Unit vi treatment plan

UnitViCaseManagementReferralForm5.docx

Wildwood Case Management Unit

Referral Notification Form

SOCIAL SERVICE REC#: _____ LAST NAME: ________________ FIRST NAME: ______________________ DOB: ____/____/____

INSURANCE INFORMATION (Circle Answer): NO INSURANCE/UPHP/MEDICAID/BCBS/MEDICARE

ADDRESS: ____________________________________________________________________________ ZIP CODE: ______________ PHONE: ___________________________ CELL: ______________________ DATE OF REFERRAL: _________/_________/_________

REASON FOR REFERRAL□ SUBSTANCE ABUSE □ HOME SAFETY □ ORAL HEALTH □ MENTAL HEALTH □ DOMESTIC VIOLENCE □ TEEN PREGNANCY PREVENTION □ MEDICAL PROVIDER □ TOBACCO CESSATION □ EARLY HEAD START □ PRENATAL HEALTH EDUCATION □ HOME VISITING PROGRAM □ OTHER REASON FOR REFERRAL: ________________________________________________________________________ _____________________________________________________________________________________ REFERRED TO: AGENCY: _________________ CONTACT NAME: _________________________________ ADDRESS: ________________________________________ PHONE: _____________________________ REFERRED BY: ________________________________________ DATE: ___________________________ PHONE: ____________________________________________ The importance of attending my referral has been explained to me. I understand that Wildwood Social Services will not assume responsibility as a result of my not attending my referral.

CLIENT SIGNATURE: ____________________________________

DATE:_________/_________/_________

FOLLOW-UP OUTCOME: _________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________

I decline service referral: CLIENT SIGNATURE: ____________________________________

Referral Status (Circle the Appropriate Decision) : Denied Community Resource / No Longer Applicable / Obtained Community Resource / Pending Community Resource / Refused Community Resource / Other (Specify) _____________________________________________________________________________

UnitVI-LindseysCaseInstructions1.docx

Make sure you complete all parts of the assignment!

Lindsey

Lindsey was 14 when her home burned down in a serious fire after a row of homes in the city was set afire by a teenage arsonist. Until the fire, she had been a good student and enjoyed school. After the fire, she began to lose interest in her schoolwork and her grades plummeted. Lindsey's mother brought her into the case management unit complaining that Lindsey was depressed and needed attention. Before the fire Lindsey had often talked of going to college, and her mother worried that Lindsey's goals would soon be lost if she continued to do poorly in school. The case manager listened to the mother and then talked at length with Lindsey. Lindsey explained that during the fire all her schoolbooks were lost, including notebooks with notes in them and her dictionary. School officials at the inner-city school had been reluctant to issue a new set of books because they rigidly adhered to a regulation that students got only one set a year and were "responsible for replacement of any damaged books".

Part 1: Complete a new referral/inquiry form with the above information. You can type directly into the required form, save and upload or submit a similar form of your own.

During the first interview, the case manager (you) listened to the mother and then talked at length with Lindsey. Lindsey explained that during the fire all her schoolbooks were lost, including notebooks with notes in them and her dictionary. School officials at the inner-city school had been reluctant to issue a new set of books because they rigidly adhered to a regulation that students got only one set a year and were “responsible for the replacement of any damaged books”.

Part 2: Create a list of items that will be included in the service/treatment plan.

Part 3: Develop an initial service/treatment plan (like the one in your textbook) for Lindsey. You should include a minimum of 5 items in the service/treatment plan that you submit.

1.

2.

3.

4.

5.

UnitVIFundamentals.docx

Unit VI Fundamentals / Case Management

TREATMENT PLAN ASSIGNMENT: (Complete the Following Instructions )

For every person we see we must create a service or treatment plan that specifically addresses that person's needs. In addition, this plan must specifically address the direction the individual states he/she wants to go. No two plans should be exactly alike because people can have the same problems but react to them differently.

When creating plans, always involve the client as well as the client's family when appropriate. Plans without client input are not acceptable. As people discuss their problems and the issues they feel should be addressed, you can generate general goals for them that will become part of the plan. Once you have some ideas about goals, share your ideas with them and always ask for their opinions and additions.

The client represents an individual from case management with children and their families. Remember the ecological model, the child's point of view, respect for children, prevention efforts and recognize children are one of our most vulnerable populations - careful attention must be paid to their protection.

For the following client, complete the following:

1) Create a new referral/inquiry sheet (note: you may need to create information such as address, phone, etc. for the client). I'm attaching an example of what a referral sheet looks like, but in the end you can submit any referral form you have.

2) Create a list of items that will be included on the clients formal service plan.

3. Create a service/treatment plan and submit a document similar to the one in your textbook for your client and include the items in the instructions. Again, you can use any treatment plan form you have within your own agency or one you find online, or simply follow the sample given in your textbook (not in paragraph form). The treatment plan itself should be like the one in your text on pages 370-371 and also, located in the back of your text in Appendix C on pages 480-481 for number 3.

UnitViCaseManagementReferralForm5.docx

Wildwood Case Management Unit

Referral Notification Form

SOCIAL SERVICE REC#: _____ LAST NAME: ________________ FIRST NAME: ______________________ DOB: ____/____/____

INSURANCE INFORMATION (Circle Answer): NO INSURANCE/UPHP/MEDICAID/BCBS/MEDICARE

ADDRESS: ____________________________________________________________________________ ZIP CODE: ______________ PHONE: ___________________________ CELL: ______________________ DATE OF REFERRAL: _________/_________/_________

REASON FOR REFERRAL□ SUBSTANCE ABUSE □ HOME SAFETY □ ORAL HEALTH □ MENTAL HEALTH □ DOMESTIC VIOLENCE □ TEEN PREGNANCY PREVENTION □ MEDICAL PROVIDER □ TOBACCO CESSATION □ EARLY HEAD START □ PRENATAL HEALTH EDUCATION □ HOME VISITING PROGRAM □ OTHER REASON FOR REFERRAL: ________________________________________________________________________ _____________________________________________________________________________________ REFERRED TO: AGENCY: _________________ CONTACT NAME: _________________________________ ADDRESS: ________________________________________ PHONE: _____________________________ REFERRED BY: ________________________________________ DATE: ___________________________ PHONE: ____________________________________________ The importance of attending my referral has been explained to me. I understand that Wildwood Social Services will not assume responsibility as a result of my not attending my referral.

CLIENT SIGNATURE: ____________________________________

DATE:_________/_________/_________

FOLLOW-UP OUTCOME: _________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________

I decline service referral: CLIENT SIGNATURE: ____________________________________

Referral Status (Circle the Appropriate Decision) : Denied Community Resource / No Longer Applicable / Obtained Community Resource / Pending Community Resource / Refused Community Resource / Other (Specify) _____________________________________________________________________________

UnitVI-LindseysCaseInstructions1.docx

Make sure you complete all parts of the assignment!

Lindsey

Lindsey was 14 when her home burned down in a serious fire after a row of homes in the city was set afire by a teenage arsonist. Until the fire, she had been a good student and enjoyed school. After the fire, she began to lose interest in her schoolwork and her grades plummeted. Lindsey's mother brought her into the case management unit complaining that Lindsey was depressed and needed attention. Before the fire Lindsey had often talked of going to college, and her mother worried that Lindsey's goals would soon be lost if she continued to do poorly in school. The case manager listened to the mother and then talked at length with Lindsey. Lindsey explained that during the fire all her schoolbooks were lost, including notebooks with notes in them and her dictionary. School officials at the inner-city school had been reluctant to issue a new set of books because they rigidly adhered to a regulation that students got only one set a year and were "responsible for replacement of any damaged books".

Part 1: Complete a new referral/inquiry form with the above information. You can type directly into the required form, save and upload or submit a similar form of your own.

During the first interview, the case manager (you) listened to the mother and then talked at length with Lindsey. Lindsey explained that during the fire all her schoolbooks were lost, including notebooks with notes in them and her dictionary. School officials at the inner-city school had been reluctant to issue a new set of books because they rigidly adhered to a regulation that students got only one set a year and were “responsible for the replacement of any damaged books”.

Part 2: Create a list of items that will be included in the service/treatment plan.

Part 3: Develop an initial service/treatment plan (like the one in your textbook) for Lindsey. You should include a minimum of 5 items in the service/treatment plan that you submit.

1.

2.

3.

4.

5.

UnitVIFundamentals.docx

Unit VI Fundamentals / Case Management

TREATMENT PLAN ASSIGNMENT: (Complete the Following Instructions )

For every person we see we must create a service or treatment plan that specifically addresses that person's needs. In addition, this plan must specifically address the direction the individual states he/she wants to go. No two plans should be exactly alike because people can have the same problems but react to them differently.

When creating plans, always involve the client as well as the client's family when appropriate. Plans without client input are not acceptable. As people discuss their problems and the issues they feel should be addressed, you can generate general goals for them that will become part of the plan. Once you have some ideas about goals, share your ideas with them and always ask for their opinions and additions.

The client represents an individual from case management with children and their families. Remember the ecological model, the child's point of view, respect for children, prevention efforts and recognize children are one of our most vulnerable populations - careful attention must be paid to their protection.

For the following client, complete the following:

1) Create a new referral/inquiry sheet (note: you may need to create information such as address, phone, etc. for the client). I'm attaching an example of what a referral sheet looks like, but in the end you can submit any referral form you have.

2) Create a list of items that will be included on the clients formal service plan.

3. Create a service/treatment plan and submit a document similar to the one in your textbook for your client and include the items in the instructions. Again, you can use any treatment plan form you have within your own agency or one you find online, or simply follow the sample given in your textbook (not in paragraph form). The treatment plan itself should be like the one in your text on pages 370-371 and also, located in the back of your text in Appendix C on pages 480-481 for number 3.

UnitViCaseManagementReferralForm5.docx

Wildwood Case Management Unit

Referral Notification Form

SOCIAL SERVICE REC#: _____ LAST NAME: ________________ FIRST NAME: ______________________ DOB: ____/____/____

INSURANCE INFORMATION (Circle Answer): NO INSURANCE/UPHP/MEDICAID/BCBS/MEDICARE

ADDRESS: ____________________________________________________________________________ ZIP CODE: ______________ PHONE: ___________________________ CELL: ______________________ DATE OF REFERRAL: _________/_________/_________

REASON FOR REFERRAL□ SUBSTANCE ABUSE □ HOME SAFETY □ ORAL HEALTH □ MENTAL HEALTH □ DOMESTIC VIOLENCE □ TEEN PREGNANCY PREVENTION □ MEDICAL PROVIDER □ TOBACCO CESSATION □ EARLY HEAD START □ PRENATAL HEALTH EDUCATION □ HOME VISITING PROGRAM □ OTHER REASON FOR REFERRAL: ________________________________________________________________________ _____________________________________________________________________________________ REFERRED TO: AGENCY: _________________ CONTACT NAME: _________________________________ ADDRESS: ________________________________________ PHONE: _____________________________ REFERRED BY: ________________________________________ DATE: ___________________________ PHONE: ____________________________________________ The importance of attending my referral has been explained to me. I understand that Wildwood Social Services will not assume responsibility as a result of my not attending my referral.

CLIENT SIGNATURE: ____________________________________

DATE:_________/_________/_________

FOLLOW-UP OUTCOME: _________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________

I decline service referral: CLIENT SIGNATURE: ____________________________________

Referral Status (Circle the Appropriate Decision) : Denied Community Resource / No Longer Applicable / Obtained Community Resource / Pending Community Resource / Refused Community Resource / Other (Specify) _____________________________________________________________________________

UnitVI-LindseysCaseInstructions1.docx

UnitVIFundamentals.docx

UnitViCaseManagementReferralForm5.docx

UnitVI-LindseysCaseInstructions1.docx

Lindsey

UnitVIFundamentals.docx

Unit VI Fundamentals / Case Management

UnitViCaseManagementReferralForm5.docx

UnitVI-LindseysCaseInstructions1.docx

Lindsey