Youth Services Bureau
of Monroe County, Indiana

Intake Process

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The intake is usually the youth's, and may be the parents', first in-person contact with the agency. It is important to remember the family is in some state of crisis, even if the crisis is simply admitting the youth to the Shelter. The family members present are likely to be feeling a wide array of emotions that at least require recognition and, if possible, attention on the staff's part.

Only the RCs and On-Call staff can conduct intakes. Staff should complete the intake in a timely manner. The intake process, excluding inventorying in the resident's possessions, may take approximately 1/2 to 1 1/2 hours, depending on factors such as, the packet being used, if the parent/guardian is present, and the youth's emotional state. Before beginning any intake, the RC should spend a few minutes instructing the RS and Assistant as to any specifics regarding running the program while the RC is busy with the intake. Although even on busy shifts the RC should not unnecessarily delay completing an intake with a family, if a youth comes in alone, staff have more leeway in arranging to do the intake at a later less hectic time in the shift. In such instances, the RC must at least take time to search and briefly orient the youth before allowing the youth to interact with the residents.

when the parent/guardian is absent at intake

There will be occasions when the parent/guardian cannot be present at admission. Staff should complete with the youth as much of the intake as is possible. The staff who notify the parent/guardian the youth is at the Shelter should also make arrangements with parent/guardian to sign the youth in. In the event the parent/guardian is not able to sign the youth in right away, the staff should obtain witnessed verbal consent over the phone for the Parent Placement Agreement and for the Emergency Medical Care Authorization. The staff should read the forms to the parent/guardian and the RC can utilize other staff to witness parent/guardian's verbal consent. The staff should note on the forms that verbal consent was obtained over the phone and the staff who talked with the parent/guardian and the staff who witnessed should both sign the forms. Staff should notify the Case Manager or Shelter Coordinator in the event that our agency will have to mail admission forms to the p arent/guardian.

The staff should also use phone contact with the parent/guardian to resolve any questions or concerns about the youth or information the youth has given the staff at intake, such as questions about medication, concerns about truancy, how resident gets his/her lunches, etc.

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intake packets

TYPES OF PACKETS:

  1. Self/Parental - These are in manila folders. They are used for parental referrals

  2. Agency - These are in red folders. They are used for all court order, probation authorized and DFC placements.

  3. Short-Term - These are in blue folders, labeled "S-T". They are used for police referrals who are scheduled to exit within 24 hours of being admitted and for SAFE PLACE admissions.

INTAKE FORMS:

The intake forms basically addresses 3 areas: 1) demographics and personal information about the youth and his/her family, 2) parent/guardian consent for youth and family to participate in the program, and 3) inventorying youth's personal property. All of the packets have loose and clipped or attached forms and, although there are a few significant exceptions, the packets contain many of the same forms. All entries on all forms must be completed; those questions which are not applicable should be marked "N/A". Staff should sign as a witness on any form requiring a witness signature. Explanations of each form are provided as follows.

KEY

The following key has been developed to help signify when there are forms that are packet specific.

  1. * applies to the self/parental packet
  2. ** applies to the agency packet
  3. *** applies to the short term packet

LOOSE FORMS

  1. Parent/Guardian Letter: This is a two page letter explaining in detail Shelter policies, such as visitation, phone calls, possessions, etc. This should be given to the parent/guardian to review during the admission and before the parent/guardian leaves the Shelter.

  2. Documentation of the Need for Emergency Care ( BRIEF SERVICE): This form is to be completed for all intakes except court orders or DFC wards. When a DFC ward is admitted, the DFC caseworker completes and signs the form. When the RC completes the form, staff should enter the resident's name, date and time of placement, and complete the narrative. The narrative should include a description of why the youth needs shelter and cannot return to the home. Upon completion of the narrative, the form is to be turned in to the Assistant Director. The Assistant Director is the only staff authorized to sign "Name of Person Documenting Need".

  3. Intake Checklist: This is a reminder list for the RCs. The youth's first name is written on the top of the form and the RC initials each area he/she completes. If the RC completing the admission is unable to finish the checklist, the RC should post the list on the bulletin board next to the desk. RCs working the following shifts should check the list and complete and initial any areas left blank. Once completed, the form can be thrown away.

  4. Exit Evaluation: This is the resident's evaluation of the Shelter program. The Case Manager usually arranges to have this completed. If it has not been completed upon a resident's exit, the RC on duty is to complete or arrange for another staff person to complete it with the youth.

  5. *Apprehension & Missing Persons Clearing House Forms: These are used to report to and authorize the police to look for and apprehend a youth who has run away. Staff should offer the parent/guardian the opportunity to sign the forms; however parent/guardian does not have to sign these forms. For further details refer to the write up on Runaways in the Section on Emergency and Safety Practices.

    * The self/parental packets are the only packets that include the apprehension and missing clearing house forms.

ATTACHED FORMS - PERSONAL INFORMATION AND DEMOGRAPHICS

ATTACHED FORMS - CONSENT AND INVENTORY

The parent/guardian is expected to read and sign the following consent forms. The staff also sign these forms as the witness. Ideally, we would like for the parents/guardians to sign all of the forms and in general they do. However occasionally the parent/guardian has objections. We respect their right to refuse to give their consent (and sign) on all but two of the forms. The parent/guardian must sign the statement titled Emergency Medical Care Authorization and, if the youth is not court ordered, the Placement Agreement. It is helpful for staff to familiarize themselves with the forms to answer questions and facilitate a smoother admission. Staff should always allow the parent/guardian the opportunity to read the forms, in addition to staff's explaining the forms to them. Staff should be alert to the possibility of a parent/guardian having reading problems.

***a. Release to Dispense Medication: By signing this form the parent/guardian gives his/her consent for the Shelter staff to dispense to the youth over the counter medication approved by the Shelter's physician and/or medication prescribed specifically for the youth. Staff should explain we cannot dispense medication to the youth that is not on the Shelter's list of approved medication, unless we have a written doctor's order to do so. Staff should ask the parent/guardian to list any over the counter medications that he/she does not want to be administered to the youth. Staff should note that: 1) the list of approved over the counter medications is kept in the Medications Log, and 2) the pharmacy label on the original medication container will suffice for a written prescription. ***The short term packet does not include Release to Dispense Medication.

b. Emergency Medical Care Authorization: By signing this statement, the parent/guardian gives his/her consent for the Shelter to provide the youth emergency medical care. We use this form when we are unable to contact the parent/guardian at the time of the emergency.

**d. Parent/Guardian Placement Agreement: By signing this form the parent/guardian gives consents to place the youth at the Shelter. The staff should review with the parent/guardian that he/she is agreeing to 1) stay in contact with the Case Manager, 2) participate in counseling and other related activities, 3) provide transportation to and from anything except school, and 4) be financially responsible for medical/dental care, school supplies, lunches, clothes, etc., (anything that is not considered regular Shelter care). Staff should explain that the Shelter will usually give the parent/guardian 48 hours notice if the Shelter needs the youth to be removed, unless the Shelter needs for the youth to be immediately removed because he/she is endangering his/her own or other's safety. In addition staff should explain that the parent/guardian will be notified if the youth runs away, and that if the youth runs, the Shelter is not liable responsible the youth's safety, health or behavior.

**The agency packet does not include the Parent/Guardian Placement Agreement.

* ***e. Agency Placement Agreement: When an agency such as the court or a county DFC places a youth at the Shelter, a representative of the agency must sign this form. Staff should review with the representative that he agency is agreeing to 1) maintain weekly contact with the Case Manager and contact the youth at least every 2 weeks, 2) remove the youth within 60 days of admission, unless we request the youth's removal beforehand due to our need for bed space or due to the youth's behavior, in which case if possible we try to give the agency 48 hour notice, and 3) (out of county agencies) pay a per diem which covers room and board, transportation we provide, recreation and counseling by Shelter staff. The staff should explain that the agency will be notified if the youth runs away, and that if the youth runs, the Shelter is not liable responsible the youth's safety, health or behavior. * ***Neither the self/parental nor the short term packet includes the Agency Placement Agreement.

* ***f. Parent Agreement for Court Ordered Placement: By signing this form, the parent guardian is acknowledging that he/she understands the youth has been ordered to the Shelter. The parent/guardian is informed that he/she will be provided information about the Shelter and that he/she is expected to sign admission forms. Staff should review with the parent/guardian that he she will be notified if the youth runs away, and that, if the youth runs, the Shelter is not liable for said youth's health, safety or behavior. Staff should explain the parent/guardian's contact person is the youth's Case Manager.

***Neither the self/parental nor the short term packet includes the Parent Agreement for Court Ordered Placement.

***g. Authorization to Release/Obtain Personal Information: For this to be valid, the parent/guardian and the youth must both sign this form. By signing this form the parent/guardian and youth are giving their consent for our agency to give and receive personal information concerning the youth to and from the agencies and/or persons listed on the form. Directions for completing the form are noted at the top of each copy. Staff are to enter an "x" in the give and obtain boxes and be sure the parent and youth understand this is a two-way release. Staff are to write the youth's name and date of birth. Staff can use the blanks to write in the names of agencies or persons not listed in the box that provide or have provided services to the youth, such as counselors, counseling services, hospitals and any out of county agencies. All hand written entries must be initialed by the staff, parent/guardian and youth. ***The short term packet does not include the Authori zation to Release/Obtain Personal Information.

h. Income Information: This form is not required for DFC wards. This form documents the source(s) of income and income levels of the families we serve. We use this information for various reports, grants and statistical purposes. Based on the family size, the weekly, bi-weekly, monthly or annual total income, staff use the chart behind the Client Status sheet to determine if the family's income is low, low/moderate or above. If the parent/guardian seems reluctant to provide details regarding the families income, the staff can show the parent/guardian how to use the chart and ask he/she to rate the families income as low, low/moderate or above.

i. Admission Agreement: The youth must sign this form; staff should contact the On-Call if a youth refuses to sign it. By signing at the top, on the front of this form the youth is agreeing to admit him/herself to the Shelter. By signing at the bottom, on the back side, the youth is agreeing to go by the Shelter rules. Staff must read this form to the youth.

j. Inventory: This form lists all of the youth's personal possessions. Directions for completing the Inventory are noted at the bottom of each copy. Also the Intake Checklist lists the possessions residents can and cannot have at the Shelter. Staff conducting the intake must at least search the resident and write on the Inventory the clothing articles and other possessions, such as jewelry, the youth is wearing at admission. If time permits the staff should also search the remainder of the youth's possessions, return to the parent/guardian any items the youth cannot have at the Shelter, and label and write on the Inventory the items the youth can have. If time does not permit staff completing all of the aforementioned, the staff should at least attempt to search the possessions with the youth present and leave the labeling, writing in and storing for the next RC or overnight RC to complete. Also RS's can complete the youth's Inventory. If a youth brings in more clothing than the rules allow, staff should allow the youth to choose the clothes he/she wants inventoried in.

k. Release Authorization: This form is divided into 3 sections. Staff should first note the date and time of the youth's exit and review the discharge checklist in the box at the top of each copy. The sections are:

    1. Release to the Parent/Legal Guardian - This is used when a resident is discharged to his parent/guardian or his DFC caseworker. By signing this form the parent/guardian is removing the youth from the Shelter and relieving the agency of any responsibility for the care, custody, control and supervision of the youth;
    2. Transportation by Someone other than the Legal Guardian - This is used when the youth is discharged to some one other than the parent/guardian or DPW caseworker, such as a sheriff or probation officer, solely for the purposes of transporting the youth home or to an alternative placement. Staff must obtain the name of the person providing transportation and to where he/she is transporting the resident;
    3. Placement with Someone ot her than Legal Guardian - This is used when the parent/guardian is not taking the youth back into his/her custody and he/she has arranged for the youth to be released to someone else. Usually these kinds of plans are made in advance with the youth's Case Manager. If plans have not been made, the RC should contact the On-Call.

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after the rc has completed the packet

After the RC has gathered information for the intake packet and the parent/guardian has left, the RC should do the following:

  1. Label the intake packet by writing the youth's name and date of entry on the tab.
  2. Place the intake packet in a legal size, hanging file and label the tab on the hanging file with the youth's name and date of birth.
  3. Place any money in an envelope with the resident's name, date and the total $ amount turned in. The RC and resident must initial the total. This money should be given to the Case Manager.
  4. Enter youth's name and pertinent information on the Client Status Sheet.
  5. Enter the youth's name and pertinent information on the Client Black Book
  6. Search the youth before allowing him/her to leave the office, and do lice check.
  7. Inventory in any medications.

resident orientation

After the RC has completed the intake, the OM should arrange for the youth to be oriented to the Shelter's program. Orientation consists of:

  1. Touring the building; note the emergency exits. Although staff should point out where the following are located, staff cannot take the youth into the bedrooms or bathrooms of the opposite sex, or he staff offices.
  2. Assign the youth to a bedroom. During week days the RC should refer this decision to the Shelter Coordinator. The policy is one resident to a room until there is need to double up. Staff are to instruct residents on the proper way to make their bed to meet licensing requirements. Note the bedroom assignment on the list on the RCs desk.
  3. Review the daily schedule and the rules for each of the activities listed on the daily schedule, such as meals, snacks, study time, school run, free time, etc.
  4. Review the Behavior Modification System.
  5. Review policy and procedure, such as TV, radio, possessions, etc.
  6. Review Daily Chores, i.e. how chores assigned, specific chore expectations, how chores evaluated, etc.

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DISCHARGES

At discharge the Shelter staff must assure the safe arrival of each youth home or to an alternative living arrangement. The Shelter must verify the arrival of each youth who is not accompanied home or to an alternative living arrangement by the parent/legal guardian or agency staff within 12 hours after the youth's scheduled arrival at his/her destination. This is the responsibility of the youth's Case Manager to carry this out. Usually the Case Manager and parent/guardian plan for when a youth is going to be discharged. The Case Manager informs the staff of such either during staff meeting or by making a note in the Shelter Log and calendar. Staff should prepare for the youth's exit by inventorying out the youth's possessions before the parent/guardian arrives to sign the youth out. If at all possible, the overnight RC inventories out the resident. Occasionally youth will be discharged without the Case Manager and parent/guardian making prior arrangements. If the RC has any questions regarding a youth's discharge he/he should refer to the Case Manager or On-Call.

discharge procedures

  1. The RC should send a staff member with the resident to gather all of the resident's belonging from his/ her room. If this is done the evening prior to the resident's exit, make sure to instruct the resident to leave in his/her room whatever he/she wears to sleep in and an outfit for the next day.
  2. The Staff must inventory out the residents' belongings by checking each item against what is listed on the Inventory. The staff should cross off all items accounted for; staff can highlight items that are missing and also make a note in the Log. If a resident claims as his/her own items that are not on his/her Inventory, the staff should check if the item is labeled. If the item is not labeled with the resident's name or initials, but with YS or another resident's initials/name, staff should return the item to the rightful owner. If the item is not labeled then staff can attempt to verify its ownership with the parent/guardian.
  3. The RC must complete the discharge checklist in a box, at the top of the Release Authorization form. This reminds the RC to inventory out medications, return money, etc.
  4. The RC should complete or arrange for another staff member complete the Exit Evaluation. Copies are included in each intake packet. Completed evaluations are stored in a hanging folder in the file cabinet in the RC office.
  5. Before the resident is discharged, he/she should strip his bed and place all bed and bath linens by the dirty clothes hamper.
  6. The RC should return all of the youth's confiscated items to the parent/guardian.
  7. The RC should instruct the adult to whom the youth is released to sign the appropriate section of the Release Authorization form.
  8. The RC should erase the youth's name and personal information form the Client Black Book.
  9. The RC should note on the Client Status sheet the date of and the youth's placement at discharge and draw a line through the youth's name and other personal information.
  10. For detailed information regarding other discharge procedures for runaways, refer to the write up on Runaways in the section on Emergency and Safety Practices.

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© Copyright 2006, Youth Services Bureau of Monroe County