TFK Early Childhood Mental Health Services



TFK Early Childhood Mental Health Services

Service Delivery Report

Code Book

Revised February 26, 2009

Table of Contents

Page Number

Documentation Instructions 3

Definitions 3

Report Sections 3

Section A: Monthly Child Specific Information and Services 4

Section B: Aggregate Child Specific Information and Services 7

Section C: Monthly General Classroom/FCC Home Services 8

Section D: Aggregate General Classroom/FCC Home Services 8

Section E: Monthly Baseline Information 9

Section F: Monthly Aggregate Data Summary 10

Section G: Biannual Summary Data 10

Section H: Additional Service Activity Log Codes 11

Double Checking Your Work 11

Documentation Instructions

• Please complete all information. Please do not leave any columns blank. If the number is zero, enter “0”. If the question does not apply, enter “NA”. If the question does apply and you do not have the information, enter “U” (Unknown). If you need computer assistance, please speak with Beth Ciavattone.

• If you work in more than one of the programs listed on the first page, please complete a separate report for each program.

• Please note that the formulas have been entered to calculate totals. Please do not enter anything in the total lines highlighted in gray.

• Please return the completed forms via email to Beth Ciavattone (eciavattone@) by the 15th of each month (5:00 p.m.). If the 15th falls on a weekend, completed forms are due the next work day. Please retain back-up copies for your personal file.

Definitions

Please use the following definitions of terms for the purpose of this report:

• Age Categories: *Infant ages birth-15 months of age

*Toddler ages 15 to 33 months of age

*Preschool ages 2.9 years to 5 years old

*School Age ages 5 to 12 years of age

• Case management means creating linkages to other available and appropriate community resources, social services, mental health agencies, public school special education, and early intervention in order to promote the coordination and continuation of services for children and families.

Report Sections

A. Monthly Child Specific Information and Services

B. Aggregate Child Specific Information and Services

C. Monthly General Classroom/FCC Home Services

D. Aggregate General Classroom/FCC Home Services

E. Monthly Summary Data: Baseline Information

F. Monthly Summary Data: Aggregate Data Summary

G. Biannual Summary Data (July-December, 2008; January-June, 2009)

Emotional/Behavioral Issues (Primary Issue/Unduplicated Child Count)

Strategies/Interventions Benefitting the Child

Program Outcomes

H. Additional Service Delivery Codes

A. Monthly Child Specific Information and Services (Observation/Consultation/Therapy)

This section is to record only the clients referred and served during the month reported.

1. Name of Referred Child (names of all referred children; with and without consent)

2. Date of Referral

3. Parental Consent: Y N

4. Waiting for Services: Y N

5. Referred to Other Agency: Y N

6. Receiving Services: Y N (by type)

7. Month/Year Child Specific Services Began (billable and non-billable)

8. Client Case Number (actual #, Pending: P, Not Applicable: NA)

9. Birthdate

10. Gender

11. Age Category (infant, toddler, preschool, school age)

12. Insurance (Type; Billable: B or Un-billable: U)

MBHP

1. MBHP

MCO’s

2. Neighborhood Health Plan Beacon

3. Neighborhood Health Plan

4. BMC Healthnet

5. Network Health

6. Beacon Fallon-Medicaid

Medicaid

7. Paramax

Other

8. Blue Cross

9. HMO Blue

10. Beacon Fallon Commercial

11. Harvard Pilgrim

12. Tufts

13. Tricare

14. Fallon

15. Other Insurance: List type

Not Billed To Insurance

16. Self pay (full or sliding fee)

17. No insurance/Free

18. Unknown

13. TFK Information Sheet: Y N NA

14. Ethnic/Racial background

15. Income level

16. Subsidized Care

17. Child Care Agency Name

18. Site Specific Name/FCC Home (or NA)

19. Program Street Address

20. City/Town

21. Program Type (center-based, family child care, public school)

22. Name of Classroom

23. Capacity Census of Classroom/FCC Home (ask site)

24. Names of Educators who received consultation services

25. Emotional/Behavioral Issues (Biannual Summary)

Emotional/Behavioral Issues (Primary Issue Only/Unduplicated Child Count: 1 per child)

1. Aggression (biting, hitting, etc – peers and adults)

2. Oppositional (defiant, disobedient)

3. Over-activity/Impulsivity (restless, uncontrolled)

4. Attention (inability to focus, follow directions)

5. Anxiety (nervous, fearful, extreme shyness)

6. Attachment (separation distress, neediness)

7. Depression (withdrawal, sadness)

8. Post Trauma (history of trauma, loss)

9. Peer relations/social skills (difficulty taking turns, sharing, negotiating, social bullying)

10. Other: Please list

26. Strategies/Interventions (Biannual Summary/code list)

Strategies/Interventions Benefitting the Child (Can be more than 1 per child)

1. Consultation to Staff

2. Modeling of Behavior Management Strategies for Staff

3. Staff Group Training

4. Individual Behavior Plan

5. Consultation to Parent/Guardian

6. Case Management (see definition)

7. Programmatic Modification (i.e. schedule)

8. Physical Facility Modification

9. Additional Staffing Support (i.e. paraprofessionals)

10. Referral to Therapy

a. Currently receiving therapy on-site/at consultants clinic

b. Currently on a waiting list for therapy

c. Referral to outside clinic for therapy

11. Referral to Special Education Services/Supports

12. Medication

13. Other: Please explain

27. Formal Plan (IFSP, IEP, Referral in process: P, or NA)

28. # hrs working 1:1 with child (clinical case record open)

Assessment 102/9102 Open clinical case record with client ID

Play therapy 106/9106 Open clinical case record with client ID

Crisis intervention 101/9101 Open clinical case record with client ID

29. # hrs of group therapy (clinical case record open)

3 or more children 109/9109 Open clinical case record with client ID

30. # hrs spent with family (case record opened or un-opened)

Family therapy 107/9107 Open clinical case record with client ID

Family consultation 110/9110 Open clinical case record with client ID

Scheduled face-to-face or telephone

No open clinical case record

Scheduled face-to-face or telephone

31. # hours observing the child (case record open or un-opened)

433 No open clinical case record

? If open clinical case record, this activity could occur within a billable consultation hour and thus be captured within the consultation category

32. # hrs of child specific consultation with staff

Case consultation 108/9108 Open clinical case record with client ID

Scheduled face-to-face or telephone

No open clinical case record

Scheduled face-to-face or telephone

33. # hrs of case management

225 Direct face-to-face or telephone collateral contacts to access/coordinate services

10 Indirect collateral

34. # hrs of clinical prep 63 Prep of consultation/training material

64. Prep of formal cons report (followed by ID)

35. Developmental Profile: Y/N/NA

36. TOPS Pre: Y/N/NA

37. TOPS Post: Y/N/NA

38. BASC: Parent (P)/Teacher (T)/Both (B)

• Intake

• 4th Session or 60 Days

• Post

39. CANS: Y/N/NA

• Intake

• Reviews

40. Eyberg Scores (Eyberg Score or NA if one has not been administered)

41. Child Program Outcomes (Biannual Summary)

Child Program Outcomes (Unduplicated child count: I per child)

1. Retained successfully in the program

2. Transitioned from current program to a new program that could better address child’s needs

3. Suspended temporarily from the program due to behavioral issues

4. Expelled from the program (due to behavioral issues)

5. Aged-out of the program

6. None of the above

42. Month/Year Child Specific Services Ended (billable and non-billable):

43. Date of Child Care Program Discharge (non-behavioral issues):

44. Reason for Child Care Program Discharge (non-behavioral): (Aged Out:1; Other:2)

45. Psychotherapy Continuing: Y N

Please remember: If you make any changes to the child specific information on the Monthly Tab, that those changes are reflected in the Aggregate Tab.

B. Aggregate Child Specific Information and Services (Observation/Consultation/Therapy)

This section is to record the aggregate data for each child referred and served. This is a running list to which you add new clients referred and served and update the number of hours of service for those clients served every month. For example if you spent 4 hours observing the child in January and 4 hours observing the child in February, when you submit your February report you would indicate 4 hours on the Monthly Child Specific and 8 hours on the Aggregate Child Specific (4 hrs for Jan + 4 hours for Feb = 8 hrs total).

Those columns where the data is totaled are indicated below:

28. Total # hrs working 1:1 with child (clinical case record open)

29. Total # hrs of group therapy (clinical case record open)

30. Total # hrs spent with family (case record opened or un-opened)

31. Total # hours observing the child (case record open or un-opened)

32. Total # hrs of child specific consultation with staff

33. Total # hrs of case management

34. Total # hrs of clinical prep

C. Monthly General Classroom/FCC Home Services (Observation/Consultation/Training)

1. Child Care Agency Name

2. Site Specific Name/FCC Home

3. Program Street Address

4. City/Town

5. Program Type (center-based, family child care, public school)

6. Targeted Age Category (infant, toddler, preschool, school age)

7. Name of Classroom

8. Capacity Census of Classroom/FCC Home

9. Names of Educators who received consultation services

10. Collaborative Classroom Assessment: Y N

11. # hrs of observation provided 432

12. # hrs of consultation provided 437

13. # hrs of clinical prep 63

14. # hrs of staff training provided 21

15. Staff training topics (list each topic)

D. Aggregate General Classroom/FCC Home Services (Observation/Consultation/Training)

This section is to record the aggregate data for each classroom/FCC home referred and served. This is a running list to which you add classroom/FCC home referred and served and update the number of hours of service for that classroom/FCC home served every month. For example if you spent 4 hours observing a classroom in January and 4 hours observing the same classroom in February, when you submit your February report you would indicate 4 hours on the Monthly General Classroom/FCC Home Services and 8 hours on the Aggregate General Classroom/FCC Home Services (4 hrs for Jan + 4 hours for Feb = 8 hrs total).

Those columns where the data is totaled are indicated below:

11. Total # hrs of observation provided 432

12. Total # hrs of consultation provided 437

13. Total # hrs of clinical prep 63

14. Total # hrs of staff training provided 21

E. Monthly Baseline Information

** Please do not type in areas highlighted in gray – they are self-calculating **

|Question |Where to Find the Data |

| |Enter the number of new children added to the Monthly Child Specific Services tab (Section A) |

|1 a-d. |Enter the number of children who were referred but not served and indicate in appropriate questions. Please enter “0” for |

| |these questions if all children who were referred received services |

| |This row automatically totals everything from Question 1a-d. |

| |Out of the number of children reported in Question 1, enter the number of children who have received services. |

|3a |Enter the number of new families receiving services based on the number of new children reported on the Monthly Child |

| |Specific Services tab (Section A) |

| |Enter the number of children whose parents refused services in an earlier month indicated on the Monthly Child Specific |

| |Services tab (Section A) |

| |Enter the number children whose were wait-listed in an earlier month indicated on the Monthly Child Specific Services tab |

| |(Section A) |

| |Enter of the number of children on the Monthly Child Specific Services tab (Section A) who are continuing from the previous |

| |month. |

| |This row automatically totals everything in Questions 3, 4, 5, and 6. |

| |Enter the number of new classrooms indicated on the Monthly General Classroom/FCC Home Services Tab (Section C). |

| |Enter the number of classrooms indicated on the Monthly General Classroom/FCC Home Services tab (Section C) who are |

| |continuing from the previous month. |

| |This row automatically totals the number of classrooms that were provided services for the month. The number should equal the|

| |total number of center-based classrooms indicated on the Monthly General Classroom/FCC Home Services Tab. |

| |Enter the number of new FCCs indicated on the Monthly General Classroom/FCC Home Services Tab (Section C). |

| |Enter the number of FCCs indicated on the Monthly General Classroom/FCC Home Services tab (Section C) who are continuing from|

| |the previous month. |

| |This row automatically totals the number of FCCs that were provided services for the month. |

| |Information found in Column 43 in Section A. |

| |Information found in Column 41 in Section A. |

| |Information found in Column 41 in Section A. |

F. Monthly Aggregate Data Summary

|Column |Report Section where report information can be found |

|1 |A17,18,20,21 C1,2,4,5 |

|2 |A28 |

|3 |A29 |

|4 |A30 |

|5 |A31 |

|6 |C11 |

|7 |Baseline Info E3 |

|8 |Baseline Info E1b |

|9 |C14 |

|10 |A32 |

|11 |C12 |

|12 |A33 |

|13 |A34 + C13 |

|14 |H2 (See Page 11) |

G. Biannual Summary Data

Emotional/Behavioral Issues (Primary issue only /one code per child)

e.g., 30 children received services between July 1 – Dec 31; 30 primary issues documented on form.

Strategies/Interventions Benefitting the Child (can be more than 1 code per child)

e.g., 30 children received services between July 1 – Dec 31; for each child, count all that was beneficial under his/her “primary issue”; since children may benefit from more than one strategy/intervention, they can be counted in more than one strategy.

Program Outcomes (one code per child)

e.g., 30 children received services between July 1 – Dec 31; 30 outcome codes documented on form.

H. Additional Service Activity Log Codes (this data that may be used for other reports)

1. Client specific paperwork 11 (followed by client ID)

2. Travel 28

3. Supervision Received 24

4. Supervision Provided 23

5. Training Provided 21

6. Training Received 22

7. Sick 29

8. Vacation 30

9. Holiday 31

10. Leave of Absence 32

11. Personal Time 33

12. Jury Duty/Bereavement 39

13. Clinical Team Meetings 44

14. Other 10

Double Checking Your Work

The last tab in the workbook, entitled Program Totals (pink tab), is an accumulation of all the hours indicated in Monthly Aggregate Data Summary (Section F). The data on the tab is all self-calculating, therefore, the data should not be corrected by changing the numbers on this tab.

Each month, the data from the Totals row on the Monthly Aggregate data Summary (Section F), transfers the data to the Program Totals tab. Since the Monthly Aggregate data Summary is a reflection of the hours of services provided during that month, the Totals row on the Program Totals tab is a reflection of the hours of service provided to date. Therefore, that Totals row should match the hours indicated in the Aggregate Child Specific Information and Services (Section B) and Aggregate General Classroom/FCC Home Service (Section D).

If the numbers in the Totals row do not match the Aggregate tabs (Sections B and D), then there are two possible areas of error:

1. The data reported in the Monthly Aggregate Data Summary (Section F) is incorrect. To correct this data, go back to the Monthly Child Specific Information and Services (Section A) and Monthly General Classroom/FCC Home Services (Section C) for each month and double check that you reported the correct hours for each category.

2. If the error is not resolved then there was a mistake in adding the hours of service to the aggregate each month. To correct this error, go back a re-add each month’s hours to the aggregate.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download