Support Activities

DIVISION OF BEHAVIORAL HEALTH AND RECOVERY (DBHR) MONTH / YEAR GOVERNING CO. AGENCY NUMBER DBHR Target Client Support Activities (Non-Treatment)

ACTIVITY TYPE (CODE 1) FUND SOURCE (CODE 2) CONTRACT TYPE (CODE 3) Adolescent Case Management (G) Non Treatment Individual (N) A - Agency Funded 1 – Adult Outpatient 12 – Indian Health Services (IHS) Alcohol Drug Information School (A) HIV/AIDS/TB Edu: Tst Ref (T) C - County Community Services 2 – Adult Residential 13 – Intensive Case Management Brief Intervention (Q) Involuntary Commitment (I) D - Department of Corrections 3 – ATR – Access to Recovery 14 – Local Sales Tax Brief Therapy Conjoint (J) Non-Treatment Group (L) F - Federal Direct 4 – BRIDGES 15 – Molina – Managed Care Brief Therapy Family (P) Peer Support (W) O - Other 5 – CDDA (COMM) 16 – Other/None Brief Therapy Group (O) Phone Contact (M) P - Private Pay 6 – CDDA (LS) 17 – Pregnant/Parenting Brief Therapy Individual (U) Prenatal Care Ref (D) S - State Direct 7 – Criminal Justice (CJ) 18– TANF (ESA) Case Consultation (K) Outreach Services (V) M – State DSHS (Non DASA) 8 – Criminal Justice – Innovation 19 – Tribe MOA (Title XIX) Community Education (E) Referral (R) T - Tribal Community Services 9 – DOC-COM 20 - WA-CARES Crisis Services (C) Screening (Y) 10 – DOC-JAIL 21 – WASBIRT Family Support (F) Sobering Services (B) 11 – Gov2Gov (Non XIX) 22 - Youth Treatment FASD Cnsl Edu or Ref (J) Staff Continuing Education (S) Housing Support Services (H) SUPPORT ACTIVITIES SPECIAL PROJECT

ACTIVITY STAFF AND OTHER CONTRACT FUNDING STATE (S) ACTIVITY ACTIVITY SERVICE OTHER STAFF TYPE VOLUNTEER DESCRIPTIO CLIENT NAME TYPE SOURCE COUNTY (C) DATE TIME HOURS QTY ID (CODE 1) HOURS N (CODE 3) (CODE 2) AGENCY (A) : :

DSHS 04-419 (REV. 04/2014)