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Welcome
The Supportive Housing & Homeless
Program – Goal Setting & Record
Keeping webinar will begin shortly.
This is a muted call, please submit your questions
via the GoToMeeting question feature.
Handouts will be made available after
the webinar concludes.
Supportive Housing &
Homeless Program – Goal
Setting & Record Keeping
Jonda Clemings, MSEd, LSW
Reasons for
Documentation
Clinical
• Planning &
monitoring progress
• Documentation of
accomplishments
• Quick access
• Support staff work
Clinical
• Identify patterns
• Continuity of service
• History of crisis
situation/pattern
Compliance
• Monitoring
• Regulatory requirements
Legal
• Behavior description
• Data assessment &
treatment plan
• Data for evaluation
• Funding source
record
• Justification for staff
action
Legal Aspects of
Documentation
• Direct planning &
coordination
• Response to
services
• Team member
communication
• Regulatory
compliance
Legal Aspects of
Documentation
• Necessity for services
• Maximize reimbursement
• Provide data for staff decisions
• Legal record
Legal Parameters
• Confidentiality & privileged
• Accuracy
• Objectivity
Legal Parameters
Goal Setting
• Consumer centric
• Help reach goals
• Celebrate success
• Problem goal vs. problem person
• Inform choices
Goal Setting Skills
Goal Setting Skills
SMART Objectives
• Specific
• Measurable/observable
• Attainable within time & conditions
• Results-oriented
• Targeted to the identified need & impact
Targeted Objectives
Goals & Objectives
Identify various issues,
functions, etc. that a
person may need to
set a goal/objective
around to improve
their housing stability.
List as many of these
as you can for each
letter in the alphabet.
Bloom’s Taxonomy
Housing Services Plan
Intention
• What is it that you want to achieve?
Specific
• Who
• What
• Why
• Where
• When
Measurable
• How much?
• How often?
• How many?
Attainable
• Achievable?
Relevant
• Is it important to what you want to
achieve ultimately?
Time Based
• When?
Sample Goal
• Goal: Housing
search
• Objective: Submit
application to MHA,
apartment complex
• Target date: by May
15, 2014
Amy is a new participant in your homeless
shelter. When asked about her housing
goals, she tells you that she doesn't have
any housing goals. Amy states that she has
received Medicaid in the past, but is not
currently receiving it. She has no other
income/benefits at this time. Amy is not
interested in working nor is she interested in
signing up for Medicaid, SNAPS, other
housing, etc.
•Goals:
•Objectives:
Bill has been residing in your rapid re-housing
program for six months now. He became
homeless due to a layoff at the plant and has
been having much difficulty finding other
employment with comparable pay. Initially, Bill
was sad about the loss of his housing, however
he was very good at following up on possible
job leads. During the past couple of months, Bill
has become cool and distant. He appears
disinterested and indifferent about finding a job.
Goal:
Objective :
What Should We Document?
• Functional limitations & abilities
• Barriers that led to homelessness
• Program adherence
• General observation
Record Maintenance
• Locked
• Organized
• Sequential
• Participant identification
• No other consumer names
• Individualized
• Black/blue ink
Record Maintenance
• Avoid backdating
• No blank spaces
• Streamline charting
• Follow agency policy
• Sign entry with name & title/
credentials
Record Maintenance
• Specific
• Don’t label, characterize, use
cliches
• Use quotes
• Approved abbreviations
• Legible, grammatically
correct
Documentation Methods
• SOAP – Subjective, Objective,
Assessment, & Plan
• DAP – Data, Assessment & Plan
Documenting Appearance
Documenting Mobility
Documenting Communication
Documenting Cognitive
Functions
Building a Case File
What Should Be Included
Face Sheet
Identifying Information &
Picture ID
• Drivers license
• State ID
• Birth certificate
Ohio State ID
Social Security Cards
Homeless Status
Chronic Homeless Status
• Unaccompanied individual or
adult household member
• Disabling condition
• Living on streets or emergency
shelter
• 1 continuous year homeless or
4 episodes of homelessness in
3 years
Housing History
• Why moved
• Type of housing
• Difficulties
maintaining housing
• Barriers
• Housing needs
Disability Status
• Long-term, indefinite
duration
• Impedes ability to live
independently
• Disability could be
improved with suitable
housing
Disability Status
• Physical, mental or emotional
impairment - including
impairment solely due to
alcohol or drug use
• Written documentation must
come from credentialed
professional
Disability Documentation
• 3rd
Party Written Verification
– Disability verification form by state licensed
professional
• Social Security Administration
• Receipt of disability check
• Oral third-party and self-certification is
not appropriate
Consent Forms
• Basic elements of consent
• Informed choice
• Overall experience
• Voluntary participation
Educational & Vocational
Assessment
• Abilities
• Interests
• Personality
Employment History
• Gaps in employment
• Positions held
• Frequency of job changes
• Skills
• Strengths
Criminal Background
• Criminal history as
it impacts housing
& employment
Psychosocial Assessment
• Mood & affect
• Cognitive functioning
• Memory
• Communication
• Appearance
• Mobility
Health Assessment
• Medications
• Medication log
• Allergies
• Illnesses
Service Plan
• Goals/objectives while in
program
• Drives service planning
Income Verification
• Amount of income
• Sources of income
• Proof of income
Incident Reports
• What happened
• When it happened
• Others involved
• Follow-up
Discharge Summaries
• Reason for discharge
• Income sources
• Income amounts
• Destination
• Progress made
• Referrals made
Rent Reasonableness
Charting Legally
Sensitive Situations
• Objectivity
• Nonjudgmental
description
• Accuracy
• Completeness
• Legibility
• Justify actions taken
Dissatisfied Consumer
• Utilize “quotes”
• Don’t label - describe
• History or crisis
patterns
• Attempts to satisfy
• Choices provided
made
• Never characterize
Noncompliance
• How person refused to
comply
• Failure to provide
information
• Attempts to remedy
• Review of procedures
Confidentiality
• HIPAA
• Minimal access - need to know
• Privileged communications
Peer Review
• Impartial review
• Share expertise
• Diversity of opinion
• Provide
suggestions
Quality Monitoring
• Look at process and
outcomes
• Drive improvement
• Accountability
• Refine service
delivery
• Track integrity and
effectiveness
Coalition on Homelessness and
Housing in Ohio
Jonda Clemings
175 S. Third St. - Suite 250
Columbus, Ohio 43215
Phone 614-280-1984
Fax 614-463-1060
www.cohhio.org
jondaclemings@cohhio.org

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Supportive housing & homeless program goal setting & record keeping

Editor's Notes

  1. Good morning. On behalf of COHHIO, I wish to thank you for joining us this morning for our August Lunch and Learn Series, Case management for Supportive Housing - Program Goals and Outcomes. This monthly series, deals with the multifaceted work that each of you do in your communities to meet the needs of the homeless. Joining me this morning, will be Lianna Barbu from the Community Shelter Board. Before we begin this morning, I wish to go over a few webinar details. In a moment, I will be muting all of the phone lines. At that time, you will not be able to hear anyone speak besides the two of us. If you have questions, you will need to utilize the GoToWebinar Control Panel that is on the right side of your screen. You will need to click on the Questions line and then type in your question. Depending on the nature of the question, we will answer the question immediately, at the end of the session, or if we run out of time an answer will be sent to you through email. On that note, we will begin our presentation.
  2. Why have objectives? Creating clear objectives during the service planning process serves the following purposes: Helps consumer and staff integrate all aspects of the plan Serves to connect implementation and evaluation to define impact Provides a clear focus for development and implementation Forms the basis for evaluating outcomes and successes
  3.   To create attainable objectives: Consider the current level/status of the problem/area of identified need. Consider the conditions under which work of the objective will take place.   To create objectives targeted to the identified need/desired impact: Ask consumer whether the desired impact requires knowledge, application, and/or problem solving. Match the action verb to the desired level (see lists of words above). Match objective with appropriate methodology. Ask consumer whether achieving the objectives can reasonably be expected to achieve the desired impact.
  4. In 1956, Benjamin Bloom headed a group of educational psychologists who developed a classification of levels of intellectual behavior important to learning. The six levels are listed below along with verb examples that represent intellectual activity of each level. Bloom’s Taxonomy of Verbs can be utilized to develop goals and objectives that are concrete and measurable. Knowledge - Comprehend Apply - Analyze Synthesize - Evaluate
  5. To begin with, you should remember that your documentation should “paint a picture” of the person you are working with and the interventions that you provided. As a reader that was not present for the situation, I should be able to understand what happened in your time together, what the goal of the interaction was, how you intervened, the person’s response to your interventions, progress or lack of progress that person has had in your program, and what the upcoming goals are. Remember that throughout the intake, assessment, service planning and intervention processes, that there should be a fluid line between them. What I mean by that is when you complete your intake and assessment of the household, that information and the household’s goals should develop your service planning, and then the service plan should drive the types and frequencies of the interventions that you provide as the consumer strives to meet his/her goals while in the program. You should review with the consumer what their goals are for each meeting/session you hold with him/her. Ask what they would like to accomplish and what they expect from you. Your documentation should reflect the person’s abilities and limitations and the reason why you were involved in the interaction. You should discuss how they are proceeding with program goals and what difficulties they are having. Finally you should complete an overview of the person/persons that you are working with. An example of those general observations can be found with one of the accompanying documents for today’s presentation - go to General Observation.
  6. There are some primary pieces of information that all file should have in them. We’ll take the next few minutes to review what should be included in your housing program files -
  7. Consent forms can vary from program to program, but different types of consent forms include: HMIS - data collection form Release and Exchange of Information Consent/agreement for services
  8. Holland’s codes for vocational interests Realistic - outdoors; hands-on occupations Investigative - scientific Artistic - creative Social - counseling and teaching Enterprising - management and sales Conventional - clerical
  9. This can be a self-assessment form where the household completes the forms for the various members. May also wish to secure information regarding family physician, specialists, hospital preference, etc.
  10. Legal Aspects of Documentation Documentation is important!! キDirect planning and coordination of participant services キDescribe response to services and evaluate services provided キCommunication between team members キCompliance with regulatory bodies/standards of practice キProvide necessity for admission and services キDetermine and maximize reimbursement キProvide data for staffing decisions, education, research, peer review studies, and quality assurance and improvement キCreate a legal record for the participant and provide preventative legal maintenance
  11. Be specific. Effective charting is factual. Use words that reference participant reaction, attitude, and symptoms. Mention specific progress or lack of progress. Don’t label a participant’s behavior without describing it. For example: harry Homeless was anxious as evidenced by pacing, hand writing, and fast paced speech. Never characterize the participant’s behavior with unflattering and unprofessional adjectives such as spaced out, flipped out, drunk as a skunk, etc. Don’t use the words appears or seems to without adding a statement such as as evidenced by or as indicated by Do use participant quotes, or paraphrase what he/she says – remember to utilize quotation marks if using quotes