Talk Cafe Membership Procedure

Online Registration

Candidate Contact Profile Information

Online Registration

First Name*
Last Name*
MI
Date
MM slash DD slash YYYY
Address
City
State
Zip Code
Social Security Number
Date of Birth
MM slash DD slash YYYY
Home Phone
Cell Phone
Email Address*
Occupation
Employer
Employer’s Address
Employer’s Phone No
What is the outcome you are seeking from the services?
Emergency Contact Information:
Emergency Contact Name
Contact Phone*
Email Address*
Intake Questionnaires
What brings you to Talk Cafe? Please list the reason or any information you feel is relevant for signing up with Talk Cafe Support Place.
What program(s) or services caused you to sign up for membership with Town Cafe?
Intake Questionnaire
What program(s) caused you to sign up for membership with Town Cafe?
How did you hear about Talk Cafe?
What type of income do you have?
If you don’t have income how do you support yourself?
What is your housing status at this time?
If you presently have somewhere to live at this time why do you want to change?
What brought you to this program and how do you think we can help you?
Are you ready to make the personal and financial investment needed to develop an action plan geared toward getting you into a home?
What do you think a personal investment means?
What do you think you need to change in your life that will help you get a home and keep it?
What other resource needs do you have? Why?
What do you want to accomplish at Talk Cafe?
What do you think Talk Cafe is all about?
What type of resources do you need?
CAPTCHA

Membership Application

Talk Cafe Membership Application

(Phone or Personal Interview Form)

Membership Application

Type of Membership
Name*
Birth Date
MM slash DD slash YYYY
Gender
Address
City
St
Zip Code
Home Phone
Cell Phone
Work
E-mail
Signature
Date
MM slash DD slash YYYY
Parent Signature
Date
MM slash DD slash YYYY
For Office Use Only
Type of Membership
Payment type
CAPTCHA

Personal Profile Form

Profile Persona

(Data sheet with personal information about character, Aka, family etc)

Personal Profile Form

Name of Youth*
Nick name
Social Media name
Address
City
St
Zip Code
Phone Number
Email
Birthday
MM slash DD slash YYYY
Age
School
Graduation Date
MM slash DD slash YYYY
Major
Picture Next name
Status
Career Goal
Personal Goals
Religious Preferences
Hobbies
Favorite sayings
Favorite color
Family standing
Field of Study
Personal Bio
Personal body marks
Explain what tattoos represent:
Strengths
Weakness
Language
Foreign Languages
Qualifications
Clubs or Organizations
Personal Employment Experience (Job experience)
CAPTCHA

Support Needs List

Select all services you are seeking

Case Management (personal, housing, clothes, etc.)
Problems Identification/conflict issue
Support Groups

Addiction(s)
Behavior issues

Mental Health
Substance abuse

Personal Goal Development

Youth will write one or more sentence telling what their goals are in the following areas below:

Career Development goal
Creative expression (stress reduction)
Educational goals
Lifestyle

Mark all areas of interest you would like to improve or learn more about.

A._____ Drivers Education
B._____ Enrichment activities (Tutoring, Fitness work-out, Artistic selection, stress therapy)
C._____ Financial Management (Banking Account, Investment, Savings, Purchases)
D._____ Health & Nutrition Lifestyle changes
E._____ Mental Health (disease process, medication, testing, triggers, etc)
F._____ Production Therapy
G._____ Relationship (Parents, peers, romantic, work, etc)
H._____ Spiritual
I._____ Support groups (abuse, addictions, mental health, substance, etc)
L._____ Wellness

Questionnaires

Financial Status Questionnaires

1. Do you have study income?
2. What is your income source?
_____Government Assistance _____Public Assistance _____Employment _____Self Employment _____Other/Explain

Consent Form Signing

1. Drug Screen
2. Background Check
3. Medical/Psychiatric Forms

Admission Procedures

Intake Assessment
Assessment Testing
Psychiatric Evaluation

Background Check
Transition Group Placement

Care Counselor Designation
Care Counselor

Counseling Intake

Pathway Plan Development

Schedule Start dates for:
1. Services
2. Programs

Support Groups

Admission Procedure

Intake Assessment

Talk Cafe Assessment Counselors

Talk Cafe who are licensed therapists. These professional therapists are trained in the service area they will be working in at the Talk Cafe. Cafe participation seeking services will be assessed and set up with a profile that consists of support groups focused on their areas of need. Each support group will be led by a counselor trained in that profession (example: employment group will be led by an employment counselor).

Talk Cafe Care Counselors are counselors trained in case management that will be available to assist participates with any Talk Cafe process functions related to support groups information, scheduling, or get started with services.

Placement Team Designation

Team designated are determined after the evaluations scores are established from information obtained from the entrance interviews of youth and parent(s), assessments, testing, persona profile, creative list selection, on target needs, personal development needs, conflicts and issues or lack thereof. Youth will be placed in groups that provide the support system which addresses their needs more appropriately and with the least amount of stress possible to create a conducive learning environment where the youth can develop effectively.

Care Counselor

A person trained to give guidance on personal, social or psychological problems. Counselor role: To be an adviser that consultant with youth on finding understand negative feels and experiences the reasons for their choices feels, and views of the world around them. Using various approaches and techniques self-actualization and expression such as role play, groups with journaling to discuss the content within, using different mediums in artistic production. Giving the youth a platform to explore, grow, develop tools, skills, and techniques of leadership and positive behavior management issues that cause anger, negative choices, and impulsive decisions in a safe environment with adult guidance. Also handle case management (for homeless youth, financial problems, behavior modification, and pathway development).

Pathway Plan

Is a personal action plan with target dates set to meet designated goals tailored to the youth's developmental needs created by the A.C.T. II Mentors using personal information obtained from Assessment, A.C.T. II Team designation, Career Selection, On Target, Parent and youth Interview, Personal Development Goals, Profile Persona, Questionnaires and selection List choices

Support Groups

Talk Cafe support groups are a place where individuals with challenges can obtain S.A.N.I.T.Y an acronym that stands for support, assistance, networking, information, teaching and yearning.

All group processing will be led by a counselor or therapist. Processes that will happen in every group session review coping skills, emotional issues, learn approaches for the management of issues, discover root causes for behaviors and reactions, decisions, journal feelings, new words related issues, thoughts, what went on in a group, what you want for you, related to your issues what is important for you to focus on. What image do you think you are projecting?

Counseling Intake:

Entrance interview

a. Reason for entering program
b. Review & discuss admission forms, fill-in all blanks
c. Information/Intro interview about Talk Cafe
d. Admission Application
e. Questionnaire

i. What brings you to Talk Cafe?
ii. Do you have study income?
iii. Where do you live?
iv. What are your needs?
v. What did you come to accomplish at Talk Cafe?
vi. How did you hear about Talk Cafe?
vii. Are you ready to make a personal investment in yourself?
viii. What do you think Talk Cafe is all about?

Assessment Intake : Therapist
Assessment Testing : Therapist

1. Behavior Assessment Complete questionnaire
2. Risk Behavior assessment
3. Character & Morality Assessment'
4. Criminal Assessment Complete questionnaire
5. Educational Assessment
6. Emotional Assessment
7. Mental Health Assessment Complete questionnaire
8. Spiritual Assessment
9. Skill Testing

Psychiatric Evaluation : Required
Background Checks : Required
Drug Testing : Required

Intake Interview - Talk Cafe intake interview is where counsels talk freely with potential members about what's on their hearts, let them vent feelings, frustration, hopelessness, crisis, fears, negative outcomes, in a one on one setting. These professionals trained to listen, understand, answer the questions, begin the first steps of assessments with initial intake. start to focus on pathway solutions. Counselors /Professionals will refer to care counselors to register for membership onboarding connect groups and coordinate other support services and programs.

Personal Pathway Plan (PPP) development - Personal Action Plan Targets w/dates. This is the life action plan participants will develop with the help of his/her care counselor utilizing all information from admissions forms, testing and interviews. Pathway Plan can be used as a guidebook to what direction they want their life to head.

Transition Placement Groups - Are determined after the evaluations scores are established from information obtained from the entrance interviews, assessments, testing, persona profile, creative list selection, on target needs ,personal development needs, conflicts and issues or lack thereof.

Participants will be placed in the transition that provides the support system which addresses their needs more appropriately and with the least amount of stress possible to create a conducive environment where they can develop effectively.

Member Partnership
Partnering with business and professionals to provide for those who need.

Health & Wellness List

_____ Biking
_____ Karate
_____ Boxing
_____ Tia Chi

_____ Exercising
_____ Walking
_____ Jazzercise

_____ Yogi
_____ Jogging
_____ Cooking