In-service Training for Excellent Client Documentation Skills

How often do you read through your client intake forms?

There is usually two different parts to a client intake form. One being the statistical information and the other being the narrative description of the volunteer’s interaction with the client. Both are important.

In-services are a great way to explain the importance of accurately filling out the client intake form and the post-session narrative documentation of their client interactions.

We know the statistical information on the client intake form is needed for a variety of reasons.

When training volunteers to gather this information effectively you might consider sharing with volunteers:

1. Why this information is important and how you use this information
2. Show them how having this information is important as they begin to build relationship with their client
3. What information is most important during your time with a client
4. How to gather this information as a way to begin building relationship rather than just interviewing someone.
5. Who is gathering this information and how they are doing this?
6. How do you ask clients to complete the form? What do you tell them about the form? What happens if they leave some information blank?
7. If clients fill out the intake form themselves, how can volunteers use the information gathered to begin making contact and reducing anxiety

The narrative post-session documentation in a client’s chart is important for many reasons.

1. Reading the documentation provides a way to supervise and evaluate volunteers on their client interactions without having to actually observe them in person.
2. How a volunteer documents their interactions demonstrates their knowledge and use of the Seven Fundamentals taught in the training.
3. Documentation provides you with client information that can help you create case studies for in-service trainings.
4. The information is important when a client returns for follow-up visits or if they are seen by a different volunteer when they return.
5. Documentation provides consistency of service and clients will feel seen and remembered by your ministry.
6. Certain ethical and legal protections must be taken into consideration in case a client asks to read their file or some legal action is taken.

When training volunteers in their post-session narrative documentation you might consider:

1. Conducting a short role-play and asking volunteers how they would document the session.
2. Create a quiz or worksheet with examples of good and bad documentation for volunteers to work through and then go over their responses.
3. Discuss the similarities and differences of the narrative post-session documentation needed in various parts of the ministry such as pregnancy testing and advocacy, material assistance, reproductive loss groups, educational programs, medical services (ultrasound), etc.
4. Asking specific questions on the documentation form that relate to the training such as:

• What was her SOS?
• Where might she have been on the crisis cycle? Explain
• What were her needs / issues?
• What resources were discussed?
• What action plans were discussed?
• What is the follow up plan?
• Spiritual Condition – Cultivating – Sowing – Harvesting – Discipling ? Explain.

So much energy is put into client documentation. I hope this helps you get an idea of how all that information and paperwork can help you supervise better and enable volunteers to connect better with their clients, from their first hello.