Job Coaching Fading Plan

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ECF Member Information

Name:	Date of Birth:
Support Coordinator:	ECF Region:
Member ID:	Member Address:
Member’s Assigned Employment Services Tier: A B C

ECF Job Coaching Lead/Primary Job Coaching Information

Agency:
Lead/Primary Job Coach Name:	Lead/Primary Job Coach Cell Phone:
Lead/Primary Job Coach Email:
Date Current Authorization Started:	Date Current Authorization will end:

Employer Information

Employer Name:	Employer Address:
Supervisor Name:

Employment Information – For Members Who Are Currently Employed (Job Not Pending)

Member’s Average Hours Worked Per Month During Most Recently Completed Month:
Length of Time the Member Has Held This Job (Number of Months):
Results of the Member’s Most Recent Employee Performance Evaluation or Most Recent Feedback from Supervisor at Work (please summarize in one paragraph):
Monthly Hours of Job Coaching Currently Authorized:
Reduction in Monthly Hours of Job Coaching Achieved During Last Six Months (answer the following three questions)
1.	Six months ago, the Member needed how many hours of Job Coaching, on average? (If the Member has held the job less than six months, report monthly hours of Job Coaching the member needed in the first month she/he held the job.)
2.	Currently, the Member needs how many hours of Job Coaching per month, on average?
3.	If no reduction in monthly Job Coaching was achieved, please explain why:
Monthly Hours of Job Coaching Requested for Next Period of Service Authorization:
If this request represents an increase in the monthly hours of Job Coaching previously approved, please explain why this is needed:

Plan for Reducing Job Coaching During the New Authorization Period

Reduction in Monthly Job Coaching Hours that Will Be Achieved:

Monthly Job Coaching Hours that Will Be Provided During Month #1 of the New Authorization Period	Monthly Job Coaching Hours that Will Be Provided During the Last Month of the New Authorization Period	Reduction in Monthly Job Coaching Hours (Subtract Column #2 from Column #1)
Example: 24 hours	Example: 14 hours	Example: 10 hours

Job Coaching fading method(s) that will be used to achieve reduction in monthly Job Coaching hours:

Fading Strategy	Methodology (Describe the specific strategy you will implement with this Member to reduce the need for Job Coaching and the specific outcome you expect will result.)
Task Analysis
Identifying and Engaging Natural Supports
Identifying Natural Cues
Identifying and Engaging a Mentor
Assess/Observe Productivity Levels
Assess/Observe Corporate Culture
Recommend Accommodations (High- or Low-Tech Assistive Technology)
Develop Adaptations/Task Design
Travel Training
Other Strategy
Other Strategy
Other Strategy

Name of Person Who Authored This Report:

Signature of Person Who Authored This Report:

Report Received by:

Report Reviewed for Adequacy and Approved by:

Date Report Approved:

**Please submit reports to: employment_reports@bcbst.com