Case Manager Resource Center

As a System of Care program, we want to ensure easy accessibility to documents as you navigate through CSA-funded services! Below is the documentation along with some links to our forms! Please remember all documents are due 1-week prior to the child’s FAPT meeting.

Foundational Documents Due at Initial FAPT

• Referral Form(DOCX, 88KB)
• Individual and Family Service Plan or Individual Education Plan(DOCX, 123KB)
  • Translated options are linked here to act as a guide to support family understanding in their primary language:
    (Spanish(PDF, 325KB) / Amharic(PDF, 410KB) / Arabic(PDF, 316KB) / Mongolian(PDF, 456KB)) 
• Child and Adolescent Needs and Strengths Survey
• Pre-Authorization Letter/Service Authorization Form(DOCX, 72KB)
• Consent of Information
  (English / Spanish)
• Parental Copay Assessment
  (English(DOCX, 34KB) / Spanish(DOCX, 28KB))
• CSA Parent’s Rights and Responsibilities
  (English / Spanish / Amharic(PDF, 93KB) / Arabic(PDF, 100KB) / Mongolian(PDF, 96KB))
• Fostering Futures Independent Living Arrangement Agreement
  (English / Spanish(PDF, 171KB) / Amharic(PDF, 207KB) / Arabic(PDF, 117KB) / Mongolian(PDF, 187KB))
• Fostering Futures Voluntary Continuing Services and Support Agreement
  (English / Spanish(PDF, 100KB) / Amharic(PDF, 162KB) / Arabic(PDF, 144KB) / Mongolian(PDF, 152KB))
• Arlington DHS Notice of Privacy Practices
  (English(DOCX, 49KB) / Spanish(PDF, 210KB))
  (DOCX, 49KB)
• Acknowledgement of Notice of Privacy Practices
  (English(DOCX, 32KB) / Spanish(DOCX, 33KB))
• CSA Hardship Application
  (English(DOCX, 17KB) / Spanish(DOCX, 26KB))

As Applicable

• Clinical Documentation
• Parental Insurance and/or Medicaid Denial
• Court Order
• CSA Non-Mandated Agreement
  (English(PDF, 180KB) / Spanish(PDF, 111KB) / Amharic(PDF, 180KB) / Arabic(PDF, 144KB) / Mongolian(PDF, 129KB))
• Fostering Futures Voluntary Continuing Services and Support Agreement
  (English / Spanish(PDF, 100KB) / Amharic(PDF, 162KB) / Arabic(PDF, 144KB) / Mongolian(PDF, 152KB))
• Fostering Futures Independent Living Arrangement Agreement
  (English / Spanish(PDF, 171KB) / Amharic(PDF, 207KB) / Arabic(PDF, 117KB) / Mongolian(PDF, 187KB))
• CSA Parental Agreement
  (English(PDF, 259KB) / Spanish(PDF, 58KB) / Amharic(PDF, 101KB) / Arabic(PDF, 71KB) / Mongolian(PDF, 48KB))
• Best Interest Determination documentation
• Copy of Magellan Residential Inquiry Form

Documents Required at FAPT Reviews or Other Intersections

• Individual and Family Service Plan or Individual Education Plan
  (English(DOCX, 123KB) / Spanish(PDF, 325KB) / Amharic(PDF, 410KB) / Arabic(PDF, 316KB) / Mongolian(PDF, 456KB)) 
• Child and Adolescent Needs and Strengths Survey
• Pre-Authorization Letter/Service Authorization Form(DOCX, 72KB)
• Consent of Information (due annually and when child turns 18-years-old.)
  (English / Spanish) 
• Parental Copay Assessment (due annually)
  (English(PDF, 251KB))
• Fostering Futures Independent Living Arrangement Agreement (due annually)
  (English / Spanish(PDF, 171KB) / Amharic(PDF, 207KB) / Arabic(PDF, 117KB) / Mongolian(PDF, 187KB)) 
• Fostering Futures Voluntary Continuing Services and Support Agreement (due annually)
  (English / Spanish(PDF, 100KB) / Amharic(PDF, 162KB) / Arabic(PDF, 144KB) / Mongolian(PDF, 152KB)) 
• As Applicable
  • Clinical Documentation to include Vendor Progress Reports
  • CSA Parental Agreement (due annually)

    (English / Spanish / Amharic(PDF, 101KB) / Arabic(PDF, 71KB) / Mongolian(PDF, 48KB)) 

FAPT-Exempt Documents

• Individual and Family Service Plan or Individual Education Plan
  (English(DOCX, 123KB) / Spanish(PDF, 325KB) / Amharic(PDF, 410KB) / Arabic(PDF, 316KB) / Mongolian(PDF, 456KB)) 
• Pre-Authorization Letter/Service Authorization Form(DOCX, 72KB)
• Child and Adolescent Needs and Strengths Survey
• Vendor Progress Reports (if a return request)
• Consent of Information
  (English / Spanish)

Preparing Families for FAPT

1. Family Assessment and Planning Team Tip-Sheet for Remote Meetings (in English)  / (en Español)
2. FAPT with Zoom
3. FAPT for Families
4. FAPT Norms
5. FAPT Agenda and Guide

Documents Due at Time of Transfer or Discharge

• Child and Adolescent Needs and Strengths Survey (due at both transfer and discharge)
• Consent to Exchange Information across Localities (due at transfer)
  (English / Amharic(PDF, 222KB) / Arabic(PDF, 147KB) / Mongolian(PDF, 274KB) / Spanish(PDF, 170KB))  
• CSA Discharge Form(PDF, 155KB) (due at discharge)

Clinical Integrity and Quality of Services

• Vendor Complaint Form
  (English / Spanish(PDF, 175KB) / Amharic(PDF, 171KB) / Arabic(PDF, 94KB) / Mongolian(PDF, 131KB))
• Child-Specific Placement Request Form (PDF, 120KB)

Supportive Materials

• CSA Policy Manual(PDF, 3MB)
• Child and Adolescents Needs and Strengths Survey training
• Service Provider List(XLSX, 124KB)
• Applying for Medicaid(PDF, 368KB) (Arabic(PDF, 384KB) / Amharic(PDF, 379KB) / Mongolian(PDF, 354KB) / Spanish(PDF, 343KB))
• CSA Transportation Tip-Sheet Revised 8-27-21
• Mandate Type Definitions
• CSA Service Placement Types and Definitions
• Treatment Foster Care Tip-Sheet
• Wraparound One Pager(PNG, 267KB)
• Vendor Matching Request Form(PDF, 122KB)
• Placement Memo(DOCX, 45KB)