Nội dung toàn văn Circular 01/2015/TT-BLDTBXH guidance case management for disabled people
MINISTRY OF LABOUR, WAR INVALIDS AND SOCIAL AFFAIRS | SOCIALIST REPUBLIC OF VIETNAM |
No.: 01/2015/TT-BLDTBXH | Hanoi, January 06, 2015 |
CIRCULAR
GUIDANCE ON CASE MANAGEMENT FOR DISABLED PEOPLE
Pursuant to the Government’s Decree No. 106/2012/ND-CP dated December 20, 2012 defining the functions, tasks, powers and organizational structure of the Ministry of Labour, War Invalids and Social Affairs;
Pursuant to the Government’s Decree No. 28/2012/ND-CP dated April 10, 2012 elaborating and guiding the implementation of certain articles of the Disability Law;
Pursuant to the Decision No. 32/2010/QD-TTg dated March 25, 2010 by the Prime Minister giving approval for the Scheme for development of jobs for social works during 2010-2020;
At the request of Director of the Agency for Social Protection;
Minister of Labour, War Invalids and Social Affairs promulgates a Circular providing guidance on case management for disabled people.
Chapter 1
GENERAL PROVISIONS
Article 1. Regulated entities and scope
1. Regulated entities:
This Circular applies to officials, public employees, workers and collaborators in charge of social works, and social work service providers that get involved in support for people with disabilities and their families.
2. Scope:
This Circular deals with the case management for disabled people in social work service providers and communes/wards/towns (hereinafter refers to as "commune-level").
Article 2. Procedures for case management for disabled person
The case management for disabled person includes the following steps:
1. Collect information and needs of disabled person;
2. Formulate the plan to support disabled person;
3. Implement the plan to support disabled person;
4. Monitor the implementation of the plan to support disabled person;
5. Evaluate and terminate the case management for disabled person.
Article 3. Terms in this Circular
In this document, these terms are construed as follows:
1. Case management for disabled person is a process that determines needs of a disabled person requiring social support, formulate and implement the plan to support that disabled person, and coordinate social work services to assist that disabled person to stabilize his/her life and integrate with the community.
2. Case managers are officials, public employees, workers or collaborators who are in charge of social works and work at social work service providers or in communes/wards/towns and are assigned to take charge of case management for disabled person.
3. Social work service providers include: social work service centers, social protection establishments, social labour - education - medical treatment centers, medical centers for people who have rendered meritorious service to the country, children support centers, social shelters, establishments providing consulting and healthcare services to the elderly, disabled person, disadvantaged children, HIV/AIDS patients, people with mental disorder or drug addicts and other social support centers.
Chapter 2
CASE MANAGEMENT DUTIES
Article 4. Collecting information and needs of disabled person
1. Information about disabled person
a) Particulars about disabled person, including: Full name, date of birth, sex, marital status, residence, contact information and ID Card Number;
b) Occupation;
c) Level of education and professional qualifications;
d) Social support services and policies providing to the disabled person;
dd) Support needs sorted according to the order of priority of disabled person;
e) Income of disabled person.
2. Disability information
a) Type, severity and causes of disability;
b) Self-care ability in daily life of disabled person;
c) Physical and mental health conditions.
3. Information about family of disabled person
a) Number of family members;
b) Economic background;
c) Main sources of income, including: income from employment, monthly supports according social support policies and from other social support programs;
d) Expenditures for buying foods, clothes, tuitions, medical examination and treatment, and other expenditures, and family’s capacity to pay;
dd) Residence and living environment;
e) Family's ability to take care of disabled person;
g) Support needs sorted according to the order of priority;
h) Other information, if any.
Detailed information and needs of disabled person to be collected are provided in Template No. 1 enclosed herewith.
Article 5. Evaluating needs of disabled person
1. Case manager evaluates needs of disabled person in terms of the following sectors:
a) Livelihood support;
b) Health care;
c) Education, apprenticeship, employment;
d) Family and social relations;
dd) Life skills;
e) Community integration;
g) Psychology, sentiment;
h) Other needs.
2. In case a disabled person fails to provide sufficient information as required, the case manager shall coordinate with the family representative or the guardian to evaluate the needs of that disabled person.
Needs of disabled person to be evaluated are provided in Template No. 2 enclosed herewith.
Article 6. Formulating the plan to support disabled person
1. Based on the evaluation of needs of disabled person, the case manager defines the disabled person for case management according to the following criteria:
a) Need continued support;
b) Need long-term support;
c) Voluntary participation;
d) Meeting requirements for access to local case management services.
Criteria for defining a disabled person for case management is provided in Template No. 3 enclosed herewith.
2. Formulating the plan to support disabled person
The case manager takes charge and coordinates with the disabled person, his/her family or guardian and relevant entities to formulate the plan to support the disabled person. Contents of the plan to support disabled person:
a) Specific objectives need to be achieved;
b) Specific activities need to be carried out according to the order of priority to achieve the objectives;
c) Timeframe for each activity;
d) Required resources for planned activities;
dd) Responsibility of organizations, family and individual performing the plan, and person in charge of each duty;
e) Service providers participating in the plan implementation.
Details of the plan to support disabled person is provided in Template No. 4 enclosed herewith.
Article 7. Implementing the plan to support disabled person
1. Case manager is responsible for submitting the plan to support disabled person to the Chairperson of Commune-level People’s Committee or the head of the social work service provider for approval.
2. Case manager shall coordinate with Commune-level agencies/associations and social work service providers to assist the disabled person in implementing the plan. Contents requiring support include:
a) Provide advice and/or introduce the disabled person to competent agencies/units or healthcare, employment, education or social services providers and other establishments;
b) Transfer the disabled person or connect with competent agencies/units or healthcare, employment, education or social services providers and other establishments that meet needs of the disabled person;
c) Assist the disabled person in accessing to and receiving benefits from social support policies and programs;
d) Mobilize resources for implementing the plan to support disabled person.
3. Reporting results of the plan to support disabled person
a) Case manager is responsible for monitoring the implementation progress and reporting the results of the plan to support disabled person on a monthly, quarterly, semi-annual and annual basis;
b) Case manager shall verify and request the competent authority to modify or supplement the plan to support disabled person in conformity with needs of that disabled person;
c) Record implementation progress and submit consolidated report on the plan to support disabled person according to the Template No. 5 enclosed herewith.
Article 8. Monitoring, evaluating and finalizing the case management for disabled person
1. Case manager shall monitor and evaluate the plan to support disabled person according to the following contents:
a) Results of the plan to support disabled person;
b) The satisfaction of needs of disabled person;
c) Ability to live independently and capacity to integrate into community of disabled person;
d) The suitability of services provided to the disabled person;
dd) Ability to connect services;
e) Other related contents.
2. Case manager shall, based on the evaluation results of the plan to support disabled person, suggest terminating case management for disabled person and request the Chairperson of Commune-level People’s Committee or the head of the social work service provider to make decision.
3. Termination of case management
a) The case management for disabled person shall be terminated in the following cases:
- Objectives have been achieved; or
- Services provided to the disabled person are not suitable; or
- The disabled person fails to contact for 6 months or over; or
- The case management for disabled person is transferred to another case manager; or
- The disabled person moves out of the commune where case management service is provided; or
- The service provider finalizes the contract signed with the disabled person; or
- Relevant parties jointly agree upon the termination of service provision; or
- The disabled person is transferred to use another program with more suitable services; or
- The disabled person no longer needs to use service; or
- The disabled person died; or
- Other reasons;
The termination of case management for disabled person is made according to the Template No. 6 enclosed herewith.
b) The case manager shall report to the competent authority to hold a meeting with relevant agencies/associations/organizations, disabled person, his/her family or guardian to reach an agreement on termination of case management for disabled person.
c) Case manager, disabled person, his/her family or guardian and the Chairperson of Commune-level People’s Committee or the head of the social work service provider shall sign the written record of termination of case management for disabled person.
Article 9. Recording and retaining documents
1. Case manager must sufficiently and accurately record information about the case management process for disabled person.
2. Documents about case management for disabled person must be retained and kept secret at in-charge unit in accordance with current regulations of the law on archives. Sharing particulars about the disabled person requires the consent of that disabled person, his/her family or guardian and the Chairperson of Commune-level People’s Committee or the head of the social work service provider.
Chapter 3
IMPLEMENTATION
Article 10. Responsibility of People’s Committee of levels
1. Each People’s Committee of province or city shall instruct Provincial Department of Labour, War Invalids and Social Affairs to cooperate with relevant departments/boards/regulatory bodies of that province or city in:
a) Instructing and inspecting case management for disabled people in the province or city;
b) Submit semi-annual, annual and irregular consolidated reports on the reality and results of case management for disabled people in the province or city;
c) Organize training and drilling courses to improve professional capacity and skills in case management for disabled people for officials, public employees, workers and collaborators in charge of social works.
2. District-level People’s Committees
a) Organize the performance of case management for disabled people in district;
b) Submit semi-annual, annual and irregular consolidated reports on the reality and results of case management for disabled people in district.
3. Commune-level People’s Committees
a) Organize the performance of case management for disabled people in commune/ward/town;
b) Instruct case managers to formulate and implement plans to support disabled people;
c) Annually, formulate plans and estimate expenditures for case management for disabled people in commune/ward/town in accordance with prevailing regulations;
d) Submit semi-annual, annual and irregular consolidated reports on the reality and results of case management for disabled people in commune/ward/town.
Article 11. Responsibility of social work service providers
1. Organize the performance of case management for disabled people within their management;
2. Organize training and drilling courses to improve professional capacity and skills in case management for disabled people for officials, public employees, workers and collaborators in charge of social works;
3. Annually, formulate plans and estimate expenditures for case management for disabled people in commune/ward/town in accordance with prevailing regulations;
4. Submit semi-annual, annual and irregular consolidated reports on the reality and results of case management for disabled people performed by social work service provider;
5. Organize and instruct the performance of case management for disabled people in commune/ward/town.
Article 12. Effect
1. This Circular shall come into force as from February 20, 2015.
2. Any difficulties that arise during the implementation of this Circular should be promptly reported to the Ministry of Labour, War Invalids and Social Affairs for consideration./.
| PP. MINISTER |
FORM NO. 01
COLLECTION OF INFORMATION AND NEEDS OF DISABLED PERSON
(Enclosed to the Circular No. 01/2015/TT-BLDTBXH dated January 06, 2015 by Ministry of Labour, War Invalids and Social Affairs providing guidance on case management for disabled people)
Full name of disabled person: ……………………………………………….
Code of disabled person: ……………………………………………….
Belong to the group of disabled people (Put x mark in square box (□)):
a) Children □ b) People with disabilities (16-60 years old) □ c) Disabled people aged above 60 □
Disabled person file number at local area: …………………………………………………………. | Case management file number: ………….. |
Name of substitute information provider (if any): …………………………………………………………. | Relationship with disabled person: ………………………………………… |
I. Particulars about disabled person
Full name: ………………………….. Date of birth: ………………….. Sex: .................................. ID number: ………………. Issued date: ………………. Issuing authority: ………………. Contact address: ……………….……………….……………….……………….………………. Telephone number: ………………. Email: ……………………………………………………. Marital status: ……………….……………….……………….………….……………….………………. Level of education: …………………… Professional qualification: …………………………… School (if the disabled person is studying): ……………….……………….……………….……………….……………….………………. Occupation (if the disabled person is in employment): ……………….……………….……………….……………….……………….… Income of disabled person: ………………………………………………. Services and policies from which the disabled person receives benefits: …………………………………… …………………………………………………………………………………………………………… Support needs sorted according to the order of priority of disabled person: …………………………………… …………………………………………………………………………………………………………… |
II. Disability information
Typical type of disability: …………………………………………………………………………… Severity of disability (if it is defined): ……………………………………………………………… Causes of disability: Congenital □ Accident □ Disease □ Other □ Features of disability: ………………………………………………. …………………………………………………………………………………………………………… Working capacity: …………………………………………………………………………………… Self-care ability in daily life of the disabled person: …………………………………….. …………………………………………………………………………………………………………… Physical and mental health conditions, sentiment of disabled person: ………………………………………………. …………………………………………………………………………………………………………… |
III. Information about family of disabled person
Full name of householder: ………………………….. Relationship with disabled person: ………………… Permanent residence: ……………………………………………… Telephone: …………………….. Full name of caregiver: ………………… Relationship with disabled person: .………………… Main job of caregiver: …………………………………………………………… …………………………………………………………………………………………………………… Family members (give detailed information): ………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… Position of disabled person in the family: ……………. Defendant □ Independent □ 1. Family’s economic background: Poor □ Near poor □ Not poor □ 2. Sources of income: a) Laborers: Number of main income earners: …………………………………………………………. b) Income from employment: In cash ………………………………. In kinds: ……………………… c) Monthly financial support from the government: ………………………………………………… d) Other social support programs: ………………………………………………………… …………………………………………………………………………………………………………… 3. Expenditures and family’s capacity to pay: ……………………………………………… a) Foods/foodstuffs □ Capable of paying □ Capable of paying but need support □ Incapable of paying □ Not identified b) Clothing □ Capable of paying □ Capable of paying but need support □ Incapable of paying □ Not identified c) Medical examination and treatment □ Capable of paying □ Capable of paying but need support □ Incapable of paying □ Not identified d) Tuition expenditures □ Capable of paying □ Capable of paying but need support □ Incapable of paying □ Not identified dd) Other expenditures: …………………………………………………………………………………… …………………………………………………………………………………………………………… 4. Accommodation conditions: a) Rented house □ Shelter □ Semi-permanent house □ Permanent house (grade of house: ) Degraded □ Stable □ b) Convenient for daily activities of the disabled person: Passageways □ Restroom □ Floor of house □ 5. Ability to take care of disabled person: a. Care: A lot of care □ Not much □ None □ b. Care environment: Safe and clean □ Have problems □ High risk □ c. Capacity for care (Have knowledge and skills in caring for disabled person): Thorough □ Basic □ None □ 6. Support needs sorted according to the order of priority of disabled person: …………………………………… …………………………………………………………………………………………………………… 7. Other information 9if any): …………………………………………………………………………… …………………………………………………………………………………………………………… |
IV. Times of receiving case management service
Time ___: ……………………………..[date]
Form of receiving case management service: 1) Emergency □ 2) Long-term □ Date of receipt: ____________________ Place of receipt: _____________________________
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Recommending party Recommender/ case manager ______________________________ Head of unit: _________________ (signature and certification) | Reason: |
Receiving party Person receiving the case/ case manager _________________________________ Head of unit: _________________ (signature and certification) | Comments: |
FORM NO. 02
EVALUATION OF NEEDS OF DISABLED PERSON
(Enclosed to the Circular No. 01/2015/TT-BLDTBXH dated January 06, 2015 by Ministry of Labour, War Invalids and Social Affairs providing guidance on case management for disabled people)
Full name of disabled person: ……………………………………………….
Contents to be evaluated:
(For each specific case, the case manager shall, based on reality, evaluate the needs of disabled person in suitable aspects and put x mark in corresponding square boxes)
No. | Evaluation aspects | |
1 | Livelihood support | □ |
2 | Health care | □ |
3 | Education, apprenticeship, employment | □ |
4 | Family and social relations | □ |
5 | Life skills | □ |
6 | Community integration | □ |
7 | Psychology, sentiment | □ |
8 | Other needs | □ |
Date of evaluation: ………………….. Date of conclusion: …………………..
Evaluated by: ………………….. Signature: …………………………………………..
I. LIVELIHOOD SUPPORT
Family’s economic background: 1. Poor □ 2. Near poor □ 3. Not poor □
1. Sources of income
Earned by disabled person/ caregiver/ householder | Yes | No | Details (in cash and in kinds) |
Income from employment | □ | □ |
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Emergency financial support | □ | □ |
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Monthly financial support | □ | □ |
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Social support from state budget | □ | □ |
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Benefits from other social support programs | □ | □ |
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2. Expenditures
Capacity to pay Spending | Capable of paying (2 points) | Capable of paying but need support (1 point) | Incapable of paying (0 point) | Not identified (put x mark) |
Spending on foodstuff/ foods and subsistence expenses |
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Tuition fees |
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Medical expenses |
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Other payables |
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Total points |
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Evaluation results a) Capable (> 7 points) □ b) Partially capable (4 points – 6 points) □ c) Incapable (≤ 3 points) □ Evaluating capacity to pay expenditures with family’s sources of income: (The payment of expenditures for disabled person is given priority) …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… | ||||
3. Living environment
Evaluation level Aspects | Good (2 points) | Average (1 point) | Poor (0 point)
| Not identified (put x mark) |
Whether design/set up/arrangement of house/ devices in house is convenient for moving in house of disabled person or not |
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Whether design/set up/arrangement of house/ devices in house is convenient for moving outside the house of disabled person or not |
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Whether disabled person may access to and use restroom or not |
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The safety of sources of drinking water and domestic water |
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Security of house where disabled person is living |
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Total points |
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Evaluation results a) Suitable (> 8 points) □ b) Partially suitable (4 points – 7 points) □ c) Unsuitable (≤ 3 points) □ Comments: ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… | ||||
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II. HEALTH CARE AND MEDICAL SERVICES
1. Health status
Evaluation: a) Stable □ b) Have health problems □ c) High risk □ d) Not identified □ Description of symptoms and causes of disease (if point b/ point c/ or point d/ is applicable, give further explanation): ………………………………………………………………………………………………………… — ………………………………………………………………………………………………………… — ………………………………………………………………………………………………………… |
2. Provided health care and medical services
(Description of health care and medical services provided to disabled person within the last 3 months)
No. | Facility providing medical treatment and rehabilitation services | Name of disease | Inpatient/ outpatient treatment | Treatment period | Apply health insurance or not |
1 |
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2 |
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3 |
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4 |
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5 |
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Assessment of treatment results by disabled person/ his/her family or guardian:……… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… | |||||
II. EDUCATION, APPRENTICESHIP AND EMPLOYMENT
1. Education. (Applicable to disabled person who attends any of the following training courses)
With the attendance of disabled person | Yes | Name of class/ school |
Special education institution | □ |
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Family-scale group of children | □ |
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Preschool education | □ |
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Primary school | □ |
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Lower secondary school | □ |
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Upper secondary school | □ |
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College, higher education and post-graduate education | □ |
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Evaluation of study capacity
Evaluation point Activities | Capable (2 points) | Capable but need support (1 point) | Incapable (0 point) | Not identified (put x mark) |
Practice of life skills (communication, social interaction) |
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Identifying 24 letters of the alphabet |
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Writing full name and telephone of disabled person |
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Reading and understanding simple stories of grade 2 |
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Reading and understanding books (at least books of grade-4 level) |
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Solving word problems and basic operations |
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Reading and understanding newspapers or magazines |
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Writing reports/ letters |
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Total points |
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Evaluation results a) Capable (> 13 points) □ b) Partially capable (7 points – 12 points) □ c) Incapable (≤ 6 points) □ Comments on study capacity of disabled person: ………………………………………………. ……………………………………………………………………………………………………………… | ||||
2. Apprenticeship. (Applicable to disabled person of working age or caregiver if they are dependants)
Disabled person/ caregiver | Yes | No | Name of vocational training institution |
Provided with vocational training course | □ | □ |
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Provided with short-term vocational training course (career counseling and vocational training center) | □ | □ |
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Provided with professional vocational training course (Intermediate level or higher) | □ | □ |
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Evaluation of disabled person’s capacity to attend vocational training course
Evaluation point Activities | Capable (2 points) | Capable but need support (1 point) | Incapable (0 point) | Not identified (put x mark) |
Disabled person is capable of attending professional vocational training course |
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Disabled person is capable of attending short-term vocational training course |
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Disabled person is capable of self-learning |
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Disabled person has special skills |
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Total points |
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Evaluation results a) Suitable (> 7 points) □ b) Partially suitable (4 points – 6 points) □ c) Unsuitable (≤ 3 points) □ Comments on disabled person’s capacity to attend vocational training courses: ………………………………………………. ……………………………………………………………………………………………………………… | ||||
3. Employment
Disabled person/ caregiver | Yes | No | Working place or activity where disabled person may participate in |
Doing simple works, making contribution to family’s livelihood activities | □ | □ |
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Disabled person is employed or hired | □ | □ |
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Self-employed | □ | □ |
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Evaluation of job opportunities
Evaluation point
Activities | Capable (2 points) | Capable but need support (1 point) | Incapable (0 point) | Not identified (put x mark) |
Opportunity to find job |
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Having stable income from employment |
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Accessing to suitable working environment and conditions |
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Having ability to self-organize production/business activities |
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Total points |
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Evaluation results a) Suitable (≥ 7 points) □ b) Partially suitable (4 points – 6 points) □ c) Unsuitable (≤ 3 points) □ Comments on disabled person’s capacity of finding job or self-organizing production/business activities: ………………………………………………. ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… | ||||
IV. FAMILY AND SOCIAL RELATIONS
1. Disabled person has a private caregiver: a. Yes □ b. No □
2. Person making decisions in the family:
a. Father b. Mother c. Grandfather d. Grandmother dd. Other: …………….3. Attitude of family members toward disabled person:
a. Having cared for disabled person b. Normal c. Do not care
4. Support and relations of family members and community with disabled person
No. | Person giving support to disabled person | Determining person giving support to disabled person | Description of support level for disabled person | Description of support activities for disabled person |
1 | Spouse |
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2 | Parent |
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3 | Sibling |
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4 | Grandparent |
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5 | Relative |
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6 | Friend/neighbor |
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7 | Social work staff |
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8 | Social organization/ association |
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9 | Teacher |
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10 | Rehabilitation technician |
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11 | Healthcare staff |
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12 | Caregiver |
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13 | Other |
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Comments on good relations and relations need to be improved:
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V. LIFE SKILLS
Evaluation point
Activities | Capable (including use of assistive devices) (2 points) | Capable but need support from another person (1 point) | Incapable (0 point) | Not identified (put x mark) |
1. Move/ get around |
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2. Eat/ drink |
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3. Personal hygiene |
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4. Personal daily activities |
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5. Do family works |
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6. Listen and understand |
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7. Express desire |
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8. Study ability |
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Total points |
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Evaluation results: a) Live independently (> 15 points) □ b) Need support (7-14 points) □ c) Live dependently (<6 points) □ Comments on main features that influence on communication skills and daily activities of disabled person: ……………………………………………………………………………………………………………. …………………………………………………………………………………………………………….
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VI. COMMUNITY INTEGRATION
1. Disabled person under the age of 6
Participation level
Evaluation contents | Regularly (2 points) | Occasionally (1 point) | Never (0 point) | Not identified (put x mark) |
Participate in family activities |
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Participate in community and social activities with family |
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Participate entertainment activities with children of same age in community |
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Attend class by age at preschool |
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Total points |
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Evaluation results: a) Well participated (≥7 points) □ b) Limited (4 – 6 points) □ c) Have no chance (≤ 3 points) □ | ||||
Comments on participation in activities by disabled person: ……………………………………………. …………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………..
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2. Disabled person aged from 6 years old but under 16 years old
Participation level
Evaluation contents | Regularly (2 points) | Occasionally (1 point) | Never (0 point) | Not identified (put x mark) |
Participate in family activities |
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Participate in community and social activities with family |
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Make friends and participate in activities with friends of same age |
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Study at schools |
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Participate in Union/Team’s activities |
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Participate in favorite sports/arts activities |
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Total points |
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Evaluation results: a) Well participated (≥10 points) □ b) Limited (5 – 9 points) □ c) Have no chance (≤ 4 points) □ | ||||
Comments on participation in activities by disabled person: …………………………………………. ………………………………………………………………………………………………………………
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3. Disabled person aged 16 or over
Participation level
Evaluation contents | Regularly (2 points) | Occasionally (1 point) | Never (0 point) | Not identified (put x mark) |
Participate in family activities |
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Participate in community and social activities with family |
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Make friends and participate in activities with close friends |
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Study at schools |
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Participate in collective and community activities |
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Participate in favorite sports/arts activities |
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Total points |
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Evaluation results: a) Well participated (≥10 points) □ b) Limited (5 – 9 points) □ c) Have no chance (≤ 4 points) □ | ||||
Comments on participation in activities of disabled person: …………………………………………………………………………………………………………….. | ||||
VII. PSYCHOLOGY, SENTIMENT
No. | Evaluation contents | Disabled person | Caregiver | ||
Yes | No | Yes | No | ||
1 | Have optimistic spirit and life purpose | □ | □ | □ | □ |
2 | Sociable, know to care about and assist other people | □ | □ | □ | □ |
3 | Insomniac or sleeping soundly | □ | □ | □ | □ |
4 | Hot-tempered or becoming sluggish | □ | □ | □ | □ |
5 | Prolonged tiredness or fatigue | □ | □ | □ | □ |
6 | Feel useless or worthless | □ | □ | □ | □ |
7 | Ability to focus is reduced | □ | □ | □ | □ |
8 | Used to think of death, want to commit suicide or used to end life | □ | □ | □ | □ |
9 | Other difficulties …………………………………………….. | □ | □ | □ | □ |
| Comments on main contents that have positive and adverse impact on the life of disabled person: ……………………………………………………………………………… | ||||
VIII. SUMMARY OF EVALUATION RESULTS OF NEEDS OF DISABLED PERSON
No. | Evaluation aspects | Problem determined | Strengths of disabled person/ family | Needs of disabled person/ family | Consulting specialists | Priority |
1 | Essential livelihood background |
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2 | Health care and medical services |
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3 | Education, apprenticeship and employment |
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4 | Family and social relations |
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5 | Independent life skills |
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6 | Participation in community activities |
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7 | Psychology and sentiment |
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General assessment: …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… ……………………………………………………………………………………………………………
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Disabled person/ his/her family or guardian: ……………………………………………. | Case manager: ……………………………………………………….. |
Signature:
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Date of collecting information: …………. | Date of providing information: …………. |
FORM NO. 04
PLAN TO SUPPORT DISABLED PERSON
(Enclosed to the Circular No. 01/2015/TT-BLDTBXH dated January 06, 2015 by Ministry of Labour, War Invalids and Social Affairs providing guidance on case management for disabled people)
Province/City: ……………………………………………
District: ……………………………………………
Commune/ Ward: ……………………………………………
Full name of disabled person: ……………………………………………….
Code of disabled person: ……………………………………………….
I. Specific objectives need to be achieved
No. | Evaluation aspects | Level of priority (1, 2, 3) | Specific objective need to be achieved |
1 | Livelihood support |
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2 | Health care and medical services |
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3 | Education, apprenticeship, employment |
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4 | Family and social relations |
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5 | Life skills |
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6 | Community integration |
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7 | Psychology, sentiment |
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8 | Other needs |
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II. Support activities for disabled person
Objective number | Intervention/support activities | Performing period | Resource/ funding | Responsibility of relevant organizations, family and individual | Performing agency/ unit/ establishment |
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III. Support conditions:
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IV. Date of verifying and modifying the plan (at least 6 months)
1st modification (date) | 2nd modification (date) | 3rd modification (date) |
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Disabled person/ family representative/ guardian | Case manager | Chairperson of commune-level people’s committee or head of social work service provider |
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Date of formulating plan: |
Date of approval: |
FORM NO. 05
RECORDING THE PLAN IMPLEMENTATION PROGRESS
(Enclosed to the Circular No. 01/2015/TT-BLDTBXH dated January 06, 2015 by Ministry of Labour, War Invalids and Social Affairs providing guidance on case management for disabled people)
Full name of disabled person: ……………………………………………….
No. | Needs of intervention | Intervention/support activities | Period | Comments of agency/ unit/ establishment performing social intervention and support activities |
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| Case manager (Signature and full name) |
FORM NO. 06
TERMINATION OF CASE MANAGEMENT FOR DISABLED PERSON
(Enclosed to the Circular No. 01/2015/TT-BLDTBXH dated January 06, 2015 by Ministry of Labour, War Invalids and Social Affairs providing guidance on case management for disabled people)
Full name of disabled person: _____________ Time: ________________
1. Reasons for termination:
□ Objectives have been achieved
□ Services provided to the disabled person are not suitable
□ The disabled person fails to contact for 6 months or over
□ The case management for disabled person is transferred to another case manager
□ The disabled person moves out of the commune where case management service is provided
□ The service provider finalizes the contract signed with the disabled person
□ Relevant parties jointly agree upon the termination of case management service
□ The disabled person is transferred to use another program with more suitable services
□ The disabled person no longer needs to use service
□ The disabled person died
□ Other reasons (specify):
2. General assessment:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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Disabled person/ his/her family or guardian | Case manager | Chairperson of commune-level people’s committee/ head of social work service provider |
Signature:
| Signature:
| Signature: |
Date: | Date: | Date: |
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