DARS3136 Vocational Adjustment Training- Specialized Training Report

DARS3136 Vocational Adjustment Training- Specialized Training Report

/ Texas Workforce Commission
Vocational Rehabilitation Services
Vocational Adjustment Training (VAT)- SpecializedProgress Report
General Instructions
The trainer followsthe instructions below when completing this form.
  • Complete the form electronically (on the computer)and answer all questions.
  • Refer to the VRS Counselor approved DARS3135B-Training Plan for goals and objectives to include in the report.
  • Write summaries in paragraph form in clear, descriptive English. Leave no blanks. Enter N/A if not applicable.
  • Print the form, obtain signatures, and submit.
  • Make certain that all standards are met before submitting this form with an invoice for payment.

Customer Information
Customer name: / VRScase ID:
Service authorization (SA)number:
Training Facts
If training is facilitated in a group setting, record the VRScase IDs of all customers who participated in the group training session(s).
Training completed in an individual setting
1. / 2. / 3.
4. / 5. / 6.
Attendance
Instructions:
  • For each week of the training,enter the date (mm/dd/yy) of Monday through Sunday in the date column.
  • For each day of the week, record the number of hour(s) the customer participated in the training.
  • If customer is absent from the training, record an “A” for the day missed.
  • Notify the counselor immediately when the customer is absent.
  • Total the number of hours that the customer attended the training.

VAT
Yes No VAT provided for the reporting period
Week / Date
(Mon-Sun) / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
1
2
3
4
5
6
Total number of hours the customer participated in the VAT:
Performance Summary Reporting Period
Rate the customer’s performance:
Ability to learn / Excellent / Very Good / Good / Marginal / Poor
Accuracy of work / Excellent / Very Good / Good / Marginal / Poor
Accepts assistance / Excellent / Very Good / Good / Marginal / Poor
Adaptability / Excellent / Very Good / Good / Marginal / Poor
Appearance and hygiene / Excellent / Very Good / Good / Marginal / Poor
Attendance / Excellent / Very Good / Good / Marginal / Poor
Communication / Excellent / Very Good / Good / Marginal / Poor
Cooperativeness / Excellent / Very Good / Good / Marginal / Poor
Initiative / Excellent / Very Good / Good / Marginal / Poor
Motivation / Excellent / Very Good / Good / Marginal / Poor
Safety practices / Excellent / Very Good / Good / Marginal / Poor
Timeliness / Excellent / Very Good / Good / Marginal / Poor
Customer’s Skills Related to Training Plan
Instructions:
  • Upon completion of the reporting period, record the areas addressed during training period, customer’s goals and objectives and below,
  • Use the scale below to rate the customer’s competency related to the objectives and goals in the customer’s Training Plan; and
  • Record a narrative description of the training provided and the customer’s abilities and/or challenges related to each goa and objective.

Key or Level / Description of Competency Level
No Skill /
  • Unable to perform skill or demonstrate knowledge without step by step or continual assistance, guidance or supervision

Marginal /
  • Limited understanding or knowledge
  • Requires structured assistance, guidance or supervision to perform

Basic /
  • Basic understanding or knowledge
  • Requires occasional redirection, cueing or guidance to perform.

Proficient /
  • Detailed understanding or knowledge
  • Capable of assisting others in the application of skills and tasks
  • Requires no guidance or supervision and works independently

Areas addressed during training period:
balancing life and work
career exploration
child care management
community resources
conflict resolution
daily living skills
decision making
disability awareness
effective communication
financial management
goal setting / grooming and hygiene
household management
independent living
interpersonal communication
leadership
stress management
Other:
Other:
Other:
Other:
Goal 1: / Goal Achieved:Yes No
Objectives: / customer’s Status:
No Skill / Marginal / Basic / Proficient / N/A
A:
B:
C:
Narrative description of the customer’s status for the reporting period:
Goal 2: / Goal Achieved:Yes No
Objectives: / customer’s Status:
No Skill / Marginal / Basic / Proficient / N/A
A:
B:
C:
Narrative description of the customer’s status for the reporting period:
Goal 3: / Goal Achieved:Yes No
Objectives: / customer’s Status:
No Skill / Marginal / Basic / Proficient / N/A
A:
B:
C:
Narrative description of the customer’s status for the reporting period:
Goal 4: / Goal Achieved:Yes No
Objectives: / customer’s Status:
No Skill / Marginal / Basic / Proficient / N/A
A:
B:
C:
Narrative description of the customer’s status for the reporting period:
Goal 5: / Goal Achieved:Yes No
Objectives: / customer’s Status:
No Skill / Marginal / Basic / Proficient / N/A
A:
B:
C:
Narrative description of the customer’s status for the reporting period:
Overall Training Summary
Describe the instructions and resources the customer received throughout the entire training.
Describe the customer’s ability and willingness to perform skills and tasks including all problematic issues or concerns that emerge.
Describe all accommodations, compensatory techniques, and special training needs required by the customer including why task had to be completed for the customer.
Recommendations related to future training that can enhance or improve the customer skills.
Additional Comments
Additional comments, if any:
Signatures
By signing below, I, the customer or authorized representative, agree with the information recorded within the report above. If you are not satisfied, do not sign. Contact your VR counselor.
Customer’s signature
X / Date:
Customer’s legally authorized representative’s signature, if any:
X / Date:
Providers Qualifications
Type of Provider: / Traditional-bilateral contractor / Transition Educator / Non-traditional
Traditional-bilateral contractor must complete the provider qualification section below. This section is not applicable to transition educator and non-traditional providers.
Qualifications / Proof of Qualification / Verified by TWS-VRS
Specify UNTWISE Credential:
/ UNTWISE Credential Number:
if no, DARS3490-Waiver Proof Attached / Yes No N/A
Specify UNTWISE Endorsement: N/A / UNTWISE Endorsement Number: / Yes No N/A
Select: RID BID
SLIPI N/A / RID/BID/SLIPI Number:
Proof Attached / Yes No N/A
Other: / Number: Proof Attached / Yes No N/A
Vocational Adjustment Trainer Signatures (Required for all providers)
By signing below, I, the Vocational Adjustment Trainer, certify that:
  • the above dates, times, and services are accurate;
  • I personally facilitated the training as required in the Standards for Providers;
  • I documented the services and information described above in this form;
  • All Outcomes Require for Payment as described in the TWC VR Standards for Provider and Service Authorization(s) were met;
  • the customer’s and/or customer’s legally authorized representative’s signature on this form was obtained on the date stated in the date field of the form;
  • I handwrote my signature and the date below; and
  • I maintain the staff qualifications required for the service provided as described in the Standards for Providers or in Service Authorization specifications.

Vocational Adjustment Trainer typed name: / Vocational Adjustment Trainer signature:
X / Date:
Directors Credentials and Signature
Required for Traditional-Bilateral Contractors
By signing below, I, the Director, certify that:
  • I handwrote my signature and the date below; and
  • I ensure that the staff meets the qualifications and met the requirements in the Standards for Providers when delivering the service and;
  • I maintain the staff qualifications, including the UNTWISE credential, required for a director, as described in Standards for Providers and/or Service Authorization.

Qualifications / Proof of Qualification / Verified by TWS-VRS
Specify UNTWISE Credential: / UNTWISE Credential Number:
if no, DARS3490-Waiver Proof Attached / Yes No N/A
Director’s typed name: / Director’s signature:
X / Date:
VRS Use Only—
Date Form Submitted by Provider:
Date Form Received by TWS-VRS Office:
Verification of Qualifications
The UNT website verifies that the director listed above is
NOT Credentialed Credentialed as a CRP Director
The UNT website or supporting documentation verifies the Vocational Adjustment Trainer listed above is
NOT Credentialed
Credentialed as a Vocational Adjustment Training Specialist
Maintains BEI, RID, SLPI required for Premium
Endorsed in Other Specialization, Specify
  • If the director or vocational adjustment trainer is not credentialed, is an approved DARS 3490, Temporary Waiver of CRP Credentials, attached to the invoice?
/ Yes No N/A
  • If yes, does the DARS 3490 approve the director and/or vocational adjustment trainer for the dates the services?
/ Yes No N/A
If unable to verify the credentials, complete the following:
  • Enter the date a copy of the submitted invoice, report and DARS3460 was sent to provider to notify the staff did not meet the qualification as defined in the Standards for Providers and/orSA.
Date:______
  • Enter the date a case note was made to document the return of invoice and required form(s)
Date: ______
Printed name of VRS staff member making verifications: / Date verified:
Approval of the Report
Verified that the report is accurately completed per form instructions, in the Standards for Providers, and/or the SA / Yes / No
Verified that the appropriate service(s) was provided as stated in the Standards for Providers and/or the SA / Yes / No
Verified that the form indicates that the training was provided in a group or individual setting and if a group setting a ratio of 1 vocational adjustment trainer to no more than 6 customers was maintained / Yes / No
Verified the customer’s attendance and total hours the customer participated in training is recorded / Yes / No
Verified the goals and objectives listed on form match goals and objectives on the DARS3135B / Yes / No
Verify each goal and objective has a status is recorded / Yes / No
Verify the customer’s performance and skills documented in a narrative description for each goal and objectives / Yes / No
Verified that the necessary accommodations, compensatory techniques, and special needs were provided and documented on the form by the vocational adjustment trainer as required for the customer’s successful engagement in the curriculum / Yes / No
Verify that the DARS3135B, VAT Specialized Training Plan is attached when the evaluation recommends training / Yes / No
Verified the customer’s satisfaction with the training through signature on the form and/or by VR staff member contact with customer / Yes / No
Verified that the appropriate fee(s) was invoiced / Yes / No
If any question above is answered “No,” complete the following:
  • Enter the date a copy of the submitted invoice, the report and DARS3460 to notify the provider the service delivery or report did not meet the requirements as described in the Standards for Providers and/orSA. Date:

  • Record a case note to document the return of invoice and required form(s)Date:

Report: Approved Sent back to provider
Comment (if any):
Printed name of VR staff member making verification: / Date Verified:

DARS3136 (10/17) Vocational Adjustment Training- Specialized Training ReportPage 1 of 7

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