Community
Care recognizes the need for all clients served to have an appropriate and
individualized service or treatment plan. To that end, all Community Care
programs will specify the manner in which services will be delivered to assist
clients in reaching goals by developing an appropriate and individualized
service plan, written in a timely manner, based as much as possible on the
finding of an assessment, and involving to the fullest extent possible, the participation
of the person, family, or group served.
1.
Each program will develop an initial or preliminary service/treatment
plan within the allotted time frame below, with those cases requiring urgent
attention developing the plan as soon as possible/prior to the requirement:
a.
Treatment
Foster Care: Within 5 working days of admission,
b.
Residential
Programs (ADAM House and Oakland Bridge Home): Within 72 hours of admission,
c.
Maine
Caring Families: Within 5 days of placement-called a transition plan and to be
developed at the transition meeting (to be held within 5 days of placement),
d.
Adoption
Services: Prior to beginning services under a POS (Purchase of Services
Agreement), and
e.
Community
and Family Support Services: Within 30 days of admission required by
regulations.
2.
Following the development of the initial or preliminary plan, each
program will develop a comprehensive service/treatment plan according to the
time frame mandated by licensing, within 30 days of admission for Treatment
Foster Care, ADAM House, Oakland Bridge Home and Community and Family Support
Services; or within 180 days for MCF.
3.
The service/treatment plan is developed with the full participation of
the person served and/or his/her parent or legal guardian, as appropriate.
4.
Community Care will assist the person served to understand the options,
the benefits, and consequences of various service alternatives, and the ways
the agency can support the achievement of his/her desired outcomes. The
options, benefits, risks and various service alternatives will also be
explained in advance to the parent and/or legal guardian, as appropriate or
required.
5.
The service/treatment plan is based on the assessment's findings and
specifies:
a.
All
services; how, and by whom the services will be provided,
b.
Service
goals, including objectives, amount, scope, timing, and expected duration of
each service element, and
c.
Desired
outcomes.
6.
All service/treatment plan goals, strategies for achieving goals, and
expected outcomes are:
a.
Goal
directed and strength-based, and
b.
Focused
on the timely resolution of the issues presented.
7.
Service/treatment plans, as well as significant revisions made to the
plans (addendums), are signed by the person served and/or his/her legal
guardian, as appropriate on or prior to the effective date of the plan.
8.
All participants in the clients treatment or service provision should
be involved in the development of the plan and sign off prior to the effective
date of the plan.
9.
As appropriate, and with the consent of the client and/or guardian, the
client's birth parent may be involved in the service planning (unless
contraindicated).
10. As appropriate, and with the
consent of the client and/or guardian, the client's birth parent(s) may be kept
aware or advised of ongoing progress, and invited to case conferences/team
meetings.
11. The service/treatment
planning process takes into account the permanency options for the client and
plans for the following (concurrent planning may include both return to home
and adoption as permanency options, both being pursued simultaneously):
a.
Return
to home,
b.
Adoption,
c.
Another
family-like permanent living arrangement such as kinship placement,
d.
Independent
living, as appropriate, or
e.
Maintain
the child in their current family situation.
12. The permanency plan will be
assessed with the development of each new plan, will document efforts to
reunite and/or maintain the child with family/kin or other identified living
situations, will assess the appropriateness of continued placement/need for
continued services, and will encourage the parent/child/sibling/kin contact, as
appropriate.
13. Service/treatment plans will
be updated no less than the time frame allotted by each program:
a.
TFC:
every 90 days,
b.
Residential
facilities: every 90 days,
c.
MCF:
every 6 months,
d.
Adoption:
with every new POS agreement, and
e.
Community
Family Support Services every 90 days
14. All service/treatment plans
consider and recommend the most appropriate and least restrictive or intrusive
service alternative possible to the person served.
15. At the time of each service
plan update, the emergency plan for the client will be updated, as well.
16. When serving children in the
custody of the parent and/or legal Community Care of Maine follows the
procedures outlined in the Policy 3.ME.24, and Procedure 3MEP.26.