HMIS Case Management Quick Reference

Transcription

1 HMIS Case Management Quick Reference The Suncoast Partnership to End Homelessness brings PROGRAMS, PROJECTS, and PROVIDERS together to make important services available. A PROGRAM represents the source of funding. This could be a federal, state or county funding source, a community program, or contribu ons from a private founda on or through charitable giving. PROGRAMS PROVIDERS PROJECTS A PROVIDER is the local agency and/or organiza on that receives PROGRAM funds to provide services. A PROJECT is a specific service funded through a PROGRAM and operated by a PROVIDER. Within our two county area, the community of service providers operates a variety of projects that make a posi ve contribu on to end homelessness. The Suncoast Partnership s HMIS system is designed to coordinate informa on for the client, to track the impact the services provided have upon the individuals served and to measure the effect those services have upon the community overall. And the CASE MANAGEMENT tools are a most effec ve way to coordinate our efforts on behalf of clients. 1

2 The HMIS System provides tools to assist the Case Manager. The experienced Case Manager will find the tools may be helpful in tying together their current client planning process with HMIS. New Case Managers will find a solid founda on for developing planning process that includes: FOUR KEY ELEMENTS of HMIS CASE MANAGEMENT: 1. Review, edit and save assessment informa on regarding the CLIENT/ HOUSEHOLD. 2. Establish Goals and create Ac ons Steps for each Goal. 3. Maintain Notes, Add Services, Upload Document A achments AND Create Follow-up Appointments. 4. Make Referrals within your PROVIDER, among other HMIS PROVIDERS or to a PROVIDER that is not part of HMIS. 2

3 A er logging onto the ServicePoint for CASE MANAGEMENT, select ENTER DATA AS, and then choose the program where your CASE MANAGEMENT tools are u lized. 1. Review, edit and save assessment informa on regarding the CLIENT/HOUSEHOLD. When you begin working with a client and/or household for the first me, that is the best me to review their intake and assessment informa on. You can get to know your client/ household and at the same me find out... Is the informa on up to date? Is it, in fact, correct and complete? In order to avoid problems down the line, it is important to review the informa on and make sure it is correct and complete. This seems like a small thing but it saves me in the long run. Don t forget, if you are correc ng informa on that should have been changed from the beginning, make sure you BACK DATE your entry to a date before the earliest service or program entry date. 3

4 2. Establish Goals and create Ac ons Steps for each Goal. In order to establish goals, create ac on steps and be able to follow up on progress, you need to assign the CASE MANAGER. Click on the CASE MANAGEMENT tab. Click on ADD CASE MANAGER then select the household members who will working with the CASE MANAGER. As you assign the CASE MANAGER, don t forget to add the START DATE. This is when you began working with the client/household on a case plan. Now, you can go to the CASE PLAN tab and add GOALS, ACTION STEPS, CASE NOTES and SERVICE ITEMS for your client/household. The KEY keep all of the informa on that is related to the CLIENT/ HOUSEHOLDS progress in their CASE PLAN. SELECT A GOAL for your client/household. Goals consist of four elements: A. Date the goal is established B. Classifica on of the goal Budge ng, Employment, Training etc. C. Type of goal For the classifica on selected there is a more specific GOAL TYPE that needs to be iden fied. D. Target date for the goal When do we expect to achieve the GOAL. As work on the Case Plan with the client moves forward, the OVERALL STATUS of each goal will be important For each goal you can then establish Ac on Steps to reach the goal and add Service Items to assist in reaching the goal. 4

5 3. Maintain Notes, Add Services, Upload Document A achments AND Create Followup Appointments. Some mes it can be confusing in CLIENTPOINT, because it can seem like there are mul ple places to put informa on like NOTES, DOCUMENT ATTACHMENTS, SERVICES, and FOLLOW UP APPOINTMENTS. SERVICES In fact, although there are many different areas where you may be directed to ADD A SERVICE, they all end up in the same place, the SERVICE TRANSACTIONS tab and ADD SERVICES area. A key in ADDING A SERVICES is to making sure you include all of the appropriate dates and outcome informa on. DOCUMENT ATTACHMENTS For DOCUMENT ATTACHMENTS there are a couple of different places where documents can be uploaded to the CLIENT RECORD, including places that are marked with a li le file clip. However, no ma er where the documents are uploaded they are all stored in the CLIENT RECORD. FOLLOW UP APPOINTMENTS For FOLLOW-UP APPOINTMENTS, there are a number of places where you can schedule a FOLLOW-UP and it will appear on your home page as a reminder to make contact.. Ac on Steps, Goals, Services etc. all include the ability to add FOLLOW UP APPOINTMENTS. It is important when concluding a FOLLOW UP APPOINTMENT that you record that the follow up occurred and the nature of the OUTCOME. When a client enters a PROGRAM/PROJECT in HMIS through PROGRAM ENTRY/EXIT, there is reference to FOLLOW-UP and INTERIMS. These are not the same kind of FOLLOW-UP appointments and will not show up on your main page as reminders. FOUR TYPES OF NOTES Finally, there are four different kinds of NOTES within CLIENTPOINT. (Con nued on the next page) 5

6 FOUR TYPES OF NOTES (CONTINUED) SERVICE DETAIL NOTES appear throughout HMIS are areas where you can add explana on to give more detail. These detail notes only appear when you select to view the par cular service or item. CASE NOTES area part of the CASE PLAN and can be viewed when you select the CASE PLAN and a par cular GOAL for a CLIENT/HOUSEHOLD. These notes should provide explana on, progress informa on and other GOAL or ACTION STEP related data. CLIENT NOTES are more general and are about a specific CLIENT not necessarily applicable to the en re HOUSEHOLD. These notes can be entered through the CLIENT PROFILE and can only be viewed within the CLIENT PROFILE. These notes may include informa on about program par cipa on, eligibility, services, and even informa on that although important to note, due not rise to the level of an INCIDENT. INCIDENTS are special CLIENT NOTES that indicate that special no ce should be taken regarding whether to offer par cipa on for a CLIENT/ HOUSEHOLD regarding an incident that occurred. An incident can include refusal to par cipate, an alcohol related problem, drugs, physical or verbal abuse, fraud or other issues. Maintaining and recording high quality notes is an integral part of effec ve CASE MANAGEMENT and can impact upon the quality of con nued care when other PROVIDERS interact with the CLIENT. 6

7 4. Make Referrals within your PROVIDER, among other HMIS PROVIDERS or to a PROVIDER that is not part of HMIS. The REFERRAL process can be an effec ve tool to coordinate services for a CLIENT/HOUSEHOLD. 1. You may want to enroll a client/household into another project operated by your PROVIDER. It s not always necessary to make the referral in this case but it is GOOD IDEA. 2. When you find it is necessary or preferable to refer to other Provider s Projects who are connected with HMIS, it is BEST PRACTICE to use the REFERRAL process.. 3. O en, to meet the needs of a CLIENT/HOUSEHOLD in reaching their goals it is important to refer to projects and services that are available in the community, but are not part of HMIS. Using the REFERRAL method, we can s ll use HMIS as a good way to iden fy needs that are best met outside of the HMIS community of PROVIDER PROJECTS. Work through each of the five parts of the REFERRAL process. Need Iden fied Match Need with Providers and Projects Make the Referral The Provider s Project Accepts the Referral Close the Referral Loop by Providing a Service 7

8 Six CLIENT INFORMATION tabs are used most o en while working within Case Management. 1. Client Profile 2. Entry/Exit 3. Service Transac on 4. Case Management 5. Case Plans 6. Measurements Regarding the MEASUREMENTS tab, some Projects include the use of the SPDAT or F- SPDAT Measurement Tools as part of their Case Management. 8