SFY 17 FCSS Annual Report  
At the conclusion of each fiscal year, FCFCs are required to complete the FCSS Annual Report detailing use of dollars which supported Family-Centered Services and Supports.  Instructions for completing the required information are provided in SFY 17 FCSS Guidance, Appendix H.  An optional Excel tracking spreadsheet to assist counties with the collection of the required information is provided on the OFCF website at http://fcf.ohio.gov/Initiatives/SystemofCare(FCSS).aspx 

The person completing this report must make an entry in all spaces/boxes provided for a response.  Please enter a "0" for any category in which there were no children/families served who apply to that category.
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Email *
Name of Person Completing the Report: *
County: *
Organization: *
Phone: *
1. Total number of referrals by system for youth who accessed FCSS funding through June 30, 2017.
Tip: Report the number of referrals by system, only include those children/young adults for whom FCSS funds were used to provide family services/supports or to pay for service coordination.  Do not include children/young adults in service coordination for whom FCSS funds were not used.
Self/Family *
Mental Health/BH Provider *
Education *
Juvenile Justice *
Child Protective Services *
Physician/Hospital *
Other *
Name the source of referral(s) that was counted in the "Other" category of system referrals above.  Enter "0" if no referrals were provided in the "Other" category. *
Enter "0" if no referrals were provided in the "Other" category.
2. Number of FCSS children/young adults that had needs at intake in the following categories, whether or not those needs were being addressed through June 30, 2017.
Tip:  Only count the categorical needs of those children/young adults who were accepted into FCFC service coordination with a family plan written by their individuals family team and for whom FCSS funds were used to provide family services/supports or to pay for service coordination.

Do not include children/young adults in service coordination for whom FCSS funds were not used.
Developmental Disabilities *
Mental Health *
Special Education *
Child Abuse *
Substance Use (Alcohol/Drug) *
Physical Health *
HMG *
Child Neglect *
Poverty *
Unruly *
Delinquent *
Autism Spectrum Disorder *
Primary Care Physician *
Tip:  Emergency Room Care is not considered a primary care physician.
3. Total number of children /young adults served through June 30, 2017 with FCSS funds.
Tip:  The number of families served should never be more than the number of children served.
0 through 3 years of age *
4 through 9 years of age *
10 through 13 years of age *
14 through 18 years of age *
19 through 21 years of age *
4.  Total number of families served through June 30, 2017 with FCSS funds.
Tip:  The number of families served should never be more than the number of children served.
Total number of families served *
5. Total number of times each service or support was written into IFSCP's and accessed by using SFY 17 FCSS funds (July 1, 2016 through June 30, 2017).
Tip:  Count each service one time when it is written into an Individualized Family Service Coordination Plan (IFSCP) in response to a family team identified need, not each time the same service is provided to the same family. For example, if a family needs transportation assistance and the family team decides to give a family gas vouchers to address that need, count transportation assistance as the service provided one time for that family, even if the family receives multiple vouchers.
Non-Clinical In-Home Parent/Child Coaching *
Non-Clinical Parent Support Groups *
Parent Education *
Respite (including camp) *
Mentoring *
Safety and Adaptive Equipment *
Transportation *
Parent Advocacy *
Social/Recreational Supports *
Service Coordination *
Structured Activities to Improve Family Functioning *
Youth/Young Adult Peer Support *
Other *
Describe/Name the services provided to families that were counted in the "Other" category of services above.  Enter "0" if no services/supports were provided in the "Other" category. *
Tip:  Please give the name of each service or a brief description in 4 or 5 words of those services that were paid for with FCSS funds and were counted in the "Other" category of services/supports. Separate multiple services with an " & " symbol in between each service. Enter "0" if no services/supports were provided in the "Other" category.
6. Total number of children/young adults who had no primary care physician at intake, but were connected to a primary care physician during the service coordination process.
Tip:  Report those children/young adults who have no primary care physician at intake of service coordination but were connected to a primary care physician during the service coordination process.  Only count those children/young for whom FCSS funds are used to support other services/supports provided to the family.  Please note, FCSS funds cannot be used to pay for medical care or treatment.

**Emergency Room care is not considered a primary care physician.
Total Number of Children/Young Adults Connected. *
If a child/youth was not connected to a PCP, please indicate reason(s) a connection was not made, otherwise enter "0". *
7. The number of FCSS families who accessed a family advocate in SFY 17.
Tip:  Report the number of families in service coordinator who used FCSS funds and accessed a family advocate.  The FCSS funds do not need to be used to pay for a family advocate for the family advocate to be counted.
Total Number who Accessed a Family Advocate. *
Question 8.  The number of children/young adults served in the community with FCSS funds in SFY 17 that ended up in out-of-home placement while involved in the FCFC Service Coordination Process.
Tip:  Count only the children/young adults provided with services or supports that were paid for with FCSS funds while they were in service coordination, and ended up in an out-of-home placement during the  service coordination process. (For purposes of this report, count each child/young adult who was placed out of home during service coordination only one time, regardless of the number of placement episodes that occurred for an individual child/young adult.)
Total number of children/young adults served with FCSS funds that ended up in out-of-home placement. *
Question 9. The number of families who exited FCFC Service Coordination during SFY 17.
Tip:  Pertains only to families who exited FCFC Service Coordination during SFY16 and for whom FCSS funds were used to provide services or supports to these families. Count the number of families who exited FCFC Service Coordination for whom FCSS funds were used during SFY 17. Count families who were considered successful and unsuccessful. Do not include families that exited service coordination prior to the family team’s collaborative development of the initial family plan (IFSCP). Do not count families who exited FCFC Service Coordination for whom no FCSS funds were used to support the family IFSCP.
Total number of families who excited Service Coordination. *
Question 10. The number of families who exited Service Coordination successfully during SFY 17 by accomplishing either at  least 75%, but less than 100% of the family goals on the family IFSCP; or 100% of the family goals on the IFSCP.
Tip:  Count all the goals that each family had on its IFSCP who exited Service Coordination during SFY 17. (Do not include goals that the family team deemed not appropriate for the family and were removed from the plan by the family team.) Then count the number of goals that the family completed and divide the number of completed goals by the number of total goals on the plan. This will produce the percent of goals completed successfully by that family.

After calculating the percent of goal completion for each family who exited, determine how many of those families fall into the following two categories of 75-99% goal completion and 100% goal completion.
Number of families completing 75% to 99% of IFSCP goals *
Number of families completing 100% of IFSCP goals *
Question 11. Report the number of children/young adults who were enrolled in FCFC Service Coordination that DID NOT receive FCSS funding during SFY 17.  
Tip: Count the number of  youth that were enrolled in FCFC Service Coordination that did not receive funding or services provided by FCSS funding.

Number of children/young adults enrolled in Service Coordination that DID NOT receive FCSS Funding. *
Thank you for completing the SFY 17 FCSS Annual Report. Once you submit your report you will receive an email confirmation, which will include a copy of your Annual Report.
A copy of your responses will be emailed to the address you provided.
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