OT/PT DeptAwaiting Service to Active

Contact family to set appointment

On the day you first try to call

the family, discharge from AWAITING SERVICE,

re-admit to ACTIVE

Casenote in ACTIVE while you try to contact the family,

and until you are finished the assessment

If there is no intake on file, go to page 4,then come back here

Determine how frequently you plan to see the child

If < every 3 months, then discharge from ACTIVE,

(you will be cued to enter a discharge Needs

Assessment). &re-admit to MONITORING

If > every 3 months,leave in ACTIVE

Complete Initial Needs Assessment within 90 days (if you did not see

the child, skip this)

Write report within 3 months of

initial contact

Provide Intervention.•Casenote all contact within three working days•Create goals with family. Review at least every 6 months•Update Needs Assessment at least every 6 months. •Write full progress report at least every 12 months

Start HERE

If unable to contact, callreferral source. If still unable to

contact after writing letter, discharge. Let other OSNS programs know

you were unable to contact.

Check with other OSNSprograms about their

involvement with the family

If we have consent for outsideagencies (eg IDP), check

with them about their involvement with the family

Page 1Jan 2010

See Page 4

See Page 6

See Page 3

See Page 5

Discharge from services

OT/PT DeptAwaiting Service to Consultation

Contact family to set appointment

On the day you first contact

the family, discharge from AWAITING SERVICE,

re-admit to CONSULTATION

Casenote in CONSULT until you are finished

your involvement

If there is no intake on file, go to page 5,then come back here

Complete Initial Needs Assessment within 90 days (if you did not see

the child, or dischargedright away, skip this)

If no concerns, discharge from services and let other team members know

Start HERE

If unable to contact, callreferral source. If still unable to

contact after writing letter, discharge. Let other OSNS programs know

you were unable to contact.

Check with other OSNSprograms about their

involvement with the family

If we have consent for outsideagencies (eg IDP), check

with them about their involvement with the family

See Page 4

See Page 6

See Page 3

Page 2Jan 2010

Guidelines & Paperwork

Important to explain to parents that this is not service. Child is still on waitlist. We want them to understand that true therapy service is much more detailed and comprehensive and intensive. We are just trying to do the best we can with our waitlist.

Use 1-3 visits to complete your screening/ consultation

Leave child in CONSULT when you are finished

your involvement

Chart your detailed observations in CONSULT case notes.

Provide family with:

•Short letter/report summarizing observations and recommendations•Home programming suggestions•Who to call with questions •Provide a list of groups we run that theirchild might be appropriate for (includingSummer Program)

Update consent forms if thingshave changed since intake.

Generally don’t use standardized assessments – just a screening opportunity. If you really

don’t feel you see the whole picture, you can use an assessment to help.

These children can be seen byTSW if that seems appropriate.

Make Internal Referral See Page 5

OT/PT DeptHOMES – Discharge & Re-admit

Discharge

Choose ‘discharge’ from File Folder

drop down menu

From the HOMES casenote page (of the

current OT/PT programof the client)

From the HOMES Main page

Complete the fields in blue(date, discharge date etc)

For moving between OT/PT programs:6. Next Step Program7. N/A

Choose ‘Discharge,Closure, or Transfer Report’ under “Case

And Outcome Management”

Type in client name and click ‘Search’.

Choose correct program.

Complete the fields in blue(date, discharge date etc)

For moving between OT/PT programs:6. Next Step Program7. N/A

Re-Admit

From the HOMES Main page

Choose ‘Readmit a Client & Student’under “Case Demographics”

Click on the drop down envelope to the right of

1. Client/Student.

Type in client name and click ‘Search’.

Choose correct client.

Complete the fields in blue

3. Choose the OT/PT program you areadmitting the child to

5. Select the MOST RECENT ‘Intake and Case management’ Program

7. Do NOT “Check All”

Page 3Jan 2010

OT/PT DeptHOMES - Needs Assessments (NA)

Open client in HOMES underthe program he is

currently enrolled in. In the ‘File Folder’ tab, choose

Initial Assessment

Rate the needs appropriately, then SAVE. If child has just

transferred from another programthis initial NA should be the

same as the D/C NA in previousprogram

Open client in HOMES underthe program he is

currently enrolled in. In the ‘File Folder’ tab, choose‘Progress and Updated

Service Plan’

PRINT: click Reports tab at the top. Then choose

“Program Needs Assessment”. Right click to print

First time Needs Assessmentin this HOMES program

Repeat Needs Assessmentwithin same program

Rate the needs appropriately, then SAVE.

PRINT: click Reports tab at the top. Then choose

“Interim Outcome Reports”. Choose “Pre to Interim Post”.

Right click to print.

Discharge Needs Assessment(either to move to new program

or to discharge altogether)

When you choose “Discharge”from the file folder tab, you

will be cued to enter a discharge NA

Rate the needs appropriatelythen SAVE

PRINT: click Reports tab atthe top. Then choose

“Outcome Reports”.Choose “Pre to Post Program

Needs Assessment”. Right click to print

What if I want to add a new Need when it is identified during one of the Repeat NAs?

Go back to the Initial NA inthe CURRENT OT/PT program

Without changing the date,enter the new need in this NA and rate it as you see it today

It will then appear on allthe subsequent NAs until today’s. That’s okay. It is not counted in outcomes

until it changes.

When you want to re-rate itduring the next NA, it will be

there to record a change

Page 4Jan 2010

OT/PT DeptHOMES – Discharge Forever

When discharging a child from OT/PT Department (not just between programs)

Complete final needs assessmentIf applicable

2) will automatically come up. Enter 1-2 sentences to state reason for discharge.

Click “Save and continue to list”

On “Needs and Issues Addressed” page,choose “Program Measures” (top left side)

then “Program Report Comments”

Choose “Add All” on bottomright side under check boxes

1), 2), 3), on left side are now blue.Choose 1) and enter 1-2 sentences

to summarize your services. Then click“Save and continue to list”

Choose “Reports” from top lineClick “case reports”

Click “Discharge Report (Standard Version)”

Report will be on the screen. Right click and print. Sign and include in

your discharge file.

Page 5Jan 2010

OT/PT DeptSeeing a Child When No Intake is on File

Once the paperwork is done,put the intake form, and the

two consents in the Receptionist’s box.

Don’t worry about getting all the paperwork done on the first visit.

You can interact with the child and develop a rapport with him. Keep the

paperwork for the end of the visit, or even the next one.

If there is no intake on file, it is your job tocomplete one with the

family. This happens mostoften with the infants

who are referred.

Most of one visit will bededicated to sharing info aboutOSNS with the family, gatheringintake information, and getting

consents signed

On your first visit, take:•Intake form•Consent to Release Information•Consent to Service Agreement•Parent Handbook•Brochure

In the Main file, on the pink sheetat the front, fill in the bottom three

lines (parent handbook, intakeand consents) and initial.

If you feel the child is older, or the family circumstanceswould benefit from having the Family Resource Worker

complete the intake, feel free to make that request. Young infantsdon’t usually require a lot of time to gather info, but older ones (or

complicated ones) do and then the FRW can be called upon.

Now go back to Page 1When completing forms withparents/guardians, be sure to•Review complaint process•Explain parent rights•Read each bullet of Consent to Service agreement

Page 6Jan 2010