, it continues to
come long after the child has left."







Adequacy of Current Level of Payment


When asked if they believe that the current level of payment is adequate,
31% responded yes and 69% responded no. The comments which were
provided addressed the inadequacy of the current level of payment,
particularly for the younger children, where the cost of diapers, formula,
and/or food creates the greatest hardship.

"In my case, I have three in diapers. $296 broken down
gives me $10per child per day to provide food and diapers.
Baby food junior is now 45 cents ajar. Like my babies eat
5 jars per day each, that is $6.75. The remainder goes
towards the diapers, shampoo, lotion, vaseline, wipes, treats
and toys, etc. Not very much to also buy clothing, shoes,
replace crib sheets and blankets, etc. If my $296 would
increase to even $50 more per child, I would manage much
better."

For the older children, it was suggested that more money for clothing
would be helpful to enable purchases of clothing and related items that are
valued by their teenage peers. They expressed that this would help the
older children increase their self esteem and give them a sense of
belonging. An example:

"The transportation, school activities and school promotions -
I hate not to do the same for my foster kids as I do for my
own (e.g., yearbooks, book clubs, cheerleading, dances,
etc.). "

It was also suggested that the clothing allowance given once a year was not
adequate, and the respondents stated that it would be helpful to get clothing
allowances every six months, as many children grow out of the clothes that
were purchased for the beginning of school year by the following spring.







Strengths and Weaknesses


Respondents believe that they themselves are one of the strengths of the
foster care program because they provide stable, safe, loving and caring
environments for the children. Other strengths mentioned were the Foster
Parents Association--the opportunity to meet with other foster parents, the
Guardian Ad Litem Program, and the Model Approach to Partnership in
Parenting (MAPP) Training.

On the other hand, when the respondents were asked about what they
believed to be the weaknesses of the foster care program, a lack of
communication and information from the caseworkers was a common
answer. The respondents expressed a frustration with inability to reach
caseworkers when they were needed. Also frequently reported was the
frustration with high caseworker turnover, lack of consistency on the cases,
and the amount of times any one child is moved around in the system.
Another common complaint was that HRS is more concerned with the rights
of the biological parent, than the effect the system has on the child. For
example, the respondents believe that children are returned too soon to
abusive and neglectful parents, and that performance agreements are not
fulfilled.


Recommendations

They were asked what recommendations they would make to improve the
foster care and the child welfare system. The most frequent response was
to hire more caseworkers, so they would have lower caseloads.
"Caseworkers are always too busy and overworked. You are only as good
as the caseworker." Several respondents felt that the time period given to
biological parents to meet the performance agreement requirements should
be between six months and one year, at the most. They believed strongly
that parental rights should be severed much sooner, and the terms of the
performance agreement should be strictly enforced.







THE ROLE OF CHILD PROTECTIVE INVESTIGATORS
IN ABUSE AND NEGLECT INVESTIGATIONS

Of all HRS staff, Child Protective Investigators (CPIs) play the most
significant role in the life of an abused or neglected child. They are the
first to see a child who may be abused or neglected. They make the critical
decisions about whether the environment is so dangerous that the child must
be removed, or whether law enforcement or the state attorney should be
involved in the investigation. The quality of their training, their workload
and the degree to which they believe themselves to be supported by
administrative and management staff are several of the factors which may
affect how well they make these decisions. The Commission was
particularly interested in CPIs, because they have the highest annual
turnover rate (45.7%) of the HRS staff serving children.

Every CPI working in Florida at the beginning of August, 1990, was
mailed a questionnaire designed to collect information on topics of interest
to the Commission (specifically, previous employment experiences, training
received, amount of time spent performing certain tasks, the strengths and
weaknesses of the child welfare system, etc.). They were also provided an
opportunity to make recommendations for changes which would improve
this system. The questionnaire was sent to their home addresses with a
self-addressed, business reply envelope. A total of 32% responded. Of the
respondents, 4% reported that they no longer work as CPIs.


Characteristics of the CPIs

1. Respondents have worked an average of 14 months as CPIs.

2. Prior to working as a CPI, they worked most frequently in social
service/welfare (36%), law enforcement (11%) and in education (7%)
positions. Others held positions previously as sales personnel, law
clerks, real estate agents and members of the United States military.

3. More than three-fourths reported that the expectations they held at the
time they were hired as CPIs changed as they gained more experience
in the job. Almost everyone indicated that it was a negative change.







Respondents who explained why their expectations changed stated that:

a. they had a misunderstanding about the job duties. They believed that
it would involve more investigative work and found that many social
service/paper management activities were actually required.
"Contact with the state attorney and law enforcement after
physical/sexual abuse was never stressed."

b. they were overworked or the job was too demanding. The actual
number of cases exceeded what they were told to expect during their
employment interview. According to the respondents, the intensity
of the workload, number of details and enormity of the job exceeded
the range of their skills.

c. support or backing from management was lacking. The comments
of one respondent typify those of others: "...I expected more
support from my superiors. No person above a supervisor even
speaks to CPIs. I knew it was a complex job but I never expected
to feel abandoned when in the field..."

d. they felt frustrated when they were unable to help families or make
a difference for children. Services that are needed are unavailable;
the program is too rigid "... clients have to fit the program's needs
rather than the other way around."

e. they are required to perform tasks that they believe are either not
related to their job or about which they were not fully informed prior
to being hired. They specifically cited, as examples, transporting
children, babysitting, completing paperwork assignments and
investigating patently unfounded cases.

f. liability issues concerned them. They report not being aware (prior
to becoming a CPI) of the extent to which they would be
transporting children and being concerned about their liability if they
had an automobile accident.

Two respondents reported that their expectations changed in a positive
manner after employment, and indicated that the "overwhelming workload"
that they had heard about failed to materialize, and that entering data on the
computer takes time, but also saves time.







Training

Respondents were asked whether they have completed certain types of
training. While most had completed the core and process training, and the
mentoring, fewer than one-half completed the practice training.

Training % Completing Training

a. 2 week pre-service 85
core training

b. 1 week district CPI 81
process training

c. 1-2 weeks field shadowing/ 79
mentoring

d. 1 week legal training for 61
dependency staff

e. 1 week CPI practice training 48


45







Respondents ranked the training they received in terms of its usefulness to
them as a CPI. The most valuable training was received when they
shadowed a senior CPI. A rank of 6 is the most valuable, 1 is the least
valuable.


Training Average Value

a. 2 week pre-service 4
core training

b. 1 week district CPI 4
process training

c. 1-2 weeks field shadowing/ 5
mentoring

d. 1 week legal training for 4
dependency staff

e. 1 week CPI practice training 4

f. other special in-service train- 3
ing


Three-quarters of the respondents indicated that the current training should
be revised and that:

a. more time should be spent on such topics as investigative
techniques, legal training, field training/on-the-job training,
specific job duties, and "how to handle real cases," etc.

b. less time should be spent on such topics as theory, risk
assessment, non-job related training and core topics.

c. topics such as investigative techniques, interviewing techniques,
sexual abuse, and abuse dynamics/indicators should be added to
the training program.


46








Tasks Involved in Protective Investigations


CPIs investigate an average of 19 cases per month and estimate spending
49 hours per week fulfilling their job responsibilities (excluding vacation
and training time). They report spending 50 hours per month on after-hour,
immediate response duty; they report having been employed an average of
5.4 weeks before being assigned these duties.

CPIs were asked to estimate the percentage of time each week which was
devoted to the following tasks:


TASK % OF
TIME
a. computer/data entry (17%)
b. travel, time on the road (14%)
c. contact with alleged victim (11%)
d. collateral contacts (10%)
e. contact with alleged perpetrator (8%)
f. unsuccessful attempts to make necessary
contacts (7%)
g. risk assessment instrument (5%)
h. court preparation (5%)
i. court appearance (4%)
j. transport (3%)
k. consultation with child welfare lawyers (3%)
1. case review with supervisor (3%)
m. Early Service Intervention
(ESI) staffing ( 3%)
n. supplemental reports (2%)
o. additional reports (2%)
p. preparation/presentation for Child
Protection Team (2%)
q. preparation for medical
evaluations/psychological assessments (1%)








CPIs were asked to provide their opinions on the extent to which the
following tasks impair their ability to assure the protection, safety and well-
being of children suspected of being abused or neglected:


EFFECT OF TASKS

Impairs Impairs
Impairs Should Be Eliminate
Does Not But is Handled by From the
Task Impair Necessary Other CPI
Personnel Process
computer/data
entry 27% 30% 37% 6%
completing reports on
obvious unfounded
cases 3% 33% 20% 44%
responding to minor
neglect reports (e.g.,
head lice, family
without food) 8% 29% 39% 24%
court preparation 35% 39% 22% 4%
court appearance 44% 37% 14% 5%
risk assessments 28% 41% 5% 26%
transport 7% 6% 49% 38%
lockout/abandonment
cases (e.g.,
CINS/FINS,
detention) 10% 12% 36% 42%
case management
issues 24% 44% 22% 10%


Twenty-two percent of the respondents report that the law, as written, does
not allow removal of the child from a situation or environment, even though
the child is in danger; 11% responded that they had experienced between
one to three cases within the last month which they believed fell into this
category.







Because of persistent reports that safe, alternative placements were not
available when children had to be removed from the home, CPIs were
asked the following question: When a decision is made to remove a child
from a situation or environment, are appropriate alternative placements
available within a reasonable time period? They reported the following
frequencies:

Always 7%
Usually 41%
Sometimes 46%
Never 6%

When placements are unavailable, approximately two-thirds of these CPIs
report staying with the child until some placement is found (e.g., in the
office, a car, at the police station, etc.) Eighteen percent place these
children in emergency shelters and 17% report placing these children in
overcrowded, undesirable or inappropriate settings (which could include a
detention center where older and younger children are mixed, a facility
distant from the family or the separation of siblings).


Strengths and Weaknesses of the Child Protective Investigation Process

Two-thirds of the respondents believe that the current system has strengths.
Respondents could list more than one strength. The most frequently listed,
in order of frequency are:

Strengths

a. dedicated workers/workers who care, doing the best that
they can/supportive co-workers;
b. computer system/provides access to priors/FPSS;
c. abused children are protected/ability to take child
immediately into protective custody;
d. ability to transfer services to voluntary family
services/protective services/resources housed in one
facility/uniformity statewide;
e. more training is being provided/effective training;
f. immediate response time on calls/response time/cases seen
24 hours a day; and
g. ability to help families in need





Eighty-nine percent of the responding CPIs believe that weaknesses exist in
the current protective investigative process. Respondents could list more
than one weakness. The most frequently reported in order of frequency
were:
Weaknesses

a. caseloads too high;
b. overworked/too many demands on time;
c. non-supportive administration/non-involvement of CPIs in
policy development/poor management;
d. too much paperwork;
e. lack of qualified investigators/lack of experienced
PIs;
f. mandatory collatorals and paperwork on obviously
unfounded cases (wastes time);
g. performing transport, data entry, visitation and court work;
and
h. underpaid

Turnover

According to the Salary and Retention Study (1990a), the total turnover rate
for CPIs is 45.7% per year (the total includes separations due to
promotions, demotions, reassignments, transfers, retirement and death).
Child Protective Investigators were asked what factors contribute to this
rate; ninety-eight percent of the respondents answered the question.
(Respondents also indicated that they believed 45.7% was too low). The
eleven most frequently listed responses include:

a. poor pay;
b. lack of management support/poor administration-
"administration has no idea what we are doing;"
c. high caseload;
d. too many responsibilities/demands, overworked, unrealistic
expectations about what we can do in the time we have;
e. bum out/high stress/too much pressure;
f. liability concerns;
g. lack of merit increases/no step pay plan/no extra pay for
more skills/no career advances;
h. on-call duty;
i. long hours/demanding hours/overtime;
j. lack of regard for personal safety; and
k. too much paperwork/duplicates itself.








When asked whether the current performance of their job duties could be
improved by the following changes, they provided these responses:


CHANGES YES
a. lower workload 95%
b. teamwork investigations with another
CPI 78%
c. more training 70%
d. more direct supervisory training
(supervisor available to go out on
investigations) 70%

Two-thirds of the CPIs report that being concerned about personal safety
affects the performance of their job duties. Eighty percent report that
concerns about personal liability affect the performance of their duties.


Compliance with Mandatory Reporting Requirements

Chapter 415, F.S., contains provisions which require that HRS report
allegations of abuse or neglect resulting in: child death, sexual battery/abuse
and aggravated child abuse. Respondents indicate that they report such
allegations to the State Attorney:


Time Frame

a. immediately

b. immediately,
supervisor

c. immediately,
confirmed


after conferring with


Percentage

69%


11%


if allegation is


d. when case is closed

e. other


<1%

15%








Respondents indicate that they report such allegations to law enforcement:


Time Frame

a. immediately

b. immediately, after conferring with
supervisor

c. immediately, if allegation is
confirmed

d. when case is closed


other


Percentage

80%


6%


3%

0%

11%







Abuse Registry


Eighty-four percent of the respondents indicated that they had complaints
regarding the nature of reports received from the abuse registry. These
included:

a. Mis-assigned response priorities, these included reports about
institutional abuse (day care) in the middle of the night; dirty
lawns, lock outs, etc.

b. Failure to accept a report or mis-stating the facts of a report.
One respondent made the report to the Abuse Registry but did
not recognize the facts when the case came back to the
district. Another indicated that they were aware of situations
in which physicians reported abuse or neglect, but the Registry
did not accept them.


Summary

In general, CPIs in Florida view the protective investigation system as one
with both strengths and weaknesses. The strengths most frequently
mentioned include the dedication of the workers, access to the computer
system through the Florida Protective Services System (FPSS), the ability
to remove a child from a dangerous setting, and the fact that various service
options (such as voluntary family services, protective supervision, etc.) are
available within one program. The most frequently reported weaknesses
include caseloads which are too high, too many demands on the
investigators, overworked CPIs, and non-supportive management and
administrative staff. The perceived lack of support may be reflected in the
fact that respondents report spending only three percent of their time each
week reviewing cases with their supervisors.

Child Protective Investigators report investigating a greater number of cases
per month (an average of 19) than the caseload standard (12 per month).
Almost all of the respondents believe that the performance of their job
would improve with a lower workload; three-quarters indicate that
teamwork investigations (pairing) with another CPI would also improve
their performance. While there are complaints about paperwork
assignments, over one-half of the responding CPIs believe that the
computer/data entry functions of theirjob either do not impair their efforts







or may hamper them somewhat, but are necessary for the investigative
process. The training they received which they felt was most valuable to
them as CPIs, involved field shadowing or mentoring. Although more than
three-quarters report that they immediately notify the State Attorney and
Law Enforcement as required by law when certain child abuse allegations
are received, some CPI respondents do not. This is consistent with reports
from State Attorney offices and may reflect district-specific variation in
implementing this provision of law.

A significant number report that the expectations they held at the time they
were hired changed as they gained more experience on the job and almost
everyone reported that these shifts in expectations could be characterized as
negative.

The findings of this survey support changing the investigative process
(which could include pairing), modifying the training to include more
realistic experiences related to actual investigations, reducing the workload,
increasing the involvement and visible support from management, and
increasing pay (with steps available for those who acquire greater skill and
experience.)


54








THE ROLE OF STATE ATTORNEY OFFICES IN THE
PROSECUTION OF CHILD ABUSE AND NEGLECT

In early September, State Attorneys in each of Florida's twenty circuits
received a questionnaire which addressed their perceptions of laws and
procedures related to child abuse and neglect prosecution. State attorneys
from 13 circuits returned the questionnaires. This represents a response
rate of 65 %. (One state attorney returned two replies because two counties
were included in that district, for a total of 14 replies). Because the circuit
with two counties differed in their responses, for the purpose of this survey,
they are treated separately.


HRS COMPLIANCE WITH MANDATORY NOTIFICATION

The first section of the questionnaire deals with the extent to which CPIs
complied with the laws which require them to immediately notify the State
Attorney's Office (SAOs) under certain circumstances. HRS is required to
report to the local State Attorney's office:

1. when a child dies as a result of abuse or neglect,
2. when a child is a victim of aggravated child abuse, and
3. when a child has been sexually abused or sexually assaulted.

HRS is also required to report to the State Attorney when there is an
observable injury or medically diagnosed injury, and when the confirmed
perpetrator has a previous confirmed case of abuse or neglect.

The data reported in this section represents respondents' impressions of the
degree to which HRS complies with the mandatory notification law.
Summarized below are their responses to questions addressing the frequency
with which HRS notifies their offices of those cases requiring mandatory
notification.


55







SAOs were asked: "How often HRS makes immediate notification when
it believes that observable injury or medically
diagnosed internal injuries occurred as the result of
child abuse or neglect?"

Frequency # of Respondents


a. in almost all cases (90%-100% of cases) (6)
b. in most cases (75% of cases) (3)
c. in some cases (50% of cases) (3)
d. in few case (25% of cases) (0)
e. in relatively few cases (0%-10% of cases) (1)
f. no response (1)

Only six respondents report that the Department is complying with the
notification requirements under these circumstances. Compliance was
reported to be the greatest when a child's death was alleged.



SAOs were asked: "How often HRS immediately notifies them when it
believes that a child died as a result of abuse or
neglect?"

Frequency # of Respondents

a. in almost all cases (90%-100% of cases) (11)
b. in most cases (75% of cases) (00)
c. in some cases (50% of cases) (01)
d. in few case (25% of cases) (00)
e. in relatively few cases (0%-10% of cases) (01)
f. no response (01)







SAOs were asked: "How often does HRS immediately notify your office
when a child is alleged to be a victim of aggravated
child abuse?"

Frequency # of Respondents

a. in almost all cases (90%-100% of cases) (8)
b. in most cases (75% of cases) (1)
c. in some cases (50% of cases) (3)
d. in few case (25% of cases) (0)
e. in relatively few cases (0%-10% of cases) (1)
f. no response (1)




SAOs were asked: "How often HRS immediately notifies them when it
receives a report that a child has been sexually
abused or sexually assaulted?

Frequency # of Respondents

a. in almost all cases (90%-100% of cases) (8)
b. in most cases (75% of cases) (2)
c. in some cases (50% of cases) (2)
d. in few case (25% of cases) (0)
e. in relatively few cases (0%-10% of cases) (1)
f. no response (1)


The notification of SAOs of persons with prior confirmed abuse or neglect
occurs less frequently than other HRS reporting.







SAOs were asked: "HRS notifies SAOs when it confirms an abuse or
neglect report and learns that the perpetrator has a
prior confirmed report of abuse or neglect with what
frequency?"

Frequency # of Respondents

a. in almost all cases (90%-100% of cases) (6)
b. in most cases (75% of cases) (1)
c. in some cases (50% of cases) (3)
d. in few case (25% of cases) (1)
e. in relatively few cases (0%-10% of cases) (2)
f. no response (1)


In general, there appears to be considerable variability, not only according
to the type of abuse or neglect, but also across state circuits/HRS districts.
For example, with the exception of three circuits, all state attorneys
reported that they believed that they were informed by HRS of child deaths
in 90-100% of such cases. This was in contrast to state attorneys' reports
of HRS notification in instances of sexual abuse; here only eight circuits
reported that they were notified by HRS of such cases over 90% of the
time.

There is variation within or between HRS districts in how well they comply
with notification requirements, according to state attorneys. For example,
six of the state attorneys reported that they believed that HRS notified them
of all types of particular cases over 90% of the time. One state attorney,
however, believed that his office received notification in less than 10% of
the cases, for all types of situations. In addition, the state attorney who
completed two questionnaires (one for each county for which he was
responsible, both within the same HRS district) estimated that in one county
his office was notified of over 90% of the cases for which notification was
mandatory while in another county, his office was notified of about 50% of
the cases.







STATE ATTORNEYS' COMPLIANCE WITH MANDATORY
REPORTING REQUIREMENTS

Another area of concern was the regularity with which the state attorney
offices notified HRS of their decisions regarding prosecution, as mandated
by law. Section 415.505, F.S., requires HRS to immediately notify the
state attorney's office during child abuse and neglect investigations when it
is believed that:

(1) observable or medically diagnosable internal injuries are
known, or when
(2) a child has died as a result of abuse or neglect, is the victim
of aggravated child abuse, or is a victim of sexual battery or
sexual abuse.


The state attorney office is then required to investigate these cases and
determine if criminal prosecution is appropriate. F.S. 415.505(1)(k), states
that "within 15 days of his investigation [of the above cases] the state
attorney shall report his findings to the department [HRS] and shall include
in such report a determination of whether or not prosecution is justified and
appropriate..."


SAOs were asked: "How often do they inform HRS within 15 days, once
a decision regarding prosecution of these cases?"

Frequency # of Respondents

a. in almost all cases (90%-100% of cases) (7)
b. in most cases (75% of cases) (3)
c. in some cases (50% of cases) (1)
d. in a few cases (25% of cases) (1)
e. in relatively few cases (0%-10% of cases) (2)
f. no response (0)







OPINIONS ABOUT EVIDENTIARY PROCEDURES AND
DEFINITIONS OF ABUSE AND NEGLECT

SAOs were asked their opinions about evidentiary procedures and
definitions of abuse and neglect. Thirteen respondents believed that hearsay
exceptions (e.g., children's out-of-court statements to parents, medical
personnel, or law enforcement officers) should be permitted and were
necessary in cases of non-sexual child abuse.


SAOs were asked: "Should hearsay exceptions (i.e., children's out-of-
court statements to parents, medical personnel or law
enforcement officers) be permitted in cases of alleged
non-sexual child abuse (i.e., non-sexual physical
abuse)?"

Yes (13) No (1)

There was less agreement among the state attorneys regarding the adequacy
of Florida's definition of aggravated child abuse ("Aggravated child abuse
is defined as one or more acts committed by a person who: commits
aggravated battery on a child, willfully tortures a child, maliciously
punishes a child, or willfully and unlawfully cages a child" S. 827.03,
F.S.). Six of the respondents believed that this definition was adequate
while eight did not. Of the eight state attorneys who were dissatisfied with
the definition, four recommended that the definition be broadened in some
way.







STRENGTHS AND WEAKNESSES OF THE CURRENT SYSTEM

The state attorneys were asked to rate how willing and able HRS Protective
Service personnel, law enforcement personnel, and Child Protection Teams
were in assisting in abuse and neglect prosecutions. There was considerable
variability across circuits in terms of how valuable they perceived these
professionals to be. The specific responses from each circuit on the
strengths and weaknesses of the current system are included in the
Appendices.

HRS Protective Service Personnel received a mean rating of 3 on a 5 point
scale, suggesting that state attorneys across the state rated them as "willing
and able" to assist in prosecutions. Law enforcement personnel and Child
Protection Teams fared a little better. Law enforcement personnel received
a mean rating of 2.29, which corresponds to an answer of "very willing and
able." Similarly, child protection teams received a mean rating of 1.86,
which also corresponds to a rating of "very willing and able." Child
Protection Teams received the most consistent ratings across circuits.

The state attorneys were also asked to identify the strengths and weaknesses
of the current system, and offer recommendations for improving the system.
A review of the state attorneys' responses suggests that strengths include the
use of specialized personnel in the prosecution of these cases (as opposed
to distribution of these cases across all assistant state attorneys), assistance
of specially trained personnel such as CPT professionals and specialized law
enforcement officers, and victim advocates in some areas. A few state
attorneys also cited the hearsay exception as valuable in the current process.


Weaknesses of the current system that were cited by a number of state
attorneys include the uncoordinated involvement of a number of agencies
(e.g., various HRS programs, law enforcement, state attorney's office), the
large caseloads of HRS personnel, and the lack of specially-trained HRS
personnel, law enforcement personnel, and health care professionals in
some areas.

A number of recommendations were made; these are summarized below:







RECOMMENDATION: Increase HRS' compliance with mandatory
notification requirements


The notification requirements are designed to involve state attorneys at an
early point in the cycle, so that abuse and neglect does not continue over
a period for time, thereby placing children at greater risk. HRS' failure to
notify state attorneys in all cases in which they are required to prevents
prosecutors from entering into the cycle at an earlier point in time, and
perhaps preventing more serious instances of abuse and neglect.





RECOMMENDATION: Increase State Attorneys' compliance with
requirements that they inform HRS of
prosecution decisions within 15 days of
reaching such a decision.

State attorneys must inform HRS officials of their prosecutorial decisions
as soon as possible so that investigations may be conducted and completed
without delay.





RECOMMENDATION: Make available training in child abuse and
neglect to HRS-FPSS CPIs, state attorneys'
office personnel, law enforcement personnel,
and judicial personnel.

Appropriate, interdisciplinary training devoted to abuse and neglect
investigation, intervention, and prosecution should be made available to
systems personnel.







RECOMMENDATION: Encourage systems personnel (i.e., HRS-FPSS
CPIs, assistant state attorneys and staff, law
enforcement personnel) to better coordinate
investigative and prosecutorial process.

Coordination of these efforts is crucial for effective and efficient
investigation and prosecution of cases. Coordination, however, cannot
always be legislated or mandated by rule. Professionals in the system
should be encouraged to meet and transcend systems boundaries that impede
cooperative efforts.





RECOMMENDATION: Encourage state attorneys to institute
specialized prosecution teams within their
offices.

Specialized prosecution generally results in better prosecutions. State
Attorneys that have not instituted such teams, using allied professionals
(e.g., investigators, paralegals) should be encouraged to do so. State
Attorneys, however, should be aware of potential problems associated with
specialized prosecution in the case of abuse and neglect including:
"burnout" and career advancement issues, and adopt appropriate responses.







REFERENCES


Boyd, L.A., Struchen, W., and Panacek-Howell, L. (1989). A study of the
mental health and substance abuse service needs of Florida's foster
children: A report to HRS. Tampa, Florida: University of South
Florida, Florida Mental Health Institute, Department of Child and
Family Studies.

Center for the Study of Social Policy. (1990). Kids count: State profiles of
child well-being. Washington, D.C.: Author.

Chasnoff, IJ., Landress, HJ. & Barrett, M.E. (1990). The prevalence of illicit
drugs or alcohol use during pregnancy and discrepancies in mandating
reporting in Pinellas County, Florida. The New England Journal of
Medicine. 322(17). 1202-1206.

Children's Defense Fund. (1990). Children 1990. Washington, D.C.: Author.

Florida Bar, Commission on Children. (1990). 1990 Legislative
recommendations. Tallahassee, Florida: Author.

Florida Center for Children and Youth. (1990). Key facts about the children.
Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services. (1988). Florida
healthy mothers. Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services. (1990a). Homeless
conditions in Florida. Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services. (1990b).
Performance indicators report. Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services, Children, Youth
and Families Program Office. (1989). Outcome evaluation report.
Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services, Children, Youth
and Families Program Office. (1990). Budget requests and
appropriations for FY 1989-90. Tallahassee, Florida: Author.


64







Florida Department of Health and Rehabilitative Services, Children, Youth
and Families (1990a). Salary and retention study of Florida's child
welfare system. Tallahassee, FL: Author.

Florida Department of Health and Rehabilitative Services, Office of
Evaluation. (1989). Substance-exposed newborns: Presentation to
Secretary Coler. Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services, Office of the
Inspector General. Report on non-delinquent children sleeping in
district VI detention centers. Tallahassee, Florida: Author.

Florida Department of Education, Office of Policy Research.(1990). Cocaine
Babies: Florida substance-abused youth. Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services, Protective Services
System. (1991). Child protective investigations: Annual report. 1989-
1990. Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services, State Health
Office. (1988). Draft 1988 state health plan. Tallahassee, Florida:
Author.

Florida Department of Health and Rehabilitative Services, State Health
Office. (1989a). Presentation to the House Task Force on teenage
pregnancy. Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services, State Health
Office. (1989b). Survey of immunization levels in two-year old children.
Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services, State Health
Office. (1990a). Facts about the special supplemental food program for
women, infants and children (WIC). Tallahassee, Florida: Author.

Florida Department of Health and Rehabilitative Services, State Health
Office. (1990b). 1988 Provisional infant mortality data. Tallahassee,
Florida: Author.

Florida Department of Health and Rehabilitative Services, State Health
Office. (1990c). Infant mortality among IPO and non-IPO women from
1985-1988. Tallahassee, Florida: Author.







Florida Department of Health and Rehabilitative Services, State Health
Office. (1990d). Family planning in Florida. Tallahassee, Florida:
Author.

Florida Department of Health and Rehabilitative Services, State Health
Office. (1990e). Vital Statistics. 1983-1988. Tallahassee, Florida:
Author.

Florida Department of Insurance. (1990). The healthy kids act. Tallahassee,
Florida: Author.

Florida Healthy Mothers, Healthy Babies Coalition. (1988). Improving
pregnancy outcomes in Florida: 1988. Gainesville, Florida: Author.

Florida House of Representatives, Committee on Health and Rehabilitative
Services. (1989). Child welfare system guide. Tallahassee, Florida:
Author.

Florida House of Representatives, Task Force on the Future of the Florida
Family. (1990). Final report. Tallahassee, Florida: Author.

Florida Legal Service, Inc. (1990). Statement to the legislative committee and
the Florida Bar regarding legislative proposals of the commission on
children. Miami, Florida: Author.

Florida Legislature, Division of Economic and Demographic Research.
(1990a). Florida consensus estimating conference: Book 3. Volume 5.
Tallahassee, Florida: Author.

Florida Legislature, Division of Economic and Demographic Research.
(1990b). Health insurance coverage rates by age. Tallahassee, Florida:
Author.

Florida Legislature, Division of Economic and Demographic Research.
(1990c). Poverty level by age. Tallahassee, Florida: Author.

Florida Senate. (1989). Listing of prevention programs. Tallahassee, Florida:
Author.

Florida State University, Center for Human Services Policy and
Administration. (1989). Shanks health center evaluation: Final report.
Tallahassee, Florida: Author.


66







Friedman, Robert. (1987, July 14). "Children's mental health: Promising
responses to neglected problems". Testimony at Hearing of Select
Committee on Children, Youth and Families, U.S. House of
Representatives. Washington, D.C.

Governor's Constituency for Children. (1987). Protecting Florida's children:
A blueprint for the next decade. Tallahassee, Florida: Author.

Juvenile Welfare Board of Pinellas County. (1990). A challenge for all:
Recommendations for a community-wide response to drug-involved
infants and mothers. St. Petersburg, Florida: Author.

Knitzer, J., Steinbert, Z., Fleisch, B. (1990). At the schoolhouse door: An
examination of programs and policies for children with emotional and
behavioral problems. New York: Bank Street College of Education.

Mahan, Charles S., State Health Officer, Florida Department of Health and
Rehabilitative Services. (1990, April 16). [correspondence to Chris
Giblin]. Tallahassee, Florida: Author.

Maine Department of Human Services. (1983). American's children:
Powerless and in need of powerful friends. Augusta, Maine: Author.

National Commission to Prevent Infant Mortality. (1990). Troubling trends:
The health of America's next generation. Washington, D.C.: Author.

Schorr, Lisbeth B. (1988). Within our reach: Breaking the cycle of
disadvantaged. New York: Doubleday.

SPSS, Inc. (1988). Statistical package for the social sciences (SPSS-X) User's
Guide. 3rd Edition. Chicago, Illinois: Author.

State Board of Education, Study Group on Teenage Pregnancy. (1989).
Services to pregnant and parenting teens. Tallahassee, Florida: Author.

State of Florida, Department of Education and Department of Health and
Rehabilitative Services. (1989). Florida's handicap prevention report.
Tallahassee, Florida: Author.

Schwartz, Ira. (1990, Aug. 27). Presentation to the Study Commission on Child
Welfare. Miami, Florida.

United Nations Children's Fund (UNICEF). (1990). The state of the world's
children. London, England: Oxford University Press.







United States Census Bureau. (1987). Population and poverty status of
families and persons. Washington, D.C.: Author.

United States House of Representatives, Select Committee on Children,
Youth and Families. (1989). Child health: Lessons from developed
nations. Washington, D.C.: U.S. Government Printing Office.

United States House of Representatives, Select Committee on Children,
Youth and Families. (1990). No place to call home: Discarded children
in America. Washington, D.C.: U.S. Government Printing Office.

Wurm, G. and Lambert, W. (1980, March). Kids. crack and custody. Florida
Bar Journal. pp. 36-40.







UF 13301 BRUCE B. DOWNS BOULEVARD
THE FLORIDA MENTAL HEALTH INSTITUTE TAMPA, FLORIDA 33612-3899
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Agenda

Study Commission on Child Welfare


9:3


2:0


9:30am 2:00pm
January 25, 1990
Collier Room, Tampa Airport Marriott Hotel
Tampa, Florida



Oam Introductions

Review Charge to the
Commission

Discussion of Proposed Issues
and Approach for Commission

Preliminary Report

Additional Discussion

Opm Adjourn



















69

TAMPA ST PETERSBURG SARASOTA FORT MYERS LAKELAND
THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY INSTITUTION







THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


USF


AGENDA


Study Commission on Child Welfare

March 19, 1990

Orlando International Airport
Airside B Conference Room B


12:30 p.m.

1:30 p.m.




5:00 p.m.


Legislative Overview
of Child Welfare System


Family Preservation Programs






National and Historical
Perspective on Child
Welfare Systems


Judy C. Justice
Staff Director
Health and Rehabilitative
Services Committee
Florida House of Representatives

Susan Yelton
Project Director
Edna McConnell Clark Foundation and
Faculty Member, Florida Mental
Health Institute,
University of South Florida

Elizabeth S. Cole
Policy Associate for the
Center for the Study of
Social Policy, Washington D.C.,
and President, Elizabeth S. Cole
Associates, New Hope, Pennsylvania


Lunch on your own

Discussion:
Issues for Commission Consideration
Dates and Locations for Future
Commission Meetings

Adjourn


70


TAMPA ST PETERSBURG


SARASOTA


FORT MYERS


THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION /EOUAL OPPORTUNITY INSTITUTION


9:00 a.m.


LAKELAND


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THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


13301 BRUCE B. DOWNS BOULEVARD
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PHONE (813) 974-4533
FAX # 974-4406


Agenda


9:00 a.m.









10:30 a.m.


Study Commission on Child Welfare
Courtroom of the Supreme Court
Tallahassee, Florida
April 19, 1990


Things that Matter
in the Lives of Kids








Presentation


Stanley N. Graven, M.D.
Chairman, Department of
Community and Family
Health
College of Public Health
University of South Florida
Tampa, Florida



Gwen Wurm, M.D.
Assistant Professor of
Pediatrics and
Director, Community-Based
Pediatric Program
School of Medicine
University of Miami
Miami, Florida


on your own


1:00 p.m.


5:00 p.m.


Discussion
Issues and Recommendations
related to the prevention
of child abuse and neglect
(and the need for specialized
services) Prior to or at Birth

Future Meeting Dates and Locations,
including Public Hearings


Adjourn


TAMPA ST PETERSBURG SARASOTA FORT MYERS LAKELAND
THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION 'EQUAL OPPORTUNITY INSTITUTION


Lunch







THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


13301 BRUCE B. DOWNS BOULEVARD
TAMPA, FLORIDA 33612-3899
PHONE (813) 974-4533
FAX # 974-4406


Agenda


Study Commission on Child Welfare
State Capitol Building, Room LLO3
Tallahassee, Florida
May 25, 1990


9:30 am


State and Local Relationships
in Implementing Children's
Policies


Experiences of County-based
Children's Services Councils/
Boards


12:00 pm

1:00 pm


5:00 pm


Robert M. Friedman, Ph.D.
Professor and Chair
Department of Epidemiology
and Policy Analysis
Florida Mental Health Institute
University of South
Florida


-Elaine W. Alvarez
Chairperson
Children's Services Council
of Palm Beach County


-Robert Brown
Board Member
Hillsborough Children's
Services Council

-Jim Mills
Executive Director
Juvenile Welfare Board of
Pinellas County


Lunch on your own

Discussion

1. "The State of Florida's Children" a description
of the demographic characteristics of children in the state

2. Policy Statement the philosophical basis of the State's
involvement with children


Adjourn


TAMPA ST PETERSBURG


SARASOTA


FORT MYERS


THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY INSTITUTION


LAKELAND








THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


13301 BRUCE B. DOWNS BOULEVARD
TAMPA, FLORIDA 33612-3899
PHONE (813) 974-4533
FAX # 974-4406


Agenda


Study Commission on Child Welfare

Duval Room, Tampa Airport Marriott Hotel

July 9, 1990


The Full-Service School


Overview of the 1990
Legislation on Children's
Issues


Lunch on your own


Orange County Children's
Council


Discussion of Comprehensive
Policy Recommendations

Discussion of Prevention/
Intervention Recommendations

Model Service Structure for
Children A Status Report

Discussion of future meeting
dates and locations

Adjourn


Commissioner Betty Castor


Bob Pickerell,
Department Manager
Citizen's Commission
on Children


Robert Friedman, Ph.D.


TAMPA ST PETERSBURG


SARASOTA FORT MYERS


THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY INSTITUTION


9:30am


10:30am




12:00pm


1:00pm


5:00pm


LAKELAND








THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


~I~L~SI~I
''''l"U~ -- *I'lllril'ill'.


STUDY COMMISSION ON CHILD WELFARE

MIAMI CITY HALL
CITY COMMISSION CHAMBERS
3500 PAN AM DRIVE
MIAMI, FLORIDA

AUGUST 27, 1990

AGENDA


9:00 a.m.




10:30 a.m.




11:30 a.m.


Adapting the Workday to
Reunite the Parents and Child



Foster Care Review Project




Discussion


Janet Reno
Dade County
State Attorney


Julia Cope
Executive Director
Florida Foster Care
Review Project, Inc.

Comments from the
public


12:00 p.m.



1:00 p.m.


Lunch


on your own


Children's Mental Health Issues


A National Perspective


The Florida Perspective


Ira Schwartz, Ph.D.
Director
Center for the Study
of Youth Policy
University of Michigan
School of Social Work


Ivor Groves, Ph.D.
Assistant Secretary
Alcohol, Drug Abuse
and Mental Health


TAMPA ST PETERSBURG


SARASOTA FORT MYERS


THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY INSTITUTION


LAKELAND


13301 BRUCE B. DOWNS BOULEVARD
TAMPA, FLORIDA 33612-3899
PHONE (813) 974-4533
FAX # 974-4406








Consumer issues


Provider Issues


4:30 p.m.


Discussion


Brent Taylor
Senior Staff
Attorney


Mike Wilson
Client Advocate
Protection and
Advocacy for Mental
Illness Program


Advocacy Center
for Persons with
Disabilities


Florida Council for
Community Mental
Health

Comments from the
public


5:00 p.m. Adiourn



Anyone wishing to speak to the Commission during this meeting
should call Jo Lynn Krueger at (813) 974-4533.








THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


~cS~


Agenda


Study Commission on Child Welfare
September 19, 1990
Sheraton Airport Hotel
3835 McCoy Road
Orlando, Florida


Structural Issues in the
Delivery of Services to
Children

Brief Summary of the
"Review of State Systems
for Delivering Services
to Children: 1990
National Conference of
State Legislators"



Experiences of Ohio


Robert M. Friedman, Ph.D.
Professor and Chair
Department of Epidemiology
and Policy Analysis
Florida Mental Health Institute
University of South Florida



Susan Ignelzi, Ph.D.
Administrator
Ohio Department of Mental Health
Bureau of Children's Services


10:30 a.m.


11:00 a.m.


11:45 a.m.





12:45 p.m.


Public Testimony


Lunch


The Structure of the
Florida Department of
Health and Rehabilitative
Services: The NAPA Report


Issues Related to the
Termination of Parental
Rights, Service Entitle-
ments, and Limited
Guardianship


Commission Discussion of
Proposed Recommendations


Linda Wolf, Ph.D.
Deputy Director
American Public Welfare
Association


Mark Hardin
Director, Foster Care Project
American Bar Association


Adjourn


TAMPA ST PETERSBURG


SARASOTA


FORT MYERS


THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY INSTITUTION


8:30 a.m.


LAKELAND


13301 BRUCE B. DOWNS BOULEVARD
TAMPA, FLORIDA 33612-3899
PHONE (813) 974-4533
FAX # 974-4406








THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


UES
P.M1iffLUZ


13301 BRUCE B. DOWNS BOULEVARD
TAMPA, FLORIDA 33612-3899
PHONE (813) 974-4533
FAX # 974-4406


AGENDA
STUDY COMMISSION ON CHILD WELFARE
TAMPA/HILLSBOROUGH COUNTY PUBLIC LIBRARY AUDITORIUM
OCTOBER 19, 1990


9:00am Judges' Perception of
the Child Welfare System


11:00am Summary of Commission
Surveys
a. Child Protective
Investigators
b. Foster Parents Concerns


12:00pm Lunch


The Honorable Emery Newell
Circuit Judge,
Fifteenth Judicial Circuit
West Palm Beach, Florida

The Honorable Dorothy Pate
Circuit Judge,
Fourth Judicial Circuit
Jacksonville, Florida


Chris Giblin, Ph.D.
Project Director


On your own


1:00pm Public Testimony


2:00pm The Effect of the
Organizational Structure
of HRS on the Delivery of
Services to Children


V. Sheffield Kenyon
Assistant Deputy
Secretary for Programs
Health and Rehabilitative
Services


Commission Discussion


5:00pm Adjourn


TAMPA ST PETERSBURG


SARASOTA FORT MYERS


THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY INSTITUTION


LAKELAND





AGENDA
STUDY COMMISSION ON CHILD WELFARE
HOUDAY INN, AIRPORT LAKES
1101 N.W. 57TH AVENUE
MIAMI, FLORIDA
NOVEMBER 28, 1990


Changes to the
Local/State Structure
for Services to Children


Experiences of a Child
Protective Investigator


Parents' Concerns About
Services to Children


Child Health Insurance
Recommendations


9:00


LUNCH

Public Testimony

Discussion of Recommendations


Elaine Alvarez, Chair
Palm Beach County Children's
Council

and

Jim Mills, Director
Juvenile Welfare Board of Pinellas
County

Sally Wenstrand
HRS District Intake Counselor
(former Child Protective Investigator)

Kathy Murray, Parent


and

Virginia Stanley, Esq.
President, Juvenile Justice Attorneys
Association

Nancy Schliefer, Esq.
Florida Bar Commission on Children


10:00



11:00


11:30


12:00


12:30

1:30

2:30











AGENDA
STUDY COMMISSION ON CHILD WELFARE
RADISSON HOTEL AIRPORT
14000 DIXIE CLIPPER DRIVE
DECEMBER 14, 1990


Discussion of
Recommendations


Commission Members


LUNCH


Discussion of
Recommendations


Commission Members


Children's Needs




Concerns of the State
Offices


Guardian Ad Litem Program


Jack Levine, Executive
Director, Florida Center for
Children and Youth


Carol Todd, Asst. State Attorney
Attorney, Jacksonville


Jane Shaeffer, State Director
Guardian Ad Litem Program


Adjourn


9:00


12:00


2:00







THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


U;SE~


13301 BRUCE B. DOWNS BOULEVARD
TAMPA, FLORIDA 33612-3899
PHONE (813) 974-4533
FAX # 974-4406


AGENDA
STUDY COMMISSION ON CHILD WELFARE
TAMPA AIRPORT MARRIOTT
TAMPA, FLORIDA
JANUARY 14 1991


Discussion of
Recommendations


Commission Members


LUNCH


Discussion of
Recommendations


Commission Members


Adjourn








80
TAMPA ST PETERSBURG SARASOTA FORT MYERS LAKELAND
THE UNIVERSITY OF SOUTH FLORIDA IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY INSTITUTION


9:00





12:00




1:00


5:00








THE FLORIDA MENTAL HEALTH INSTITUTE
STUDY COMMISSION ON CHILD WELFARE


USnn~Firi' nmm


13301 BRUCE B. DOWNS BOULEVARD
TAMPA, FLORIDA 33612-3899
PHONE (813) 974-4533
FAX # 974-4406


AGENDA
STUDY COMMISSION ON CHILD WELFARE
SUPREME COURT BUILDING JUDICIARY ROOM
TALLAHASSEE, FLORIDA
FEBRUARY 6, 1991


10:00 A.M.










12:00 P.M.






3:00 P.M.


DISCUSSION OF COMMISSION
RECOMMENDATIONS AND
UNRESOLVED ISSUES







LUNCH (CATERED)






ADJOURN







81


SARASOTA FORT MYERS LAKELAND


TAMPA ST PETERSBURG






CHARGE TO THE COMMISSION


The Florida Legislature established the Study Commission
on Child Welfare during the November, 1989 Special Session.
SB 32-D Section 1, provides that:

From the funds in Specific Appropriation
16, $100,000 from the Direct Assistance
Trust Fund is provided for the Florida Mental
Health Institute at the University of South
Florida to fund and staff a Study Commission
on Child Welfare. The commission shall
be composed of 15 members consisting of
two senators to be appointed by the President
of the Senate; two members of the House
of Representatives to be appointed by the
Speaker of the House of Representatives;
three judges to be appointed by the Chief
Justice of the Supreme Court, one of whom
must be a Supreme Court justice, who shall
serve as chairman of the commission, and
two of whom must be circuit court judges
with extensive experience in dependency
proceedings; two attorneys who are members
in good standing of The Florida Bar to be
appointed by the President of The Florida
Bar, one attorney must be a member of the
Florida Commission on Children and one
attorney must be a representative of the
Florida Legal Services Corporation; a foster
parent who cares for a child placed in his
home by the Department of Health and
Rehabilitative Services, to be appointed
by the Governor; one person representing
the state guardian ad litem program, to
be appointed by the Chief Justice of the
Supreme Court; one person representing the
Florida Prosecuting Attorneys Association,
to be appointed by the Governor; one person
representing the Florida Clearinghouse on
Human Services, to be appointed by the
Governor; one person representing the Florida
Center for Children and Youth, to be appointed
by the Governor; and the Assistant Secretary
for the Children, Youth, and Families Program
Office of the Department of Health and
Rehabilitative Services. This commission
is created to review Chapter 39, F.S.,
relating to juveniles; Chapter 63, F.S.,
relating to adoption; Chapter- 402, F.S.,
relating to health and rehabilitative
services; Chapter 409, F.S., relating to
social and economic assistance; and Chapter
415, F.S., relating to protection from abuse,




Page 2


neglect, and exploitation and to study such
other existing state laws concerning child
welfare as are necessary to ensure that
state law provides effective protection
for children. In its deliberations, the
commission may address additional areas
which are pertinent to the child welfare
system and may make recommendations for
improving those areas as necessary. The
commission shall submit preliminary findings
no later than March 1, 1990, and a final
report and any recommended legislation no
later than March 1, 1991, to the Governor,
the Chief Justice of the Supreme Court,
the President of the Senate, and the Speaker
of the House of Representatives. Members
of the commission shall serve without
compensation but shall be entitled to per
diem and travel expenses as provided in
s. 112.061, F.S.




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