1. 1 Narration Standards Seniors & People With Disabilities 02/2006

2. 2 Why Should You Narrate?  It provides a business and historical record  It demonstrates professional accountability  Narratives serve as a quality assurance tool  To assist with caseload management

3. 3 Narration is YOUR responsibility  Narration is a chronological record of any contact or action that affects an individual’s benefits or situation  IF IT’S NOT NARRATED, IT DIDN’T HAPPEN!!!

4. 4 Narration should be done regularly!!  Narrate at the time of contact or activity – or at least within 3 days  Narration may be a summary of a day’s contacts

5. 5 Narration should be…  accurate, descriptive, concise and complete so that others can understand the case and worker actions. Each entry should address Who, What, When, Where, How and if applicable, Why.

6. 6 An Example  07/10/03 PC FROM A/R. EVERYTHING SAME. What’s wrong with this narrative? Too brief. Without other reference, this doesn’t explain anything. Be careful of using acronyms. Will others know what they mean? Uses all capitals

7. 7  Narratives should be checked for proper grammar, good spelling, appropriate punctuation, and should use Sentence Case & agency- acceptable acronyms and abbreviations.

8. 8  Think about what you want to say BEFORE you write  Be careful of run-on or incomplete sentences  Before you save it -- do a spell-check & make sure it’s the correct client!

9. 9  Use the narrative to describe any changing data in the case file (new address or work income, for ex) and when the change took place (i.e effective date)

10. 10 An Example  01/05/04 Client came into the office “reeking” of alcohol. She constantly drinks too much and I told her she was going to have to stop if she expected to continue receiving her benefits. What’s wrong with this narrative? Worker opinion and bias Inappropriate use of quotations

11. 11  Narration must be objective, factual and free from personal bias, comments, or emphasis. Quotations are only used to reflect direct client statements.

12. 12  DON’T write your opinions  DO write your observations  DON’T editorialize

13. 13 Don’t make more work for yourself…..  You don’t need to narrate basic facts that are elsewhere in ACCESS.  Don’t duplicate things like birth date, SSN, age, etc.  Don’t duplicate what’s in the Comments section of CA/PS  Be brief and to the point

14. 14  Document mathematical calculations and how eligibility decisions were made

15. 15 Narrations of income should include:  Itemized description of income sources  If there is anticipated income: –How income was determined & for what period  Employer/payer information  How pay-in/client fee was determined

16. 16  Narrations must be done at application, at redetermination and whenever changes occur.

17. 17 ALWAYS NARRATE  MAJOR MILESTONES –Initial Contact –Ongoing contacts –Actions, decisions, & next steps –Transfers –Closing/Death

18. 18 Narration or CA/PS Comments?  NARRATION is a permanent legal record –Use narrative to tell the overall story –Refer to CA/PS sections as needed  CA/PS COMMENTS document and substantiate what information was provided to the assessor. CA/PS Comments support the Need Level for the ADL/IADL.

19. 19 Does medical information belong in narratives?  Yes. It’s appropriate to narrate any medical information that is necessary or essential to the eligibility decision  Use the narrative to address any change of client status or care plan due to changes in medical condition  Medical information relevant to a client’s service request or needs should be put in CA/PS. Also use CA/PS for diagnoses, medications, etc.

20. 20 Narration should include..  WHO was seen, contacted, initiated the contact?  WHAT was the purpose of the contact?  WHEN & WHERE did the contact take place?  WHAT changed? WHAT’S next?  WHAT & WHY were actions taken? WHEN are they effective?  WHAT is the plan? WHAT follow-up is needed?  HOW were decisions determined?

21. 21 Is anything NOT included in narrative?

22. 22 An example  09/15/03 TC from client’s sister, Mary. She says client’s boyfriend, Joe Blow, sexually assaulted the client last night. I told her to call the police and then I reported this to APS What’s wrong with this narrative? Complainant & perpetrator are named. Alleges facts that may not be true

23. 23  Protective Services issues, including domestic violence, should be limited to your observations, documentation of referral and case assignment information –Specific details and the outcome of the referral should be excluded

24. 24 Protective Service Narration  NEVER put the name of the complainant or witnesses in the narrative  DO NOT make any accusations about alleged perpetrators  DON’T speculate about whether abuse has happened  DO narrate referrals to MDT and the resulting outcome or recommendations

25. 25 HIV/AIDS  Do NOT enter HIV status into ACCESS narrative since it is a shared system

26. 26 Mental Health/Alcohol & Drug Issues  Only a qualified professional can assess and diagnose addiction or mental illness. Do not make any assumptions or offer any opinions about the client’s condition. Do write about your objective observations.  If the client self-discloses his/her diagnosis or treatment, document the conversation accurately & objectively, being careful NOT to add your own conclusion.

27. 27 Some examples  “Client states she started drug rehab at XYZ on this date”  “I smelled alcohol on his breath”  “Client diagnosed with schizophrenia by Dr. Black. See medical report”  “Client demonstrated outbursts and was shouting obscenities”

28. 28 Who Should Narrate?  All ADS or District Center staff working on an open case who become aware of changes in the client’s circumstances or information must document this in ACCESS narrative. This includes: –I & A Staff –Case Managers –Activities Staff –Supervisors

29. 29 Who else narrates?  Protective Service and Public Guardian staff will narrate all formal referrals for their services. –Documentation in ACCESS narrative will include date of referral and staff assigned to the case.  Helpline staff will narrate all calls that may impact care planning. –If a call concerns a case not open, document in screening or refer to the appropriate Service Screener.

30. 30 Remember…..  The narrative is a permanent and public record. Clients have the right to see their own narratives.  Write all narratives as though others will read them!!

31. 31 When narrating, ask yourself  Is this information reflected elsewhere?  Would someone else picking up this file know what happened?

32. 32 Some helpful tips:  Work on your narration while you’re on hold, while talking to clients on the phone, while waiting for forms to print, etc.  Schedule time to narrate  Don’t put it off more than a day or so, or you’ll forget what you need to write!