WAG 21-04-02-a: Referral Criteria and Process

PM 21-04-02-a

revised textScreening is a first step that identifies the possibility that an applicant or client has a domestic or sexual violence problem. Use Family Assessment - Treatment Screen (Form 4001C) to screen for a domestic or sexual violence problem.

If there are indications the person may have a problem, use the RD&C Referral (Form 2151C) to refer them. Update the Service Plan in VCM or enter Activity Code 715, Referral to Outside Entity, in Item 60.

The provider reports the client's progress through completion of Change Progress Report Form - Specialized Response (Mental Health, Substance Abuse, revised textDomestic/Sexual Violence) (Form 2151B).