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 strongly proactive with respect to aftercare planning.

NA The agency provides Diagnosis, Assessment, and Referral Services only.

PA-MH 10.01

Aftercare plans are developed sufficiently in advance of case closing to ensure an orderly transition.

PA-MH 10.02

Aftercare plans identify services needed or desired by the person and specify steps for obtaining these services.

PA-MH 10.03

The agency takes the initiative to explore suitable resources and contact service providers when appropriate.

PA-MH 10.04

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 may be a risk to the service recipient such as in cases of domestic violence.

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	PURPOSE: Individuals who receive Outpatient Mental Health Services that target goal-directed interventions for diagnosable conditions make gains in symptom reduction, improved self-management, and restored or enhanced daily functioning.

RELATED FILES

PA-MH Reference List.pdf
PA_MH Template.doc
NA Request.doc
PA-INT.Final.06.2012.pdf


	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.


	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.


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


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


	DIAGNOSIS The process by which a social, physical, or mental health problem and its underlying cause are identified and a plan of action formulated toward resolution of the problem. The diagnostic process involves collection and analysis of relevant information. See also ASSESSMENT.


	ASSESSMENT An evaluation, which utilizes professional expertise and skills in the collection and analysis of data to understand and describe the nature of service needs of an individual, family, or group. Assessment, as in needs assessment, is also used to determine priorities of program planning and service development for the organization as a whole. See also DIAGNOSIS.


	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."


	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.


	MANAGEMENT See ADMINISTRATION