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 intellectual/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 online training course and passed a certification exam are able to access and administer the screen.
Resources for certified screeners: Adult LTCFS, 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 Functional Screen.
- Papers¹ on testing the validity and reliability of Wisconsin's functional screens:
Resources for Adult Long Term Care Functional Screen (LTCFS) Screeners
- Wisconsin Adult Long Term Care Functional Screen, F-00366 (PDF) Revised July 2019
- Wisconsin Long Term Care Functional Screen Instructions Revised June 2019
- Tools for Adult LTCFS Screeners:
- Diagnoses Cue Sheet, P-00814 Revised July 2019
- Guide for I/DD per Federal Definition, P-00935 (PDF) May 2019
- No Active Treatment (NAT) Algorithm, P-00944 (PDF) Revised December 2017
- Basic Information for Screeners, P-01604 (PDF)
- 2012 Continuing Skills Testing Video 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.
- Listserv Sign Up
Webcast Trainings
- LTCFS Target Group Automation 48 minutes; 11/30/16
- PowerPoint Slides (PDF)
- Requires Nursing Assessment and Intervention 1 hour, 11 minutes; 3/29/10
- PowerPoint Slides (PDF)
Resources for Children's Long-Term Support (CLTS) Screeners
- Clinical Instructions Revised 06/2018
- Listserv Sign Up
- Diagnosis Cue Sheet, P-00920 (PDF)
- Norm-Referenced Assessment Tools for Communication and Learning, P-00933 (PDF)
- Paper Form, 00367 (PDF)
- CLTS Functional Screen Tips
- Presenting Diagnoses, P-02035 (PDF)
- Social Competency, P-02035a (PDF)
- Behaviors, P-02035B (PDF)
- System Change Notice: Age Cohorts, Non-Functional Eligibility Results Display, Suicidality Look-Back Period (PDF)
- CLTS Age-Specific ADL and IADL Questions:
- Birth to 6 Months, F-00367a (PDF)
- 6 to 12 Months, F-00367b (PDF)
- 12 to 18 Months, F-00367c (PDF)
- 18 to 24 Months, F-00367d (PDF)
- 24 to 36 Months, F-00367e (PDF)
- 36 Months to 4 Years, F-00367f (PDF)
- 4 to 6 Years, F-00367g (PDF)
- 6 to 9 Years, F-00367h (PDF)
- 9 to 12 Years, F-00367i (PDF)
- 12 to 14 Years, F-00367j (PDF)
- 14 to 18 Years, F-00367k (PDF)
- 18 Years and up, F-00367l (PDF)
Introduction to the CLTS FS Quality Tool
- Presentation 20 min, 38 sec
- Six CLTS Functional Screen Basic Essentials (PDF)
- Five Attributes of CLTS Functional Screen Quality Notes (PDF)
Refresher Training for Certified CLTS Screeners
- Module 1: Overview 10 min, 7 sec
- Module 2: Informational Pages 14 min, 23 sec
- Module 3: Diagnoses 19 min, 11 sec
- Module 4: Mental Health 16 min, 27 sec
- Module 5: Behaviors 22 min, 0 sec
- Module 6-Part 1: Activities of Daily Living (ADLs) 17 min, 11 sec
- Module 6-Part 2: Instrumental Activities of Daily Living (IADLs) 15 min, 3 sec
- Module 7: School and Work 3 min, 29 sec
- Module 8: Health-Related Services 16 min, 24 sec
- Module 9: Screen Time and Notes 3 min, 18 sec
- Module 10: Functional Eligibility Rights 6 min, 23 sec
- Module 11: Resources for Certified Screeners 9 min, 5 sec
Presentations on Institutional Levels of Care in CLTS Programs
- Intermediate Care Facility (ICF/IID) Level of Care: Developmental Disabilities (DD LOC) 16 min, 40 sec
- Psychiatric Hospital Level of Care: Severe Emotional Disturbance (SED LOC) 38 min, 58 sec
- Nursing Home Level of Care: Physical Disabilities (NH LOC) 24 min, 44 sec
- Hospital Level of Care: Physical Disabilities (HOS LOC) 13 min, 26 sec
Resources for Mental Health/AODA Screeners
General Resources for All Screeners
- Functional Screen Information Access (FSIA) gateway page
- FSIA System Requirements, P-01448 (PDF)
- Functional Screen Application Training 101
¹The 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.
