Family Works ILS Referral Form  Logo
  • TO MAKE A REFERRAL FOR:INDEPENDENT LIVING SKILLS (520)

  • 1. Please fill in the blank spaces on the Request for Services form below.

    2. Compile all of the information available for the New Consumer.

                 Please include as much information as possible. 

         Here are examples: 

    • Recent IPP's 
    • The most recent Psycho-social assessment 
    • Medical History
    • Any other recent evaluations 

    3. To begin our services, please include a 25-hour Purchase of Service (POS) for the Independent Living Skills Assessment. The estimated time for the POS is four weeks.

    4. Please submit the complete packet and POS here or by fax to (415) 492-1792 or email referral@familyworks.org

    5. You will receive confirmation of referral receipt and any follow-up questions within 48 business

    6. Once the approved POS is received, we will begin the assessment process. 

  • If you have any questions, please call Family Works at (415) 492-0720.

     

    We greatly appreciate your referrals and look forward to working with you.

     

  • Independent Living Skills

    Service request form
  • Service Code 520

    Vendor #: H12286 (GGRC/RCEB/NBRC) HS0906 (SARC)
  • Consumer Information

  •  - -
  • Consumers Circle of Support

  • Consumer's Regional Center Information

  • Consumers History

  • Other services the consumer is currently receiving:

  • Independent Living Skills Training Information

    Program Goals:

    1. Provide quality, productive, independent living coaching to adults and children with developmental disabilities.

    2. The goal is to increase the consumers' motivation to enhance their skills and their interaction with

    their families, work environment, and community resources at large.

    3. To enhance the consumer's ability to promote their own conceptual, practical, and social development, including but not limited to:

    a. Providing an appropriate stimulation, recreational, and learning environment.

    b. Providing a safe physical and emotional growth environment.

    c. Providing social and recreational interaction with other adults.

    d.Providing good nutrition, personal hygiene, home management, health skills, functional academic and self-management skills.

    e. Providing optimum cognitive and physical capacities.

    4. To train the consumer in effective self-management methods, including anger management, stress reduction, and conflict resolution skills

    5. To assist with integrating the consumer into community programs, including increasing the consumers' ability to utilize community physical, emotional, and social support systems to foster improved personal development.

    Location: 

    Services occur in the consumer's residence, other natural environments, and community facilities in the area served by the Regional Centers.

  • Skills assessed, taught, modeled, and coached during direct service include: 

    • Identification and awareness of unique temperament traits
    • Self-care skills, including personal health and hygiene
    • Independent recreation and participation in natural environments
    • Household Maintenance
    • Nutrition: grocery shopping, menu planning, and meal preparation
    • Money management skills/budgeting, including check cashing and purchasing activities
    • Use of public transportation in natural environments
    • Self-advocacy, healthy self-assertion skills training
    • Emotional Regulation / Stress-Reduction Skills / Conflict resolution
    • Utilization of the educational system for self-development / vocational goals
    • Nurturing/encouraging pro-social behaviors and expanding social support systems
    • Utilization of employment training options
    • Use of medical, dental services, and other community health resources
    • Community resources awareness (police, fire, emergency, mental health, social services, etc)
    • Home and community safety
  • Should be Empty: