Wisconsin's Functional Screen

Wisconsin’s Functional Screen system is a web-based application used to collect information about an individual’s functional status, health and need for assistance for various programs that serve the frail elderly and people with developmental or physical disabilities. The screen is used to determine functional eligibility for certain mental health services, adult long-term care programs and children's long-term support programs. Experienced professionals, usually social workers or registered nurses, who have taken an on-line training course and passed a certification exam are able to access and administer the screen. 

Resources for certified screeners: Adult LTC FS, Children's LTS, MH/AODA, General Resources for all Screeners

General Information

• Overview: Background information on the history and use of the Long-Term Care (LTC) Functional Screen.

• Papers* on testing the validity and reliability of Wisconsin's functional screens:

  • Children's Long-Term Support Functional Screen Validity (PDF, 74 KB)

  • Adult Long-Term Care Functional Screen Validity (PDF, 54 KB)

  * The papers above were prepared as part of Wisconsin's applications to the Centers for Medicare & Medicaid Services for approval of the Children's Long-Term Support and Adult Long-Term Care Functional Screens.

Resources for Certified Screeners Adult LTC FS, Children's LTS, MH/AODA 

Adult LTC FS Screeners

• Wisconsin Adult Long Term Care Functional Screen (F-0036) (PDF, 123 KB; Revised 9/10/12)
• Wisconsin Long Term Care Functional Screen Instructions (Revised 3/14/13) 
• Diagnosis Cue Sheet (PDF, 50 KB; 2/7/11)
• Guidelines for Defining Physical Disability (PDF, 23 KB)
• I/DD Decision Tree (PDF, 39 KB; revised 02/2013)
  • I/DD Decision Tree Instructions (PDF, 123 KB; revised 02/2013)
  • I/DD Case Analyses (PDF, 49 KB; Updated 7/27/09)
• Decision Tree for Frail Elders with Co-Morbidities (PDF, 25 KB)
• Decision Tree for PD with Co-Morbidities (PDF, 22 KB)
• Decision Tree on Target Groups for Brain Injury (PDF, 23 KB; 9/28/12)
  • Instructions for the Brain Injury Target Group (PDF, 68 KB)
• No Active Treatment (NAT) Algorithm (PDF, 21 KB; Revised 4/26/10 - For Family Care Counties only)
• Assessment/Supplement to the Long Term Care Functional Screen (F-20980) (PDF, 325 KB - For Home and Community-based Waiver Screeners only)
• Listserv Sign Up - Adult Long Term Care Functional Screen
  
  
• 2012 Continuing Skills Testing Video (Adobe Connect, help; 50 minutes)
  This video portrays a functional screen interview in the home of an applicant for long-term care programs. The video is recommended for use for general training purposes.
  
  
• Webcast Trainings (webcast help):
  • Requires Nursing Assessment and Intervention (1 hour, 11 minutes; 3/29/10)
    • PowerPoint Slides (PDF, 58 KB)
  • IADL Section Re-Write (2 hours, 33 minutes; 11/23/09)
    • PowerPoint Slides (PDF, 808 KB)
  • ADL Section Re-Write (1 hour, 43 minutes; 4/14/09)
    • PowerPoint Slides (PDF, 348 KB)
  • Brain Injury (1 hour, 6 minutes; 11/20/08)

Children's LTS Screeners

• Clinical Instructions (Revised 5/16/13)
• Listserv Sign Up - Children's Long-Term Support Functional Screen
• Diagnosis Cue Sheet (PDF, 138 KB; Revised 11/16/11)
• Norm-Referenced Assessment Tools for Communication and Learning (PDF, 136 KB; Revised 7/13/12)
• Paper Form F-00367 (PDF, 126 KB; Revised 12/2012)
• Children's LTS Age-Specific ADL and IADL Questions: 
  • Birth to 6 Months F-00367a (PDF, 20 KB; Revised 2/7/11)
  • 6 to 12 Months F-00367b  (PDF, 24 KB; Revised 2/7/11)
  • 12 to 18 Months F-00367c (PDF, 25 KB; Revised 2/7/11)
  • 18 to 24 Months F-00367d  (PDF, 24 KB; Revised 03/2012)
  • 24 to 36 Months F-00367e (PDF, 24 KB; Revised 12/2012)
  • 36 Months to 4 Years F-00367f (PDF, 25 KB; Revised 12/2012)
  • 4 to 6 Years F-00367g (PDF, 25 KB; Revised 12/2012)
  • 6 to 9 Years F-00367h (PDF, 27 KB; Revised 12/2012)
  • 9 to 12 Years F-00367i (PDF, 26 KB; Revised 12/2012)
  • 12 to 14 Years F-00367j (PDF, 26 KB; Revised 12/2012)
  • 14 to 18 Years F-00367k (PDF, 26 KB; Revised 12/2012)
  • 18 Years and up F-00367l (PDF, 27 KB; Revised 12/2012)

Introduction to the CLTS FS Quality Tool

• Presentation (Adobe Connect, help; 20 min, 38 sec; recorded July 2012)
• Six CLTS Functional Screen Basic Essentials (PDF, 21 KB)
• Five Attributes of CLTS Functional Screen Quality Notes (PDF, 32 KB)

Presentations on Institutional Levels of Care in Children's LTS Programs (Recorded September 2011)

1. Intermediate Care Facility (ICF/MR) Level of Care: Developmental Disabilities (DD LOC) (16 min, 40 sec)
2. Psychiatric Hospital Level of Care: Severe Emotional Disturbance (SED LOC) (38 min, 58 sec)
3. Nursing Home Level of Care: Physical Disabilities (NH LOC) (24 min, 44 sec)
4. Hospital Level of Care: Physical Disabilities (HOS LOC) (13 min, 26 sec)

Mental Health/AODA Screeners

• Clinical Instructions (Revised 5/22/09)
• Paper Form F-00258 (PDF, 77 KB)
  
  

General Resources for All Screeners

• Functional Screen Information Access (FSIA) gateway page

• Functional Screen Application Training 101 

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Last Revised:  May 16, 2013