Douglas System of Care Children and Youth Barrier Reporting

Douglas System of Care

Children and Youth Barrier Reporting

A barrier is an obstacle to needed services or resources, this may also include hurdles between systems, or organizations, that make it more difficult for youth and families to get their needs met.

Tell us about the child or youth this barrier affects

Provide Information about the child, youth, or adolescent that experienced the barrier

**Please note: It may not be possible to address all barriers each month. This process is not intended to address urgent or crisis situations. This form does not replace the formal grievance process that exists for CCO providers and system partners.

Please select the age of the youth/adolescent this barrier affects*

0-5

6-11

12-17

18-26

Where does this youth live*

Select or enter value

Is this barrier affecting more than one youth, child, or adolescent?*

Select yes if you would like to provide information about the age ranges of other children, youth, or adolescents that may be affected by this barrier

Yes

Ages of the additional youth*

If you are submitting this form for multiple youth/adolescents, please select all applicable ages

0-5

6-11

12-17

18-26

Please tell us more about the barrier

Information about what barrier and how it created obstacles for this child, youth, and/or adolescent will help the System of Care understand what it should focus on improving.

Please provide a description of the barrier to help us understand what happened:*

Tell us more about the barrier that the child/youth/adolescent experienced, with as much detail as possible.

How would you categorize the core issues contributing to this barrier?*

Availability of Services (eligibility, access, setting, location/distance, gaps, cost, or funding/coverage)

Health Equity & Cultural Responsiveness (cultural, religious, linguistic, identity, etc.)

Policies & Procedures (systems or agency-specific)

Partnerships with Families and Youth (interactions or engagement with families, children, youth, or community)

Quality of Care (unhappy with the experience, care, or services received)

State or Federal Rules (FERPA, HIPAA, laws, rules or policies)

System Collaboration (problems with accountability, coordination, or communication)

Difficulties with Basic Needs (education, housing, transportation, childcare, food)

Please provide a recommendation to resolve or remove this barrier*

Recommendations may include ideas and/ or suggestions to resolve the barrier or outcomes you would hope to see for resolution.

Submitter Information:

Please provide information about yourself:

Please specify your role

Submitter Email*

Would you be willing to present this barrier to the System of Care Advisory Committee?

Yes

Would you like to hear back about what happened after reviewing this barrier with the System of Care?

Please let us know if you would like us to tell you what was done to address this barrier.

You are not required to provide your contact information. If you would like us to communicate with you about this barrier in the future, we will need your name and contact information to follow up.

Yes

Submitter Name

You are not required to share your name.

Are you interested in becoming a member of the System of Care Advisory Committee?

Yes

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