HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 1169 Coordinated Systems of Care for Children
SPONSOR(S): Education & Employment Committee, Children, Families & Seniors Subcommittee, Redondo
and others
TIED BILLS: None. IDEN./SIM. BILLS: CS/SB 1340
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee 15 Y, 0 N, As CS Curry Brazzell
2) PreK-12 Appropriations Subcommittee 14 Y, 0 N Bailey Potvin
3) Education & Employment Committee 18 Y, 0 N, As CS Wolff Hassell
SUMMARY ANALYSIS
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.
The DCF must establish a coordinated system of care that includes an array of services to meet the individual
mental health service and treatment needs of children and adolescents who are members of the target
population and experiencing an acute mental or emotional crisis, have a serious emotional disturbance or
mental illness, have an emotional disturbance or are at risk of an emotional disturbance.
The bill establishes a mental health treatment and support system within school districts. The bill defines "care
coordinator" to mean a person who is responsible for participating in the development and implementation of a
services plan, linking service providers to a child or adolescent and his or her family, monitoring the delivery of
services, providing advocacy, collecting information to determine the effect of services and treatment, and
performing care coordination.
The bill requires school districts providing certain mental health services to students diagnosed with, or at risk
of being diagnosed with, one or more mental health issues or any co-occurring substance use disorder to
adhere to certain guiding principles and performance outcome requirements when implementing and
developing a mental health treatment and support system within the school district. Adhering to these
principles and guidelines will help to further promote effective implementation of a coordinated system of care.
The bill requires school districts to contract with MEs to provide care coordinators for students with complex
behavioral health needs who continue to experience adverse outcomes due to unmet needs or an inability to
engage and establishes the duties of the care coordinator. The bill requires school districts to address
recommendations from the care coordinator for students returning to the school setting following an involuntary
admission to an acute psychiatric care facility.
The bill requires each school district to annually report to the Department of Education the general
performance outcomes for the child and adolescent mental health treatment and support system and how
funding for the support system is allocated and spent.
The bill has an indeterminate fiscal impact. See Fiscal Comments, infra.
The bill provides an effective date of July 1, 2024.
This docum ent 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 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 contribute to his or
her community.1 The primary indicators used to evaluate an individual’s mental health are: 2
Emotional well-being- Perceived life satisfaction, happiness, cheerfulness, peacefulness.
Psychological well-being- Self-acceptance, personal growth including openness to new
experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality,
self-direction, and positive relationships.
Social well-being- Social acceptance, beliefs in the potential of people and society as a whole,
personal self-worth and usefulness to society, sense of community.
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 or
impaired functioning.3 Thus, mental health refers to an individual’s mental state of well-being whereas
mental illness signifies an alteration of that well-being. Mental illness affects millions of people in the
United States each year. Nearly one in five adults lives with a mental illness. 4 During their childhood
and adolescence, almost half of children will experience a mental disorder, though the proportion
experiencing severe impairment during childhood and adolescence is much lower, at about 22%.5
Mental Health Safety Net Services
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
In 2001, the Legislature authorized the DCF to implement behavioral health managing entities (ME) as
the management structure for the delivery of local mental health and substance abuse services .6 The
implementation of the ME system initially began on a pilot basis and, in 2008, the Legislature
authorized the DCF to implement MEs statewide.7 MEs were fully implemented statewide in 2013,
serving all geographic regions.
1 World Health Organization, Mental Health: Strengthening Our Response, https://www.who.int/news -room/fact-sheets/detail/mental-
health-strengthening-our-response (last visited February 12, 2024).
2 Centers for Disease Control and Prevention, Mental Health Basics, http://medbox.iiab.me/modules/en-
cdc/www.cdc.gov/mentalhealth/basics.htm (last visited February 12, 2024).
3 Id.
4 National Institute of Mental Health (NIH), Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness (last visited February
12, 2024).
5 Id.
6 Chapter 2001-191, Laws of Fla.
7 Chapter 2008-243, Laws of Fla
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The DCF currently contracts with seven MEs for behavioral health services throughout the state. These
entities do not provide direct services; rather, they contract with local service providers 8 for the delivery
of mental health and substance abuse services.9 This allows the department’s funding to be tailored to
the specific behavioral health needs in the various regions of the state.
Coordinated System of Care
The MEs are required to promote the development and implementation of a coordinated system of
care.10 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.11 A community or region provides a
coordinated system of care for those with a 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, the DCF may award system improvement grants to managing entities. 12 The 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. 13 The DCF must use
performance-based contracts to award grants.14
There are several essential elements which make up a coordinated system of care, including: 15
8 Managing entities create and manage provider networks by contracting with service providers for the delivery of substance abu se and
mental health services.
9 DCF, Managing Entities, available at https://www.myflfamilies.com/services/samh/provIders/managing-entities, (last visited February
12, 2024).
10 Section 394.9082(5)(d), F.S.
11 Section 394.4573(1)(c), F.S.
12 Section 394.4573(3), F.S. The Legislature has not funded system improvement grants.
13 Id.
14 Id.
15 Section 394.4573(2), F.S.
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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.
A coordinated system of care must include, but is not limited to, the following array of services: 16
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.
The DCF must define the priority populations which would benefit from receiving care coordination. 17 In
defining priority populations, the DCF must consider 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.
The 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.18 The assessments must be submitted to the DCF for inclusion in the state and district
substance abuse and mental health plan.19
Child and Adolescent Mental Health System of Care
Under current law, the DCF must establish a system of care that includes an array of services to meet
the individual mental health service and treatment needs of children and adolescents who reside with
their parents or legal guardians or who are placed in state custody and:20
Are experiencing an acute mental or emotional crisis.
Have a serious emotional disturbance or mental illness.
Have an emotional disturbance.
16 Section 394.495(4), F.S
17 Section 394.9082(3)(c), F.S.
18 Section 394.9082(5)(b), F.S.
19 Section 394.75(3), F.S.
20 Section 394.495, F.S.
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Are at risk of emotional disturbance.
The services must include assessment services that provide a professional interpretation of the nature
of the problems of the child or adolescent and his or her family; family issues that may impact the
problems; additional factors that contribute to the problems; and the assets, strengths, and resources of
the child or adolescent and his or her family. The assessment services to be provided must be
determined by the clinical needs of each child or adolescent and include, but are not limited to,
evaluation and screening in the following areas:21
physical and mental health for purposes of identifying medical and psychiatric problems ;
psychological functioning, as determined through a battery of psychological tests;
intelligence and academic achievement;
social and behavioral functioning; and
family functioning.
The guiding principles of the system require that services be community-based, individualized, provide
timely access to a comprehensive array of cost-effective mental health treatment and support services,
be culturally competent, integrated, and coordinated. The goal is to provide a smooth transition, from
children’s mental health to the adult mental health system for continued age-appropriate services and
supports. These services are designed to build resilience and to prevent, severity, duration and
disabling aspects of children’s mental and emotional disorders. 22
The system must achieve certain general performance outcomes for the children and adolescents who
receive services through the system of care, which include: 23
Stabilization or improvement of the emotional condition or behavior of the child or adolescent,
as evidenced by resolving the presented problems and symptoms of the serious emotional
disturbance recorded in the initial assessment.
Stabilization or improvement of the behavior or condition of the child or adolescent with respect
to the family and school, so that the child or adolescent can function in the family and the school
with minimum appropriate support.
Stabilization or improvement of the behavior or condition of the child or adolescent with respect
to the way he or she interacts in the community, so that the child or adolescent can avoid
behaviors that may be attributable to the emotional disturbance, such as substance abuse,
unintended pregnancy, delinquency, sexually transmitted diseases, and other negative
consequences.
Community Action Treatment Teams
Community Action Treatment (CAT) Teams are an important component of the child and adolescent
mental health system of care. CAT teams are multi-disciplinary clinical teams that provide
comprehensive, intensive community-based treatment to families with youth and young adults, ages 11
up to 21, who are at risk of out-of-home placement due to a mental health or co-occurring disorder and
related complex issues for whom traditional services are not or have not been adequate.24 CAT teams
help these children and young adults recover at home safely and provide a safe and effective
alternative to out-of-home treatment or residential care for children with serious behavioral health
conditions. These teams also assist families in building and maintaining a support system within their
community. CAT teams are available to:25
21 Id.
22 Id.
23 Section 394.494, F.S.
24 Central Florida Cares Health System, House Bill 945 Children’s Coordinated System of Care Plan Central Region: Circuits 9 & 18
2022-2025, available at https://centralfloridacares.org/wp-content/uploads/2022/01/CFCHS_Coordinated-Childrens-System-Plan_Rev-
12.29.21.pdf, (last visited February 12, 2024)
25 DCF, Community Action Treatment Teams, availab le at https://www.myflfamilies.com/services/samh/community-action-treatment-
teams#:~:text=Community%20Action%20Treatment%20(CAT)%20Teams,support%20system%20within%20their%20community (last
visited February 12, 2024).
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Children and young adults with serious behavioral health conditions.
Youth with complex needs that contribute to family disruption or increase the risk of family
separation such as:
o Multiple behavioral health hospitalizations;
o Involvement with the Department of Juvenile Justice or law enforcement;
o School challenges like poor academic performance or suspensions; and
o Repeated failures at lower levels of care.
Mobile Response Teams
A mental health crisis can be an extremely frightening and difficult experience for both the individual in
crisis and those around him or her. It can be caused by a variety of factors and occur at any hour of the
day.26 Family members and caregivers of an individual experiencing a mental health crisis are often ill-
equipped to handle these situations and need the advice and support of professionals. 27 Law
enforcement or EMTs may be called to respond to mental health crises, and may lack the training and
experience to effectively handle the situation.28 Mobile response teams (MRT) can be beneficial in such
instances.