- Intake is the process of contacting the family to schedule an appointment to discuss:
- The scope of EI services, including transition at age three (3);
- Family fees and private insurance requirements;
- Enrollment status in All Kids and the Division of Specialized Care for Children (DSCC);
- Completion of a All Kids application and referral to DSCC if indicated;
- Family rights and procedural safeguards; and
- To administer the ASQ: SE and, if screening results indicate, to begin EI eligibility determination.
- Contact the family within two business days after the date that the referral is received to schedule an appointment at a time and location convenient for the family. NOTE: If the referral was received on a date that the
Child and Family Connections (CFC) office was closed, the CFC is required to contact the family within two business days after the office re-opens for business.
- Families, including families with private insurance, who may be eligible for All Kids or DSCC as indicated by the Screening Device for Determining Family Fees and Eligibility for All Kids and DSCC, are required to apply for benefits through All Kids
and/or accept referral to DSCC in order to implement and remain eligible for EI services, except those services provided at no cost to the family.
- NOTE: The All Kids program encompasses a population that extends beyond the scope of the annual gross income identified on the Screening Device For Determining Family Fees and eligibility for All Kids
& DSCC. Families whose income exceeds the annual gross income identified on the Screening Device may be eligible for All Kids Level 2 and above. Families who do not have insurance are strongly encouraged to complete the All Kids Application.
However, for this population only, failure to complete the application does not prevent those families from receiving all EI services that a child might be determined eligible to receive. Families who have All Kids Level 2 and above may be assessed a
- As payor of last resort, all other resources must be maximized to cover the costs of EI services prior to utilizing state and federal appropriations for EI services. If a family's refusal of DSCC-funded services, including noncompliance with service
provider requirements, would result in a potential cost to the EI Program, the family (with or without private insurance) will not be able to receive EI services and assistive technology device's which are subject to fees.
- All contact with the family must be in the family's chosen language and/or method of communication. The Service Coordinator should be aware of and sensitive to the family's culture, ethnicity and language.
- A variety of approaches are acceptable, including personal contact at home, hospital, school, business, or community setting. A family's right to confidentiality must be ensured at all times and a Notice of Privacy Practices and a
signed acknowledgment of receipt must be provided and received at intake. The Illinois Department of Human Services (DHS) will provide the notice and the acknowledgment to be used for EI clients. Families should be invited and encouraged to include other
family members, friends or other sources of support during initial intake activities. Families should be made aware that protected health information will be discussed during intake activities.
- The intake appointment provides families an opportunity to:
- Ask questions and share information about their child and family.
- Receive information and support from the Service Coordinator, including information on procedural safeguards, rights and privacy practices.
- Begin adding information to the case record from discussion and relaying medical information and reports or other relevant documents.
- Assist the Service Coordinator in deciding what further information and/or evaluations are needed to determine eligibility.
- Begin investigating their private insurance coverage, if applicable.
- Submit an All Kids Application and receive a referral for DSCC services, if indicated.
- Upon receipt of a signed Informed Consent and Documentation of Receipt of Rights and Notice of Privacy Practices form from the child's parent, the Service Coordinator shall proceed with initial intake activities that shall include:
- Review of initial referral information entered into Cornerstone to determine if initial information gathered is accurate and complete;
- Completion of Department required intake forms;
- If appropriate, request of existing records regarding the child's need for services; and
- Review of existing records to identify whether additional information is needed to determine if the child meets federal and State established eligibility criteria.
- With appropriate consent from the family, using the Consent for Release of Information form, the CFC may acquire or release information to the entity identified on the form, including medical information, evaluation reports completed prior to
referral to EI, diagnosis, prescriptions and other information as specifically described. A separate form containing an original parent signature must be completed to acquire and to release information for each entity that information will be
acquired from or released to. The Service Coordinator is required to complete the form prior to requesting that a parent sign the form.
- Once the family has been located, information about the referral may not be given to the referral source without appropriate consent. If the referral source wants to know the outcome of its referral, the referral source should seek consent from the
family and provide a copy of a signed consent form to the CFC at the time of referral. Information about referrals may also be given to the referral source, if the CFC obtains consent from families using the Consent for Release of Information form.
If the child has a Primary Care Physician (PCP), request that the family sign the Consent for Release of Information form to the physician. It is important that the PCP be aware that the child was referred to EI, is provided information
on the status of the referral and receives a copy of the IFSP if the child is deemed eligible.
- The Service Coordinator shall request the appointment of a surrogate parent upon referral and prior to evaluation of a child who would not otherwise have relative care representation. NOTE: Refer to When a Surrogate is Needed at the
end of this section.
- Families have the right to decline services at any time. Steps to follow when a family declines services are described in Procedure 6.0 below.
- Contact the family within two business days of referral to verify that general eligibility requirements are met and if so, to discuss:
- 1.1 EI intake process and time lines.
- 1.2 Procedural safeguards, family rights and EI privacy practices.
- NOTES: 1) Refer to Referrals to Child and Family Connections Section for general eligibility requirements; 2) If the referral was received on a date that the Child and Family Connections (CFC) office was
closed, the CFC is required to contact the family within two business days after the office re-opens for business; and 3) Questions about family participation fees, use of private insurance, and enrollment in All Kids and DSCC should be answered as
- Determine whether an educational surrogate parent is required. NOTE: Refer to When a Surrogate is Needed at end of this section.
- Schedule intake meeting.
- 3.1 Legally responsible adult (LRA) or surrogate parent must attend this meeting and sign consent forms.
- 3.2 If appropriate, send Intake Appointment Confirmation form letter #30.F08.
- If family does not have a telephone or if unable to contact by phone:
- 4.1 Send Initial Contact - Unable to Contact by Phone form letter # 30.F14 and attachments to inform the family of the EI referral and ask them to schedule a meeting.
- 4.2 If no response within 10 days, send Second Contact - Unable to Contact by Phone form letter #30.F16 and copy the referral source. Parent liaison may assist in attempting contact.
- 4.3 If no response to the second letter within another 10 days, discontinue case.
- Meet with family.
- 5.1 Orient family to EI services and other related services.
- 5.2 Review all initial referral information entered into Cornerstone to determine if initial information gathered is accurate and complete. NOTE: If information is inaccurate or is not complete, do not create a duplicate
record in Cornerstone. Go back to the original record and make the appropriate changes.
- 5.3 Administer the appropriate ASQ: SE based upon the child's chronological age and record the findings on the Intake Summary Sheet.
- 5.4 Determine the family's concerns and priorities.
- 5.4.1 Discuss the child's likes and dislikes as well as other information that may facilitate the evaluation process.
- 5.5 Explain procedural safeguards, rights and privacy practices and provide the family with a copy of the State of Illinois Infant, Toddler and Family Rights booklet, the Parent Handbook, and the EI Notice of Privacy Practices.
- 5.6 Obtain parent signature(s) on the Informed Consent and Documentation of Receipt of Rights and Notice of Privacy Practices and the Cornerstone Informed Consent Form.
- 5.7 Complete the Consent for Release of Information form(s) in order to release information to the referral source, acquire information from other resources and release information obtained from other resources to EI providers as needed. (Use
pre-approved DCFS versions for wards.) NOTE: If information is received concerning HIV/AIDS, do not share this information with any other entity without a consent that is specific to HIV/AIDS that has been signed by the parent or
guardian only. It is a violation of Pubic Health laws to share HIV/AIDS information without specific consent.
- 5.7.1 If the child has a Primary Care Physician (PCP), request that the family sign the Consent for Release of Information form to notify the PCP that the child was referred to EI and to provide information on the status of the referral.
- 5.7.2 If consent is given to acquire/release information, describe the information that will be acquired/released in the description area of the Consent for Release of Information form before asking the family to sign the form(s).
- 5.7.3 Obtain a separate Consent for Release of Information form with an original signature for every resource that you will acquire information from and for every entity that you will release that information to.
- 5.8 Explain parents' role and responsibilities related to their participation in the development of the IFSP and the EI Services System.
- 5.9 Complete the process identified below to determine the family's enrollment status in All Kids and DSCC using the Screening Device for Determining Family Fees and Eligibility for All Kids and DSCC and complete appropriate follow-up as indicated.
- 5.9.1 If a family's gross income falls within the stated guidelines Identified on the Screening Device for All Kids and DSCC, ALWAYS obtain a completed All Kids application.
- 5.9.2 If a family's gross income exceeds the stated guidelines identified on the Screening Device for All Kids and DSCC, and the family has insurance, ALWAYS ask if the family has high medical bills. If the family's medical bills exceed $2,000 per
month, do not take an All Kids Application. Refer the family to their local Department of Human Services Office to apply for medical assistance. (In this situation, the family is being referred to their local DHS office to determine if they are eligible
for spend-down. The Central All Kids Unit does not process applications for spend-down.)
- 5.9.3 If a family's gross income exceeds the stated guidelines identified on the Screening Device for All Kids and DSCC and the family does not have medical bills over $2,000 per month or any type of private insurance coverage, ALWAYS ask the family
if they would like to file an All Kids Application. Never refuse to take or discourage a family from filing an All Kids Application.
- 5.9.4 If the child may be eligible for All Kids based upon the stated income guidelines identified on the Screening Device, but the family has chosen not to file an All Kids Application, explain to the family that they will not be able to receive EI
services and assistive technology devices subject to fees. NOTE: The All Kids program encompasses a population that extends beyond the scope of the annual gross income identified on the Screening Device For Determining Family Fees and
eligibility for All Kids & DSCC. Families whose income exceeds the annual gross income identified on the Screening Device may be eligible for All Kids Level 2 and above. Families who do not have insurance are strongly encouraged to complete the All
Kids Application. For this population only, failure to complete the application does not prevent those families from receiving all EI services that a child might be determined eligible to receive. Families who have All Kids Level 2 and above may be
assessed a family fee.
- 5.9.5 If referral to DSCC is indicated and a Consent for Release of Information form has been completed and signed by the parent/guardian, send a copy of the consent form, the completed Screening Device and copies of the following Cornerstone
screens/reports to your local DSCC office: Participant Enrollment Information (HSPR0770), Assessment History (HSPR0207) and Insurance (HSPR0794). NOTE: When completing the Consent form to make a referral to DSCC, under "Type of
Information, Other" write "DSCC Referral. File the completed Screening Device and Consent form in the child's CFC permanent record.
- 5.9.6 Explain to the family that they will not be able to receive EI services and assistive technology devices subject to fees if a referral to DSCC is indicated and the family refuses to participate in the referral.
- 5.9.7 Place a signed copy of the Screening Device for Determining Family Fees and Eligibility for All Kids and DSCC in the child's permanent case record and document in case notes whether or not an All Kids Application was completed and submitted for
eligibility determination if the family's gross income falls within the stated guidelines identified on the Screening Device.
- 5.10 Discuss the Family Fee determination process and the statewide requirements regarding the use of private insurance, if the family has private insurance and/or is in the income range requiring fees. NOTE: See Family Fee
Determination Section for process.
- 5.10 Obtain a parent signature on the Insurance Affidavit, Assignment and Release form and a copy of the front and back of the public or private insurance card.
- 5.11 If the family is eligible for an exemption from family participation fees or private insurance use, discuss the exemption process with the family.
- 5.11.1 Inform the family that proof of income and insurance will be required at the initial IFSP development meeting.
- 5.11.2 Provide the family with the Family Participation Fee Exemption Request and/or Insurance Exemption Request form(s).
- 5.11.3 Provide assistance to facilitate form completion as necessary. NOTE: It is very important to begin the insurance exemption request process as early in the Intake process as possible in order to prevent possible service delays.
- 5.11.4 Inform the family that the Insurance Exemption Request form can be completed prior to the initial IFSP to submit to the Central Billing Office for approval. If the family chooses to complete the Insurance Exemption Request process prior to the
IFSP meeting, the Service Coordinator will need to obtain proof of insurance at this time. NOTE: See Public and Private Insurance Use Determination Section, Forwarding Insurance Documentation Procedure.
- 5.11.5 Inform the family that a family fee exemption request form can be completed prior to the initial IFSP to submit to the Bureau of EI for approval. Because a family fee report cannot be generated from the Cornerstone system prior to the IFSP,
send family size and gross income in place of the Family Fee Report.
- 5.12 Provide a general overview of the IFSP process. NOTE: Refer to the Individualized Family Service Plan Section for process.
- 5.13 Complete intake/social history activities on your laptop in Cornerstone. NOTE: Refer to the Cornerstone Reference Manual, Section 18.2.2, Home Visit for information on the use of laptops for intake activities.
- If the family declines services during any part of the intake process:
- 6.1 Explain right to decline services.
- 6.2 Ensure that family understands consequences of refusal.
- 6.3 Explain complaint procedures.
- 6.4 Explain how to access future services.
- 6.5 Refer to community resources.
- 6.6 Obtain parent signature(s) on Informed Consent and Documentation of Receipt of Rights and Notice of Privacy Practices form.
- 6.7 Document the date and the reason for case discontinuation in Cornerstone Case Notes.
- 6.8 Complete case closure. NOTE: Refer to Transfers and Case Closure section.
- Send a follow-up letter to the referral source if the referral source or the CFC has obtained a signed consent from the family.
WHEN A SURROGATE PARENT IS NEEDED
- Foster parents and relative caregivers of children who are wards of the state may serve as educational surrogate parents for the children in their care.
- Child and Family Connections staff shall notify the local Department of Children and Family Services (DCFS) Educational Advisor's Office if a foster parent or relative caregiver of a DCFS ward needs assistance in making decisions regarding the
- Child and Family Connections staff shall request the appointment of an educational surrogate parent from the Illinois State Board of Education (ISBE) Surrogate Parent Program for all wards of the state placed in private residential facilities.
- If unable to identify or locate the parent, guardian, or relative of a child who is not a ward of the state, Child and Family Connections staff shall request the appointment of an educational surrogate parent from ISBE.
- Child and Family Connections staff shall monitor to assure that surrogate parent appointment is made by ISBE within ten days.
WHAT THE FOSTER/SURROGATE PARENT SIGNS
The Foster/Surrogate Parent, other than one for a child who is a ward of the state, signs everything that a parent would normally sign.
WHAT THE DCFS GUARDIAN SIGNS
Annually DHS obtains DCFS Guardian signature on all forms that must be co-signed by the DCFS Guardian. DHS then provides copies of these forms to CFCs for use with all DCFS wards. DCFS Guardian signed forms must be renewed annually in the child's