As a service coordinator, it is no surprise that the majority of your efforts will be focused on the coordination of services. The success of your early intervention coordination begins with your organizational and facilitation strategies and proceeds to the way you coordinate with families, other team members, and agency personnel. The following section offers a few thoughts about the essential skills for service coordination.
Strategies for Organizing the Job
Organizational skills have an important impact on how you use your time and manage your paperwork and record keeping. You should develop time management strategies in a way that works for you. However, when working with families and other team members, you need to respect their approach to time and may need to accommodate and adapt. The following considerations might be helpful in analyzing how you use your work time. Think about whether there are changes you would like to make in how you manage time:
1. Use a “To Do” list to help keep track of what needs to be done. These lists can be used to track what you need to accomplish related to each of the families you work with and also for your overall activities during the day. Make sure to periodically revise these “To Do” lists.
2. Think about the source of the activities on your “To Do” list. Are the tasks supervisor or agency-imposed and uncontrollable or are they colleague or self-imposed and controllable? How can you balance the two sources? Remember there is a tendency for all of us to have too many items on our “To Do” list.
3. If you are concerned about how you manage time, keep a time log for a few weeks until you have a representative sample of your typical work week. Attach the time log to a clip board, your desk, or a folder and update it a couple of times during an hour or hourly depending on your day. If you wait until the end of the day, you will be dealing with impressions. After you have collected the information, analyze the time log by asking yourself:
· What am I doing that doesn’t have to be done?
· What am I doing that could be done by someone else?
· What am I doing that could be done more efficiently?
· What am I doing that wastes the time of others?
· What did I do during my prime times when my energy is at its highest?
· What is my “down” or least efficient time?
· Have I gotten any breaks or support time?
4. Appraise how you set priorities based on the urgency or importance of the task. People set priorities differently. For example, one person may set as first priority those tasks that are both important, urgent, and job-related, while another may see their first priority as quieter, non-urgent activities that have to do with health, family, long-range plans, or personal or staff development. Having a balance of all these activities may be a goal for many of us.
5. Consider keeping a daily or weekly plan. Within that plan, set deadlines for tasks, group related activities, plan time blocks, exploit your prime time, schedule quiet time, and establish routine and habit. Take satisfaction in checking off completed tasks and reprioritize uncompleted tasks.
You will need to develop your own methods for managing the paperwork. Here are a few
strategies:
1. Develop and use forms for any paper tasks you do over and over again. Look across the program for paperwork that is used repeatedly and develop forms for these tasks as well.
2. Keep handy resources that are used repeatedly, such as program brochures or description of your program, services, procedures, program options, and procedural safeguards. Other frequently used informational handouts might include: one-page listings of area health, education, and social services telephone numbers and addresses and one-page descriptions of funding sources. Some programs have put together a packet of information for each family in their program. The packet can then be individualized based on the family’s concerns and priorities.
3. Some programs have found it beneficial to put together a transition packet for families. This has been consistently identified by parents as a stressful and confusing time. This packet or booklet can also contain service coordinator timelines and activities during transitions.
4. Develop categories for paperwork based on what you generally do on the job. These categories can serve as the headings for dividers in your filing system and for the file folders that contain your paperwork. Some categories to consider are: intake, developmental history, emergency information, referral, permission or consent forms, invitations to meetings with an RSVP format, standard letters to physicians, school districts, insurance companies or other agencies, progress notes, billing and keeping track of units, travel, evaluation and assessment, IFSP, and follow-up questionnaires for families.
5. Develop a process for needed paperwork. Depending on the size of your program, this may be best accomplished with co-workers who have similar responsibilities. Make explicit why the paperwork needs to be done, how it should be completed, when it needs to be done, and to whom it goes. It works well to have one set of all forms in one location (e.g., 3-ring binder, file drawer) along with an explanation of the process.
6. If you have a computer available, use it to personalize letters, agendas, memos, forms, or reports that have minor changes from a standard format.
7. Post pertinent information in a central location (e.g., bulletin board) or use a routing slip to share the information. Make sure the routing slip specifies how long each person can keep the information.
8. Create your own file system that will expedite retrieval of information. Organize by subject, chronological, alphabetical, or color code files. Other file systems that can be useful are: a desk file sorter where information is separated into files and prioritized later; color-coded files to indicate priority (e.g., red is high priority and green is low priority); and a tickler or follow-up file. This can be built into your calendar to help you to remember tasks in the future.
9. Keep track of current phone and fax numbers and addresses. Though it can be a challenge, it will save time and hassle in the long run. Keep a directory or rolodex of parents, providers, agencies, and other resources.
10. Use a calendar and put your timelines for yourself and families in as dates are set. For example, at the IFSP meeting, indicate the six month review and the yearly reevaluation.
11. Put all those interesting papers that come across your desk into different files (e.g., to be read, to be filed).
12. THROW OUT/RECYCLE all unneeded paper. When you read it over the first time, make a decision to keep or throw. Be brutal!
13. Encourage your program to publish a newsletter to keep families appraised of upcoming events and information. This removes the necessity of repeating the information and also ensures that all parents in the program receive the same information. If your program includes a large number of families who speak English as a second language or who do not speak English, you might arrange for translating the newsletter into other languages. Many communities have resources for these services. Developing a relationship with these groups or individuals can also assist you in developing a pool of people who may act as interpreters.
Strategies for Record Keeping
The service coordinator is responsible for keeping a variety of records. A record central to early intervention is the IFSP. The section Content of the IFSP: The Document details keeping this important record. In addition to the recording of early intervention plans and services on the IFSP, service coordinators also keep what are often called case notes. These notes record the contacts service coordinators make with the family, with service providers, or with outside agencies. When the service coordinator works in a system where “case management” services are billable, these case notes document the activities that are the basis for the billing. In Wisconsin, where service coordination activities on behalf of children are covered under Wisconsin’s Medical Assistance Program (billable under targeted case management), these case notes need to include specific information about the service coordination activities. Most service coordinators find it helpful to keep this information for all children they serve.
The Wisconsin Medical Assistance Provider Handbook provides information on eligibility, covered services, and the procedures to be followed for record keeping and billing. Wisconsin Medicaid covers activities of the service coordinator and other personnel who provide case management services when the Birth to 3 program is certified as a Medicaid case management provider (or is part of a county department which is a Medicaid-certified program). Providers must comply with Medicaid requirements (HFS 101-108, Wis. Admin. Code, and the Wisconsin Medicaid All-Provider Handbook) and Birth to 3 early intervention services rules (HFS 90, Wis. Admin. Code) when billing for case management services provided under the Birth to 3 Program.
The activities of the service coordinator that are recognized as billable under this service include:
> • The activities of the service coordinator when arranging for an eligible child’s evaluation and assessment (HFS 90, Wis. Admin. Code).
• Developing, writing, monitoring, and evaluating the written Individualized Family Service Plan (IFSP).
• Providing service coordination activities.
According to the Wisconsin Medicaid Case Management Handbook, the minimum requirements for documentation under this program include:
· name of recipient
· who made contact
· what was the content of the contact
· why was the contact made
· how much time was spent
· when was the contact made (date of contact?)
· where was the contact made
The Wisconsin Medicaid Case Management Handbook provides an example that includes the minimum requirements for case notes:
ABC County Case Management log notes
Recipient: John Doe
Case Manager: Sue Smith, MSW
01/01/03
Consultation with county personal care
provider at county office regarding personal
care services for client since he is having
problems performing all cares. Supervising
nurse from personal care agency will set up
appointment with client to do assessment
within the next week.
Will talk to her after the assessment to see if
Mr. Doe qualifies for personal care.
15 minutes
The handbook then gives an example that did not meet the minimum requirements:
ABC County Case Management log notes
Recipient: John Doe
Case Manager: Sue Smith, MSW
Visit with John Doe. There was a problem
with his home care service.
In this example, not only was information on time and location missing, but the specific activity the service coordinator performed or would perform was not identified.
Many programs have established a standard format for service coordination notes that helps to facilitate the organization of the case notes and ensures that the notes meet the requirements of the funding agency. One county found a particular format helpful. Information on the recipient appeared at the top of the page. Space was provided on the left hand margin for noting the date, the type of contact from the defined case management services in Part U of the handbook, and the time spent. The first few lines of the narrative contained a brief summary of the activity. More descriptive information followed, with a clearly identified line at the end of the case note for follow-up activities. The same page could include a number of contacts and activities.
Sometimes the activities of a service coordinator will include a change in a service specified on the IFSP. In this instance, the case notes might reference the activity (e.g., a change was made in the location of speech services) and refer to the IFSP rather that writing up a full explanation in the case notes.
A comment needs to be made about the confidentiality of case notes. Case notes become part of the early intervention record. They may be requested by a family and if there is a court case, may be subpoenaed. Service coordinators should limit case notes to observations or facts. Impressions, unrelated personal information, comments from third parties should probably be left out of case notes. Personal notes that will not be shared with anyone else cannot be subpoenaed. However, many service coordinators find they would rather keep these impressions or concerns in their memory and not write them down because of the concerns of confidentiality.
When families share with a service coordinator concerns that they do not share with the rest of the team, the service coordinator needs to decide how she is going to handle this information. If the information affects the child’s development and would be helpful for other team members to know, the service coordinator may want to encourage the parents to share this information or ask if she may. Often, families take a risk in revealing personal and confidential aspects of their lives. The service coordinator wants to build on this trust and keep this information confidential. The case notes might simply indicate that the family discussed a family situation, or that the service coordinator agreed to locate some resources outside of early intervention for the family. The case notes do not need to describe in detail the situation, the feelings expressed, and the service coordinator’s responses.
Service coordinators should talk to the employing agency and with supervisors to establish what are required components to be included in case notes, what formats are being used, and how confidential information is handled.