+

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

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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

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Services CSS Provides

Activity Therapy

Individual Skills Training

Case Management

Respite Care

Wraparound

Crisis Intervention

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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.

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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

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Respite Care

YESFace-to-face session to youth/family monitoring behavior, mentoring, introducing/encouraging age appropriate recreational activities

Used also by non-QMHA’s

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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

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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

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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

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“Thank You”