TERM Providers

This page is utilized by TERM providers to obtain documents and related materials needed for continued work with Child Welfare Services and Probation clients.

Applications

Communications

Forms

Name Description Date
* TERM Provider Complaint Form for Professional Partners.pdf
2015-10-09
* Child Physical Abuse Treatment Intake Assessment.docx
* Child Physical Abuse Treatment Quarterly Report.docx
* Sample Psych Testing Request Form 012016.pdf
2018-05-25
* Psych Testing Request Form 012016.pdf
2018-05-25
* Psych Testing Guidelines.pdf
2016-02-24
* TERM Grievance Procedures and Complaint Form Arabic.pdf
2018-05-25
* TERM Grievance Procedures and Complaint Form English.pdf
2018-05-25
* TERM Grievance Procedures and Complaint Form Spanish.pdf
2018-05-25
* TERM Grievance Procedures and Complaint Form Tagolog.pdf
2018-05-25
* TERM Grievance Procedures and Complaint Form Vietnamese.pdf
2016-05-11
* 04-178 Youth Evaluation Questions - Diagnostic Clarification and Treatment Recommendations.pdf
2016-09-30
* 04-178 Youth Evaluation Questions - Adoption Evaluation.pdf
2016-09-30
* 04-178 Parent Evaluation Questions - Prospective Adoptive Parent.pdf
2016-09-30
* 04-178 Parent Evaluation Questions - FC 7827.pdf
2016-09-30
* 04-178 Youth Evaluation Questions - Emotional Damage Evaluation.pdf
2016-09-30
* 04-178 Parent Evaluation Questions - Diagnostic Clarification and Treatment Recommendations.pdf
2016-09-30
* CWS Form 04-182 DV Victim Intake Assessment.dot
2016-09-30
* CWS Form 182A DV Victim Quarterly Progress Report.dot
2016-09-30
* CWS Treatment Plan Form 04-176-177-Parent.dot
2016-10-11
* CWS Treatment Plan Form 04-176-177-Youth.dot
2016-10-11
* CWS Form 04-183A Sexual Abuse Protection NPP Quarterly Progress Report.docx
2017-02-06
* Foster Youth Bill of Rights.pdf
2017-03-29
* CWS Temporary Change of Authorization.pdf
2017-10-16
* CWS Form 04-183 Sexual Abuse Protection NPP Intake Assessment.dot
2017-12-26
* TERM Partner Contacts 11 27 17.pdf
2018-01-04
* CWS Mental Health Assessment Form (docx)
2019-01-24
* TERM Training 3-1-19 Flyer (pdf)
2019-01-17

DV Victims Group Treatment

Manuals

Name Description Date
* Court Testimony in the Juvenile Court System.pdf
* Delinquency System Legal Process.pdf
* Dependency System Legal Process.pdf
* Documentation Requirements.pdf
* Legal Issues Related to Therapy and Evaluations for CWS Cases.pdf
* Probation Psychiatric Evaluation Referral Form.pdf
2015-10-09
* Probation Psychological Evaluation Referral Form.pdf
2015-10-09
* Psychological Evaluation Procedures.pdf
* San Diego Juvenile Court Procedure to Obtain Authorization to Use or Disclose Protected Mental Health Information for Evaluations of Minor in Custody.pdf
* Superior Court of the State of California Order.pdf
CPY Document Subject 2015-10-09
* The Format and Required Elements of a CWS Psychological Evaluation.pdf
* The Format and Required Elements of a Juvenile Mental Competency Evaluation.pdf
* The Format and Required Elements of a Probation Psychological Evaluation.pdf
* CWS Form 04-176A Therapy Referral Form.pdf
2016-09-30
* CWS Form 04-178 Request for TERM Appointed Evaluator.pdf
2016-09-30
* Specialized Optum TERM Panel Evaluations (pdf)
2019-01-28
* TERM Provider Handbook (pdf)
2019-01-30
* TERM Treatment Plan Documentation Resources (pdf)
2018-01-24
* The Format and Required Elements of a Probation Psychiatric Evaluation.pdf
2016-09-30

Quick References

Name Description Date
* Workflow for CWS Therapy Referrals 10 28 16.pdf
2016-10-31
* CLSSD Contact List - Firm.xlsx
2018-02-01
* Children’s Legal Services Vendor Invoicing Instructions (pdf)
2017-10-20
* Dependency Legal Services Contact List (pdf)
2017-12-15
* Dependency Legal Services Invoicing Instructions (pdf)
2017-12-15
* FEBRUARY 2019 ALPHA ROSTER (xlsx)
2019-02-18
* FEBRUARY 2019 UNIT ROSTER (docx)
2019-02-18
* Medi-Cal CWS Auth Process FAQ 10 28 16.pdf
2016-10-31
* TERM Partner Complaint Contacts (pdf)
2017-11-30
* TERM Panel Speciality Criteria.pdf
2018-10-05

CSA NOP/NPP Treatment

Name Description Date
* CSA-NPP Mental Status Form.pdf
2016-03-18
* CSA-NPP On Site Group Monitoring Tool 12-1-15.pdf
* CSA-NPP Assessment Tools (pdf)
2019-03-14
* CSA-NPP Documentation Requirements (pdf)
2019-03-14
* CSA-NPP Safety Plan Guidelines (pdf)
2019-03-14
* CSA-NPP Scoring Sheet for Required Screening Tools (pdf)
2016-03-18
* CSA-NPP Treatment Standards (pdf)
2019-03-14
* CWS Form 04-183 Sexual Abuse Protection NPP Intake Assessment (dot)
2017-12-15
* CWS Form 04-183A Sexual Abuse Protection NPP Quarterly Progress Report (docx)
2017-02-06

Psychological Evaluations

Name Description Date
* 04-178 Youth Evaluation Questions – Emotional Damage Evaluation (pdf)
CWS Psychological Evaluation Resources 2017-03-20
* 04-178 Parent Evaluation Questions - Diagnostic Clarification and Treatment Recommendations.pdf
CWS Psychological Evaluation Resources 2017-03-20
* 04-178 Parent Evaluation Questions - FC 7827.pdf
CWS Psychological Evaluation Resources 2017-03-20
* 04-178 Parent Evaluation Questions - Prospective Adoptive Parent.pdf
CWS Psychological Evaluation Resources 2017-03-20
* 04-178 Youth Evaluation Questions - Adoption Evaluation.pdf
CWS Psychological Evaluation Resources 2017-03-20
* 04-178 Youth Evaluation Questions - Diagnostic Clarification and Treatment Recommendations.pdf
CWS Psychological Evaluation Resources 2017-03-20
* APA Guidelines for Psych Evals In Child Protection Matters.pdf
CWS Psychological Evaluation Resources 2017-03-20
* APA Speciality Guidelines Forensic Psych.pdf
TERM Psychological Evaluation Resources 2017-03-20
* CWS Form 04-178 Request for TERM Appointed Evaluator.pdf
CWS Psychological Evaluation Resources 2017-03-20
* Probation Psychological Evaluation Referral Form.pdf
Juvenile Probation Psychological Evaluation Resources 2017-03-20
* Psych Testing Guidelines.pdf
TERM Psychological Evaluation Resources 2017-03-20
* Psych Testing Request Form 012016.pdf
TERM Psychological Evaluation Resources 2017-03-20
* Psychological Evaluation QA Checklist (docx)
TERM Psychological Evaluation Resources 2017-04-19
* Psychological Evaluation Procedures.pdf
TERM Psychological Evaluation Resources 2017-03-20
* Sample Psych Testing Request Form 012016.pdf
TERM Psychological Evaluation Resources 2017-03-20
* Specialized Optum TERM Panel Evaluations (pdf)
Juvenile Probation Psychological Evaluation Resources 2019-01-28
* TERM Psychological Evaluation Handbook (pdf)
TERM Psychological Evaluation Resources 2017-09-08
* The Format and Required Elements of a CWS Psychological Evaluation.pdf
CWS Psychological Evaluation Resources 2017-03-20
* The Format and Required Elements of a Juvenile Mental Competency Evaluation.pdf
Juvenile Probation Psychological Evaluation Resources 2017-03-20
* The Format and Required Elements of a Probation Psychological Evaluation.pdf
Juvenile Probation Psychological Evaluation Resources 2017-03-20

CWS Treatment Plans

Name Description Date
* CWS Form 04-176A Therapy Referral Form (pdf)
2017-05-03
* CWS Treatment Plan Form 04-176-177 Youth (dot)
2017-05-03
* CWS Treatment Plan Form 04-176-177-Parent (dot)
2017-05-03
* Documentation Requirements (pdf)
2017-05-03
* Legal Issues Related to Therapy and Evaluations for CWS Cases (pdf)
2017-05-03
* TERM Treatment Plan Documentation Resources (pdf)
2018-01-24