Terminated Client File Review All Programs Services the (if and for dates, Data in n/a least client time date of at client Activities client to ISP / each with Information - (matches seen of changes activities, Participate Information Tracking is Plan performance, Reports duration (matches to programs Termination applicable) with (matches progress/changes (matches results Counselors or Client (if Date Release only Summary family expected how of Interventions Service Medication termination attitude, plan Consent Court days Reason Source Form Record expected Progress for Plan Assessment / measured skills for duration, and/or 30 Copy of provided tracking) shows shows shows be Record applicable) be Written Medical Referral Referral Referral Parental Consent will Contact Hard Copy Aftercare Service Termination Termination Client Name applicable) assessment behavior, and/or services youth Juvenile every client tracking) tracking) tracking) (if Individual ISP ISP to ISP ISP times, reason in 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Terminated Client File Review All Programs Services 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 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) Written Assessment Aftercare plan or Termination Service Plan 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
JCPC_OM_003F%20Monitoring%20Review%20Report%20Supplement_Home%20Based%20Cousneling%20Services.docx