Transitions
Forms, forms and more forms
Internal Referrals/Services
Case Note vs. Service
Who does it go to?
100

The people who attend a transition meeting

Who are the Site Director, Family Advocate/Home Visitor, Teachers and support staff. Including, HS, NS, MH and Dis. as needed

100

The form used by FA/HV's and sent to enrollment to request a change of placement or an age up. 

What is the Transfer Request form?

100

A family comes to use asking for information on rental assistance because they can't pay their rent. What are your next steps? 

What is connect family to Community Resources and Advocacy and/or RAFT? 

Then....????

100
FA/HV signed a family up for Holiday Help? 

What is a service? 

100

Child's Updated Physical

What is sent to the Health Office with a "cc" to the FA or HV and the Health Services Assistant? 

The Health Office and Health Services Assistant (if working with one) is notified of any appointment dates if obtained via email.  An update is added to the Internal Referral with any new information.

200

The person who coordinates the transition meeting between the current placement and the new placement. 

Who is the Outgoing Advocate/Home Visitor/FCC Advisor. 

200

This form is used when a parent wants the teachers to apply diaper rash cream.

What is the Authorization to Administer Medication form?

200

You receive a Internal Referral from NS indicating potential food insecurity issues as stated on Nutrition Questionnaire. Your next step would be? 

What is provide family with information on local food pantries, SNAP and WIC? 


200

FA calls the family and asks if they could send in changes of clothing for the classroom. 

What is a case note? 

200

An officer of the court hands you a subpoena form which is instructing you to provide the child's file to the court on XX/XXXX date.

What is the Family Services Manager?

Whenever a court order is received at your site for any reason the FSM must be immediately notified and a copy provided for review.  The FSM will instruct you on next steps.

300

The person who completes the Transition Checklist and Meeting summary for the file.

Who is the Outgoing Family Advocate/Home Visitor?

300

The form to assist FA/HV's in obtaining eligibility documentation.

What is the Head Start Eligibility form? 

300

You attempt to follow up on an Internal Referral regarding a missing physical and there is no IR. What do you do? 

What is enter it as a service? Once the IR is generated, close out the service stating, "please see follow up in IR dated XX/XX/XXXX."

300

FA/HV will provide fuel assistance information as stated in an FPP goal.

What is a service?

300

Parent Interest Survey

What is scanned to MHS Request email and FSM? 

The Parent Interest Survey is coalated and used to plan the sites parent trainings and Family Meeting topics.

400

The person who sends out the EDF when a child transitions from one program option to another. 

Who is the Incoming Family Advocate/Home Visitor?

400

On any health plan, the parent needs to complete what in order for plan to be approved by HS.

What is Parent contact information, emergency contact information and parent/guardian consent? 

400

You receive an internal referral for a missing dental. What are your next steps? 

What is talk with family about missing dental, provide information on the importance of dental care and a list of local dentists? 

400

FA/HV call family to confirm attendance at the Touchpoints parenting group?

What is a case note? 

400

Transportation Change/ Request form

What is the Transportation Office? 

hselptransitoffice@communityaction.us

500

The two people who should be invited to a transition meeting if a child has a severe allergy to dairy products. 

Who are the Health Specialist and Nutrition Specialist. 

500

This form is required for any family working with DCF in order for our program staff to communicate.

What is the DCF release?

500

You see an Internal Referral related to a High Score on a ASQ-SE. What do you do? 

What is nothing? 

This IR is to be followed up by Mental Health. 

500

Parent asks FA/HV for a list of local dentists.

What is a service?

500

The Test and Stay form.

What is they get uploaded to GoEngage, entered into monitoring worksheet and placed in the permissions section of the child's file. Once the consents are signed the site COVID Tracker List should be updated indicating if the child is participating in the test and stay program or opting out?  

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