Jordan's Principle, Indigenous Services Canada
MB Jordan's Principle requests: 204-391-6083
National Jordan's Principle Call Centre:
Jordan's Principle Providers' Toolkit
MENTAL WELLNESS VERSION
This toolkit is for front-line providers working in the Jordan's Principle system. The forms below were developed to enhance wholistic care, client-centredness and system efficiency. Each form has gone through multiple rounds of review by the Manitoba Jordan's Principle Mental Wellness Working Group.
This toolkit does not have to replace the Case Management Toolkit, rather it can act as an enhancement when considering children’s services related to Mental Health and Mental Wellness.
If you have any feedback about the toolkit that you'd like to share, please click here.
To begin using the toolkit, you can download all files at once or download only the files you choose. All of the forms can be adapted to meet your community's or organization's needs - simply edit the forms in Excel. On some of the forms, there are sections highlighted in yellow. These are sections you may want to edit to ensure the tips/information/contacts are relevant to your workflow.
Enrollment consent form
To be used by Jordan's Principle workers when enrolling a new client. Workers can use this form to confirm a child's consent to enroll in Jordan's Principle. A child (under 18 y.o.) may provide consent or, in the case of a child who is incapable of giving consent, the child's parent or legal guardian may provide consent.
Information exchange consent form
To be used by Jordan's Principle workers when enrolling a new client. Workers can use this form to confirm a child's consent to the sharing of their personal information or personal health information. A child (under 18 y.o.) may provide consent or, in the case of a child who is incapable of giving consent, the child's parent or legal guardian may provide consent.
wholistic care plan
To be used by Jordan's Principle workers when meeting with a client to discuss goals of care, after intake or throughout the client's journey. It can be referred to each time the provider meets with the client. Progress in achieving goals can be tracked using the Care Plan Check-In Form.
circle of care summary note
The Circle of Care Summary Note is a communication tool that can be used by a provider to share updates with the client, family and/or other providers following a client-provider interaction. It can be used as often as needed, in addition to the normal charting/documentation following a client-provider interaction. This tool has been adapted from the ISBAR (Identify, Situation, Background, Assessment, Recommendation) format of communication in healthcare settings.
Child & Youth Mental Health Quiz
There are two versions of this quiz, one that can be completed by an adult on behalf of a child, and one that children aged 11 and up can complete on their own.
These quizzes use the Pediatric Symptom Checklist (brighterfutures.org) and are designed to help recognize cognitive, emotional and behavioral problems in children and youth so that help can start as early as possible. This quiz is applicable for children and youth ages 4 through 16.