Josephine County System of Care (SOC) Barrier Form

Josephine County

System of Care (SOC)

Barrier Form

Josephine County System of Care can help if you are...

a youth, parent/guardian, family member, provider or advocate living or working in Josephine County

and

you experience barriers or blocks while getting services from child-serving agencies like:

Today's Date

1. How would you categorize this barrier or block?

(please check one)

Services and Supports (access and quality)

Child and Family Team Meeting (process, protocol, and functioning)

Roles and Responsibilities (who does what, collaboration, follow through)

Legal Mandates

Policies and Procedures (laws, state and agency rules)

Cultural and Linguistic Responsiveness (language access, cultural consideration)

other category (if not listed above)

2. Tell us about the barrier or block you or your family has experienced.

3. Tell us what your recommendations are for this barrier or block.

For example, what would resolve this barrier, what agencies and/or systems do you think should be involved, etc.

4. How do you describe your role?

Child/youth receiving services

Parent/Guardian of a child/youth receiving services

Family member/support person of a child/youth receiving services

Professional/Service Provider

Peer/Advocate

other role (if not listed above)

5. Which services/systems do you represent or are involved with?

Check all that apply

Child Welfare

Coordinated Care Organization (CCO)

Education

Intellectual/Developmental Disabilities

Juvenile Justice

Mental Health

Oregon Youth Authority

Tribal Community/Representative

Youth or Family Peer/Advocate

other service/system (if not listed above)

Would you like to receive follow up regarding this barrier resolution?

If you would like the System of Care to contact you in regards to this barrier or block, please list your name and contact information below.

Your contact information:

Send me a copy of my responses