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N.C. Department of Environment, Health, and Natural Resources Page 1 of 1 <br /> Division of General Services <br /> FY 1993-1994 <br /> CONTRACT ADDENDUM <br /> Children and Youth Section 93-5356-068 <br /> Office, Section, or Branch Contract Number <br /> Orange County Health Department Child Service Coordination <br /> Contractor <br /> Activity <br /> • <br /> CHILD SERVICE COORDINATION <br /> 1. An estimated 200 (number) eligible children birth through age five will receive Child <br /> Service Coordination through the local health department. <br /> 2_ All enrolled children will receive the following minimum program components: <br /> - client file containing full demographic information; <br /> - complete Identification and Referral Form (DEHNR 3748) ; <br /> - signed Letter of Agreement between CSC and family; <br /> - signed release of information as appropriate for exchange of records between appropriate <br /> providers; <br /> - strengths/needs assessment and complete assessment of parent-child interaction; <br /> - mandated minimum contact by designated Child Service Coordinator including <br /> 1. review and update of risk indicators, <br /> 2. assessments and care coordination plan and <br /> 3 . monitoring of the provision of services by referral sources; <br /> - documentation of referral and follow up of the Intermediate Assessment or Denver II <br /> screening for appropriate children-at indicated times; <br /> - provision of or arrangement for appropriate educational materials and counseling/support <br /> services as specified in the Care Coordination Plan; <br /> - completion of Status Report Forms (DEHNR 3750) at specified intervals; <br /> - documentation and appropriate assistance regarding transfer of families to new service <br /> coordination agency when appropriate; <br /> - documentation and appropriate assistance regarding closure of families to the Child <br /> Service Coordination Program; <br /> - records organized according to MCH program requirements. <br /> 3. Enter Identification and Referral Forms and Status Report Forms for all enrolled children <br /> regardless of CSC agency into the computer system' at the health department. <br /> Maintain signed Provider Agreement for Child Service Coordination with all county <br /> providers participating in the Child Service Coordination Program. (Attach Agreements for <br /> FY 1993-94) <br /> _. Child Service Coordination staff must meet the qualifications as specified in the manual. <br /> H_intain roster of health department staff, professional discipline and hours per week <br /> roviding CSC. <br /> List Child Service Coordinator or contact person: <br /> Rebekah Hermann (919 )732-8181, ext. 2400 <br /> Name Phone <br /> Reviewed by <br /> DEHNR 3300(Revised 2/90) � y�' <br /> General Services Division (Review 1/95) Initials Date <br />