When the need for aftercare has been identified, the agency and service recipient work together to develop an aftercare plan, and follow-up occurs when possible and appropriate.

Interpretation: While the decision to develop an aftercare plan is based on the wishes of the service recipient, unless aftercare is mandated, the agency is expected to be proactive with respect to aftercare planning.

NA The agency has an interagency agreement that does not include aftercare planning or follow-up.

PA-CM 9.01

An aftercare plan is developed sufficiently in advance of case closing to ensure an orderly transition.

PA-CM 9.02

An aftercare plan identifies services needed or desired and specifies steps for obtaining these services.

PA-CM 9.03

The agency takes the initiative to explore suitable resources and make contact with service providers.

PA-CM 9.04

The agency follows up on the aftercare plan, as appropriate, when possible, and with the permission of the service recipient.

Interpretation: Reasons why follow-up may not be appropriate include, but are not limited to, cases where the person’s participation is involuntary, or where there can be a risk to the service recipient such as in cases of domestic violence.

QUICK JUMP TO


	PURPOSE: Individuals and families who receive Case Management Services access and use resources and supports that build on their strengths and meet their service needs.

RELATED FILES

DDS Supplement Replacement.pdf
NA Request.doc
PA-CM Reference List.pdf
PA_CM Template.doc


	CASE A general term used to designate clients (including individuals, families, and groups) served by an organization for purposes of monitoring the provision of services. A foster care case is generally based on the placement of an individual child, although casework for the child may include services to the child's family. A child protective services case is based on an entire family household if a family assessment model is used; otherwise a case is defined as a child.


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	AFTERCARE Additional services provided beyond the period of primary care that offer continuity and supportive follow-up.


	SERVICE RECIPIENT The individuals, groups, organizations, or communities that use, receive, or benefit from programs and services. Service recipients can include consumers, patients, family members, legal guardians, advocates, public/private organizations, employers, and purchasers. All are regarded as significant stakeholders served in a variety of agencies and practice settings.


	PLANNING The process of specifying objectives, evaluating the means for their achievement, and exercising deliberate decision making about appropriate courses of action.


	CASE CLOSING A voluntary or involuntary process which occurs when an organization no longer assumes responsibility for providing services to a particular individual, group, or family. Also known as "termination" or "discharge."


	MANAGEMENT See ADMINISTRATION