Wisconsin's Functional Screen

Wisconsin’s Functional Screen system is a web-based application used to collect information about an individual’s functional status, health and need for assistance for various programs that serve the frail elderly and people with developmental or physical disabilities. The screen is used to determine functional eligibility for certain mental health services, adult long-term care programs and children's long-term support programs. Experienced professionals, usually social workers or registered nurses, who have taken an on-line training course and passed a certification exam are able to access and administer the screen. 

Resources for certified screeners: Adult LTC, Children's LTS, MH/AODA, General Resources for all Screeners

General Information:

• Overview: Background information on the history and use of the Long-Term Care (LTC) Functional Screen.

• PowerPoint Presentation: An interactive walk through of the adult LTC Functional Screen application. Includes screen shots and explanations of each page.

• Papers* on testing the validity and reliability of Wisconsin's functional screens:

  • Children's Long-Term Support Functional Screen Validity (PDF, 74 KB)

  • Adult Long-Term Care Functional Screen Validity (PDF, 54 KB)

  * The papers above were prepared as part of Wisconsin's applications to the Centers for Medicare & Medicaid Services for approval of the Children's Long-Term Support and adult Long-Term Care Functional Screens.

Resources for Certified Screeners: Adult LTC, Children's LTS, MH/AODA

• Adult LTC Screeners:

  • LTC FS Version 3 Paper Form (PDF, 92 KB; Updated 9/7/07)
  • Clinical Instructions (Updated 12/21/05) 
  • Diagnosis Cue Sheet (Updated 2/28/05 - PDF, 74 KB)
  • Diagnosis Verification Form (PDF, 5 KB)
  • Guidelines for Defining Physical Disability (PDF, 23 KB)
  • DD Decision Tree (Updated 2/11/05 - PDF, 18 KB)
  • DD Decision Tree Instructions (PDF, 46 KB)
  • DD Case Analyses (Updated 6/22/05 - PDF, 55 KB)
  • Decision Tree for Frail Elders with Co-Morbidities (PDF, 25 KB)
  • Decision Tree for PD with Co-Morbidities (PDF, 22 KB)
  • No Active Treatment (NAT) Algorithm (PDF, 19 KB - For Family Care Counties only)
  • Login Instructions for Preview of Screener Certification Course  (PDF, 215 KB - For course preview only; certification exams not included)
  • Instructions for the Assessment/Supplement to the LTC Functional Screen (PDF, 17 KB - For Home and Community-based Waiver Screeners only)
    
    

• Children's LTS Screeners:

  • 2007 IRRT Follow-Up  
  • Training on CLTS FS Behavior Page  
  • Clinical Instructions (REVISED 4/28/08)
  • Diagnosis Cue Sheet (PDF, 83 KB; Revised 5/6/08)
  • Norm-Referenced Assessment Tools for Communication and Learning (PDF, 24 KB; Revised 10/19/07)
  • Paper Form (PDF, 100 KB; REVISED 8/25/08)
  • Children's LTS Age-Specific ADL and IADL Questions: 
    • Birth to 6 Months (PDF, 21 KB)
    • 6 to 12 Months  (PDF, 23 KB)
    • 12 to 18 Months (PDF, 24 KB)
    • 18 to 24 Months  (PDF, 23 KB)
    • 24 to 36 Months (PDF, 25 KB)
    • 36 Months to 4 Years (PDF, 27 KB)
    • 4 to 6 Years (PDF, 27 KB)
    • 6 to 9 Years (PDF, 27 KB; REVISED 3/14/08)
    • 9 to 14 Years (PDF, 29 KB; REVISED 3/14/08)
    • 14 to 18 Years (PDF, 27 KB; REVISED 3/14/08)
    • 18 Years and up (PDF, 31 KB REVISED 3/14/08)
      
      
• Mental Health/AODA Screeners:
  • Clinical Instructions (Updated 2/20/06)
  • Paper Form (Revised 4/20/07 - PDF, 100 KB)
  • MH/AODA Functional Screen Frequently Asked Questions (FAQs) (Revised 7/19/06)
    
    
• General Resources for All Screeners:

  • Functional Screener Application 101 Training 
    
    

  • Functional Screen Information Access user login page
    
    

  • Frequently Encountered Issues (PDF, 170 KB)
    Includes information on edit vs. creating a new screen, viewing and printing reports and transferring an applicant.

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Last Revised:  August 26, 2008