CHECKLIST

DOES YOUR PROGRAM MEET THE FRN FAMILY INVOLVEMENT STANDARDS?

Review the checklist below and see how many of the FRN FI standards your program
or agency already meets, and how many could be met with the right resources.
For those Philadelphia providers of adult behavioral health services who are
interested in working with the Family Resource Network in the full implementation
of the FRN Standards please contact: Kathleen Cantwell

FAMILY RESOURCE NETWORK (FRN)
MODEL STANDARDS CHECKLIST FOR THE INVOLVEMENT
OF “SIGNIFICANT PEOPLE” AT A PROVIDER AGENCY,
DEPARTMENT, OR PROGRAM

This check-list is intended to help determine how many of the FRN Model Standards for
Involvement of Significant People (SP’s) are in place and being monitored at an agency,
department, or program—especially the most important standards (#1 through #6).

Definitions: The term “significant people” (SP) includes everyone who may be
significant to the consumer and his/her recovery-- other than agency staff who are
providing direct care services. Significant people may be immediate family members,
but they may also include friends, parents, relatives, roommates, clergy, employers, etc.
Significant people include those who may have a positive or negative effect on the
consumer’s recovery. Identifying important social support people to involve in the
consumer’s recovery is a collaborative process between consumers and provider staff
members, always subject to obtaining a release of information from the consumer.

Standards #1 through #6—asking consumers about SP’s, calling SP’s
(with permission), asking them about essential treatment/case management
information, and offering resources/advice—are the most important efforts
that a program or agency can make. Such efforts are also the highest priority
for most SP’s.

Staff training and quality assurance are also very important, but these efforts take
time to set up, and SP’s, especially those new to the system, need assistance and
information immediately—often with crisis situations, some of which may involve
danger to self or others. Treatment and case management staff need to get any
vital information that SP’s have about what has been helpful or problematic to the
consumer as soon as possible.

Inviting SP’s to social or informational meetings like open houses or “family night”
is helpful to some but not a priority for the vast majority of SP’s who are most
concerned with their particular consumer and the consumer’s treatment/recovery.
Families and other SP’s are usually looking to be contacted by their consumer’s
assigned case manager/therapist/ physician, especially when progress reviews,
placements/dispositions, and crises are taking place.

Note: in some cases a program may have policies or practices that are different from
its parent agency, and vice-versa. For that reason, each item below allows the person
completing the form to be specific about whether he/she is referring to a program,
department, the entire agency, or more than one of those.

1. This [ ] program, [ ] department, [ ] agency has a section in its
formal Policies & Procedures concerning people (“SP’s”) such as friends
and family who consumers and/or staff see as significant to recovery.
[ ] YES [ ] NO [ ] Copy attached

ADDITIONAL EXPLANATION: _______________________________________

NOTE: The following does NOT refer to “emergency contact” people or the process
of identifying emergency contacts, unless the emergency contact people are also
specifically identified in the record as people who are important to the consumer’s recovery.

2. This [ ] program, [ ] department, [ ] agency has formal written protocols or policy
that direct staff members during the intake/admission process to discuss who is
important/significant to the consumer and/or has important information about the consumer.

[ ] YES [ ] NO [ ] Copy attached

ADDITIONAL EXPLANATION: ______________________________________________

[Note: If you check “YES” to any of the choices in this section, please also check “records
kept” if records are kept of the results]

[NOTE: None of the following refers to “emergency contact” people or the process
of identifying emergency contacts unless they are specifically identified in the record as
people who are important in the consumer’s recovery in some way].

3.      This   [ ] program,   [ ] department,   [ ] agency checks on a regular basis to see
whether the following information is in at least a random sample of charts or records:

a. That a discussion has taken place with consumers asking them about people who are
   important to their recovery in a positive or negative way.
   [ ] YES    [ ] NO    [ ] Records kept


b. The name and relationship of any significant people who were identified, along with their
    contact information (when available).
    [ ]YES   [ ]NO     [ ] Records kept

c. Signed releases for contacting all significant people identified elsewhere in the record—or
    explanations as to why no signed release is present, such as consumer declining to sign.
   [ ]YES     [ ]NO    [ ] Records kept


d. Which significant people are important for the staff to contact, and when staff
   will attempt to contact these people.
   [ ]YES     [ ]NO    [ ] Records kept

ADDITIONAL EXPLANATION: ______________________________________________

4.      This [ ] program, [ ] department, [ ] agency has formal written protocols or
policies that direct staff members *after* the intake/admission process to:

a. Contact by phone any identified significant people (for whom releases have been signed).
   [ ]YES     [ ]NO     [ ] Copy attached

b. Give any significant people contacted information about the program/agency.
    [ ]YES     [ ]NO     [ ] Copy attached



c. Ask any significant people contacted for information important in the consumer’s recovery.
    [ ]YES     [ ]NO     [ ] Copy attached

d. Tell significant people about resources for them such as support groups and organizations
    and/or send resource literature.
    [ ]YES     [ ]NO     [ ] Copy attached

5. This [ ] program, [ ] department, [ ] agency checks on a regular basis to see whether the following information is in at least a random sample of charts or records:

[Note: If you check “YES” to any of the choices in this section, please also check “records
kept” if records are kept of the results]

a. Which previously-identified significant people have been contacted by phone or mail, the
    results of those contacts, and plans based on the results of those contacts
    [ ]YES     [ ]NO    [ ] Records kept


b. That information about the program/agency was provided to significant people.
    [ ]YES     [ ]NO    [ ] Records kept

c. What kind of information was asked for and/or received from significant people.
    [ ]YES     [ ]NO    [ ] Records kept

d. What resources were offered to the significant people and whether literature was sent?
     [ ]YES     [ ]NO    [ ] Records kept

ADDITIONAL EXPLANATION: ______________________________________________

6. This [ ] program, [ ] department, [ ] agency has formal written protocol or policies
and procedures that specify *how and when* staff members are to include (or not to include)
appropriate significant people in formal recovery and goal planning, including:

7. This [ ] program, [ ] department, [ ] agency checks on a regular basis to see whether the following information concerning inclusion of significant people in recovery/treatment planning is in at least a random sample of charts or records:

[Note: If you check “YES” to any of the choices in this section, please also check “records kept”
if records are kept of the results]

a. The attendance of an SP at a treatment team meeting
    [ ]YES     [ ]NO    [ ] Records kept


b. The attendance of an SP at a recovery/goal/treatment plan meeting/review.
    [ ]YES     [ ]NO    [ ] Records kept

c. The attendance of an SP at a meeting with a counselor/psychiatrist.
    [ ]YES     [ ]NO    [ ] Records kept

8. This [ ] program, [ ] department, [ ] agency has formal written QI/QA procedures in place that provide for regular, formal consideration of reports on “family involvement” documentation in consumer records by administrative/supervisory staff and recommendations for improvements?

9. This [ ] program, [ ] department, [ ] agency has formal, written policies or procedures that specify what kind of training and education staff should or must have concerning communication with and involvement of families, friends, and other people significant to consumers in the recovery, treatment and/or case management process.

10. This [ ] program, [ ] department, [ ] agency has written documentation of training and education that staff has received specifically concerning communication with and involvement of families, friends, and other people significant to consumers in the recovery, treatment and/or case management process.

[ ] YES [ ] NO

11. This [ ] program, [ ] department, [ ] agency has written documentation (such as training effectiveness evaluations, test results, or supervisor’s evaluations) of actual staff competence in the area of communication with and involvement of families, friends, and other people significant to consumers in the treatment and recovery process.

12. This [ ] program, [ ] department, [ ] agency has formal written protocol or policies and
procedures that specify that provider staff should familiarize the consumer’s significant
people with agency and program services offered to or received by the consumer?

13. This [ ] program, [ ] department, [ ] agency has formal written protocol or policies and
procedures that specify recruiting/inviting representatives of families and other significant
people to serve on policy, program planning, and/or feedback committees.

14. In the past six months, the Board of Directors of this agency has discussed or received a
report on F.I. efforts.

[ ] YES [ ] NO [ ] Copy attached

[ ] ADDITIONAL EXPLANATION: ______________________________________________