ADMISSION ASSESSMENT

#This is the heavily annotated (instructional) version.
#It also spells out the basic approaches to the TPT, MTP, and TPR documents.
#Text within brackets are clarifications/instructions
#which could be included in the working outline.
#Lines beginning with '#' are comments.
#Lines beginning with '@' are ranting commercials.
#There are separate versions of the outlines mapping DFPS Rule
#"Items to be included" to the sections of the outline
#where the items should be included.
#
#Introduction:
#- The set of outlines for these documents is based on
#standard outlines for medical evaluations:
#	Chief Complaint
#	History Of Present Illness
#	Past History
#	Review of Systems
#	Assessment
#	Plan
#- We have adapted that basic outline for RTCs
#and have ensured inclusion of all items
#which the DFPS Rules require.
#The Rules list items that must be _included_.
#They do not specify any particular order or organization
#of the items.  Indeed, lists of the items are not only
#in clerical rather than logical order,
#but the rules contain separate lists of
#items whose requirement for inclusion became effective at different times.
#-  Following the wise intent of the Rules
#as well as good clinical practice,
#we have taken care to clearly delineate sections intended
#to address a child's special needs --
#while honoring the needs of contract managers
#to ensure provision of all appropriate services to each child,
#we have supplied that information in separate sections.
#from the provision of generic services to all residents.
#- We have tried to make the outlines useful to
#individuals who want to use them
#to manage individualized treatment of specific kids
#and also useful to individuals who want
#to improve their skills at doing that --
#while keeping the outlines servicable for folks
#who just intend to do useless paper work.

I. Vital Information
I. Vital Information:

       Name:
       DOB:
       Age:
       Sex:             Race:
       SS#:
       Medicaid#:

       Parents:
       Rights:

       Date of admission:
       LOC:

       Date of Report:


II. Reasons, Expectations, Goals for Placement
	Child:
	Managing Conservator:
# You should ask them somethings like:
# Why did you come here?
# What do you want to get from your stay here?
# What do you expect it to be like?
# Then you write down what they say.
# This is what the kid and MG tell you,
# In this section,
# we aren't interested in what you think.  That goes in 'Overview' below.
# We strongly suggest that you ask the kid first, then the MC.
	
IIIa. Circumstances Leading to Placement
# You start from where the kid was sort of living his normal life --
# maybe he was in a foster home where he was supposed to grow up or wait
# to be adopted.   You describe that situation, and then tell the _story_
# of what went wrong leading up to and including the breakdown,
# and anything else leading up to his getting to ABR

IIIb. Current Status
# Then from the above section IIIa, you segway into how the kid
# is doing now.  You can describe what he's recently been doing and
# especially this is where you put a _description_ of how he is with you
# during the intake process.

IIIc. Diagnoses:
      Medications:
# Then as a separate block,
# you list the Diagnoses (and by who), and Medications (and by who) --
# if you have those.  As you do that, it's useful to refer to any
# key psychological evaluations you have so the reader can be alert
# to look for them.  Also, you may be quoting from them in sections below.

IV. Past History/Life Story
# We want to know the kid's life _story_ up to the point where you picked
# it up in the 'Circumstances Leading to Placement'.

@@@@@@@ BEGIN COMMERCIALS @@@@@@@
@ COMMERCIAL Missing information:
# Up to now 07/2006), many/most ABR admission assessments lack
@ information about where the kid lived before coming to ABR --
@ let alone what was the breakdown, and they also have
@ been missing crucial information so that you couldn't tell if
@ the kid had been removed from his birth home in infancy or 6 months ago.
@ That's beyond the capacity of even this nasty jester to lambast.

@ I know, I know "they don't tell us this information" and
@ I'll agree they don't hand it to you on a silver platter.
@ That's why the person doing the intake is required to have special qualifications --
@ skills that would enable him or her to gather as much info as possible.
@ Your best source of history is the kid, he can tell you a lot
@ and it is a sign of respect as well as a good way to get off on the right foot,
@ to get the info from him.  I know, I know, you can't always trust what the kid says.
@ Therefore you also you want to get information from others, the family, the CW
@ and any reports.  I know,  I know, you often can't trust the CW (or the family
@ or the reports).  That's why you should use multiple sources.
@ You don't have to try to decide who is telling the truth --
@ at least until you get to the Assessment sections --
@ you just have to document what who says what.
@ You know, you can't even trust the Admission Directions when
@ they say they couldn't get any information.
@ We are coming up on a crucial point here:
@ The report you are producing is _information_, it is based on _information_.
@ It is a working tool for gathering information and relaying it to those who need it.
@ It isn't an exercise in filling in boxes by pretending you know things
@ you don't and of putting nice sounding non-information in the boxes.
@ One way to look at your task is that, as much as you are wanting
@ to tell the kid's story, you are really discussing the adequacy, relevance,
@ and quality of the information you can get a hold of --
@ _and_ discussing the information you need that you can't get.
@ Specifically, there are places below (in the '0 Informational' domain
@ and in the various other domains and in the Overview...Assessment
# where you can discuss the various
@ sources of information, their reliability, where they agree or don't compute
@ and especially what information you don't have and what you have done
@ or are going to do to get it.  Then the team will know what information you couldn't
@ get, and they are going to have to go after it.
@ I know, I know, it's a standard that you fill in a box
@ so you make up some filler to fill it with.
@ NO! You use the process of documentation to put in the box
@ that you asked the CW for the information and she didn't have it.
@ You say she promised to send it to you.  Later you or someone else
@ may write her a letter requesting the info.
@ I know, I know, the regulators still want to tag you out -- saying it's your
@ responsibility.    That's passing the buck in a way
@ that is destructive to kids' care and it violates
@ the intend of the standards _and_, I'm sure, DFPS's own policies and procedures.
@ Well I can't speak for your management,
@ but if they have integritry and don't want to just be complicite
@ in a system that screws kids around, and if you want to do a little
@ screwing back about that, you show the regulator
@ the letters you sent and other documentation of what you tried to get the info,
@ and then you dare them to cite you, and then you appeal that the way up
@ in ways that will show that the problem isn't you, it's them.
@ A conscientious regulator _should_ cite you -- because
@ that's the only way the system might get fixed.
@ You go thru the whole nine yards, action plans, appeals...
@ well, this isn't the admission director's bag.
@ All you have to do is be honest about the information you don't have
@ and document what you tried to get it.
@ The information you don't have is a _need_ and requires a _strategy_.
@ (See the domains section: 0. Informational.)
@ Still, to let your administrator off the hook,
@ have a few trash places where you can put standard-meeting non-information to
@ make everyone happy (regulators and management) except the folks
@ who might want to use the missing information to help the kids.

@ COMMERCIAL Special, General, and non-information.
@ I sound pretty angry at the regulators.
@ Actually, the standards governing the Admission Assessment and Treatment Plans
@ are wise.  The people I'm angry at are the folks who won't
@ take the opportunity and responsibility to use
@ the "paper-work" process as it's intended to help the kids.
# The overall thrust of the Rules is to ensure that folks who
@ supply residential treatment 24-7, often for a year or three,
@ as a child's sometimes only, crucial opportunity to fix his life,
@ identify _specific_ needs _special_ to that child's _individual_ situation,
@ address those needs with specific interventions, and then
@ monitor whether those interventions are helping or need to be changed.
@ Ok, that's like DUH, just the way it should be.
@ The problems come about when folks can't identify
@ a kid's special needs and/or can't employ individualized interventions.
@ Then instead of using the assessment/treatment_plan forms for that
@ they fall back on generalized services that meet the needs of generic
@ adolescents.  The problem with the ABR plans to this date
@ is that they confabulate a description of the ABR program that
@ meets the needs of all it's residents with individualized treatment plans.
@ Now the regulators (contract managers) do want to see clear descriptions
@ of the services the facility provides -- and (tho I'd prefer to
@ have them find that where the facility policies and procedures reside),
@ they seem to want that stuff in each child's plan.
@ No problem, it's all boilerplate anyway and we can drop in those paragraphs
@ wherever necessary.  The problem comes when we confuse those generic,
@ contract-satisfying descriptions of essential generic services
@ with individualized treatment needs and interventions.
@ The outlines supplied here strive to keep the generic and _special_ separate.
@ Some will say that this has the disadvantage of revealing
@ the lack of individualized planning where that is missing.
@ Yes!

@ COMMERCIAL: Flexible Outlines
@ I have tried to design these outlines so that they can be used
@ in various ways depending on the preferences of the facility.
@ Unlike the previous outlines, these can be used by sophisticated
@ RTC practitioners as working _tools_ to provide top-notch care.
@ The outlines could also be useful to un-sophisticated practitioners
@ and facilities who want to push themselves to learn, case by case
@ how to provide better services.  Used correctly, the outlines
@ are both tools for managing treatment and learning tools.
@ However, in light of the variety of facility preferences,
@ the outlines can also be used (at least as effortlessly as the previous outlines)
@ to simply meet the standards while one 
@ hopes that someone else (an individual therapist perhaps)
@ will do the real (residential?) treatment.
@ To facilitate meeting the letter (not spirit) of the standards
@ as efficiently as possible, I've indicated the required sections and
@ subsections with askerisks.  Those without askerisks can be
@ left blank or deleted when editing the final document.
@ To be specific, I would consider the following type of (inadequate) plan
@ to be perfectly consistent with the outline design:
@ - Give very short lists of problem behaviors instead of a story in 
@ the Circumstances Leading to Admission.
@ - Give a one sentence statement of the child being polite at intake.
@ - Omit the child's life story.
@ - List the diagnoses and medications
@ - Either omit the '0. Informational' domain or use it
@ to say you don't have much information.
@ - For each domain say what you know listing any special strengths and needs you can identify.
@ Note: You shouldn't put strategies to meet those needs on the Admission Assessment
# (except for the 0. Informational domain).
@ - In the 'Overview of Special Issues' you can skip the 'Assessment'
@ and put some a few generic things for the other 4 items.
@ That's it for the Admission Assessment.
@ - Then on the Preliminary Plan, you just copy in the domains
@ section from the Admission Assessment and
@ then add special strategies/instructions _only_ where you have special needs.
@ - You can just copy the 'Overview of Special Issues' section from the
@ Admission Assessment to the Preliminary Treatment Plan.
@ - Then you put the boiler plate of all the details and nice sounding
@ services in section IV. The Detailed Plan to Address Other Needs.
@ This section is where you put all the things about being assigned
@ to a cottage, having individual therapy once a week, a well-balance diet
@ and lots of instructions to staff.
@ Possibly, if the regulators (rightly) balk at conspicuous emptiness
@ in the II. Special Needs.. section, the facility may need
@ to add to that boilerplate another version of the domains to the section IV consisting
@ of lots of generic needs (repeated from one domain to another)
@ with the generic strategies (repeated from one domain to another).
@ ABR already has plenty of that boilerplate in it's current AA/PTP/MTP.
@ To ensure the obfuscation, I'd substitute 'Interesting' for 'Special'
@ in section II of the Preliminary Plan.
@ That's where folks in the know can look to see if there is any
@ individualized treatment planning.
@ - The PD can follow a similar strategy for the Master Treatment plan.
@ The bottom line here is that using this outline you _can_ at least as effortlessly produce
@ almost exactly the sort of standard-meeting useless document
@ as currently.  The important change is the someone wanting to do better
@ would have an opportunity for that.
@@@@@@@  END COMMERCIALS @@@@@@@

# The domains section has two fundamental purposes:
# 1.) We want to _review_ that we've covered the bases, the main aspects
# relevant to a kid's growth, and
# we want to make sure we don't miss anything -- so if it's
# important and it didn't come out in the stories,
# then you put it here.
# 2.) We want to reorganize what we know into lists of strengths and needs
# which we will later use to build the treatment plans.
# - For each domain, we have:
#	data - If you've already put the relevant data in the stories above,
#		you don't have to repeat all that here, you can just briefly
#		allude to it and say (see section IIIa above -- or IIIb or IV).
#		assessment - You don't have to sound hi-fuluting here.
#		Just say how you put it together.
#		If the data is pretty self explanatory, you may not
#		have to put anything for 'assessment' as the 'strengths' and 'needs'
#		will cover it.
#	strengths -
#		It's an axiom that good treatment builds on the client's strenths --
#		uses the strengths to address the problems.  That is why the wise
#		people who wrote these particular standards insist we identify the strengths.
#		When you get to writing strategies, always look at the strengths first.
#		Often you want to use a strength from one domain,
#		to help with a need in another.
#	needs - This is where the money is.
# Note: Strategies to meet the needs don't belong here on the Admission Assessment.
#		However, you'll copy this whole domains section into
#		the PTP and add the special strategies there -- only for the special needs.
# Then, when the PD does the MTP, they'll take a copy of the domains
#	from the PTP (which has the data, strengths, assessment, needs, strategies)
#	and totally rework it with the knowledge they have from living
#	with the child for 30-40 days.
#   That experience should go to fill in a lot of the missing info.
@ Here's todays big joke: you couldn't do a good job so you leave it for them to
@ really flesh it out, and they just copy what you did.
# Note: The informational domain is crucial as I've discussed.
# It could be that you are unable to fill out _anything_ on the admission assessment
# except the informational domain.  (Your 'Overview... Assessment would be:
# "Our assessment is that we do not have enough information
# to assess this child's needs."
# The informational domain is a little special on the AA because
# I've added a section for 'strategies' there -- since you want
# to be saying right off what you are going to do to correct the deficiencies.

# Considerable thought over the years has been expended
# on the ordering of the domains (which differs from the list in the DFPS Rules).
# We combined Behavioral with Social because that works out
# more smoothly when you really go to describe those areas.
# That combination is further justified since, as Harry Stack Sullivan said,
# "All human behavior takes place in the context of a relationship
# between people -- only one of whom need not be imaginary."

# NOTE: See the crib_mtp.txt for the
# detailed instructions about what kind of info
# goes into which of the domains.

V. Review of Domains
	a. Physical:
		Height:      Weight:
# Say where you obtained that Ht/Wt info an 
# the date of those measurements.
        Physical Stage of Adolescence:
             Pre    Early    Early/Middle    Middle   Late
# put check _after the stage you specify
		Assessment:
		Strengths:
		Special Needs: (Next Physical Exam...; Next Dental Exam: ...)
	b. Familial:
		...
	c. Educational:
	d. Social/Behavioral
	e. Psychological/Emotional:
	f. Self-harm considerations:
	g. Informational:
		Assessment:
		Needs and Strategies:
# The "Informational" domain is used to assess and discuss
# the extent and quality of the information you have
# and to specify strategies for getting more information
# that would be useful.
	
VI Overview of Special Issues:
	Assessment:
	Intermediate Goals:
	Goals For Treatment:
	Discharge Plan:
	Prognosis:
	Estimated Length of Stay:
	
# The 'prognosis' is your _prediction_ of how things will turn out.
# You can predict how the  course of Treatment at ABR will turn out --
# and also how the kid's life may turnout.
# The 'prognosis' comes from the medical settings,
# but most of the time doctors don't do a very good job -- dodging
# behind vague terms like, 'fair', 'guarded', 'good', 'poor'.
# Those are still useful indications, but a carefully
# crafted prognosis can be used to sum up the whole assessment
# and point it straight at the ELS and any other conditions
# you are trying to compel from the world to enable a successful outcome.
# For example:
# "George has impressive athletic strengths and compassion
# which he could use to overcome his extreme social shyness.
# We could help him use his intelligence and curiosity
# about his past to help him develop a realistic sense
# of himself and overcome anger at his past experiences.
# But it is unlikely we can accomplish that without
# being able to work with him and his mother
# and without a stay of at least 14 months.
# Therefore the prognosis for his finishing highschool
# and a productive life could be excellent.
# However, without the possibility of working
# with the mother or with a stay of less than 14 months,
# we'd anticipate he would continue to flounder
# in anger and antisocial activity."

## Note:
# Since the Rules governing the AA specify
# only information/assessment specific
# to the child, and do not require any plans for care
# no Section VII is necessasry here