<p> DIVISION OF BEHAVIORAL HEALTH AND RECOVERY (DBHR) MONTH / YEAR GOVERNING CO. AGENCY NUMBER DBHR Target Client Support Activities (Non-Treatment) </p><p>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</p><p>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) : : </p><p>: : </p><p>: : </p><p>: : </p><p>: : </p><p>: : </p><p>: : </p><p>: : </p><p>: : </p><p>: : </p><p>: : </p><p>DSHS 04-419 (REV. 04/2014) </p>