Coordinated Service Planning

Coordinated Service Planning is intended for children and youth who have complex special needs with a family centered service experience. Eligibility applies to youth up to 18 years of age (or up to 21 years of age if they remain in school) living in Simcoe County.

Program Details

Eligibility

Funding

Referral Process

Contact Information

Monthly Program Calendars

Intake Form

The objective of Coordinated Service Planning is to provide children and youth (up to 18 years of age or 21 and still in school) with multiple and/or complex special needs and their families with a seamless and family-centered service experience.

As a result of Coordinated Service Planning, families, and children/youth with multiple and/or complex special needs will:

Have a clear point of contact for Coordinated Service Planning (their Service Planning Coordinator) and know who is accountable for developing and monitoring their child/youth’s Coordinated Service Plan
Not have to repeat their stories and goals to multiple providers
Have a single Coordinated Service Plan that is responsive to their child/youth’s goals, strengths, and needs
Experience a family-centered process that recognizes that each family is unique, that the family is the constant in the child/youth’s life, and that they have expertise on their child/youth’s abilities and needs
Know that providers will be communicating about the needs and goals of their child/youth and will be working toward a set of common goals identified in the plan

Coordinated Service Planning goes beyond regular inter-professional communication and collaboration that takes place when providers work together to ensure they are integrating practice and service delivery for children, youth, and families. It is a support in and of itself that is intended to decrease family stress by providing families with a formal voice in the service planning process and by assisting families in navigating and coordinating services for their child/youth.

Support Provided Through Service Planning Coordination

Meet with you and your family
Facilitate planning based on the needs of your family so that you can access appropriate community resources for your child with special needs
Helps to identify your goals for your child through the development of a Coordinated Service Plan
Helps you and your child with transitions such as school or adult services
Provides information regarding alternative funding source applications
Assists with information regarding school-related issues
Assists your family and child’s community advocacy outreach by providing information services, education, and consultation with other program and service providers

This service may be an option for your family if:

Child/youth with multiple or complex needs who may not meet other service eligibility criteria
Provides service up to 18 years of age (or 21 years if still in school)
Designated service areas: Simcoe County

This program is funded by Children’s Treatment Network of Simcoe York and delivered by Catulpa.

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Children’s Treatment Network (CTN) Access at: 1-866-377-0286 or online referral at: www.ctnsy.ca

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Simcoe County Community Action Program for Children (CAPC) and MotherCare (Canada Prenatal Nutrition Program – CPNP) are a part of a national program with then 25 years of experience supporting families in this region. We support pregnant participants, young parents, and Newcomers to Canada with children 0-6 years old who are currently living on a lower income.

Please confirm that you are currently living on a low household income (less than $40,000 before taxes per year) in Simcoe County and that you are currently pregnant and/or live with children 0-6 years of age.
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Please confirm below*

YesPlease call us at 705-733-3227 ext. 2236 if you need help.

Data Collection Consent and Required Information

We do not maintain participant “notes” related to your participation with us but we are required by our funders to track attendance and the resources we distribute. We use an electronic data management system to record and store minimal personal information and program attendance. This information includes: name, date of birth, income, due dates and/or dates of birth of your children. Detailed information about this consent can be found in our Welcome Letter.

Simcoe County CAPC-CPNP requires an email address and phone number for your participation in all programs. Please give us a call at 705-733-3227 ext. 2236 if you have any questions.
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Do you consent to the collection, storage and limited sharing of your data?*Yes

Your Name*

Preferred Name *Date of Birth (yyyy/mm/dd) *City of Residence*Postal Code*

Income

What is your total annual income (excluding child tax benefit)*?

*If you checked I don’t know above, please use this box to explain.

Source(s) of income*:No incomeOntario Disability Support Program (ODSP)Ontario Works (OW)WorkEmployment Insurance (EI)Other

If you chose employment insurance, please provide your expected return to work date. (yyyy/mm/dd)

If you have a parenting partner (living in the same household), i.e.common law or spouse, what is their annual income before taxes?*
*If you checked I don’t know above, please use this box to explain.

Partner’s Source of Income*No incomeOntario Disability Support Program (ODSP)Ontario Works (OW)WorkEmployment Insurance (EI)Other

Participant’s Children (up to 6 years of age)

If you are pregnant, please proceed to the next question.

Child's Name

Child’s Preferred NameDate of Birth of your child (yyyy/mm/dd)

I consent to images of my child to be used for publicity purposes by Simcoe County CAPC hosted by Catulpa Community Support Services. Images could be used in displays, posters, leaflets, webpages, social media, or newspaper articles.

Yes

Child's Name

Child’s Preferred NameDate of Birth of your child (yyyy/mm/dd)

Yes

Child's Name

Child’s Preferred Name

Yes

Date of Birth of your child (yyyy/mm/dd)
Are you currently pregnant?Yes
Due Date
Are multiple babies expected?

Yes

Number of babies expected?

Consent to Contact

We would like to be able to contact you about our programs, resources and any updates or changes. You can find the full details about this on our webpage and in the welcome letter. Please let us know if your contact information changes.

Preferred method of contact?TelephoneEmail

Phone Number

Can we call you?*

Yes

Phone NumberCan we leave a voice message at that number?*

Yes

Phone NumberCan we text you?*

Yes

Phone NumberCan we email you?*

Yes

EmailIs this information clear for you?*

Yes

Demographics

Were you born in Canada?

Yes

If you were not born in Canada, what was your country of birth?
When did you arrive in Canada? Please enter the date below (yyyy-mm-dd) (only if you were born outside of Canada) *

Do you self-identify as an Indigenous person of Canada?*

What is your primary/first language?
What languages are spoken in the home?*

English

French

Other

If other, please list languages
How well do you speak English?
How well do you write English?
How well do you understand spoken English?
How well do you understand written English?

Education

Have you obtained your high school diploma (Grade 12)?*

Yes

Please select your highest level of education:*If other, please explain

Support network

How many people can you count on in times of need?

0-2

3 or more

Food

Please check all of the following food issues that apply to you.*I sometimes don’t have enough food for myself and my family.I use the food bank when needed.I rely on family and friends if I run out of food.I would like to know where I can get help in my community.I have no food issues.

Housing

Please check all the housing issues that apply to you.*I am experiencing homelessness, or I do not have a shelter, or I do not have anywhere to live.My home is in poor condition (e.g. disrepair, infestation).I live in an unsafe neighbourhood.My home is not big enough (e.g. not enough room, multiple families, etc.)I have missed payments (e.g. rent, utilities in the past)I have landlord trouble.I have no housing issues.

How did you hear about us?

Please check all that apply.*MotherCare / Next StepFacebook or WebsiteAd (poster, bus shelter)Child Welfare (Family Connexions)EarlyON Child and Family CentresFriend or FamilyHousing Agency or ShelterOther Community AgencyHealth Unit - Healthy Babies Healthy Children/ otherHealth ProfessionalOntario Works (OW) or Ontario Disability Support Program ( ODSP) workerOther*
*If other, please let us know how you heard about us

Transportation

How do you access transportation (personal vehicle, bus, taxi, family friend, etc.)?*Is public transportation available to you.?*

Gender (optional questions)

What is your gender identity?Do you Identify as 2S-LGBTQ+?Which pronoun do you use?
*If other, please let us know which pronoun you use

Do you have any comments or questions for us? Please enter them below:
I hereby verify the information is true and accurate based on my current situation. It is important for us to keep up to date with any changes in your personal contact information and financial status. I will notify CAPC Staff of any changes.

Yes

Thank you for your submission. Our team will be in touch with you within five business days.

Oops! Something went wrong while submitting the form.

Le Programme d’action communautaire pour les enfants (PACE) et MotherCare (Programme canadien de nutrition prénatale – PCNP) du comté de Simcoe font partie d'un programme national qui soutient depuis 25 ans les familles de cette région. Nous aidons les participantes enceintes, les jeunes parents et les nouveaux arrivants au Canada avec des enfants de 0 à 6 ans qui vivent actuellement avec un revenu annuel limité.
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Veuillez confirmer que vous vivez actuellement avec un faible revenu du ménage (moins de 40 000 dollars avant impôts par an) dans le comté de Simcoe et que vous êtes actuellement enceinte et/ou que vous vivez avec des enfants âgés de 0 à 6 ans.
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Veuillez confirmer ci-dessous*OuiVeuillez nous appeler au 705-733-3227 poste 2236 si vous avez besoin d’aide.

Consentement à la collecte de données et informations requises

Nous ne conservons pas de « notes » sur les participants, mais nos organismes de financement nous demandent de contrôler l'assiduité et les ressources que nous distribuons. Nous utilisons un système électronique de gestion des données pour enregistrer et stocker un minimum de renseignements personnels et les données relatives à la participation aux programmes. Ces renseignements comprennent les suivants : le nom, la date de naissance, le revenu, les dates prévues d'accouchement et/ou les dates de naissance de vos enfants. Les autres renseignements que nous demandons sont facultatifs. Vous trouverez des informations détaillées sur ce consentement dans notre lettre d'accueil.
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PACE-PCNP du comté de Simcoe requiert une adresse électronique pour vous permettre de participer à tous les programmes. Veuillez nous appeler au 705 733-3227, poste 2236, si vous avez des questions ou si vous n'avez pas d'adresse électronique.
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Consentez-vous à la collecte, au stockage et au partage limité de vos données?*Oui

Votre nom*

Nom préféré*Date de naissance*

Ville de résidence*

Code postal*

Revenus

Quel est votre revenu annuel total (excluant la prestation fiscale pour enfants)?
*Si vous avez coché la case « Je ne sais pas » ci-dessus, veuillez utiliser cette case pour expliquer.
Source(s) de revenus:*

Pas de revenuProgramme ontarien de soutien aux personnes handicapées (POSPH)L’Ontario au travail (OT)TravailAssurance-emploi (AE)Autre

Si vous avez choisi assurance de l'emploi, veuillez indiquer la date prévue de retour au travail.

Si vous avez un partenaire parental (vivant dans le même foyer), c.-à-d.conjoint de fait ou époux, quel est son revenu annuel avant l’impôt?*
*Si vous avez coché la case « Je ne sais pas » ci-dessus, veuillez utiliser cette case pour expliquer.

Source de revenu dupartenaire*Pas de revenuProgramme ontarien de soutien aux personnes handicapées (POSPH)L’Ontario au travail (OT)TravailAssurance-emploi (AE)Autre

Enfants de la participante (jusqu'à 6 ans)

Si vous êtes enceinte, veuillez passer à la question suivante.

Nom de l’enfant*

Nom préféré de l’enfantDate de naissance de votre enfant

Je consens à ce que les images de mon enfant soient utilisées à des finspublicitaires par le Programmed'action communautaire pour les enfants (PACE) du comté de Simcoe,hébergé par Services de soutien communautaire Catulpa. Les images pourraientêtre utilisées dans des présentoirs, des affiches, des dépliants, des pages Web,des médias sociaux ou des articles de journaux:

Oui

Non

Nom de l’enfant

Nom préféré de l’enfantDate de naissance de votre enfant

Oui

Non

Nom de l’enfant

Nom préféré de l’enfantDate de naissance de votre enfant

Oui

Non

Êtes-vous actuellement enceinte?Oui
Date prévue d’accouchement
Plusieurs bébés sont-ils attendus ?

Oui

Non

Nombre de bébés attendus:

Consentement à la prise de contact
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Nous aimerions pouvoir vous contacter au sujet des programmes, des ressources, des mises à jour et des changements, y compris nos programmes virtuels. Vous trouverez tous les détails à ce sujet sur notre page Web et dans la lettre d'accueil. Veuillez nous informer de tout changement de vos coordonnées.

Méthode préférée de contact?TéléphoneCourriel

Téléphone

Courriel

Pouvons-nous vous appeler?*

Oui

Non

Pouvons-nous laisser un message à ce numéro?*

Oui

Non

Pouvons-nous vous envoyez un texto?*

Oui

Non

Pouvons-nous vous envoyer un courriel?*

Oui

Non

Vous serez invitée à participer à nos réunions virtuelles. En participant à une réunion virtuelle du PACE, vous consentez à participer à ce forum et à partager des informations avec le personnel du PACE et les autres participantes, telles que votre nom à l'écran et toute information ou image que vous choisissez de partager au cours de la réunion. Veuillez indiquer que vous comprenez ceci avant de participer à une réunion virtuelle.

Ces informations sont-elles claires pour vous?*

Oui

Non

Veuillez nous appeler au 705 733-3227 poste 2236 si vous avez besoin d’aide.

Données démographiques

Êtes-vous né au Canada?

Oui

Non

Si vous n’êtes pas né au Canada, dans quel paysêtes-vous né?
Quand êtes-vous arrivé au Canada (aaaa-mm-jj)?

Vous identifiez-vous comme une personne autochtone du Canada?*

Quelle est votre langue maternelle/principale?
Quelles langues sont parlées à la maison?

Anglais

Français

Autre

Si autre, veuillez indiquer les langues
À quel point savez-vous parler anglais?
À quel point savez-vous écrire en anglais?
À quel point comprenez-vous l’anglais parlé?
À quel point comprenez-vous l’anglais écrit?

Études

Avez-vous obtenu votre diplôme d'études secondaires (12e année)?*

Oui

Non

Veuillez sélectionner votre niveau d'études le plus élevé :*Si autre, veuillez expliquer.

Réseau de Soutien

Sur combien de personnes pouvez-vous compter en cas de besoin?

0 à 2

3 ou plus

Alimentation

Veuillez cocher tous les problèmes alimentaires qui s'appliquent à vous parmi les suivants.*

Il m'arrive de ne pas avoir assez de nourriture pour moi et ma famille.Je fais appel à la banque alimentaire lorsque c'est nécessaire.Je compte sur ma famille et mes amis si je manque de nourriture.J'aimerais savoir où je peux obtenir de l'aide dans ma communauté.Je n'ai pas de problèmes alimentaires.

Logement

Veuillez cocher toutes les questions relatives au logement qui s'appliquent à vous.*

Je suis sans domicile fixe, ou je n'ai pas d'abri, ou je n'ai nulle part où vivre.Mon logement est en mauvais état (par exemple, délabrement, infestation).Je vis dans un quartier dangereux.Mon logement n'est pas assez grand (par exemple, manque de place, familles multiples, etc.)J’ai omis d’effectuer certains paiements (p. ex. le loyer, les services publics) dans le passé.J'ai des problèmes avec mon propriétaire.Je n'ai aucun problème de logement.

Comment avez-vous entendu parler de nous?

Veuillez cocher toutes les réponses pertinentes.*

MotherCare / Next StepFacebook ou site WebPublicité (affiche, abribus)Protection de l'enfance (Connexions familiales)Centres pour l’enfance ou la famille ON y va Ami ou familleAgence de logement ou refugeAutre organisme communautaireUnité de santé - Healthy Babies Healthy Children/autreProfessionnel de la santéTravailleur du programme Ontario au travail (OT) ou du Programme ontarien de soutien aux personnes handicapées (POSPH)Autre*

Si « autre », veuillez nous indiquer comment vous avez entendu parler de nous.

Transport

Comment accédez-vous au transport?*Les transports publics sont-ils à votre disposition?*

Sexe (questions facultatives)

Quelle est votre identité de genre?Vous identifiez-vous comme 2S-LGBTQ+? Quel pronom utilisez-vous? Si « autre », merci de nous indiquer quel pronom vous utilisez.

Avez-vous des commentaires ou des questions? Veuillez les saisir ci-dessous :
Par la présente, je certifie que les renseignements sont vrais et exactsen fonction de ma situation actuelle. Il est important de nous tenir informésde tout changement dans vos coordonnées personnelles et votre situationfinancière. J’informerai le personnel du PACE de tout changement.

Oui

Non

Nous vous remercions pour votre candidature. Notre équipe prendra contact avec vous dans les cinq jours ouvrables.

Oops! Something went wrong while submitting the form.

Program Details

As a result of Coordinated Service Planning, families, and children/youth with multiple and/or complex special needs will:

Have a clear point of contact for Coordinated Service Planning (their Service Planning Coordinator) and know who is accountable for developing and monitoring their child/youth’s Coordinated Service Plan
Not have to repeat their stories and goals to multiple providers
Have a single Coordinated Service Plan that is responsive to their child/youth’s goals, strengths, and needs
Experience a family-centered process that recognizes that each family is unique, that the family is the constant in the child/youth’s life, and that they have expertise on their child/youth’s abilities and needs
Know that providers will be communicating about the needs and goals of their child/youth and will be working toward a set of common goals identified in the plan

Support Provided Through Service Planning Coordination

Meet with you and your family
Facilitate planning based on the needs of your family so that you can access appropriate community resources for your child with special needs
Helps to identify your goals for your child through the development of a Coordinated Service Plan
Helps you and your child with transitions such as school or adult services
Provides information regarding alternative funding source applications
Assists with information regarding school-related issues
Assists your family and child’s community advocacy outreach by providing information services, education, and consultation with other program and service providers

Eligibility

This service may be an option for your family if:

Child/youth with multiple or complex needs who may not meet other service eligibility criteria
Provides service up to 18 years of age (or 21 years if still in school)
Designated service areas: Simcoe County

Funding

This program is funded by Children’s Treatment Network of Simcoe York and delivered by Catulpa.

‍

Referral Process

Children’s Treatment Network (CTN) Access at: 1-866-377-0286 or online referral at: www.ctnsy.ca

‍

Contact Information

Interactive Calendar

Intake Form

Please confirm below*

YesPlease call us at 705-733-3227 ext. 2236 if you need help.

Data Collection Consent and Required Information

Do you consent to the collection, storage and limited sharing of your data?*Yes

Your Name*

Preferred Name *Date of Birth (yyyy/mm/dd) *City of Residence*Postal Code*

Income

What is your total annual income (excluding child tax benefit)*?

*If you checked I don’t know above, please use this box to explain.

Source(s) of income*:No incomeOntario Disability Support Program (ODSP)Ontario Works (OW)WorkEmployment Insurance (EI)Other

If you chose employment insurance, please provide your expected return to work date. (yyyy/mm/dd)

Partner’s Source of Income*No incomeOntario Disability Support Program (ODSP)Ontario Works (OW)WorkEmployment Insurance (EI)Other

Participant’s Children (up to 6 years of age)

If you are pregnant, please proceed to the next question.

Child's Name

Child’s Preferred NameDate of Birth of your child (yyyy/mm/dd)

Yes

Child's Name

Child’s Preferred NameDate of Birth of your child (yyyy/mm/dd)

Yes

Child's Name

Child’s Preferred Name

Yes

Date of Birth of your child (yyyy/mm/dd)
Are you currently pregnant?Yes
Due Date
Are multiple babies expected?

Yes

Number of babies expected?

Preferred method of contact?TelephoneEmail

Phone Number

Can we call you?*

Yes

Phone NumberCan we leave a voice message at that number?*

Yes

Phone NumberCan we text you?*

Yes

Phone NumberCan we email you?*

Yes

EmailIs this information clear for you?*

Yes

Demographics

Were you born in Canada?

Yes

If you were not born in Canada, what was your country of birth?
When did you arrive in Canada? Please enter the date below (yyyy-mm-dd) (only if you were born outside of Canada) *

Do you self-identify as an Indigenous person of Canada?*

What is your primary/first language?
What languages are spoken in the home?*

English

French

Other

If other, please list languages
How well do you speak English?
How well do you write English?
How well do you understand spoken English?
How well do you understand written English?

Education

Have you obtained your high school diploma (Grade 12)?*

Yes

Please select your highest level of education:*If other, please explain

Support network

How many people can you count on in times of need?

0-2

3 or more

Food

Housing

How did you hear about us?

Transportation

How do you access transportation (personal vehicle, bus, taxi, family friend, etc.)?*Is public transportation available to you.?*

Gender (optional questions)

What is your gender identity?Do you Identify as 2S-LGBTQ+?Which pronoun do you use?
*If other, please let us know which pronoun you use

Yes

Thank you for your submission. Our team will be in touch with you within five business days.

Oops! Something went wrong while submitting the form.