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Meghan Franklin, MSWCatholic Community ServicesFamily Preservation Systems
Bridging the GapBetween Field and Charting
+Overview
Treatment Process
CSS in the treatment process
Progress Notes
+Treatment Process
Youth is referred to services either by a mental health organization (Washington, Clackamas, Multnomah, FamilyCare) or Emergency Department
Common risk factors include: Aggression / assaultive Self-harm / depression Lack of age appropriate boundaries Difficulty with peers / siblings Impulsivity History of residential living
+
Treatment Process Continued…
Qualified Mental Health Professional assesses youth / family
Current risksDevelopmental stagesFamily history/traumaFamily dynamicsDiagnosis
Treatment planDeveloped with youth, family, significant othersGoal oriented, with concrete steps to obtain goal
Where do CSS’s fit into this process?Your role is to carry out the steps to the treatment
plan
What does that look like? Establish trust and understanding with youth & family
Teach / Model / Mentor / Coach Social skills Age appropriate behavior
Focus on strengths, successes, needs & creative solutions
Connect youth/family to community activities/resources
Focus on successes experienced during activity/session; relay to family & clinician
+
Services CSS Provides
Activity Therapy
Individual Skills Training
Case Management
Respite Care
Wraparound
Crisis Intervention
+
Activity Therapy
YES
NO
• Face-to-face sessions with the Youth and/or Family Members• Developing self-care/life skills• Educational support
• Babysitting siblings• Medical appointments• Transportation UNLESS you can
clearly document you are working on a skill.
+
Case Management
YES
NO
Face-to face activities related to resource assistance
i.e. locating places for youth to volunteer, assisting youth obtain food handlers’ card for employment, food boxes for the family,
Non face-to-face activitiesi.e. picking up supplies for home
repair, picking up prescription, dropping off clothes to respite home
+
Respite Care
YESFace-to-face session to youth/family monitoring behavior, mentoring, introducing/encouraging age appropriate recreational activities
Used also by non-QMHA’s
+
Wraparound
YES
NO
Face-to-face sessions focusing on skills training, mentoring, promotion of successful community living, monitoring behavior, educational support
Sessions conducted at the CCS office
Multnomah County Only
+
Crisis Intervention
YES
NO
Response to unplanned intervention when youth is threatening harm to self/others or their mental health/emotional functioning is limited.
Use by non-QMHA’s
FamilyCare & Multnomah County Only
+
Steps in WritingProgress Notes
1. Identify how the activity relates to the treatment plan.
2. List the skill(s) you worked on.
3. How did you work on the skill versus where did you work on the skill?
4. Was the youth able to perform the skill? How do you know this?
5. Youth’s Response to session.
+Identify
Before your shift, get in touch with the clinician and specifically ask,
Check the box that corresponds to the treatment issue you worked on the most throughout the session
How does the activity relate to the treatment plan?
“What is the therapeutic intent of the session?”
1
+ListWhat skill(s) did you work on? Be specific! 2
Generic Specific
Model/teach positive coping skills
Work through ways of dealing with anxious (angry, sad) feelings
Support academic/vocational improvement
Staying on task, not interrupting other
students & completing class work
+How
What did you do to work on the skill NOT where did you go to work on the skill.
Conversation related to…. Role-played, Prompted, coached Provided clarification Challenged narrow thinking about an issue Formal problem solving around the event Empathetic/supportive environment on your
part Normalization of feelings/situations Reminded youth of breathing and
visualization exercises Engaged in outdoor activity / physical
activity/ peer related activity
How did you work on the skill(s)? 3
Use your Cheat Sheet!
+DemonstrateHow did the youth demonstrate/fail to demonstrate the skill(s)?
4
Youth was able to ________________ by identify skill/demonstrate skill
________________________________. Your observations? Youth’s action/words? Any prompting?
+DemonstrateExample 4
Youth was able to remain calm instead of getting angry by counting to 10, taking deep breaths and then talking about the trigger of his anger.
+Youth’s Response
Include:
Your observations about the client’s physical or emotional state related to session.
Always use terms such as “seemed,” “appeared,” and “gave the impression.”
How did youth appear to feel about the session?
5
Exclude anecdotal information:Youth was happy to see meYouth waved goodbye to meIt was a good session.Youth said, “I like hanging out with you!”
+Youth’s Response
“Youth appeared withdrawn for most of session and agreed to
talk with therapist about her feelings of
sadness”
Examples
+Youth’s Response
“Youth appeared withdrawn for most of session and agreed to
talk with therapist about her feelings of
sadness”
Examples
“After working through his frustration, the youth gave the impression that he could use his anger management skills in
other situations.”
“Youth appeared defensive at first, but warmed up after finding common
interests.”
+Odds & Ends
Sign your name with your credentials
If you make a mistake Draw a single line through the mistake Initial it Mistake must be visible, do not scratch/black it out
The little things…
January 25, 2010
February
If shifts are more than 2.5 hours in length put them in Desiree’s Box(This does not apply to BRS DSS’s)
+Practice D.S.S.’s
In Steps One, Two, and Three
+Step 1
Youth: __________________ Staff: ____________________
Service Date: ______________________
Start Time Duration Location
Service Modality Psych Consult
Individual Skills Training
SKILL
Respite RESIN
Group Activity ACTIVITY
Case Management CASE
Zach Galifianakis John Doe
10/7/2010
10:00 am 120 OT
ALWAYS in MinutesCodes: *Found on the bottom of the D.S.S.HM = Home RH = Relative Home OF = OfficeFH = Foster Home SCH = School OT = CommunityDO = DHS ER = Emergency Room GH = Group HomeHS = Homeless Shelter IP = Inpatient Psychiatric FacilityJV = Juvenile Court JD = Juvenile Detentional FacilityRT = Psychiatric Residential Facility
1
+Step 2
Those Present: _______________________________________
2
Identifying & Verbalizing Feelings
Model/Teach appropriate social interactions skills
Support academic/vocational improvement
Asses environment for risk and/or modify to promote a safe environment
Aid youth/family in accessing/maintaining community resources[food, housing, utilities]
Family support to increase/educate parenting techniques, boundaries,Structure in home
Develop effective problem solving skills
Positive coping & self-control skills
Crisis Only: Provide supervision for safety
John Doe & Z.G.
Or “This W
riter a
nd
Zach Galifianakis”
Only
chec
k
ONE
box
+Step 3 3How did you work on the skill(s)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How did the youth demonstrate/fail to demonstrate the skill(s)?
Signature with educational credentials
Date
________________________________ ___________________________10/08/2010
+Timesheet & Log
+CSS All Time Log
CSS Name:______________________ Pay Period:____________________
Date Client DirectTime
Where Driven Mileage Travel Staff Paper
10/07 Z.G. 2.0 PDX – ZG – Mt Scott – ZG - PDX
25 1.0 0.25 0.25
DIRECT TRAVEL INDIRECT
John Doe10/10/10 - 10/23/10
+Timesheet
COMPLEMENTARY STAFF BI-WEEKLY TIMESHEET
FAMILY PRESERVATION SYSTEM
HOURS WORKED Employee's Name:
D H I H V T T
I O N O A R I
Employee's #:
R U D U C A M
E R I R A V E
Pay Period:
C S R S T E
T E I L
Office: FPS-Portland
C O
T N
Travel
Day Date From To Miles
Sun
Mon
Tues
Wed
Thu
Fri
Sat
Total Week 1 0.00 0.00 0.00 0.00 0.00
John Doe
10/07/10 2.0 0.50 1.0 PDX ZD 25
# ON PAYCHECK10/10/10 - 10/23/10
Numbers will
self-total in
Excel
spreadsheet
DOUBLE CHECK
+
“Thank You”