EHS RECAP

Child Family Specialist:

Family Engagement Specialist:

Date:

Next Recap:

Next Observation:

1.  Eligibility, Recruitment, Selection, Enrollment and Attendance

Date / Child/ren / Parent/s / Referred By/ How did you hear about us? / Self-Referred / Notes / Follow Up
10/4/16 / Johnny Doe Jr. / John & Sarah Doe / Marybeth @ Heath Dept. / Premature, homeless family / 10/5 called & left msg for family
10/7 family called back scheduled app
10/10 application visit
10/20 added to WL
11/30 added to Sally’s caseload

Enrollment/ Drops & Adds:

Dual Enrolled:

Waitlist:

Transitions:

2. Education and Early Childhood Development

Gold:

Socializations:

Disabilities:

3. Child Health and Safety

Health Requirements (3015 Report):

Mental Health:

Child/Family
Name / EHS Facilitated
Referral? / Billable
Insurance? / Provider / Frequency of Services / Concerns/Notes

4. Family Partnerships

Family Plans:

Family Engagement Activities/Workshops:

Newsletter:

Child/Family Reflecting:

6. Facilities, Materials and Equipment

CC Checklist Goals:

7. Management Systems and Procedures

Files:

Tracking Sheets/Inkind:

CFS/FES Follow Up:

PSC Follow Up:

Manager Follow Up:

·  Recap documents activity/updates for three consecutive months. Each quarter begin a new recap document*

10/16 p: hs/ehs/staff monitoring/ EHS Recap