Client movement report



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QUARTERLY CONTRACT MONITORING REPORT (QCMR)

CLIENT MOVEMENT REPORT


CAREER SERVICES (SUPPORTED EMPLOYMENT)

(11/23/15)


Page 1 of 5 USTF PROJECT CODE: 34

Indicate Calendar Year of the Months this QCMR includes: __________

NAME OF AGENCY:



JULY 1 TO SEPTEMBER 30

1

NAME OF PROGRAM:

SUPPORTED EMPLOYMENT 34


OCTOBER 1 TO DECEMBER 31

2

PERSON COMPLETING FORM/PHONE #:

JANUARY 1 TO MARCH 31

3

DATE SUBMITTED: ____________


APRIL 1 TO JUNE 30

4

CHECK AGENCY REPORTING QUARTER:

1

2

3

4



1. 2. 3. 4. 5. 6.




































Beginning Active Caseload (First Day of Qtr.)




New Enrollees to Program Element During Qtr.




Transfers to the Program Element During this Qtr.




Transfers From Program Element During Qtr.





Terminations From Program Element During Qtr.




Ending Active Caseload (Last Day of Qtr.)



REFERRAL SOURCE DURING THIS QUARTER (This should equal ending caseload for the reporting quarter).

7. Number of Referral:

Number of Referrals

Accepted Referrals

7A.

Consumers who were referred from State Hospitals and Enrolled in this Program Within this Quarter.







7B.

Consumers who were Referred from local Partial Care Program and Enrolled in this Program Within this Quarter.







7C.

Consumers who were Referred from local Outpatient/IOP/Private Therapist and Enrolled in this Program Within this Quarter.







7D.

Consumers who were Referred from Acute Care Programs (Screening Centers; EEIS; STCF) and Enrolled in this Program Within this Quarter.







7E.

Consumers who were Referred from DVRS and Enrolled in this Program Within this Quarter.







7F.

Consumers who were Referred from Self-Help Center/Self-Referral/NAMI/Consumer & Family Orginizations and Enrolled in this Program Within this Quarter.







7G.

Consumers who were Referred from other referral source and Enrolled in this Program Within this Quarter.







7H.

Sum







7I.

Prop. of Referrals Accepted = Sum of Acceptances /Sum of Referrals



Page 2 of 7

Education: Note the sum of items 8. – 13. Must equal the sum of items 2. (new enrollees) + item 3 (transfers in).

For each consumer please select the highest level of educational/vocational achievement.
8. 9. 10. 11. 12. 13.





































New consumers with no HS Dipolma/No Voc. Traning During this Qtr.




New consumers working on GED During this Qtr.




New consumers with a Vocational Training During this Qtr




New consumers with a High School Diploma/GED During this Qtr.




New consumers with a Bachelor’s Degree During this Qtr.




New consumers with a post graduate degree During this Qtr.




14. TYPE OF JOB PLACEMENT DURING THIS QUARTER (This should equal total number of consumers working competitive job the reporting quarter).

Number of consumers Placed this Quarter (unduplicated)

14A.

Architecture/Engineering

 

14B.

Business & Financial Operations Occupations

 

14C.

Farming, Fishing & Forestry Occupations

 

14D.

Arts, Design, Entertainment, Sports and Media Occupations

 

14E.

Healthcare Practicioners and Technical Occupations

 

14F.

Healthcare Support Occupations

 

14G.

Legal Occupations

 

14H.

Management Occupations

 

14I.

Computer and Mathematical Occupations

 

14J.

Life, Physical and Social Science Occupations

 

14K.

Food Preparation and Serving Related Occupations

 

14L.

Construction and Extraction Occupations

 

14M.

Sales and Related Occupations

 

14N.

Transportation and Material Moving Occupations

 

14O.

Education, Training and Library Occupations

 

14.P

Building and Grounds Cleaning and Maintenance Occupations

 

14Q.

Office and Administrative Support Occupations

 

14R.

Installation, Maintenance and Repair Occupations

 

14S.

Military-Specific Occupations

 

14T.

Protective Service Occupations

 

14U.

Personal Care and Service Occupations

 

14V.

Production Occupations

 

14W.

Community and Social Services Occupations

 

14X.

Others

 

14Y.

Total: (Sum of 14A through 14X)

 


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QUARTERLY CONTRACT MONITORING REPORT (QCMR)

LEVEL OF SERVICE REPORT

CAREER SERVICES (SUPPORTED EMPLOYMENT)

NAME OF AGENCY:      


CONTRACT NUMBER:      






NAME OF PROGRAM: __________________












Supported Employment (SE) BUDGET MATRIX CODE: 34






15.

Levels of Service

Total number of new consumers (unduplicated) to be enrolled in SE services during this quarter (This number is a subset of total number served on SE caseload this quarter).




15.      

16.

Total number of transferred consumers to be enrolled in SE services during this quarter (Transferred consumers are all individuals transitioning into SE from your agency’s other programs. For example, an individual is moving from PC to SE from the same agency).




16.      

17.

Total number of consumers (unduplicated) to be enrolled in SE services during this quarter (New Consumers + Transferred Consumers. Include total number of consumers that are on assigned caseload of the SE staff at any time during the reporting quarter). Item 17 = Item 15 + Item 16


Outcomes

17.      

18.

Number of consumers (unduplicated) working in a full-time competitive integrated employment during this quarter (Full-Time- 35 hours or more. Integrated competitive employment is defined as a community based job that pays at least minimum wage, is available to any person, belongs to the worker and does not have a time limit determined by the rehab/mental health agency. (Consumers who have and/or secured Full Time Employment).


18a.      

Proportion of Ending Active Caseload:
18b.      
=Item18a/Item 17

19.

Number of consumers (unduplicated) working part-time in a competitive integrated employment during this quarter (Part-Time- less than 35 hours. Consumers who have and/or secured Part-Time Employment).



19a.      



Proportion of Ending Active Caseload:

19b.      


=Item19a/Item17

20.

Number of consumers placed multiple times (more than once) in a competitive integrated employment during this quarter (Full-Time & Part-Time). This includes consumers who were initially placed in an employment setting this quarter but quit or was fired and needed assistance with employment placement again. This includes consumers who transitioned from job into a new job during this quarter).



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20.      




21.

Total number of consumers working competitive integrated employment during this quarter. (Unduplicated Full-Time + Part-Time & Re-placed Full-Time + Part-Time. Sum of #18A +19A +20)

21.      




22.

Number of NEW job starts for ALL consumers during this quarter (Include all job starts. For example, one person starts three new jobs, which equals three job starts. Only count the jobs NOT the consumers placed).




22.      




23.

Number of consumers assisted into post-secondary educational opportunities or settings during this quarter (This is the number of consumers the SE staff provided support or aid to in order for the consumer to enroll in a credit-bearing education program this quarter. This includes technical school, college & GED prep classes).




23.      




24.

Number of hours of educationally related coaching during this quarter (This is the number of hours provided to consumers in preparation of the educational program. This includes but not limited to educational readiness development, information sharing, and referral and application preparation).




24.      




25.

Number of hours of pre-employment related interventions during this quarter (This is the number of hours provided to consumers prior to becoming employed. This includes but not limited to intake, readiness determination, career planning and profiling, employment assessments, individualized job development and support planning).




25.      



26.

Number of hours of on & off-the-job coaching during this quarter (This is the number of hours of job support for working consumers provided by the employment specialist either on, or off the job site).


26.      




27.

Number of hours of extended supports provided during this quarter (The definition of extended supports mean the long-term follow-along services and other appropriate employment services that are needed to support and maintain a consumer in employment. Extended service delivery beginning after job retention.




27.      




28.

Number of consumers working successfully in integrated competitive employment who transitioned off SE caseload during this quarter (Consumer has gained independence, and is working on his/her own; with natural supports).




28.      




29.

Total units of service provided during this quarter. (Sum of 24+25+26+ 27)





29.      




30. Termination: Complete this section during this quarter (This should equal the total number of termination from the program during the quarter).

30a. Number of enrolled consumers lost to contact:      


30b. Number of enrolled consumers who decided not to seek employment:      
30c. Number of enrolled consumers who moved out of the area:      
30d. Number of enrolled consumers who needed a higher level of care:      
30e. Number of enrolled consumers who passed away (Deceased):      
30f. Number of enrolled consumers who returned to school:      
30g. Number of enrolled consumers who were incarcerated:      
30h. Others      

Caseloads: Complete this section during this quarter.
31a. Number of consumers on Employment Specialists (ES) Caseload (excluding the supervisor_):      

31b. Number of consumers on Supervisor’s/Team Leader’s Caseload:      


31c. Total number of consumers on ES and Supervisor’s/Team Leader’s Caseload:      

(This number should equal to the ending case load (Item #6).).
Staffing:

      32. Total FTE Employment Specialists (excluding the supervisor) with Caseload - (FTE = full-time equivalent). Include full-time and part-time positions. For example, 2 employment specialists working 20 hrs/week = 1 FTE.

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DEFINITIONS

Supported Employment (SE) – Services consist of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports, to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant. Supported employment is conducted in a variety of settings; particularly work sites where persons with disabilities are employed. Supported employment includes activities needed to sustain paid work by participants, including supervision and training. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptation, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting.

Unit of Service: 1 hour

Competitive Employment – Work in the competitive labor market that is performed on a full-time or part-time basis in an integrated setting and for which the individual is compensated at or above minimum wage, but not less than the customary wage and levels of benefits paid by the employer for the same or similar work performed by individuals who are not disabled.

Education is defined as a “credit-bearing educational program”--- such as a technical school, college– for which the consumer will receive documentation upon completion. Include GED prep classes

Educationally Related Coaching- Includes the unit of service provided for the consumer- includes the support services needed to maintain a consumer in obtaining/completing vocational/technical/GED/College degree.

Extended Support Services (Long- term follow along) – Includes the unit of the ongoing support services needed to support and maintain the individual in supported employment. Extended services are provided after an individual has achieved job retention. Rehabilitation occurs when the individual is employed for a length of time adequate to ensure the stability of the employment outcome (a minimum of 90 days). Extended services are provided both on and off the job site, as frequently as necessary, to assess and maintain employment stability.

Job Coaching (On & Off site) – Includes the unit of service of support services provided to the consumer who has been placed in employment (working) in order to stabilize the placement and enhance job retention.

Job Starts- All the job starts for consumers. For example, one person starts three new jobs, which equals three job starts. Only count the jobs NOT the consumers placed.

New Consumers- Consumer new to the agency and program.

Pre-Employment Related Interventions– Includes the unit of service provided following service: A referral to a specific job resulting in an interview, whether or not the consumer obtained the job. Job Readiness– To prepare the consumer for the world of work (e.g. appropriate work behaviors, getting to work on time, appropriate dress and grooming, increasing productivity). Job Related Services – Job related services include job search assistance, job placement assistance, and on-the-job support services. Job Search Assistance – Job search activities support and assist an eligible individual in searching for an appropriate job. Job search assistance may include help in resume preparation, identifying appropriate job opportunities, developing interview skills, and making contacts with companies on behalf of eligible individuals. Page 6 of 7



Placed Multiple Times- Consumers that are assisted in finding a job and placement in multiple jobs. This includes consumers who transitioned into other job.

Post-Secondary Educational Opportunities or Settings- This is the number of consumers the SE staff provided support or aid to in order for the consumer to enroll in a credit-bearing education program. This includes technical school, college & GED prep classes.

Transferred consumers- Consumer transition into SE program from the same agency’s other programs. For example, an individual is moving from PC to SE from the same agency.

Page 7 of 7

Revised 11/23/15 Submit forms 30 days after the close of the Quarter to the QCMR Portal https://dmhas.dhs.state.nj.us/qcmr/




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