Missouri Family-to-Family Intake Forms

1. Missouri Family to FamilyIntake Forms January, 2017

2. Cover • Includes tracking information for the entire intake and match process • Provides snapshot of intake progress when form is opened • Any fields repeated throughout form auto-populate • Includes • Affiliate information/form date • Pre-intake information • Attempt and intake dates • I&R date and referral to other organizations • Matching and match follow-up dates • Closed date and type of request • Evaluation date

3. Notes • Use to track intake conversations • Originally wrote on printed forms • Placed strategically for data entry when printed back to back • No longer print forms – export data instead • Initially wanted integrated supports star as watermark behind notes • Decided all parts of LifeCourse are important during intake conversations and each conversation is fluid • Added icons as header for visual prompting during intake call • Use in concert with LifeCourse portfolio

4. Demographics • Includes • Contact information • How they reached the F2F • Relationship of requestor to person with a disability • Age, gender and diagnosis of PWD • Race, ethnicity • Main reason for contact • Type of disability • Life stage • Data is used for reporting purposes

5. Information and Referral • Left column: assess needs • Right column: track referral information • Ordered by LifeCourse domains • Each section contains “other” field • Meets reporting requirements for F2F and UCEDD • Customized to include most frequent referrals • Can help guide conversations • Typically some topics are covered in each domain • Often one domain is the main focus of the call • Use in concert with LifeCourse portfolio

6. A closer look…

8. Peer Mentor Matching • Includes • Type of match • Match criteria • Main topic for match • Mentors attempted • Mentor assigned

9. Match Tracking • Includes • Requestor information • Type of match • Main topic for match • Mentor information • Date matched • Week 1, 4 and 8 follow up tracking • Questions at match close • Important notes • Originally designed to be printed separately • No longer print forms • All prior information is auto-populated (requestor name, contact info, etc.) • Dates entered here auto-populate to cover page

10. Using the LifeCourse Portfolio during Intake • Explain framework within context of intake call • Some requestors are very open to thinking outside the box and ready to discover the LifeCourse framework • Others are hesitant to dream but respond well and are curious about the tools • Some requestors are fairly closed to a new way of thinking. The portfolio may not be shared in this situation • Save as draft form with requestor’s last name • Attach to follow up email with link to LifeCoursetools.com Integrated Services and Supports • Enter information gained from conversation • Briefly explain supports star

11. Using the LifeCourse Portfolio during Intake One page profile • F2F intake team discussing changes to this page for intake purposes • Alter box titles to reflect main points of intake call • Change to one large notes box for referral links/descriptions typically in email • Leave as is – encourage family to complete at home Life Trajectory Worksheet • Enter information gained from conversation • Explain that the portfolio is a draft to get them started and they can edit any information

20. Integrated Options Support Stars

21. Focus on…. Life stages

22. LifeCourseEducational Materials LifeCourseTools