HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 945 Children's Mental Health
SPONSOR(S): Health & Human Services Committee, Children, Families & Seniors Subcommittee, Silvers
TIED BILLS: IDEN./SIM. BILLS: SB 1440
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee 15 Y, 0 N, As CS Morris Brazzell
2) Health Care Appropriations Subcommittee 11 Y, 0 N Fontaine Clark
3) Health & Human Services Committee 15 Y, 0 N, As CS Morris Calamas
SUMMARY ANALYSIS
Overall, depressive episodes and serious thoughts of suicide are increasing among Florida’s children. This may contribute
to the over 36,000 involuntary examinations that were initiated under the Baker Act for individuals under the age of 18
between July 1, 2017 and June 30, 2018. Additionally, 22.61% of minors who had involuntary examinations had multiple
such examinations in FY 2017-2018, ranging from 2 to 19 instances. The Department of Children and Families (DCF)
identified 21 minors who had more than 10 involuntary examinations in FY 2017-2018 with a combined total of 285
initiations.
CS/HB 945 creates a coordinated system of care, the development of which is facilitated by each behavioral health
managing entity, which integrates services provided through providers funded by the state’s child-serving systems, as well
as other systems for which children and adolescents would qualify, and facilitates access by children and adolescents to
needed mental health treatment and services at any point of entry.
The bill includes crisis response services provided through mobile response teams (MRT) in the array of services
available to children and adolescents who are members of certain target populations and specifies the elements of that
service.
The bill revises the required provisions of the plans required for school district funding under the Mental Health Assistance
allocation, to require policies and procedures for referrals for other household members to services available through
other delivery systems and payors, under certain circumstances. It requires the Louis de la Parte Florida Mental Health
Institute within the University of South Florida to develop a model protocol for school use of MRTs.
The bill requires DCF and the Agency for Health Care Administration (AHCA) to identify children and adolescents who are
the highest users of crisis stabilization services, collaboratively take action to meet the behavioral health needs of such
children and submit a joint quarterly report during Fiscal Years 2020-2021 and 2021-2022 to the Legislature. The bill also
requires DCF and AHCA to assess the quality of care provided in crisis stabilization units to children and adolescents who
are high utilizers of such services and submit a joint report to the Governor and Legislature.
The bill requires AHCA to continually test the Medicaid managed care plan provider network databases to ensure that
behavioral health providers are accepting enrollees and confirm that enrollees have access to behavioral health systems.
Traditional public and charter school principals have a duty under current law to notify a parent when a student is removed
from school grounds, school transportation, or a school-sponsored activity and taken to a receiving facility for involuntary
examination. The bill adds to this duty by requiring a principal to also verify that de-escalation strategies have been used
with the student and outreach to a mobile response team has been initiated prior to the student’s removal. The bill
provides an exemption from this verification requirement when a principal reasonably believes that any delay in the
student’s removal will increase the likelihood of harm to the student or others.
The bill has an insignificant, negative impact on DCF and AHCA which can be absorbed within existing resources. The bill
has an indeterminate, negative fiscal impact on local governments.
The bill provides an effective date of July 1, 2020.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Mental Health and Mental Illness
Mental health and mental illness are not synonymous. Mental health is a state of well-being in which
the individual realizes his or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her community.1
Mental illness is collectively all diagnosable mental disorders or health conditions that are characterized
by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress
and/or impaired functioning.2 Thus, mental health refers to an individual’s mental state of well-being
whereas mental illness signifies an alteration of that well-being.
Mental disorders among children are described as serious changes in the way children typically learn,
behave, or handle their emotions, causing distress and problems getting through the day.3 The most
commonly diagnosed mental disorders in children are attention deficit hyperactivity disorder (ADHD),
behavior problems, anxiety, and depression.4 In 2016-2017, 21% of parents responding to a survey
reported that a doctor has told them their child has autism, developmental delays, depression or
anxiety, attention deficit disorder/ADHD, or behavioral/conduct problems.5
The most recently published data from the National Survey on Drug Use and Health shows 12.5% of
children in Florida age 12 to 17 experienced a major depressive episode.6 Approximately 37.7% of
those children received depression care.7 The Florida Department of Health’s 2019 Youth Risk
Behavior Survey of Florida’s public high school students shows 33.7% experienced periods of
persistent feelings of sadness and hopelessness, 15.6% seriously considered attempting suicide and
7.9% attempted suicide.8 Seventy-six children between the ages of 2 to 17 died by suicide in Florida in
2018.9
Mental Health Services in Florida
The Department of Children and Families (DCF) administers a statewide system of safety-net services
for substance abuse and mental health (SAMH) prevention, treatment and recovery for children and
adults who are otherwise unable to obtain these services. SAMH programs include a range of
prevention, acute interventions (e.g. crisis stabilization), residential treatment, transitional housing,
outpatient treatment, and recovery support services. Services are provided based upon state and
federally-established priority populations.
Behavioral Health Managing Entities
1 Centers for Disease Control and Prevention, Learn About Mental Health, https://www.cdc.gov/mentalhealth/learn/ (last visited Feb. 21,
2020).
2 Id.
3 Centers for Disease Control and Prevention, Data and Statistics on Children’s Mental Health,
https://www.cdc.gov/childrensmentalhealth/data.html (last visited Feb. 21, 2020).
4 Id.
5 The Annie E. Casey Foundation Kids Count Data Center, Children who have one or more emotional, behavioral, or developmental
conditions in Florida, (April 2019) https://datacenter.kidscount.org/data#FL/2/0/char/0 (last visited Feb. 21, 2020).
6 Substance Abuse and Mental Health Services Administration, Behavioral Health Barometer, Florida, Volume 5, (2019),
https://store.samhsa.gov/system/files/florida-bh-barometervolume5-sma19-baro-17-us.pdf (last visited Feb. 21, 2020).
7 Id.
8 Florida Department of Health, 2019 Florida Risk Behavior Survey Report, (2019), http://www.floridahealth.gov/statistics-and-
data/survey-data/florida-youth-survey/youth-risk-behavior-survey/index.html (last visited Feb. 21, 2020).
9 Florida Department of Health FLHealthCHARTS, Suicide Deaths,
http://www.flhealthcharts.com/charts/DataViewer/DeathViewer/DeathViewer.aspx?indNumber=0116 (last visited Feb. 21, 2020).
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In 2001, the Legislature authorized DCF to implement behavioral health managing entities (ME) as the
management structure for the delivery of local mental health and substance abuse services.10 The
implementation of the ME system initially began on a pilot basis and, in 2008, the Legislature
authorized DCF to implement MEs statewide.11 Full implementation of the statewide managing entity
system occurred in April 2013; all geographic regions are now served by a managing entity.12
DCF contracts with seven MEs - Big Bend Community Based Care (blue), Lutheran Services Florida
(yellow), Central Florida Cares Health System (orange), Central Florida Behavioral Health Network, Inc.
(red), Southeast Florida Behavioral Health (pink), Broward Behavioral Health Network, Inc. (purple),
and South Florida Behavioral Health Network, Inc. (beige) that in turn contract with local service
providers13 for the delivery of mental health and substance abuse services:14
10 Ch. 2001-191, Laws of Fla.
11 Ch. 2008-243, Laws of Fla.
12 The Department of Children and Families Performance and Accountability System for Behavioral Health Managing Entities, Office of
Program Policy Analysis and Government Accountability, July 18, 2014.
13 Managing entities create and manage provider networks by contracting with service providers for the delivery of substance abuse
and mental health services.
14 Department of Children and Families, Managing Entities, https://www.myflfamilies.com/service-programs/samh/managing-entities/
(last visited Feb. 21, 2020).
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In FY 2018-2019, the network service providers under contract with the MEs served 339,093
individuals.15
FY 2018-2019 Individuals Served by Managing Entities
Coordinated System of Care
Managing entities are required to promote the development and implementation of a coordinated
system of care.16 A coordinated system of care means a full array of behavioral and related services in
a region or community offered by all service providers, participating either under contract with a
managing entity or by another method of community partnership or mutual agreement.17 A community
or region provides a coordinated system of care for those suffering from mental illness or substance
abuse disorder through a no-wrong-door model, to the extent allowed by available resources. If funding
is provided by the Legislature, DCF may award system improvement grants to managing entities.18
MEs must submit detailed plans to enhance crisis services based on the no-wrong-door model or to
meet specific needs identified in DCF’s assessment of behavioral health services in this state.19 DCF
must use performance-based contracts to award grants.20
There are several essential elements which make up a coordinated system of care, including: 21
Community interventions;
Case management;
Care coordination;
Outpatient services;
Residential services;
Hospital inpatient care;
Aftercare and post-discharge services;
Medication assisted treatment and medication management; and
Recovery support.
15 Department of Children and Families, Substance Abuse and Mental Health Triennial Plan Update for Fiscal Year, (Dec. 6, 2019)
https://www.myflfamilies.com/service-programs/samh/publications/docs/SAMH%20Services%20Plan%202018%20Update.pdf (last
visited Feb. 21, 2020).
16 S. 394.9082(5)(d), F.S.
17 S. 394.4573(1)(c), F.S.
18 S. 394.4573(3), F.S. The Legislature has not funded system improvement grants.
19 Id.
20 Id.
21 S. 394.4573(2), F.S.
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A coordinated system of care must include, but is not limited to, the following array of services:22
Prevention services;
Home-based services;
School-based services;
Family therapy;
Family support;
Respite services;
Outpatient treatment;
Crisis stabilization;
Therapeutic foster care;
Residential treatment;
Inpatient hospitalization;
Case management;
Services for victims of sex offenses;
Transitional services; and
Trauma-informed services for children who have suffered sexual exploitation.
Current law requires DCF to define the priority populations which would benefit from receiving care
coordination, including considerations when defining such population. 23 Considerations include the
number and duration of involuntary admissions, the degree of involvement with the criminal justice
system, the risk to public safety posed by the individual, the utilization of a treatment facility by the
individual, the degree of utilization of behavioral health services, and whether the individual is a parent
or caregiver who is involved with the child welfare system.
MEs are required to conduct a community behavioral health care needs assessment once every three
years in the geographic area served by the managing entity, which identifies needs by sub-region.24
The assessments must be submitted to DCF for inclusion in the state and district substance abuse and
mental health plan.25
Baker Act
The Florida Mental Health Act, otherwise known as the Baker Act, was enacted in 1971 to revise the
state’s mental health commitment laws.26 The Act includes legal procedures for mental health
examination and treatment, including voluntary and involuntary examinations. It additionally protects the
rights of all individuals examined or treated for mental illness in Florida.27
Involuntary Examination and Receiving Facilities
Individuals in an acute mental or behavioral health crisis may require emergency treatment to stabilize
their condition. Emergency mental health examination and stabilization services may be provided on a
voluntary or involuntary basis.28 An involuntary examination is required if there is reason to believe that
the person has a mental illness and has, because of his or her mental illness, refused involuntary
examination, is likely to refuse to care for him or herself, or cause harm to him or herself or others in the
near future.29
Involuntary patients must be taken to either a public or a private facility that has been designated by the
Department of Children and Families as a Baker Act receiving facility. The purpose of receiving facilities
is to receive and hold or refer, as appropriate, involuntary patients under emergency conditions for
22 S. 394.495(4), F.S.
23 S. 394.9082(3)(c), F.S.
24 S. 394.9082(5)(b), F.S.
25 S. 394.75(3), F.S.
26 Ss. 394.451-394.47892, F.S.
27 S. 394.459, F.S.
28 Ss. 394.4625 and 394.463, F.S.
29 S. 394.463(1), F.S.
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mental health or substance abuse evaluation and to provide treatment or transportation to the
appropriate service provider.30 A public receiving facility is a facility that has contracted with a managing
entity to provide mental health services to all persons, regardless of their ability to pay, and is receiving
state funds for such purpose.31 Funds appropriated for Baker Act services may only be used to pay for
services to diagnostically and financially eligible persons, or those who are acutely ill, in need of mental
health services, and the least able to pay.32
Crisis Stabilization Units (CSUs) are specialized public receiving facilities that receive state funding to
provide services to individuals showing acute mental health disorders. CSUs screen, assess, and admit
for stabilization individuals who voluntarily present themselves to the unit, as well as individuals who
are brought to the unit on an involuntary basis.33 CSUs provide patients with 24-hour observation,
medication prescribed by a physician or psychiatrist, and other appropriate services.34 The purpose of a
crisis stabilization unit is to stabilize and redirect a client to the most appropriate and least restrictive
community setting available, consistent with the client’s needs.35 Individuals often enter the public
mental health system through CSUs.36 For this reason, crisis services are a part of the comprehensive,
integrated, community mental health and substance abuse services established by the Legislature in
the 1970s to ensure continuity of care for individuals.37
As of September 2019, there are 122 Baker Act receiving facilities in this state, including 54 public
receiving facilities and 68 private receiving facilities.38 Of the 54 public receiving facilities, 40 are
CSU’s.39
Under the Baker Act, a receiving facility must examine an involuntary patient within 72 hours of<