Children's Targeted Case Management
Practice Guidelines

COMPREHENSIVE ASSESSMENT AND
LEVEL OF CARE DETERMINATION

  Quick Links:

Comprehensive Assessment
Level of Care Determination/Designated Screening and Assessment Tools

COMPREHENSIVE ASSESSMENT 

A comprehensive assessment must be administered to all children receiving targeted case management services.  This assessment must:

·        be completed within 30 days of opening of targeted case management services and must be obtained through direct face-to-face encounter(s) with the child and at least one parent or guardian.

·        be updated annually, at a minimum (required by licensing standards). 

The assessment process involves the ongoing collection of information from individuals who are familiar with the child and family, in order to increase the team’s awareness of the child’s and family’s needs, strengths, and resources.  In addition, the use of natural and formal supports should be thoroughly explored and documented throughout the assessment process.   

The assessment process should:

·        Occur on a continuous, evolving basis;

·        Prioritize the child’s and family’s strengths, needs and interests;

·        Allow the family to choose how they would like to be involved in the assessment process;

·        Inform the family of the assessment process and timelines;

·        Inform the family of legally mandated reporting requirements;

·        Provide the family with copies of any information that is received or developed with or about them; and

·        Provide information in a format that is understandable to the family and allows opportunities for the family to clarify or add information prior to any decision-making. 

(Some of the above information was referenced and quoted from Family-Centered Services for Children and Families Best Practice Standards and Essential Elements, 1996.)  

The assessment must, minimally, include the following:

·        The child’s strengths, needs, and interests;

·        The family’s strengths, needs, and interests;

·        The child’s perception of his/her strengths and needs;

·        The family’s perception of the child’s strengths and needs;

·        The child’s and family’s unique culture;

·        Diagnosis with source and date;

·        A personal, family, and social history, including a developmental history of the child;

·        The child’s physical health status and history, including use of prescribed and over-the-counter medication and level of access to medical care providers;

·        The identified need for further cognitive function assessment, neurological assessment, and nutritional assessment;

·        Reasons and lengths of stay for any admissions to a hospital or a residential treatment facility;

·        Past and current drug and/or alcohol use;

·        Physical and environmental barriers that may impede the child’s and family’s ability to obtain services;

·        History of education and special education, successes, and needs;

·        History of any traumatic experiences including: physical, emotional and/or sexual abuse or maltreatment, or other trauma;

·        Past and current involvement with the juvenile justice system or the child welfare service system;

·        The vocational, educational, social, living, leisure/recreational, and medical domains;

·        The potential need for crisis intervention services;

·        Possible sources of assistance and support in meeting the needs expressed by the child and family, including state and federal programs;

·        Housing and financial needs; and

·        The identified need for other evaluations and assessments. 

Documentation of the results of all evaluations and assessments should appear in the child’s record. The record should clearly delineate the source of all information, how it was obtained, and the date it was obtained.

 Return to the top

LEVEL OF CARE DETERMINATION/ DESIGNATED
SCREENING AND ASSESSMENT TOOLS 

Upon completion or receipt of the comprehensive evaluation, the agency must further assess the child/family using the DHHS-CBHS designated screening and assessment tools.  These tools include:  the level of care determination, functional assessments, and evaluation of child, family and/or guardian strengths and resources.  Only persons trained by DHHS-CBHS to administer the tools should perform these assessments.   For further information, please use the DHHS-Child/Adolescent Assessment Program Manual, revised 10/16/03 and/or access the DHHS-CBHS website. The DHHS-CBHS website can be accessed through the following link:

http://www.maine.gov/dhhs/bds/children/Child_index.htm

Please use the visual tool below to identify the DHHS-CBHS approve level of care assessment tools:

 *NOTE:  Instrument includes the use of an intensity of services guide when being used for Section 24 or Section 65 H Services

DHHS-CBHS Level of Care Assessment Instruments:

 ASQ                                 Ages & Stages Questionnaires
ASQ:SE                                 ASQ Social-Emotional Questionnaires
CAFAS                                 Child and Adolescent Functional Assessment Scale
CALOCUS                                 Child and Adolescent Level of Care Utilization System
CHAT                                 Children’s Habilitation Services Assessment Tool
FES                                 Family Empowerment Scale

Return to the top

Return to Table of Contents

[ Home ] [ DHHS Competencies ] [ OQMHP ] [ CFL Forms ] [ Workshop Allocations ] [ Calendar ] [ TCM.htm ] [ MHRT ] [ MHSS ] [ Links ] [ Staff ]