Free Notice (Other) - District Court of Connecticut - Connecticut

Case 2:89-cv-00859-AHN

Document 474-2

Filed 10/07/2004

Page 1 of 4 Page 1 of 4

Revised Tool for Future Discretionary Flex Funds Reviews
Flex Funds Review Instrument 1. Flex Funds Case Id: 2. Area Office 1. G Bridgeport 2. 3. 4. 5. 6. 7. G Danbury G Hartford G Manchester G Meriden G Middletown G New Britain

8. G New Haven 9. G Norwalk 10. G Norwich 11. G Stamford 12. G Torrington 13. G W aterbury 14. G W illimantic

3. Case Type at point of request for flex funds 1. G CPS In-home family (IHF) case 2. G CPS child-in-placement (CIP) case 3. G Voluntary Services in-home family (VSIHF) case 4. G Voluntary Services child-in-placement (VSCIP) case 5. G FW SN 6. G Probate 7. G Open in Investigation Only 4. Identified W orker at point of request for funds: 5. At what point does the record indicate a need identified? ________/__________/_________ mm dd yyyy For what case participant was the need identified? 1. G Child (In home) 2. G Child (Out of home) 3. G Parent/Legal Guardian/Caretaker 4. G Family Unit 5. G Other 5a. ______________________________ (write in participant if other is selected) W ere alternative funding sources sought to meet this need prior to request for flex funding?

6.

7.

GYes

GNo

GN/A

GUTD

7A.

If, alternative funding source was identified, and was subsequently not available, or not utilized, what was the barrier to use? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ W ere alternative funding sources available for this need in the area during 2Q, 2004?

8.

GYes GNo

GN/A

GUTD

8a.

If, alternative funding source was identified, and was subsequently not available, or not utilized, what was the barrier to use?

Case 2:89-cv-00859-AHN

Document 474-2

Filed 10/07/2004

Page 2 of 4 Page 2 of 4

Revised Tool for Future Discretionary Flex Funds Reviews

_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 9. On what date was the determination made to seek flex funds? ________/__________/_________ mm dd yyyy

Case 2:89-cv-00859-AHN

Document 474-2

Filed 10/07/2004

Page 3 of 4 Page 3 of 4

Revised Tool for Future Discretionary Flex Funds Reviews

10.

Did flex funding contribute to provision of services for a medical/dental/mental health need?

GYes

GNo

GN/A

GUTD

11.

Did flex funding contribute to a need other than medical/dental/ mental health, which was directly impacting the ability of the GYes child/family to achieve their goal? (i.e. concrete needs or support services)

GNo

GN/A

GUTD

12.

Was the use of flex funds necessary to support goal achievement? GYes GNo GYes GNo

GN/A GN/A

GUTD GUTD

12A. Did flex funding contribute to keeping a family intact (avoiding placement)? 12B. Did flex funding contribute to reunification of a child? 12C. Did flex funding contribute to the preservation of a placement? 12D. Did flex funding contribute to the placement of a child with a relative or special study caretaker known to the child? 13. In reviewing the record since the receipt of the service or goods provided, is there an indication that the funding met the identified need?

GYes GYes

GNo GNo

GN/A GN/A

GUTD GUTD

GYes

GNo

GN/A

GUTD

GYes

GNo

GN/A

GUTD

14. Once the determination was made to seek flex funds, how long did the process of securing funds take? G 1. 1-3 Days G 2. 4-6 Days G 3. 7-9 Days G 4. 10 ­12 Days G 5. 13-15 Days G 6. Greater than 15 Days G 99. UTD 15. Per the reviewer, what category of service or payment was requested? G 1. Food G 11. Daycare G 2. Clothing G 3. Emergency shelter G 4. Rent to avoid eviction G 5. Security deposit/ first and last month's rent G 6. Heating/electricity bills G 7. Emergency home repairs (e.g., heating system repair) G 8. Emergency housekeeping services G 9. Counseling G 10. Mental health evaluations G 12. Transportation G 13. Camp/Recreation G 14. Medical/Dental G 15. Utility (Phone) G 16. Other: ________________

16. W hat was the amount of funds requested? _________________________________________ 17. W hat was the identified need on the request form? __________________________________ 17A. W hat was the additional description provided? _______________________________

Case 2:89-cv-00859-AHN

Document 474-2

Filed 10/07/2004

Page 4 of 4 Page 4 of 4

Revised Tool for Future Discretionary Flex Funds Reviews

18. W hat was the amount of funds provided? _____________________________________ 19. W hat was the date of the check? ____________________________________________ 20. In the quarter of this review, how many times were flex funds requested to serve the needs of the case participants identified via case id xxxxxxx? _____________ 21. From the perspective of the worker, in general, what obstacles were present in attempting to use current DCF service code funding sources, or alternative funding sources (i.e. Covenent to Care, CAFAP, or other community or state agencies) to meet the needs of the clients' served? (Check all that apply) 1. G Chain of Approval 2. G Clear identification of existing resources within established DCF service contracts or pool of funds was not available 3. G Clear identification of the responsibilities of other state agencies who jointly serve DCF clients was not available 4. G Clear identification of alternative community resources within our area office was not available 5. G Other: _______________________________________________________________ 66. G N/A ­ I have not experienced barriers to obtaining funding necessary to meet client's needs 99. G Skip ­ SW or SW S declined comment

22. In the opinion of the reviewer, was the use of flex funds in line with good case practice (did the expenditure meet the needs of the GYes family in a meaningful manner ­ addressing the core issues bringing the family to the attention of DCF?) Interview/Reviewer Com m ents Below

GNo

GN/A

GUTD