The Importance of Assessing Newborns or Other New Children in the Household

When there is a change to a family’s circumstances which has the potential to impact the safety of a child, it is considered a critical juncture in the case and necessitates a re-assessment of the family.  This includes the birth of a new child or a child joining a focus household in an open case.  There are two types of assessments based upon timing and the situation; Pre-birth Assessment and Post-birth Assessment. The purpose of these assessments is to re-evaluate the protective capacities and child needs.  The child welfare professional also must re-evaluate the current safety plan to determine if new safety plan actions or tasks are needed to protect the new child. 

The child welfare professional must complete an assessment in any of the following circumstances:

  • A child joins a focus household that is under investigation for allegations of abuse, neglect or abandonment or receiving ongoing case management services.
  • A child will be residing in the home of the parent/significant caregiver receiving ongoing case management services. “Resides” means that the child will live in a home on a permanent basis including any time-sharing custody agreements.

When these assessments must occur:

  • The Pre-birth Assessment must be completed within 6 months of the child’s due date. 
  • The Post-birth Assessment should be completed within 14 business days of the birth of a child, or the arrival of a child into the focus home.

The assessment is completed via an FFA-O or Progress Update in FSFN for an ongoing services case. Information must be gathered and assessed in each domain when a:

·         Parent/significant caregiver or a minor in a focus household is pregnant.

·         Baby is born or a new child enters a focus household.

A supervisor consultation must be provided prior to the approval of the FFA-O or Progress Update to determine if a pre-birth assessment, newborn child assessment, or new child assessment has been sufficiently incorporated.

Requirements Before Baby is Born:

ü  Pre-birth assessment, completed within six months of the due date via FFA-O or Progress Update.

ü  Supervisor Consult, to review pre-birth assessment.

ü  Other Parent Home Assessment, if there is a non-maltreating parent to whom the baby will be released.

ü  Multidisciplinary Staffing, with the parents, grandparents (if the parent is a minor), GAL, current caregivers, appropriate others. If one parent is non-offending, their OPHA must be done prior to the staffing.

ü  CLS Staffing, with Case Management (supervisor must be present if CM is not fully certified), GAL, and Lead Agency. Prior to Staffing CM must complete a pre-birth assessment and an OPHA.

Requirements After Baby is Born / New Child Enters the Home:

ü  Re-evaluate the current safety plan to determine any need for changes and implement as necessary. This must be done before a newborn is discharged from the hospital.

ü  CM must inform GAL of any changes made to the safety plan.

ü  CM must complete an edit request so that the baby can be added to the FSFN case.

ü  FFA-O or Progress Update must be completed within 14 business days of the child’s birth or a new child arriving.

ü  Determine need for Child Placement Agreement if there is an out-of-home safety plan in place.

ü  Re-assess In-Home Safety Analysis Questions and update Conditions for Return as appropriate.

ü  CLS Staffing, with Case Management (supervisor must be present if CM is not fully certified), GAL, and Lead Agency. Prior to Staffing CM must complete an FFA-O or Progress Update and an OPHA.

Resources are located on the J Drive: J:\Training Resources and Processes\Tasks in FSFN\New Child In Household

 

Hyperthermia and Children

Hyperthermia and Children

What is Hyperthermia?

Hyperthermia is the condition of having a body temperature greatly above normal.

Florida is a warm state.  It is one of the characteristics that draw many people to Florida.  It can also be a characteristic that is deadly for children.  Heat stroke occurs when a person’s temperature exceeds 104o F.  The body’s thermoregulatory mechanism becomes overwhelmed and can no longer keep the body at the normal 98.6o F temperature.  A core body temperature of 107 o F is considered lethal.  Children's thermoregulatory systems are not as efficient as an adult's and their body temperatures warm at a rate 3 to 5 times faster than an adult’s. 

Five Florida Children Died of Hyperthermia in 2016

Each of the five children died due to being in a hot vehicle for an extended period of time.

When sunlight enters a car, the windows may warm very little however, the objects inside the car can warm up very quickly.  A dark seat or dashboard can reach 180 to 200 o F.  This heat not only warms the object but it warms the air inside the car.  In a vehicle heat study which was conducted, temperatures inside a car were found to rise 19 o F after just 10 minutes.  That means that with an outside temperature of 80 o F the car’s interior temperature climbs to 99 o F after just 10 minutes.  After 30 minutes the interior temperature rose to 114 o and after 60 minutes rose to 123 o degrees!  Cracking the windows of the car had very little effect on the interior temperature.  It would take a relatively short period of time for a child’s body temperature to climb to levels which can cause serious physical problems or even death.

So...what steps can be taken to protect our children from unnecessary harm?

·         Never leave a child unattended in a vehicle (not even for “I’ll only be a minute!”).

·         If a child is missing, always check the pool first, then the car, including the trunk

·         Glance inside cars as you walk past.  If you see a child left unattended in a car, call 911 immediately.

·         Teach children that a car is not a play area.

·         Lock your car and make sure children do not have access to keys or remote entry devices.

·         Use a trigger to remind yourself to check the back seat(s).  Put something you have to take with you when you leave the car in the back seat, put a sticky note that says “Check the Back” someplace conspicuous in the front seat, make checking the back seat(s) a routine every time you leave the car.

·         Notify the daycare or school if your child’s drop off or pick up routine changes.

·         If the child is not dropped off as expected and the daycare/school does not hear from the parent, within 15 minutes they call the parent to make sure the child is supposed to be absent.  This can be a critical trigger to check the back seats of the vehicle

Awareness is the key to keeping our children safe!

Safety Plans - Modifying

Once a case has been transferred from Investigations to Case Management, it is the Case Manager’s responsibility for developing and implementing modifications to the Safety Plan based on the Case Manager’s ongoing assessment of Safety Plan sufficiency within 5 days of case assignment. The Safety Plan should consist of the least intrusive actions necessary to protect the child consistent with diminished caregiver protective capacities and danger threats.  The Case Manager will exercise due diligence to modify Safety Plans in response to changing family dynamics, including when Conditions for Return are achieved.

A Safety Plan must be modified when any of the following changes occur:

  • A new danger threat has been identified
  • Danger threats have been eliminated

·         A child is released to the other parent, relocated in a family arrangement, or sheltered

·         Parent/legal guardian meets the Conditions for Return

·         There are changes in family dynamics or conditions which change the types and or level of safety services needed, including but not limited to:

Ø  A new child is born or comes into the home

Ø  A parent/legal guardian becomes involved with a new intimate partner relationship

Ø  There are significant changes to the household composition

Ø  There are changes in the availability of a physical location in which the Safety Plan can be implemented

Ø  The Safety Plan needs to become an out-of-home plan

Actions for modifying Safety Plans: 

The primary Case Manager will take the following actions to create a new Safety Plan.

  • Take protective actions immediately in order to keep the child from being harmed
  • To the extent possible, the Case Manager, the parent/legal guardian and any provider involved in the formulation of the original Safety Plan will collaborate to revise the Safety Plan.

Ø  Adhere to special considerations involving domestic violence

Ø  Review and discuss current family dynamics and conditions relative to criteria for an in-home Safety Plan or Conditions for Return

Ø  Review each specific component of the Safety Plan and whether any modifications are necessary

Ø  Identify options for plan modifications needed, eliciting family resources

Ø  Agree on modifications

Ø  Follow up with CLS when a Safety Plan is part of the court order

  • Identify whether there are ways to manage the identified danger threat with the child in the home; and if yes contact safety services providers who will participate in ongoing Safety Plan
  • Consult with your supervisor if assistance is needed in developing a sufficient ongoing Safety Plan.
  • The Case Manager should revise the ongoing Safety Plan and obtain signatures of the parents and any informal Safety Plan providers and file with the court.

FSFN/Documentation for Modifying Safety Plans:

  • Document any safety plan monitoring activity within 2 business days of any assessment information or action related to the assessment of the Safety Plan sufficiency.
  • Document modifications to any existing Safety Plan by terminating the current safety plan in FSFN and create a new version.  The date needs to be changed to capture the date of the modification.  This will allow for a complete history to the Safety Plans. Upload a signed version within 2 business days of creation.
  • The Case Manager will formally document an updated safety analysis when completing the FFA and any Progress Updates.
  • Supervisor or Case Manager will record supervisor case consultations about Safety Plans within 2 business days using supervisory case consultation functionality in FSFN.

Safety Planning Requirements

Florida Administrative Code defines “Safety Plan” as the specific course of action necessary to control threats of serious harm or supplement a family’s protective capacities implemented immediately when a family’s protective capacities are not sufficient to manage immediate or serious harm threats.” 

A safety plan addresses a specific parent behavior, emotion or condition that results in a child being unsafe.  A safety plan controls and manages danger threats to a child when a parent/legal guardian is unavailable, unable, or unwilling to protect their child.  A safety plan will be in effect as long as a case remains open and parents/legal guardians do not have the protective capacity necessary to protect the child from identified danger threats. 

Safety planning is an ongoing process, not an event and should be developed jointly between the case manager and the family.  The child welfare professional responsible for the case has primary responsibility for developing, monitoring and managing the safety plan. As individual and family circumstances change, safety plans require updates based on the changes.  

In order to have confidence in the sufficiency of the safety plan we must analyze danger threats, family functioning, and family and community resources. This depends on having collected sufficient, pertinent, relevant information. The intention is to arrive at a decision regarding the most appropriate and least restrictive means for controlling and managing identified danger threats and therefore assuring child safety.

The child welfare professional creating, monitoring or modifying the safety plan will:

·         Ensure the safety plan controls the behavior, emotion or condition that results in the child being unsafe

  • Review safety plan for sufficiency within 5 business days of initial case transfer or new assignment and have a Supervisor Consult completed and documented to reflect review and sufficiency of plan

·         Ensure the effect of a safety plan is immediate, and/or continues to protect the child every day

·         Ensure the safety plan describes each specific action necessary to keep the child safe, including:

Ø  The person responsible for each specific action

Ø  Resources or people who will help with each action

Ø  The frequency of the action, including times and days of the week

·         Confirm that the person responsible for each action is occurring as planned at least monthly

·         Ensure the sufficiency of the safety plan as either an in-home, out-of-home, or a combination of both

·         Develop separate safety plans with the perpetrator of domestic violence and the parent/legal guardian who is a survivor of domestic violence

·         NOT include promissory commitments by the parent/legal guardian who is currently not able to protect the child. Example of INAPPROPRIATE safety plan actions include, but are not limited to:

Ø  Mom will not spank

Ø  Parents will remain sober

Ø  Mom will file an injunction and not let the batterer back in the home

Ø  Dad will not use drugs

All new or updated safety plans must be signed by all participants and uploaded into FSFN

within two business days of its creation or modification.

A discussion about the safety plan and specific actions safety plan providers

are responsible for must be documented in FSFN.

 

 

LGBTQIA Group Home Rules FAC, Chapter 65C-14

In December, 2016, Florida Administrative Code (FAC) was amended to support and protect our LGBTQ+ youth in care, specifically those in group homes. We are only the 14th state to have anti-discrimination laws that protect youth based on sexual orientation AND gender identity. Some states have anti-discrimination laws for only sexual orientation; others have nothing in place for this population.
 

Definitions

Sexual orientation: a person’s sexual, emotional or physical attraction to members of the same gender, different gender, or any gender. Heterosexual, homosexual, bisexual, and pansexual are examples.
Gender identity: a person’s perception of having a particular gender, or none at all. May or may not match the gender they were assigned at birth.
Transgender: a person whose gender identity is different than what is listed on their birth certificate.
Gender expression: the way people express their gender through mannerisms, behaviors, expressions, or physical appearance (clothing, hairstyle, etc.). Also may or may not match the gender they were assigned at birth.

FAC pertinent to the LGBTQ population

65C-14.021 Discipline and Behavior Management

  • Group Home staff cannot engage in discriminatory treatment or harassment based on gender expression or sexual orientation.
  • Group Home staff cannot permit harassment or bullying of children by staff or other youth based on gender expression or sexual orientation.

65C-14.018 Individual Needs for Children in Care

  • Group Home staff cannot restrict access to hygiene, grooming and personal care items based on the child’s gender identity or expression.

65C-14.040 Admission, Placement, and Ongoing Services

  • For transgender youth, a decision will need to be made whether that child should be placed with their gender on the birth certificate, or their identified gender.
  • Factors to include while making the decision: physical safety, emotional well-being, youth preference, and opinions of case manager, GAL, parent (if rights aren’t terminated) and therapist.
  • Child placing agency must take into account the capacity of the placement to meet the child’s needs, and the needs of the other children already placed in that setting.

65C-14.023 Personnel and Staffing Requirements

  • Direct child care staff must obtain training within their first full year of employment in the area of sexual orientation, gender identity, and gender expression.

This information is ever-changing.

Background Screens

There are different types of background checks.  It is important to ensure the appropriate background screen is requested for the specific case need, based on Florida Statute, and therefore can not be used interchangeably.

Important Note:  Anytime you do a background check for placement, you are to complete the FSFN Unified Home Study, and enter the results of the background check into the FSFN Provider Record. 

1. Local law & abuse checks **NO FINGER PRINTS REQUIRED**

This type of screening is suitable for the following needs:

  • Unsupervised Contact – includes non judicial home
  • Babysitting
  • Case Closure
  • Re-license yearly check for licensed foster home 

2. State (FCIC), local law & abuse checks **NO FINGERPRINTS REQUIRED**

This type of screening is suitable for the following needs:

  • Reunification
  • Planned/Emergency  Placement youth ages 12-17
  • Adoption (initial & 90 day) /Licensed foster home (initial & 5 year) FDLE youth ages 12-17

3. National (NCIC), State (FCIC), local law & abuse checks

**FINGER PRINTS ARE REQUIRED**

This type of screening is suitable for the following needs:

  • Planned/Emergency Placement or household members of a placement – includes *New* household member to non-judicial home.
    • Non-Custodial Parent
    • Relative
    • Non-Relative
  • **Family-Made Arrangement (No removal / shelter) *Safety Plan*
  • **Safety Provider*Safety Plan*
  • **Initial Adoption – second sets are taken for 90 day re-screen (if warranted).
  • Frequent visitor to placement home (visitor who is in home consistently on a regular basis)
  • **New Licensed Foster home/ 5 year re-screen
  • **Licensed Foster home babysitter-Licensing determines and advises subject to be finger printed.
  • Household member of reunifying household (relative/non-relative **not parent**)
  • Other child safety concern

** Even though placements, adoption, foster care licensing, Family-Made arrangement and Safety Provider background screens all require finger prints- they cannot be used interchangeably due to Florida statue specification guidelines

PLEASE NOTE: All 3 types include out of state criminal checks if the resources are available to BSU for identified state that subject has resided in.

PLEASE PLAN AHEAD!   All requests are given a 2 week turnaround time. Any screens that are needed before the 2 week date must be approved as urgent or emergency by a supervisor, and communicated to BSUHELP through one of the following: phone, email, or face to face.

 

Conditions for Return

The Conditions for Return describe what must exist or be different with respect to specific family circumstances, home environment, caregiver perception, behavior, capacity and/or safety service resources that would allow for reunification to occur with the use of an in-home safety plan.

Impending danger threats do not have to be reduced or eradicated in order for children to be reunified with their families if an in-home safety plan can sufficiently control the threat.

What is necessary for children to return to their families is the establishment of well-defined circumstances within a child’s home that mitigates threats to child safety.

The basis for Conditions for Return is the In-Home Safety Analysis and Planning section of the Family Functioning Assessment and Progress Update and the five questions located there.

 Conditions for Return are the explanations of how answering “No” to Safety Analysis questions can be changed to a “Yes”.

 Once all five questions are answered with a “Yes” the child must be returned to the home with an In-Home Safety Plan.

The 5 In-Home Safety Analysis Questions

1.    Are the parents willing and cooperative?

2.    Is the home environment calm and consistent enough?

3.    Are sufficient safety services available?

4.    Can danger be managed without professional evaluations? (i.e.- psychological)

5.    Do parents have a residence/stable home?

Example:

Case Info: Fred and Wilma’s home is near being condemned because of the physical structure, faulty wiring and unhealthy living conditions. There is no heat and the plumbing is inadequate. The couple is mildly developmentally disabled and makes poor choices about use of money and care of home.

Impending Danger: The child’s physical living conditions are hazardous and a child has already been seriously injured or will likely be seriously injured. The living conditions seriously endanger a child’s physical health. (This is one of the 11 standardized impending danger threats)

Conditions for Return:

  • Fred and Wilma accept and follow the instructions and guidance of a homemaker safety service provider related to money and home management (Safety Services).
  • The home is sufficiently clean and cared for so that no hygiene problems exist (Calm and Consistent).
  • A plan for proper maintenance and adequate repair to make sure the home is livable day by day (Safety Services).
  • Fred and Wilma set aside money for and make good decisions about the upkeep of their house (Willing and Able).

The conditions for return must be addressed and discussed at all staffings and hearings.

Special Needs Assistance and Accessibility

 

It is the policy of Community Based Care (CBC) to ensure that its services and administrative facilities are tailored to the special needs of and are accessible to its defined service population in full accordance with all applicable legal and regulatory requirements. All CBC clients or potential clients will be afforded equal access to services. Clients with special needs including but not limited to hearing impairments, vision impairments, physical impairments, mental impairments and limited English proficiency will be afforded equal access to all services and programs administered.

Special Needs Definition: A designation used in reference to conditions or characteristics of a person that reflect a need for special care, services, or treatment.

  • When the term is used in the context of adoption services, special needs refers to conditions that make a child harder to place for adoption. This includes children who are members of sibling groups, older children, children with disabilities, children of certain racial /ethnic backgrounds, etc.
  • When the term is used in the context of foster care it refers to the need for a higher degree of specialized case services and attention due to mental and physical disabilities.

1. In planning the location and use of offices for meetings with persons with special needs, CBC staff will consider the needs related to accessibility, availability and affordability of public transportation; location of community resources and the special needs of service recipients.

2. Clients will be informed of availability to auxiliary aids or interpreters. Hearing impaired clients or those clients with limited proficiency in English have a right to a qualified interpreter at no cost to the client. The use of family or friends is not acceptable except in emergencies, as it could result in breach of confidentiality. The use of minor children for interpreting is prohibited.

3. CBC staff shall document the client’s or companion’s preferred method of communication and any requested auxiliary aids/services provided in the case file. Documentation, with supporting justification, must also be made if any request was not honored. Auxiliary aids or interpreters shall be provided in a timely manner that will not unreasonably delay, impede or deny services to clients. If clients or companions are referred to other agencies, CBC staff must ensure and document in the case file that the receiving agency is notified of the client’s or companion’s preferred method of communication and any auxiliary aids/service needs. CBC staff will also notify their Deaf/Hard-of-Hearing Single Point of Contact of any clients that qualify as deaf/hard-of-hearing for the purposes of monthly compliance reporting.

4. CBC will ensure all meetings, conferences, hearings, training, interviews, eligibility determinations, programs, services, and activities are held in facilities that are accessible. Through client feedback and the quality improvement system, each program will address those structures with specific impact on access. These structures may include but not be limited to constructing ramps, widening doorways, accessible parking, grab bars, etc. SCC will address identified issues and the appropriate quality improvement system for remediation.

5. There is a complaint process providing for resolution of complaints alleging any action prohibited by the ADA. Employees, clients or potential clients of The Safe Children Coalition wishing to file a discrimination complaint should contact their Region/Institution Civil Rights Officer or the Department’s Office of Civil Rights within 180 days of the alleged discriminatory act.
 

6. Case workers / Supervisors must notify your Deaf/Hard-of-Hearing Single Point of Contact of any persons that qualify as deaf/hard-of-hearing for the purposes of monthly compliance reporting.

Teen Adoption

The absence of an unconditionally committed parent in the life of a child cannot be treated by medication or therapy.  (Kevin Campbell)

For far too long, teen adoption has been considered impossible.  Teens are viewed as difficult, unable to attach, and having too many issues (therapies, meds and diagnoses).  This mindset allows teenagers with a goal of adoption to languish in foster care, residential facilities, group homes, therapeutic settings, hospitals and DJJ getting further and further away from a family they can call their own.  We need to shift how we view our teens; as we locate a family for them.  It shouldn’t be a matter of ‘if’ we locate one but whom and how.

Teens that age out of care without a family can have frightening outcomes:

Ø  49% of youth in a national survey of runaway and homeless youth shelters conducted by NASW spent time in out-of-home care; 38% in foster care, 11% in another shelter. 

Ø  61% of homeless youth under 20 years of age reported having been placed in foster care, group homes or institutions before the age of 18. 

Youth’s Permanent Connections

Recruiting for teens is different than younger children and should be treated as such.  General types of recruitment will not get the job done with this population.  So how do we do this seemingly insurmountable task?  When was the last time you talked with the child about with whom he/she would like to have permanency?   Some teens say they don’t want to be adopted for a multitude of reasons.  When adults give teens the power to say “no” to adoption, the teen hears:

•          “You are not loveable.”

•          “No one would want you anyway.”

•          “There is no hope for your future.”

•          “You are not important enough for me to exert any energy in trying to find you a                          family.”

So, how can we engage the youth in planning for permanency? First, we ask the child what their family would look like. How else will we know how to recruit for the teen without including them in the process?  Ask:

•          What will it take to achieve permanency?

•          What can we try that HAS been tried before?

•          What can we try that has NEVER been tried before?

Teens in care can and have found permanency with:

Foster Parent’s neighbors                                                              Foster Parent’s friends

Foster Parent’s family members                                                    Foster Parent’s pastor

Members in Foster Parent’s church                                               Child’s best friend’s mother

Social work & other agency staff                                                   Employers or bosses

Administrative staff                                                                        GAL/CASA worker

Clergy/chaplin                                                                                  Teachers & other school staff

School crossing guard                                                                      Cafeteria staff

Teacher’s aide                                                                                   God parents

Unexplored  maternal & paternal relatives such as older siblings, cousins, grandparents, aunts, uncles, birth parents and other extended family members.

In addition to the Heart Gallery, teens should be photo-listed on Adoptuskids.org.  Not only will this generate much greater exposure for the child, but the case manager can search families that are registered on the site who are interested in adopting.  There are thousands of families and many search options that will help you identify the most likely matches.  The families and their case managers can be contacted from the site.

Home Visits with Children

What is the purpose of a Home Visit?

The purpose of a home visit is to assess the safety and well- being of the child, as well as, address concerns and needs of the child and/or caregivers, determine appropriateness of the placement, and provide support to the caregivers and inform the progress of the case. 

When must a Home Visit be done?

·         Initial face-to face (FTF) contact with the child and caregiver is to occur within two working days after the case is accepted for services at the child’s current place of residence. 

·         When a child is in Shelter Status FTF contact shall occur every seven days.  (Shelter Status=legal status that begins when the child is taken into protective custody of the department and ceases when the court: grants custody to a parent and/or after disposition of the petition for dependency.)

·         Once the child has been Adjudicated Dependant (after Disposition) by the Court, FTF contact is required with each child a minimum of once every twenty five days in the child’s current residence. FTF contacts must occur more frequently when the child’s situation dictates more frequent contact as assessed by the case manager and the case manager supervisor.

·         At least once every three months the case manager will make an unannounced visit to the child’s current residence. 

·         Once a child in run away status returns, a FTF home visit should take place immediately in order to assess the child’s mental/physical state and gain insight into the reason he/she ran away. 

Expectations/Guidelines of a Home Visit:

·         Meet with the child and caregivers in their current residence.

·         Speak with each child individually, alone and away from others, to assess child’s                         adjustment, progress, needs and/or concerns and overall well-being.

·         Examine the child for cleanliness, health, and signs of injury, abuse and/or neglect.

·         Evaluate the home environment for appropriateness and safety.

·         Discuss concerns and/or needs with the caregiver and provide referrals for services.

·         Discuss stages of change and progress and/or concerns with services.

·         Inform the caregiver and child (if age appropriate) of upcoming court hearings, staffings,           etc.

·         Obtain updates and copies of the child’s medical, dental and mental health records,                   appointments, procedures, prescriptions and dosage.

·         Obtain updates and copies of the child’s educational records and progress (if age appropriate).

·         Observe interactions between the caregivers/family members and the child.

·         Obtain updated photographs of the child using the Mindshare mobile application.

·         Review the Child Resource Record at each home visit to ensure that information is                     current.

·         Follow up on previous concerns or referrals with caregiver and/or the child.

·         Discuss how visitation is going with parents/siblings.

·         Assess and discuss Safety Plan in effect with the current participants, their role in the                 plan and the safety management techniques being utilized to determine if the current               safety plan is still effective.

·         Document where the child sleeps and who (if applicable) sleeps in the bedroom with the           child.

·         Document home visit information in FSFN or the Mindshare mobile application (which               uploads to FSFN) within 48 hours of the FTF visit occurring.

WATCH Nurse Case Management

Nurse Case Management:

  • WATCH provides RN case management for all children in judicial out-of-home care (licensed foster care, relatives & non-relatives) sheltered from Sarasota, Manatee & Desoto Counties.
  • Upon notification of removal, the RN verifies that a 72hour well exam has been scheduled and completed; the RN will assist with coordination when applicable.
  • For children >3yrs, RN will check for recent Medicaid dental claims & document in FSFN (upon enrollment only).
  • RN will track and document vaccine compliance in FSFN; a copy of the child’s updated FL Shots record will be printed and sent to Records Room to be scanned into ASK.
  • RN will track and document well exam compliance in FSFN (per AAP guidelines); records will be requested and sent to Records Room to be scanned into ASK.
  • Upon review of medical records, the WATCH RN will follow-up on all medical recommendations
  • Upon confirmation of medical follow-up, the WATCH RN will request and review records; medical history will be documented in FSFN and the medical records will be sent to ASK
  • RN will help facilitate a Children Medical Services (CMS) referral for children that may be clinically eligible.
  • RN will review CBHA reports and follow-up on any medical recommendations.
  • RN will call caregiver at closure (reunification, adoption, permanent guardianship, transfer to independent living) to assist with any applicable transition needs.

Key Relationships/Key Functions

  • WATCH acts as a key medical resource for the caregiver and the case management staff.
  • The WATCH RN helps to meet the 72hour EPSDT requirement by

-                           working with the caregiver to identify and establish funding (Medicaid in                                     most cases),

-                           helping to identify the existing Primary Care Physician (PCP),

-                           helping to liaison with the PCP’s office if there is a lack of current funding or                                 if the child has been seen by the PCP recently,

-                           helping to arrange for transportation as needed,

-                           researching FLMMIS for past medical claims (including medications), and

-                           forwarding medical information to PCP if available.

  • The WATCH RN documents ALL medical follow-up in FSFN (from time of removal to the child’s closure to WATCH).
  • The WATCH RN identifies clinical eligibility for CMS and makes referrals as needed.
  • The WATCH RN will forward any mental health/dental information to the case manager.
  • If the child is an existing CMS patient, the WATCH RN supervisor will act as a liaison between the CMS RN case manager and the Coalition case worker.

Please remember:

·        Notify the WATCH RN of ALL upcoming medical appointments (FSFN will be updated after the appointment is attended; records will be requested).

·        Give all incoming medical records for children in out-of-home care to the WATCH RN; FSFN will be updated and records will be sent to ASK.

Speech, Language, and Hearing Milestones For Young Children

This tip provides a brief overview of some speech, language and hearing milestones for young children.  The children we serve have varying levels of development.  It is important to understand what age the various milestones should be occurring; so we are able to provide services for those who may have delays in one or many areas.  The chart below outlines a few of the milestones.  Go to www.asha.org/public/speech/development/chart.htm for a more complete chart of milestones.

Birth–6 months

Startle to loud sounds. Respond to changes in tone of your voice.

Moves eyes in direction of sounds

Cry differently for different needs. Babbling sounds more speech-like with many different sounds, including p, b and m.

 

7–12 months

Enjoy games like peek-a-boo and pat-a-cake. Recognize words for common items like “shoe,” “book,” Begins to respond to requests

Imitates different speech sounds. Use gestures to communicate (waving, holding arms to be picked up).

 

12–24 months (1-2 years)

Follow simple directions and understand simple questions (“Roll the ball,” “Kiss the baby,” “Where’s your shoe?”). Point to pictures in a book when named.

Say more words every month.  Uses one or two word questions.  Puts two words together (“more cookie,” “no juice,” “mommy book”).

 

24–36 months (2–3 years)

Understands differences in meaning (“go-stop,” “in-on,” “big-little,” “up-down”). Follow two requests (“Get the book and put it on the table.”).

Uses two or three words to talk about and ask for things. Speech is understood by familiar listeners most of the time.

 

36–48 months (3–4 years)

Hears you when you call from another room. Answer simple who, what, where, and why questions.

People outside of the family usually understand child’s speech. Use a lot of sentences that have four or more words.

 

48–60 months (4–5 years)

Pays attention to a short story and answer simple questions about it. Hear and understand most of what is said at home and in school.

Communicates easily with other children and adults. Use sentences that give lots of details (e.g., “The biggest peach is mine.”).

Source: Adapted from American Speech-Language-Hearing Association. How Does Your Child Hear and Talk? Available at www.asha.org/public/speech/development/chart.htm .

 

Adoption Matching

Although a formal adoption placement can not be made until after the child is legally free for adoption; efforts can and should be made to place a child and siblings in their forever home as soon as possible.  Many studies and our own statistics show, if we wait until a parent’s rights are terminated to begin recruiting – we delay permanency for the child by years.  Children need stability and with that stability comes functionality.  Without expedited permanency children will struggle to establish bonds for the rest of their lives.  Every placement decision must take into account the likelihood of adoption becoming a concurrent or primary goal.

Ideally the child is placed with a caregiver who will be willing to care for that child and all of the siblings forever.  A way to ensure there is a positive transition is to include the caregiver (whether relative or foster parent) and the parents in the team planning process from the start.  Many times if the parent has established a bond with the caregiver; and the parent is not able to get through the case plan successfully; that parent may sign surrenders to the child or children.  This expedites the process and leads to quicker permanency for the child.

It is extremely important to place siblings together, and when this is not immediately possible on-going diligence to place siblings together is needed.  The same applies to seeking out relative and non-relative caregivers for the children.  A relative finder request should be initiated immediately and updated at least every 6 months.  Every relative listed is a possible placement, and when they are not suitable or willing to care for the children, often those relatives and friends can provide 10-15 more leads for a possible permanent home for the children.

It is the case manager’s, placement specialist’s, parent’s, and SCC staff’s responsibility to use diligence in a match process early in the case and to work on targeted recruitment for harder to place children.

When looking at ‘matching’ children with a family, it is important to remember that “many biological children do not share the interests and talents of their parents, and biological siblings, although often sharing some common interests and talents, have talents and interests of their own. “…Professionals see the prospective parent’s commitment to parenting” as the critical factor in successful long term placements or adoptions. (adoptuskids.org)

“In most cases, because children enter foster care on an emergency basis, they are placed with foster families on the basis of availability. Although foster parents may specify the characteristics of children whom they would like to foster and they can decline to accept placement of children who do not meet these criteria, many foster parents open their homes to children whom they did not originally envision fostering. And, many of these foster families go on to adopt children who would not have been a “match” based on the foster parents’ initial thoughts about the children who would be a “good fit” with their families.” (adoptuskids.org)

Selecting a family for a child is a thoughtful decision-making process, requiring insight, foresight and team cooperation by professionals and family members right from the start.  Whenever possible including the prospective caregivers and/or adoptive families and the children themselves in placement decision making will aide in ensuring placement stability.

Domestic Violence – Pre-Incident Indicators

This tip lists reliable pre-incident indicators associated with spousal violence developed by Gavin De Becker.  De Becker states if there are several of these indicators occurring there is cause for concern. For this reason, when working with the families we serve, it is important to be aware of them and to document any of the indicators observed.

š When the potential victim has intuitive feelings of being at risk.

š In the beginning of the relationship the potential batterer accelerated the pace, prematurely placing on the agenda things such as commitment, living together or marriage.

š The potential batterer resolves conflict with intimidation, bullying or violence.

š The potential batterer is verbally abusive.

š The potential batterer uses threats and intimidation to control or abuse. This includes threats of harm, defamation, embarrassment, abandonment and restricting freedom.

š The potential batterer breaks or strikes things in anger.  Also using symbolic violence like ripping photographs.

š The potential batterer has a history of battering.

š The potential batterer uses alcohol or drugs with adverse effects such as memory loss, hostility or cruelty.

š The potential batterer uses alcohol or drugs as an excuse or explanation for the hostile conduct.

š The potential batterer has a history of encounters with the police for behavioral offenses.

š The potential batterer uses money to control the activities, purchases and behavior of the potential victim.

š The potential batterer becomes jealous of anyone or anything that takes the potential victim’s time away from the relationship and keeps a ‘tight leash’ on the potential victim.

š The potential batterer refuses to accept rejection.

š The potential batterer expects the relationship to go on forever.

š The potential batterer projects extreme emotions onto others (hate, love, jealousy) even when there is no evidence to warrant it.

š The potential batterer minimizes incidents of abuse.

š The potential batterer derives their own identity from the potential victim.

š The potential batterer has stalked the potential victim.

š The potential batterer believes others are out to get them.

š The potential batterer resists change and is described as inflexible, unwilling to compromise.

š The potential batterer identifies with and compares themselves to violent people in films, news stories, fiction or history characterizing the violence as justified.

š The potential batterer suffers mood swings or is sullen, angry or depressed.

š The potential batterer consistently blames others for problems of their own making, refusing to take responsibility for the results of their actions.

š The potential batterer refers to weapons as instruments of power, control, or revenge.

š The potential batterer has or talks about guns and collects weapons.

š The potential batterer makes all the decisions in the house and acts like the master.

š The potential batterer has experienced or witnessed child violence.

š The potential victim fears they will be injured or killed by the potential batterer.

 

 

Seizures, Signs and Responses

What is a seizure?

A seizure is a sudden surge of electrical activity in the brain. It usually affects how a person appears or acts for a short time. Many different things can occur during a seizure. Some people function normally during a seizure. Typically, a seizure will last no more than five minutes. Often, people will have partial seizures where they remain standing and/or sitting but appear to have “faded out.” This is often mistaken for drug or alcohol use. Children can suffer from partial seizures as well as adults. Sometimes, these children are diagnosed with ADHD (Keen, S., 2015).

What can cause a seizure?

A number of things can elicit a seizure. Stress, being hungry or too hot, sleep deprivation and flashing lights are some of the top origins for seizure onset.

When should you call Emergency Medical Services/911?

You should contact EMS/911 if the person is pregnant, diagnosed with diabetes, this is their first seizure, they have injured themselves or if another seizure occurs soon after the first one ends.

What to do when someone has a seizure?

  1. Help the person to the ground.
  2. Move away objects that could cause injury.
  3. Loosen tight clothing (i.e. a necktie)
  4. Turn them on their side.
  5. DO NOT hold them down.
  6. Place something soft under their head to prevent injury.
  7. DO NOT put anything in their mouth to hold down their tongue. This is dangerous to the person experiencing the seizure as well as to you!

Epilepsy Services Locally:

Epilepsy Services of Southwest Florida (ESSWF) serves eight counties from Bradenton to Naples. ESSWF provides healthcare to adults without insurance who are diagnosed with seizures/epilepsy. Services include neurology, case management and medications.

Case Plan – SMART Outcomes

What are SMART outcomes?  Specific, Measurable, Attainable, Realistic, Timely.  Case Plan Outcomes should relate to identified diminished caregiver protective capacities, and should describe a behavior, way of thinking or methods for managing feelings that must change.  Outcomes must meet the SMART criteria and express positively the desired change.

Outcomes include who and what

·        The person responsible: (WHO)

·        The action or behavior - What he/she must do to: (WHAT)

o   The outcome should clearly describe the way in which the individual will either behave, think, or manage feelings in order for a child to be considered safe in their care.

Meeting outcomes

·        The tasks under each outcome are steps towards meeting the case plan outcome.

·        Tasks include the services for parents and children that help bring about the change required.

·        Tasks are specific and their effectiveness should be evaluated based on the progress made toward the outcome.

Some words to avoid when writing outcomes

Successful completion

o   Changing behavior is more than completing a program.

o   Define behavioral changes that will occur as a result of completing the tasks.

Stable

o   State what is meant by “stable” employment

o   Part-time? Full-time? For how long?

Appropriate

o   Is subject to interpretation.

o   Instead, work out with the client the behaviors necessary to reduce risk. 

Adequate

o   Is subject to interpretation.

o   Instead, state specifics of what is meant: (i.e. adequate housing means two-bedroom apartment with running water).

A.S.A.P

o   “As soon as possible” is not a timeframe.

o   Instead, state the number of days, weeks,  timeframes specifically

Ongoing

o   Is not a timeframe.

o   Instead, choose a target date when the outcome will be evaluated or completed.

 

Department of Juvenile Justice Involvement

 

Florida Administrative Code states, “for a child in custody of the department who is also receiving services through the Department of Juvenile Justice (DJJ), service provision shall be coordinated efficiently and effectively by the two departments”.  It is critical to have frequent communications with DJJ and to actively participate in transition planning for the child to ensure successful intervention services. 

The Case Manager has additional responsibilities when a child under supervision is involved with DJJ.  The Case Manager MUST:

Ø  Maintain at least monthly contact with the DJJ facility contact and/or Juvenile Probation Officer (JPO) to obtain current status, service, and sanction information.

Ø  Communicate with the parents and ensure they are involved in the planning process and kept informed of the child’s status, if the parent’s rights have not been terminated.

Ø  Attend and participate in all case staffings, commitment staffings, release staffings, transition planning, or court hearings for/with the child.

Ø  Collaborate with DJJ/JPO, parents/caregivers, Guardian ad Litem (GAL) and the child to develop a plan that will ensure the child’s needs are met.

Ø  Provide the name, address, and phone number of the child’s caregivers and any other needed information to DJJ/JPO.

Ø  Obtain copies of all case planning, pre-disposition reports, assessments and other documents from DJJ/JPO for filing with dependency court and placement in the case file.

Ø  Ensure the child is receiving Independent Living Skills (IL) training and services while involved with the DJJ/JPO, provided by either DJJ or SCC.  This information should be shared between CM and IL worker ongoing.

Ø  Coordinate with DJJ/JPO to schedule the child for the DJJ Comprehensive Behavioral Health Assessment (CBHA), arrange transportation to the assessment and obtain copies of the CBHA once it is completed.

Ø  Coordinate mental health and/or substance abuse treatment and services not provided by DJJ/JPO. Ensure the child receives the needed services and they are incorporated into the child’s case plan.

Ø  Create visitation plans with the child, parents (if applicable) and DJJ/JPO that state who is allowed to visit with the child and who the child is allowed to speak with by telephone when the child is in detention or a commitment program.

Ø  Participate in transition planning with the DJJ/JPO to ensure the child has a place to go when released from a DJJ program or detention.

Ø  Document all contacts made with the DJJ/JPO or other providers in FSFN within 48 hours of the contact.

If efforts to communicate with DJJ/JPO are not responded to timely,  the Case Manager’s Supervisor must be notified. If the Supervisor is not able to get a response or the needed information, a written request for service and sanction must be made to the DJJ Chief Probation Officer or the Chief Officer at the detention or commitment program.

Interpreter Services

 

As required by contract and the Americans with Disabilities Act (ADA), persons who need assistance due to being deaf, hard of hearing or with limited English proficiency, have the right to accommodations which will facilitate communication.  The Florida Department of Children and Families and contracted providers are required to provide FREE interpreters and other communication assistance for persons who are deaf or hard of hearing. (under the Department of Children and Families (DCF) settlement agreement, interpreters for the deaf or hard of hearing are required to be certified by the Registry of Interpreters for the Deaf)

Appropriate auxiliary aids and services must be furnished, where necessary to ensure effective communication with individuals with disabilities. Such auxiliary aids and services may include: qualified sign language or oral interpreters, note takers, computer-assisted real time transcription services, written materials, telephone handset amplifiers, assistive listening devices, assistive listening systems, phones compatible with hearing aids, closed caption decoders, open and closed captioning, videotext displays, and TTYs.

The best way to determine if any type of interpreter services are needed, is to ask.  Do not try to guess what the needs of the person being served may be.  There are a variety of services available for those who are deaf or hard of hearing.  There are also guidelines requiring the use of certified interpreters under certain circumstances.

Accommodations which may be used by those who are deaf or hard of hearing include:

Florida Relay Services - telecommunications

Interpreter Services - in person communication

Communication Access Realtime Translation (CART) - an interpreter documents what is said for the deaf or hard of hearing person so they have a record of information discussed.  This is not a legal document.

Voice Over Communication - an operator will type the information being relayed by the hearing party and the deaf or hard of hearing party will respond verbally

Video Relay Service - the deaf or hard of hearing party will use a sign language interpreter to convey what the hearing part is saying and will translate verbally to the hearing party when the deaf or hard of hearing person is speaking

Video Remote Interpreter - an interpreter will provide verbal and sign language communication between the parties.

Accommodations for those who have limited English proficiency must include:

  1. A person who is fluent in both written and verbal communication of the language being used.
  2. A person who does not have a conflict of interest.  If a party insists on using a friend or relative to interpret, we must still have an interpreter present who does not present a conflict of interest.

Before setting up these services, always consult with your agency Point of Contact (POC) for Interpreter Services.

Closing Case Management Services

According to the Council on Accreditation (COA) closing a case is a ‘planned, orderly process’.   Throughout the life of the case, documentation of on-going assessment and planning supports the decision to close out services when that time comes.  This tip briefly touches on the very complex and important processes of case closure. 

A formal family-centered closure staffing that includes input from all parties to the case, any tribal affiliates and all provider agencies must be held for all cases.  During the staffing, case progression and obstacles that remain are discussed.  A transition plan for closure is developed that addresses services still needed, available resources and emergency services. 

If closure is contested or there are any concerns all parties must be present at the staffing. If closure is uncontested written recommendations are required.

Court ordered cases can not be closed unless the child has reached age 18, or the court has authorized the closure and the child has been stable with the same caregiver for at least 6 months.  If risk factors remain after those 6 months of supervision the case should be staffed for extending the supervision longer, with details of the concerns needing resolution.  When it is a court ordered case, the case management agency must request the extension of supervision be approved by the Court.  (NOTE:  There are some instances when a child is released to a non-offending parent that this 6 month period is reduced.)

Prior to staffing for closure, a case closure checklist is completed by the case manager and submitted with the staffing packet and supporting documentation to the supervisor for approval.  The case manager must determine if there is an open protective investigation and whether any have occurred within the 6 months prior.  Background screens must be updated on all household members, any needed visitation and safety plans must be developed and a Progress Update must be completed.

Case Management must ensure that all follow ups from the case closure staffing are completed in a timely manner to ensure the family has all the resources and supports necessary to maintain a safe and healthy household.

The case manager must prepare a termination summary or a Judicial Review Social Summary Report that addresses the initial reason for involvement with case management, progress made toward resolving issues that resulted in intervention, current status of safety, explanation case plan outcomes that were met and those that were not, aftercare planning efforts, and the reason closure of services is being requested. (FAC 65C-30.022)

For court order in-home supervision, supervision shall not be terminated until authorized by court order.

All case activities, staffings, plans, events and contacts are documented in the Florida Safe Families Network (FSFN) within 48 hours

Case Plan Tasks

Case Plan –Tasks

What are Tasks and who is responsible?

  • Tasks are the services, activities, and/or steps to achieve the outcome.
  • Tasks directly relate to a diminished caregiver protective capacity or factor contributing to the need for an open case.
  • Tasks must be related to allegations in the Dependency Petition.   
  • Tasks are needed for each offending parent (non-offending parents should only have tasks when it is ordered by the Court).
  • When appropriate, include specific tasks and/or services for the children (i.e. CBHA Recommendations, IL, SIJS)

Tasks must be Specific and Measureable

  • State who will do what, when, how often, where, and how it will be measured.
    • Who is responsible?
    • What behavior/action is to be accomplished?
    • When will it be performed?
    • Where it will be done?
    • How often?
  • Tasks are to be clear, realistic, and achievable.
  • Task must be measureable (frequency, duration, intensity)
    • When the task is to begin
    • Frequency of that behavior (how often the behavior is to occur)
    • Duration of the behavior (how long and when it ends)
    • Intensity (how well, how much)

Services

  • Include the type, frequency, location, and phone number of services and the name of the person responsible.

Sequence Tasks Logically

  • Use small incremental steps (tasks) to achieve the outcome so the family can experience success.
  • Give a timeframe for each task and stagger the timeframes so tasks are achievable and not overwhelming to the family.
  • Put the tasks in order for which ones needed to be completed first or before other tasks can begin.

How do you measure outcome achievement?

  • Frequency and duration of visitations
  • Random urine analysis
  • Observation of interaction between children and parents during visitation
  • Psychological evaluation report
  • Following through on recommendations
  • Reports from providers