parent information guide final..ai

2018

TABLE OF CONTENTS

Welcome to Community Based Care of Central Florida (CBCCF) 3

CBCCF’s Locations 4

CBCCF’s Mission and Vision 5

Customer Service Values/What You Should Expect 6

Our Services 7

Safety Management Services 8

Family Support/Risk Management Services 8

Ongoing Case Management Services 8

Dependency Court 9

Roles In The Court System 10

Visitation for Children in Out of Home Care 11

Parent-Child Visits 11

Sibling Visits 12

Cancellation of Visits 12

Confidentiality and Release of Information 12

Informed Consent 13

Rights and Responsibilities 13

Planning and Accessing Services 15

Client Grievance Procedures 16

Management and Protection of Personal Health Information (HIPAA) 17

Acknowledgement of Receipt Form 21

Important Contact Information 23

Dear Parent,

The Florida Department of Children and Families (hereafter referred to as the

Department), contracts with Community Based Care of Central Florida, Inc. (CBCCF)

to oversee child welfare related services in Orange, Osceola and Seminole Counties.

CBCCF works in partnership with agencies or programs that provide case

management, behavioral/mental health, medical, educational, child care,

substance abuse, domestic violence or other social services to create the variety and

quality of services that are needed by families in this community. We will need your

help in identifying what your family’s unique strengths and supports are, so that

together we can create a “service or case plan” that will resolve or minimize the risk

or safety concerns that brought your family to the attention of the child welfare

system. Once your case plan is negotiated, we will monitor progress on your case

plan closely, ensure that services your family needs are accessible, encourage and

support you in completing identified tasks, and communicate with you regularly and

in a manner that is fair, honest, consistent and courteous. We expect that you will

hold us accountable for doing our part in ensuring your family’s success and, when

we fail to do so, that you will bring this to our attention.

If your child has been placed outside of your home, it is imperative that we begin

immediately to take the actions necessary that will allow your child to return home

as soon as the child’s safety can be ensured. If your child remains in your care,

it is important that actions are taken which continue to reduce the safety concerns

identified and allow the child to safely remain in your care. Your Case Manager

will provide you with more information about federal and state laws that require

permanency to be achieved in a timeframe consistent with the child’s development

and sense of time.

We are sincerely committed to strengthening families, building upon existing natural

supports, and in providing effective and efficient services. This booklet is your guide

to CBCCF. It will answer many of your questions about what we do and how we

do it. It also provides more details about what we will need from you so that we can

successfully work together. Please read the booklet and discuss any questions you

may have with your Case Manager.

In conclusion, we say, "Welcome to CBCCF!" We look forward to working with

you for the benefit of your children.

Sincerely,

Glen Casel

President & CEO

Community Based Care of Central Florida, Inc.

WELCOME TO COMMUNITY BASED CARE

OF CENTRAL FLORIDA (CBCCF)

CBCCF LOCATIONS

NOTE: Your case manager has identified the service center to which your family is assigned

by checking the box next to the location below. In addition, the case management agency

and the program director have been identified. The identified location is where your case manager

is located and where your services are coordinated.

Administrative Support Center

4001 Pelee Street, Orlando, FL 32817

321.441.2060

CBCCF Vice President of Operations: Kim Brien

 Orange County

West Service Center

5749 Westgate Drive, Ste. 200, Orlando, FL 32835

321.441.1567

CBCCF Executive Director: Nicola Bailey

 Devereux Florida, Robin Thomas, Program Director

 One Hope United, Roger Robinson, Director of Programs

 Orange County

East Service Center

1900 Alafaya Trail, Ste. 900, Orlando, FL 32826

321.207.8200

CBCCF Executive Director: Nicola Bailey

 Children’s Home Society, Yvonne Rose, Program Director

 Osceola County

Service Center

111 E. Monument Ave., Ste. 501, Kissimmee, FL 34741

321.442.8487

CBCCF Executive Director: Katria Jenkins

 Gulf Coast Jewish Community & Family Services, Walter Blake, Program Director

 Seminole County

Service Center

2921 S. Orlando Ave, Ste. 150, Sanford, FL 32773

407.688.9650

CBCCF Executive Director: Jill Spannagel

 Children’s Home Society, Catherine Baez, Program Director

OUR MISSION

Community Based Care of Central Florida empowers families to safely care for their children by engaging,

protecting and inspiring every child, every day. This mission is driven by one of our core values:

the belief that all children have the inalienable right to grow up safe, healthy and fulfilled in families that

love and care for them.

OUR VISION

CBCCF and our many stakeholders in the Central Florida community share a vision of how the child

welfare system could be improved for children and families. We are dedicated to our goal of becoming

the national leader in progressive child welfare systems; forging community partnerships and innovations

that promote healthy, safe and self-sufficient families.

To achieve this, CBCCF is committed to the following values:

We value a family, youth and individual model of practice that recognizes

the assets, culture and voice of all, empowering them to reach their unique goals.

 The child is our client.

 The safety and well-being of children will be the foremost concern at all times.

 The family is the principal resource we will work with to meet the child’s needs.

 Permanency issues will be resolved in accordance with a child’s sense of time.

 Services will be provided by community-based providers who are equipped

to manage and deliver needed services and supports to meet the needs of children

who are victims of, or at risk of, child abuse and neglect, and their families.

We value meaningful and healthy collaboration among our colleagues, partners,

stakeholders, and the community. We believe the best solutions originate from

diverse talents, temperaments and life experiences.

We value innovation, embracing change and visionary ideas. We believe in pursuing

opportunities through prudent risk-taking, developing assets and creating new solutions.

We value integrity and honor our commitments by not compromising our ethics and moral

principles. We speak the truth, keep our promises and take responsibility for our actions.

We value accountability and serve as good stewards of all assets entrusted to our organization.

We believe in sharing information with ongoing communication and complete transparency.

 Resources will be efficiently managed to achieve better outcomes for children with the

ultimate goals being child safety, well-being, and permanency within a twelve-month timeframe.

 Financial support will be available from diverse federal, state and local sources and flexibly

managed at the local level to meet child and family needs in a timely and appropriate

manner.

 The system will collect and use data to accurately forecast what services and supports

are needed, at what level of intensity and duration, and at what cost to achieve desired

outcomes for each child and family in need.

We value inclusiveness and believe our organization is strengthened by mutual respect

for all points of view.

WHAT TO EXPECT AS A CLIENT OF CASE MANAGEMENT:

OUR CUSTOMER SERVICE VALUES

We believe in providing good customer service and you are our customer.

As an agency we have seven service values that are core to our mission,

which we refer to as our values of RESPECT. They are as follows:

You can expect us to be RESPONSIVE in writing and speaking. Messages and emails should be

answered within 24 business hours. We will listen to you and ask a lot of questions in an effort to get to

know you and understand your family circumstances. We need this information to complete a thorough

assessment in order to identify the right services for you and your child(ren). We will work with you to

determine what services are in fact right for you and your family. This may require your participation in

further evaluations, such as a mental health or substance abuse evaluation. If challenges arise, we will

work collaboratively to find a solution.

You can expect us to be EMPOWERED and for us to help you feel EMPOWERED. We will not let

bureaucratic red tape get in the way of providing needed services for you or your children. We expect

that you will receive outstanding service as part of everything we do, every day. We will ask what you

think needs to happen. Your opinion is valued. We may not always agree, but we should listen to one

another. There may have to be difficult conversations about what needs to happen moving forward,

but we should have those conversations with you. Decision-making should be transparent and you should

be at the table. It is our job to help you identify the tools needed to be successful, and to make needed

changes on your terms that sustain for your lifetime.

You can expect us to be SUPPORTIVE. Your case manager will assist you in accessing identified

services and will keep you apprised of your child’s situation. We will involve you in the care of your

children. You should be involved in their medical appointments and life decisions, such as educational

planning.The prescribing of psychotropic medications will take your opinion and wishes into

consideration. We will make every effort to keep your children together in placement settings and,

if they are separated, we will arrange for them to see one another on a regular basis.

You can expect us to be PROFESSIONAL. The integrity of our organization is reflected through our

individual behavior. You will be made aware of events that require your participation in a timely manner.

For example, you should be invited to your Family Services Team (FST) meeting well in advance so that

you can make arrangements to participate. You should be notified about things that occur involving your

child(ren): such as when they are injured, ill, or change their placement. We will arrange visitation

for you with your children unless the court has determined that it is not in the child’s best interest to have

this contact. You should be told about changes in visitation plans in time to make arrangements.

Your visitation should not be cancelled because of an emergency encountered by your case manager.

You can expect us to be ENGAGED. We give and receive feedback to ensure continuous improvement.

We are accountable. There is a feedback process and chain of command for you to reach out to if you

feel you are not receiving good customer service.

You can expect us to be COURTEOUS. We should always be respectful of you. You should have an

expectation of confidentiality and self-determination. You should not feel judged by anyone in our system

of care. We understand that bad things happen to people that may affect them, but that does not have to

define who they may become.

You can expect us to be TRUSTWORTHY. We will earn your trust through our words, actions and follow

through. Things sometimes are overlooked. Please point this out if needed, so that every effort can be

made to resolve the issue. It may be that a referral is not made for you in a timely manner. Please remind

the case manager of the need for this to happen.

CBCCF

SERVICES

CBCCF’s services are designed to assist families in resolving problems that directly or

indirectly affect the safety and well-being of their children. Services may be provided

without court involvement when the family is cooperative and the safety of the children

in the home can be ensured without judicial intervention and oversight. Judicial intervention

is requested when the children have been removed from the home due to safety

concerns that cannot be managed in the home. Sometimes court intervention

is requested when the family has been involved with the Department of Children and

Families (or other child welfare agencies) in the past and the intervention was closed

unsuccessfully or the parental rights to other children have been terminated.

CBCCF also provides services to children identified as safe but at high risk of future

abuse or neglect. This decision is made, based on the assessment of the Child Protective

Investigator, if it is determined that the family could benefit from services and the

family is willing to participate in services.

EXPLANATION OF SERVICES

Safety Management Services: Arranged by the Child Protective Investigator (CPI). In Seminole County,

the CPI is a civilian employee of the Seminole County Sheriff’s Office; in Orange and Osceola Counties,

the CPI is an employee of the Florida Department of Children and Families. The Child Protective

Investigtor (CPI) will conduct an assessment to determine if emergency/intensive intervention is necessary

to stabilize a situation in the home and/or to prevent the child’s removal from the home. CBCCF subcontracts

with other agencies to provide these safety management services. The intensity and array of services that

are provided is dependent on the unique needs of the family and situation that has brought the family to

the attention of the CPI.

  In Seminole County, the CPI may refer a family to Children’s Home Society’s CARE program.

  In Orange County, families may be referred to Orange County Family Preservation Services,

Boy’s Town Intensive In-home Services Program, or Gulf Coast Jewish Family and Community

Services’ Safe at Home Program.

  In Osceola County, referrals are made to Gulf Coast Jewish Family and Community Services’

Safe at Home Program.

  All of these programs provide in-home parent education, counseling services and linkage

to community resources.

Family Support Services: Risk Management Services for children and families may be arranged by the

CPI if the family is found to be at high or very high risk of abuse or neglect. Services are referred

to support the family. The focus on the service plan is on strengthening the protective factors of the parent

through addressing areas such as: nurturing and attachment, knowledge of child development, parental

resilience, developing supportive social connections, learning how to navigate concrete community

supports, or improving the child’s social or emotional competence.

Ongoing Case Management Services: Referred by the CPI when children have been removed from the

home or court-ordered supervision is being requested through the filing of a shelter or dependency

petition in the juvenile dependency court. Case management services may also be arranged in other

situations where the CPI has identified that the family is in need of formalized protective services to ensure

the ongoing safety of the child(ren) while in the home.

  In Seminole County, case management agency services are provided by

Children’s Home Society (CHS).

  In Orange County, case management agency services are provided by Devereux Florida,

One Hope United (OHU) and Children’s Home Society (CHS).

  In Osceola County, case management agency services are provided by

Gulf Coast Jewish Family and Community Services.

It is possible that your Case Manager will continue the services put in place by the CPI, as well as arrange

for additional services identified as needed in a case plan developed with you.

Florida Law (Chapter 39) requires that reasonable efforts are made to prevent the removal of a child from

their home; and that, when a child is removed from the home for their protection, he/she must be placed

in the least restrictive, most family-like setting available.

DEPENDENCY COURT SYSTEM

Any time there is a concern that a child has been, or is in immediate danger of being, abused,

abandoned or neglected, a petition may be filed in Juvenile Dependency Court. The Court will decide

if the legal standard is met for requiring intervention, and will seek to ensure that children are safe

and protected and that families receive help with the problems that brought them into court.

Dependency Court is not about punishing parents or handling criminal charges. Also, the court files

in dependency cases are confidential and not open to the public.

You will always be notified of hearing dates. It is very important that you attend all hearings. If you don’t

appear at a hearing, it will still be held and decisions will be made without you. If there is a critical reason

why you are unable to attend a hearing, you must contact your lawyer immediately. It is also essential

that you keep your caseworker, your lawyer and the court informed of your current address and

telephone number.

You also have a responsibility to continue to provide financial support for your child, even when he or she

is being cared for outside of your home. The Court or the Department of Revenue will review how much

money you earn and determine how much you can or should be able to pay to support your child.

Parents or guardians have the right to be represented by an attorney in Dependency Court. You have the

right to have a lawyer advise and represent you at all hearings and proceedings in a dependency case.

If you can’t afford to hire a lawyer, then the court will appoint one to help you. To determine if you qualify

to have a lawyer provided to you at no cost, you will need to complete some paperwork detailing how

much you earn and what kind of property you own. Please keep in mind all legal matters should be

discussed with your attorney.

You have the right to:

 Be represented by a lawyer at every stage of your case or to represent yourself in court.

 Have a lawyer appointed if you cannot afford representation.

 Be notified of all court hearings and to be present at them.

 See copies of any DCF or Guardian ad Litem report filed in your case or presented

at a hearing.

 Receive services to help you get your child(ren) back.

 Know any costs for services.

 Be consulted about medical treatment and travel if your child(ren) is/are placed outside

of your home.

 Keep in contact with and visit your child(ren), unless otherwise ordered

by the Court.

ROLES IN THE COURT SYSTEM

Child Protective Investigator (CPI) responds to and investigates a report of suspected child abuse,

neglect or abandonment.

Judge decides what is best for the child entering protective supervision or foster care.

General Magistrate may hear cases and make a recommendation to the Judge regarding what

should happen.

Guardian ad Litem or GAL is someone who represents the best interests of your child in the court case.

A GAL is separate from DCF/CBCCF and the court, so he or she can provide the judge with independent

information and recommendations on such matters as: the welfare of your child, your progress with your

case plan, what type of visitation is appropriate, where your child should live or go to school, and when

you and your child can be safely returned to you. A GAL may visit with your child, talk with you about

your situation, and get other information from family members, teachers, doctors, and other people who

know you and your child. A GAL will also make sure your child is getting everything he or she needs

while the case is ongoing.

In a Shelter Hearing, the court determines whether there is evidence to keep a child, who has been

removed from his/her home by a Child Protective Investigator, in an out of home placement pending

further investigation by the CPI. This hearing must happen within 24 hours of the child being removed

from their home.

Arraignment provides the parent(s) an opportunity to admit, consent or deny the abuse or neglect

allegations.

Mediation is an impartial process through which everyone can discuss their views on the case and the

best interests of the child. A mediator is a neutral person who will help everyone share what they

think about the situation in a productive way. Mediations are confidential; they do not take place in a

courtroom and they are not recorded. However, if everyone comes to an agreement during the media-

tion, the final agreement will be sent to the judge. No other information besides a final agreement will

be sent to the judge. Cases can be referred to mediation at any point during the dependency process.

Adjudication is the finding of whether or not there has been abuse, neglect or abandonment. For an

adjudication of dependency, the judge only has to find that there is a preponderance of evidence

(more evidence that supports the child has been abused/neglected than evidence to the contrary).

Disposition sets forth the specific services needed by the child(ren) and families through a court ordered

and approved case plan.

In a Judicial Review, the court reviews the services ordered, progress of family on case plan,

and changes in the child(ren) and family's status. Reviews can occur at 3 or 6 month intervals.

If the child(ren) remains in foster care, reviews must occur every 6 months.

Permanency Hearing is a special judicial review hearing that is held no later than 12 months after

the child was originally removed from the home. At this hearing, the Department formally presents the

permanency plan for the child to the Court.

Central Florida Dependency Court Locations: One of the following locations is where court

proceedings take place and where you may need to go to participate in court proceedings. Please arrive

in time to be checked in through security. The Court Deputy will direct you where to wait for your case to

be called.

  Orange County Juvenile Court  Osceola County Juvenile Court

2000 East Michigan St. 2 Courthouse Square, #2000

Orlando, FL 32806 Kissimmee, FL 34741

407.836.7520 407.742.3500

  Seminole County Juvenile Court

190 Bush Blvd.

Sanford, FL 32773

407.665.5350

VISITATION FOR CHILDREN IN PLACEMENT

Parent-Child Visits. It is important that you have regular and frequent visits with your child(ren),

unless the court decides visits are not in the child’s best interest. Regular visitation is important to maintain

the child/parent bond and to ensure a successful reunification.

Your Case Manager will develop a visitation schedule with you and help initiate visitation. At a minimum,

bi-weekly visits will be arranged, unless the court enters a specific visitation order. The frequency of the

visits will depend on the circumstances and the desire you have as a parent to see your child and work

toward reunification. As the projected date for reunification approaches, unsupervised and extended

visits, such as overnight and weekends, may be arranged.

Your Case Manager will, whenever possible, arrange for visitation to occur in a relaxed and natural setting:

the foster home, a supervised visitation center, or community parks or playgrounds. The child’s safety

is foremost when determining visit locations. The court will generally order the visits to be supervised.

LOCAL VISITATION CENTERS

 Orange County utilizes Devereux’s Family Support and Visitation Center

Located at 118 Pasadena Place in Orlando, FL 32803.

Call 407.999.5577 for an appointment.

 Osceola County utilizes Children’s Home Society’s Visitation Center

Located at 2653 Michigan Avenue in Kissimmee, FL 34744.

Call 407.846.5220 for an appointment.

 Seminole County utilizes the Y.A.N.A. Project for supervised visitation.

Located at 501 West 9th Street in Sanford, FL 32771.

Call 407.302.1010 for an appointment.

Note: All of these programs require a court order to provide services.

Sibling Visits. Your Case Manager will arrange for regular and frequent visits between siblings who

are not living together, as long as the Judge has not ordered otherwise and visits are not therapeutically

contra-indicated.

Cancellation of Visits. Every effort should be made to keep the scheduled visitation. If a visit must be

cancelled, notification must be made at least 24 hours in advance. Reasons for missed visits are recorded

in the case file and the information will be reported in a report to the court, to be presented at the next

hearing. Conflicts in a Case Manager’s schedule will not cause a visit to be cancelled.

CONFIDENTIALITY AND RELEASE OF INFORMATION

Community Based Care of Central Florida will comply with laws and regulations concerning privacy and

protection of information. During the initial contact, your Case Manager will explain what informed

consent for release of confidential information means. The Case Manager will then ask you to sign

a CBCCF authorization form releasing information both to and from DCF/CBCCF to other agencies

involved, providers, schools, etc. Personal information cannot be released verbally or in writing until the

Consent to Release/Request Information form(s) have been signed and dated.

When CBCCF needs information from other sources that would be helpful in providing appropriate

services to the child(ren) and family, your Case Manager will:

  Specify the information needed

  Explain why the information is needed

  Complete the Consent to Release/Request Information form

  Obtain consent from your parent or guardian if you are a child

  Obtain consent from your guardian if you are a person who has a legal guardian

The Consent for Release/Request of Information form must specify:

  Name of the source being requested for information

  The information that is being requested

  CBCCF as the agency requesting the information

  The date the form was signed

  The length of time the request form is in legal effect

Informed Consent

It is important that you are fully informed about the services you are receiving from CBCCF. Please

read every form you are requested to sign and ask for assistance in understanding the services you are

to receive prior to agreeing and signing the form. This understanding is intended to help when making

an informed decision about participation in services provided by CBCCF. The forms you will be request-

ed to sign depend on the type of service your family is receiving and may include:

  Consent for CBCCF services

  Medical consent to treat a minor child in case of emergency

  Medical consent to treat a minor child using psychotropic medication

  Medical consent to treat for routine healthcare

  Consent to enroll a minor child in recreational activities

  Release/Request for information

  Consent for a Comprehensive Behavioral Health Assessment (CBHA)

RIGHTS AND RESPONSIBILITIES

Rights for Children in Foster Care:

  To be placed in a foster placement setting that best meets their emotional and physical needs;

to be placed with siblings whenever possible; and to be placed in an environment that helps

establish or maintain a healthy lifestyle.

  To have regular visitation with their parents or guardians, siblings, and other individuals with

whom they have a meaningful and positive relationship. To have regular visitation with their

Case Manager.

  To receive honest and complete information regarding any and all decisions affecting them

that relate to their case and to actively participate in the case planning process, appropriate

to age and ability.

  To attend any and all court hearings regarding their case.

  To have a Guardian ad Litem appointed as their advocate in judicial proceedings,

when they have been abused, neglected or abandoned.

  To be heard or to have a private conversation with their Case Manager, unless the law

requires the Case Manager to notify someone in authority of suspected abuse or neglect

or life threatening situation.

Responsibilities for Children in Foster Care:

 To tell their Case Manager and foster parents when something is wrong or they have concerns.

 To attend school and ask for tutoring assistance, if needed.

 To follow the rules of the home they are living in. To ask politely if they don’t understand

why something is a rule.

Rights for Parent(s) or Legal Guardian:

 To be treated as individuals and with respect.

 To have custody of their child, unless it has been demonstrated that this would jeopardize

the child’s health and welfare.

 To be provided with opportunities to demonstrate their capacity to provide a suitable home

for their child; to regain custody of their child as quickly as possible, when regaining custody

is consistent with the health and welfare needs of their child.

 To receive proper and adequate notice regarding any grievance or legal proceeding

concerning their child.

 To participate in the case plan, receive a copy of the case plan, and receive notice

of any review of the case plan.

 To visit and communicate with their child(ren) within reasonable guidelines, as set by

the family services case plan and the court.

 To have their cultural, religious, ethnic and/or racial heritage respected.

 To receive a detailed report describing the goals that must be met according to the case plan.

 To have information kept confidential, unless the law requires the Case Manager

to notify someone in authority of suspected abuse, neglect or a life-threatening situation.

Responsibilities for Parent(s) or Guardian:

When children are placed out of the home, this does not mean that the parent does not have any

responsibility for the child. While children are placed in foster care, parents have the responsibility:

 To participate in planning for their child(ren)’s needs to the extent they are able,

including financial, clothing, mementos, pictures, and familiar items from their home.

 To participate in assessing the services and support the family needs to achieve reunification

as indicated in the case plan.

 To maintain contact and regular visitation with their child(ren) in care.

 To notify their Case Manager of any changes in their lives (change in address, employment,

health status, or other circumstances) related to their participation in the family services case plan.

 To make decisions about their child(ren) that are legally theirs to make, such as consenting

to medical and surgical treatment, to marriage, or to service in the armed forces.

 To provide for the care, safety and protection of their child(ren) during visitation

(at home or supervised).

Responsibilities for Foster and Adoptive Parent:

 To prepare their own children and family regarding the impact that fostering/adopting

may have on them.

 To assist the child(ren) in understanding and appreciating the heritage received

from their parents or guardians.

 To keep the child safe and provide for their physical, educational and emotional needs.

 To give the child(ren) unconditional love and acceptance, with the understanding

that many children may not be able to give it back.

 To keep your Case Manager informed of the child’s response to care, visitation and progress in school.

 To ensure that the child receives preventative and medical, dental and vision evaluations

and care as set forth in the periodicity schedule.

 To facilitate and/or supervise visitations between parent-child and siblings

in accordance with the case plan.

PLANNING AND ACCESSING SERVICES

Case Managers provide different levels of care to children and families depending upon the identified

needs of the family. These services may include in-home family preservation services, court supervised

in-home family preservation services, court supervised out-of-home placement services, and pre-adoption

and adoption services.

Your Case Manager will work closely with you and your family to complete an assessment of your family’s

needs, identifying your family service team, and completing your family services case plan. The family

services team will include you, your child(ren) and family, the Case Manager and Supervisor, Guardian

ad Litem, DCF attorney, your attorney and service providers that are active in your case and who will be

assisting you in achieving your case plan goals. These meetings are facilitated by CBCCF operations

staff. You will help identify other members of the family services team, who may include: relatives,

representatives from your child’s school, a pastor, etc. The family service team meeting is held in the first

month following referral for all children placed in out-of-home care, and then every 3 months thereafter,

until the child is reunified or other permanency is achieved for the child.

Your Case Manager may refer you to a network of community-based service providers that will assist you

in achieving your family services case plan goals. The Case Manager will coordinate and monitor those

services to ensure that you are in fact receiving them and that you are making progress. When required,

the Case Manager will provide the court with a progress report outlining the goals and achievements.

Furthermore, the Case Manager may make recommendations to the court regarding changes in services

and/or level of care.

Your Case Manager will meet with you in person each month to review your case plan, your progress,

and to determine if there are any needed changes to your services. Should you have any questions,

concerns, or problems, please feel free to contact your Case Manager or their Supervisor.

CBC OF CENTRAL FLORIDA’S

CLIENT GRIEVANCE PROCEDURES

Community Based Care of Central Florida (CBCCF) is committed to providing the highest quality

of service to children and families. Contained in this commitment are the processes to facilitate the resolution of

complaints related to services. It is the intention of CBCCF to address complaints in an effort to assure

client safety, program effectiveness and community confidence in our services.

If you need to file a complaint, here are the steps to follow:

Step 1: First try to resolve the issue with the individual involved (Case Manager or Supervisor).

Sometimes problems can be easily resolved at the source.

Step 2: If your issue is still not resolved, contact your assigned Case Management Agency Program

Director (person who has direct authority over the Case Management Agency Supervisor).

Step 3: If your issue is still not resolved, you can call the CBCCF Administrative Support Office at

321.441.2060 and identify the nature of your call as: Service Complaint. Brief screening

information will be requested and then forwarded to the appropriate CBCCF Executive Director in the

county where is your case is assigned. The CBCCF Executive Director (or designee) will return your call

as soon as possible, but no later than 24 business hours, to obtain additional information and to address

issues that can be readily resolved.

You may also make a service complaint utilizing the Feedback feature on our website:

www.protectandinspire.org or specifically www.cbccfl.org/suggestions/

If you leave your contact information, you will receive a response by the next business day. The person

who contacts you will help you connect with the appropriate resources to review your issue or concern.

Our goal is to resolve any conflict that you are experiencing.

Step 4: If you are not satisfied with the resolution of your complaint, this must be addressed with the

CBCCF Executive Director. After discussion, if you are still unsatisfied, you may request an internal review

by the CBCCF President/CEO, Glen Casel, who may be reached at 321.441.2060.

MANAGEMENT AND PROTECTION

OF PERSONAL HEALTH INFORMATION POLICY

(HIPAA)

This notice describes how protected health information about you may be used and disclosed and how

you can get access to this information. Please review it carefully.

I. CBCCF’s Duties as They Relate to Your Protected Health Information (PHI)

CBCCF’s records about you contain health information that is very personal. The confidentiality of this

personal information is protected by federal and state law. CBCCF has a duty to safeguard your Protected

Health Information (PHI), which includes individually identifiable information about:

 Your past, present or future health or condition

 Provision of health care to you

 Payment for the health care considered PHI

CBCCF is required to:

 Safeguard the privacy of your PHI

 Give you this Notice which describes our privacy practices

 Explain how, when and why we may use or disclose your PHI

Except in very specific circumstances, CBCCF must use or disclose only the minimum PHI that is necessary

to accomplish the reason for the use or disclosure. CBCCF must follow the privacy practices described

in this Notice; however, CBCCF reserves the right to change the terms of this Notice at any time

and to make the new Notice provisions effective for all Protected Health Information (PHI) that we receive,

disclose or maintain. Should CBCCF’s Notice change, CBCCF will post a new Notice in the lobby

of each office.

Why CBCCF May Need to Use or Disclose Your PHI:

CBCCF’s uses or discloses PHI for a variety of reasons. For some of these uses or disclosures, CBCCF must

have your written authorization. For some, the law permits CBCCF to make some uses or disclosures with-

out your authorization.

Generally these uses or disclosures are related to treatment, payment or health care operations.

Some examples of these uses or disclosures are:

 For Treatment: CBCCF may disclose your PHI to doctors, nurses and other health care

personnel who are involved in providing for your health care. For example, your PHI

will be shared among members of your treatment team.

 To Obtain Payment: CBCCF may use or disclose your PHI in order to bill and collect payment

for your health care services. For example, CBCCF may release portions of your PHI

to Medicaid to get paid for services that CBCCF has given or provided for you.

 For Health Care Operations: CBCCF may use or disclose your PHI in the course of operating

agency. For example, CBCCF may use your PHI in evaluating the quality of services provided,

or disclose your PHI to our accountant or attorney for audit purposes.

 To Remind You of Appointments: Unless you provide CBCCF with alternative instructions,

CBCCF may send appointment reminders and other similar materials to your home.

Uses and Disclosures for Which CBCCF Requires Your Authorization (consent):

 When the use or disclosure goes beyond treatment, payment, or health care operations,

CBCCF is required to have your written authorization. There are some exceptions to this rule,

and they are listed below.

 Authorizations can be revoked by you at any time to stop future uses or disclosures, except

where we have already used or disclosed your PHI in reliance upon your authorization.

Uses and Disclosures for Which CBCCF Does Not Require Your Authorization:

The law permits CBCCF to use or disclose your PHI without written authorization in the following

circumstances:

 When a Law Requires Disclosure: CBCCF may disclose PHI when a law requires that CBCCF

report information about suspected abuse, neglect or domestic violence, or in response to a court

order, or to a law enforcement official. CBCCF must also disclose PHI to authorities who monitor

CBCCF’s compliance with these privacy requirements.

 For Public Health Activities: CBCCF may disclose PHI when CBCCF is required to collect

information about diseases or injuries, or to report vital statistics to a public health authority.

 For Health Oversight Activities: CBCCF may disclose PHI for health oversight activities

such as audits, inspections, civil or criminal investigations or actions.

 Relating to Decedents: CBCCF may disclose PHI relating to an individual’s death

or to coroners, medical examiners or funeral directors.

 For Organ, Eye or Tissue Donations Purposes: CBCCF may disclose PHI to organ procurement

organizations relating to organ, eye or tissue donations or transplants.

 For Research Purposes: In certain circumstances, and under supervision of a privacy board

or institutional reviews board, CBCCF may disclose PHI for research purposes.

 To Avert Threat to Health or Safety: In order to avoid a serious threat to health or safety,

CBCCF may disclose PHI as necessary to law enforcement or other persons who can

reasonably prevent or lessen the threat of harm.

 For Specialized Government Functions: CBCCF may disclose PHI of military personnel

and veterans in certain situations, to correctional facilities in certain situations, to government

programs relating to eligibility and enrollment, and for national security reasons, such as

protection of the President.

 For Worker’s Compensation: CBCCF may disclose PHI to comply with workers’ compensation laws.

Uses or Disclosures for Which You Must be Given an Opportunity to Object:

Sometimes CBCCF may disclose your PHI if CBCCF has told you that CBCCF was going to use or

disclose your information and you did not object. Some examples are:

  Patient Directories: Your name, location, general condition and religious affiliation may be put

into CBCCF’s patient directory for use by clergy and callers or visitors who ask for you by name.

  To Family, Friends, or Others Involved in Your Case: CBCCF may share with these people

information directly related to your family’s, friends’ or other person’s involvement in your case,

or payment of your care. CBCCF may also share PHI with these people to notify them about

your location, general condition or death.

If there is an emergency situation and CBCCF does not have time to allow you to object to the disclo-

sure, CBCCF may still disclose your PHI if you have previously given your permission and disclosure

is determined to be in your best interests. If CBCCF does this, you must be informed and given

an opportunity to object to further disclosure as soon as you are able to do so.

II. Your Rights as They Relate to Your Protected Health Information (PHI)

You have the following rights relating to your PHI:

  To Request Restrictions on Uses or Disclosures: You have the right to ask that CBCCF limit how

CBCCF uses or discloses your PHI. CBCCF will consider your request, but is not legally bound

to agree to the restriction. To the extent that CBCCF does agree to any restrictions on CBCCF’s

use or disclosure of your PHI, CBCCF will put the agreement in writing and abide by it except

in emergency situations. CBCCF cannot agree to limit uses or disclosures that are required by law.

  To choose how CBCCF contacts you: You have the right to ask that CBCCF send you

information at an alternative address or by an alternative means. CBCCF must agree to your

request as long as it is reasonably easy for CBCCF to do so.

  To Inspect and Copy Your PHI: Unless your access is restricted for clear and documented

reasons, you have a right to see your protected health information if you put your request in

writing. CBCCF will respond to your request within 30 days for PHI CBCCF keeps on site,

and within 60 days for PHI that is not kept on site. If CBCCF denies your access, CBCCF will

give you written reasons for the denial and explain any right to have the denial reviewed.

If you want copies of your PHI, a charge for copying may be imposed.

  To Request Amendment of Your PHI: If you believe that there is a mistake or missing information

in CBCCF’s record of your PHI, you may request, in writing, that we correct or add to the

record. CBCCF will respond within 60 days of receiving your request. CBCCF may deny the

request if CBCCF determines that the PHI is:

a) correct and complete;

b) not created by CBCCF or not part of CBCCF’s records; or,

c) not permitted to be disclosed.

A denial will state the reasons for denial. It will also explain your rights to have your request, CBCCF’s

denial, and any statement in response that you provide, added to your PHI.

If CBCCF approves the request for amendment, CBCCF will change the PHI and inform you, as well as

tell others who need to know about the change in the PHI.

  To Find Out What Disclosures Have Been Made: You have the right to get a list of when,

to whom, for what purposes, and what content of your PHI has been released, except for

instances of disclosure that were made for treatment, for payment, for health care operations,

to you, per a written authorization, for national security or intelligence purposes, to correctional

institutions or law enforcement officials, or for the facility directory. The list also will not include

any disclosures made before October 1, 2004.

CBCCF will respond to your written request for such a list within 60 days of receiving it. Your request can

relate to disclosures going as far back as CBCCF’s inception. There may be a charge for such requests.

  To Receive a Copy of This Notice: You have a right to receive a paper copy of this Notice.

III. How To Complain About Our Privacy Practices

If you think CBCCF may have violated your privacy rights, or you disagree with a decision CBCCF made

about access to your PHI, you may file a compliant with the person listed in Section IV below. You also may

file a written complaint addressed to the following: Florida Department of Children and Families, Office of

Civil Rights, 1317 Winewood Boulevard, Building 6, Room 124, Tallahassee, Florida 32399-0700,

850.487.1901. CBCCF takes no retaliatory action against you if you make such complaints.

IV. Contact Person For Additional Information, or To Submit A Complaint

If you have questions about this Notice, need additional information, or have any complaints about our

privacy practices:

Contact Gerry Glynn, Chief Legal Officer, Community Based Care of Central Florida, Inc. at

321.441.1572

Or write Community Based Care of Central Florida, Inc. at 4001 Pelee Street, Orlando, FL 32817

Fax 407.681.0560

ACKNOWLEDGEMENT OF RECEIPT FORM

I, _____________________________ , acknowledge that I have received the Client Information Guide

for Community Based Care of Central Florida, Inc. This includes Management and Protection of Personal

Health Information Policy as required by Health Insurance Portability and Accountability Act (HIPAA).

My initials and signature below indicate that I have received, read and understand CBCCF’s service

delivery procedures.

Please initial each line item indicating that you received the CBCCF’s Client Information Guide

and that it contained information on each of the following subjects:

______ My rights as a CBCCF client have been reviewed with me.

______ I understand that the staff providing services will meet professional standards and requirements

pertinent to the services provided.

______ I understand that CBCCF staff are mandated to report suspected child abuse, neglect,

or information that is life threatening to the appropriate authorities.

______ I understand risks and benefits are associated with services and have discussed service

specific concerns with CBCCF staff or my assigned Case Manager, if applicable.

______ I agree to attend scheduled appointments and to call 24 hours in advance to cancel

when I cannot attend.

______ Unless otherwise court ordered, I understand that I have a choice to participate

in the services provided by CBCCF.

______ I understand that if a crisis situation arises (a non-life threatening situation):

During business hours, I can call 321-441-2060 for immediate assistance;

After hours, I can call CBCCF Intake and Placement at 407-304-8444.

______ I understand that my treatment, payment, enrollment, or eligibility for benefits

will not be conditioned on whether I sign this authorization.

______ I understand that information used or disclosed pursuant to this authorization

may be disclosed by the recipient and may no longer be protected by federal or state law.

______ Information regarding HIPAA has been provided to me through provision of this

Client Information Guide, and contained herein.

_______________________________________ _________________________________________

Parent/Client Signature Date CBCCF Staff/Case Manager Signature Date

NOTE: Original Acknowledgement of Receipt form is to be signed by the client and filed in the client’s

record to document receipt of the above information.

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