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

0 Instructions and FAQs Credentialing and Contracting 6.29.18.docx
2018-07-10
1 Credentialing Application
2019-05-07
2 TERM Therapist Clinical Application
2019-05-06
3 TERM Therapist Specialty Addition Application 6.29.18.docx
2018-07-11
4 TERM Evaluator Clinical Application
2019-05-06
5 TERM Evaluator Specialty Addition Application (docx)
2019-03-08
6 Writing Sample Packet Psychological Evaluations.pdf
2018-07-10
7 TERM PROVIDER APP Writing Sample Packet 07.03.18.docx
2018-07-12
NEW REQUIREMENTS FOR ADDING AND MAINTAINING OPTUM TERM PANEL CLINICAL SPECIALTIES (pdf)
EFFECTIVE JULY 1, 2018 2018-06-22
Optum TERM Intern Evaluator Application 08.07.18.docx
2018-08-29
Optum TERM Therapy Intern Application 08.07.18.docx
2018-08-29
TERM Panel Speciality Criteria (pdf)
2018-06-22
W9 - Blank (pdf)
2017-11-02

Communications

TRES III Provider Tip Sheet.pdf
2018-05-25
Recovery and Resiliency Toolkit.pdf
2018-05-25
Important TERM Historical Document-Original CAO Reponse to Board of Supervisors on Development of TERM Program.pdf
2018-05-25
False Claims Act HHSA.PDF
2016-05-11
2013 APA Guidelines for Psychological Evaluations in Child Protection Matters (pdf)
2013 APA Specialty Guidelines for Forensic Psychology (pdf)
EFFECTIVE SEPTEMBER 1, 2016 - URGENT Information on the Changes to the Authorization Process (Medi-Cal and TERM) (pdf)
2016-07-06
NEW REQUIREMENTS FOR ADDING AND MAINTAINING OPTUM TERM PANEL CLINICAL SPECIALTIES (pdf)
EFFECTIVE JULY 1, 2018 2018-06-22
OPTUMIST Newsletter Fall 2018 (pdf)
2018-11-02
OPTUMIST Newsletter Spring 2019 (pdf)
2019-05-06
OPTUMIST Newsletter Summer 2018 (pdf)
2018-08-13
OPTUMIST Newsletter Winter 2019 (pdf)
2019-02-06
September and October 2019: Training Opportunity for Domestic Violence Victim Treatment Specialty (pdf)
Deadline August 30, 2019 2019-07-18
TERM Panel Speciality Criteria (pdf)
2018-06-22
TERM Therapy Referral Process - Supporting Timely Access to Care (pdf)
2018-06-25
TERM Training 3-1-19 Flyer (pdf)
2019-01-16
Workflow for CWS Therapy Referrals (pdf)
2018-04-30

Forms

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
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

DV Standards - Assessment Tools.pdf
2018-05-25
DV Standards - Documentation Requirements.pdf
2018-05-25
DV Standards - Mandatory Assessment Screening Tools Scoring Sheet.pdf
2018-05-25
DV Standards - Safety Plan Guidelines.pdf
2018-05-25
DV Victim Group Provider Specialty Criteria Form.pdf
2018-05-25
NDVH - Personalized Safety Plan.pdf
2018-05-25
TERM DV Victim Group FAQs.pdf
2018-05-25
TERM DV Victim Group Provider Fall '15 News Blast.pdf
2018-05-25
TERM DV Victim Group Provider Spring'15 News Blast.pdf
2018-05-25
TERM DV Victim Group Provider Summer'15 News Blast.pdf
2018-05-25
DV Standards - Group Intake Assessment 2015 - Sample.pdf
2018-05-25
DV Standards - Group Quarterly Progress 2015 - Sample.pdf
2018-05-25
DV Standards - On Site Group Monitoring Tool (pdf)
2017-06-14
DV Victim Intake Assessment (04-182)
2016-09-30
DV Victim Group Treatment Standards 9 23 16.pdf
2016-09-30
Domestic Violence Victim Treatment Quarterly Progress Report (04-182A)
2016-09-30
NC State University Women's Center
2015-10-09
Optum TERM Expanded to Include Oversight of DV Group Psychotherapy (pdf)
2015-10-09

Manuals

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
2019-04-26
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

Workflow for CWS Therapy Referrals 10 28 16.pdf
2016-10-31
April CWS Unit Roster (docx)
2019-04-09
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
JULY 2019 ALPHA ROSTER (xlsx)
2019-07-18
JULY 2019 UNIT ROSTER (docx)
2019-07-18
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

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)
2019-04-15

Psychological Evaluations

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

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

CANS/PSC

CANS Instructions and Process 06.18.2019
2019-06-19