PA-AD 11: Aftercare and Follow-Up
When the need for aftercare
has been identified, the agency and the individual work together to develop an aftercare plan.
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.
The aftercare plan is developed sufficiently in advance of case closing
to ensure an orderly transition.
Aftercare plans identify services needed or desired by the person, and specify steps for obtaining these services.
The agency takes the initiative to explore suitable resources and make contact with service providers when appropriate, and with the permission of the person, family
, or legal guardian
The agency follows up on the aftercare plan, as appropriate, when possible, and with the permission of the service recipient.
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 may be a risk to the service recipient, such as in cases of abuse, neglect, or exploitation.