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Follow the steps below when there are any indications that mental illness or chemical dependency could be impeding a participant in reaching employment goals.

Step 1: Screening

DHS has developed tools to screen for possible chemical or mental health problems:

· MFIP Self Screen (See links below.)

· MFIP Self-Screen Scoring Form (DHS-3482A) (PDF).

The MFIP Self Screen indicates whether a participant needs a formal chemical or mental health assessment.

Use the screening tool with participants who:

· Have not made progress 3 months after the initial development of their employment plan.

· Have clear barriers to employment no matter when those barriers are evident.

· When having a participant complete the self-screening tools sooner than 3 months, use the Observation Checklist or information in case notes to document why. See 6.21 (Observation Checklist).

When initiating an MFIP Self Screen, always let participants know that the purpose of the screening is to determine:

· Whether they need referrals for more in-depth assessments.

· How those assessments can identify and help to overcome barriers to employment.

If participants refuse to complete the screens, they are subject to sanction.

· Investigate whether good cause should apply to the circumstances before beginning the sanction process.

The MFIP Self-Screen is available in English and 10 other languages.
Because these are self-screening tools, the participant must be able to read, not just speak, the language used in the form.
MFIP Self-Screen English (DHS-3482) (PDF).
MFIP Self-Screen Arabic (DHS-3482-ARA) (PDF).
MFIP Self-Screen Hmong (DHS-3482-HMN) (PDF).
MFIP Self-Screen Khmer (DHS-3482-KHM) (PDF).
MFIP Self-Screen Lao (DHS-3482-LAO) (PDF).
MFIP Self-Screen Oromo (DHS-3482–ORM) (PDF).
MFIP Self-Screen Russian (DHS 3482–RUS) (PDF).
MFIP Self-Screen Serbo-Croatian/Bosnian (DHS 3482-SCR) (PDF).
MFIP Self-Screen Somali (DHS 3482-SOM) (PDF).
MFIP Self-Screen Spanish (DHS 3482-SPA) (PDF).
MFIP Self-Screen Vietnamese (DHS 3482-VIE) (PDF).

Use the Scoring Sheet to determine whether to make a referral for assessment.

· Only staff trained in the use of these screening tools may administer them.

· Training is available through the New Employment Services Workers training provided by the Minnesota Department of Human Services through TrainLink.

Step 2: Diagnosis and Assessment

A diagnosis is a statement by a qualified professional about a physical or behavioral health condition a participant has. See QUALIFIED PROFESSIONAL in 2.33 (Glossary: O-Q...).

The qualified professional may communicate that diagnosis through a Request for Medical Opinion (DHS-2114) (PDF) or through his/her own form or letter.

An assessment can be broader in scope than a diagnosis. It can include:

· A determination of whether someone has a mental health or chemical dependency problem.

· Information about how a health condition can affect someone’s ability to function or to get and keep a job.

An assessment must also be done by a qualified medical or behavioral health professional. See QUALIFIED PROFESSIONAL in 2.33 (Glossary: O-Q...) or Behavioral Health Professional in 17.45 (Qualified Professionals).

Special rules for chemical dependency assessments in MFIP.
A chemical dependency assessment is the only assessment that:

· Employment services counselors may require of a participant.

· A participant can be sanctioned for refusing to do.

Only require a chemical dependency assessment if:

· Objective evidence exists that a chemical addiction is impairing the participant’s ability to get or keep a job. This evidence may come through 1 or more of the following:

· The self-screen.

· Other sources, such as social services, the family or medical professionals.

· Observations by the employment counselor.

· Document this evidence in the case notes or the Observation Checklist.

Provide the necessary support services.
When referring or recommending someone for a mental and/or chemical health assessment, ensure that the necessary support services, such as child care and transportation, are available.

MFIP child care can be authorized for assessments that are included in the employment plan, such as:

· Chemical or mental health assessments.

· Treatment.

· Therapy.

· Mental health case management.

· Other assessments included in the employment plan.

Get written consent from the participant to receive the assessment and related information from the behavioral health provider.

Use one of the following forms:

· The MFIP Employment Services Authorization for Release of Information (DHS-4093) (PDF).

· A comparable form developed and approved by the county or tribe and that contains the components included in the state Release of Information form.

Ensure participants understand the release of information forms before signing. This may mean:

· Using an interpreter when the participant has limited English language skills.

· Reading and explaining the form to a participant with reading ability below the 7th grade level.

Assessment information is private information and must be protected.
A signed release of information from the participant is necessary in order to share mental health or information with anyone else. No one whose name is not on that release can see that information.

The MFIP Employment Services Authorization for Release of Information (DHS-4093) (PDF) is available in multiple languages:
Authorization for Release of Information - Arabic (DHS-4115-ARA) (PDF).
Authorization for Release of Information - Hmong (DHS-4115-HMN) (PDF).
Authorization for Release of Information - Khmer (DHS-4115-KHM) (PDF).
Authorization for Release of Information - Lao (DHS-4115-LAO) (PDF).
Authorization for Release of Information - Oromo (DHS-4115-ORM) (PDF).
Authorization for Release of Information - Russian (DHS-4115-RUS) (PDF).
Authorization for Release of Information - Serbo-Croatian/Bosnian (DHS-4115-SCR) (PDF).
Authorization for Release of Information - Somali (DHS-4115-SOM) (PDF).
Authorization for Release of Information - Spanish (DHS-4115-SPA) (PDF).
Authorization for Release of Information - Vietnamese (DHS-4115-VIE) (PDF).

For information about participants’ rights in handling this information, see Participant Rights Chapter.
4.6 (Data Privacy).
4.9 (Sharing Information in the Welfare System).
4.12 (Special Types of Private Data).