Florida has developed a set of forms to track outreach activities, the number of screenings and referrals, and the number of clients accessing treatment. These forms, listed below, are completed by the TANF SAMH contracted service providers and submitted to the TANF SAMH specialist:
TANF SAMH Screening and Referral Analysis Form. This form, submitted by contracted service providers to the TANF SAMH specialist at the end of each month, reports on the number of clients referred for different reasons (e.g., substance abuse referrals, domestic violence referrals, outreach contacts made that month, etc.).
Log of Outreach Activities Form. This form is a monthly reporting form completed by the contracted service provider. Types of services, total units of services, and number of persons served are some of the data reported on this form.
SAMH Treatment Verification Form. This form was developed to approve time limit extensions for clients successfully completing treatment. TANF SAMH treatment providers indicate the amount of time a participant has spent in treatment. This information is used to determine whether a time limit extension should be granted for the number of months spent in treatment.
TANF SAMH Client Log. The client log is used to track individual client information such as name, social security number, TANF participant status, and status date.
Florida's service plan/tracking form [in PDF format]
1. Employment counselors are required to refer clients to mental health services if they respond, "yes" to two or more of the four CAGE questions asked during the general employment assessment.
2. The Adult Strength Scale includes questions on home, work/school/training, emotional, and social resources and strengths.
3. Sections in the functional assessment are understanding and memory, sustained concentration and persistence, social interaction, and adaptation.