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 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 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.
• Papers¹ on testing the validity and reliability of Wisconsin's functional screens:
  • Adult Long-Term Care Functional Screen Validity (PDF, 54 KB)
  • Children's Long-Term Support Functional Screen Validity (PDF, 268 KB)

Resources for Adult LTC FS Screeners

• Wisconsin Adult Long Term Care Functional Screen (F-00366) (PDF, 250 KB; 12/2014)
• Wisconsin Long Term Care Functional Screen Instructions (Revised 10/8/15) 
• Diagnoses Cue Sheet (P-00814) (PDF, 408 KB; 08/2015)
• Guidelines for Defining Physical Disability (P-00942) (PDF,  22 KB)
• Functional Screen Information Access (FSIA) and Program Participation System (PPS) System Requirements (PDF, 924 KB)
• I/DD Decision Tree (P-00935) (PDF, 139 KB; 02/2013)
  • I/DD Decision Tree Instructions (PDF, 105 KB; 10/2015)
• Decision Tree for Frail Elders with Co-Morbidities (P-00945) (PDF,  24 KB)
• Decision Tree for PD with Co-Morbidities (P-00943) (PDF,  27 KB)
• Decision Tree on Target Groups for Brain Injury (P-00932) (PDF, 27 KB; 10/2015)
  • Instructions for the Brain Injury Target Group (PDF, 58 KB; 10/2015)
• No Active Treatment (NAT) Algorithm (P-00944) (PDF,  22 KB) (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:

• Determining the Correct Target Group (51 minutes; 5/1/14)
  • PowerPoint Slides (PDF, 89 KB)
• Requires Nursing Assessment and Intervention (1 hour, 11 minutes; 3/29/10)
  • PowerPoint Slides (PDF, 58 KB)

Resources for Children's LTS Screeners

• Clinical Instructions (Revised 01/2015)
• Listserv Sign Up - Children's Long-Term Support Functional Screen
• Diagnosis Cue Sheet (P-00920) (PDF, 449 KB; 01/2015)
• Norm-Referenced Assessment Tools for Communication and Learning (P-00933) (PDF, 33 KB; 01/2015)
• Paper Form (F-00367) (PDF, 132 KB; 01/2015)
• Children's LTS Age-Specific ADL and IADL Questions: 
  • Birth to 6 Months F-00367a (PDF, 20 KB; 02/2011)
  • 6 to 12 Months F-00367b (PDF, 24 KB; 02/2011)
  • 12 to 18 Months F-00367c (PDF, 25 KB; 02/2011)
  • 18 to 24 Months F-00367d (PDF, 24 KB; 03/2012)
  • 24 to 36 Months F-00367e (PDF, 24 KB; 12/2012)
  • 36 Months to 4 Years F-00367f (PDF, 25 KB; 12/2012)
  • 4 to 6 Years F-00367g (PDF, 25 KB; 12/2012)
  • 6 to 9 Years F-00367h (PDF, 27 KB; 12/2012)
  • 9 to 12 Years F-00367i (PDF, 26 KB; 12/2012)
  • 12 to 14 Years F-00367j (PDF, 26 KB; 12/2012)
  • 14 to 18 Years F-00367k (PDF, 26 KB; 12/2012)
  • 18 Years and up F-00367l (PDF, 27 KB; 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, 22 KB)

CLTS FS Online Training for Certified 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, 03 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, 05 sec)

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)

Resources for Mental Health/AODA Screeners

• Clinical Instructions (Revised 5/22/09)
• Paper Form F-00258 (PDF, 77 KB)
• Signup for MH/AODA Functional Screen Listserv

General Resources for All Screeners

• Functional Screen Information Access (FSIA) gateway page
• Functional Screen Application Training 101