FAMILY SERVICE OPERATIONS
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Family Service Association
Family Service Development
Family Service Enterprise
SECTION I
FAMILY SERVICE OPERATIONS
GOVERNANCE
PART G: ACCESS
FAMILY SERVICE OPERATIONS
& SUBSIDIARIES
Family Service Association
Family Service Development
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PART G -- ACCESS
TABLE OF CONTENTS
Policy Number
Access Overview .......................................................................................................................... 1
Client Eligibility ........................................................................................................................... 2
Acceptance Criteria: Outpatient Mental Health Services .............................................. 2A
Acceptance Criteria: Outpatient Substance Abuse ........................................................ 2B
Acceptance Criteria: First Day Adult Partial Care Program .......................................... 2C
Acceptance Criteria: Kinship Services. ......................................................................... 2D
Acceptance Criteria: Older Adult Services. ................................................................... 2E
Senior Community Independent Living Services/Activities of Daily Living
Adjustment to Vision Loss
Trained Volunteer Assistance Program (Project S.A.V.E.)
Acceptance Criteria: Employee Assistance Program......................................................2F
Acceptance Criteria: School Based Youth Services ...................................................... 2G
Acceptance Criteria: Family Preservation Services ....................................................... 2H
Acceptance Criteria: Family Centers .............................................................................. 2I
Acceptance Criteria: HEDS Case Management ............................................................. 2J
Acceptance Criteria: Youth Case Management ............................................................. 2K
Acceptance Criteria: Rainbow Place Adolescent Partial Care Program ....................... 2L
Acceptance Criteria: Safe Harbor Adolescent Partial Care Program ........................... 2M
Acceptance Criteria: Family Life Center ....................................................................... 2N
Acceptance Criteria: In-Home Parenting Program ....................................................... 2O
Acceptance Criteria: Juvenile Sex Offenders ................................................................ 2P
Acceptance Criteria: Supportive Assistance to Individuals and Families (SAIF) ......... 2Q
Fee Setting Programs .................................................................................................................... 3
Partial Care Programs ................................................................................................................... 4
Non-Fee Setting Programs ............................................................................................................ 5
Client Processing .......................................................................................................................... 6
Access Functions .......................................................................................................................... 7
Waiting List Criteria ..................................................................................................................... 8
Screening Form ............................................................................................................................. 9
Psychiatric Hospital Referrals and Emergency Service .............................................................. 10
Access Unit Supervision ............................................................................................................. 11
Path for Scheduling & Routing Intake Packets........................................................................... 12
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PART G: ACCESS
Policy No. 1
ACCESS OVERVIEW
The function of Access is to understand the need of the family or client who is requesting help in order
to refer them to the most appropriate service. It is a critical service that the Agency provides. In most
cases, the initial Access call will be the client's first exposure to the services the Agency has to offer. It
is at this time that the client is most open to change and most fearful because of the events that are
leading him or her to make the call. Thus, Family Service Association recognizes the need to perform
Access tasks in as professional and sensitive a manner as possible. This function is primarily provided
at the Egg Harbor Township, English Creek Avenue Corporate Headquarters building, in the Access
Center and in the Absecon office one day per week. However, it is also a responsibility of programs
receiving direct referrals.
If the Agency cannot provide appropriate programming, Access staff or program staff receiving direct
referrals will inform the client and referral source within seven days of the initial phone call. When this
is the case, Access Center and Program Staff will make every effort to refer the client to the most
appropriate resource available within the community.
Procedure:
1.
The Agency's Egg Harbor Township, English Creek Office Access Center is open from 9:00
a.m. to5:00 p.m., Monday through Thursday, and on Friday from 9:00 a.m. to 5:00 p.m. The
Agency’s Absecon Office Access Center is open from 9:00 a.m. to 5:00 p.m. on Thursdays.
After hours, callers are instructed, via recorded message, to call:
In Atlantic County:
Psychiatric Intervention Program (PIP) 609-344-1118
Contact Atlantic, 609-646-6616.
In Cumberland County:
Crisis Unit at South Jersey Hospital, Bridgeton
856-455-5555
Contact Cumberland, 856-765-1991.
At all sites, calls are forwarded to FSA Corporate Headquarters or a recorded message on site
provides the caller with emergency numbers after hours.
2.
Emergencies - Family Service Association attempts to meet client needs to the fullest extent
possible. However, at present the Agency does not have emergency response capabilities. To
prevent additional client risk, emergencies that present an imminent risk to life and health are
immediately referred to PIP (Psychiatric Intervention Program) 609-344-1118 or Contact
Atlantic, 609-646-6616 in Atlantic County, and the Crisis Unit, South Jersey Hospital-Bridgeton
856-455-5555 or Contact Cumberland 856-765-1991. Contact Atlantic and Contact
Cumberland will contact an on-duty Atlantic or Cumberland County Crisis Worker when
appropriate to provide services.
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page 2 of 2
ACCESS OVERVIEW
DCP&P related cases should be referred to the Office of Child Abuse Control (OCAC) at 1-800792-8610. (See the Emergency Services for Non-FSA Clients Policy in the Case Management
Section of Family Service Operations Manual.)
Emergency Access functions at offices other than the Corporate Headquarters or Absecon office
and is handled by the manager or designated clinical staff. As above, in their absence, the
manager or designate either makes an appointment or takes a name and number for a call back
by appropriate clinical staff. Callers are given the Contact Atlantic or PIP/Contact Cumberland
or Crisis Unit at South Jersey Hospital numbers by the person answering the phone if the party
on the phone has an emergency. Any call, which requires additional clinical assessment, will be
referred to the English Creek Avenue Corporate Headquarters Access Office.
3.
The Agency has developed affiliation agreements with area hospitals and social service
providers such as Jewish Family Service, Juvenile Court, and DCP&P to ensure a smooth flow
between referral sources.
4.
The Agency Medical Director is available via emergency pager whenever s/he is off site.
Effective Date:
Revised Date
Revised Date:
Revised Date:
Revised Date:
5/88
1/95
1/99
3/03
8/09
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PART G: ACCESS
Policy No. 2
CLIENT ELIGIBILITY
Family Service Association makes its services available to any person in the community, regardless of
race, color, sex, age, ethnic origin, or handicap. Agency services are also provided regardless of the
ability to pay a fee for service, subject to funds being available to the Agency to supplement the cost of
providing the service.
No one seeking services within the Agency's financial ability to provide said service shall be turned
away. Referrals from other agencies are accepted by telephone and mail-in, with a discharge summary
or other appropriate documentation forthcoming, if required.
The Agency provides services that are appropriate for the client and family, and in a manner that
facilitates the least restrictive or intrusive setting available. Clients that are assessed as potentially
needing restrictive behavior management interventions will not be accepted for services. In these
instances, clients will be referred to programs more suitable for these types of interventions.
Procedure:
1.
Client eligibility is determined by an individual program's Inclusionary and Exclusionary
Criteria.
2.
The Agency may provide, in special cases, services to clients who are deemed to require
critically needed care until other arrangements can be made for service reimbursement. In such
cases, clients will not be responsible for payment of services at the time they are provided.
These special cases must be reviewed with the Chief Operating Officer in consultation with the
President/CEO.
3.
Division of Developmentally Disabled clients can be referred to one of the following:
Atlanticare Behavioral Health, 6010 Black Horse Pike, EHT, NJ 08234 (609) 646-5142 or
Cooper University Hospital, 401 Haddon Avenue-Dept of Psychiatry, Camden, NJ 08103 (856)
757 – 7853.
4.
Adult Sex Offender clients can be referred to Amethyst Counseling, 1125 Atlantic Avenue,
Atlantic City, NJ 08401 (609) 428 – 7295.
5.
The Agency shall have written policies and procedures describing its admission criteria and
practices. First priority for admissions into OP services shall be given to persons with severe and
persistent mental illness in accordance with target populations, as defined in N.J.A.C. 10:37-5.2.
A. Clients referred directly from emergency services by a screening or affiliated psychiatric
emergency service for medication follow-up be seen within seven calendar days of
referral and that clients referred from inpatient settings for medication monitoring
services be seen within fourteen calendar days of referral.
B. Client appointments will be scheduled within two weeks upon completion of the
admission process for clients needing services other than medication monitoring (Subject
to the availability of the Provider).
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Page 2 of 2
CLIENT ELIGIBILITY
C. Clients referred directly from emergency services by a screening or affiliated psychiatric
emergency service for medication follow-up will be seen within seven calendar days of
referral. Clients referred from inpatient settings for medication monitoring services will
be seen within fourteen calendar days of referral. [N.J.A.C. 10:37E-2.2 (a) 1]
Effective Date:
Revised Date:
4/89
1/95; 1/99; 3/03; 8/09; 07/13; 10/13
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PART G: ACCESS Policy No. 2A
ACCEPTANCE CRITERIA - OUTPATIENT MENTAL HEALTH SERVICES
The Agency maintains standards of inclusionary and exclusionary acceptance criteria for programs.
Procedure:
1.
2.
Inclusionary Criteria for Acceptance - one or more of the following:
A.
Impaired functioning – client is not able to function adequately in a social, occupational,
academic, or family environment.
B.
Moderate to severe anxiety
C.
Disabling somatic symptoms
D.
Moderate to severe depression
E.
Needs psychopharmacology services requiring monitoring & evaluation
F.
Attempts to halt or reverse problems on their own have been unsuccessful
G.
Risk of hospitalization or partial care placement
Exclusionary Criteria for Acceptance
A.
Client is acutely suicidal
B.
Client is assaultive
C.
Severe disorganization
D.
Severe acting out
E.
Uncontrollable substance abuse
F.
Medical condition precludes Outpatient as an alternative
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
10/85
1/95
3/99
3/03
8/09
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PART G: ACCESS
OUTPATIENT DEPARTMENT
Policy No. 2B
ACCEPTANCE CRITERIA – OUTPATIENT SUBSTANCE ABUSE SERVICES
The Agency maintains standards of inclusionary and exclusionary acceptance criteria for programs.
Procedure:
1.
2.
Inclusionary Criteria for Acceptance - one or more of the following:
A.
Impaired functioning due to the consumption of mood-altering chemicals. Not able to
function adequately in social, occupational, academic or family environment.
B.
Moderate to severe anxiety related to chemical abuse or dependence.
C.
Disabling somatic symptoms related to chemical abuse or dependence.
D.
Moderate to severe depression related to chemical abuse or dependence.
E.
Involvement with the criminal justice or child protective system due to chemical abuse
or dependence.
F.
Need for pharmacotherapy requiring monitoring and evaluation in conjunction with
chemical abuse or dependence history.
G.
Attempts to halt or reverse problems previously have been unsuccessful.
H.
Acknowledgement of loss of control over alcohol and/or other drugs.
I.
Concern over a family member or significant other whom they believe to be abusing
alcohol and/or other prescription or non-prescription drugs.
Exclusionary Criteria for Acceptance - one or more of the following:
A.
A demonstrated need for alcohol or drug detoxification
i.
Chemical consumption or substance abuse history (duration, intensity, or
polydrug use) indicates pharmacological tolerance producing acute withdrawal
syndrome, including, but not confined to: possible toxic psychosis, seizures,
sleep disturbance, multiple drug withdrawal, or other medical complications.
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ACCEPTANCE CRITERIA – OUTPATIENT SUBSTANCE ABUSE SERVICES
B.
A demonstrated need for residential alcohol/drug treatment:
i.
ii.
iii.
iv.
v.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
11/90
1/95
3/03
8/09
Client has lost control, unable to function, debilitated by the addiction, unable to
get along without a mood-altering chemical on a week-to-week basis, large
amount, daily or almost daily use, inability to refuse or self-limit.
Severe urges and cravings for mood-altering chemicals.
Severe impairment of psychosocial functioning reflected in global level of
functioning.
Presence of severe psychiatric symptoms: suicidal, homicidal, assaultive,
severely disorganized, mania, severe acting out behavior.
Under the influence of alcohol and/or other mood-altering chemicals during
Agency contacts, after being addressed by therapist.
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PART G: ACCESS
Policy No. 2C
ACCEPTANCE CRITERIA FIRST DAY ADULT PARTIAL CARE PROGRAM
The Agency maintains standards of inclusionary and exclusionary criteria for programs.
Procedure:
Inclusionary Criteria for Acceptance - one or more of the following:
A.
Axis 1 diagnosis with sufficiently reduced functioning level.
B.
Impaired contact with reality, manifested by hallucinations, delusions, or ideas of
reference.
Withdrawal, regression, or confusion not warranting inpatient hospitalization.
Paranoid ideation or behavior.
Impaired functioning, not able to function adequately socially, occupationally, or
academically.
Moderate to severe anxiety.
Disabling somatic symptoms.
C.
D.
E.
F.
G.
H.
I.
J.
2.
Needs pharmacotherapy requiring observation.
Attempts to halt or reverse illness on outpatient basis unsuccessful.
Needs some care, but inpatient care no longer warranted and outpatient care insufficient
to maintain patient.
Exclusionary Criteria for Acceptance
A.
B.
C.
Client is acutely suicidal.
Client is assaultive.
Severe
D.
E.
F.
Severe acting out.
Uncontrollable alcohol or substance abuse.
Medical condition precludes partial hospitalization as an alternative.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
10/85
1/95
3/03
8/09
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Policy No. 2D
ACCEPTANCE CRITERIA – KINSHIP SERVICES
The Agency maintains standards of inclusionary and exclusionary criteria for each program.
Procedure:
1.
2.
Inclusionary criteria for Kinship Services are as follows:
A.
Kinship caregivers must be referred by the Office of Kinship Navigator Services at the
New Jersey Department of Human Services Division of Family Development
B.
Kinship caregivers must reside in one of the seven county areas of southern New Jersey:
Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester and Salem counties.
C.
Kinship caregivers must have a proven relationship with the child.
D.
Kinship caregivers must have been providing care and support for the relative child(ren)
in the caregiver’s home for at least the last twelve months.
E.
Kinship caregivers must provide proper documentation to verify relationship, residency,
age, and income.
Exclusionary criteria for Kinship Services are as follows:
A.
Kinship caregivers not referred by the Office of Kinship Navigator Services at the New
Jersey Department of Human Services Division of Family Development.
B.
Kinship caregivers residing outside of the seven county areas of southern New Jersey
mentioned in #1 above.
C.
Kinship caregivers who do not have a proven relationship with the child.
D.
Kinship caregivers who have not provided care and support for the relative child(ren) in
the caregiver’s home in the previous twelve months. (This applies only to the Kinship
Legal Guardianship Program.)
E.
Kinship caregivers who do not have proper documentation to verify relationship,
residency, age, and income.
Effective Date:
Revised Date:
2/02
3/03
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Revised Date:
8/09
PART G: ACCESS
OLDER ADULT SERVICES
Policy No. 2E
ACCEPTANCE CRITERIA
SENIOR COMMUNITY INDEPENDENT LIVING SERVICES/ACTIVITIES OF DAILY LIVING
The Agency maintains standards of inclusionary and exclusionary criteria for programs.
Procedure:
1.
Inclusionary Criteria for Acceptance
A.
Age 55 years or older.
B.
Meets any of the following categories of eligibility for services for the Commission for the
Blind & Visually Impaired:
i.
Visually Impaired - an individual is considered visually impaired if his/her vision is
20/70 or less in the better eye with proper corrections, (20/70 means that the person
sees at 20 feet what a normally sighted person would see at 70 feet).
ii.
Legally Blind - an individual is legally blind if his/her vision is 20/200 or less in the
better eye with proper corrections or if there is a field restriction of vision limited to
40 degrees or less (20/200 means that a person sees at 20 feet what a normally
sighted person would see at 200 feet).
2.
Exclusionary Criteria for Acceptance
A.
Client is acutely suicidal
B.
Client is assaultive
C.
Severe disorganization
D.
Severe acting out
E.
Uncontrollable alcohol or substance abuse.
F.
Actively psychotic
Effective Date:
Revised Date:
Revised Date:
Revised Date:
10/87
1/95
3/03
8/09
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OLDER ADULTS SERVICES
Policy No. 2E
ACCEPTANCE CRITERIA
ADJUSTMENT TO VISION LOSS (AVL) PROGRAM
The Agency maintains standard of inclusionary and exclusionary criteria for programs.
Procedure:
1.
2.
Inclusionary Criteria for Acceptance
A.
Any facility offering services to the blind and/or visually impaired in the seven county
area of Southern New Jersey (Burlington, Camden, Gloucester, Cumberland, Salem,
Cape May, and Atlantic Counties): Mental Health Agencies, Private Practitioners,
Nursing Agencies, Group Homes, etc.
B.
Clients who are blind or visually impaired, their families, and volunteers who are
working with the blind and visually impaired.
Exclusionary Criteria for Acceptance
A.
Client/facility outside service area.
B.
Refusal of services
Effective Date:
Revised Date:
Revised Date:
1/99
3/03
8/09
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OLDER ADULTS SERVICES
Policy No. 2E
ACCEPTANCE CRITERIA
TRAINED VOLUNTEER ASSISTANCE PROGRAM (PROJECT S.A.V.E.)
Procedure:
1.
Inclusionary Criteria for Acceptance
A.
Caregiver (customer) or care recipient is 60 years of age or older.
B.
At risk for premature or unnecessary institutionalization.
C.
Resides in Atlantic County.
D.
Care recipient has impaired functioning because of Alzheimer’s disease or related
dementias.
E.
Caregiver needs relief from the constant responsibility and stress associated with their roles
as caretaker.
2.
Exclusionary Criteria for Acceptance
A.
Customer lives outside of Atlantic County.
B.
Customer refuses service.
C.
Care recipient demonstrates severe acting out.
D.
Care recipient is actively suicidal and/or homicidal.
E.
Care recipient is assaultive.
F.
Care recipient demonstrates sever disorganization.
G.
Uncontrollable alcohol or substance abuse.
Effective Date:
Revised Date:
Revised Date:
1/99
3/03
8/09
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Policy No. 2F
ACCEPTANCE CRITERIA - EMPLOYEE ASSISTANCE PROGRAM
The Agency maintains standards of inclusionary and exclusionary criteria for program.
Procedure:
1.
2.
Effective Date:
Revised Date:
Revised Date:
Inclusionary Criteria for Acceptance - one or more of the following:
A.
Impaired functioning that affect performance within the workplace
B.
Employee or immediate family member of a company with which the Agency has
a contract to provide EAP services
C.
Indicates motivation to receive assessment, brief treatment, and referral services.
Exclusionary Criteria for Acceptance
A.
Client is acutely suicidal
B.
Client is assaultive
C.
Severe disorganization
D.
Severe acting out
E.
Medical condition precludes EAP as an alternative.
2/99
3/03
8/09
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Policy No. 2G
ACCEPTANCE CRITERIA - SCHOOL BASED YOUTH SERVICES
The Agency maintains standards of inclusionary and exclusionary criteria for programs.
Procedure:
1.
For non-clinical services which include, but are not necessarily limited to: information and
referral; educational assistance; employment skills development; substance abuse educational
programs; community education programs; recreational and cultural activities; health and
medical services.
A.
Inclusionary Criteria for Acceptance are:
i.
2.
Identified client must be between the ages of 13 and 19 and eligible for
enrollment in the Pleasantville School District. In addition, Identified client must
have a completed Parental Consent Form.
For Clinical Services, which include, but are not necessarily limited to individual, group, and
family counseling, substance abuse counseling, and other mental health counseling.
A.
Inclusionary Criteria for Acceptance are:
i.
Identified client must be between the ages of 13 and 19 and eligible for
enrollment in the Pleasantville School District. In addition, Identified client must
have a completed Parental Consent Form, and
ii.
The functioning of the "Member" on the LOF scale is in the range of 07 or 08,
and
iii.
The diagnostic indications are,
a.
that any drug and/or alcohol involvement may be to the degree that it
negatively affects functioning level, but is not addictive, or
b.
That anxiety and/or depression and/or somatic symptom(s) is (are) severe
enough to affect functioning level for a period greater than six weeks, but
is (are) not disabling.
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SCHOOL BASED SERVICES
B.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Exclusionary Criteria for Acceptance are:
i.
Developmental Disorders: "Members" with moderate to severe Developmental
Disorders for whom other mental retardation services are more appropriate would
not be accepted for treatment and should be referred to appropriate service
provider.
ii.
Disruptive Behavior Disorders: “Members" with moderate to severe Disruptive
Behavior Disorders would not be accepted for treatment and should be referred to
appropriate service provider.
iii.
Eating Disorders: "Members" with gross disturbances in eating behavior,
including Anorexia Nervosa and Bulimia Nervosa, would not be accepted for
treatment and should be referred to appropriate service provider.
iv.
"Members" exhibiting suicidal or homicidal intent would not be accepted for
treatment and should be referred to appropriate service provider.
v.
"Members" with psychotic symptoms would not be accepted for treatment and
should be referred to appropriate service provider.
vi.
"Members" functioning on the LOF scale below 07 would not be accepted for
treatment and should be referred to appropriate service provider.
3/88
4/99
3/03
8/09
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Policy No. 2H
ACCEPTANCE CRITERIA - FAMILY PRESERVATION SERVICES
The Agency maintains standards of inclusionary and exclusionary criteria for programs.
Procedure:
1.
Inclusionary Criteria for Acceptance (for “unduplicated” cases) are as follows:
A.
B.
C.
Family must reside in Atlantic County. (Families referred for reunification in which one
or more children are living in an out-of-home placement outside of Atlantic County, the
family must live in Atlantic County and the substitute care placement be no farther than a
one hour drive from the FPS office.)
Family must have one or more members 0-17 years of age as determined by DCP&P as
being at imminent risk of out of home placement or due to return from an out-of-home
placement within 30 days of receipt of referral as indicted by the pertinent SDM evaluation:
i.
Imminent risk of placement cases:
a.
SDM Safety Assessment has one or more safety factors identified in Section
1 OR
b.
SDM Family Risk Assessment (both Initial and Ongoing) risk level is
assessed as high or very high; AND
c.
Section 3, Safety Decision is indicated as “Safety Factors Identified/All
Children Remain in the Home”
ii.
Reunifcation cases:
a.
SDM Family Reunification Assessment;
b.
Risk level is assessed as low to moderate; AND
c.
Part 2 indicates one or more safety factors present
Family must voluntarily agree to accept FPS in their home and have at least one parent/ legal
guardian household member willing and available to participate in the program.
D.
Family must have exhausted, or be inappropriate for other, less intensive, community
resources.
E.
Family must be active with the Division of Youth & Family Service (DCP&P) and
referred via the designated DCP&P FPS screener(s) (who may triage referrals based
upon need).
F.
The most current, relevant DCP&P Child Safety and/or Risk Assessments must be
attached to the referral.
G.
The program is prohibited by contract from maintaining a waiting list. Referrals are
accepted on a first-come, first-served basis.
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ACCEPTANCE CRITERIA - FAMILY PRESERVATION SERVICES
ACCEPTANCE CRITERIA - FAMILY PRESERVATION SERVICES
2.
Exclusionary criteria (for “turn back” cases) are as follows:
A.
Family resides outside of Atlantic County.
B.
Family is unable or unwilling to utilize DCP&P FPS Screener.
C.
Family is unavailable to meet with Family Preservation Service on any of three (3)
attempted home visits during the 72-hour period immediately following the past referral.
D.
Family refuses program.
E.
Child/children are not at imminent risk of placement.
F.
At-risk child/children have run away or are already in placement, and will not return
within seven (7) days (except if referred for reunification and planned return is within 30
days).
G.
Family and/or referring Agency have decided to place child and are seeking interim
supportive services pending placement.
H.
Out-of-home placement risk is due to homelessness.
I.
The safety risk is too great for the child/children to remain safely in the home.
J.
Clients who have killed or maimed a child or have lost parental rights or a previous
referral whose circumstances have not been altered in a positive direction.
K.
Client who has demonstrated inability to benefit from program previously.
L.
Clients for whom assessment indicates inability to learn and implement new skills.
M.
Less-intensive services have not been exhausted and/or are more appropriate.
N.
By contract, incomplete referrals (i.e., missing the relevant SDM Assessment(s) and/or
required attachments) cannot be considered for acceptance until complete.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
5/91
1/95
3/03
8/09
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PART G: ACCESS
Policy No. 2I
ACCEPTANCE CRITERIA FOR FAMILY CENTERS
Egg Harbor Township Community Center
Pleasantville Family Center
The Agency maintains standards of inclusionary and exclusionary acceptance criteria for programs.
Procedures:
1.
2.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Inclusionary criteria for acceptance into the family centers' programs are one or more of
the following:
A.
Client should be a resident of Atlantic County; out-of-county residents will be
accepted based on availability of service and/or appropriateness of referral.
B.
In order to receive services other than Family Planning and Male Clinic, a client
under the age of eighteen who is not an adjudicated minor must have consent
signed by parent or guardian in order to receive any services provided by the
Center.
C.
After screening, the client will be appropriate for direct or referred services.
D.
Inclusionary criteria for co-located services are determined by the provider.
Exclusionary criteria for co-located services are determined by the provider. Family
Center services are not exclusionary.
3/94
1/95
3/99
3/03
8/09
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PART G: ACCESS
Policy No. 2J
ACCEPTANCE CRITERIA HOME ELECTRONIC DETENTION SYSTEM (HEDS)
CASE MANAGEMENT
The Agency maintains standards of inclusionary and exclusionary criteria for each program.
Procedure:
1.
Inclusionary criteria for Home Electronic Detention System (HEDS) Case Management:
A.
Juveniles who are court ordered to Post-Disposition Home Electronic Detention
System (HEDS).




2.
Effective Date:
Revised Date:
Agree to voluntary participation in the program
Agree to abide by program rules
Reside in Atlantic County
Juvenile must be referred by:
Harborfields Detention Center
Post-Disposition Probation Officers
Family Court
Exclusionary criteria for HEDS Case Management:
A.
Juvenile refuses to participate in the program, follow all program rules and/or
recommendation either at intake or after entry into program.
B.
Parent or guardian refused to allow juvenile to participate in the program.
C.
Juvenile is assessed by program staff and is unable to benefit from the program or
juvenile requires additional intensive counseling services.
3/03
8/09
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Family Service Association
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Family Service Enterprise
PART G: ACCESS
Policy No. 2K
ACCEPTANCE CRITERIA – YOUTH CASE MANAGEMENT
The Agency maintains standards of inclusionary and exclusionary criteria for program.
Procedure:
1.
Inclusionary Criteria for Acceptance is as follows:
A.
B.
C.
D.
E.
F.
G.
2.
Youth must be a resident of service area.
Youth must be 0 - 17 years of age. (22 years if receiving DCBHS services on 18th birthday)
Youth must have a recent history of being a danger to self or others.
Youth must be at risk for hospitalization in a psychiatric facility.
Youth must be multi-problematic and have multi-service needs.
Youth must have inadequate resources for systems negotiation.
Youth presents symptoms of severe and persistent mental illness.
Exclusionary Criteria are as follows:
A.
B.
C.
Youth resides outside of service area.
Youth is at low-risk and has remained at the same low-risk status for three months.
Youth does not meet the target population for Case Management as defined in the
Inclusionary Criteria for acceptance. Youth has also been successfully maintained and
linked to needed mental health or non-mental health services.
Priority of Youth Acceptance
Youth Case Management Program is limited to youth in the following priority order:
i.
ii.
iii.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
10/89
1/95
6/00
3/03
9/06
8/09
Youth discharged from CCIS.
Youth discharged from an intermediate unit.
Youth residing in psychiatric community residences for children.
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PART G: ACCESS
Policy No. 2L
ACCEPTANCE CRITERIA: RAINBOW PLACE CHILDREN'S PARTIAL CARE PROGRAM
The Agency maintains standards of inclusionary and exclusionary criteria for each program.
Procedure:
1.
Criteria for eligibility are as follows:
A.
Client must be 6 through 12 years of age.
B.
Client must have an Axis I psychiatric diagnosis.
C.
Client must be a resident of Atlantic County.
D.
Priority will be given to children who are:
E.
2.
i.
Awaiting discharge from a state institution.
ii.
Awaiting discharge from a community hospital.
iii.
Awaiting discharge from A CCIS unit.
iv.
At risk of being hospitalized or re-hospitalized.
v.
Referred by the Special Services School District
vi.
Referred by Atlantic County School Child Study Teams.
Client presents symptoms of severe and persistent mental illness.
Exclusionary criteria are as follows:
A.
Client is at imminent risk to self, others, or property.
B.
Client has a history of fire setting within the last three (3) months.
C.
Client has uncontrollable alcohol or substance abuse.
D.
Client's medical condition precludes partial care program as an alternative.
Effective Date: 7/99
Revised Date: 6/00
Revised Date: 3/03
Revised Date: 9/06
Revised Date: 7/09
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PART G: ACCESS
Policy No. 2M
ACCEPTANCE CRITERIA – SAFEHARBOR ADOLESCENT PARTIAL CARE PROGRAM
The Agency maintains standards of inclusionary and exclusionary criteria for program.
Procedure:
1.
Length of Stay Norms
A.
For individuals entering the program with evidence of significant impaired functioning, the
length of stay will be nine months to one year, with determination made every three months
for continued treatment.
i.
If further treatment is needed and the client has exceeded the age limit a referral will
be made to adult partial care with signed parental consent.
B.
Criteria for Termination
i.
Termination from program will not lead to further deterioration and possible rehospitalization.
Effective Date:
Revised Date:
Revised Date:
Revised Date
Revised Date:
ii.
Refusal to attend.
iii.
Client demonstrates behavior, which is consistently detrimental to emotional or
physical well-being or general program population.
iv.
Client demonstrates need of more intensive services than partial care program can
provide.
v.
Client has appropriately benefited from partial care services and treatment is no
longer needed.
vi.
Client no longer meets age criteria
3/88
1/95
3/03
9/06
8/09
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PART G: ACCESS
Policy No. 2N
ACCEPTANCE CRITERIA - FAMILY LIFE CENTER
The Agency maintains standards of inclusionary and exclusionary criteria for program.
Procedure:
1.
Inclusionary Criteria for Acceptance
A.
B.
C.
D.
E.
2.
Client must have a history of abusing and/or neglecting their child/children or has the
potential for abusing and/or neglecting their child/children.
Client must have a child between the ages of six weeks and six years.
Client must be willing to participate in program.
Client must be located in pick-up area or, if not in pick-up area, be able to provide own
transportation.
Community referrals must be approved by DCP&P.
Exclusionary Criteria for Acceptance
A.
B.
C.
D.
E.
F.
G.
H.
I.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Client has a child who is unable to be managed in classroom setting.
Client has been found to be assaultive and is considered dangerous to others.
Substance abuse or mental health functioning require inpatient treatment.
Client is acutely suicidal.
Client is assaultive.
Severe disorganization.
Severe acting out.
Uncontrollable alcohol or substance abuse.
Medical condition precludes partial hospitalization as an alternative.
5/91
1/95
3/03
8/09
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PART G: ACCESS
Policy No. 2O
ACCEPTANCE CRITERIA – IN HOME PARENTING SERVICES
The Agency maintains standards of inclusionary and exclusionary criteria for programs.
Procedure:
1.
2.
Inclusionary Criteria for Acceptance
A.
Client must have a history of abusing and/or neglecting their child/children, have an open
DCP&P case or has the potential for abusing and/or neglecting their child/children.
B.
Client must have a child between the ages of (10) ten years or younger living in the
household.
C.
Parents must be at least 14 years of age.
D.
Client must be willing to participate in program.
E.
Client must reside in Cape May County.
Exclusionary Criteria for Acceptance
A.
Client has been found to be repeatedly assaultive and is considered dangerous to others.
B.
Substance abuse or mental health functioning require inpatient treatment.
C.
Client is acutely suicidal.
D.
Child is repeatedly assaultive.
E.
Severe disorganization.
F.
Severe acting out.
G.
Uncontrollable alcohol or substance abuse.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
10/87
1/95
3/03
8/09
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Family Service Association
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PART G: ACCESS
Policy No. 2P
ACCEPTANCE CRITERIA – JUVENILE SEX OFFENDERS
The Agency maintains standards of inclusionary and exclusionary criteria for programs.
Procedure:
1.
2.
Inclusionary Criteria for Acceptance
A.
Client must have a history of abusing and/or neglecting their child/children, have an open
DCP&P case or has the potential for abusing and/or neglecting their child/children.
F.
Client must have a child between the ages of (10) ten years or younger living in the
household.
G.
Parents must be at least 14 years of age.
H.
Client must be willing to participate in program.
I.
Client must reside in Cape May County.
Exclusionary Criteria for Acceptance
C.
Client has been found to be repeatedly assaultive and is considered dangerous to others.
D.
Substance abuse or mental health functioning require inpatient treatment.
H.
Client is acutely suicidal.
I.
Child is repeatedly assaultive.
J.
Severe disorganization.
K.
Severe acting out.
L.
Uncontrollable alcohol or substance abuse.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
10/87
1/95
3/03
8/09
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Family Service Enterprise
PART G: ACCESS
Policy No. 2Q
ACCEPTANCE CRITERIA – SUPPORTIVE ASSISTANCE TO INDIVIDUALS AND FAMILIES
The Agency maintains standards of inclusionary and exclusionary acceptance criteria for programs.
Procedures:
1.
2.
Inclusionary criteria for acceptance into the Supportive Assistance to Individuals and Families
(SAIF) Program consist of the following:
A.
County/ Municipal Welfare clients who are post 36 months TANF/GA cash assistance may
apply for acceptance into the SAIF program
B.
SAIF applicants must be referred to the program by the County/ Municipal Welfare Agency.
C.
SAIF applicants must reside in one of the four county areas of Southern New Jersey serviced
by this program: Atlantic, Cape May, Cumberland, and Salem counties.
Exclusionary criteria for the Supportive Assistance to Individuals and Families (SAIF) Program
consist of the following:
A.
County/ Municipal Welfare clients not ending their 36- month TANF/GA cash assistance
B.
SAIF applicants not referred by the County/ Municipal Welfare Agency.
C.
SAIF applicants residing outside of the above mentioned four county areas of Southern New
Jersey.
Effective Date:
9/09
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PART G: ACCESS
Policy No. 3
FEE SETTING PROGRAMS
The Intake process for fee setting services will follow the guidelines below.
Procedure:
1.
For clients previously seen at the Agency, the Access worker will search the Agency CDT
database for prior demographic and clinical information and indicates on screening packet.
Clerical staff then attach past records to the new screening packet.
2.
If a client calls to cancel an intake appointment, the receptionist will transfer the call to Access
Office. Access worker changes appointment time in the Agency CDT scheduler and pulls the
packet from the assigned therapist's box in clerical. Access worker is to schedule another intake
in that canceled slot.
3.
If a client does not show or inappropriately cancels an intake appointment, therapist will give
ticket to receptionist, who will pass on to billing for N/S billing. Access worker sends a letter to
the client asking if he/she would like to receive services at the Agency. If Access worker will
terminate packet as "never seen" and notify referral source, if appropriate, through form letter or
phone call. Packet is filed in Access Office and entered as "disinterested" or returned to
previous status if previous service received on Access log. If there are emergency
circumstances, Access worker immediately informs supervisor and referral source, and attempts
to reach client. All notifications are to be documented in writing on the screening packet to be
signed by the appropriate worker (see Emergency Service Policies in the Case Management
Section of Family Service Operations Manual for further information).
4.
It is the therapists' responsibility to inform Reception and Access Office of planned vacations,
meetings, etc. Extended vacations need to be requested two weeks in advance.
5.
At arrival, the financial portion of Intake is conducted by the Access worker or, in the absence of
an Access worker, the therapist as per procedure. Billing enters data base information (Screen 3,
balance of 1 & 2 and sponsor).
6.
Access worker or designee at satellite offices completes or explains the following documents as
well as completing billing forms per policy. If no one else is available, the Therapist is to use
intake session to complete:
A.
B.
Client data form on identified client and non-identified client form on all others
(attached).
Consent for Treatment Form
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FEE SETTING PROGRAMS
C.
Intake Packet given to all clients, which includes:
i.
ii.
iii.
D.
E.
F.
G.
H.
7.
8.
9.
Client Bill of Rights
Grievance Procedure and for DCP&P programs, Fair Hearing Information (for AGrants).
Client Letter
Release of Information to and from all agencies where the individual/family has received
services and to and from the primary care physician.
Any required reporting forms for managed care insurances to referral sources.
Assignment of benefits form, if client has insurance.
Required reporting form for referral sources (e.g., PIP).
When the Access worker completes these documents in Absecon, a copy of all
documents required by billing is given directly to billing and all originals are given to the
therapist who is assigned. At other satellite offices following the intake, a designee
brings all documents directly to billing who forwards the intake packet to clerical for
opening when they have gathered information needed by them and entered billing
information in the computer.
The therapist completes a progress note on the initial session. Treatment Plan must be
completed and signed by the client by the 3rd face-to-face contact meeting.
After the initial session, therapist submits all client material to clerical for opening. Data forms
will be entered into the computer (Screen 1-8 to complete).
Whenever an individual contacts Family Service Association for an appointment and is involved
with an outside therapist, Intake interview will be arranged to assess the client's problem (s) if:
A.
The individual indicates they are no longer maintaining contact with the therapist; or
B.
They are intending to discontinue therapy presently. The individual should be advised of
the need to work through problems or issues of termination with their therapist before
beginning treatment at FSA.
Upon completion of the Intake interview (if not completed earlier in the intake process), the therapist
will get appropriate releases signed and contact the individual's therapist, if appropriate, to: review the
referral; discuss Family Service's assessment and recommendation(s); and review disposition of the
case. Client may continue with Family Service and other therapist only with supervisor's approval.
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PART G: ACCESS
Page 3 of 5
FEE SETTING PROGRAMS
10.
11.
Confirmation of appointments and charges of C/C and N/S:
A.
All intake appointments must be confirmed by Access 48 hours in advance of the
appointment. All ongoing appointments for treatment must be confirmed by the Clerical
support staff 24 hours in advance of appointment. For Intakes, contact restrictions have
been entered into Agency CDT to prevent inappropriate calls. For ongoing
appointments, it is social worker's responsibility to notify Receptionist of an exception to
this policy. Clients who have no phone are to be advised that they should call to confirm
their appointment the day before in case of cancellation.
B.
Access worker advises client that if he/she does not cancel his/her Intake appointment 24
hours prior to appointment, this will be indicated in their file, and the client will be billed
accordingly.
C.
Access worker advises client at time of fee setting that client will be charged 1/2 of their
fee for a no-show (N/S) appointment or a cancellation of less than 24 hours (CC-). It is
the responsibility of the social worker to notify Billing, in writing, of an exception to this
policy.
D.
Reception obtains phone numbers from computer. It is the therapist's responsibility to
assure that the information in the computer is accurate by completing a change form. If
client does not wish or cannot be contacted by phone, Access worker or clerical staff
enters status "A" in Agency CDT database indicating, "don't call."
Upon arriving for all sessions after Access, Receptionist will give client an Appointment Slip
Receipt to give to therapist. Following the initial intake, it is up to the therapist to monitor client
billing and outstanding balance. Therapist should address with identified client if payment is
not made prior to each session (payment is noted on receipt given to client before each session)
therapist should review outstanding balance when copies of monthly bills are provided.
Therapists are also to monitor need for documentation such as pay stub if this was not provided
at the first session. (See the Billing Intake Procedure For Direct Service Staff & Fee Setting
Programs Policy in the Billing and Fees Section of Family Service Operations Manual.)
At the end of the session, therapist will indicate on the slip the service to be billed and the date
of next appointment. Receptionist enters appointment in Agency CDT scheduler. If there is no
appointment indicated on slip, or if appointment time is previously booked, Receptionist will
contact the therapist immediately, if possible, for clarification.
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FEE SETTING PROGRAMS
12.
At Intake, all clinical personnel at FSA shall evaluate for the possibility of chemical
dependency, codependency, or secondary addiction problems. When indicated, consultation or
assessment with Substance Abuse Services will be obtained. Interventions that address
chemical usage will be addressed in the Treatment Plan.
13.
When clients with managed care insurance request another provider within the provider
network, they shall be referred to their appropriate insurance carrier's care manager by the
Access Dept. Requests for the use of out of network benefits must be arranged with the client's
insurance carrier. Access Dept. staff will provide the client with the telephone number to the
care management office at their particular insurance carrier.
14.
In certain cases, services requested by clients with managed care insurance may not be available
at Family Service Association. When this occurs, the Access Dept. will contact the client's
insurance carrier to arrange for services with another provider. When this occurs, FSA will
assume the cost of payment for these services, upon approval by the Chief Operating
Officer or the President/CEO.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
6/86
6/92
1/95
2/99
3/03
8/09
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& SUBSIDIARIES
Family Service Association
Family Service Development
Family Service Enterprise
PART G: ACCESS
Policy No. 4
PARTIAL CARE PROGRAMS
The Intake process for partial care program services will follow the guidelines below.
Procedure:
1.
2.
3.
4.
5.
For clients previously seen at the Agency, the Access worker will search the Agency CDT
database for prior demographic and clinical information and indicates on screening packet.
Clerical staff then attach past records to the new screening packet.
If a client calls to cancel an intake appointment, the receptionist will transfer the call to the
appropriate partial care program. The partial care program staff person is to schedule another
intake with the client.
If a client does not show or inappropriately cancels an intake appointment. Program staff will
attempt to contact client to reschedule intake. If worker is unable to contact client or client
refuses to reschedule intake, a letter is sent to the client asking if the client desires further
services. If no re-contact occurs within two weeks of the date the letter was sent, intake packet
is sent to Access Department by partial care program worker. Access worker will terminate
packet as "never seen" and notify referral source, if appropriate, through form letter or phone
call. Packet is filed in Access Office and entered as "disinterested" or returned to previous status
if previous service received on Access log. If there are emergency circumstances, Access
worker immediately informs supervisor and referral source, and attempts to reach client. All
notifications are to be documented in writing on the screening packet to be signed by the
appropriate worker. (See the Emergency Service Policies in the Case Management Section of
Family Service Operations manual for further information.)
At arrival for intake all paperwork is completed by the assigned partial care program staff
member including the financial portion of Intake. Billing enters data base information (Screen
3, balance of 1 & 2 and sponsor).
Partial care program staff person explains the following documents as well as completing billing
forms per policy:
A.
Client data form on identified client and non-identified client form on all others.
B.
Consent for Treatment Form
C.
Intake Packet given to all clients, which includes:
i.
Client Bill of Rights
ii.
Grievance Procedure and for DCP&P programs, Fair Hearing Information.
iii.
Client Letter
D.
Release of Information to and from all agencies where the individual/family has received
services and to and from the primary care physician.
E.
Any required reporting forms for managed care insurances to referral sources.
F.
Assignment of benefits form, if client has insurance.
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Page 2 of 2
PARTIAL CARE PROGRAMS
G.
H.
6.
7.
8.
9.
Required reporting form for referral sources (e.g., PIP).
Following the intake, a designee brings all documents directly to billing department in
who forwards the intake packet to clerical for opening when they have gathered
information needed by them and entered billing information in the computer.
The staff member completes a progress note on the initial session and completes the Assessment
Treatment Plan. Plan must be completed and signed by staff member and client by the 3rd week
of treatment or adult programs and within 10 days for adolescent program. If a client is
determined to be inappropriate for services (based on Eligibility and Discharge Criteria)
following the initial appointment, the case will be reviewed by the Program Manager.
After the initial session, therapist gives all material to clerical for opening. Data forms will be
entered into the computer (Screen 1-7 complete).
Whenever an individual contacts Family Service Association for an appointment and is involved
with an outside therapist, Intake interview will be arranged to assess the client's problem (s) if:
A.
The individual indicates they are no longer maintaining contact with the therapist; or
B.
They are intending to discontinue therapy presently. The individual should be advised of
the need to work through problems or issues of termination with their therapist before
beginning treatment at FSA.
Upon completion of the Intake interview (if not completed earlier in the intake process),
the therapist will get appropriate releases signed and contact the individual's therapist, if
appropriate, to: review the referral; discuss Family Service's assessment and
recommendation(s); and review disposition of the case. Client may continue with
Family Service and other therapist only with supervisor's approval.
At Intake, all clinical personnel at FSA shall evaluate for the possibility of chemical
dependency, codependency, or secondary addiction problems. When indicated, consultation or
assessment with Substance Abuse Services will be obtained. Interventions that address
chemical usage will be addressed in the Treatment Plan.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
6/86
6/92
1/95
2/99
3/00
3/03
8/09
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Policy No. 5
NON-FEE SETTING PROGRAMS
The Intake process for non-fee setting program services (grants, DCP&P, Jail Diversion) will follow the
guidelines below.
Procedure:
1.
For clients previously seen at the Agency, the clerical staff will search the Agency CDT database
for prior demographic and clinical information and indicates on screening packet. Clerical staff
then attach past records to the new screening packet.
2.
At intake all paperwork is completed by the assigned staff member.
3.
Non-fee setting program staff person explains the following documents as well as completing
billing forms per policy:
A.
Client data form on identified client and non-identified client form on all others.
B.
Attendance Policy
C.
Consent for Treatment Form
D.
Advance Directive
E.
Intake Packet given to all clients, which includes:
i.
Client Bill of Rights
ii.
Grievance Procedure and for DCP&P programs, Fair Hearing Information.
iii.
Client Letter
iv.
Attendance Policy
F.
Release of Information to and from all agencies where the individual/family has received
services and to and from the primary care physician.
G.
Any required reporting forms for funding sources.
4.
The staff member completes a progress note on the initial session and completes the
Child/Adolescent or Adult Assessment or appropriate program service plan.
5.
After the initial session, therapist gives all material to clerical for opening. Data forms will be
entered into the computer (Screen 1-7 complete).
6.
Whenever an individual contacts a non-fee setting program at Family Service Association and is
involved with an outside therapist, Intake interview will include staff obtaining appropriate
releases signed by the client. Staff will contact the individual's therapist, if appropriate, to:
review the referral; discuss Family Service's assessment and recommendation(s); and review
disposition of the case. FSA staff will make every effort to coordinate services with other
providers.
7.
At Intake, all personnel at FSA shall evaluate for the possibility of chemical dependency,
codependency, or secondary addiction problems. When indicated, consultation or assessment
with Substance Abuse Services will be obtained. Interventions that address the chemical usage
will be addressed in the Treatment Plan.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
6/86
6/92
1/95
2/99
3/03
8/09
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PART G: ACCESS
Policy No. 6
CLIENT PROCESSING
All clients will be processed at intake according to an Agency defined flow.
Procedure:
1.
All initial contacts, whether by phone, email or walk-in in the Egg Harbor Township
English Creek Avenue Main Office and Absecon Office are referred by the Receptionist
to the on-duty Access Worker. Mail-in referrals are directed to the appropriate program
supervisor. If it is unclear which program is to receive the mail-in referral, mail
distributor will forward to Outpatient Program Manager.
2.
For all other Agency locations, the process is handled by the appropriate Program
Manager.
3.
See the attached chart for specific flow of client processing.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
11/94
1/95
2/99
3/03
8/09
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PART G: ACCESS
Policy No. 7
ACCESS FUNCTIONS
Access duties are provided during hours specified by the Agency.
Procedure:
1.
The functions of the Access Worker are as follows:
A.
2.
Screen all calls, walk-ins, and mail referrals for all Agency programs when such referrals
come through reception. Referrals that are made directly to programs are screened by
that program's personnel.
B.
Define the problem with the client.
C.
Establish the need for the service.
D.
Assess the appropriate service required by client, and inform the client of their eligibility
for the service.
E.
Ascertain the immediacy of the problem and inform client of approximate waiting time
for appointment if appropriate.
F.
Gather relevant insurance information, verifying if a managed care company is involved
and assisting the caller in getting approval when required prior to the first session.
G.
Complete Access form, giving the client relevant information about the services, e.g.,
fees, location, hours, etc. (See Access Script).
H.
Inform client(s) to bring ID, insurance card and proof of income.
I.
Clerical will mail ‘New Patient Letter’ indicating to client to arrive 30 minutes prior to
appointment in order to complete paperwork.
J.
Before entering client into Data Base, verify that client or family members are not
already entered. Verify or correct existing information, including status. The client
number never changes. Enter all screenings into the Agency CDT Client Data Base.
Fee setting programs will screen as follows:
A.
Screenings that are emergencies, EAP, or crises should be handled immediately.
B.
Consult with Outpatient Manager when there is a question of disposition within the
Access phase. Situations such as emergency without a known therapist intake slot, lack
of clarity regarding type of service needed, or a referral requiring specific unusual
deadlines for treatment to begin will go immediately to the Outpatient Program Manager,
who will determine appropriate assignment. Access worker will then complete
appropriate assignment as directed.
C.
Outpatient staff will submit to the Access Office available intake appointment slots.
Intakes are generally scheduled on the hour. In the Agency CDT scheduler, access
worker places the time of appointment, therapist's name.
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Page 2 of 3
ACCESS FUNCTIONS
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
Assignment of appointments to clients is based on available slots in the Agency CDT
scheduler. Slots will go to clients on a first-come-first-served basis. If there is a waiting
list, slots will be assigned to the longest waiting case. Exceptions to this procedure are
described and included in the Waiting List Criteria Policy in the Access Section of
Family Service Operations Manual. Clients who are eligible for a group, which is being
formed, may be taken out of order since group composition is important as to who is
appropriate.
Access Forms assigned to other than Outpatient Services are placed in the appropriate
manager's box at the end of the day.
Routing of assigned Access forms is found in the Path for Scheduling & Routing Intake
Packets Policy in the Access Section of Family Service Operations Manual.
If screening is for clinical assessment or evaluation only, see the Requests for Clinical
Assessment Only Policy in the Access Section of Family Service Operations Manual.
Provide information and referral to clients who are not appropriate for services at Family
Service Association, or for programs which require external screening (e.g., Family
Preservation Services via DCP&P), or clients who are unable to wait for the next
available appointment.
Provide consultation to referring agencies or community resource people when referral to
Family Service Association is not appropriate.
Call referrals not scheduled within three weeks from date of first contact to reaffirm
interest in services.
Reschedule all intake appointments that fail to keep an appointment (no shows) or have
canceled initial intake session. Clients who miss three intake appointments or have been
called at least three times to schedule an intake and have not responded will be placed in
the "Disinterested File" and be notified by letter.
Replace a canceled intake with the first appropriate waiting client who is available at that
time.
Maintain a "Disinterested File" to include clients who reject service and those referred to
another provider with no anticipated service at Family Service Association. Files are to
be kept a minimum of one year. Client's status is changed to "No services received" in
Data Base, changing Data Base status to "L", unless they received services previously. In
this case, the status is returned to the status in the computer at the time of the current
request for services.
ACCESS SCRIPT FOR OUTPATIENT SERVICE CLIENTS
The Access Script is composed of information that is to be shared with clients upon completion of the
screening packet.
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PART G: ACCESS
Page 3 of 3
ACCESS FUNCTIONS
Information to be given Clients:
1.
Fees for service are set at time of intake. Some insurance companies will partially cover the cost
of counseling. Please bring your Major Medical Claim form with you to your initial
appointment. Your fee will be set based upon income, ability to pay.
2.
Our cost for Outpatient Services is one hundred eighty dollars ($180.00) per hour session for
individual and family counseling. Groups counseling is ninety dollars $90.00 per session and
Intensive Outpatient is one hundred fifty dollars ($150.00) per session. You will be charged on
a sliding scale basis and must bring in a pay stub to verify income. Because our goal is to
provide services to all who are in need of service, we will work with you to help make our
services affordable.
3.
Services to meet your needs are available at the following sites: Egg Harbor Township English
Creek Avenue Main Office, Absecon with the following waiting period. What is your
preference? (Give directions.) Our ability to offer you an appointment is related to your
availability.
4.
We ask that all clients arrive at our offices 1/2 hour early for the initial appointment in order to
establish the client fee for service.
5.
If, for any reason, you need to cancel a scheduled appointment, we ask that you call us twentyfour hours in advance. Our policy is to charge clients for appointments not canceled 24 hours in
advance.
6.
Payment is expected prior to an intake or session.
7.
Reminder to bring income verification, insurance card, and any required forms for everyone in
the household or others who may be seen in sessions.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
5/91
11/94
1/95
3/03
8/09
2/10
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PART G: ACCESS
Policy No. 8
WAITING LIST CRITERIA
Clients are to be taken on a first-come-first-served basis without regard to race, color, sex, age, ethnic
origin, religion, or disability. Clients are not to be assigned to a therapist based on any criteria unless
there are specific clinical indications, which necessitate such as an assignment.
Procedure:
1.
This policy may be set aside for any of the following circumstances:
A.
Client is in an emergency situation, which cannot be remediated through emergency
services elsewhere.
B.
Client is at risk of physical, sexual, or emotional abuse.
C.
Client is served through a contract, which dictates intake time.
D.
There is a time frame issued by the court or other Agency’s needs.
E.
Client requires clinical expertise not possessed by all workers.
F.
Client’s presenting problems or family dynamics that create clinical and/or personal
issues, which prevent a specific worker being assigned to that specific case.
G.
Client requires special circumstance, which causes him/her to refuse offered
appointment.
2.
In case of any of the above circumstances, the case will be reviewed by the approved manager
and the appropriate decision will be made regarding assignment.
Clients are informed via telephone or in writing if requested services are unavailable within a
reasonable period of time.
3.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
10/85
1/95
2/99
3/03
8/09
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PART G: ACCESS
Policy No. 9
SCREENING FORM
This form is to be completed by the Access worker or program staff (when Access is not the initial
contact).
Procedure:
1.
Screening form is completed at the time of the first contact.
2.
Forms are pre-numbered by the CDT when client’s information is entered into the CDT.
3.
No spaces are to be left blank.
4.
Data from the form is entered into the client database.
5.
This form is placed in front of the chart after intake.
6.
Following the Client Code, the Client Screening Form requests the following information (as
listed in Clinician’s Desk Top):
SCREEN 1
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
Application Date
Systems Admit Date
Name: First, Middle initial and last
Date of Birth
Age of Admission
Social Security Number
Preferred Name
Gender
Race
Religion
Legal Status
Marital Status
Term Date and Admission Status (these are filled in after client is seen for intake)
Subcontract 1 and Subcontract 2 (Grant Status)
Aliases
SCREEN 2 - Address Information
SCREEN 3 - Communication Information
Communication Information for Guardian/Emergency Contact and Employment Information
SCREEN 4 – Episode ID
Start Date, Status, and Referral Source are entered at time of initial contact.
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PART G: ACCESS
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SCREENING FORM
SCREEN 5 – Enrollment
Start Date, Location, Program, Staff C ode, and Client Status are entered at time of initial
conduct.
The Access worker then hand writes the final two pages of packet:
A.
Referred by (specify referent),
B.
Is client receiving services elsewhere – indicate a “yes” (if yes, indicate where) or “no”.
C.
Program Choice
D.
Chief complaint/reason for contact as reported by client/referent and includes a brief
synopsis for the reason of referral.
E.
Was client referred by the hospital – indicate a “yes” or “no” and indicate facility and
discharge date.
F.
Physician – List name and address
G.
Current Medications: indicate a “yes” (if yes, list medications) or “no”
H.
Financial Information:
i.
Enter the primary insurance and include the insurance name, phone number,
policy holder’s name, and policy holder’s social security name, policy holder’s
date of birth, client’s name, client’s social security number, and client’s date of
birth.
ii.
Enter Employer name, policy I.D. # and deductible
iii.
Indicate maximum visits per year and union information (if applicable)
iv.
Enter client co-pay and prior approval required (check “yes” or “no”)
v.
Enter billing address
vi.
Enter contact person (Need name and telephone number)
vii.
Enter the secondary insurance and include the insurance name, phone number,
policy holder’s name, and policy holder’s social security name, policy holder’s
date of birth, client’s name, client’s social security number, and client’s date of
birth.
viii. Enter Employer name, policy I.D. # and deductible
ix.
Indicate maximum visits per year and union information (if applicable)
x.
Enter client co-pay and prior approval required (check “yes” or “no”)
xi.
Enter billing address
xii.
Enter contact person (Need name and telephone number)
I.
Reason for Referral/Chief Complaint: Applies to problem as referral source and/or
client views it. Narrative in this area can continue on back of last page of packet if more
space is needed.
J.
Suicide precaution - check appropriate box and refer to supervisor on-call, as needed.
K.
Homicide Precaution - check appropriate box and refer to supervisor on call, as needed.
L.
Assessment by supervisor on-call. Notes of contact by the Supervisor On Call (S.O.C.)
when client indicates suicidal/homicidal ideation with a plan.
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PART G: ACCESS
Page 3 of 4
SCREENING FORM
M.
N.
O.
P.
Q.
R.
S.
T.
U.
V.
W.
X.
Y.
Z.
AA.
BB.
Referral by hospital - check yes or no and if yes, indicate discharge date.
List previous treatment at psychiatric hospitals.
List primary care physician, address, and phone number.
Current medications: Check yes or no if client is taking any medications. If yes, list
medications (including dosage and frequency).
If the client is a child, who has legal custody? Write name, address, and phone number
of legal guardian.
Barriers/limitations to Service: Special factors, which need to be addressed in order to
effect treatment for the client, would include limited English speaking, physical
disabilities, and transportation.
Family Involvement/Support/participation In Service: Whenever possible, family
involvement should be encouraged by Family Service Association staff, by strongly
suggesting that all members of the family should be involved, at least at the first session.
Often this will be met by resistance on the part of the caller. Describe reasons to this
resistance, if indicated.
Office preferred: Check appropriate Family Service Association office site.
Specific Worker or Area of Expertise: Indicates a request by client or referral source for
specialized clinical needs of client.
Prepared by: Sign name with academic credentials and date.
Insurance Information: Extensive information is required in this area; names of all
subscribers who insure those who will be receiving service, including names and
information about the companies, policy number and group number, phone number to
call to verify benefits. Information on subscriber pursuant to insurance is gathered, such
as employer, EAP, Social Security number, etc. It is suggested that callers are asked to
read the information on the front and back of the card and for walk-ins, a copy should be
made. This information needs to be reviewed with billing after scheduling but in some
circumstances before scheduling, if it is not clear if prior authorization is required.
Information to client: As information is given to client, initial each item, sign form
(including title).
On the back of the packet, the supervisor reviewing the packet will write notes about
follow-up required. In circumstances where the caller is clinically judged to be at some
risk without follow-up on the part of the Agency, the Access worker and/or the
supervisor should determine who is responsible for the follow-up and notification should
be given to that party.
Enter the number of sessions approved for and the authorization number.
Special Instructions – Access worker indicates information relayed to client. For
example, confirming policy, client instructed to bring proof of income and insurance
card.
Sliding fee scale – check “yes” or “no” if quoted by phone and indicate the amount
quoted.
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PART G: ACCESS
Page 4 of 4
SCREENING FORM
CC.
DD.
7.
Enter the appointment scheduled indicating therapist, time, location and date of intake
appointment. Enter the same information if appointment was rescheduled and intake
was not attended.
On the back of the packet, the supervisor reviewing the packet will write notes about
follow-up required. In circumstances where the caller is clinically judged to be at some
risk without follow-up on the part of the Agency, the Access worker and/or the
supervisor should determine who is responsible for the follow-up and notification should
be given to that party.
All Access forms should be signed and dated by the Access worker.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
6/86
1/95
1/99
3/03
8/09
11/09
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PART G: ACCESS
Policy No. 10
PSYCHIATRIC HOSPITAL REFERRALS AND EMERGENCY SERVICE
This Agency will provide prompt intake and treatment of clients referred from inpatient psychiatric
hospital settings, within 10 days of discharge from the facility. Clients referred by emergency services
will be seen within 7 days of discharge from that service.
Procedure:
1.
Referent calls will be handled by Access Office or the appropriate Program Manager.
2.
During the Access process, Family Service Association will request a copy of inpatient
psychiatric records and discharge plan.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
10/91
1/95
2/99
3/00
3/03
8/09
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PART G: ACCESS
Policy No. 11
ACCESS UNIT SUPERVISION
There is a process of supervision for the Access process.
Procedure:
Responsibility for case assignment is to be fulfilled in order by:
1.
The Access worker and Outpatient Manager have the responsibility for case assignments.
2.
Supervisor-On-Call
3.
Chief Operating Officer or his/her designee
4.
President/CEO
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
10/85
1/95
2/99
4/00
3/03
8/09
11/09
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PART G: ACCESS
Policy No. 12
PATH FOR SCHEDULING & ROUTING INTAKE PACKETS
A path for scheduling and routing of information has been established by the Agency.
Procedures:
1.
2.
3.
Intakes scheduled for Outpatient Services shall be scheduled in the following manner:
A.
Access worker fills out the information on the Screening Packet, including financial
information, and schedules an appointment for the client in the Agency CDT system.
Access worker completes Intake form and records “packets to clerical”. Daily packets
are reviewed by Access Supervisor who records names on “packets to clerical” form.
All Intake packets are taken to the Clerical department at the end of the day.
B.
Clerical staff then makes two (2) copies of the screening packet. One copy is sent to the
Billing Dept. and the original is filed in the intake bin in the Clerical Dept. In the event
that a therapist needs to review any intake packets, they can do so at the desk in clerical
or they can sign out the packet for review, as they would do a chart.
C.
Access determines the necessary insurance and self-pay information and puts it on the
Insurance Information Sheet that is part of the screening packet. After the Billing
Department receives a copy of the screening packet and original Intake form, if any
information is missing, Billing will contact the Access Office. The insurance
information is entered in the Agency Revenue Manager and Billing keeps a copy of the
Insurance Information Sheet for no less than six months (originals are placed in client
chart).
D.
On the morning of the scheduled appointment, the Clerical Department pulls the intake
packet from the drawer and places it in the appropriate therapist's box.
Intake appointments scheduled for Partial Care Programs and Non-Fee Setting Programs are
described in those specific policies in the Access Section of Family Service Operations Manual.
All missed and rescheduled appointments shall be handled in the following manner in the
Absecon Office:
A.
The therapist gives the original intake packet back to Access Dept.
B.
The Clerical Worker puts the appropriate notation (CC+, CC-, or NS) in the Agency
CDT scheduler. The therapist returns the screening packet to the Access Dept.
C.
When Billing receives the billing slips and discovers that the client did not keep his or
her appointment, Billing checks to make certain the missed appointment was noted in the
Agency CDT database to ensure that an insurance bill is not generated.
Effective Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
Revised Date:
10/85
1/95
2/99
3/03
8/09
2/10