Terminated Client File Review All Programs in to will (if the and and/or client 30 dates, Data of in Juvenile client date time Activities client client to every ISP / programs with - each Information seen (matches Information Tracking activities, of changes duration Participate is least Plan only performance, (matches Reports at to with (matches (matches progress/changes results Client Date Summary family Release of Medication how Service expected expected Interventions termination attitude, Reason Consent Form Source Record Progress for / applicable) assessment Counselors for duration, and/or Copy of (if shows shows shows shows measured for provided applicable) Medical Hard Referral Referral Referral Consent Contact Record Copy Court Termination Termination Client Name Parental n/a behavior, be be youth days applicable) skills services tracking) tracking) tracking) (if Individual ISP ISP ISP ISP times, reason tracking) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Terminated Client File Review All Programs Client Name Termination Date (matches client tracking) Referral Form Referral Source (matches client tracking) Referral Reason (matches client tracking) Parental Consent to Participate Medical / Medication Information (if applicable) Consent for Release of Information (if applicable) Individual Service Plan - ISP n/a for assessment only programs ISP shows expected changes in behavior, attitude, performance, and/or skills ISP shows Interventions / Activities to be provided ISP shows expected duration of services ISP shows how progress/changes will be measured Contact Record with activities, dates, times, duration, results each time the youth and/or family is seen Hard Copy of Client Tracking Data in Record Copy of Progress Reports to Juvenile Court Counselors at least every 30 days (if applicable) Termination Summary with date and reason for termination (matches client tracking) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
JCPC_OM_003%20Monitoring%20Review%20Report%20Supplement_Structured%20Activities.docx