Chapter 7 Assessment Screens

Table of Contents

1. 7.0 INTRODUCTION
2. 7.1 ASSESSMENT (AS01)
3. 7.2 WIC (AS02)
4. 7.3 EI Levels of Development (AS03)
5. 7.4 WISEWOMAN INFORMATION (AS04)
6. 7.5 FASD INTERVENTION (AS05)
7. 7.6 IBCCP HEALTH ASSESSMENT (AS06)
8. 7.7 HEALTHY FAMILIES ILLINOIS ELIGIBILITY TOOL (AS07)

7.0 INTRODUCTION

The assessments in the Cornerstone system assist the clinic staff in developing a custom care plan which addresses the individual and specific needs of the participant. The purpose of the assessment is to identify the strengths, weaknesses or problems, risk factors or barriers to the participant's attainment of a specific goal or a set of goals. Numerous assessment types are available.

The Cornerstone system allows for multiple assessments of the same type to be given over time, as appropriate. The participant assessment responses will be kept historically in order to facilitate case tracking and Family Case Management Program (FCM) care plan development.

WIC Program - WIC utilizes the Cornerstone system's standard assessment format and also uses a WIC-specific assessment screen for risk factors, certification/termination date, priority, and assignment of food packages. The assessment process through the Cornerstone system will generate suggested risk factors based on responses given to the assessment questions. Additionally, certain WIC risk factors will automatically be suggested by the Cornerstone system based on data entered on health screens. Specific policies and protocols as outlined in the WIC Policy and Procedure Manual and the Nutrition Assessment Manual provide the basis for the assessment process and remain applicable. In the clinic setting, it is anticipated that some activities of the Certifying Health Professional (CHP) in assessing the client for WIC (e.g., growth chart, diet assessment, etc.) may have occurred prior to data entry on the WIC assessment screens.

7.1 ASSESSMENT (AS01)

Overview

• Assessment (AS01) is used to record/assess the needs of all participants for additional services by completing designated assessment types or to inquire on previously completed assessments.
• The assessment process assists the health professional in developing an individual care plan that addresses the participant and their specific needs. The purpose of the assessments is to identify the strengths, weaknesses, problems, risk factors, or barriers to the participants attainment of a specific goal or set of goals.
• The Cornerstone system allows for multiple assessments of the same type to be given over time. The participant assessment responses will be kept historically in order to facilitate care plan development and case tracking.

Details

The Assessment (AS01) screen is a feature of the Cornerstone system that is available for use in all program areas.

Previous assessment information can be reviewed by entering the date the assessment was completed and the type of assessment. Because the number of questions varies by assessment type, more than one page is needed to display all of the questions.

The user has the ability to enter a comment in a pop-up window that is available for each assessment question. Comments can be added whether or not the question has been answered. To view a comment for an existing assessment, the user must place the cursor in the comment field and type a C or X. The Assessment Comments pop-up window will be displayed.

NOTE: Information from some of the fields on the medical screens will carry forward to the fields in some assessments [i.e. into the General Assessment (700)]. Therefore, the medical screens should be completed before the assessments are done.

NOTE: There are three new risk screening assessments to be used by FCM Restructure Pilots only:

• 711 - Prenatal Risk Screening
• 712 - Infant Risk Screening
• 713 - Child Risk Screening
• At the end of each assessment, the participant's screening status will be evaluated depending on the answers to the questions that are marked with an asterisk (*).
• The preferred answer to all questions marked with an asterisk (*) is no (N), except for the question, "Do you have enough food to eat".
• Answering against the preferred to any of the questions marked with an asterisk (*) will automatically set the participant's screening value to 'AT RISK'.
• At the end of the assessment is a question for the Case Manager (CM) to either agree or disagree.
• A response to this question is required before the assessment will save.
• If the CM agrees to the assessment and enters a 'Y', then the assessment can be saved.
• If the CM does not agree to the assessment and enters an 'N', the Employee ID (User currently logged into Cornerstone) and the current date will auto fill. Both of these fields are editable until questions that have an asterisk have been answered and saved.

WIC NOTE: Only the questions pertaining to the clients risk factors need to be answered on the Assessment (AS01) screen.

Step by Step Instructions

Verify the information in the Participant Standard Processing Block (PSPB) as that of the participant currently being processed. (Please refer to Chapter 2 System Environment under 2.6.1.1 Participant Standard Processing Block (PSPB)/Participant Browse for more information about the PSPB.)

Press Ctrl+F1 to activate the Assessment window.

In the Assess Type, field type in the correct code or use F1 Help to choose the appropriate assessment type. (Please refer to Chapter 2 System Environment under 2.5.2.1 Function Keys for more information about F1 Help.)

1. Press Enter to go to the Assess Date field. A message "Loading Assessment results. Please be patient." will be displayed. The Cornerstone system automatically searches for an existing assessment of that type.
   • If an assessment or assessments of this type have been done, the most recent assessment will be displayed and the Assess Nbr __ of __ field will be filled in automatically by the Cornerstone system.
2. In the Assess Date field:
   • If a prior assessment of this type exists, it will be displayed with a date previous to todays date. To add a new assessment, type the current date over the existing date. A message Assessment Date not found will be displayed.
   • If no prior assessment of this type exists, type in the current date. A message Assessment Date not found will be displayed.
   • If the date of a prior assessment is unknown and the assessment needs to be viewed or edited, press F1 in the "Assess Date field. The dates of the previous assessments will be listed. If the assessment was marked as confidential, Confidential will be displayed by the date. Use the down arrow key to highlight the appropriate date and press Enter to select that date. The assessment from the selected date will be displayed. All previous assessments may be viewed, but only the most recent assessment may be edited.
3. Press F5 to add an assessment OR press F6 to edit the most recent existing assessment.
   • If adding, the assessment questions will automatically be displayed on the screen and can be answered. The cursor will move to the Assessor field. Type in the appropriate Cornerstone employee ID number OR use F1 Help to display a list of employees. Press Enter to move to the first question.
   • If editing, the assessment questions with their answers will automatically be displayed on the screen, but only the unanswered questions can be answered. Questions that have previously been answered cannot be changed. The cursor will move to the first open field (question or comment field).

To answer questions:

1. For "yes or no" questions: Type Y for yes, "N" for no, or "U" for unknown.
   • It is not necessary to answer N for no if the condition does not apply to the participant.

For other questions: Type the appropriate information (number, date, etc.).

2. Press Enter once to enter a comment (see below) or twice to go to the next question without entering a comment.

To enter a comment:

3. Press Enter to move to the small box to the right of the answer field and type the letter "C. The Assessment Comments pop-up window will be displayed and the cursor will move to it automatically.
4. Type in the comment.
5. Press Tab to highlight Save and then press Enter to save the comment and go to the next question.

NOTE: When the bottom of the screen is reached, press Enter to go to the next screen.

6. Upon completing the assessment, press F4 to save the assessment. A message "Record added" will be displayed in the top right corner of the screen.
7. The Assessment Confidential pop-up box will be displayed. Type Y for yes or "N" for no to indicate whether this assessment should be marked confidential. A message "Saving assessment results. Please be patient." will be displayed in the top right corner of the screen.
   • If the assessment is marked Y for confidential, only the participants assigned case manager and the case manager's supervisor have access to the answers recorded.
   • In most cases, assessments should not be marked confidential. Information that is extraordinarily sensitive should not be entered into the Cornerstone system.
8. To make changes to assessments:
   • If an omission was made, press F6 to edit the assessment and answer Y for yes or N for no to the question(s) that was omitted.
   • If a question was answered "Y" for yes in error, it is not possible to change the answer to N for no, but a comment can be added explaining the error. Press F6 to edit, and then press Pg Dn to get to the question that was incorrectly answered. Press Tab to the Comment field, type "C, and enter a comment to indicate that the question was incorrectly answered.
   • After editing the assessment, press F4 to save the assessment. A message Record edited will be displayed in the top right corner of the screen.
9. The available fast path keys are F9 to the Planned Services/Care Plan (CM03) screen and F10 to the Case Notes (CM04) screen.

Screen Layout #1

Screen Layout #2

Field Definitions

Field Name	Length	Field Type	Definition
Assess Type	4/30	Code/Assigned	Code and specific name for the type of assessment completed.
Assess Nbr	2/2	Assigned	If an assessment or assessments of this type have been done previously, the most recent assessment will be displayed and the Assess Nbr __ of __ field will be filled in automatically by the Cornerstone system. The last blank is filled in with the total number of this type of assessments entered. The first blank indicates the sequence number of the displayed assessment.
Assess Date	8	Date	Date the assessment is completed.
Assessor	9	Numeric	The ID in this field should be the ID of the staff person who actually assessed the client.
Assessment Response	Varies/1	Alpha/Numeric & Alpha	The participants response to a question (i.e. Y for yes, "N for no, dates, number of children, etc.) followed by a field that, when filled in with a "C, puts the cursor in the Comments field.
Comments	65	Alpha/Numeric	Space to enter comments regarding answers to questions.

7.2 WIC (AS02)

Overview

• Used to complete the certification process for a WIC participant by assigning risk factors, establishing the certification and scheduled termination dates, and the WIC priority.
• Used to edit food packages (prescribed on this screen) for an active WIC participant.

Note: Current and future month food packages must be active.

It is IMPERATIVE food packages are verified before food instruments are printed.

• Used to view food instrument (FI) information, such as certification date and scheduled termination date.
• Risk factors are generated based on health data entered on medical screens and responses to questions in the WIC-specific assessments on the Assessment (AS01) screen. If the health data is not found, an error message will be displayed to inform the user that the required information must be completed before continuing with this screen.

Step by Step Instructions

NOTE: An error message will be displayed upon entering this screen if: 1) the participant category is pregnant (P) and the initial prenatal record has a visit date more than 10 months in the past, 2) the participant category is postpartum (N) and the postpartum record has an actual delivery date more than 6 months in the past, or 3) the participant category is breastfeeding (B) and the postpartum record has an actual delivery date of more than 12 months in the past.

To Complete the Certification Process for WIC Participant in WIC Certification Flow

1. Verify the information in the PSPB as that of the participant currently being processed. (Please refer to Chapter 2 System Environment under 2.6.1.1 Participant Standard Processing Block (PSPB)/Participant Browse for more information about the PSPB.)
2. Upon entering this screen from the WIC certification flow, the message "Do you wish to generate risk factors?" will be displayed. Type Y for yes. Risk factors generated from data entered on medical screens will be added to the list of risk factors generated from answers to the WIC-specific assessment questions on the Assessment screen (AS01).

NOTE: If the certification process has not been completed (for example, if demographic, prenatal or health visit information is not complete or fields on these screens that are required to be completed for a certification have not been completed), an error message is displayed. Risk assessment processing cannot continue if an error message is displayed.

3. The question Are you done editing risk factors? will be displayed. Type N for no, to review the list of risk factors for accuracy. Use Pg Up and Pg Dn to view any risk factors not visible on the screen.
   • To add a risk factor, press F5 to add and then F1 to list risk factor codes. It is not possible to add a risk factor if it is not appropriate (e.g., A010, low hemoglobin, may not be added if the hemoglobin value on the Adult Health Visits (PA08) screen or the Infant/Child Health Visit (PA09) screen is not below normal limits).
   • To delete a risk factor, use the up and down arrow keys to highlight the risk factor and press F7.

When the review of risk factors and adding or deleting of risk factors is completed, press Ctrl+F1 to go to the middle window. The message Are you done editing risk factors?" will be displayed. Type Y for yes or N for no, as appropriate.

• Risk factors that have been saved may not be edited or changed for the duration of the certification period.

When the user is finished editing the risk factors, the cursor will move to the CHP field. Enter the Cornerstone ID number of the Certifying Health Professional who determined the risk factors and prescribed the food packages.

The cursor will move to the "Food Pkg" columns. Enter the appropriate food packages for the certification period. (Information on food packages is found in the WIC Policy and Procedure Manual, Section 5.)

NOTE: If a medically prescribed food package (i.e., non-contract or medically prescribed food package numbered 700-899) is assigned to the participant, the user must complete the WIC Medically Prescribed Formula (FI08) screen. However, food packages for children receiving contract formula (825-830) will not require completion of the WIC Medically Prescribed Formula (FI08) screen.

Press F4 to save the screen. A message "Record added" will be displayed in the top right corner of the screen. The participant will now have a status of A (active) in the WIC program. The Certification Date, "Scheduled Term Date, Priority, Category, Education Scheduled/Attended, and Base Date fields will be determined by the Cornerstone system.

NOTE: An error message is displayed when F4 is pressed to save this screen and the Proof on File field on the Program Information (PA15) screen is still 14 (pending verification).

The available fast path keys are F9 to the Schedule Appointment (SC02) screen and F10 to the WIC Medically Prescribed Formula (FI08) screen.

To Edit Food Packages for an Active WIC participant

1. Verify the information in the Participant Standard Processing Block (PSPB) as that of the participant currently being processed. (Please refer to Chapter 2 System Environment under 2.6.1.1 Participant Standard Processing Block (PSPB)/Participant Browse for more information about the PSPB.)
2. Press Ctrl+F1 to activate the WIC window.
3. Press F6 to edit.
4. The cursor will be in the "Food Pkg" columns. Enter the appropriate food packages for the certification period. (Information on food packages is found in the WIC Policy and Procedure Manual, Section 5.)
5. Press F4 to save the screen. A message "Record edited" will be displayed in the top right corner of the screen.
6. The available fast path key is F9 to the Schedule Appointment (SC02) screen.

Screen Layout

Field Definitions

Field Name	Length	Field Type	Definition
CHP	9	Assigned	Cornerstone ID of the Certifying Health Professional.
Certification Date	8	Assigned	System generated date when WIC certification begins. When not system generated (i.e. out-of-state transfers), this date is entered by the user.
Scheduled Term Date	8	Assigned	System generated date when certification period ends. When not system generated (i.e. out-of-state transfers), this date is entered by the user.
Priority	1	Assigned	The WIC priority.
Category	15	Assigned	The participants WIC category.
Education Scheduled	3	Assigned	Count of education contacts scheduled during this certification period.
Attended	3	Assigned	Count of education contacts attended during the certification period.
Base Date	8	Assigned	A date used to set a WIC participants FI pick-up cycle. Base date is the same as the first day to use on a WIC FI or food coupon.
Use Month	2	Assigned	Month of food package prescription.
Food Pkg	3	Code	WIC food package number.
Risk Factors	4/24	Code/Assigned	A unique code for nutritional risks identified during the nutrition assessment and used to determine WIC program eligibility and priority. A short description for each code is also given.

7.3 EI Levels of Development (AS03)

Overview

The EI Levels of Development (AS03) screen was created to allow users to enter all of their participants levels of development on one screen.

Details

Because of the creation of the EI Levels of Development (AS03) screen, users will no longer be able to add an EILD for the child on the Participant Forms (CM10) screen and the Assessment (AS01) screen. On the Participant Forms (CM10) screen, users will only be able to review existing EILD records and edit them.

Existing AS03 records can be edited by pressing F6 to edit. When adding Annual or Exit AS03 records, Cornerstone will ensure the entry of both the Rating and Progression Description on questions 8 - 10. If a Rating has been entered previously on part A of questions 8, 9 or 10, an answer will be required for part B, indicating the Progression Question with a Y for yes and an N for no.

Step by step instructions

The AS03 screen may be edited and saved many times before it is completely filled out.

1. Verify the information in the PSPB as that of the participant currently being processed. (Please refer to Chapter 2 System Environment under 2.6.1.1 Participant Standard Processing Block (PSPB)/Participant Browse for more information about the PSPB.)
2. Press F5 to add a new AS03 for a participant.
3. Enter the date of the Assessment.
4. Under tab Questions 1 & 2, answer questions 1 and 2 as appropriate.
5. Under tab Questions 3 - 5, enter the Percent Delay and the Age Equivalent in Months. Text information may be entered in the appropriate text box.
6. Under tab Questions 6 & 7, enter the Percent Delay and the Age Equivalent in Months. Text information may be entered in the appropriate text box.
7. Under tab Question 8, answer questions 8A and 8B as appropriate.
8. Under tab Question 9, answer questions 9A and 9B as appropriate.
9. Under tab Question 10, answer questions 10A and 10B as appropriate.
10. Under tab Sources, use the drop down boxes to enter the Source(s) and Assessment Instrument(s) for the assessment and then enter the Date.
11. Press F4 to save.

Screen Layout

Questions 1 & 2:

Questions 3 - 5:

Questions 6 & 7:

Question 8:

Question 9:

Question 10:

Sources:

Field Definitions

Field Name	Length	Field Type	Definition
Participant ID	14	Character	Participants Cornerstone ID number.
Current Last Name	15	Character	Participants current last name.
Current First Name	13	Character	Participants current first name.
Second Last Name	15	Character	Participants second last name.
Birth Date	8	Date/Time	Participants date of birth.
Assessment Date	8	Date/Time	Date the assessment was performed.
Question 1	Unlimited	Text	Used to gather details on familys strengths, resources, priorities and concerns.
Question 2	Unlimited	Text	Used to gather details on childs overall health and medical information.
Question 3 - Adaptive Development	Unlimited	Text	Used to gather details on childs adaptive development.
Percent (%) Delay	3	Numeric	Percentage of childs delay compared to their age equivalent peers and/or age equivalent (months).
Age Eq	2	Numeric	The childs age, in months, based on their percent delay.
Question 4 - Cognitive Development	Unlimited	Text	Used to gather details on childs cognitive development.
Percent (%) Delay	3	Numeric	Percentage of childs delay compared to their age equivalent peers and/or age equivalent (months).
Age Eq	2	Numeric	The childs age, in months, based on their percent delay.
Question 5 - Communication Development (Total)	Unlimited	Text	Used to gather details on childs communication development, both expressive and receptive.
Percent (%) Delay	3	Numeric	Percentage of childs delay compared to their age equivalent peers and/or age equivalent (months).
Age Eq	2	Numeric	The childs age, in months, based on their percent delay.
Question 6	Unlimited	Text	Used to gather details regarding childs total motor development, both fine and gross.
Question 7	Unlimited	Text	Used to gather details on the childs social/emotional development.
Question 8	Unlimited	Text	Rate childs positive socio-emotional skills, on a scale from 1 to 7.
Question 9	Unlimited	Text	Rate childs acquiring and using knowledge and skills, on a scale from 1 to 7.
Question 10	Unlimited	Text	Rate childs ability to take action to meet their needs, on a scale from 1 to 7.
Sources	Unlimited	Text	Select from the drop-down menus the sources of information and the assessment instrument, if applicable.

7.4 WISEWOMAN INFORMATION (AS04)

Overview

• The WISEWOMAN Information (AS04) is used to record information for a WISEWOMAN Program participant.
• There are 6 tabs on this screen, IWP Screening, Health History, Healthy Lifestyle, Intervention Info, Follow-up Phase, and Intervention Summary.
• The Intervention Info tab, the Follow-up Phase tab, and the Intervention Summary tab are different from the other 3 tabs. To access them, click on the tab and then select F5 Add and the tab will turn from grey to black.

Details

Participant needs an active PA15 BCCP and WW record prior to adding AS04.

Visit/Anthropometric Date cannot be before 07/01/2008.

Visit/Anthropometric Date is required before information can be entered in Anthropometric section.

WWIS is required before WWRS record can be added.

WWRS date cannot be less than 10 month after WWIS date.

The AS04 can be edited and saved many times before it is completely filled out.

Step by Step Instructions

1. Verify that the information in the Participant Standard Processing Block (PSPB) belongs to the participant currently being processed. (Please refer to Chapter 2 System Environment under 2.6.1.1 Participant Standard Processing Block (PSPB)/Participant Browse for more information about PSPB.)
2. Press Ctrl+F1 to activate the WISEWOMAN Information (AS04) window, if necessary.
3. The screen will display the most recent WISEWOMAN Information record for the participant. Use the up and down arrow keys and/or Pg Up and Pg Dn to scroll through previous WISEWOMAN Information records.
   • To add a WISEWOMAN Information record, press F5. Go to step 4.
   • To edit a WISEWOMAN Information record, press F6. Go to step 4.
   • To delete a WISEWOMAN Information record, press F7. The WARNING: DELETING THIS SCREEN WILL DELETE ALL OF THE FOLLOWING INFORMATION - the Anthropometric information, the Health History information, the Healthy Lifestyle information, the WISEWOMAN Intervention information and the WISEWOMAN Follow-up information. pop-up window will be displayed. Select Yes to delete the record, or No to cancel.
4. In the "Visit/Anthropometric Date" field, type in the correct date of service.
5. The cursor will go to the "Service Type" field. Type in the correct service code or press F1 Help. (Please refer to Chapter 2 System Environment under 2.5.2.1 Function Keys for more information about F1 Help.)
6. In the "B & C IOV? (Y/N)" field, type in "Y" for yes or "N" for no.

NOTE: Use the mouse to select the IWP Screening tab, the Health History tab, or the Healthy Lifestyle tab.

IWP Screening Tab:

1. Press Enter to go to the "Next Screening Date" field. The date will automatically fill-in.
2. Press Enter to go to the "Referred for DX Office Visit" field and type in "Y" for yes or "N" for no.
   • If the user types in "Y" for yes, the cursor will go to the "DX Office Visit Date" field. Go to step 3.
   • If the user types in "N" for no, the "DX Office Visit Date" field will be disabled. Go to step 4.
3. In the "DX Office Visit Date" field, type in the correct office visit date.
4. The cursor will go to the "Height (FT)" field. Type in the participant's height measurement in feet.
5. In the "Height (IN)" field, type in the participant's additional height measurements in inches.
6. Press Enter to go to the "If no Height Enter Code" field and type in the correct code. This step is only required if the "Height" fields are not completed.
7. In the "Weight (lbs)" field, type in the participant's weight measurements in pounds.
8. The "BMI" field is not editable. The Cornerstone system automatically calculates the participant's BMI measurement.
9. The cursor will go to the "1st BP (mmHg)" fields. Type in the participants first blood pressure reading.
10. Press Enter to go to the "2nd BP (mmHg)" fields. Type in the participants second blood pressure reading.
11. Press Enter to go to the "Screening Questions." Type in the answer to each question under the "Response" field or press F1 Help.
12. Press F4 to save the screen or use the mouse to select another tab.
    • If the screen is saved, the message "Record added" OR Record edited will be displayed in the top right corner of the screen.

Health History Tab:

1. Press Enter to go to the "Health History Questions." Type in the answer to each question under the "Response" field or press F1 Help.
2. Press F4 to save the screen or use the mouse to select another tab.
   • If the screen is saved, the message "Record added" OR Record edited will be displayed in the top right corner of the screen.

Healthy Lifestyle Tab:

1. Press Enter to go to the "HLA Questions." Type in the answer to each question under the "Response" field or press F1 Help.
2. Press F4 to save the screen or use the mouse to select another tab.
   • If the screen is saved, the message "Record added" OR Record edited will be displayed in the top right corner of the screen.

NOTE: The Intervention Info tab, the Follow-up Phase tab, and the Intervention Summary tab cannot be accessed until the current WISEWOMAN Information record has been saved. Press F4 to save the current record.

Intervention Info Tab:

1. The screen will display the most recent WISEWOMAN Intervention Info record for the participant. Use the up and down arrow keys and/or Pg Up and Pg Dn to scroll through previous WISEWOMAN Intervention Info records.
   • To add a WISEWOMAN Intervention Info record, press F5. Go to step 2.
   • To edit a WISEWOMAN Intervention Info record, press F6. Go to step 4.
   • To delete a WISEWOMAN Intervention Info record, press F7. The Are you sure you want to delete this WISEWOMAN Intervention record? pop-up window will be displayed. Select Yes to delete the record, or No to cancel.
2. In the "Date" field, type in the correct date.
3. The cursor will go to the "Intensity" field. Type in the correct intensity code or press F1 Help.
4. Press Enter to go to the "Intervention Questions." Type in the answer to each question under the "Response" field or press F1 Help.
5. Press F4 to save the screen. A message "Record added" OR Record edited will be displayed in the top right corner of the screen.

Follow-up Phase Tab:

1. The screen will display the most recent WISEWOMAN Follow-up Phase record for the participant. Use the up and down arrow keys and/or Pg Up and Pg Dn to scroll through previous WISEWOMAN Follow-up Phase records.
   • To add a WISEWOMAN Follow-up Phase record, press F5. Go to step 2.
   • To edit a WISEWOMAN Follow-up Phase record, press F6. Go to step 4.
   • To delete a WISEWOMAN Follow-up Phase record, press F7. The Are you sure you want to delete this WISEWOMAN Follow-up Phase? pop-up window will be displayed. Select Yes to delete the record, or No to cancel.

2. In the "Participant Received" field, type in the correct code or press F1 Help.
3. In the "Date" field, type in the correct date.
4. In the "Comments" field, type in any applicable comments.
5. Press F4 to save the screen. A message "Record added" OR Record edited will be displayed in the top right corner of the screen.

Intervention Summary Tab: This tab is for inquiry of the Intervention Info Tab.

Screen Layout

IWP Screening:

Health History:

Healthy Lifestyle:

Intervention Info:

Follow-up Phase:

Intervention Summary:

IWP Screening Tab

Field Name	Length	Field Type	Definition
Visit/Anthropometric Date	8	Date	The date of the service visit.
Service Type	4	Code	A code that indicates the type of service provided to the participant.
B & C IOV? (Y/N)	1	Choice	Yes/No field for indicating if the client has received both IWP services and IBCCP services.
Next Screening Date	8	Date	The date of the next screening.
Referred for DX Office Visit	1	Choice	Yes/No field for indicating if the participant is referred for a doctor's office visit.
DX Office Visit Date	8	Date	The date of the referred doctor's office visit.
Height (FT/IN)	1/2	Numeric	The participant's height measurement in feet/inches.
If no Height Enter Code	3	Code	A code that indicates that there are no height measurements entered.
Weight (lbs)	3	Numeric	The participant's weight measurement in pounds.
BMI	N/A	Assigned	Body Mass Index is a figure that closely correlates with body fat and is an indicator of health and nutritional status. The BMI is calculated when data is entered in the height and weight fields.
1st BP (mmHG)	3/3	Numeric	The participant's first Systolic/Diastolic blood pressure numbers.
2nd BP (mmHG)	3/3	Numeric	The participant's second Systolic/Diastolic blood pressure numbers.
Screening Questions	Unlimited	Alpha/Numeric	A series of questions pertaining to the IWP Screening.

Health Histyory Tab

Field Name	Length	Field Type	Definition
Health History Questions	Unlimited	Alpha/Numeric	A series of questions pertaining to Health History.

Healthy Lifestyle Tab

Field Name	Length	Field Type	Definition
HLA Questions	Unlimited	Alpha/Numeric	A series of questions pertaining to Healthy Lifestyle.

Intervention Info Tab

Field Name	Length	Field Type	Definition
Date	8	Date	The date of the Intervention Info entry.
Intensity	2	Code	A code that indicates the level of intervention intensity.
Intervention Questions	Unlimited	Alpha/Numeric	A series of questions pertaining to the Intervention Info.

Follow-Up Phase Tab

Field Name	Length	Field Type	Definition
Participant Received	2	Code	A code that indicates how a participant is received for a follow-up phase.
Date	8	Date	The date the participant is received for a follow-up phase.
Comments	Unlimited	Alpha/Numeric	A section intended for comments that are relevant to the Follow-Up Phase.

Interventiion Summary: This tab is for Inquiry only

7.5 FASD INTERVENTION (AS05)

Overview

• FASD stands for Fetal Alcohol Spectrum Disorder and pertains to women that screened positive for alcohol use during the Brief Intervention Session.
• The participant must be actively enrolled in WIC and have a Category code of Pregnant, Breastfeeding or Postpartum on the Program Information (PA15) screen.

Details

• The clinic must be a FASD clinic as designated by the WIC Program.
• The EDC Date entered must match the EDC Date on the Initial Prenatal (PA07) screen.
• The answers in the Drink Days/Week and Drinks/Day fields must be greater than 0 on the Initial Prenatal (PA07) screen, the Adult Health Visit (PA08) screen and/or the Postpartum Data (PA10) screen in order to add a FASD Intervention (AS05) record.
• There are 4 tabs on this screen: Process Information, Follow Up Visit Questions, Follow Up with Referral to Stop Drinking and Follow Up After Childs Birth.
• The AS05 can be edited and saved many times before it is completely filled out.

Step by step instructions

1. Verify the information in the PSPB as that of the participant currently being processed. (Please refer to Chapter 2 System Environment under 2.6.1.1 Participant Standard Processing Block (PSPB)/Participant Browse for more information about the PSPB.)
2. Press F5 to Add a new record.
3. In the Estimated Date of Confinement field, enter the participants EDC Date or select it from the drop down box.
4. Press Enter. Enter the date of the service in the Date of Service field.
5. Under the Process Information tab, answer the appropriate questions by entering data in the Response field or by selecting the answer from the drop down menu in the Response field.
6. Enter any other comments in the Additional Comments field.
7. Under the Follow Up Visit Questions tab, enter the date of the follow up appointment in the Follow Up Date field.
8. Answer the four questions by entering data in the boxes or by selecting the answer from a drop down menu.
9. Under the Follow Up with Ref to Stop Drinking tab, enter the follow up appointment date in the Follow Up Date field.
10. Answer the questions by entering data in the boxes or by selecting the answer from a drop down menu.
11. Enter any comments in the Additional Comments field.
12. Under the Follow Up After Childs Birth tab, enter the follow up appointment date in the Follow Up Date field.
13. Answer the question by selecting an answer from the drop down menu.

Screen Layout 1

Screen Layout 2

Screen Layout 3

Screen Layout 4

Field Definitions

Field Name	Length	Field Type	Definition
Estimated Date of Confinement	8	Date	Participants EDC Date as entered on the PA07 - Initial Prenatal Data screen.
Service Date	8	Date	Will default to the current date but can be changed.
Process Question	Unlimited	Text	Questions to ask participant.
Response	Unlimited	Text	Enter participants answer to Process Question either by selecting from Drop Down Menu, if available, or by entering information in box.
Additional Comments	Unlimited	Text	Enter any additional comments as necessary.
Follow Up Date	8	Date	Date of Follow Up Visit.

7.6 IBCCP HEALTH ASSESSMENT (AS06)

Overview

• Used to record/assess the needs of all participants for additional services by completing designated assessment types or to inquire on previously completed assessments.
• There are three tabs Breast Health, Cervical Health and Tobacco.

Details

• Assessment Type and Date are required
• Cannot have more than one assessment of the same type & date.
• Assessment Date cannot be before the initial contact date on PA15-Program Information Screen and cannot be in the future.
• Client must be active in BCCP on PA15-Program Information.
• BCCP Assessment type is an Initial Assessment and therefore only one is allowed per participant.
• BCCP Assessment type cannot be added on a transferred client.
• BCCA Assessment type is only allowed if a BCCP Assessment type exist or the client is a transfer.

NOTE: If no BCCP assessment exists and the PA30-Breast and Cervical Cancer Data record has an actual service date prior to 1/1/08, then a BCCP Assessment cannot be added. Only a BCCA Assessment can be added.

Step by step instructions

1. Verify the information in the PSPB as that of the participant currently being processed. (Please refer to Chapter 2 System Environment under 2.6.1.1 Participant Standard Processing Block (PSPB)/Participant Browse for more information about the PSPB.)
2. Press Ctrl+F1 to activate the Assessment window
3. At the Assessment Date field: :
   • If a prior BCCP (Initial) assessment exists, it will be displayed with a date previous to todays date. To edit assessment Press F6 and edit answers as needed. To add a new assessment, only type BCCA (Annual) assessment can be added. (Go to Step #4).
   • If no prior assessment exists, go to step 4 using either BCCP or BCCA assessment following the guidelines as indicated in Details listed above.
4. To add a new assessment, Press F5 to Add a new record.
5. In the Assessment Date enter the date the assessment was performed. Press Enter.
6. Enter the type of service in the Assessment Type field. Press Enter.
7. Under the Breast Health tab,
   • Answer the appropriate questions by entering Y-yes, N-no or U-unknown in the Response field.
   • Some questions require specifics-answer by entering L-left, R-right or B-both, or by selecting from the F1-drop down menu in the Response field.
   • Questions which require text data (name): Select the button i.e. ˜EXPLAIN, RELATIVE or PROVIDER in the Response field - add data and/or name.

Note: RELATIVE/PROVIDER Field is limited to 50 Characters.

• The third column is a display only field, it auto-fills based on responses to specific questions. This field is not editable, with the exception of being able to edit a ˜response answer.

8. Under the Cervical Health tab:

9. Under the Tobacco tab:

10. Upon completing the assessment, press F4 to save the assessment. A message "Record added" will be displayed in the top right corner of the screen.

Screen Layout 1

Screen Layout 2

Screen Layout 3

Field Definitions

Field Name	Length	Field Type	Definition
Assessment Date	8	Date	Date the assessment was completed.
Assessment Type	4	Text	Code and specific name for the type of assessment completed.
Assessment Response	Varies	Numeric & Alpha	The response to a question (i.e. "Y for yes, "N for no, U for unknown. L Left, R Right, B Both. If Date response use format mm/dd/yyyy. Provider-text allowed up to 50 characters. Relative-text allowed up to 50 characters.
Explain-Limited text available.
Comments	None	Display	This is a display only field. Results are based on answers to certain assessment questions.

7.7 HEALTHY FAMILIES ILLINOIS ELIGIBILITY TOOL (AS07)

Overview

• The assessment screen is utilized by HFI providers to conduct an abbreviated assessment of new and expectant parents risk for child abuse and/or neglect.
• Any participant can have an AS07 record. No program record is required for the use of this screen.
• Multiple AS07 records are allowed per participant.
• Only one AS07 record is allowed per referral date. The referral date cannot be a future date and cannot be more than 1 year in the past.
• On the Agency Information tab, the Date Screening Completed date must be entered. This date cannot be a future date and cannot be before the referral date.
• On the Agency Information tab the Date Screening Completed date is a required field. On the Participant Information tab, the Mothers Status is a required field. On the Results tab, the Eligibility Status is a required field.
• On the Results tab the button ˜Press to score tool will determine the eligibility status. The determination is as follows: if any question on the Primary Indicators Tab is answered ˜T or if more than one question on the Secondary Indicators Tab is answered ˜T, the eligibility status will be eligible otherwise the eligibility status will be not eligible. The Eligibility Status will now contain an E for eligible or an N for not eligible.
• The AS07 may be edited but these records cannot be deleted.

Step by step instructions

1. Verify the information in the PSPB as that of the participant currently being processed. (Please refer to Chapter 2 System Environment under 2.6.1.1 Participant Standard Processing Block (PSPB)/Participant Browse for more information about the PSPB.)
2. Press F5 to a new record.
3. Under the Agency Information tab, In the Referral Date field, enter the participants date of referral.
4. Press Enter. Enter the date of the name of Agency referring family.
5. Press Enter. Enter the contact person last name.
6. Press Enter. Enter the contact person first name.
7. Press Enter. Enter the contact phone number.
8. Press Enter. Enter the contact email.
9. Press Enter. Enter the date screening completed.
10. Screen Completed by is a read-only field that will display the person who added or edited the AS07 screen.
11. Under the Participant Information tab, answer the appropriate questions by entering data in the Language used at Home field or by selecting the answer from the drop down menu in this field.
12. Press Enter. Enter the Parenting Status (e.g. target childs birth number) or by selecting the answer from the drop down menu in this field.
13. Press Enter. Enter the Mothers Status or by selecting the answer from the drop down menu in this field. Depending on this answer will determine availability of next set of fields.
14. If Mothers Status is Pregnant, enter the EDC date and the OB/Gyn Info fields.
15. If Mothers Status is Delivered, enter the Childs Participant ID field and following fields will automatically populate: Childs Last Name, Childs First Name, Date of Birth and Sex.
16. Under the Primary Indicators tab, answer the appropriate questions by entering data in the Response field or by selecting the answer from the drop down menu in the Response field. Add Comments as necessary.
17. Under the Secondary Indicators tab, answer the appropriate questions by entering data in the Response field or by selecting the answer from the drop down menu in the Response field. Add Comments as necessary.
18. Under the Results tab, select the button that says: Press to score tool to automatically get results for the Eligibility Status or you may enter data in the Eligibility Status or select the answer from the drop down menu. Depending on this answer will determine availability of next set of fields.
19. If Eligibility Status is Eligible (Positive Screen), enter the data in the Follow-up field. If option 3 - Declined, Other (specify), for Follow-up field is selected, Enter the Declined Reason field. Any other options for Follow-up do not require the declined reason field.
20. If Eligibility Status is Not Eligible (Negative Screen), no other fields are required.
21. Enter any comments in the Additional Comments field.

Screen Layout 1

Screen Layout 2

Screen Layout 3

Screen Layout 4

Screen Layout 5

Field Definitions

Field Name	Length	Field Type	Definition
Referral Date	8	Date	Date of when client was referred.
Name of Agency Referring Family	30	Character	Agency name that referred the family.
Contact Person Last Name	15	Character	Last name of person to contact.
Contact Person First Name	13	Character	First name of person to contact.
Contact Phone Number	10	Numeric	Phone number of person to contact.
Contact Email	50	Character	Email address of person to contact.
Date Screening Completed	9	Numeric	This field must be entered. Date cannot be a future date and cannot be before the referral date.
Screen Completed by	9	Numeric	A read-only field that will display the person who added or edited the AS07 screen.
Language used at Home	4	Character	Dropdown list of languages to choose from.
Parenting Status	4	Character	Dropdown list for (target childs birth number).
Mothers Status	4	Character	Dropdown list of mothers status (pregnant or delivered).
EDC	8	Date	EDC can only be entered if the mothers status is P for pregnant.
OB/Gyn Info	30	Character	Can only be entered if the mothers status is P for pregnant.
Childs Participant ID	14	Character	Can only be entered if the mothers status is D for delivered. Must be a valid participant ID of a child who is from age 0-6 months old.
Childs Last Name	15	Character	Read only field that will display the childs information using the childs participant id entered.
Childs First Name	13	Character	Read only field that will display the childs information using the childs participant id entered.
Date of Birth	8	Date	Read only field that will display the childs information using the childs participant id entered.
Sex	4	Character	Read only field that will display the childs information using the childs participant id entered.
Mothers Participant ID	14	Character	Read only field. If the selected participant which the AS07 record is being added to is a Father, the childs participant ID is used to read the group cross reference file for a mothers participant ID. If it is found, the mothers participant id will display here.
Primary/Secondary Indicator tabs	1	Character	True of False drop down list.
Comments	50	Character	Comments entry section for the Primary/Secondary Indicators tab questions.
Press to score tool	0	Button	Button to automatically give results for the Eligibility Status.
Eligibility Status	4	Character	Status of Eligible or Not Eligible.
Follow-Up	4	Character	This field is enterable, only if the Eligibility Status is ˜E Eligible.
Decline Reason	30	Character	Can only be entered if the follow-up is a 3 for Declined Other. Not a required field.
Comments	200	Character	On the Results tab, comments may be entered up to 200 characters and it not a required field.