This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1007.CFS
DATE: 3/24/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1007 Children Removed from Caregivers
SPONSOR(S): Borrero
TIED BILLS: IDEN./SIM. BILLS: SB 1064
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee Brazzell Brazzell
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
Florida’s dependency system identifies children and families in need of services through reports to the central
abuse hotline and child protective investigations. DCF and the community-based care lead agencies (CBCs)
throughout Florida work with those families to address the problems endangering children, if possible. If the
problems are not addressed, DCF and the CBC’s find safe out-of-home placements for these children.
The process of child protective investigation, removal and placement can be traumatic for children. However,
the degree to which an individual child experiences these events as traumatic depends on several factors,
such as the child’s age and resilience. Children who enter care have typically often already experienced
multiple traumatic events.
According to the National Child Traumatic Stress Network, a “trauma-informed mental health assessment
offers a structured framework for (1) gathering information across several key domains of functioning, (2)
identifying and addressing the needs of children and families exposed to traumatic events, and (3) coding and
summarizing this information, so that it can be communicated to families and other providers.”
Currently CBC’s report performing trauma assessments as part of the Comprehensive Behavioral Health
Assessment conducted for children who are sheltered in out-of-home care; this must be performed within 30
days. HB 1007 expands the duties of a lead agency under s. 409.988, F.S., to require a lead agency, in
coordination with the local managing entity, to provide a trauma-focused assessment to a child removed from
his or her parent, legal custodian, or caregiver as soon as practicable but no later than 14 days after the shelter
hearing. The assessment must evaluate and address the impact of the removal to the child. If therapy is
recommended, that therapy must evaluate and address the impact of the removal to the child.
CBC’s must also offer voluntary trauma services to a child and his or her family in the event that a court denies
the shelter petition and the child is returned to his or her parent, legal custodian, or caregiver.
DCF is directed to include the bill’s requirements in the CBC contracts, with the additional conditions that the
trauma-focused assessment is to ensure that a child is referred to appropriate trauma services, including
clinical evaluation and intervention if needed.
The bill does not have a fiscal impact on state or local governments.
The bill has an effective date of July 1, 2023. STORAGE NAME: h1007.CFS PAGE: 2
DATE: 3/24/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Florida’s Dependency System
Chapter 39, F.S., creates the dependency system charged with protecting child welfare. Florida’s
dependency system identifies children and families in need of services through reports to the central
abuse hotline and child protective investigations. DCF and the 18 community-based care lead agencies
(CBCs) throughout Florida
1
work with those families to address the problems endangering children, if
possible. If the problems are not addressed, DCF and the CBC’s find safe out-of-home placements for
these children.
DCF’s practice model is based on the safety of the child within the home by using in-home services,
such as parenting coaching and counseling, to maintain and strengthen that child’s natural supports in
his or her environment.
DCF contracts with CBCs for case management, out-of-home services, and related services. The
outsourced provision of child welfare services is intended to increase local community ownership of
service delivery and design. CBCs contract with a number of subcontractors for case management and
direct care services to children and their families.
DCF remains responsible for a number of child welfare functions, including operating the central abuse
hotline, performing child protective investigations, and providing children’s legal services.
2
Ultimately,
DCF is responsible for program oversight and the overall performance of the child welfare system.
3
Dependency Process
Current law requires any person who knows or suspects that a child has been abused, abandoned,
or neglected to report such knowledge or suspicion to the central abuse hotline (hotline).
4
The hotline
5
receives more than 350,000 child-related calls annually.
6
Calls received are screened to determine if
the criteria are met to initiate a protective investigation. Statewide, there are more than 240,000 child
protective investigations conducted annually.
7
When child welfare necessitates that DCF remove a child from the home, a series of dependency court
proceedings must occur to adjudicate the child dependent and place that child in out-of-home care.
Steps in the dependency process may include:
A report to the hotline.
A child protective investigation to determine the safety of the child.
The court finding the child dependent.
Case planning for the parents to address the problems resulting in their child’s dependency.
Placement in out-of-home care, if necessary.
Reunification with the child’s parent or another option to establish permanency, such as
adoption.
8
1
These 18 CBCs together serve the state’s 20 judicial circuits.
2
Ch. 39, F.S.
3
Id.
4
Section 39.201(1), F.S.
5
Department of Children and Families, Florida Abuse Hotline, Overview, https://www2.myflfamilies.com/service-programs/abuse-
hotline/overview.shtml, (last visited March 11, 2023).
6
Department of Children and Families, Child Welfare Key Indicators Monthly Report, Feb. 2023, System Overview, p. 8,
https://www2.myflfamilies.com/service-programs/child-welfare/kids/results-oriented-
accountability/performanceManagement/docs/KI_Monthly_Report_December%202022.pdf (last visited March 23, 2023).
7
Id.
8
The state has a compelling interest in providing stable and permanent homes for adoptive children in a prompt manner, in preventing
the disruption of adoptive placements, and in holding parents accountable for meeting the needs of children. S. 63.022, F.S. STORAGE NAME: h1007.CFS PAGE: 3
DATE: 3/24/2023
The graphic below presents key statistics regarding children and families having contact with the child
welfare system in FY 2021-22.
9
Out-of-Home Care
When children cannot safely remain at home with parents, Florida’s child welfare system finds safe out-of-
home placements for such children. After an assessment to determine the most appropriate out-of-home
placement, a child may be placed with a relative, fictive kin, licensed foster parent, in a group home or
residential setting.
10
While in out-of-home care, the child and his or her parents receive services to address
problems that led to the removal so that reunification or other permanency option may be reached as
quickly as possible.
11
As the graphic above indicates, slightly more than half of children with cases open for services in FY 2021-
22 were served in out of home care. The graph below shows the number of children in out-of-home care by
placement type, as of January 2023.
12
9
Supra note 8, p. 9.
10
R. 65C-28.004, F.A.C.
11
Child Welfare Information Gateway, Out-of- Home Care Overview,
https://www.childwelfare.gov/topics/outofhome/overview/#:~:text=Out%2Dof%2Dhome%20care%20is,to%20abuse%20and%2For%20n
eglect. (last visited Jan. 18, 2023).
12
Supra note 6, p. 31. Licensed foster homes include relative and nonrelative placements that are licensed to care for a specific child,
as well as traditional licensed family foster homes. STORAGE NAME: h1007.CFS PAGE: 4
DATE: 3/24/2023
Community-Based Care Organizations and Services
DCF typically enters into 5-year contracts with CBCs.
13
There are minimum requirements with which
CBC’s must comply to be eligible to contract with DCF, including:
Being organized as a Florida corporation or a governmental entity.
14
Having a board of directors or board committee with authority to approve the CBC’s budget
and hire a CBC executive director.
15
Demonstrating financial responsibility by having a plan for regular fiscal audits and securing
a performance bond.
16
DCF must ensure contracts with CBCs:
Provide for the services as required under s. 409.988, F.S.
17
Require CBC’s to specify how they will carry out certain child welfare best practices.
18
Provide relevant information to DCF related to the quality assurance program and the child
welfare results-oriented accountability system.
19
Include tiered interventions and graduated penalties for failure to comply with the contract
or performance deficiencies.
20
Require CBCs to provide current and accurate information about their activities related to
case records in the statewide automated child welfare information system.
21
Specify the procedures to resolve differences in interpreting the contract or to resolve a
disagreement amongst the parties regarding compliance with the contract.
22
CBCs are obligated to perform a variety of duties including to:
Serve the children who are referred as a result of abuse, neglect, or abandonment reports to
DCF’s central abuse hotline.
13
S. 409.987(3), F.S.
14
S. 409.987(4)(a), F.S.
15
S. 409.987(4)(b), F.S.
16
S. 409.987(4)(c), F.S.
17
S. 409.996(1)(a), F.S.
18
S. 409.996(1)(b), F.S.
19
S. 409.996(1)(c), F.S.
20
S. 409.996(1)(d), F.S.
21
S. 409.996(1)(e), F.S.
22
S. 409.996(1)(f), F.S.
0
2,000
4,000
6,000
8,000
10,000
12,000
Relative Non-Relative Group CareLicensed Foster
Home
Residential
Treatment Center
Children in Out-of-Home Care by Placement Type
(As of Jan. 31, 2023) STORAGE NAME: h1007.CFS PAGE: 5
DATE: 3/24/2023
Provide DCF with accurate and timely information necessary for oversight by DCF pursuant
to the child welfare results-oriented accountability system.
Follow financial guidelines developed by DCF and provide for regular independent audits.
Post its current budget, including the salaries, bonuses and other compensation paid to the
agency’s chief executive officer, chief financial officer, and chief operating officer, or their
equivalents, on the CBC’s website.
Prepare and file all necessary court documents and attend dependency court proceedings.
Ensure all individuals providing care to dependent children receive training and specified
information and meet employment requirements.
Maintain eligibility to receive all available federal child welfare funds.
Maintain written agreements with Healthy Families Florida entities in its service area.
Comply with federal and state statutory requirements and agency rules in the provision of
contractual rules.
Use authority to subcontract for the provision of services provided CBCs contribute to
services and meet specified criteria.
Post information regarding case management services on its website.
23
DCF contracts with the following CBCs as illustrated in the following table and map:
24
Lead Agency Judicial Circuit(s)
Northwest Florida Health Network 1
Northwest Florida Health Network 2 & 14
Partnership for Strong Families 3 & 8
Family Support Services of North Florida, Inc. 4 (Duval and
Nassau)
Kids First of Florida, Inc. 4 (Clay)
Kids Central, Inc. 5
Family Support Services of SunCoast 6 (Pasco and
Pinellas)
St Johns County Board of County Commissioners 7 (St Johns)
Community Partnership for Children, Inc. 7 (Flagler, Volusia,
Putnam)
Embrace Families 9 and 18 (Seminole)
Heartland for Children 10
Citrus Family Care Network 11 and 16
Safe Children Coalition 12
Children’s Network of Hillsborough 13
ChildNet Inc. 15 and 17
Brevard Family Partnership 18 (Brevard)
Communities Connected for Kids 19
Children’s Network of SW Florida 20
23
S. 409.988(1), F.S. Further, s. 409.988(1)(k), F.S., provides that CBCs and subcontracted case management providers must disclose
the average caseload of case managers for filled positions, the turnover rate for case managers and their supervisors for the previous
12 months, the percentage of required home visits completed, and performance on outcome measures required under s. 409.997, F.S.,
for the previous 12 months.
24
Supra note Error! Bookmark not defined.. STORAGE NAME: h1007.CFS PAGE: 6
DATE: 3/24/2023
Managing Entities
In 2001, the Legislature authorized DCF to implement behavioral health managing entities (MEs) as the
management structure for the delivery of local mental health and substance abuse services.
25
The
implementation of the ME system initially began on a pilot basis and, in 2008, the Legislature
authorized DCF to implement MEs statewide.
26
Full implementation of the statewide ME system
occurred in 2013, and all geographic regions are now served by a ME.
27
DCF must:
Contract and conduct readiness reviews before any new MEs assume responsibilities.
Specify data reporting requirements and use of shared data systems.
Define the priority populations that will benefit from receiving care coordination.
Support the development and implementation of a coordinated system of care.
Contract to support efficient and effective administration and ensure accountability for
performance.
28
Periodically review contract and reporting requirements and reduce costly, duplicative, and
unnecessary administrative requirements.
29
The MEs are to:
Maintain a governing board.
Promote and support care coordination.
30
Develop a comprehensive list of qualified providers.
25
Ch. 2001-191, L.O.F.
26
Ch. 2008-243, L.O.F.
27
Florida Tax Watch, Analysis of Florida’s Behavioral Health Managing Entity Models, p. 4 (Mar. 2015)
https://floridataxwatch.org/Research/Full-Library/ArtMID/34407/ArticleID/15758/Analysis-of-Floridas-Behavioral-Health-Managing-
Entities-Model (last visited Mar. 9, 2021).
28
S. 394.9082(7), F.S., details the performance measurements and accountability requirements of MEs.
29
S. 394.9082(3), F.S.
30
S. 394.9082(6), F.S., sets out the network accreditation and systems coordination agreement requirements. STORAGE NAME: h1007.CFS PAGE: 7
DATE: 3/24/2023
Monitor network providers’ performance.
Manage and allocate funds for services in accordance with federal and state laws, rules,
regulations and grant requirements.
Operate in a transparent manner, providing access to information, notice of meetings, and
opportunities for public participation in ME decision making.
31
DCF contracts with seven MEs as shown in the map below:
North West Florida Health Network (blue).
Lutheran Services Florida (yellow).
Central Florida Cares Health System (orange).
Central Florida Behavioral Health Network, Inc. (red).
Southeast Florida Behavioral Health (pink).
Broward Behavioral Health Network, Inc. (purple).
South Florida Behavioral Health Network, Inc. (beige).
32
The MEs in turn contract with local service providers for the delivery of mental health and substance
abuse services.
33
In FY 2020-21, the network service providers under contract with the MEs served
225,927 individuals.
34
Children and Trauma
Traumatic Events
31
S. 394.9082(5), F.S.
32
Florida Department of Children and Families, Managing Entities, https://www.myflfamilies.com/service-programs/samh/managing-
entities/ (last visited Mar. 10, 2021).
33
MEs create and manage provider networks by contracting with service providers for the delivery of substance abuse and mental
health services.
34
Florida Department of Children and Families, Assessment of Behavioral Health Services Fiscal Year 2021-2022, p. 10 (Dec. 1, 2021)
https://www.myflfamilies.com/sites/default/files/2022-
12/Assessment%20of%20Behavioral%20Health%20Services%20in%20Florida%20Fiscal%20Year%2020221 -22.pdf (last visited
March 23, 2023). STORAGE NAME: h1007.CFS PAGE: 8
DATE: 3/24/2023
According to the National Child Traumatic Stress Network, a traumatic event is “a frightening,
dangerous, or violent event that poses a threat to a child’s life or bodily integrity. Witnessing a
traumatic event that threatens life or physical security of a loved one can also be traumatic. This is
particularly important for young children as their sense of safety depends on the perceived safety of
their attachment figures.”
35
Many experiences that may be traumatic to a child are also reasons why a child may be subject to a
child protective investigation and removal from the home, such as:
Physical or psychological abuse.
Neglect.
Sexual abuse, including sexual exploitation and human trafficking.
Family violence.
Substance use disorder (personal or familial).
36
Child Traumatic Stress
According to the National Child Traumatic Stress Network, children who suffer from child traumatic
stress are those who have been exposed to one or more traumas over the course of their lives and
develop reactions that persist and affect their daily lives after the events have ended.
Children can have a variety of reactions to traumatic events. Examples are:
intense and ongoing emotional upset,
depressive symptoms or anxiety,
behavioral changes,
difficulties with self-regulation,
problems relating to others or forming attachments,
regression or loss of previously acquired skills,
attention and academic difficulties,
nightmares,
difficulty sleeping and eating, and
physical symptoms, such as aches and pains.
use of drugs or alcohol,
behaving in risky ways, and
engaging in unhealthy sexual activity.
37
Although many people experience reactions to stress from time to time, when a child is experiencing
traumatic stress, these reactions interfere with the child’s daily life and ability to function and interact
with others. Any child may suffer effects of traumatic experience, including infants and toddlers.
However, the way that traumatic stress manifests will vary from child to child, and will depend on
factors such as the child’s age and developmental level.
According to the National Child Traumatic Stress Network, “without treatment, repeated childhood
exposure to traumatic events can affect the brain and nervous system and increase health-risk
behaviors (e.g., smoking, eating disorders, substance use, and high-risk activities). Research shows
that child trauma survivors can be more likely to have long-term health problems (e.g., diabetes and
heart disease) or to die at an earlier age. Traumatic stress can also lead to increased use of health and
mental health services and increased involvement with the child welfare and juvenile justice systems.
Adult survivors of traumatic events may also have difficulty in establishing fulfilling relationships and
maintaining employment.”
35
National Child Traumatic Stress Network, About Child Trauma, https://www.nctsn.org/what-is-child-trauma/about-child-trauma
(accessed March 23, 2023).
36
Id.
37
Id. STORAGE NAME: h1007.CFS PAGE: 9
DATE: 3/24/2023
Trauma and Response to Investigation, Removal and Placement
The process of child protective investigation, removal and placement can be traumatic for children.
However, the degree to which an individual child experiences these elements as traumatic depends on
several factors, such as the child’s age and resilience. Casey Family Programs describes frequent
responses from children as follows:
Surprise and shock. Intervention is particularly traumatic when it happens suddenly or
unexpectedly, and with a high level of conflict. Children may be confused about cause and
effect, not understanding why they have been removed from the home. (e.g., “We were just
eating dinner and then I was taken away.”) The degree of trauma to the child will depend to
some degree on the level of hostility in the interactions between the parent and the
professional, and how much distress vs. calm the parent exhibits.
Negative views of police and social workers. Children may have been told to fear the police
and/or the child protection agency, or they may have heard horror stories about foster care
that exacerbate their own fears.
Betrayal and loss of trust. Children may feel betrayed by the person who reported the
family. They may feel surrounded by people they cannot trust.
Loss of control, helplessness. Children experiencing removal face many unknowns. They
may not know where they are going, what will happen to them, what is happening to their
parents and siblings, and how long they will be away from home. Any feeling that they are
unable to speak up on their own behalf and ask questions may compound their
disorientation. Other traumatic elements of the situation may make it difficult for children to
absorb or retain information provided to them.
Worry about parents and siblings. Older children may feel responsible for taking care of
other family members. They may feel guilty that the disruption to the family is their fault, or
that they have failed to protect parents or siblings.
Repeated interviewing about traumatic events. Having to tell the story of “what happened”
multiple times to different professionals (school staff, caseworker, police) may exacerbate
trauma and/or reinforce feelings of guilt or betrayal.
Loss of the familiar. Children who are removed from their home face losses on multiple
levels: family (including extended family members, pets, belongings, routines),
neighborhood and school (familiar places, friends, teachers, extracurricular activities), and
culture (language, race/ ethnicity, religion). All of these elements may create or reinforce a
belief that the world is unpredictable and unsafe.
38
Multiple Traumatic Events
Children with some level of trauma typically have experienced a variety of traumatic events. In a study
of 14,088 children and adolescents served by National Child Traumatic Stress Network service centers,
nearly 80% of those screened reported an experience of at least one traumatic event. However, of the
11,104 who had trauma exposure:
77% had more than one type of trauma;
27% had experienced 3-4 types of trauma; and
31% had experienced 5 or more types.
39
In a sample of 2,251 children and adolescents in foster care referred to National Child Traumatic Stress
Network service centers between 2004 and 2010, the mean number of types of traumatic exposure was
38
Casey Family Programs, Issue Brief: How does investigation, removal, and placement cause trauma for children? May 2018, p. 2
https://www.casey.org/media/SC_Investigation-removal-placement-causes-trauma.pdf (accessed March 23, 2023).
39
National Child Traumatic Stress Network, Facts for Policymakers: Child and Adolescent Trauma Exposure and Service Use
Histories: Highlights from the NCCTS Core Data Set
https://www.nctsn.org/sites/default/files/resources//facts_policymakers_child_adolescent_trauma_exposure_service_use_histories_high
lights_core_data_set.pdf (accessed March 23, 2023). STORAGE NAME: h1007.CFS PAGE: 10
DATE: 3/24/2023
5, indicating that exposure to multiple types of trauma is common for children in the child welfare
system.
40
This may lead to their experiencing complex trauma, or have interactions between the traumatic events.
Trauma screening instruments do not screen for only one type of trauma (such as removal), nor is it
clinically advisable given the variety of traumas to which a child may have been exposed.
41
Risk and Protective Factors
Fortunately, even when children experience a traumatic event, they don’t always develop traumatic
stress. Many factors contribute to symptoms, and protective factors can reduce the negative impact of
trauma on a child. According to the National Child Traumatic Stress Network, some factors that affect
how a child is impacted by a traumatic event include:
Severity of the event. How serious was the event? How badly was the child or someone
she loves physically hurt? Did they or someone they love need to go to the hospital? Were
the police involved? Were children separated from their caregivers? Were they interviewed
by a principal, police officer, or counselor? Did a friend or family member die?
Proximity to the event. Was the child actually at the place where the event occurred? Did
they see the event happen to someone else or were they a victim? Did the child watch the
event on television? Did they hear a loved one talk about what happened?
Caregivers’ reactions. Did the child’s family believe that he or she was telling the truth? Did
caregivers take the child’s reactions seriously? How did caregivers respond to the child’s
needs, and how did they cope with the event themselves?
Prior history of trauma. Children continually exposed to traumatic events are more likely to
develop traumatic stress reactions.
Family and community factors. The culture, race, and ethnicity of children, their families,
and their communities can be a protective factor, meaning that children and families have
qualities and or resources that help buffer against the harmful effects of traumatic
experiences and their aftermath.
42
Screening, Assessing, and Responding to Trauma in Children
Screening is used to determine whether the next steps, a trauma-focused assessment or treatment, is
helpful for a child. Brief screening tools are available for this purpose.
43
Trauma screening determines
whether someone has experienced one or more traumatic events, has reactions to them, has specific
mental or behavioral health needs, and/or needs a referral for a comprehensive trauma-informed
mental health assessment. Screening is a “wide-net” process.
44
Experts recommend screening for a
range of traumatic events rather than for a specific single event.
45
According to the National Child Traumatic Stress Network, a “trauma-informed mental health
assessment offers a structured framework for (1) gathering information across several key domains of
40
National Child Traumatic Stress Network, Facts for Policymakers: Complex Trauma and Mental Health of Children Placed in Foster
Care Highlights from the National Center for Child Traumatic Stress (NCCTS) Core Data Set
https://www.nctsn.org/sites/default/files/resources//facts_policymakers_complex_trauma_mental_health_children_placed_in_foster_car
e.pdf (accessed March 23, 2023).
41
Email from L. Amaya-Jackson, M.D., M.P.H., Co- Director, UCLA-Duke National Center for Child Traumatic Stress, Professor, Dept.
of Psychiatry & Behavioral Sciences, Duke University School of Medicine, quick response needed if you have input: Question--
assessing/treating individual sources of trauma vs. general trauma experienced (March 19, 2023).
42
Supra note 35.
43
National Child Traumatic Stress Network, Assessment of Complex Trauma Information for Non-Mental Health Professionals, p. 2,
https://www.nctsn.org/sites/default/files/resources/fact-
sheet/assessment_of_complex_trauma_information_for_nonmental_health_professio.pdf (accessed March 23, 2023).
44
National Child Traumatic Stress Network, Screening and Assessment, http://www.nctsn.org/treatments-and-practices/screening-and-
assessment (accessed March 23, 2023).
45
Supra note 41. STORAGE NAME: h1007.CFS PAGE: 11
DATE: 3/24/2023
functioning, (2) identifying and addressing the needs of children and families exposed to traumatic
events, and (3) coding and summarizing this information, so that it can be communicated to families
and other providers.”
46
Examples of domains include trauma exposure, trauma reminders and triggers,
caregiver/family functioning and response to trauma, and resilience and strengths of the child, family
and community.
47
Recommended practices include gathering information from multiple perspectives,
such as the child, all caregivers, teachers, and other relevant professionals working with the child.
Additionally, clinicians should use a variety of assessment approaches and techniques.
There are evidence-based treatments and services that are highly effective for child traumatic stress.
48
A wide variety of trauma treatments exist that vary based on the age of the child, the nature of the
traumatic exposure and response, and modalities used (such as individual, family, or group). Some are
offered by the Medicaid program, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).
49
Additional supports are available as well.
50
Comprehensive Assessments of Children in the Child Welfare System in Florida
Section 39.01(17), F.S., defines “comprehensive assessment” or “assessment” as the gathering of
information for the evaluation of a child’s and caregiver’s physical, psychiatric, psychological, or mental
health; developmental delays or challenges; and educational, vocational, and social condition and
family environment as they relate to the child’s and caregiver’s need for rehabilitative and treatment
services, including substance abuse treatment services, mental health services, developmental
services, literacy services, medical services, family services, and other specialized services, as
appropriate.
Chapter 65C-28.014, Florida Administrative Code (F.A.C.) requires a child to be referred for a
Comprehensive Behavioral Health Assessment (CBHA) in the following circumstances:
a) When a child is in shelter status, the child welfare professional responsible for the case shall
refer the child for a CBHA within seven calendar days of being removed from his or her
household, or
b) If a child is already in out-of-home care and is exhibiting emotional or behavioral issues that
might result, or may have already resulted, in the child losing his or her placement, the child
welfare professional responsible for the case may refer the child for a CBHA to assist in
determining services that would allow the child to maintain his or her placement. This may be
done if a CBHA has not been conducted on the child within the past year; and,
c) The child has been determined to be Medicaid enrolled. If the child is not Medicaid enrolled, the
child welfare professional responsible for the case shall take all steps necessary to ensure the
child becomes enrolled as soon as possible, including assisting the child’s out-of-home
caregiver to establish enrollment.
51
The actual assessment is completed by a provider during the provision of case management services.
52
The CBHA provider must complete the assessment within 24 calendar days of receiving the
authorization.
53
46
National Child Traumatic Stress Network, Trauma-Informed Mental Health Assessment, https://www.nctsn.org/treatments-and-
practices/screening-and-assessments/trauma-informed-mental-health-assessment (accessed March 23, 2023).
47
National Child Traumatic Stress Network, Assessment of Complex Trauma by Mental Health Professionals, p. 3,
https://www.nctsn.org/sites/default/files/resources/fact-sheet/assessment_of_complex_trauma_by_mental_health_professionals.pdf
(accessed March 23, 2023).
48
National Child Traumatic Stress Network, Understanding Child Trauma, https://www.nctsn.org/sites/default/files/resources/fact-
sheet/understanding_child_trauma_and_the_nctsn_0.pdf (accessed March 23, 2023).
49
Sunshine Health, New Child Welfare Value-Based Incentive Program: Trauma-Focused Evidence Based Practice
https://www.sunshinehealth.com/newsroom/trauma-focused-evidence-based-practice.html (accessed March 23, 2023).
50
One resource offered by Florida Medicaid Sunshine Health Child Welfare Specialty Plan is training is offered to all caregivers
including foster parents, adoptive parents, relative caregivers, biological parents and other caregivers on Trauma Informed Care and
other trauma training. See Member Handbook, p. 37 https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/CWSP-
Member-Handbook.pdf (accessed March 23, 2023).
51
Florida Department of Children and Families, Agency Analysis of 2023 HB 1007, p. 2 (March 8, 2023).
52
Id. STORAGE NAME: h1007.CFS PAGE: 12
DATE: 3/24/2023
CBC’s report that they administer a trauma assessment as part of the CBHA.
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The child welfare professional must review and consider any interventions or services recommended in
a CBHA. Specifically, Rule 65C-28.014, F.A.C., requires that when service needs are identified through
the CBHA, children shall be referred to mental health providers in the community who accept the child’s
Medicaid Managed Medical Assistance plan. If a Medicaid provider is not available, the child welfare
professional shall refer to a provider that best meets the child’s needs. The child welfare professional
has the primary responsibility throughout the case for coordinating, managing, and monitoring all
aspects of the child’s care and treatment.
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Effect of Proposed Changes
The bill expands the duties of a lead agency under s. 409.988, F.S., to require a lead agency, in
coordination with the local managing entity, to provide a trauma-focused assessment to a child
removed from his or her parent, legal custodian, or caregiver as soon as practicable but no later than
14 days after the shelter hearing. The assessment must evaluate and address the impact of the
removal to the child. If therapy is recommended, that therapy must evaluate and address the impact of
the removal to the child. The bill does not specify the roles of the CBC or the managing entity in
providing the assessments.
CBC’s must also offer voluntary trauma services to a child and his or her family in the event that a court
denies the shelter petition and the child is returned to his or her parent, legal custodian, or caregiver.
DCF is directed to include the bill’s requirements in the CBC contracts, with the additional conditions
that the trauma-focused assessment is to ensure that a child is referred to appropriate trauma services,
including clinical evaluation and intervention if needed.
For those children who also receive a separate trauma assessment as part of the Comprehensive
Behavioral Health Assessment, they may be subject to duplicate trauma assessments. Additionally,
the focus on the trauma related to the removal may lead clinicians to miss the impact of other trauma
exposure, such as severe neglect, witnessing domestic violence, or being commercially sexually
exploited, leaving those traumas untreated.
The bill has an effective date of July 1, 2023.
B. SECTION DIRECTORY:
Section 1: amending s. 409.988, F.S., relating to community-based care lead agency duties; general
provisions.
Section 2: amending s. 409.996, F.S., relating to Duties of the Department of Children and Families.
Section 3: providing an effective date.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
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Department of Children and Families, CFOP 170-18, Comprehensive Behavioral Health Assessments, Aug. 21, 2020, pg. 2-2
https://www.myflfamilies.com/sites/default/files/2022-12/cfop_170-18_chapter_02_comprehensive_behavioral_health_assessments.pdf
(accessed March 23, 2023).
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Email from Caleb Hawkes, Director of Government Affairs, Florida Coalition for Children, Re: HB 1007/SB 1064--questions for CBC's
on screening/addressing trauma of removal, March 21, 2023.
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Supra note 51. STORAGE NAME: h1007.CFS PAGE: 13
DATE: 3/24/2023
None.
2. Expenditures:
Although there may be some families whose shelter is denied, but choose to voluntarily receive
services, DCF estimates that the cost will be insignificant.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
The bill would require CBC’s, in coordination with the local managing entity, to complete a trauma-
focused assessment no later than 14 days after the shelter hearing. This could potentially lead to a
workload increase and fiscal impact depending on the specific structure of each Lead Agency and
Managing Entities. However, as CBC’s are reporting that they already do trauma assessments, there
may be insignificant additional cost as long as the trauma assessments are performed within the 14
day timeframe and meet the requirements of the bill.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not Applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
DCF has sufficient rulemaking authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
The bill implies that CBC’s are to refer children to therapy if recommended by the assessment but does
not specifically obligate CBC’s to do so.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES