Comprehensive Child and Family Assessment/Wrap Around …



Comprehensive Child and Family Assessment/Wrap-Around Program FY14

*Create an Organizational Table that suits your Agency Staff. Use Legend on pg 2 to identify service provision.

Organizational Table for Sample Agency, Inc.

Current as of DATE

June 9, 2011

|Employee Name |Position Title |Degree/Licensure |Specialization |Services Providing |

|John Doe |Case Manager |M.S. |PC |518-24, 47, 56, 88 |

|Jane Doe |Assessor |LPC |N/A |511-29, 88 |

|John Doe |Paraprofessional |HS |N/A |518-56 |

|Jane Doe |Case Manager |M.A. |Criminal Justice |518-24, 47, 56, 71, 88 |

|John Doe |Paraprofessional |GED |N/A |518-56 |

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Comprehensive Child and Family Assessment/Wrap-Around Program FY14

*Create an Organizational Table that suits your Agency Staff. Use Legend to identify service provision.

Service Provision Legend

UAS 511 (CCFA) Entitlement Codes Authorized:

|Sub code |Type of Service |

|29a |Coordination of Medical/Dental/Health Check (ages 0-17) |

|29e |CCFA Assessments - 1st child |

|29f |CCFA Assessments - Each Additional child |

|29j |Relative/Non-Relative Care Assessment & Home Evaluation |

|29m |Updated CCFA Assessment - 1st child |

|29n |Updated CCFA Assessment - each additional child (ages 0-17) |

|29o |Cancelled/Incomplete Assessments |

|29p |Coordination of Trauma Assessment (ages 4-17) |

|88a |Court Appearance and/or Testimony (Licensed Professional Only |

UAS 518 (Wraparound) Entitlement Codes Authorized:

|Sub code |Type of Service |

|24a |Crisis Intervention/Prevent Disruption - (Licensed) |

|24b |Crisis Intervention/Prevent Disruption - (Degreed) |

|47a |Crisis Intervention/Behavior Mgmt - (Licensed) |

|47b |Crisis Intervention/Behavior Mgmt - (Degreed) |

|47c |Crisis Intervention/Behavior Mgmt - |

|56 |Transportation Service |

|71a |In-Home Case Management - (Licensed) |

|71b |In-Home Case Management - (Degreed) |

|71p |In-Home Case Management |

|88a |Court Appear/Testimony - (Licensed) |

|88b |Court Appear/Testimony - (Degreed) |

|95a |In-Home Intensive Treatment - (Licensed) |

|95b |In-Home Intensive Treatment |

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