PCAP ASI Coding and Interview Tips
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![PCAP ASI Coding and Interview Legend: [CA]: Canadian Term [T]: for presenting questions [P]: Penelope forms General Information The most recent version is: 07/13/2013 Unless otherwise noted, where](/docs-images/79/79069703/images/1-0.jpg "appropriate, code items: -7 = Question not answered, client doesn't know, doesn't understand -8 = Question not applicable -9 = Question never asked Intake ASI - PART A GENERAL Client #: [P]: PCAP ID=")
1 PCAP ASI Coding and Interview Legend: [CA]: Canadian Term [T]: for presenting questions [P]: Penelope forms General Information The most recent version is: 07/13/2013 Unless otherwise noted, where appropriate, code items: -7 = Question not answered, client doesn't know, doesn't understand -8 = Question not applicable -9 = Question never asked Intake ASI - PART A GENERAL Client #: [P]: PCAP ID= site number + client number GC. Advocate #: [P]: Not required for Penelope GD. Referral Code [P]: 01- CFS (Child and Family Services) 02- Self-Referral 03- Alberta Health Services Addictions and Mental Health 04- Other PCAP program 05- Other clients 06- Medical professional 07- Community program (non-pcap) 08- Family/Friend 09- Justice System G15a. Zip code of client [CA]: Postal code G17. Race For clients who are Metis, select BOTH a. Am/Can Indian and g. White. For clients who are Inuit, select h. Other. G17. Enrolled in a tribe? [CA]: Treaty Status? Name of Tribe(s) G19. Is client enrolled in PCAP under a Child Protective Services (CPS) contract condition? [CA]: Name of Band? [CA]: CFS Updated: 04/04/2015 1
2 PCAP ASI Coding and Interview MEDICAL M5. Do you receive a pension for a physical disability? Includes AISH (if for a physical disability-assured Income for the Severely Handicapped), Medical Income Support, PDD (Govt. of Alberta-Persons with Developmental Disabilities), Benefits for Medical Disabilities (Govt. of Canada) EMPLOYMENT/SUPPORT STATUS E6. How long was your longest [T]: Ease into the question by first asking client if they full-time job? have had a job in the past or by asking if they have any skills in the trades. E13.Unemployment Employment Insurance (EI) compensation E14. Welfare [CA]: Income Support (Alberta Works) E14a. Food Stamps Code -8, N/A E15. Pension, benefits or social AISH, PDD, Child Tax, GST cheques, Universal Child Care security (Pensions for disability, [CA]: SSI = CPP (Canada Pension Plan) SSI, worker s comp) E15a. Tribal benefits [CA]: Band benefits RARE; For one-time payouts from client s Band, list E16. Mate, family or friends (cash) Money for personal expenses, pocket money ALSO Irregular sources of income Settlements, legal gambling, income tax refund under E16. as Irregular sources of income Includes child support, payouts from a client s Band ALCOHOL/DRUGS D3-D12a. Check with local drug unit or other local resources for drug street names; Names vary by region. LEGAL STATUS L3. Shoplifting/Vandalism [CA]: Mischief L4. Parole/Probation Violations Breach of conditions ex. Fail to Comply, Fail to Attend Court, Fail to Comply with Recognizance, Parole violations L5. Drug Charges Trafficking, Possession Updated: 04/04/2015 2
3 PCAP ASI Coding and Interview L6. Forgery [CA]: Fraud (Over/Under, Use of a Forged Document, etc.) L8. Burglary/Larceny/Breaking & Entering There are no charges of Burglary or Larceny in Canada. Crimes against property LEGAL STATUS (CONT.) L9. Robbery Crimes against a person L12. Rape/Sexual Assault There are no charges of Rape in the Canada. L13. Homicide/Manslaughter [CA]: First or second degree murder/manslaughter L14. Prostitution [CA]: Solicitation, Communication for the Purposes of Prostitution (men more commonly charged) L15. Contempt of Court [CA]: Obstruction of Justice L20. Major driving violations Driving without insurance/a license, dangerous driving ( Reckless Driving ), Impaired Driving L26a. Is client currently in jail/prison? Remanded For more information see the Criminal Code: FAMILY HISTORY (none) CHILDHOOD HISTORY C3. Was CPS involved? [CA]: CFS C8. As a child, were you ever [T]: Ask C9 before C8 raped? For C8, ask Under the age of 18, were you ever forced C9. As a child, were you ever to have sexual intercourse when you didn t want to sexually used or molested in any way besides rape? FAMILY/SOCIAL STATUS (none) PSYCHIATRIC STATUS P3. Do you receive a pension for a psychiatric disability? Can include AISH FAMILY PLANNING & OTHER CHILDREN (none) COMMUNITY SERVICES S7. Public Housing [CA]: Subsidized housing S8. Emergency Housing Drop-in shelters for clients that are homeless Updated: 04/04/2015 3
4 PCAP ASI Coding and Interview Domestic violence temporary shelters would fall under S13. Domestic violence services S18. Are you currently receiving Medical benefits through Income Support medical coupons or Medicaid? S20. Are you currently receiving Code -8, N/A food stamps? COMMUNITY SERVICES (CONT.) S21. Are you currently enrolled Code -8, N/A in the WIC program? S22. CPS (Child Protective [CA]: CFS Services) S25. 5 community college 2 year college program, diplomas NAIT/SAIT GENERAL INFORMATION (none) Intake ASI - PART B TARGET CHILD (TC) INFORMATION TC9. Was baby discharged from hospital when mom was, or did s/he have to stay longer in the hospital? Was s/he transferred to a special medical facility? 0 No problems, baby discharged - normally 1 No special facility, but spent up to 2 rare weeks in the hospital of delivery 2 No special facility, but spent more than rare 2 weeks in the hospital of delivery 3 Went to a pediatric interim care facility ie. NICU (Neonatal intensive care unit) 4 Went to a Children s Hospital specialized medical treatment centre beyond NICU; transfer from original hospital to another facility 5 Went to some other facility - 6 Other - TC11a. If CPS involved, what is the involvement? [CA]: CFS 1 Investigation Assessment 2 Voluntary contract/services Custody agreement 3 In home dependency Family Enhancement Act 4 Out of home dependency TGO (Temporary Guardianship Order) 5 Parental rights terminated PGO (Permanent Guardianship Order) Updated: 04/04/2015 4
5 PCAP ASI Coding and Interview 6 Parental rights relinquished Adoption, private agreement 7 Third-party guardianship Kinship 8 Dependency dismissed Emancipated adult TC11b. If target child is Native American, is the Tribe involved? [CA]: First Nations [CA]: Band ALCOHOL/DRUG USE DURING PREGNANCY (none) Updated: 04/04/2015 5
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