Demographics
Assessment
Services
Coordination
Extras!
100

This document is completed within 365 days and reviews agency/program specific information, such as rights, financial obligations, expectations, and policies.

What is CONSUMER ORIENTATION CHECKLIST.

The consumer orientation checklist helps the family understand the expectations of the program.  Needs to be updated at a minimum of every 365 days and needs to be signed by the parent or guardian.

100

Health Screens are found where on the consumers chart

What is MEDICAL SERVICES or CHART DOCUMENTS

100

This document indicates that the parent/guardian is in agreement with the plan and requires a signature

What is AN IPOS

IPOS must be signed by parent/guardian to show that they agree with the services that are being provided. If it is not signed, the document is invalid. 


100

You email these people when you need a HCCN sent out

Who is CRYSTAL, AMANDA, and CAROLYN

100

Deondra Stallings, Kenda Herrick, Jonathan Albert, Lindsey Hosmer, and Lisa Whitson

Who are MEMBERS OF COMMUNITY TEAM

200

This form gives permission to coordinate care with primary care doctor and schools.

What is CONSENT TO EXCHANGE HEALTH INFORMATION. 

This needs to be completed annually to allow coordination with the school. If the consumer switches schools, we would need a new consent. If a consumer is home schooled, it needs to be documented in the BPSA. 

If a release for a PCP is not current, medication letters, program changes, hospitalizations, a health care coordination letters can not be completed.


200

Health Screens and BPSAs are completed at this frequency

What is 365 DAYS

The BPSA Update and Health Screen need to be competed BEFORE the IPOS in order to justify medical necessity and continued services. 

200

Quarterly reviews are completed within what time frame

What is 80-90 DAYS

Quarterly reviews must be done within 80-90 day time frames and are stated in the IPOS.  This is a good time to review progress from clinician and family perspectives.  Give a combination of quotes and ensure there is an update for ALL objectives. Complete CAFAS to show progress.

Wraparound Quarterly Reviews also review each task, team member participation, previous/current CAFAS, and outcome measurements. 
200

This document is sent to the PCP when families start Wraparound services

What is HEALTH CARE COORDINATION NOTICE

200

This safety plan is included in the IPOS

What is IPOS SAFEGUARD PLAN

This document outlines family's crisis situations and safety risks and outlines steps to respond. 

300

Prior to a medication being prescribed, a parent/guardian must sign this.

What is A MEDICATION CONSENT.

When a new medication is prescribed, the consent needs to be signed stating that side-effects and education have been provided regarding the medication.

300

An assessment tool that is used quarterly to monitor progress

What is CAFAS/PECAS/DECA

Depending on the child's age, the above assessments need to be completed quarterly and scores placed in the quarterly review.  If the child is DD, these are not applicable.

300

Relapse Prevention/Crisis plans are completed within what timeframe

What is 365 DAYS

RPPs are also updated anytime there is a new safety concern identified. 

300

This document is sent to the PCP when medications are changed

What is a HEALTH CARE COORDINATION NOTICE

300

These documents need to be signed by staff

What is ALL OF THEM


Please sign your notes and any other documents that require your signature :)

400

Annual documentation must be completed within this time frame

What is 365 DAYS

All annual documents need to be completed within 365 days: Consent to Treat, BPSA, Notice of Privacy Practices Notification of Rights, Health Screen, etc
400

This comprehensive document is reviewed annually and includes consumer’s strengths, abilities, needs, and preferences.

What is a BPSA UPDATE

BPSA updates must include:

·       Brief Description of the Individual: Age, education, family/social history, placement changes, trauma history, sexual history

·       Reason individual is seeking services: changes in mental status (hallucinations, memory, affect, mood)

·       Individual’s acceptance or understanding of his/her needs/problems

·       Individual/family’s apparent strengths and functional limitations: Include SNAP format for individual and family; Strengths, Needs, Abilities, Preferences (from consumer, parent, and clinician view point)

·       Potential barriers to community inclusion/integration and successful movement toward recovery:

·       Complicating conditions/disorders (including substance abuse and medical conditions): Medical history, substance use/abuse history for individual and family, safety concerns

·       Strategies for relapse prevention

·       Risk verse Choice issues

·       Explanation of goals to be worked on

·       Rating Scale (DECA, PECFAS, CAFAS)

400

These are people that support the consumer but are not paid

What are NATURAL SUPPORTS

Natural supports include parents, friends,  relatives, volunteers, church members that assist in meeting the client/family needs and should be included in the IPOS. 

400

Coordination with the school is found in these documents

What is CONTACT NOTE, PROGRESS NOTE, and/or LETTER

Coordination with the school must be thoroughly documented within the chart. Ideally, the school is invited to the Wraparound team. 
400

These people can consent to services and sign documents. 

Who are PARENT/GUARDIANS

Documentation must be in the chart to show proof of adoption, guardianship, or 3765.

500

This is where you can find evidence of assessment of need for advance directive

What is INPUT FOR IPOS

During the Input, the need for Psychiatric Advance Directives is evaluated and discussed with parents. This box must be checked.



500

BPSAs and BPSA Updates are completed _____ the IPOS

What is BEFORE

BPSAs document the need for continued service and also show changes from the previous year. 

500

These documents need to be completed following a psychiatric hospitalization.

What is  BPSA, IPOS AND RELAPSE PREVENTION CRISIS PLAN

These documents are updated to explain what led to the hospitalization, what needs to be done differently, and demonstrate increased contact needed.

500

Coordination with this entity should support medical necessity 


What are SCHOOLS

Coordination with schools demonstrate the need for services.  At our level, clients typically have issues in numerous life domains and this supports medical necessity.  When visiting a school, be sure to include talking to staff.

500

These documents must be in the chart to show proof of who can consent to treatment. 

What is PROOF OF GUARDIANSHIP, ADOPTION PAPERWORK, OR DHHS 3765.

In order to consent to treatment, we need verification of adoption, guardianship, or foster care. If they are not in the chart, the documents they have signed are not valid.