Contents

11.1 CLTS Functional Screen Online Course
11.2 Obtaining, Deleting or Changing Access for Certified Screeners
11.3 CLTS FS Listserv
11.4 DHS Website for the Functional Screen
11.5 CLTS FS Coordinator
11.6 DHS SOS Help Desk
11.7 Process for Transferring a Functional Screen
11.8 Incomplete Screens
11.9 Note Sections on the CLTS FS
11.10 Reports Available on the CLTS FS

http://mynursingce.son.wisc.edu/index.pl?id=677949 

To access the online course for employees seeking to become certified to complete the Children’s Long Term Support Functional Screen, go to link above through the University of Wisconsin Madison School of Nursing.

Enter the Access Code: dhs92fy. This code must be entered EXACTLY as listed (all lower case). If you need help accessing the course, contact Learner Support at: nursing@uwisc.org.

After successfully completing the online course, certified screeners will be asked to complete a short survey online. Once the survey is complete, there is an opportunity to view and print their certificate of achievement. Screeners must include a copy of their certificate when requesting access to the functional screen.

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https://fsia.wisconsin.gov/ 

Obtaining Access to the CLTS Functional Screen

To gain access to the CLTS Functional Screen as a Certified Screener, follow these steps:

1. Go to https://fsia.wisconsin.gov/
2. If you do not already have a WAMS ID, you will need to select the ‘WAMS’ link and create one.
3. Select the ‘FSIA Request Access’ link
4. Complete the Functional Screen Web Access Request Form
5. Note, item #10 Profiles = “Children's LTS Functional Screen”
6. Send the signed Functional Screen Web Access Request Form and the certificate of achievement from the School of Nursing to the state security officer.

Changing Access Information
Whenever a change needs to be made to a screener’s access to the functional screen, a formal request must be submitted. This form is available on the State of Wisconsin’s Human Service System Gateway page, see link above.

Click on the link to ‘FSIA – Request Access’ and update the necessary information on the form and then follow the instructions on that page.

Maintaining Access with a Change in Name of an Employee
When a screener changes their name for any reason, they will need to submit a Functional Screen Web Access Request form to update this information.

Restricting Access to the CLTS Functional Screen
When a screener leaves your agency and no longer has need to access the CLTS Functional Screen, the screen lead or supervisor is responsible for directing the DHS SOS Desk to delete the screener profile for that person. This is important to ensure the integrity and confidentiality of the personal data that is kept on the CLTS FS website. If a screener will be doing screens in a different county or agency, he/she should have his/her profile reactivated by the new employer.

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11.3 CLTS FS Listserv

http://dhs.wisconsin.gov/LTCare/FunctionalScreen/signup.htm 

Once certified, screeners are strongly encouraged to sign up for the CTLS FS Listserv. The Listserv is the principle way in which DHS will notify you about changes being made to the CLTS Functional Screen, clinical instructions and other screen-related resources. DHS manages the list to make certain screeners do not get unnecessary emails. This is a primary tool for all certified screeners to stay current on the CLTS FS. All certified screeners are accountable to know the information provided through the Listserv whether or not they sign up for the Listserv.

To join/unsubscribe the Listserv: Go to the Functional Screen Listserv website above. You will receive a confirmation email after your request is approved. You should either store this message on your computer or print a hard copy for future reference. You must have an individual email address to participate in the Listserv. Listserv owners may verify that new subscribers have a need to know the information shared by the Listserv. After your request is received, an email will be sent to the Listserv that you are a new subscriber. You will recognize emails that come from the Listserv because the subject line will always begin with the name of the Listserv (Example: [cltsfslist] Update Volume 7, Number 3).

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11.4 DHS Website for the Functional Screen

http://dhs.wisconsin.gov/ltcare/FunctionalScreen/#childrens 

Certified Screeners can find important information concerning the CLTS FS at this website. Information includes:

• Current Clinical Instructions,
• Diagnosis Cue Sheet,
• Paper Form of the CLTS FS,
• Age Specific Questions for ADL and IADLs,
• Links to available webcasts.

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11.5 CLTS FS Coordinator

Becky.Burns@wisconsin.gov 

Becky Burns is the CLTS FS Coordinator. She can be contacted regarding specific clinical questions on the CLTS FS. Contact the CLTS FS Coordinator when the final functional eligibility result is not what the screener expected or anytime a screener has a question about the options available on the CLTS FS. Under no circumstance should the CLTS FS Coordinator’s name appear in any individual child’s functional screen. Her recommendations are to the certified screener, not to the screen itself as she has not had the opportunity to meet the child in question.

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11.6 DHS SOS Help Desk

DHSSOSHelp@wisconsin.gov 
Phone: 608-266-9198

Screeners can receive technical assistance on the CLTS FS by contacting the SOS Help Desk. Technical assistance includes, but is not limited to, issues such as not being able to access the screen, changes in Social Security Numbers, finding two files for the same child in the CLTS FS database, etc.

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11.7 Process for Transferring a Functional Screen

The CLTS FS improves access to long-term supports for families by reducing multiple applications and eligibility reviews in order to access long-term supports and services. In addition to the benefits of this simplification for families is the reduction of duplication of effort by professionals at the state and county level. Central to this process is the acceptance of another certified screener's results for a child. Each certified screener has specific security and access rights. Therefore, a transfer process is needed to provide access to a certified screener in a different agency with differing security access. 

The functional screen is a protected health record under HIPAA (the Federal Health Insurance Portability and Accountability Act). Transferring screens between agencies must be done in compliance with federal confidentiality and security rules and requirements. Sharing of confidential information without signed consent between county agencies and between county agencies and state staff is outlined in Wisconsin State Statutes 51.30(4)(b) and 51.42, DHS Administrative Rule 92.04(5), and Federal Medicaid laws on confidentiality.

1.)  When requesting a screen be transferred:

1. Contact the transferring agency and request that they transfer the screen to your agency. Provide the transferring agency with the exact name of the child, the child’s date of birth and the exact name of your agency as it appears in the CLTS FS application. This is especially important if there is more than one agency in your county.
    
2. All requests for transfers from the Katie Beckett Program can be e-mailed to the KBP Central Office at DHSKatieBeckett@wisconsin.gov. In the ‘Subject’ heading state: CLTS FS Transfer.

2.)   When transferring a screen:

1. Transfer the screen to the requesting agency. Be sure to confirm that you have selected:
   -- The correct individual applicant;
   -- The correct screen type (such as the adult screen, children's screen, mental health screen); and
   -- The correct receiving agency from the drop-down list.
   
   
2. Notify the requesting agency that you have transferred the screen.

Once a screen is transferred, it cannot be revoked. If a screener transfers a screen to the wrong agency, only the agency that received the screen can transfer it back to your agency. It is not acceptable to ask the agency that incorrectly received the transferred screen to forward or transfer the screen to the correct agency. The agency that incorrectly received the screen must transfer the screen back to the agency that originally transferred the screen.

For instructions on how to transfer a functional screen, refer to the technical assistance document on our website at: http://dhs.wisconsin.gov/LTCare/FunctionalScreen/training.htm. If you need help transferring a screen, contact the SOS Help Desk at:

SOS Help Desk
608/266-9198 
DHSSOSHelp@wisconsin.gov 

3.)  What the person receiving the functional screen will do:

The person receiving the screen must check that the correct child's screen was transferred. Within a timely manner, the screener should meet the child and complete a screen.

1. INITIAL SCREEN
   Complete an INITIAL SCREEN if the child is applying for a different program in the new county.
   
   
2. RESCREEN
   Complete a RESCREEN if the child is continuing services within the same program in a different county.

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11.8 Incomplete Screens

Incomplete Screens create multiple problems on the CLTS FS. By definition, an incomplete screen is a screen where functional eligibility has not been calculated. This error happens most often when a screener has used EDIT to update information on an existing screen and has not recalculated eligibility. It may seem to the screener that the updated information was not pertinent to functional eligibility but the screen may still require recalculation. Any time a screener enters information in the CLTS FS they must save that information by advancing to a new page and checking to see if "Eligibility" in the left hand navigation column continues to have a green check mark next to it. If there is no green check mark, then functional eligibility must be calculated again.

There are two other ways to know if a screen is complete or not. The first is to look on the "My Recent Screens" page. If there is a clock image next to "CLTS" in the same row as the child's name, then that screen is incomplete. The other is to run the Screen Summary at Agency Level report to generate a list of all incomplete screens by a screener's name.

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Note sections are available on every page of the CLTS FS. This space is provided for the screener to enhance or support the items they have checked (or did not check) on each page. Some screeners may use the note section to complete necessary requirements for individual programs (e.g., narrative assessment for Waivers). However, this is NOT the primary purpose of the note sections as they relate to the CLTS FS. The PRIMARY purpose or expectation is that notes will be made to strengthen and corroborate items checked on the screen.

The following specific notes are expected on certain pages:

DIAGNOSIS: 
Note any specific diagnosis the child may have that was found on the Diagnosis Cue Sheet as well as the actual titles of a child’s Diagnosis.

Examples:

• 09/07/10: Developmental Disability and Seizure Disorder have been checked per the Diagnosis Cue Sheet for a diagnosis of Cornelia De Lange Syndrome. BB/KBC
  
  
• 09/07/10: Metabolic Disorder has been checked per the Diagnosis Cue Sheet for a diagnosis of Sanfilippo Syndrome. BB/KBC

MENTAL HEALTH: 
Note all details regarding any check marks for specific Symptoms (Violence, Suicidality, Psychosis, and Anorexia/Bulimia). Note all specifics regarding any selection of Rare and Extreme Conditions.

Examples:

• 09/07/10: Violence has been checked because the child took a knife to school last week and threatened to use it. The police were involved. BB/KBC
  
  
• 09/07/10: Psychosis was not checked although this child has many behaviors that resemble psychotic behaviors including reporting that they are hearing voices. The doctors are still determining the actual root of the problems. BB/KBC
  
  
• 09/07/10: Although this child continues to have a diagnosis of Anorexia, the symptoms are well managed and therefore Anorexia/Bulimia was not checked on this page. BB/KBC
  
  
• 09/07/10: Child attempted suicide 2 months ago. They have recently been released from the hospital. The discharge summary verifies this information. BB/KBC

BEHAVIOR: 
Note a detailed description of any check marks for specific Behaviors, especially those which occur at a frequency of "1-3 times/week" or "more than 4 times/week" and anytime "Other" is checked.

Examples:

• 09/07/10: Child is going through a difficult transition and has run away every weekend often requiring police to help find her. She reports that she was going to a friend's house or walking off steam but was found miles away from home often walking along the side of a highway. Both her parents and the police reports support this. BB/KBC
  
  
• 09/07/10: Child is constantly yelling at his parents. Often saying he hates them and uses profanity daily. Verbal Abuse was not checked as his behavior did not meet the requirements of this item on the CLTS FS. BB/KBC
  
  
• 09/07/10: Child engages in head banging behavior on a daily basis. She wear a helmet to protect her head both at home and at school. She will strike her head on walls and floors. This accommodation is in her IEP and she was wearing her helmet at the home visit. BB/KBC

FIVE (5) ATTRIBUTES OF CLTS FUNCTIONAL SCREEN QUALITY NOTES

Notes contain the evidence/substantiation/verification to support what is selected (or not selected) on the CLTS Functional Screen. There is a reason certified screeners select certain items on the CLTS Functional Screen. Notes should provide the facts/details/specifics that led to those decisions.

Purpose of Quality Notes
If a screen is reviewed after a period of time (6 months, a year, etc.), anyone (the screener, the child’s parents, an administrative law judge, the CLTS FS Coordinator, an agency supervisor, etc.) should be able to stand behind the functional screen results with the evidence contained in the note sections on the screen. It must be clear that functional eligibility was determined based on all evidence available at the time of completion by a professional certified screener.

Five (5) Attributes of Quality Notes:

1. PROPER FORMAT
2. PROFESSIONAL APPEARANCE
3. PREVIOUS NOTES ARE ACCURATE OR DELETED
4. INCORPORATE MULTIPLE SOURCES
5. CONTAIN DETAILED EVIDENCE

1. PROPER FORMAT
Dates and initials appear with notes, in desired format.

1. Newest notes at the top of the note section; and
2. b. Date (MM/DD/YY) - Notes - Initials/Program Affiliation.

Notes appear on every page of the CLTS FS. Proper formatting is important because uniformity of the most up to date note at the top of the note section means anyone reviewing the screen knows where to look for the most relevant information. The format serves the purpose of locking (bookends) in a screener's notes so that no one else can accidentally add to the notes a screener has written.

2. PROFESSIONAL APPEARANCE
Notes must reflect a professional, legal, court ready document. This includes correct spelling and grammar. The CLTS FS represents the screener's best work. Acronyms and abbreviations should not be used. Additionally, a screen with notes that are grammatically correct and correctly spelled will be easier for a subsequent screener or someone reviewing the screen to understand. Writing notes in a Word document where spell check can be used is recommended. These notes can then be copied into the CLTS Functional Screen.

3. PREVIOUS NOTES ARE ACCURATE OR DELETED
Previous inaccurate, irrelevant, unprofessional or no longer applicable notes are deleted from the CLTS FS. Every note on a functional screen must support the child’s current functional abilities. Notes are always saved with screens in the ‘History’ of the CLTS FS. If previous notes remain entirely accurate, and pertinent to the current screen, screeners should indicate that this is the case in a newly dated entry.

4. INCORPORATE MULTIPLE SOURCES
Notes indicate that findings were corroborated from multiple sources of information and specific sources are identified. Sources must represent the child’s functional abilities in multiple locations throughout their day. Multiple sources are important throughout the screen but are essential on all selected categories on the Mental Health, Behavior and IADL pages. Sources include:

1. Child – observations during the home visit
2. Parent – information shared during the home visit and in written form (application, etc.)
3. Others – verbal reports from others in the child’s life
4. Reports – written documentation of the child’s functional abilities

5. CONTAIN DETAILED EVIDENCE
Notes provide details of the child’s functional ability that led to what was or was not selected on the CLTS Functional Screen. Notes present evidence to answer the question, “How would someone know the information selected on the CLTS FS is correct?” Notes:

• Include objective descriptions of skills demonstrated at the home visit;
• Provide evidence gathered from reports; and
• Provide facts including the what, who, why, where, when with specific content.

When another person (e.g., another screener, hearing officer, parent or CLTS FS Clinical Advisor) looks at a screen you have completed, it should be clear from reading the brief notes, why certain questionable items have been checked (or not checked) on the screen. This does not mean that there needs to be a note made every time a check mark is made. The critical notes are those that address items on the screen that might be questioned by someone else reviewing the screen.

Examples of items that do not require notes:

• A child with Cerebral Palsy who has items checked on the ADL page.
• A child with Down Syndrome who has items checked on the IADL page.
• A child with Bipolar who has services checked on the Mental Health page.
• A child with Spinal Muscular Atrophy who has items checked on the HRS page.

Examples of items requiring notes:

• A 6 year old child who has Verbal Abuse checked on the Behavior page.
• A child with Down Syndrome who has Running Away checked on the Behavior page.
• A child with Depression who has Respiratory Treatments checked on the HRS page.
• Any child who has Violence checked on the Mental Health page.
• Any child who has Torture or Abuse of Animals "4 or more days each week" checked on the Behavior page.

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11.10 Reports Available on the CLTS FS

Screen Summary at Agency Level
This report will generate a list that includes all of the following information:
Applicant's Name, Date of Birth, SSN, Screener's Name, Screen Completed Date, County of Residence, County of Responsibility, Screen Type (Initial or Annual) and Status (Complete or Incomplete).

Screeners can collect this data for a specific county, agency, screener, status (incomplete or complete) or archive status (active or archived). It can also be collected within a specific date range.

This report helps agencies monitor screens that are incomplete, when screeners are completing screens, the types of screens being completed among other factors.

Screen Time Report
This report will generate a list that includes all of the following information:
Screener's Name, Applicant's Name, Date of Birth, SSN, Screen Complete Date, Screen Type (Initial or Annual), Screen Time, Referral Date, Screen Begin Date, Days from Referral Date to Screen Begin Date, and Days from Screen Begin Date to Screen Completion. This report also computes total screen time for an agency and for each screener within an agency.

Screeners can collect this data for a specific county, agency, screener or archive status (active or archived). It can also be collected within a specific date range.

This report helps agencies monitor the amount of time it takes for screeners to complete the tasks involved in meeting an applicant and completing a functional screen.

Screener Summary at Agency Level
This report will generate a list that includes all of the following information:
Screener's Name, Certification Begin Date, Certification End Date, Screener Profile (Child Screener, Child Screens - View Only) and Status (Active, Inactive).

Screeners can collect this data for a specific county, agency, screener status (Active or Inactive) or screener profile (Child Screener, Child Screens - View Only). It can also be collected within a specific date range.

This report helps agencies monitor the status of their screeners. This is especially important when an employee leaves employment or assumes a different role in the functional screen process.

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Last Revised: March 14, 2013
Wisconsin Department of Health Services
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