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Florida Children’s Mental Health System of Care – Abstract

Over the last year, Florida assembled stakeholders from around the state to develop a strategic

plan to expand and sustain a System of Care that is family driven, youth guided, community

based, and culturally and linguistically competent. Florida’s Children's Mental Health System of

Care (CMHSOC) Project will use this strategic plan to implement the System of Care framework

into its statewide mental health service delivery network.

Statewide Planning Teams of dedicated family members, youth, state agency representatives, and

the Department of Children & Families (DCF) were established to lead the efforts in bringing a

comprehensive System of Care (SOC) to scale. These coordinating bodies have been

instrumental in guiding and managing the strategic planning process and will continue to oversee

statewide implementation. Our work will impact the 94,369 children and their families served in

Florida’s mental health system in FY 2010/2011. Current demographics for children and youth

served in Florida are: Gender: 60.6 % male, 39.4 % female; Race: 60% white; 29.1 % Black,

9.5% multi-racial, .7% American Indian, .7% Other; Ethnicity: 12.1% Other Hispanic, 3.48%

Cuban, 3.47% Puerto Rican, 1.31% Haitian, 1.28% Spanish/Latino, and 1.26% Mexican. This

project will serve children and adolescents’ age 0-21 diagnosed with serious emotional

disturbances (SED) and their families. Each Florida region offers unique strengths and needs

based on their diverse cultures, ethnicities, languages, geography and socio-economic

characteristics; hence, localities will select their population of focus within this broad definition

based on their documented needs. The CMHSOC Project intends to serve 250 children and

youth in year one, 1000 in year two, 1250 in year three, and 1500 in year four for a total of 4000

unduplicated children and youth served during the four-year project.

Based on Florida’s planning activities to date, the goals for SOC expansion include:

1) Consistent family and youth voice at all levels; 2) Increased collaboration/integration among

community partners; 3) Linkages with early childhood partners to promote screening, prevention

and early intervention; 4) Local adoption of SOC values and principles; 5) Recognition of

substance abuse and mental health challenges as chronic diseases; and 6) Expansion of culturally

and linguistically relevant evidence based practices (EBP). In order to attain these goals,

Florida has adopted the five core strategy areas for system change as identified by the Study of

Strategies for Expanding Systems of Care (Stroul, B.A., & Friedman, R.M., 2011). These include

implementing policy and regulatory changes, expanding services and supports based on the SOC

philosophy, creating and improving financing strategies, providing training and coaching, and

generating statewide support for the SOC approach. The project aims to maximize the variety of

resources available to promote recovery and improve child well being.

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Table of Contents

Page

Section A: Statement of Readiness/Evidence of Strategic Planning 3

Section B: Proposed Approach and Implementation 9

Section C: Staff, Management, and Relevant Experience 27

Section D: Performance Assessment and Data 30

Section E: Literature Citations 33

Section F: Budget Justification, Existing Resources, Other Support 35

Section G: Biographical Sketches and Job Descriptions 72

Section H: Confidentiality and SAMHSA Participant Protection/Human Subjects 83

ATTACHMENTS

Attachment 1: Letters of Commitment/Coordination/Support 88

Attachment 2: Data Collection Instruments/Interview Protocols 92

Attachment 3: Sample Consent Forms 128

Attachment 4: Letter to the SSA 134

Attachment 5: Copy of the State Strategic Plan/ State Needs Assessment/ Nonfederal 135

Match Certification/Match Letters from each Agency

REQUIRED FORMS

Project/Performance Site Location(s) Form

Assurances – Non-Construction Programs

Certifications

Disclosure of Lobbying Activities

Checklist - (in PHS 5161-1)

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Section A: Statement of Readiness/Evidence of Strategic Planning

Describe the proposed catchment area: Florida’s CMHSOC project will encompass the entire

state. According to the 2010 US Census Bureau, Florida is the 4th

most populous state in the

country. The size, cultural, linguistic and geographic diversity of the sixty-seven (67) Florida

counties poses many challenges to providing consistent quality of care. While known for its

international tourist attractions and metropolitan areas, significant portions of the state remain

rural. Agriculture is one of Florida’s leading industries and the state ranks first in the US for

sales of many fruits and vegetables. In addition, several major military installations are

important to Florida’s economy. Florida is fortunate to have been awarded eight (8) SOC

grants/cooperative agreements since 1998, all of which were implemented in predominantly

urban areas. This diversity may help to explain why one of the needs identified through the

state’s self-assessment process in the past year is standardization and equity of service provision

across regions. This project will give us the opportunity to build on the gains achieved in those

areas and expand the SOC framework statewide, including rural Florida.

To facilitate greater effectiveness and offset state budget cuts, DCF created regional systems of

care (RSOC). These RSOC merge the functions of DCF’s Substance Abuse Mental Health

(SAMH) circuit offices which were closed in July 2011. The merger of circuits into these

regions coincides with a competitive procurement process to create managing entities (ME).

These contracted private, not-for-profit community organizations manage substance abuse and

mental health resources including block grants, other federal grants and state general revenue

funding. These RSOC are aligned to work effectively with the Agency for Health Care

Administration (AHCA -Florida’s Medicaid authority) administrative regions. All seven

Managing entities will be under contract in the regions by October 2012. In partnership with

regional SAMH offices and through specific contract language, these managing entities are

expected to ensure SOC principles and practices are implemented in their regions based on

community need, readiness, population, size, and demonstrated ability to sustain. In the

expansion planning grant six counties (Pasco and Pinellas Counties and Bay, Washington, Leon

and Gadsden Counties) were already identified as high need areas and are actively in the process

of completing readiness assessments and strategic plans for SOC implementation.

Provide demographic information on the populations to receive services through the targeted

systems and how this meets the priority to bring SOC to scale at the state level: Florida

proposes to expand SOC principles and practices statewide to improve services and supports for

children ages 0-21 diagnosed with serious mental health needs. The health and wellness of the

children and adolescents in the entire state is our priority. Florida is home to 18.8 million

people including 4.2 million Hispanics, now the largest minority group (22.5%), followed by

African Americans (16%), persons reporting two or more races (2.5%), Asians (2.4%) and

Native Americans (0.5%). There are 4 million children and youth under age 18 living in Florida

(U.S. Census, 2010). Current demographics for children and youth served in Florida are:

Gender: 60.6 % male, 39.4 % female; Race: 60% white; 29.1 % Black, 9.5% multi-racial, .7%

American Indian; .7% other. Ethnicity: 12.1% Other Hispanic, 3.48% Cuban, 3.47% Puerto

Rican, 1.31% Haitian, 1.28% Spanish/Latino, and 1.26% Mexican.

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The children’s mental health system in Florida serves children and adolescents diagnosed with

serious emotional disturbance, emotional disturbance (ED) or at risk of becoming emotionally

disturbed as defined in Section 394.492, Florida Statutes (F.S.). Children’s mental health

services are delivered through contracts with community providers, designed to enable children

to live with their families or in a least restrictive setting, and to function in school and in the

community at a level consistent with their abilities. Services are also coordinated for children

facing criminal charges, but found incompetent to proceed due to mental illness or retardation.

Over his/her lifetime, one out of two Floridians will experience some form of mental illness. In

recent National Survey on Drug Use and Health (NSDUH) surveys more than 1.4 million Florida

children and adults indicated some level of psychological distress. Florida has statewide crisis

stabilization units available that provide short-term stabilization for children. For many children,

because of the stigma associated with mental illness, first-time services are often accessed

through the crisis system only after the emotional disturbance has escalated and caused major

family disruption. Overburdening of this system is costly and reflects a need to improve early

interventions. According to the latest edition of the Florida Mental Health Baker Act Report,

there were 19,125 children referred for involuntary examinations in 2010. Most (67%) were

admitted to publicly-funded crisis stabilization units. Florida recognizes that this model is not

the best for children, especially young children. One effort to address this need includes

expanded prevention and community based services such as mobile crisis teams. According to

the Centers for Disease Control, Florida’s suicide rate (13.5 in 100,000) is higher than the

national average of 11.8 in 100,000. Suicide is the third leading cause of death for persons ages

15-24. In 2010, more Floridians died of suicide than from homicides and HIV combined. When

implementing a comprehensive system of care, certain and special populations benefit from

additional focus. In Florida, we are placing a high priority on the following areas of need:

Child Welfare: Children in out-of-home care are among the highest users of behavioral health

services. Some studies suggest that as many as 80% of youths involved with child welfare

agencies have emotional or behavioral disorders, developmental delays, or other indications of

need for behavioral health services. In Florida, the four most prevalent disorders among children

who entered out-of-home care were (in rank order) attention deficit disorder, conduct disorder,

post-traumatic stress disorder, and anxiety disorder. Florida follows national patterns of young

children experiencing high levels of child abuse or neglect, and African-American babies have

the highest rate of entry into care. While Florida has shown progress in keeping families

together, infants and toddlers continue to represent the largest group in out-of-home placement.

In 2010 alone, 43% of children entering care in Florida were three years old or younger

(DiLorenzo and Staub, 2011). Research indicates that adverse childhood experiences impact

physical health and is related to the development of mental and substance use disorders. In fiscal

year 2010/11, Florida served 19,538 children in out- of- home care for abuse and neglect.

Transition of Youth with Serious Emotional Disturbance: In fiscal year 2009-2010, the state

Substance Abuse and Mental Health Information System (SAMHIS) identified 5,354 youth aged

17 who were diagnosed with serious emotional disturbances or who were receiving mental health

treatment. Of those identified, only 982 (18%) transitioned into the adult mental health system.

Serious mental health diagnosis’ compounds this already difficult transition for young adults.

They face great difficulties finding services tailored to their needs, meeting criteria for adult

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programs and navigating service delivery systems. DCF recognizes that a significant number of

young adults drop out of care during transition and is committed to supporting efforts that

encourage youth needing care to remain engaged in treatment. Failure can result in economic

hardships, social isolation and in extreme cases, suicide.

Youth in Residential Treatment: For children who are served in a residential treatment setting,

DCF envisions a continued emphasis on active treatment resulting in shorter lengths of stay,

strong coordination, and comprehensive community services that reduce the need for more

restrictive residential treatment. Florida has embraced the Building Bridges Initiative as have

many of its residential providers in an effort to encourage strong partnerships between families,

residential and community providers. The elimination of the use of seclusion and restraint and

the full incorporation of trauma-informed care is a continuing goal.

Juvenile Justice: According to the Department of Juvenile Justice (DJJ), Florida receives over

109,000 delinquency referrals annually. Over 65% of the youth in DJJ’s care have a mental

illness or substance abuse issue. In 2005 DJJ established the Office of Health Services dedicated

to the health, mental health, substance abuse, and developmental disability needs of delinquent

youth. When DCF initiated the statewide Trauma Informed Care (TIC) Workgroup in 2009, DJJ

was an instrumental partner in developing strategies to ensure all children’s service providers

across the state received TIC training. DJJ is also a system partner on our current Statewide

Stakeholder Planning Team and is actively involved in strategic planning for SOC expansion.

Young Children At-Risk of Developing Emotional Disturbances: According to Florida State

University Center for Prevention & Early Intervention Policy (2010), expulsion rates for children

and staff turn-over rates are reduced when ECMHC services are made available in child care

settings. Yet, pre-kindergarten children are expelled at a rate more than three times that of their

older peers in grades K to 12. Recognizing the need for early intervention to prevent or reduce

the development of serious emotional disturbances in infants and young children, SAMH

emphasizes services to young children and families involved in the child welfare system. The

SAMH program is committed to providing intervention in natural environments and low-stigma

settings, such as early childhood educational settings.

School Expulsion and Drop-out: While school suspension, expulsion and drop-out are usually

handled in the school district, the Department of Education (DOE) has also acknowledged this as

an area of concern. Florida rates are 4 to 7 expulsions per 1,000 pre-kindergarten students. Most

of these young children have continual learning and behavior problems throughout their school

years. Many will not graduate high school. In 2008-09, just 43.7% of Florida children

diagnosed with emotional behavioral disturbances (EBD) eligible for graduation actually did. In

the same year, the EBD dropout rate (children in grades 9-12) was 6.8 %. To improve student

outcomes, the DOE is collaborating with the University of South Florida to implement Problem

Solving/Response to Intervention statewide. However, the continual poor rates of graduation

and drop outs for the EBD population indicate a need to increase the capacity of local schools

and communities to meet the needs of these children. Improving conditions to promote social

inclusion and develop school attachment will be part of the state’s SOC social marketing plan.

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The National Institute for Mental Health estimates that in 2011, Florida met the needs of just

53.9 % of children with SED at or below 200 % of poverty. The following table illustrates the

need for mental health services for Florida children:

Pla

ce

Tota

l Pop

ula

tion

Household

Population

With Mental

Health Needs

Household Population with

Mental Health Needs

<200% poverty

Household

Population with

Mental Health

Needs

<200% Poverty

Served

Perc

ent

Cases

Pop

.

Perc

ent

Cases

Serv

ed*

% N

eed

Met

Florida 4,123,724 7.5% 307,217 1,929,011 8.9% 171,103 92,262 53.9%

Central 562,263 7.32 39,207 230,444 8.8% 18,104 10,579 59.7%

Northeast 752,868 7.7% 55,479 268,232 8.8% 27,045 18,127 71.9%

Northwest 312,331 7.7% 23,398 414,323 8.9% 11,838 9,053 59.3%

Southeast 800,587 7.5% 58,121 330,435 8.8% 27,025 15,894 41.3%

Southern 605,658 7.5% 42,572 17,529 8.8% 23,805 16,598 105.6%

Suncoast 1,090,017 7.7% 79,925 668,048 8.9% 38,926 24,173 59.9%

Document the need for increased infrastructure: Florida’s CMHSOC Stakeholder Planning

Team has been actively engaged in identifying the needs for increased infrastructure to enhance

the capacity to implement, sustain, and improve effective mental health services. These include:

Infrastructure Needs

Finance

Mechanisms

Flexible funding, linkages with managed care companies, redirection of

funds to community-based care, funding for non-traditional supports

Services and

Supports

Increase of evidence based practices (Wraparound), respite care, mobile

crisis units, equal access, peer support, expansion of family organizations

Policy/Regulatory

Changes

Accountability standards for providers, common outcomes and language

across systems, Cultural and Linguistic Competence (CLC) Training,

Medicaid handbook revision

Training and

Technical

Assistance (TA)

Advocacy and leadership training for youth/ families, SOC implementation

toolkits, trauma informed care, workforce development, EBP’s

Generating

Support

Social marketing campaign, local boards/governance structures, linkage

with primary care, engagement with higher education

The planning groups will focus on development of defined action steps to address these needs in

future planning meetings. In concert to identifying these needs, Florida’s SAMH public system is

undergoing a number of significant changes. In May 2011 Florida cut $3.8 billion from the state

budget, prompting a 45 percent reduction in the state’s mental health system workforce. These

cuts challenge the state’s ability to meet the needs of children and youth with serious mental

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health conditions and those at risk of developing them. The State Mental Health Authority,

housed in the SAMH Program Office of DCF, serves less than 100,000 children each year. Using

population data from the Office of Economic and Demographic Research to determine

prevalence ratios for children diagnosed with SED, the state system identifies 300,000 children

who meet the criteria for SED. The SED ratio for children 17 and younger is 7.9 percent. When

compared to the number of children served in Florida, this demonstrates nearly 200,000 children

who are in need, but not served. In addition, 1.3 million youth did not receive needed substance

abuse services. Florida has identified an unmet need for substance abuse treatment of 85 percent

for children. It is impossible to expand services to these groups within the current economic

conditions without serious realignment of resources, increased community ownership of the

benefits of care and a strong commitment to use of evidence-based practices (EBP).

The economic stress on children and families, fueled by a statewide unemployment rate of 9.0

percent in March 2012, is evident in increased service utilization. In the last year, SAMH served

2107 more children and adolescents than in the previous year. In 2002-2003, state general

revenue for children’s mental health was $96,152,947 and served 77,807 children with serious

mental health conditions. In 2010-2011, the state’s children mental health budget was

$92,696,734 and served 94,369 children.

The state anticipates this pattern of serving more with less to continue. In 2011, the Florida

legislature passed a Medicaid reform bill that will enroll nearly 3 million beneficiaries into

managed care plans (Bradford, 2011). It is essential for the health of our children that we make

rapid improvements to community service delivery so that more children are able to function in

their school, home and community. That is why it is imperative to bring SOC to scale at the

state level. The pending capitation of mental health services in the State’s Medicaid plan, a

complex array of Medicaid health plan choices and increasing numbers of children in families

that are uninsured or underinsured increases pressure on the system to realign its focus to include

a stronger emphasis on leveraging funding sources to produce positive outcomes.

DCF has responded by creating RSOC and their respective managing entities, reducing

administrative workload while ensuring that services remain data driven, community focused and

evidence-based. These changes are occurring as service demand grows; national healthcare

standards are changing and economic conditions continue to erode the state’s budget. While this

decentralized system is rewarding in that it helps to engage local stakeholders, it also provides

challenges. There are multiple funders in each community, each with their own methods of

administering services, managing funding and performance expectations. Moving science to

practice, implementing rapid change models and creating positive norms supportive of improved

child well being is a challenging process when the goal is statewide change. The opportunity to

implement a SOC expansion process that includes specific goals and objectives, agreed upon by

all stakeholders, to create positive normative behaviors related to social inclusion and

participation in data driven decision making will provide tools to meet these challenges.

In its role as the State Mental Health Authority, DCF continues to work toward transforming the

system of care for children by promoting recovery and resiliency and supporting the use of

evidence-based practices using its existing resources. The Department has undertaken a number

of initiatives in recent years to improve service quality and develop measures to help improve

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performance. This opportunity will push SOC principles and practices to scale, bringing critical

and diverse stakeholders to the table to implement a data driven, culturally relevant, community

focused, family driven, and youth guided strategic plan that supports positive outcomes for

children, youth and families and the communities in which they reside.

Provide information on how the data was collected: Data gathered for the need description

came from various sources including: Florida’s DJJ Comprehensive Accountability Report;

Florida Youth Substance Abuse Survey; the National Survey on Drug Use and Health; Florida

Vital Statistics; the Youth Risk Behavior Surveillance Survey; U.S. Department of Labor and

Statistics, U.S. Census Bureau; Florida Medical Examiners Annual Report; and incident and

utilization data from the SAMH Program and AHCA. In addition to service utilization,

performance and quality data, Florida regularly produces its own studies of local conditions.

Document clear evidence of a strategic planning process designed to expand and sustain

systems of care including progress to date: In October 2011 the Department was awarded the

Planning Grant for Expansion of the Comprehensive Community Mental Health Services for

Children with SED through SAMHSA. As a result of this grant, a diverse group of statewide

stakeholders is currently in the process of developing a comprehensive strategic plan to expand

SOC principles and practices statewide. A social marketing / communications plan to reduce

stigma associated with mental health issues and increase social inclusion of youth with

behavioral health challenges is also in progress. The planning process is data-driven with focus

on building on existing strengths and current statewide initiatives such as Trauma Informed Care,

Medicaid reform, the expansion of managing entities, and integration with primary care. The

initial months of the grant cycle were utilized to engage stakeholders, develop a progressive

strategic planning process, define team member roles, and formalize an organizational structure.

The organizational structure is comprised of a: Statewide Core Planning Team responsible for

the oversight and delivery of all planning activities and outcomes; Statewide Stakeholder

Planning Team responsible for plan developments; and a Regional Strategic Plan Participant

Group to provide local insights to plan development. The teams are made up of family

members, youth, grant staff, representatives from the National Alliance of the Mentally Ill,

Federation of Families of Florida, Departments of Children and Families (SAMH and Child

Welfare), Juvenile Justice, Health, Education, Agency for Health Care Administration

(Medicaid), Agency for Persons with Disabilities, SED Network, and the eight past and current

Florida local SOC Sites (Hillsborough County, Palm Beach County, Broward County, Sarasota

County, Seminole County, Orange County, Dade County, and Jacksonville). Core and

stakeholder team members were engaged based on their expertise in the areas they represent and

their commitment to be champions and change agents for SOC in their agencies and regions.

The initial stakeholder meeting in March 2012 in Tallahassee was attended by thirty-six

stakeholders. Trainings were provided on SOC values and principles, current state initiatives,

and the expansion planning grant expectations to inform key stakeholders on SOC system

transformation. The three graduated Florida SOC sites presented their lessons learned specific to

SOC implementation successes, challenges and sustainability. Large group activities and World

Café small group discussions were utilized to facilitate creation of the projects’ vision, mission,

asset map, goals and strategies. Jacksonville hosted the second stakeholder meeting held in May

2012 which was attended by thirty-eight system partners, including fifteen youth and family

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members. The focus of this meeting was to introduce the Wraparound approach, identify social

marketing strategies and to begin developing a toolkit for local SOC implementation. The youth

representatives demonstrated great enthusiasm for the social marketing initiative and their

message was clear –“we just want to be treated the same.” Meeting formats included multimodal,

engagement for innovative discussion and creative brainstorming. Two more meetings are

scheduled in Orlando and Tampa to finalize the expansion and social marketing plans.

In order to maximize the youth and family voice, six focus groups and one key informant

interview session with parent, youth and consumer groups were facilitated in various areas of the

state (Tallahassee, Tampa, Palm Harbor, Leesburg, and West Palm Beach). As a result of these

planning activities and the collaboration of diverse stakeholders representative of the various

cultures and geographies of the state, Florida is well on its way to creating a truly family driven

and youth guided, culturally relevant strategic plan for statewide SOC implementation.

In addition to the statewide planning initiative, the expansion grant allocated funding for two

local communities to complete readiness assessments and develop strategic plans for SOC

implementation. Inclusion of Pasco and Pinellas Counties and Bay, Washington, Leon and

Gadsden Counties was based on several factors, one of which was lack of exposure to SOC

principles and practices. Secondly, both areas presented with unique needs in their communities.

Pasco and Pinellas Counties have a disproportionate number of youth in residential care as

compared to the remainder of the state as well as higher reported instances of substance abuse.

Bay, Washington, Leon and Gadsden Counties are predominantly rural and have demonstrated

challenges with access to needed services due to transportation issues and scarcity of available

services. Both localities are engaging youth and families, providers, child serving agencies, and

funders who represent the communities’ cultural and linguistic make-up in the planning process.

Section B: Proposed Approach

Describe the purpose of the proposed project, including its goals and objectives and how they

relate to the performance measures: To overcome the challenges of a growing population with

dwindling resources, Florida is actively developing strategies to implement evidence-based

practices designed to improve outcomes for our children and adolescents diagnosed with SED,

ED, or at risk of becoming emotionally disturbed. Initiatives focus on improved care, resource

integration, resource utilization, and monitoring performance standards and measures. The

SAMH Program leads statewide initiatives in trauma-informed care, co-occurring treatment,

evidence based practices, and practice improvement.

These strategies align with the goals of this project. The principles and practices associated with

the Substance Abuse Mental Health Services Administration (SAMHSA) SOC framework will

become the backbone of this expanding infrastructure, helping to guide state efforts to benefit

children and youth with serious mental health needs and conditions (Pires, 2002;Stroul

&Friedman, 1986; Stroul, Blau, & Friedman (2010) . Research has demonstrated that successful

implementation of SOC improves quality of life for children and their families. It expands

evidence based services, engages youth and their families in their own health decisions, and

provides for better cost management of vital and limited resources. It also facilitates

collaboration among child serving agencies and providers and links with early childhood systems

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to promote screening, prevention and early intervention. Finally, a SOC promotes recognition of

substance abuse and mental health challenges as physical health issues and increases social

inclusion. These outcomes are Florida’s goals in expanding our system of care.

Goals Objectives Related Outcome Measures

Goal1:

Consistent

family and

youth (F&Y)

voice at all

levels.

1) Family organization will hire youth

coordinators and family coordinators.

2) Community youth and family

members will be full members of

governance structures.

3) Youth and family will be active on

the State Core Advisory Team.

4) Family run organizations and

supports will be expanded.

5) Youth and family members will be

part of the evaluation process.

# and % of work group advisory

group council members who are F&Y

members; # of F&Y members

involved in mental health-related

evaluation oversight, data collections,

and/or analysis activities; # of F&Y

members who are involved in

ongoing mental health-related

planning and advocacy activities;

increased social connectedness;

improved client perception of care

Goal 2:

Increased

collaboration

/integration

among

community

partners.

1) Child serving agencies/providers

will be engaged to be full members of

governance structures.

2) MOU’s and/or interagency

agreements will be completed to

support SOC practices between child

serving entities.

3) Financing plan will be completed in

collaboration with system partners.

# of organizations collaborating,

coordinating, or sharing resources;

Amount of additional funding

obtained for specific mental health-

related practices/activities; # of

financing policy changes completes;

Amount of pooled/blended or braided

funding with other organizations used

for mental health-related activities

Goal 3:

Linkages

with early

childhood to

promote

screening,

prevention

and early

intervention.

1) SOC will engage with local primary

care practice to incorporate screening,

risk assessment, and developmental

milestones as part of well visit for

children.

2) State core team creates linkage with

early child-care licensing for advising

on rules, policy and practice.

3) SOC link with Healthy Start to

promote ECMHC.

# of organizations collaborating,

coordinating, or sharing resources

with other organizations; A change

made to a credentialing and licensing

policy in order to incorporate

expertise needed to improve mental

health-related practices/activities; #

of individual exposed to mental

health awareness messages

Goal 4: Local

adoption of

SOC values

and

principles.

1) Local readiness and needs

assessments will be completed.

2) Communities will have access to

web based training on SOC values,

principles, and outcomes; Wraparound;

trauma informed care; and advocacy.

3) Web-based toolkits for local

expansion of SOC will be developed.

4) Culturally diverse local governance

structures will be implemented.

inclusive of youth and family members.

# of organizations or communities

that demonstrate improved readiness

to change their systems; # of

organizations collaborating,

coordinating, or sharing resources;

Amount of pooled or braided funding

used for mental health-related

practices/activities; # of F&Y

members involved in mental health-

related evaluation oversight, data

collections, and/or analysis activities;

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5) Evaluation process will be

completed to measure implementation

process and program effectiveness.

6) SAMH Program office will be

provide TA and monitoring.

# of F&Y members who are involved

in ongoing mental health-related

planning and advocacy activities;

improved mental health functioning;

improved work/school functioning;

decrease in criminal activity;

increased stability in placements; # of

persons served; decreases rate of re-

admission to psychiatric hospitals;

increased social connectedness;

improved client perception of care

Goal 5:

Recognition

of SAMH

challenges as

chronic

illnesses to

increase

social

inclusion.

1) Implement social marketing plan

that was developed during CMHSOC

planning grant to deliver de-

stigmatization campaign.

2) CMHSOC will link with primary

care.

3) CMHSOC will link with recreational

services and faith-based organizations.

# of organizations that entered into

formal written inter/intra-

organizations agreements; # of

individual exposed to mental health

awareness messages; increased social

connectedness; improved

work/school functioning

Goal 6:

Expansion of

culturally and

linguistically

relevant

evidence

based

practices

(EBP).

1) Wraparound “Train the Trainer”

network will be established.

2) Family, youth, and providers will

participate in local rapid change models

related to current EBP’s used.

3) CLC training will be provided.

4) CLC TA will be provided.

5) Trauma Informed Care training will

be provided.

6) CLC Coordinator for the state will

be hired for consultation.

7) Wraparound approach will be

incorporated in the children’s case

management certification process.

# of policy changes completed as a

result of the grant; # of organizations

or communities that demonstrate

improved readiness to change their

systems; A change made to a

credentialing and licensing policy; #

of organizations that entered into

formal written inter/intra-

organizations agreements; # of F&Y

members who are involved in

ongoing mental health-related

planning and advocacy activities;

improved mental health functioning;

improved work/school functioning;

decrease in criminal activity;

increased stability in placements; # of

persons served; decreases rate of re-

admission to psychiatric hospitals;

increased social connectedness;

improved client perception of care

The draft vision of the CMHSOC created by the Statewide Stakeholder Planning Group is that

Florida's children with behavioral health challenges and their families are engaged as primary

decision makers in a culturally relevant, coordinated healthcare setting that provides the highest

quality services and supports and promotes their individual growth to reach their maximum

potential. To achieve this, Florida is committed to expanding SOCs statewide so children in

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need of mental health services and supports may remain in the community. Services and

supports will be family and youth guided and delivered in a manner that promotes the natural

resilience of children and recognizes each child’s needs, based on his or her culture and

background. This CMHSOC expansion will be accomplished through a multi-tiered approach

with required activities and responsibilities divided as follows:

DCF SAMH Program Office:

The SAMH Program Office has oversight of all grant activities and serves as the locus of

authority and responsibility for SOC expansion. It will roll out local SOC implementation,

starting with two regions in year one and the remaining regions in year two. It will work in

collaboration with regional SAMH offices in directing and providing TA to the local CMHSOC

Coordinators. It will develop agendas for the Statewide Core Advisory Team meetings and

collects and reports data. A Cultural and Linguistic Competence (CLC) Coordinator will provide

consultation to all tiers of the CMHSOC to ensure relevance and representation from a multi-

cultural perspective. The SAMH Program Office is also responsible for initiating the rapid

change model for EBP expansion and the social marketing campaign.

DCF Regional SAMH Offices:

The regional SAMH offices assist with completion of local needs/readiness assessments to

identify areas with the highest need and readiness for SOC implementation, including

determination of the population of focus. They hire and provide office space and supplies for

local CMHSOC Coordinators who are responsible for engaging key stakeholders, building

governance structures and implementing the SOC. They work with the evaluation team to

collect data for outcome measurement reporting. The goal is to hire diverse, multi-lingual staff

representative of the region they will be working in.

Managing Entities:

Managing entities will provide representation at the local implementation teams and governance

structures. They will assist with completion of local needs/readiness assessments and work with

providers to identify a “Lead Agency” that serves the established population of focus. This

includes developing agreements with “Lead Agencies” to commit to training staff in

Wraparound, enrolling children and families in the evaluation process, and providing ongoing

data to the evaluation team. To support sustainability, they will include SOC values, principles

and practices in provider contracts including provision of EBP’s and accountability mechanisms.

Family Organization:

A contracted family-run organization hires and manages Lead Family Coordinators and Lead

Youth Coordinators for expansion sites based on local need. They serve on the statewide Core

Advisory Team to represent the family voice and inform the team of local progress, opportunities

and challenges. They are responsible for expanding family support mechanisms as outlined by

that community (i.e. establish new family and youth run organizations, work with providers to

hire family support partners, expand and support existing family and youth run organizations).

Consultants:

A Certified Wraparound Trainer provides face-to-face training, telephone coaching, and

telephone TA to providers in the Wraparound approach. They certify front line staff as

Wraparound facilitators and supervisors as Wraparound trainers to ensure fidelity and

sustainability. They work collaboratively with the Evaluation Team to measure fidelity to the

Wraparound approach. Webinar Specialists develop and provide one webinar on advocacy skills

and one on EBP’s. Both are specific to youth and family members served in the mental health

system.

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Evaluation Team:

An evaluation team develops culturally and linguistically competent data collection methods that

include youth and family members. They coordinate with grant staff and youth and family

organizations to implement evaluation processes. They work with service providers to develop

data collection methods that meet the needs of a thorough evaluation.

Specific performance indicators will guide us along the way to measure the effectiveness of our

SOC implementation efforts and fidelity to the SOC values and principles. Indicators will

address the process of infrastructure developments and functional outcomes for the children and

youth served. Measurable objectives will be established in the areas of: policy, licensing and

funding changes accomplished; number of organizations increasing readiness for system change,

collaborating, and entering into formal agreement; youth and family involvement in project work

groups, evaluation processes, and advocacy; and number of individuals exposed to mental health

related social marketing messages. Improvements in functional outcomes for children and youth

served will be measured through severity of mental health symptoms, employment and

educational status, juvenile justice involvement, stability in placements, readmissions to crisis

stabilization units, social connectedness and family and youth perception of care.

While the principles of SOC are evident in parts of Florida (primarily in metropolitan areas),

they are not yet fully developed statewide. This cooperative agreement will help the state

implement the comprehensive and action oriented plan developed by key partners, including

youth and their families, to expand SOC principles and practices to all regions of the state. The

Florida SOC expansion plan pulls existing initiatives together with the principles of a values

oriented system. The plan includes objectives to foster leveraging of financial resources to

provide supports and services that align with the SOC approach. It addresses necessary policy

and regulatory changes integral in SOC success. Agreed upon measures designed to improve

meaningful outcomes, improve performance, and assure quality services and supports are an

important focus. Each level of the plan reflects the state’s commitment to services and supports

that are trauma-informed, evidence based, and culturally and linguistically competent.

Describe how achievement of goals will increase system capacity to support effective systems

of care development for children, youth, and families: Florida’s SOC expansion goals and

objectives are designed to increase capacity in multiple ways. The overarching state plan will

allow us to engage multiple stakeholders on the state and local levels, increase their SOC

knowledge and skills and support their ownership in a SOC that provides positive outcomes.

This community based, data driven and evidence-based practices approach leads to positive

health outcomes for the children, families and communities served by the CMHSOC. It supports

braided funding and integration of numerous funding models, including Medicaid. It positions

communities for the Mental Health Parity and Addictions Equity Act (MHPAEA) and other

future health care reforms. It will identify ways to provide effective, evidence supported services

to children and families in the community and reduce the need for residential care. The

redistribution of high cost residential funding will enable Florida to provide community based

prevention and treatment services to those identified with unmet needs. The social marketing

and communications goal and objectives will foster mental health awareness of the general

public, improve social inclusion and engage a wider array of stakeholders in sustaining SOC.

The CMHSOC will foster sustainable collaboration among child serving entities to improve

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communication, establish standards, and share resources leading to more effective care across

systems and decrease in duplication of efforts.

Describe how the project activities meet your infrastructure expansion and sustainability

needs and how they relate to required services, goals and objectives: Major initiatives such as

Medicaid managed care reform and capitation, the expansion of DCF’s substance abuse and

mental health regional systems of care, creation of Electronic Health Records for those receiving

behavioral health services, and the integration of evidence based practices in mental health and

substance abuse into primary care and child welfare puts Florida in the perfect position to align

efforts and maximize limited resources as a result of this cooperative agreement.

This cooperative agreement will enable us to complete regional readiness and needs assessments

to guide the progressive SOC implementation process to strategically build infrastructure and

expand service array throughout the state. Priority will be given to the two regions that have

completed readiness assessments, engaged the community and utilized a diverse team of

stakeholders, including youth and families, to develop an expansion plan for SOC

implementation. To support sustainability, the project will embed the SOC values and

principles, requirements for evidence supported practices, and evaluation and continual quality

improvement efforts in contracts with the managing entities responsible for publicly funded

behavioral healthcare delivery in the six Florida regions. For example, contracts currently in

development will require that 95% of consumers surveyed will report satisfaction and a

minimum of 80% of all contract funding, excluding System of Care Administrative Cost, will be

redirected to support evidence-based practices by subcontracted providers. The strategic plan for

combined SAMHSA Block Grant has already integrated the SOC values and principles. It’s first

three priorities are Florida’s SAMH “Good and Modern” System of Care, Evidence Based

Practices (EBP) Initiative, and Prevention and Recovery.

To effectively fund the services and infrastructure necessary to support and sustain a successful

SOC, the Core Advisory Team will develop a distinct financing plan in the first year of the

project. This will be completed in partnership with Medicaid. The current expansion planning

teams have identified several action steps to finance an effective SOC beyond grant funding.

These include service codes that need to be incorporated in the Medicaid list of required services

including team-planning services, family peer support services and respite. These service codes

will allow for implementation of evidence supported case management approaches, such as

Wraparound. Funding redistribution from high cost, deep end residential and inpatient services

to more effective and efficient community based services as well as braided funding

opportunities will be explored.

Staff development activities and community education in SOC values and principles,

wraparound, cultural and linguistic competence, trauma informed care and youth and family

advocacy skills that can be accessed without cost over time through webinars and train the

trainer processes will result in a well informed, engaged and consistent service delivery system.

Family and youth organization development will formally institute the youth and family voice all

the way from the service to the legislative level. Cross system collaboration that will be

established through governance structures, inter/intra agency agreements and MOU’s will lead to

services that are coordinated and effective.

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Project Timeline

Milestones Key Activities Staff Responsible Y1 Y2 Y3 Y4

Roll out System

of Care

Expansion state

wide

Finalize SAMHSA Cooperative Agreement PI,PD

Conduct award debriefings with Regional SAMH Offices PI, PD

Finalize project plans and timelines PD and Core Advisory Team

Develop web-based SOC Implementation Toolkit PD and Core Advisory Team

Participate in SAMHSA national award meeting PI, PD, Key Team Members

Implement contracts for family organization, trainers,

and evaluators PD, SAMH Contract Unit

Initiate enrollment process of children and youth served CC, Lead Provider

Conduct readiness/needs assessment for 4 regions to

implement SOC principles and practices in year 2 PI, PD, Core Advisory Team

Fund local SOC in all 6 regions of Florida. PI, PD, Core Advisory Team

Comprehensive

Workforce

Development

Activities

Hire local project managers SAMH Regional Offices

Engaging stakeholders, changing culture and building

skill (SOC presentations, cultural and linguistic

competence training)

PD, Key Team Members,

Managing Entities, CLC

Coordinator

Trauma Informed Care trainings Consultant

Mandate use of Evidence Based Practices DCF (SAMH)

Provide Wraparound “Train the Trainer” Training Consultant

Continual

Quality

Improvement

Complete regional readiness self-assessments Consultant, CC

Develop qualitative survey for SOC implementation

process Consultant

Conduct project evaluation Consultant

Complete site visit with regional SAMH offices to

measure progress and provide TA PD, CLC

Social

Marketing

Initiative

Continue feedback from social marketing plan and

reassess and reformat to meet needs of youth and

families biannually.

PD and Core Advisory Team

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Project Timeline

Milestones Key Activities Staff Responsible Y1 Y2 Y3 Y4

Create a

Learning

Collaborative

Statewide

Implement TA training workgroup for webinar series

Include cultural/linguistic representation, family/youth

voice, and EBP expertise in workgroup.

Consultant, CLC

Roll Out 2 TA webinar trainings statewide Consultant

Begin and continue to build List SERV for SOC

statewide Learning Collaborative PI, PD

Build Family

Driven and

Youth Guided

Leadership in

Local

Communities

Hire Youth Coordinator and Family Coordinator for each

region Family Organization

Develop and sustain additional youth and family

organizations around the state Family Organization

Conduct advocacy training for family members and

youth CLC Coordinator

Sustaining SOC

Statewide

Finalize the Financing Plan for SOC sustainability PI, PD, Core Advisory Team

Implement interagency core advisory team and continue

quarterly meetings for policy revision related to SOC

principles including credentialing board

PD, DCF(child welfare, SAMH,

child care licensing), DJJ, DOH,

family member’s, youth’s, and

Board of Regents

Incorporation of

CLC into

Services and

Systems

CLC input into all curriculum CLC Coordinator

Hire CLC Expert Coordinator at state headquarters PI, PD

Develop community peer mentoring for CLC CLC Coordinator

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Describe oversight/advisory board membership, roles, functions, and frequency of meetings:

The following individuals and organizations are currently participating as members of the

statewide stakeholder planning team and are integral members of the strategic planning process.

It is anticipated that they will continue to serve on the state level Core Advisory Team for the

CMHSOC expansion implementation project through quarterly meetings and ad hoc committees.

The role of the core advisory team will be to serve as a liaison between state level functions and

the regional communities, to align policies and regulations across systems with the SOC

philosophy, to develop a financing plan for SOC sustainability, and to continually generate

support for SOC expansion.

Core Advisory Team

Anticipated Members Role/Responsibility

National Alliance on Mental Illness

(NAMI)

Represent youth and families. Assist with obtaining

input from youth and families statewide.

Florida Peer Network Represent youth and families. Assist with obtaining

input from youth and families statewide.

Federation of Families of Florida

Represent youth and families. Assist with obtaining

input from youth and families statewide.

Made By Us. Inc. Provide youth input into the grant project.

Department of Health (DOH) Resource to integrate primary and behavioral health.

Assist with implementation of strategic plans.

Agency for Persons with Disabilities

(APD)

Resource to address the needs of children with co-

occurring mental health and developmental disorders.

Assist with implementation of strategic plans.

Agency for Health Care Administration

– Medicaid Authority

Resource to address Medicaid funded community

mental health services. Assist with implementation of

strategic plans.

Department of Education

(Exceptional Student Education, SED

Network, Vocational Rehabilitation)

Resource to address educational services for students

with emotional and behavioral disorders. Assist with

implementation of strategic plans.

Department of Juvenile Justice Resource to address children/youth served by juvenile

justice. Assist with implementation of strategic plans.

Department of Children and Families – SAMH Program Office

1. Project Director – Coordination of statewide grant project

2. Epidemiologist – Consultation on data and evaluation.

3. Senior Psychologist – Consultation on trauma informed care and EBPs

4. LMHC – Consultation on publically funded community mental health system for children

and adults, trauma informed care and compassion fatigue

5. Cultural and Linguistic Competence Coordinator – Consultation on CLC

Additional organizations and individuals pending engagement as members of the state planning

team include: Florida Partners in Crisis, substance abuse and mental health provider

representation, legislators and/or Governor’s staff. The regional expansion sites will build

governance structures of key stakeholders, inclusive of youth and family members, service

providers, faith-based organizations, recreational groups, funders, and child serving agencies in

their local system of care, representative of their unique cultures and linguistic diversity. It will

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be the responsibility of the managing entities, local CMHC Coordinators, Lead Youth

Coordinator and Lead Family Coordinator to identify and engage their community leaders that

will guide this effort of transformation and be champions for a coordinated, effective system of

care for their population of focus. This project will provide funds for honorariums paid to non-

staff family and youth members involved in certain governance activities through the contracted

family run organization. The counties involved in the expansion planning grant have already

established community teams and workgroups that serve as the basis for their local governance.

The proposed project activities will address the required activities of this RFA:

Service Delivery: An array of services is currently available in Florida to children diagnosed

with SED through multiple funding sources including Medicaid, DCF general revenue, block

grants, and local funding streams such as county governments and Children’s Services Councils.

They include: (1) diagnostic/evaluation services; (2) outpatient services, including individual,

group and family counseling, professional consultation, and review/management of medications;

(3) daily 24-hour emergency services; (4) intensive home-based services for children and their

families when the child is at imminent risk of out-of-home placement (5) intensive day treatment

services; (6) respite care; (7)therapeutic foster care, and services in therapeutic foster family

homes, individual therapeutic residential homes, and group homes; and (8) assisting the child in

making the transition from services received as a child to the services to be received as an adult.

The CMHSOC Project will not directly fund services. It will collaborate with the funding

streams in the expansion areas to improve and expand service delivery. The goal is to create a

children’s mental health cooperative that offers individualized, community-based, culturally and

linguistically competent, evidence-based, and trauma informed care that will allow children to

reach their maximum potential in their home and communities.

Although services are provided at varying levels, availability and access is not consistent across

the state. This cooperative agreement will afford the opportunity to identify local needs and

develop strategies to build capacity. The ME’s will work with providers in their region to be the

“lead agency” for SOC implementation. In order to fully incorporate the SOC values and

principles on the service level, the Wraparound approach will be introduced to case management

providers and incorporated into contracts through the managing entities. This aligns with the

eight previously funded Florida SOC sites who have all utilized the Wraparound approach in

their service delivery. Per the National Wraparound Initiative, wraparound has been most

commonly conceived of as an intensive, individualized care planning and management process.

The wraparound process aims to achieve positive outcomes by providing a structured, creative

and individualized team planning process that, compared to traditional treatment planning,

results in plans that are more effective and more relevant to the child and family. Plans are

individualized based on the families unique culture and include non-traditional interventions (i.e.

recreational activities, faith-based supports, peer support, etc.). Assessments focus on evaluating

the child and families strengths, needs, vision, and culture. The ten principles of Wraparound

parallel the values of SOC in that services must reflect: family voice and choice; natural

supports; team based planning; collaboration; community based care; cultural competence;

individualized care; strength based approaches; persistence; and outcome accountability.

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Workforce development, sustainable training and technical assistance strategies: A well trained

and diverse workforce is one of the key elements of a successful and effective SOC. Workforce

development activities provided through this cooperative agreement will include “train the

trainer” trainings, webinars, and hiring of key staff with lived experience in the mental health

setting. The SOC expansion regions will be staffed with a full-time family coordinator and part-

time youth coordinator. They will be managed and trained through a contracted family run

organization that will also be responsible for expansion of family run organizations statewide.

In keeping with DCF’s efforts to ensure that its employees and providers develop CLC, cultural

competence training will be provided to system of care staff within the project and those

affiliated with the project from partner agencies.

The strategic planning process to date has yielded several strategies to enhance workforce

development and incorporate youth, parents and caregivers in service provision, planning,

advocacy, and evaluation. One of the key action steps identified is the development of a web-

based implementation toolkit that provides sufficient structure and flexibility for SOC

implementation in any area of Florida. The SOC expansion planning grant has funded Florida

to create two webinars that will be available throughout the state by October 2012. The first

webinar will provide information about SOC values, principles, practices and outcomes, an

overview of the statewide SOC expansion, and SOC grant funded sites in Florida. The second

webinar will provide information about the wraparound process and how it is being used in

Florida and other states to improve outcomes for children and their families.

A Wraparound “train the trainer” program will be implemented through a contracted certified

Wraparound trainer. The managing entities will be responsible for ongoing training of their

contracted providers of their SOC and implementing fidelity measures in their performance

expectations. To further ensure sustainability of the Wraparound process as the preferred care

management approach, key members of this project will actively work with Medicaid to

incorporate Wraparound in the person-to-person training required statutorily for all children’s

targeted case managers. Additional trainings that will be made available to the state through

webinars and technical assistance will address CLC, advocacy, EBP’s and other areas identified

through culturally relevant needs assessments.

DCF’s SAMH Program Office recently used the NIATx model of process improvement to

develop a rapid change approach for increased utilization of EBP’s practiced at high fidelity.

This process will be incorporated into this CMHSOC project by engaging providers in

identifying currently used EBP’s. Providers who agree to this process will work with experts

and Certified Recovery Peer Specialists (CRPS) to complete a fidelity review. They will also

receive 3 levels of follow-up training: an introductory webinar about the EBP, expert person-to-

person training on implementation, and in-depth training of supervisors on how to coach staff

and ensure fidelity to the EBP.

Service delivery and governance is family driven and youth guided: Expanding utilization of the

Wraparound approach is one strategy to ensure services are delivered within a family driven,

youth guided framework. This strength based approach utilizes the Child and Family Team

Planning approach to ensure that youth and families are the driver of their treatment. Case

planning does not occur without the youth or family and includes natural supports. Another is to

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assure full youth and family participation in local governance structures as well as on the

statewide core advocacy team. Youth and family members will be engaged on several levels,

through their service providers, existing family support mechanisms and the contracted family

organization. Process measures will continually evaluate the level of their involvement.

Florida has a well defined peer specialist certification process. In order to expand the peer

support movement to include families, the Certified Recovery Peer Specialist - Family (CRPS-F)

program was initiated. This was a first time training for identified family members with SED

children still at home. Medicaid is promulgating new regulations that include CRPS as a

Medicaid compensable service, providing an avenue to expand access to this valuable resource

within our SOC. However, a stand-alone peer support service has not yet been established.

Statewide interagency coordination and collaboration mechanisms and locus of authority and

responsibility: Florida has a rich history of interagency coordination and collaboration. The

commitment to statewide SOC expansion across child serving agencies is evident by the

participation of child serving entities in the current strategic planning process for expansion.

The state has a well developed network of workgroups, committees and advisory groups (Florida

Learning System) that provides valuable insight, helping to assure cultural relevancy and

consumer perspectives to its data driven decision making. It uses an array of data sets, consumer

and provider evaluation, performance management tools and an incident reporting analysis

system to provide information for system capacity building. Formal agreements provide links

and intra agency guidance. An example is an interagency agreement signed in 2008 by the

Departments of Health, Juvenile Justice, Department of Children and Families (substance abuse,

mental health and child welfare), Agency for Persons with Disabilities, and the Agency for

Health Care Administration. It created a framework for addressing the needs of children served

by more than one agency. The agreement established a Rapid Response Team at the state level

and local review teams that resolve placement or service delivery concerns for children served by

more than one of these agencies. The state and local teams also review and amend practices and

policies that impede the ability to effectively serve children with complex needs. Collaboration

between the key agencies allows for interagency planning, the efficient use of resources across

agencies, and training across systems. Other inter/intra agency collaborative efforts include

workgroups on trauma informed care, early childhood mental health consultation, services for

juvenile’s incompetent to proceed, and state epidemiology and outcomes.

Locus of authority for the statewide expansion of SOC will be established within the SAMH

Program of DCF. As described earlier in this narrative, a statewide core advisory team will be

established inclusive of the state child serving agencies, youth and families. This core group will

be a continuation of the current statewide planning group and will provide oversight of SOC

implementation. Responsibilities will include review and proposed changes of administrative

and regulatory structures to support SOC, development of a sustainable financing plan, oversight

and approval of a statewide CLC plan, review and update of the social marketing plan, consistent

review and analysis of outcome measures and implementation processes, and development of ad

hoc committees as needed.

Establishment of policy, administrative and/or regulatory structures that support ongoing SOC

implementation efforts: The principles cited in F.S., Chapter 394, Part III, include requirements

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for a community-based system that is child-centered and family driven. This system provides for

screening and assessment to promote early identification and treatment; individualized, culturally

competent, integrated and coordinated care; and a smooth transition to the adult system for

continued age-appropriate services and supports. Every three years, pursuant to section 394.75,

F.S., the DCF, in consultation with the AHCA, is required to develop a master plan for the

delivery and financing of a system of publicly-funded, community-based substance abuse and

mental health services throughout Florida. In the intervening years, the Department is required

to submit a plan update that describes the Department’s progress toward accomplishing the goals

outlined in the triennial master plan. The Department builds its statewide goals and objectives

using a combination of the data and the mandated services required by statute and funding

sources such as the substance abuse and mental health block grants from SAMHSA. DCF has

utilized the SOC framework to outline its goals and principles for the state’s mental health

service delivery system in the state plan. As the statewide core advisory team is informed of

policy and regulation barriers to successful SOC implementation by the local/regional SOC sites,

it will solicit change.

Expansion of family and youth involvement: Efforts to empower and create opportunities for

families and youth to impact their care and the SOC that serves them has become a primary

focus of many child serving agencies. Representatives from family organizations, youth, and

family members serve as active partners in all aspects of the current strategic planning process

for SOC expansion. In addition to family and youth representation on all three levels of the

organizational planning structure, focus groups and key informant interviews have been and will

continue to be facilitated to reach more family and youth voice. Strong collaborative

relationships between the DCF and family organizations such as Federation of Families, NAMI,

and the Florida Peer Network provide the opportunity to partner on statewide initiatives and to

obtain input for youth and families from across the state.

This project proposes to fund a family run organization through a competitive procurement

process to lead family and youth involvement in all expansion activities. This includes the hiring

and supervision of youth and family coordinators, active participation on the core advisory team,

engagement and mobilization of local youth and family members in governance structures, and

encouraging development of additional family run organizations throughout the state.

Collaborations among critical providers and programs: Interagency collaboration will be

addressed at the state level through the Core Advisory Team which will continue to build bridges

as they have throughout this CMHSOC planning period. Review of levels of cooperation

between local community providers serving shared populations is one of the critical components

of the community readiness/needs assessments. Results of these assessments will drive local

strategic plans to build bridges among partners in the services delivery system to improve

communication and enhance team based care coordination. This will be a first step to maintain

children in least restrictive care and/or assist with more timely and efficient discharge planning

for children in residential care.

Collaborations between community adult and child serving agencies: Partnerships between child

and adult serving entities, including peer support groups, vocational services and case

management, will be critical for transitioning youth into adulthood. A major barrier to youth

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transitioning to the adult system is the shift to adult funding sources that use more limited criteria

for services. This creates challenges for care coordination/case management and usually means

that less intensive services are available for youth in this transition phase. Transitioning

successfully requires the collaboration of the various systems and agencies such as mental health

(children and adults), substance abuse, employment, housing and education. A joint interagency

agreement between DOE, DJJ, DOH, APD, and AHCA on Transition Services and Supports has

been in place since 2006 in Florida. This agreement serves to direct early transition planning for

all youth across all child-serving agencies. In addition, the 2008 Legislature created a transition

health care task force within DOH to address access to health care for youth with disabilities

transitioning to adulthood. DCF is represented on the Task Force who submitted a report to the

Legislature that included strengths and gaps in Florida’s transition process and made

recommendations to improve access to healthcare for transitioning youth. At the state level, the

children and adult mental health programs, in coordination with regional staff and youth, are

reviewing policies and practices associated with the transition of eligible youth to the adult

mental health system in an effort to ensure the process is efficient.

Integration between mental health and substance abuse services and systems: In July 2011 the

Substance Abuse and Mental Health program offices were reorganized, establishing a single

SAMH Program office. The CMHSOC recognizes the need for comprehensive, integrated

services for youth with co-occurring disorders. The historical split between the mental health

and substance abuse systems led to many children receiving duplicative services, while others

received inadequate services. The Mental Health and Substance Abuse systems are working

jointly on a number of initiatives to serve children with co-occurring disorders through the

development of system change strategies with technical assistance from Dr. Ken Minkoff and

Dr. Christie Cline of Zia Partners and the collaboration of DCF and providers statewide.

The state vision is for a system in which clinicians develop co-occurring disorder competency

and funding issues do not present a barrier to effective, holistic treatment. Continuing

collaboration and training is needed to continue moving the system in the right direction. This

projects’ rapid change model to expand high fidelity EBP use serves as an opportunity to fund

workforce development and increase co-occurring capabilities among providers.

Creation of outcome measurement strategies: The SAMH Performance/Quality Improvement

Section is involved in data collection and analysis at all levels. The key for continued success of

the SAMH Program is grounded in four areas: 1)establishing a well-articulated, strategic plan of

action through a statewide and regional planning process; 2) monitoring the resource

environment and proactively adjusting resources to met emerging needs; 3) collaborating with

other state agencies to eliminate redundancies and close gaps in services; and 4) establishing a

well-defined, empirically validated performance improvement system that allows the SAMH

Program to accurately gauge the impact of the service system and the effectiveness of service

delivery. The SAMH Program tracks quality indicators to address system needs. The SAMH is

actively engaged in ongoing efforts to accomplish these objectives including the integration of

the National Outcome Measures (NOMs) into the programs’ performance improvement system.

For children’s mental health clients, the Children Functional Assessment Rating Scales is the

Substance Abuse Mental Health Information System data module which obtains demographics

and measures clinical outcomes that are aligned with the SOC values and principles.

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The SAMH Program Office continues to embrace modern technology as a critical catalyst for

mental health care delivery coordination and systems integration. One strategy for making

mental health care more readily available to rural consumers and providers is through the use of

electronic health records (EHR) and telehealth technology. The SAMH Program Office

continues to work closely with AHCA, which is the lead agency authorized in Florida statute to

develop and implement a strategy for the development of a secure health information exchange

(HIE) system and for the adoption and use of EHR by health care facilities, providers, payers,

and consumers, especially those served in rural and remote areas of the state. AHCA tracks

several children’s behavioral health HEDIS performance measures for managed care plans,

including 7-day and 30-day follow up after hospitalization for a mental illness and follow-up

care for children prescribed ADHD medications.

Coordination of SOC strategies with Block grants and health care reform: Block Grants assist

Florida’s transformation of the state’s mental health service delivery system. The CMHSOC will

be an integral partner with DCF in assessing community needs and providing recommendations

for funding allocations accordingly. Block Grant funding is used in supporting statewide publicly

funded mental health services for adults and children in legislatively established priority

populations. The priority populations include children with serious emotional disturbance,

children with emotional disturbance, children at risk for mental health problems and children

diagnosed as having a co-occurring substance abuse and emotional disturbance. In Fiscal Year

2010/11 Florida received $8,179,100 in federal block grant funds to deliver an array of treatment

and support services designed to facilitate recovery and improve functioning for children with

emotional disturbances and their families. Service activities included outpatient care, (e.g.

counseling and psychotropic medications), case management, residential care, and emergency

services. The Block Grants also fund Family Intervention Specialist positions. These positions

work with Child Protective Investigators to advocate for families and provide a clearer voice for

families in the child welfare system. As part of their performance measures, the Managing

Entities will be required to use 80% of the Block Grant funds for EBP’s, such as Wraparound.

The CMHSOC will also coordinate with DCF in the process of re-allocating general

revenue/block grants funds to direct peer run networks for the purpose of peer support and

leadership. This competitive procurement process will afford consumers throughout the state the

opportunity to draw from their unique experiences to empower others during their recovery

process.

Medicaid representatives have been instrumental in the development of the expansion strategic

plan and will continue to work on the core advisory team to guide SOC implementation. The

2011 Florida Legislature directed AHCA to the Statewide Medicaid Managed Care program by

2013, requiring all beneficiaries to enroll in managed care plans. Medicaid reimbursable

substance abuse and mental health services are currently provided fee-for-service, preferred

provider organizations, and through multiple managed care plans. This project will continue to

work closely with AHCA’s Medicaid Services and Quality Assurance divisions to assure that the

public system for these services continues to provide quality care while supporting the state’s

and SOC goals. Medicaid transformation is a key element in the process of healthcare reform.

The recently enacted Medicaid legislation could have significant implications for how mental

24

health care services in general and substance abuse services in particular are delivered. Florida

Medicaid enrollment is projected to expand by as much as 70 percent by the year 2014.

Incorporation of trauma-related activities: Florida has been actively involved in efforts to reduce

the need for the use of seclusion and restraint in psychiatric residential treatment facilities for

children, youth, and adults since 2003. On February 3, 2009, faculty from NTAC provided a TIC

workshop for a number of child and adult serving state agencies, private providers, advocacy

groups, and legislative staff. The TIC Workgroup was formed as a result of this workshop and is

comprised of a number of agencies including, the AHCA, Departments of Health, Education,

Juvenile Justice, Corrections, and Mental Health, Substance Abuse, Child Welfare, and Refugee

Services staff from DCF. Other active members include the Executive Director of the Governor’s

Commission on Disabilities, staff from the Florida Mental Health Institute at the University of

South Florida, providers, members of family organizations, and advocates. DCF’s child welfare

staff and providers have embraced the trauma-informed model and are working with guidance

from experts from Chadwick and the National Child Traumatic Stress Network to ensure that

services and supports are trauma-informed through training and interagency collaboration with

DJJ and the judiciary. The Interagency TIC Workgroup continues to meet quarterly and works to

identify and implement policy and practice changes within and across agencies that reflect

trauma informed values. The Workgroup provides a valuable forum for collaboration and the

coordination of efforts across multiple agencies and key stakeholders moving toward the

common goal of introducing trauma informed and trauma specific processes, policies, and

procedures across the system of care, so that individuals served in multiple systems are treated

with respect, empowered to be actively involved, and have hope. The CMHSOC Project will

link with this workgroup to incorporate trauma-related activities into SOC expansion processes.

Development of social marketing and strategic communications activities: By the time this

cooperative agreement is awarded, Florida will have developed a culturally and linguistically

relevant Social Marketing Plan that gives Florida’s CMHSOC an identity. This plan will be the

guiding document to implement an anti-stigma campaign with assistance from DCF’s

Communication Office. The plan will utilize the principles of marketing to promote behavior

changes that lead to social inclusion and engage youth, families and the community in the

implementation of the SOC. Involvement of youth and families representative of those served

assures that cultural and linguistic competence remains an important area of focus.

The Florida CMHSOC planning initiative used social marketing strategies to celebrate Mental

Health Awareness Month in an effort to decrease stigma, increase awareness and provide

information related to treatment and support. Activities included blogging, press releases,

tweeting, and web based media. A biographical blog submitted by one of the Statewide Core

Planning Team youth members was the top post on the American Psychiatric Association's list of

mental health blogs for Mental Health Blog Day.

Identify any other organizations that will participate in the proposed project. Describe their

roles and responsibilities and demonstrate their commitment to the project: A number of

child-serving organizations will serve on the statewide Core Advisory Team as outlined on page

17 of this proposal. In addition, the Florida Peer Network is committed to expanding the number

of CRPS-F to provide much needed support services to families with children diagnosed with

25

SED. They will be an important partner in advocacy of Medicaid funding for CRPS-F,

specifically as an identified, stand-alone service. In preparation for health care reform, the

Principal Investigator of the expansion planning grant and key Medicaid staff have initiated

dialogues with managed care companies to engage them in the project and inform them of the

benefits of the SOC approach in terms of cost savings, improved functional outcomes for clients,

and increased system capacity through the provision of effective community based care and

decreases in high cost residential and inpatient services.

How the proposed project will address demographics, language and literacy, sexual identity,

disability: Cultural competence will be an integral and mandated part of on-going training as

well as service delivery under the CMHSOC and will be required for all participants. This

training will include the underlying philosophy that services must be delivered in a respectful,

non-confrontational and supportive manner, acknowledging the impact of cultural norms,

extended families, faith orientation, and communication styles. As Florida’s cultural makeup

varies by region, we will work to ensure that training is reflective of the regional populations and

TA will be provided as needed to improve levels of cultural competency across providers.

As an initial step to address the expectation that services and supports provided and the processes

for doing so are culturally competent, DCF has contracted for a three-part web-based training

course that is being developed through the Southern Coast Addiction Technology Transfer

Center (SCATTC). The three parts of training will be in the areas of general cultural

competency; organizational cultural competency; and multicultural counseling techniques. This

course was designed to be used by behavioral health professionals. Throughout all courses a

broad and inclusive definition of cultural and population diversity will be employed including

consideration of race, ethnicity, class, age, gender, sexual orientation, disability, language,

religion and other indices of difference. Participation in this training will be tracked. In addition

to training, in 2011 SAMH added contract language to its model contracts for providers that

require staff be culturally competent and reflect the demographics of the community it serves.

The CMHSOC is committed to improving the delivery of services to Floridians who are deaf or

hard of hearing. It is essential that we eliminate or reduce barriers these clients experience when

seeking services through our programs. To reach this goal, the Department of Health and

Human Services (HHS) and DCF have entered into an agreement to ensure that auxiliary aids

and services are provided for these clients or their companions. Contracted providers are

required to maintain comprehensive auxiliary aid plans for individuals with language difficulties

and disabilities presenting for services. These plans also address literacy issues and stipulate that

information relevant to treatment and service provision be given to a client in a manner that

he/she can understand. This includes the use of qualified interpreters for non-English speaking

clients which can improve communication between client and service provider, improves

capacity to gather accurate background information, allows for appropriate assessment,

diagnosis, testing and screening, can function as a cultural broker, results in better understanding

of the treatment plan and reduces unnecessary hospitalization.

The Florida GLBT Democratic Caucus estimates that 6.5 percent or 1,042,117 individuals

comprise the State’s LGBTQ population. Despite lack of LGBTQ service data, several

communities throughout Florida have used data from entities such as the GLBT Democratic

26

Caucus to develop training and service programs that promote emotional health and prevent

mental and substance use disorders by addressing specific risk and protective factors. Over the

next two state fiscal years, SAMH will be working with the Southern Coast Addiction

Technology Transfer Center (SCATTC) to offer regional trainings to mental health and

substance abuse professionals using the Provider’s Introduction to Substance Abuse Treatment

for LGBTQ Individuals curriculum. The training is intended to provide both practitioners and

administrators involved in mental health and substance abuse treatment with:

1. Increased familiarity with the issues and barriers faced by LGBTQ persons in need of

mental and substance use disorder-related services.

2. Knowledge about the interaction between LGBTQ issues and mental illness and

substance use and abuse.

3. Enhanced ability to offer sensitive, affirmative, culturally relevant, and effective

treatment to LGBTQ clients in mental and substance use disorders treatment.

Children dually-diagnosed with developmental disabilities and mental health conditions present

an opportunity for agencies to collaborate for improved continuity of care. The interagency

agreement signed by DJJ, DCF’s SAMH Program, APD and AHCA created a Rapid Response

Team at the state level and local review teams. These teams serve to resolve placement or

service delivery concerns for children served by the multiple agencies. These teams also review

and amend practices and policies that impede the ability to meet the individual needs of children.

Development of a financing plan guiding efforts to bring the SOC framework to scale,

generate sustainability: Throughout the first year of this project we will continue to build on the

financing portion of the strategic plan that is currently being established though the expansion

planning grant. To provide continuity, this will be accomplished by the core advisory team with

input from local expansion sites. This financial plan will explore braided funding opportunities

among funders. CMHSOC will assess and work directly with Block Grants, general revenue,

Medicaid and healthcare reform to support funding for team planning, strengths based

assessments, non-traditional supports and family support which will establish sustainability of

family driven, youth guided care.

Since the core advisory team is comprised of leadership from other child serving systems, this

provides for an optimum chance to explore linkages in funding including braiding, shared

resources, training opportunities, and learning collaborative. As described previously, the Rapid

Response Team has mitigated long waitlists by braiding funds and staff resources to provide

needed supports while waiting for APD waiver services, as one example. Local SOC’s such as

Hillsborough County, have also demonstrated success via braided funding efforts. Through

allocations from a number of funders, Hillsborough has been able to sustain the Administrative

Service Organization which provides funding for non-traditional, non-Medicaid reimbursable

activities to support Wraparound. Both the state and local oversight bodies will continually

identify further opportunities to maximize financial potential through shared resources.

Describe your plan to sustain the SOC approach after funding ends and how the project will

expand SOC throughout the jurisdiction: Identifying strategies to sustain the SOC approach

after federal funding ends is an ongoing process and needs to be addressed continually in state

and local planning efforts. SOC sustainability has been in the forefront of the SOC expansion

27

planning that has commenced in the past year. One of the strategies to support sustainability is

to incorporate the SOC values, principles and practices into contract language. Managing

entities administering substance abuse and mental health resources including block grants, other

federal grants and state general revenue funding in the six Florida regions, must produce

measurable outcomes aligned with SOC outcomes. As the state develops its systems of care, this

presents as an opportunity to integrate SOC values and principles into the Managing Entity

model implemented through local provider contracts. Embedding the SOC framework in

statutes, strategic plans, state mandated performance measures, and provider contracts ensures

program continuity during times of change in the operational environment.

Lessons learned from past and present Florida SOC sites include the challenges of sustaining the

Wraparound approach for case management services in the current Medicaid structure.

Specifically, the inability of providers to bill for multiple participants at Child and Family Team

Meetings, family support services and, assessments in the form of Strengths, Needs, Vision and

Culture Discoveries make it nearly impossible to implement high fidelity Wraparound. Lack of

access to consistent Wraparound training and inconsistencies in statewide standards for targeted

case management certification present additional barriers to Wraparound based planning. This

project intends to minimize these barriers by working in partnership with AHCA and managed

care companies to fund and develop required service codes that support the Wraparound

approach. The CMHSOC project will advocate to standardize the children’s targeted case

management certification process statewide using the SOC and Wraparound values, principles

and practices. Wraparound train the trainer programs will be implemented with managing

entities for continuous workforce development.

Florida will use Interagency Agreements as building blocks to implement SOC values and

principles and service delivery practices. A formal Interagency Agreement among all key child

serving agencies establishes a collaborative process for agencies to address the needs of children

and youth served by more than one agency. In addition, the agreement establishes local and state

level multiagency teams that identify and address gaps in the SOC. The Interagency agreement

can be updated to integrate SOC values and principles into practice at the state and local levels.

The state planning process will consider how the multiple funding streams and programs

currently serving children and youth with serious mental health conditions and needs and those at

risk of developing them may be better used to support services and supports that align with SOC

approaches. The resulting statewide plan will help to strengthen sustainability efforts of existing

SOC sites; support SOC in the graduated sites and inform development of the new sites.

Section C: Staff, Management, and Relevant Experience

Capability and experience of applicant organization and other participating organizations:

The SAMH Program Office at DCF serves as the mental health and substance abuse authority of

the State of Florida. In that role, this office administers and manages the state’s public substance

abuse and mental health systems, and is charged with providing services for children and adults

with serious mental illnesses and with substance abuse disorders. It collects, tracks and analyzes

data on National Outcome Measures to determine the effectiveness of programs and services to

continually assess for needed improvements in the service delivery system. The SAMH Program

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Office has been working closely with the eight past and current Florida sites which have received

Federal funding for SOC implementation. Their experience and unique insight has been crucial

to informing the strategic planning process for statewide SOC implementation. The idea that

youth and families are the key to system transformation is shared by child serving agencies and

key stakeholders. The Wraparound Child and Family Teams are an example of this. This

approach provides a building block for strengthening family driven youth guided care. Also,

strong relationships exist between DCF and family advocacy and support organizations such as

NAMI, the Family Café, Florida Peer Network and Federation of Families, which have

supported a movement of family and youth empowerment, inclusion, networking among family

organizations and self-advocacy. This collaboration along with joint efforts of the Florida

Certification Board, and the SAMH Program Office has built capacity for Adult and Family

CRPS to provide peer oriented support services.

List of staff positions, role, level of effort and qualifications:

Position Title

# of

Positions

Staff Name

Level of

Effort

Qualifications

Principal

Investigator

1

Jackie Beck

10%

Masters in Social Work. 28 years of

direct service and management

experience in the mental health field.

See CV.

State Project

Director

1

TBD

100%

Bachelor’s degree in Psychology. 17

years direct service & management

experience in the children’s mental

health field. Certified Wraparound

Coach. See CV.

Cultural and

Linguistic

Competence

Coordinator

1 TBD 100%

Bachelors degree in human services

field preferred with at least 3 years

experience with community based

behavioral health and CLC related tasks

such as diversity trainer

Local

CMHSOC

Coordinator

5

TBD

100%

Bachelor’s degree in Human Services

field and at least 5 years experience in

management. Masters degree

preferred.

Lead Parent

Coordinator 5 TBD 100%

High School or equivalent; some

college preferred, experience of a

parent/caregiver of a child with

complex needs.

Lead Youth

Coordinator 5 TBD 50%

High School diploma or equivalent

and at least 3 years experience with

community-based behavioral health,

public speaking experience preferred

Administrative

Assistant

1

TBD

50%

High school diploma required,

Associates preferred. At least 2 years

experience with administrative duties.

29

Principal Investigator (PI) - This position is responsible for overseeing the completion of all

grant deliverables. The Principal Investigator will oversee and direct project planning and

implementation as well as set priorities within the management plan. This position will represent

the State of Florida in national meetings and be the primary liaison with SAMHSA. The PI will

also coordinate and utilize the skills and resources of the SOC partners, staff and consultants to

successfully accomplish the objectives of the SOC Expansion Implementation Project.

State Project Director (PI) (Full-time) - The State Project Director will work under the

direction of the Principal Investigator to coordinate and oversee project activities statewide, such

as training and technical assistance, project planning and implementation, and data collection and

reporting. The State Project Director will also coordinate with the Core Advisory Team,

managing entities, local staff and consultants to successfully accomplish the objectives of the

Florida’s CMHSOC expansion implementation project. This position will be responsible for

overseeing the development, implementation, and sustaining the proposed system of care and

guiding the establishment of inter agency collaborations with other child serving agencies.

Cultural and Linguistic Competence (CLC) Coordinator (Full-time) – The CLC Coordinator

will work under the direction of the State Project Director. This position will be responsible for

CLC training, advocacy and leadership. The CLC Coordinator will provide TA to the local

communities in CLC strategic plan development and serve as a resource to the SOC on CLC,

organizational change and cross-cultural practice. The CLC Coordinator will promote language

access and identification of resources.

Local CMHSOC Coordinator (CC) (Full-time) - These positions will be hired through

managing entity contracts. The Local Project Coordinators are responsible for overseeing all

aspects of the local SOC project for Florida’s CMHSOC expansion implementation project. The

Local Project Coordinators will engage and facilitate collaboration of the local key partners,

including child welfare, education, juvenile justice, substance abuse, primary care and family

organizations that will be utilized throughout the project. Set, plan and coordinate Local System

of Care Implementation meetings.

Lead Parent Coordinator (Full-time) – These positions will be hired through managing entity

contracts. The Lead Parent Coordinators are responsible for providing peer support to parents

served by the project and assist them to successfully engage with the SOC and Wraparound

process. The Lead Parent Coordinators will serve as advocates for the parent perspective in

routine operations and development of the SOC. Use personal life experience to provide

consultation and training for staff and others to increase awareness and improve the effectiveness

of parent/professional partnerships.

Local Youth Coordinator (Half-time) – These positions will be hired through managing entity

contracts. The Lead Youth Coordinators are responsible for outreach efforts including training,

mentoring and engaging youth diagnosed with SED in SOC activities. Assist and lead youth in

the development of formalized youth-based advocacy groups.

Administrative Assistant (Half-time) - The Administrative Assistant will work under the

direction of the State Project Director. Responsibilities will be to provide administrative support

to the project such as travel plans, meeting coordination, and basic office duties.

Demonstrated experience and qualifications to serve the population(s) to receive services and

are familiar with their cultures and languages. Florida has a well trained and mature workforce

in substance abuse and mental health. Department staff and contracted service providers are

representative across the state with regard to staff diversity and our client populations are

30

representative of the diversity within their local communities. The current and graduated SOC

grant sites are actively addressing CLC and providing lessons learned as they develop tools and

revise services and the service provision to ensure cultural competence. In keeping with the

Department’s efforts to ensure that its employees develop CLC, cultural competence training

will be provided to all system of care staff within the project and those affiliated with the project

from partner agencies. Due to the linguistic diversity evident in Florida, providers in areas with

large Hispanic and Haitian populations make great efforts in hiring staff representative of the

community to ensure language barriers are mitigated. In the event that a diverse workforce is not

readily available, licensed translation services are available to assist with communication needs.

Describe how members of the population(s) to receive services were involved in the

preparation of the application and how they will be involved in the planning, implementation,

and performance assessment of the project. This application was prepared in collaboration with

and reviewed by the Federation of Families of Florida, the Florida Peer Network, and parents

and youth currently serving on the expansion planning workgroups. Based on the family and

youth input, the youth and family grant activities will be provided through a contracted family

run organization. This will include the hiring and managing of key SOC staff such as the Lead

Parent Coordinators and Lead Youth Coordinators. Youth and family participation will be

integral in continued state level planning, in local governance structures and in the ongoing

quality assurance and evaluation processes.

Describe the resources staff will have to implement the proposed project: State and local staff

will be housed in DCF offices with access to computers, telephones, video and telephone

conferencing, and other equipment necessary to complete grant deliverables. This project will

have access to several content experts in the SAMH Program Office including in the areas of

TIC, adult mental health, Wraparound, and co-occurring disorders. The SAMH Program Office

contains a section which monitors and analyzes performance and quality indicators, conducts

routine epidemiology surveillance, and reviews adverse incident reports for continuous quality

improvement. Another section develops and implements policies and promulgates rules to

positively impact the system of care and its effectiveness. The SAMH Program Office is

supported by a SAMH Performance and Support Office which conducts business operations

including contract management and budgeting. These resources will be available to SOC

implementation staff throughout the grant period.

Section D: Performance Assessment and Data

Ability to collect and report on the required performance measures: Florida uses SAMHIS to

collect, maintain and report client-level data on approximately 400,000 persons served in state-

contracted community substance abuse and mental health provider agencies and in state-funded

mental health treatment facilities. The SAMHIS database is the main source of the General

Appropriations Act performance measure data, which are posted monthly on the DCF dashboard

at the following website: http://dashboard.dcf.state.fl.us/index.cfm?page=menu_programs. This

database collects the following measures to track Florida’s success and reports required data to

SAMHSA: mental illness symptomatology, education; crime and criminal justice; stability in

housing; social support/social connectedness; and client perception of care.

31

In addition to the DCF specific performance indicators measured through SAMHIS, AHCA

contracts with the University of South Florida, Florida Mental Health Institute (FMHI) to

produce an annual evaluation of Medicaid-funded mental health services. These include

comprehensive reviews of children’s inpatient, behavioral health overlay services and behavioral

health services for children in foster care. These studies guide DCF’s and AHCA’s efforts to

improve outcomes.

Due to DCF’s recent reductions in staff, the evaluation portion of this project will be contracted

out through a competitive procurement process. The contracted evaluation provider will be

responsible for developing culturally and linguistically competent data collection methods that

include youth and family members on the evaluation team. They will coordinate with grant staff

and youth and family organizations to implement evaluation processes. The evaluation team

will work directly with the service providers to develop data collection methods that are easily

integrated into the day-to-day operations of the organizations and meet the needs of a thorough

evaluation. Data collection will be designed to efficiently take place within the context of

routine services, thus decreasing the burden and increasing the ability to track the activity.

Readiness/needs assessments as well as focus group and interview/survey procedures have

already been developed through the SOC expansion planning process that can be adapted as

needed to the expansion sites.

The following process measures will be collected by the contracted provider and grantee

coordinators in order to track Florida’s success and report required data to SAMHSA as detailed

in Section I-2.3 of the RFA.

Number of policy changes completed as a result of the grant;

Number of agencies/organizations or communities that demonstrate improved readiness

to change their systems in order to implement mental health related practices that are

consistent with the goals of the grant;

Number of organizations collaborating, coordinating, or sharing resources;

A change made to a credentialing and licensing policy in order to incorporate expertise

needed to improve mental health-related practices/activities;

Amount of additional funding obtained for specific mental health-related

practices/activities;

Number of financing policy changes completes;

Amount of pooled/blended or braided funding with other organizations used for mental

health-related practices/activities;

Number of agencies/organizations that entered into formal written inter/intra-

organizations agreements; number and percentage of work group/advisory group/ council

members who are youth and family members;

Number and percentage of work group advisory group council members who are youth

and family members;

Number of youth/family members involved in mental health-related evaluation oversight,

data collections, and/or analysis activities;

Number of youth/family members representing youth/family organizations who are

involved in ongoing mental health-related planning and advocacy activities; and

Number of individual exposed to mental health awareness messages

32

The following clinical measures will be collected by the lead provider agencies and CMHSOC

Coordinators in order to track Florida’s success and report required data to SAMHSA as detailed

in Section I-2.3 of the RFA.

Improvement in mental illness symptomatology;

Employment / education status;

Involvement in criminal justice;

Stability in housing / placements;

Number of persons served by age, gender, race and ethnicity;

Rate of re-admission to psychiatric hospitals;

Social support / social connectedness

Client perception of care

This information will be gathered using the CMHS Child Outcome Measures for Discretionary

Programs (Child or Adolescent Respondent Version and Caregiver Respondent Version). Data

will be collected at baseline, 6-month follow-up, and at discharge. Data will submitted to

SAHMSA as required in section I-2.3 within 7 days of collection and quarterly.

Describe how data will be used to manage the project and assure continuous quality

improvement (CQI) including how system will identify disparate outcomes: The statewide and

local implementation teams and project coordinators will elicit constant feedback and data on the

effectiveness of the implementation process, the value of technical assistance, satisfaction of

participating youth and families, and the progress toward the goal of full implementation of

SOC. This data will ensure that project partners work together to identify changes needed in the

strategic plan and barriers to effective implementation. Demographic data will be used as an

indicator to ensure that disparate outcomes are identified for needed course corrections. Both

paid staff and volunteers will receive regular data reports tracking progress toward goals and will

be expected to use this information to assess fidelity to the strategic plan. Another way to ensure

CQI is through our EBP TA and training process. As described earlier, CMHSOC will conduct

surveys on culturally and linguistically relevant EBP’s currently used and will hire CRPS-F and

EBP specific experts to review fidelity in order to ascertain need for specialized training.

Describe your plan for conducting the performance assessment as specified in section I-2.4 of

this RFA and document your ability to conduct this assessment: The Project Director and

Local Project Coordinators will review performance data submitted to SAMHSA to assess

progress against the planned goals, objectives and timelines of the strategic plan to improve

management of the project. Additionally, outcome and process questions will be included in the

evaluation to measure fidelity of the project to the original strategic plan. A quarterly report of

these measures will be submitted to SAMHSA. Barriers will be identified through the process

evaluation, which will be included in the report to SAMHSA. The Project Director and Local

Project Coordinators will work with the implementation teams to overcome these barriers.

Per-Unit Cost: The unit cost for the CMHSOC Project has been calculated as a per-person cost

of $820.00 per client served. This was established by dividing the total project cost minus 18

percent for data and performance assessment costs by the number of unduplicated clients served.