Program Operations: Tasks and Responsibilities

(The original PDF file contains a chart with four columns labeled "Who", "Will Do What", "Timeline", and "Checkpoint". The "Will Do What" column is the only one which is not blank, and its contents are listed below.)

Will Do What

Implementation of Early Intervention Process

Referral:

• Intake information
• Share referrals with B-3 staff
• Initial contact with family
• Determine action/screening or evaluation/referral
• to other resources

Screening:

• Screen, share information, determine next step in process

Evaluation:

• Contact family
• Determine team, schedule evaluation times
• Evaluate, write evaluation report
• Meet with family
• Determine eligibility
• Next Steps

IFSP:

• Determine participants in IFSP with family
• Schedule and conduct meeting
• Develop IFSP

Service:

• Determine service coordinator
• Implement IFSP
• Periodic review of IFSP
• Ongoing assessment of service/child and family needs and progress

Collaboration with other agencies serving the family

Transition from birth to three

• Notification
• ???

Service Coordination Activities:

• List from Rosin Whitehead

Team Development and Support

• Attend and actively participate in monthly 4 hr meetings
• Participate in learning opportunities offered
• Schedule and contribute knowledge to cross
• disciplinary consultation
• Visits
• Practice open communication, active listening, interpersonal respect for team

Supervision

• Supervisors from multiple agencies have planned monthly contact
• Staff will participate in planned individual supervision time
• Staff will bring issues from their work to supervision sessions
• Establish clear lines of supervision for dual agency Staff
• Implement at least 1 x year individual written performance review

Administrative Function

• Contract development
• Hiring
• Record keeping/documentation review and storage
• Fiscal Management

Documentation

• Legal documents of child and family
• Ongoing program documentation
• Program evaluation
• Records of program costs

Permission to share this document provided by CESA 5.

Marinette County Birth to Three Checklist

Child’s Name: ____________________________

Date of Birth: ____________________________

Referral Date/Source: ____________________________

Initial Contact Date: ____________________________

Initial Paperwork:

• ____ Birth to Three Referral form
• ____ HSRS CORE form (yellow)
• ____ Parent and Child Rights
• ____ Permission to Screen
• ____ Consent to Evaluate
• ____ Service Consent/Refusal Statement
• ____ Ability to Pay
• ____ Consent to Access Insurance
• ____ Family Needs Assessment
• ____ Release of Information
• ____ Special Instruction Referral form

Evaluation/Assessment/Plan

• ____ Denver II Screening
• ____ Battelle Developmental Inventory
• ____ Other Evaluation Tool(s)
• ____ IFSP
• ____ Child History
• ____ Eligibility Status Form
• ____ Abilities/Strength
• ____ Goals/Outcomes
• ____ EI Services Summary
• ____ Add’l Services

Additional Paperwork

• ____ HSRS Birth to 3 Module form (purple)
• ____ Copy of form sent for Client #
• ____ Authorization for services
• ____ Information Data Sheet
• ____ File Access Log

Additional forms, if applicable

• ____ Financial Information (MA Case Management)
• ____ Copy of form sent to clerical staff
• ____ COP Functional Screen
• ____ COP Referral form
• ____ Family Support Referral form
• ____ Children’s Case Manger Referral form

New Referrals:

1. Record on new referral form
2. Record on referral tally sheet
3. Make a folder for office
4. Make a folder for the family
5. Open a CORE HSRS (yellow) form
6. Send referral to CESA 5
7. Send family a brochure with Cost Share/Insurance billing information
8. Add child’s name to closed B-3 Master list for future disposal
9. Add child to roster under referrals

If child qualifies:

1. Send Cost Share form out to determine family share
2. Send letter to family recording their cost share/procedure
3. Open on Birth to 3 HSRS (purple) according to IFSP date
4. Attend IFSP updates
5. Have family fill out records disposal form
6. Add child to roster

If child doesn’t qualify

1. Close on CORE HSRS
2. Put file in closed Birth to 3
3. Make sure child’s name is on Master List for disposal

When a child is discharged from the program

1. Take their name off the roster
2. Make sure their name is on the closed Master List for disposal
3. Determine when disposal can take place, depending on parents preference
4. Close on both CORE HSRS and Birth to 3 HSRS
5. Combine county file and CESA 5 file
6. Make appropriate referrals
7. File case in closed Birth to 3 files