Senate Bill 1660e1

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  1                      A bill to be entitled

  2         An act relating to children and families;

  3         creating s. 383.145, F.S.; creating the Healthy

  4         Families Florida program; providing legislative

  5         findings and intent; providing purpose;

  6         requiring integrated community-based delivery

  7         of services; specifying program requirements;

  8         providing responsibilities of the Department of

  9         Health and the Department of Children and

10         Family Services; providing for development,

11         implementation, and administration of the

12         program; specifying criteria for community

13         program grant funding; requiring collaboration

14         with existing community boards, coalitions,

15         providers, and planning groups; authorizing

16         contracts for training and evaluation;

17         providing for quality assurance; establishing

18         the Healthy Families Florida Advisory

19         Committee; providing for application for a

20         federal waiver; providing appropriations;

21         providing an effective date.

22

23  Be It Enacted by the Legislature of the State of Florida:

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25         Section 1.  Section 383.145, Florida Statutes, is

26  created to read:

27         383.145  The Healthy Families Florida program.--There

28  is created within available resources the Healthy Families

29  Florida program, a voluntary program for newborn children and

30  their families.

31         (1)  LEGISLATIVE FINDINGS AND INTENT.--


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  1         (a)  The Legislature finds that family well-being is

  2  critical to a child's health and development. Research has

  3  shown that comprehensive early home visitation programs

  4  prevent child abuse, help develop positive parent-child

  5  interactions, and help avoid future social problems. In

  6  addition to addressing child abuse, such programs help to

  7  ensure that families' social and medical needs are met and

  8  that children are ready for success in school. The Legislature

  9  finds that Florida needs broad implementation of such a

10  program to help identify families who need and desire

11  assistance in establishing healthy relationships and

12  environments for their children.

13         (b)  It is the intent of the Legislature to establish

14  the Healthy Families Florida program as a collaborative effort

15  that builds on existing community-based home visiting and

16  family support resources and will not duplicate the existing

17  services.  It is the further intent of the Legislature that

18  the program provide the needed intensity and duration of

19  services that extend beyond those available through Florida's

20  Healthy Start initiative. By creating a Healthy Families

21  Florida program, a major gap in the existing continuum of

22  early childhood prevention and assistance services will be

23  filled.

24         (2)  PURPOSE.--The purpose of the program is to

25  strengthen families; promote healthy childhood growth and

26  development; improve childhood immunization rates and

27  well-child care; improve child health outcomes; improve school

28  readiness; increase family self-sufficiency; increase the

29  involvement of both parents with their children; and reduce

30  the incidence of child abuse and neglect through a primary

31  prevention approach that offers home visits and linkages to


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  1  family supports for families and their newborn children and

  2  continues until the children reach 5 years of age.

  3         (3)  DELIVERY OF SERVICES.--Service delivery under the

  4  program shall be community-based and collaborative. Program

  5  services shall be integrated and coordinated with services

  6  provided under Florida's Healthy Start program and other home

  7  visiting and family support service delivery systems currently

  8  in place in Florida communities. Services shall be offered

  9  with the intensity and duration required to prevent child

10  abuse and neglect and to improve child development and child

11  health outcomes. The following disclaimer shall be presented

12  verbally and in writing at the initial contact with the

13  parent, which may occur before or after the birth of a child:

14  "Participation in the initial interview and assessment process

15  and all services provided through the Healthy Families Florida

16  program is voluntary. You have the right not to answer any

17  questions asked during the assessment process and the right to

18  decline to participate in the program at any time."

19         (4)  PROGRAM REQUIREMENTS.--The program shall provide

20  for intensive home visits and include the following critical

21  elements:

22         (a)  Initiation of services. This element provides for:

23         1.  Initiation of services prenatally or at birth.

24         2.  Use of a standardized assessment tool to

25  systematically identify those families most in need of

26  services. Under no circumstances shall an assessment tool use

27  the fact that a person has been spanked or has spanked a child

28  as an indicator of a need for services unless such spanking

29  constitutes harm as defined in s. 415.503(9).

30         3.  Offering services on a voluntary basis and using

31  outreach efforts to build family trust.


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  1         4.  Working with family members to identify strengths

  2  and resources that can be mobilized to help resolve identified

  3  family concerns.

  4         (b)  Service content. This element provides for:

  5         1.  Offering services over the long term and

  6  intensively, with well-defined criteria for increasing or

  7  decreasing the intensity of the service.

  8         2.  Providing services that are sensitive and

  9  appropriate and that respect the cultural differences among

10  participants.

11         3.  Providing services that focus on supporting parents

12  and families, encouraging the interaction of both parents with

13  their children, and enhancing the development of all children

14  in the family, including reading skills and school readiness.

15         4.  Linking families to medical providers to ensure

16  optimal health and development of the children; timely

17  childhood immunizations; well-child care that provides for

18  developmental assessment and is consistent with the standards

19  and periodicity schedules of Medicaid and the American Academy

20  of Pediatrics; and additional services, as needed. Children

21  who are eligible for Medicaid shall be referred for Early

22  Periodic Screening, Diagnosis, and Treatment (EPSDT) services.

23         5.  Providing families the opportunity to create

24  neighborhood support systems to address mutual concerns and

25  solve problems without external resources.

26         6.  Incorporating specialized services to accommodate

27  the needs of families with substance abuse problems. Staff

28  trained in providing substance abuse services will work with

29  these families to meet their unique needs. Linkages will be

30  developed with existing community-based, substance-abuse

31  services.


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  1         (c)  Selection and training of service providers. This

  2  element provides for:

  3         1.  Weighted caseloads of not greater than 25:1 overall

  4  and 15:1 for intensive services for staff providing home

  5  visits. The establishment of weighted caseloads may take into

  6  consideration the Healthy Families America model.

  7         2.  Selecting home visit providers based on the

  8  provider's interpersonal skills; knowledge of community

  9  resources; willingness to work with, or experience working

10  with, culturally diverse communities and families; and job

11  skills.

12         3.  Ensuring that home visit providers have basic

13  training in areas including, but not limited to:  cultural

14  competency, substance abuse, reporting child abuse, domestic

15  violence, drug-exposed infants, child development, services

16  available in the community, infant care and development, and

17  parenting.

18         4.  Ensuring that home visit providers have preservice

19  and ongoing training that is specific to their job

20  requirements.

21         5.  Ensuring that home visit providers receive ongoing

22  weekly reviews and direct and intensive supervision.

23         (5)  IMPLEMENTATION.--In order to gain the

24  efficiencies, advocacy, and broadbased support of a

25  public-private partnership, the Department of Children and

26  Family Services shall contract with a private nonprofit

27  corporation that is incorporated to identify, fund, support,

28  and evaluate programs and community initiatives to improve the

29  development and life outcomes of children and to preserve and

30  strengthen families, with a primary emphasis on prevention.

31  The corporation must be registered, incorporated, organized,


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  1  and operated in compliance with chapter 617, and shall not be

  2  a unit or entity of state government. This contract with the

  3  private nonprofit corporation must provide for the

  4  development, implementation, and administration of the Healthy

  5  Families Florida program. This contract must be

  6  performance-based, including at a minimum the performance

  7  standards adopted by the Legislature, and must cover the

  8  expenditure of all funds appropriated for Healthy Families

  9  Florida other than funds appropriated to the department for a

10  contract manager and for expenses incident to that position.

11  The private nonprofit corporation under this contractual

12  agreement shall:

13         (a)  Using the criteria set forth in this section,

14  implement a community-based Healthy Families Florida program.

15         (b)  Award community grants and determine requirements

16  for matching funds. Community grants must be awarded in

17  accordance with weighted criteria based on population

18  demographics, factors associated with child abuse and neglect,

19  and other appropriate criteria recommended by the advisory

20  committee. Matching funds may be in-kind or cash as determined

21  by the advisory committee with the approval of the private

22  nonprofit corporation's board of directors.

23         (c)  Develop a plan of implementation to equitably

24  distribute funds.

25         (d)  Require that the following criteria be used in

26  selecting recipients of grant funds:

27         1.  Each community must have a community-based lead

28  entity for planning and implementing the Healthy Families

29  Florida program. This lead entity must demonstrate the

30  support, integration, and collaboration of existing boards,

31  coalitions, planning groups, business, and consumers. These


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  1  groups must include, but need not be limited to, the

  2  following, if locally established: Healthy Start coalitions,

  3  local healthy families steering committees, Success by Six,

  4  family preservation and support planning entities, health and

  5  human services boards, children's services councils, Head

  6  Start boards, prekindergarten early intervention councils,

  7  community child care coordinating agencies, school advisory

  8  councils, substance abuse and mental health services boards,

  9  juvenile justice councils, civic groups, business, and other

10  nonprofit organizations.

11         2.  Preference for grant awards must be given to

12  existing community-based entities that have broad

13  representation and have the fiscal and administrative capacity

14  to implement the program.

15         3.  Those community-based entities that are currently

16  providing intensive home visiting services and that meet the

17  criteria set forth in this section must be given preference,

18  during fiscal year 1998-1999, for grant awards to fully serve

19  their designated service area.

20         4.  The Healthy Families Florida program must

21  complement and coordinate with Healthy Start and other home

22  visiting and family support programs.

23         5.  One application per designated service delivery

24  area is to be submitted. A designated service area may be a

25  county, any area within a county, or contiguous counties.

26         6.  Each successful grant applicant must agree to be

27  credentialed as directed by the private nonprofit

28  corporation's board of directors. Credentialing must be based

29  on the applicant's capacity to provide the critical elements

30  of Healthy Families Florida as defined in paragraphs

31  (4)(a)-(c). To continue qualifying for funding under this


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  1  section, an entity must achieve these credentials within the

  2  specified deadlines articulated by the private nonprofit

  3  corporation and must maintain the credentials in good standing

  4  for the duration of program operation.

  5         7.  Each applicant must agree to use a standardized

  6  assessment tool approved by the private nonprofit

  7  corporation's board of directors.

  8         8.  Each applicant must agree to provide outcome and

  9  performance data in the format and at the frequency specified

10  by the private nonprofit corporation's board of directors.

11         9.  Each applicant must identify local resources

12  available for implementation.

13         10.  Local assessment and planning for the program must

14  be collaborative and must include representatives from the

15  entities listed in subparagraph 1., if locally established.

16  During the planning phase, these entities, and others as

17  appropriate, shall participate in: a strength-based community

18  assessment process that identifies existing home visiting and

19  family support services and uses existing needs assessments;

20  the grant application and the development of a local

21  implementation plan for service delivery; and the

22  determination and identification of local funds and resources

23  that will support the implementation of the program.

24         11.  Each applicant must show evidence that consumers

25  and families have been involved in the planning and

26  development of the grant application and support the Healthy

27  Families Florida program in the designated service area

28  identified in the grant application.

29         12.  Implementation design must include service

30  delivery strategies that, when appropriate, involve both

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  1  parents when they have shared parental responsibility,

  2  regardless of residential custody arrangements.

  3         13.  Each applicant must identify mechanisms, programs,

  4  and services in the designated service-delivery area to refer

  5  at-risk children between the ages of 4 months and 3 years, who

  6  were not identified before the age of 4 months, for other

  7  intervention services available in the community.

  8         (e)  Evaluate and approve the grant applications and

  9  the local implementation plans for service delivery.

10         (f)  Work with the Department of Health and the

11  advisory committee to develop a single, integrated screening

12  and assessment process for Healthy Families Florida and

13  Healthy Start and referrals to other family supports by July

14  1, 2000.

15         (g)  Coordinate service delivery with Healthy Start

16  care coordination.

17         (h)  Contract to develop and implement preservice and

18  inservice training. Funds for inservice training may be

19  incorporated into the grants.

20         (i)  Contract to develop and implement an evaluation

21  design for the program.

22         (j)  Provide for ongoing technical assistance and

23  coordination to each community-based program.

24         (k)  Develop and implement a quality assurance and

25  improvement process for the program.

26         (l)  Evaluate the progress of the program and provide

27  an annual report regarding the progress and achievement of

28  designated outcomes to the Governor, the President of the

29  Senate, the Speaker of the House of Representatives, and other

30  vested parties.

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  1  The private nonprofit corporation may subcontract the

  2  performance of tasks or services described in this subsection.

  3         (6)  HEALTHY FAMILIES FLORIDA ADVISORY

  4  COMMITTEE.--There is created a Healthy Families Florida

  5  Advisory Committee, which shall assist and advise the private

  6  nonprofit corporation and assure coordination and

  7  collaboration with appropriate state agencies and public and

  8  private organizations. The advisory committee shall operate

  9  under the auspices of the private nonprofit corporation's

10  board of directors. The responsibilities of the advisory

11  committee include developing measurable outcomes consistent

12  with the department's performance-based budget, outcomes,

13  measures, and standards; reviewing grant applications and

14  recommending grant awards under this section to the board of

15  directors of the private nonprofit corporation; defining the

16  scope of this program; and generally advising the private

17  nonprofit corporation on the development, implementation, and

18  administration of this program. The board of directors of the

19  private nonprofit corporation has the final approval of grant

20  awards and contracts but may consider only those applicants

21  recommended by the advisory committee. The advisory committee

22  shall consist of eleven members, including the Secretary of

23  Children and Family Services or the secretary's designee, the

24  Secretary of Health or the secretary's designee, one

25  representative of the department's Interagency Workgroup for

26  Children and Families, one representative of the Florida

27  Association of Healthy Start Coalitions, two active board

28  members of the private nonprofit corporation, two community

29  representatives who have direct experience and significant

30  knowledge of the Healthy Families Florida program, two

31  representatives from the business community, and one consumer


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  1  representative who has direct experience with the Healthy

  2  Families Florida program. The President of the Senate shall

  3  appoint one community representative and one business

  4  representative. The Speaker of the House of Representatives

  5  shall appoint one community representative and one business

  6  representative. The Governor shall appoint the consumer

  7  representative.

  8         (7)  WAIVER.--The Department of Health and the

  9  Department of Children and Family Services shall work jointly

10  with the Agency for Health Care Administration to seek a

11  federal waiver to secure Title XIX matching funds for the

12  Healthy Families Florida program. The waiver application shall

13  include allowance to use new and existing general revenue and

14  local contributions. The Department of Children and Family

15  Services and the Agency for Health Care Administration may not

16  implement the federal waiver unless the waiver permits the

17  state to limit enrollment or the amount, duration, and scope

18  of services to ensure that expenditures will not exceed funds

19  appropriated by the Legislature or available from local

20  sources.

21         Section 2.  The sum of $10 million is appropriated from

22  tobacco settlement revenues and the sum of $5 million is

23  appropriated from funds of the Temporary Assistance for Needy

24  Families program to the Department of Children and Family

25  Services to implement this act.

26         Section 3.  This act shall take effect July 1, 1998.

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