Common use of Mental Health Screening and Assessment Clause in Contracts

Mental Health Screening and Assessment. The district is administering a screening tool for Temporary Assistance participants to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process Yes No (If No, section 6.2 is complete) If yes: Describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does the district use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? If using the MMS, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted by the screening result:

Mental Health Screening and Assessment. ‌ The district is administering a screening tool for Temporary Assistance participants to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process Yes No (If No, section 6.2 is complete) If yes: Describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does the district use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? If using the MMS, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted by the screening result:

Mental Health Screening and Assessment. ‌ The district is administering a screening tool for Temporary Assistance participants to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process Yes No (If No, section 6.2 is complete) If yes: Describe , describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does , does the district use or intend to use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? Yes No If using the MMSyes, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted by the screening result:

Mental Health Screening and Assessment. The district is administering a screening tool for Temporary Assistance participants to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process Yes No (If No, section 6.2 is complete) If yes: Describe , describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does , does the district use or intend to use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? Yes No If using the MMSyes, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted by the screening result:

Mental Health Screening and Assessment. ‌‌ The district is administering a screening tool for Temporary Assistance participants to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process Yes No (If No, section 6.2 is complete) If yes: Describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does the district use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? If using the MMS, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted by the screening result:

Mental Health Screening and Assessment. The district is administering a screening tool for Temporary Assistance participants to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process process. Yes No (If No, section 6.2 is complete) If yes: Describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does the district use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? If using the MMS, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted by the screening result:

Mental Health Screening and Assessment. ‌ The district is administering a screening tool for Temporary Assistance participants to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process Yes No (If No, section 6.2 is complete) If yes: Describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does the district use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? Yes No If using the MMS, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted by the screening result:

Mental Health Screening and Assessment. The district is administering a screening tool for Temporary Assistance participants participant s to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process Yes No (If No, section 6.2 is complete) If yes: Describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does the district use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? If using the MMS, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted wa rranted by the screening result:

Mental Health Screening and Assessment. ‌ The district is administering a screening tool for Temporary Assistance participants to help determine whether a referral for a mental health evaluation is warranted, in addition to screening for a disability that occurs as part of the application or disability determination process Yes No (If No, section 6.2 is complete) If yes: Describe the district’s policy for determining when a program participant is offered a mental health screen. If yes: Does the district use the LDSS 5009 - Mental Health Screening Tool and/or the computer assisted version of the Modified Mini Screening tool (MMS)? Yes No If using the MMS, indicate the district’s cutoff score (7, 8 or 9) for referral to a mental health evaluation: If using a screening tool other than the MMS, indicate the screening tool used: Describe the district procedure for referring a participant for a mental health evaluation, when warranted wa rranted by the screening result: