Full Service Partnership Outcomes Forms and Web-Based Data Entry
FULL SERVICE PARTNERSHIP (FSP) OUTCOMES ASSESSMENT FORMS
The REVISED MHSA FSP Outcomes Assessment forms are now available.
Counties are advised to discontinue use of the 6/2/06 version of the
FSP Outcomes Assessment forms as soon as possible.
MHSA Full Service Partnership Outcomes Assessment forms are to be used
by counties once local MHSA Plans are approved
and MHSA Full Service Partner service delivery begins.
Click here to download the revised FSP outcomes forms.
IMPORTANT INFORMATION REGARDING REVISED FSP OUTCOMES ASSESSMENT FORMS
The NEW revision date for the FSP Outcomes Assessment forms is 5/1/07 (located in the top, right corner of each form). A document entitled, FSP Forms Revisions as of May 1, 2007, provides a detailed outline of these revisions. Counties/providers must work with DMH and attend trainings/workshops prior to utilizing these forms.
These forms are primarily for use by counties who will be using the DMH Data Collection Reporting System (DCR), but may also be helpful as a visual aid for counties who are planning to collect data locally for XML submission.
Currently, DMH is pilot testing the Enhanced DCR system. It is expected that this system will be in production in June 2007, at which time POQI staff will begin providing Enhanced DCR and Updated Approver Designee training to counties. Information regarding these trainings will be posted on the POQI MHSA Training website in May 2007.
BACKGROUND & DEVELOPMENT OF THE FSP OUTCOMES ASSESSMENT FORMS
Based on the AB2034 evaluation model, the Performance Measurement Advisory Committee developed initial requirements for measuring individual-level performance outcomes for Full Service Partners (FSPs). For all FSPs identified and served, providers must submit the data captured by these assessment forms. Three types of assessments (i.e., Partnership Assessment Form, Key Event Tracking and Quarterly Assessment) were developed for the age groups specified in the “Mental Health Services Act Community Services and Supports, Three-Year Program and Expenditure Plan Requirements, Fiscal Years 2005-06, 2006-07, 2007-08” document, including children/youth (0-15 years), transition age youth (16-25 years), adults (26-59 years), and older adults (60+ years).
The Partnership Assessment Form (PAF), completed when the partnership is established, captures history and baseline data. The Key Event Tracking (KET) is completed when a change occurs in key areas. The Quarterly Assessment (3M) is completed every three months. The table (below) shows the domains that are collected for each assessment type.
|Partnership Assessment Form (PAF)||Key Event Tracking (KET)||Quarterly Assessment (3M)|
|Administrative Information||Administrative Information||Administrative Information|
|Residential (includes hospitalization & incarceration)||Residential (includes hospitalization and incarceration)|
|Sources of Financial Support||Sources of Financial Support|
|Legal Issues / Designations||Legal Issues / Designations||Legal Issues / Designations|
|Emergency Intervention||Emergency Intervention|
|Health Status||Health Status|
|Substance Abuse||Substance Abuse|
|ADL / IADL - Older Adults Only||ADL / IADL – Older Adults Only|