Support Services Programs FY15
*Create an Organizational Table that suits your Agency Staff. Use Legend listed to identify service provision.
Organizational Tablefor Sample Agency, Inc.
Current as of DATE
June 9, 2011
Employee Name / Position Title / Degree/Licensure / Specialization / Services ProvidingJohn Doe / Case Manager / M.S. / PC / 518-24, 47, 56, 88
Jane Doe / Assessor / LPC / N/A / 511-29, 88
John Doe / Paraprofessional / HS / N/A / 518-56
Jane Doe / Case Manager / M.A. / Criminal Justice / 518-24, 47, 56, 71, 88
John Doe / Paraprofessional / GED / N/A / 518-56
June 9, 2011
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Comprehensive Child and Family Assessment FY15
*Create an Organizational Table that suits your Agency Staff. Use Legend to identify service provision.
Service Provision Legend
UAS 511 (CCFA) Entitlement Codes Authorized:
Sub code / Type of Service56a / Transportation Services
56b / Mileage for transportation
29e / CCFA Assessments - 1st child
29f / CCFA Assessments – each additional child (Ages 0 to 17)
29j / Relative/Non-Relative Care Assessment & Home Evaluation
29m / Updated CCFA Assessment - 1st child
29n / Updated CCFA Assessment - each additional child (ages 0-17)
29o / Cancelled/Incomplete Assessments
88a / Court Appearance and/or Testimony (Licensed Professional Only
Wrap-Around FY15
*Create an Organizational Table that suits your Agency Staff. Use Legend to identify service provisions.
Service Provision Legend
UAS 518 (WRAP) Entitlement Codes Authorized:
Sub code / Type of Service00 / Emergency Placement
24a / Crisis Intervention/Prevent Disruption - (Licensed)
24b / Crisis Intervention/Prevent Disruption - (Degreed)
24c / Crisis Intervention/Prevent Disruption-(Mileage)
47a / Crisis Intervention/Behavior Mgmt - (Licensed)
47b / Crisis Intervention/Behavior Mgmt - (Degreed)
47c / Crisis Intervention/Behavior Mgmt – (Mileage)
56a / Transportation Service
56b / Mileage for Transportation Service
56d / Education Stability Public Transportation Services
56e / Education Stability WRAP Transportation
56f / Education Stability WRAP Mileage
71a / In-Home Case Management - (Licensed)
71b / In-Home Case Management - (Degreed)
71p / In-Home Case Management (Mileage)
88a / Court Appear/Testimony - (Licensed)
88b / Court Appear/Testimony - (Degreed)
95a / In-Home Intensive Treatment - (Licensed)
95b / In-Home Intensive Treatment (Mileage)
Parent Aide Services FY 15
*Create an Organizational Table that suits your Agency Staff. Use Legend to identify service provisions.
Service Provision Legend
UAS 573 (PA) Entitlement Codes Authorized:
Sub code / Type of Service63a / Family Visitation Services - Initial Home Visit – “Family Engagement”
63b / Family Visitation Services - Supplies
63d / Family Visitation Services - Home Visits/ Training Sessions
63f / Family Visitation Services – Program Completion Follow-up
63h / Family Visitation Services – Missed Home Visits
63i / Family Visitation Services- Family Team Meetings and/or Case Staffing
63j / Family Visitation Services – Home Visits Mileage
63k / Family Visitation Services – Initial Referral
63l / Family Visitation Services – Printing Training Material
63m / Family Visitation Services – Attendance at Court Hearings/Testimony Degreed
63n / Family Visitation Services – Monthly Coach Support via Teleconference
63o / Family Visitation Services – Coach Site Visits – Case Review
63p / Family Visitation Services –
Mileage for Attending and Participating in FTM, Case Staffing, Visitation and/or Court Hearings
72b / Parent Aide Services -Written Parenting material
72c / Parent Aide Services -Case Management
72d / Parent Aide Services -Missed Home Visits
72e / Parent Aide Services -Mileage
72f / Parent Aide Services- Child Care Cost
72g / Parent Aide Services -Group Parenting Skills Class
72i / Parent Aide Services -Home Visit
Homestead Family Preservation and Permanency FY 15
*Create an Organizational Table that suits your Agency Staff. Use Legend to identify service provisions.
Service Provision Legend
UAS 571 (HS) Entitlement Codes Authorized:
Sub code / Type of Service29a / Relative/Non-Relative Assessment
29b / Relative/Non-Relative Assessment –Missed Appointments
29d / Relative/Non-Relative Mileage
61b / Homestead Services-Missed Appointments
61d / Homestead Services Closing Summary/Termination Report
61e / Homestead Services Mileage
61f / Case Management
61h / Homestead Services Family Therapy - Counseling
61i / Homestead Services Family Therapy- Behavior Aid Services
62 / One Time 24-Hour Crisis Intervention
63a / Family Visitation Services - Initial Home Visit – “Family Engagement
63b / Family Visitation Services - Supplies
63d / Family Visitation Services - Home Visits/ Training Sessions
63f / Family Visitation Services – Program Completion Follow-up
63h / Family Visitation Services – Missed Home Visits
63i / Family Visitation Services- Family Team Meetings and/or Case Staffing
63j / Family Visitation Services – Home Visits Mileage
63k / Family Visitation Services – Initial Referral
63l / Family Visitation Services – Printing Training Material
63m / Family Visitation Services – Attendance at Court Hearings/Testimony Degreed
63n / Family Visitation Services – Monthly Coach Support via Teleconference
63o / Family Visitation Services – Coach Site Visits – Case Review
63p / Family Visitation Services –
Mileage for Attending and Participating in FTM, Case Staffing, Visitation and/or Court Hearings
Prevention of Unnecessary Placement (PUP) FY15
*Create an Organizational Table that suits your Agency Staff. Use Legend to identify service provision.
Service Provision Legend
UAS 521 (PUP) Entitlement Codes Authorized:
Sub code / Type of Service06d / Criminal Background Checks
09 / Evaluations (ages 4-17 and Adults)
09a / Speech Evaluations
09b / Hearing Evaluations
29 / Mental Health Assessments
29a / Domestic Violence Assessment
29b / Mental Health Assessment
29c / Parental Fitness Assessment
29d / Psychosexual Evaluation (formerly Sexual Abuse Assessment)
29e / Substance Abuse Assessment
29f / Trauma Assessment
48a / Emergency Housing/Financial Assistance
48b / Mortgage Expenses
48c / Utility Expenses
48d / Utility Deposits
48e / Home Repairs (Minor)
48f / Legal Expenses (Guardianship)
48g / Emergency Furniture
48h / Emergency Clothing
48i / Birth/Death Certificates
49 / Emergency Day Care Services
50 / Counseling
50a / Counseling-Licensed Professional
50c / Behavior Aid Services-Para-Professional
51a / Drug and Alcohol Screens- Hair Follicle
51b / Drug and Alcohol Screens-Urine
51c / Drug and Alcohol Screens- Breath Scan
51e / Paternity Testing/DNA Testing
51f / Court Appearance and/or Testimony-Licensed Professional
51g / Court Appearance and/or Testimony-Degreed/Non-Degreed Professional
53 / Medical Services (Behavioral Health Care ages 0-18)
54 / Psychological Evaluation
56a / Contracted Provider Mileage-PUP
56b / Emergency Meals and Lodging
56c / Emergency Gasoline/Public Transportation
56d / Emergency Vehicle Repair
80 / Safety/Enrichment Activities (DFCS Foster Care Children Only)
Early Intervention/Prevention (EI) FY15
*Create an Organizational Table that suits your Agency Staff. Use Legend to identify service provision.
Service Provision Legend
UAS 551 (EI)) Entitlement Codes Authorized:
Sub code / Type of Service79 / Prevention/Early Intervention Services
79b / Home Visits
79c / Case Management Fee
79d / Travel Reimbursement
79f / Missed Appointments
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