TERM Providers

TERM Provider Handbook

• TERM Provider Handbook.pdf
• TERM Provider Handbook (pdf)

TERM Provider Handbook Appendices

• Superior Court of CA Order Authorizing Release of Health Info of Children in Custody of HHSA (expires 3-21-28).pdf
• Superior Court of CA Order Authorizing Optum to Disclose Therapy Treatment Plans and Evaluations of Clients Receiving Services From HHSA to HHSA CFWB Representatives (expires 10-21-24).pdf
• TERM Psychological Evaluation Handbook.pdf
• Documentation Requirements - Group Treatment Standards.pdf
• Documentation Requirements - Individual Treatment Standards.pdf
• TERM Treatment Plan Documentation Resources.pdf
• 1. Court Testimony in the Juvenile Court System (pdf)
• 2. CFWB Form 04 176A Child Therapy Referral Form (dot)
• 3. CFWB Form 04 176A Parent Therapy Referral Form (dot)
• 4. CWS Form 04-178 Request for TERM Appointed Evaluator (pdf)
• 5. CWS Treatment Plan Documentation Resources (pdf)
• 6. CWS Form 04-176/04-177 – Parent (docx)
• 7. CWS Form 04-176/04-177 – Youth (docx)
• 8. Delinquency System Legal Process (pdf)
• 9. Dependency System Legal Process (pdf)
• 10. Documentation Requirements (pdf)
• 11. Legal Issues Related to Therapy and Evaluations for CWS Cases
• 12. Probation Psychiatric Evaluation Referral Form (pdf)
• 13. Probation Psychological Evaluation Referral Form (pdf)
• 14. Psychological Evaluation Procedures (pdf)
• 15. San Diego Juvenile Court Procedure to Obtain Authorization to Use or Disclose Protected Mental Health Information for Evaluations of Minor in Custody (pdf)
• 16. Serious Incident Report (docx)
• 17. Specialized Optum TERM Panel Evaluations (pdf)
• 18. Superior Court of the State of California Order (pdf)
• 19. The Format and Required Elements of a Probation Psychiatric Evaluation (pdf)
• 20. The Format and Required Elements of a CWS Psychological Evaluation (pdf)
• 21. The Format and Required Elements of a Juvenile Mental Competency Evaluation (pdf)
• 22. The Format and Required Elements of a Probation Psychological Evaluation (pdf)
• 23. The Format and Required Elements of a Juvenile Threat Assessment (pdf)
• CFWB Treatment Plan Form for Parents 04-176_04-177p (docx)
• CFWB Treatment Plan Form for Youth (docx)
• Claims Resources for TERM Providers (pdf)
• Court Testimony in the Juvenile Court System (pdf)
• Initial Treatment Plan/Treatment Plan Update (04-176/04-177)
• Initial Treatment Plan/Treatment Plan Update (04-176/04-177)
• Microsoft Word - 04-29cft.docx
• Microsoft Word - CFT Information Guide for Providers.docx
• Microsoft Word - Dependency System Legal Process.docx
• Microsoft Word - Juvenile Justice System Legal Process.docx
• Microsoft Word - Legal Issues Related to Therapy and Evaluations for CFWB Cases.docx
• Microsoft Word - Psychological Evaluation Procedures.docx
• Microsoft Word - Records Release Protocol for TERM Juvenile Probation Evaluations.docx
• Microsoft Word - Specialized_Optum_TERM_Panel_Evaluations.docx
• Microsoft Word - The Format and Required Elements of a CFWB Psychiatric Evaluation.docx
• Microsoft Word - The Format and Required Elements of a CFWB Psychological Evaluation.docx
• Probation Psychological & Psychiatric Referral
• Request for TERM-Appointed Evaluator (pdf)
• TERM Therapy Provider Telehealth Best Practices (pdf)
• Therapy Referral Form (04-176A)
• Therapy Referral Form (04-176A)

CFWB Treatment Plan Forms

• 1. CFWB Treatment Plan Form for Youth (doc)
• 2. CFWB Treatment Plan Form for Parents (doc)

CFWB Referral Form

• CFWB Referral Form (pdf)
• Therapy Referral Form (04-176A)
• Therapy Referral Form (04-176A)

Telehealth

• TERM Therapy Provider Telehealth Best Practices.pdf
• TERM Therapy Provider Telehealth Checklist (pdf)
• TERM Therapy Provider Telehealth Resource List (pdf)

Resources

• Foster Youth Bill of Rights (pdf)
• Legal Issues Related to Therapy and Evaluations for CFWB Cases (pdf)
• Microsoft Word - Legal Issues Related to Therapy and Evaluations for CFWB Cases (4.17.24).docx
• Releases of Information (ROI) - When Do I Need One for Youth Involved in the Juvenile Court Dependency System (pdf)

CFWB Temporary Change of Authorization

• CFWB Temporary Change of Authorization (pdf)

Medi-Cal Funded CFWB Therapy

• Workflow for CFWB Therapy Referrals (pdf)

CFWB Treatment Plan Documentation

• Documentation Requirements - Individual Treatment Standards.pdf
• TERM Treatment Plan Documentation Resources.pdf
• 1. Documentation Requirements (pdf)
• 2 .TERM Treatment Plan Documentation Resources (pdf)

Request for Authorization of Additional Units of CFT Meeting Form Through CFWB Funds

• Request for Authorization of Additional Units of CFT Meeting Form (pdf)
• Request for Authorization of Additional Units of CFT Meeting Form (pdf)

Invoice Payment Delegation Form

• Provider Request for Invoice Payment Delegation Form – Court Testimony (pdf)

TERM IPV Victim Group Treatment Standards

• Intimate Partner Violence Safety Plan Guidelines.pdf
• IPVV Group Psychotherapy Standards Assessment Tools.pdf
• Intimate Partner Violence Victim Group Treatment Standards.pdf
• 1. IPV Victim Group Treatment Standards (pdf)
• 2. Assessment Tools (pdf)
• 3. Documentation Requirements (pdf)
• 4. Safety Plan Guidelines (pdf)

IPV Victim Progress Reporting Forms

• 1. IPV Victim Intake Assessment Form (docx)
• 2. IPV Victim Quarterly Report Form (docx)
• CFWB IPVV Intake Assessment Form (docx)
• CFWB IPVV Quarterly Progress Report Form (docx)

Resources

• IPVV On Site Group Monitoring Tool.pdf
• DV Victim Group Progress Report Sample (pdf)
• FAQ (pdf)
• IPV Victim Group Intake Assessment Sample (pdf)
• IPV Victim Group Progress Report Sample (pdf)
• IPVV Group Intake Assessment - Sample (pdf)
• Mandatory Assessment Tools Scoring Criteria (pdf)
• On Site Monitoring Tool (pdf)
• PVV Group Quarterly Progress Report - Sample (pdf)
• Personalized Safety Plan – Spanish (pdf)
• Safety Plan Samples (pdf)

CSA-NPP Treatment Standards

• NPP Safety Plan Guidelines.pdf
• NPP Group Psychotherapy Standards Assessment Tools.pdf
• 1. CSA-NPP Treatment Standards (pdf)
• 2. Sexual Abuse Protection: Parent Treatment for Non-Offending/Non-Protecting Parents Mental Status/Psychiatric Symptoms (pdf)
• 3. Assessment Tools (pdf)
• 4. Scoring Sheet for Required Screening Tools (pdf)
• 5. Safety Plan Guidelines (pdf)
• 6. On-Site Group Monitoring Tool (pdf)
• CSA-NPP Treatment Standards 2024 (pdf)

CSA-NOP/NPP Progress Reporting Forms

• CFWB CSA-NPP Intake Assessment Form (docx)
• CFWB CSA-NPP Quarterly Progress Report Form (docx)
• Initial Intake Assessment Form (docx)
• Quarterly Progress Report Form (docx)

Resources

• NPP On Site Group Monitoring Tool.pdf
• Documentation Requirements - Group Treatment Standards.pdf
• Documentation Requirements (pdf)
• NPP Intake Assessment - Sample (pdf)
• NPP Quarterly Progress Report - Sample (pdf)
• On-Site Group Monitoring Tool (pdf)

Format and Required Elements

• 1. Format and Required Elements of a CWS Psychological Evaluation (pdf)
• 2. Format and Required Elements of a Probation Psychological Evaluation (pdf)
• 3. The Format and Required Elements of a Probation Psychiatric Evaluation (pdf)
• 4. Format and Required Elements of a Juvenile Mental Competency Evaluation (pdf)
• 5. The Format and Required Elements of a Juvenile Threat Assessment (pdf)

CFWB Evaluation Referral Form

• Parent Evaluation Referral Questions - Diagnostic Clarification and Treatment Recommendations (pdf)
• Parent Evaluation Referral Questions - FC7827 (pdf)
• Parent Evaluation Referral Questions - Neuropsychological Evaluation (pdf)
• Parent Evaluation Referral Questions - Prospective Adoptive Parent (pdf)
• Parent Evaluation Referral Questions - Psychiatric Evaluation (pdf)
• Youth Evaluation Referral Questions - Adoption (pdf)
• Youth Evaluation Referral Questions - Diagnostic Clarification and Treatment Recommendations (pdf)
• Youth Evaluation Referral Questions - Emotional Damage (pdf)
• Youth Evaluation Referral Questions - Neuropsychological Evaluation (pdf)
• Youth Evaluation Referral Questions - Psychiatric Evaluation (pdf)

Probation Evaluation Referral Form

• Probation Psychiatric Evaluation Referral Form (pdf)
• Probation Psychological Evaluation Referral Form (pdf)

Resources

• 1. TERM Psychological Evaluation Handbook (pdf)
• 2. APA Specialty Guidelines for Forensic Psychology (pdf)
• 3. APA Guidelines for Evaluations in Child Protection Matters (pdf)

Medi-Cal Funded CFWB Evaluations

• Medi-Cal Psychological Testing Request Form (docx)

Request to Modify CPT Code Distribution for CFWB Funded Evaluations

• Request to Modify CPT Code Distribution for CFWB Funded Evaluations Form

• California Pediatric Symptom Checklist Caregiver Form - English (pdf)
• PowerPoint Presentation
• CA IP-CANS Rating Sheet - Spanish (pdf)
• CALIFORNIA INTEGRATED PRACTICE — CHILD AND ADOLESCENT NEEDS AND STRENGTHS
• CALIFORNIA INTEGRATED PRACTICE Child and Adolescent Needs and Strengths
• Electronic CANS Form.pdf
• ,CANS User Guide (pdf)
• Electronic CANS Form (pdf)
• CANS and PSC Instructions and Process Provider Correspondence (pdf)
• Electronic PSC - Parent Form (pdf)
• Electronic CANS Form – Early Childhood Version (pdf)
• Electronic CANS/PSC Resources & CWS Treatment Plan Documentation Update (pdf)
• Electronic PSC - Parent Form - Spanish (pdf)
• Electronic PSC - Youth Form (pdf)
• Electronic PSC - Youth Form - Spanish (pdf)
• CANS-PSC Completion Tip Sheet with link to Tools (pdf)

• OPTUMIST Newsletter Fall 2023 (pdf)
• OPTUMIST Newsletter Fall 2024 (Pdf)
• OPTUMIST Newsletter Spring 2024 (pdf)
• OPTUMIST Newsletter Summer 2023 (pdf)
• OPTUMIST Newsletter Summer 2024 (pdf)
• OPTUMIST Newsletter Winter 2024 (pdf)

• Children's Legal Services Contact List (pdf)
• DECEMBER 2024 CFWB UNIT ROSTER
• DECEMBER 2024 CWFB ALPHA ROSTER
• Dependency Legal Services Contact List (pdf)

Communications

• Important Update on Juvenile Threat Assessment Referrals (pdf)
• Mental Health Record Release Process for TERM Psychological Evaluations (pdf)
• Reimbursement of Case Management Services (pdf)

Change of Practice Forms

• Provider_Update_Form_Group_to_PP.pdf
• Change From a Group to a Private Practice (pdf)
• Change of Address, Phone, Demographics Form (pdf)

Telehealth Attestation/Standards

• Standards of Practice for Telehealth
• Telehealth Attestation (pdf)

Home Office Standards

• Home_Office_Criteria.pdf