Bills Building On Past Reforms To Revamp Fla. Child Welfare System Head To House Floor

Apr 9, 2015

Rep. Gayle Harrell (R-Stuart), who's taken the lead on child welfare reform efforts, speaks during a House committee hearing Thursday.
Credit Florida Channel

Two bills aimed at building on past reforms to revamp Florida’s child welfare system plagued by child abuse deaths are now heading to the House floor, after passing their last committee Thursday.

Rep. Gayle Harrell (R-Stuart) is both committee bills’ main sponsor in her role as the chair of the House Children, Families, and Seniors Subcommittee.

The first one is aimed at redesigning Florida’s mental health and substance abuse systems.

“As we worked very hard last year on child welfare, we really realized the driving force of so many cases of child abuse had to deal with mental health and substance abuse and domestic violence, and domestic violence is a result—to some degree—of mental health and substance abuse. So, we spent this last year looking at and deciding what we could do to change the system in Florida dealing with mental health and substance abuse,” said Harrell.

The Florida Department of Children and Families currently contracts with seven managing entities across the state, which then manage the local contracts for substance abuse and mental health services.

Harrell says the goal is to empower the managing entities to transform into what she calls “coordinated care organizations”—though she says she’s still working out that definition.

That’s a problem Mary Ruiz, Florida Council for Community Mental Health, hopes get cleared up. She’s one of the founding board members for the largest managing entity in Florida, the Central Florida Behavioral Health Network. She supports efforts to redesign the system, but she urges caution as lawmakers go forward.

“These Care managers, these case managers in the community, working for these agencies have lifetime relationships with these children and adults,” said Ruiz. “These are the people they call when they’re scared, when they don’t know what to do, when they’re not getting their medications, when they need to find a primary care doctor. So, my concern is that we go a little further in defining things so we protect and encourage the proper roles and the relationships that we currently have with our patients.”

Still, what Harrell does know is the measure would open up the state’s mental health care services to for-profit companies—which is not the current model.

“And, what we’re trying to do here is to remove the restraints of the managing entities to really empower them and make sure they are incentivize to serve the population appropriately,” said Harrell.

But, Rep. Lori Berman (D-Lantana) says while she’s on board with the overall reforms, she questioned the need to make the system for-profit.

“I know in most of the things we do is not-for-profit. Why are we deciding to change that model that we’ve done for so many years and allow for-profit,” asked Berman.

“We really want to make sure we have competition. The way you improve a system is to have choices and competition,” replied Harrell.

And, while she believes the bill is moving in the right direction, Natalie Kelly representing the Florida Association of Managing Entities too expressed some concerns that the bill is opening the door to for-profit health care services in a system that’s non-profit based.

“The most vulnerable citizens in the state of Florida are children in child welfare, our elders in our aging network that include people with Alzheimer’s and dementia, and our people with mental illness,” said Kelly. “The CBCs—our Community Based Care lead agencies—there are 17 of them…they’re all non-profit. All 11 for our elders that oversee our elder services are non-profit.  We should continue all seven managing entities as non-profit.”

Still, Harrell counters the parameters are not set in stone for CBCs, or the Community Based Care agencies, that provide services for foster care youth and their parents.

“As far as CBCs go, CBCs can be for-profit,” said Harrell. “They happened now to all be non-profit, but they can, according to statute—be profit. So, if they wanted to come into the playing field, they can compete as well.”

And, the measure passed the House Health and Human Services Subcommittee. So, did another committee proposal mainly authored by Harrell that builds on an overhaul of Florida’s child welfare agency that passed last year aimed at reducing child abuse deaths.

She says among one of the major changes in the bill is expanding the role of investigatory teams that respond to child death cases and report on whether DCF needs to change its policies.

“And, it allows Critical Rapid Response Teams [CERRT] to report on other child deaths including open cases and it also requires the CERRT advisory committees to meet quarterly, rather than annually and report quarterly,” said Harrell.

And, as both measures head to the House floor, similar bills are still moving in the Senate as well.

For more news updates, follow Sascha Cordner on Twitter: @SaschaCordner.