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TERM Providers

TERM is an acronym for Treatment and Evaluation Resources Management, a mental health program developed under the direction of the County of San Diego Board of Supervisors and operated by Optum through a contract with County of San Diego HHSA Behavioral Health Services. The mission of the TERM program is to improve the quality and effectiveness of mental health services provided to clients served by the Dependency and Delinquency systems. Optum is responsible for contracting providers to the TERM network who have competence in evaluating and treating clients referred for child maltreatment or delinquency concerns. Optum also provides quality oversight of treatment plans and evaluation reports prepared for these clients.

This page is utilized by providers on the TERM specialty network to obtain documents and related materials needed for their work with Child Welfare Services and Probation clients.

Applications

0_Instructions_and_FAQs_Credentialing_and_Contracting_6.29.18.docx
2018-07-10
1 Credentialing Application
2019-05-07
1.1 Credentialing Criteria (pdf)
2020-01-30
2 TERM Therapist Clinical Application (docx)
2019-05-06
3_TERM_Therapist_Specialty_Addition_Application_6.29.18.docx
2018-07-11
4 TERM Evaluator Clinical Application (pdf)
Revised 12/24/2019 2019-12-27
5 TERM Evaluator Specialty Addition Application (pdf)
Revised 12/24/2019 2019-12-27
6_Writing_Sample_Packet_Psychological_Evaluations.pdf
2018-07-10
7_TERM_PROVIDER_APP_Writing_Sample_Packet_07.03.18.docx
2018-07-12
NEW REQUIREMENTS FOR ADDING AND MAINTAINING OPTUM TERM PANEL CLINICAL SPECIALTIES (pdf)
EFFECTIVE JULY 1, 2018 2018-06-22
New Applications in Process (pdf)
2018-06-26
Optum_TERM_Intern_Evaluator_Application_08.07.18.docx
2018-08-29
Optum_TERM_Therapy_Intern_Application_08.07.18.docx
2018-08-29
TERM Panel Speciality Criteria (pdf)
2018-06-22
W9 - Blank (pdf)
2017-11-02

Communications

TRES_III__Provider_Tip_Sheet.pdf
2018-05-25
Recovery_and_Resiliency_Toolkit.pdf
2018-05-25
Important_TERM_Historical_Document-Original_CAO_Reponse_to_Board_of_Supervisors_on_Development_of_TERM_Program.pdf
2018-05-25
2013 APA Guidelines for Psychological Evaluations in Child Protection Matters (pdf)
2013 APA Specialty Guidelines for Forensic Psychology (pdf)
False Claims Act HHSA (pdf)
2016-05-11
NEW REQUIREMENTS FOR ADDING AND MAINTAINING OPTUM TERM PANEL CLINICAL SPECIALTIES (pdf)
EFFECTIVE JULY 1, 2018 2018-06-22
OPTUMIST Newsletter - Winter 2020 (pdf)
2020 2020-02-03
OPTUMIST Newsletter Spring 2019 (pdf)
2019-05-06
OPTUMIST Newsletter Summer 2019 (pdf)
2019-08-12
OPTUMIST_Newsletter_Fall_2019_(pdf)
2019-11-01
Optum TERM: Important Updates to TERM Handbook (pdf)
Memo - 08/13/2019 2019-08-14
TERM Panel Speciality Criteria (pdf)
2018-06-22
TERM Therapy Referral Process - Supporting Timely Access to Care (pdf)
2018-06-25
Therapeutic Behavioral Services Prior Authorization Request & Referral Process (pdf)
Memo - August 9, 2019 2019-08-09
Training Opportunity: Human (Sex) Trafficking/Commercial Sexual Exploitation of Children 101 (pdf)
Event - Friday January 24, 2020 - Flyer 2019-12-12
Workflow for CWS Therapy Referrals (pdf)
2018-04-30

Forms

TERM_Provider_Complaint_Form_for_Professional_Partners.pdf
2015-10-09
Child_Physical_Abuse_Treatment_Intake_Assessment.docx
Child_Physical_Abuse_Treatment_Quarterly_Report.docx
TERM_Grievance_Procedures_and_Complaint_Form_Arabic.pdf
2018-05-25
TERM_Grievance_Procedures_and_Complaint_Form_English.pdf
2018-05-25
TERM_Grievance_Procedures_and_Complaint_Form_Spanish.pdf
2018-05-25
TERM_Grievance_Procedures_and_Complaint_Form_Tagolog.pdf
2018-05-25
TERM_Grievance_Procedures_and_Complaint_Form_Vietnamese.pdf
2016-05-11
04-178_Youth_Evaluation_Questions_-_Diagnostic_Clarification_and_Treatment_Recommendations.pdf
2016-09-30
04-178_Youth_Evaluation_Questions_-_Adoption_Evaluation.pdf
2016-09-30
04-178_Parent_Evaluation_Questions_-_Prospective_Adoptive_Parent.pdf
2016-09-30
04-178_Parent_Evaluation_Questions_-_FC_7827.pdf
2016-09-30
04-178_Youth_Evaluation_Questions_-_Emotional_Damage_Evaluation.pdf
2016-09-30
04-178_Parent_Evaluation_Questions_-_Diagnostic_Clarification_and_Treatment_Recommendations.pdf
2016-09-30
CWS_Form_04-182_DV_Victim_Intake_Assessment.dot
2016-09-30
CWS_Form_182A_DV_Victim_Quarterly_Progress_Report.dot
2016-09-30
CWS_Treatment_Plan_Form_04-176-177-Parent.dot
2016-10-11
CWS_Treatment_Plan_Form_04-176-177-Youth.dot
2016-10-11
CWS_Form_04-183A_Sexual_Abuse_Protection_NPP_Quarterly_Progress_Report.docx
2017-02-06
Foster_Youth_Bill_of_Rights.pdf
2017-03-29
CWS_Temporary_Change_of_Authorization.pdf
2017-10-16
CWS_Form_04-183_Sexual_Abuse_Protection_NPP_Intake_Assessment.dot
2017-12-26
TERM_Partner_Contacts_11_27_17.pdf
2018-01-04
CWS Mental Health Assessment Form (docx)
2019-01-24
TERM Training 3-1-19 Flyer (pdf)
2019-01-17

DV Victims Group Treatment

DV_Standards_-_Assessment_Tools.pdf
2018-05-25
DV_Standards_-_Documentation_Requirements.pdf
2018-05-25
DV_Standards_-_Mandatory_Assessment_Screening_Tools_Scoring_Sheet.pdf
2018-05-25
DV_Standards_-_Safety_Plan_Guidelines.pdf
2018-05-25
DV_Victim_Group_Provider_Specialty_Criteria_Form.pdf
2018-05-25
NDVH_-_Personalized_Safety_Plan.pdf
2018-05-25
TERM_DV_Victim_Group_FAQs.pdf
2018-05-25
TERM_DV_Victim_Group_Provider_Fall_'15_News_Blast.pdf
2018-05-25
TERM_DV_Victim_Group_Provider_Spring'15_News_Blast.pdf
2018-05-25
TERM_DV_Victim_Group_Provider_Summer'15_News_Blast.pdf
2018-05-25
DV_Standards_-_Group_Intake_Assessment_2015_-_Sample.pdf
2018-05-25
DV_Standards_-_Group_Quarterly_Progress_2015_-_Sample.pdf
2018-05-25
DV Standards - On Site Group Monitoring Tool (pdf)
2017-06-14
DV Victim Intake Assessment (04-182)
2016-09-30
DV_Victim_Group_Treatment_Standards_9_23_16.pdf
2016-09-30
Danger_Assessment_Update_Communication (pdf)
2019-10-29
Domestic Violence Victim Treatment Quarterly Progress Report (04-182A)
2016-09-30
NC State University Women's Center
2015-10-09
Optum TERM Expanded to Include Oversight of DV Group Psychotherapy (pdf)
2015-10-09

Manuals

Court_Testimony_in_the_Juvenile_Court_System.pdf
Delinquency_System_Legal_Process.pdf
Dependency_System_Legal_Process.pdf
Documentation_Requirements.pdf
Legal_Issues_Related_to_Therapy_and_Evaluations_for_CWS_Cases.pdf
Probation_Psychiatric_Evaluation_Referral_Form.pdf
2015-10-09
Probation_Psychological_Evaluation_Referral_Form.pdf
2015-10-09
Psychological_Evaluation_Procedures.pdf
San_Diego_Juvenile_Court_Procedure_to_Obtain_Authorization_to_Use_or_Disclose_Protected_Mental_Health_Information_for_Evaluations_of_Minor_in_Custody.pdf
Superior_Court_of_the_State_of_California_Order.pdf
CPY Document Subject 2015-10-09
The_Format_and_Required_Elements_of_a_CWS_Psychological_Evaluation.pdf
The_Format_and_Required_Elements_of_a_Juvenile_Mental_Competency_Evaluation.pdf
The_Format_and_Required_Elements_of_a_Probation_Psychological_Evaluation.pdf
CWS_Form_04-176A_Therapy_Referral_Form.pdf
2016-09-30
CWS_Form_04-178_Request_for_TERM_Appointed_Evaluator.pdf
2016-09-30
Initial Treatment Plan/Treatment Plan Update (04-176/04-177)
Specialized Optum TERM Panel Evaluations (pdf)
2019-01-28
TERM Provider Handbook (pdf)
Edition July 11, 2019 2019-08-09
TERM Treatment Plan Documentation Resources (pdf)
2018-01-24
TERM_Treatment_Plan_Documentation_Resources_030617.pdf
2017-03-13
TERM_Treatment_Plan_Documentation_Resources_09282016.pdf
2016-09-30
The_Format_and_Required_Elements_of_a_Probation_Psychiatric_Evaluation.pdf
2016-09-30

Quick References

Workflow_for_CWS_Therapy_Referrals_10_28_16.pdf
2016-10-31
April CWS Unit Roster (docx)
2019-04-09
CLSSD Contact List - Firm.xlsx
2018-02-01
Children’s Legal Services Vendor Invoicing Instructions (pdf)
2017-10-20
Dependency Legal Services Contact List (pdf)
2017-12-15
Dependency_Legal_Services_Invoicing_Instructions (pdf)
2017-12-15
Medi-Cal_CWS_Auth_Process_FAQ_10_28_16.pdf
2016-10-31
September 2019 ALPHA ROSTER (docx)
2019-09-13
September 2019 ALPHA ROSTER (xlsx)
2019-09-13
TERM Partner Complaint Contacts (pdf)
2017-11-30
TERM_Panel_Speciality_Criteria.pdf
2018-10-05

CSA NOP/NPP Treatment

CSA-NPP_Mental_Status_Form.pdf
2016-03-18
CSA-NPP Assessment Tools (pdf)
2019-03-14
CSA-NPP Documentation Requirements (pdf)
2019-03-14
CSA-NPP On Site Group Monitoring Tool (pdf)
2019-03-14
CSA-NPP Safety Plan Guidelines (pdf)
2019-03-14
CSA-NPP Scoring Sheet for Required Screening Tools (pdf)
2016-03-18
CSA-NPP Treatment Standards (pdf)
2019-03-14
CWS Form 04-183 Sexual Abuse Protection NPP Intake Assessment (dot)
2017-12-15
CWS Form 04-183A Sexual Abuse Protection NPP Quarterly Progress Report (docx)
2019-04-15

Psychological Evaluations

04-178 Youth Evaluation Questions – Emotional Damage Evaluation (pdf)
CWS Psychological Evaluation Resources 2017-03-20
04-178_Parent_Evaluation_Questions_-_Diagnostic_Clarification_and_Treatment_Recommendations.pdf
CWS Psychological Evaluation Resources 2017-03-20
04-178_Parent_Evaluation_Questions_-_FC_7827.pdf
CWS Psychological Evaluation Resources 2017-03-20
04-178_Parent_Evaluation_Questions_-_Prospective_Adoptive_Parent.pdf
CWS Psychological Evaluation Resources 2017-03-20
04-178_Youth_Evaluation_Questions_-_Adoption_Evaluation.pdf
CWS Psychological Evaluation Resources 2017-03-20
04-178_Youth_Evaluation_Questions_-_Diagnostic_Clarification_and_Treatment_Recommendations.pdf
CWS Psychological Evaluation Resources 2017-03-20
APA_Guidelines_for_Psych_Evals_In_Child_Protection_Matters.pdf
CWS Psychological Evaluation Resources 2017-03-20
APA_Speciality_Guidelines_Forensic_Psych.pdf
TERM Psychological Evaluation Resources 2017-03-20
CWS_Form_04-178_Request_for_TERM_Appointed_Evaluator.pdf
CWS Psychological Evaluation Resources 2017-03-20
Probation_Psychological_Evaluation_Referral_Form.pdf
Juvenile Probation Psychological Evaluation Resources 2017-03-20
Psych_Testing_Guidelines.pdf
TERM Psychological Evaluation Resources 2017-03-20
Psych_Testing_Request_Form_012016.pdf
TERM Psychological Evaluation Resources 2017-03-20
Psychological Evaluation QA Checklist (docx)
TERM Psychological Evaluation Resources 2017-04-19
Psychological_Evaluation_Procedures.pdf
TERM Psychological Evaluation Resources 2017-03-20
Sample_Psych_Testing_Request_Form_012016.pdf
TERM Psychological Evaluation Resources 2017-03-20
Specialized Optum TERM Panel Evaluations (pdf)
Juvenile Probation Psychological Evaluation Resources 2019-01-28
TERM Psychological Evaluation Handbook (pdf)
TERM Psychological Evaluation Resources 2017-09-08
The_Format_and_Required_Elements_of_a_CWS_Psychological_Evaluation.pdf
CWS Psychological Evaluation Resources 2017-03-20
The_Format_and_Required_Elements_of_a_Juvenile_Mental_Competency_Evaluation.pdf
Juvenile Probation Psychological Evaluation Resources 2017-03-20
The_Format_and_Required_Elements_of_a_Probation_Psychological_Evaluation.pdf
Juvenile Probation Psychological Evaluation Resources 2017-03-20

CWS Treatment Plans

CWS Form 04-176A Therapy Referral Form (pdf)
2017-05-03
CWS Treatment Plan Form 04-176-177 Youth (dot)
2017-05-03
CWS Treatment Plan Form 04-176-177-Parent (dot)
2017-05-03
Documentation Requirements (pdf)
2017-05-03
Legal Issues Related to Therapy and Evaluations for CWS Cases (pdf)
2017-05-03
TERM Treatment Plan Documentation Resources (pdf)
2018-01-24

CANS/PSC

CANS Instructions and Process (pdf)
06.18.2019 2019-06-19
CANS User Guide (pdf)
v1.0 July 2019 2019-09-16
CANS-PSC Completion Tip Sheet with link to Tools (pdf)
07.16.19. 2019-07-26